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6 


BOSTON!  ENSIS 


ii^\:\TEPd)(jCI:;7^ 


ans 


■ 


THE 


Hnit  Cimilar.   (BM.  isss. 

aito  ''Sit  MeOical  efrmlat/' 


%  MuUi^  lonrnsi 


OF 


MEDICINE  AND  MEDICAL  AFFAIRS. 


FROM    JULY    TO    DEOBMBEB, 


1904. 


LONDON  :    8  HENRIETTA  STREET.  STRAND;   DUBLIN:  16  LINCOLN   PLACE. 


DEC  1  \.m 


Jul.  4,  1905. 


INDEX. 


The 


UndiSrrM  sad  CixcnUr. 


INDEX. 


VOL.    LXXVIII    NEW    SERIES.     (VOL.    OXXIX    OLD    SERIES.) 
JULT   TO  DECEMBER,   1904. 


A  medical  hero,  375 

A  straoge  oongreM.  239 

Aarons.  Dr.,  a  neir  uterine  mop,  48s 

Abdominal  abeoea.  Dr.  Tufier,  193 

Abdominal   venoeity,   "fpMid   capon 

Baed,  207 
Abexdeea  Univetsatf  (Mae  list),  109 
Abotitioa  of  tea  burial,  608 
Abraham,  Dr.,  dermatological  caaee, 

360 
Abase  of  hoepiUb,  334 
Accidental  bamorrhage,  treatment  of, 

Acetopyriae,  466 


Acetoieocie,  361 
«,  Dr. 


(ilhutrated), 


Acetosoiie, 

163 

Acne  vulgaris,  575 
Acneform  tnbercnlidet  of  the  skin,  67 


'3.. 


Action  against  Sir  P.  H.  Watson,  337 

Action  for  mnlprazis,  134 

Action  of  (UgitaHs,  ^6a 

Action  of  sugar  on  the  uterus,  638 

Activity  oi  fluoresoent  substances,  43 

Acute  rheumatism,  310 

Acute  rlieumatism  in  childhood.  374 

Acute  yellow  atrophy  of  the  Ever, 

Addioma  hasmorrhagica  of  the  endo- 
metrium (ihistrated),  Dr.  Alex- 
aatfler,  649 

Administration  of  the  RA.M.C.,  177 

Adrenalin,  66 

Adrenalin  inhalaat,  361 

Adrenalin  ointment,  561 

A^^'SSTferttie  staff  of  tha  Royal 

Infirmary,  Edinburgh,  338 
Age  limit,  th^.330 
Aida  to  dissection,  23 
Aix-la^Shapelli.  40 


AllNininttcia,  63a 

Alcohol  as  a  food,  490 

Alcohol  of  tremor,  640 

AloohoUc  automatism,  608 

Alcoholic  insanity,  616 

AloohoUc  treatment  of  erysipelas,  413 

Alcoholism  and  insanity,  368,  391 

Aldershot  poisoning  outbreak.  338 

Alexander,  Dr.,  adenoma  hismor- 
rhagicum  of  the  endometrium 
(illustrated),  649 

Alien  lunatics,  339 

AUcaptonuria,  604 

AUe^  unauthorised  post-mortem, 
180 

AUsopp's  lager  beer,  361 

Almatein,  466 

Alterations  in  examination  of  the 
Royal  University,  IreUnd,  641 

AmoBbial  enteritis,  173 

An  evoitful  career,  133 

Anasthesia  in  operations  on  the  naso- 
pharynx, 499 

Angina  utoerosa,  663 

Angostura  bitters,  78 

Ankyloatomiasis,  331 

Annual  mr^ting  of  Uie  British  Medical 
Assoaation,  39 

Annual  meeting  of  the  R.CS.Eng., 
576 

Another  drink  cure,  330 

Another  tuberculous  cure,  348 

Anthelmintics  in  children,  333 

Anthrax,  death  from,  160 

Antiseptic  barber,  608 

Antiseptic  vahie  of  iodofbnn,  340 

Antistteptococous  serum  and  rheu- 
matism, 143 

Aphasia,  66 

Apothecaries'  Hall,  Ireland,  333 

Appendidtb,  173 

Army  Medical  Sorvice  (past  hst),  x6z 


Arterio^sclerotis,  438 

Artificial  production  of  leukamia, 
the,  34  X 

Ashmead,  Dr.,  influence  of  nuclein  in 
Bright's  disease,  370 

Aspects  of  overcrowding,  some,  636 

Aspiration  of  the  cranium,  43 

Association  of  Port  Sanitary  Autho- 
rities, 33  X 

Athletics  and  health,  99 

Australian  surgery  thirty  years  ago, 
369 

Awards  at  the  St.  Louts  Bxhibition, 
45X.  46X 


B.  Eucaine  (lactate  Schering),  306 
Backache,  40 

Bacteria  u  the  stomach,  640 
Bacterial  action  of  typhoid,  467 
Bacteriological  Institute  in  Madxas, 

339 
Bacteriological  section  of  the   ICing 
Institute,  Madras,  Liettt.-(x>l.  Chris- 
tophers, 330 
Bacteriology  of  pertussis,  367 
Bacteriology  of  pneumonia,  48 
Bad  hamorrfaoids.  Dr.  J.  W.  Martin, 

X43 
Bangour  Asylum,  383 
Banks,  Sir  W.  M.,  the  late,  61  x 
Badlv  ventilated  schools  at  Bumtey, 

Barendt,  Dr.,  vestiges  of  syphilis,  36 

Baxlcer  anatomical  prize,  xoS 

BaAow's  disease,  663 

Bath,  315. 

Bathing  during  menstruation,  X37 

Bechterew's  reflex,  339 

Beck's,  Mr.,  double,  607 

Bedding  ana  disease,  371 

Belfast  District  LunatiG  Asyhim,  261 


239. 


Belfast  guardians,  433 

Belt  in  whooping-cough,  the.  499 

Bequests   to  medical  charities,   33 

3^1,  380 
Ben-ben  as  an  epidemic,  7x 
Beri-ben,  diagnosis  of,  ^o 
Biids  and  mammalian  tuberculosis. 

548 
Birmingham  University  (pass  list).  x^3 
Births— end  of  each  No. 
Bishop  Teign ton,  xi7 
Biss,  Dr.  H.,  preventive  treatment  of 

scarlet  fever,  313,  341 
Bleeding  haBmonhoids,  3x0 
Bleeding  piles,  X43 
Blood-letting  m  eclampsia,  490 
Blood  pressure,  349 
Bob  Sawyer— oi  nauseam,  668 


Boric  acid  and  kidney  disease,  393 
"  BorsUl  •'  system,  the,  468 
Bovinine,  78 


Boyd,  Dr.,  classification  of  pauper 
consumptives  in  Irish  workhouses, 
433 

Brachycardia,  362 

Brackett,  Dr.,  suppurative  knee- 
joint,  x67 

Bradshaw  lecture,  Mr.  M.  Robson,  593 

'*  Breathing  out  slaughter,"  341 

Brenner  Bad,  63 

Bright's  disease,  Dr.  Chryssovergis, 
347 

British  health  resorts,  39,  64,  91,  xx7 
X44i  170,  107,  333,  330,  309,  333, 
?6o,  385,  486,  515,  541 

Bntish  Medical  Assoaation's  annual 
meeting,  xo3,  i3x,  X39,  134 

Broroo-derma  tuberosum,  xx9 

Browne,  Sir  Thomas,  335 

Brutality  of  kindness,  319 

Bubonic  plague  in  the  Tyne,  363 

Budleigh  SiOtertott,  91 


TheMedieft] 


Sapplementto 


and  Circnlftr 


INDEX. 


Bunet,  Dr.,  aoetosooa  (illustrated), 
X65 

CaBsarean  section,  I>r.  Tweedy,  598 
Caisson  disease,  74 
Caledonian  Medical  Society,  42a 
Calwell,  Dr.,  meUbolisra,  539,  565 
Camphorated  naphthol,  gx 
Cancer  of  the  breast,  521 
Cancer  of  the  larynx,  Dr.  Semon,  479 
Cancerous  uterus  removed  by  com- 
bined vaginal  and  abdominal  hys- 
terectomv.  Dr.  Duncan,  434 
Canities  following  alopecia  areata,  485 
Cape  as  a  health  resort,  the,  497 
Carbolic  add  poisoning.  331 
Carbonic  oxide  poisoning,  581 
Care    of    children's    mouths,     Mr. 

Spokes,  143 
Caie  of  imbecile  children,  zoi 
Carmichael  prixe,  533 
Carpenter,  Dr.,  faUl  case  of  oedema, 


50 


Cash,  Dr.,  doeage  of  remedies,  591 

Cathodal  rays,  ^48 

Cause  of  appendicitis, 

Cause  of  rabies,  579 

Catalysors  in  treatment,  143 

Catholic  University  Medical  School. 

^  533 

Cavendish     lecture,     Dr.     MikuUcz- 

Radecki,  6 
Cell  and  immunity,  340 
Central  British  Red  Cross  Council,  636 
Central  Midwives  Board,  12  108,  383, 
^  506.  587.  615 
Central    Midwives    Board    and    the 

Rotunda  Hospital,  420 
Central  Midwives  Board  again,  70 
Cha^ford,  360 

Chair  of  surgery  in  Dublin,  the,  498 
Chalfont  epifeptic  ookny,  47 
Chabner's  Hospital,  396,  382 
Chancey,  Mr.  A.  (iUustrated),  51 
Charing-Cro$s  Hospital,  588 
Charing     Cross     HospiUl     Medical 

School,  400 
Cheinisse,  Dr.,  mosquito   theory  of 
infection   in   malaria   and   j'ellow 
fever,  33  ;  prolonged  lacteal  seoer- 
tion  as  a  cause  of  constitutional 
debility,  330 ;  periodic  paralysis  of 
hereditary  organ,  68 x 
Chemical   and   pharmaceutical   Con- 
gress, 33  K 
Chemistry  of  fine  wine,  36X 
Chemists  and  prescribing,  534 
Chemists'  Exhibition,  647 
Chicago  oculist's  "  cure  "  for  intem- 
perance, 182 
Chicken-pox,  i6x 
Chiklhood  Society,  400 
ChiUren's  tooth-brush,  the,  3x8 
Chloroform  anassthesia,  497 
Ch  oroform  Committee's  report,  147 
Chloroform  fatality,  2x3 
Cholecystotomy,  X98 
Cholera  in  Persia,  78,  134 
Cholera  in  St.  Petersburg,  187 
Christiani,  Dr.,   thyroid  grafting  in 

human  beinss.  X67 
Christophers,   Lieut.-Col.,     bacterio- 
k>gical  section  of  the  King  Institute, 
Madras,  220 
Chronic  cases  in  hospital  wards,  366 
Chronic  colitis,  92 
Chronic  entero-stenosis,  690 
Chronic  nephritis,  334 
Chronic  renal  disease.  Dr.  W.  Hale 

White,  XXX 
Chronic  X-ray  dermatitis,  446 
Church,  Sir  )\.  S.,  our  sanitary  needs, 

XX2 

Circulatory  disturbance  after  com- 
pression of  the  thorax,  X98 

Cirrhosis  of  the  liver,  322 

Qhr  Hospital  for  Diseases  of  the 
SUn,  Dublin,  634 

City  Orthopasdic  Hospital,  370 

Clarke,  Dr.  J.,  modem  surgery  of 
Joints  (IUustrated),  533 

Classification  of  pauper  consump- 
tives in  Irish  workhouses.  Dr.  Boyd, 
432 

Clever  malingering,  526 

Clinical  experiences,  Dr.  Pearse,  623 

Cocainisation  of  the  spinal  cord,  Mr. 
R.  Jones,  363 

Collier,  Dr.  Wm.  (portrait),  xo2 

Colour-hearing,  Dr.  Chalupecky,  334 

Colour  impressions,  633 

Cok>tomy  and  colectomy,  Mr.  F.  T. 
Paul  (Ihistrated),  8x 

Coma,  224 

Comparative  advantages  of  inorg  anic 
and  organic  iron  in  the  treatmeot 

f  of  anaemia,  Dr.  W,  MurreU,f4 


Comparative  examination  of  bkxjd. 

Concemmg  quacks,  232 
Conferring  of  honorary  degrees  on  Sir 
F.  Treves  and  Major  Ronakl  Ross, 
^695 

Congenital  muscular  defects,  X72 
Congenital  word-deafness,  669 

CORRESPONDENCE. 

Alcoholism  and  insanity.  397, 423, 449 

Annual  temperance  question,  77 

Celluloid  combs,  646 

Chloroform  anasthesia,  33  x 

Constipation,  387 

Coroner  Troutbeck  and  house  sur- 

geons,  373 
Diminishing  birth-rate,  76,  X03,  X28, 

X57,  X83,  2x0,  235.  a6x,  321,  343, 


Jan.  4,  ^965. 


^.373..  398,  539 
Disclaimer,  a,  448 


Epidemic  diarrhoea  and  dirty  feeditur- 

bottlCS,  2XX  . 

Experimental   treatment   of   cancer, 

2XX 

Hospital  funds  and  the  small  hospi- 
tels,  617,  646,  674,  700 

Inoperable  cancer,  448,  476,  503,  531 

King's  College  and  antivivisection,  422 

Lack  of  practical  mettiods  in  surgical 
teaching,  503 

Lay  press  and  the  profession,  674 

Local  supervision  of  certified  mid- 
wives,  530 

London  Hospital  funds,  the  London 
Hospital  and  Mr.  S.  Coleridge,  700 

Lunacy  question,  27,  5a,  77^  262,  321, 
344 

Mere  analyst  as  an  expert  in  toxico- 
logy, 6x7 

Medical  geology,  236 

Medical  men  and  dnnk  legislation,  129 

Meteorobgy  and  health  resorts,  184 

Midwives  Act,  449 

Midwives'  Board  again,  ro6,  423 

Midwives'  institute,  52.  77 

Municipal  dentistry,  304 

Opthahnological  Society  and  spec- 
tacle makers,  64    ' 

Our  "dailies,"  103 

Position  of  medical  officers  of  health, 
262 

Prevention  of  perineal  rupture,  X37. 
184 

Proposed  sterilisation  of  certain  de- 
generates, 26,  137,  449 
Public  Opinion  "  and  the  hospital 
penny  fund,  430 

Public  schools  and  flogging,  449 

Sanitary  and  buikiing  bye-laws,  26,  52 

Some  of  the  newer  methods  of  opening 
and  ck»ing  the  abdomen,  X03,  129. 

Spa  treatment  of  arthritis  deformans, 

St.  George's  and  hospital  centraUsa- 

tion,  26 
Superstition  and  psychotogy,  183 
Taormina  mineral  springs,  587' 
Vernon  Harcourt  inhaler,  476 
What  is  insanity  ?   372 
Whooping-cough,  398 

Congress  of  the  Royal  Institute  of 
Public  Health  at  Folkestone,  29 

Conjoint  Examination  Board  in 
Ireland  (pass  list),  X09,  X35.  40X, 

^  533.  559 

Conservatism  in  surgery,  4r6 

Constipation,  Dr.  T.  Robinson,  538 

Consumption  cure,  a,  609 

Consumptives  in  hospital,  693 

Continental  health  resorts,  40,  65 

Copper  sulphate,  206 

Copper  as  a  bactericide,  697 

Correcting  positicxi,  231 

0)rset  again,  the,  698 

Corysa,  332 

Crichton,  Dr.,  Medical  Acts  amend- 
ment, 623  ;  work  of  the  General 
Medical  Council,  405 

Craniotomy,  501 

Crime  of  devotion,  a,  668 

Caminal  charges  and  insanity,  X9 

Criminal  responsibiity  of  the  alco- 
holic, Dr.  W.  C.  SuUivan,  33 

Croupous  pneumonia,  93 

Croquet  ball  in  the  vagma  for  years, 

Cr>'nin  and  creoUn,  6x9 

Cyogenine  231 

Cyst  of  the  right  FaUopian  tube,  Dr. 

Fenwick,  414 
Cysticercus  of  the  pia  mater,  66 
Cyto-diagnosis   in   nervous   diseases, 

445 


Dangers  of  ceUubid  combs,  610 
Dangers  of  ice,  the,  669 
Dangers  of  iced  drinks,  X26 
Danger  of  nitric  add,  422 
Dangers  of  the  drinking  cup,  13  x 
Dan|^er  of  public-houses,  X27 
Davies,  Dr.,  spa  treatment  of  arthritis 

deformans,  5x3 
Davos,    Queen    Alexandra's    Sana- 

torium,  448 
Deafness  in  schools,  349 
Dearth  of  medical  men  in  Russia,  367 
Death   of   eminent   foreign   medical 

.  643 
Death   in  "  a  pleasant  confection," 

Death  of  a  medical  man  from  chk>ro- 

form,  373 
Deaths— end  of  each  No. 
E>egenerates  again,  130 
Degrees  in  veterinary  medicine,  32  x 
Dennatok>gical  cases,  Dr.  Meachen, 

62,  223.  483 
Demorahsation  of  the  consumptive, 

256 
Detachment  of  the  choroid,  Mr.  R.  D. 

Joyce,  86 
Diagnosis  of  ataxy,  ox 
Diagnosis  of  tuberculosis,  466 
Diagnostic  value  of  the  strawberry 

tongue,  258 
DialyBc   treatment  of   a£Fections   of 

the  stomach,  Prof.  Havem,  337 
Diet  in  relation  to  dental  diseases,  227 
Digestibility  of  white  bread,  178 
Digitaline,  X87 

Dilatation  of  the  colon,  3x2,  374 
Dimsdale,  Baron.  443 
Diminishing  birth-rate,  49 
Diminishing  birth-rate,  Dr.  D.  Walsh, 

31.  56 
Diphtheria  outbreak  in  Ireland,  333 
Direct  bronshoscopy,  496 
Disease  of  the  "  ego,"  204 
Diseases  of  the  brain,  224 
Diseases  of  country  women, 
Diseases  of  the  pancreas,  4x 
Disinfection  of  books,  323 
Disinfection    of    the  .clinical 

mometer   24 
Doctor  in  the  schools,  72 
Doctor's  death  from  plague,  53 
Doctors  at  St.  Aloysius,  X47 
Dogs  in  warfare.  670 
Dosage  of  remedies.  Dr.  Cash,  591 
Double  empyasmia,   Mr.   Monsarrat, 

23X 
Doyen's  work  in  cancer,  672 
Draughts  in  railway  carriages,  696 
Drinking  habits,  Dr.  Harford,  380 
Dropsy  m  renal  disease,  32  x 
Dual  aspect  of  medical  practice,  2x 
Dublin  hospital  appointments,  423 
Duke,  Dr.,  uterine  applicator  (illus- 


3x7 


ther- 


Bxophthahnic  goitre,  631 
Experimental  endocarditis,  119 
Experimental   treatment   of 

Mr.  S.  Keith,  137 
Exposing  a  scarlet  fever  patient,  ^4 
Extraordinary  action  for  malpraxis, 

319 
Eye  massage,  392,  4ax 


Faith  cure  by  fire,  74 

Fallopian  tuD»  ligatured  twice  at 
previous  operations,  Dr.  Taylor,  657 

Fahnottth.  309 

False  certificate,  a,  29 

False  legs  of  iron,  334 

Family  care  of  the  insane,  Dr.  Wickel, 
304 

Fatal  case  of  oedema,  Dr.  Carpea'er. 
567 

Fatol  kindness  of  an  hospital  visitor, 
205 

Fate  of  biliary  calculi,  257 

Fatty  degeneration,  124 

Fear  of  death,  the,  256 

Fenwick,  Dr.  S.,  parotitis  as  a  com- 
plication of  gastric  ulcer(illastrated), 

FieUen,  Dr.,  the  personal  element  in 
he  admimstration  of  anaesthetics, 
54 

Figs  as  physic,  578 

Fire  in  the  Edinburgh  Royal  Infir- 
mary, 51 

Fisher,  Dr.  T.  C,  open-air  treatment 

■   of  tuberculosis.  1x4 

Fistula  of  bladder  and  bowel,  440 

Five  abdominal  sections  in  four 
years,  237 

Fk>rence  Nightingale,  47X 

Folk-medicine  in  Fife,  500 

Food  adulteration  in  London,  32^ 

Food  and  Drugs  Act,  pn»ecutioa 
under,  674 

Foot  massa^,  21 

Foreign  bodies,  X90 

Foreign  bodies  in  the  nose,  662 

Forma\in  in  milk,  74 

Forster  Green  Hospital,  397 

Forty  thousand  deaths  from  cholera, 
2x3 

Foundation  stone  of  the  new  St. 
Barthok)mew's  Hospital,  48 

Fraser,  Dr.,  hospitai  isolation  of 
scarlet  fever,  327 

Freezing  Rdntgen  bums,  14 

Freidrichshall,  78 

French  asylum  scandal,  45 x 

Fried  fish  and  typhoid  fever,  49 

Fright  or  fear-illness,  443 

Frost-bite  in  Tibet,  443 

Fimctions  of  the  dental  pulp,  237 


trated),  456 
Duriiam  University,  x6i ;   (pass  list), 

375,  435 
Dysmenorrhoea,  603 
Dysmenorrhoea  treated  by  electricity, 

146 


Early  dia^osis  in  mental  disease,  492 
Early  rising,  49 
Echinococcus  hcpaticus,  4x3 
Edinburgh    University  improvement 

fund,  673 
Education  under  the  Bfidwives  Act, 

Dr.  Maclean,  434 
Educational  No.,  267-300 
Effect  of  smoldng  upon  the  throat, 

Efficiency  of  surgical  dressings,  2x 

Egypt  as  a  health  resort,  13,  197 

Ehruch's  colour  reaction,  604 

Elephantiasis,  X72 

Eosin  light-treatment,  549 

Epigastric  pain,  63X 

Epilepsy  or  drunkenness,  254 

Epithehal  cancer,  4x2 

Erythema  induratum  scrofulosorum, 

4a 
Ether  and  the  blood,  666 
"  Ether  dav,"  499 
Ether  drinking  in  Glasgow,  582 
Ethical  pharmacy,  669 
Ettles,  Dr.,  as  *'  medical  referee,"  474 
Evatt,  Surgeon-Gen.,  on  Irish  medical 

schools,  554 
Evolutio  praBcox,  312 
Examination  of  sight,  662 
Examination  of  sputa  in  children,  X79 
Examination  of  waters,  384  . 
Examinations  of  the  Central  Midwives 

Board,  X53 
Execution  by  electricity,  x5k 
Exit  the  Stete,  73 


Gale  norvegienne,  574 

Gangrenous  cystitis,  632 

Garden  city,  the,  3x6 

Gas  cysto  in  the  brain,  603 

Gas  poisoning,  69 

Gas  stoves,  20 

Gastric  anthrax,  X99 

Gastroptosis,  X23 

General    Medical    Counci^Autanm 

session,  583,  6x3 
G«ieral  Medical  Council  and  ite  pco- 

ceedings,  Mr.  G.  Jackson,  679 
Genesis  of  pubnonary  i^thisis,  490 
Gentleness  m  manipulation,  697 
Genu  valgum,  X4 

Germ-laden  railway  carriages,  153 
Giles,  Dr.  A.  R.,  pessaries,  x 
Glasgow  Eastern  Medical  Society,  424 
Glasgow  medical  club,  642 
Glasgow  Maternity  Hospital,  6x2 
Gla^ow  Ofrfithalmic  Institution,  303 
Gkisgow  Southern  Hospital,  424 
Glasgow  University  (pass  list),   X09, 

400 
Glasgow  Western  Infirmary,  583 
Glass-house    residences    of    medical 

writers,  206 
Glycogen  reaction  of  the  leucocytes,  41 
Gordon  portrait,  the,  25 
Gouty  paralysis,  3x1 
Graduation  ceremony  at  Edinburgh, 

X02 
"Grafte,"  668 
Gubb,  Dr.  A.S.,  the  seaside  cure,  ,x  X2  ; 

pulmonary  embolism,  626 
Guild  of  St.  Luke,  40X 
Gun-shot  wound,  387 
Guy's  Hospital  prise  day,  53 


Hadwen  v.  Price,  X24 
Hasmangioma  and  noma,.  3^87 


Jan.  4,  1905. 


IKDEx: 


SnpplaiMBt'to 
The  Medical  Frees  and  Circnlar. 


Hamatic  ocnoeDtraiiaii  and  nephritis, 

HsBOiatosea  case,  5M 
Haamolysia,  67 
Hamoptysis  in  phthisis,  490 
Hans,  the  *h<"V«ng  stallion,  3x5 
Harbum,  Dr.,  sciatica,  32^ 
Harford,  Dr.,  drinking  habits,  380 
Harveian  Society  of  UMidon,  363 
Hats  or  no  hats,  557 
'*  Harvey  Lewis  "  memorial  hospital, 

693         • 
Hayem.  Prof.,  dialytic  treatment  of 

altections  of  the  stomach,  537 
Headache   of  anaemia,   the.   Dr.   D. 

Walsh,   381 
Headache  powders,  i«>  . 

Health  and  statistics  of  Ireland,  556 
Health  of  Belfast,  156.  613 
Health  of  Doblin,  4S 
Heart  in  diphtheria,  52t7 
Heart  in  tnberculosis,  the,  500 

Heart  massage,  xoo 

Heart  syphihs,  600 

Heavy  damages  for  assault,  647 

Helfield,  Dr.,  Mediterranean  fever,  481 

Helpful  agent  in  the  treatment  of 
surgical  debility,  a.  Dr.  Purdy,  483 

Hemianasthesia,  Dr.  Scherb,  338 

Heminopsia  in  oramia,  335 

Hepatic  cirrhosis,  491 

Hepatic  levnlose  urea,  93 

Hepatic  rupture,  63a 

Hepburn,  Prof.,  preseatation  to,  51 

Hereditary  bias,  Mr.  R.  C.  Lucas,  59 

Hereditary  syphilis,  49a 

Herpes  soster,  41X.  466 

His  and  Weigert,  604 

Historic  drug  house,  97 

History  of  syphihs,  580 

Holiday  exercise,  x75 

Hortou  Lunatic  Asyhun,   x6o 

HospiUl  abuse,  x8 

HospiUl  amalgamation,  xs*  „  ^      , 

Hospital  funds  and  the  small  hospi- 
tals, 576 

'*  Hospital "  and  the  funds,  the,  6xx 

Hospital  for  the  insane,  579      , 

Hospital  isolation  and  scarlet  fever, 

Hospit^  uoUtion  and  scarlet  fever, 
Dr,  BlillanJ,  2x8.  377  .     , 

Hospital  isolation  of  scarlet  fever,  Dr. 
Fra^sr,  337 

Hospital  isolation  of  scarlet  fever,  Dr. 

Hospil^' Sunday  Fund,  64 
Hospital  museums,  699 
Hospitals  and  post-mortems.  X34 
Human  and  bovine  tuberculosis,  638 
Human  foot-and-mouth  disease,  394 
Hungry  school  children,  336 
Hydrocele.  543.. 
Hydroidiobia  an^  mocolaUon,  574 
Hygiene  as  she  is  wrote,  581 
Hygiene  in  the  Bast,  394 
Hygiene  of  paddling,  X35 
Hygiene  of  slavery,  334 
Hygiene  of  the  elevator,  4x9 
Hygienic  aspects  of  religion,  304 
Hygromed,  the,  430 
Hypenomia,   385 

Hyperaemic  treatment  of  phthisis,  4^7 
Hyperemesis  gravidarum,  335 
Hypodermic  medication  m  cancer,  4x6 
Hypnotism  m  the  Bast,  96 

Identification,  150  ,  ^ 

Identification  by  finger  pnnts,  47x 
Idiote  and  imbeciles,  365 
Ilfracombe,  64  ,  ^     *u 

Imagination  as  a  cause  of  death.  47o 
Immunisation  of  peritoneal  wounds, 

loiperial  sanitary   commissioner   for 

India,  446 
Improved   Hagedon's  needle  holder, 

Iniprovcd    stethoscope    (iUustrated), 

Inaugural    address    of    the    Royal 

Medical  Sotiety,  475 
Incarcerated  hernia,  334        .  . 
Incorporated    Medical  Practitioners' 

Association  and  the  Midwives  Act, 

343 
Incubation  period  of  typhoid  fever, 

Infantile  alcoholism,  333 

Infantile  diarrhflea,  337  ,    .        ^    ^^ 

Infantile    general    paralysis    of    the 

insane.  Dr.  Carpenter,  460 
Infantile  myxoedema.  1x9 
Infants'  Health  Society,  605 
Infectious  diseases,  334 


Infectious  diseases  at  Montrose,  35 
Inflation  in  acute  intussusception,  x79 
Influenza  rampant,  694 
Influence  of  attention  upon  work,  50  x 
Influmoe  of  castration  on  the  blood 

of  the  female,  3xx 
lofiuence    of    nuclein    in     Bright*s 

disease.  Dr.  Ashmead,  379 
Inoperable    cancer    by    hypodermic 
medication,  treatment  of.  Dr.  Shaw- 
Mackenzie,  403 
Inspection  of  city  restaurants,  335 
Insects  as  plague-cirriers,  553 
Insular  sclerosis,  Dr.  F.  Pahner,  343 
Insanity  in  India,  3x7 
Interrupted  circulation  in  treatment, 

356 
Internal  effects  of  formaldehyde,  533 
Intestinal  antisepsis,  490 
Intestinal  diverticula,  xox 
International  medical  language,  X78 
International    Congress    of    Phyno- 

logists,  365 
International  Congress  of  Surgeons, 

425 
Intractable  prolapse  of  the  uterus  and 

vagina,  extirpation  of,  Dr.  Martin 

439 
Intra-peritoneal  torsion  of  the  omen- 
tum, X9S 
Intravenous  injection  of  salicylates, 

47a 
Intussusception,  3x3 
Invagination  caused  by  adenoma,  633 
Invagination  of  the  Ixmel,  363 
Iodised   pack   in    the    treatment   ot 

puerperal  septicannia,  45 
Irish  Medical  Schools'  and  Graduates' 

^Issociatioa.  X35.  507,  5S8 
Irish  Poor-law  Medical  Service,  Dr. 

McHui^,  406 
Irish   Poor-law   Medical   Association 

and  its  okl  friend,  "The  Medical 

Press  and  Circular,"  149 
Irish  question,  an,  x6o 
Irregular  method  of  dispensing,  308 
Is  a  homoeopath  a  quack  ?  95 
Isolation  HospiUl,  the,  Dr.  Marriott, 

353 
Isolated  uterus,  466 
Is  tubercle  inherited  ?    375 


Jackson,    Mr.    G^,    General    Medical 

Council  and  its  proceedings,  679 
Jackson's  epilepsy,  31 1>  334 

Jaundice  and  the  Widal  reaction,  98 
ervis  Street  Hospital,  Dublin,  399 
essett,    Mr.    B.,    large    fibro-cystic 

tumour  of  the  uterus,  85 
Jones,  Mr.   R.,  cocainisation  of  the 

spinal  cord.  ^63 
Journal  "  Pubuc  Opinion,"  and  the 

hospitals,  the,  370  ' 

Joyce,  Mr.  R.  D.,  detachment  of  the 

chon^,  86 
Jubilee  of  modem    nursing,    528 
J  ud^e's    "  surprise "    at    a    medical 
witness,  6x0 


Keith,  Mr.  S.,  experimental  treatment 

of  cancer,  X37 
Kelynack,  Dr.,  sanatorium  treatment 

ot  consumption,  356 
Kepler's  malt   extract  with   h«no- 

globin,  374 
Keratooonus,  335 

Killed  by  swallowing  a  wasp,  365 
King  Edward's  Coronation  fund  for 

nurses,  45  x 
Kinjs's   College    Hospital   and    anti- 

vivisection,  390 
King's  College  scholarships,  373 
KkMowski  antimony  poisoning  case. 

Dr.  Wakio,  X93 
Kopiik's  spots,  633 
Kynance,  X97 
Kyphosis  of  muscular  origin,  I79 


Lack  of  practical  methods  m  modem 
surgical  education,  Mr.  E.  Owen, 

427. 
Large    abscess    of    the    ovary.    Dr. 

Tayter,  657 
Large    fibro-cyslic    tumour    of    the 

uterus,  Mr.  B.  Jessett,  83 
Largest  hospital  in  the  worU,  45X 
Last  great  sacrifice  for  honour,  30  x 
Lead  colic,  xx7 

L'Entente  cordiale— "  Au  revoir,"  414 
Lcishman-Donovan  bodies,  304 


,  643 

Leukamia  healed  by  X-rays,  663 
Lesions  in  movable  kidneys,  338 
L.G.B.  and  tramps,  the,  73 
Life  losses  on  the  A^,  33  x 
ligature    of     the    efferent    uterine 

vessels  for  pyasmla,  633 
Light  as  an  anaesthetic,  578 
Light  treatment  of  small-pox,  180 
Lig[ht  treatmeats,  438 
lilies  V.  roses,  30 
lame-juice  in  scurvy,  X35 

LITERATURE. 

Aids  to  surgery,  Dr.  Cunning,  3X3 
Ailments   of   women   and   girls,    F. 

Stacpole,  X33 
Anatomy,  Dr.  Toldt,  643 
Applied  anatomy.  Dr.  Taylor,  363 
Asthma  in  relation  to  the  nose,  Dr. 

Francis,  641 
Army  Medical  Department  for  1902, 

Atlas  of  the  extemal  diseases  of  the 

eye,  Dr.  Haab,  347 
Bacteriology  of  milk.  Dr.  Newman, 

645 
Blood  pressure  in  surgery.  Dr.  Crile, 

364 
Care  and  feeding  of  children,  Dr.  Holt, 

347 
Case    against    anti-vivisection,    Mr. 

Paget,  ^47 
Clinical  diagnostic  bacteriology,  Dr. 

Goles,  374 
Clinical    lectures    and    essays.    Dr. 

RoUeston,  X07 
Closure  of  laparotomy  wounds,  Mr. 

Swaffieid,  337 
Degenerates,  Dr.  Rentoul,  xo8 
Diseases  of  the  ear,  Mr.  Lake,  x86 
Diseases  of  women.  Dr.  Galabin,  364 
Disinfection    and    sterilisation.    Dr. 

Andrewes,  3xx 
Edinburah  ixiedical  joumal,  338 
Essentials   of   pelvic  diagnosis,   Mr. 

Bishop,  363 
Examination  of  the  urine,  Dx.  Wat- 
son, 3X3 
Four   epochs   of  woman's   life.   Dr. 

Galbraith,  213 
Gynecological  pathology,  Orthmann's, 

324 
Gyn»cok>gy,  Dr.  Pryor,  333 
Handbook    of    urine    analysis,    Dr. 

Bedford,  345 
Pydrotherapy,  Dr.  Barach,  xo6 
Index  of  symptoms.  Dr.  Leftwich,  X33 
Infectivity  ot  enteric  fever.  Dr.  Collie, 

37 
Insomnia,  Sir  J.  Sawyer,  X58 
International  clinics,  346 
Lateral  curvature  of  the  spine,  Mx.  N. 

Smith,  X06 
Le  ventre,  Dr.  Bourcat,  348 
Manual  of  ambulance.  Dr.   Riddell, 

338 
Manual  of  surgery.  Dr.  Thomson,  X33 
Manual  of  surgery,  Drs.  Thomson  and 

Miles,  644 
Medical  electricity.  Dr.  Tamer,  334 
Medical  ophthalmoscopy,  Dr.  Gowers, 

Medico-Legal  Society,  transactions  of 

the,  643 
Midwifery  for  midwives.  Dr.  Cakler, 

X58 
Milk,  Dr.  Wilkiughby,  345 
Modem  surgery.  Dr.  da  Costa,  38 
Nature  of  man,  Prof.  Metchnikoff,  348 
Nervous  diseases.  Dr.  Oppenhein,  346 
New    Sydenham    Society    atlas    of 

jMustration,  xo7 
O^thahnic  science  and  practice,  Mr. 

Juler,  3X3 
Organic  nervous  diseases,  Dr.  Starr, 

X85 
Patent  foods  and  patent  medicines. 

Dr.  Hutchison,  344 
Physical  deterioration,  Mr.  Smith,  237 
Physiolo^    and    pathology    of    the 

urine.  Dr.  Maim,  X07 
Physioiogv  of  digestion  and  diabetics. 

Dr.  Rooertson.  364 
Practical  prescribing.  Dr.  Kiricly,  333 
Practice  of  medicine.  Dr.  Stevens,  37 
Prevention  of  disease  in  armies,  Mr. 

CakiweU,  158 
Prostate  gland.  Dr.  Richardson,  644 
Purin  bodies  of  foodstuffs.  Dr.  Hall, 


Radio-] 


lo-activity,  Mr.  Soddv,  333 
Railway   and   other  acodents,   Dr. 

Haimlton,  505 
Refraction,  Dr.  Gibbons,  336 


Report  of  the  General  Prisons  Board 

423 
Report    of     the     Registrar-General, 

Ireland,  646 
Saunder's  year-book,  159 
Sqoint    occurring    in    children,    Mr. 

Browne  and  Dr.  Stephenson,  3X3 
Squire's  pocket  companion,  37 
St.  Barthobmew's  Hospital  re{»orts. 

Surgical  bandaging,  Mr.  Smith,  x86 

Text-book  of  chnical  anatomy,  Prof. 
Eisenbrath,  505 

Text-book  of  legal  medicine,  x6o 

Therapeutics  of  mineral  springs  and 
climates.  Dr.  Yeo,  X50 

Tumours,  innocent  and  malignant, 
Mr.  Bland-Sutton,  338 

Trypanosomiasis  expedition  to  Sene- 
gambia,  Drs.  Dutton  and  Todd,  X33 

Wounds  in  war,  Surgeon-Gen.  Steven- 
son, X07 

Literary  notes  and  gossip,  78,  186, 
264,  349.  398.  531.  674 

"  Live  rails,"  393 

Liverpool  Hospital  Saturday  Fund, 
6x9 

Liverpool  mortality,  365 

Liverpool  School  of  Tropical  Medi- 
cine, 646 

liverpool  University  (pass  list),  x6x 

London  HospiUl  Medical  School,  134, 
375 

London  Hospital  and  hospital  abuse, 

London  Hospital  fund,  the  hospitals 

and  Mr.  Stephen  Coleridge,  665 
London  Hospital  "  funds  "  and  the 

small  hospitals,  635 
London  Polyclimc  dinner,  646 
London  School  of  Tropical  Medicine, 

X08 
London  University  (pass  list),  X87 
Lons  hours  and  nerve  strain,  393 
Lord  Chancellor  and  the  medical  pro- 
fession, X48 
Lucas,  Mr.  R.  C,  hereditary  bias,  59 
Lumbago,  41  x 
Lunacy  in  GLisgow,  6x7 
Lunacy  in  Ireland,  383,  6x6 
Lynton  and  Lynmo«ith,  333 


MacDermott,  Dr.,  study 'of  biono- 
mics, X63 

MacDermott,  Dr.,  value  of  the  offida  1 
reports  on  insanity,  677 

Maclean,  Dr.,  education  under  tlie 
Midwives'  Act,  454 

MacGrejSor,  Sir  Wm.,  351 

Magnetic  opium,  97 

Management  of  diphtheria  suspects, 
34X 

Marriages — end  of  each  No. 

Marriott,  Dr.,  the  isolation  hospital, 

Martm,  Dr.,  extirpation  of  intract- 
able prolapse  of  the  uterus  and 
vagina,  429 

Massage  school,  4x8 

Mater  Biisericordias  Hospital,  598 

Maternity  work  in  Edinburgh,  321 

McHugh,  Dr.,  Irish  Poor-law  Medical 
Service,  406 

McKeown,  Dr.,  proposal  memorial  to, 
X83,  397 

McWalter,  Dr.,  necessity  for  school 
hygiene,  84 

Meachen,  Dr.,  dermatological  cases, 
63,  333,  485 

Meat  extracts  in  medicine,  473 

Meat  inspection,  548 

Meath  Hospital,  434 

Medical  aid  to  seamen,  533 

Medical  Acts  amendment.  Dr.  Crich- 
ton,  625 

Medical  and  dental  companies,  207 

Medical  appointments  in  Belfast,  156 

Medical  commission,  336 

Medical  diploma tes  of  Scotland,  50  x 

Medical  "Frumps,"  393 

Medical  Graduates'  college  and  Poly- 
clinic, 56X 

Medical  inspection  of  schools  in 
Ireland,  306 

Medical  journalist,  a,  339 

Medical  men  and  drink  legislation  y-t 

Medical  men  and  administrative 
justice,  337 

Medical  men  and  literary  composi- 
tion, X74 

Medical  men  and  poisonous  drugs  606 

Medical  men  m  lay  newspapeis/^^* 

Medical  profession,  335     *^  *^   '  *^3 


SnpaltaMiiit  to 
The  MedkiaKms  and  CireiUfl 


INDEX. 


Jan.  4,  1905. 


Medical  professionXn  Gennaay,  18  z 
Medical  report  on  the  Boer  War,  696 
Medical  Sickness  and  Accident  Society, 

16,  ^99,  618 
Medical  thinking  and  medical  thought, 

300 
Medical   treatmoit  of  ulcer   of   the 

stomach,  Dr.  Kobin,  307 
Medicine  and  pathology,  314 
Medtoo-kgal  Society,  375,  424,  589 
Medico   Psychological  Association  of 

Great  Britain  and  Ireland,  39 
Mediterranean  fever,  Dr.  Helfield,  48^ 
Meeting    of     the    General    Medical 

Council,  50s 
Mesotan,  506 

Metabolism,  Dr.  Calwoll,  339 
Meteorism,  362,  ^87 
Metropolitan  Asylums  Board,  560 
Metropolitan  hospital  Sunday  Fund, 

and  the  small  hospiub,  637 
Microorganisms  in  the  stomach,  606 
Midwives'  Act,  351,  442 
Bfiddesex  Hospital  Medical   Schools, 

375 

ne  in  children,  466 


ulicz's  disease,  548 

Mikulicz-Radicke,  Dr.,  the  Cavendish 
lectures,  6 

Milk  supplies,  132 

Milk-borne  disease,  495 

MiliUnt  anti-vacdnists,  5^3 

Millard,  Dr.,  hospital  isolation  and 
scarlet  fever,  218 ;  hospital  iosia- 
tion  and  scarlet  fever :  the  statis- 
tical aspect,  377 

MiUinery  and  science,  133 

Milo  food,  374 

Milroy  lectures,  619 

Mihau,  Dr.,  tapping  of  the  lumbar 
region,  453 

Modem  surgery  of  joints.  Dr.  J. 
Clarke  (illustrated),  335 

Monsarrat,  Mr.,  operative  treatment 
of  tuberculous  disease  of  the  knee- 
joint  (iUustrated),  189 

Moral  imbecility,  339 

Morphia  poisoning,  187 

Mosquito  theory  of  infection  in  ma- 
laria and  yelbw  fever.  Dr.  Chei- 
nesse.  33 

Motor  functions  of  the  varus,  93 

Mr.  Coroner  Troutbeck  on  young 
medical  men,  363 

Mullion,  170 

Multiple  tests  for  drunkenness,  308 

Municipal  dentistry,  472 

Municipal  medical  attendance,  123 

Municipalities  and  bacteriology,  326 

Muretin,  13 

Murray's  Royal  Asyhun,  396 

Murrell,  Dr.  W.,  comparauve  advan- 
tages of  inorganic  aiod  organic  iron 
in  the  treatment  of  anaemia,  4 

Mujdc  and  medicine,  323 

MysBsthenia,  120 


Nasal  polypi,  orighi  of,  Dr.  Yonge,  142 
National  Association  for  the  Preven- 
tion of  Tuberculosis,  673 
National  dental  hospital,  389 
National  epileptic  oobny,  A44 
Navy  Medical  Service  (pass  list),  389 
Necessity    for    school    hygiene.    Dr. 

McWalter.  84 
Nephritic  calculi,  633 
Nervous  diseases,  224 
Neurasthenia,  673,  696 
Neurosis  of  the  oesophagus,  231 
New  books,  28,  349,  305 
New  cancer  treatment,  446 
New  dental  journal,  328 
New  disease,  a,  100 
New  field  for  {^armaceutical  chemists, 

203 
New  hospitals  in  Glasgow,  343 
New  medical  school  at  Dundee,  447 
New  method  of  testing  the  heart,  130 
New    methods    of    treatment.    Dr. 

Weyll,  141 
New   president  of  Queen's   College, 

Cork,  ^32 
New  president  of  the  Royal  College  ot- 

Fhysidans,  Ireland,  444 
Newquay,  230 
New  remedies,  361 
New  sanatorium,  422 
New  scholarship  for  pharmacy  stu- 
dents, 32% 
New  tabk)ia  preparations,  134 
New  uterine  mop  (illustrated).  Dr. 

Aarons,  4^5 
New  wodcnouse  sauitorium,  476 
Newspaper  medicardisoovery,  132 
Nixon,  air  C.  J.,  various  phases  of  a 
hospital's  woik,  309 


No  public  morturay,  320 

Noise  and  sickness,  98 

Nomenclature  in  pulmonary  tubercu- 
k»is,  43 

North-east  London  Clinical  Society,  33 

North  of  Bnglanrt  miner's  dis|»ite,  33 

Notification  of  infectious  disease,  422 

Notices  to  correspondents — end  of 
each  No. 

Nottingham  Medico-cfairuzgical  So- 
ciety, 647 

Novel  method  of  suturing  wounds,  333 

Novel  test  for  sobriety,  694 

Nucleinate  of  soda,  xp8 

Numbering  the  people,  692 

Nuns  as  nurses,  30  z 

Nunes  for  middk-dats  houses,  4x9 

Nurse's  slander  action,  100 

Nutrition  in  wasting  diseases  of  child- 
ren and  adults  (illustrated).  Dr.  D. 
Walsh,  437 


OBITUARY. 

Allingham,  Mr.  H.  W.  (with  portrait), 
304 ;    Banks,  Sir  W.,  Z84  ;    Bate- 


.  X85;  ,  

332  ;  Benham,  Dr.,  333  ;  Birkett, 
Mr.  J.,  33 ;  Boulton.  Dr.  350  ; 
Campoell,  Dr.  G.  A.,  700 ;  Camp- 
bell, Surg.-Major,  363  ;  Carver,  Dr.. 
322  ;  Chakleoott,  Dr.,  643;  Chap- 
lin, Dr.,  330  ;  Chataway,  Mr.,  423  ; 
Cranny,  Dr..  Z32  ;  Croker,  Dr.,  350, 
373;  Crossneld,  Mr.  xo6 ;  Finsen, 
Prof.,  330  ;  Flint,  Dr.,  Z32  ;  French, 
Surg.-Major,  237  ;  George,  Dr.,  78  ; 
Goodworth,  Dr.,  430 ;  Greenway, 
Major,  X83  ;  Gresswell,  Dr.,  643  ; 
Hamilton,  Dr.,  373  ;  Harthan.  Mr., 

S2  ;  Haworth,  Dr.,  398  ;  Hector, 
:.,  641 ;  Hodges,  Dr.,  398 ; 
Hughes,  Mr.,  azz  ;  Hume,  Dr.,  430  ; 
Izod,  Dr.,  332  :  Jameson,  Surg.- 
Gcn-.  322 ;  Jones,  Mr.,  398 ; 
Kennedy,  Dr.  j .,  643  ;  Lamg,  Dr., 
C.  F.,  700  ;  LeTall,  Mr., 3747Liisb. 
Dr.,  643.:  MacBwan,  Insp.-Gen., 
263  ;  M'Keown,  Dr.,  78  ;  M'Leod, 
B*^"  532;  Money,  Dr.  A.,  477; 
Moore,  Dr.  R.  B.,  673  ;  Moore,  Dr. 
R.  H.,  477;  Neville,  Dr.,  361; 
Orton,  Mr.,  423  ;  Parker,  Dr.,  78  ; 
Phillips,  Dr.,  333  ;  Poore,  Dr.  G.  V., 
388  (illustrated),  6z8 ;  Reardon, 
Dr.,  Z33 ;  Russell,  Dr.,  430 ; 
Russell,  Dr.  J.  B.,  476;  Ryan, 
Ueut.-CoL,  423 ;  Scanlan,  Mr., 
z^8;  Silcock,  Dr.  A.  Q.,  700; 
Simon,  Sir  J .,  zo6  ;  Smith,  Di.  G., 
Z37  ;   Thomson,  Major.  388  ;   Tip- 

Bitts,  Suzg.-Major,  3xz  ;  Vintras, 
r.,  332;  Wallace,  Dr.,  423; 
Whamond,  Dr.,  37/;  Williams, 
Mr.,  Z32 ;  Wilson,  Brigade-Surg., 
374  ;    Wood,  Dr.,  322 

O'Brien,  Dr.,  radium  in  therapeutics, 

139 
Obscure  form  of  alcoholism  involving 

irresponsibility.  Dr.  C.  Shaw,  62  z 
Occupation  pains,  38Z 
Ocular  gymnastics,  72 
Ocular  symptom  in  diabetes,  93 
OU  Royal  Hospital,  Belfast,  673 
Open-air   treatment  of   tuberculosis. 

Dr.  T.  C.  Fisher,  Z14 
Opening  and  ck)sing  the  womb,  Mr. 

E.  H.  Tweedy,  60 
Opening  of  the  session  at  Edinburgh 

University,  448 

THE  OPERATING  THEATRES. 

Cancbr  Hospital — 

Gastro-enterostomy  fifteen  months 
after  pyloplasty,  68 

Obstruction  of  the  pylorus,  3Z3 
Chklska  Hospital  for  Womkn^ 

Abdominal  panhysterectomy,  94 
Frknch  Hospital  and  Dispensary  — 

Appendidtis,  x6 
Great  Northern  Hospital — 

Distended  gall-bladder,  232 

Inflamed  appendix,  300 

Re-excision  of  hip,  388 

Removal  of  appendix,  120 

Suprapubic  cystotomy,  493 
^uy's  Hospital— 

Badly-united  fracture,  333 

Cancer  of  the  stomach,  333 

Chronic  constipation,  33 

Excison  of  the  rectum  for  canceZf 

Renal  sorBsry,  364 

Novel  and  very  effective  mode  of 


treatoMnt  of  general  suppurative 
peritonitis,  633 
Itauan  HosprrAL— 
Foreign  body  an  the  lower  end  of 
cDsophagus,  388 
King's  Ck)LLBGE  Hospital — 
Combined    suprapubic    lithotomy 
and  prostatectomy,  467 
London  Hospital — 
Operation  for  sinus  following  appen- 
dicular abscess,  549 
Middlesex  Hospital — 
Cholecystectomy,  x6 
Thyroid  cyst,  333 
North-West  London  Hospital — 
Active  intestinal  obstruction,  X30 
Amputation  of  the  hip-joint,  Z73 
Chronic  nasal   catarrh   of   eleven 

years'  standing,  690 
Polypus  of  the  rectum,  533 
Recurrent  polypi,  69X 
Removal  of  the  tongue,  43 
Syphilitic  stenosis  of  the  larynx, 

523 
Two  cases  of  intermittent  obstruc- 
tion with  hydronhoia,  44 x 
Royal  Ear  Hospital— 
Nasal  obstruction,  4x4 
Royal  Free  Hospital — 
Enudeation  of  the  eye  for  injury. 

Gastrostomy,  336 

Traumatic     extra-dural     luunor- 
rhage,  604 
Royal    Westminster    Ophthalmic 
Hospital — 
Conical  cornea,  664 
St.  Bartholomew's  Hospitax^~ 
Perforated  gastric  ulcer  in  a  man, 

312 
Strangulated  femoral  hernia  in  a 
man,  664 
St.  George's  Hospital — 

Optical  iridectomy,  94 
St.  Mark's  Hospital  por  Fistula — 
Abdominal  fixation  of  the  sigmoid 

meso-ook>n,  68 
Anal  tumour,  4x3 
Laparotomy,  413 
St.  Mary's  HosprrAL — 
Richter's  hernia  simulating  chronic 
intestinal  obstruction,  X46 
St.  Peter's  HosprrAL — 
Complete    prostatectomy    for    en- 
larged prostate,  330,  373 
Nephro-lithotomy,  aoo 
St.  Thomas's  Hospital — 
Perforated  gastric  ulcer,  493 

Operative  treatment  of  tuberculous 
disease  of  the  knee-joint,  Mr.  K.  W. 
Monsarrat  (illustrated),  189 

Ophthalmic  surgeon  on  legal  evidence, 
an.  408 

Oral  infection,  336 

Organisms  in  sore  throat,  472 

Origin  of  elements,  330 

Orthostatic  tachycardial,  549 

Osteo-arthropathica,  X09 

Osteopathy  in  England,  608 

Otogenic  menin^tis,  349 

Our  French  visitors,  393 

Our  sanitary  needs,  Sir  W.  S.  Church, 

ZI3 

"  Our  Visitors,"  390 

Ovarian  cyst,  663 

Ovarian  disease  assodated  with  ute- 
rine fibroids.  Dr.  B.  Fenwick,  34Z 

Overlying  of  infants,  417 

Owen,  Mr.  E.,  lack  of  practical 
metiiods  in  modem  surgical  educa- 
tion, 42:r 

Oxford  University  (pass  list) ,^339. 70 x 

Oxygen  Hospital,  33 


Paget,    Dr.    S.,   paraffin    in    plastic 


surgery,  334 

lin  m  the  ear,  33  x 


Pain  _  .  _ 

Pahner,  Dr.  F.,  insular  sclerosis,  343 

Paracentesis  in  pericardial  effusion, 
303 

Paradise  of  bone-setters,  443 

Paraflto  in  plastic  surgery,  Mr.  S. 
Paget,  334 

Parisian  on  American  surgery,  a,  38  z 

Parliamentary  representation  of  Glas- 
gow and  Aberdeen  Universities, 
42 X,  330i  646 

Parotitis  as  a  complication  of  gastric 
uloer  (iUustrated),  Dr.  Fenwick  and 
Dr.  Rhodes,  393 

Pastime  of  cycnng,  6zx 

Patellar  fracture,  14 

Paul,  Mr.  F.  T.,  colotomy  and  colec- 
tomy (illustrated),  8k 

Peazse,  Dr.,  clinical  experiences^  633 


Peculiar  tvpe  oi  defenecatioa*  asz 

Perforated  gastric  uloer  •itwniaH^g 
appendidtis,  Dr.  Ball,  ^09 

Periodic  paralysis  of  hereditvy  origiii. 
Dr.  Cheinetse,  68z 

Pepper  as  a  drnsiag  for  woonds,  368 

Penzance,  54Z 

Peripheral  paralysis,  67 

Peritoneal  tuberottk>-is,  4Z3 

Perityphlitis  question,  13 

Personal,  34,  50.  75»  xoz,  138,  154, 
x83,  309,  334*  260,  320,  343»  372, 
395>  5421,  446,  474>  S02,  529.  558> 
382,  6zz,  64Z,  673,  699 

Personal  element  in  the  administra- 
tion of  anasthetics.  Dr.  FieUea,  654 

Penonal  hygieae  in  soldiers,  671 

Pessaries,  th-.  A.  R.  Giles,  x 

Pest  infection,  the,  143 

Pharmacy  law  in  the  Transvaal,  338 

Phlebitis,  X44 

Phtegmonous  tonsillitis,  547 

Phosphoric  add  in  gastnc  medioa- 
tion,  X36 

Physical  deterioration  committee,  33s 

Physical  culture,  327 

Plague  figures,  38,  147,  2x3,  339 

Pleuritic  effusion,  65 

plum-pudding  from  all  points  at 
view,  6^1 

Pneumonia  and  public  health,  333 

Pneumonia  in  Chicago,  638 

Pneumothorax,  Z78 

Poisoning  by  boot-blacking,  474 

Poisoning  by  boric  add,  4x8 


Poisoned  by  gelsUnium,  70X 
PoUution  of  Belfast  Lough,  673 
Poor-law  Medical  Service  in  Ireland, 


561 

Poplar  workhouse  scandal,  359 
Popular  medical  phraseology,  z3z 
Portruah  cottage  hospital,  Z83 
Position  of  gynascology,  150 
Podtion  of  gynacology  at  the  meet* 

ings  of  the  B.M.A.,  }z8 
Post-dated  medical  certificate,  177 
Post-diphtiieritic  adiponty,  3Z7 
Post  office  as  censor,  30 
Post-operative     distfnsion     of     the 

stomach,  66 
Postal  workers'  sanatorium  scheme, 

263 
Pregnancy  and  puerperal  involutioo, 

663 
Pregnancy  and  uterine  evolutioa,  689 
Pregnancy  in  uterus  bicomis,  3Z9 
Preparation  of  the  suiveon's  hand,  393 
Prevention  of  heart  msease,  493 
Pzeventioa  of  perineal  rapture,  Z37 
Prevention  and  trea<' 


treatment  of  canoer. 


<34 


Preventive  treatment  of  scarlet  fever, 
Dr.  Biss,  3Z3.  34Z 

Preventive  treatment  of  canoer,  667 

Prevention  of  malaria,  301 

Primary  peritonitis  in  infancy,  310 

Primary  sarconu  of  the  small  mtes- 
tines,  z^6 

Prime  Minister  on  matter,  the,  328 

Private  hospitals,  340 

"  Professor  "  Alex,  670 

Professional  penalty  for  extortion,  443 

Progeries  and  senilism,  37X 

Progress  of  sanitary  sdenoe,  Z36 

Prognosis  of  diabetes,  603 

Prolonged  lacteal  secretion  as  a  cause 
of  constitutional  debility.  Dr. 
Cheinesse,  330 

Prominence  of  scapula,  xxo 

Proposed  age  limit  at  BdinbuxCh 
Royal  Inftcmary,  448 

Prosecution  of  an  unregistered  den- 
tist, 70Z 

Protection  of  the  holiday  maker,  x8z 

Pseudo-halhidnation,  33  x 

Pseudo-hermaphrodism,  67 

psittacosis,  333 

Public  health  administration,  _z7 

Public  health  laboratory  at 


Pubhc  libraries   and  mfectious  dis- 
eases, 336 
Public  sanatoria  for  phthisis,  233 
Public  vaccinators'  fees,  47 
Public  vaccinator  as  magistrate,  673 
Puerperal  infection  treated  by  intra- 
uterine application  of  iodised  | 


Dr.  Cabanes.  38 
Puhnonary  embolism,  Dr.  Gubb,  636 
Pulmonary  peritonitis,  4x3 
Pulmonary  phthisis,  modem  view  of, 

Purdy,  Dr.,  a  helpful  sgent  in  the 
treatment  of  surgical  aebiMty,  483 

Puruknt  pericarditis  tieated  sur- 
gically, 66  _ 


Jan.  4«  X9t>5. 


INDEX. 


SvpblMitiit  to 
Th«  MMieal  Prats  aadCErciilar. 


Qnateroeateiiary  of  the  Royal 
CoDese  of  Sa^s«oiis,  Bdinbargh,  538 

Qoantitathre  analysis  of  bkxxl  ozida- 
tioQ,  S23 

Queen  Aexandfa's  Saaaioriam,  396 

Queen's  College,  Gahray,  533 

Qoinqnand's  sign,  305 


Rabai^ti,  Dr.,  tuberculous  synovitis 

of  the  knee-joint,  683 
Radical  treatment  of  ulcers,  146 
Radium  experiments,  xx8 
Radium  in  therapeutics,  Dr.  O'Brien, 


R«2un 


639 


Bum  rays  in  diphtheria,  370 
Railway  lavatory,  the,  207 
Rays  in  blood  diseases,  3S5 
Recent  appointmeats  at  the  Royal 

University,  526 
Recent  hamatogea  trial,  48 
Rectal  feeding  in  ulcus  veatricuU,  xiS 
Recurrent  typhoid,  467 
Red  cnMB  work  in  Japan, 
Registration  of  nurses,  98 
Registration  of  medical  students,  666 
Regnlatioas  of  the  Royal  Univeisity 

dt  Ireland,  70X 
Reid,  Dr.,  value  of  laboratory  work 

in  medicine,  408 
Remedy  for  physical  deterioration,  46 
Remodelled  Lath  hospital,  the,  673 
Removal  of  the  Gaasenan  ganglion,  2X 
Renal  insufficiency,  X7x 
Renal  surgery,  199 
Repetition  of  prescriptions,  579 
Repeated  rupture  of  the  uterus,  580 
Responsibilities   of   nursing   associa- 
tions. 72 
Revivalism,  580 

Reversed  peristalsis  of  intestines,  3x9 
Risks  of  professional  life,  X24 
Robin,   Dr.,    medical    treatment   of 

nicer  of  the  stomach,  307  ' 
Robinson,  Dr.  T.,  constipation,  538 
Robson,  Mr.,  Bradshaw  lectures,  595 
RAntgen  thys  lor  the  Russian  Army, 

239 
Royal  AcadeoiT  of  Medicine,  424 
Royal  Aimy  Medical  Corps  (volun- 
teers), 477 
Royal  Qtv  of  Dublin  Hospital,  424 
Royal  College  of  Physicians  and  Sur- 
geons (pass  hst},  109,  2X3,  S33»  6i9> 
647 
Royal  CoUeoe  of  Physidans^and  Sur- 


Colege  of  Physicians,  London, 

Royal  College  of  Physiaans,  London 

(pass  Hst),  i6x 
Royal  College  of  Physicians  of  Ireland, 

450 
Bml  College  of  Surgeons,  Bdinburgh, 

^  Hst),  x6i,  477      .    „     ,    J 
Ropl  College  of  Surgeons  in  England, 

589 
Royal  College  of  Surgeons,  Ireland— 

prise  Bst,  53 
Royal  Odk^  of  Surgeons  in  Ireland 

(paas  ist),  100.  135,  ¥>9»  550 
Royal  CeXkssb  of  Surgeons  m  Ireland, 

307 
Royal  Commission  on  extra-asylum 

Rt^l^Sr  Hospital,  507 
Royal  Fiee  Hospital,  39*  , 
Royal  Univerrity  of  Ireland,  79*  '34 
Royal   Univenity   of    Ireland    (pass 

lilt),  400,  m.  4?3„        „^.  ^      . 
Royal  Veterinary  (college,  Edmburgh, 

160 
Royal  Victoria  Hospital,  ^76 
Royal  WaterkK)  Hospital  for  Children 

and  women,  45r>  919 
Rubber  gkyves,  3x8 


Saaatoria  as  public  educators,  610 
Sanatorium  for  consumptives,  X56 
Sanatorium  treatment  of  consump- 
tion. Dr.  Kelynack,  356 
Sanitary  institute,  265 
Sanitary  reorganisation  of  the  army, 

S^tation  and  art,  55a  ^  ^^ 
ftftyffMo  caxe.  Dr.  A.  S.  Gubb,  xx2 
Seiaore  of  tubercakras  meat,  337 
Scarlet  lever  and  hospital  isolation, 

SaaSca,  Dr.  Baxbutn,  329 


Faculty  of  Physicians 

and  Surgeons,  Glssgow  (pass  list), 

'09»  '3S>  4351  553 
Royal  Couece  of  fhysidans  of  Edin- 

RoyalC 


Sciatic  dislocation  of  the  hip,  387 
Sdence  schools  in  T.C.D.,  555 
Scientific  palmistry,  442 
Schleussner  X-ray  plates,  506 
School  boaxd  certificates,  6x2 
School  dentistry,  X23 
Scottish  Diplomates*^  Association  and 

the  title  of  "  doctor,"  208 
Seaside  therapeutics,  xsx 
Self -certified  lunatics,  177 
Semon,  Dr.,  cancer  of  the  larynx,  479 
Senate  of  the  Royal  University  of 

Ireland,  x6o 
Senile  gangrene,  631 
Sense  of  smell,  258 
Sentimentality  among  guardians,  232 
Sequence  of  disease  phenomena,  3x6 
Sepsis,  42 

Serum  therapy,  255 
Serravallo's  iron  and  cinchona  tonic, 

Serum  treatment  of  puerperal  fever, 
386 

Seventh  International  (Congress  of 
Otok)gy,  195  ,.       , 

Secret  of  secret  remedies,  670 

Sciatica.  688 

Scientific  research  at  Khartoum,  697 

Sicns  of  drunkenness,  67X 

Silver  nitrate  in  eye  work,  ¥rith  par- 
ticular reference  to  argyrol,  Dr.  S. 
Stephenson,  651 

Shakespeare's  grave,  238 

Shaw,  Dr.  C,  obscure  form  of  alco- 
holism involving  irresponsibility, 
621 

Shaw-Mackence,  Dr.,  treatment  of 
inoperable  cancer  by  hypodermic 
medication,  403 

Short  way  with  hmatics,  417 

Sidlaw  Sanatorium,  23 

Sidmouth.  39 

Sight-testing  by  spectacle-makers,  69 

Significance  of  the  diaxo  reaction,  498 
ises  "  of  lunacy,  97 
Mr.,  sterilising  of  surgical 

Slander   action    against   Sir   P.    H. 

WatBon,  75 
Slander  ease,  a,  49 
Sleeping  sickness  on  the  Cct^t  559 
Simulated  tmilateral   amaurosis.  Dr. 

ospitals  and  the  funds,  494 
Small-pox  at  Buxton,  X87 
Small-pox  epidemic,  X30 
Small-pox  epidemic  in  Belfast.  530 
Small-pox  epidemic  in  Ulster,  183 
Small-pox  in  a  prison,  187 
Small-pox  in  Belfast,  25,  559 
Small-pox  in  Ulster,  343 
Small-pox  outbreak,  20X,  209, 235, 372 

6xt 
Smith,  Prof.  L.,  complimentary  diimer 

to,  503 


Smith,  Prof.,  resignation  of,  209 
Smoking  without  harm,  239 
SmyiyTDr.  Wm.  J.  (lUustrated),  475 
Soap  before  school,  470 
Soap  tincture  for  the  hands,  34X 
Soaety  for  the  Study  of  Inebriety,  199 
Society  of  Apothecaries  of  London 

(pass  list),  xoo,  X87,  2jp,  435»  477 
Sooe^  for  the  Relief  of  Widows  and 

Orphans  of  Medical  Men,  79>  4^5 
Soki^,  324 
Sore-thJcoat  at  Belvedere  Fever  Hos- 

South-West  London  Medical  Society, 

435 
Spasmus  nutans.  4x2 
Spa  treatment  ot  surthritis  deformans. 

Dr.  Davies,  ^X3 
Specific  agghitmation,  663 
Special  report  of  the  Central  Mkl- 

wives  Board,  477 
Speech,  silence,  aad  bacteria,  368 
Spinal  anasthesia  in  laboor,  577 
Spokes,  Mr.,  care  of  children's  mouths, 

143 
Spontaneous  rupture  in  ascites,  71 
Sprains,  xa 
Stagnin,  09 

State  registration  of  nurses,  26x 
Stature  and  sickness,  233 
Steedman's  powders,  698 
Stephenson,  ur.  S.,  silver  nitrate  in 

eye  work,  with  particular  reference 
*to  argyrol,  631 
Sterile  water  anasthesia,  334 
Sterilising  of  sufgical  drnsingB,  Ma. 

Skirving,  3x2 
Stovaine,  36X 


St.   Andrews   University  rectorship, 

St.  Barthokmew's  Hospital,  375 
St.  Bartholomew's  rebuilding,  441 
St.  Ives,  223 

St.  John  Ambulance  Association,  202 
St.  Mary's  Hospital  Medical  Schools, 

399 
St.  Thomas's  Hospital  house  appoint- 
ments, 263 
St.  Thomas's  Hospital,  398 
St.  Vincent's  Hospital,  333,  424 
Studious  habit,  the,  4x8 
Study  of  bionomics,  Dr.  Maodermott, 

163 
Study  of  Greek,  640 
Streptococcus  curative  serum,  ^62 
Subcutaneous   injection  of   gelatine, 

23X 
Suburban  sanitation,  638 
Suckling  of  infants,  3x8 
Sudden  deaths  in  typhoid,  xx9 
Suggested  visit  to  Paris,  6x8 
Sugaring  of  wine,  693 
Smdde,  44 

Sullivan,  Dr.  W.  C,  criminal  respon- 
sibility of  the  aloohoUc,  33 
Sulphide-carbide  poisoning,  xx9 
Slimmer  diarrhoea  of  infants,  231 
•*  Sundown  "  journalism,  i8x,  473 
Superstition  and  psychology,  122 
Suprarenin,  367 

Supply  of  drugs  to  Irish  unions,  371 
Suppurative  knee-joint.  Dr.  Bradcett, 

Surgeon's   account   of    the    Russian 

outrage,  473 
Surgeon's  post  in  French  duels,  328 
Surgery  in  the  newspapers,  609 
Surgery  of  the  gaU-bladder,  688 
Surgery  of  the  pancreas,  662 
Surgical  examination  at  Edinburgh, 

639 
Surgical  treatment  in  gout,  497 
Suture  of  an  artery,  X78 
Suture  of  the  heart,  332 
Swedish  physical  culture  and  quali- 
fied medical  practice,  33 x 
Syers,  Dr.,  medical  cases,  X70 


Sympathy  with  Dr.  Arthur  Griffiths, 

647 
Symbiosis  among  bacteria,  698 
Syphilis  and  mercurial  vapours,  373 
Syphilis  of  the  thyroid  gland,  690 
Syphilitic  diseases  of  the  eye,  X40,  633 


"  Tabkad  "  lithium  citrate,  374 

Talma's  operation,  X09 

Tappmg  of  the  lumbar  region,  Dr. 

Tapping  'the  bladder,  463 

Tar  acne,  483 

Tattooing  and  disease,  698 

Teacher  and  student,  46 

Tearing  of  the  mesentery,  67 

Teadiing  of  hygiene  in  primary 
schools,  336 

Teignmouth,  X44 

Temperance  lectures  in  schools,  369 

Testa's  cumnt,  322 

Text-books  on  obstetrics,  202 

Therapeutical  Society,  X34,  420 

Thexmo-palpation,  375 

The  plague,  147 

The  dustman,  old  and  new,  99 

ITiiosinamin  in  cicatricial  contrac- 
tion, 689 

Thompson.  Dr.,  acute  yellow  atrophy, 
of  the  liver,  394 

Thought  of  death,  the,  47 

Thirroid  gland,  X4 

Thyroid  grafting  in  human  beings. 
Dr.  Chnstiani,  x67 

Theory  of  the  streptoooocus  serum,  93 

Toilette  eye  drops,  694 

Torquay,  486 

Tottenham  Hospital  dixmer,  307 

Toxixis  for  the  eye,  368 

Transition  between  the  male  and 
I,  466 


TRANSACTIONS   OF   SOCIETIES. 

BaiTiSH  Gynecological  Society — 
Accessory  Fallopian  tubes^  89 
Adenoma  of  the  endometrium,  639 
(dancer,  430 
Cancer  of  the  body  of  the  uterus, 

638 
Carcinoma  of  the  Fallopian  tubes, 

657 
Cystoma  of  left  ovary,  438 
Diouble  tuberculous  pyosalpinr,  435 
Ectopic  gestation,  059 
Gangrene  of  the  leg,  88 


Hystero-salpingo-odphorectomy,437 
Intractable  prolapse  by  extirpation 

of  the  uterus  and  vagina,  343 
New  uterine  mop,  89 
Ovarian    disease    associated    with 

uterine  fibroids,  542    i 
Specimens,  87,  434»  54* 
llterine  fibroid,  660 
British    Lakyngological,     Rhino- 
logical,  AND  Otologic AL  Associa- 
tion— 
Cases,  571 

Microscopical  specimens,  372 
Clinical  Society  op  London— 
Gases,  5x3 

Clinical  evening,  461 
Intussusception  in  chiUren  627 
Postoperative   acute   local   tuber- 
culosis, 369 
Posterior  basic  meningitis,  368 
Unilateral  tuberculous  meningitis, 
368 
Edinbuegh     Medico  -  Chirurgical 
Society — 
Complete     transposition     of     the 

viscera,  63 
Form  of  the  stomach,  661 
Gout,  3x7 

Metastatic  gonorrhceal  conjunc- 
tivitis, 63 
SteriUsing  of  surgical  dressings,  5i7 
Syphilitic  synovitis  in  diildrca,  5x7 
Toilet  of  the  anus,  66x 
Laryngological  Society  op 
London — 

Actinomycoss  in  the  tonsil,  320 
Cases,  320 

Incrustations  in  the  trachea,  630 
Liverpool  Medical  Institution — 
Central  round-celled  sarcoma,  686 
Concussion  of  the  brain,  373 
Extraction  of  double  cataract,  372 
Fracture  of  the  femur,  3x9 


forthyle    chk>- 


Gastric  ulcer,  6^0 
Improved    inhauer 

nde,  3x9 
Perineal  prostatectomjr,  686 
Phthisis  and  cancer  in  Kngland  aad 

Wales,  316 
Plantar  redexes,  630 
practice  of  asepsis  in  obstetrics,  461 
Simple  extraction  of  cataract  by 

Teale's  method,  463 
Some  old  and  new  remedies,  373 
Spinal  ooeainisation,  373 
Medico-Lxcal  Society — 
Degeneration  .   Its  causes  and  pre- 
vention, 687 
North-East  London  Clinical  So- 
ciety— 

Annual  meeting,  39 
Cases,  488,  602 
Specimens,  602 
North  OP  Bmgland  Obstetrical  and 
Gynjbcolooical  Society^ 
Caesarean  section,  600 
Double  ovarian  papiUomatous  cystic 

tumour,  600 
Rupture  of  the  uterus,  463 
Royal  Academy  op  Medicine    in 
Ireland— 
Acute  intestinal  obstruction  from  a 

gall-stone,  629 
Acute    yeUow  atophy  of  the  liver, 
.  59? 
Aortic  aneurysm  perforating    the 

oesophagus,  487 
Caisson  disease,  343 
Cases,  369 

Exhibits,  3x8  ;  Uving,  660 
Glanders,  399 
Glioma  at  retina,  399 
Healini;  of  wounds,  3x8 
Hodgkm's  disease,  346 
Influence    of    fitwo-myomata    on 
and  parturition,  369 


Lvmphatic  leukamia,  486 

MyeuBmia,  399 

Radical  cure  of  inguinal  and  femora 
hexnisB,  629 

Sporadic  cretinism,  343 

Syringomyelia,  66x 
Sreppield     Medico  -  CniauaoicAL 

Society— 

Cases,  488 

Gall-stone  producing  acute  intes- 
tinal obstruction,  488 

Specimens,  488 
Society  por  the  Study  op  Disbasx 

in  Children — 

Achondroplasia,  xo 

Cases,  465 

Multiple  sarcomata,  9 

Pxovmdal  meeting,  90 

"--  '-  «ns,  601  J 

lymphaticos,  xo 


__^, to 

The  Madical  Prast  and  Circular. 


INDEX. 


Jan,  4.  1905- 


Sudden  and  unexpected  death  in 
children,  686 

Tumour,  case  of,  9 
Society  of    Medical  Officers    of 

Health — 

Annual  dinner,  410 
The  Childhood  Society— 

Increase  ol  insanity,  520 

Ph]rsical  deterioration,  46s 

Proper  feeding  of  children,  489 
Therapeutical  Society — 

Brandy,  6oa 

Strychnos  tozifera,  603 
Ulster  BCsdical  Society — 

Inefficient  gastric  operation,  631 

Injuries  to  joints,  631 
West  Lokdon  Mbdico-Chirurgical 

Society — 

Clinical  meeting,  546 

Diagnosis     of     acute     abdominal 
disease,  685 

Notes  on  psychology    10 


Transplantation  of  the  urethra,  4x8 
Treatment  of  bad  temper,  609 
Treatment  of  blood  diseases,  603 
Treatment  of  bums,  547 
Treatment  of  foreign  bodies  in  the  ear, 

688 
Treatment  of  neuralgia  by  injections 

of  air,  417 
Treatment  of  obesity,  574 
Tricuspid   incompetency,   Dr.    Roes, 

Trigeminal  neural^a,  469 
Trinity  College,  Dublin,  400 


Trinity  College,  Dublin  (pass  list),  29, 
xoo,  53^,  550,  539»  647  ,701 

Tubercle  badui  in  the  breath,  73 

Tuberculin  reaction,  439 

Tuberculous  synovitis  of  the  knee- 
joint.  Dr.  Raba^liati,  683 

Tuffier,  Dr..  abdominal  abscesses,  193 

Tumours  of  the  bladder,  41 

Tumours  of  the  central  nervous 
system,  92 

Tweedy,  Mr.  B.  H.,  opening  and  dos- 
ing the  womb,  60 

Twin  spirits,  555 

Two  sides  of  the  body,  22 

Two  thousand  operations  for  appen- 
dicitis, 4x5 

Typhoid  fever,  363 

Typhoid  infection,  235 


Ulcus  ventriculi  pepticun.  439 
Ulster  Medical  Society,  25,  373,  530, 

359* 

Ubter  Medical  Society,  annual  dinner 
of  the,  6x3 

Unavoidable  mishaps  following  opera- 
tion, 69X 

University  of  Liverpool,  400 

University  of  London  (pass  list),  X33, 

239 
Unpleasant  experience,  an,  x8o 
Urinary  infection,  to  prevent,  334 
Urosepsis,  X4 

Urticaria  from  odours,  690 
Urticaria  zanthelasmoidea,  689 


Use  of  salicylic  add,  343 

Uterine  applicator  (lUustrated),  Dr. 

Duke,  436 
Uterine  carcinomatous  operations,  ^^7 


Vaccination  certificates,  23s 

Vaccination  frauds,  325 

Vaginal  gonorrhcea,  373 

Vaginal  secretions,  23 

Value  of  an  eye,  325 

Value  of  examination,  300 

Value  of  laboratory  work  in  medicine, 
Dr.  Reid,  408 

Value  of  meat  extracts,  4x9 

Value  of  the  official  reports  on  in- 
sanity. Dr.  MacDermott,  677 

Varicose  ulcers,  633 

Various  phases  of  a  hospital's  work. 
Sir  C.  J.  Nixon,  509 

Venous  thrombosis  in  typhoid  fever, 
444 

Vermin  in  children's  heads,  23 

Veronal  poisonine,  49  x 

Vestiges  of  syphiUs,  Dr.  Barendt,  36 

Vitality  of  ^erms  in  water,  333 

Vital  statistics  of  Ireland,  X95 

Voice  of  authority  in  medical  studies, 
301 


Walsh,  Dr.  D.,  the  diminishing  birth- 
rate, 3X,  s6 :  nutrition  in  the  wasting 
diseases  ot  children  and  adults 
(illustrated),  437;  headache  of 
axuemia,  381 


WaUo,  Dr.,  the  Kk)eowBki  antimony 

poisoning  case,  X93 
Weekly  national  biU  of  health,  s^B 
Weight-carrying  and  growth,  578 
WeOoome  historical  exhibition,   the. 

West  London  Medico-Chirurgical  So- 
ciety, 2x3,  351, 

Westminster  Hospital  entrance  scho- 
larships, 332 

Westminster  HospiUI  Medical  School, 
X08 

Weyll,  Dr.,  new  methods  of  treat- 
ment, X4X 

White,  Dr.  W.  Hate,  chronic  renal 
disease,  xx 

Wickel,  Dr.,  family  care  of  the  insane, 

WilL  and  bequests,  2x3 
Wisdom  of  swimming,  2^x 
Wooden  heads  and  wooden  legSi  39  x 
Woik  as  a  therapeutic  measure,  394 
Work  of  the  General  Medical  Council, 

Dr.  G.  Crichton,  403 
Work    of    the   National    Veteriiiary 

Association,  206 


X-ray  operator  as  medical  witnesses 
557 


Yonge,  Dr.,  origin  of  nasal  polvpi,  X42 
Young,    Dr.,    hospital  isolatioci    o 


scarlet  fever,  303 


%%t 


^tmht 


« 


.%- 


"SALUS  POPULI  SUPREMA  LEX." 


Vol.  CXXIX. 


WEDNESDAY,    JULY    6,    1904. 


No.    J. 


(Prigfnal  dommunfcatlonB. 
PESSARIES  : 

THEIR    USES    AND    LIMITATIONS,    (a) 

By  ARTHUR  E.  GILES,  M.D.,  B.Sc.,  F.R.C.S., 

Surgeon  to  Oat-Patients.  Cheltea  Hospital  for  Women ;  Gynncoloflrist 
to  the  Tottenham  Hospital. 

In  considering  the  question  of  pessaries,  it  is 
well  that  we  should  firmly  grasp  the  principles 
underlying  their  use  in  the  treatment  of  dis- 
placements of  the  female  pelvic  organs.  Briefly, 
their  uses  are  : — 

1 .  To  eflPect  a  cure,  as  in  some  cases  of  backward 
displacement,  where  the  uterus  may  be  expected 
to  retain  its  proper  position  unaided,  after  it  has 
been  maintained  in  that  position  for  some  time 
by  means  of  a  pessary. 

2.  As  a  temporary  expedient,  whilst  waiting  for 
operation,  and  in  cases  of  retroversion  of  the  gravid 
uterus,  where  the  normal  position  will  be  main- 
tained when  the  uterus  has  attained  a  certain  size. 

3.  As  a  palliative  measure,  when  radical,  that  is, 
operative,  treatment  is  impracticable,  undesirable, 
or  declined  by  the  patient. 

These  are  the  broad  principles  ;  and  the  precise 
indications  will  be  presently  set  forth  in  detail. 

Before  proceeding  further,  we  must  disabuse 
ourselves  of  certain  fallacies,  which  appear  to  be 
widely  spread  and  deeply  rooted  in  the  minds  either 
of  the  public  or  of  members  of  our  profession. 
Among  these  fallacies  we  may  signalise  the  follow- 
ing :— 

That  the  vagina  is  a  natural  predestined  re- 
ceptacle for  a  pessary  of  some  kind. 

That  the  vagina  is  a  grave  in  which  a  pessary 
may  be  interred,  undisturbed,  and  without  hope 
of  resurrection. 

That  a  pessary  is  a  good  and  proper  placebo  in 
all  obscure  and  intractable  disorders  of  the  pelvic 
organs,   and   in   nervous   disturbances   generally. 

That  anteversion  of  the  uterus  is  a  displace- 
ment. 

That  a  rubber  ring  pessary  is  generally  service- 
able in  backward  displacements. 

That  a  displacement  necessarily  requires  local 
treatment. 

Another  fallacy  formerly  in  vogue,  if  we  may 
judge  by  what  we  may  see  in  instrument-makers' 
catalogues,  but  now,  I  think,  relegated  to  the  limbo 
of  discredited  traditions,  is  the  supposition  that 
the  first  stage  in  the  career  of  a  would-be  women's 
specialist  is  the  invention  of  a  new  pessary  or  the 
modification  of  an  old  one. 

Pessaries  are  not  an  unmixed  blessing  to  woman- 


a)  A  Paper  read  before  the  North-East  London  Clinical  Society. 


kind  ;    they  have  drawbacks  and  potential  risks ; 
but  as  they  are  necessary  in  certain  cases,  we  may 
qualify  our  disapproval  of  them  by  describing 
them  as  a  necessary  evil.     In  some  cases  where 
their  use  might  be  otherwise  called  for,  there  are 
definite     contra-indications.     Among    these    we 
may  enumerate  the  following  : — All  inflammatory 
conditions  of  the  pelvic  organs,  including  vaginitis, 
endonietritis,    pelvic    peritonitis    and    cellulitis; 
and    inflammatory   disease   of    the   appendages, 
ulceration  of  the  vagina,  erosion  of  the  cervix, 
pregnancy  in  the  later  months,  displacements  due 
to  tumours,  and  incorrigible  displacements,  namely, 
such  as  are  associated  with  fixation  due  to  adhe- 
sions.    I  have  several  times  had  occasion  to  re- 
move a  pessary  from  a  case  in  which  the  fundus  of 
the  uterus  was  firmly  held  by  adhesions  in  the 
pouch   of    Douglas.     I    have    removed    pessaries 
from  cases  where  the  instrument  was  lying  in  a 
pool  of  muco-pus  derived  from  a  raw,  red  erosion 
of  the  cervix,  and  I  have  found  them  adding  to 
the  discomfort  of  a  patient  with  a  uterine  fibroid, 
when  there  was  barely  room  for  the  uterus  and 
tumour.     It  may  appear  superfluous  to  suggest 
that  a  normal  condition  of  the  pelvic  organs  is  a 
i  contra-indication  to  the  use  of  a  pessary  ;    yet  I 
I  have    not  infrequently   removed  supports,  gene- 
rally rubber  rings,  from  cases  where  every  organ 
was  normal  and  in  good  position.     These  have 
generally  been  neurotic  cases,   where  no   doubt 
the  medical  attendant  has  despaired  of  relieving 
I  the  multifarious  aches  and  pains  complained  of, 
I  and  has  introduced  a  pessary  as  a  sort  of  placebo, 
'  a  material  sign  on  which  the  patient  may  rest  her 
I  faith  that  she  is  getting  better.     In  my  experience, 
!  the  more  normal  organs  are  interfered  with  in  the 
hope  of  relieving  obscure  symptoms,  the  worse  do 
I  those  symptoms  become.     All  these  are  instances 
;  of  the  abuse  of  pessaries.     Properly-fitting  pes- 
;  saries,    rightly   applied,    in   suitable   cases,    have 
I  enough  to  answer  for  in  the  way  of  drawbacks 
and  complications,  without  the  reputation  of  this 
therapeutic  measure  being  further  damaged  and 
prejudiced  by  their  use  in  unsuitable  and  normal 
I  cases. 

Indications   for   the    Use   of   Pessaries. — I   now 

pass  on  to  consider  the  conditions  where  pessaries 

I  are  of  service,  and  the  particular  kind  to  be  used 

'  in  each  case.     These  conditions  fall  into  three 

classes,  which  may,  however,  be  more  or  less  com- 

i  bined  : — 

1.  Hernia  of  the  vaginal  walls,  that  is,  cysto- 
cele  and  rectocele. 

2.  Prolapse  and  procidentia  of  the  uterus. 

3.  Backward  displacements  of  the  uterus. 

I.  Hernia   of   the    Vaginal   Walls. — In    uncom- 


2    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


July  6,   1904. 


plicated  cases  of  cystocele  and  rectocele,  a  rubber- 
ring  pessary  usually  answers  best,  whether  there 
be  a  cystocele  alone,  a  rectocele  alone,  or  a  com- 
bination of  the  two.  But  in  some  cases  of  cysto- 
cele a  ring  does  not  answer,  owing  to  the  tendency 
of  the  anterior  vaginal  wall  to  slip  down  in  front  of 
the  pessary  ;  and  I  have  then  sometimes  found 
an  inverted  Hodge,  with  a  single  curve,  meet  the 
case.  When  a  rubber  ring  is  used,  it  should  be 
thick  in  section,  as  in  the  Meyer  pattern  ;  if  a 
large,  thin  ring  be  introduced,  the  vaginal  wall 
will  come  down  through  it.  Solid  wooden  or 
vulcanite  rings  should  be  avoided,  because  during 
their  introduction  and  removal  they  stretch  the 
vaginal  orifice  unduly.  Sometimes  the  perinaeum 
is  so  deficient  that  the  vaginal  orifice  is  the  widest 
part  of  the  passage  ;  in  such  a  case  no  ring  will 
keep  in  situ,  any  more  than  a  ball  could  be  held 
up  in  a  hollow  cone  whose  apex  was  upwards. 
We  must  then  rely  on  some  kind  of  vaginal  stem- 
I)essary,  such  as  Napier's,  held  in  position  with 
perineal  bands  fastened  to  a  band  round  the  waist. 

2.  Cystocele  and  rectocele  are  frequently  com- 
bined with  prolapse  and  procidentia  of  the  uterus ; 
or  the  uterus  may  descend  without  the  vaginal 
walls  being  affected,  otherwise  than  secondarily. 
In  any  case  the  uterine  displacement  is  the  one 
which  calls  for  treatment,  and  the  vaginal  con- 
dition will  be  treated  incidentally,  and  at  the 
same  time. 

For  prolapse,  that  is,  descent  of  the  uterus  within 
the  vagina,  a  rubber  ring  usually  answers  best. 
But  if  the  perinaeum  be  deficient,  we  shall  require 
a  Napier  pessary,  or  other  vaginal  stem-pessary. 
Sometimes  the  perineal  bands  are  not  well  borne, 
as  they  may  cause  chafing  and  irritation  ;  and 
we  may  then  have  to  resort  to  that  makeshift 
of  therapeutic  insolvency,  a  Zwancke  pessary, 
or  to  that  other  refuge  of  the  destitute,  a  GarieFs 
air-pessary.  The  effect  of  the  latter  is  to  keep  the 
vagina  in  such  a  chronic  state  of  distension  that 
the  natural  shrinkage  of  the  vagina  incidental 
to  the  climateric,  which  is  looked  to  as  the  means 
of  bringing  about  an  ultimate  spontaneous  cure, 
is  thwarted  indefinitely. 

For  procidentia,  that  is,  descent  of  the  uterus 
outside  the  vagina,  we  have  to  proceed  somewhat 
as  for  prolapse,  with  this  difference,  that  the  vagi- 
nal orifice  is  so  stretched  by  the  descent  of  the 
uterus  that  no  ring  will  keep  in  at  first.  But, 
unless  the  perinaeum  has  been  much  torn,  if  the 
patient  be  kept  in  bed  for  a  week  or  so,  and  the 
uterus  remains  within  the  vagina,  the  orifice 
will  usually  contract  again  sufl&ciently  to  retain  a 
rubber  ring. 

3.  Backward  Displacements  of  the  Uterus. — ^This 
is  the  class  of  displacement  most  difficult  to  deal 
with.  In  uncompUcated  cases,  where  the  uterus 
is  mobile,  and  has  not  been  long  out  of  place,  a 
cure  may  not  infrequently  be  obtained  by  means  of 
a  well-fitting  Hodge  pessary,  or  one  of  its  modifi- 
cations, such  as  an  Albert  Smith,  a  Thomas  or  a 
Braxton  Hicks.  In  the  two  latter  forms,  the 
posterior  bau:,  which  rests  in  the  posterior  fornix, 
is  thickened.  There  are  various  conditions,  how- 
ever, which  make  for  failure.  If  the  retroversion 
has  existed  long,  the  uterus  may  attain  a  condition 
of  hyperplasia,  and  the  heavy  fundus  then  topples 
backwards  over  the  pessary.  If  one  or  both  ovaries 
be  prolapsed,  the  Hodge  is  liable  to  cause  such 
painful  pressure  that  its  use  has  to  be  discontinued. 
If  there  be  cicatricial  contraction  obliterating  the 


posterior  vaginal  fornix,  or  forming  bands  across 
it,  a  Hodge  is  unavailing.  I  recently  had  such  a 
case  in  the  hospital,  where  an  antero-posterior  band 
stretched  across  the  fornix  from  the  apex  of  the 
cervix,  and  the  only  possible  way  of  correcting 
the  displacement  was  by  ventrofixation  of  the 
uterus,  which  was  accordingly  done.  If  the  uterus 
be  the  subject  of  a  congenital  retroflexion,  we 
may  push  the  organ  somewhat  forward,  but  the 
retroflexion  will  remain,  and  undo  our  work.  For 
such  a  condition,  pregnancy  is  the  best  cure. 
Lastly,  if  the  uterus  be  held  down  by  adhesions 
to  the  floor  of  the  pelvis,  pessary  treatment  is  out 
of  the  question.  I  have  no  confidence  in  the  plan 
(which  has  been  proposed)  of  forcibly  breaking 
down  adhesions  by  manipulation  ;  to  tear  a  hole  in 
the  bowel  by  such  manoeuvres  would  not  be  a 
difficult  matter. 

I  may  say  here  that  it  is  bad  practice  to  intro- 
duce a  Hodge  or  other  pessary  without  first  cor- 
recting the  displacement,  in  the  hope,  which  is  a 
vain  one,  that  the  constant  pressure  of  the  instru- 
ment will  gradually  overcome  the  resistance.  By 
such  a  course  we  merely  add  risk  to  inefl&ciency. 

Precautions  to  be  Observed  in  the  Use  of  Pes- 
saries.— The  first  thing,  as  I  have  just  remarked, 
is  that  the  displacement  should  be  corrected.  In 
selecting  a  pessary,  some  consideration  should  be 
given  to  the  material.  A  non-absorbent  surface 
is  best,  therefore  hard  rubber,  vulcanite,  celluloid 
or  block  tin  may  be  chosen.  The  next  thing 
is  to  see  that  the  pessary  is  a  proper  fit ;  if 
too  large  it  will  cause  injurious  pressure, 
if  too  small  it  will  be  inefficient.  But  in 
case  of  doubt  it  is  better  to  err  in  the  first 
instance  in  the  direction  of  under-size.  The 
patient  should  be  seen  again  within  a  week, 
in  order  that  the  efl&ciency  of  the  pessary  may  be 
tested.  A  pessary  tends  to  favour  leucorrhoea, 
and  adso  to  retaiin  the  secretion,  and  therefore  the 
patient  should  be  instructed  to  use  a  douche  at 
intervals.  For  this  purpose  plain  water  or  boracic 
lotion  is  best ;  aistringent  lotions  are  to  be  avoided, 
because  they  tend  to  coagulate  the  secretion  on 
the  pessary,  which  thus  becomes  coated  over  with 
a  medium  highly  favourable  to  the  ubiquitous 
bacillus.  The  patient  must  be  firmly  impressed 
with  the  necessity  for  periodic  inspection.  My 
rule  is  two  to  three  months  as  the  longest  interval. 
The  object  of  the  inspection  is  that  the  pessary 
may  be  properly  cleaned,  that  its  efficiency  in 
maintaining  the  normal  position  of  parts  may 
be  watched,  that  it  may  be  removed  when  it 
appears  probable  that  this  can  be  done  without 
a  return  of  the  displacement,  and  that  we  may 
have  eaurly  warning  of  any  untoward  results  of 
the  sojourn  of  the  pessary  in  the  vagina.  The  im- 
portance of  the  last  point  may  be  judged  of  from 
what  I  have  now  to  say  of  the  drawbacks  resulting 
from  retained  pessaries. 

Injuries  Due  to '  Neglected  Pessaries. — Some 
years  ago  I  pubUshed  some  observations  on  this 
subject,  and  I  can  best  illustrate  my  present  re- 
marks by  reproducing  a  table  of  twelve  case  that 
came  under  my  notice. 

Harm  is  produced  in  one  of  three  ways  :  (a) 
misfit ;  (b)  sepsis  ;  (c)  narrowing  of  the  vaiginal 
orifice.  The  precautions  to  be  used  against  the 
first  two  have  been  mentioned.  Narrowing  of  the 
vaginal  orifice  occurs  normally  after  the  menopause; 
in  the  case  of  women  who  are  not  living  a  conjugal 
life,  it  may  become  very  marked,    so    that  if  a 


July  6,  1904. 


ORIGINAL  COMMUNICATIONS. 

Table  of  Cases  of  Retained  Pessary. 


The  Medical  Press.    3 


M 

1 

s 

Condition       for 

Variety 

Length      of 

Injury  Produced 

(A 

i 

M 

WHICH  Pessary 

OF 

Time 

BY   THE 

0 

< 

W 

WAS  Worn. 

Pessary. 

Worn. 

Pessary. 

I 

64 

W 

"  Falling  of  the 
womb  " 

Thick    wooden 
ring 

12  years 

Purulent  vaginitis;  incarceration  of  pessary; 
extraction  under  ether  necessitating  tearing 
of  vulva. 

2 

35 

s 

Not       known 

Vulcanite  Hodge 

6    months 

Grooving  and  ulceration  of  left  lateral 
vaginal  fornix. 

3 

57 

M 

Procidentia 

Rubber     ring 

4  years 

Purulent  vaginitis. 

4 

64 

M 

?  Procidentia 

Rubber  ring 

3   years 

Purulent  vaginitis  ;  urethritis  ;  ulcerated 
patch,  posterior  vaginal  fornix. 

5 

30 

M 

Not  stated 

Rubber  ring    • 

I J  year 

Purulent  vaginitis. 

6 

74 

M 

Prolapse 

Rubber  ring 

12  years 

Purulent  vaginitis. 

7 

72 

M 

Not  stated 

Blackbee's 

8  or  9  years 

Horse-shoe  shaped  ulcerated  groove  in- 
volving vaginal  vault  and  lateral  walls; 
vesico-vaginal  fistula. 

8 

26 

M 

Retroversion 

Block  tin  Hodge 

6  months 

Grooving  and  ulceration  of  right  lateral 
fornix  ;  fusion  of  edges  of  groove  forming  a 
band  anchoring  the  pessary. 

9 

45 

S 

Not  stated 

Rubber  ring 

3i  years 

Purulent  vaginitis;  excoriations  of  pos- 
terior vaginal  walls. 

10 

71 

M 

Procidentia 

Vaginal  stem- 

6  weeks 

Purulent   vaginitis. 

II 

46 

M 

Retroversion 

pessary 
Vulcanite  Hodge 

3  months 

Grooving  and  ulceration  of  posterior  vaginal 
fornix. 

12 

45 

M 

Procidentia 

Zwancke's  pes- 
sary 

"  many 
years  " 

Purulent  vaginitis  ;  proliferation  of  granu- 
lations with  formation  of  fibrous  bands 
passing  through  the  perforations  in  the 
pessary  and  connecting  anterior  and  pos- 
terior vaginal  walls. 

pessary  has  been  introduced  and  left  for  five  or 
ten  years  it  may  be  found  impossible  to  remove 
it  without  a  good  deal  of  injury  to  the  tissues  of 
the  vulva.  This  is  what  happened  in  Case  i. 
Apart  from  the  inconveniences  arising  from  this 
natural  involution,  the  injuries  produced  are  as 
follows  : — The  first  thing  is  vaginitis,  which  soon 
assumes  a  purulent  form.  This  may  occur  as  a 
result  of  want  of  cleanliness,  even  when  an  instru- 
ment fits  tolerably  well ;  and  hence  it  is  the  most 
common  and  sometimes  the  only  condition  pro- 
duced by  rubber  rings,  as  in  Cases  3,  5,  and  6. 
The  vaginitis  may  be  associated  with  urethritis, 
as  in  Case  4.  Then  ulceration  may  supervene, 
either  in  patches,  when  due  to  a  rubber  ring,  as  in 
Cases  4  and  9,  or  in  the  form  of  a  groove,  in  the 
case  of  a  hard,  narrow  instrument,  when  locaUsed 
pressure  evidently  plays  an  important  part.  In 
this  way  were  produced  the  injuries  in  Cases  2, 
7,  8,  9,  and  12.  The  grooves  become  lined  with 
granulations  which  tend  to  grow  up  around  the 
pessary,  and  may  at  length  grow  over,  partly  im- 
bedding the  instrument,  as  in  Cases  2  and  7  ; 
or  may  fuse,  forming  a  bridge  of  tissue  firmly 
holding  the  pessary  to  the  vaginal  wall,  as  in  Case  8. 
Or,  again,  in  the  case  of  a  flattened  pessary  with 
perforations,  the  granulations  may  sprout  and 
project  through  the  perforations,  forming  bands 
between  the  anterior  and  posterior  vaginal  walls, 
as  in  Case  12. 

The  situation  of  the  grooving  will  depend  on  the 
shape  and  position  of  the  instrument.  In  the  case 
of  a  Hodge  pessary,  the  posterior  vaginal  fornix  is 
most  apt  to  suffer.  A  vaginal  stem-pessary  will 
affect  the  tissues  round  the  cervix.  The  Black- 
bee's  pessary  in  Case  7  produced  a  quite  special 
lesion.  This  instrument  used  to  be  employed  for  ante- 
version,  when  this  was  considered  a  pathological 
condition,  and  it  rests  partly  in  the  anterior  fornix, 


and  partly  against  the  lateral  vaginal  walls; 
and  in  these  positions  the  ulcerations  had  occurred. 
Ulceration  in  the  anterior  fornix  is  almost  certain 
to  lead  to  the  serious  condition  of  vesico-vaginal 
fistula,  as  occurred  in  this  case.  A  recto-vaginal 
fistula  might  similarly  result  from  ulceration  of 
the  posterior  vaginal  wall.  The  dangers  of  re- 
tained pessaries  may  thus  be  summed  up  as  : — 

a.  Purulent  vaginitis. 

h.  Urethritis. 

c.  Ulceration  of  the  vagina. 

d.  Imbedding  of  the  pessary  in  the  vaginal 
tissues. 

t.  Vesico-vaginal  fistula. 

/.  Recto-vaginal  fistula. 

g.  Incarceration  of  the  pessary  from  narrowing 
of  the  vaginal  outlet. 

Alternatives  to  the  Use  of  Pessaries. — We  have 
seen  that  at  their  worst  pessaries  are  capable  of 
producing  serious  injuries  ;  at  their  best  they  have 
certain  inherent  drawbacks.  Thus  there  is  the 
tendency  to  set  up  irritation,  resulting  in  constant 
leucorrhoea  and  entailing  the  necessity  for  regular 
douching  ;  there  is  the  necessity  for  examination 
and  manipulation  at  more  or  less  frequent  intervals, 
which  most  women  naturally  find  very  objection- 
able ;  there  is  the  uncertainty  of  results  ;  and 
lastly,  in  favourable  cases  there  is  the  prospect  of  a 
woman  having  to  wear  a  pessary  for  ten,  fifteen, 
or  twenty  years. 

With  a  mode  of  treatment  that  is  open  to  such  an 
indictment,  it  is  not  surprising  that  alternative 
plans  have  been  sought.  For  some  cases,  as  I 
have  said,  pessaries  remain  the  only  treatment  ; 
but  there  is  no  doubt  that  the  modem  tendency 
is  to  restrict  their  scope,  and  to  regard  many 
forms  as  obsolete.  Pessaries  were  introduced 
when  no  operative  radical  treatment  was  known 
or    practicable.      Anaesthetics,     antiseptics     and 


4     Ths  Mbdical  Press. 


ORIGINAL  COMMUNICATIONS. 


July  6,  1904- 


improved  technique  have  quite  altered  this.  It  is 
not  within  the  scope  of  these  observations  to  em- 
bark in  detail  upon  the  question  of  the  treatment 
of  displacements;  but  in  considering  the  uses  and 
limitations  of  pessaries  it  is  at  least  permissible 
to  indicate  that  there  is  a  more  excellent  way  than 
theirs.  Thus,  most  cases  of  prolapse  of  the  vaginal 
walls  can  be  improved  or  cured  by  perineorrhaphy 
and  other  plastic  operations  ;  and  abdominal  sur- 
gery provides  many  procedures  for  the  definite 
cure  of  prolapse  and  backward  displacements. 
Experience  leads  me  without  reserve  to  profess 
myself  one  of  those  who  would  fain  see  the  use 
of  pessaries  restricted  to  the  irreducible  minimum 
by  the  substitution  for  them  of  operative  measures, 
which  do  all,  and  more  than  all,  that  pessaries 
can  do — without  their  manifold  drawbacks  and 
risks. 


THE  COMPARATIVE  ADVAN- 
TAGES  OF  INORGANIC  AND 
OF  ORGANIC  IRON  IN  THE 
TREATMENT  OF  ANAEMIA. 

By  WILLIAM  MURRELL,  M.D.,  F.,R.C.P., 

PhjiicUo  to    the   Westminster    Hospital;    Lecturer  on  Olinlcsl 

Medicine,  and  Joint  Lecturer  on  Medicine  in  the  Westminster 

Hospital  Medical  School. 

Much  difference  of  opinion  exists  among  thera- 
peutists as  to  the  comparative  advantages  of  inorganic 
and  of  organic  iron  in  the  treatment  of  anaemia,  and 
in  this  country  few  attempts  have  been  made  to  in- 
vestigate the  subject  scientifically.  It  is  perhaps 
hardly  a  matter  for  surprise,  for  clinical  haematology  is 
stiU  in  its  infancy,  and  experiments  of  this  kind  are 
liable  to  many  sources  of  error.  Ringer  and  Sainsbury 
point  out  that  in  some  cases  the  astringent  prepara- 
tions are  unsuitable,  but  that  in  most  cases  they  pro- 
duce better  results  than  the  Blaud  preparations  of  iron. 
This  statement  in  a  slightly  modified  form  has  appeared 
in  many  successive  editions  of  "  Ringer's  Therapeu- 
tics," and  it  is  practically  certain  that  it  is  an  im- 
pression derived  from  clinical  observation  and  that 
it  does  not  rest  on  the  solid  foundation  of  blood  counts 
and  estimations  of  hsmoglobin  values. 

Professor  Ralph  Stockman,  of  Glasgow,  is  equally 
positive  in  his  advocacy  of  the  superior  value  of  the 
inorganic  salts,  but  an  examination  of  his  admirable 
paper  in  the  British  Medical  Journal,  an  article  replete 
with  most  valuable  information,  shows  that  this  was 
not  one  of  the  points  which  fell  within  the  scope  of  his 
investigation.  He  records,  it  is  true,  some  observa- 
tions with  Robert's  "  hsemol "  and  "  haemogallol,*' 
which  failed  to  give  very  encouraging  results,  but  it  is 
doubtful  if  these  preparations  have  any  claim  to  be 
regarded  as  true  organic  iron  compounds  or  if  they 
would  respond  to  MacCallum's  test.  He  proves  con- 
clusively that  iron  is  the  only  drug  of  any  value  in 
the  treatment  of  anaemia,  but  beyond  that  he  does 
not  go.  and  he  records  no  comparative  examination 
with  difierent  preparations  of  iron.  Dr.  C.  D.  F. 
Phillips,  in  the  last  edition  of  his  "  Inorg^anic  Sub- 
stances," is  cautious  in  his  expression  of  opinion,  and 
says : — "  The  choice  of  a  compound  in  any  case  of 
anaemia  or  chlorosis  seems  to  me  always  to  depend  on 
the  susceptibilities  of  the  patient  to  the  drug.  Some 
are  never  able  to  take  the  astringent  preparations  even 
when  the  alimentary  canal  is  not  deranged."  Iron,  as 
far  as  we  know,  is  the  only  drug  of  any  value  in  the 
treatment  of  anaemia,  and  there  is  no  reason  to  suppose 
that  in  this  condition  arsenic  increases  either  the 
number  of  red  blood  corpuscles  or  the  haemoglobin 
value.  Manganese  in  this  connection  is  equally  inert, 
and  although  I  have  prescribed  it  largely  and  in  all 
forms,  and  with  much  success,  for  the  relief  of  functional 
amenorrhcea  in  chlorotic  girls,  I  do  not  believe  that  it 


exerts  the  slightest  influence  in  removing  anaemia  or  in 
improving  the  condition  of  the  blood.  The  inutility 
of  prescribing  iron  with  either  arsenic  or  manganese 
in  anaemia  is  obvious,  for  iron  alone  answers  the  purpose 
admirably,  and  the  addition  of  another  drug  is  super 
fluous. 

The  generally  accepted  view  is  that  all  forms  of  iron 
are  useful  in  anaemia,  but  that  they  diJSer  much  in  their 
efficacy  and  in  the  rapidity  of  their  action.  The  in- 
organic salts  are  more  frequently  prescribed  in  hospital 
practice,  whilst  for  private  patients  the  Blaud  and  less 
Irritating  preparations  are  the  favourites.  The  ex- 
planation of  this  is  simple,  for  it  is  well  known  that  the 
more  robust  hospital  patient  requires  larger  doses  of 
most  drugs,  purgatives  for  example,  than  private 
patients,  and  that  the  latter  are  more  readily  incon- 
venienced by  remedies  which  irritate  the  mucous 
membranes  of  the  stomach  and  intestines.  No  mere 
expression  of  opinion,  however,  is  of  much  value,  and 
the  only  evidence  on  which  reliance  can  be  placed  is 
that  founded  on  comparative  blood  examinations.  It 
is  not  every  case  of  anaemia  which  lends  itself  to  this 
investigation.  Cases  of  pernicious  anaemia  are  beyond 
the  scope  of  the  action  of  iron,  and  are,  as  a  rule,  but 
little  benefited  by  it.  Cases  of  parasitic  anaemia,  such 
as  those  due  to  the  ankylostomum  duodenale.  are  best 
treated  by  intestinal  antiseptics,  although  iron  is  useful 
in  a  later  stage.  The  anaemias  due  to  toxaemia,  such 
as  lead  poisoning,  have  their  specific  treatment,  although 
here  again,  when  the  existing  cause  has  been  removed, 
the  judicious  administration  of  iron,  especially  in  a 
Blaud  form,  proves  beneficial.  Anaemia,  following 
organic  change,  such  as  cancer  of  the  liver  secondary 
to  a  primary  deposit  in  some  other  organ,  runs  a  down- 
ward course,  and  is  not  arrested  by  the  administration 
of  any  drug.  StiU,  there  are  many  forms  of  anaemia 
which  readily  lend  themselves  to  investigations  of  this 
nature.  The  best  examples  are  the  secondary  anaemiais 
of  hsmorrhage,  such  as  we  get  in  the  haematemesis  o* 
gastric  ulcer  and  the  chlorosis  of  young  women,  which 
forms  so  large  a  part  of  our  out-patient  practice.  But 
here  again  a  difficulty  is  introduced,  for  out-patient 
work  is  not  conducive  to  accuracy  of  observation  and 
certainly  not  to  scientific  observation.  A  chlorotic 
patient  on  her  first  visit  is  submitted  to  a  blood  exauni- 
nation,  and  is  given  a  prescription  for  some  form  of 
iron.  A  week  later  she  comes  again  and  there  is  an 
alteration,  perhaps  an  improvement,  in  her  blood 
count  and  in  the  percentage  of  haemoglobin,  but  there 
is  no  proof  that  the  medicine  was  taken  with  regularity 
or,  for  the  matter  of  that,  at  all.  The  only  cases  really 
adapted  for  experimental  observation  aie  those  seen 
in  private  practice  or  in  the  wards  of  a  hospital,  where 
the  administration  of  every  dose  is  checked  and  syste- 
matically reported.  Even  under  the  most  favourable 
circumstances  there  are  fallacies  to  be  avoided.  A 
chlorotic  woman  is  taken  into  the  hospital,  she  hats 
the  benefit  of  rest  in  bed,  she  is  placed  under  favourable 
hygienic  conditions,  her  bowels  are  regulated,  and  she 
is  carefully  dieted.  These  are  disturbing  elements. 
What  influence  have  they  on  the  anaemia,  and  will 
they  alone  effect  a  cure  ?     Here  is  a  case  in  point : — 

Case  I. — A  girl.  aet.  21 ,  was  admitted  on'October  loth. 
1 90 1,  suffering  from  anaemia  of  four  months'  duration. 
She  complained  of  general  weakness,  shortness  of 
breath,  and  palpitation  on  exertion  and  loss  of  appetite. 
Her  red  corpuscles  numbered  3,100,000  perc.mm.,and 
were  normal  in  shape  and  size.  The  leucocytes  were 
9,200  and  the  haemoglobin  value  was  50  per  cent.  She 
was  kept  in  bed,  placed  on  a  liberal  diet,  and  consti- 
pation was  relieved,  but  no  iron  was  given.  On 
October  29th,  the  red  corpuscles  were  2.687,000,  and 
the  haemoglobin  value  was  35  per  cent.  She  was  more 
anaemic  than  on  admission,  and  had  made  no  progress 
towards  recovery.  She  was  then  given  five  grains  of 
exsiccated  sulphate  of  iron  three  times  a  day,  increaised 
a  few  days  later  to  ten  grains.  On  November  12th, 
the  red  corpuscles  were  4,900,000.  and  haemoglobin 
value  was  60  per  cent.  The  improvement  was  very 
marked,  being  at  the  rate  of  158,000  and  i*8  per  cent, 
a  day.     This  case  shows  that  thejpatient  in  no  way 


July  6,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Pvf^s. 


benefited  by  her  nineteen  days'  expectant  treatment, 
and  that  she  improved  with  remarkable  rapidity  when 
iron  was  administered. 

It  seemed  desirable  to  obtain  some  kind  of  standard 
as  to  the  increment  of  erythrocytes  and  daily  increase 
in  haemoglobin  value  with  inorganic  iron,  and  the 
following  cases  throw  some  light  on  the  subject : — 

Case  II. — A  housemaid,  act.  23,  was  admitted  on 
May  loth.  1901,  suffering  from  anaemia  and  vomiting. 
The  patient  stated  that  she  had  been  ill  for  four  years, 
and  that  she  had  been  obliged  to  give  up  her  work  in 
consequence.  Her  erythrocytes  numbered  3,320,000, 
and  the  haemoglobin  value  was  48  per  cent.  She  was 
given  five  grains  of  exsiccated  sulphate  of  iron.  On 
May  2ist,  the  erythrocytes  were  4,300,000  and  the 
haemoglobin  value  was  63  per  cent.  The  increase  in 
the  red  cells  was  at  the  rate  of  140,000  a  day  and  the 
haemoglobin  a  little  over  2  per  cent. 

Cask  III. — A  girl,  aet.  21,  had  suffered  intermittently 
from  anxmia  since  the  age  of  13.  She  had  had  much 
treatment  and  was  for  seven  weeks  an  inmate  of  a  con- 
valescent home.  On  admission,  her  erythrocytes  were 
1,725,000,  the  haemoglobin  value  being  only  15  per 
cent.  She  was  given  dried  sulphate  of  iron  three  times 
a  day,  and  in  eleven  days  the  erythrocytes  had  risen 
to  2,970,000,  and  the  haemoglobin  to  36  per  cent.  This 
was  at  the  rate  of  140,000  red  cells  and  1-9  per  cent, 
haemoglobin  a  day. 

Case  IV. — A  woman,  aet.  44,  had  been  suffering  from 
shortness  of  breath  and  swelling  of  the  ankles  for  some 
months,  so  that  she  was  unable  to  follow  her  occupation. 
There  was  no  cardiac  mischief,  and  the  urine  was  free 
from  albumin.  The  erythrocytes  numbered  2,225,000, 
and  the  haemoglobin  value  was  54  per  cent.  On  the 
sulphate  of  iron  treatment  the  blood  corpuscles  rose 
in  twenty-three  days  to  2,875,000,  and  the  haemoglobin 
value  to  61  per  cent.  The  increase  in  the  number  of 
red  cell3  was  at  the  rate  of  only  29,000  a  day,  and  the 
haemoglobin  -03  a  day. 

Case  V. — A  girl,  aet.  21,  a  school  teacher,  was  ad- 
mitted complaining  of  dyspnoea  and  palpitation  on 
exertion.  She  had  suffered  from  anaemia  with  amenor- 
rhoea  for  three  years.  She  had  never  had  rheumatic 
fever,  but  there  was  a  soft  apex  systolic  murmur,  pro- 
bably not  organic  in  origin.  Her  red  cells  were  3,250,000 
and  the  haemoglobin  value  was  43  per  cent.  It  was  a 
typical  case  of  oligocythaemia  and  oligochromaemia. 
She  was  given  sulphate  of  iron,  and  at  the  expiration  of 
eighteen  days  the  red  cells  numbered  4,450,000,  and 
the  haemoglobin  value  was  55  per  cent.  The  average 
daily  increase  was  75,000  and  0*66  per  cent. 

Taking  the  average  of  these  five  cases  treated  with 
exsiccatai  sulphate  of  iron  it  will  be  seen  that  the  daily 
increase  of  red  blood  corpuscles  was  103,200  and  of 
haemoglobin  value  1-33  per  cent.  I  have  notes  of  other 
cases,  in  some  of  which  the  results  were  less  striking, 
and  I  am  satisfied  that  in  ordinary  chlorosis  treated 
with  sulphate  of  iron  a  daily  increase  of  100,000  a  day 
with  1*3  per  cent,  haemoglobin  is  a  liberal  estimate. 

I  made  a  similar  series  of  observations  with  tincture 
of  perchloride  of  iron  given  three  times  a  day  in  either 
fifteen  or  twenty  minim  doses,  with  the  following 
daUy  improvement : — 

Case.  Erythrocytes.  Hemoglobin. 

VI.  112,500  1*33 

VII.  156,000  030 

VIII.  82,000  055 

IX.  50,000  0-54 

X.  4S.OOO  053 

This  gives  a  daily  average  increase  of  erythrocytes 
of  89,000,  and  of  haemoglobin  value  0*65  per  cent,, 
which  is  less  favourable  than  with  sulphate  of  iron, 
especially  with  regard  to  haemoglobin.  Combining  the 
results  of  the  sulphate  of  iron  and  perchloride  of  iron 
cases  it  works  out  at  96,000  and  0-99  per  cent.,  or, 
roughly,  a  daily  increase  of  100,000  erythrocytes  and 
1  per  cent,  haemoglobin  value.  This  may  be  taken  as 
the  inorganic  iron  standard  under  favourable  circum- 
stances. 

Romberg,  in  cases  of  anaemia  in  which  the  red  cells 


were  below  4,000,000,  found  that  the  daily  increase 
under  inorganic  iron  treatment  was  not  more  than 
43,000  with  0-99  per  cent,  haemoglobin.  Probably  our 
observations  were  made  under  somewhat  different  cir- 
cumstances, and  although  we  are  in  accord  with  respect 
to  the  haemoglobin,  his  increment  of  red  cells  is  below 
mine. 

I  have  had  a  comparatively  limited  experience  with 
Blaud's  pill,  which  I  regard  as  inferior  to  the  dried 
sulphate  of  iron  pill.  Thayer  states  that  in  severe 
cases  of  anaemia  when  the  red  cells  were  below  2.000,000 
and  the  haemoglobin  value  was  under  20  per  cent.,  ten 
grains  of  Blaud's  pill  three  times  a  day  increased  the 
red  cells  at  the  rate  of  107,000  a  day  and  the  haemo- 
globin value  at  the  rate  of  27  per  cent.  I  cannot  but 
regard  this  as  a  very  high  estimate.  The  average 
duration  of  the  treatment  was  twenty-eight  days, 
which  is  in  excess  of  that  usually  required. 

Turning  now  to  organic  iron.  Several  preparations 
have  recently  been  introduced  made  from  spinach 
growing  on  ferruginous  soil.  I  have  had  some  ex- 
perience of  one  of  these,  a  dark  green  fluid  with  a 
pungent  aromatic  taste,  due  probably  to  the  addition 
of  flavouring  agents.  It  is  not  necessairy  to  give  details, 
but  the  results  worked  out  at  70,000  a  day  for  the  red 
corpuscles,  whilst  the  increase  in  haemoglobin  value  was 
small.  I  have  also  notes  of  cases  treated  with  a  popular 
blood  preparation,  the  result  showing  an  improvement 
of  86,000  red  corpuscles  and  i  "67  per  cent,  haemoglobin 
a  day. 

Probably  the  best  of  the  organic  iron  preparations 
is  the  iron-vitellin.  discovered  by  Dr.  A.  C.  Barnes,  of 
Philadelphia.  This  is  a  definite  chemical  product 
which  gives  a  negative  reaction  with  MacCallum's  test. 
It  is  a  red  solution,  neutral  in  reaction  and  both  odpur- 
less  and  tasteless.  I  have  used  it  not  only  in  anaemia 
but  in  various  other  conditions,  and  it  hais  yielded  ex- 
cellent results.  The  first  test  was  a  severe  one,  for  the 
patient  was  suffering  from  cancer  of  the  stomach. 

Case  XI. — A  woman,  aet.  39,  was  admitted  on 
April  28th,  with  severe  haematemesis,  apparently  due 
to  gastric  ulcer,  the  symptoms  of  which  were  of  short 
duration.  The  erythrocytes  numbered  2,180,000,  the 
leucocytes  16,600,  and  the  haemoglobin  value  was 
25  per  cent.  She  was  fed  by  the  rectum  and  was  given 
an  aperient  iron  mixture  three  times  a  day.  On  May 
1 2th,  there  was  another  profuse  haemorrhage,  and  on 
the  13  th  a  smaller  one.  On  the  14th,  the  erythrocytes 
were  2,900,000,  the  leucocytes  13,200,  and  the  haemo- 
globin value  was  28  per  cent.  She  was  markedly 
cachectic  and  was  losing  flesh  rapidly.  Nodules  were 
detected  on  the  surface  of  the  liver ,  evidently  malig- 
nant, and  probably  due  to  a  primary  growth  in  the 
stomach.  She  was  given  iron-vitellin  in  half-ounce 
doses  three  times  a  day.  There  was  no  recurrence  of 
the  haemorrhage.  On  May  25  th,  the  erythrocytes  were 
2,280,000,  the  leucocytes  14,600,  and  the  haemoglobin 
value  24  per  cent.  On  June  ist,  the  erythrocytes  were 
2,670,000,  the  leucocytes  12,200,  and  the  haemoglobin 
value  30  per  cent.  The  patient  died  on  June  14th. 
and  the  correctness  of  the  diagnosis  was  confirmed  at 
the  autopsy.  In  a  case  of  malignant  disease  running  a 
downward  course  no  marked  improvement  could  have 
been  expected  from  any  drug,  but  there  was  no  re- 
currence of  the  haemorrhage  and  there  was  some  increase 
in  the  percentage  of  haemoglobin. 

The  following  case  was  more  successful  and  gave  ex- 
cellent results  : — 

Case  XII. — The  patient  was  a  housemaid,  aet.  17, 
who  had  been  suffering  from  chlorosis  for  six  months, 
for  which  she  had  had  much  treatment  without  benefit. 
On  June  2nd,  her  red  corpuscles  numbered  2,410,000, 
and  her  haemoglobin  value  was  40  per  cent.  She  was 
placed  on  iron-vitellin  three  times  a  day,  and  on  June 
8  th,  the  red  cells  were  4,230,000,  the  haemoglobin  value 
being  42  per  cent.  She  had  menstruated  during  the 
time.  The  increase  in  red  cells  wais  at  the  rate  of 
303,000  a  day,  and  haemoglobin  value  0-33  per  cent. 
Although  diminution  in  haemoglobin  value  is  the 
essential  feature  of  chlorosis,   there  is,  in  many  cases. 


6     Thb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


July  6,   1904. 


a  decreased  number  of  erythrocytes,  and  the  red  cells 
are  small  and  irregular  in  shape. 

The  next  are  similar  cases  : — 

Case  XIII.— A  girl,  aet.  23,  complained  of  frontal 
headache,  general  weakness,  and  lassitude  and  dyspnoea 
on  exertion.  The  bowels  were  obstinately  confined 
and  the  catamenia.  had  been  absent  for  four  months. 
The  conjunctivae,  lips,  and  nails  were  pale,  and  the  con- 
dition was  obviously  due  to  anaemia.  She  had  taken 
Blaud's  pill  in  five-grain  doses  three  times  a  day  without 
any  amelioration  of  the  symptoms,  but  with  increased 
constipation,  the  bowels  acting  only  every  four  or  five 
days.  The  accumulation  of  faeces  was  removed  by  the 
administration  of  five  grains  of  calomel,  after  which 
she  was  given  'half -ounce  doses  of  the  iron  solution 
three  times  a  day.  There  was  an  immediate  improve- 
ment in  her  general  condition,  and  in  three  weeks  her 
red  cells  increased  from  2,850,000  to  4,782,000,  being 
at  the  rate  of  92,000  a  day.  The  haemoglobin  value 
increased  from  52  to  70  per  cent.,  being  at  the  rate  of 
085  per  cent,  a  day. 

Case  XIV. — The  patient  was  a  woman,  aet.  26.  whose 
blood  was  examined  at  intervals  of  four  days  for  a 
fortnight.  The  initial  count  showed  erythrocytes 
2.260.000,  with  haemoglobin  value  56  per  cent.  At  the 
second  examination  the  red  cells  were  3.400.000.  with 
haemoglobin  62  per  cent.  Four  days  later  they  num- 
bered 4,200,000,  and  the  haemoglobin  value  was  68  per 
cent.  At  the  final  examination  at  the  expiration  of 
fourteen  days  the  red  cells  were  4.480,000,  with  haemo- 
globin value  76  per  cent.  In  this  case  the  ride  was  at 
the  rate  of  158,000  a  day  and  haemoglobin  1*6  per  cent. 
The  iron  solution  was  given  in  half -ounce  doses  three 
times  a  day. 

The  next  case  belongs  to  a  different  category : — 
Case  XV. — A  governess,  aet.  30,  suffered  from 
anaemia,  the  result  of  a  prolonged  attack  of  rheumatic 
fever  with  mitral  regurgitation.  She  was  breathless 
and  incapable  of  much  exertion.  Her  erythrocytes 
numbered  3.450.000,  and  her  haemoglobin  value  was 
43  per  cent.  She  was  given  iron-vitellin  for  ten  days, 
and  at  the  expiration  of  that  period  the  red  cells  were 
4,500.000,  with  haemoglobin  62  per  cent.  Her  sub- 
jective symptoms  had  disappeared,  her  appetite  had 
improved,  and  she  was  able  to  take  a  fair  amount  of 
exercise.  The  erythrocytes  had  increased  at  the  rate 
of  105.000  a  day,  and  the  haemoglobin  value  1*9  per 
cent,  a  day.  The  iron-vitellin  in  this  and  other  cases 
apparently  exerted  a  general  tonic  action  quite  apart 
from  its  influence  on  the  blood  constituents.  In  two 
cases  in  which,  although  the  patients  were  markedly 
debilitated,  the  erythrocytes  numbered  over  6.000,000, 
an  improvement  in  tone  and  in  the  general  condition  of 
the  health  followed  its  administration.  It  seems  to  be 
useful  in  those  anomalous  cases  of  anaemia  such  as  are 
met  with  in  children  in  which  diminution  in  the  number 
of  red  cells,  and  even  of  haemoglobin  value,  is  not  the 
predominant  factor. 

The  next  was  a  case  of  secondary  anaemia : — 
Case  XVI. — A  woman,  aet.  28,  was  anaemic  as  the 
result  of  a  profuse  haematemesis  due  to  gastric  ulcer. 
For  some  weeks  she  had  complained  of  pain  referred 
to  the  pyloric  end  of  the  stomach  following  each  meal. 
There  was  only  one  attack  of  bleeding,  and  it  was 
difficult  to  estimate  the  amount,  although  apparently 
it  was  profuse.  The  family  history  was  not  good,  the 
mother  having  died  of  malignant  disease  of  the  uterus. 
On  the  day  following  the  haematemesis  the  erythrocytes 
numbered  3,260.000,  the  white  cells  were  6,500,  and 
the  haemoglobin  value  was  50  per  cent.  The  patient 
was  kept  in  bed  in  a  recumbent  position  and  was  given 
three  pints  of  milk  in  the  twenty-four  hours.  The 
bowels  were  kept  well  open,  and  half  an  ounce  of  the 
iron  solution  was  ordered  three  times  a  day.  There  was 
no  return  of  the  bleeding,  and  at  the  expiration  of  ten 
days  solid  food  was  taken  without  difficulty.  The 
erythrocytes  then  numbered  4,460.000.  the  white  cells 
were  7,500,  and  the  haemoglobin  value  was  70  per  cent. 
The  daily  increase  of  red  cells  was  120,000  a  day  with 
2  per  cent,  haemoglobin. 


The  last  case  belongs  to  a  type  which  is  by  no  means 
uncommon  : — 

Case  XVII. — A  man,  aet.  53,  complained  o!  want  of 
energy  and  general  weakness  with  shortness  of  breath 
on  exertion,  especially  on  going  upstairs.  For  many 
years  he  had  led  an  active  life  mentally,  but  had  taken 
very  little  physical  exercise,  rarely  walking  more  than 
half  a  mile  a  day.  He  was  a  free  liver,  and  took  three 
good  meals  a  day  with  a  plentiful  allowance  of  alcohol 
at  lunch  and  dinner,  usually  in  the  form  of  champagne , 
with  an  occasional  glass  of  port  and  whisky  in  the 
evening.  He  had  put  on  flesh,  but  his  muscles  were 
flabby  and  the  superficial  veins  of  the  face  and  nose 
were  enlarged  and  congested.  He  was  emphysematous 
and  suffered  from  a  chronic  cough,  kept  up  by  incessant 
smoking.  He  was  in  a  nervous  and  irritable  condition, 
and  slept  badly.  His  arteries  were  hard  and  the  heart 
was  dilated,  although  there  was  no  murmur.  The  liver 
was  enlarged,  and  there  was  a  trace  of  albumin  in  the 
urine.  The  bowels  were  confined,  but  were  relieved 
from  time  to  time  by  large  doses  of  an  aperient  bitter 
water.  His  red  corpuscles  numbered  2,750,000,  and 
the  haemoglobin  value  was  38  per  cent.  He  was  kept 
in  bed.  his  alcohol  was  knocked  off,  and  he  was  given 
three  pints  of  milk  and  a  pint  of  beef- tea  a  day.  The 
bowels  were  kept  freely  open  with  sulphate  of  magne- 
sium, and  an  ounce  of  iron-vitellin  was  given  three  times 
a  day.  At  the  expiration  of  ten  days  he  had  materially 
improved,  the  albumin  had  disappeared  from  the  urine, 
his  tongue  was  clean,  he  slept  better,  and  ex- 
pressed a  strong  desire  for  food.  His  erythrocytes  had 
mcreased  to  4,400,000,  the  leucocytes  had  fallen  to 
9,500,  and  the  haemoglobin  was  47  per  cent.  The  daily 
increase  in  the  erythrocytes  was  165,000,  and  haemo- 
globin value  0-9  per  cent. 

Excluding  the  first  of  these  cases,  which  was  ob- 
viously unsuited  for  treatment,  we  find  that  under  the 
iron-vitellin  treatment  the  daily  increase  in  erythro- 
cytes was  1 57.000.  and  the  haemoglobin  percentage  i  -26. 
This,  with  regard  to  the  red  blood  corpuscles,  shows 
an  improvement  of  50  per  cent,  over  the  best  inorsanic 
iron  treatment,  and  with  regard  to  the  haemoglobin 
value  a  gain  of  25  per  cent. 

These  observations  are  admittedly  incomplete  and 
merely  touch  the  fringe  of  the  subject,  but  they  show 
that  a  good  organic  iron  preparation  compares  favour- 
ably with  the  best  of  the  inorganic  salts  apart  from 
the  great  advantage  of  being  eaisily  assimilated  and 
free  from  the  discomforts  which  so  frequently  attend 
the  administration  of  the  astringent  forms  of  the][drug. 

ABSTRACT   OF 

TCbe  Caven&tob  Xecture 

ON 

EXPERIMENTS       ON       THE       IMMUNISATION 

AGAINST   INFECTION   OF  OPERATION 

WOUNDS,  ESPECIALLY  OF  THE 

PERITONEUM,  (a) 

By    JOHANN    VON    MIKULICZ-RADECKI,    M.D.. 

LL.D., 

Professor  of  Surfj^^ry  in  the  UniTertity  of  Brealau. 

Mr.  President  and  Gentlemen, — The! successful 
treatment  of  infectious  diseases  to-day  involves  in 
many  cases  a  combination  of  the  two  methods  of  treat- 
ment discovered,  the  one  by  Edward  Jenner  and  the 
other  by  Lord  Lister.  Hygienic  measures  based  upon 
Listerian  principles  attempt  to  exclude  or  render 
harmless  the  cause  of  infection,  whilst  specific  preven- 
tive inoculation  endeavours  to  render  individuals  more 
capable  of  resisting  infection.  Surgery  has  made  but 
little  use  of  the  principle  of  preventive  inoculation 
because  the  multitude  of  pyogenic  micro-organisms 
which  may  infect  the  wound  adds  greatly  to  the  diffi- 
culty of  finding  a  practical  method  of  inoculating  against 
them.  The  immunisation  of  wounds  does  not  press 
with  the  urgency  of  general  infectious  diseases  because 


(a)  Delivered  before  the  West  London  tf  edioo-Chirurgical  Society 
June  24th,  1904. 


July  6.   1904. 


ORIGINAL  COMMUNICATIONS. 


the'^majority  of  wounds  are  efficiently  guarded  from 
infection  by  antiseptic  treatment.  There  are,  however, 
many  operations  in  which  the  principle  of  antisepsis 
becomes  useless  because  the  affected  tissues  or  organs, 
owing  to  their  physiological  properties  or  their  patho- 
logical conditions,  are  invaded  by  pathogenic  organisms. 
The  problem  of  effectually  disinfecting  the  mucous 
membrane  of  the  stomach  and  intestines  in  preparation 
for  operation  has  not  yet  been  solved.  We  possess,  it 
is  true,  a  number  of  technical  expedients  for  limiting 
the  danger  of  infection,  but  they  do  not  succeed  with 
certainty  in  preventing  it  in  every  case.  The  dan- 
gerous peritonitis  in  serious  operations  on  the  stomach 
and  intestines  is  due  to  the  fact  that  the  bacilli  from 
the  intestines  escape  in  too  great  a  number  to  be 
tolerated  by  the  peritoneum  ;  that  is  to  say,  the  natural 
power  of  resistance  of  the  peritoneum  in  the  individual 
is  not  sufficient  to  overpower  the  mass  of  bacteria  in- 
troduced. We  can  diminish  the  danger  of  peritonitis 
at  the  present  time  only  by  increasing  the  power  of 
resistance  of  the  peritoneum  against  intestinal  bacteria. 
One  means  of  effecting  this  is  by  producing  an  artificial 
hyperleucocytosis.  Loewy  and  Richter  were  the  first 
to  try  by  the  injection  of  albumoses,  especially  spermin, 
into  animals  to  produce  a  hyperleucocytosis  and 
thereby  to  make  the  animals  capable  of  resisting  in- 
fection of  pneumococci.  In  a  similar  way  Jakob,  by 
intravenous  and  subcutaneous  injection  of  albumose 
into  rabbits,  made  them  proof  against  pneumococci 
and  mouse  septicaemia.  After  each  injection  a  hypo- 
leucocytosis  occurred  first  and  later  a  hyperleucocytosis. 
If  the  infection  was  brought  about  during  hypoleu- 
cocytosis  the  animals  without  exception  died.  On  the 
other  hand,  the  course  of  the  disease  was  influenced  in 
the  most  favourable  way  when  the  infection  was  intro- 
duced after  a  hyperleucocytosis  had  occurred,  and  was 
still  increasing.  Hahn  succeeded  in  showing  that 
during  that  stage  of  hyperleucocytosis  the  blood  of  men 
and  dogs  possessed  a  higher  bactericidal  value  than 
normal  blood.  Hahn  used  yeast  nuclein  in  his  experi- 
ments on  dogs  and  tuberculin  in  those  on  man.  These 
experiments  do  not  seem  to  have  led  to  any  practical 
result  in  the  case  of  man.  At  any  rate,  Goldscheider 
did  not  entertain  great  hopes  of  the  therapeutic  value 
of  hyperleucocytosis.  More  recently  Hofbauer,  in 
Vienna,  has  obtained  favourable  results  in  undoubted 
puerperal  septicaemia  by  the  administration  of  from 
five  to  six  grammes  of  nuclein  by  the  mouth.  The 
slight  therapeutic  value  of  artificial  hyperleucocytosis 
in  disease  which  has  already  made  itself  evident — as, 
for  example,  in  pneumonia — can  be  readily  understood. 
The  infected  organism  is  at  the  time  of  the  application 
of  the  remedy  overpowered  by  the  pathogenic  microbes  ; 
all  the  engines  of  defence  of  the  organism  have  already 
had  to  be  led  into  the  field.  A  still  further  increase 
through  a  later  artificial  hyperleucocytosis  cannot  be 
expected. 

The  question  arises  whether  artificial  hyperleucocy- 
tosis may  not  be  of  value  in  practice  as  a  prophylactic. 
According  to  the  above-mentioned  experiments  one 
cannot  exclude  the  possibility  that  by  a  partly  antici- 
pated mobilisation .  of  great  masses  of  leucocytes  the 
latter  may  overcome  the  bacteria  which  have  obtained 
entrance  in  the  first  instance  in  relatively  small  masses 
with  greater  ease  than  if  the  leucocytes  delay  their 
attack  in  force  until  the  number  and  virulence  of  the 
bacteria  in  the  tissues  have  markedly  increased. 
Whether  the  observations  of  Jakob  are  applicable  to 
the  peritoneum  had  to  be  established  by  experiments  on 
animals  before  they  could  be  used  upon  man.  Dr. 
Miyake,  of  Japan,  who  recently  worked  in  my  clinic, 
undertook  at  my  suggestion  these  experiments  upon 
animals.  These  were  carried  out  in  the  Breslau 
Hygienic  Institute  under  the  control  of  Professor 
Flugge.  We  already  had  a  predecessor  named  Salieri, 
who,  in  1902,  carried  out  experiments  to  increase  the 
resistance  of  the  peritoneum  against  bacillus  coli  in- 
fection, and  found  that  with  small  quantities  of  normal 
saline  solution  he  could  increase  the  natural  resistance 
in  guinea-pigs  by  sevenfold  to  sixteen-fold.  The  ex- 
periment was  made  three  times  on  man  in   cases  of 


The  Medical  Press.     7 


laparotomy  in  which  Salieri  injected  from  30  to  60 
cubic  centimetres  of  saline  solution  into  the  abdominal 
cavity.  Salieri  believed  that  he  obtained  favourable 
results,  but  in  my  opinion  the  operations  carried  out 
by  him  do  not  definitely  demonstrate  an  increased 
resistance  of  the  peritoneum.  Salieri  was  led  to  under- 
take his  investigation  by  the  well-known  experiments 
against  cholera  conducted  by  Issaeff,  in  1894.  Issaeff 
produced  in  guinea-pigs  hyperleucocytosis  in  the  peri- 
toneal transudate  by  intraperitoneal  injections  of 
normal  saline  solution,  of  bouillon,  of  nucleic  acid,  and 
of  tuberculin.  At  the  summit  of  this  hyperleucocy- 
tosis he  injected  virulent  cholera  vibrios  into  the  peri 
toneum  and  noted,  according  to  the  nature  of  the  in- 
jected fluid,  a  more  or  less  marked  increase  in  the  re- 
sistance of  the  peritoneum  to  the  injected  cholera 
bacilli.  The  most  powerful  reaction  was  obtained  with 
nucleic  acid.  With  an  injection  of  one  cubic  centi- 
metre of  a  2  per  cent,  solution  of  nucleic  acid  the  peri- 
toneum was  able  to  withstand  from  13  to  17  lethal 
doses  of  cholera  vibrios.  Issaeff  observed  that  the 
destruction  of  the  microbes  was  carried  out  by  the 
leucocytes  of  the  peritoneal  transudate.  After  only 
two  hours  the  phagocytosis  was  evident.  In  the  third 
hour  free  micro-organisms  could  no  longer  be  found  in 
the  exudate  and  after  five  hours  the  process  of  destruc- 
tion of  microbes  was  completed.  Just  as  Issaeff  used 
guinea-pigs  for  his  experiments,  we.  too,  selected  that 
animal.  Although  the  prospects  of  a  satisfactory 
specific  active  immunisation  of  man  against  the  virus 
of  peritonitis,  as  has  been  explained,  are  extremely 
small,  nevertheless  we  made  experiments  in  this  direc- 
tion first,  for  in  guinea-pigs  the  conditions  are  much 
more  favourable.  The  bacilli  coli  sdone  are  markedly 
pathogenic  for  the  peritoneum  of  the  guinea-pig,  whilst 
the  other  co-excitors  of  peritonitis  in  man,  especially  the 
streptococcus  and  staphylococcus  pyogenes,  are  almost 
entirely  harmless  to  guinea-pigs.  The  experiments 
were  carried  out  in  this  way.  From  half  a  loopful  to 
two  loopfuls  of  a  sterilised  culture  was  injected  into 
the  peritoneum  from  a  strain  of  bacillus  coli.  After 
a  definite  interval,  which  was  different  in  different 
experiments,  had  elapsed,  the  animals  tolerated  the 
introduction  of  five  loopfuls  of  living  virulent  culture 
and  also  the  escape  of  the  contents  of  the  intestine 
into  the  abdominal  cavity.  The  active  immunisation 
with  a  strain  of  bacillus  coli  (derived  from  man)  was 
thus,  we  may  presume,  able  to  protect  against  other 
bacillus  coli  strains  that  were  accidentally  present  in 
the  contents  of  the  intestine.  Nevertheless,  it  is 
possible  to  come  across  by  chance  strains  in  the  case  of 
which  this  does  not  occur.  That  in  man  we  have  to 
reckon  not  only  with  different  strains  of  bacilli  coli,  but 
also  with  different  strains  of  streptococci  and  other 
pathogenic  bacteria,  has  been  demonstrated  above. 
On  these  grounds  we  did  not  make  any  further  experi- 
ments for  obtaining  a  specific  active  immunisation  even 
of  guinea-pigs.  The  further  experiments  consisted 
exclusively  in  producing  a  general  increase  in  resistance 
by  hyperleucocytosis.  In  accordance  with  the  pro- 
cedure of  Issaeff  we  tried  the  injection  of  various  fluids 
into  the  peritoneal  cavity  ;  later,  subcutaneous  injec- 
tions were  also  tried,  for  this  form  of  application  is 
better  adapted  to  man  than  that  of  intraperitoneal  in- 
jections. Sodium  chloride  solution  (0*85  per  cent.), 
neutral  bouillon  (2  per  cent.),  starch  in  physiological 
salt  solution,  and  nucleic  acid  were  used  for  injection. 
The  first  three  solutions  were  only  used  intraperiton- 
toneally,  nucleic  acid  subcutaneousiy  as  well.  For 
intraperitoneal  injection  2  per  cent,  of  nucleic  acid  was 
used,  for  subcutaneous  injection  5  per  cent,  neutralised 
nucleic  acid  solution ;  one  cubic  centimetre  of  the  solu- 
tion was  injected  per  250*330  grammes  bodyweight. 
We  found,  in  agreement  with  earlier  experimenters, 
that  the  intraperitoneal  injections  of  normal  saline 
solution  in  the  quantities  above  mentioned  gave  rise 
to  a  marked  hyperleucocytosis  in  the  peritoneal  transu- 
I  date.  The  maximum  was  reached  after  from  17  to  18 
I  hours  with  an  increase  to  about  fourfold  the  normal 
I  leucocytosis.  Still  greater  was  the  effect  when 
I  the  peritoneal  cavity  was  washed  out  with  50  cubic 


8    -The  Medical  Press 


ORIGINAL  COMMUNICATIONS. 


July  6,   1904. 


centimetres  of  normal  saline  solution  ;  in  this  case  about 
two-thirds  of  the  solution  was  left  in  the  cavity. 
Maximum  hyperleucocytosis  occurred  after  24  hours 
and  resulted  in  live  times  the  normal  number  of  leu- 
cocytes. The  reaction  due  to  neutral  bouillon  was 
much  less  marked  than  that  of  normal  saline  solution. 
But  a  far  more  energetic  action  followed  the  2  per 
cent,  aleuronat  mucilage.  The  maximum  peritoneal 
hyperleucocytosis  occurred  in  30  hours  and  rose  to 
between  seven  and  eight  times  the  normal  number.  A 
similar  result  followed  the  use  of  nucleic  acid,  but  the 
reaction  was  more  speedy.  The  maximum  was  be- 
tw^een  seven  and  eight  times  the  normal,  and  occurred 
eight  hours  after  the  injection.  Along  with  the  local, 
general  leucocytosis  in  the  blood  took  place,  but  to 
nothing  like  the  same  extent.  The  maximum  in  one 
case  was  double  the  normal  number  of  white  cells. 
Subcutaneous  injection  also  of  5  per  cent,  nucleic  acid 
led  to  a  hyperleucocytosis  in  the  peritoneum,  as  well 
as  in  the  blood.  The  latter  reached  almost  to  the  same 
height  as  with  the  injection  in  the  peritoneum,  the 
former  remained  far  below.  It  reached  approximately 
two  and  a  half  times  the  normal  number.  The  import- 
ant point  is  that  here  also,  as  in  the  experiments  of 
Jakob,  the  injection  caused  a  hyp>oleucocytosis  in  all 
cases  after  half  an  hour  to  one  and  a  half  hour.  With 
normal  saline  solution  and  with  bouillon  it  was  not 
considerable  ;  with  aleuronat  and  nuclein  it  fell  even 
to  one-tenth  of  its  original  amount  in  the  peritoneal 
transudate.  No  general  disturbance  of  any  importance 
occurred.  With  the  injection  of  normal  saline  solution 
the  temperature  was  scarcely  raised  ;  with  aleuronat 
and  nucleic  acid  there  was  a  rise  of  from  05°  to  1*5° 
during  the  first  hours  after  the  injection. 

After  these  experiments  we  used  the  injection  with 
the  above-mentioned  fluids  as  a  preliminary  to  an  in- 
fection of  the  peritoneum,  and  in  the  first  instance  a 
strain  of  bacterium  coli  was  employed,  which  we  found 
to  be  very  virulent  for  guinea-pigs.     After  it  had  been 
ascertained  by  eleven  test  experiments  that  the  mini- 
mum lethal  dose  was  a  quarter  of  a  loopful,  the  pre- 
pared animals  were  infected  with  the  same  strain.     The 
infection  of  the  peritoneum  followed  regularly  seven 
hours  after  the  preparatory  treatment,  and  therefore  at 
a  time  when  the  hyperleucocytosis  had  not  yet  quite 
reached   the  maximum.     The  result  was  as  follows : — 
The  effect  of  a  single  injection  into  the  peritoneum  of 
one  cubic  centimetre  of  normal  saline  solution  was 
relatively  weak,   the  power  of  resistance  being  only 
doubled  (the  infection  after  washing  out  the  peritoneum 
with  saline  solution  could  not  be  employed  because  the 
bacillus  coli  strain  at  the  time  of  the  experiments  in 
question  had  already  lost  its  virulence).     Much  more 
energetic  was  the  action  of  the  intraperitoneal  injection 
of  aleuronat,  since  it  increased  the  resistance  of  the 
peritoneum   eightfold.     Nucleic    acid    was   still   more 
active,  for  with  this  the  power  of  resistance  of  the  peri- 
toneum was  raised  from  sxteen  to  twenty-fold.     The 
subcutaneous    injections  of  0-5  per  cent,  neutralised 
nucleic    acid  similarly  increased  the  power  of    resist- 
ance of  the  peritoneum  from  sixteen    to  twenty- fold. 
Distinctly    weaker    was    the     action   of    a    0-25    per 
cent,     solution.       The     effect      of     repeated     intra- 
peritoneal   injections    of    nucleic    acid  was  consider- 
ably stronger.      In    this    manner    the    resistance    of 
the  peritoneum    could    be   raised    to  forty  times  the 
normal.     Repeated  subcutaneous  injections  of  nucleic 
acid  led  to  32  times  the  normal  resistance.     I  may  note 
in  passing  that  none  of  the  fluids  used  for  injections 
in  the  neutralised  form  had  any  bactericidal  action  upon 
the  bacterium  coli  selected   for  injection.     It  would 
have  been  very  desirable  to  carry  out  the  same  series 
e»f  experiments  against  the  other  bacteria  that  collabo- 
rate in  the  production  of  peritonitis  in  man,  and,  above 
all,    against    the    streptococcus    and    staphylococcus 
aureus  and  albus.     Unfortunately,  we  found,  in  agree- 
ment   with    other    people's    observations,    that    the 
streptococci  and  staphylococci  isolated   from  patients 
in  our  clinic  w-ere  non- virulent  for  guinea-pigs.     We 
therefore  tried  experiments  upon  rabbits,  but  the  same 
difficulty  arose.     It  is  not  easy  to  find   a  strain  of 


staphylococci    which     has    a    pathogenic    effect     on 
the   peritoneum   of   the    rabbit.     We    can    definitely 
assume    from    the     experiments     of     Kisskalt     that 
in    combating     the    staphylococcus     pyogenes     both 
leucocytosis  and  the  destruction  of  the  bacteria  by  the 
method  of  phagocytosis  play  at  least  as  important  a 
part  as  when  the  fight  is  between  the  organism  and 
the  bacterium  coli.     So  far  as  the  streptococcus  is  con- 
cerned the  strains  isolated  from   our  clinic  were  in- 
sufficiently virulent  for  the  peritoneum  of  the  rabbit. 
One  of  the  strains  of  the  streptococcus  given  to  us  by 
Dr.   Aronson.  of  Berlin,  was,  it  is  true,  virulent  for 
rabbits,  but  to  such  a  great  extent  that  it  acted  as  a 
specific   bacterium   of   these   animals.     Against    these 
highly  virulent  specific  bacteria  little  effect  is,  as  we 
already  know,  produced  by  a  general  increase  of  re- 
sistance by  hyperleucocytosis.     In  these  cases  only  a 
specific    immunisation   is   of   avail   against    infection. 
For  these  reasons  the  experiments  could  not  be  carried 
out  in  the  way  referred  to.     On  the  other  hand,  the 
experiments  upon  bacilli  coli  were  supplemented  in  a 
most  satisfactory  manner  by  a  series  of  observations 
which  simulated  the  natural  conditions  occurring  in 
peritonitis  due  to  perforation.     The  experiments  con- 
sisted in  performing  a  laparotomy  and  forcing  through 
an  opening  in  the  stomach  or  intestine  as  much  of  their 
contents  as  could  be  obtained   from   the   immediate 
neighbourhood  of  the  incision.     Of  five  control  animals 
which  had  not  been  previously  prepared  four  died  from 
peritonitis  between  five  and  sixteen  hours  after  the 
operation.     The  fifth  became  extremely  ill  but  finally 
recovered,  but  the  amount  of  intestinal  contents  which 
was  transferred  to  the  peritoneum  was  less  in  this  case 
than  in  the  others.     Ten  animals  were  prepared.     These 
recovered  without  exception.     The   preparation   con- 
sisted in  three  intraperitoneal  injections  of  nucleic  acid, 
two  injections  of  sterilised  bacteria  coli,  three  more  in- 
jections of  nucleic  acid  into  the  peritoneum,  and  two 
subcutaneous   injections   of   neutralised   nucleic   acid. 
In  each  case  laparotomy  was  performed  seven  hours 
after  the  injection.     These  experiments  are  such  as  to 
excite  our  interest  in  the  highest  degree,  for  by  sub- 
cutaneous injections  of  nucleic  acid  it  was  possible  to 
raise  the  resistance  of  the  peritoneum  to  such  an  extent 
that   even  a  considerable  quantity  of   intestinal  con- 
tents could  be  placed  in  the  peritoneal  cavity  without 
causing  damage,  whilst  without  previous  treatment  an 
acute,  rapidly  fatal  peritonitis  followed  almost  without 
exception.     This  opens  out  a  new  field  for  the  surgeon 
in    preventing    post-operative    peritonitis.     On    three 
more  animals  a  therapeutic  experiment  with  neutralised 
2  per  cent,  nucleic  acid  was  tried.     This  solution  was 
injected  subcutaneously  some  time  after  the  injection 
of  the  peritoneum  with  bacilli  coli.     It  was  found  that 
when  the  infection  had  preceded  the  injection  by  six 
hours  the  peritoneum  was  able  to  stand  only  four  times 
the  lethal  dose  ;  whilst  if  the  infection  had  taken  place 
only  one  and  a  half  hour  before,  then  the  animal  was 
able  to  withstand  eight  times  the  lethal  dose.     One 
animal  which  received   twelve   times   the   fatal   dose 
along  with  the  nucleic  acid  injection  succumbed  nine- 
teen hours  after  the  infection.     It   therefore  follows 
that  subcutaneous  injection  of  nucleic  acid,  if  not  used 
at  too  great  an  interval  after  the  peritoneal  infection, 
possesses   a   definite   therapeutic   value.     This   obser- 
vation may  perhaps  be  of  value  in  acute  cases  of  peri- 
tonitis from  perforation. 

I  felt  justified  after  these  promising  experiments  upon 
animals  in  beginning  similar  experiments,  safeguarded 
by  every  precaution,  upon  man.  W'e  first  tried  a  i  per 
cent,  solution  of  the  neutralised  nucleic  acid,  and 
gradually  increased  the  strength  up  to  4  per  cent.  As 
a  rule,  50  cubic  centimetres  of  the  solution  were  injected 
subcutaneously.  Intraperitoneal  injection  was  tried 
in  one  case,'  and  that  the  very  first,  but  this  method 
was  entirely  relinquished  owing  to  its  difficulty  and 
the  trouble  it  gave  the  patient.  The  4  per  cent,  solu- 
tion was  injected  twice.  Thenceforth  we  always  used 
the  2  per  cent,  solution,  so  that  an  adult  man  received 
about  one  gramme  of  nucleic  acid  to  75  kilogrammes 
of  bodyweight.     In  all,  58  cases  were  treated   in    this 


July  6.   1904.. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Press.     9 


way.  In  55  cases  the  operations  were  upon  the 
stomach,  intestine,  or  other  abdominal  viscera,  and 
in  three  cases  for  extra-abdominal  disease.  In  four 
cases  the  operations  did  not  take  place  until  more  than 
34  hours  after  the  injection  was  given.  We  have  thus 
on  four  occasions  had  the  opportunity  of  observing  the 
effect  of  the  injection  by  itself.  After  the  subcu- 
taneous injection  of  neutralised  nucleic  acid  we  have 
constantly  observed,  not  only  in  animals  but  also  in 
man,  a  hyperleucocytosis  in  the  blood  which  was 
almost  always  preceded  during  the  first  hour  or  so  by 
a  hypoleucocytosis.  The  question  how  high  a  degree 
of  hyperleucocytosis  was  obtained  through  the  injec- 
tion is  difficult  to  answer  on  the  basis  of  our  obser- 
vations. We  are  not  in  a  position  to  make  any  definite 
statements  as  to  the  beginning  of  the  most  favourable 
phase  of  hyperleucocytosis  because  the  operation  was, 
in  the  great  majority  of  cases,  apparently  performed 
before  the  commencement  of  this  phase.  Only  in  five 
cases  was  there  a  distinct  fall  in  the  hyperleucocytosis 
before  the  operation  ;  in  one  of  these  it  occurred  be- 
tween 13  and  19  hours  after  the  injections.  The  opera- 
tions were  performed  in  four  cases  from  five  to  six 
hours,  in  nine  cases  from  nine  to  twelve  hours,  and  in 
twelve  cases  from  13  to  19  hours  after  the  injections. 
The  experiments  on  guinea-pigs  showed  that  the 
optimum  for  nucleic  acid  was  reached  seven  hours 
after  the  injection.  It  seems  to  occur  in  man  con- 
siderably later.  We  have  therefore  recently  fixed  the 
interval  between  preventive  injection  and  operation 
at  1 2  hours.  We  believe  that  we  thus,  as  a  rule,  follow 
out  the  instructions  to  operate  on  the  rising  tide  of 
leucocytosis. 

As  regards  the  phenomena  accompanying  the  in- 
jection of  nucleic  acid,  no  serious  local  or  general 
symptoms  have  as  yet  come  under  our  observation. 
In  the  two  cases  in  which  a  4  per  cent,  solution  had 
been  injected  the  sensation  of  giddiness  lasted  but  a 
short  time.  The  most  unpleasant  factor  for  the  patient 
is  the  local  reaction.  A  tenderness  and  a  slight 
swelling  around  the  point  of  injection  remain,  as  a  rule, 
throughout  the  day.  An  intense  erysipelas-like  red- 
ness in  two  cases  was  seen,  and  it  disappeared  without 
leaving  any  trace  after  24  hours.  The  only  sign  of 
reaction  which  appears  with  regularity  is  a  slight 
increase  in  the  temperature,  which  may  be  observed 
during  the  first  few  hours  after  injection  (99°  to  100°). 
In  five  cases  the  temperature  remained  below  986°,  in 
27  cases  it  rose  to  100°,  in  six  cases  to  101°,  in  three 
cases  to  102^.  and  in  three  cases  above  102°. 

You  will  now  ask  me  how  far  the  immediate  object 
of  the  injection  of  nucleic  acid  was  attained,  and  how 
far  the  preparation  of  the  cases  had  a  favourable  effect 
upon  the  course  of  the  operation.  In  ten  cases  of 
resection  of  the  stomach  for  carcinoma  nine  recovered, 
six  of  them  without  the  slightest  complication.  The 
progress  was  marked  by  a  smoothness  that  was  quite 
exceptional  before  this  treatment  was  adopted.  Two 
cases  which  presented  exceptional  difficulty  in  the 
removal  of  the  carcinoma  did  undoubtedly  within 
24  hours  develop  peritonitis  with  a  pulse  up  to  160, 
which  according  to  our  usual  experience  foretold  the 
most  dismal  prognosis.  The  patients  fortunately 
survived  this  peritonitis.  In  the  ninth  case  which 
recovered  the  progress  was  disturbed  from  the  fourth 
day  by  broncho-pneumonia.  The  tenth  case  died  ; 
after  seven  days  of  uninterrupted  progress  he  developed 
pneumonia,  to  which  he  succumbed  three  weeks  after 
the  operation.  Of  the  remaining  operations  I  should 
like  to  refer  first  to  22  cases  of  gastro-enterostomy  and 
entero-anastomosis,  12  of  which  were  for  carcinoma. 
Of  these  cases  19  recovered  and  three  died.  In  all 
three  cases  death  was  most  certainly  not  due  to  post- 
operative peritonitis,  but  in  one  case  to  perforation  of 
an  ulcerated  carcinoma  of  the  stomach  two  weeks 
after  the  operation,  in  another  case  to  continued 
haemorrhage  from  a  carcinoma  of  the  stomach  16  days 
after  the  operation,  and  in  the  third  to  peritonitis 
arising  from  a  tuberculous  granuloma  in  the  intestine 
four  weeks  after  operation.  Of  six  cases  of  resection 
of  the  intestines  at  one  operation  four  recovered  and 


two  died.  In  one  case  death  occurred  from  collapse 
on  the  second  day  after  a  very  prolonged  operation  of 
double  resection  for  carcinoma  ;  in  the  other  case, 
where  the  injury  was  a  bullet  wound,  death  took  place 
on  the  tenth  day  from  haemorrhage  from  the  vena  cava. 
In  neither  of  the  cases  was  there  any  peritonitis.  One 
case  of  opening  the  stomach  and  stretching  the  cardiac 
orifice,  performed  on  account  of  spasm,  recovered. 
So  also  did  six  cases  of  operation  on  the  bile-duct, 
seven  other  operations  upon  abdominal  organs  without 
opening  the  intestinal  tract,  and  three  extra-abdominal 
operations.  The  last  to  be  mentioned  are  two  cases 
of  nephrectomy  which  were  treated  before  the  opera- 
tion with  nucleic  acid.  In  both  cases  in  order  to  re- 
move the  suppurating  kidney  the  peritoneum  had  to 
be  widely  opened.  One  case  recovered  ;  the  other 
died  12  days  after  the  operation  from  haemorrhage 
from  the  renal  artery.  In  this  case,  too.  there  was  no 
peritonitis.  We  therefore  have  45  laparotomies  in 
which  the  abdominal  cavity  was  exposed  to  infection 
by  the  contents  of  the  stomach  or  intestines  or  by 
some  other  infectious  secretion.  Of  these  cases  38  re- 
covered and  in  none  of  the  seven  fatal  results  was  peri- 
tonitis the  cause  of  death. 

While  relating  my  clinical  experiences,  I  have  re- 
ferred to  nucleic  acid  only  as  a  method  of  producing 
leucocytosis,  but  we  have  also  used  in  most  cases,  and 
especially  in  severe  operations  upon  the  stomach  and 
intestines,  a  second  means  which,  according  to  ex- 
perimental observations,  is  able  to  increase  consider- 
ably the  power  of  resistance  of  the  peritoneum — I  mean 
the  intraperitoneal  infusion  of  normal  saline  solution. 
Departing  from  my  earlier  practice  I  have  used  more 
and  more  during  the  last  two  years  free  irrigation  of 
the  peritoneal  cavity  with  warm  normal  saline  solution 
in  all  laparotomies  in  which  the  peritoneum  runs  some 
risk  of  infection. 


irran0actfon9  of  Societies* 


SOCIETY    FOR    THE    STUDY    OF    DISEASE    IN 

CHILDREN. 

Meeting  held  Friday,  May  27TH,   1904. 


Mr.  W\\lter  Edmunds,  F.R.C.S..  in  the  Chair. 

A  Case  of  Multiple  Sarcomata  of  the  Scalp  in  a  child, 
act.  2.  was  shown  by  Mr.  Wilson  for  Dr.  Edmund 
Cautley.  In  September,  1903,  the  right  eye  had  been 
excised  for  glioma.  One  month  previously  lumps  had 
been  noticed  on  the  head,  which  had  grown  rapidly. 
At  present  the  new  growths  were  numerous,  large,  and 
scattered  over  the  scalp.  There  was  also  evidence  of 
involvement  of  the  left  eye,  and  a  purple  discoloration 
of  the  eyelids  on  both  sides  was  present.  The  face 
was  of  a  waxy  pallor  and  oedematous. 

Mr.  George  Pernet  described  a  case  of  multiple 
sarcomatous  growths  in  the  skin  in  which  the  right  eye 
was  bulged  forward,  presumably  from  a  primary  growth 
behind  it. 

A  Case  of  Tumour  Occupying  the  Left  Half  of  the 
Abdomen,  in  a  girl,  ait.  6,  was  shown  by  Mr.  Francis 
Jaffrey.  She  had  suffered  from  pain  in  the  left  side 
of  the  abdomen,  haematuria,  and  difficulty  in  micturi- 
tion. The  tumdur  wais  smooth  and  elastic,  did  not 
fluctuate,  and  was  fairly  movable.  He  was  of  opinion 
that  it  was  a  case  of  sarcoma  of  the  left  kidney,  and 
asked  as  to  the  advisability  of  operative  treatment. 

Mr.  Watson  Cheyne  agreed  with  the  diagnosis,  but 
thought  that  complete  removal  could  not  be  looked  for, 
as  the  pedicle  of  the  kidney  seemed  to  be  involved. 

Mr.  Clement  Lucas  thought  that,  as  the  case  was 
probably  hopeless  if  left  alone,  an  effort  might  be  made 
to  remove  the  tumour  if  possible. 

The  Chairman  (Mr.  Walter  Edmunds)  thought  that 
an  exploratory  incision  might  be  employed  to  deter- 
mine whether  the  tumour  was  removable  or  not.  He 
asked  for  pairticulars  as  to  history  of  such  cases  after 
operation. 

Mr.    Thomson    Walker    said    that     an     increasing 


10     The  Medical  Press. 


SPECIAL   ARTICLES. 


July  6,  1904. 


number  of  renal  tumours  were  removed  from  children 
with  immediate  good  results,  and  with  a  good  after- 
history,  namely,  of  three  to  five  years  in  which  no 
recurrence  had  taken  place.  Each  case  must  be  taken 
on  its  own  merits,  and  if  the  tumour  were  examined 
from  within  the  abdomen  there  would  be  a  better  chance 
of  ascertaining  whether  it  was  removable,  and  whether 
there  was  likely  to  be  a  recurrence. 

A  Case  of  Status  Lymphaticus  was  described  by  Mr. 
Hunter  Tod.  An  infant,  act.  6  months,  had  been  the 
subject  of  laryngeal  stridor  and  died  suddenly.  Dr. 
Walter  Emery  showed  the  organs  from  this  and 
another  infant  affected  with  the  status  lymphaticus. 
There  was  an  enlargement  of  practically  all  the  lym- 
phoid tissues  of  the  body,  including  the  thymus,  the 
glands  (especially  the  mesenteric),  the  solitary  follicles 
and  Peyer's  patches  in  the  intestine,  the  tonsils,  and 
the  adenoid  tissue  of  the  naso-pharynx.  The  spleen 
and  tongue  were  normal,  the  latter  not  showing  en- 
largement of  the  circumvallate  papillae,  which  had 
sometimes  been  described  as  of  diagnostic  value.  The 
thymus  gland  weighed  almost  exactly  an  ounce  in 
each  case,  but  there  was  no  evidence  of  direct  pressure 
on  the  vagus,  the  trachea,  or  the  heart.  He  drew 
special  attention  to  the  marked  thickening  in  parts  of 
the  intestinal  wall  from  the  overgrowth  of  lymphoid 
tissue. 

Dr.  E.  P.  Baumann  confirmed  this  observation.  He 
had  seen  two  fatal  cases,  one  an  infant,  aet.  3  months, 
and  the  other  aet.  9  months.  The  first  infant  wais 
brought  to  the  hospital  in  a  state  of  great  respiratory 
embarrassment,  cyanosed,  and  uttering  peculiar  re- 
spiratory sobs.  Death  soon  ensued,  and  the  thymus 
was  found  to  weigh  four  and  a  half  ounces.  It  lay 
chiefly  on  the  right  side,  pressing  on  the  heart,  and  it 
might  also  have  pressed  on  the  trachea,  causing  death 
directly  from  suffocation. 

Mr.  Thomson  Walker  said  this  was  a  very  important 
subject,  not  only  from  the  medico-legal  point  of  view, 
but  also  from  the  surgical.  One  writer  had  collected 
ten  cases  in  which  death  had  occurred,  at  the  com- 
mencement of  chloroform  administration,  or  during  it, 
or  immediately  after  the  operation.  In  addition  to 
the  other  changes  mentioned,  a  hyperplasia  of  the 
arteries  had  been  noted,  leading  to  narrowing  of  the 
lumen. 

Dr.  Emery,  in  reply,  said  that  one  could  not  abso- 
lutely exclude  pressure  on  the  trachea  from  the  post- 
mortem findings.  The  thymus  might  suddenly  become 
engorged  with  blood  and  exert  direct  pressure  on  the 
trachea,  and  all  signs  of  this  might  have  passed  off 
before  the  post-mortem  examination. 

A  Case  of  Tuberculous  Periostitis  was  shown  by  Mr. 
LocKHART  Mummery.  There  was  a  fluctuatmg 
swelling  on  the  middle  finger  of  the  right  hand,  and 
the  right  radius  and  right  cheek  were  also  the  seats  of 
tuberculous  growths.  ,,      , 

A  Case  of  Paralysis  of  the  Left  Trapezius  Muscle 
following  an  Attack  of  Herpes  was  shown  by  the  Chair- 
man (Mr.  Walter  Edmunds).  The  patient  was  a  girl, 
aet.  6.  who,  three  weeks  after  an  attack  of  herpes  affect- 
ing the  skin  over  the  left  shoulder  and  the  upper  part 
of  the  left  scapula,  was  found  to  have  "  winging  "  of 
the  left  scapula.  Thiis  was  found  to  be  due  to  weakness 
of  the  left  trapezius  muscle,  which  responded  neither  to 
galvanism  nor  faradism. 

A  Case  of  Achondroplasia,  in  a  boy,  aet.  12,  was  de- 
monstrated by  Mr.  Harold  Balme.  As  usual  in  this 
affection  the  membrane  bones  were  unaffected,  while 
all  the  long  bones  showed  marked  shortening. 

Mr.  A.  D.  Reid  showed  a  series  of  skiagrams  of  this 
patient,  with  the  following  abnormal  features  :  (i )  The 
ends  of  the  diaphyses  were  expanded  ;  (2)  both  humeri 
were  bowed  ;  (3)  there  was  a  lateral  curve  in  the  left 
tibia  and  fibula ;  (4)  the  ends  of  the  diaphyses  of  the 
long  bones  were  notched  ;  and  (5)  the  phalanges  were 
short  and  broad. 

A  Case  of  Tuberculous  Disease  of  the  Elbow- Joint,  with 
Dislocation  of  the  Upper  End  of  the  Radius,  in  an  infant, 
aet.  1 5  months,  was  shown  by  Mr.  J.  Thomson  Walker. 
Three  months  after  a  fall  the  elbow  had  become  swollen 


and  tender,  and  the  child  was  treated  at  another 
hospital  for  fracture  about  the  elbow,  the  arm  being 
put  up  in  splints,  and  later  massage  was  used.  Under 
this  treatment  the  arm  got  steadily  worse.  Mr. 
Thomson  Walker  found  the  ends  of  the  humerus,  radius, 
and  ulna  to  be  markedly  thickened,  and  the  joint 
swollen.  There  was  also  thickening  of  the  fifth  meta- 
carpal bone  of  the  left  hand.  As  regards  the  diagnosis, 
he  had  to  consider  whether  a  fracture  had  ever  been 
present,  and  whether  syphilis  might  not  be  a  factor  in 
the  case,  as  there  was  a  history  of  numerous  mis- 
carriages. Under  mercurial  inunction  and  splinting 
the  condition  had  almost  entirely  cleared  up  after  four 
months.  The  patient  then  passed  from  observation, 
and  some  months  later  the  joint  wsls  found  to  be  much 
worse,  and  the  upper  end  of  the  radius  was  dislocated 
forwards.  Later  there  was  definite  evidence  of  tuber- 
culosis in  the  joint. 

A  Girl,  Oft.  2,  with  Motor  Paraplegia  and  with  Absence 
of  Speech,  which  might  have  been  Congenital,  or  Syphilitic, 
or  Secondary  to  Scarlet  Fever  and  Diphtheria,  was  ex- 
hibited for  diagnosis  by  Dr.  Ewart.  He  demonstrated 
a  method  of  using  the  reflexes  (superficial  and  deep) 
as  a  means  of  exercising  paralysed  muscles,  which  he 
had  not  previously  published. 

A  paper  on  A  Case  of  Perforated  Gastric  Ulcer  in  a 
boy,  aet.  13,  was  read  by  Mr.  Watson  Cheyne  and  Dr. 
R.  H.  W.  WiLBE.  The  patient  had  enjoyed  good 
health  until  the  onset  of  the  illness,  which  was  marked 
by  severe  abdominal  pain  about  the  umbilicus.  He 
rapidly  became  worse,  and  after  consultation  the  same 
evening  it  was  decided  to  operate.  The  appendix  was 
examined,  found  to  be  diseased,  although  not  actively, 
and  was  removed.  As  the  signs  pointed  to  some 
rupture,  the  rest  of  the  abdomen  was  explored,  and 
over  the  front  of  the  stomach  some  turbid  fluid  was 
found,  and  gas  bubbled  up.  On  further  searching,  a 
small,  round  perforation  was  found  on  the  anterior 
surface  of  the  stomach  about  an  inch  from  the  cardiac 
end,  from  which  gastric  juice  and  gas  were  escaping. 
The  ulcer  was  treated  in  the  usual  way,  and  the  boy 
made  an  uninterrupted  recovery.  They  referred  to 
the  rarity  of  perforating  gastric  ulcer,  apart  from 
tuberculosis,  at  this  age.  Another  point  of  interest  was 
that  a  diseased  appendix  was  found  and  removed,  but 
the  presence  of  gas  in  the  abdomen  showed  that  there 
must  be  some  other  lesion.  Unless  this  sign  had  been 
regarded  as  conclusive  they  would  not  have  discovered 
the  ulcer,  for  its  situation  wais  so  remote  that  every  part 
of  the  intestines  and  stomach  had  been  previously 
examined,  and  very  careful  searching  was  required  to 
find  it. 

Mr.  Clement  Lucas  was  not  quite  sure  from  the 
history  of  the  case  that  tuberculosis  could  be  excluded 
as  the  cause  of  the  ulcer.  The  condition  was  certainly 
a  very  rare  one. 

Dr.  Porter  Parkinson  referred  to  a  case  he  had 
met  with  in  a  child  of  two  years,  where  death  was  due 
to  a  perforating  gastric  ulcer,  and  where  post-mortem 
no  trace  of  tubercul  osis  could  be  detected  in  any  part 
of  the  bodv. 


Special  Hrticles. 

BRITISH    SANATORIA    FOR    CONSUMPTION.- 
XLIII. 


[by   our    special    medical    commissioner.] 

THE  DARTMOOR  SANATORIUM,  CHAGFORD, 
DEVON. 
Devon's  famous  highlands,  Dartmoor,  has  long 
been  a  favourite  resort  of  the  artist  and  the  antiquary, 
and  a  happy  hunting  ground  for  the  sportsman,  but 
its  possibilities  as  a  health  station  have  received  but 
little  serious  study.  Various  well-known  resorts  in 
Devon  have  been  widely  advocated  and  extensively 
used  as  residences  for  the  consumptive,  but  it  is  a 
somewhat  remarkable  fact  that  at  present  there  are 
only   three   sanatoria,    one    public   and    two  private. 


July  6,   1904. 


SPECIAL    ARTICLES. 


The  Medical  Press.       H 


where  efficient  and  systematic  open-air  treatment  is 
provided  in  accordance  with  modern  procedure. 
Dartmoor,  particularly  in  the  neighl)Ourhood  of  its 
marginal  fringe,  offers  climatic  and  geographical 
conditions  peculiarly  suited  to  the  needs  of  many 
phthisical  cases ;  and  Chagford,  on  its  eastern  border, 
furnishes  a  locality  almost  ideal  for  the  hygienic 
management  of  many  patients  with  pulmonary'  tuber- 
culosis. Dr.  A.  Sco'tt  Smith  has.  therefore,  shown 
wise  discernment  in  establishing  his  Dartmoor  Sana- 
torium at  Torr  House,  on  the  eastern  slopes  of  Devon's 
tableland,  at  an  elevation  of  about  750  feet  above  sea 
level,  and  about  a  mile  and  a  half  above  and  to  the 
west  of  the  charming  hamlet  of  Chagford,  193  miles 
distant  from  London, and  situated  at  an  altitude  of  650ft. 
We  have  thoroughly  explored  the  district  and  have 
carefully  inspected  the  sanatorium,  and  have  had 
the  privilege  of  a  personal  study  of  the  manner  and 
method  of  management  there  employed,  and  are  thus 
able  to  testify  not  only  to  the  local  advantages  of  the 
district,  but  can  aiso  bear  witness  to  the  very  efficient 
and  scientific  conduct  of  the  treatment. 

Dr.  Scott  Smith  is  himself  an  old  tuberculous  patient 
who  has  had  wide  experience  of  sanatorium  manage- 
ment. He  is  an  ardent  disciple  of  Walther.  and  his 
establishment  is  conducted  on  strict  Nordrach  lines, 
but  softened  by  a  sympathy  which  is  characteristic 
of  the  best  in  English  medicine,  and  strengthened  by  a 
sound  common  sense  which  must  appeal  to  all  unfor- 
tunate Britishers  fortunate  enough  to  come  under 
Dr.  Scott  Smith's  firm  and  far-seeing  control. 

The  sanatorium  is  particularly  well  placed,  sheltered 
by  hills  and  trees  from  trying  winds,  freely  open  to  the 
south  and  immediately  surrounded  by  attractive 
grounds.  The  institution  has  been  fitted  for  its  purpose 
by  a  wise  adaptation  and  modification  of  a  large 
and  well  -  constructed  private  country  house.  The 
patients' rooms  have  been  furnished  in  accordance  with 
modem  demands.  The  dining-room  is  a  large,  airy 
and  well-lit  apartment.  The  house  is  provided  with 
electric  light ;  the  drainage  system  is  excellent,  and 
there  is  a  plentiful  supply  of  water  both  for  baths  and 
drinking  purposes. 

At  the  present  time  the  establishment  is  being 
enlarged  by  the  addition  of  several  admirably  designed 
rooms. 

Dr.  Scott  Smith,  as  we  have  had  ample  opportunities 
of  observing,  devotes  himself  entirely  to  the  direction 
of  his  sanatorium.  Every  case  is  constantly  under 
his  supervision,  and  each  detail  of  the  patient's  life 
is  subjected  to  medical  direction.  Great  care  is  given 
to  the  nutrition  of  the  sufferers,  and  hyper-alimentation 
is  rigorously  enforced.  The  amount  of  exercise  and 
rest  is  carefully  regulated.  The  walks  are  peculiarly 
attractive,  numerous,  and  in  gradient,  degree  of  pro- 
tection and  exposure  allow  of  great  variation.  We 
consider  the  sanatorium  almost  unique  among  English 
institutions  in  the  excellence  of  its  facilities  for  pic- 
turesque and  suitable  pedestrian  exercise.  Other 
forms  of  exercise  are  wisely  discouraged,  and  patients 
are  not  advised  to  spend  time  in  shelters.  They  are 
thoroughly  instructed  in  the  hygienic  management  of 
their  disease.  The  fear  of  chills  from  exposure  or 
the  dangers  supposed  to  arise  from  getting  wet  are 
demonstrated  to  be  in  great  measure  mytliical.  No 
systematic  medication  is  employed. 

The  sanatorium  is  placed  in  a  truly  romantic  neigh- 
bourhood, embracing  some  of  the  finest  river,  mountain 
and  moorland  scenery  in  England.  Opportunities 
for  hill-climbing  lie  close  at  hand,  and  tors  ranging 
from  800  to  1 ,400  feet  are  within  easy  reach.  Patients 
with  artistic  tastes  will  find  endless  material  for 
brush  or  pencil  in  the  perfect  river  peeps  on  the  South 
Teign,  along  the  banks  of  which  suitable  cases  can 
freely  ramble.  We  consider  the  psychical  influence 
of  the  district  to  be  one  peculiarly  advantageous  to 
phthisical  patients  of  refined  tastes  and  artistic 
inclinations. 

It  should  be  added  that  Dr.  Scott  Smith  and  his 
wife  take  all  their  meals  with  the  patients,  and  lead 
the  same  open-air  life.     The  maintenance  of  English 


home  life  is  an  element  the  advantage  of  which  patients 
are  not  slow  to  appreciate. 

The  terms  depending  on  the  room  occupied  are  from 
three  to  five  guineas  per  week,  inclusive  of  medical 
attendance,  board  and  lodging. 

The  sanatorium  is  by  no  means  so  inaccessible  as 
might  be  thought.  A  carriage  can  be  sent  to  meet 
patients  on  arrival  at  either  of  \he  two  available 
railway  stations,  viz.,  Moretonhampstead  (G.W.R.) 
five  miles  off,  or  Okehampton  (L.  &  S.W.R.),  eleven' 
miles  distant. 

Moretonhampstead  can  be  reached  from  London  vid 
Exeter  and  Newton  Abbott  in  about  five  and  a  half 
hours ;  and  Okehampton  vid  Exeter  in  about  four 
and  a  half  hours.  During  the  summer  months,  by 
leaving  Waterloo  at  11  a.m.  Okehampton  may  bs 
reached  at  3.12  p.m. 

Omnibuses  under  the  direction  of  G.W.R.  run  from 
Moretonhampstead  to  Chagford,  and.  we  believe, 
motor  cars  will  soon  be  doing  this  journey.  The 
L.  &  S.W.R.  have  recently  started  a  service  of  motor 
cars  from  Exeter  to  Chagford.  the  distance  being 
covered  in  some  two  hours. 


NORTH   OF   ENGLAND   COLLIERY   SURGEONS 
AND  THEIR  FEES. 

Prior  to  the  formation  of  the  Northumberland  and 
Newcastle  Medical  Association,  the  colliery  doctors 
in  that  county  were  paid  by  the  miners  6d.  a  fortnight 
per  family  for  medical  attendance,  which  sum  was 
supplemented  by  a  small  fee,  varying  indifferent  locali- 
ties, from  grown-up  sons  and  lodgers.  This  rule  had 
continued  for  sixty  years,  but  with  the  increased  cost 
of  education  and  of  appliances  it  was  felt  by  the  medical 
men  to  be  insufficient  remuneration  for  a  hard  class  of 
practice.  Abuses,  moreover,  such  as  those  of  com- 
mittee management,  had  begun  to  creep  in.  Four 
years  ago  the  Association  in  question  was  formed  and 
proved  successful  both  in  removing  abuses  and  in 
raising  fees  to  a  minimum  of  gd.  per  fortnight.  Re- 
cently in  several  districts  (especially  in  one  where 
the  miners  had  tried  to  fight  this  Association  by  means 
of  imported  practitioners)  an  agitation  has  been 
fomented  amongst  the  men,  but  its  leaders  not  finding 
their  local  efforts  satisfactory,  their  delegates  referred 
the  matter  to  the  County  Miners'  Union.  At  the 
request  of  the  Union,  representatives  from  the  Medical 
Association  met  a  committee  of  the  Union  and  discussed 
the  matter.  The  subjoined  relates  to  the  report  made 
by  the  doctors'  committee  to  this  Association  and 
adopted   by  them. 

The  difficulty  which  has  for  some  time  been  cropping 
up  amongst  the  miners  with  regard  to  medical  fees  has 
now  entered  upon  a  new  phase  in  Northumberland.  A 
statement  has  been  issued  setting  forth  the  particulars 
of  a  conference  on  the  subject  between  Messrs.  H.  Boyle, 
R.  Young.  G.  Middleton,  A.  McKay  and  S.  Morton  on 
behalf  of  the  miners,  and  Mr.  Rutherford  Morison  and 
Drs.  Cromie.  Ruddock,  and  Bunting  on  behalf  of 
I  he  Medical  Union,  in  which  it  is  pointed  out  the 
since  the  doctors'  fees  had  been  raised  wages  had  fallen 
40  per  cent,  of  the  percentage  above  the  miners' 
standard  wage,  and  on  this  account  the  medical  fees, 
it  was  contended,  should  be  reduced. 

The  medical  representatives  claimed  that  the  in- 
creased fee  had  not  been  asked  for  or  granted  because 
the  miners'  wages  were  temporarily  high.  The  reasons 
were — 

1.  That  for  sixty  years  the  medical  fees  for  attend- 
ing upon  miners  had  been  sixpence  a  fortnight.  During 
this  time  wages  in  all  occupations  except  medical  had 
largely  increased. 

2.  That  sixty  years  ago  a  medical  degree  could  be 
obtained  with  less  than  three  years  of  study.  Now  the 
least  time  possible  was  five  years.  The  time  occupied 
and  the  expense  of  obtaining  a  qualification  to  practise 
were  double. 

3.  That  four  years  ago  it  was  made  illegal  for  medical 
men  to  employ  unqualified  assistants  ;  consequently, 
all  assistants  must  now  be  qualified,  and  it  was  difficult 


12    The  Medical  Press, 


FRANCE. 


July  6,   loo^- 


to  get  them  into  colliery  practice  and  expensive  to  keep 
them  there.  The  attendance,  now  given  being  entirely 
by  qualified  men,  is  of  more  value  than  that  formerly 
given  ;    and 

4.  That  the  increased  cost  of  drugs,  instruments, 
dressings,  &c.,  added  materially  to  the  expense  of 
practice. 

The  miners  meet  this  by  asserting  that  many  of  the 
serious  cases  are  now  sent  to  hospitals,  and  that  it  is 
unusual  to  perform  operations  at  the  houses  of  patients. 

On  behalf  of  the  doctors  it  is  held  that  the  advance 
of  medical  science  has  made  hospital  treatment  neces- 
sary, and  as  an  example  an  affliction  common  and 
serious  amongst  miners  is  given.  For  the  cure  of  this 
291;  operations  were  performed  at  the  Royal  Infirmary, 
Newcastle,  in  1903,  and  in  95  cases  out  of  a  hundred 
the  cure  is  permanent,  whilst  so  lately  as  ten  years  ago 
the  operation  was  seldom  performed  with  hope  of 
success.     For  these  cases  no  fees  are  received. 

Against  this  the  miners  point  out  that  in  most  colliery 
districts  qualified  nurses  maintained  by  the  workmen 
greatly  assist  the  medical  practitioners. 

The  medical  representatives,  after  careful  considera- 
tion, advise  the  Medical  Association  in  the  following 
terms: — "That  in  their  opinion  it  is  i^mpossible  to 
obtain  and  retain  the  services  of  qualified  medical  men 
of  ability  and  good  character  for  colliery  districts  at 
less  than  the  fee  of  9d.  a  fortnight,  which  was  fixed  upon 
as  a  minimum  ;  that  a  reduction  of  the  present  medical 
fees  would  tend  to  lowering  of  the  standard  of  medical 
work,  and  defeat  the  endeavour  of  our  Association  to 
increase  the  usefulness  and  the  skill  of  our  members." 

The  foregoing  having  been  placed  before  the  Council, 
the  Miners'  Association  has  been  empowered  to  take 
steps  to  bring  about  a  reduction  of  50  per  cent,  in  the 
fees  now  paid,  the  figures  in  the  proxy  vote  being  as 
follows  : — For,  141  ;  against,  30  ;  majority  in  favour, 
III. 

It  wijil  be  seen  that  the  Miners'  Association  has  been 
instructed  to  take  steps  to  have  the  doctors'  remunera- 
tion lowered  by  50  per  cent. 

It  therefore  becomes  a  matter  of  imperative  im- 
portance that  medical  men  should  refrain  from  taking 
appointments  of  any  description  in  the  county  of 
Northumberland  without  first  inquiring  from  Mr. 
Garforth  Drury,  of  95  Pilgrim  Street,  Newcastle- 
upon-Tyne.  Secretary  N.  and  N.M.A.,  or  from  Dr.  Cox. 
Gateshead,  Hon.  Secretary  North  of  England  Branch, 
B.M.A. 


CENTRAL  MIDWIVES'  BOARD. 


Meeting  held  June  30TH,  1904. 
Dr.  F.  H.  Champneys  in  the  Chair. 

Dr.  Ward  Cousins  moved  that  "  registered  members 
of  the  medical  profession  only  be  eligible  for  appoint- 
ment as  examiners  under  the  Central  Mid  wives'  Board." 
It  was,  in  his  opinion,  eminently  necessary  that  as  the 
teachers  were  fully  qualified  as  medical  men  the 
examiners  should  be  so  too,  as  only  such  could  under- 
stand questions  bearing  on  midwifery,  and  their  medical 
confrites  felt  very  strongly  on  this  point.  Take,  for 
instance,  the  duties  of  a  midwife  before  and  after  labour  : 
her  duties  with  regard  to  sanitation,  the  feeding  of 
infants,  all  such  are  safest  to  be  taught  by  a  medical 
man. 

Mr.  E.  Parker  Young  considered  it  retrogressive 
not  to  have  fully  qualified  medical  men  as  examiners. 

Miss  Wilson  objected,  considering  a  woman  who 
taught  nursing  would  be  the  best  to  put  questions  on 
that  subject,  and  a  fully  qualified  matron  was  capable 
of  doing  this.  At  any  rate,  the  matter  should  be  left 
in  the  hands  of  the  Board.     To  this 

Dr.  Cullingworth  agreed,  arguing  it  might  be  taken 
for  granted  that  no  unsuitable  person  would  be  ap- 
pointed. Undoubtedly  women  were  fit  for  their  own 
part  of  the  work,  but  no  strict  rule  should  be  laid  down 
as  to  their  appointment. 

Dr.  Sinclair  considered  the  matter  ought  to  be 
finally  settled,  his  remark  being  seconded  by 


Dr.  J.  W.  Cousins,  who  considered  nursing  as  a  very 
high  art  indeed,  and  the  duties  of  a  lying-in  room  should 
be  done  by  the  best  nurses.  How  could  any  woman, 
merely  taught  under  the  flimsy  rules  of  a  board  of 
guardians,  do  this  well  ?  She  might  acquire  a  vast 
amount  of  book  learning,  but  hospital  or  infirmary 
practice  was  absolutely  necessary. 

The  Chairman  suggested  substituting  "  may  "  for 
"  must."  In  certain  circumstances  a  highly  trained 
midwife  might  be  useful  on  the  Board.  There  were 
many  things  a  midwife  could  do  better  than  the  doctor, 
such  as  making  beds  and  dressing  babies,  but  he  had  to 
I  see  that  she  did  them. 

I  Dr.  J.  W.  Cousins  here  inquired  whether  medical 
'  men  were  to  be  asked  to  collaborate  with  unqualified 
'  persons. 

!  It  was  finally  resolved  that  the  Examining  Board 
■  should  consist  of  qualified  medical  practitioners  only. 
I  the  meeting  then  passing  on  to  consider  whether  such 
!  should  be  obtained  by  advertisement  or  invitation,  it 
j  being  agreed  and  passed  that  invitation  would  produce 
I  better  applicants.  The  question  of  payment  was 
I  raised  by 

Mr.  Parker  Young,  who  thought  that  if  they  were 
to  have  one  examiner  for  every  twelve  candidates 
(oral)  it  would  mean  that  he  would  work  only  three 
hours  a  day.  and  if  not  less  than  two  examiners  were 
appointed  with  a  fee  of  los.  6d.  for  every  candidate, 
where  would  the  working  expenses  come  from,  the  en- 
trance fee  being  one  guinea  ?  It  was  finally  agreed  to 
reduce  the  payment  to  7s.  for  each  examiner. 

Miss  Paget,  at  this  stage,  put  in  a  protest  against  the 
arrangements  for  examinations — i.e.,  that  twice 
yearly  the  same  papers  should  be  given  in  London  and 
the  provinces.  She  maintained  that  to  wait  six  months 
after  failure  was  too  long  for  a  woman  who  had  her 
living  to  earn. 

Dr.  Sinclair,  in  reply,  said  a  good  midwife  would  not 
fail.  If  she  did,  things  ought  not  to  be  made  too  easy, 
it  being  finally  arranged  that  the  words  "  oftener 
if  necessary  "  should  be  inserted  after  the  words  "  twice 
a  year  in  London  and  the  provinces,"  and  an  examiner 
to  attend  at  the  various  centres  of  examination  even 
if  the  candidates  numbered  below  twelve. 


JFtancc* 


[from  our  own  correspondent.] 


Paris,  JvAy  3rd,  1304. 
Treatment  of  Sprains. 

The  treatment  of  sprains  depends,  says  Dr.  Mores  tin . 
on  the  period  in  which  the  surgeon  sees  the  patient. 
It  is  not  often  that  he  is  called  in  immediately  after  the 
accident  ;  generally  one  or  two  days  elapse,  when  the 
blood  has  had  time  to  effuse  into  the  synovial  bursae  or 
to  infiltrate  the  cellular  tissue.  At  other  times, 
the  accident  is  several  days  if  not  weeks  old,  and  in  such 
cases  one  is  no  longer  in  presence  of  a  sprain  but  of  it 
complications. 

At  the  outset,  the  pain  must  be  relieved  and  infiltra- 
tion prevented  if  possible.  Later,  it  will  be  necessary 
to  obtain  the  absorption  of  the  effusion,  and  hinder 
complications.  When,  however,  the  lesion  is  already 
of  a  certain  date,  these  latter  have  to  be  treated. 
Formerly,  a  large  place  was  given  to  "  blisters  "  in  the 
treatment  of  sprains,  but  they  have  for  a  long  time 
fallen  into  disuse,  and  rightly  so.  But  cold  or  hot 
applications  have,  on  the  contrary,  rendered  good 
service.  Immersion  in  hot  or  cold  water  constitutes, 
when  possible,  a  simple  remedy  not  to  be  ignored. 
Baudens  strongly  recommended  in  cases  of  ankle 
sprains,  plunging  the  foot  in  cold  water  and  keeping 
it  there  as  long  as  was  agreeable  to  the  patient,  fol- 
lowed by  a  compressive  bandage.  The  ice  bag  or. 
on  the  contrarv,  a  hot-water  bottle  or  hot  sand  are 


July  6,   1904. 


GERMANY. 


The  Medical  Press.      ^3 


sometimes  excellent  resources  in  sprains  of  the  knee 
or  the  hip-joint.  However  that  may  be,  the  real 
curative  treatment  consists  in  mechanical  means,  by 
^vhich  the  tissues  are  compressed  so  as  to  provoke 
absorption  of  the  blood,  lymph,  exudations,  or  con- 
secutive infiltrations. 

Of  these  means,  the  most  ancient  is  compression. 
Before  cotton-wool  was  employed,  it  was  a  painful  and 
even  dangerous  method,  but  with  the  apparatus  as 
known  to-day  compression  gives  very  good  results. 
Yet  this  treatment  is  insufficient,  and  can  only  be 
justified  by  the  impossibility  of  having  recourse  to 
massage,  or  the  elastic  bandage  applied  in  the  interval  of 
the  baths  or  the  stances  of  massage ;  thus  the  apparatus 
is  a  means  not  to  be  neglected.  The  elastic  bandage  is, 
in  the  opinion  of  Dr.  Morestin.  the  most  perfect  means 
of  obtaining  absorption  of  the  blood  or  any  other 
■effusion  into  the  joint  provided  it  is  not  drawn  too 
tight.  Massage  is  of  very]  general  application, 
although  its  good  effects  were  long  ignored  by  surgeons. 
The  pressure  should  be  gradual,  centripetal,  and  pain- 
less. At  the  beginning  it  should  be  light  and  super- 
ficial, so  as  to  accustom  the  painful  region  to  the  con- 
tact of  the  hands.  Gentleness  is  the  principal  point  in 
the  operation.  Massage  is  particularly  successful  in 
ankle  sprain.  When  applied  immediately  after  the 
accident  it  works  like  a  miracle.  After  from  ten  to 
twenty  minutes  of  intelligent  massage,  the  patient 
recovers  the  use  of  the  articulation.  In  the  case  of 
knee  sprain,  massage  would  be  rather  prejudicial. 
The  elastic  bandage  should  be  preferred  after  the  first 
two  or  three  days  of  the  accident.  Massage,  on  the 
other  hand,  is  the^only  beneficial  treatment  of  sprain 
of  the  hip  and^the  shoulder,  especially  if  employed  at 
the  very  first,  otherwise,  if  several  days  have  passed, 
an  apparatus  for  continued  traction  to  obviate  stiffness 
of  the  joints  should  be  applied.  As  to  rendering  the 
joints  immovable,  the  day  has  passed  since  such  useless 
and^hurtful  treatment  has  been  employed. 


aermans. 

[from 'our  own  correspondent.] 


Berlin,  July  2iid,  1904. 

At  the  Society  for  innere  Medizin,  Hr.  Eulenburg 
showed 

Two  Cases  of  Acromegaly. 

The  first  was  that  of  a  machinist  who  had  an  accident 
three  years  ago.  The  speaker  had  been  applied  to  for 
an  opinion  as  to  the  connection  between  the  accident 
and  the  now  existing  disease.  The  patient  was  stand- 
ing before  the  water-level  indicator  of  a  boiler  when  an 
-explosion  took  place.  In  his  fright  he  struck  away  the 
object  he  was  standing  on  and  fell  among  the  coals. 
He  had  numerous  injuries  about  the  face,  complained 
of  headache,  and  had  a  staggering  gait.  After  a  few 
days  he  went  to  work  again,  but  soon  had  to  give  it  up 
altogether.  After  this  the  symptoms  of  acromegaly 
appeared.  These  were  most  pronounced  about  the 
head,  the  hands  and  feet,  the  trunk,  and  especially 
about  the  vertebral  column.  There  was  marked 
widening  and  thinning  of  the  sella  turcica,  and  above 
the  sella  a  half-dark  shadow  that  pointed  to  tumour 
of  the  hypophysis.  There  were  no  other  characteristic 
symptoms  of  tumour,  and  the  field  of  vision  was  normal. 

The  ^question  was :  Was  the  acromegaly  a  conse- 
quence of  the  accident  ?  The  Court  of  Arbitration 
had  decided  not.  An  objection  to  this  finding  had  been 
raised,  and  the  speaker  had  given  his  opinion  that  the 
IX)ssibility  of  a  connection  between  the  two  could  not 
be  denied.     In  confirmation  of  this  were  the  facts  that 


acromegaly  among  men  was  very  rare  indeed  after 
forty,  and  that  in  ajcoUection  of  ^fif  ty-five  cases  it  onl}' 
occurred  after  that  age  in  three,  and  in  each  case  in 
connection  with  an  accident.  It  was  also  a  question 
whether  the  shock  or  the  injuries,  or  both  combined, 
should  be  looked  upon  as  the  cause. 

The  second  case  was  that  of  a  man,  set.  25,  who  had 
been  shot  in  the  face  with  small  shot  about  four  years 
ago.  Some  of  the  shot  corns  could  still  be  felt  under 
the  skin.  Some  months  later  the  patient  took  part  in 
some  military  exercises,  and.  later,  hemianopsia 
was  noted,  and  at  the  same  time  the  acromegaly. 
There  had  beeil  no  change  in  the  condition  since  then. 
In  this  patient  also  the  head,  hands,  and  feet  were  very 
much  changed,  especially  on  the  right  side.  Rontgen 
illumination  showed  widening  and  thinning  of  the  sella 
turcica,  but  there  was  no  shadow  above  it  as  in  the  pre- 
vious case,  so  that  there  was  no  sign  of  a  tumour  of  the 
hypophysis.  Here  the  intracranial  symptoms  were 
markedly  developed,  hemianopsia,  phthisis,  imperfect 
action  of  the  rectus  internus  muscle,  polydipsia,  hyper- 
idrosis,  and  scoliosis  of  the  vertebral  column. 

The  speaker  finally  showed  the  Rontgen  image  of  a 
third  case,  that  of  a  married  lady.  aet.  29,  who  had 
never  menstruated.  For  a  long  time  she  had  suffered 
from  orbital  migraine  then  amaurosis  of^the  right  optic 
appeared,  and  distinct  imbecility.  The  signs  of  acro- 
megaly appeared  later.  The  picture  showed  widening 
and  thinning  of  the  sella  turcica  and  a  shadow  above 
it  the  size  of  a  walnut ;  here  also  there  was  probably 
a  tumour  of  the  hypophysis. 

Muretin. 

Hr.  Litten  spoke  on  muretin,  prepared  by  the  firm  of 
Bayer  and  Co.,  and  recommended  as  a  depoisoned 
antifebrin,  the  daily  dose  of  which  was  05  gramme 
in  divided  doses.  It  was  stated  to  be  a  very  power- 
ful  antipyretic,  particularly  useful  in  the  pyrexia  of 
phthisical  patients.  The  drug  was  handed  to  him  for 
experiment,  and  the  results  of  these  had  not  corre- 
sponded to  the  promises  held  out.  As  regarded  its 
harmlessness  he  had  seen  moderate  collapse  in  one  case 
and  outbursts  of  perspiration  in  every  case,  that  lasted 
for  hours  and  left  the  patients  exhausted.  These 
sweats  were  so  constant  and  persistent  that  patients 
refused  to  continue  taking  the  medicine. 

At  the  Surgical  Congress  the 
Present  State  of  the  Perityphlitis  Question 
was  discussed  by  Hr.  von  Bungner.  He  would  make 
the  attempt  to  bring  about  some  convergence  of  the 
present  very  divergent  views  of  physicians.  He  could 
there(pre  only  discuss  certain  points.  The  patho- 
logical anatomists  had  revised  their  views  as  to  the 
relation  of  the  vermiform  appendix  to  the  peritoneum, 
as  it  had  been  shown  that  suppuration  might  be  set  up 
by  the  processus.  Its  length  varied  with  age  and  other 
normal  conditions.  As  regards  its  walls,  the  submucosa 
was  the  most  important  part,  which  was  very  rich  in 
follicles.  In  his  opinion  an  acute  inflammation  pre- 
ceded the  chronic,  and  not  vice  versii.  The  inflamma- 
tion was  generally  limited  to  the  submucosa  and  the 
muscular  layer  was  usually  destroyed  along  with  the 
former.  When  late  attacks  came  on  perforation 
readily  took  place  in  those  spots  where  these  layers 
had  been  destroyed,  and  the  mucous  and  serous  layers 
lay  together.  Whether  pus  was  poured  into  the  peri- 
toneal cavity  depended  on  whether  adhesion  had  pre- 
viously taken  place.  There  were  both  an  acute  and  a 
chronic  perityphlitis.  The  chronic  form  was  usefully 
treated  by  operation.  The  appendix  was  extirpated 
so  that  nothing  of  it  was  left  behind.  In  cases  of 
pyaemia,    the    metastatic  collections  must  be  traced 


14    The  Medical  Press. 


AUSTRIA. 


July  6,  1904. 


out.  In  paratyphlitis  the  lumbar  region  must  be  care- 
fully examined.  In  perityphlitic  abscess  early  opera- 
tion was  indicated.  The  processus  should  not  be  re- 
moved unnecessarily,  only  when  it  was  lying  free. 

He  also  distinguished  a  perityphlitis  and  an  epi- 
typhlitis  simplex.     Here  operation  should  not  be  per- 


tion,  and  trophic  disturbance ;     (4)  general  enfeeble- 
ment  or  cachexia. 

Blum  remarked  that  morbid  changes  in  the  male 
apparatus,  like  prostatic  hypertrophy,  produced 
tetanoid  phenomena,  known  by  Trousseau  as  Chvostek's 
symptom.     He  was  inclined  to  believe  that  the  urine 


formed  in  the  acute  stage,  say  the  moderate  surgeons  ;  ;  was  not  alone  the  cause  of  these  tetanoid  attacks  and 
the  radical  ones  would  operate  in  all  cases  to  remove  :  thought  the  prostate  was  as  much  to  blame  as  the  re- 


the  threatened  danger.  In  most  recent  times  the 
majority  of  surgeons  had  expressed  themselves  in 
favour  of  early  operation,  but  it  involved  certain  risks. 
Cases  of  simple  perityphlitis  generally  ran  their  course 
in  about  five  days,  and  by  the  second  adhesions  had 
formed,  which  must  be  broken  up  at  an  operation. 
This  involved  the  danger  of  leading  to  general  peri- 
tonitis. One  must  decide  early  whether  these  cases 
should  be  treated  surgically  or  medically.  If  the 
decision  was  to  treat  them  surgically  the  operation 
should  be  performed  on  the  second  day  at  the  latest. 

Httstrta* 

[from  our  own  correspondent.] 


ViHNA,  Jnly  Srd,  1904. 
Genu  Valgum  Adolescentium. 

At  the  Gesellschaft  Aberle  exhibited  a  patient 
with  bilateral  genu  valgum  which,  according  to  the 
history,  had  not  developed  earlier  than  the  ninth 
year.  The  Rontgen  rays  proved  the  bending  to  be  in  the 
lower  part  of  the  femur  in  both  legs. 

The  proper  treatment  to  be  followed  was  osteotomy, 
in  accordance  with  the  rules  laid  down  by  MacEwen 
and  Schede. 

Patellar  Fracture. 

Biidinger  had  two  patients  to  show  on  whom  he  had 
operated  for  fractured  patella.  In  both  cases  he  applied 
para-  and  pre-patellar  stitches  without  stitching  the 
patella  itself.  Early  passive  movement  in  from  live 
to  seven  days  was  applied,  with  a  rapid  healing  of  the 
fractured  jmrts. 

Eiselsberg  prefaced  a  discussion  on  this  form  of  treating 
factured  patellx.  He  was  also  of  opinion  that  both 
active  and  passive  movements  should  be  commenced 
in  the  first  week  of  the  treatment.  Much  was  said  by 
the  following  speakers  for  and  against  the  treatment 
which  might  be  summed  up  as  speculative. 
Freezing  Rontgen  Burns. 

Riehl  showed  the  society  a  young  woman  who  had 
suffered  severely  from  bums  on  the  chest  caused  by 
the  Rontgen  rays,  which  he  had  treated  successfully 
by  freezing  the  skin  with  ether  chloride  spray. 

At  the  same  time  he  showed  a  man,  aet.  65.  on«whom 
he  had  acted  with  the  Rontgen  rays  for  an  idiopathic, 
haemorrhagic,  cutaneous  sarcoma  with  perfect  success, 
as  the  morbid  condition  has  now  quite  disappeared. 

Freund  remarked  that  this  therapy  of  freezing  in 
Rontgen  ray  injuries  is  consistent  with  the  application 
of  the  Rontgen  rays  in  dermatitis.  As  to  the  effects 
in  sarcoma  he  was  sceptical,  as  some  do  well,  while 
others  are  unaffected. 

Spiegler  said  he  had  a  peculiar  result  from  the  treat- 
ment %vith  the  Rontgen  rays  in  the  case  of  a  lady,  whose 
chin  became  dark  blue  in  colour. 
Urosepsis. 

Kornfeld  gave  the  members  a  resume  of  the  sympto- 
matology of  urosepsis,  which,  he  said,  varied  from 
local  irritation,  like  prostatic  hypertrophy,  stenosis, 
&c.,  to  the  general  haematic  changes  in  fever.  These 
he  divided  into  (i)  Uric  fever  appearing  in  an  acute, 
recurrin?,  or  chronic  form  ;  (2)  gastric  phenomena  ; 
(3)  nervous  changes  su  h  as  tetany,  migraine,  pigmenta- 


moval  of  the  thyroid  was  for  myxcedema.  Basedow 
confirmed  this  connection  by  producing  genital  atrophy, 
which  resulted  in  myxcedema.  The  very  fact  of 
metastasis  occurring  in  mumps  points  to  a  glandular 
connection  with  the  genital  apparatus,  and  knowing 
that  the  removal  of  these  glands  produce  a  lowered 
state  of  the  vitality  it  is  reasonable  to  believe  that 
the  suspension  or  abolition  of  the  prostate  interferes 
with  the  poietic  function  of  the  organism  by 
withholding  some  necessary  secretion  for  per- 
fecting the  vital  force.  Another  strong  argu> 
ment  in  favour  of  the  genital  origin  of  many  of 
these  diseases  is  the  result,  of  removing  the  ovaries 
which  we  recognise  as  ovarian  cachexia.  Is  it 
not  probable  that  atrophy  or  injury  of  the  prostate  will 
produce  a  similar  result  ? 

Kornfeld  could  not  agree  with  Blum  although  he 
admitted  there  was  a  good  deal  of  analogy  in  his  argu- 
ment. In  the  ovarian  cachexia  referred  to,  a  number  of 
the  phenomena  were  present  that  dissociated  it  from 
the  prostate ;  and  furthermore  very  many  cases  of 
prostatic  parenchyma  destruction  are  met  with  where 
no  cachexia  exists. 

Thyroid  Gland  and  Epithelial  Cells. 

The  discussion  on  this  subject  was  resumed.  Pineles 
read  a  paper  some  time  ago  attributing  the  changes  in 
the  gland  to  alterations  in  the  epithelial  cells. 

Escherich  disagreed  with  Pineles'  theory  of  the 
insufficiency  of  the  epithelial  cells  being  the  cause  of 
the  tetany.  In  children,  where  tetany  is  more  common 
under  one  year  of  age,  the  connection  is  more  likely 
to  arise  from  improper  feeding  than  insufficient  epithe- 
lial cells  in  the  thyroid. 

Jonas  put  forward  "  Gastric  dilatation  tetany  "  in 
support  of  Pineles'  theory.  The  dilatation,  he  contended, 
was  not  the  cause  of  the  tetany,  but  an  accident  in  the 
course  of  the  morbid  changes,  while  the  insufficiency 
of  the  epithelial  corpuscles  could  not  be  said  to  be 
due  to  the  dilatation. 

Loebl  thought  [the  tetany  in  gastro-intestinal 
diseases  could  not  be  called  accidental,  asgastro-enteritis 
when  severe  always  produced  the  Chvostek-Erb  and 
Trousseau  phenomena.  In  addition  to  this  Italian 
experimenters  have  removed  the  cceliac  plexus  and 
produced  tetany  with"all^the  associated  symptoms. 

Redlich  concurred  with  Pineles  in  the  belief  that 
injury  to  the  epithelial  cells  of  the  gland  was  the  cause 
of  the  tetany.  It  is  unfortunate  for  this  argument  that 
no  exact  proof  can  be  brought  forward  to  substantiate 
either  hypothesis,  but  from  the  weight  of  inference 
adduced  the  proximate  cause  seemed  to  preside  in 
the  epithelial  cell. 

Frankl-Hochwart  did  not  agree  with  Pineles,"  and 
would  only  ask  one  question,  which  he  thought  most 
pertinent.  Why  is  it  that  tetany  is  so  seldom  met 
with  in  the  site  of  the  thyroid  gland  if  it  be  due  to 
insufficient  epithelial  cells?  To  this  Pineles  answered 
that  the  question  supported  the  theory  of  cell 
insufficiency. 

In  the  cretin  the  gland  itself  was  only  affected,  while 
the  epithelial  cells  remained  unaffected. 

In  answer  to  those  who  had  compared  children,  he 
quite  agreed  that  the  symptoms  resembled  strumipriva* 


July  6,  1904. 


EGYPT  AS  A  HEALTH   RESORT.         The  Medical  Press.     15 


but  were  not  exactly  the  same.  The  experiments  of 
Konigstein  on  animals  conclusively  proved  this  :  that  as 
soon  as  the  epithelium  appeared  the  tetany  disappeared. 
It  is  possible,  however,  that  gastro-intestinal  affections 
may  have  the  effect  of  reducing  or  otherwise  rendering 
the  epithelial  cells  inefficient,  which  would  conse- 
quently produce  tetany  as  expected. 

EGYPT    AS    A    HEALTH    RESORT. 


[by     our     special     travelling     correspondent.] 


With  your  kind  permission,  I  shall  venture  to  give 
you  some  idea  of  the  climatology  of  certain  parts  of 
Egypt,  and  inasmuch  as  so  many  who,  after  taking  a 
tour  of  a  few  weeks  only  in  Egypt,  go  back  to  their 
native  country  and  compile  works  containing  the 
climatic  phenomena  of  the  country,  bearing  pompous 
titles,  as  "  Egypt  and  the  Egyptians,"  or  **  Pharo's 
Rgypt,"  &c.,  I  may,  perhaps,  be  excused  as  an  indi- 
vidual who  has  resided  for  some  considerable  time  in 
Egypt,  with  a  good  knowledge  of  Arabic  and  Egyptian 
biology,  if  I  presume  to  pen  the  following.  In  this  I 
shall  try  to  give  an  outline  of  the  climate  and  other 
interesting  points  of  Suez,  Geb-el-Tor,  Ismailia, 
Port  Said,  Alexandria,  Cairo,  Luxor,  Assouan,  and 
Wady  Haifa,  leaving  my  fellow-practitioners  to  draw 
inferences  and  to  recommend  one  or  the  other  place  as 
to  the  suitability  of  the  patients  under  their  care. 

Suez  is  a  small  port  inhabited  chiefly  by  European 
employ^  of  the  Suez  Canal  Company,  as  well  as  by 
the  different  coaling  agents  and  their  clerks  and  a  very 
limited  number  of  merchants,  and  the  main  branch  of 
the  Eastern  Telegraph  Company  and  staff,  having 
their  own  building,  club,  cricket  and  football  team,  &c. 
The  residents  of  Suez,  excluding  the  Egyptians,  are 
composed  of  Greeks,  lyfaltese,  English,  Italians,  and 
the  remainder  mostly  Austrians  of  different  sects. 

Terre-Pleine  is  about  five  minutes  run  from  Suez  town, 
where  there  are  the  Suez  Canal  offices,  Suez  Canal 
workshops,  and  shipping  and  coaling  agencies;  it  is 
kept  very  clean,  with  a  pleasant  avenue  and  a  good 
view  of  the  harbour  and  canal.  The  residents  from 
the  balconies  of  their  houses  (which  are  situated  on 
the  Canal  border)  can  see  the  transit  of  the  different 
ships  homeward  and  outward  bound ;  hotels  also  exist 
at  Terre-Pleine,  the  oldest  of  which  is  the  Hotel Bachet. 
The  climate  of  Suez  and  Terre-Pleine  during  the  months 
of  July,  August,  and  September  is  almost  unbearable, 
but  the  heat  is  dry  and  no  diseases  prevail,  except 
some  cases  of  sunstroke  and  purulent  ophthalmia, 
which  can  be  avoided.  During  the  winter  season  the 
climate  is  temperate,  dry,  and  bracing,  and,  I  believe, 
most  suitable  for  persons  suffering  from  asthma, 
rheumatism,  and  phthisis  ;  but  in  summer  I  would  not 
recommend  the  place  to  any.  There  are  several  well- 
known  practitioners,  of  whom  Dr.  Creswell,  principal 
medical  officer,  Government  Hospital ;  Dr.  Attfield, 
Director  Quarantine  Office,  and  Dr.  Gautier,  principal 
medical  officer  to  the  French  Hospital,  may  be  named. 

G^-el-Tor  is  a  quarantine  station  on  the  Red  Sea, 
about  100  miles  from  Suez,  the  inhabitants  of  which  are 
for  the  most  part  Copts,  appertaining  to  the  Greek 
Orthodox  Church.  A  branch  chapel  of  the  Grand 
Cathedral  of  St.  Catherine  of  Mount  Sinai  exists  at 
Geb-el-Tor.  There  is  no  vegetation  bar  a  garden  belong- 
ing to  the  said  church,  which  is  cultivated  by  the  monks 
for  their  own  consumption  ;  there  are  no  hotels,  very 
few  houses,  practically  speaking  no  trade,  and  steamers 
only  call  at  that  port  in  time  of  the  Mecca  Pilgrimage  to 
obtain  their  "  libra  pratique  "  for  the  Canal.  During 
the  rest  of  the  year  a  Government  steamer  runs  to  and 
fro  during  certain  dates  to  supply  the  quarantine 
camp  and  the  employes  with  their  necessaries.  What 
I  desire  to  point  out  in  this  station  is,  that  a  natural 
thermo-mineral  spring  exists,  called  Mammram  Mousa, 
which  means  Moses'  bathing- place,  encircled  by  a  low 
mud  and  stone  wall  of  very  old  standing,  with  different 
names  engraved  on  the  wall  by  Arabs  and  Europeans 
who  had  called  there — but  certainly  not  as  the  Arabs 


believe— from  the  time  of  Moses.  The  waters 
of  the  said  spring  were  analysed  by  me,  and  they  con- 
tain sulphur,  sodium,  calcium,  lithium  and  traces  of 
iron  and  iodine,  and  I  believe  them  to  be  very  valuable 
in  gout,  derangements  of  the  liver  and  in  syphilis. 
Kindly  note  that  I  am  writing  from  experience,  and  not 
merely  re-echoing  other  people's  belief.  I  therefore- 
recommend  those  suffering  from  the  above  complaints, 
who  have  tried  the  Continental  waters  without  any 
obvious  benefit,  to  try  once  again  the  thermo-mineral 
spring  at  Geb-el-Tor.  during  the  Mecca  Pilgrimage,  as 
then  the  tourist  will  be  able  in  one  way  or  another  to- 
find  through  the  quarantine  staff  some  suitable  accom- 
modation. The  climate  in  winter  is  dry.  bracing,  and 
temperate  ;  in  summer  it  is  very  warm,  but  almost 
always  with  a  favourable  breeze  during  the  evening  ; 
it  is  the  healthiest  spot  in  Egypt. 

Ismailia  is  the  centre  station  between  Suez  and 
Port  Said,  with  the  Suez  Canal  head  offices ;  it  is  very 
neatly  kept,  there  are  many  gardens,  and  vegetation  is 
in  abundance,  but  it  is  very  monotonous  and  un- 
healthy. Malaria  and  intermittent  fever  prevail. 
The  climate  in  summer  is  very  warm,  and  in  winter  very 
damp  ;  there  are  several  hotels  and,  but  for  the  Canal 
Company's  offices  and  the  cleanliness  of  the  town, 
nothing  is  worthy  of  note. 

Port  Said  is  one  of  the  most  important  coaling 
stations  in  the  world,  with  a  great  many  English  firms,, 
shipping  agencies,  and  residents,  in  fact,  the  British 
population  form  the  Port  Said  aristocrats,  and  by 
including  the  British  Subjects  the  importance  of  the 
town  trsuie  might  be  said  to  be  ruled  by  them.  Next 
comes  the  Greek  population,  and  the  remainder  is  com- 
posed of  French,  Italians,  Austrians,  and  Montenegrins. 
The  climate  in  summer  is  warm  and  damp  ;  in  winter^, 
very  damp  and  foggy  ;  the  town  is  not  very  clean  and 
there  are  no  gardens.  Port  Said,  broadly  speaking, 
is  unhealthy,  every  other  person  is  subject  to  neuras 
thenia,  every  three  out  of  ten  to  rheumatism  and  gout 
But  should  any  tourist  intend  visiting  Egypt,  I  would' 
advise  him  to  visit  Port  Said  ;  there  are  several  very 
good  hotels,  of  which  the  Eastern  Exchange  is  the 
most  attractive.  The  town  is  alwa3rs  in  motion  on 
account  of  the  different  steamers  that  coal  there  and 
the  landing  of  their  passengers.  The  caf^s,  casinos,, 
hotels,  bars,  shops,  and  the  pidgin-English  made  use 
of  by  the  Egyptians  is  worth  while  seeing  and  hearing. 
Port  Said  has  some  competent  practitioners,  Dr. 
Cuffey  and  Dr.  Grillet  (English),  and  several  of  French 
nationality. 

Alexandria  is  a  well-known  city,  and  several  English 
steamship  companies  have  a  r^ularservice  to  that  port. 
It  is  a  very  pretty  place,  with  a  large  number  of  British 
residents  and  a  well-directed  municipality,  which  tries- 
to  put  into  execution  all  the  latest  sanitary  improve- 
ments. Alexandria  possesses  some  very  good  hospitals, 
of  which  the  Greek  hospital  is  the  leading  one,  not  only^ 
from  a  sanitary  point  of  view,  but  as  regards  treatment 
and  nursing,  and  is  under  the  able  management  of  Dr. 
Valassopoulos.  Then  comes  the  Deaconess'  Hospital 
(also  called  the  Prussian  Hospital),  of  which  Dr.  A. 
Morrison  is  a  regular  attendant  and  who  is  not  only  a 
very  capable  surgeon  but  possesses  in  a  hi^h  degree 
that  savoir  faire  which  is  decidedly  attractive  to  his 
extensive  connection.  As  far  as  the  sanitary  arrange- 
ments of  the  hospital  itself  are  concerned,  some  urgent 
things  are  lacking,  but  this  is  entirely  due  to  the  man- 
agement, and  not  to  the  surgeon.  Then  comes  the 
French  hospital  under  the  able  management  of  Dr.  Le- 
grand  (French)  and  Dr.  Massa  (Italian),  and  very 
shortly  an  English  hospital  will  be  built .  as  the  funds 
for  its  construction  are  daily  flowing  in.  The  life 
at  Alexandria  is  gay,  the  town  is  full  of  caf6s,  bars'and 
other  places  of  amusement ;  there  are  some  very  good 
Turkish  baths  of  which  El  Hammann  el  Masri.  situated 
at  Sikkhat  el  Warsha,  bears  the  palm.  Half  an  hour's 
distance  from  Alexandria  is  San  Stefano,  with  its  beauti- 
ful casino  and  sea  baths,  and  where  every  tourist  can 
enjoy  his  bath  and  breakfast  at  a  very  reasonable  price. 
Alexandria  possesses  the  St.  Andrew's  School,  having 
at   its  head  Mr.    A.    Buchanan,    M.A.     As    for    the 


l6     The  Medical  Press. 


OPERATING   THEATRES. 


July  6.   1904. 


climate.  Alexandria  is  very  damp  in  winter,  and  un- 
suitable for  p>eople  suffering  from  constitutional  diseases; 
in  summer  it  is  warm.  The  town  is  well  worth  visiting, 
and  should  any  tourist  require  medical  advice  he  may 
unhesitatingly  and  with  entire  confidence  place  himself 
in  the  hands  of  Dr.  A.  Morison  or  Dr.  Legrand. 
Influenza  and  hepatic  disorders  are  the  prevailing 
diseases.     In  my  next  I  shall  treat  of  Upper  Egypt. 


XCbe  ^petattno  Zbcatvcs. 

MIDDLESEX  HOSPITAL. 
Cholecystectomy. — Mr.  John  Murray  operated 
on  a  woman,  aet.  46,  who  had  been  admitted  with  the 
following  history  : — In  1898  she  had  had  an  attack  of 
pain  on  the  right  side  with  swelling;  this  was  followed 
by  jaundice.  In  looi  she  had  a  similar  attack.  Four 
weeks  before  admission  she  complained  of  pain  in 
the  epigastric  region,  accompanied  by  vomiting  and 
marked  tenderness  in  the  right  hypochondrium  ;  a 
distinct  swelling  could  be  felt,  somewhat  ovoid  in  shape, 
extending  about  three  inches  below  the  costal  margin. 
This  last  attack  was  followed  by  jaundice.  On 
admission,  the  patient  still  had  pain  in  the  right 
hypochondrium,  some  tenderness  on  palpation,  and 
a  distinct  swelling  could  be  felt  in  the  region 
of  the  gall-bladder.  There  was  no  jaundice.  The 
woman's  general  condition  was  good.  Operation 
was  decided  upon.  A  five-inch  incision  was  made 
splitting  the  fibres  of  the  right  rectus,  and  the 
abdomen  opened.  The  gall-bladder  was  adherent 
to  the  structures  around,  and  when  the  adhesions  had 
been  separated  the  gall-bladder  was  drawn  up  into  the 
wound  and  incised  after  sterilised  gauze  had  been 
packed  all  around  so  as  to  shut  ofif  the  peritoneum. 
It  was  found  to  be  very  much  thickened  and  to  contain 
a  number  of  calculi ;  these  were  removed  with  forceps 
and  scoop.  After  the  gall-bladder  had  been  cleared 
out  the  cystic  duct  was  examined,  and  was  found  to 
contain  calculi.  On  attempting  to  reach  these  through 
the  gall-bladder  the  wall  of  the  latter  split  longitudin- 
ally, and  as  the  communication  between  it  and  the  duct 
was  so  small  that  it  was  impossible  to  remove  the 
stones  through  the  gall-bladder,  Mr.  Murray  therefore 
decided  to  remove  this  organ.  It  was  therefore 
freed  from  the  under  surface  of  the  liver,  and  was  then 
easily  drawn  out  of  tRe  wound,  and  the  calculi  intheduct 
extracted  by  slitting  up  the  gall-bladder  a  little  further. 
The  gall-bladder  was  then  removed  and  the  stump  of 
the  cystic  duct  stitched  to  the  peritoneum.  The 
wound  was  then  sutured  in  layers  and  a  small  tube 
inserted  into  the  dilated  portion  of  the  duct  and 
another  into  the  peritoneal  cavity  at  the  lower 
part  of  the  wound,  which  was  then  dressed.  On 
counting  the  stones  there  were  found  to  be  thirty- 
eight,  most  of  them  being  of  moderate  size.  Mr. 
Murray  said  that  in  this  case  the  diagnosis  was  obvious. 
ThrejB  attacks  of  pain,  each  followed  by  jaundice,  and 
the  presence  of  swelling  in  the  region  of  the  gall-bladder 
in  the  last  attack,  all  pointed  unmistakably  to  the 
presence  of  gall-stones.  It  was  decided  to  operate, 
he  pointed  out,  first  of  all  because  there  had  already 
been  three  definite  attacks,  secondly,  because  the  gall- 
bladder could  be  felt  distinctly  four  weeks  after  the 
onset  of  the  last  attack,  and  lastly  because  the  pain  and 
tenderness  had  persisted.  With  reference  to  the 
operation,  he  said  that  he  preferred  the  incision 
through  the  rectus  itself,  splitting  the  fibres,  to  an 
incision  in  the  semi-lunar  line,  because  the  wound  was 
more  easily  brought  together  subsequently  and  there 
was  less  danger  of  a  ventral  hernia.  With  regard  to 
the  removal  of  the  gall-bladder,  this,  he  said,  was  ne- 
cessary owing  to  the  splitting  of   the  organ  during  the 


attempts  to  extract  the  stones  from  the  cystic  duct ; 
the  ease  with  which  it  tore  was  owing  to  the  fact  that 
the  wall  was  enormously  thickened,  the  thickening  being 
due  to  the  presence  of  inflammatory  infiltration  ;  apart 
from  this,  removal  was  the  easiest  way  of  extracting 
the  stones  from  the  cystic  duct.  The  thickened  and 
infiltrated  state  of  the  gall-bladder  rendered  its  removal 
advisable.  In  speaking  of  the  treatment  he  had  em- 
ployed for  the  duct,  he  said  it  was  the  safest  on  account 
of  the  quantity  of  muco-pus  in  the  gall-bladder  ;  for  the 
same  reason  the  tube  had  been  introduced  into  the 
peritoneal  cavity. 

The  tubes  were  removed  on  the  third  day;  at  the 
end  of  a  week  some  bile  appeared  on  the  dressings, 
and  this  continued  for  a  fortnight  and  then  ceased. 
The  patient  left  for  a  convalescent  home  a  month 
after  the  operation. 

FRENXH  HOSPITAL  AND  DISPENSARY. 

Oper.\tion  for  Appendicitis — Interestino 
Family  History. — Mr.  Clayton  Greene  operated  on 
a  woman,  aet.  20.  who  had  been  admitted  for  appen- 
dicitis, with  the  following  symptoms  :  Pain  in  right 
iliac  fossa,  vomiting,  and  constipation.  On  examina- 
tion, definite  resistance  was  found  in  the  right  iliac  fossa. 
The  temperature  was  101°  on  admission,  but  came  down 
in  two  days,  after  a  treatment  consisting  in  the  adminis- 
tration of  a  drachm  of  magn.  sulph.  every  half  hour. 
At  the  operation,  the  appendix  was  found  with  its  tip 
glued  down  by  adhesions  in  the  pelvis.  The  adhesions 
having  been  broken  down,  the  appendix  was  brought 
to  the  surface  and  found  to  be  very  congested  and 
covered  with  a  network  of  vessels.  It  was  rather 
thickened,  but  no  concretion  could  be  felt.  On 
slitting  open  the  appendix  no  concretion  was  found, 
but  only  a  small  quantity  of  viscid  mucus.  The 
appendix  was  removed  by  turning  back  a  cuff  of 
peritoneum,  next  passing  a  p-iirse-string  suture  round 
the  cuff,  then  removing  the  appendix,  and  turning  in 
the  free  edge  of  the  peritoneum  so  as  to  get  the  stump 
of  the  appendix  inside  the  cuff,  and,  finally,  drawing 
the  purse-string  suture  tight.  The  wound  was  closed 
in  three  layers.  The  peculiarity  about  this  case  was 
that  the  whole  family,  viz..  the  father,  the  mother,  two 
brothers,  and  two  sisters,  and  the  uncle,  all  had  suffered 
from  appendicitis.  The  mother  died  without  opera- 
tion, the  uncle  and  two  sisters  were  operated  on  and 
recovered,  and  the  two  brothers  recovered  without 
operation. 

The  patient's  temperature  never  rose  after  the  opera- 
tion, and  in  a  week  she  was  convalescent,  the  pain  and 
tenderness  having  disappeared. 


Medical  Sickneisand  Aocident  Society. 
The  usualj  monthly  meeting  of  the  executive 
committee  of  the  Medical  Sickness,  Annuity  and  Life 
Assurance  Society  was  held  at  429  Strand,  London. 
W.C.  on  the  24th  ult.  There  were  present  Dr.  de 
Havilland  Hall  in  the  chair  ;  D.  J.  Pickett,  Dr.  St. 
Clair  B.  Shadwell,  Mr.  J.  Brindley  James,  Dr.  M. 
Greenwood,  Dr.  Walter  Smith,  Dr.  W.  Knowsley 
Sibley,  Dr.  F.  J.  Allan,  and  Dr.  J.  B.  Ball.  The  accounts 
presented  showed  that  the  business  of  the  Society  is 
satisfactorily  growing.  Each  year  a  large  addition  has 
been  made  to  the  funds,  which  now  amount  to  3^180,000, 
and  it  is  estimated  that  during  the  current  year  more 
than  ;i  10,000  will  be  paid  to  the  members  as  sickness 
allowance.  The  list  of  those  permanently  incapacitated 
shows  no  sign  of  lessening  although  several  deaths  have 
occurred  among  them  during  the  last  four  months,  but 
fresh  cases  have  come  forward,  and  the  number  of  those 
who  have  to  draw  annuities,  generally  one  hundred 
guineas  a  year,  steadily  grows.  Prospectuses  and  all 
particulars  on  application  to  Mr.  F.  Addiscott.  Secre- 
tary. Medical  Sickness  and  Accident  Society,  23 
Chancery  Lane,  London,  W.C. 


July  6.  1904. 


LEADING   ARTICLES. 


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SALUS   POPULI   SUPREMA  LEX. 


WEDNESDAY.  JULY  6,  1904. 


THE  IMMUNISATION  OF  PERITONEAL 
WOUNDS. 

The  extreme  sensitiveness  of  the  peritoneum 
and  its  peculiar  liability  to  septic  infection  are  the 
chief  factors  with  which  .the  surgeon  has  to  contend 
in  any  operation  upon  the  abdomen  and  its 
contents.  Wounds  of  this  serous  membrane  so 
lower  its  resistance  that  it  becomes  a  more  easy 
prey  to  septic  organisms,  while  the  bacterium  colt 
itself  is  well  known  to  acquire,  under  certain 
conditions,  pathogenic  properties.  Peritoneal  in- 
fection from  the  mucous  membrane  of  any  part 
of  the  gastro-intestinal  tract  still  occurs  with  too 
great  frequency,  in  spite  of  the  most  elaborate 
precautions.  We  are  here  face  to  face  with  a 
grave  problem,  namely',  the  prevention  of  such 
infection  and  the  consequent  diminution  in  the 
mortality  after  operations  upon  the  stomach  and 
intestines.  In  certain  diseases  characterised  by 
an  invasion  of  the  system  by  specific  organisms, 
which  at  the  same  time  secrete  toxins,  we  have, 
to  some  extent,  the  power  of  producing  an  arti- 
ficial immunity  by  the  injection  of  a  specially 
prepared  serum,  or  antitoxin.  Successful  as  many 
of  these  sera  have  been,  there  is  an  undoubted 
difficulty  in  adjusting  or  adapting  them  to  the 
varying  strains  of  the  same  organisms,  the  viru- 
lence of  which  is  seldom  constant.  This  is  a 
disadvantage  which  will  be  gradually  overcome 
by  greater  perfection  in  bacteriologic£d  technique, 
as  well  as  by  an  increased  knowledge  of  the  life 
history  of  pathogenic  germs.  Many  experiments 
have  also  been  undertaken  with  a  view  to  the 
preparation  of  prophylactic  sera,  a  few  of  which 
have  been  put  to  practical  use,  as,  for  instance, 
in  the  inoculation  against  typhoid  fever.  The 
other  method,  and  the  only  one  which,  in  the 
present  state  of  our  knowledge,  is  applicable  to 
infectious    conditions   of  the  peritoneum,  is  that 


of  increasing  the  power  of  resistance  of  the  body 
against  bacterial  invasion.  This  aspect  of  im- 
munisation is  the  one  dealt  with  by  Professor 
von  Mikulicz,  of  Breslau,  who  delivered  before  the 
West  London  Medico-Chirurgical  Society  the 
Cavendish  Lecture,  published  in  our  present 
issue.  The  production  of  a  hyperleucocytosis 
is  one  of  the  means  by  which  this  increased 
resistance  is  attained,  and  the  experiments  of 
Loewy,  Richter,  Jakob  and  Hahn  have  shown  that 
certain  animals  have  been  rendered  immune 
against  pneumococcic  and  septicaemic  infection 
by  the  injection  into  their  bodies  of  substances 
capable  of  exciting  hyperleucocytosis.  Intra- 
peritoneal injections  of  normal  saline  were  em- 
ployed in  1902  by  Salieri  for  the  purpose  of  in- 
creasing the  resistance  of  the  peritoneum  against 
infection,  while  Issaeff  had  also  experimented  in 
the  same  direction.  The  possibility  of  thus 
immunising  peritoneal  wounds  in  the  human 
subject  has  been  made  a  special  study  by  Professor 
von  Mikulicz,  after  further  experiments  had  been 
undertaken  upon  animals  by  all  the  different 
methods  tried.  A  2  per  cent,  solution  of  neutra- 
lised nucleic  acid  was  found  to  be  the  most  effica- 
cious in  producing  hyperleucocytosis.  This  was 
injected  in  man  subcutaneously,  in  quantities 
of  50  c.c,  and  in  no  case  was  any  serious  local  or 
general  manifestation  observed.  In  all,  fifty- 
eight  cases  were  thus  injected,  fifty-five  of  which 
were  operations  upon  abdominal  viscera  and  three 
of  extra- abdominal  disease.  The  only  sign  of 
reaction  was  a  slight  rise  of  temperature  during 
the  first  few  hours  after  the  injection.  As  far  as 
results  are  concerned,  the  number  of  cases  treated 
in  this  manner  is  admittedly  small,  but  in  forty- 
five  laparotomies  in  which  the  peritoneum  was 
exposed  to  infection  from  the  contents  of  the 
stomach  or  intestines,  seven  only  were  fatal,  and 
in  none  of  these  was  post-operative  peritonitis 
the  cause  of  death.  The  operations  were  under- 
taken on  the  "  rising  tide  of  leucocytosis," 
which  attains  its  maximum  in  man  about  ten  or 
twelve  hours  after  the  preventive  injection. 
Solutions  of  normal  saline  appear  also  to  have  the 
power  of  increasing  the  resistance  of  the  peri- 
toneum to  B,  coli  infection,  hence  the  practice 
adopted  by  many  operating  surgeons  of  irrigating 
the  peritoneal  cavity  with  this  fluid  after  laparo- 
tomy would  seem  to  be  based  upon  scientific 
principles.  This  method  of  producing  artificial 
immunity  of  the  peritoneum  should  prove  of 
great  advantage  to  surgery  in  general,  and,  if 
confirmed  by  subsequent  observers,  will  do  much 
to  rob  operations  upon  the  abdominal  viscera  of 
their  dangers. 


PUBLIC     HEALTH     ADMINISTRATION. 

For  many  years  business  men  have  been  anxious 
to  see  the  Board  of  Trade  re-modelled,  and  its 
Parliamentary  chief  raised  to  the  dignity  of  a 
Secretary  of  State,  whilst  those  interested  in  social 
matters  have  been  advocating  that  a  similar  process 
of  transformation  should  take  place  at  the  Local 


l8     The  Medical  Pkess. 


LEADING  ARTICLES. 


July  6,   1904. 


Government  Board.  As  the  result  of  these  agita- 
tions a  Committee  was  appointed  by  the  Treasury 
last  year,  charged  with  the  duty  of  investigating 
the  two  proposals.  Their  report  has  just  lately 
been  issued,  and  it  cannot  be  said  that  its  recom- 
mendations will  be  very  satisfying  to  those  ardent 
spirits  who  wished  to  see  a  Minister  of  Public 
Health,  with  all  the  dignity  of  Cabinet  rank, 
created  to  infuse  vigour  and  initiative  into  the 
public  health  administration  of  the  country.  The 
Committee  has  taken  a  narrow  view  of  the 
terms  of  reference  supplied  to  it,  and,  with  regard 
to  the  Local  Government  Board,  has  confined 
itself  to  the  question  of  the  salaries  paid  to  the 
higher  officials  in  making  positive  recommenda- 
tions. These  recommendations  are  in  themselves 
a  step  in  the  right  direction,  for  they  propose  that 
the  President's  salary  shall  be  raised  to  ;£3,ooo  a 
year,  and  those  of  the  Parliamentary  and  Per- 
manent Secretaries  to  ;f  1,500  and  ;f 2,000  re- 
spectively. On  the  accepted  principle  that  people 
value  a  man's  opinion  in  proportion  to  what  they 
pay  him  for  it,  it  may  now  be  anticipated  that 
the  prestige  of  the  Local  Government  Board  will 
be  somewhat  increased  if  the  Committee's  recom- 
mendations are  adopted,  but  that  is  all.  On  the 
negative  side,  however,  it  is  to  be  noticed  that 
the  Committee  had  before  it  two  suggestions, 
both  of  which  it  rejected.  One  was  put  forward 
by  the  British  Medical  Association,  and  embodied 
the  views  of  the  Council  that  the  President  of  the 
Board  should  be  a  Secretary  of  State,  with  full 
emoluments  and  status  ;  that  one  of  the  members 
of  the  Board  should  be  a  medical  man,  and  that 
the  administration  of  the  Medical  Acts  should 
be  transferred  to  the  Board  from  the  Privy  Council. 
The  other  was  that  of  the  Public  Health  Committee 
of  the  House  of  Commons,  presented  by  Sir  Michael 
Foster,  advocating  that  the  health  duties  of  the 
Board  should  be  divorced  from  those  relating  to* the 
Poor-law,  and  taken  over  by  a  separate  staff 
acting  under  a  Parliamentary  secretary.  The 
Committee  thought,  with  regard  to  the  proposal 
of  the  British  Medical  Association,  that  the 
duties  of  the  Board  were  already  sufficiently 
onerous,  and  that  it  would  be  a  mistake  to  increase 
them,  whilst  it  held  that  to  adopt  Sir  Michael 
Foster's  proposals  would  be  attended  with  con- 
siderable practical  difficulty.  It  may,  therefore, 
be  taken  as  settled  that  any  change  in  the  con- 
stitution or  organisation  of  the  Local  Government 
Board  is  out  of  the  question  for  the  next  few  de- 
cades, and  the  public  health  administration  of  this 
country  will  continue  to  proceed  on  its  old  Hues 
for  good  or  for  evil.  It  is  a  great  pity  that 
this  opportunity  for  reform  has  been  lost.  The 
growth  of  the  Local  Government  Board's  work 
since  its  institution  in  1871  has  been  prodi- 
gious, and  it  is  now  the  largest  of  the 
Government  departments.  Every  day  almost 
sees  an  increase  in  the  business  it  has  to  transact. 
Interest  in  matters  relating  to  local  government 
has  grown  more  and  more  as  people  have  realised 
that  their  interests  lie  in  their  own  hands,  and  that 
if  they  suffered  from  disabilities  and  grievances, 


it  is  due  to  their  own  inertia  in  not  removing  them 
by  constitutional  means.  But  with  the  healthy 
devolution  of  powers  it  has  been  found  necessary 
to  keep  a  firm  control  over  irresponsible  and  ex- 
travagant boards  by  the  central  organisation, 
and,  on  the  whole,  it  must  be  admitted  that  the 
influence  of  the  Local  Government  Board  has 
generally  been  for  good.  Still,  the  complex  and 
multifarious  duties  of  the  Board  are  such  that 
administrative  jumbles  cannot  be  avoided,  and 
when  the  importance  of  safeguarding  the  public 
health  in  our  present  crowded  towns  and  cities 
is  considered,  it  is  of  the  greatest  moment  that 
a  strong,  well-stafled  and  vigorous  Board  should 
be  available  to  co-ordinate  and  control  the  policy 
of  the  various  authorities  carrying  out  the  Acts 
in  the  districts  they  serve.  The  association  of  the 
poor-law  with  public  health  is  not  a  happy  one, 
for,  however  much  one  may  wish  the  former  to  be 
construed  humanely  and  intelligently,  it  has  not 
the  vital  effect  on  the  very  existence  of  the  com- 
munity that  the  PubUc  Health  Acts  have,  and, 
like  poor  relations,  it  tends  to  bring  obloquy  on 
its  associates.  Drains  and  water-works  do  not 
fire  the  public  imagination,  and  when  they  are 
joined  with  workhouses  and  casual  wards,  they 
tend  to  be  looked  upon  as  unfortunate  necessities — 
that  are  best  left  to  other  people.  The  situation 
may  be  summed  up  by  saying  that  the  whole  of 
the  public  health  administration  suffers  from 
lack  of  dignity,  and  that  while  the  Local  Govern- 
ment Board  continues  to  be  a  minor  office, 
as  a  reward  for  a  good  party  hack,  in  which  he  may- 
serve  his  apprenticeship  to  the  higher  grades  in 
the  Cabinet,  so  long  will  the  public  health  service 
continue  to  be  regarded  as  of  secondary  importance 
to  the  State.  Any  hope  of  seeing  it  otherwise  is 
postponed  indefinitely  by  the  Committee's  re- 
commendation. 


HOSPITAL  ABUSE. 
We  have  for  several  years  past,  whenever  the 
opportunity  offered,  impressed  on  our  readers 
the  magnitude  of  the  evil  involved  in  the  present 
system  of  hospital  administration,  and  we  have 
done  our  best  to  suggest  the  lines  along  which 
reform  should  take  place.  At  present,  there  is 
little  doubt  that  the  class  for  whom  hospitals 
have  been  founded  and  are  maintained — the 
necessitious  poor — is  not  the  class  who  make 
most  use  of  them.  On  the  contrary,  the  wards  are 
occupied  and  the  dispensaries  crowded  by  well-to- 
do  artisans  and  people  of  the  lower  middle  class,, 
who  ought  to  be,  and  are,  able  to  pay  for  medical 
attendance.  A  double  injustice  is  thus  done  : 
the  money  contributed  by  the  charitable  public  is 
to  a  large  extent  misapplied,  and  at  the  same  time 
the  general  practitioner  is  deprived  of  his  legiti- 
mate means  of  livelihood.  In  addition,  and  per- 
haps of  even  greater  importance  from  a  socio- 
logical point  of  view,  is  the  concomitant  pauperi- 
sation of  a  large  class  of  the  community.  The 
persons  responsible  for  the  present  state  of  things 
are  primarily  the  governors  of  hospitals,  for  it  is 
to  them  that  the  administration  ol  the  hospital 


July  6,  1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Press.     19 


funds  has  been  entrusted  by  the  charitable  public. 
The  responsibility,  however,  does  not  end  with 
them,  for  it  is  the  duty,  in  this,  as  in  other  matters 
of  hospital  management,  of  the  medical  pro- 
fession in  general  and  of  hospital  physicians  and 
surgeons  in  particular,  to  keep  the  boards  of 
governors  in  touch  with  the  best  opinion.  In  a 
previous  discussion  (a)  of  this  subject,  we  laid 
down  what  we  thought  should  be  the  guiding 
principles  of  hospital  boards  in  the  matter — "  efl&- 
ciently  to  relieve  the  greatest  amount  of  suffering 
with  the  maximum  amount  of  economy  that 
eflSciency  will  permit,  and  to  see  that  funds 
collected  in  the  name  of  charity  are  expended  in 
the  furtherance  of  charity."  To  aid  in  the  carrying 
out  of  these  principles,  we  suggested  that  inquiries 
should  always  be  made  as  to  the  means  and  cir- 
cumstances of  patients  attended  at  hospitals, 
and  that,  if  necessary,  a  special  ofl&cer  should  be 
appointed  whose  duty  it  would  be  to  make  such 
inquiries,  and  verify  them  by  further  investi- 
gations if  thought  advisable.  Although  but  little 
attempt  has  yet  been  made  either  by  hospital 
boards  or  by  the  profession  to  inaugurate  any 
serious  reform,  it  is  something  that  the  profession 
is  at  length  being  roused  to  take  an  interest  in  the 
matter,  and  as  a  sign  of  this  we  welcome  the  action 
of  the  Dublin  Division  of  the  British  Medical 
Association  in  requesting  its  Executive  Committee 
to  inquire  into  the  alleged  abuse  of  Dublin  hos- 
pitals and  their  dispensaries.  The  special  report 
drawn  up  is  being  considered  at  the  annual 
meeting  this  week,  and  deserves  very  serious  con- 
sideration. The  Committee  state  what,  indeed, 
is  notorious,  that  patients  who  are  able  to  pay 
for  treatment  outside  are  at  present  in  receipt 
of  hospital  reUef  and  treatment,  and  they  are  of 
opinion  that  the  only  practical  way  to  meet  this 
abuse  is  to  compel  such  persons  to  pay  for  the 
treatment  received.  While  we  are  in  the  main  in 
agreement  with  these  expressions  of  opinion,  and 
believe  that  the  only  way  to  exclude  undeserving 
patients  from  hospital  relief  is  to  charge  them  a 
fee  commensurate  with  what  they  would  pay  for 
similar  advice  elsewhere,  we  fear  that  some  of  the 
suggestions  made  by  the  Committee  are  Uable 
to  be  misunderstood.  As  long  as  the  charging  of 
fees  for  hospital  treatment  is  used  simply  as  an 
instrument  of  protection  from  imposture,  it  is 
both  admirable  and  effective,  but  if  it  is  to  be  used 
to  any  degree  as  a  means  of  income,  for  either  the 
hospital  or  its  medical  staff,  it  is  Uable  to  very 
serious  abuse.  A  card  which  the  DubUn  Com- 
mittee suggest  for  use  by  the  governors  of 
Dublin  hospitals  in  recommending  patients  for 
treatment,  in  its  present  form,  at  any  rate,  would 
leave  the  way  open  for  some  misuse.  It 
consists  of  two  alternative  forms  of  recom- 
mendation ;  one,  in  the  case  of  needy  patients 
unable  to  contribute  anything,  and  the  other 
recommending     so-and-so     "as    a    pay    patient, 

unable   to   pay   more   than   / per  week  for 

treatment."      It    seems    to    us    that    the    latter 

(«)  MsDicAii  Pans  amd  CncuLAS,  Aagust  28bh.  1001. 


clause  may  act  in  quite  the  contrary  way  to  the 
intention  of  those  who  framed  it,  and  might 
simply  result  in  turning  the  general  hospital 
into  a  gigantic  general  practice,  which,  aided  by 
its  prestige,  influence,  and  funds,  could  compete 
with  neighbouring  practitioners  at  cut-rates  with 
disastrous  results.  As  we  know  nothing  could  be 
further  from  the  intentions  of  the  Dublin  Division 
than  such  a  result  of  their  action,  we  venture  to 
draw  attention  to  this  matter  of  detail,  while  fully 
concurring  with  the  general  views  of  the  Com- 
mittee as  to  the  desirabiUty  of  testing  the  means 
of  all  applicants  for  charitable  medical  relief. 


Botes  on  Current  Uopfcs* 


Criminal  Charsres  and  InBanity. 

British  law  is  a  complicated  engine  that  creaks 
ominously  as  it  wins  along  its  slow  and  laborious 
journey.  Criminal  law  is  at  present  administered 
by  the  police,  whose  one  desire  appears  to  be  to 
shut  up  as  many  persons  for  as  many  years  as 
magistrates  and  judges  will  permit.  As  a  rule, 
unsupported  evidence  from  a  poUce  constable  is 
practically  law,  a  fact  which  helps  him  not  a 
little  in  attaining  the  highest  possible  position  in 
the  force,  namely,  that  of  a  constable  who  has 
never  failed  in  a  prosecution.  The  scientific  treatment 
of  criminology  is  unknown  in  our  law  administra- 
tion. An  accused  person  may  be  palpably  mad 
as  mad  can  be,  but  nevertheless  be  committed 
to  gaol  for  short  or  long  terms  of  punishment. 
The  need  of  some  advisory  board  of  lunacy  experts 
was  shown  last  week  at  the  Old  Bailey.  A 
woman,  formerly  a  prisoner  at  I^wes  Gaol,  on 
her  release  from  that  place  brought  an  action  for 
breach  of  promise  against  a  major-general  of  the 
neighbourhood,  one  of  the  visiting  justices.  The 
action  was  fantastic,  grotesque,  and  erratic,  and 
naturally  failed.  Subsequently  the  plaintiff  was 
prosecuted  for  perjury,  and  in  a  first  trial  the 
jury  could  not  arrive  at  a  verdict.  In  the  second 
trial  she  was  found  guilty  and  sentenced  to  four 
years'  penal  servitude.  With  the  propriety  of 
that  sentence  we  are  not  here  concerned,  beyond 
pointing  out  that  the  first  jury  clearly  thought 
there  was  room  for  doubt.  The  point  to  which 
we  would  call  attention  is  that  the  state  of  the 
prisoner's  mind  was  not  scientifically  determined. 
The  Common  Serjeant,  who  tried  the  second 
case,  asked  if  there  was  any  reason  to  suppose  the 
woman  was  wrong  in  her  head.  Then  up  and  spake 
a  bold  detective-inspector,  "Oh,  no  I  my  lord.  She 
is  a  very  wicked,  dangerous  and  clever  and  design- 
ing woman. ' '  That  illustrates  the  average  attitude 
both  of  the  police  and  of  the  lawyers  with  regard 
to  mental  responsibihty  of  alleged  criminals.  It 
seems  incredible  that  the  Common  Serjeant  of 
London  should  be  content  to  take  evidence  as  to 
mental  soundness  from  a  pohceman.  But  there 
is  a  glimmer  of  hope,  for  we  no  longer  hang  for 
petty  thefts,  and  have  we  not  the  Bertillon  methods 
of  detection,  and  a  First  and  a  Juvenile  Offenders 
Act  ? 


20    The  Medical  Peess.       NOTES    ON    CURRENT    TOPICS. 


July  6,   icxm. 


The  Post  Office  €us  Censor. 

We  have  often  complained  of  the  inertia  shown  I 
by  the  Post  Office  authorities  both  here  and  in  ' 
America  in  regard  to  the  nature  of  the  advertise-  i 
ments  which  pass  through  the  mails.     Although  | 
it  is  in  print  as  a  rule  of  the  Office  that  no  indecent 
printed   matter  shall   be   allowed    to   pass,   it   is  ' 
notorious  that  we  are  pestered  day  by  day  by  j 
advertisements  of  various  proprietary  medicines 
which    are    offensively    indecent,    not    only    in 
printed  matter  but  in  accompanying  illustrations. 
In  the  lower  class  of  our  own    newspapers,  also, 
and  in  many  American  journals,  advertisements 
inciting  not  merely  to  immorality,  but  to  actual 
crime  constantly  appear,  and  the  papers  have  a 
wide  distribution  through  the  post.     Under  the 
circumstances,  it  is  good  news  to  hear  that  the 
United  States  Postal  Department  have  at  length  j 
determined    to   institute   an   effective   censorship  | 
against    the    passage    through    its    channels    of  | 
offensive   advertisements.     The   regulation   is    to 
apply,    not   merely    to   indecent   advertisements, 
but  to  announcements  of  patent  medicines  and 
other   quack  remedies  wherever  chemical  analysis 
reveals  premeditated  fraud.     It  will  be  enforced 
also    against    newspapers,    which,    after   warning 
from   the  Post  Office,   continue  to  admit  quack 
advertisements    to    their   columns.     In   all   such 
cases,  the  papers  will  be  excluded  from  the  mails. 
The    energies    of    the    American    postal    officials 
will  be  fully  occupied  for  some  time  to  come  in 
deciding,  as  they  promise  to,  "  every  case  on  its 
merits."     As    a    consequence,    moreover,     their 
exchequer  and  our  waste-paper  baskets  will  be 
somewhat  the  lighter. 


contrivance  could  scarcely  be  imagined.  The  car- 
bonic acid,  sulphurous  acid,  and  other  products  of 
combustion,  accompanied  by  the  fumes  of  volatile 
fats  and  particles  of  organic  material  from  the  food 
that  has  been  cooked,  contaminate  the  air  of  the 
building,  and  are  breathed  and  re-breathed  by  the 
whole  family.  Nor  are  the  working  classes  the 
only  sufferers  in  this  respect.  The  same  reasons 
that  lead  them  to  use  gas  for  cooking  influence 
those  of  the  upper  classes  who  live  in  flats  and 
small  houses;  and  although — from  the  greater 
air-space  available — the  family  are  not  so  much 
affected,  the  servants  who  pass  their  time  in  the 
kitchen  are  poisoned  daily.  No  gas-cooking 
apparatus  should  be  allowed  to  be  used,  unless 
provided  with  a  thoroughly  efficient  extract  shaft 
for  the  products  of  combustion.  Let  him  who 
doubts  these  things  look  at  the  walls  and  the 
ceiling  of  a  room  where  a  gas-stove  is  in  frequent 
use. 


Gas   Stoves.  j 

In  and  around  London  the  old-fashioned  home  is  j 
gradually  tending  to  disappear.  The  working-  i 
classes,  aping  their  (so-called)  "  betters,"  are  desert- 
ing houses  and  cottages  for  flats  and  those  euphoni- 
ously-named substitutes  for  all  that  is  desirable, 
"  maisonettes."  The  artisan  and  the  labourer  no 
longer  settle  down  to  the  enjoyment  of  love  in  a 
cottage,  but  wander  about  and  migrate  from  one 
quarter  of  the  city  to  another.  Their  houses 
are  no  longer  their  castles,  but  mere  shifting 
tabernacles,  and  their  aim  is  to  limit  as  far  as 
may  be  the  expenditure  of  time,  thought  or 
money  upon  the  environment  of  the  dwell- 
ing to  what  is  absolutely  necessary.  Anything, 
therefore,  that  saves  trouble  is  welcome,  and  the 
gas-stove,  rented  from  the  company,  undoubtedly 
economises  the  energies  erstwhile  devoted  to 
cooking  with  the  old-fashioned  kitchen  range.  A 
penny-in-the-slot  provides  a  supply  of  gas,  and 
there  is  an  end  of  the  matter  ;  the  old  bother 
of  making  up  a  fire  or  of  cleaning  the 
grate  has  vanished.  But  the  ease  thus  ob- 
tained is  dearly  purchased,  for  these  gas-stoves 
are  provided  with  no  adequate  shafts  to  con- 
duct their  fumes  into  the  external  atmosphere, 
and,  consequently,  the  products  of  combustion 
are  retained  in  the  kitchen,  or  find  their  way 
by  diffusion  into  the  bedrooms.     A  more  unhealthy 


Lilies  versus  Boses. 
Until  comparatively  recent  years  one  used  to 
expect  a  certain  amount  of  good  sense  in  news- 
papers during  the  major  portion  of  the  year, 
relieved  by  nonsense  only  during  the  few  weeks 
in  the  heat  of  the  summer,  when  '*  copy  "  was 
scarce  and  the  regular  writers  either  slack  or 
holiday- making.  But  with  the  phenomenal 
growth  of  journalism  during  the  last  twenty 
years  or  so,  it  has  been  found  impossible  to  main- 
tain a  high  standard  of  accuracy  and  interest — 
at  any  rate  in  the  less  responsible  journals — and 
nowadays  nothing  seems  too  silly  to  "fill  up  " 
the  columns  of  some  of  our  contemporaries.  A 
paragraph  is  going  the  rounds  of  the  ladies*  papers, 
by  far  the  worst  offenders,  that  a  "  foreign  chemist" 
has  made  the  brilliant  discovery  that  the  lily  of 
the  valley  has  a  depressing  effect  on  the  heart, 
so  that  a  spray  worn  by  a  lady  on  her  bosom  will 
make  her  appear  cold  and  listless,  though  were 
roses  lying  there  she  could  be  responsive  enough. 
The  only  hearts  that  are  likely  to  be  depressed 
are  those  of  the  medical  men  who  read  such 
stuff  as  this.  The  lily  of  the  valley  is  one  of  the 
oldest  medicinal  plants  known,  and  though  it 
had  almost  become  obsolete  at  one  time,  it  has 
recently  been  growing  in  favour,  as  its  active 
principle,  convallaria,  has  an  action  remark- 
ably like  digitalis,  and  when  that  drug  acts 
unfavourably,  convallaria  is  often  used  as  a 
substitute.  Although  a  rather  active  poison, 
convallaria  in  small  doses  is  a  cardiac  tonic,  and 
if  the  odour  of  the  lily  of  the  valley  could  exert 
any  therapeutic  influence — which  is  inconceivable 
— it  ought  to  be  a  stimulating  one,  whilst  the 
rose  is  medicinally  one  of  the  most  inert  of  plants. 
One  can  assure  the  ladies,  therefore,  that  if  they 
wish  to  add  to  their  charms  by  wearing  the  most 
modest  of  flowers,  they  may  do  so  without  fear 
of  ulterior  consequences,  and  that  the  lily  of  the 
valley  is,  if  anything,  more  likely  to  stimulate 
their  hearts  than  the  rose  of  Sharon.  Possibly, 
after  all,  the  writers  of  this  amusing  fiction  had 
in  their  minds  former  experiences  of  joy  or  sorrow 


July  6,   1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.     21 


produced  in  their  own  masculine  bosoms  by  the 
sight  of  roses  or  of  lilies  worn  by  lovely  woman. 


Removal  of  the  Gasserian  Gangrlion. 

There  are  few  accepted  operations  in  the  range 
of  surgery  which  appear  at  first  sight  more  difficult 
of  accomplishment  than  the  removal  of  the 
Gasserian  ganglion,  and  it  is  not  to  be  wondered 
at  that  few  except  the  most  courageous  surgeons 
have  so  far  been  found  to  practise  it.  Yet  there 
is  no  operation  which  is  more  urgently  demanded 
in  certain  conditions  than  this,  since  in  cases  of 
persistent  and  so-called  "  intractable  "  trigeminal 
neuralgia  it  stands  out  almost  the  only  treatment 
which  may  substitute  a  life  of  ordinary  comfort 
for  one  of  intolerable  misery.  At  the  same  time, 
the  operation  is  not  by  any  means  so  hazardous 
as  is  generally  supposed.  The  mortality  during  the 
past  two  or  three  years  has  been  rapidly  lessening, 
and  in  the  hands  of  Sir  Victor  Horsley,  who  has 
operated  on  as  many  as  120  cases,  has  run  as 
low  as  25  per  cent.  The  higher  rates  of  mortality 
in  the  practice  of  other  surgeons  are  due,  not  so 
much  to  any  want  of  skill  in  the  actual  perform- 
ance of  the  operation  as  to  a  reluctance  to 
undertake  it  before  the  patient  has  become 
exhausted  by  continued  pain,  loss  of  rest  and  food, 
and  often  by  narcotic  drugs.  Surgeons  who, 
following  Horsley 's  example,  have  had  the  decision 
to  operate  early,  have  not,  as  a  rule,  had  any 
difl&culty  in  obtaining  results  as  good  as  his. 
It  should  be  remembered,  however,  that  the  opera- 
tion is  one  of  the  most  serious  that  can  be  per- 
formed, and  it  should  never  be  undertaken  by  a 
surgeon  who  is  not  thoroughly  conversant  %vith 
the  anatomy  of  the  floor  of  the  cranium  and  the 
parts  adjacent  thereto. 

Effloiency  of  Surgrical  Dressings. 

It  is  curious  how  little  fixity  of  knowledge 
there  is  as  to  the  relative  advantages  of  the 
various  materials  used  in  surgical  dressing. 
Each  surgeon  has,  as  a  rule,  his  favourite  materials, 
which  he  uses  with  but  httle  variation,  though 
from  time  to  time  he  drops  one  or  other  from  his 
store,  and  substitutes  something  new.  He, 
indeed,  usually  places  implicit  confidence  for  all 
purposes  in  the  substance  he  is  using  at  the 
moment,  though  it  captivates  his  good  opinion 
but  for  a  short  time.  He  is,  however,  rarely  ready 
to  offer  any  scientific  grounds  for  his  use  of  a  par- 
ticular material.  He  finds  it  work  well,  and  he 
is  doubtless  right  to  hold  by  it,  but  it  would  be 
more  useful  to  himself  and  others  to  make  some 
inquiries  as  to  the  points  in  which  it  is  successful, 
and  the  points  where  it  fails.  It  is  .to  satisfy 
themselves  in  a  scientific  way  as  to  the  efficiency  as 
drainage  materials  of  various  popular  surgical 
dressings  that  Drs.  M'Gregor  and  Ramsey,  of 
Glasgow,  have  performed  a  series  of  experiments 
recently  communicated  to  a  contemporarj\  (a) 
Working  with  absorbent  wool,  wood-wool,  cellulose, 
boracic  lint,  and  various  gauzes,  they  tested  the 
powers  each  material  shows  in  absorbing  and  in 

(a)  BriL  Med.  Joum,^  June  11th,  1904. 


conducting  moisture.  It  is  to  be  noted  that 
the  two  properties  are  not  at  all  identical,  for 
some  of  the  materials  which  were  able  to  suck  up 
moisture  with  ease  were  but  badly  able  to  transmit 
it.  Again,  some  materials,  while  acting  as  ex- 
cellent drains  of  fluid,  were  quite  unable  to  convey 
cellular  elements.  Speaking  generally,  the  ob- 
servers come  to  the  conclusion  that  for  the  trans- 
mission of  fluids  with  solids  in  suspension,  dry 
boracic  lint  forms  the  most  efficient  drain.  Cellu- 
lose wadding  is  nearly  as  useful,  but  its  friability 
renders  it  difficult  of  apphcation,  unless  enclosed 
in  gauze.  As  a  simple  mop  or  sponge  to  apply  to 
an  open  wound,  absorbent  wool  and  cellulose  are 
found  to  be  equally  trustworthy.  It  is  important 
to  note  that  even  the  best  drain  gets  blocked  in 
less  than  eight  hours,  so  that  a  more  frequent 
dressing  than  is  customary  is  indicated. 


Foot  Massaere. 
It  is  refreshing  to  hear  of  a  really  sensible 
American  craze,  especially  when  the  goodness 
thereof  threatens  to  invade  our  shores.  The 
report  comes  that  we  are  to  be  inundated  with  a 
wave  of  "  foot  massage,"  a  form  of  chiropody 
that  aims  at  restoring  the  function  of  the  toes  so 
that  they  may  be  able  to  perform  the  movenients 
that  Nature  designed  them  to  execute.  But  it  is 
not  so  much  the  foot  massage  itself  that  deserves 
commendation  as  its  corollary,  namely,  that  pointed 
toes  and  tight  boots  will  go  out  of  fashion.  If  the 
toes  are  to  be  made  capable  of  flexion  and  exten- 
sion at  will,  it  is  obvious  that  the  massage  will 
be  of  little  avail  if,  in  the.  interval  between  the 
treatment,  the  toes  are  to  be  encased  in  boots 
which  pinch  and  restrict  them.  It  will  be  neces- 
sary for  the  art  of  the  masseur  to  be  backed  up  by 
the  common  sense  of  the  subject,  and  if  this  entails 
the  wearing  of  well-fitting  boots  and  shoes,  not 
only  will  the  practitioner  be  relieved  of  many  of 
his  diffTculties  in  treating  bunions  and  ingrowing 
toe-nails,  but  many  ladies  will  sigh  with  relief 
to  think  that  they  can  enjoy  a  comfort  in  walking 
that  fashion  has  denied  them  for  so  many  years. 
Let  the  foot  masseur  come  and  do  his  best  ;  if 
he  succeeds  where  doctors  and  their  warnings  have 
failed,  they  will  not  grudge  him  his  success. 


The  Dual  Aspeot  of  Medioal  Prcu^tice. 

The  calling  of  medicine  is  one  which  may  be 
viewed  from  many  different  standpoints.  The 
most  lofty  is  perhaps  that  which  regards  the  physi- 
cian as  the  true  exponent  of  the  healing  art, 
equipped  with  special  knowledge,  and  endowed 
with  powers  wherewith  to  combat  disease  in  every 
shape  and  form.  The  practitioner  thus  stands 
before  all  men  on  a  higher  plane,  ever  ready  to  give, 
and  to  give  freely,  to  all  and  sundry  who  apply  to 
him  for  relief  from  their  sufferings.  This  is  the 
humanitarian  view  which  supposes  that  the  doctor 
is  actuated  by  no  other  motive  at  any  time  than 
that  of  pure  philanthropy.  We  are  proud  to 
believe  that  many  from  among  our  ranks  have, 
ndeed,  served  their  day  and  generation  without 


2  2    The  Medical  Pkess. 


NOTES  ON  CURRENT  TOPICS. 


July  6,  1904. 


ever  a  thought  of  reward,  and  out  of  pure  love  to 
their  fellow-creatures.  Would  that  it  were  pos- 
sible for  every  member  of  the  profession  so  to 
practise,  but,  unfortunately,  such  an  ideal  is  out 
of  the  question,  save  for  a  privileged  few.  The 
commercial  aspect  of  medicine  forces  itself  upon 
the  attention  of  the  majority  of  its  practitioners, 
producing  a  jarring  note  upon  the  ears  of  many, 
but  to  others,  unwillingly  perhaps,  in  the  first 
instance,  it  offers  the  only  possible  solution  to  a 
life  which  could  scarcely  exist  at  all  were  the  highest 
ideals  to  be  slavishly  followed.  Regarded  from 
this  point  of  view  the  medical  man  or  woman 
is  only  a  skilled  workman  whose  services  have  a 
definite  money  value  in  the  world's  market.  The 
doctor  must  live  as  well  as  his  patient,  though  the 
latter  often  fails  to  recognise  the  fact.  Public 
bodies,  and  even  the  State  itself,  also  ignore  it, 
with  the  result  that  a  great  outcry  is  made  when- 
ever a  medical  practitioner  ventures  to  assert 
his  rights  and  demands  payment  for  his  services. 
Too  much  gratuitous  work  is  demoralising  to  the 
public,  and  must  slowly  tend  to  the  destruction 
of  the  physicians  humanitarian  instincts.  Every 
labourer,  even  those  in  the  field  of  medicine,  is 
worthy  of  his   hire. 


Two  Sides  of  the  Body. 

The  belief  in  the  inferiority  of  the  left  side 
ol  the  human  body  is  one  of  those  popular  super- 
stitions   which    have    been    handed    down    from 
remote  ages,  and  which  is  shared,  to  some  extent, 
by  the  members  of  a  learned  profession  even  at 
the  present  day.     It  is  well  known,  for  instance, 
that  pain  is  more  frequently  felt  upon  the  left 
side,   and  it  is  quite  a  common  saying  among 
gynaecologists  that  the  sinister  half  of  the  body  is 
the  weaker  and  less  resistant.     Sometimes  there 
is  an  anatomical  explanation  for  this,  as,  for  ex- 
ample, the  presence  of  a  loaded  sigmoid  flexure. 
The  mode  in  which  the  spermatic  veins*  empty 
themselves    may  account,  in    some    degree,  for 
the  greater  prevalence  of  varicocele  upon  the  left 
side.     The  evolutionary  factor  which  has  resulted 
in  the  superiority  of  the  left  cerebral  cortex  has  had, 
of  course,  the  chief  influence  in  enduing  the  right 
side  with  greater  powers  than  the  left.     As  far  as 
we  are  aware,  no  observations  have  been  made 
as  to  whether  left-handed  individuals  suffer  pain 
more  acutely  upon  the  left  side  of  their  bodies, 
but  there  is  no  reason  why  the  sensory  as  well  as 
the  motor  conditions  should  not  be  reversed  in 
such.     Tradition  and  sentiment  have,  probably, 
much  to  do  with  this  ancient   belief.      Not  only 
is  the  left  side  supposed  to  be  inferior  in  function 
to  the  right,  but  it  has  been  credited  with  being 
of  sinister  import.     The  common  saying  that  the 
individual  whose  left  ear  tingles  is  being  spoken 
evil  of  would  appear   to  have  its  origin  in  great 
antiquity.     Dr.  Richard  Caton,  in  the  course  of 
the  Harveian  Oration  before  the  Royal  College  of 
Physicians,  referred  to  a  passage  from  an  ancient 
Egyptian  papyrus,   in  which  it  was  stated  that 
the  "  breath  of  life  "  was  contained  in  the  right  ear, 
and  the  '*  breath  of  death  "  in  the  left.     This  is! 


in  all  probability,  one  of  the  earUest  references 
regarding  the  common  beUef  in  the  sinister  import 
of  the  left  side  of  the  body. 

The  Need  of  a  Standard  of  Purity  of  Food 
and  Drink. 

At  no  time  up  to  the  present  has  there  been  so 
much    activity    shown    by    local    authorities    in 
enforcing  as  far  as  is  legal  a  high  standard  of 
purity  of  articles  sold  as  food.     The  administration 
of  the  various  Acts  is,  as  is  well  known,  in  the 
hands  of  local  bodies,  who  are,  however,  as  in  the 
case  of  other  matters  of  public  health,  under  the 
supervision    of    the    Local    Government    Board. 
In  a  question  of  public  health,  however,  a  local 
board  acts  under  the  direct  advice  of  its  medical 
officer,  who  is    himself  in  close  relation  with  the 
medical    department    of  the  Local  Government 
Board,    which    thus    establishes   a   certain   uni- 
formity of  poUcy  throughout  the  whole  country. 
As  regards  food  and  drink,  however,  there  is  no 
such    uniformity    of    standard    of    policy.     The 
examination  of  specimens  is  in  the  hands  of  an 
analyst,  whose  duty  is  limited  to  reporting  on 
specimens  submitted  to  him.     He  has  no  advisory 
functions,   and  he  is  not  brought  into  contact 
with  the  Local  Government  Board,  whose  control 
is,  under    present    conditions,  entirely  nominal. 
Dr.  Louis  Parkes,  who  draws  attention  (a)  to  the 
present  unsatisfactory'  state  of  affairs,   suggests 
that  the  Local  Government  Board  should  provide 
themselves  with  expert  advice  from  a  person  not 
only  skilled  in  methods  of  analysis,  but  having 
expert  knowledge  of  the  various  manufacturing 
processes  employed  in  the  preparation  of  food  and 
drink.     Aided  by  a  staff     of  trained  inspectors, 
it  should  be  his  duty  to  exercise  general  super- 
vision, not  only  over  the  sale  of  articles  of  food, 
but  over  their    manufacture  or  importation.     He 
should  further  lay  down  standards  for  the  purpose 
of  sale  of  foods  and  drugs,  and  the  Ijocal  Govern- 
ment Board  could  thus  impose  uniform  standards 
on  the  various  local  authorities. 


Latter-Day  Becruitinfir* 
The  returns  of  recruiting  given  in  the  lately 
issued  Report  of  the  Army  Medical  Department 
for  1902  are  of  an  interesting  nature,  some  in- 
cidental light  being  thrown  upon  the  question  of 
the  alleged  physical  degeneracy  of  the  nation. 
During  the  year,  out  of  87,609  recruits  inspected, 
no  less  than  26,913,  or  307*19  per  1,000,  were  re- 
jected as  unfit.  The  chief  causes  of  rejection  were 
as  follow  : — 

Defective  vision       3.437 

Disease  of  heart 1,518 

Disease  of  veins i  ,078 

Loss  or  decay  of  teeth 4.316 

Defects  of  lower  extremities 1.075 

Flat  feet i  ,090 

Malformation  of  chest  and  spine     . .  395 

Under  height    i  ,01 5 

Under  chest  measurement 4.969 

Under  weight    i  ,903 

The  total  number  of  rejections  was  increased  on 


(a)  PractUioner,  June,  1904. 


July  6,   1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.     23 


that  of  1 90 1  by  nearly  a  third,  probably  in  de- 
ference to  the  abandonment  of  Mr.  Brodrick's 
Army  Corps.  It  is  interesting  to  note  that  one  of 
the  chief  causes  of  rejection  was  non-existent  as  a 
medical  test  a  few  years  ago,  namely,  defective 
teeth. 


The  North  of  England  Miners'  Dispute. 

The  North  of  England  colliery  doctors,  as  re- 
corded elsewhere  in  our  columns  (page  11),  have 
recently  formed  themselves  into  a  strong  and 
united  body  under  the  name  of  the  Northum- 
berland and  Newcastle  Medical  Association  They 
succeeded  in  raising  fees  from  the  inadequate 
scale  that  had  been  in  force  for  the  last  sixty  years. 
The  miners,  however,  have  resolved  to  cut  down 
medical  remuneration  by  something  like  50  per 
cent.  The  matter  has  now  entered  the  fighting 
phase.  Quite  recently  the  miners  have  imported 
medical  men,  hoping  therewith  to  reduce  the  estab- 
lished colliery  surgeons  to  terms.  It  is  to  be  hoped 
that  no  medical  men  will  be  found  willing  in  the 
present  dispute  to  accept  any  such  degrading 
position.  Treachery  of  that  kind,  unfortunately, 
is  not  punishable  as  **  infamous  "  conduct,  but  it 
is  certainly  regarded  with  universal  detestation 
and  abhorrence  by  all  honourable  members  of  the 
medical  profession. 


during  the  puerperium  tend  to  inhibit  and  finally 
destroy  pathogenic  organisms  by  phagocytosis, 
but  that  bacteria  existing  in  the  passages  before 
parturition  can  gain  a  foothold  in  the  tissues  only 
if  those  passages  are  injured  during  labour. 
This  explanation,  if  the  right  one,  will  help  to 
clear  up  a  good  deal  of  obscurity. 


Vaffinal  SeoretionB. 

The  mystery  that  attaches  to  not  a  few  cases 
of  infection  of  the  female  genitalia  makes  of  value 
every  contribution  to  our  knowledge  of  the 
functions  and  constitution  of  the  secretions  of  the 
various  portions  of  the  genital  canal.  An  in- 
teresting paper,  (a)  discussing  the  question  of  the 
possibility  of  auto-infection  in  the  puerperium,  has 
lately  appeared  from  the  pen  of  Wladimiroflf,  of 
the  Pasteur  Institute.  It  is  now  generally  agreed 
the  normal  vaginal  secretion  is  actively  antiseptic 
in  virtue  of  the  lactic  acid  produced  in  it  by  the 
vagina-bacillus,  and  as  this  bacillus  is  normally 
present,  any  stray  organisms  that  may  enter  the 
vulva  by  means  of  instruments,  pessaries,  and 
such  agencies  generally  perish,  unless  introduced  in 
overwhelming  force.  The  cervical  secretion,  on 
the  other  hand,  is  sterile,  and  neutral  or  alkaline  in 
reaction,  so  that  it  forms  an  admirable  culture 
medium  for  bacterial  growth  and  activity. 
Although  the  vaginal  secretion  is  generally  in- 
creased as  to  acidity  during  pregnancy,  during  the 
puerperium  all  acidity  disappears  for  five  or  six 
weeks,  and  thus  it  has  seemed  that  the  lochial 
secretions  would  tend  to  furnish  a  ready  field  for 
microbic  invasion.  The  wonder  would  therefore 
average  sojOurn  being  close  on  four  months.  Exclud- 
ing seven  cases  which  were  only  under  treatment  for  a 
month,  the  disease  was  arrested  in  twenty-four,  and 
improved  in  twenty.  At  present  the  finances  compel 
the  directors  to  fix  the  charges  at  a  minimum  of  £1  per 
week;  but  to  benefit  the  working  classes,  considering 
that  a  residence  of  six  months  is  desirable,  they  ought 
to  be  able  to  admit  at  from  5s.  to  los.  weekly.  This 
would  do  much  to  enhance  the  usefulness  of  the  in- 
stitution by  inducing  cases  to  come  early  enough  and 
to  stay  long  enough  to  have  a  good  chance  of  being 


Vermin  in  Children's  Heads. 
A  NOTE  on  this  subject  which  appeared  in  these 
columns  a  few  weeks  ago  attracted  a  good  deal 
of  interest  among  those  who  have  the  credit 
and  health  of  the  rising  generation  at  heart.  It 
was  pointed  out  at  that  time  that  the  present 
moment  afforded  an  especially  favourable  oppor- 
tunity for  the  new  educational  authorities  to 
take  steps  to  end  the  disgrace  of  having  most  of 
the  children  attending  elementary  schools  infected 
with  head-lice.  The  Brighton  municipal  autho- 
rities, advised  by  their  able  and  energetic  medical 
ofl&cer,  Dr.  Newsholme,  are  never  slow  in  acting 
up  to  the  level  of  the  best  opinion  of  the  day. 
and  one  notices  with  satisfaction  that  they  have 
taken  this  matter  seriously  in  hand  by  appointing 
a  trained  nurse  in  the  place  of  an  attendance 
officer.  By  this  means  an  instructed  and  ex- 
perienced person  will  be  able  to  visit  the  children's 
homes  and  bring  their  condition  as  to  cleanliness 
to  the  notice  of  the  parents.  Although  there  will 
be  no  legal  compulsion  to  make  them  conform 
to  the  advice  given,  it  may  safely  be  assumed  that 
a  tactful  presentation  of  the  state  of  things  will 
be  pretty  generally  successful  in  making  the 
parents  ashamed  of  their  delinquencies.  The 
nurse  is  to  act  directly  under  the  medical  officer, 
and  will  assist  also  in  visiting  houses  when  in- 
fectious disease  has  broken  out,  so  that  her  func- 
tions will  be  manifold.  It  is  to  be  hoped  that 
Brighton's  example  will  encourage  other  autho- 
rities to  go  and  do  likewise. 

Aids  to  Dissection. 

It  will  be  generally  admitted  that  a  thorough 
grounding  in  practical  dissection  is  indispensable 
for  all  those  who  seek  to  obtain  a  working  know- 
ledge of  the  way  in  which  the  human  body  is 
built  up.  To  the  surgeon  especially  an  intimate 
acquaintance  with  the  minute  details  of  anatomy 
is  essential,  and  hardly  less  so  to  the  physician. 
Yet,  strangely  enough,  this  is  the  very  part  of 
the  medical  student's  studies  most  often  shirked, 
the  more  so  in  these  days  of  diagrams  and  photo- 
graphic illustrations.  Dissecting  is  sometimes 
irksome,  but  time  spent  in  laboriously  hunting  out 
a  minute  vessel  or  in  tracing  a  course  of  an  almost 
invisible  nerve  is  well  spent,  for  there  is  nothing 
like  actual  use  of  the  knife  and  forceps  to  impress 
anatomical  details  indelibly  upon  the  memory. 
Half  an  hour  spent  in  the  dissecting  room  of  a 
hospital  is  better  than  three  hours  passed,  book  in 
hand,  in  a  wax-model  museum.  However  faithfully 
a  part  or  organ  of  the  body  is  modelled,  the 
natural  colours  included,   and    however    realistic 


24THB  Medical  Press. 


photographic  representations  of  the  same  may  be, 
they  cannot  take  the  place  of  manual  dissection! 
We  notice  that  a  new  stereoscopic  atlas  of  human 
anatomy  has  recently  been  published,  and  whUe 


PERSONAL. 


July  6,   1904. 


The  Earl  of  Radnor  will  preside  at  the  Congress  of 
the  Royal  Institute  of  PubUc  Health,  to  be  held  at 
l-olkestone  from  July  21st  to  26th. 


we  n.ar.el  at  the  vividness  of  ■  partV-' ;;;;tr;;;d  I  ^sX^^^l\^^tJ: orof^^ritL'^:a^t:^ 
m  tnis  lashion,  and  have  nothing  but  admiration  (  f*^*^^  ^^^^^  ^^  J^ly  21st  and  22nd  at  Chandos  Street' 
for  the  excellence  of  the  illustrations  we  fee*!  that    ^°i*^°'V  

:hZr.:^r^  f  rr--^  r  *' ""^-' '  »"■  ™»- ^^^^^^^^ 

snouia  be  tempted  to  trust  to  these  and  similar  ;  

means  of  acquiring  anatomical  knowledge  instead  '  ^^?tf"  Jo«n  Beddoe.  of  Clifton,  will  deliver  the  firet 
of  going   straight    to    the   dead   body   itself.     Inllil^lT'^l^;;^ 

their  right  place  such  atlases  and  diagrams  may  *       ^ 

be  true  "  aids  "  to  dissection,  but  there  is  a  danger  ,J^j;  }'  ^'  Douglas  Kerr,  of  Bath,  is  the  owner  of 
lest    they    should    become    hindrances    by    being  i  lanVyifhTrlce'^'''"^"!^ 

substituted  for  individual  manual  labour  in  the  |      Surgeon-Lieutenant-Colonel  Gaskell  V  D    T  P 
dissecting  room.      Verbum  sap.  on    June   23rd    last    formally  handed     over  *  to     the 

.  I  M^y°r  and  Corporation  of  St.    Helens    the    grounds 

Disinfection  of  the  Clinical  ThermometGr      7        ^®  ^^^  presented  to  his  fellow-citizens,  to  be 
The    Httle   instrument    of   precS^Tlmth    is  I  '"^""  ^'  ^"^  ^"^^^^^  ^^'•"- 
carried  about  by  every  medical  practitioner,  and  '      The  appointment  of  Mr.  Otho  Galgey  M  R  C  P  I    as 
which  alone  is  the  correct  guide  to  the  state  of  the  i  Z^^^^^  member  of  the  Legislative  Council  of  St.  Lucia 
patient's    temperature,    has    often    been    anathe-  approved  by  His  Majesty  the  King, 

matised    by   its   users.     At   one    time    the   index  '      -      -     ■ 
cannot  be  shaken  down,  while  at  another  it  is 
too  fragile  or  the  reading  is  said  to  be  inaccurate. 
These   supposed   faults    are,    in   many   instances, 
due  to  the  manner  in  which  the  cUnical  thermo- 
meter is  used  rather  than  to  the  instrument  itself 
Another  charge,   however,   has   a  sounder  basis 
namely,  that  it   is  often   the   medium  by  which 
infection  is  conveyed  from  one  person  to  another. 
Like  any  other  apparatus  brought  into  intimate 
contact  with  the  sick,  the  thermometer  requires 
most  careful  disinfection  after  use.     In  hospital 
practice  this  is  most  easily  and  efficiently  done 
for  as  soon  as  the  temperature  is  noted  the  instru- 
ment is  at  once  placed  bulb  downwards  in  a  small 


The  Duchess  of  Albany  will  open  the  new  ophthalmic 
out-patient  department  at  the  Royal  Hospital,  Rich- 
mond, on  July  8th.       

Dr.  J.  LoRRAiN  Smith,  Professor  of  Patholoirv  in 
Queen's  College.  Belfast,  has  been  elected  President  of 
the  Ulster  Medical  Society  for  the  ensuing  year,  1904-5, 

The  Duchess  of  Albany  last  week  paid  a  visit  to  the 
Koyal  Hospital  for  Incurables.  Putney,  for  the  purpose 
of  opening  the  annual  sale  of  work  held  there  for  the 
benefit  of  the  Institution. 

Princess  Christian  was  present  on  June  28th 
f  *  3.  meeting  of  the  National  Health  Society,  held  at 
the  Mansion  House,  London,  and  presented  certificates 
and  diplomas  to  those  who  had  been  successful  in  the 
annual  examinations. 

The  Duke  of  Argyll  presided  on  the  28th  ult.  at  a 


-Jwnwaras  m  a  small         "".    ^""^^^  ^^  Argyu  presided  on  the  28th  ult.  at  a 
vessel  of  carbolic  lotion,   or  similar  disinfectinir    fl  a'""^^  ?'^^^P®''°''^^°°^*^^^°°^aLa^yTrevelyan, 

out    antiseptic    precautions    in    private    practice 


though,  happily,  it  is  becoming  less  so.  stiU 
the  busy  practitioner  often  has  to  be  content 
with  hastUy  dipping  the  bulb  of  the  thermometer 
m  water  and  wiping  it  upon  a  towel  or  handker- 
chief, whereupon  it  is  dropped  back  into  its  case 
in  a  condition  which,  in  the  great  majority  of 
instances,  cannot  be  said  to  be  aseptic.  Many 
attempts  have  been  made  to  get  over  the  difficulty 

off^iT^  r  ^^^  ^l^  **^'  °*  P"t«n&  a  few  drops 
of  formahn  into  the  case,  as  was  Suggested  b^ 

™fw»y^'i"*  ^y^'-  T^^t  tWs  antiseptic  is  really 
powerful  in  preventing  the  growth  of  organisms 
when  employed  for  this  purpose  has  been  recenUy 
demonstrated  by  Dr.  F.  P.  Denny  fa)  wh^  h^ 
elaborated  a  series  of  bacteriolojcal  tJS?  S 
outcome  of  which  shows  that  two%r  thr^  dro^ 

th^^?rfnH  .*^  "?  9"'*^  «"*"««»  to  disinfect 
the  bulb  and  to  keep  it  in  a  fit  state  for  use. 

„     _  „  PERSON.\L. 

or,  fL^      Makins  presided  over  a  briUiant  Katharine 


Sir  Charles  Tupper,  the  veteran  ex-Premier  of  the 
pomimon  of  Canada,  in  his  early  youth  was  eniraffed 
m  medical  practice  for  a  short  period  of  his  career. 

♦K^SP^;-^^®^'^'^  ^°^"  ^^  ^^^  elected  a  member  of 
ine  Bertm  Academy  of  Science  in  succession  to  the  late 
Prof.  Vu-chow.  The  Berliner  Tageblatt  states  that 
^ot.  Koch  has  resigned  the  post  of  Director  of  the 
lierhn  Institute  for  Infectious  Diseases. 


The  Wightman  Lecture  of  the'Society  for  the  Studv 
of  Disease  in  Children  will  be  delivered  bv  Mr  R 
hIT'S^  L^^^^s-.BS.Lond.,  F.R.C.S.,  at  the  Victoria 
Hall  Hotel  Cecil  on  Friday.  July  isth.  at  6.30  p.m 
The  title  of  the  lecture  is  "  The  Hereditary  Bias  and 
^%^^^^'^°'^"^*''^*  ^^  *^«i^  Relation  to  the  Diseases 
and  Defects  of  Children."  The  lecture  is  open  to  all 
members  of  the  medical  profession 


Disease  of  heart  .    I'liS 

Disease  of  veins .....'.';.';;;:;:;::;  1.078 

Loss  or  decay  of  teeth 4  ,,6 

Defects  of  lower  extremities. . .        '  *  7 07c 

Flat  feet    •■•  J'^ 

Malformation  of  chest  and  spine       '  '^ 

Under  height    "  j  ^^^ 

Under  chest  measurement. ^'060 

Underweight ;;;;;;  f;^ 


(a)  Boton  Med,  and  Surg.  j(nim.,  June  2nd,  iwi. ^'^^  *°^^  number  of  rejections  was  increased  on 


(a)  Practiiioner,  June,  1904. 


July  6,  1904. 


SPECIAL  CORRESPONDENCE. 


Thb  Msozcal  Press.    23 


Special  (EorrespotiDence* 

[from  our  own  correspondents.] 


SCOTLAND. 

Epidemic  of  Sore  Throat  at  Belvedere  Fever 
Hospital. — During  about  three  weeks  of  May  there 
%\'as  an  outbreak  of  sore  throat  involving  thirty-ninf 
persons,  mostly  members  of  the  staff,  in  this  hospital. 
A  bacteriological  examination  showed  that  in  two- 
thirds  of  the  cases  from  which  swabs  from  the  throat 
was  taken,  the  organism  present  was  Loeffler's  bacillus, 
sometimes  in  almost  pure  culture.  The  outbreak  was 
clearly  due  to  milk  infection,  for  an  organism  with  the 
same  microscopic  and  cultural  characters  was  isolated 
from  a  sore  on  the  hand  of  one  of  the  milkers  at  the 
farm  from  which  the  milk  supply  of  the  hospital  is 
obtained. 

Treatment  of  Infectious  Diseases  at  Montrose. 
— In  the  last  annual  report  of  the  medical  officer  of 
health  it  is  stated  that  while  twenty  cases  of  scarlet 
fever  were  removed  to  the  fever  hospital,  ten  of  diph- 
theria and  four  of  typhoid  were  sent  to  the  infirmary. 
Dr.  Connor  explains  that  the  removal  of  the  patients  to 
the  latter  institution  was  necessary  on  account  of  the 
skilled  nursing  required,  but  points  out  the  desirability 
of  having  such  arrangements  made  at  the  Fever  Hos- 
pital as  would  enable  him  to  treat  all  infectious  cases 
there.  In  consequence  of  this  report  the  Local  Govern- 
ment Board  caused  inquiry  to  be  made,  and  the  results 
of  this  inquiry,  communicated  by  the  secretary,  were 
under  the  consideration  of  the  Town  Council  on 
June  6th,  and  were  remitted  to  the  Public  Health 
Committee.  From  the  strictures  of  the  Local  Govern- 
ment Board's  medical  officer  it  would  seem  that  a  good 
deal  is  needed  before  it  can  be  said  that  infectious 
disease  is  being  properly  dealt  with  in  Montrose.  The 
person  in  charge  of  the  Fever  Hospital  is  not  a  trained 
nurse,  and  although  many  cases  of  scarlet  fever  may 
in  their  issue  prove  to  have  been  of  little  gravity,  the 
local  authority  ought  to  fix  the  standard  of  attendance 
to  meet  the  necessities  of  the  grave  cases  which  may 
occur,  not  those  of  the  mildest.  The  arrangements  for 
the  treatment  of  enteric  fever  and  diphtheria  in  the 
infirmary  are  the  result  of  use  and  are  the  faulty 
expedients  of  bygone  days  which  are  totally  opposed 
to  present  experience.  Patients  and  their  friends  have, 
in  Sir  Henry  Littlejohn's  opinion,  just  cause  of  com- 
plaint as  to  the  danger  which  medical  and  surgical  cases 
run  from  their  proximity  to  infectious  cases  in  the 
wards.  A  separate  ward  containing  two  beds  is  set 
apart  near  the  operating  theatre  for  diphtheria  cases  ; 
this  is  done  for  convenience  should  an  operation  be 
needed.  For  tracheotomy,  however,  the  elaborate 
arrangements  of  a  modern  theatre  are  unnecessary,  and 
to  operate  on  a  dangerous  infectious  disease  in  a  room 
filled  with  all  the  requirements  of  modern  surgery  for 
the  prevention  of  infection  in  ordinary  operations 
defeats  the  purpose  of  these  precautions,  and  therefore 
is  reprehensible.  The  Board  trust  that  the  local 
authority,  having  at  present  no  accommodation  for 
infectious  disease,  of  which  the  Board  can  approve,  will 
at  once  staff  and  equip  the  Fever  Hospital  so  as  to  make 
it  suitable  for  the  proper  treatment  of  all  the  cases  of 
infectious  disease  for  which  they  are  responsible. 

SiDLAw  Sanatorium,  Dundee. — The  buildings  have 
now  been  completed  by  ex-Provost  Moncur's  liberality 
in  providing  a  well-equipped  sanatorium  at  a  cost  of 
£2S,ocfO.  During  the  first  year  of  the  sanatorium's 
existence,  eighty-seven  patients  were  admitted,  the 
average  sojourn  being  close  on  four  months.  Exclud- 
ing seven  cases  which  were  only  under  treatment  for  a 
month,  the  disease  was  arrested  in  twenty-four,  and 
improved  in  twenty.  At  present  the  finances  compel 
the  directors  to  fix  the  charges  at  a  minimum  of  £1  per 
week;  but  to  benefit  the  working  classes,  considering 
that  a  residence  of  six  months  is  desirable,  they  ought 
to  be  able  to  admit  at  from  5s.  to  los.  weekly.  This 
would  do  much  to  enhance  the  usefulness  of  the  in- 
stitution by  inducing  cases  to  come  early  enough  and 
to  stay  long  enough  to  have  a  good  chance  of  being 


I  cured.  The  directors  therefore  appeal  to  the  wealthy 
to  help  them  by  endowing  the  sanatorium. 

BELFAST. 
Ulster  Medical  Society. — The  annual  meeting  of 
this  society  was  held  on  Thursday  last  in  the  Medical 

I  Institute,  Belfast.     The  President,  Dr.  John  Campbell. 

i  F.R.C.S.,  in  the  chair.  The  report  of  Council  moved  by 
Dr.  Houston  and  seconded  by  Dr.  Calwell,  showed  that 
the  Society  is  in  a  very  flourishing  condition,  the  total 

I  number  of  Fellows  and  Members  being  197.  The 
report  stated  that  during  the  past  year  steps  had  been 

j  taken  to  procure  a  bust  of  the  donor  of  the  Institute. 
Sir  Williani  Whitla,  and  to  this  end  a  commission  had 
been  given  to  Miss  Kathleen  Shaw,  *vho  had  nearly 
completed  the  work.  The  financial  statement  was 
presented,  and  its  adoption  moved  by  the  Hon. 
Treasurer,  Dr.  W.  B.  McQuitty,  and  seconded  by 
Professor  Byers.  From  this  it  appeared  that  the  annual 
income  of  the  Society  from  members'  subscriptions  is 
about  ;f30O,  and  that  in  addition  to  this  several  mem- 
bers had  contributed  special  donations  amounting  in 
all  to  ;^  1 09  to  aid  in  the  improvement  of  the  Society's 
library.  The  sum  expended  on  books  and  periodicals 
during  the  year  was  £136.  At  the  close  of  the  financial 
year  a  sum  of  £$0  was  invested,  and  a  balance  of  £132 
remained  in  hand.  The  Hon.  Librarian's  report  was 
read  by  the  Hon.  Secretary,  in  the  absence  of  Dr. 
R.  R.  Leathern,  and  was  seconded  by  Dr.  Nelson.  It 
drew  attention  to  the  recent  division  of  the  library  into 
consulting  and  lending  departments,  the  latter  being 
designed  largely  for  the  benefit  of  country  members. 
The  following  office-bearers  for  the  session  1904- 1905 
were  elected  : — President.  Professor  J.  Lorrain  Smith  ; 
Vice-Presidents.  Dr.  Hadden  (Portadown)  and  Dr. 
J.  B.  Moore  (Belfast)  ;  Hon.  Secretary,  Dr.  Thos. 
Houston ;  Hon.  Treasurer,  Dr.  W.  B.  McQuitty ; 
Hon.  Librarian,  Dr.  R.  R.  Leathern  ;  Members  of 
Council  (in  addition  to  the  seven  trustees),  Drs.  D.  P. 
Gaussen,  J.  R.  Davison,  J.  Hall,  D.  J.  McKinney, 
J.  S.  Morrow,  and  W.  L.  Storey.  Dr.  J.  C.  McCarroU 
(Carrickfergus)  and  Dr.  William  Mair  (Queen's  College, 
Belfast)  were  elected  Fellows  of  the  society. 

The  Gordon  Portrait. — At  the  conclusion  of  the 
ordinary  business  an  interesting  function  took  place, 
a  portrait  of  the  late  Dr.  Gordon,  Professor  of  Surgery 
in  Queen's  College,  being  presented  to  the  society  by 
his  daughter,  Mrs.  Gordon  Stallard.  In  the  absence 
of  that  lady  through  illness,  the  portrait,  which  was 
hung  in  the  large  hall  of  the  Institute,  was  unveiled  by 
Mrs.  John  Campbell.  Sir  William  Whitla,  who  made  the 
presentation  for  Mrs.  Gordon  Stallard.  spoke  of  the 
suitability  of  this  home  for  the  portrait,  where  it  looked 
down  on  so  many  who  had  been  pupils,  and  some  who 
had  been  friends,  of  the  great  surgeon  and  teacher. 
The  President  of  the  Society,  in  receiving  the  portrait, 
said  that  Dr.  Gordon  had  been  not  only  a  member,  but 
also  a  president  of  the  Society,  and  on  that  account,  as 
well  as  for  his  world-wide  reputation,  he  welcomed  the 
gift  of  this  portrait.  Professor  Sinclair,  Dr.  Gordon's 
successor  in  the  chair  of  surgery  at  Queen's  College, 
moved  a  vote  of  thanks  to  Mrs.  Gordon  Stallard  on 
behalf  of  the  Ulster  Medical  Society.  Dr.  Gordon  was. 
he  said,  more  than  a  name,  even  to  the  younger  mem- 
bers of  the  Society,  for  the  great  principles  he  enun- 
ciated have  been  passed  on  by  his  successors.  Dr. 
Gordon's  power  as  a  teacher  he  believed  to  be  due  to  his 
rigid  self-criticism  before  laying  down  any  surgical 
principles.  No  one  who. had  known  him  could  forget 
his  almost  childlike  glee  over  some  new  observation 
he  had  made,  and  his  heart-whole  devotion  to  his  pro- 
fession. Those  who  had  been  privileged  to  know  him 
held  him  in  the  warmest  esteem  and  affectionate  regard. 
Dr.  Joseph  Nelson,  as  senior  trustee,  seconded  the 
motion.  When  a  student  he  had  lived  as  a  member  of 
Dr.  Gordon's  household  for  two  years,  so  that  his  know- 
ledge of  him  was  very  intimate,  and  he  endorsed  all 
that  Professor  Sinclair  had  said.  Dr.  Henry  O'Neill 
also  spoke. 

Small-pox  in  Belfast. — The  past  week  shows  some 
improvement  as  regards  the  number  of  new  cases  of 


26    The  Medical  Press. 


CORRESPONDENCE. 


July  6,   1904. 


small-pox  in  the  city,  as  only  four  were  found  and  re- 1 
moved  to  the  Small-pox  Hospital  at  Purdysburn.  One  ' 
of  these  was  the  wife  of  a  medical  man  practising  in  the 
Ballymacarrett  side  of  Belfast,  who  had  attended  some 
of  the  previous  cases.  The  others  were  all  in  one  house, 
and  will  probably  be  the  starting  point  of  further  cases, 
for  two  unvaccinated  children  had  been  ill  for  a  fort- 
night or  more,  and  it  was  only  when  the  father  also 
became  ill  that  the  facts  came  to  light.  There  can  be 
little  doubt  that  the  people  were  quite  aware  of  the 
nature  of  the  disease,  and  tried  to  conceal  it.  One 
of  the  cases  in  hospital  died  during  the  week  ;  all  the 
others  are  doing  well.  At  a  meeting  of  the  Belfast 
Corporation  held  last  week  it  was  stated  that  the  total 
admissions  to  the  Small-pox  Hospital  up  to  date,  since 
the  beginning  of  the  outbreak,  were  93.  There  were 
55  discharges,  2  deaths,  and  36  patients  remained  in 
hospital.  At  the  intercepting  hospital  on  the  Twin 
Islands,  302  people  had  been  provided  for,-  of  whom 
94  still  remained,  21  cases  having  contracted  small-pox. 
At  the  same  meeting  Alderman  King  Kerr,  M.D.,  gave 
some  interesting  facts  about  vaccination  and  its  effects, 
as  seen  in  this  epidemic.  In  the  case  of  one  family, 
which  had  been  exposed  to  infection,  six  were  re- 
vaccinated  and  two  refused  ;  the  six  escaped  and  the 
two  took  small-pox.  In  another  case  there  were  40 
contact  cases,  of  whom  39  were  revaccinated  and  one 
disappeared  to  avoid  it.  Later  on  he  reappeared  with 
the  disease,  the  other  39  having  escaped  !  Not  a  single 
revaccinated  case  has  been  seen  at  the  Purdysburn 
Hospital. 

CorresponDence* 

[We  do  not  hold  ourselves  responsible  for  the  opinions  of  our  Cor- 
respondents}. 


SANITARY     AND     BUILDING     BYE-LAWS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — A  little  space  in  your  influential  journal  to 
sAiggest  that  our  municipal  and  borough  councils  make 
obligatory  the  use  of  some  kind  of  approved  exhaust 
ventilator  on  soil-pipe  air-shafts.  Whatever  the  sup- 
posed virtue  of  the  wire  balloon  may  have  been  origin- 
ally, it  is  always  found  to  allow  "  blowdown  "at  any 
seaside  place  or  district  where  gusty  winds  are  frequent. 
Something  better,  too,  is  required  than  a  cowl  that 
merely  permits  escapement  or  prevents  blowdown,  but 
does  not  promote  an  efficient  updraught. 

Our  sanitary  bye-laws  should  aJso  require  all 
closets  or  bathrooms  to  be  painted.  Paper  absorbs 
and  retains  foul  air  and  is  a  not  unlikely  source  of 
infection.  Again,  ordinary  roofs,  other  than  mansards, 
should  be  provided  with  at  least  one  turret  ventilator 
and  top  floors  or  landings  be  ventilated  with  Tobin  tubes 
Otherwise  the  upper  parts  of  the  house  will  receive  and 
retain  the  exhausted  fumes  from  the  kitchen  and  house 
generally.  An  "  outlet "  ventilator  should  also  be 
required  in  the  external  walls  of  rooms  not  provided 
with  a  fireplace  and  an  exhaust  ventilating  shaft  to  all 
kitchens,  sculleries,  bathrooms,  and  lavatories.  These 
methods  are  especially  necessary  at  seaside  places  owing 
to  the  difficulty  in  securing  ventilation  without  draught 
or  disturbance  due  to  the  high  and  variable  winds. 
There  is  no  reason  why  most  of  our  seaside  towns  should 
not  rank  amongst  the  healthiest  of  health  resorts  if 
only  sajiitary  regulations  of  this  sort  were  rigorously 
enforced. 

It  is  also  time  that  builders  and  building  owners 
constructed  their  houses  for  some  definite  purpose.  An 
advertisement  prior  to  building,  inviting  the  require- 
ments of  prospective  buyers  or  tenants,  would  be 
sufficient.  At  present  they  build  something  that  may 
(or  may  not)  suit  as  a  private  house  ;  a  boarding  house, 
a  private  hospital,  a  boarding  school,  &c.,  &c., 
result,  dismal  discomfort ;  one  or  two  medium-sized 
and  a  large  number  of  small,  draughty,  wrongly  lit, 
uncomfortable  rooms  describes  most  of  our  modem 
houses.  Whereas  if  they  were  built  for  some  definite 
purpose,  adapted  to  the  special  needs  of  the  neighbour- 
hood, they  would  be  suited  to  the  requirements  of  each 


case  and  the  occupiers  would  be  comfortable.  For 
example,  there  are  places  where  boarding  houses  are  in 
special  demand.  Or  again,  places  famous  for  a  cure  for 
some  particular  ailment.  Invalid  visitors  to  such 
places  unable  to  climb  stairs,  &c.,  should.be  provided 
with  ample  accommodation  on  the  ground  floor.  The 
stock  private  or  residential  house  cannot  meet  both  of 
these  cases.  Our  Continental  cousins  have  long  since 
solved  this  difficulty  with  the  result  that  each  class  of 
visitor  is  made  happy.  Our  seaside  resorts  suited  to 
invalids  and  hohday  folk  alike  would  largely  benefit 
by  such  special  structures. 

I  am.  Sir.  yours  truly. 

Modern  us. 

ST.  GEORGE'S  AND  HOSPITAL 
CENTRALISATION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Your  leader  of  June  29th  on  the  above  subject 
is  practical  and  to  the  point.  You  very  prof)erly 
state  "  there  is  no  poor  population  close  at  hand — and 
domestic  servants  furnish  a  considerable  proportion 
of  the  patients  attending  the  institution."  We  all 
know  that  domestic  servants  everywhere,  more  es- 
pecially the  West  End  of  London,  enjoy  higher  wages 
than  ever.  Why,  then,  should  a  hospital  be  kept  for 
persons  who  earn  ^£2  5  to  £^0  per  annum,  besides  board 
and  lodging,  and  most  likely  never  give  any  contribu- 
tion to  the  hospitals  whatever?  Surely  this  is  an 
additional  instance  of  hospital  abuse.  Numbers  of 
people  subscribe  to  the  hospitals  under  the  delusion 
they  are  helping  the  very  poor,  who  alone  should  have 
the  benefit,  and  yet  the  pampered  menial  in  receipt  of 
iy>  or  1^0  a  year  will  take  advantage  of  free  advice 
and  medicine  at  the  expense  of  the  ignorant  philan- 
thropic public  who  think  it  a  salve  to  their  conscience 
when  about  to  die  to  leave  their  money  to  hospitals, 
little  knowing  how  badly  it  will  be  applied.  It  will  be  a 
just  judgment  on  selfish  hospital  boards  when  your 
prognostication  comes  true  (as  it  assuredly  will), 
and  the  "outer  metropolis  builds  its  own  hospitals," 
leaving  St.  George's  and  others  severely  alone. 

I  am.  Sir,  your   truly. 

West  End. 


PROPOSED      STERILISATION      OF      CERTAIN 

DEGENERATES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — In  The  Medical  Press  and  Circular  of 
June  29th,  a  correspondent  asks  if  my  proposal  to 
sterilise  certain  degenerates  is  *'  merely  academic." 
Certainly  not.  All  our  present  efforts  to  check  lunacy 
and  other  forms  of  degeneracy  have  failed  lamentably. 
The  Lunacy  Commissioners  recognise  this.  If  it  were 
not  for  the  large  and  increasing  number  of  suicides, 
we  should — even  in  this  country,  where  new  ideas  and 
change  are  repugnant  to  nine-tenths  of  the  people — 
have  been  compelled  to  take  action.  I  fear  a  number 
of  correspondents  have  failed  to  read  my  work.  I  have 
given  away  360  copies,  while  it  has  been  published  on 
a  purely  charitable  basis.  Those  "  who  have  honoured 
me  "  (is  not  this  the  usual  jargon  ?)  by  reading  it,  will 
note  that  I  refer  only  to  the  question  of  degenerates 
begetting  offspring.  I  do  not  propose  any  interference 
with  their  marriage  even.  I  only  contend  that  there 
are  certain  named  degenerates  who  have  no  right,  moral 
or  social,  to  curse  an  offspring  with  their  disease,  or 
to  burden  the  ratepayers  by  supporting  them.  In  my 
work,  one  case  is  referred  to  where  an  imbecile  woman 
was  confined  of  nine  children  by  a  partly  imbecile 
father.  It  has  lately  been  pointed  out  that  in  a  work- 
house in  Yorkshire  five  unmarried  imbecile  women 
have  been  confined  of  fifteen  children.  And  yet  even 
we  doctors  rant  and  cant  about  degeneration,  and  with 
an  unctuous  hypocrisy  wonder  why  these  things  are 
allowed  to  develop.  In  the  same  way  we  allow  persons 
removed  from  asylums  to  resume  conjugal  [relations  or 
to  marry.  WTiy  ?  Is  this  the  right  thing  to  do  ?  If 
not,  why  do  we  fail  to  take  action  ?  But  what  can 
the  ordinary  medical  do  when  a  man  of  the  professional 


July  6.   1Q04. 


LITERATURE. 


'fllB    MlFilCAL    PRKSS.        I'J 


Standing  and  ability  of  Dr.  Mercier  attempts  to  ridicule 
the  whole  question  and  to  switch  it  off  on  to  the  tracts 
of  india  ink  marks.  Surely  life  is  too  serious,  and 
the  present  condition  of  lunacy  too  grave  to  joke 
about. 

I  am.  Sir,  yours  truly. 

Robert  R.  Rentoul. 
Liverpool. 

LUNACY— A  PRACTICAL  DEFINITION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — As  once  a  lecturer  on  legal  medicine  and 
induced  for  various  reasons  to  study  legally  and 
clinically  the  subject  of  lunacy,  I  have  ventured  to 
draw  your  attention  to  it.  I  cannot  agree  with  Dr. 
Clement  H.  Sers  that  we  are  sometimes  provoked  "  to 
shake  our  fists  in  the  face  of  any  bullying  counsel." 
The  way  in  which  I  have  seen  members  of  my  profession 
refuse  to  certify  in  such  cases,  and  far  worse  ones,  as 
the  Archdeacon's  brother  has  impressed  me  frequently; 
and  I  must  say  that  I  have  always  found  in  a  Court  of 
Law  a  far  higher  spirit  of  justice  and  good  feeling  among 
those  conducting  the  legal  business  than  among  those 
engaged  on  either  side,  in  matters  medical.  The 
question  that  a  doctor  has  to  decide  when  he  is  called 
upon  to  give  an  opinion  on  the  mental  condition  of  the 
patient  is  simply  this:  Is  this  person  in  a  condition 
that  frees  everyone  from  responsibility  in  regard  to 
his  actions,  and  can  he  be  trusted  to  do  no  injury  to 
himself  or  to  others  by  the  derangement  of  mind 
to  which  he  is  temporarily  or  chronically  subject  t 

If  that  person  has  property  the  lawyer  naturadly  takes 
greater  interest  in  the  case  than  if  he  is  a  pauper. 
The  interests  of  the  patient  must  be  considered  on  the 
one  hand  and  the  interest  of  the  community  in  which 
he  lives  on  the  other.  We  have  to  distinguish  very 
clearly  when  we  are  called  upon  to  certify  whose 
interests  have  most  to  be  considered.  In  such  a  case 
as  the  Archdeacon's  brother,  a  lawyer  would  perhaps 
take  the  view  that  other  people  can  be  left  to  take  care 
of  themselves,  till  crime  has  brought  the  lunatic  within 
reach  of  the  law.  When  we  see  a  poor  feeble- 
minded person  who  controls  valuable  property  being 
influenced  in  an  unfair  way  in  the  management  and 
disposal  of  it,  we  are  justified  for  the  good  of  that 
person,  and  in  the  interests  of  others,  in  certifying.  The 
lawyer  would  be  the  first  to  agree  with  that  view, 
particularly  if  the  patient  were  a  woman.  Can  this 
person  be  treated  badly  by  others,  or  influenced  badly 
by  them?  On  the  other  hand,  can  this  person  be  dangerous 
to  others  ?  These  are  the  simple  questions  that  a  doctor 
ought  to  be  called  upon  to  answer  when  asked  to 
certify.  If  he  cannot  answer,  at  once  and  satisfactorily, 
these  questionSk  he  ought  to  certify  accordingly,  and 
let  his  opinion  be  handed  on  to  those  who  can  properly 
deal  with  it.  The  doctor  has  no  personal  interest  in 
such  a  case,  or  ought  not  to  have,  and  no  responsibihty. 
This  is  ail  that  the  law  requires,  and  we  need  have  no 
fear  that  a  "  doctor  "  will  be  bullied  by  a  lawyer  when 
he  gives  his  honest  and  impartial  opinion  in  a  case  of 
lunacy. 

I  am,  Sir,  yours  truly, 
R.  L. 


Xitetatute* 


SQUIRE'S  POCKET  COMPANION.(fl) 
This  is  a  new  book  evolved — Phocnix-like — from 
the  ashes  of  an  old  and  famous  volume.  It  is  new  in 
the  sense  of  fresh  arrangement  and  of  added  and 
excised  matter,  but  old  n  the  solid  familiar  outlines  fo 
Squire's  classical  "Companion  to  the  Pharmacopoeia" 
which  has  outlived  several  medical  generations.  The 
present  book  has  been  compiled  principally  for  the 
use  of  medical  men,  and  it  is  the  only  book  of  the  kind 
which  contains  all  the  official  substances  together  with 
all  the  non-official  substances  which  are  of  any  import- 
ance, arranged  in  alphabetical  order  throughout.     The 


(a)  "Pocket  Companion  to  the  British  PhanoftcopoBia." 
Wy.itt  Squire.    London  :  J.  and  A.  Churchill,  1904. 


By  Peter 


apparent  exceptions  to  this  arrangement  are  the 
grouping  of  several  preparatons  under  one  headinc:,  such 
for  example  as  the  new  silver  salts  under  '-  Argenti 
Nitras."  where  they  can  be  more  conveniently  com- 
pared than  would  be  the  case  if  they  were  distributed 
through  the  book  under  the  intials  of  their  fancy  names. 
The  non-official  substances  which  have  not  fulfilled 
original  expectations  are  mentioned  collectively  in 
small  type  under  the  substance  to  which  they  most 
nearly  relate.  The  paragraphs  "  Prescribing  Notes  " 
originally  introduced  in  the  "Companion"  have  been 
largely  increased  both  in  number  and  in  extent,  and 
add  considerably  to  the  value  of  the  book.  The  solu- 
bilities and  methods  of  prescribing  are  written  from 
the  results  of  actual  experiments  instituted  for  that 
purpose  by  a  special  staff  that  has  been  engaged  upon 
the  work  for  two  years.  Other  practical  notes  of  a 
similar  nature  are  also  scattered  throughout  the  work, 
and  indeed  the  guiding  principle  of  utility  is  every- 
where apparent. The  references  to  medical  literature 
are  very  complete  and  in  one  instance  that  of  **  Soda- 
Chlorinatae  Liquor,"  page  573,  A. J. P.  1904,  266  bears 
the  date  of  June,  1904. 

When  the  preparations  official  and  not  official  of  any 
substance  occupy  many  pages  a  saving  of  time  will  be 
effected  by  reference  to  the  list  "  Official  Preparations  " 
and  "  Not  Official  "  which  are  given  under  the  Dose  or 
Prescribing  Notes  of  the  principal  substance. 

As  an  up-to-date  book  of  ready  reference  for  the 
consulting  room  table  of  any  medical  man,  be  he 
consultant  or  general  practitioner.  Squire's  "Pocket 
Companion  "  would  be  hard  to  beat. 


INFECTIVITY  OF  ENTERIC  FEVER,  (a) 
In  this  octavo  pamphlet  of  forty-seven  pages,  the 
wTiter  endeavours  to  show  cause  for  a  revision  of  our 
views  on  the  etiology  of  enteric  fever.  He  tells  us  that  his 
"  aim  is  to  demonstrate  that  enteric  fever  is  an  infec- 
tious disease,  communicable  by  direct  personal  inter- 
course, just  as  typhus  fever  is  ;  and  that  explanations 
of  its  origin  from  drinking  water  have,  in  several 
instances,  failed  in  the  ablest  hands."  Dr.  Collie 
writes  with  great  clearness  and  force  in  support  of  this 
thesis.  His  work  is,  of  course,  an  iconoclastic  attack 
on  a  quasi-scientific  position  which  would  appear  to 
have  been  regarded  by  the  great  majority  of  the  medical 
men  of  one  generation  as  practically  impregnable. 
Under  such  circumstances  we  do  not  consider  it  our 
duty  to  enunciate  our  own  private  views  in  form  of  an 
ex  cathcdrd  opinion ;  which  would  almost  surely  have 
no  other  effect  than  that  of  adding  a  new  elenient  of 
discord  to  a  discussion  which  cannot  fail  to  promote  the 
dissemination  of  further  knowledge,  without,  at  the 
same  time,  convincing  the  holders  of  either  view. 
Accordingly,  we  will  merely  observe  that  Dr.  Collie's 
facts  and  arguments  show  that  the  defenders  of  the 
older  position  have  to  deal  with  a  skilled  and  well- 
armed  opponent.  We  shall,  ourselves,  look  forward 
with  interest  to  future  revelations  and  arguments. 
In  the  meantime,  the  increased  caution  which  they 
tend  to  promote  cannot  fail  to  have  a  general  good 
effect. 


STEVENS'  PRACTICE  OF  MEDICINE.  (6) 
Thts  manual,  which  has  been  before  the  profession 
for  many  years,  is  by  an  American  author,  and  has 
now  reached  its  sixth  edition.  The  chief  object  of  the 
book  is  to  present  students  with  an  outline  of  the 
subject  which  may  be  expanded  by  theoretical  and 
clinical  lectures.  Bearing  this  fact  in  mind,  we  do 
not  expect  to  find  the  work  overloaded  with  details ; 
in  lact,  the  complaint  in  this  country  would  generally 

(a)  "  The  Infectivitv  of  Enteric  Fever :  with  Obiervationa  on  its 
Origin  and  Incidence' at  Caius  CoUej^e,  Cambridg^e,  Festinioe  and 
Wicken  Bonant."  Bv  Alexander  Collie,  M.AAberd,,  late  Clinical 
Instructor  at  the  Eastern  HospiUls.  &c.  B  istol :  John  Wri|rht  and 
Co.     1904.  .  „ 

{b)  "  A  Manual  o(  the  Practice  of  Medicine.  Prepared  Especially 
for  Students."  By  A.  A.  Stevens,  A.M.,  M.D.,  Professor  of  Pathologry 
in  the  Woman's  Medical  College  of  Pennsylvania.  &c.  Sixth  £dition. 
Revised  and  Enlarged.  lOs.  6d.  net.  Philadelphia  and  New  Yorlc  : 
W.  B.  Saunders  and  Co.    IdOS. 


28    Thb  Medical  Pkess. 


OBITUARY. 


July  6.   1904. 


be  oi  its  brevity,  detailed  description  being,  in  many 
paurts,  inadequate  for  a  student  preparing  lor  exa- 
mination. That  this  is  so  may  be  readily  seen  by 
glancing  over  any  of  the  descriptions  of  diseased  con- 
ditions. Thus,  rheumatic  fever  has  four  pages  devoted 
to  its  consideration,  pulmonary  tuberculosis  eight, 
aortic  aneurysm  three,  and  alcoholism  two  respectively. 
Interspersed  throughout  the  book,  however,  are 
numerous  simple  and  useful  prescriptions,  a  feature 
which  will  prove  very  helpful  to  junior  practitioners. 
Seventy  pages  are  devoted  to  diseases  of  the  skin, 
and  this  is,  in  our  opinion,  a  wise  addition,  as  we  have 
often  had  to  complain  of  the  absence  of  their  mention 
in  other  manuals  intended  for  the  use  of  student!^. 
J'bis  edition  has  been  carefully  revised  and  enlarged, 
so  that  in  its  new  form  it  really  enters  upon  a  tresh 
lease  of  life,  which,  we  doubt  not,  will  be  a  long  one. 


COSTA'S  MODERN  SURGERY,  (a) 
The  fourth  edition  oi  this  book  has  been  revised 
and  brought  up  to  date.  In  the  treatment  of  the 
various  forms  of  aneurysm,  the  author  gives  in  the 
case  of  the  large  arteries,  the  history  of  the  first  opera- 
tion, then  the  anatomy  of  the  vessel,  and  methods  of 
treatment,  and  finally  the  results.  This  section  is 
interesting  and  complete.  In  the  treatment  of  tuber- 
culous disease  of  the  hip,  when  rest  and  fixation  of  the 
joint  fail  to  cure,  he  recommends  the  use  of  intra- 
articular injections  ot  iodoform  and  glycerine,  saying, 
"  always  try  these  injections  before  doing  a  resection," 
and  *'  it  may  be  necessary  to  give  from  ten  to  twenty 
injections."  As  these  mjections  are  given  once  a 
week  this  may  require  a  prolonged  treatment,  and, 
it  seems  to  us,  the  risk  of  such  a  number  of  injections 
would  equalise  that  of  resection — we  certainly  prefer 
resection  as  soon  as  rest  and  fixation  fail.  Section 
XXVII.  dealing  with  "  Diseases  and  Injuries  of  the 
Abdomen,"  is  very  complete,  and  the  various  lesions 
and  operative  measures  are  fully  discussed,  the 
various  operations  on  the  stomach  and  intestines  being 
particularly  well  dealt  with.  In  the  section  on 
"  Diseases  and  Injuries  of  the  Rectum  and  Anus,"  the 
treatment  of  fistula  seems  to  have  been  overlooked  in 
the  revision  of  the  book,  for  we  find  no  reference  to 
excision  and  suture  of  the  diseased  tract,  which  method, 
in  suitable  cases,  greatly  shortens  the  after-treatment. 
In  the  treatment  of  pruritus  ani,  the  author  says. 
"  In  very  severe  cases  touch  with  a  solution  of  silver 
nitrate  (i-io),*iemploy  the  Paquelin  cautery,  or  resect 
the  mucous  membrane  as  in  Whitehead's  operation 
lor  haemorrhoids."  We  fail  to  see  how  the  latter  will 
be  of  use,  as  the  disease  in  these  cases  is  entirely  outside 
the  mucous  membrane.  On  the  whole,  this  book  is 
complete,  pleasant  to  read,  and  one  of  the  best  single 
volume  surgical  works  we  have  come  across. 


NEW  BOOKS  AND  NEW  EDITIONS. 
The  following  have  been  received  since  the  publication 
of  our  last  list : — 

!:.iDKKY  Appleton  (Londou). 

Clinical  Lectares  and  Essays  on  Abdominal  and  other  Subjects       By 
H.  D.  RoHeston,  M.A.,  M.D.,  &c.    Pp.  178.    Price  58.  net. 
Baillikrs,  Tindall  and  Cox  (London). 

Lectures  on  Clinical  Psychiatry.  By  £>r.  Emil  Kraepelin.  Autho- 
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Johnstone,  M.D.Edin.,  M.R.C.P.Lond.  Pp,  ^08.  Price  los.  6d. 
net. 

Questions  and  Answers  on  Bfidwifery  for  Bfidwives,  with  Syllabus  of 
Lectures  for  the  "  L.O.S."  By  A.  B.  Calder,  M.B.,  M.R.C.S. 
Pp.  143.    Price  IS.  6d.  net. 

The  Pzevention  of  Disease  in  Annies  in  the  Field.  By  Robert  Cald- 
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Price  ps.  net. 

Cleft  Palate  and  Hare-Lip  :  the  Earlier  Operation  on  the  Palate. 
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©bituars* 

ALFRED  ELLIS  VAUGHAN.  L.R.C.P.Ed. 
The  death  is  announced  of  Dr.  Alfred  Ellis  Vaughan, 
L.R.C.P.E.,  etc.  He  was  medical  officer  for  the 
Haslington  poor-law  district,  was  surgeon  to  the  Lord 
Crewe  Court  of  Foresters,  and  held  other  public  posi- 
tions. He  was  educated  at  Owens  College,  Edinburgh, 
and  Glasgow,  and  took  the  diploma  of  the  Edinburgh 
Physicians  in    18  88. 


Pla«rue  Flffupes. 
Up  to  July  6th,  there  have  been  27  cases  of  plague 
among  whites  and  120  among  coloured  people.  Thir- 
teen whites  and  83  coloured  people  have  succumbed  to 
the  disease.  The  last  previous  statement  as  to  beri- 
beri showed  that  there  were  40  cases. 


July  6,  1Q04. 


MEDICAL    NEWS. 


The  Medical  Peess. 


29 


AeDical  Tlew6* 


Annual  Meeting  of  the  British  Medical  Association. 

The  annual  meeting  of  the  Association  at  Oxford 
on  July  26th.  27th.  28th,  and  29th,  will  be  inaugurated 
by  a  service  in  Christ  Church  Cathedral  at  10.30  o'clock, 
when  the  sermon  will  be  preached  by  the  Rev.  James 
Franck  Bright.  D.D.,  Master  of  University  College. 
The  first  general  meeting  of  members  will  be  held  on 
Tuesday,  July  26th,  at  12  o'clock  noon,  to  be  followed 
by  the  representative  meeting.  At  8  o'clock  the 
President,  Dr.  Collier,  will  receive  the  Colonial  and 
foreign  guests  in  the  Sheldonian  Theatre,  and  deUver 
his  Presidential  Address.  On  Wednesday,  honorary 
degrees  will  be  conferred  in  the  Sheldonian  Theatre, 
and  at  2  o'clock  the  general  meeting  will  resume  its 
session  to  consider  where  the  association  shall  meet  in 
1905,  and  to  nominate  the  President-elect.  At 
8  o'clock  Sir  William  Selby  Church,  Bart.,  K.C.B., 
M.D..  D.Sc,  will  deUver  an  address  in  medicine  in  the 
Sheldonian  Theatre.  On  Thursday  at  2  o'clock.  Sir 
William  MacEwen.M.D.,  F.R.C.S.,  LL.D..  will  deliver 
an  address  in  Surgery  in  the  Sheldonian  Theatre.  At 
7.30  the  dinner  of  the  Association  will  be  held  in  the 
Hall  of  Christ  Church.  At  8  o'clock  a  popular  lecture 
will  be  delivered  in  the  Town  Hall  by  Dr.  George  Bagot 
Ferguson,  F.R.C.S.,  M.Ch.Oxon.  On  Friday  at 
2  o'clock  the  representative  meeting  will  again  sit  should 
it  not  have  completed  its  work.  On  Wednesday, 
Thursday,  and  Friday  from  10  a.m.,  to  i  p.m..  the 
following  fourteen  scientific  sections,  viz.,  medicine, 
surgery,  obstetrics  and  gynaecology,  state  medicine, 
psychological  medicine,  pathology,  physiology,  ana- 
tomy, ophthaUnology,  dermatology,  laryngology  and 
otology,  tropical  diseases,  navy,  army,  and  ambulance, 
dental  surgery,  will  meet  in  the  University  Museum 
Buildings,  the  work  promising  to  be  of  special  interest. 
Much  hospitality  will  be  offered  to  members.  On 
Wednesday  the  President  and  members  of  the  Oxford 
Division  will  hold  a  reception  in  Wadham  College 
gardens,  while  in  the  evening  the  Vice-Chancellor  and 
members  of  Oxford  University  will  give  a  soiree  in  the 
Museum.  On  Thursday  there  will  be  garden  parties  in 
the  afternoon  and  in  the  evening  an  entertainment  in 
New  College.  On  Friday  afternoon  the  Duke  of 
Marlborough  will  receive  a  limited  number  of  guests  at 
Blenheim  Palace,  and  in  the  evening  the  Mayor  of 
Oxford,  Mr.  E.  A.  Bevers.  M.R.C.S.,  will  hold  a  recep- 
tion in  the  City  Buildings.  For  Saturday  various 
excursions  have  been  arranged  to  places  of  interest 
round  Oxford. 

The  Conffresi  of  the  Royal  Institute  of  Public  Health  at 
Folkestone. 

The  meeting  of  the  Royal  Institute  of  Public  Health 
will  be  held  at  Folkestone  from  July  21st  to  26th,  under 
the  presidency  of  the  Right  Hon.  'the  Earl  of  Radnor. 
Dr.  W.  J.  Simpson  and  General  Sir  William  Stirling, 
K.C.B.,  preside  over  the  sections  of  Tropical  Medicine 
and  the  Early  Physical  Training  of  the  Imperial  Forces. 
Papers  will  be  read  and  discussed  bv  Mr.  James  Cantlie, 
Colonel  A.  Crombie,  C.B..  I.M.S.  (retired),  Brigade- 
Surgeon-Lieutenant-Colonel  W.  Hill  Climo,  A.M.S. 
(retired),  Surgeon-General  G.  J.  H.  Evatt,  C.B.,  A.M.S. 
(retired),  and  Brigade  -  Surgeon  -  Lieutenant  -  Colonel 
James  Turton,  A.M.R.  In  the  section  of  Comparative 
Pathology,  Bacteriology,  and  Chemistry  Dr.  Edward 
E.  Klein,  F.R.S.,  the  president,  will  deal  with  "  The 
Aim  and  Scope  of  Bacteriological  Analyses  of  Water 
and  Shell-fish  with  Reference  to  Sewage  Pollution." 
The  Mtdico-Piychological  Association  of  Great  Britain 
and  Ireland. 

Dr.  R.  Percy  Smith  will  preside  at  the  sixty-third 
annual  meeting  of  this  association,  to  be  held  on  July  2  ist 
and  22nd,  at  11  Chandos  Street,  Cavendish  Square.  W. 
On  July  2ist,  at  2  p.m.,  the  President  will  deliver  his 
address,  after  which  Dr.  G.  E.  Shuttleworth  will  read 
a  paper  on  "  The  Education  and  Treatment  of  Young 
Epileptics/'  and  Dr.  C.  Hubert  Bond,  a  paper  on  "A 
Plea  for  the  Closer  Study  of  the  Bodyweight  and  its 
Relation  to  Mental  Disease."  On  July  22nd,  at 
10  a.m.,  papers  will  be  read  by  Dr.  A.  W.  Campbell 


and  Dr.  John  Turner  dealing  respectively  with  "  Fur- 
ther Histological  Studies  in  the  Localisation  of  Cerebral 
Function  and  the  Finer  Anatomy  of  the  Nervous 
System  with  Special  Reference  to  the  Doctrine  of  Con- 
tinuity." "  The  Psychology  of  Hallucinations  "  will 
be  introduced  by  Dr.  W.  H.  B.  Stoddart.  Papers  deal- 
ing with  "  The  Care  and  Treatment  of  the  Insane,"  will 
be  read  by  Dr.  G.  M.  Robertson,  Dr.  J.  Milson  Rhodes, 
and  Mr.  J.  Carswell,  at  2  p.m.  On  the  evening  of 
July  2ist,  the  annual  dinner  will  be  held  at  the  White- 
hall Rooms  of  the  Hotel  M^tropole,  and  on  July  22nd, 
from  4  p.m.,  to  7  p.m.,  the  President  and  Mrs.  Percy 
Smith  invite  members  of  the  Association  to  a  garden 
party  at  the  Botanical  Gardens,  Regent's  Park,  N.W^ 
Tickets  for  the  dinner  can  be  obtained  from  the 
honorary  secretary.  Dr.  Robert  Jones,  price  one  guinea, 
including  wine. 

A  False  Certificate. 

At  Hampshire  Assizes  on  Saturday,  Charles  Hust- 
wick  was  sentenced  to  eighteen  months'  hard  labour 
for  giving  a  false  certificate  as  to  an  infant's  death. 
It  was  stated  accused  had  acquired  some  medical 
knowledge  and  posed  as  a  doctor.  He  had  previously 
been  sentenced  to  five  years'  penal  servitude  for  an 
illegal  operation.  He  had  also  adopted  a  name  found 
in  the  "  Medical  Register." 

Small-pox  at  Stockport. 

The  week  before  last,  twenty-one  cases  of  small-pox 
were  reported  in  Stockport.  The  majority  of  the  cases 
were  traced  to  the  lower  part  of  the  town, where  a  child 
was  visited  by  a  number  of  neighbours,  whilst  suffering 
from  the  disease,  which  was  wrongly  thought  to  be 
measles.  St.  Paul's  Church,  Heaton  Moor,  was  closed 
on  Sunday,  owing  to  the  apparitor's  wife  having  been 
attacked  by  small-pox.  The  church  will  be  disinfected 
prior  to  being  reopened.  This  serious  invasion  of 
Stockport  is  naturally  causing  a  good  deal  of  alarm 
locally. 

PASS  LISTS. 
Trinity  College.  Dublin. 

The  following  candidates  passed  the  examinations 
indicated  during  Trinity  Term,  1904  : — 

Anatomy  and  Institutes  of  Medicine. — John  C.  P. 
Beatty,  Francis  R.  Coppinger,  Robert  E.  Wright, 
Thomas  J.  Cobbe,  Thomas  H.  Peyton,  John  W.  Tomb 
{passed  on  high  marks) ;  Charles  T.  Atkinson,  Richard 
Connell,  Richard  G.  S.  Gregg,  Gustav  W.  Thompson, 
Theodore  C.  Somerville,  Charles  G.  Sherlock,  Reginald 
Holmes,  Thomas  L.  de  Courcey,  Henry  D.  Drennan, 
Dudley  S.  Torrens,  Edward,  C.  Stoney,  Herbert  J. 
Wright,  Malcolm  K.  Acheson,  William  Hutchison, 
Robert  B.  Jackson,  George  E.  G.  Vickery,  Francis 
Casement,  Francis  W.  H.  Bigley,  Ernest  Jameson, 
Ernest  D.  Caddell,  Edward  Evans,  William  A.  Nichol- 
son. 

Physics  and  Chemistry. — Richard  P.  Hadden  {passed 
on  High  Marks)  ;  Charles  F.  F.  Davies.  William  R.  G. 
Atkins,  Ernest  C.  Lambkin,  Dixie  P.  Clement,  Johannes 
C.  Pretorius,  Robert  V.  Dixon,  James  F.  Clarke. 
Douglas  M.  Moffatt,  Robert  G.  Orr,  Wilham  E.  Hop- 
kins, Frederick  A.  Anderson,  Gerald  Mecredy,  Henry 
H.  Ormsby,  Samuel,  F.  A.  Charles,  Norman  Jewell, 
Charles  W.  Laird,  James  D.  Murphy,  John  L.  Phibbs, 
Albert  V.  Richardson,  Harold  S.  Sugars,  Richard  J. 
Attridge. 

Botany  and  Zoology. — Ralph  T.  Brooks,  Arthur  H. 
Land,  Ernest  C.  Lambkin  {passed  on  High  Marks) ; 
Charles  F.  F.  Davies,  Richard  P.  Hadden,  Albert  J. 
Stals,  William  E.  Hopkins,  Charles  W.  Laird,  Charles 
G.  S.  Baronsfeather,  Henry  R.  Kenny,  Johannes  C. 
Pretorius,  Dixie  P.  Clement,  Frank  N.  Smart.  Robert 
E.  T.  Tatlow,  Douglas  M.  Moffatt,  John  L.  Phibbs, 
William  R.  G.  Atkins.  Thomas  P.  S.  Eves,  William 
Knapp,  George  H.  Stack,  James  Brereton-Barry, 
Gordon  A.  Jackson,  Norman  Jewell,  Alfred  H.  Smith, 
Alexander  S.  Winder,  James  Beckett,  Derrick  W. 
Knight,  John  T.  M'Donnell,  Kenneth  Smith,  Cecil 
Grene,  Frederick  C.  Newland. 

Diploma  in  Public  Health. — Parts  i  and  2,  Alexander 
H.  Marks. 


30      The  Medical  Pkess.      NOTICES  TO  CORRESPONDENTS. 


July  6.  1904. 


Sotktz  to 
(!r<rrrtgpmtbentg>  ^farrt  %t\itta,  &c 

WS^  OoKBUFOHDiNTs  requiringT  a  Kply  in  this  oolumn  are  pwrtioa- 
larly  requested  to  make  use  of  a  ditUnetive  Signatwre  <tr  initial,  and 
aroid  the  practioe  of  signing:  themselves  "Reader,"  "Subscriber," 
4  *  Old  Subscriber,"  te.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

OBieiNAL  A&TICLU  or  LiTTKBS  intended  for  publication  sho  d  b 
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  identitv. 

CONTRiBUTOiui  are  kindly  requested  to  send  their  communica  ions, 
it  resident  in  England  or  che  Colonies,  to  the  Editor  at  the  London 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

Shrswsburt.— The  original  error  lay  in  employing  a  chemist  to 
take  the  radiogram  of  your  patient's  shoulder  instead  of  a  skilled 
tmedical  operator.  A  chemist's  knowledsre  of  anatomy,  both  surgical 
and  pathological,  is  nii,  and  his  evidence  in  a  court  of  law  would  be 
worthless.  On  the  other  hand  the  medical  X-ray  expert  is  eften 
able  to  give  information  that  is  essential  to  the  proper  treatment  of 
a  given  case  and  to  furnish  evidence  incontrovertible  in  a  court 
•of  law. 

OuFTOViEHSis.^  Skipping  as  an  aid  to  health  is  clearly  not  available 
"for  more  than  a  certain  proportion  of  mankind.  You  had  better  con- 
sult Dr.  Bond,  of  Gloucester,  upon  the  subject.  He  is  the  apostle  of 
this  modern  cult. 

Da.  T.  Frbkch. — The  invitation  to  furnish  contributions  on  special 
subjects,  of  a  medical  nature,  to  lay  journals  should  be  declined  in 
all  oases  where  the  objectis  to  provide  professional  advice  with  a 
view  to  displacing  the  services  of  a  medical  man. 

Mr.  Coopbr  Johvstov.— The  organisation  of  a  street  ambulance 
«vstem  is  one  that  you  would  do  well  to  take  up  locally.  There  is 
abundant  room,  nay,  an  urgent  need  in  most  provincial  centres  for 
«omething  of  the  kind.  There  can  be  no  doubt  that  a  vast  amount  of 
ttiuman  suffering  and  to  some  extent  of  life  itself  would  be  prevented 
if  the  means  of  speedy  removal  of  the  sick  and  injured  were  at  hand  in 
all  of  our  great  towns.  There  is  a  good  deal  to  be  said  in  favour  of 
a  co-operation  between  the  philanthropists  and  the  pMice  and  the 
fire  brigade  services. 

M.B.C.S.  (Meltonian).— The  sea-side  is  not  likely  to  do  any  mjury  to 
the  chronic  skin  condition  you  mention.  If  you  have  any  doubts  on 
the  point,  send  your  patient  to  a  consultant. 

^Keetings  of  tite  ^oneliea,  JUttvtxvs,  •Stc, 

Wedhesdat,  JVLT6th. 

Obstetrical  Societt  of  Londok  (20  Hanover  Square,  W.).— 8  p.m. 
toecimens  will  be  shown  by  Dr.  Lewers,  Dr.  Pursiow,  Dr.  Bikes,  Dr. 
Ate  Mr.  A.  Doran  and  Dr.  H.  Williamson,  Dr.  V.  Bonney,  Dr. 
Handfleld-Jones,  Dr.  F.  Taylor.  Short  Communication :— Dr.  Jft. 
Boxall :  Case  of  Inverted  Uterus.  Sponteneous  Re-position.  Paper  : 
—Dr.  Pembrey  (introduced  by  Dr.  A  Houth)  and  Mr.  G.  B.  Smith  : 
<>n  Sacs  containing  FoBtuses  and  lying  free  in  the  Peritoneal  Cavity 
of  a  Rabbit.  _,  _         -,^^ 

Thursday,  July  7th. 

The  Roxtoex  Socnrrr  (28  Hanover  Sguare).—&  80  p  m.  Annual 
General  Meeting.  Annual  Report  and  Balanve  Sheet.  Election  of 
Officers  for  the  ensuing  year. 

MouBT  Vernon  Hospital  for  Consumption  and  Diseases  of  the 
Chest  (7  Fitzroy  Square,  W.)-- 5  p  m.  Dr.  F.  Price :  The 
Diagnosis  of  Early  Pulmonary  Tuberculosis  (illustrated  by  cases). 
(Poet  Graduate  Couise.) 

Friday,  July  8th. 
Ophthalmolooical  Society  of  the  Unttbd  Kingdom  (11  OhandosSt., 
Cavendish  Square,  W.).— Cases  will  be  shown  by  Mr.  J.  B.  Sm>'th 
and  Mr.  R.  S.  Batten.     Paper  :    Mr,  O.  Coats  :  Lantern  Demon- 
stration on  Cases  of  Thrombosis  of  the  Central  Vein. 
Tuesday,  July  12th. 

The  Society  for  the  Study  of  Inebriety.— In  the  Rooms  of  The 
Medical  Soc  iety  of  London  (11  Chandos  Street,  W.).  —  4  p  m.  After- 
noon Meeting.  Dr.  WiUiam  G.  Sullivan,  Deputy  Medical  Officer 
HM  Prison,  Pentonvllle  :  On  •*  The  Criminal  Responsibiliiy  of  the 
Aiooholic."  Each  Member  and  Associate  Is  at  liberty  to  introduoe 
a  visitor. 

Brecon  and  Radnor  Asylum,  Talgarth,  R.S.O.— Assistant  Medical 
.  Officer.  Salary  £100  per  annum  with  furnished  apartments, 
board,  attendance,  and  laundry.  Applications  to  the  Medical 
Superintendent. 

The  Royal  National  Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Ventnor.— Senior  Resident  Medical  Officer.  Salary  £300 
per  annum,  with  board  and  lodging  in  the  Hospital.  Appli- 
cations to  the  Secretary,  34  Craven  Street,  Cnaring  Cross, 
London.     (See  Advt.)  ,  „      «  ,^        «    .. 

Nottingham  Consumption  Sanatorium,  Mansfleld. —  Resident 
Medical  Officer,  fialarv  £150  per  annum,  with  boa^d.  lodging, 
and  v^-ashing.  AppUcations  to  the  Clerk,  Mr.  Geo.  Sheldon,  d6A 
Bridle-smith  Gate,  Nottingham.  ^^   ^^    , 

Combined  Sanitary  District  of  West  Sussex.— Medical  Officer  of 
Health.  8alary  £650  per  annum,-  to  include  all  travelling 
expenses.  Applications  to  A.  C.  C^ole,  Solicitor,  9  Carfax, 
Horsham. 


*^fii°r***\?  Hospital  for  Children  and  Dispensary  for  Women, 
A^r^y^  ^--^hologist  and  Registrar.  Salary  £100  per  annum. 
Apphoations  to  Thomas  Hayes,  SscKtory. 
i!!f^  HospitaL-House  Surgeon.  Salary  £100  per  annum,  with 
board  and  residence.  Applications  to  F.  H.  Stevens.  Hon. 
Secretary.  146  Milton  Roicl,  Gravesend.  «'»^^«»»»  "<>«• 

"^SJ^.^^o"?^   *1?,.?'^y    Asylum.-Senior  Assistant   Medical 
Officer.    Salary  £150  per    annum,  with  board,  lodging,  and 
r     ^"°*!5y-    Applications  to  the  Medical  Superintendent. 

S?i.I®i'?GS'*°*'®  Hospital,  Hanipstead  Road.  N.W.-Resident 
Medical  dfflcer.  Sa'ary  £200  per  annum,  board,  lodging,  and 
washing.  Applications  to  A.  Cfiodger,  Secretary. 
TSU^.  J^^'^^^J'^  Darenth,  Dartfoid.  Kent.-Male 
Aaaistont  Medical  Officer.  Salary  £160  per  annum,  with  rations, 
lodging,  attendance,  and  washing.  Applications  to  the  Office  of 
the  Board,  Embankinect,  London,  E.cf. 

M^'^W^'^^^^'o*^®  Lunatic  Asylum.  Dunedin.^-Assistant 
Medical  Officer  Salary  £250  per  annum,  with  board  lodging,  and 
!?fi?'"«^-.  -Applications  to  the  Agent-General  for  New  Zealand. 
U\ict>na  Street,  London.  8. W.  . 

Nottingham  General  Dispensary. -Assistant  Resident  Surgeon. 
Salary  £160  per  annum,  with  furnished  apartments,  attendance, 
light,  and  fuel.  Applications  to  Secretary,  M.  I.  Preston, 
Journal  Chambers,  Nottingham. 

Royal  National  Hospital  for  Consumption  and  Diseases  of  the  Chest, 
ventnor.— Two  AssistantResident  Medical  Officers.  Salary  £100 
per  annum,  with  boaidand  lodging  in  the  Hospital.  Applica- 
tions  to  the  Secretary.  24  Craven  Street,  Chariog  Cross,  London, 
W.C.    (SeeAdvt.^  ' 

Boysl  Orthopaadic  Hospital,  Temporary  premises,  SoBolsover  Street, 
^.'—^^^^^ ^^rKeon  Mid  Registrar.  Salary  £300  per  annum, 
without  board.  Applications  to  Tata  S.  Mansford;  Secretary, 
'oee  Advt.) 

St.  Thomas's  Hosnital.-Casualty  Officer.  Salary  £100  per  annum, 
with  board  and  residence.  Application  to  the  Secretar}'  of  the 
Medical  School. 

Wandsworth  Union  Infirmary,  St.  John's  Hill,  near  Clanhani 
Junction.— Junior  Assistant  Medical  Officer.    Salarv  £100  per 

West  Riding  Asylum,  WakefleM— Pathologist  and  Assistant  MedicaJ 
Officer.  Salary  £l40  pec  annum,  with  furnished  apartments 
board,  washing  and  attendance.  Applications  to  the  Medical 
Director. 


JLppoittlmems. 


Gray,  Walter    Gordon.  L.R.C.P.,  LM.Bdin.,  M.R.C.S.,  Medical 

Officer  of  Health  for  the  Holsworthy  (Devon)  Dural  District. 
Kesnan,  J.  F.,  of  Ballin4Jee,  Edgeworthstown,  as  Certifying  Sur- 
geon under  the, Factory  and  Workshop  Act  for  the  district  of 

Ballinalee,  which  includes  Granard  Urban  District  and  Granard 

No.  1  Rural  District 
Meade.   Charles   Grahah,  L.S.a.,  Medical  Officer  for  the  Withe- 

ndge  District  by  the  South  Molton  (Devon)  Board  of  Guardians. 
Paliikr,Predbrick8.,M.D..M.R.C.P.,  Assistant  Phj'sician  to  the 

West  End  Bospital  for  Diseases  of  the  Nervoiis  Svstem. 
Parsons,  John  Herbert,  B.S.,  D.Sc  ,  F.B.O.S  ,  Ophthalmic  Surgeon 

to  the  Hospital  for  Sick  Children,  Great  Ormond  Street. 
Pryce.  H.    Vaouhan,  F.R.C.8.Eng.,    M.A.,    M.B.,     B.C.Cantab  , 

Honorary  Medical  Officer  to  the  Brighton,  Hove,  and    Preston 

Dispensary. 
Richards,    Thoxas,  L.R.C.P.Lond.,   M.R.C.8 ,    District    Medical 

Officer  by  the  Cardiff  Board  of  Guardians.  9 
Short,  T.  Sydney,  M.D.Lond.,  M.R.C.P.,  D. P. H. Cantab.,  Honorary 

Physician  to  the  General  Hospital,  Birmingham. 
Simpson,  Lilian  G.,  M.D.Brux.,  L.R.O.P.  A  S.Edin.,  Senior  Resident 

Medical  Officer  to  the  Canning  Town  Medical  Mission  Hospital 

and  Dispensary. 
Williams,  W..  M.A.,  M.D.Oxon.,  Examiner  in  Preventive  Medicine 

in  the  University  of  Oxford. 


j^irtkB- 


Darb-Bascombb.— On  June  28th,  at   the  Grange,  Saffron  Walden, 

Essex,  Edith   inee  Hastings-Miller),  the  Mnfe  of  C.  Dare-Bas- 

combe,  M.R.C.8. ,  L.R.<\P.,  of  a  son. 
MiCHELS.— On  July  2,  at  48  Finsbury  Square,  the  wife  of  E.  Michels. 

F.R.O.S..  of  a  daughter. 
Secker  Walker.— On  June  29th  at  Oakwood  Grange,  Roundhav, 

Leeds,  the  wife  of  H.  Secker  Walker.  F.R.C.S.,  of  a  son. 
Wioo.— On  July  Ist,  at  86  Haverstock  Hill,  N.W.,  the  wife  of  James 

Wigg,  L.H.C.P.Lond.,  of  a  son. 


Morton— Leslie.— On  July  Ist,  at  St.  Stephen's  Church,  Putnev, 
Philip  Sidnev,  son  of  Robert  Morton,  Esq,  of  27  Hamilton 
Terrace,  N.W.,  to  Philadelphia  Eraser  Pinkerton,  youngest 
daughter  of  the  lata  W.  Bumup  Leslie.  Esq»,  M.D..  of  Stone- 
haven, N.B.,  and  of  Mrs.  Leslie,  40  Oakfaill  Road,  Putney,  S.  W. 


deaths- 

KiRKMAN.-On  July  Ist.  at  St.  Stephen's,  Southwold,  Suffolk, 
Joshua  Kirkman,  M.A.,  lata  vicar  of  St.  Stephen's,  Hampstead, 
and  eldest  surviving  B.>n  of  John  Kirkman,  M.D.,  of  Melton, 
Woodbridge,  aged  76.  ^  ^  ,^    ^ 

Leeper.— On  June  26,  suddenly,  at  Southsea,  GeorgelR.  Leeper, 
M.B.,  T.C.D.,  third  surviving  son  o  the  late  Rev.  Canon 
Leeper,  D.D.,  Dublin.  ,^^  ^  .    «     ^    ,     j    ^^ 

MVRPUY— On  June  28th,  at  5  Thonihill  Crescent,  Sunderland,  the 
residence  of  her  son,  Sarah  Murphy,  widow  of  William  Chapman 
Murphv,  M.D.,  aged  90. 


Mh  ^dxal  ^xm  m4  ^itmht. 


•"SALUS   POPULI   SUPREMA    LEX." 


Vol.  CXXIX, 


WEDNESDAY,    JULY  13,    1904. 


No,   2. 


a)rfdfnal  Communications* 

THE  DIMINISHING  BIRTH- 
RATE. 

PART  I. 

By  DAVID  WALSH,  M.D.Edin., 

Senior  Physician,  Weatern  Skin  Hoapitai,  London,  W.,  &c. 

The  Inaugural  Address  of  the  British  Gynaecological 
Society  for  the  year  1904  discussed  the  diminishing 
birth-rate  of  the  United  Kingdom,  together  with  '*  its 
Causes,  Tendency,  and  Possible  Remedy."  It  was 
•  delivered  by  the  distinguished  President,  Dr.  John  W. 
Taylor,  of  Birmingham,  whose  remarks  have  excited 
widespread  interest  among  all  classes  of  society. 
Although  its  subject  is  by  no  means  purely  medical, 
yet  matters  of  such  vital  social  importance  are  dealt 
with  that  no  apology  need  be  offered  for  presenting  a 
short  criticism  of  Dr.  Taylor's  arguments  and  con- 
clusions in  the  columns  of  a  medical  journal. 

Dr.  Taylor  rightly  said  that  his  subject  was  a  great 
one.  In  spite  of  that  recognition,  however,  he  has 
surveyed  the  situation  almost  entirely  from  a  single 
standpoint,  namely,  that  of  the  assumed  evils  re- 
sulting from  the  artificial  prevention  of  conception. 
By  thus  narrowing  the  field  of  inquiry  he  has  failed  to 
bring  the  many  sides  of  an  extremely  complex  social 
'question  into  view.  As  a  matter  of  fact,  his  Address 
is  little  more  than  a  plausible  but  not  very  convincing 
piece  of  special  pleading  against  the  unfortunate  prac- 
tices to  which  he  attributes  so  much  of  the  moral  and 
physical  defects  of  society.  The  causes  and  results  of 
the  limitation  of  families,  however,  must  be  examined 
under  a  far  more  searching  and  catholic  light  than  that 
provided  by  Dr.  Taylor.  Many  of  the  issues  involved 
may  be  discussed  entirely  apart  from  either  the  prac- 
tices of  prevention  or  the  crime  of  abortion,  both  of 
which  the  moral  citizen  must  unhesitatingly  condemn. 
Nevertheless,  however  great  our  desire  to  place  society 
on  a  sound  footing,  if  we  accept  theories  and  assump- 
tions offhand  we  may  find  our  well-meant  efforts 
diverted  into  a  Quixotic  tilting  against  windmills. 

Dr.  Taylor's  general  statement  that  the  birth-rate  of 
the  United  Kingdom  is  steadily  declining  may  be 
accepted.  He  shows  that  the  birth-rate  has  fallen 
5*2  per  1,000  persons  living  during  the  past  thirty 
years,  while  the  marriage-rate  has  remained  practically 
stationary.  From  that  point  forward,  however,  his 
article  contains  hardly  a  single  proposition  that  will 
stand  serious  examination.  His  chief  assumptions 
with  regard  to  the  falUng  birth-rate  appear  to  be  as 
follows  : — 

I. — ^That  the  fall  in  the  birth-rate  refers  solely  to 
married  persons. 

II. — ^That  among  married  folk  the  decline  is  due 
almost  entirely  to  the  artificial  prevention  of  concep- 
tion. 

III. — That  a  falling  birth-rate  necessarily  indicates 
a  failure  in  national  prosperity. 

IV. — His  main  conclusion,  or,  from  my  point  of 
view,   assumption,  is  that   preventive     practices   are 


injurious  to  the  moral  and  physical  well-being  of  parents 
adopting  them,  as  well  as  to  non-prevented  children 
of  such  unions. 

In  the  present  brief  article  I  propose,  as  a  medical 
man,  first  to  examine  the  above  assumptions,  and  to 
ask  if  they  tally  with  the  facts  of  the  case ;  then  to  dis- 
cuss the  proposed  remedies  ;  and,  finally,  to  add  a  few 
observations  and  suggestions  of  my  own.  An  attempt 
will  at  the  same  time  be  made  to  indicate  the  broad 
lines  on  which  a  comprehensive  survey  of  the  ground 
might  with  advantage  be  conducted,  although  I  cannot 
hope  that  every  side  of  this  intricate  question  will  be 
exhausted  or  even  opened  up. 

Assumption  I :  That  the  fall  in  the  birth-rate  refers 
solely  to  married  persons, — As  already  remarked.  Dr. 
Taylor's  proposition  may  be  admitted  when  he  says 
that  the  birth-rate  has  fallen  5-2  per  1,000  persons 
living  during  the  past  thirty  years,  while  the  marriage- 
rate  has  been  nearly  stationary.  But  when  he  goes  on 
to  infer  that  the  fall  in  question  must  be  due  to  some 
condition  affecting  married  life,  he  at  once  plunges  into 
a  morass.  His  figures  have  not  taken  into  considera- 
tion the  obvious  extra-marital  condition  of  illegitimacy, 
the  results  of  which  are  included  in  the  general  birth- 
rate of  5*2.  Now,  a  striking  feature  of  the  period  he 
covers  is  the  decrease  in  the  number  of  illegitimate 
births  in  the  United  Kingdom,  for  they  share  in  the 
steady  fall  from  6*8  per  cent,  to  3*9  per  cent,  of  the 
total  births  during  the  past  fifty  years.  If  this  loss  of 
2-9  per  cent,  of  illegitimate  births  had  not  occurred 
the  level  of  the  general  rate  would  stand  at  the  present 
moment  not  far  off  the  level  of  twenty  years  ago. 
This  may  be  made  clear  by  the  following  figures  : — 

TABLE   I. 
Illegitimate  rate  per  1,000  births  20  years  ago 
Ditto        ditto        ditto  at  present 


Loss  from  decreased  illegitimate  births  per  1,000 
births 


68 
39 

29 


Present  total  birth-rate  per  1,000  persons  living,  29*1. 

But  if  no  loss  had  occurred  from  the  decline  in 

illegitimacy,   this  rate  would  have  increased  in  pro- 

-  1,029 

portion  of ^ 

'^  1,000 

Working  this  out,  we  get — 

as  the  total  birth-rate  would  be  at  the  present  moment 
had  there  been  no  falling  off  in  illegitimacy.  But  in 
1884  the  total  birth-rate  stood  at  31.  so  that  had  not 
the  declining  birth-rate  affected  illegitimacy,  we  should 
have  had  a  birth-rate  of  practically  30  in  1904  com- 
pared with  31  in  1884.  My  figures,  I  am  aware,  may 
not  be  absolutely  accurate,  but  I  think  it  may  be  safely 
concluded  that  the  fall  in  the  married  birth-rate  is  much 
less  than  that  shown  by  Dr.  Taylor.  In  a  word,  his 
figures  are  vitiated  at  the  outset  by  his  failure  to  con- 
sider the  facts  of  the  extra-marital  condition  of  ille- 
gitimacy. 

It  is  impossible,  therefore,  to  accept  his  fundamental 


32     Thx  Medical  Pkess. 


ORIGINAL  COMMUNICATIONS. 


July  13.  1904. 


proposition  that  "  we  may  take  the  birth-loss  in  the 
United  Kingdom  as  due  to  causes  operating  in  the 
married  life  of  its  inhabitants." 

Assumption    II:     Thai    among    married    folk    the 
decline  is  due  almost  entirely  to  the  artificial  prevention 
of  conception, — Before  examining   the  grounds  upon 
which  Dr.  Taylor  forms  this  conclusion,  or  assumption, 
as  I  prefer  to  call  it  in  the  absence  of  convincing  proof, 
let  us  first  consider  another  vitiating  factor,  namely, 
the  increasingly  later  age  at  which  marriages  take  place. 
True,  he  mentions  this  condition,  but  only  to  brush  it 
aside  somewhat  cavalierly  in  his  anxiety  to  reach  his 
main   conclusion.     It   deserves,    in   my   opinion,    far 
greater  weight  than  he  is  inclined  to  attach  to  it.     The 
age  at  which  a  man  marries  has,  or  should  have,  within 
reasonable  limits,  but  little  effect  on  the  prospect  of  his 
becoming  a  father,  for  if  of  sound  constitution  he  may 
beget  children  at  ninety  or  any  other  patriarchal  age. 
The  average  life  of  civilised  man,  however,  is  com- 
paratively  short,    and    hence    the   influence   of   late 
marriage  upon  fertility  is  appreciable.    One  cannot 
lose  sight  of  the  fact,  moreover,  that  a  man  who  marries, 
say,  at  thirty-five  has  already  lost  some  twenty  years 
of  active  procreative  life  had  he  been  living  under  un- 
restricted   conditions.     But  when  the  marriage  age  of 
woman  is  taken  into  account  we  find  a  very  different 
state  of  things.     In  her  case  the  number  of  years  during 
which  she  may  expect  to  become  a  mother  is  strictly 
limited,  and  decreases  with  every  year  of  her  Ufe  untU 
about  five-and-forty,  the  fall  in  marriage  fertility  being 
specially    noticeable    after    twenty-five.     Now,    as    a 
matter  of  fact,  the  age  at  which  women  marry  in  the 
United  Kingdom  is  becoming  rapidly  later,  for  whereas 
the  period  1 894-1901  shows  a  6  per  cent,  increase  of 
population,  yet,  on  the  other  hand,  the  total  number 
of  women  marrying  under  twenty  years  of  age  decreased 
by  nearly  300,  instead  of  the  increase  of  many  thou- 
sands that  would  have  taken  place  had  these  under- 
age marriages  continued  in  their  former  proportion. 
These  figures  are  all  the  more  remarkable  if  compared 
with  the  increase  of  over  32,000  marriages  of  women 
between  twenty  and  forty  during  the  same  period. 

We  find,  then,  that  marriage  is  becoming  later  in 
both  sexes,  a  fact  that  in   itself  connotes  a  lessened 
expectation  of  children,  because  the  parents'  lives  are 
shorter,   while  procreative  power  slackens  with  ad- 
vancing age  in  the  male  and  ceases  altogether  with 
middle  age  in  the  female.     The  later  age  at  which  men 
marry  is  doubtless  due  to  the  increased  difficulty  of 
gaining  a  footing  in  life,  especially  in  the  learned  pro- 
fessions.    Men  who  marry  thus  later  in  life  are  likely, 
as  a  broad  rule,  to  marry  women  of  an  age  somewhat 
approaching    their    own,    and    with    correspondingly 
lessened  expectation  of  child-bearing  life,  a  fact  that 
is  well  shown  in  the  following  table,  which  was  placed 
before  the  Royal  Statistical  Society  by  Dr.  Ogle,  in 
March,  1890 : — 

TABLE  II. 
Age  at  Marriage. 
Occupation.  Bachelors.  Spinsten. 

Miners   . .  . .  . .  . .     24*06        22*46 

Textile  trades  ..         ..  ..  ..     24*38         23*13 

Shoemakers  and  tailors  24*92        24*31 

Artisans  25*35         23*70 

Labourers         ..  ..         ..  25*56        23-66 

Commercial  clerks      ..    -      ..         ..     26*25         24-43 

Shopkeepers  and  shopmen   . .  . .     26*67         24-22 

Farmers  and  sons      . .  . .     29*23         26*91 

Professional  and  independent  class  . .  31*22  26*40 
This  table  shows  a  close  relationship  between  the 
class  of  society  to  which  persons  belong  and  the  age  at 
which  they  marry — the  better  the  social  circumstances 
the  later  the  marriage  age.  The  general  disparity  is 
most  striking  when  we  compare  the  extremes,  which 
show  a  difference  of  seven  years  in  the  case  of  the  men 
and  four  in  that  of  the  women.  The  marriage  age  of 
unskilled  labourers  is  probably  much  below  that  of 
miners  and  other  skilled  labourers.  The  marriage  age, 
again,  of  such  learned  professions  as  that  of  law  and 
medicine  is,  most  likely,  some  years  beyond  that  of  all 
professional  and  independent  classes  taken  together. 


If  we  allow,  say,  a  further  margin  of  four  years  for 
unskilled  labour  at  one  end  of  the  scale  and  four  years 
for  the  learned  professions  at  the  other,  we  have  a 
difference  of  fifteen  years  in  their  respective  marriage 
ages. 

The  increasing  mean  age  of  marriage  is  well  shown 

in  the  following  tables  drawn  up  in  1874  by  Mr.  Ansell  r 

TABLE  III. 

Rate  of  Mortality,  London,  1874. 

Period  of  Marriage, 

Meaa  Age  at  ManitLge.      Meur 
IMfferenor 
-^     *««n.  Bachelore.    Spinsten.    inA^^es. 

Before  1840     ..  ..         28*64        24*75         3*89 

Since  1840   (to  1874)  . .         29*95         25*53         4*42 
Both  periods    ..  ..         29*31         25*16         4*16 

TABLE  IV. 

Mean  Axe  at  Mwriafe.  Maan  Diffcr- 

Bachelon.       Spiniters.  ence  in  Agea» 
2789              24*30  3*59 

28*89  24*52  3*74 


Date. 
1800 
1810 
1820 
1830 
1840 
1850 
i860 
1870 


28*64 

2474 

29*01 

29-94 

2939 

25*1 

29*76 

25*41 

30-14 

25*64 

3051 

25*84 

3*90 
4*05 

4'20' 

4*35 
4*50 
465 


The  later  age  of  marriage,  then,  is  a  factor  of  prime 
importance  in  the  decrease  of  a  birth-rate.  Taking  it 
along  with  the  fall  in  the  illegitimate  birth-rate,  we 
find  two  conditions  sufficient  in  themselves  to  account 
for  a  good  deal — if  not  the  greater  part — of  the  decrease 
in  the  general  birth-rate  of  the  United  Kingdom  which 
furnishes  the  basis  of  Dr.  Taylor's  investigations. 
The  assumed  fall  of  5*6  in  the  total  married  birth- 
rate is  a  bubble  that  collapses  when  we  subtract  the 
illegitimate  births.  The  assumed  cause  of  the  decline 
in  the  birth-rate  of  married  persons,  namely,  artificial 
prevention,  collapses  also  when  we  apply  the  test  of  the 
later  marriage  age.  Increased  continence  is  not  con- 
sidered worthy  of  discussion  as  a  possible  influence  in 
the  decline,  either  legitimate  or  illegitimate. 

It  is  clear,  therefore,  that  if  Dr.  Taylor's  foundations 
are  thus  insecure,  the  walls  of  his  superstructure  will 
have  little  chance  of  surviving.  However,  in  order  to 
arrive  at  a  basis  of  argument,  we  will  return  to  our 
common  point  of  agreement,  that  is  to  say,  the  ad- 
mitted fall  of  5*6  in  the  total  birth-rate  of  1,000  persons 
living.  Similar  conditions,  it  seems  reasonable  to 
assume,  will  ultimately  affect  the  birth-rate  both  of 
married  and  unmarried  persons.  For  instance,  if  the 
lessened  number  of  illegitimate  births  may  be  ascribed 
to  a  generally  higher  standard  of  sexual  morality,  there 
is  no  apparent  reason  why  a  similar  continence  should 
not  limit  the  offspring  of  married  life  ;  or,  assuming 
with  Dr.  Taylor  that  artificial  prevention  is  the  main 
cause  of  limitation,  the  practice  is  likely  to  affect  child 
bearing  as  regards  unmarried  women  not  less  than 
married  women. 

Dr.  Taylor  quotes  the  following  figures  as  the  average 
yearly  number  of  births  per  1,000  persons  living  in 
Great  Britain  and  Ireland  during  the 

TABLE  V. 
F«ve-yearly  periods.  Birth-rate  per  1.000. 

1874— 1878  34*3 

1879— 1883  32-6 

1884— 1888  31-2 

1889 — 1893  29*8 

1894 — 1898  29*1 

But  he  has  chosen  twenty-five  years  of  steady 
decline.  If  he  had  included  the  thirty  years  before 
1874  he  would  have  found  a  period  of  steady  increase. 
In  England  alone  the  birth-rate  from  1838 — 1841  was 
31*97  per  1,000  population,  (a)  For  the  United  King- 
dom I  have  not  been  able  to  obtain  the  exact  average 
rate,  but  it  would  be  somewhere  roughly  about  30. 
So  that  the  birth-rate  of  1900  has  practically  reverted 
to  that  of  1840.  During  the  sixty  years  that  intervened 
there  was  a  steady  increase  for  nearly  thirty  years  to 
a  maximum  (36*3  in  1876).  and  then  a  steady  fall  for 

(a)  "  Fifth  Annual  Report  of  Registrar-General  in  England,  1843." 


July  13.  1904. 


ORIGINAL  COMMUNICATIONS.  Th«  Medical  Press.    33 


thirty  years  to  a  minimum  and  somewhat  lower  figure 
than  that  of  1840.  Dr.  Taylor  says  the  fall  is  due  to 
artificial  prevention  of  conception,  which  he  carefully 
states  is  a  new  condition  introduced  within  the  last 
thirty-five  years.  To  what  does  he  attribute  the 
increase  ?  Why,  again,  does  the  birth-rate  of  1840, 
before  artificial  prevention  was  in  vogue,  stand  prac- 
tically at  the  same  figure  as  that  of  1900  ?  Clearly, 
by  his  own  account,  prevention  had  nothing  to  do 
with  the  avezage  birth-rate  of  30  in  the  year  1840. 
It  is  just  as  necessary  for  Dr.  Taylor  to  find  an  ex- 
planation for  the  figures  of  1840  as  those  of  1900.  The 
figures  that  he  would  have  us  believe  are  of  such 
terrific  import  in  1900  must  surely  have  had  their 
significance  in  1840. 

Is  it  not  possible  that  the  birth-rate  has  waxed  and 
waned  during  the  latter  half  of  the  nineteenth  century 
in  obedience  to  economic  laws  ?  We  know,  for  in- 
stance, that  the  marriage-fate  varies  exactly  with  the 
activity  of  trade,  and  the  number  of  births  has  a  close 
relationship  with  the  general  prosperity.  We  know, 
moreover,  that  as  the  result  of  free  trade,  the  last 
century  witnessed  a  vast  increase  in  the  national  wealth, 
as  well  as  its  more  eaual  distribution  in  the  shape  of 
wages  and  income.  May  not  the  increase  and  decrease 
of  the  birth-rate  be  regarded  as  a  delicate  index  of  the 
general  prosperity,  not  only  as  regards  the  actual 
amount  of  wealth  in  the  country,  but  as  to  its  just  and 
equitable  distribution  ?  The  decline  in  the  birth-rate 
of  1900  may  possibly  point  to  an  approaching  limit 
of  population  under  present  social  conditions. 

The  facts  of  the  case  may  be  conveniently  illustrated 
by  taking  the  particular  instance  of  the  Borough  of 
Islington,  with  an  estimated  population  for  1903  of 
339.197  persons.  The  picture  reproduces  in  miniature 
the  main  features  of  the  National  birth-rate,  and 'hits 
been  carefully  dealt  with  by  the  abl6  medical  officer  pi 
health.  Dr.  Alfred  E.  Harris.  The  later  marriage  age 
of  woman  is  shown  in  the  following  table  : —  (a) 

TABLE  VI. 
Showing  the  Proportion  op  Married  Women  at 
Four  Periods  of  their  Child-bearing  Ages, 
in  every  1,000  of  such  Married  Women. 
CenaasTMrs. 


Afire  Periods. 

1891. 

1901. 

DeareaM 

1 5 — 20 

8-14 

636 

—   178 

20 — 25 

..        133-05 

12469 

—  836 

25—35        ..       ' 

. .       468-^ 

481-99 

+  13-05 

35—45        .. 

..        389-87 

38696 

—  2*91 

I,000-0P         I.OOO'OO 

The  next  table  brings  out  clearly  the  fact  that 
although  the  number  of  women  capable  of  bearing 
children  had  largely  increased,  yet  the  number  of 
children  borne  by  them  had  largely  decreased.  So  far 
as  the  births  among  unmarried  women  are  concerned, 
a  decrease  of  20*2  per  cent,  in  the  birth-rate  is  recorded. 
TABLE  VII. 


1889-98. 
Average  number  of  un- 
married   women    and 
widows  at  child-bear- 
ing ages         . .  . .     45.032 

Average  number  of  mar- 
ried  women  at  child- 
bearing  ages    . . 

Births  per  1,000  un- 
married women  and 
widows  at  child-bear- 
ing ages 

Births  per  1,000  married 
women  at  child-bearing 
ages 

Number  of  births  among 
unmarried  women  and 
widows  at  child-bear- 
ing ages 

Number  of  births  among 
married  women  at  child- 
bearing  ages    . . 


1899-08. 


Increaee  or 
Decrease. 


47,711         +2,689 


39,152     42,59«        +3.446 


661 


5-28 


-1-33 


2376        211*3         —26-3 


1,488        1,258         — 230 


46.524     45.015       —1.509 


(a)  "48th  Aaoual  Report  of  (he  Borough  of  IsliDgton,"  1904. 


The  illegitimate  births  registered  in  IsUngton  be- 
tween 1851  and  1900  were  in  ten-yearly  perils: — 
TABLE  VIII. 
Periods.  Illegitimate  Births. 

1851— 1860  1,335 

1 86 1 — 1870  2,651 

1871 — 1880  2,429 

1881 — 1890  3»475 

1891 — 1900  2,710 

The  birth-rates  of  Islington  from  1841  to  1903  were  :^- 
TABLE  IX. 

Periods.  Birth-rite. 

1841 — 1850  28*65 

185 1 — 1860  34*54 

1861 — 1870  37-20 

1871 — 1880  3660 

1881— 1890  3256 

1891— 1900  291 1 

1901  27-62 

1902  26-80 

1903  2648 
During  the  sixty  years  covered  by  the  ten-yearly 

p^ods,  the  birth-rate  rose  to  a  maximum  about  its 
middle,  while  the  figures  ^t  the  beginning  and  the  end 
nearly  coincide. 

Dr.  Taylor  advances  no  facts  in  support  of  his  asser- 
tion that  artificial  prevention  of  conception  is  the 
main  cause  of  the  decline  in  the  birth-rate.  Most 
medical  men  receive  the  confidence  of  patients  m 
sexual  matters,  and  they  would  probably  admit  that 
such  practices  are  increasimgly  prevalent  among  the 
better>ofI  classes  of  the  United  Kingdom.  They 
would  probably  agree,  also,  in  questioning  prevention 
as  the  main  cause  of  the  failing  birth-rate,  principaJUy 
on  account  of  the  futile  character  of  the  means  em* 
ployed.  Such  methods  are  usually  adopted  by  those 
in  whom  continence  is  not  a  virtue,  and  breakdowns  in 
the  arrangements  occur  often  enough  to  nullify  the 
gross  effect  of  most  of  the  precautions.  On  the  con- 
trary, how  often  does  one  meet  with  the  opposite  state 
of  mind — a  desire  for  children  which  Nature  denies  } 
Admit  that  artificial  prevention  is  increasing  among 
the  wealthier  classes.  Dr.  Taylor  would  have  to  prove, 
in  order  to  maintain  his  position,  that  a  corresponding 
decrease  in  the  birth-rate  has  not  affected  the  birth- 
rate of  the  poorer  classes.  He  had  made  no  attempt 
— not  even  by  the  royal  road  of  assertion — to  show  that 
artificial  prevention  is  practised  to  any  extent  among 
the  poor. 

{To  he  concluded.) 

A  CRITICISM  OF  THE 

MOSQUITO  THEORY  OF 
INFECTION 

IN 

MALARIA  AND  YELLOW  FEVER. 

By  Dr.  L.  CHEINISSE, 
Ex-InterDs  of  tht  HospiUla  of  Montpellier. 
[specially  reported  for  this  journal.] 
To  raise  the  question  of  the  importance  of  the 
mosquito  in  respect  of  the  infection  of  malaria  and 
yellow  fever  will  no  doubt  savour  of  audacity  to  many, 
but  I  propose  to  do  so  in  deference  to  Montaigne's 
niaxim  that  "  when  a  new  doctrine  is  put  forwai^  we 
have  every  reason  to  look  askance  at  it."  Indeed,  it  is 
impossible  not  to  feel  a  lurking  scepticism  in  view  df 
the  enthusiasm  with  which  this  novel  theory  has  been 
everywhere  accepted.  When,  some  fifty  years  ago, 
J.  C.  Nott  promulgated  the  theory  that  mosquitoes 
were  instrumental  in  conveying  the  infection  of  yellow 
fever,  he  little  thought  that  one  day  his  hypothesis 
would  become  the  credo  of  epidemiology,  not  only  ia 
respect  of  vomito  negro,  but  of  other  infective  diseases. 
Habent  sud  fata.  Suspected  by  Nott  and  elaborated  by 
Finlay,  the  theory  of  the  transmission  of  yellow  fever 
by  mosquitoes  ehcited  no  echo,  and  it  had  fallen  into 
oblivion  when  the  researches  of  certain  English  and 
Italian    observers   on   the   f6le   of    the    mosquito   in 

C 


34    ttfft  MtDtCAL  Press. 


ORIGINAL  COMMUNICATIONS. 


July  13,  1904. 


propagating^malaria  directed  attention  to  this  factor  of 
contagion.  *•  The  mosquito,"  writes  M.  Bard,  --  intro- 
duced into  the  domain  of  pathology  by  the  filaria,  soon 
aspired  to  a  wider  field  of  usefulness,  and  at  present 
ycilow  fever  is  in  part  its  work,  while  malarial  fever 
is  its  predilection."  But  this  writer  is  too  modest  in 
describing  the  rdle  of  the  mosquito  in  yellow  fever  as 
"partly"  accounting  for  infection.  Things  have 
reached  such  a  pass  that  it  is  impossible  to  conceive 
the  ^'contagious  character  of  typAttt  aimaril  without 
invoking  the  assistaAce  of  the  Stygomyia  fasciaia. 
According  to  present  views  quarantine  is  unnecessary, 
nay,  even  a  person  suffering  from  the  disease  cannot 
transmit  it  in  the  absence  of  the  mosquito  link  of  the 
chain.  The  American  Cuban  Commission  is  equally 
emphatic  on  this  point,  so  that  •  the  prophylaxis  of 
yellow  fever  is  reduced  to  the  simple  aphorism : 
Vitandi  culices,  delendi  culices. 

In  support  of  this  view  we  are  referred  specially  to 
the  observations  of  American  pathologists  on  the 
inoculation  of  yellow  fever  by  mosquitoes.  Apart  from 
the  fact  that  these  observations  are  open  to  criticism 
it  is  worthy  of  note  that  they  leave  the  exact  nature  of 
the  poison  a  matter  of  douf)t.  The  parasites  of  the 
Stygomyia  fasciata  comprise  fungi,  ferments  and 
^porozoa,  but  none  of  these  has  any  bearing  on  yellow 
fever. 

The  etic^ogical  similarity  between  malaria  and  yellow 
fever,  so  often  invoked  in  favour  of  current  views, 
obviously  falls  to  the  ground.  For  the  analogy  to  be 
^complete  it  would  be  necessary  to  admit,  in  regard  to 
yellow  fever,  the  existence  of  a  specific  luematozodn 
"which,  like  that  of  malaria,  has  its  evolution  in  two 
diiSerent  hosts.  As  M.  Bandi  remarks,  it  would  be 
strange  if  this  problematic  hsematozoon  could  pass 
xme  phase  of  its  existence  in  the  organism  of  an.  insect 
without  the  latter  exhibiting  the  slightest  trace  of  this 
cellular  parasite.  From  this  point  of  view  the  mosquito 
theory,  as  applied  to  malaria,  is  much  more  satisfactory. 
The  description  of  an  invisible  germ  ingested  with 
contaminated  blood,  which  for  twelve  days  undergoes 
9ome  obscure  change  in  the  body  of  the  Stygomyia, 
hardly  commands  acceptance.  Moreover,  it  is 
especially  by  analogy  that  the  theory  of  the  trans- 
mission by  mosquitoes  has  been  extended  to  yellow 
fever.  The  moment  is  opportune  to  ask  ourselves 
to  what  extent  this  theory  falls  into  line  with  the  facts 
even  in  respect  of  malaria,  a  question  that  has  been 
infinitely  better  studied  than  the  problem  of  typhus 
umarii. 

The  transmission  to  man  of  the  malarial  poison  by 
the  anopheles  is,  we  must  admit,  based  on  a  consider- 
able number  of  duly  observed  facts.  The  infective 
r^le  of  this  insect  has  been  experimentally  established, 
and  the  life  history  of  Laveran's  haematozodn,  with 
its  two  phases,  the  asexual  reproduction  in  the  human 
blood  and  the  sexual  generation  inside  the  body  of  the 
mosquito,  is  weU  known.  But  does  that  justify  the 
assumption  that  the  infection  of  the  human  being  by 
the  insect  and  that  of  the  insect  by  man  constitute  the 
complete  cycle  ?  In  other  words,  is  the  mosquito 
bite  an  indispensable  formality  before  man  can  become 
infected  with  malaria  ?  Can  we  really  affirm  that  in 
the  absence  of  the  mosquito  there  is  no  risk  of  con- 
tracting malaria  ? 

I  do  not  propose  to  discuss  seriatim  all  the  arguments 
that  have  been  brought  forward  in  support  of  the 
mosquito  theory,  especially  as  many  of  them  have 
already  been  refuted,  (a)  Moreover,  their  importance 
varies  greatly,  many  of  them  having  been  advanced 
merely  to  bolster  up  the  theory,  and,  therefore,  do 
not  deserve  attention.  It  is  obviously  impossible  to 
admit  that  the  comparative  immunity  of  the  abori- 
gines of  hot  climates  is  due  to  the  thickness  of  their 
skins  and  to  the  pronounced  odour  which  scares  away 
the  mosquito,  since  filariasis — also  transmitted  by 
culicedes — is  commoner  among  the  black  than  among 
the  white  population. 


(«)  Bee  **  L*  Th/orie  det  ]ffoueti<]ues  eat-elle  Univoqae  ? 
LyoH  Mtd.,  Noyemlwr,  1900. 


NanuTo. 


Instead  off  discussing  at  length  arguments  of  this 
class,  I  prefer  to  bring  together  a  certain  number  of 
facts  which,  far  from  confirming  the  r^e  of  the  ano- 
pheles as  the  sole  agent  of  transmission  of  malaria, 
tend  rather  to  throw  doubt  upon  the  existence  of  any 
constant  relationship  between  any  kind  of  mosquito 
and  malarial  infection. 

First    of    all  the  geographical  distribution    of    the 
anopheles  by  no  means  corresponds  to  the  distribution 
of  malaria.     This  insect  abounds  in  certain  regions 
whence  malaria  has  quite  disappeared,  or  has  never 
existed.     It  may  be  objected  that  the  most  important 
fact  to  take  into  consideration  is  the  numerical  dis- 
tribution of  the  insects  in  question.     But  even  from 
this  point  of   view  the  theory  fails,  for,  according  to 
Dr.  Sargent,  they  are  far  more  numerous  on  the  banks 
of    the    Essonne,  where  malaria  is  almost  unknown, 
than   in   certain   admittedly   malarial   districts    near 
Algiers.     Dr.   Sargent  is  therefore  obliged  to  explain 
the  disappearance  of  malaria  on  the  banks   of   the 
Essonne    by   invoking    other   factors— drainage,    &e. 
In  any  case,  it  is  obvious  that  there  is  no  sort  of  parallel- 
ism between   the  presence  and  number  of   anopheles 
and  the  existence  of  malaria.     We  shall  be  told,  of 
course,    that   the  anopheles  is  only  dangerous  as  a 
vehicle  for  the  transmission    of   the  virus,  and  that 
in  the  absence  of  infected  subjects  the  insect  is  harm- 
less.    But,   apart  from  the  fact   that   this  does  not 
explain  the  disappearance  of  malaria  from  districts 
once  infected  where  the  anopheles  continues  to  abound, 
the  theory  is  one  which  M.  Celli  himself  admits  is  not 
without  exceptions,  since  he  mentions  districts  where, 
though  malaria  is  rife  and  the  anopheles  numerous, 
new-comers  are  not  infected.     M.  de  Francesco,   on 
the  other  hand,     points  to  districts  deeply  infested 
with  malaria  where  no  anopheles  has  been  seen.     He 
consequently  protests  against    the  dogmatism  which 
declares  this  insect  to  be  the  sole  agent  in  the  pro- 
pagation   of    malaria.     If  the  anopheles  can  do  this 
thing,  why  not  the  CtUex  pipiens  ?     It  is  true  that  he 
did  not  succeed  in  discovering  in  the  intestines  and 
salivary  glands  of  the  latter  the  ovoid  and  the  sper- 
moid  of  the  haematozodn,  nor  the  zygotes  which  is 
the  outcome  of  their  conjunction,  but  is  it  not  well 
known   to  be  unnecessary    for    the    hsematozoon  of 
malaria  to  traverse  the  body  of  another  being  to  be 
enabled  to  convey  the  poison  of  malaria  ? 

It  is  not  enough,  indeed,  to  admit  that  the  anopheles 
has  no  monopoly  in  this  respect  as  the  partisans  of 
the  theory  would  have  us  believe.  The  truth  is 
that  malaria  can  be  propagated  without  the  inter- 
vention of  a  mosquito  of  any  sort.  Epidemics  of  the 
kind  have  already  been  described,  as,  for  instance, 
after  heavy  rains  (Canton  of  Lourmel,  Algeria).  Dr. 
Gros  remarks,  in  reference  to  this  outbreak,  that  he 
had  done  his  best  to  discover  some  specimens  of  ano- 
pheles, but  had  utterly  failed,  although  the  local 
conditions  were  distinctly  favourable  to  their  develop- 
ment. Mosquito  bites  may  certainly  serve  as  the 
front-door  for  the  entrance  of  the  malarial  poison, 
but  there  are  certainly  other  means  of  penetration. 
Even  if  an  insect  of  some  kind  be  regarded  as  indis- 
pensable to  the  transmission,  it  is  not  necessarily  or 
always  the  anopheles. 

I  will  now  adduce  some  epidemiological  observations 
more  to  the  point.  Taking  the  sanitary  returns  of 
the  Prussian  army,  Dr.  Grawitz  made  graphic  records 
of  the  prevalence  of  malaria  in  the  ist  and  4th  Corps, 
the  regiments  most  subject  thereto. .  Now  malarial 
infection  is  very  general  from  the  onset  of  spring, 
that  is  to  say,  at  a  season  when,  in  Eastern  Prussia 
and  Posen,  mosquito  bites  must  be.  extremely  rare. 
On  the  other  hand,  during  July  and  August  the 
incidence  of  the  disease  falls  quite  suddenly,  although 
the  men  are  at  that  time  most  discomforted  by 
mosquito  bites. 

Dr.  MuUer,  a  Russian  army  medical  ofi&cer,  has 
studied  the  co-relationship  of  mosquito  bites  and 
malaria  for  three  yearis  in  Bessarabia;  a  region  where 
malaria  is  endemic.     In  the  three  years  in  question 


July  13,  1904. 


ORIGINAL  COMMUNICATIONS.        Th«  Medical  Pems.    35 


the   proportion    per    thousand  of    men  attacked-  by 
malaria  was  as  ioUows : — 

1899.        1900.        1901.' 
May 378  445  393 

June 5*90         2'9i  5*8 1 

uly 3*24  481  9'8o 

August 3'44         7*56        1 1 '22 

With  respect  to  the  mosquitoes,  he  states  that  they 
irere  altogether  wanting  in  1899,  while  in  1900  they 
•abounded  in  these  districts ;  in  190 1  there  were  but 
lew,  and  they  almost  disappeared  in  August,  which 
happened  to  be  cold.  More  than  this,  in  June,  1900. 
the  proportion  of  soldiers  infected  was  only  one-half 
that  in  1899.  Lastly,  during  the  third  year,  when 
mosquitoes  were  rare,  the  sickness  remained  at  about 
the  same  figure  as  in  1899  for  the  first  two  months,  then, 
in  July,  without  any  perceptible  increase  in  the  number 
of  mosquitoes,  it  increased  considerably,  and  in  the 
ioUowing  month,  at  a  time  when  the  mosquitoes  had 
disappeared  altogether,  the  percentage  reached  a 
height  never  before  attained.  In  short,  apart  from 
the  month  of  May.  the  malarial  sickness  during 
1901  was  throughout  twice  as  great  as  the  previous 
year,  which  was  particularly  rich  in  mosquitoes. 

It  would  be  difficult  to  allege  a  more  flagrant  dis- 
crepancy between  the  presence  of  mosquitoes  and  the 
prevalence  of  malaria.  If.  on  the  other  hand,  we 
bear  in  mind  the  other  factors,  such  as  temperature, 
atmospheric  moisture,  the  rainfall.  &c.,  it  is  seen  that 
the  oscillations  recorded  on  the  charts  correspond  to 
these  meteorological  or  telluric  influences. 

Dr.  Kourlov's  observation  at  Tomsk,  in  Siberia, 
are  not  less  conclusive.  Malarial  infection  usually 
commences  to  make  itself  felt  in  March,  at  a  time  when 
the'  earth  is  still  covered  with  snow,  and  the  thermo- 
meter marks  about  10°  C.  below  zero,  conditions 
hardly  favourable  to  the  existence  of  mosquitoes.  It 
attains  its  masumum  in  April,  yet  there  was  on  an 
average  twenty-seven  days  under  freezing  point,  and 
the  average  temperature  was  1*2°  C.  below  zero. 
According  to  Dr.  Vender,  who  carried  out  his  observa- 
tions in  another  Siberian  town.  Kolyvan,  malaria 
commences,  as  at  Tomsk,  in  March,  and  since  the 
disease  is  propagated  during  March  and  April  without 
the  intervention  of  the  mosquito,  we  are  entitled  to 
ask  whether  these  really  play  such  an  active  part  in 
its  dissemination. 

However  this  may  be,  it  is  evident  that  the  mosquito 
cannot  be  regarded  as  the  sole  agent  of  the  transmission 
of  the  disease.  This  being  so,  it  becomes  us  to  exhibit 
a  certain  reserve  before  accepting  the  triumphant 
narratives  of  protection  against  malaria  by  gauze 
shutters.  Although  the  very  antiquity  of  the  telluric 
theory  is  against  it,  we  need  not  fea^  to  hold,  with 
Dr.  Bard,  that  the  improvement  is  to  be  attributed 
rather  to  improvements  in  the  soil  than  to  the  des- 
truction of  the  larvae  of  mosquitoes. 

If  this  be  the  case  in  respect  of  malaria  the  greater 
must  be  our  reserve  when  it  is  sought  to  extend  the 
theory  to  yellow  fever.  It  is  purely  a  case  of  reasoning 
by  analogy ;  indeed,  we  are  asked  to  believe  in  "  the 
presence  of  hxmatozoa,  as  in  malaria,  which,  moreover, 
offers  the  closest  resemblance  to  yellow  fever." 
These  hypothetical  hsmatozoa  of  yellow  fever  cannot 
for  the  time  being  be  otherwise  described  than  as  pre- 
senting a  certain  resemblance  with  the  "  animalcule  " 
de9cribed  by  Athanasius  Kircher  and  von  Leeuwenhoek 
as  being  at  the  root  of  all'  epidemic  maladies.  It  really 
seems  as  if,  in  the  words  of  an  eminent  English  observer, 
*'  the  reign  of  the  bacteria  has  attained  its  apogee,  and 
that  of  the  hxmatozoa  is  now  about  to  begin." 

No  doubt  the  results  of  experimental  inoculations  of 
yellow  fever  by  mosquitoes  are  extremely  suggestive, 
but  as  Dr.  Berenger-Feraud  points  out,  the  disease 
thus  inoculated  may  not  improbably  be  inflammatory 
bilious  fever,  i.e.,  a  relatively  mild  form  of  yellow 
fever.  This  view  is  endorsed  by  Dr.  Mendonca,  who 
feels  certain  that  the  disease  observed  by  Finlay  and 
by  American  observers  at  Cuba  and  Sao  Paulo  was, 
in  reality,  the  inflammatory  fever  of  the  Antilles. 
The  only  really  characteristic  experihients  are  those 


carried  out  by  Dr.  Guiteras  at  the  Havana  Hospital, 
in  which  the  typical  symptoms  were  present,  and  the 
diagnosis  was  verified  post-mortem.  But,  unfor- 
tunately for  their  conclusions,  it  is  precisely  the  experi- 
ments carried  out  at  Havana  that  gave  positive 
results,  while  those  of  Reed,  Carroll,  and  Agramonte 
failed  to  demonstrate  the  truth  of  the  new  hypothesis. 

Without  discussing  in  detail  the  conclusions  of  the 
American  Cuban  Commission,  I  submit  that  we  can  in 
no  wise  attribute  the  disappearance  of  yellow  fever 
at  Havana  to  measures  taken  for  the  destruction  of 
mosquitoes.  Dr.  Souchon,  basing  his  conclusions  on 
the  statistics  of  yellow  fever  since  18 17,  points  out 
that  the  disease  usually  wears  itself  out  in  from  two 
to  four  years,  unless' revived  by  fresh  cases  imported 
from  outside,  whence  it  follows  that  quarantine  and 
the  disinfection  of  merchandise  are  necessary  measures. 
Moreover,  Dr.  Souchon  states  that  the  number  of 
mosquitoes  has  not  apparently  diminished  in  Havana. 
Dr.  Andrade  reports  several  instances  of  places  in 
Brazil  where  the  authorities  succeeded  in  stamping 
out  yellow  fever  before  the  mosquito  theory  had  been 
invented.  On  the  other  hand,  the  destruction  of 
mosquitoes  at  Sao  Paulo  and  neighbouring  localities 
does  not,  so  far.  appear  to  have  had  any  influence  on  the 
prevalence  of  the  disease. 

In  1 90 1  Dr.  Purnell  published  a  series  of  observations 
OQ  the  transmission  of  yellow  fever  by  infected  fomites, 
and  he  points  out  that  the  lapse  of  time  between  the 
original  cases  and  the  subsequent  infection  was  too 
great  to  allow  it  to  be  possible  to  incriminate  the 
mosquito.  He  himself  attributes  but  trifling  import- 
ance to  the  part  played  by  the  mosquito  in  the  dis- 
semination of  yellow  fever.  The  history  of  the  great 
epidemic  at  Grand  Bassam  in  1902  is  specially  con- 
clusive from  this  point  of  view,  This  place  had  on 
several  occasions  witnessed  outbreaks  of  the  disease, 
and  the  last  epidemic  was  in  1899,  since  which  date 
no  cases  presented  themselves,  until,  on  July  19th 
and  20th,  1902,  some  well-marked  cases  occurred. 
In  1899  cases  had  occurred  in  pretty  well  all  the  houses 
of  Bassam,  and  in  one  house  five  out  of  six  died.  Near 
this  house  was  a  pool  of  brackish  water  into  which  the 
dejections  and  soiled  effects  of  the  victims  were  thrown 
in  1899.  The  medical  authorities  had  long  demanded 
the  filling  in  of  this  pool,  and  in  July.  1902.  steps  were 
taken  with  this  object  in  view.  Now,  all  the  persons 
attacked  by  yellow  fever  in  1902  liv^  in  the  neigh- 
bourhood of  this  pool,  or  had  close  relations  with  those 
who  did.  It  follows  that  contaminated  objects  are 
capable  of  transmitting  the  disease,  even  after  three 
years — that  is  to  say,  long  after  the  infected  mosquitoes 
must  have  perished,  even  if  we  credit  them  with 
extraordinary  longevity. 

Before  deciding  that  the  prophylactic  measures 
hitherto  enforced  are  absurd,  it  behoves  us  to  think 
twice*  for  at  present  it  seems  a  bold  thing  to  contend 
that  the  whole  prophylaxis  of  yellow  fever  consists 
"  in  preventing  the  Stygomvia  fasciata  from  biting  the 
healthy  after  biting  the  sick." 


THE 

CRIMINAL   RESPONSIBILITY 

OF   THE 

ALCOHOLIC,  (a) 

By    WILLIAM    C.    SULLIVAN,    M.D., 

Deputj  Medical  Offloer,  H.M.  PriBon,  PentonviUe. 

The  author  made  allusion  to  the  fact  that  the 
legal  responsibility  of  the  alcoholic  had  already 
been  the  subject  of  discussion  by  the  Society, 
and  in  this  connection  the  names  of  Dr.  Crothers 
and  of  Dr.  Norman  Kerr  were  specially  to  be 
remembered. 
'  He  remarked  that  when  we  speak  of  alcoholic 

(«)  Abfltxmct  of  ft  Paper  reed  before  the  Society  for  the  Stadv  of 
Inebriety,  at  the  Rooms  of  the  Medicil  Society  of  London,  Taeeday, 
July  12th)  1904. 


36    Thx  Medical  Pxxss. 


ORIGINAL  COMMUNICATIONS. 


crime  we  generally  have  in  mind  homicidal 
offences,  for,  though  alcohol  leads  to  other  forms 
of  dehnquency,  it  is  in  murder  that  its  influence 
is  most  evident ;  in  this  country,  at  all  events,  it 
is  the  most  important  individual  cause  of  that 
crime.  In  discussing  legal  responsibility,  it  will 
be  practically  convenient  to  adopt  the  same 
attitude,  and  to  limit  our  observations  to  cases  of 
homicide. 

In  such  cases  the  question  of  responsibility 
arises  in  connection  with  three  conditions : — 
(i)  Chronic  alcoholic  insanity ;  (ii)  dehrium  tremens ; 
and(iii)  the  dreamy  mental  state  of  morbid  drunken- 
ness. 

In  the  first-named  condition  the  question  is 
decided  by  the  same  criteria  that  are  admitted  in 
non-alcohohc  insanity,  so  that  its  consideration 
need  not  detain  us.  Similarly,  cases  of  distinct 
delirium  tremens  present  no  special  difficulty. 
It  is  when  we  come  to  cases  of  alcoholic  auto- 
matism, to  crimes  committed  in  the  dream  states 
of  pathological  drunkenness,  that  we  meet  with 
differences  in  opinion  and  practice,  the  condition 
being  sometimes  held  of  no  account,  sometimes 
admitted  as  an  extenuating  circumstance,  and 
sometimes  treated  as  equivalent  to  legal  insanity. 
On  this  account,  and  because  these  cases  constitute 
the  large  majority  of  alcoholic  crimes,  it  is  desirable 
to  devote  special  attention  to  them,  and  they 
are  accordingly  suggested  as  the  special  subject 
of  this  discussion. 

The   objection    to   recognising   alcoholic   auto- 
matism as  a  morbid  condition  modifying  legal 
responsibility  appears  to  rest  chiefly  on  the  fear 
that  there  would  be  therein  some  risk  of  abuse  ; 
any  criminal,  it  is  said,  would  only  need  to  get 
drunk    in    order    to    secure    immunity    from    his 
misdeeds.     Those  who  entertain  this  fear,   how- 
ever, do  not  take  account  of  the  fact  that   the 
automatism    of    the    alcoholic    is    really    a    very 
definite  condition  as  to  its  character  and  as  to 
its   causation.     Of  course,   an   element   of  auto- 
matism belongs  even  to  the  common  phenomena 
of  drunkenness,  but  it  is  only  when  the  symptom 
has  become  very  much  exaggerated  in  degree  that 
we  have  the  dream  states  here  considered,  with 
their  tendencies  to  criminal  conduct.     And  this 
exaggeration   occurs   only  in  neuropathic  subjects. 
Most   commonly   this  neuropathic  predisposition 
is   due   to   chronic   alcoholism ;   what   ordinarily 
happens,   in  fact,   is   this — after  many  years  of 
intoxication   marked   by   symptoms   of   common 
drunkenness,   the  individusd  acquires  a  peculiar 
susceptibility  to  alcohol,  so  that  relatively  small 
doses  lead  to  more  or  less  lengthy  dream-states,  in 
which  the  patient   may  seem  to  speak   and   act 
pretty  coherently,  though  in  reaUty  he  is  in  a  sort 
of  somnambulistic  state  and  knows  nothing  at  all 
afterwards  of  what  he  has  done,  or  has  only  a 
hazy  recollection  of  it ;  in  one  of  these  phases  he 
will    probably    murder    his    family,    or    attempt 
suicide.     Besides  chronic   intoxication,   which   is 
the  most  frequent  cause,   other  conditions  also 
predispose  to  automatism  under  alcohol,  and  of 
these   epilepsy,    head    injury,    and    insane   here- 
ditary taint  are  the  most  important. 

It  is  this  constant  relation  to  a  definite  neuro- 
pathic disposition  that  is  the  most  distinctive 
and  important  fact  about  alcoholic  automatism, 
and  the  recognition  of  this  fact  should  go  far  to 
dispose  of  the  fear  that  the  admission  of  irrespon- 
sibility in  such  cases  would  lead  to  abuse.     No 


July  13,  1904. 


one  becomes  mad  when  drunk  who  is  wholly  sane 
when  sober. 

Regarding  the  condition  of  memory  in  these 
cases,  it  is  to  be  noted  that  the  amnesia  is  often 
incomplete,  and  also  that  its  development  may 
be  delayed,  so  that  there  may  be  a  clearer  recol- 
lection of  the  crime  immediately  after  the  dream 
phase  than  at  a  later  period. 

In  connection  with  the  general  demeanour  of 
the  automatic  drunkard,  much  interest  attaches, 
to  a  recent  observation  of  von  Gudden,  who  has 
found  that  in  about  half  the  cases  of  this  condition 
with  irritability  of  temper,  there  is  impairment  of 
the  light  reflex,  lasting  as  long  as  the  dreamy 
state  persists.  This  may  possibly  prove  a  valuable^ 
medico-legal  test. 

The  admission  of  morbid  drunkenness  as  a 
condition  excluding  full  responsibility  is  especially- 
desirable  in  that  it  would  further  the  trend  of 
public  opinion  to  adopt  preventive  measures, 
against  the  criminal  alcoholic.  It  is,  in  fact,, 
mainly  as  a  means  of  eliminating  potential 
criminals  that  the  institutional  treatment  of 
ordinary  drunkards  is  of  use  to  the  community. 
When,  therefore,  the  chronic  alcoholic  has  once 
shown  the  disposition  to  dream  states  with  im- 
pulsive tendencies,  especially  homicidal  or  suicidal, 
he  ought  to  be  dealt  with  on  the  same  footing 
as  the  impulsive  epileptic — immune  from  or- 
dinary punishment,  but  unfit  for  ordinary  freedom. 

THE   VESTIGES  OF   SYPHILIS. 

By  FRANK  H.  BARENDT,  M.D.Lond.,  F.R.C.S., 

Senior  Physician.  St.  G«orvre*fl  Hospital  for  DiaeaMSOf  the  SUn; 

Oonsultuifr  Denoatologist  Bojal  Sonthern  Hospital,  Liverpool. 

It  frequently  happens  that  the  question  of  syphihs 
arises  in  connection  with  the  disease  from  which 
the  patient  is  suffering.  As  a  correct  answer 
is  of  supreme  importance  in  treatment,  it  occurred 
to  me  that  a  short  account  of  those  imprints  that 
may  be  left  behind  by  the  disease  would  be  of 
general  interest. 

I  need  not  allude  at  length  to  the  numerous 
diseases  which  may  arouse  in  our  minds  a  suspicion 
of  previous  syphilis.  It  is  well  known  that  many 
anomalous  nerve  affections — eye,  ear,  nose,  throat, 
and  cutaneous  troubles,  &c. — often  suggest  sy- 
philis as  an  etiological  factor.  It  therefore  be- 
hoves us  to  make  use  of  all  the  knowledge  of  this 
far-reaching  disease  that  we  have  in  the  excellent 
chnical  observations  that  have  been  handed  down 
to  us  by  syphilographers  of  former  days. 

With  regard  to  inherited  syphilis,  the  Hutchin- 
sonian  triad  is  now  universally  accepted  as  an 
indication  of  congenital  syphilis,  and  all  of  us  recog- 
nise its  value.  The  condition  of  all  the  permanent 
teeth  is  important,  and  a  careful  examination  of 
the  molars  should  not  be  omitted.  These  are 
often  dome-shaped,  due  to  the  imperfect  develop- 
ment of  the  cusps,  and  present  consequently 
smaller  grinding  surfaces  than  normal.  This 
condition  of  the  molars  has  remained  well  marked 
in  cases  where  the  notches  in  the  incisor  teeth 
have  lost  their  striking  character  through  attrition. 
Are  there  any  signs,  more  or  less  permanent, 
upon  which  we  can  rely  as  evidence  of  syphilis- 
which  the  patient  may  have  acquired  years  ago  ? 
At  the  outset,  we  can  ask  the  patient  the  leading 
question,  to  which  we  may  get  a  correct  answer ; 
but  the  nature  of  the  disease,  the  method  of  in- 
fection, the  evanescent  memory  of  early  lapses 
from  right  conduct,    all  combine  to  render  the: 


July  13,  1904. 


ORIGINAL  COMMUNICATIONS. 


Thk  Mkdical  Pkkss.     37 


patient  prone  to  oblivion  of  such  an  event  in  his  life, 
especially  if  unmarked  by  his  having  had  to  seek 
medical  advice.  Even  when  an  unwilling  ad- 
mission is  extracted,  it  frequently  happens  that 
he  glosses  it  over  with  a  smoothness  that  makes 
his  cross-examiner  wonder  whether  his  suspicions 
are  not  after  all  iU-founded  ;  and  that,  in  his  desire 
to  clutch  at  some  definite  cause,  he  may  wrongly 
appraise  the  diagnostic  value  of  the  statements 
of  his  patient. 

Far  be  it  from  me  to  malign  any  special  calling, 
but  I  cannot  help  thinking  that  if  the  patient  is, 
or  has  been,  a  sailor  or  soldier,  or  one  wh6se business 
takes  him  frequently  from  home,  these  occupa- 
tions bring  greater  liabiUty  to  the  infection  of 
S3rphilis  than  any  other  in  this  country.  Another 
point  I  should  lay  stress  upon  is  the  abuse  of 
alcohol  in  the  early  adult  life,  for  there  is  no  doubt 
that  syphilis  has  often  been  acquired  when  the 
control  of  the  higher  senses  is  impaired. 

As  regards  the  nature  of  the  initial  lesion,  I 
venture  to  think  that  too  much  value  is  attached 
to  the  absence  of  a  sore,  be  it  soft  or  hard,  on  the 
penis,  and  too  little  to  the  history  of  what  our 
patients  call  a  **  simple  running."  It  is  a  matter 
of  common  knowledge  that  the  famous  John 
Hunter,  from  an  experiment  on  his  own  body,  largely 
retarded  our  progress  by  confounding'  syphilis 
and  gonorrhoea,  and  ascribing  them  to  the  same 
contagium.  His  error  has  been  explained  by 
-the  supposition  that  he  inoculated  himself  with 
-the  discharge  from  a  urethral  chancre,  and  that 
-the  discharge  mistaken  by  him  for  gonorrhoea 
-was  due  to  the  concealed  chancre.  I  have  care- 
fully read  the  history  of  this  famous  experiment, 
3nd  feel  that  such  an  acute  observer  as  he  un- 
•doubtedly  was  could  scarcely  have  overlooked 
"the  presence  of  a  urethral  chancre.  I  venture  to 
•suggest  that  the  disease  with  which  he  inoculated 
liimself  was  actually  syphilitic  urethritis.  That 
■syphilis  may  produce  urethritis  is  admitted  by  all 
•competent  recent  syphilologists,  and,  like  syphilitic 
colpitis,  is  due  to  the  presence  of  syphilides  in  the 
mucosa.  We  admit  the  infectivity  of  mucous 
patches  in  the  mouth  and  throat,  and  therefore 
-the  simple  running,  as  the  phrase  goes,  taken 
together  with  the  anomalous  disease  the  patient 
at  the  time  of  our  examination  presents,  may  turn 
out  to  have  been  a  true  syphilitic  urethritis,  and 
represent  the  primary  stage  of  infection.  At  any 
rate  we  must  not  exclude  all  possibihty  of  syphiUs 
because  there  is  no  history  of  sore  or  of  skin 
troubles,  and  only  one  of  simple  running. 

Syphilis  d*emblee  of  French  sjrphilographers, 
-where  the  initial  eflFect  is  not  demonstrable,  can 
thus  be  explained,  the  site  of  the  initial  infection 
being  intra-urethral,  of  the  nature  of  a  mucous 
patch,  and  unnoticed  by  the  patient.  The  same 
holds  good  for  balano-{>osthitis,  for  it  is  well  known 
that  &e  desquamating  papule— one  type  of  the 
initial  sore  of  syphiUs — ^may  be  masked  by  a  profuse 
:secretion  due  to  balanitis  and  posthitis.  Extra- 
genital infection  should  not  be  forgotten ;  and 
although  infrequent  in  this  country,  suspicious 
•depressed  stellate  scars,  in  the  absence  of  a  satis- 
iactory  history  of  trauma,  should  put  us  on  our 
guard.  Digital  infection  is  by  no  means  so  rare 
.as  is  gener^dly  supposed,  and  is  not  only  confined 
to  medical  men  and  midwives. 

A  few  remarks  may  not  be  out  of  place  with 
i-regard  to  secondary  syphilis,  i.e.,  the  presence  of 
.S3rphilides  of  the  skin  and  mucosae  as  far  as  these 
«can  be  inspected  during  life.     It  is  well  known  how 


unobservant  many  patients  are  of  .skin  eruptions* 
especially  when  they  are  not  pronounced  and  un' 
accompanied  by  itching.  We  should  remember 
that  women  infected  by  their  husbands  fre- 
quently never  have  and  give  no  history  of  a  secon- 
dary eruption,  especially  when  pregnancy  occurs 
about  the  time  of  infection.  As  far  as  my  ex- 
perience goes,  I  have  seen  secondary  syphilis 
most  frequently  in  women  who  are  not  and  have 
never  been  pregnant ;  but  in  those  who  are  parous 
and  indubitably  have  contracted  syphilis  in  their 
early  married  hie,  it  has  been  rare  to  get  a  history 
of  cutaneous  and  mucosal  eruptions,  although 
one  of  frequent  abortions  is  common  enough.  In 
both  sexes  a  history  of  piles  should  not  make 
us  forget  the  possibility  of  their  being  condylomata. 

Of  the  vestiges  left  by  antecedent  syphilis, 
no  one  by  itself  is  pathognomonic  ;  and  such  as 
they  are,  they  must  be  carefully  weighed  together 
with  the  nature  and  history  of  the  disease  for 
which  the  patient  seeks  our  advice.  One  of  the  most 
important  is  a  scar, depressed, irregularly  marginate, 
and  occupying  a  region  of  the  body  not  liable  to 
injury  in  ordinary  pursuits,  and  where  history 
of  injury  is  excluded.  If  such  scars  are  multiple 
the  suspicion  is  strengthened  ;  and  if  in  addition 
there  is  a  disturbance  of  pigmentation  giving  rise 
to  map-Uke  configuration,  the  explanation  should 
be  very  satisfactory  indeed  from  the  patient  if 
we  are  to  abolish  from  our  minds  the  idea  of 
syphilis.  The  presence  of  a  scar  on  the  penis  is 
of  value  ;  whether  a  soft  sore  produced  it  or  a 
hard  one  has,  or  ought  to  have,  little  weight  with 
us  when  we  suspect  syphilis.  Far  too  much 
has  been  made  of  this  character  as  a  diagnostic 
criterion  ;  and  although  most  writers  admit  of 
the  two  types  of  sores,  yet  a  soft  sore  may  be  the 
site  of  the  inoculation  of  syphilis,  just  as  a  hard 
sore  may  be  but  a  local  ulceration  due  either  to  a 
specific  bacillus  (Ducrey)  or  to  pus  organisms. 
The  multiplicity  of  a  sore  is  no  proof  at  all  of  its 
being  simple  in  its  nature  ;  and  when  in  Vienna 
I  saw  multiple  hard  chancres,  two  being  on  the 
left  index  finger,  one  on  the  corona,  and  two  on 
the  body  of  the  penis.  In  my  experience,  when- 
ever a  patient  admits  having  had  a  chancre,  the 
scar  can  be  discerned  on  careful  examination  of 
the  site  even  when  several  years  have  elapsed 
since  infection.  Herpes  preputialis  may  leave 
scars,  especially  after  recurrent  attacks,  but  here 
we  have  no  loss  of  substance  to  the  same  extent 
that  obtains  in  chancres. 

Syphilis  has  been  termed  big-pox  in  contra- 
distinction to  variola  or  smadl-pox.  Pustular 
syphilides  are  at  present  among  the  least  frequent 
of  secondary  eruptions,  and  such  is  the  experience 
of  Continental  observers.  I  m3rself  have  only 
seen  one  case  where  the  secondary  eruption  was 
stated  to  be  pustular,  and  at  first  glance  I  mistook 
the  condition  for  a  previous  attack  of  small-pox. 
The  pocks  were  deeper  and  whiter,  and  the  imme- 
diate surrounding  integument  was  much  more 
pigmented,  but  the  pitted  face  looked  very  like 
that  produced  by  small-pox.  There  was,  how- 
ever, abundant  evidence  of  the  disease  being 
syphihtic,  quite  apart  from  the  patient's  statement. 

Scars  in  the  sural  and  peroneal  regions,  although 
the  legs  are  more  hable  to  injury  than  other  mem- 
bers, are  always  suspicious.  On  the  front  of  the 
shins  the  evidence  is  of  little  value,  for  most  of  us 
have  had  some  injury  infiicted  upon  them  at  some 
time  or  another.  Pigmentation  in  this  region 
is  frequently  seen  in  women  who  have'a  penchanf 


38     Tbs  Medical  Pkess. 


CLINICAL  RECORDS. 


July  13,  1904- 


or  warming  this  part  of  their  anatomy,  and  must 
not'  be  wrongly  [interpreted.  It  constitutes  the 
"  e'phelides  ab  igne  "  of  authors,  and  when  well 
developed  may  lead  to  mistakes  in  diagnosis. 

Eruptions  on  the  palms  and  soles  are  suggestive, 
especially  when  they  take  the  form  of  discrete 
papules  surrounded  by  a  scaly  ring,  papules  en 
collarette,  as  French  dermatologists  call  them. 
In  examining  the  skin,  and  especially  the  hands 
and  feet,  for  such  vestiges,  the  patient  should  be 
watm,  otherwise  the  natural  mottUng  of  the  skin 
— ^the  so-called  cutis  marmorata — may  interfere 
with  our  correct  appreciation  of  such  eruptions. 

Leucodermia  is  an  important  change,  and  when 
present  is  a  valuable  sign  of  previous  syphilis. 
It  is  due  to  circumscribed  loss  of  normal  pigment, 
whereby  white  spots  are  formed,  surrounded  by 
pigmented  rings  which  shade  ofiE  into  the  normal 
colour  of  the  skin.  Such  spots  of  leucodermia 
niay  develop  in  the  site  of  former  efflorescences, 
be  these  early  or  late  syphiUdes.  They  persist 
for  a  long  time,  are  most  often  seen  on  the  nape  of 
and  sides  of  neck,  and  are  apparently  more  fre- 
quent  among  women  than  men.  I  can  testify 
to  the  value  of  this  important  cutaneous  change, 
and  have  frequently  found  it  confirm  the  suspicion 
of  syphilis.  The  affection  may  assume  figured 
patches,  and  the  marked  pigmented  border  helps 
to  distinguish  it  from  leucodermia  which  may 
arise  in  the  course  of  malignant  disease.  In  all 
cases  of  suspected  syphilis,  I  would  urge  the  care- 
ful inspection  of  the  neck,  especially  for  white 
spots  surrounded  with  pigment  rings — standing  out 
in  marked  contrast  to  the  neighbouring  skin. 
This  can  readily  be  done  without  drawing  too 
much  attention. 

Generally  speaking,  syphilides  are  essentially 
pigment  disturbers,  and  therefore  any  mottling  or 
discoloration  of  the  skin  should  be  taken  note 
of  in  determining  the  question  of  previous  syphilis. 
Gentle  pressure  by  a  microscopic  slide  will  expel 
the  blood  from  the  subjacent  capillaries,  and  thus 
render  the  pigmentation  more  readily  manifest. 

White  scars  in  the  rosa  of  the  lips  are  of  great 
value,  especially  if  these  are  at  the  angles  of  the 
mouth.  The  mucosa  should  be  most  carefully 
inspected,  more  particularly  the  inner  surface  of 
the  cheeks ;  fine  irregular  and  opalescent  streaks 
are  always  suggestive  and  persist  for  a  long  time 
after  other  manifestations  of  syphilis  have  passed 
away.  Any  marked  loss  of  submucous  tissue 
causing  depressicxi  of  the  mucosa  is,  in  the  absence 
of  any  history  of  traumatism,  most  suspicious. 

Many  authors  lay  stress  on  enlargement  of 
nuchal  glands  as  persisting  long  after  cutaneous 
and  mucosal  S3rphilides  have  disappeared.  In 
my  experience  I  rarely  have  found  such  a  con- 
dition, although  it  is  conunon  enough  for  these 
glands  to  share  in  the  general  adenopathy  that 
accompanies  the  secondary  period. 

But  there  is  one  site  in  women  where  syphilides 
linger  longest,  and  that  is  at  the  junction  of  the 
hairy  scalp  and  nape  of  neck,  just  as  in  men  in 
the  temporal  region.  These  areas  should  always 
be  inspected  for  traces  of  S3rphilides.  The  long 
persistence  of  seborrhoeic  eruptions  should  always 
suggest  a  possible  syphihtic  basis. 

llie  eyes  should  sdways  be  examined  for  the 
Argyll-Robertson  sign  ^oss  of  pupil  reflex  to 
light,  with  the  power  for  accommodation  unim- 
paired). This  sign  when  present  should  always 
arouse  a  suspicion  of  previous  syphilis  being  the 
cause»  even  when  no  other  nerve  lesion  is  manifest. 


I  beheve  that  these  vestiges  constitute  irre- 
futable proof  of  acquired  syplulis,  and  should  ever 
be  present  in  the  mind  of  the  examiner  when  this 
question  arises.  I  have  endeavoured  to  guard 
myself  from  being  too  dogmatic,  and  I  repeat  that 
there  is  not  one  of  these  points  taken  by  itself 
that  may  not  be  capable  of  another  interpretation. 
On  the  other  hand,  when  we  meet  with  two  or 
more — e,g,,  scars  and  pigmented  areae  with  no 
history  of  trauma,  I  think  we  are  perfectly  justified 
in  placing  a  patient  who  is  sufiering  from  some 
disease  of  which  the  etiology  is  veiled,  tentatively^ 
at  least,  on  antisyphihtic  treatment. 

Clinical  KecorDs. 


A  SERIES  OF  CASES  OF  PUERPERAL  INFECTION 

TREATED  BY  THE  INTRA-UTERINE  APPLI-^ 

CATION  OF  IODISED  GAUZE. 

Under  the  Care  of  E.  Cabanes.  M.D., 
Ohef  de  Cliiiiqu«  at  the  School  of  Medicine  of  Alflrien. 

For  some  time  past  I  have  treated  every  case  of 
puerperal  infection  that  has  come  under  my  care  by 
a  novel  procedure  which  has  yielded  such  uniformly 
satisfactory  results  that  the  notes  of  some  of  the  naore, 
recent  cases  may  not  be  without  interest.  Briefly 
described,  the  treatment  comprises  the  removal  of  any 
fragments  of  placenta  or  membranes,  by  the  aid  of 
the  blunt  curette  if  necessary,  followed  by  irrigation^ 
with  an  antiseptic  solution.  The  next  step  is  to  intro- 
duce into  the  uterine  cavity  a  strip  of  gauze  steeped 
in  an  aqueous  solution  of  iodine  and  iodide  of  potassiuui, 
4  per  cent,  of  each.  The  strip  is  only  loosely  packed.. 
and  when  the  cavity  has  been  filled  a  vaginal  douche 
is  given  and  a  plug  of  iodoform  gauze  placed  in  con- 
tact with  the  cervix  to  absorb  any  leakage  of  iodine, 
thus  avoiding  injury  to  the  vagina.  The  dressing  may 
advantageously  be  renewed  every  twelve  hours  so  long, 
as  there  is  the  slightest  rise  of  temperature,  but  marked 
benefit  usually  follows  the  very  first  dressing.  The 
treatment,  moreover,  is  applicable  as  well  to  recent 
cases  as  to  cases  of  old  standing.  The  presence  of 
peri-uterine  inflammation  is  no  bar  to  its  performance  ; 
indeed,  it  is  indicated  in  all  cases  of  uterine  infection, 
at  all  stages  and  under  all  conditions. 

Case  I.  Puerperal  Septicemia  of  twenty  days'  stand- 
ing.— ^Madame  S.,  multipara,  became  feverish  soon, 
after  delivery  of  a  child  at  term.  Eight  days  later 
(January  5  th)  medical  advice  was  obtained,  and  the 
uterus  was  washed  out  twice  daily  with  boiled  water, 
in  spite  of  which  the  temperature  continued  to  oscillate- 
between  99°  and  103.8°  F.  Iririgations  with  sublimate 
solution  were  then  substituted,  but  the  disease  con- 
tinued to  run  its  course  unchecked,  and  the  patient  fell* 
into  a  state  of  intense  prostration,  with  severe  rigors 
and  exhausting  sweats.  On  the  15  th,  her  temperature- 
was  104°  F.,  and  the  pulse  150  per  minute.  Her  con- 
dition was  alarming  in  the  extreme.  The  first  iodised 
dressing  was  then  introduced,  and  on  the  following  day 
the  temperature  was  almost  normal.  The  dressings, 
however,  were  renewed  twice  daily,  and  by  the  i8th  the 
temperature  had  returned  to  normal,  the  pulse  being 
96.  This  case  is  noteworthy  in  that  the  dressing  gave* 
an  immediate  result,  although  the  infection  was  of 
twenty  days'  standing.  Nine  dressings  were  applied  in- 
all  before  the  temperature  finally  returned,  to  normal. 

Case  II.  Puerperal  Septicamia. — ^Madame  O.,  primi- 
para,  was  delivered  of  twins  on  February  5th,  having 
been  attended  by  the  same  midwife  as  the  patient  in 
the  preceding  case.  In  the  meantime,  this  midwife 
had  infected  several  other  parturients,  two  of  whom 
succumbed  to  the  disease.  Things  went  on  all  right  for 
the  first  ten  days,  when  the  patient  was  seized  with 
fever,  and  her  pulse  rose  to  24  per  minute.  On  the  i6th 
the  temperature  rose  to  105°  F.,  and  she  had  severe* 
rigors.  The  vulva  and  cervix  were  covered  with  a 
diphtheroid  exudation,  and  there  was  a  discharge  of 
pus  from  the  os  uteri.     After  the  application  of  the- 


July  13,  1904. 


BRITISH  HEALTH  RESORTS. 


iodised  dressing  the  temperature  fell  to  99°  F.  and  the 
pulse  to  100.  On  the  17th,  it  rose  again,  but  after  two 
more  dressings  it  fell  permanently  to  normal.  After  the 
19th  only  antiseptic  injections  were  employed. 

Casb  III. — ^Miss  X.,  primipara,  was  confined  on 
3rlarch  1 2th.  Her  temperature  became  irregular  on 
the  19th,  and  Dr.  Vincent  was  called  in  consultation. 
On  the  20th,  although  her  temperature  was  only 
99**  F.,  the  pulse  was  120,  and  she  had  just  had  two 
severe  rigors.  There  was  a  rather  extensive  laceration 
of  the  cervix,  and  the  lochia  were  somewhat  offensive. 
Blood-stained  pus  could  be  seen  escaping  from  the 
OS  uteri.  The  patient  was  curetted  and  in  the  course 
of  the  ensuing  twenty-four  hours  two  iodised  dressings 
were  introduced.  An  hour  after  the  curettage  she  had 
another  violent  rigor,  during  which  the  pulse-rate  rose 
to  130  per  minute  ;  but  on  the  20th,  after  a  third 
dressing,  the  temperature  fell  to  and  remained  normal. 
The  patient  was  discharged  cured  a  fortnight  after 
the  onset  of  the  illness. 

Case  IV. — Miss  P.,  the  subject  of  syphilis,  had 
aborted  for  the  third  time  as  the  result  of  an  illegal 
operation  at  two  and  a  half  months.  She  had  been  ill 
for  a  week,  but  as  her  temperature  continued  to  rise 
she  reluctantly  called  in  a  doctor.  She  was  evidently 
gravely  infected,  and  the  vaginal  discharge  was  in- 
tensely fcBtid.  She  was  admitted  to  hospital,  where 
the  uterus  was  immediately  curetted  and  the  iodised 
dressing  applied.  The  temperature  was  only  99°,  but 
she  developed  symptoms  of  pelvi-peritonitis,  which  con- 
tinued to  run  its  course,  although  on  the  third  day 
all  disagreeable  odour,  had  disappeared  from  the 
vaginal  discharge.  She  ultimately  developed  pyosal- 
pinx,  which  gradually  and  slowly  became  encysted, 
the  uterus  remaining  embedded  in  a  mass  of  fibrous 
adhesions.  The  constitutional  infection  found  expres- 
sion in  a  pulmonary  infarct  and  a  metastatic  abscess  in 
the  right  rectus  abdominis  miiscle,  in  spite  of  which 
she  recovered.  One  is  fain  to  ask  what  her  fate  would 
have  been  if  the  uterus  had  not  been  thoroughly  asepti- 
cised.  This  case  is  particularly  interesting  in  that  it 
proves  the  utility  of  the  treatment  even  in  cases  in 
which  the  infection  has  extended  beyond  the  limits  of 
the  uterus.  Although  the  dressing  does  not,  of  course, 
hinder  the  evolution  of  the  peri-uterine  compUcations, 
it  at  any  rate  removes  the  original,  and  also  the  cen- 
tral, focus  of  infection,  and  in  so  doing  it  must  un- 
questionably tend  to  modify  the  course  of  the  collateral 
infective  manifestations. 

Conclusions, — ^The  results  obtained  in  every  case  of 
puerperal  infection  which  has  come  under  my  obser- 
vation since  I  began  this  treatment  appear  to  me  to 
lustify  the  following  conclusions,  viz.,  (i)  that  the 
iodis^  dressing  can  be  applied  repeatedly  without  the 
slightest  risk  to  the  infected  uterus  ;  (2)  it  should  be 
applied  every  twelve  hours  in  order  to  make  sure  of 
obtaining  prompt  and  certain  effects  ;  (3)  its  repeated 
api^cation  cuts  short  the  attack  of  puerperal  endo- 
metritis within  a  few  hours  ;  (4)  it  may  determine  re- 
covery even  in  advanced  cases ;  and  (5)  it  is  aLso applic- 
able to  cases  of  generalised  septicaemia,  although  com- 
plicated by  peritonitis,  in  that  it  removes  the  central 
focus  of  infection,  although  in  such  cases  its  curative 
influence  is  necessarily  r^uoed.    • 

trransactions  of  Societies. 


Th«  MgpicAL  PaBss.    39 


NORTH-EAST    LONDON    CLINICAL     SOCIETY. 

The  annual  meeting  of  this  Society  was  held  at  the 
Tottenham  Hospital,  N.,  on  Thursday,  July  7th,  1904, 
the  President,  Dr.  J.  W.  Hunt,  being  in  the  Chair. 
The  Council's  Report  for  the  last  session  showed  that 
much  good  work  had  been  done,  many  valuable  com- 
munications having  been  made  in  the  shape  of  papers, 
-while  the  Clinical  Cases  and  pathological  specimens 
exhibited  at  the  meetings  had  been  both  abundant  and 
of  more  than  usual  interest. 

The  report  having  been  adopted,  the  ballot  for  officers 
for  the  ensuing  session  then  took  place  with  the  following 
result: — President,     Dr.     R.     Murray     Leslie.     Hon^ 


Treasurer,  Dr.  A.  E.  Giles.  Hon.  Librarian,  Dr.' A.  J. 
Whiting.  Hon.  Secretaries,  Messrs,  H.  W.  Carsonjand 
C.  E.  Hutt.  The  Vice-Presidents  and  Council  werelalso 
elected  in  accordance  with  the  recommendation  of  the 
Council.  r- 

The  meeting  then  resolved  itself  into  a  garden-party 
held  in  the  beautiful  and  picturesque  grounds  of  the 
hospital  (by  kind  permission  of  the  Board),  and  which 
was  well  attended  by  members  and  their  friends,. 

JJritiBb  Dealtb  Kesorts.— i. 

[by  our  special  medical  commissioner.] 

SIDMOUTH. 
SiDMOUTH  forms  an  ideal  south-country  resort.  It 
is  situated  in  East  Devon  between  the  Rivers  Exe  and 
Axe,  in  the  well-wooded  Vale  of  Sid.  Early  in  the 
nineteenth  century  it  had  gained  a  position  as  a 
desirable  health  station,  and  although  of  recent  years 
it  has  been  overshadowed  by  the  rapid  growth  of  other 
western  resorts,  it  now  bids  fair  to  gain  distinction 
among  the  places  offering  special  attractions  to  the 
invalid  and  the  health-seeker.  The  town,  quiet  and 
picturesque,  and  free  from  the  barbarities  of  the 
modem,  tripper-frequented  watering-place,  lies  wedge- 
shaped  in  a  horse-shoe  valley.  While  open  on  the 
south  to  the  sea  it  is  protected  on  the  west  and  east 
by  red  sandstone  cliffs,  which  form  the  seaward  limits 
of  the  protecting,  wooded  and  green-pastured  hills. 
The  town  is  thus  shielded  from  the  winds  most  trying  to 
the  invalid,  and  yet  so  placed  as  to  allow  of  the  maximum 
exposure  to  the  sun.  The  soil  is  dry  and  porous.  The 
natural  vegetation  of  the  place  is  abundant,  and  well 
attests  the  mildness  of  the  climatic  conditions  and  rich- 
ness of  the  land.  The  grassy,  tree-covered  slopes,  and  the 
richly  wooded  and  high-hedged  lanes,  secure  ample 
shelter  and  protection  for  the  invalid.  The  hillsides 
and  sloping  valley  form  admirable  ground  for  the 
carrying  out  of  graduated  exercise,  whUe  the  pleasing, 
old-fashioned  sea  front  provides  a  fair  extent  of  level 
ground  for  bath-chair  cases  and  those  needing  a  restful 
exposure  in  the  open.  For  the  active,  there  are  the 
Salcombe  and  Peak  cliffs  close  at  hand,  the  breeze- 
blown  tops  of  which  may  be  gained  by  a  not  too  steep 
ascent  of  about  500  feet.  On  these  airy  uplands  there 
is  ample  opportunity  for  vigorous  exercise  amidst 
picturesque  surroundings,  and  with  far-reaching  views 
of  sea-coast  and  undulating  inland  country. 

Sidmouth  enjoys  much  sunhght.  In  winter,  there 
is  said  to  be  more  sunshine  than  in  most  of  our  other 
south  coast  resorts ;  while  in  summer  it  is  claimed  that 
there  is  considerable  protection  from  excessive  glare. 
As  regards  the  temperature,  Sidmouth  is  warm  in 
winter  and  not  unduly  hot  in  summer.  The  average 
of  the  winter  minima  is  nearly  two  degrees  above  that 
of  London,  and  the  average  of  the  winter  maxima 
17**  above  that  of  the  metropolis.  During  1903, 
the  mean  temperature  of  the  year  was  50-1*', 
and  the  average  mean  of  the  last  thirty-two  years, 
49-61''.  The  mean  daily  range  was  for  the  last 
twenty-four  years  8-6*'.  It  is  interesting  here 
to  note  that  during  the  great  summer  heat  of  1899, 
the  mean  temperature  of  the  month  of  August  at  Sid* 
mouth  was  63-^^  (the  highest  register  during  the  pre- 
vious thirty  years),  and,  notwithstanding  this,  it  was 
from  ten  to  twenty  degrees  cooler  than  London,  and  five 
degrees  below  that  of  any  other  health  resort  on  the 
south  coast  during  the  greater  part  of  the  month, 
Sidmouth  may  rightly  claim  to  possess  a  peculiarly 
equable  climate,  cool  in  summer  and  mild  in  winter. 
The  absence  of  sudden  change  of  temperature  goes  far 
to  make  the  place  a  particukurly  suitable  residence  for 
convalescents,  invalids,  delicate  children,  adults  of 
feeble  constitution,  and  the  aged.  It  may  be  here 
added  that  frost  and  snow  are  almost  unknown,  and 
fog  is  rare.     Thunderstorms  are  also  infrequent. 

Devonshire  is  generally  recognised  as  a  rainy  county, 
but  at  Sidmouth  the  rainfall  is  comparatively  low,  and 
is.  said  to  be  36  per  cent,  below  that  of  the  rest  of  the 


40  TaE  Mkdical  Pisss. 


FRANCE. 


July  13,  1904. 


county.  This  is  doubtless  due  to  the  fact  that  the 
surrounding  hills  waylay  the  rain-laden  clouds,  while 
the  high  ground  of  Dartmoor  precipitates  much  of  the 
moisture  brought  by  the  west  winds  from  the  Atlantic. 
The  rainfall  for  1903  was  36*39  inches,  which  is  5*77 
laches  above  the  last  twenty  years'  average  (30*62 
inches).  The  relative  humidity  is  returned  at  83,  and 
well  indicates  the  prevalence  of  desirable  conditions 
lor  the  invalid.  As  already  indicated,  the  natural 
position  of  the  town  affords  admirable  protection  from 
winds  most  trying  to  the  feeble.  The  funnel-like  form 
of  the  Vale  of  Sid  doubtless  in  part  accounts  for  the 
prevalence  of  invigorating  breezes,  which  fortunately 
free  Sidmouth  from  the  relaxing  and  enervating 
ehanacters  of  certain  of  our  well-known  southern 
resorts. 

\tnule  Nature  has  been  kind,  man,  in  his  control  of 
Che  district,  has  been  wise.  There  are  no  artificial 
attractions  offered  to  the  mere  frivolous  visitor.  The 
86a-front  is  spoilt  by  no  pier  or  unsightly  pavilion,  and 
even  the  railway  station  lies  a  go€>d  mile  inland.  If 
Sidmouth  is  to  continue  to  grow  in  favour  with  both 
physician  and  patient,  it  wiU  be  well  that  its  natural 
simplicity  be  preserved.  Excellent  accommodation  is  pro- 
Tided  in  several  well-appointed  hotels.  Particular  men- 
tion should  be  made  of  the  new  Victoria  Hotel,  situated 
within  sight  and  sound  of  the  sea.  and  yet  surrounded 
by  trees,  at  the  western  end  of  the  front.  The  hotel 
has  been  excellently  designed,  and  is  perfect,  not  only 
fn  hygienic  equipment  but  in  all  that  makes  for  com- 
fort and  even  luxury.  Cert^un  suites  have  been  so 
arranged  as  to  allow  of  an  open-air  treatment  of  any 
invalid  residents.  The  numTOr  of  private  apartments 
in  the  town  is  limited.  Sidmouth  is  also  provided  with 
weU-designed  baths,  where  Aix  and  Nauheim  treat- 
ments, in  addition  to  the  usual  complement  of  sea  and 
fresh-water  baths,  are  carried  out,  under  the  conduct 
of  an  experienced  manager,  as  we  have  had  personal 
opportunities  of  ascertaining.  Adjoining  the  baths  is 
a  well-conducted  club,  open  to  visitors. 

On  the  hillside,  at  the  western  end  of  the  town,  are 
attractive  golf  links.  The  hill  slopes  in  the  immediate 
neighbourhood  of  the  town  should  prove  peculiarly 
attractive  to  those  of  delicate  health  desiring  a  per- 
manent countr^^  and  sea  coast  residence.  There  is  a 
fairly  good  drainage  system,  and  the  water  supply  is 
of  exceptional  quiuity  and  non-irritating  to  the  skin. 
The  town  is  clean  and  well  lit.  For  the  robust  there 
are  ample  facilities  for  sea-bathing  and  the  shore  is 
safe  for  children.  Sidmouth  is  a  perfect  resort  for  the 
convalescent,  the  chronic  invalid,  and  the  aged  and 
all  requiring  the  benefits  of  a  "  rest  cure,"  and  such 
climatic  conditions  as  are  associated  with  an  equable 
and  not  too  relaxing  marine  residence. 

Catarrhal  and  cardiac  forms  of  asthma  are  said  to  do 
well  at  Sidmouth.  The  baths  offer  means  for  the 
trustworthy  treatment  of  judiciously-selected  cardiac 
and  rheumatic  cases.  Certain  forms  of  neuras- 
thenia should  also  gain  much  benefit,  and  for  the 
recreation  of  the  over-worked  brain  labourer  and  the 
rejuvenescence  of  thejadedvictimof  society,  Sidmouth 
hais  much  to  offer. 

A  well-illustrated  official  guide  has  been  published 
nnder  the  auspices  of  the  Sidmouth  Urban  District 
Council,  and  interesting  booklets  have  been  issued  con- 
cerning the  baths.  "Hie  excellent  health  reports  of 
Dr.  Pullin.  the  Medical  Officer  of  Health,  may  also  be 
studied  with  advantage.  Sidmouth  is  167  miles  from 
London  on  the  L.S.W.  Railway,  and  may  be  easily 
reached  from  Waterloo  Station  in  about  four  and  a 
kalf  hours. 


Continental  txaltb  Hcsoxts. 

[^ROM    OUR   SPECIAL   CORRESPONDENT.] 

AIX-LA-CHAPELLE  (Aachen). 
The    celebrated    hot-springs    here    are    regaining, 
dowly,  perhaps,  but  steadily,  some  of  their  former  pre- 
ea^xMsaos  among  German  mineral-water  resorts.    The 


vigorous  advertising  of  some  of  the  newer  spas  has 
gained  for  them  fame  in  recent  years ;  and,  com- 
paratively, the  number  of  annual  visitors  to  the  older 
Continental  health-stations  has  not  increased  pro- 
portionally to  the  respective  merits  of  the. waters. 
Aachen,  however,  can  yet  challenge  comparison  for 
its  highly  valuable  springs,  the  elegance  of  its  accom- 
modation, and  its  city  conveniences  with  any  of  its 
more  energetic  and  youthful  competitors. 

In  selecting  a  place  of  sojourn  for  a  "  cure  *'  con- 
tinuing several  weeks,  the  advantages  of  a  town  resi- 
dence merit  attention.  As  a  city  of  over  126,000 
inhabitants,  Aix-la-Chapelle  has  these  ;  and,  added  to 
them,  many  local  and  antiquarian  attractions.  Its 
hotels,  pensions,  and  apartment-houses  are  numerous 
and  at  all  prices.  Amongst  them,  the  Hotel  Grand 
Monarque  is  deservedly  popular  with  British  and 
Americans  for  its  up-to-date  comforts,  good  table, 
and  attendance. 

The  mineral  springs  are  numerous,  both  in  the  town 
and  the  vicinity,  and  are  used  for  drinking  as  well  as 
external  applications.  They  are  prescribed  for  a 
variety  of  diseases,  especially  for  gout,  strictures,  and 
rheumatism. 


I'rance. 


[from    our   own   CORRESPONDENT.] 


Pakis,  July  10th.  1904. 
Backache. 

Backache,  says  Dr.  Fiessinger,  belongs  to  divers 
affections.  It  is  a  symptom  of  very  unequal  value,  as 
it  is  met  with  in  the  most  benign  as  well  as  in  the 
gravest  maladies.  It  is  for  the  practitioner  to  discover 
the  nature  of  the  pain.  A  patient  comes  to  consult 
him  for  a  pain  in  the  back  and  asks  to  be  relieved, 
and  how  will  he  set  about  it  ? 

The  principal  seats  of  the  pain  are  two — the  dorsal 
and  the  lumbar  region.  In  the  former,  the  pain  is 
generally  to  be  found  at  the  apex  of  the  right  scapula. 
This  pain  is  not  increased  by  pressure  ;  it  is  a  case  of 
myalgia  and  not  of  neuralgia.  A  great  number  of 
patients  complain  of  this  pain  ;  it  results  from  nervous 
strain  or  nervous  irritation,  provoked  by  an  organic 
lesion.  Neurasthenia  and  dyspepsia  are  the  two  great 
causes  of  the  backache.  Germain  She  added  anaemia 
to  these  causes,  but  anemia  and  neurasthenia  have 
frequently  dyspepsia  for  a  common  origin.  The 
fatigue  of  nursing  frequently  provokes  backache.  In 
such  cases  nursing  should  be  interrupted  and  prepara- 
tions of  iron  given.  The  public  often  attributes  this 
pain  to  the  presence  of  phthisis,  and  the  idea  is  some- 
times correct,  for  consumption  frequently  follows 
phosphaturia  and  general  anaemia.  Backache  an- 
nounces the  nervous  strain  of  the  individual.  In 
other  cases,  the  pain  spreads  out  over  the  sides,  in- 
dicating dry  pleurisy  or  tuberculous  toxaemia.  Auscul- 
tation of  the  apex  of  both  lungs  should  be  carefully 
made,  and  arsenic  combined  with  general  tonics  ordered. 

In  hysteria,  backache  is  very  frequent ;  it  occupies 
the  vertebral  column  and,  limited  to  three  or  four 
vertebrae,  the  pain  suggests  the  beginning  of  Pott's 
disease. 

All  of  those  cases  should  be  treated  on  their  merits, 
but  where  the  cause  is  really  neurasthenia,  with  in- 
somnia, sensation  of  lassitude,  &c.,  subcutsuieous 
injections  of  lecithin,  spermin,  or  glycero-phosphate 
of  soda  over  the  painful  spot  modifies  the  local  pain 
and  at  the  same  time  tones  up  the  general  condition. 
They  succeed  better  than  local  applications.  If  th^ 
latter  be  used  the  following  might  be  prescribed  :-^ 


July  13.   1904. 


GERMANY. 


Thx  Medical  Pums.    41 


Menthol. 
Guaiacol. 
Gomenol, 
Vaseline, 


Chloroform,  ^j; 
Camphorated  oU,  jiss; 
Ext.  of  belladonna ;  grs.  xv  ; 
Ext.  of  hyoscikmius,  grs.  xv  ; 
Ext.  of  opium,  grs.  xv. 
The  actual  cautery,  a  small  blister  or  a  slight  galvanic 
H:urrent  will  succeed  if  ordinary  treatment  fails. 

The  pain  in  the  lumbar  region  is  frequently  caused 
by  rheumatism.  Sudations  and  local  injections  of 
-salicylate  of  soda  (salicylate  of  soda,  5j,  water  3v) 
form  an  excellent  treatment  in  such  cases.  Where  the 
lumbar  pain  is  caused  by  an  effort  or  brusque  move- 
ment, it  is  a  case  of  traumatic  lumbago,  and  is  readily 
^amenable  to  a  few  applications  of  the  thermo-cautery, 
followed  by  a  galvanic  or  faradic  current. 

In  diabetes,  lumbar  pain  has  been  frequently  noticed, 
*due,  accoifding  to  Willis,  to  irritation  of  the  nerves. 
Inflammation  of  two  or  more  of  the  vertebrae  has  been 
mistaken  for  an  ordinary  lumbago.  Every  pain  pro- 
voked by  the  movement  of  the  vertebral  column  should 
be  closely  examined.  Many  cases  of  Pott's  disease 
have  been  overlooked,  the  patient  being  believed  to 
:  suffer  from  lumbago. 

Another  affection  which  gives  rise  to  lumbar  pain  is 

'•cancer  of  the  stomach,  and  frequently  the  patient  will 

•complain  of  nothing  else,  the  gastric  troubles  being 

but  vague  at  that  early  period  of  the  disease.     The 

pain,  however,  should  not  be  confounded  with  that  of 

neurasthenia.     The  latter  is  more  dull,  less  paroxysmal, 

and  disappears  during  sleep,  whereas  the  pain  of  cancer 

«comes  in  stabs,  awakens  the  patient  in  the  night,  making 

-him  cry  out.     The  only  treatment  in  this  case  is  by 

injections   of   morphia.     In   certain   acute   affections 

(small-pox,    nephritis),  pain  in  the  lumbar  region  is 

•complained  of.     Called  to  a  man  suffering  from  pain 

in  the  lumbar  region  as  the  result  of  cold,  and  whose 

•eyelids  are  puffy,  the  urine  should  be  examined  for 

albumin. 


Germans. 

[from     our    own    corrbspondbnt.] 

BsBLur,  July  10th,  1904. 

At   the  Surgical  Congress  Hr.   Kuffner,   Tubingen, 
discussed 
The  Glycogen  Reaction  of  the  Leucocytes  and 

ITS  Significance  in  Surgery. 
He  said  that  it  was  known  that  Erhlich  had  shown 
the  presence  of  an  iodophile  substance  in  the  leucocytes. 
This  substance  was  said  to  be  increased  in  some  diseases, 
and  its  appearance  was  said  to  be  proof  of  suppuration. 
Tlie  speaker  had  examined  a  series  of  470  cases  as  to 
whether  the  glycogen  reaction  was  really  such  a  proof, 
and  from  his  examination  he  must  say  it  was  not.  It 
was  always  present  in  acute  inflammations,  whether 
there  was  suppuration  or  not ;  it  was  thus  present  in 
every  case  of  appendicitis.  The  reaction  was  useless 
also  in  superficial  suppuration.  A  negative  finding 
was  also  without  significance,  as  it  could  not  be  found 
in  some  cases  of  abscess.  He  found  it  comparatively 
ffrequently  in  tuberculosis — viz.,  in  72  cases.  Here  it 
perhaps  might  serve  as  a  proof  of  mixed  infection, 
but  even  here  it  was  occasionally  absent.  The  reaction 
was  of  more  value  from  a  prognostic  point  of  view,  in  so 
far  as  a  diminution  of  the  reaction  after  operation 
corresponded  to  cessation  of  the  inflammatory  process. 
The  reaction  could  not,  therefore,  be  recognised  as  a 
4:linicaUy  important  sign. 

.Ur.  Jtehn,  Frankfort,  spoke  on 


Tumours  of  the  Bladdeb  in  Colour  Workers. 
He  said  that  he  had  already  (in  1895) reported  on  cases 
of  bladder  tumour  in  aniline  factories.  He  now  re- 
ported on  twenty- three  cases.  Such  cases,  in  the  speaker's 
opinion,  would  still  further  increase  the  longer  such 
factories  were  in  being,  and  the  longer,  workpeople 
were  employed  in  them.  These  bladder  tumours  were 
only  observed  in  factories  where  aniline  and  its  homo- 
logous and  allied  substances  were  prepared.  As 
regarded  the  frequency  of  the  disease  he  had  instituted 
a  collective  investigation  which  had  been  extended  to 
England.  As  regarded  the  length  of  time  people  had 
worked  in  such  factories  before  the  disease  appeared, 
the  shortest  period  was  nine  years  and  the  longest 
twenty-two  years.  Five  of  the  patients  had  papillo- 
mata.  two  of  them  afterwards  becoming  maligiiant ; 
of  the  remaining  eighteen;  one  suffered  from  sarComa 
and  seventeen  from  carcinoma.  In  foiir  cases  the 
carcinoma  was  multiple.  The  prognosis  was  un- 
favourable.    Eleven  of  the  cases  had  died. 

Hr.  Strauss  had  recently  seen  such  a  case.  It 
occurred  in  a  man  who  had  been  employed  in  a  benzo- 
dine  factory  for  twelve  years,  and  who  had  passed 
portions  of  carcinoma  in  his  urine  a  year  before  opera- 
tion. The  cystoscope  showed  a  large  tumour  with 
intact  bladder  mucous  membrane.  The  man  had 
retention  of  urine  from  blocking  of  the  outlet.  The 
operation  showed  that  the  whole  mucous  surface  of  the 
bladder  was  healthy,  that  the  whole  bladder  was  filled 
with  a  tumour  of  soft  consistence,  and  that  the  pedicle 
of  the  growth  was  only  the  size  of  a  shUling  piece. 
Near  the  pedicle  was  a  small  hard  tumour,  which  had 
penetrated  the  submucous  tissue,  and  which  proved  to 
be  a  carcinoma. 

Hr.  Kiittner  found  it  strange  that  such  tumours 
were  limited  to  the  bladder  area,  and  that  they  did  not 
occur  in  other  parts  of  the  tract  washed  by  urine. 

Hr.  Bardenheuer,  Cologne,  had  seen  and  opeirated  on 
two  such  cases.  One  of  the  patients  soon  died  of 
recurrence,  the  other  was  still  in  good  health  after 
three  years. 

Hr.  Schwerin  said  that  the  managers  of  colour  factories 
had  set  experiments  on  foot  with  a  view  of  preventing 
the  disease.  For  years  animal  experiments  had  been 
carried  on  with  a  view  to  determining  the  exact  cause. 
They  had  not  succeeded  in  causing  such  tumours  to 
grow,  probably  because  they  took  too  long  to  originate 
and  the  animals  could  not  be  kept  alive  long  enough  for 
such  growth  to  begin. 

At  the  Free  Society  of  Surgeons  Hr.  Neumann  spoke 
on 

The  Diagnosis  of  Diseases  of  the  Pancreas. 
(a)  Pancreatic  cysts  that  had  developed  towards  the 
rights  so  that  they  gave  the  impression  of  renal  cysts, 
and  especially  when  at  operation  they  were  attached  to 
the  lower  pole  of  the  kidney,  lay  retro-peritoneally 
behind  the  caecum  and  ascending  colon.  The  pan- 
creatic ferments  would  be  found  in  the  content^,  {b) 
Symptoms  of  ileus  with  rise  of  temperature.  ,  At  a 
laparotomy  there  was  occlusion  by  a  band ;  on  separa- 
tion of  the  band  a  stool  followed.  After  a  few  days 
vomiting  returned.  A  cystic  tumour  in  the  upper  part 
of  the  abdomen.  Suturing  in  of  the  cyst  lying  behind 
the  peritoneum.  The  day  after  a  brown  fluid  escaped 
with  a  penetrating  odour.  The  right  kidney  not  to  be 
felt.  The  cyst  contents  had  no  pancreatic  reaction  ; 
but  neither  chemically  nor  microscopically  was  there 
any  indication  of  its  origin.  After  some  time  pyo- 
nephrosis of  the  right  kidney.  Later  on  extirpation 
of  the  kidney.  The  original  cyst,  the  position  of 
which  corresponded  to  a  cyst  of  the  pancreas,  was  a 


4^     The  Medical  Pkxss. 


AUSTRIA. 


paranephritic  abscess  that  had  developed  towards  the 
middle  line. 

He  had  recently  operated  on  three  cases  of  acute 
haemorrhagic  pancreatitis.  All  three  died  after 
temporary  improvement  in  a  state  of  diabetic  coma.  On 
post-mortem  was  found  a  large  infarct  of  the  liver. 

Hr.  Braun  said  that  a  boy  had  been  trodden  upon  by 
a  horse  over  the  epigastrium  a  fortnight  before  admis- 
sion, and  peritonitic  symptoms  had  come  on.  There 
was  bulging  of  the  epigastrium  which  was  connected 
with  the  liver.  Laparotomy  was  performed.  There 
were  distinct  fatty  necroses,  and  a  cavity  behind  the 
stomach  filled  with  a  tinted  secretion  that  contained 
pancreatic  ferments.  Drainage  of  the  cavity  was 
performed   and  recovery  took  place. 

Hr.  Koite  related  a  case  in  which  everything  agreed 
with  a  diagnosis  of  cyst  of  the  pancreas.  The  tumour 
was  tapped,  then  incised,  when  there  was  excessive 
bleeding.  The  pancreas  was  packed,  but  the  patient  died 
from  haemorrhage.  After  death  the  pancreas  was  found 
to  be  healthy,  and  also  the  left  kidney,  but  on  the  other 
hand  the  left  suprarenal  capsule  was  absent.  There  was 
carcinomatous  growth  in  the  wall  of  the  cyst.  He  had 
seen  two  pancreatic  cysts  developing  towards  the  right, 
but  both  were  of  a  malignant  nature. 

Busttta. 

[from  our  own  correspondent.] 


VinnrA,  July  10th,  1904. 
The  Activity  of  Fluorescent  Substances. 

In  the  Congress  for  Internal  Medicine,  Tappeiner  gave 
a  number  of  demonstrations  to  prove  the  activity  of 
fluorescent  substances  on  the  amoeba.  The  sun's  rays 
are  equally  as  potent  when- acting  through  rarefied  air. 
When  applied  to  fish  or  the  flagellata  in  this  manner,  a 
few  days  is  sufficient  to  kill ;  in  frogs  and  the  para- 
mcecium  caudatum  the  time  is  four  times  as  long, 
and  he  concludes  that  the  higher  animals  are  decidedly 
less  sensitive  to  the  influence  of  photo-dynamic  sub- 
stances than  the  lower. 

Again,  the  enzymes,  such  as  trypsin  and  diastase,  lose 
their  normal  activity  after  a  few  hours'  exposure  to 
ordinary  daylight.  The  virulence  of  ricini,  diph- 
theria, and  tetanus  toxins  can  be  quite  destroyed  by 
the  presence  of  a  fluorescent  substance.  He  accordingly 
demonstrated  dogs  and  guinea-pigs  to  which  he  had 
administered  fatal  doses,  while  the  control  animals  died 
within  a  short  time  after  administering  the  toxin.  For 
this  purpose  the  least  refracted  rays  are  the  best,  as 
they  penetrate  deepest  into  the  tissue.  As  might  be 
expected,  the  power  of  absorption  is  another  factor 
that  must  be  considered.  If  the  tissues  be  painted  with 
an  eosin  solution,  through  which  the  light  must  pass 
to  act  on  any  of  the  above  toxins,  the  result  will  be 
negative,  as  the  photo-dynamic  power  of  the  rays  is 
abrogated  by  absorption.  He  affirms  that  the  efficacy 
of  photo-dynamic  material  increases  by  the  reduced 
intensity  of  the  fluorescent  process. 

This  knowledge  of  fluorescent  substances  may  yet 
explain  many  of  the  cures  effected  in  cutaneous  diseases. 
Thus  four  applications  of  the  rays  after  painting  a 
carcinomatous  growth  with  eosin  were  effectual  in 
curing  the  patient.  This  painting  with  an  eosin  lotion 
is  particularly  efficacious  in  labial  and  nasal  carcinoma. 
In  vulval  or  mammary  carcinoma  no  evidence  of  success 
is  yet  forthcoming.  Lupus  is  greatly  benefited  by  this 
method,  while  the  intensity  of  the  secondary  symptoms 
in  S3rphilis  are  greatly  reduced  by  its  application.  The 
efficacy  of  quinine  in  xnalaria  is  also  accentuated,  as 
the  light  acts  effectually  on  the  virus. 


July  13,  1904^ 


Seifert  agreed  with  Tappeiner  and  related  cases  of 
lupus  and  sycosis  non-parasitaria,  which  he  had^cured 
after  eight  applications. 

Erythema  Induratum  Scrofulosorum. 

Ehrmann  presented  three  cases  of  Bazin's  erythema 
scrofulosorum.  This  disease,  he  said,  in  prefacing 
his  remarks,  was  first  described  by  Bazin  about  i860,, 
although  it  appears  to  have  been  common  enough  before 
this  time  in  both  Germany  and  Austria.  The  disease 
declares  itself  on  the* extremities  and  less  seldom  on» 
the  trunk,  in  the  form  of  walnut  swellings,  red  at  first, 
but  soon  taking  on  a  brown  knotty  colour  with  a  central 
part  that  breaks  down  in  a  cheesy  discharge.  It  occurs* 
commonly  in  people  with  all  the  S3rmptoms  of  tuber- 
culous scrofula,  which  will  persist  for  years,  and  often 
recede  under  iodide  trea(;pient.  The  R5ntgen  rays 
seem  to  make  them  disappear  promptly,  but  they 
unhappily  soon  recur  again. 

These  cases  were  first  diagnosed  as  syphilitic  gummata» 
which  was  subsequently  modified  to  erythema  nodosum 
and  scrofuloderma.  Localisation  was  against  syphilis, 
although  the  colour  was  in  its  favour,  but  mercury  had 
no  effect  on  it,  though  iodide  had  after  a  time.  Against 
the  nodosum  theory  the  chronicity  and  hardness  was 
fatal.  The  colour  of  erythema  nodosum  is  red.  passing 
into  a  violet  colour,  and  finally  appearing  as  a  bluish- 
green  surface,  as  in  erythema  contusiforme.  Scrofulo- 
derma is  sharply  separated  by  the  ragged  softening  of 
the  centre,  whose  perforations  are  often  numerous,  with 
irregular  openings,  which  are  often  covered  with  the 
same  thin,  ragged  pellicle ;  and  no  tuberculous  bacilli 
are  to  be  found  in  the  discharge. 

Neisser  said  that  he  recently  had  a  similar  case  that 
was  diagnosed  as  syphilis  at  the  beginning,  but  was 
detected  by  the  presence  of  tuberculous  nephritis. 

Schrotter  said  he  recollected  a  case  in  1869  that  came 
into  Professor  Dittel's  wards  with  sores  on  the  abdomen, 
and  no  proper  classification  could  be  arrived  at.  Shortly 
afterwards  hoarseness  set  in  which  resulted  in  ulceration 
of  the  arytsnoid  cartilage,  which  confirmed  the  dia- 
gnosis of  syphilis.  Anti-syphilitic  treatment  soon 
cleared  the  abdomen  and  throat.  He  considers 
Ehrmann's  case  to  be  of  a  similar  character. 
Sepsin   and   Decomposing  Substances   in   Bowel. 

Faust  drew  the  attention  of  the  meeting  to  sepsin, 
which;  he  said,  was  similar  in  composition  to  the  toxin 
found  in  meat  and  an  active  poison  when  introduced 
into  the  organism  by  the  glands  or  gastro-intestinal 
canal.  Bergmann  obtained  a  crystalline  substance  a 
few  years  ago  from  five  grammes  of  yeast,  which  he> 
designated  sepsin,  having  the  formula  CjHj^NjOj^ 
from  which  cadaverin,  C5H14NJ,  can  be  obtained. 
Faust  thinks  this  sepsin  is  the  active  principle  of  de>- 
composition  in  the  animal  as  yeast  is  the  active  agent 
in  the  vegetable  world. 

Diagnostic  Aspiration  of  Cranium. 

Neisser  next  introduced  the  "  probe  puncture  "  of 
the  cranium,  which  he  had  performed  120  times  with 
the  [object  of  discovering  the  real  cause  of  cerebral 
disturbance.  With  modem  appliances  this  diagnostic 
operation  can  be  performed  almost  with  impunity,  as 
the  dura  mater  need  not  be  injured  in  the  hands  of  a 
skilful  operator.  The  cranium  being  a  hard,  un- 
yielding covering  conceals  all  morbid  changes  from  the 
surgeon,  but  as  soon  as  he  reaches  the  soft  covering  of 
the  encephalon  any  bulging  reveals  abscess,  haemor- 
rhage, or  any  change  in  the  state  of  the  vessels.  There 
are  many  old  products,  both  extra-  and  intra-dural,  that 
can  be  diagnosed  in  this  way  that  would  never  have 
come  to  light  till  after  the  post-mortem.  Meningeal 
cysts  and  tumours  can  be  diagnosed  and  removed  at 


July  13.'  1904. 


LEADING   ARTICLES. 


The  Medical  Press.     43 


the  same  time  when  found  necessary.  By  this  means 
he  has  often  removed  50  c.c.  of  fluid  and  preserved 
life.  Abscesses  cannot  be  diagnosed  with  certainty, 
.  and  must  be  probed  first. 

He  would  not  say  this  probing  was  perfectly  safe, 
nor  would  he  encourage  it  without  sufficient  reasons, 
although  he  had  only  two  deaths  in  all  his  operations. 
New  Hospital. 

On  June  21st,  Hr.  Hartel,  the  Minister  of  Education, 
laid  the  foundation  stone  of  the  new  "  K.  K.  Allge- 
meinen  Krankenhause,"  which  the  Viennese  look 
forward  to  as  a  new  epoch  in  the  calendar.  The  Kaiser 
was  unable  to  be  present  in  person,  but  the  enthusiasm 
lacked  nothing  in  his  absence. 

trbe  a)peratind  trbeatres* 

NORTH-WEST  LONDON  HOSPITAL. 
Removal  of  the  Tongue  for  Epithelioma 
Following  Chronic  GLOSsms. — Mr.  Mayo  Collier 
operated  on  a  man,  aet.  74,  this  being  the  third 
time  he  had  operated  on  this  patient  for  a  definite 
hard  mass  on  the  fore  part  of  the  tongue.  Mr.  Collier 
said  this  was  the  third  operation,  the  first  two  having 
been  twelve  and  twenty-four  months  ago  respectively. 
This  case,  he  thought,  was  of  considerable  interest,  in 
so  far  as  the  tongue  had  been  watched  by  him  for  the 
last  ten  years.  The  patient  had  always  enjoyed  good 
health,  excepting  having  suffered  from  occasional  slight 
attacks  of  rheumatism,  associated  with  a  gouty  ten- 
dency. In  the  last  eight  years  he  had  complained  of 
soreness  of  the  tongue,  for  the  relief  of  which  treatment 
had  apparently  failed.  The  area  of  soreness  was 
limited  to  the  anterior  half,  the  upper  surface,  the  tip, 
and  the  borders.  Effervescing  wines,  vinegar,  salt, 
pepper,  mustard,  or  any  pungent  substance  caused 
extreme  pain.  Menthol,  cocaine,  chromic  acid,  and 
various  other  remedies  had  been  applied  by  Mr.  Collier 
without  the  smallest  benefit.  Four  years  ago  a  dis- 
tinct white  plaque  appeared  on  the  left  of  the  median 
raph^  ;  this  was  followed  a  year  afterwards  by  a 
second  plaque,  below  and  external  to  the  first.  Asso- 
ciated with  these  plaques  were  several  areas  denuded 
of  epithelium,  causing  the  tongue  to  be  extremely 
sensitive  to  pressure  or  contact.  Mr.  Collier,  having 
his  suspicions  as  to  the  nature  of  the  upper  plaque, 
excised  this  area  down  to  the  muscular  tissue.  It  was 
found  on  microscopical  examination  to  be  a  tjrpical 
commencing  epithelioma,  which  had  not  yet  invaded 
the  muscular  tissue.  The  general  glossitis  was  not 
improved  by  operation,  and  the  tongue  still  remained 
as  tender  and  sensitive  as  before.  Twelve  months 
afterwards  the  second  plaque,  below  and  external  to  the 
first,  appeared  to  become  more  marked'and  seemed  to 
extend  laterally.  Mr.  Collier  again  operated  and  re- 
moved the  second  plaque  by  a  more  extensive  incision. 
This  also  was  found  to  be  commencing  epithelioma. 
After  the  second  operation  Mr.  Collier  lost  sight  of  the 
patient  until  quite  recently,  when  the  man  presented 
himself  with  well-marked  hardening  and  thickening  of 
the  tip  of  the  tongue  some  little  distance  from  the  sites 
of  the  two  previous  operations.  Mr.  Collier  said  that 
nothing  less  than  an  extensive  operation  in  this  case 
would  be  of  any  avail,  but  as  the  patient  expressed  his 
unwillingness  to  undergo  any  operation  which  would 
prevent  his  feeding  himself  or  speaking,  and  as  his 
age  was  now  74,  and  there  was  no  evidence  of  glandular 
infection,  Mr.  Collier  contented  himself  with  removing 
about  half  the  tongue  by  a  V-shaped  incision,  so  as  to 
include  the  areas  of  the  two  previous  operations.  The 
present  c^ration  was  commenced  by  passing  a  stout 


ligature  through  the  growth  and  the  tip  of  the  tongue,, 
the  sides  of  the  base  of  the  organ  were  brought  forward 
and  steadied  by  two  pairs?  of  clutch  forceps  held  by  two- 
assistants.  This  steadied  and  held  forward  the  root 
of  the  tongue,  and  allowed  the  easy  introduction  of 
the  deep  and  superficial  sutures  and  the  application  of 
any  ligatures  to  the  vessels.  Mr.  Collier  said  that  the 
application  of  clutch  forceps  to  the  sides  of  the  base 
of  the  tongue  during  this  operation  was  a  matter  of 
the  utmost  importance  ;  it  faciUtated  respiration,  and 
the  admission  of  the  anaesthetic  ;  it  controlled  haemor- 
rhage from  the  linguals,  and  prevented  blood  from 
passing  into  the  larynx  ;  it  rendered  the  application  of 
ligatures  to  the  linguals  perfectly  easy,  and  it  allowed 
the  putting  in  of  sutures  and  the  adjusting  of  the  cut 
surfaces  with  as  little  trouble  as  would  have  been 
experienced  in  adjusting  a  wound  of  the  skin..  The 
incisions  were  made  with  an  ordinary  pair  of  scissors* 
so  as  to  leave  a  lateral  flap  on  each  side  which  could 
be  adjusted  to  form  a  new  tip.  There  was  practically 
no  haemorrhage  during  these  incisions.  The  linguals 
were  easily  found  and  ligatured,  and  the  flaps  were 
brought  together  by  deep  and  superficial  sutures  with 
great  ease  and  rapidity.  Mr.  CoUier  thought  that  with 
the  precaution  of  holding  steadily  the  base  of  the 
tongue  with  clutch  forceps  and  with  the  aid  of  good 
assistants,  the  operation  for  the  removal  of  the  tongue 
was  divested  of  all  anxiety. 

Erratum. — Owing  to  a  printer's  error,  a  line  of  the 
MSS.  was  omitted  in  "  The  Operating  Theatres  "  of 
June  22nd.  On  page  66$,  second  column,  after  line  9^ 
the  f (lowing  words  should  come :  "  upon  the  hyo- 
glossus  muscle.  With  regard  to  the."  In  line  10, 
there  should  be  a  comma  after  "  h3rpoglos6al  nerve," 
not  a  semicolon. 

Rbqutbbbd  fob  TftANBxnsiOM  Abroad. 

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SALUS  POPULI  SUPREMA  L£X. 


WEDNESDAY.  JULY  13,  1904. 

NOMENCLATURE  IN  PULMONARY 
TUBERCULOSIS. 
At  the  present  day,  when  sanatoria  for  pul« 
monary  tuberculosis  are  springing  up  like  mush- 
rooms all  over  the  country,  there  is  a  distinct  want 
of  some  general  system  of  nomenclature  if  definite 
information  is  to  be  gained  of  the  results  of  their 


44    I'he  Medical  Press. 


LEADING  ARTICLES. 


July  13.  1904- 


work,  especially  if  comparison  is  to  be  made 
between  different  institutions.  It  is  customary 
to  speak  of  three  stages  in  the  pathology  of  the 
disease,  but  these  stages,  like  the  three  weeks  of 
typhoid  fever,  are  merely  arbitrary  periods  fixed 
for  the  sake  of  convenience,  and  everyone  con- 
versant with  the  manifestations  of  tubercle  knows 
that  the  three  stages  often  co-exist  in  the  same 
lung.  The  same  may  be  said  of  the  term  "  cured  " 
— it  is  convenient  practically,  but  it  is  scientifically 
unjustifiable.  No  patient  who  has  suffered  from 
tuberculosis  ever  returned,  or  ever  will  return,  to 
the  status  quo  ante.  "  Arrest  "  is  certainly  more 
accurate,  but  what  one  man  might  call  arrest, 
another  might  term,  with  equal  propriety,  quies- 
<:ence,  and  so  on  with  every  phase  of  the  disease.  It 
is,  then,  we  think,  desirable  that  some  uniformity 
should  be  introduced  in  the  terminology  of  the 
clinical  conditions  of  tuberculosis  of  the  lungs, 
for  while  one  sanatorium  may  be  turning  out  50 
per  cent,  of  cures,  another  of  equal  repute,  but 
with  a  more  fastidious  medical  officer,  might  not 
return  5.  Both  practitioners  might  be  equally 
conscientious,  but  their  views  as  to  what  consti- 
tuted a  "  cure  "  might  differ  enormously,  and 
the  comparative  merits  of  the  institutions  they 
served  would  be  liable  to  be  disproportionately 
assessed  by  their  committees  and  the.  public. 
Whatever  opinion  may  be  held  as  to  the  appro- 
priateness of  sanatoria  for  dealing  with  the  disease, 
these  institutions  are  now  on  trial  in  Great  Britain  ; 
•some  persons  have  put  forward  the  most  opti- 
mistic predictions  as  to  their  potentialities,  others 
are  filled  with  gloomy  forebodings.  At  all  events, 
Ifor  good  or  for  evil  numbers  of  public  and  private 
sanatoria  are  now  established,  and  it  will  be  in- 
structive to  be  able  to  review  the  record  of  their 
attainments  after  they  have  dealt  with  a  sufficiently 
large  number  of  cases  to  enable  a  fair  judgment  to 
ibe  formed.  But  no  such  review  will  be  possible 
unless  a  uniform  system  of  terminology  is  adopted 
ior  expressing  the  conditions  of  the  patients  on 
«ntry,  on  discharge,  and  after  such  a  period  of  years 
has  elapsed  that  the  effect  of  the  treatment  may 
be  manifested  as  to  its  durability.  It  is  well 
within  the  experience  of  not  a  few  medical  men 
that  the  "  cured  "  or  "  arrested  "  patient  has  in 
■some  instances  left  the  sanatorium  only  to  die  a 
iew  months  later  of  acute  general  tuberculosis, 
so  that  no  fair  view  of  the  success  of  sanatorium 
life  can  be  taken  till  the  patient  has  resumed  his 
daily  duties  for  some  considerable  time  after 
•discharge.  In  pressing  for  some  definite  sys- 
tem of  nomenclature  one  would  suggest  that  some 
•central  authoritative  body,  say,  a  medical  com- 
mittee of  the  National  Association  for  the  Pre- 
vention of  Consumption,  should  issue  a  scheme 
•detailing  the  various  terms  which  should  corre- 
spond to  certain  clinical  conditions,  and  that  each 
sanatorium  should  make  returns  under  those 
headings.  No  such  scheme  could  be  absolute 
<xt  perfect,  for  clinical  conditions  do  not,  from 
their  very  nature,  lend  themselves  to  exact 
•classification,  but  some  good,  broad,  working 
•terms  might  be  suggested  to  which  medical  officers 


should  conform  as  far  as  possible.  As  a  model 
for  such  a  scheme  the  classification  of  the  stages  of 
pulmonary  tuberculosis  issued  last  April  by  the 
American  Climatological  Association  might  be 
adopted,  for  although  objection  may  be  taken 
to  some  of  their  definitions  as  being  arbitrary, 
at  least  they  submit  terms  in  which  the  general 
results  of  treatment  can  be  commonly  expressed. 
This  Committee  take  as  their  basis  of  nomen- 
clature eight  phases  in  the  history  of  the  disease, 
the  incipient,  the  first,  second,  and  third  stages, 
the  progressive,  the  quiescent,  the  arrested,  and 
the  apparently  cured,  and  to  each  of  these  they 
attach  a  definite  meaning,  expressed  as  to  sym- 
ptoms and  physical  signs.  Thus,  the  incipient 
includes  those  cases  in  which  there  are  **  slight 
physical  and  subjective  signs,  with  history  in- 
dicative of  pulmonary  tuberculosis.  Sputa,  if 
present,  without  baciUi  "  ;  the  arrested,  *'  absence 
of  all  constitutional  symptoms  ;  expectoration  and 
bacilli  still  present ;  physical  signs  may  or  may 
not  persist  ;  foregoing  to  have  existed  for  at  least 
three  months  "  ;  the  apparently  cured,  "  all  con- 
stitutional symptoms  and  expectoration,  with 
bacilli,  absent  for  a  period  of  two  years  under  the 
ordinary  conditions  of  Ufe,"  and  so  on.  These 
definitions  may  not  be  ideal  ones,  but  they  are 
comprehensive  and  easily  understood,  and  it 
would  be  a  great  advantage  if  they,  or  some  such 
terms,  could  be  generally  adopted  over  here. 
Without  some  such  system  it  will  be  impossible 
to  form  an  intelligent  opinion  of  the  results  of 
sanatorium-treatment  as  a  whole,  and  equally  im- 
possible to  decide  on  which  side  the  advantage  to 
the  patient  inclines  with  regard  to  the  different 
types  of  sanatoria  advocated  by  different 
authorities. 


SUICIDE. 
The  recent  discussion  at  the  Medico -Legal 
Society  on  the  question  of  suicide  brings  this 
interesting  subject  forward  again  in  all  serious- 
ness and  with  all  its  puzzles.  The  word  ''suicide," 
as  Mr.  Henslowe  WelUngton  pointed  out,  means 
self-murder,  and  not  simply  self -killing,  so  that 
the  stereotyped  finding  of  the  coroner's  jury, 
"Suicide  whilst  temporarily  insane,"  is  paradoxical, 
though  one  cannot  doubt  that  the  verdict  is 
generally  put  forward  in  consideration  of  the 
feelings  of  the  distressed  relatives,  and  not  neces- 
sarily as  the  result  of  conviction.  For,  whatever 
the  alienist  may  say,  there  is  alwa3rs  a  large  margin 
of  cases  of  self-destruction  in  every  country  for 
which  is  is  difficult,  indeed  impossible,  to  account 
for  on  the  ordinary  ground  of  insanity.  No  one 
doubts  that  insanity,  temporary  and  permanent, 
is  the  usual  cause  that  incites  people  to  self- 
destruction,  and  that  premeditation  and  planning 
in  connection  with  the  act  are  quite  reconcilable 
with  mental  aberration.  The  classic  case  of  the 
Naples  shoemaker  is  quite  sufficient  to  establish 
the  latter  point.  This  individual  first  showed 
his  claim  to  insanity  by  castrating  himself  and 
flinging  the  genitalia  out  of  the  window.  After  a 
year's    treatment    he    recovered,    and    then    he 


JULY    13.    1904. 


LEADING  ARTICLES. 


The  Medical  Press.    45 


conceived  the  idea  that  God  had  commanded  him  to 
suffer  on  the  cross.     For  two  years  he  worked 
silently  making  arrangements  to  fulfil  this  behest, 
and  when  he  had  completed  his  plans  he  was 
discovered  one  morning,  nailed  to  a  cross  with  a 
stab  in  his  left  side,  hanging  out  of  his  window. 
The  whole  business  was  so  cleverly  contrived  that 
he  had  managed,  after  completing  the  crucifixion, 
to  shift  the  cross  out  of   the  window  by  move- 
ments of  his  body.     Although  rescued,  he  per- 
sisted in  refusing  food  till  he  died.     But  though 
deliberation  in  preparation  and  determination  in 
execution    are    quite    compatible    with    insanity, 
there  remains  a  number  of  cases  in  which  the 
murder  of  the  "  self  "  is  as  true  a  murder  as  the 
murder  of  another,  and  it  is  just  this  group  of 
cases  that  are  the  bane  of  every  civilised  state. 
Suicide  among  savages  is  said  to  be  very  rare, 
but  in  every  country  of  which  we  have  historical 
record  it  has  been  more  or  less  rife,  and  in  tables  of 
figures  for  1882  we  hnd  that  suicides  in  Europe 
vary  from  21  per  million  per  annum  in  Ireland  to 
371    per  million  in  Saxony.     Admitting   that   a 
laxge  number  of  these  cases  are  due  to  mono- 
ideaism,  resulting  from  strain  and  stress,  there  are 
still  many  in  which  the  evidence  of    rationalism 
is  so  well  marked  that  it  cannot  be  reasonably 
gainsaid.     We  might  take  the  case  of  Whitaker 
Wright,  for  example.     This  man  had  been  living 
for  years  in  the  lap  of  luxury,  held  in  esteem  and 
confidence  by  many  of  the  highest  and  most  trusted 
in   the  realm,   and  in  perfect   domestic  felicity. 
When  brought  to  the  bar  of  justice  he  conducted 
himself  with  dignity,  and  fought  his  case  with 
eminent   sanity,   but   he   had  obviously   decided 
that — to  him — an  adverse  verdict  with  all  that 
it  entailed  would  rob  him  of  all  that  life    held 
dear,  and  he  made  his  preparations  accordingly. 
After  sentence  was  passed,  he  quietly  and  com- 
posedly carried   out  his  fell  purpose.     It   is   as 
impossible  to  attribute  a  self-murder  of  this  kind 
to  insanity  as  it  is  those  of  the  Japanese  officers 
who  prefer  suicide    to  falling  into    the  enemy's 
hands,    or    those   of     the   Carthaginian   generals 
whose  etiquette  it  was  to  destroy  themselves  if 
beaten  in  battle.     We  get  to  this  position,  that 
strong-minded  men  deliberately  prefer  death  to 
certain  alternatives,  and  they  do  so  while  in  full 
possession  of  their  faculties.     They  are  no  more 
insane  than  the  man  who  volunteers  to  lead  a 
forlorn  hope  to  certain  death — they  prefer  death 
to  what  they  consider  disgrace.     In  certain  States 
self-destruction    has    not    only    been    considered 
justifiable,  but  even  honourable  ;  in   the  island 
Ceos,    the  inhabitants  were  expected    to  poison 
themselves  at  the  age  of  sixty  to  make  way  for 
younger  people,  and  when  Marseilles  was  a  Greek 
colony,  poison  was  provided  by  the  Senate  for 
those  whose  motives  for  killing  themselves  met 
with     the     magistrates'     approval.     In     modem 
countries  the  practice  of  suicide,  not  merely  as  a 
manifestation  of  insanity,  is  certainly  increasing, 
and    although     in    Great    Britain    and   America 
it  has  not  reached  the  proportions  that  it  has 
assumed     on     the    Continent,    it    constitutes    a 


sufficiently  serious  problem.  The  epidemic,  o*^ 
imitative,  tendency  of  suicide,  especially  of  a. 
plausible  suicide,  is  well  recognised,  and  it  is  a 
practice  that  gets  more  and  more  apologists  as- 
time  goes  on.  It  is  not  a  problem  that  is  easily^ 
solved,  how  best  to  check  this  morbid  tendency. 
Laws  have  been  passed  in  many  countries  to- 
punish  the  would-be  suicide,  and  to  dishonour  him. 
and  his  family,  but  though  drastic  measures  of 
this  kind  are  said  to  have  been  successful  in. 
Egypt  and  Miletus  in  the  past,  they  have  certainly- 
proved  ineffectual  in  England.  One  exciting^ 
cause  in  modem  countries  that  is  within  control 
is  the  liberty  accorded  to  the  Press  to  report 
with  lurid  detail  and  in  large  type  the  details  of. 
sensational  suicides,  but  the  question  passes  out 
of  the  realm  of  medicine  when  it  deals  with  other- 
than  the  self-destmction  of  the  insane.  Our  duty- 
ends  when  we  have  shown  that  there  are  rational 
suicides  as  well  as  insane  ones,  and  that  the 
verdict  of  **  temporary  insanity  "  is  often  un- 
scientific, and,  therefore,  not  to  be  commended,, 
even  on  grounds  of  the  broadest  humanity. 


THE  IODISED  PACK  IN  THE  TREATMENT 
OF    PUERPERAL    SEPTICEMIA. 
In  spite  of  numerous  and  often  drastic  methods 
of  treatment,  puerperal  infection  remains  a  grave 
complication  of  childbed.     Although   in   hospital 
wards  the  mortahty  has  been  reduced  to  about. 
1*5  per  thousand,  in  private  practice  the  death- 
rate  is  not  perceptibly  less  than  before  the  intro- 
duction of  antiseptics,  no  doubt  simply  because- 
advantage  is  not  taken,  and  in  many  instances  can- 
not possibly  be  taken,  of  their  action.     Injection  of 
antistreptococcic  serum,  though  occasionally  ef- 
fectual, has  proved  untrustworthy  and  is  at  best 
no  more  than  a   useful  adjuvant.     Curettage  of 
the  uterus,  though  a  rational  procedure,  is  attended 
by  risks  so  considerable  that  eminent  authorities, 
have  expressed  their  disapproval  of  its  use.     It  is. 
obvious,   indeed,   that   while   digital  removal   of 
placental    debris    fulfils    an    urgent    indication,, 
neither  it  nor  curettage  can  do  much  in  the  direction 
of  arresting  the  invasion  of  the  uterine  sinuses 
and  crypts  by  the  microbial  host  which  has  gained, 
a  footing.     Antiseptic  irrigations  are,   no  doubt, 
useful  as  far  as  they  go,  but  their  influence  is  ex- 
tremely  ephemeral,  and  during  the  intervals  the 
infective    process    runs     its   course    unhindered.. 
It  is  evident  that  if  we  wish  to  exert  a  definite - 
effect  on  the  septic  process  we  can  only  do  so  by 
maintaining  the  germicide  in  contact  with  the  in- 
fected walls  of  the  uterine  cavity.     This  is  not 
altogether  a  novel  suggestion,  but  so  far  as  we  are  • 
aware  it  is  one  which  has  not  hitherto  been  syste- 
matically practised,  yet  the  cases  which  we  publish 
elsewhere,  (a)   reported   by  Dr.  Cabanes,   of   the 
Medical  School  of  Algiers,  seem  to  show  that  it  is 
possible  to  secure  extremely  satisfactory  results, 
by  a  procedure  based  on  this  principle.     Briefly 
described,  his  method  comprises  the  cleansing  of 
the  uterine  cavity,  and  packing  it  loosely  with  gauze- 
steeped  in  a  4  per  cent,  solution  of  iodine  and 

(a)  See  "  CUniGal  Becoids." 


46    Th»  Mbdical  Pmss,       NOTES    ON    CURRENT    TOPICS. 


July  13,  1904. 


iodide    of    potassium    in    sterilised    water.     The 
dressing  is  renewed  every  twelve  hours  or  so  until 
apyrexia  is  obtained.     We  gather  that  the  treat- 
ment has  been  adopted  in  a  fairly  large  number 
of  cases  with  uniformly  good  results,  although  in 
several  instances  the  virulence  of  the  infection 
was  conclusively  demonstrated  by  the  death  of 
.several  patients  infected  by  the  same  midwife, 
but  who  had  not  been  subjected  to  the  treatment 
in    question.     The    experience    of    Dr.    Cabanes 
«hows  first  of  all  that  the  treatment  is  free  from 
any  risk  of  its  own,  and  the  promptness  with  which 
the  symptoms  of  puerperal  endometritis  yielded 
to  the  dressing  is  equally  conclusive.     The  method 
is  quite  within  the  scope  of  the  average  obstetri- 
tcian ;    it  necessitates  no  special  appUances,  and 
•the  extra  trouble  which  it  entails  cannot  weigh 
with  us  in  view  of  the  extreme  gravity  of  the 
compUcation.     The    method    is    appUcable    even 
when  the  infective  process  has  extended  beyond 
the  limits  of  the  uterus  proper,  for  although  it 
may  not  directly  modify  the  subsequent  course  of 
peri-uterine  inflammation,  the  removal  of  the  ori- 
ginal and  principal  focus  of  infection  cannot  but 
•exert  a  favourable  influence  on  the  constitutional 
condition  which,  after  all,  constitutes  the  gravest 
part  of  the  problem.     We  see  no  reason  to  sup- 
pose that  the  method  would  prove  less  serviceable 
in  other  hands  than  it  appears  to  have  done  in 
those  of  Dr.  Cabanes,  and  its  simplicity  is  a  further 
reason  for  giving  it  a  trial. 


than  the  "  chronic  medical  students "  who  at 
four  or  five  and  twenty  discover  that  the  attain- 
ment of  their  goal  is  an  impossibility.  They 
have  wasted  five  or  six  years  in  work  dull  and 
useless  to  them,  and  this  waste  might  have  been 
saved  by  friendly  but  firm  advice  at  the  outset. 
With  regard  to  students  whose  moral  character 
renders  them  unsuitable,  the  case  is  less  hard, 
though  to  them,  too,  it  would  be  bare  justice  to 
announce  in  the  earUer  years  of  their  studentship 
the  decision  of  the  authorities  of  their  school.  We 
recognise  with  Dr.  Musser  the  impossibility,  in 
matters  of  individual  character,  of  suggesting 
anything  in  the  way  of  a  general  Une  of  action, 
but  we  think  he  does  well  in  emphasising  the 
enormous  responsibility  in  making  or  marring 
men's  Uves  which  lies  with  every  teacher  of  medi- 
cine. 


notes  on  Current  XTopics* 

Teacher  and  Student. 
Among  the  many  topics  touched   on  in   Dr. 
Musser's    thoughtful    and    eloquent    Presidential 
Address   to   the    American  Medical   Association, 
there  is  none  demanding  graver  attention  from 
the  teachers  in  our  hospitals  and  medical  colleges 
than  the  question  of  the  attitude  they  should 
adopt  towards   unfit  students.       Every  conscien- 
tious teacher  must,  from  time  to  time,  be  brought 
into  contact  with  students  who,  by  their  character, 
whether  the  fault  be  mental  or  moral,  must  be 
regarded   as   unfit   to   become   members   of   the 
medical  profession.     It  may  be  that  there  is  an 
almost  entire  lack  of  power  of  concentration  and 
of  memory,  accompanied  by  stupidity,  of  such  a 
degree  as  to  render  the  acquisition  of  the  necessary 
knowledge  an  impossibiUty.     On  the  other  hand, 
there  may  be  such  moral  obhquity,  and  absence  of 
honesty    and    frankness,    as    at    any    rate    make 
professors  hesitate  to  allow  the  imprimatur  of  their 
school  to  be  attached  for  Ufe  to  a  man  of  such 
character.     In  both  cases  there  is  great  difl&culty 
in  deciding  on  the  course  to  adopt.      It  is  true 
that  in  the  former  case  the  quaUfying  examinations 
will,  of  themselves,  weed  out  unsuitable  candidates, 
but  it  would,  in  many  instances,  be  kinder  and 
more  just  to  warn  the  man  of  his  ineligibihty  in 
his  early  years  of  study  than  to  allow  him  to 
waste  his  best  years  in  fruitless  toil,  presenting 
himself  again  and  again  for  a  test  he  can  never 
satisfy.     There  are  few  men  more  to  be  pitied 


A  Remedy  for  Physical  Deterioration. 

A  SPIRITED  effort  is  being  made  by  Dr.  Henri 
CazaUs  to  hft  the  question  of  physical  deteriora- 
tion into  a  stage  of  practical  activity,  so  far  as 
France  is  concerned.     He  beUeves  that  the  evil  is 
largely  due  to  the  prevailing  ignorance  as  to  the 
baneful  effects  of  alcohoUsm,  of  syphilis,  and  of 
tuberculosis.     His  plan  of  campaign,  which  was 
set  forth  in  a  recent  communication  to  the  Aca- 
demic de  Medecine,  is  worthy  of  careful  consideration 
in  this  country,  where  the  same  causes  are  at  work, 
and  are  at  the  present  time  claiming  increasing 
attention.     Dr.    CazaHs   proposes   that   the   ma- 
chinery of  the  State  be  made  available  for  the 
dissemination  of  the  knowledge  which  is  so  much 
wanted.     He  points  out  that  since  the  immense 
majority  of  the  male  population  are  called  upon 
to  serve  in  the  army  or  in  the  navy,  there  exists 
a  ready  channel  for  the  education  of  the  masses, 
and  that  so  good  an  opportunity  should  not  be 
wasted.    He  suggests  that  a  short  set  of  statements 
might  be  drawn  up  by  the  Academic  with  a  view 
to  their  being  appended  to  the  soldier's  or  to  the 
sailor's  "  Uvret."     In  this  manner  a  definite  im- 
pression would  soon  be  made  upon  the  entire 
community.     Another  important  measure  is  sug- 
gested by  the  appalling  lack  of  appreciation  on  the 
part   of   those   who   contemplate   matrimony   of 
the  responsibiUties  which  they  incur  in  relation  to 
the  health  of  their  future  offspring.  Cazalisdoes  not 
on  this  occasion  press  his  well-known  advocacy 
of  a  preliminary  and  voluntary  exchange  of  certi- 
ficates of  health  ;  but  he  considers  that  the  State 
might  so  far  intervene  for  the  prevention  of  any 
further  deterioration  of  the  race  as  to  provide  the 
recipients    of    marriage    certificates    with    some 
appropriately  worded  reminder  of  those  principles 
which  most  closely  affect  the  health  and  vitality 
of   the    future    generation.     A  third   suggestion, 
which   is   intended   for  the   benefit   of   mothers 
and  nurses,  is  so  much  to  the  point,  whilst  entirely 
free   from   any   possible   objection,   that   it   has 
already  been  adopted  in  principle  by  the  Municipal 
Council  of  Paris,  and  is  likely  to  be  soon  adopted 
throughout  the  land.     It  is  recommended  that  a 
set  of  instructions   as   to  the   management  and 


July  13,  1904. 


NOTES    ON    CURRENT    TOPICS,      Th»  Medicai-  Press.     47 


feeding  of  infants  be  drawn  up  by  the  Acad6mie 
and  supplied  to  parents  or  to  their  representatives 
-when  making,  at  the  Mairie,  the  official  declara- 
tion of  a  birth.  Dr.  Cazalis  is  to  be  congratulated 
^pon  this  instalment  of  success  in  his  philan- 
thropic and  most  praiseworthy  endeavour.  The 
best  results  may  be  expected  from  some  such  self- 
working  sytem  of  education  in  matters  of  health, 
and  it  cannot  be  doubted  that  the  soundness  and 
strength  of  the  race  will  benefit  in  a  full  measure 
from  this  organised  diffusion  of  elementary 
knowledge  of  family  hygiene. 

Fublio  Vacoinators'  Fees. 

The  Departmental  Committee  that  has  been 
inquiring  into  the  subject  of  the  fees  paid  to 
public  vaccinators  and  the  other  expenses  entailed 
on  the  guardians  by  vaccination  generally 
has  made  its  report,  which  is  now  being  con- 
•sidered  by  Mr.  Walter  Long  and  his  advisers- 
What  the  report  contains  is  not,  of  course,  known, 
but  according  to  Mr.  Long's  own  statement  at 
the  time  of  its  appointment,  the  Committee  owed 
its  raison  d'etre  to  a  desire  to  cut  down  expenses. 
A  vigorous  protest  was  entered  in  these  columns 
at  the  time  against  any  attempt  being  made  to 
reduce  the  fees  now  paid  to  the  public  vaccinators, 
and  it  is  to  be  hoped  that  it  is  not  too  late  to  re- 
^mphasise  the  point  before  the  Local  Government 
Board  decision  is  made.  The  1890  Act  entailed 
fresh  and  very  onerous  duties  on  the  public 
vaccinators,  duties  which  were  placed  on  them 
-entirely  in  the  interests  of  the  parents  of  children, 
and  not  at  all  in  their  own.  It  was,  then,  only 
fair  that  their  fees  should  be  raised,  for  a  medical 
man's  time  is  his  money,  and  the  amount  of  time 
r  spent  in  going  from  house  to  house  is  obviously 
tenfold  more  than  that  spent  in  vaccinating  chil- 
dren brought  to  a  vaccination  station.  The  Act 
has  certainly  disposed  of  the  last  reasonable  ob- 
jection on  the  part  of  the  poor  to  have  their 
children  vaccinated,  and  it  has  certainly  resulted 
in  a  large  increase  in  primary  vaccinations.  It 
would,  therefore,  be  in  the  nature  of  a  breach  of 
confidence  to  revert  to  the  old  scale  of  fees,  or 
anything  like  it,  and  any  such  proposal  would  lead 
to  a  very  justifiable  outburst  of  indignation  in 
the  profession.  The  small-pox  scares  that  have 
agitated  the  community  during  the  few  years 
since  the  passing  of  the  Act  have  naturally  led  to  a 
large  number  of  re- vaccinations,  and  the  expenses 
in  the  administration  of  the  Act  have  risen  pro- 
pKjrtionately.  But  these  expenses  must  be  con- 
sidered as  abnormal,  and  the  money  thus  spent  is 
surely  far  better  utilised  than  in  building  temporary 
hospitals  for  small-pox  patients  and  paying  for 
their  nursing  and  maintenance.  Any  attempt 
to  go  back  on  the  contract  under  which  public 
vaccinators  were  appointed  would  be  viewed 
with  unanimous  displeasure  by  the  profession. 

The  Thouffht  of  Death. 
A  LAY  contemporary  has  been  collecting  opinions 
from  various  sources  with  a  view  to  ascertaining 
what  death  means  to  the  dying  man  or  woman. 


It  is  a  solemn  subject,  and  one  that  easily  lends 
itself  to  morbid  treatment  and  speculation,  but 
at  the  same  time  it  is  one  that  may  not  unprofitably 
engage  the  thoughts  of  serious  people.  To  those 
whose  painful  duty  it  has  been  to  stand  by  the  bed- 
side of  many  a  dying  patient,  as  has  fallen  to  the 
lot  of  most  medical  men  in  active  practice,  the 
actualities  of  the  situation  appear  in  a  different 
light  from  that  presented  to  the  popular  mind. 
There  are,  of  course,  many  modes  of  death,  which 
differ  from  each  other  in  the  widest  possible 
manner.  One  man  may  be  cut  off  from  the  enjoy- 
ment of  (apparently)  complete  health  and  strength 
by  an  attack  of  syncope  or  cerebral  haemorrhage 
in  a  few  seconds,  whilst  another  dies  by  inches 
from  malignant  disease  or  tuberculosis.  It  is 
often  said  that  death  by  drowning  is  a  pleasant 
experience,  and  some  persons  who  have  been 
rescued  after  prolonged  immersion  have  narrated 
happy  dreams  that  have  passed  through  their 
mind,  until  rudely  awakened  therefrom  by  their 
rescuer.  This,  however,  is  not  the  common  lot  of 
the  nearly-drowned,  and  in  any  case  the  pre- 
liminary stages  of  asphjrxia — whether  by  filling 
the  air-passages  with  water  or  by  any  other  means 
— are,  though  fortunately  short,  attended  by  most 
horrible  sensations.  The  actual  passage  iroxa  life 
to  death  in  the  vast  majority  of  cases,  if  not 
actually  all,  is  not  only  painless,  but  occurs  during 
a  period  of  unconsciousness.  The  transition 
causes  as  little  disturbance  subjectively  as  the 
passage  from  wakefulness  to  sleep,  and  the  only 
people  who  suffer  in  anticipation  are  those  whose 
illness  is  accompanied  by  clouding  of  the  intellec- 
tual faculties.  Nor  do  these  alwa3rs  suffer,  for  we 
have  it  on  record  that  the  celebrated  William 
Hunter  said  to  his  friend  Combe,  shortly  before  his 
death,  "  If  I  had  strength  enough  to  hold  a  pen, 
I  would  write  how  easy  and  pleasant  a  thing  it  is 
to  die." 


Ohalfont  Epileptic  Oolony. 
It  was  a  bold  and  humane  step  that  the  founders 
of  the  Chalfont  Epileptic  Colony  took  when  they 
inaugurated  an  estabUshment  where  useful  em- 
ployment, combined  with  skilled  supervision, 
could  be  exercised  over  the  unfortunate  individuals 
whose  liability  to  fits  rendered  their  existance 
both  dangerous  to  themselves  and  useless  to  others. 
The  recent  meeting  of  the  governors  calls  atten- 
tion to  the  fact  that  its  aims  are  not  only  being 
fulfilled,  but  that  more  is  being  learned  by  ex- 
perience of  the  capacity  of  epileptics  and  of  their 
suitability  for  various  tasks.  The  men  are  em- 
ployed in  a  number  of  trades,  such  as  carpentering 
and  painting,  beside  farm-labouring,  and  the 
women  are  kept  occupied  with  laundry,  needle  and 
housework.  It  can  scarcely  be  hoped  that  the 
colony  will  ever  be  quite  self-supporting,  when  all 
the  circumstances  under  which  it  carries  on  its 
work  are  considered.  Thus  Dr.  Aldren  Turner 
reports  that  29  per  cent,  of  the  epileptics  suffer 
so  much  from  mental  impairment  that  their 
capacity  for  work  even  under  direction  is  very 
small,  whilst  of  the  remaining  70  per  cent,   57 


4^    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


July  13,  1904/ 


suffer  from  more  or  less  intellectual  defect.  This 
leaves,  therefore,  only  13  per  cent,  who  are  really 
averagely  intelligent  and  capable.  The  work 
done  at  Chalfont  has  had  good  effects  in  several 
directions,  notably  in  stimulating  the  London 
County  Council  to  establish  a  smilar  colony  at 
Horton,  and  it  is  to  be  hoped  that  now  that  it  is 
evident  that  the  epileptic  can  be  made  a  useful 
member  of  society,  more  of  these  institutions  will 
be  built  and  equipped  in  different  parts  of  the 
country.  One  of  the  best  tests  of  the  degree  of 
civihsation  that  a  State  has  reached  is  the  way  in 
which  it  treats  its  halt  and  maimed,  and  no  more 
enUghtehed,  humane  and  beneficent  work  could 
be  conceived  than  that  of  making  the  epileptic 
a  happy  and  useful  member  of  the  society  in 
which  he  lives. 


The  Foundation-stone  of  New  St. 
Bartholomew's  Hospital. 
On  the  5th  inst.  the  King  and  Queen  visited 
St.  Bartholomew's  Hospital  for  the  purpose  of 
laying  the  foundation-stone  of  the  reconstructed 
Hospital.  On  arrival  Their  Majesties  were  received 
by  the  Prince  of  Wales  in  his  capacity  of  President 
of  the  Hospital,  accompanied  by  the  Princess, 
together  with  a  reception  committee  of  the 
Chairman,  Sir  Trevor  Lawrence,  the  Senior 
Almoner,  Mr.  Alderman  Alliston,  Sir  Ernest 
Flower,  M.P.,  Dr.  Gee,  Senior  Physician,  and  Mr. 
John  Langton,  Senior  Surgeon.  Prayers  were 
read  by  the  Bishop  of  London,  and  an  address 
from  the  Governors  was  read  by  the  Prince  of 
Wales.  The  King  then  duly  laid  the  foundation- 
stone,  an  immense  block  of  polished  red  granite. 
An  interesting  little  ceremony  foUowed  in  the 
shape  of  the  conferring  of  a  Governorship  of  the 
Hospital  upon  the  Queen.  This  is  the  first  occasion 
upon  which  that  qualification  has  been  bestowed 
upon  a  lady.  The  total  estimated  cost  of  the 
scheme  is  about  half  a  million.  The  City  was 
en  fite,  and  the  scene  at  St.  Bartholomew's  was 
of  a  most  brilliant  description,  worthy  of  the 
records  of  the  ancient  City  with  which  the  In- 
stitution has  been  for  so  many  centuries  connected. 


The  Baoteriolofiry  of  Pneumonia. 

For  many  years  there  has  been  waged  a  contest 
as  to  the  causation  of  acute  pneumonia,  between 
those  who  regarded  Frankel's  diplococcus  as  the 
sole  bacterial  cause,  and  those  who  gave  a  similar 
pre-eminence  to  Friedlander's  pneumo-bacillus. 
in  general,  opinion  seemed  to  have  settled  in 
favour  of  the  diplococcus,  though  from  time  to 
time  a  case  was  reported  where  it  was  apparently 
absent,  and  no  sufficient  pathogenic  germ  could 
be  found  except  the  pneumo-bacillus.  Kokawa, 
however,  has  recently  pointed  out  that  there  are 
in  reality  two  types  of  the  disease,  differing 
markedly  in  pathology,  one  being  due  to  each  of 
the  two  organisms  mentioned.  As  points  of 
difference,  he  draws  attention  to  the  greater 
production  of  mucus  in  the  bacillary  than  in  the 
coccal  infection,  and  to  the  fact  that  in  the  former 
there  is  usually  more  of  the  lung  involved.     In 


it,  too,  haemorrhage  into  the  alveoH  is  usually  less^ 
marked,  and,  consequently,  during  the  stage  of 
grey  hepatisation  there  is  less  fibrinous  coagulum. 
The  bacilli  are  found  embedded  both  in  the- 
leucocytes  and  in  the  epithehal  cells,  which  usually- 
show  vacuoles.  It  is  well  known  that  the  diplo- 
coccus may  cause  very  varied  infections,  and  so,, 
too,  in  the  case  of  the  pneumo-bacillus,  Kokawa 
brings  evidence  to  show  that  it  may  be  the  causal 
agent  in  pleuritis,  pericarditis,  endocarditis,  otitis: 
media,  and  other  inflammations. 


The  Health  of  Dublin. 
It  is  refreshing. to  find  that  the  death-rate  in 
Dublin  has  at  length  reached  a  reasonable  figufe. 
In  the  week  ending  July  2nd  it  was  only  at  the 
annual  rate  of  167  per  1,000,  being  a  little  lower 
than  that  of  London,  while  the  mean  rate  during^ 
the  corresponding  week  of  the  past  ten  years  was 
21*9.  We  have  no  reason  to  suppose  that  the- 
drop  in  the  death-rate  is  more  than  a  temporary 
accident,  depending  to  great  extent  On  the  weather. 
A  large  proportion  of  the  deaths  in  Dtiblin  are 
due  to  diseases  of  the  respiratory  system,, 
and  during  the  mild  weather  recently  enjoyed 
these  are  naturally  lessened  in  incidence.  The 
real  crux  of  the  health  question  in  Dublin  is,  of 
course,  the  housing  problem,  and  to  grapple  with 
this  no.  serious  attempt  has  yet  been  made.  It 
is  true  that  the  Corporation  and  several  voluntary 
bodies,  such  as  the  Association  for*  the  Housing 
of  the  Very  Poor  and  the  Alexandra  College  Guild, 
are  engaged  in  supplanting  condemned  tenements, 
by  suitable  sanitary  dweUings.  Their  efforts 
are,  however,  on  such  a  small  scale  that  they  can 
only  be  regarded  as  instructive  and  successful 
experiments,  for  at  the  present  rate  of  progress  it 
would  take  a  Uttle  over  a  century  to  substitute  a 
sufficient  number  of  artisans'  dwdlings  for  slum 
tenements  to  supply  the  working^  population  of 
Dublin. 


The  Recent  HsBmatogen  TriaL 

The  facts  of  the  recent  Haematogen  trial  at 
King's  Bench  will  be^'fresh  in  the  minds  of  many 
of  our  readers.  The  defendant  Bauer,  of  Gebruder,. 
Bauer  and  Company,  has  drawn  attention  to  our 
comments  on  that  action  contained  in  our  issue- 
of  June  22nd,  1904.  The  paragraph  in  question 
mentions  briefly  the  grounds  of  action  and  issue 
of  the  trial.  It  then  dwells  upon  the  hardship 
entailed  upon  the  plaintiff  by  the  adverse  verdict, 
which  deprived  him  of  his  trade  mark.  The  only 
passage  that  can  conceivably  be  construed  as 
reflecting  upon  the  defendant  Bauer  is  the  follow- 
ing : — "  The  injustice  arises  out  of  the  English 
system  which  allows  any  trade  mark  to  be  regis- 
tered, but  grants  it  no  subsequent  authority  or 
support.  If  Hommel'smark  is  bad  now,  it  was 
bad  at  the  time  of  registration.  Why  should 
an  honourable  firm  be  permitted  to  spend  large 
sums  of  money  in  introducing  a  legitimate  article, 
recognised  by  the  medical  profession,  only  to 
find  out  in  the  course  of  a  costly  trial  in  the  High 
Courts    that  their  trade  mark  may  be  used  by 


July  13,  1904. 


NOTES    ON    CURRENT    TOPICS. 


Thb  Medical  Press.     49 


any  unscrupulous  competitor  ?  "  These  sentences 
were  obviously  intended  to  be  general  in  their 
application,  and  we  can  assure  Mr.  Bauer  there 
was  no  intention  to  include  him  amongst  the 
class  indicated  by  the  words  "  any  unscrupulous 
competitor."  If  our  words  are  capable  of  that  in- 
terpretation we  regret  the  circumstance  extremely 
and  willingly  withdraw  the  passage  tn /o/o.  It  would 
be  contrary  to  the  policy  and  principles  of  The 
Medical  Press  and  Circular  to  exceed  in  any 
way  the  limits  of  absolutely  fair  comment.  The 
English  system  of  permitting  the  registration 
of  trade  marks  without  attempting  to  test  their 
validity  seems  to  us  to  invite  strong  editorial 
comment.  We  regret  if  any  passing  ambiguity 
of  expression  should  have  given  rise  to  misunder- 
standing by  suggesting  a  particular  application 
of  what  was  advanced  as  a  general  proposition. 


A  Slander  Oase. 

An  action  for  damages  for  slander  which  pro- 
mises to  be  interesting  to  medical  men  is  listed 
for  hearing  in  the  Irish  Courts.  Dr.  FitzGibbon, 
a  medical  man  residing  in  county  Wicklow,  is 
the  plaintiff,  and  the  alleged  slander  arose  in  a 
rather  curious  way.  The  plaintiff's  dog  had  a 
fight  with  another  dog,  and  came  off  victorious, 
inflicting  wounds  on  the  other's  ear.  These 
wounds  were  stitched  and  treated  by  the  plaintiff, 
and  the  dog  ultimately  completely  recovered. 
The  defendant,  however,  a  gentleman  residing  in 
the  neighbourhood,  is  stated  to  have  made  re- 
marks reflecting  on  the  plaintiff's  treatment  of  the 
dog,  and  in  general  of  his  skill  as  a  surgeon.  The 
damages  claimed  are  small  in  amount,  but  it  is 
the  first  case  we  remember  where  a  medical  man's 
professional  treatment  of  an  animal  has  given  rise 
to  an  action  at  law. 


The  Diminiflhing  Birth-rate. 

The  fact  that  the  birth-rate  of  the  United  King- 
dom has  been  steadily  faUing  for  the  last  thirty 
or  forty  years  must  sooner  or  later  be  faced  by  the 
nation.  Whatever  the  exact  meaning  of  the 
handwriting  upon  the  wall,  it  deserves  careful 
and  skilled  investigation  by  our  best  scientific 
brains.  Some  months  ago  the  subject  was  brought 
forward  by  Dr.  Taylor,  of  Birmingham,  who 
attributed  the  decline  in  the  birth-rate  to  the  use 
of  preventive  methods  by  married  persons.  Such 
practices  he  claimed  to  be  productive  of  a  host  of 
physical  and  moral  evils  both  to  the  individual 
and  the  community.  His  views  were  at  once 
accepted  by  many  Churchmen,  more  especially 
the  Bishop  of  Ripon,  and  have  excited  world-wide 
interest  and  discussion.  Dr.  Taylor's  views,  how- 
ever, are  not  to  pass  unchallenged  by  the  medical 
profession.  In  the  present  number  of  The  Medi- 
cal Press  and  Circular  (July  13th,  1904), 
we  print  an  article  by  Dr.  David  Walsh  upon  the 
subject.  He  agrees  with  Dr.  Taylor's  main  pro- 
position that  the  birth-rate  has  fallen  5*6  during 
the  past  half  century.  After  that  point,  however, 
he  claims  that  hardly  a  single  statement  of  that 
writer  will  stand  serious  examination.     To  begin 


with.  Dr.  Taylor  has  overlooked  the  fact  that  the 
total  birth-rate  includes  illegitimate  births,  but 
he  nevertheless  took  that  total  rate  as  the  basis 
of  his  bald  assertion  that  the  birth  loss  of  the 
United  Kingdom  is  due  to  "  causes  operating  on  the 
married  life  of  its  inhabitants."  Dr.  Walsh  advo- 
cates neither  side,  but  simply  weighs  the  argu- 
ments advanced.  His  closely  reasoned  article- 
should  be  read  by  all  interested  in  the  subject.  It 
is  comforting  to  find  that  medical  men  do  not  all- 
agree  with  Dr.  Taylor  in  his  doleful  jeremiad  onj 
the  wholesale  lunacy  and  depopulation  of  the 
United  Kingdom  somewhere  in  the  near  future. 


Fried  Fish^and  Typhoid  Fever. 

Of  late  the  sensational  scare  attributing  ty- 
phoid fever  to  the  eating  of  fried  fish  has  once 
more  gone  the  round  of  the  lay  press.  When  the 
suggestion  was  first  mooted  we  expressed  the  most 
frank  doubt  as  to  the  truth  of  any  such  connection^ 
The  fried  fish  theory  originated  some  years  ago  ini 
the  attempt  to  run  to  earth  a  mysterious  epidemic 
of  typhoid  fever  in  South  London.  At  the  time- 
it  was  carefullly  investigated  and  reported  upon 
by  Dr.  Waldo,  the  then  Medical  Officer  of  Health 
for  Southwark.  He  came  to  the  conclusion  that 
the  outbreak  could  not  be  connected  with  the  fish- 
shops,  and,  as  a  matter  of  fact,  the  agency  at 
work  in  the  spread  of  that  particular  epidemic 
remains  a  mystery  to  this  day.  As  regards  fried 
fish,  it  is,  on  the  face  of  it,  extremely  unlikely  that 
the  typhoid  germs  could  survive  the  process  of 
cooking.  It  is  suggested  by  Dr.  Hamer,  who 
first  raised  the  alarm,  that  the  typhoid  bacilli 
left  in  the  intestines  of  the  fish  are  so  protected 
that  they  remain  alive  and  subsequently  infect 
consumers.  It  would  be  hard  to  find  fish  cooked 
whole  in  that  manner  in  any  fried-fish  shop  in 
London.  The  trade  is  confined  almost,  if  not 
quite,  entirely  to  shces  "or  fillets  of  large  fish. 
Without  absolute  or  overwhelming  scientific  proof 
it  seems  a  thousand  pities  that  the  good  reputation 
of  so  cheap  and  valuable  a  popular  article  of  food 
should  be  endangered.  Further,  we  venture  to 
say  that  convincing  evidence  of  the  theory  of  the 
spread  of  typhoid  fever  by  fried  fish  shops  has 
not  hitherto  been  forthcoming.  The  typhoid 
bacillus  fortunately  is  not  a  salamanaer  tnat  can 
withstand  a  ten  minutes  bath  of  boiling  oil. 


Early  Rising. 
A  CERTAIN  old  saw,  inculcated  by  nurses  andf 
copy-books,  used  to  make  early  rising  an  indis- 
putable preliminary  to  health,  wealth,  and  wis- 
dom, and  the  medical  profession,  doubtless  through 
stupidity  and  prejudice,  have  so  far  clung  to  this, 
tradition  that  their  patients  have  ceased  to  look 
to  them  for  sympathy  when  they  are  indolent  in 
their  habits.  However,  times  change,  and  doctois 
with  them,  and  just  as  a  straw  shows  which  way 
the  current  is  flowing,  so  do  two  pronouncements, 
emanating  from  medical  men — one  in  the  North 
of  England  and  another  in  America — indicate 
that  the  tide  of  opinion  is  changing.  The  English, 
physician  thinks  that  it  is  dangerous  to  healths 


50   The  Medical  Press. 


PERSONAL. 


July  13.   1904- 


and  even  to  life  to  get  up  in  a  hurry,  whilst  the 
American,  an  alienist,  by  the  way,  thinks  that  this 
way  madness  lies.  **  The  free  and  lazy  savage 
gets  up  when  he  feels  ready,  and  rarely  or  never 
becomes  insane."  To  be  forced  to  get  up  early 
**  grinds  the  soul,  curdles  the  blood,  swells  the 
spleen,  destroys  all  good  intentions,  and  disturbs 
all  day  the  mental  activities,  just  as  a  tornado 
disturbs  and  levels  with  advancing  ruin  a  forest 
of  mighty  pines."  The  pathology  of  this  tor- 
nadoing  American  may  not  be  very  exact,  but 
his  poetry  is  inestimable,  and  it  behoves  one  in 
the  future  to  take  care  that  the  arrival  of  one's 
shaving-water  in  the  morning  is  allowed  to  pass 
unnoticed,  lest  coagulation  of  the  blood  and  con- 
gestion of  the  spleen  bring  one  to  a  bad  end.  The 
virtuous  wife  who  rose  before  dawn  to  give  a 
potion  to  her  maidens  may  now  be  bidden  to 
lie  a-bed  until  she  feels  inclined  to  get  up,  ^r^a. 
very  limited  number  of  rubies  will  outweigh  h^ 
market  value,  and  the  *'  smart  set  "  i^R^bd  able 
to  turn  night  into  day  ^^ithout  a  q\iuitm  of  con- 
science or  a  tinge  of  remorse.  WhenjSuch  P)^0i-1 
cal  experts  "  are  quoted  in  the  dailij;  n^perst  one 
can  only  animadvert  on  the  wonderfuVproCTess  of 
medicine  since  our  fathers'  time.         ^<^^  75  P 

The  Cause  of  Appendicitis. 

With  appendicitis  on  every  side,  and  people 
keenly  interested  in  the  subject,  it  is  natural  that 
they  should  constantly  be  asking  their  doctor, 
*'  What  is  the  cause  of  appendicitis  ?  "  The 
medical  attendant,  for  his  part,  may  either  enter 
into  a  technical  disquisition  which  may  leave  the 
inquirer  about  as  wise  as  when  he  began,  or  he 
may  take  refuge  in  the  prevailing  ignorance  of 
the  profession,  and  answer,  "  Nobody  knows." 
At  any  rate,  the  position  is  not  an  enviable  one, 
and  does  not  enhance  his  prestige.  A  paper  by 
Dr.  Rubin,  of  Chicago,  in  the  Medical  News, 
details  some  ingenious  experiments  made  by  him- 
self with  a  view  to  discovering  some  mechanical 
explanation  for  the  condition.  The  method  he 
adopted  was  to  cut  out  a  portion  of  the  gut, 
which  included  the  caecum  and  the  appendix, 
from  the  cadaver,  of  a  subject  who  had  died  of 
some  affection  not  connected  with  the  intestine. 
After  washing  the  excised  bowel,  he  placed  in  its 
lumen  various  objects,  such  as  beans,  peas,  and 
shot,  and  then  shook  and  rolled  the  intestine  about 
in  imitation  of  peristaltic  movement.  Although 
he  used  considerable  force,  n^ne  of  the  objects 
entered  the  cavity  of  the  appendix.  He  then  pro- 
ceeded to  blow  out  the  bowel  with  gas,  keeping  the 
peas  and  beans  still  in  the  lumen,  and  when  the 
inflation  was  complete,  he  proceeded  to  carry  out 
the  same  shaking  and  rolUng  process.  In  nine  out 
of  ten  experiments  he  found  that  the  appendix 
became  filled  with  shot,  whilst  in  two  even  peas 
entered  the  cavity.  The  only  case  in  which  the 
shot  did  not  enter  freely  was  one  in  which  the 
appendix  was  hypertrophied  and  had  a  stricture 
of  the  lumen,  and  even  in  this  instance  one  small 
shot  found  its  way  in.     It  would  seem,  therefore. 


that  flatulence  would  be  very  likely  to  be  a  pre- 
disposing cause  of  appendicitis,  and  that  the 
blowing  up  the  cavity  of  the  appendix  with  intes- 
tinal gas  would  enable  portions  of  faeces  and  foreign 
bodies  to  gain  access  to  it.  If  this  be  indeed  the 
case,  it  may  prove  possible  to  avert  threatened 
attacks  of  appendicitis  by  diet  and  drugs,  but 
till  something  more  definite  is  known,  one  must 
be  content  to  follow  the  old  course. 


The  Diafirnosis  of  Beri-beri* 

In  view  of  the  recent  outbreak  of  beri-beri 
which  has  occurred  among  the  Chinese  labourers 
imported  into  South  Africa,  a  correspondent  has 
written  to  the  Times  enclosing  an  extract  from 
the  address  delivered  by  Sir  Patrick  Manson  at 
St.  George's  Hospital  on  October  ist,  1897,  in 
which  the  need  for  post-graduate  instruction  in 
Tf^ipl^aljiicdicine  was  eloquently  brought  forward. 
T^s^bQ^^^^Uater  the  London  School  of  Tropical 
Medicinr'y A  founded,  mainly  through  the  instru- 
meniality  ^Vhe  Right  Hon.  Joseph  Chamberlain, 
antt  W  caniection  with  the  Seamen's  Hospital 
Society ;  ^Wb  institution  has  played  a  most  im- 
*^*f\i.tiij^i  in  the  education  of  medical  men  in 
diseases.  This  fact  would  seem  to  have 
been  forgotten  by  the  writer  of  the  letter,  for  he 
points  out  that  beri-beri  is  common  in  the  port  of 
London,  and  implies  that  a  correct  diagnosis  is 
seldom  made.  Were  there  no  opportunities  for 
seeing  the  disease  and  of  receiving  instruction  as 
to  its  clinical  and  pathological  features  such  an 
implication  would  be  justified,  but  now  that  there 
are  two  schools  of  tropical  medicine  in  this  country 
there  is  no  particular  reason  why  all  medical  prac- 
titioners should  not  have  a  nodding  acquaintance 
with  the  malady.  Difl&culty  of  recognition  is 
most  apt  to  occur  when  the  disease  appears  in  a 
sporadic  fashion,  for  then  it  is  only  the  more 
prominent  symptoms  which  are  especially  noted, 
such  as  heart  disease,  dropsy,  or  peripheral 
neuritis.  The  presence  of  the  last-mentioned  sym- 
ptom, when  due  to  maladies  other  than  beri-beri, 
is  liable  to  be  confounded  with  that  affection. 
The  three  forms  of  the  disease  recognised  by 
Cantlie,  the  wet,  dry,  and  mixed,  are  not  always 
separated  one  from  the  other,  but  the  mixed 
variety  is  that  most  usually  encountered.  The 
presence  of  oedema  Umited  to  the  front  of  the  shins, 
the  absence  of  knee-jerks,  the  existence  of  a  patch 
of  anaesthesia  on  the  inner  side  of  the  calves, 
combined  with  some  evidence  of  heart  weakness, 
would  lead  one  to  suspect  beri-beri  in  any  given 
patient. 

PERSONAL. 


The  Queen  has  presented  a  signed  engraving  of 
herself  to  the  Royal  University  of  Ireland,  through  the 
Chancellor  of  the  University,  the  Earl  of  Meath.  Her 
Majesty  is  an  Honorary  Graduate  of  the  Royal  Uni- 
versity. 

His  Majesty  the  King,  accompanied  by  the  Queen, 
on    the    5  th    inst.    proceeded   in   semi-state    to     St. 


July  13,   1904- 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.     51 


Bartholomew's  •Hospital,  when  he  laid  the  founda- 
tion stone  of  the  new  additions  to  the  presenc  struc- 
ture. 


Mr.  E.  B.  I'Anson.  the  architect  of  the  new  building, 
Tiad  the  honour  of  a  special  presentation  to  His  Majesty 
iDfimediately  before  the  laying  of  the  foundation  stone. 

His  Majesty  the  King  presented  ;f  1,000  to  the 
Building  Fund. 


Her  Majesty  the  Queen  was  presented  with  th^ 
first  lady  governorship  granted  by  St.  Bartholomew's- 

W.  H.  Clayton-Greene,  B.A.,  M.B.,  B.C.Cantab., 
F.R.C.S.Eng.,  has  been  appointed  su|>emumerary 
rsurgeon  in  charge  of  out-patients  to  St.  Mary's  Hos- 
pital, Paddington. 


Professor  John  Shoemaker,  the  distinguished 
American  physician,   was  recently   presented   with  a 

•silver  shield  and  a  silver  loving  cup  by  the  Medico- 
Chirurgical  College  of  Philadelphia  at    a    celebration 

•of  the  thirtieth  anniversary  of  his  entrance  into  the 
medical  profession.  A  brilhant  function  was  held  in 
the  college,  with  the  foundation  and  the  development 

•of  which  Dr.  Shoemaker  has  been  intimatelv  connected. 


The  Wightman  Lecture  of  the  Society  for  the  Study 
•of  Disease  in  Children  will  be  delivered  at  the  Hotel 
Cecil  on  July  15th,  at  6.30  p.m.,  by  Mr.  R.  Clement 
Lucas. 


The  Marquis  of  Londonderry,  as  President  of  the 
Board  of  Education,  on  the  nth  inst,  received  a  medical 
•deputation  in  favour  of  the  compulsory  teaching  of 
hygiene  and  temperance   in  public  elementary  schools. 


The  Royal  College  of  Physicians  of  London  has 
announced  the  following  lecturers  for  1905  : — Dr.  \V.  C. 
Bosanquet  as  Goulstonian  lecturer  ;  Dr.  W.  H.  AUchin 
as  Lumleian  lecturer ;  Dr.  Norman  Moore  as  Fitz- 
Patrick  lecturer ;  Dr.  Leonard  E.  Hill  as  Ohver- 
Sharpey  lecturer  ;  and  Dr.  W.  H.  R.  Rivers  as  Croonian 
lecturer. 


The  Earl  of  Derby,  as  Chancellor  of  the  University 
•of  Liverpool,  early  in  the  present  month  presided  at 
the  first  public  conferring  of  degrees  of  that  university, 
and  was  himself  presented  for  the  honorary  degree  of 
CC.L. 


Dr.  Loudini  was  recently  entertained  at  a  public 
dinner  and  presented  with  a  purse  of  gold  by  the  Liver- 
pool University  Association,  on  the  occasion  of  his 
assumption  of  the  office  of  Bursar  of  the  University. 

We   regret    to   announce    that    Mr.    F.    A.    Barton. 

M.R.C.S.,   the  well-known  expert  in  airship  matters, 

met  with  a  serious  accident  last  week  owing  to  the 

•explosion  of  a  gas  cylinder  while  engaged  in  filling  his 

balloon.      From  latest  accounts  he  is  doing  well. 

Dr.  James  Wallace,  on  the  occasion  of  his  departure 
from  Stonehaven,  has  been  presented  with  a  silver 
tea-tray  by  his  numerous  friends  and  patients. 

Mr.  Walter  C.  C.  Pakes,  M.R.C.S.,  has  received  a 
'handsome  presentation  in  recognition  of  his  services  as 
medical  officer  of  health  to  the  Rand  Plague  Com- 
mittee, a  post  which  he  has  recently  resigned. 

Mr.  Clement  Lucas  presided  at  the  biennial  festival 
•dinner  of  Guy's  Hospital  Medical  College  held  on  the 
•5th  inst.  at  the  H6tel  Metropole,  London. 


Professor  George  Gaffky,  who  has  left  his  Pro- 
♦fessorship  at  Giessen  to  succeed  Professor  Koch  at 
Berlin,  was  one  of  Koch's  earliest  assistants,  and 
.accompanied  him  on  the  cholera  expedition  of  1883-84. 


THE  NEWLY-ELECTED  PRESIDENT  OF  THE 
R.C.S.L 
Mr.  Arthur  Chance,  F.R.C.S.L,  Vice-President, 
who  succeeds  Sir  I^mbert  Ormsby,  President  of  the 
Royal  College  of  Surgeons,  Ireland,  has  filled  the  posts 
of  Surgeon-in-Ordinary  to  the  Lord  Lieutenant  of 
Ireland  and  Examiner  in  Surgery  to  the  College.  He 
is  Surgeon  to  the  Mater  Misericordiae  and  to  the  Dublin 
Orthopaedic  Hospitals,  and  consulting  surgeon  to  the 
St.  Michael's  Hospital.  Our  portrait  is  from  a  photo- 
graph by  F.  P.  D'Arcy,  Dublin. 


Special  corrcdponDence* 

[from  our  own  correspondent.] 


SCOTLAND. 

Fire  in  the  Edinburgh  Royal  Infirmary. — 
Considerable  damage  was  done  in  the  Pathological 
Department  of  the  Infirmary  by  a  fire  which  occurred 
on  July  4th,  shortly  after  midday.  Dr.  Shennan,  the 
pathologist,  was  engaged  on  a  post-mortem  examina- 
tion at  the  time,  and  the  alarm  was  given  by  molten 
lead  dropping  through  the  ceiling  of  the  theatre,  which 
was  occupied  by  students.  The  room  above,  used  as  a 
pathological  laboratory,  was  discovered  to  be  in  flames, 
and,  notwithstanding  the  efforts  of  the  Infirmary 
brigade  and  the  city  fire  brigade,  the  whole  upper 
storey  of  the  building  was  gutted,  damage  to  the  extent 
of  about  ;fi,ooo  being  caused,  besides  the  loss  of  much 
valuable  pathological  material.  The  fire  is  believed  to 
have  been  caused  by  an  electric  wire  fusing,  and  the 
only  reason  why  it  assumed  such  serious  dimensions 
was  an  inadequate  water  supply.  This  was  a  matter 
of  strong  complaint  at  the  usual  managers*  meeting 
held  in  the  afternoon,  and  it  was  decided  to  com- 
municate with  the  V^'ater  Trust  on  the  matter.  The 
Pathological  Department  is,  of  course,  quite  isolated 
from  the  rest  of  the  hospital,  but  if  a  fire  took  place  in 
the  main  building  the  defective  water  supply  might 
easily  have  more  serious  consequences  than  in  this 
instance.  The  laboratory  of  the  Royal  College  of 
Physicians  has  been  placed  at  the  disposal  of  the  In- 
firmary pending  the  restoration  of  their  own. 

Presentation  to  Professor  Hepburn,  Cardiff. — 
The  eighteenth  annual  dinner  of  the  Edinburgh  Com- 
pany R.A.M.C.  Volunteers  was  made  the  occasion  of  a 
presentation  to  the  former  commanding  ofl&cer,  Surgeon- 
Major  Hepburn,  who,  during  so  many  years  of  his  work 


52    Thb  Medical  P&bss. 


CORRESPONDENCE. 


July  13.  igtH- 


in  Edinburgh,  took  the  deepest  interest  in  the  welfare 
of  the  corps.  The  presentation  took  the  form  of  a 
gold  watch,  and  was  subscribed  for  by  former  members 
of  the  company  all  over  the  world.  In  a  felicitous 
speech,  Lieutenant  Waterston,  the  commanding  ofl&cer, 
expressed  the  warm  feelings  of  regard  which  all  the 
past  and  present  members  of  the  company  felt  for 
Professor  Hepburn.  Between  seventy  and  eighty 
members  of  the  company  were  present,  among  the 
guests  being  Colonel  Hughes,  D.S.O.,  R.A.M.C.,  the 
P.M.O.  Scottish  District,  Major  Scott,  R.A.M.C.,  and 
Mr.  C.  W.  Cathcart,  the  first  commanding  ofl&cer  of 
the  Edinburgh  Company. 

Corredpon^ence* 

[Wc  do  not  hold  ourselvee  responsible  for  the  opinions  of  our  Cor- 
respondents].  !^ 


SANITARY  AND  BUILDING  BYE-LAWS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Your  correspondent,  "  Modemus,"  must  be  of 
a  particularly  sanguine  temperament  if,  with  any 
knowledge  of  the  Local  Government  Board,  its  bye- 
laws,  and  their  administration  by  local  authorities,  he 
imagines  the  refinements  of  sanitation  he  suggests  are 
likely  ever  to  be  adopted  and  put  in  force.  Very 
few  municipalities  strictly  enforce  the  present  model 
bye-laws,  which  they  almost  all  adopt ;  and  where  the 
council,  urban  or  rural,  as  often  happens,  is  composed 
of  or  dominated  by  mean,  ignorant,  and  vulgar  men — 
small  tradesmen  and  jerry  builders — they  do  not  enforce 
any  which  seem  irksome  to  their  interests  or  those  of 
their  friends.  Medical  ofl&cers  of  health  are  here,  as  in 
so  many  other  directions,  practically  powerless.  They 
may  point  out  quietly  to  the  sanitary  committee  the 
iniquity  of  disregarding  essential  measures  for  the 
prevention  of  disease;  but  they  are  the  servants 
of  the  authority,  and  it  is  as  much  as  their 
place  is  worth  to  raise  any  public  protest  against  even 
the  most  glaring  of  abuses.  The  great  bulk  of  the 
public  know  little  and  seem  to  care  less  about  local 
government.  There  exists  almost  complete  lack  of 
local  patriotism  in  this  regard  throughout  the  country. 
Men  of  position  and  intellect  as  a  rule  refuse  to  take 
any  part  in  local  government.  They  will  not  offer 
themselves  as  candidates  for  membership  of  councils, 
nor  take  any  active  steps  in  putting  fit  men  on.  Demo- 
cratic institutions  cannot  be  administered  to  full 
advantage  unless  all  intelligent  citizens  take  a  due 
interest  in  their  working.  The  present  apathy  forms 
a  danger  to  the  nation.  Even  in  Londop  not  more 
than  40  per  cent,  of  the  burgesses  could  be  induced  to 
vote  at  the  last  County  Council  election.  There  exists 
in  England  very  little  of  the  municipal  corruption  such 
as  disgraces  the  United  States  ;  but  a  very  great  part 
of  the  legislation  which,  if  energetically  enforced,  would 
bring  the  country  into  a  position  relatively  of  vast 
sanitary  improvement  is  now  either  altogether  neg- 
lected or  only  carried  out  in  a  partial  and  ineffective 
fashion. 

I  am.  Sir,  yours  truly, 
July  7th,  1904.  M.  O.  H. 

LUNACY— A   PRACTICAL   DEFINITION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— Although  I  have  not  the  advantage  of  your 
correspondent  "  R.  L."  in  legal  training,  he  will 
excuse  me  saying  that  his  letter  scarcely  touches  mine 
except  when  he  refers  to  my  having  incidentally 
adopted  the  perhaps  not  very  graceful  expression  of 
"a  bullying  counsel;"  and  I  cannot,  moreover,  quite 
agree  with  him  if  he  thinks  the  millennium  has  quite 
arrived  amongst  gentlemen  at  the  bar,  as  it  is  proverbi- 
ally whispered  that  when  a  counsel  has  no  leg  to  stand 
upon  he  resorts  to  the  practice  of  "  bullying "  his 
opponent. 

Your  correspondent  in  his  letter,  June  22nd,  calls 
attention  to  what  appears  to  me  the  indefiniteness  of 
insanity  and  quotes  the  evidence  of  Dr.  Distin  and  his 
vague  opinion  expressed  in  court,  viz,,  "  the  man  was  a 


criminal  lunatic,  but  that  it  was  one  of  those  cases  where 
they  could  not  certify  insanity"  ;  and  in  my  reply  I  sup- 
plemented this  by  reciting  a  case  of  a  medical  witness 
who  informed  a  Counsel  that  it  would  take  two  days 
(or  to  that  effect)  to  formulate  a  definition,  so  on  the 
face  of  all  this  I  ventured  to  suggest  **  a  morbid  con- 
dition of  mind  requiring  supervision"  as  a  likely- 
definition.  Your  correspondent  does  not,  I  note,  criti- 
cise my  definition,  neither  does  he  offer  one  of  his  own; 
but  on  the  other  hand,  strange  to  say,  he  appears  now 
neither  to  acquiesce  with  Dr.  Distin  because  he  adds — 
"  In  such  a  case  as  the  Archdeacon's  brother  a  lawyer 
would,  perhaps,  take  the  view  that  other  people  can  be 
left  to  take  care  of  themselves  till  crime  has  brought 
the  lunatic  within  reach  of  the  law."  Surely,  "  R.  L." 
would  not  endorse  the  view  of  leaving,  say,  a  homicidaT 
or  suicidal  patient,  or  tending  that  way,  to  take  care 
of  himself  till  a  crime  was  committed ;  if  not»  what 
relevance  is  there  in  making  this  remark  ? 

Now,  sir,  I  apprehend  that  the  law  takes  cognisance 
of  insanity  in  its  criminal  and  civil  code,  and  consti- 
tutes itself  the  guardian  of  an  insane  person  only  in  one 
sense,  and  that  is  so  far  as  the  liberty  or  freedom  of 
action  of  any  individual  is  concerned ;  so  that  to  con- 
ceive and  differentiate  any  practical  definition  of 
insanity,  we  must  take  care  as  far  as  possible  to  conform 
to  and  limit  such  definition  to  the  ideas  which  the  law^ 
entertains  on  the  subject — i.e.,  liberty. 

In  a  letter  in  your  columns  a  short  time  ago  I 
defined  insanity  in  its  broadest,  logical  and  most 
comprehensive  area  as  *'  a  greater  or  less  deviation 
from  reason  "  ;  but  if  is  obvious  that  such  a  wide  defini- 
tion would  embrace  all  minds  and  delusions  the  outcome 
of  feeble  judgment  and  defective  reasoning  powers 
which,  although  these  weaknesses  might  render  such 
minds  unfavourable  competitors  in  the  battle  of  life, 
nevertheless  would  be  insufficient  to  convince  a  jury 
of  the  necessity  for  legal  supervision,  neither  do  we  wish 
to  convince  them  in  such  cases.  On  the  other  hand  we 
have  to  show,  on  a  lunacy  certificate  supplied  to  us  by 
law,  from  our  own  observation  and  from  hearsay  evi- 
dence, that  degree  oi  "  morbid  condition  of  mind  requir- 
ing supervision"  and  to  substantiate  such  certifi- 
cate in  a  law  court  if  need  be,  I  know  not  what 
your  correspondent  thinks  of  my  definition,  and  it  is 
open  to  anyone  to  improve  upon  it  or  furnish  a  better. 
However,  it  is  certain  that  when  a  medical  witness 
proffers  evidence  on  insanity  in  a  court  and  he  is 
asked  the  abstruse  question,  "What  is  insanity?" 
he  should  be  armed  to  the  teeth  with  some  answer, 
however  simple,  which  may  appeal  to  and  satisfy  the 
commonsense  and  intelligence  of  an  English  jury. 
I  am,  sir,  your  truly, 

Brighton,  July  7th,  1904.         Clement  H.  Sers;. 

THE  MIDWIVES'  INSTITUTE. 

We  have  received  from  the  secretary  of  the  Midwives" 
Institute,  and  also  from  Messrs.  Brown,  Ringrose,  and 
Lightbody,  letters  repeating  the  denial  of  the  appear- 
ance on  the  agenda  paper  of  the  former  body  of  a  paper 
called  "  Malthusianism,  or  Tired  Ovaries."  The 
second   letter  contains   the  following  paragraphs : — 

"  Our  clients,  the  Incorporated  Midwives'  Institute 
have  consulted  us  with  regard  to  the  statements  con- 
tained in  the  leading  article  headed  '  The  Lifting  of 
the  Veil,'  in  your  issue  of  June  8th  last,  and  in  your 
comment  at  the  foot  of  the  Institute's  secretary's  letter 
to  you  as  in  your  issue  of  June  29th  last. 

"  The  statements  contained  in  the  leading  article  of 
which  the  Institute  complain  have  been  already  clearly 
indicated  in  their  secretary's  letter  to  you  above  re- 
ferred to,  and  in  her  further  letter  to  you  of  June  30th 
last,  of  which  we  are  instructed  you  have  taken  no- 
notice.  Further,  the  secretary's  letters  have  already 
amply  repudiated  as  untrue  the  statements  contained 
in  the  article  in  question.  We  therefore  consider  it 
unnecessary  to  explain  or  repudiate  same  further. 

"  The  further  statements  contained  in  your  comment 
above  referred  to,  viz.,  that  the  writer  of  the  leading 
article  saw  an  agenda  paper  purporting  to  come  from 
the  Midwives'   Institute  containing   the   title  of  the 


July  13,   1904 


MEDICAL  NEWS. 


The  Mbdical  Press.    53 


paper  as  given  in  the  leading  article,  and  stating  that 
•such  paper  was  down  for  the  next  meeting  of  that 
Institute,  however,  gives  our  clients  still  further  cause 
for  complaint,  as  it  is,  we  are  instructed,  absolutely 
untrue  that  any  such  paper  was  ever  put  down  on  any 
agenda  of  the  Incorporated  Midwives'  Institute. 

'•  It  would  appear,  however,  from  a  record  of  the 
proceedings  of  the  Midwives'  Society  (of  Manchester  ?) 
for  December  2nd,  1897,  that  a  paper  with  the  title 
referred  to  in  the  leading  article  was  then  read  before 
that  Society.  Our  clients  cannot  believe  that  either  the 
writer  of  the  leading  article  or  you  yourself  could  through 
ignorance  thus  confuse  the 'name  or  proceedings  of 
The  Incorporated  Midwives'  Institute  of  London 
with  those  of  The  Midwives'  Society  of  Manchester, 
the  latter  being,  we  are  instructed,  a  small  society 
•established  some  years  ago  at  Manchester  (whether 
now  existing  our  clients  are  unaware) ;  but  they  very 
strongly  object  to  their  Institution  being  confused  in 
:any  way  with  the  Society  referred  to." 

We,  of  course,  accept  this  explicit  disclaimer,  but 
we  would  point  out  that  a  similar  doubt  to  that  which 
makes  our  correspondents  add  (of  Manchester  ?)  to 
the  title  of  the  Midwives'  Society  is  possibly  responsible 
for  the  confusion  which  is  stated  to  have  occurred  in 
-our  case  between  the  "  Midwives'  Institute  "  and  the 
■"  Midwives'  Society."  The  agenda  paper  in  question 
was,  to  our  knowledge,  sent  to  a  nurse,  as  an  induce- 
ment and  with  an  invitation  to  join  the  Midwives' 
Institute  or  Society.  We  were  distinctly  under  the 
impression  that  the  invitation  came  from  the  former 
"body,  but  as  one  society  would  be  most  unlikely  to 
•enclose  the  agenda  paper  of  another  unless  there  was 
a  very  close  connection  between  the  two,  we  have 
l^leasure  in  accepting  our  correspondents'  repudiation. 
Will  they  in  return  inform  us  if  the  "  Incorporated 
Midwives'  Institute  "  was  absorbed  or  is  in  any  way 
^connected  to  or  affiliated  with  the  "  Midwives' 
Society  ?  "—Ed. 

MR,  JOHN  BIRKETT. 
We  regret  to  announce  the  death  of  Mr.  John 
Birkett,  at  his  residence,  Sussex  Gardens,  Hyde  Park, 
London,  on  the  6th  inst.,  in  his  ninetieth  year.  He 
was  educated  at  Guy's  Hospital,  and  in  Paris,  and 
admitted  a  member  of  the  Royal  College  of  Surgeons, 
England,  in  1837,  elected-  an  honorary  Fellow  in  1844, 
and  Jacksonian  prize  winner  for  1848.  He  was  surgeon 
and  lecturer  on  surgery  at  Guy's  Hospital  and  sub- 
sequently consulting  surgeon;  examiner  in  surgery 
to  the  Royal  College  of  Physicians,  London,  Hunterian 
Professor  of  Surgery  and  Pathology,  and  examiner  in 
surgery  to  the  University  of  London,  and  for  many 
years  Government  Inspector  of  Anatomy  in  England 
and  Wales.  Mr.  Birkett  was  also  president  of  the 
Royal  College  of  Surgeons,  England,  a  Fellow  of  the 
Royal  Medical  and  Chirurgical  Society,  and  of  the 
-Medical  Society  of  London. 


AeDfcal  Views* 


Ppize  Day  at  Guy*s  Hospital. 
The  distribution  of  prizes  to  the  successful  students 
•of  the  Guy's  Hospital  Medical  School  took  place  on 
July  6th.  at  the  Hospital.  The  prizes  were  presented 
by  Lord  Goschen  and  among  the  medallists  and 
prizemen  were  S.  J.  Darke,  who  gained  the  ;£ioo  open 
scholarship  in  Arts.  H.  A.  Sanford  was  awarded  the 
£150  open  scholarship  in  science,  and  C.  W.  Greene 
took  the  £$0  scholarship  for  university  students. 
Lord  Goschen  in  his  address  expressed  admiration 
at  the  progress  made  in  scientific  research,  and  pointed 
out  that  further  research  and  study  were  required  to 
•open  up  the  Hinterland  of  the  unknown  in  medical 
science.  All  students,  however,  could  not  be  scientific 
investigators,  the  country  must  have  general  practi- 
tioners as  well.  He  warned  his  hearers  that  the 
medical  student  from  his  earhest  education  and  work  | 
necessarily  dealt  with  facts  and  the  material  aspects 


of  nature,  so  that  he  had  reason  to  guard  himself 
against  materialistic  influences.  There  was  anothe. 
danger,  and  that  was  from  the  moral  point  of  view. 
The  close  and  constant  contact  with  the  darker  side 
of  human  nature — ^with  sin,  crime,  and  disease — might 
lead  a  medical  man  to  become  pessimistic,  but  he 
urged  them  to  hold  to  their  faith  in  human  nature 
and  to  hold  high  the  standard  of  honesty.  The  garden 
party  held  afterwards  in  the  Hospital  gardens  was 
attended  by  over  3,000  people,  and  the  gathering 
proved  a  brilliant  success. 

Th9  Nopth-Bast  London  Cltnleal  Society. 

The  annual  dinner  of  the  above  Society  was  held  on 
Friday,  July  8th,  1904,  at  the  Great  Eastern  Hotel, 
Liverpool  Street.  The  President,  Dr.  J.  W.  Hunt, 
occupied  the  Chair.  Among  those  present  were  Dr. 
F.  de  Havilland  Hall,  Dr.  A.  T.  Davies,  Mr.  Langton, 
and  Mr.  L.  H.  G.  Kerr.  In  replying  to  the  toast  of 
•*  The  Society,"  Dr.  R.  Murray  Leslie,  the'president- elect 
for  the  ensuing  session,  remarked  that  the  North-East 
London  Clinical  Society  differed  in  many  respects  from 
other  London  medical  societies,  in  that  the  meetings 
were  held  during  the  afternoons,  which  had  been  found 
to  be  the  most  convenient  time  for  the  great  majority 
of  busy  practitioners.  He  also  referral  to  the  ex- 
cellence of  the  clinical  material,  and  to  the  free  dis- 
cussions which  characterised  the  meetings.  He  hoped 
that  members  would  avail  themselves  of  the  oppor- 
tunities which  were  extended  to  them  of  attending  the 
lectures  to  be  delivered  at  the  North- East  London 
Post-Graduate  College,  for  issuing  which  invitation  he 
had  the  authority  of  the  Dean,  Dr.  A.  J.  Whiting.  A 
good  musical  programme  was  provided,  and  altogether 
the  members,  together  with  their  lady  friends,  spent  a 
most  enjoyable  evening. 

The  Oxysren  Hospital. 

H.R.H.  Princess  Louise,  as  patron  of  this  institu- 
tion, attended  the  annual  meeting  last  week  in  Fitzroy 
Square,  at  which  many  members  of  the  committee  and 
other  supporters  were  present.  Mr.  Burdett-Coutts 
occupied  the  chair,  and  urged  the  great  need  of  further 
financial  support.  A  sum  of  between  ;£70O  and  ;£8oo 
was,  he  said,  needed  for  immediate  requirements,  and 
upon  a  very  slender  income  the  hospital  was  fulfilling 
a  really  valuable  work  of  scientific  and  pathological 
research.  A  vote  of  thanks  to  Her  Royal  Highness 
was  moved  by  Mr.  J.  B.  Lonsdale,  M.P.,  and  seconded 
by  Dr.  Stoker,  who  said  that  he  first  derived  the  idea 
of  using  pure  oxygen  from  the  Zulus,  who  exposed 
their  wounds  or  injuries  to  the  fresh  air  and  sunshine 
of  the  hills  and  uplands  with  frequent  gratifying  results. 
Royal  College  of  Surgeons  in  Ireland.— Prize  List, 
Summer  Session,  1904. 

Barker  Anatomical  Prize. — £$1  los.,  C.  Cooper. 

Mayne  Scholarship.— -£1$,  A.  N.  Crawford. 

Carmichael  Scholarship. — £1$,  J-  Prendiville. 

Gold  and  Silver  Medals  in  Operative  Surgery. — Gold  : 
J.  S.  Dunne.  Silver  :  P.  D.  Sullivan  and  J.  C.  Murphy 
(equal). 

Stoney  Memorial  Gold  Medal  in  Anatomy. — J. 
Prendiville. 

Practical  Histology.— H.  C.  Garden,  first  prize  {£2) 
and  medal ;  D.  Adams,  second  prize  {£1 )  and  certificate. 

Practical  Chemistry.— 1^.  H.  F.  Taaffe,  first  prize  {£2) 
and  medal;  F.  C.  Warren,  second  prize  {£1)  and 
certificate. 

Public  Health  and  Forensic  Medicine. — ^M.  Cohen, 
first  prize  {£2)  and  medal ;  T.  H.  Massey,  second  prize 
{£1)  and  certificate. 

Materia  Medica.—F.  C.  Warren,  first  prize  {£2)  and 
medal;    J.  B.  Kelly,  second  prize  {£1)  and  certificate. 

Biology.—].  C.  S.  Day,  first  prize  {£2)  and  medal ; 
T.  C.  Boyd  and  H.  W.  White  (equal),  second  prize  {£1) 
and  certificate. 

The  winter  session  will  commence  in  October. 
Prospectus  now  ready. 

Doctor's  Death  fk*om  Plague. 

News  of  the  death  of  Dr.  Noel  Unsworth,  Cairo,  is 
to  hand.  He  took  an  active  part  in  combatting  the 
cholera  epidemic  of  1902,  and  had  subsequently  been 
engaged  on  plague  duty  in  the  delta  for  the  Sanitary 
Department.  He  contracted  bubonic  plague  three  days 
before,  and  died  last  Sunday  morning. 


54       The  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


^^icw  to 
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TRIALS  OF  MEDICAL  MEN. 
The  following, according  to  the  Captam^  are  some  of  the  sweets  of 
a  doctor's  life  :— If  he  goes  to  Church  reguUrly.  it  is  because  he 
has  nothing  else  to  do ;  if  he  does  not  go,  it  is  because  he  has  no 
respect  for  the  Sabbath  or  religion.  If  he  has  a  good  carriage,  he  is 
extravagant ;  if  he  uses  a  poor  one,  on  the  score  of  economy,  he  is 
deficient  in  necessary  pride.  If  he  visi  s  his  patients  every  day,  it  is 
to  run  up  a  bill ;  if  he  does  not.  it  is  unjustiflable  negligence.  If  he 
says  anything  about  religion,  he  is  a  hypocrite ;  if  he  does  not.  he  is  an 
infidel.  If  he  uses  any  of  the  popular  remedies  of  the  day,  he 
indulges  the  whims  and  prejudices  of  the  people  to  fill  his  pockets ; 
if  he  does  not  use  them,  it  is  from  professional  selfishness.  If  he  is 
in  the  habit  of  having  counsel  often,  it  is  because  he  knows  nothiog; 
if  he  objects  to  have  it,  on  the  ground  that  h<9  understands  his  own 
business,  he  is  afraid  of  ezposii  g  his  ignorance  to  his  superiors.  If 
his  horse  is  fat,  it  is  because  he  has  nothing  to  do  :  if  it  is  lean,  it  is 
because  itdoesD'tget  enough  to  eat.  If  he  drives  fast  it  is  to  make 
the  people  think  somebody  is  verv  ill ;  if  he  drives  slow,  he  takes  no 
interest  in  the  welfare  of  his  patients.  Finallv,  if  he  gets  paid  for 
one  hiUf  of  his  services,  he  has  the  reputation  of  being  a  great 
doctor.  "  M.  U." 

A  CRRorroR  suing  a  doctor  in  the  Clerkenwell  County  Court 
mentioned  that  the  debt  was  "  f or  a  pair  of  trousers  to  bury  the 
doctor's  wife  in.'*  Visibly  startled,  the  Judge  exclaimed, "  Surely 
burial  reform  has  not  come  to  that  yet." 

AN  OFT  REPEATED  EPIGRAM. 

Tiis  following  epigram  was  quoted  by  Dr.  Hutchinson  in  a  debate  on 

the  Licensing  Bill  in  the  House  of  Commons.    It  can  hardly  be  said 

to   be  a4  rtm  to  the  discussion,  and  was   moreover    incorrectly 

reported.    It  should  run  thus  :— 

« *  God  and  the  Doctor  we  alike  adore, 
But  only  when  in  danger,  not  before  ; 
The  danger  past,  both  are  alike  requited, 
God  is  forgotten,  and  the  Doctor  slighted." 
FnnfBUROH  Studritt.— We  have  seen  no  announcement  of  a  new 
edition  cf  the  book  referred  to  and  think  another  is  unlikely  Just 

^     *  THE  CENTRAL  inDWIVES'  BO^RD. 

Wr  understand  that  the  resolution  at  the  last  meeting  reported  in 
our  issue  for  July  8th  that  "  registered  members  of  the  medical 
profession  only  be  eligible  for  appeintment  as  examiners  under  the 
Central  Midwives'  Board  *'  was  not  carried  :  Dr.  Japp  Sinclair,  Dr. 
Ward  Cousins,  and  Mr.  Parker  Young  voting  for  ;  and  Dr.  CuUL-:g- 
w  orth.  Miss  Wilson,  Miss  Oldham,  and  Miss  Paget  against  it. 


cPleetxngB  of  the  ^tsdt\xt%,  "fxtivxtz,  ict. 

Wrdhisdat,  July  ISth. 

D  RRMATOLOGiCAL  SociRTT  OK  LoNDOH  (11  Chaod  06  Street,  Caveu- 
dish  Square.  W. )  .^6.1 5  p.m.    Demonstration  of  Cases  of  Interest. 

Mrdical  Oraduatm*  Oollegr  AMD  PoLYCUHic  (2S  Chenles  Street, 
W.C  ).-  4  p.m.     Mr.  L.  Cheatle  :  Clinique.      iSurgical.)    6.15  p.uL 
Dr.  8.  Ttiylor :  Hemoptysis  and  its  Treatment. 
Tbursdat,  July  14th. 

Thr  BRrnsn  Gtwjbcolooical  Socirtt  (20  Hanover  Square.  W.).— 
Specimens,  Mr.  Christopher  Martin:  (1)  Bone  Crochet  Hook 
removed  from  the  Abdominal  Cavity.  (2)  Two  specimens  shoning 
Arrested  Development  of  the  Uterus.  Dr.  Macnaughton -Jones : 
(1)  Specimen  illustrating  the  Relation  of  Hydrosalpinx  to  Accessory 
Fallopian  Tubes,  with  notes.  (2)  Specimens  of  Adnexal  Tumours 
bearing  on  the  question  of  Hysterectomy.  (S)  Adnexal  Sections 
with  the  Epidiascope.  Mr.  Bowreman  Jessett :  (1 )  Removal  of 
Large  Fibro-Cvstic  Tumours  by  Abdominal  Hysterectomy,  followed 
by  gangrene  of  the  Right  Leg.  (2)  Uterus  removed  by  Ab(*ominal 
Hysterectomy  ^ith  large  Sub-mucous  polypi  Interstitial  Fibroid, 
and  Sub-peritoneal  Fibroids.  Dr.  Jervois  Aarons:  A  new  Uterine 
Mop. 

MXUROLCOICAL  SOCISTT  OP   THR     UVITRD    KlXODOM     (11     ChandOS 

street.  Cavendish  Square,  W.).— 8  p.m.  Clinical  Meeting.  Exhibition 
of  Cases  of  Myelopathic  Muscular  Atrophy. 

Mrdical  Graduatrs'  Collror  avd  Poltclinxc  (22  Chenies  Street, 
W.C.).— 4  pm.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  5.16  p.m. 
Dr.  S.  Taylor  :  Bspmoptysisand  its  Treatment. 

MouBT  Vrritoh  HoBPrrAL  por  Cohscjmption  ard  Disrasrs  of  thr 
Chist     (7  Fitsroy    Square,  W.)— 6   p  m.    Dr.  F.   Price  :    Aortic 
stenosis  (iUustrated  by  cases).   (Post  Graduate  Course.) 
Friday,  July  15th. 

SociRTY  FOR  TDR  STUDY  OP  DisRASR  IN  Childrrh  (Victoria  Hall, 
Hotel  Cecil).— 6.30  p.m.  Mr  R.  C.  Lucas  :  The  Hereditary  Bias  and 
Early  Environment  in  their  ReUtion  to  the  Disease  and  Defects  of 
Children .    ( Wightman  Lecture. ) 


July  13.  1904. 


Borou^i  Asylum,  Canterbury. -Assistant  Medical  OfBoer.-fialair 

£140  per  annum,  with  furnished  quarters,  board,  and  laundrr 

A  ^/iS'^i*^* '?"',  ^  **>«  ^«*««^*  Superintendent.        '  ^^^ 

^  »£l'ir^*^  Asylum.-Aa8i8tant  Medical  Offlcer.-SahMr  £120  with 

SJw.'-  .    i?*1L*P2f*?*l°^' *'*^®"^^«»  "<*  washing.     AppU- 
cations  t^  the  Medical  Superintendent.  *^*^ 

City  of  Leeds  —Infectious  DifieaBes  Hospitals. -Second  Assistant 
Resident  Medical  Officer.  Salary  £120  a  year,  with  board 
hSSSf^f^nl  ^^'^^?\  Applications  to  the  Medical  Superl 
lutendent.  City  Hospitals,  Seaoroft,  Leeds. 

Brecon  and  Riuinor  Asylum,  Talgarth,  R.8.O.— Assistant  Medical 
2S:2'-  ,?^^^^  ^^^  F'  »°n"n^  ^-ith  furnished  apartments, 
board,  attendance,  and  laundry.  AppUcations  to  the  Medical 
Buperintendent. 

^®^^?^  National  Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Ventnor.-Senior  Resident  Medical  Officer.  Salary  £800* 
per  annum,  with  board  and  lodging  in  the  Hospital.  Appll- 
L^lidon  Secretary,  84  Craven  Street,    Cnaring  Ci^ 

Roy^  National  Hospitsl  for  Consumption  and  Diseases  of  the  Chest. 
Ventnor.-Two  AssistantResident  Medical  Officers.  Salary  SS 
per  annum,  with  board  and  lodging  in  the  Hospital.  Appliea^ 
tions  to  the  Secretary,  34  Craven  Stree t,. Charing  Croea,  London, 

Hereford  County  and  City  Asylum. -Senior  Assistant  Medical 
Officer.    Salary  £150  per    annum,  with  board,    lodging.  uMf 

Q^.,lt  ^7'  .Applications  to  the  Medical  Superintendent. 

Southwark  Union,  Ix>ndon.-  Second  Assistant  Medical  Officer, 
LjfrJi'^U^^B''^'**^^'^'*^^®  8-^-  S»'»ry  £100  per  annum: 
with  board,  lodging,  and  washing.  Applications  fci  Howaxtf 
Riwi  8E  Offices,  John  Street  West.  Blackfriai» 

Dorset  County  Hospital,  Dorchester.— House  Surgeon .—Sa'aryiloS 
per  annum.     AppMcations  to  W.  E.  Groves.  Valetta,  loenway. 

JlppoitttmeniB. 

^''^XvS'^*?*^^^?^  ••  ;-»<^-S.Eng.,  Surgeon  to  the  Western 
Ophthalmic  Hospital,  London. 

Claytom-Gbbekr,  W.  H.  M.B  ,  BC.Oantab.,  F.R.0.8 Eng  Saner- 
numerary  Surgeon  in  Charge  of  Out-patients  to  St.*  Mar?* 
Hospital.  Psddington.  ■' 

CovRTRifAY,  F.  W.  E..  L.R.C.P.,  L.R.C.a.  Medical  Referee  to  the 
'Rmpire  Guarantee  and  Insurance  Corporation,  Limited. 

Edmurds,  Edoar  Flrychrr,  M.B.,  B.S.Durb.,  Assistant  House  Sur- 
geon to  the  Rotherham  Hospital  and  Dispensary. 

Emmrrsok,  a.  T..  M.D.Toronto,  Clinical  Assistant  to  the  Ch^lsM 
Hospital  for  Women.  ^•«»— 

JoHRSTOir,  H.  Myj^MA;,  ,M.B..  BCh.,  Chief  Demonstrator  of 
Anatomy  m  Trinity  College,  Dublin. 

Mackrrzir,  Marior  R,  M.B.,  Ch.B.Edin.,  House  Surgeon  to  the 
East  End  Branch  of  the  <  hildren*s  Hospital.  Sheffield 

NiCHOLLs,  T.  J..  L.R.C.P.,  and  8  I.  House  Surgeon  to  Mercer's  Hos- 
pital, Dublin,  vifeTtr.  Willington  resigned.  ""^'^«  "" 

Palmrr,  Frrdrricr  S.,  M.D..  M.R.C.P..  Assistant  Physician  to  the 
West  End  Hospital  for  1  iseases  of  the  Nervous  System 

Prtrr,  Alasyair  Gordoh,  MB.,  Ch.B.Aberd..  Senior  House  SonreoD 
to  the  Great  Northern  Central  Hospital.  "'^wo 

ROWLRTTR,  Robery  Jamrs,  B.A.,  M.D.Dubl.,  AnKsthetist  to  the 
Incorporated  Dental  Hospitel  of  Ireland. 

Sasr.  Wilfrid.  M.R.C.8  ,  L.R.C.P.Lond..  Assistant  Annsthetlat  to 
the  Cancer  Hospital,  Brompton,  S.  W. 

Syriihrn,  W.,  B  a..  M.B.Toronto.  Clinical  Asiiitant  to  the  C helsea 
Hospital  for  Women^ 


J^irtkB. 


4HatrmgeB. 


^''^?J■w■;;^^^*^"'^T^  i^J^  **^  8'-  BwtholmeWa  Churt*, 
Dublin,  Major  J.  L.  J.  Clsrke.  East  Yorkshire  Regt..  D  A  AG 
Srd  Army  Corps,  only  son  of  Lt.-Colonel   /Alfred  Clarke'    Md'" 
Royal  Military  College.  Oamberley.  to  Lilian,  only  dauirhter  of 
bir  George  and  Lady  O'Farrell,  of  1»  Fitzwilliam  Squari 

GODDARD— RooRRS.— On  July  7th.  at  the  Parish  Church,  Watford 
Claud  Francis,  the  fourth  son  of  the  late  Eugene  Goddsrd  M  D  * 
of  Highbury-,  and  Mrs.  Goddard,  of  Fernbank.  Sudburv  Hanow* 
to  Annie  Evelyn,  the  eldest  daughter  of  James  Boeers  of 
Watford.  .,J„^ 

HARYLRY-PKRRp.-On  July  6th,  at  the  Parish  Church,  Harrow-on- 
the-Hill,  John  Dawson  Hartley,  P.R.C.8.,  of  S^TheTerrmoe 
Gravesend,  elder  son  of  Stephen  Hartley.  High  Stwet,  Harrow' 
to  Margaret  Young,  second  daughter  of  William  Perrin  of 
Harrow.  • 

Hrlsdoh-PrrBdy.— On  July  6th,  at  St.  Peter's  Good  worth  Clat- 
ford.  Charles  Victor  Helsden,  M  R.C.a.E.,  of  Pen  ton  Wews^ 
Bants,  to  Catherine,  younger  daughter  of  the  late  John  Preedv'' 

Patch- SMFTH.-On  July  5th  at  Esher  Pariah  Church.  Buinet 
Graham  Patch.  B.A.M.C..  youngest  son  of  Colonel  R.  Patch 
C.B.,  Indian  Army,  of  Fersfield  Newton  Abbot,  te  Edith* 
younger  daughter  of  E.  G.  Warren  Smith,  of  Esher 


^tatkB. 


BzRKRfT.-On  July  6th,  at  1,  Sussex  Gardens,  Hyde  Park.  Johi» 
Birkett,  F.R,C.S.,  in  his  90th  year.  ' 

Craioir.— At  Blagdon,  near  Bristol.  Francis  Louis  Craiirie  the 
fourth  son  of  the  late  Dr.  Craigie.  and  Mrs.  Jane  Craiirie  sf 
Holyoake.  ^   ' 


Wit  ^diml  ^tm  mA  ^itmlm. 


^SALUS    FOPULI    8TJPBEMA    LEZ-' 


Vol,  CXXIX. 


WEDNESDAY,    JULY   20,    1904, 


No.   3. 


(Ptiginal  Communications* 

THE  DIMINISHING  BIRTH- 
RATE, 

By  DAVID  WALSH,  M.D.Edm.. 

SttDior  Pbyiiciui,  Wettern  Sklii  VovpiUl.  LoDdon,  W..  to. 

PART  li. 

Assumption  III :  That  a  falling  birth-rate  neces- 
•sarily  indicates  a  failure  in  national  prosperity. — Dr. 
Taylor  quotes  as  his  ke3mote  Ruskin's  dictum  "  that 
the  finsd  outcome  and  consummation  of  all  wealth 
is  the  producing  as  many  as  possible  full-breathed, 
bright-eyed  and  happy-hearted  human  creatures." 
The  whole  trend  of  his  article,  however,  shows  that  he 
is  governed  by  the  underlying  fallacy  that  a  steadily 
increasing  birth-rate  is,  by  sheer  force  of  numbers 
alone,  necessarily  a  sign  of  national  prosperity. 
In  young  or  undeveloped  countries,  that  may  be  the 
case.  In  all  countries,  however,  there  is  a  limit  of 
supportable  population,  and  when  that  point  is 
reached  disaster  must  follow. 

Following  a  method  that  is  now  classical,  let  us  take 
the  case  of  an  imaginary  island,  of  an  area,  say,  of 
twenty  square  miles,  which  by  its  natural  resources 
can  maintain  a  population  of  two  thousand  souls.  It 
is  obvious  that  if  the  population  exceed  that  maximum, 
general  want  and  misery  will  result,  until  disease  and 
starvation  reduce  the  numbers  to  two  thousand  or  less. 
But  suppose  that  ships  from  other  lands  visit  our 
island,  and  enable  its  inhabitants  to  exchange  their 
surplus  granite  and  other  products  for  the  foreigners' 
foodstuff,  then  a  fresh  lease  of  life  will  be  granted 
them.  Some  of  the  surplus  population,  moreover,  will 
be  able  to  relieve  the  pressure  at  home  by  emigration. 
Still,  twenty  square  miles  will  not  support  an  indefinite 
number  of  people,  however  great  their  natural  re- 
sources and  their  trading  facilities.  When  the  popu- 
lation reaches  the  second  or  artificially  raised  maximum, 
say,  of  twenty  thousand,  another  disastrous  readjust- 
ment must  take  place,  and  the  inhabitants  will 
have  either  to  die  down  again  or  to  emigrate.  To 
introduce  children  into  an  over-crowded  society  of  that 
kind  would  be  to  subject  them  to  misery  and  death, 
to  say  nothing  of  the  injury  inflicted  upon  the  already 
existing  population.  Yet,  if  we  agree  with  Dr.  Taylor 
that  it  is  wrong  to  place  a  check  upon  lawful  procreation, 
the  parents  of  that  community  would  be  morally  con- 
strained to  go  on  rearing  children  under  conditions  of 
food  and  air  starvation.  The  starveling  generation 
thus  produced  would  be  short-lived  and  riddled  with 
insanity,  crime,  alcoholism,  and  other  signs  of  de- 
generacy. 

Let  us  now  apply  the  test  of  the  supportable  limit 
•of  population  to  the  two  statements  of  Ruskin,  which 
were  accepted  as  axioms  by  Dr.  Taylor.  The  pro- 
positions run  thus  :  First,  "  There  is  no  wealth  but  life. 
That  country  is  richest  which  nourishes  the  greatest 
number  of  noble  and  happy  human  beings  "  ;  and, 
again,  "  the  final  outcome  and  consummation  of  all 
wealth  is  in  the  producing  as  many  as  possible  fu]l- 


breathed,  bright-eyed  and  happy-hearted  human 
creatures."  From  these  axioms  we  deduce  there  are 
three  tests  of  the  wealth  of  a  community — the  growth 
in  numbers  of  inhabitants,  their  health  and  their 
happiness.  Numbers  alone  without  the  correlations  of 
health  and  happiness  are  no  indication  of  wealth,  and 
that  country  which  propagates  an  increasing  quantity 
of  deformed,  imbecile  and  immoral  offspring  would  be 
worse  off  than  another  country  which  produced  a 
smaller  number  of  healthy  and  happy  children.  If 
Dr.  Taylor,  therefore,  quotes  Ruskin  in  proof  of  the  un- 
qualified assumption  that  the  wealth  of  a  nation  con- 
sists in  the  mere  number  of  children  it  produces,  he 
seems  to  the  writer  to  be  starting  on  a  false  premise. 
Quality,  according  to  Ruskin,  is  at  least  as  essential 
as  quality.  His  axioms,  when  applied  to  poor  and 
over-crowded  populations,  absolutely  discountenance 
the  unlimited  procreation  of  children,  inasmuch  as 
slum  children  cannot  be  •*  full-breathed,  healthy  and 
happy."  and,  in  point  of  fact,  they  are  as  a  class 
ricketty,  pale,  unwholesome  and  vicious.  The  wealth 
of  a  country,  tested  numerically,  must  be  further 
qualified  by  its  ability  to  maintain  the  fresh  generation 
at  a  standard  of  well-being  in  body  and  in  mind  at 
least  equal  to  its  own.  Dr.  Taylor  has  advanced  the 
fallacy  of  partial  quotation.  Let  us  now  add  the  rest 
of  the  passage  from  Ruskin  as  to  the  "  full-breathed, 
bright-eyed  and  happy-hearted  human  creatures." 
"  Our  modem  wealth,"  he  writes,  "  I  think,  has  rather 
a  tendency  the  other  way.  most  political  economists 
appearing  to  consider  multitudes  of  human  creatures 
not  conducive  to  wealth,  or,  at  best,  conducive  to  it 
only  by  remaining  in  a  dim-eyed  and  narrow-chested 
state  of  being."  Yet  if  the  poorer  classes  are  to  go  on 
multipl3ring  children,  according  to  Dr.  Taylor's  theory 
of  what  is  their  moral  duty,  they  can  for  the  most  part 
swell  the  population  only  by  degenerate  and  short-lived 
offspring. 

The  production  of  mere  numbers  of  offspring,  then, 
apart  from  their  quality  and  destiny,  is  no  true  test  of 
the  inherent  prosperity  of  a  nation.  Great  repro- 
ductive activity  is  often,  as  in  consumptives,  a  sign  of 
degeneracy.  The  young  generation,  to  satisfy  the 
sanitarian  and  the  economist,  must  be  healthy  and 
long-lived.  To  thrust  feeble  children  under  conditions 
of  poverty  into  an  already  over-crowded  community 
is  to  commit  an  act  of  selfish  imprudence,  the  con- 
sequences of  which  must  react  on  the  parents  in  a 
manner  not  less  disastrous  than  the  evils  attributed 
by  Dr.  Taylor  to  the  artificial  prevention.  The  ulti- 
mate population  test  is  thus  expressed  by  Ruskin  : — (a) 

"  The  radical  question  is,  not  how  much  habitable 
land  is  in  the  world,  but  how  many  human  beings  ought 
to  be  maintained  on  a  given  space  of  habitable  land." 
Suppose  parents  to  be  living  in  a  certain  spot  that  has 
reached  its  limits  of  supportable  population.  Can  it 
be  seriously  maintained  that  the  unlimited  pro- 
duction of  children  would  still  be  a  moral  obligation  ? 
Yet  that  is  Dr.  Taylor's  proposition,  unqualified  by  any 
conditions  as  to  class  in  society,  income,  social  circum- 
stances, or  facts  of  environment.     If  I  interpret  his 


(a)  •«  Ad  TAlorem."    JohnBuakiii    .1882.    P.  lOS, 


56    Thb  Medical  Prxss. 


ORIGINAL  COMMUNICATIONS. 


July  20,   1904. 


meaning  aright,  the  plain  bounden  duty  of  all  married 
persons,  whether  dwelling  in  rich  houses  or  in  sordid 
hovels,  is  to  beget  as  many  children  as  pc^ible. 

Beyond  a  doubt,  poverty  shortens  life  both  for 
parents  and  for  children.  The  remarkable  statistics 
of  Ansell  show  that  the  child  of  rich  parents  has  a  far 
greater  chance  of  survival  to  adult,  middle,  and  old  age 
than  the  child  of  the  poor.  Dr.  Drysdale,  again,  has 
shown  that  poverty  is  the  main  cause  of  premature 
death  in  old  countries,  such  as  those  of  Europe,  {a) 
But  the  great  proportion  of  increase  now  takes  place 
among  the  poor,  whose  children  are  foredoomed  to 
pay  a  terrible  toll  of  suffering  and  premature  death. 
Can  a  nation  be  really  the  richer  for  so  vast  a  multi- 
plication of  feeble  and  shortened  lives  ? 

In  a  young  country,  such  as  a  sparsely-populated 
colony,  the  mere  multiplication  of  numbers  may  be  a 
just  measure  of  its  prosperity.  In  an  old  and  over- 
populated  country  it  may  be  the  reverse.  At  the  same 
time  in  the  more  densely  populated  country  the  State 
is  able  to  employ  part  of  its  surplus  as  soldiers  and 
sailors,  and  capital  to  trade  on  the  necessities  of  the 
struggling  workers  by  grinding  down  wages  to  the 
lowest  level. 

Assumption  IV  {or  unsupported  conclusion] :  That 
preventive  practices  are  injurious  to  the  moral  and 
physical  well-being  of  parents  adopting  them,  as  well  as 
to  the  non-prevented  children  of  such  marriages. 

Doubtless  now  and  then  some  of  the  pathological 
accidents  mentioned  by  Dr.  Taylor  follow  the  use  of 
preventive  measures.  They  cannot,  however,  be 
common,  and  Dr.  Taylor  must  forgive  us  for  not  attach- 
ing great  weight  to  the  two  or  three  instances  of  acute 
mischief  he  is  able  to  recall  from  his  extensive  ex- 
perience. A  certain  number  of  persons  are  killed  every 
year  in  crossing  the  street,  apparently  in  obedience  to 
some  obscure  law  of  average  fatality  that  is  inseparable 
from  the  majority  of  human  actions  and  pursuits.  To 
bring  forward  these  exceptions  would  not  be  to  estab- 
lish any  general  causative  relation  between  crossing  the 
street  and  sudden  death.  Yet  that  is  the  kind  of  argu- 
ment considered  good  enough  by  Dr.  Taylor  when  he 
condemns  preventive  methods  as  physically  injurious, 
because  he  has  known  one  or  two  cases  of  peritonitis, 
and  one  of  purulent  infection  follow  their  use.  Nor 
can  we  accept  more  seriously  his  statements  as  to  mis- 
chievous results  of  a  chronic  nature.  Neurasthenia  is 
the  only  specific  instance  he  advances,  and  he  ascribes 
that  condition  to  **  sexual  onanism  "  and  absence  of 
the  male  element  from  the  female  economy.  It  is  well 
known  that  neurasthenia  may  follow  any  excess,  among 
the  married  or  the  unmarried,  among  those  who  desire 
conception  or  those  whq  prevent  it ;  but  it  is  at  least 
as  common  in  the  woman  who  has  had  many  children 
as  in  any  other  individual  or  class  of  society.  But  if 
the  object  of  all  should  be  to  raise  up  as  many  children 
as  possible,  continence — apart  from  its  disciplinary 
effect — must  be  bad  too.  for  it  robs  the  community  of 
possible  accession  to  its  ranks,  and  the  State  that 
demands  children  will  bear  an  equal  grudge  against 
the  continent  and  against  the  sexual  onanist,  for  both 
conspire  to  prevent  its  heritage.  The  increase  of 
juvenile  crime,  again,  cannot  reasonably  be  assigned  to 
any  limitation  of  the  size  of  families.  The  only  child, 
or  the  child  of  a  small  family,  is  always  better  looked 
after  in  mind,  body  and  estate  than  the  child  who  has 
eight  or  ten  or  more  brothers  and  sisters,  for  reasons 
tluit  are  obvious.  Besides,  the  overwhelming  pro- 
portion of  criminals  is  drawn  from  the  class  in  which  the 
limitation  of  families  is  least  practised.  Lastly,  I  ask 
Dr.  Taylor  if  the  vast  majority  of  female  troubles  that 
come  under  his  professional  care,  both  in  private  and 
more  especially  m  hospital  practice,  is  not  far  more 
often  due  to  multiple  than  to  restricted  child-bearing  ? 
From  my  point  of  view,  an  enormous  proportion  of  the 
avoidable  disease,  insanity  and  crime  that  constitutes 
so  great  a  blot  upon  our  modem  civilisation  may  be 
traced  to  the  unrestricted  multiplication  of  the  children 
of  the  poor. 


(a)  "  Population   Question.*'     B.    C. 
Society  of  London,  October  27tta,  1870. 


DiTKlAle,   M.D.      Medical 


Dr.  Taylor  has  courageously  attacked  a  delicate 
subject,  but  to  my  mind  he  has  missed  the  real  sig- 
nificance of  the  fall  in  the  birth-rate  during  the  last 
half  century  or  so.  He  is  a  man  of  eminence  in  his 
profession,  and  of  unquestioned  candour  and  honesty 
of  purpose.  For  all  that,  it  is  impossible  to  accept  his 
views  upon  this  most  important  matter  without  careful 
critical  examination.  It  would  be  little  short  of  dis- 
astrous were  his  particular  views  permitted  to  go  out 
into  the  world  unchallenged  as  those  accepted  generally 
by  the  medical  profession. 

One  of  the  first  questions  that  suggests  itself  in 
approaching  this  subject  is  whether  the  United  King- 
dom may  not  have  reached  its  limit  of  supportable 
population.  The  growth  of  juvenile  crime,  of  insanity, 
and  of  paup>erism,  and  the  increasing  numbers  of  the 
unemployed  working  classes,  seem  to  show  that  under 
existing  social  conditions  a  further  increase  in  children 
becomes  a  positive  disadvantage.  The  poor  are  now 
the  prolific  classes  of  the  community,  that  is  to  say. 
the  very  persons  who  bring  their  offspring  without 
stint  into  an  environment  that  fosters  pauperism  and 
the  other  evils  spoken  of.  The  existence  of  so  great  a 
mass  of  avoidable  misery  and  waste  of  life  to  my  mind 
proves  incontestably  that  under  existing  social  con- 
ditions the  supportable  limit  of  population  has  been 
reached  so  far  as  the  poor  of  our  country  are  concerned. 
True,  that  limit  may  at  any  time  be  enlarged  so  as  to 
admit  of  a  happier  existence  for  a  greater  number  of 
the  population.  Some  small  relief  may  be  effected  by 
emigration,  but  after  all  said  and  done,  that  is  only  a 
temporary  measure,  which  must  come  to  an  end  sooner 
or  later.  The  sound  remedy  will  possibly  or  probably 
be  found  in  laws  that  lead  to  greater  equality  in  the 
distribution  of  wealth  and  of  opportunity  to  the 
individual  citizen. 

Ruskin's  view  of  the  three  remedies  commonly  sug- 
gested by  the  economist  for  over-population  is  mu^ 
to  the  point,  (a)     He  writes : — '*  These  three  are,  in 
brief,  colonisation  ;  bringing  in  of  waste  lands;  or  dis- 
couragement of  marriage.     The  first  and  second  of  these 
expedients  merely  evade  or  delay  the  question.     It 
wm,  indeed,  be  long  before  the  world  has  been  all 
colonised,  and  its  deserts  all  brought  under  cultivation. 
But  the  radical  question  is,  not  how  much  habitable 
land  is  in  the  world,  but  how  many  beings  ought  to  be- 
maintained  on  a  given  space  of  habitable  land."     The- 
third  expedient— discouragement  of  marriage — is  not 
discussed  by  Ruskin.     His  answer,  however,  may  be 
plainly  inferred  from  his  general  views  on  the  necessity 
of  proper  conditions  of  environment  for  every  citizen. 
When  Ruskin  first  published  his  book  methods  of  pre- 
vention had  not  b^x>me  widely  known  or  advocated, 
or  he  might  possibly  have  added  a  fourth  expedient. 
What  are  thb  Influences  that  Govern  the  In- 
crease OR  Decrease  of  a  Human  Population? 
In  the  lower  form  of  animal  life  limitation  of  numbers 
is  regulated  by  laws  of  which  we  know  little  or  nothing. 
Darwin  has  somewhere  pointed   out   that  wood-lice- 
multiply  at  such  a  rate  that  a  single  pair,  if  left  alone, 
would  in  a  comparatively  short  time  be  able  to  cover 
a  continent.     But  in  no  locality  do  wood-lice  obtain  a 
preponderating  numerical  superiority.     The  herring,  in 
common  with  most  fishes,  produces  a  countless  progeny, 
but  the  herring  tribe  remains  a  fairly  constant  inhabi- 
tant of  the  sea.     So,  too,  with  rabbits  and  mice  and* 
other  mammals.     The  rule  in  Nature  appears  to  be 
that  each  species  should  produce  a  progeny  vastly  in 
excess  of  the  actual  needs  of  the  case.     Further,  the 
limit  of  numbers  seems  to  be  fixed  in  some  ill-defined 
but  remorseless  way.     Why  should  not  similar  laws 
apply  to  mankind  ?   At  the  present  moment,  as  in  past 
ages,   he  reproduces  his  kind  in  numbers  vastly  in 
excess  of   those   that   actually  survive   to   the   next 
generation.     Lastly,  man,  from  his  special  endowment 
of  brain,  may  impose  an  artificial  limitation  upon  child- 
bearing,  and  by  this  very  intellectual  limitation  may 


(a)  *'  Unto  thie  Last." 
London.    Pp.  102. 


By  John  Baekin.     Third  edition.     1882.. 


July  20,  1904. 


be  constituting  himself  an  unconscious  instrument  of 
evolution. 

The  population  of  England  and  Wales  has  taken 
about  fifty-eight  years  to  double  itself.  By  the  law 
of  population,  the  latter  increases  in  regular  geome- 
trical progression  when  the  births  exceed  the  deaths, 
and  the  ratio  of  the  births  and  of  the  deaths  remains 
constant.  Were  the  population  of  England  and 
Wales  to  go  on  doubling  twice  in  1 16  years,  the  figures 
would  soon  become  stupendous.  Farr,  (a)  dealing  with 
this  point,  quoted  a  passage  from  an  early  edition  of 
Malthus'  "  Political  Economy."  "  If  any  person  will 
take  the  trouble  to  make  the  calculation,  he  will  see 
that,  if  the  necessaries  of  life  could  be  obtained  without 
limit,  and  the  number  of  people  could  be  doubled  every 
twenty-five  years,  the  population  which  might  have 
been  produced  from  a  single  pair  since  the  Christian 
era  would  have  been  sufficient,  not  only  to  fill  the  earth 
quite  full  of  people,  so  that  four  should  stand  upon 
every  square  yard,  but  to  fill  all  the  planets  of  our  solar 
system  in  the  same  way,  and  not  only  them,  but  all 
the  planets  revolving  round  the  stars  which  are  visible 
to  the  naked  eye,  supposing  each  of  them  to  be  a  sun, 
and  to  have  as  many  planets  belonging  to  it  as  our  sun 
has." 

That  preventive  methods  are  increasingly  practised 
among  the  better-to-do  classes  must  be  admitted. 
Some  figures  bearing  on  the  relation  between  social 
position  and  fertility  were  given  by  Dr.  ].  Bertillon,  (6) 
quoted  by  Dr.  Newsholme  at  the  meeting  of  the  Inter- 
national Statistical  Institute  at  St.  Petersburg, 
September,  1897.  The  statistics  relate  to  the  births 
per  1 ,000  women,  aet.  1 5  to  50,  per  annum,  in  different 
quarters  of  the  undernoted  cities. 

Gla^tnfieation.  Paris.     Berlin.      Vienna.      London. 

"Very  poor  quarters    ..      108  157         200         147 

Poor  quarters  95         129         164         140 

Comfortable  quarters         72         114         IS5         ^^7 
Very  comfortable  q'ters      65  96         153         107 

Rich  quarters  ..        53  63         107  87 

Very  rich  quarters     . .        34  47  71  63 

Average  ..       71  loi  141  109 

The  stress  of  human  suffering  from  increase  of  popu- 
lation beyond  readily  supportable  limits  must,  of 
necessity,  fall  mainly  upon  the  poorer  classes.  It 
demands  a  considerable  exercise  of  faith  to  ask  such 
poverty-stricken  families  to  accept  the  teaching  that 
the  multiplication  of  children  is  one  of  man's  highest 
moral  obligations.  Dr.  Drysdale  (c)  speaks  plainly 
enough  on  this  last  point  as  follows  : — 

"  My  argument  is,  then,  as  Sir  Henry  Thompson 
expresses  it,  that  our  farm  is  over-stocked  with  human 
animals,  and  that  this  is  the  only  real  cause  of  the  per- 
manent death-rate  in  our  cities  ;  and  I  contend  that  so 
long  as  the  people  of  Great  Britain  continue  to  add  to 
the  population  in  the  ratio  of  362,923,  as  was  done  in 
1877,  or  to  have  an  annual  birth-rate  of  36  per  1,000, 
it  is  useless  to  expect  anything  from  drainage  schemes 
or  the  other  expedients  of  public  hygiene.  Slums  will 
always  exist  as  long  as  people  have  such  low  wages 
that  they  cannot  afford  house-room  enough  for  the 
over-numerous  offspring  they  engender,  a  species  of 
improvidence  so  conspicuous  as  yet  among  the  poorer 
classes  in  the  United  Kingdom." 

The  stress  of  many  children  falls  with  terrible  seve- 
rity upon  the  mother  where  the  family  income  is  small. 
Take  the  case  of  the  wife  of  the  struggling  clerk,  the 
labourer  whose  work  is  inconstant,  the  poor  curate,  or 
the  medical  man  in  small  practice,  in  a  word,  of  any 
family  belonging  to  the  not-rich  class  of  society  where 
one  child  might  be  brought  up  well  enough.  Child 
upon  child  has  to  be  fed,  cared  for,  clothed,  and  edu- 
cated, until  the  life  of  the  mother  is  that  of  a  slave,  to 
say  nothing  of  the  tax  of  frequent  maternity  upon  a 
body  that  is  undermined  with  toil,  privation,  anxiety 
and  short  commons.     The  curate's  lot  in  life  is  to 

(a)  Supplement  to  "  Thirty-Fifth  Annual  Report  of  the  BeRistrar- 
General.  '  1878.    P.  9.  ,        „  rv    «  -. 

(6)  "  ViUl  Statittice."  London,  1899.    A  Neweholme,  M.D.  P.  76. 
(c   "Population  Question."    Dr.  Dryedale.    Op.  cU, 


ORIGINAL   COMMUNICATIONS.       The  Medical  Press.     57 


inculcate  morals  into  the  mind  of  his  fellow-men.  Can 
he,  when  a  poor  man,  justify  his  position  in  multiplying 
his  family  indefinitely  ?  Should  he  not  either  practise 
continence  or  decline  the  responsibilities  of  marriage, 
rather  than  drag  a  refined  woman  into  a  position  of 
drudgery,  broken  health,  and  shortened  life,  while  at 
the  same  time  his  numerous  progeny  are  curtailed  in 
necessaries  of  life,  in  comforts,  and  in  education,  so  that 
in  many  cases  private  means  must  be  eked  out  bv  the 
charity  of  strangers?  The  patient  self-sacrifice  of  the 
mother  of  all  ages,  past  and  present,  is  written  in  blood 
on  the  pages  of  the  world's  history.  It  would  be  easy 
to  draw  a  lurid  picture  of  the  difference  between  the 
many  and  the  few  children  so  far  as  the  mother  is  con- 
cerned. Ansell,  an  acute  observer,  partially  recognises 
the  situation  in  the  following  suggestive  passage  : — 

"In  the  upper  and  professional  classes,"  he  writes, 
"  it  is  upon  the  men  that  the  wearing  toil  and 
anxieties  of  life  chiefly  press,  the  women  enjoying  a 
comparative  exemption  from  them.  At  the  present 
age,  when  so  many  are  striving  to  be  foremost  in  the 
race  of  life,  the  husband  is  frequently,  or  it  may  be  con- 
stantly, engaged  in  an  arduous  struggle  to  maintain  or 
improve  his  position,  and,  whether  successful  or  un- 
successful he,  in  too  many  instances,  injures  his  health 
in  the  effort.  Unless,  however,  he  be  exceptionally 
unfortunate,  and  at  the  same  time  have  no  friends  to 
fall  back  upon,  his  wife  and  family  will  probably  still 
be  sufficiently  supplied  with  the  bare  physical  neces- 
saries for  healthy  existence.  With  the  labouring  classes 
the  case  is  very  different.  Among  them  the  mental 
anxieties  of  obtaining  a  livelihood  are  rarely  great 
enough  to  produce  injurious  results,  but  if  the  husband's 
wages  are  insufficient,  the  consequent  physical  priva- 
tions tell  upon  the  health  of  his  family,  his  wife  in- 
cluded, at  least  as  much  as,  and  probably  more  than, 
upon  his  own."  (a) 

But  to  review  :  We  find  a  fall  in  the  birth-rate — 
not  as  great  as  Dr.  Taylor  shows,  nor  confined  to  the 
married  population,  as  he  imagines — ^but  still  a  fall,  and 
we  find  that  this  fall  is  great  among  the  upper  classes  of 
society,  and  probably  affects  to  a  certain  extent  the 
lower  classes  also.  Now,  what  does  this  show  ?  We 
reply  that  in  this  great  competition  the  necessary  limita- 
tion of  future  generations  is  showing  itself  most  among 
the  educated  classes — a  kind  of  intellectual  limitation. 
This  may  be  a  matter  of  regret,  especially  if  one  adopts 
with  Dr.  Taylor  the  Spencerian  doctrine  that  inherited 
qualities  are  transmissible,  but  it  is  not  a  new  pheno- 
menon. It  is  the  result  of  the  law  that  society  tends 
to  grow  like  a  plant  from  below  upwards.  The  Romans, 
whose  patrician  families  were  the  most  exclusive  the 
world  has  ever  seen,  found  that  these  families,  far 
from  increasing,  had  to  be  added  to  from  time  to  time 
by  recruits  from  the  plebeians,  if  they  wished  to  main- 
tain an  aristocracy  in  the  State.  Of  five  hundred  of 
the  oldest  noble  f amiUes  in  our  own  country,  only  five  at 
the  present  day  can  trace  their  ancestrv  back,  by  the 
male  line,  to  the  fifteenth  century.  There  has  been 
no  increase  here,  although  our  aristocracy  have  not 
minded  marrying  "  beneath  them  "  in  a  way  that 
the  Romans  would  never  have  dreamed  of.  A  similar 
tale  is  told  by  the  nobility  of  every  modern  European 
State.  The  "  advantages  "  of  civilisation  do  not  con- 
duce to  rapid  breeding  of  man  ;  the  more  refined,  the 
more  comfortably  circumstanced,  the  better  educated 
classes  have  not  the  procreative  genius  of  their  less 
happily  circumstanced  fellows.  In  the  case  of  our- 
selves at  the  present  day,  instead  of  a  few  aristocratic 
families  enjoying  these  advantages,  we  have  a  large 
class  of  independent  and  professional  men  whose  re- 
finement and  education  is  no  whit  inferior  to  that  of 
the  "  governing  caste."  Therefore,  as  this  class  grows 
in  the  community,  and  it  is  daily  growing,  the  curtailed 
birth-rate  to  which  it  gives  rise  affects  a  larger  and 
larger  number  of  persons,  and  the  gross  effect  becomes 
more  and  more  noticeable.  It  is  interesting  to  specu- 
late on  the  correlation  of  these  two  factors,  increased 


(o)  **  Bate  of  Mortality  and  other  SUtistica  of  Pamiliea.     OhM. 
Ansell.    London.    1874.    P.  27. 

D 


58    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


culture  and  diminished  procreative  fertility,  but  in  a 
society  where  these  obtain  one  finds  the  subordination 
of  the  carnal  part  of  man  to  his  intellectual  part  to 
lead  to  rebellion  in  the  normal  physiological  functions — 
pregnancy  becomes  dystocia,  menstruation — dysmenor- 
rhcea,  fertility — sterility.     It  is  the  principle  of  having 
the  cake  and  eating  it  too,  and  whether  the  limitation 
of  the  offspring  of  the  upper  classes  come  from  low 
sexual  reproductive  power,  or  from  the  direct  inter- 
vention of  his  intellectual  processes  through  celibacy, 
marital  continence,  or  artificial  prevention — or  all  these 
combined,  as  we  find  at  present — these  are  only  the 
expression  of   a  great   social    law    against   which    it 
is  no   use    rebelling.     The    prosperity    of    trade    has 
brought  more  and  cheaper  luxuries  to  the  homes  of  the 
nation,  so  that  the  standard  of  material  comfort  has 
risen    vastly ;     this    increase   of    trade    has    required 
keener  intellectual  competition,  and  the  brain  has  been 
taxed  as  against  the  body.     Education  has  become  a 
necessity  of  national  existence,  and  education  teaches 
people  to  think  and  look  ahead.     The  great  present 
stress  in  the  grapple  for  bread  is  an  intra-cranial  stress 
acting  in  a  well-fed  body  ;    but  the  stress  is  none  the 
less  keenly  felt  because  it  is  primarily  cerebral,  but 
rather    more    so.     The    poor,    the  less  intellectually 
developed,  the  serf,  can  always  be  trusted  to  breed  ; 
the  sexual  act  constitutes  one  of  their  few  relaxations — 
and  pleasures.     They  follow   their  natural  instincts. 
It  is  your  brain- trained  man  who,  like  a  wild  animal 
in  captivity,  refuses  to  breed.     At  the  risk  of  repetition 
it  may  be  asked  again  whether  this  fall  in  the  birth-rate 
may  not  be  the  expression  of  a  natural  law  setting  a 
limit  to  the  too-great  multiplication  of  a  hungry,  in- 
dustrial, education-requiring    community.     It    seems, 
indeed,  to  be  the  natural  instinct   of  self-preservation 
asserting  itself  at   the  expense  of    the    reproductive 
instinct,  which  two  instincts  Littr6  has  shown  to  be 
the  eventual  basis  of  all  impulses  in  ourselves.     Dr. 
Taylor,  rather  inconsistently,  regards  these  signs  as  a 
' '  handwriting  on  the  wall,"  and  at  the  same  time  denies 
that  thQy  are  signs  of  decay.     We  are  inclined  to  concur 
in  the  latter  belief.     We  think  they  are  due  not  to 
gangrene  but  to  temporary  congestion,  and  that  appro- 
priate treatment  may  be  successful  in  warding  off  a 
fatal  termination.     He  instances  Japan  as  an  old  nation 
possessed  of  new  life  and  activity — sl  second  youth.     I 
hesitate  to  think  that  he  can  attribute  this  in  any  way 
to  the  sexual  morality  of  that  country,  which  is  noto- 
riously deplorable,  and  her  success  as  a  debutante  in 
"  Welt-politik  "  must  merely  be  in  spite  of,  and  not 
because  of,  her  inter-sexual  arrangements.     But  what 
is  the  result  of  the  over-population  of  Japan,  now  that 
its  eyes  are  opened  by  education,  and  that  she  has 
found  her  own  strength  ?     A  "  land-hunger,"  which 
Dr.  Taylor  extols,  which  shows  itself  by  two  bloody 
contests  in  a  space  of  ten  years,  and  which  may  end  by 
inflaming   the   whole   world !     We   hope  for  a  more 
prosaic,  if  less  eventful,  solution  to  our  own  difficulties. 
In    the  case  of  France  there  can  be  little  doubt  that 
the  decrease  in  population  is  due  to  the  adoption  of 
preventive  practices  by  all  ranks  of  society.     In  other 
words,  the  views  of  the  educated  class  with  regard  to 
the     undesirability    of    multiple  child-bearing    have 
permeated  to  the  labourers.  That  process,  if  continued, 
must  mean  fewer  persons  available  for  fighting  and  for 
the     hard   work    of   the   State   generally.     The   only 
remedy,  so  far  as  one  can  suggest,  is  that  the  State 
make  the  conditions  of  living  easier  by  a  readjustment 
of  burdens,  and  the  cheapening  of  the  necessaries  of  Iife» 
while  life  is  at  the  same  time  made  longer,  sounder  and 
more  valuable  by  the  development  of  medical  science 
and  administrative  hygiene.     A  similar  line  of  reasoning 
applies  to  the  falling  birth-rate  of  Australia 

And  now  to  the  solution.  Dr.  Taylor  would  have 
the  State  encourage  the  fathers  of  large,  well-brought- 
up  families  by  various  aids,  financial  and  educational. 
Unfortunately,  we  fear  that  the  State  would  not  be 
likely  to  take  into  consideration  the  quality  of  the 
bringing  up  of  a  family  ;  the  most  that  could  be  hoped 
for  would  be  that  the  size  of  the  family  should  be  the 
qualification  for  assistance,  and  this,  again,  would  really  * 


July  20.   IQ04. 


be  needed  only  m  the  middle  classes.  The  poor  have 
no  direct  taxation  that  could  be  remitted,  and  thcit 
education  is  aheady  provided  for.  There  is  a  good 
deal  to  be  said  for  this  plan,  but  it  would  be  only  an 
inducement  after  all,  and  might  not  meet  with  great 
favour  m  practice.  Next.  Dr.  Taylor  has  a  somewhat 
cryptic  proposal  for  the  State  jealously  to  guard  the 
earliest  possible  date  at  which  productive  work  could 
be  begun  by  those  entering  professions.  We  may  say 
at  once  that  such  a  matter  is  in  the  hands  of  the  pro- 
fessions and  the  public,  and  at  a  day  when  the  cry  is 
all  for  a  higher  standard  of  preliminary  education  for 
the  professions,  it  is  not  feasible.  Then  Dr.  Taylor 
would  make  pregnancy  less  distressing  by  medical 
advice,  diet,  and  management.  Well,  we  all  do  our 
best  as  it  is,  and  pregnancy  is  never  hkely  to  be  other 
than  a  rather  trying  and  painful  business  for  the  well- 
brought-up  mother.  Finally,  Dr.  Taylor  makes  a 
strong  appeal  to  the  forces  of  religion  and  morality  to 
aid  in  putting  down  artificial  prevention,  though  he  is 
of  opinion  that  occasional  abstinence  in  married  life 
is  "allowable." 


But  is  not  this  treatment  merely  symptomatic,  and 
would  not  its  effect,  if  successful,  be  rather  to  alleviate 
than  cure  the  body  corporate  ?  And.  again,  might  it 
not  be  possibly  harmful  by  increasing  the  present  undue 
competition  of  the  upper  middle  classes  ?  And  yet 
again,  would  it,  could  it  be  eventually  successful  in  the 
face  of  natural  laws  ?  Unless  some  new  distribution  of 
wealth  be  unexpectedly  brought  about,  or  unless  some 
new  fiscal  system  give  an  impetus  to  trade  like  that 
given  by  Free  Trade  in  the  middle  of  last  century,  or 
unless  some  new  sources  of  material  wealth  be  tapped, 
mere  increase  in  numbers  is  not  wanted  in  this  country 
for  its  own  purposes.  And  this  being  the  melancholy 
fact,  the  natural  industrial  conditions  of  demand  and 
supply  will  combine  to  check  over-production  by  some 
means  or  other. 

In  the  long  run  the  woman's  innate  desire  to  bear- 
children  must  outweigh    the  difficulties   and  dangers 
incidental  to  pregnancy  and  parturition.     At  present, 
the  prospect  of  not  being  able    to  bring  up  children 
weighs  heavily  on  both  parents  or  potential  parents  of 
the  upper  and  upper  middle  classes.     It  is  by  means  of 
this  fear  that  the  natural  law  of  limitation  of  upper 
sections  of  a  population  is  acting.     Its  expressions  are- 
found  in  late  marriages,  celibacy,  marital  abstinence, 
and   artificial  prevention.     Now  it  is  apparent   that 
these  methods  are  each  and  all  the  result  of  deliberate 
choice,  that  is  to  say,  they  are  the  results  of  the  exercise 
of  judgment  and  prudence,  which,  again,  are  the  objects 
of  all  education  and  intellectual  development  to  form. 
Judgment  may  decide  rightly  or  wrongly,  but  it  is  in 
itself  the  highest  product  of  mental  training.     There- 
fore, if  we  find  judgment  being  exercised  somewhat 
widely  to  limit  the  population,  it  must  be  because- 
many  of  those  in  the  best  position  to  judge  have  decided 
that  future  increase  is  baneful.     Now,  if  we  admit 
that  cehbacy  is  preferable  to  incontinence,  that  late- 
marriage  is  better  than  rash  marriage,  and  that  absten- 
tion in  married  life  is  allowable,  we  are  led  to  the  con- 
clusion that  artificial  prevention  is  the  last  resource 
available  to  that  class,  and  it  is  a  large  one,  of  educated 
p>ersons  who  desire  the  domestic  advantages  of  mar- 
riage at  an  early  period  in  their  lives,  and  are  not  blessed 
with  the  power  of  restraint.     That  it  is  a  commendable 
resource  we  do  not  argue,  but  that  it  is  one  to  be  faced 
fairly  and  squarely  as  certain  to  occur  in   the  pre- 
sent state  of  society,  and  one  that  can  be  abrogated" 
only  by  altering  the  conditions  that  lie  at   its    root. 
It  is  no  desire  to  "  make  the  worse  appear  the  better 
reason  "  that  forces  one  into  this  position.  __  It  is  no- 
more  a  condonation  of  artificial  prevention  to"point  out 
its  inevitability  than  it  would  be   a   condonation  of 
prostitution  to  point  out  that  it  always  has  existed  in 
civilised  countries,  and  must  do  so  if  those  conditions - 
that  produce  it  remain  operative. 

The  recommendation  of  Thomas  k  Kempis.  frequenter 
tibi  vio'entiam  fac,  will  indicate  an  alternative  course 
for  such  as  have  not  the  gift  of  continence,  but  human? 


July  20,  1904. 


ORIGINAL  COMMUNICATIONS. 


Thb  Medical  Pbess.     59 


nature  being  what  it  is.  there  can  be  no  doubt  that 
while  the  incentive  to  prevention  as  to  prostitution 
exists,  there  will  be  response  to  the  invitation  in  certain 
quarters.     We  have  sdready  indicated  our  views  on 
the  exaggerated  importance  that  we  consider  has  been 
attached  to  prevention,  as  opposed  to  late  marriage, 
as  a  factor  in  the  decline  of  the  birth-rate.     But  if 
prevention  is  a  constitutional  disease  as  we  consider, 
nothing  short  of  radical  treatment  will  cure  it,  and  in 
grave   illness   tinkering  remedies  are   to  be  avoided. 
But,  beyond  the  organisation  of  extensive  schemes  of 
colonisation,  there  remains  another  prime  duty  in  this 
matter  for  the  State  to  perform— that  is,  the  preven- 
tion   of    marriage    among    criminals,    lunatics,    and 
diseased  persons.     The  power  of  veto  is  asserted  by  the 
State  in  the  regulation  of  marriage  with  regard  to  con- 
sanguinity ;  wtiy  should    it  not    be  equally   enforced 
in    the    case   of   the  other  more  serious  cjnditions  ? 
Heaven    knows    we   have    enough    of    all    of    them 
at    present,    and    that    chronic    inebriates,    hardened 
criminals,  lunatics,  and  tuberculous  patients  should  be 
discharged  from  institutions  with  free  licence  to  per- 
petuate their  stigmata  to  generations  yet  unborn  is  a 
disgrace   to  a  nation  that  calls  itself  civilised  !     Dr. 
Rentoul  has  proposed  that  by  a  simple  surgical  opera- 
tion degenerates  should  be  placed  in  such  a  position 
that   the  possibility  of  their  propagating  their  kind 
should  be  for  ever  obviated.     It  remains  to  be  seen 
whether  such   a    suggestion   will   find  support    from 
society  in  general,  but  a  check  on  the  productivity  of 
these  classes  v  ould  be  an  unmixed  gain  to  any  country 
in  the  world.     While  giving  Dr.  Taylor  every  credit  that 
his  courage  deserves,  we  think  that   the  crusade  he 
advocates  would  be  little  effective  unless  the  pressure 
that  leads  to  the  occurrence  of  these  unfortunate  con- 
ditions can  be  relieved  by  some  such  method  as  we 
have  advocated. 

On  the  whole,  then,  I  find  Dr.  Taylor  has  brought 
forward  little  to  support  his  assumption  either  as  to 
the  cause  or  the  effects  of  the  diminishing  birth-rate. 
In  a  matter  of  such  vast  national  importance,  it  is 
desirable  that  an  exact  scientific  conclusion,  that  is  to 
say,  the  truth,  should  be  arrived  at  as  nearly  as  may 
be.  Possibly  the  end  might  be  best  approached  by 
way  of  a  Royal  Commission  of  Inquiry,  with  a  full 
examination  of  expert  medical,  social,  and  statistical 
evidence.  In  any  case,  I  think  the  candid  reader  will 
agree  with  me  that  the  causes  of  our  diminishing  birth- 
rate do  not  all  lie  on  the  surface. 

The  heads  of  my  own  conclusions  may  be  thus  briefly 
summarised  : — 

1.  There  has  been  a  fall  in  the  total  birth-rate  of 
the  United  Kingdom  during  the  past  half  century,  while 
there  has  been  little  change  in  the  marriage-rate  in  the 
same  period. 

2.  That  the  fall  affects  both  legitimate  and  illegiti- 
mate births,  and  is  therefore  active  outside  the  married 
state. 

3.  That  the  fall,  roughly  speaking,  of  the  last  thirty 
years  was  preceded  by  a  proportionate  rise  during  the 
thirty  years  before  that  again.  Thus  the  average  total 
birth-rate  of  1840  roughly  corresponds  with  that  of 
1900. 

4.  That  in  order  rightly  to  appreciate  the  fall  of 
the  latter  thirty  years  of  the  period  mentioned,  it  is 
necessary  to  inquire  into  the  causes  of  the  rise  in  the 
first  thirty  years. 

5.  That  the  rise  may  have  been  due  to  the  wave  of 
national  prosperity  that  passed  over  the  country  during 
the  latter  half  of  the  nineteenth  century,  subsequent 
to— or  because  of — the  introduction  of  Free  Trade. 

6.  That  the  diminishing  birth-rate  may  similarly  be 
a  delicate  index  of  decreasing  national  prosperity. 

7.  That  the  fall  may  possibly  be  due  to  the  fact  that 
under  present  social  conditions  the  maximum  limit  of 
supportable  population  may  have  been  reached. 

8.  That  the  falling  birth-rate  may  be  partly  ex- 
plained by  the  increasing  tendency  to  postpone  mar- 
riage to  a  later  age. 

9.  That  a  portion  of  the  fall — not  the  main  part — 
may  be  ascribed  to  artificial  prevention  of  conception 


practised  chiefly  among  the  better- to-do  classes  of  the 
community. 

10.  That  the  general  tendency  among  wealthy  and 
patrician  classes  has  always  been  towards  lessened 
fertility  and  sterility  {i.e.,  apart  from  special  preven* 
tive  methods). 

11.  That  increased  celibacy  must  be  taken  into  coa* 
sideration,  as  well  as  the  facilities  and  the  relative 
frequency  of  divorce. 

12.  The  constant  drain  of  healthy  soldiers  and 
sailors  lost  in  active  service  in  various  parts  of  the 
world  must  also  be  taken  into  consideration.  (This 
point  has  not  been  raised  in  the  foregoing  article.) 

13.  That  there  is  no  trustworthy  evidence  to  show 
that  the  practices  of  prevention  lead  to  grave  physical 
and  moral  evils  in  the  parents,  and  in  the  non-pre» 
vented  issue  of  such  marriages. 

14.  That  intellectual  limitation  of  marriage  fertility 
may  be  an  evolutionary  manifestation  of  the  highest 
intellectual  development,  anticipating  thereby  the  de- 
struction wrought  by  natural  laws  upon  superfluous 
individuals  in  the  community. 

15.  That  it  is  necessary  to  consider  the  quality  as 
well  as  the  quantity  of  the  children  brought  into  the 
world,  as  well  as  the  chances  of  their  survival  to  a 
ripe  age. 

16.  That  it  is  the  immediate  duty  of  the  State  to 
take  steps  to  check  the  reproduction  of  criminals, 
lunatics,  and  of  grossly  diseased  persons  suffering  from 
heritable  maladies. 

17.  That  an  enormous  proportion  of  the  avoidable 
disease,  insanity,  and  crime  that  constitute  so  great  a 
blot  upon  our  modem  civilisation  may  be  traced  to  the 
unrestricted  multiplication  of  the  children  of  the  poor, 

18.  That  the  limit  of  population  in  the  United 
Kingdom  supportable  under  present  social  conditions 
may  have  been  neared  or  actually  reached. 

19.  That  the  soundest  remedy  may  possibly  or 
probably  be  found  in  laws  that  lead  to  greater 
equality  in  the  distribution  of  wealth  and  of  opportunity 
to  the  individual  citizen. 


TCbe  Midbtman  Xecture 

ON 

HEREDITARY   BIAS 

AND 

EARLY    ENVIRONMENT  IN  THEIR  RELATION 

TO      THE      DISEASES      AND      DEFECTS      OF 

CHILDREN,  (a) 

By  R.  CLEMENT  LUCAS.  B.S.,  F.R.C.S., 

Coneulting  8nrg«on,  Evelina Ho0piU<  for  Children;  Senior  Svrg^om, 

Ouy'8  Hospital. 

After  alluding  in  sympathetic  terms  to  the  circum- 
stances which  led  to  the  foundation  of  the  Wightma« 
Lecture  by  Charles  Wightman,  Esq.,  Mr.  Lucas  pro- 
ceeded as  follows  :— The  truth  of  the  general  axiom 
that  the  child  must  resemble  his  parents  will  be  uriivcr- 
sally  admitted.  The  variations  in  the  appearance  of 
the  offspring  are  frequently  to  be  accounted  for  by  the 
relative  vigour  of  one  or  other  parent.  If  all  the 
strength  be  centred  in  one  parent  certain  peculiaritici 
are  apt  to  arise.  Thus,  it  has  been  observed  in  the 
case  of  the  peerage  that  marriage  with  an  only  daughter 
is  a  common  cause  of  the  extinction  of  titles.  Witk 
regard  to  longevity,  all  evidences  point  to  the  fact  that 
length  of  life  was  being  gradually  extended  by  reason 
of  a  more  widespread  knowledge  and  observation  of 
the  laws  of  hygiene. 

When  we  come  to  consider  what  diseases  are  actually 
hereditary,  we  are  met  with  a  difficulty  at  the  outset. 
There  are  several  diseases  which  were  once  thought 
to  be  of  an  hereditary  nature  which  we  now  know  are 
not  so.  As  late  as  1863.  Dr.  Sedgwick  stated  that 
pityriasis  versicolor  attacked  all  the  males  of  a  certain 
family.  Those  who  believed  in  the  influence  of 
"  diathesis "     received     a    rude     shock    when    Kock 


(a)  AbPtract  of  Lecture  delivered  before  the  Societ j  for  the  Stoidf 
of  DiFeoae  in  Children,  July  15th.  1904. 


6o    Tttfi  MftDtCAL  Press. 


ORIGINAL  COMMUNICATIONS. 


July  20,   1904- 


discovered  the  tubercle  bacillus.  The  eyes  of  such 
distinguished  observers  of  clinical  facts  as  Sir  Thomas 
Watson  may  even  be  closed  from  a  too  strict  adherence 
to  the  diathetic  theory.  When  I  became  attached  to 
the  Evelina  Hospital  for  Children,  I  inquired  into  the 
family  history  of  every  case  of  tuberculosis  in  infants 
tinder  the  age  of  two,  with  the  result  that  one  or  other 
parent  nearly  always  suffered  from  phthisis.  Are  we, 
therefore,  to  throw  over  tuberculosis  altogether  as  a 
diathetic  disease  ?  The  so-called  "  types  "  of  con- 
sumptives may  be  rather  considered  as  an  hereditary 
effect  than  a  cause  of  the  disease.  If  Cohnheim's 
theory  be  true,  namely,  that  the  bacilli  have  the  power 
of  penetrating  into  the  germ  or  sperm-cell,  then  the 
outlook  of  the  offspring  of  tuberculous  parents  is  hope- 
less from  the  earliest  period  of  existence. 

Up  to  the  time  of  the  discovery  of  the  specific 
bacillus  by  Hansen,  in  1871.  the  hereditary  nature  of 
leprosy  was  firmly  believed  in,  and  even  now,  in  certain 
parts  of  the  world,  segregation  is  still  practised.  But 
the  Indian  Commission  failed  to  discover  evidences  of 
such  heredity  in  more  than  5  or  6  per  cent,  of  the 
cases.  The  manner  in  which  the  disease  is  spread  only 
remains  to  be  further  elucidated.  Together  witli 
malaria  the  above  affections  must  now  be  classed  under 
the  specific  diseases. 

Passing  on  to  syphilis,  which  we  know  descends  from 
one  generation  to  another,  we  find  that  it  very  seldom 
goes  on  to  the  third  generation.  Mr.  Hutchinson  says 
that  in  eight  cases  of  congenital  syphilis  he  only  met 
with  one  doubtful  instance  of  transmission  to  the 
third  generation,  and  I  have  notes  of  only  one  case. 
The  term  "  transmitted  "  is  better  than  "  congenital/' 
as  better  expressing  our  knowledge  of  its  hereditary 
character.  If  both  parents  are  affected  with  the 
disease  the  results  are  doubly  disastrous  for  the  off- 
spring. Here  we  may  note  the  fact  that  the  later 
children  of  S3rphilitic  parents  are  generally  the  more 
robust,  in  contra-distmction  to  those  of  strumous 
parentage. 

There  is  one  disease  which  is  common  in  large  cities, 
and  which  is  responsible  for  much  of  the  physical  de- 
generation of  the  present  day,  and  that  is  rickets.  It 
is  a  purely  dietetic  disease,  and  it  may  be  induced  in 
any  child  simply  by  bad  feeding.  Its  hereditary  effects 
are  well  seen  in  puppies. 

Now  that  a  special  diplococcus  has  been  found  in 
acute  rheumatism,  this  disease  also  can  no  longer  be 
considered  as  purely  hereditary.  Its  antithetic  counter- 
part, gout,  can  be  produced  in  successive  generations, 
for  the  children  of  gouty  parents  are  generally  brought 
up  under  the  same  conditions  of  affluence  as  them- 
selves. It  is  possible,  nay,  even  probable,  that  this 
malady  will  be  found  to  be  of  an  infective  nature. 

Congenital  defects  due  to  diseases  of  the  nervous 
system  are  fairly  common.  Dr.  Shuttleworth  has 
found  that  in  20  per  cent,  of  all  cases  of  idiocy  a  history 
of  mental  disease  in  one  or  other  parent  may  be  ob- 
tained. The  researches  of  Galton  and  Karl  Pearson 
show  that  certain  nervous  diseases  are  not  only  here- 
ditary but  are  transmitted  in  definite  proportions  to 
the  sons  and  daughters  of  the  parents  so  affected. 
Psychical  tendencies  are  transmitted  as  well  as  physical 
qualities. 

Haemophilia  is  a  disease  which  presents  peculiar 
characteristics,  inasmuch  as  it  selects  the  males  and 
yet  is  transmitted  by  the  females.  Other  abnormal 
conditions  appear  to  follow  the  same  law,  such  as  colour- 
blindness ana  polydipsia.  Several  ocular  defects  are 
distinctly  hereoitary,  such  as  coloboma  and  nyctalopia. 

It  is  when  we  come  to  external  defects,  however,  that 
the  influence  of  heredity  is  most  clearly  marked.  As 
far  as  the  skin  is  concerned,  ichthyosis  is  transmitted 
through  several  members  of  the  same  family,  and  this 
for  many  generations.  Psoriasis,  in  like  manner,  often 
runs  in  families.  Such  congenital  abnormalities  as 
supernumerary  digits  have  been  traced  through  five 
generations.  With  regard  to  hare-lip,  I  have  previously 
recorded  the  fact  that  abs^iice  of  the  lateral  incisor 
tooth  in  the  mother,  is  frequently  the  precursor  of  this 
deformity  in  the  offspring,  and  I  desire  to  add  further 


the  observation  that  a  feebly  developed  incisor  tooth 
may,  similarly,  foreshadow  the  occurrence  of  hare-lip 
in  the  child.  Many  instances  of  the  transmission  of 
multiple  deformities  through  successive  generations 
have  been  recorded  in  the  transactions  of  this  Society, 
some  of  which  have  been  conditions  of  great  rarity. ' 

The  influence  of  intra-uterine  amputation  of  limbs 
and  other  parts  of  the  body,  due  to  constriction  by 
the  umbilical  cord,  has  probably  been  considerably 
overrated.  There  are  many  arguments  which  militate 
greatly  against  the  acceptance  of  this  view,  and  I 
would  rather  suggest  that  such  deformities  are  due  to 
errors  far  back  in  the  process  of  development,  perhaps 
of  the  nature  of  incompatibility  between  the  germ  and 
the  sperm-cell.  Once  such  a  deformity  has  been  well 
established,  it  is  very  difficult  to  eradicate.  The 
"  tyranny  of  ancestry  "  has  first  to  be  overcome,  and 
this  is  not  an  easy  process. 

The  influence  of  the  parents  upon  the  physical  de- 
terioration of  the  present  day  is  even  more  important 
than  the  effects  of  bad  food  and  surroundings  upon  the 
children  themselves.  Both  the  health  of  the  parents 
and  the  nutrition  of  their  offspring  are  matters  in  which 
the  better  observance  of  the  laws  of  health  cannot  fail 
to  react  favourably  upon  the  physical  condition  of 
the  nation. 


SOME  OF  THE  NEWER   METHODS    OF 

OPENING  AND  CLOSING   THE 
ABDOMEN,  (a) 

By  E.   HASTINGS    TWEEDY,   F.R.C.P.I., 
Master  of  the  Rotunda  Hospital,  I>ub1in. 

There  is  no  more  remaikable  fact  in  the  surgery' 
of  the  present  day  than  the  want  of  unanimity 
existing  as  to  the  best  method  of  opening  and 
closing  the  abdomen  in  abdominal  operations  for 
pelvic  diseases.  The  propriety  of  a  vertical 
incision  has  only  recently  been  called  in  question. 
It  is  still  the  operation  of  election  among 
British  surgeons,  but  on  the  Continent  the  trans- 
verse incision  has  largely  superseded  it.  This 
plan,  since  my  appointment  to  the  Rotunda 
Hospital  in  November  last,  I  have  adopted  in 
nineteen  cases,  and  it  is  to  the  result  of  my  obser- 
vations in  these  that  I  now  desire  to  draw  attention. 

Let  me  first  say  that  the  transverse  incision  is 
performed  in  two  ways,  different,  but  not  anta- 
gonistic, and  which  of  the  two  the  operator  adopts 
depends  entirely  upon  the  object  he  has  in  view. 
If  his  purpose  be  to  obtain  the  most  extensive 
\'iew  ever  yet  attempted  of  the  pelvic  regions, 
he  should  proceed  as  Mackenrodt  does  in  his 
very  radical  operation  for  uterine  cancer.  The 
skin,  fascia,  recti  muscles  and  peritoneum  are 
divided  by  a  long,  slightly  curved  incision,  close 
to  and  above  the  pubes  ;  portions  of  the  oblique 
muscles  at  either  side  will  probably  also  be  severed, 
and  by  this  an  extraordinarily  clear  view  and 
extended  field  will  be  obtained  in  which  to  operate. 
The  incision  is  a  formidable  one ;  necessitating 
as  it  does  the  severance  of  the  muscular  supports 
of  the  abdomen,  the  proper  union  of  which  can 
never  be  hoped  for,  a  weak  scar  is  more  than 
likely  to  result,  and  save  for  the  removal  of  cancer, 
I  know  of  no  justification  for  such  an  incision. 
If,  on  the  other  hand,  the  object  is  not  primarily 
that  of  obtaining  an  extensive  view,  the  second 
method  will  be  found  applicable,  and,  I  believe, 
preferable  in  many  cases  in  which  a  vertical 
incision  has  heretofore  been  made.  In  it  a 
transverse  and  slightly  curved  opening  is  made  at 


(a)  Read  before  the  Obstetrical  Rection  of  the  Royal  Academy  of 
Medicine  in  Ireland.  Friday,  April  15th,  1904. 


July  20,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    6z 


the  margin  of  the  pubic  hair,  through  skin,  adipose 
tissue,  and  sheaths  of  the  recti.  These  structures 
are  raised  as  a  thick  flap  above  and  below  the 
incision,  from  the  muscles  l)ring  beneath  them. 
The  division  between  the  recti  can  now  clearly  be 
made  out ;  the  latter  are  separated  and  the  abdomen 
opened  in  the  usual  manner.  The  advantages  of 
such  an  incision  are  manifest.  In  the  first  place 
it  runs  in  the  direction  of  the  elastic  fibres  of  the 
skin,  as  a  rule  the  parts  fall  naturally  into  position 
on  the  completion  of  the  operation,  and  the  fear 
of  hernia  is  reduced  to  a  minimum,  the  severed 
aponeurosis  is,  throughout  the  greater  part  of  its 
course,  protected  by  the  muscles,  and  it  is  only  the 
transverse  slit  extending  between  these  that  could 
by  any  possibility  permit  of  the  escape  of  the 
abdominal  contents.  The  appUcation  of  a  few 
interrupted  sutures,  superficially  placed  in  the 
muscles,  sufficient  to  keep  them  in  apposition 
until  adhesions  form  between  them  and  their 
overlying  fascia,  will  effectually  prevent  the 
occurrence  of  hernia.  The  scar  left  after  such  a 
wound  has  no  tendency  to  spread.  It  runs  in  the 
direction  of  the  natural  wrinkles  of  the  abdomen, 
and  has  the  added  advantage  of  being  covered 
by  the  pubic  hair. 

I  have  on  several  occasions  curved  the  incision  to 
a  considerable  degree,  in  order  to  obtain  more 
room.  This  I  now  look  upon  as  a  procedure  to 
be  avoided  if  possible,  as  it  adds  to  the  unsightliness 
of  the  scar.  This  method  of  operating  should  be 
confined  to  the  less  severe  abdominal  sections. 
In  suitable  cases,  however,  it  will,  I  am  sure, 
steadily  gain  in  favour.  On  one  occasion  the 
fascia  did  not  come  easily  together,  and  excessive 
strain  on  it  had  to  be  prevented  by  keeping  the 
patient's  legs  flexed  for  a  few  days.  One  case 
alone  showed  slight  indications  of  a  stitch  abscess 
at  the  extreme  end  of  the  incision  ;  the  operation 
was  undertaken  for  the  cure  of  an  old  ventral 
hernia.  It  was  impossible  to  sterilise  the  skin 
efficiently.  The  woman  suffered  from  a  severe 
bronchial  cough  of  a  chronic  character,  and  as  a 
further  compUcation  a  pneumonic  area  of  dulness 
developed  after  the  operation.  Finally,  I  may 
add  that  the  incision  does  not  lend  itself  well 
to  the  employment  of  an  abdominal  drainage-tube. 

Hernial  formation  is  unfortunately  a  very 
common  sequela  of  abdominal  operations.  In 
no  less  than  six  instances  I  have  opened  the 
abdomen  within  the  past  four  months  for  the 
relief  of  this  complication.  Of  these,  two  were 
operations  not  performed  in  this  country,  and 
one  of  them  was  so  remarkable  that  it  is  worthy  of 
being  recorded. 

The  woman  entered  the  hospital  some  four 
weeks  ago,  suffering  from  the  effects  of  a  former 
abdominal  section  performed  eight  years  pre- 
viously. On  the  evening  of  her  arrival  in  hospital, 
during  a  fit  of  coughing  her  abdomen  ruptured, 
and  masses  of  intestines  extruded  on  to  the  skin, 
the  pubic  hair,  and  sheets.  A  full  hour  elapsed 
before  an  operation  for  her  relief  could  be  effected, 
but  notwithstanding,  I  am  happy  to  say  her 
recovery  has  been  uneventful. 

The  prevention  of  hernia,  is,  I  think,  entirely 
dependent  on  a  proper  technique  being  followed 
in  the  closing  of  the  abdominal  wound,  in  the 
accomplishment  of  which  the  main  objects  should 
be  strict  asepsis,  careful  apposition  of  the  more 
important  abdominal  layers,  and  lastly  the  pre- 
vention of  subcutaneous  haemorrhage.     The  attain- 


ment of  these  ends  will  always  remain  doubtful 
in  the  practice  of  those  surgeons  who  employ  the 
through-and- through  suture. 

It  seems  to  me  a  safe  precaution  to  close  off 
the  peritoneum  [in  the  first  instance  ;  this  can  be 
very  readily  accompUshed  by  means  of  a  con- 
tinuous suture  of  fine  silk.  This  No.  2  silk  is 
with  us  antiseptically  prepared  by  being  boiled  on 
two  occasions  separated  by  an  interval  of  twenty- 
four  hours  in  I  in  1,000  corrosive  sublimate 
solution.  The  object  sought  by  such  preparation 
is  to  render  the  silk  actively  inhibitory  to  the 
growth  of  germs  with  which  of  necessity  it  must 
come  in  contact  until  such  time  as  the  phagocytic 
action  of  the  tissues  can  exert  their  full  power. 
Whether  the  posterior  sheaths  and  recti  muscUs 
should  be  sutured  is  still  a  debatable  point.  For 
my  part  I  beUeve  such  a  procedure  is  not  only 
unnecessary  but  positively  harmful..  The  union 
between  muscular  structures  is  proverbially  weak, 
and  sutures  piercing  at  right  angles  to  their 
fibres  must  impair  their  vitaUty  by  strangulating 
portions  of  their  vascular  and  nervous  supply. 

It  is  no  doubt  essential  to  keep  the  muscles 
in  close  apposition,  and  this  can  with  certainty  be 
done  by  properly  suturing  their  external  sheaths. 
To  attain  this  end  I  was  formerly  in  the  habit  of 
uniting  the  sheaths  by  interrupted  sutures  of 
silk-worm-gut  placed  in  mattress  fashion  after 
the  manner  advised  by  Kelly.  This  proved  most 
satisfactory,  and  has  only  now  been  abandoned 
by  me  in  favour  of  the  fine  continuous  suture  of 
silk  for  the  reason  that  the  latter  can  be  applied 
more  rapidly.  The  method  of  suturing  above 
described  will  almost  certainly  protect  against 
future  hernia,  and  I  need  hardly  say  tluit  in 
bringing  it  to  your  notice  I  make  no  claim  to 
originality. 

The  closure  of  the  skin  wound  I  have  not  as 
yet  dealt  with,  and  it  is  in  connection  with  this 
that  I  desire  to  call  attention  to  my  recently 
introduced  method  which,  so  far  as  I  know,  is 
novel.  I  pass  a  subcutaneous  silk-worm-gut 
suture  immediately  beneath  the  skin  in  the  usual 
manner  and  thread  either  end  through  a  perforated 
leaded  plate  similar  to  the  one  I  now  show.  These 
plates  are  cut  out  of  ordinary  roof  lead  ;  in  width 
they  measure  about  two  inches,  while  its 
length  is  made  to  correspond  to  that  of  the  incision. 
The  lead  can  be  perforated  opposite  the  ingress 
and  egress  of  the  suture  by  means  of  a  strong 
surgical  needle.  Through  these  the  ends  of  the 
suture  are  passed,  and  having  been  drawn  taut 
are  tied  together  over  the  plate.  The  plate 
should  be  sterilised,  and  both  it  and  the  skin  be 
in  a  perfectly  dried  state  before  its  application. 
Aseptic  dressings  are  placed  over  the  plate,  and 
an  abdominal  binder  applied  in  the  usual  manner, 
the  parts  being  left  undisturbed  for  foreuten  days. 
On  the  expiration  of  that  time  the  dressings  can 
be  removed  and  will  be  practically  unstained. 
The  suture  is  now  cut  and  the  leaden  plate  lifted 
off.  It  does  not  adhere  to  the  skin,  but  will  be 
found  to  act  after  the  manner  of  a  smoothing 
iron  in  procuring  exact  apposition  of  the  opposing 
edges,  and  preventing  over-riding  of  surfaces. 
The  plate  affords  a  ready  means  of  preventing  the 
suture  slackening,  and  does  not  permit  the  wound 
to  pucker.  Moreover,  I  feel  convinced  that  the 
lead  itself  exercises  a  favourable  influence  on  the 
healing  process,  for  I  cannot  otherwise  account  for 
the  perfection  of  the  scar. 


62     The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


July  20,  1904. 


tlbe  ®aNp4tfent  Z)epattmentd. 


TOTTENHAM  HOSPITAL. 

Dermaiological  Cases  under  the  Care  of 

G.     Norman     Meachen,     M.D.,     M.R.C.P. 

Case  I. — Lichenoid  Transformation  of  Scratch  Marks. 
— ^The  patient,  a  married  woman,  aet.  31,  had  suffered 
from  an  irritable  eruption  for  about  six  months.  Her 
genepl  health  had  not  been  affected,  and  she  had  had 
no  previous  illnesses.  On  examination,  there  was 
discovered  a  profuse  eruption  of  lichen  planus,  the 
lesions  being  typically  flat-topped,  shiny,  and  more 
plentiful  upon  the  lower  extremities,  where  their  colour 
tww  somewhat  duskier.  No  lesions  were  observed 
upon  the  buccal  mucous  membrane.  There  were 
several  scratch-marks  visible,  as  the  rash  was  very 
pruriginous,  and  upon  some  of  these  it  could  be  seen 
that  the  linear  streak  made  by  the  flnger-nails  was 
thickly  set  with  small  papules  showing  all  the  characters 
of  lichen  planus.  One  recent  scratch  upon  the  right 
hand,  which  the  patient  stated  was  inflicted  accidentally, 
also  showed  the  papules  in  place  of  the  usual  superficial 
blood-crust  which  forms  under  normal  circumstances 
as  the  result  of  a  deep  scratch. 

Dr.  Meachen  remarked  that  the  so-called  lichenoid 
transformation  of  scratch-marks,  occasionally  met  with 
in  this  disease,  was  a  most  interesting  feature.  As  far 
as  the  pathology  of  the  affection  went,  the  condition 
was,  in  itself,  an  evidence  that  the  morbid  process  was 
prone  to  attack  those  areas  of  the  skin  whose  resistance 
was  lowered  or  whose  vitality  was  impaired.  He  in- 
stanced the  case  described  by  Dr.  West,  in  which  the 
lichen  papula  appeared  in  a  scratch-mark  inflicted 
by  a  kitten  before  any  other  part  of  the  eruption 
appear^  elsewhere.  The  only  remedy  which  really 
did  seem  to  possess  a  specific  influence  upon  the  course 
of  lichen  planus  was  arsenic,  and  this  patient  was  there- 
fore put  upon  three  minims  of  Fowler's  solution,  thrice 
daily,  to  commence  with.  A  weak  tar  lotion  was 
ordered  for  local  application. 

Case  II. — Prurigo  Mitis. — A  little  girl,  nearly  three 
years  old,  was  brought  to  the  hospital  with  a  very 
irritable  eruption  which  the  mother  stated  had  been 
present  for  about  eighteen  months.  She  had  attended 
other  hospitals.  The  child  was  said  to  be  in  good  health, 
although  its  sleep  was  much  disturbed  at  night  by  the 
irritation. 

On  inspection,  the  skin  over  the  lower  part  of  the 
trunk,  thighs,  and  legs,  and  to  a  lesser  extent  over  the 
chest  and  upper  extremities,  was  covered  by  a  profu- 
sion of  small  conical  papules,  many  of  which  were 
surmounted  by  a  blood-crust,  indicating  the  irritable 
character  of  the  eruption.  The  extensor  surfaces  were 
more  affected  than  the  flexor.  On  passing  the  hand 
lightly  over  the  areas  the  firm  nature  of  the  papules 
could  be  felt.  There  were  no  urticarial  wheals  nor 
were  there  any  eczematous  patches  anywhere.  There 
did  not  appear  to  have  been  any  great  error  in  the 
dieting  of  the  child,  for  the  mother  had  endeavoured 
to  carry  out  previous  instructions.  The  bowels  were 
habitually  irregular  in  their  action.  The  glands  in  the 
firoins  were  not  enlarged,  and  no  other  member  of  the 
family  had  ever  suffered  or  was  suffering  from  a  similar 
complaint. 

The  diagnosis  of  this  case  rested  upon  the  papular 
nature  of  the  eruption,  the  absence  of  wheals  or  exuda- 
tion, and  its  chronicity.  Itching  was  always  a  well- 
marked  symptom  of  the  disease,  and  the  scratching 
which  it  evoked  was  responsible  for  the  secondary 
lesions  which  were  plentifully  seen  in  the  present  case. 
The  affection  usually  commenced  at  or  about  the  end  of 
the  first  year  of  life,  and  sometimes  persisted  for  several 
years.  Geographical  conditions  and  racial  character- 
istics seemed  to  have  an  important  bearing  upon  the 
prevalence  of  the  disease,  for  it  was  distinctly  rare  in 
America  and  it  was  said  to  be  relatively  more  frequent 
among  children  of  the  Jewish  community. 

The  treatment  of  this  affection  sometimes  taxed  the 
ingenuity  of  the  physician  to  the  utmost.     Sedatives 


were  often  required  at  night,  a  draught  of  chloral  and 
bromide  being  suitable  for  this  purpose.  Constitu- 
tional and  hygienic  treatment  was  necesssary  in  the 
majority  of  cases,  plenty  of  fresh  air  and  good  plain 
nourishment  being  enjoined.  Cod-liver  oil  and  malt 
internally  was  indicated  in  marasmic  infants.  To  relieve 
the  irritation,  lotions  of  carbolic  acid,  i  in  80,  or  of 
creolin,  i  per  cent.,  were  useful.  This  child  was  given 
5  min.  of  the  tinct.  cinchonas  in  the  mist.  mag.  sulph. 
cum  rheo.  three  times  a  day. 

Case  III. — Eczema  of  the  Face  with  Catarrhs  of  Mucous 
Membranes, — A  little  girl,  aet.  3,  had  suffered  from 
right  otorrhoea  for  a  fortnight,  and  was  brought  by  her 
mother  to  the  skin  department  with  a  "  breaking-out  ** 
upon  the  face.  A  few  days  before  this  the  right  eye 
became  inflamed.  There  was  a  typical  weeping, 
papular  and  crusty  eczema  of  the  face,  chiefly  limit^ 
to  the  right  side,  but  extending  downwards  a  short 
distance  upon  the  neck.  The  auricle  was  also  involved, 
and  there  was  an  acute  conjunctivitis  with  photophobia 
upon  the  same  side. 

The  association  of  eczema  in  young  children  with 
various  catarrhal  affections  of  the  mucous  membranes 
was  not  unfrequently  observed.  A  running  at  the  nose 
was  prone  to  lead  to  an  eczematous  dermatitis  of  the 
upper  lip  and  adjacent  parts  of  the  cheeks,  while  a 
purulent  discharge  flowing  from  the  external  auditory 
meatus  often  determined  the  appearance  and  the  dis- 
tribution of  an  eczema  in  the  immediate  vicinity  of  the 
affected  ear.  In  such  instances  the  skin  affection  was 
clearly  secondary  to  the  other  catarrhal  conditions,  and 
when  these  were  cured  the  skin  got  well.  Sometimes, 
however,  parents  will  persist  in  the  statement  that  the 
eczema  appeared  first.  Believing,  as  we  do.  that 
eczema  is  a  true  cutaneous  catarrh,  whether  this  be 
produced  by  micro-organisms  or  not,  it  is  not  incon- 
ceivable that  this  morbid  process  should  affect  several 
anatomically  allied  tissues  at  the  same  time.  Only 
upon  this  theory  can  we  account  for  the  appearance  of 
simple  or  a  phlyctenular  conjunctivitis  coincidently 
with  an  acute  facial  eczema.  Regarding  an  otorrhcea 
in  the  light  of  an  exciting  cause  of  the  skin  affection, 
it  is  useless  to  expect  much  improvement  in  the  latter 
until  the  aural  discharge  be  cured. 

XEransactions  of  Societies* 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  July  6th,  1904. 

Professor  Chiene,   C.B.,    President,   in   the   Chair. 


Mr.  H.  J.  Stiles  showed  a  girl,  aet.  7,  on  whom 
he  had  operated  for  a  large  abdominal  tumour  of  long 
standing.  It  occupied  the  upper  zone  of  the  abdomen, 
and  while  its  lower  margin  reached  below  the  umbilicus, 
it  was  chiefly  epigastric  and  extended  below  the  left 
costal  margin.  At  first  sight  it  resembled  a  pancreatic 
cyst  or  a  large  hydronephrosis,  but  as  it  could  be  freely 
moved  from  below  the  ribs,  and  from  one  loin  to  the 
other,  it  was  concluded  that  it  was  unconnected  either 
with  the  kidney,  loin,  or  pelvis.  Eventually  a  probable 
diagnosis  of  mesenteric  cyst  was  arrived  at,  and  this 
was  confirmed  at  the  operation,  when  the  cyst  was  found 
to  be  firmly  adherent  to  the  muscular  wall  of  the  intes- 
tine. It  was  formed  of  fibrous  tissue,  covered  with 
peritoneum  and  lined  with  endothelium,  and  had 
probably  developed  from  one  of  the  lymphatics. 

Dr.  Edwin  Bramwell  showed  (i)  an  interesting  case 
in  connection  with  Edinger's  theory  of  the  etiology  of 
tabes.  The  patient  was  a  watchmaker  who  had  had 
syphilis  ten  years  ago.  He  had  dimness  of  vision  and 
loss  of  accommodation  in  the  right  eye,  and  Argyll- 
Robertson  pupil  in  the  left  eye.  There  were  no  other 
signs  of  tabes.  Edinger's  view  of  the  etiology  of 
tabes  was  that,  while  a  specific  infection  is  the  predis- 
posing cause,  any  excessive  functional  activity  pre- 
cipitates the  lesion.  In  this  case  the  patient  habitually 
used  his  right  eye  a  great  deal.  (2)  A  case  of  chronic 
poliomyelitis    in    a    hammerman.     The   patient    had 


July  20.   1904. 


TRANSACTIONS  OF  SOCIETIES.         The  Medical  Press.    63 


.-gradually  progressive  weakness  of  the  right  arm 
•of  three  years'  duration.  Six  months  ago  he  had  stopped 
work,  and  since  then  the  condition  had  undergone  arrest. 
There  was  marked  atrophy  of  the  upper  arm,  the 
biceps  being  very  feeble,  the  upper  part  of  the  trapezius 
atrophied,  its  lower  and  middle  parts  gone.  The 
supinator  longus  was  also  much  wasted,  and  both  the 
latissimi  dorsi  failed  to  react  to  electricity.  The 
deltoid  and  triceps  were  intact.  It  was  evident  that 
the  muscles  involved  by  the  atrophy  were  those  used  in 
the  patient's  occupation. 

Dr.  Allan  Jamieson  showed  a  case  of  acne  rosacea 
of  the  hypertrophic  type  affecting  the  nose.  The 
condition  had  been  much  improved  by  slicing  off  thin 
layers  of  the  superficial  textures  under  adrenalin  and 
cocaine.  (2)  A  case  of  lupus  vulgaris  of  five  years' 
duration  sheeting  the  nose,  upper  lip,  hard  palate  and 
gums.  Treatment  by  the  X-rays  had  had  little  effect, 
but  the  use  of  radium  bromide  for  twenty- two  hours 
in  all  had  produced  an  almost  complete  cure. 

Mr.  P.  M.  Caird  showed  (i)  a  patient  after  removal 
of  a  large  right-sided  renal  tumour  (nephroma).  The 
patient's  haemoglobin  was  down  to  48  per  cent.,  he  had 
heart  disease,  bronchitis,  and  ascites,  and  was  in  a  very 
precarious  condition  before  operation.  He  had 
enucleated  an  enormous  tumour  of  a  somewhat  rare 
nature,  growing  as  it  did  from  the  adrenal  and  swallow- 
ing up  the  whole  kidney.  (2)  A  woman,  xt.  54,  who 
had  heart  disease,  ascites,  and  bronchitis,  and  sym- 
ptoms of  chronic  obstruction,  from  whom  he  had 
removed  a  carcinoma  of  the  transverse  colon.  The 
tumour  was  the  sixe  of  the  fist,  and  had  been  taken 
away  along  with  a  piece  of  the  bowel,  the  ends  being 
reunited  by  end-to-end  suture.  (3)  Coxa  vara  in  a  boy, 
aet.  7,  who  had  had  difficulty  in  walking  for  two  years. 
He  had  a  peculiar  swinging  gait,  the  hip- joints  were 
freely  movable,  but  abduction  was  impossible,  and 
skiagrams  showed  that  the  neck  of  the  femur  formed 
almost  a  right  angle  with  the  shaft. 

Mr.  J.  W.  Dowden  showed  a  man,  aet.  60,  two  years 
after  an  extensive  series  of  operations  for  epithelioma 
of  the  floor  of  the  mouth,  and  (2)  a  patient  two  years 
after  removal  of  epithelioma  of  the  lip. 

Dr.  R.  A.  Fleming  showed  a  patient  who,  since  1901, 
had  been  subject  to  curious  attacks  of  a  sensation  of 
suffocation  whenever  she  laughed  or  coughed.  Nothing 
could  be  found  to  account  for  the  spasm,  which  in 
some  ways  resembled  whooping-cough,  there  being  a 
short,  gasping  inspiration  and  a  long  wheezing  expira- 
tion with  a  cou^h  between  the  two  phases.  The  con- 
dition was  obviously  nervous  and  great  benefit  had 
followed  the  use  of  high  frequency  currents,  though 
other  remedies  had  previously  done  little  good. 

Mr.  J.  M.  CoTTERiLL  showed  (i)  a  man,  aet.  52,  who 
had  had  a  tumour  of  the  liver  for  three  years.  The 
probable  diagnosis  was  sarcoma,  but  removal  of  a  piece 
of  the  growth  for  microscopic  examination  had  revealed 
nothing  definite.  A  month  ago  the  patient  had 
developed  a  large  swelling  of  the  epididymis,  which 
suggested  that  the  condition  might  be  syphilitic.  (2) 
A  boy  with  congenital  deformity  of  the  ear,  jaw,  and 
face,  and  spina  bifida. 

Mr.  A.  Scot  Skirving  showed  a  girl  with  peculiar 
arrest  of  development  of  the  fourth  metacarpal  bone. 

Sir  Thomas  R.  Eraser  gave  a  communication  on 

A  CASE  OF  COMPLETE  TRANSPOSITION  OF  THE  VISCERA 
WITH  CEREBRAL  TUMOUR  AND  OTHER  PATHOLOGICAL 
CONDITIONS. 

After  briefly  referring  to  another  case  of  the  same 
condition,  which  had  been  under  observation  on  a 
previous  occasion,  a  description  of  this  case,  that  of  a 
man,  aet.  24,  in  which  the  diagnosis  had  been  made 
during  life  and  confirmed  after  death,  wa^  given.  The 
patient  was  already  aware  of  his  peculiarity,  his  atten- 
tion having  been  drawn  many  years  ago  to  the  fact  that 
his  heart  was  beating  on  thewrongside.  Inconsequence 
of  this,  he  was  seen  by  Dr.  Bruce,  of  Glasgow,  who  haid 
made  the  diagnosis  and  described  the  case  in  the 
Glasgow  Medical  Journal  for  1895.  He  was  admitted 
to  the  Royal  Iniinnary  on  account  of  pyuria  and 
^>aroxysmal    headache.      On     physical    examination. 


a  complete  transposition  of  all  the  viscera — heart, 
stomach,  liver,  spleen,  and  large  intestine — was  made 
out.  He  also  had  a  supernumerary  thumb  on  the  right 
hand.  The  urine  contained  pus,  but  no  tube-casts, 
and  the  diagnosis  of  pyelitis  was  made.  Examination 
of  the  nervous  system  revealed  the  fact  that  he  was 
right-handed,  and  that  he  had  congenital  anosmia. 
The  headaches  were  of  such  a  nature  as  to  suggest 
intra-cranial  pressure,  but  the  diagnosis  was  not  at 
first  clear,  and  was  only  confirmed  several  months 
later  when  he  returned  to  the  Infirmary  on  account 
of  their  inceasing  severity,  associated  with  blindness. 
He  died  somewhat  suddenly  without  any  further 
definite  cerebral  symptoms.  On  post-mortem  examina- 
tion a  cyst,  about  the  size  of  a  marble,  was  found  in  the 
centre  of  the  brain  pressing  on  the  left  foramen  of 
Monro,  and  the  condition  of  the  viscera  referred  to 
above  as  ascertained  by  clinical  examination  was 
confirmed.  The  rarity  of  cyst  in  this  position  was 
referred  to,  and  the  literature  of  transposition  of  the 
viscera  shortly  discussed.  While  many  cases  were  upon 
record,  in  only  a  few  had  the  diagnosis  been  made  ante- 
mortem.  A  minute  anatomical  investigation  of  the 
viscera  had  been  carried  out  under  the  supervision  of 
Professor  Cunningham,  and  beyond  the  fact  that  there 
was  a  complete  transposition  of  the  organs  extending 
to  the  minutest  arteries  and  nerves,  kidneys,  pancreas-— 
in  short,  to  all  the  structures  of  the  body — ^no  anatomi- 
cal peculiarities  had  been  detected. 

The  paper  was  discussed  by  Dr.  Edwin  Bramwell, 
who  mentioned  a  case  of  cyst  of  the  brain  in  exactly 
the  same  locality,  which  had  come  under  his  notice 
some  years  before. 

Dr.  W.  G.  Sym  read  a  paper  on 

METASTATIC   GONORRHCEAL   CONJUNCTIVITIS, 

Ordinary  conjunctivitis  occurring  in  the  subjects  of 
gonorrhoea  was  a  very  acute  inflammatory  process 
indeed  ;  it  began  unilaterally,  and  the  second  eye  was 
infected  from  the  first.  There  was  great  chemosis, 
profuse  discharge,  commonly  ulceration  of  the  cornea, 
and  numerous  gonococci  were  present  in  the  pus  from 
the  eye.  The  syinptoms  of  the  metastatic  form  were 
quite  dissimilar ;  it  was  more  allied  to  the  joint  affec- 
tions and  iritis  of  gonorrhoea,  was  subacute  with  slight 
watery  or  mucoid  discharge,  few  gonococci ;  while 
ulceration  of  the  cornea  was  rare.  He  had  seen  two 
cases  only,  briefly  as  follows: — (i)  A  man  had  had 
gonorrhoea  three  months  previously  and  the  discharge 
had  stopped  three  weeks  before  the  eye  symptoms  set  in ; 
along  with  the  conjunctivitis  several  joints  became 
painful,  these  s3nnptoms  improved  and  then  there  was 
a  relapse.  There  was  moderate  injection  of  the  con- 
junctiva with  secretion  of  watery  mnco-pus,  a  small 
peripheral  ulcer  of  the  cornea  and  some  hyperaemia 
of  the  iris  which  might  occur  along  with  any  corneal 
ulcer.  The  left  ankle  and  wrist  were  inflamed.  No 
bacteriological  examination  was  made.  (2)  A  male 
who  had  suffered  from  gonorrhoea  for  three  weeks,  but 
never  very  badly,  as  he  had  been  carefully  treated  from 
the  first.  The  possibility  of  direct  infection  was  ex- 
cluded. Conjunctivitis  had  been  present  for  three  days, 
but  was  not  very  severe — very  much  resembling  a 
moderate  case  of  ordinary  catarrhal  conjunctivitis. 
The  ocular  conjunctiva  was  injected,  and  the  lids 
swollen.  The  patient  complained  of  no  rheumatism, 
but  on  being  questioned  admitted  that  he  had  had  pain 
in  the  shoulder  for  about  twenty-four  hours,  to  which, 
however,  he  had  paid  little  heed.  Subsequently, 
other  joints  became  involved.  A  few  gonococci  were 
found  in  the  conjunctival  secretion,  though  with  some 
difficulty.  Recovery  under  the  use  of  sublimate  lotion 
and  protargol  was  complete,  but  the  joints  were  some- 
what obstinate.  Direct  infection  here  was  excluded 
by  the  care  which  the  patient  had  taken,  the  bilateral 
onset,  and  the  presence  of  joint  effusion.  These 
two  cases  were  the  only  ones  Dr.  Sym  had  met  with, 
and  the  condition  was  not  even  referred  to  in  most  of  the 
text-books.  It  had,  however,  been  discussed  at  the 
Ophthalmological  Congress  at  Utrecht,  and  at  the 
British  Medical  Association  Cheltenham  meeting. 
The  origin  of  the  condition  was  uncertain ;  probably  it 


64  The  Medical  Press. 


BRITISH  HEALTH  RESORTS. 


July  20.   1904. 


was  due  to  the  bacterial  toxins  rather  than  to  the 
bacteria  themselves,  as  dead  cultures  of  gonococci 
produced  a  mild  conjunctivitis  in  animals.  Probably 
the  disease  was  not  very  rare,  and  it  was  well  that 
ophthalmologists  and  surgeons  who  saw  many  cases 
of  venereal  disease  should  bear  in  mind  its  existence. 
Dr.  Logan  Turner  read  a  paper  <mi 

OBSERVATIONS     ON     THE     OPERATIVE       TREATMENT      OF 
CHRONIC  SUPPURATION   IN  THE  FRONTAL   SINUS. 

The  author  first  pointed  out  that  a  great  deal  had  been 
written  upon  this  subject,  and  that  probably  the 
literature  would  be  still  further  increased  owing  to  the 
fact  that  we  had  not  yet  arrived  at  a  perfectly  satis- 
factory method  of  dealing  with  these  cases  surgically. 
Relapses  not  infrequently  occurred,  a  considerable 
number  of  post-operative  fatalities  had  been  recordedf 
and  the  question  of  disfigurement  was  a  prominent  one 
in  connection  with  the  removal  of  bone  in  the  region  of 
the  forehead. 

Many  operations  had  been  devised,  but  whatever 
might  be  the  technique  of  the  operation  performed, 
there  were  two  principles  underlying  the  various  methods 
of  procedure.  First,  opening  the  sinus  through  its 
anterior  wall,  curetting  the  cavity  and  draining  into 
the  nose,  an  operation  associated  with  the  names  of 
Ogston-Luc ;  secondly,  obliteration  of  the  sinus  by 
the  removal  of  the  anterior  bony  wall  of  the  cavity  only, 
or  of  its  anterior  and  inferior  walls.  Evidence  was 
then  brought  forward  to  show  that  opening  and  draining 
the  sinus  was,  in  a  large  number  of  cases,  an  unsatisfac- 
tory procedure.  Anatomical  reasons  were  to  be  found  in 
the  varying  extension  of  the  sinus  upon  the  forehead 
and  into  the  roof  of  the  orbit,  and  also  in  the  recesses 
and  partial  subdivisions  of  the  sinus  which  might  be 
completely  overlooked  through  a  moderate  -  sized 
opening  made  in  the  anterior  waJl  of  the  cavity.  Again, 
the  inability  to  deal  thoroughly  with  the  ethmoidal 
cells  so  frequently  affected  along  with  the  frontal  sinus 
led  to  re-infection  of  the  latter  cavity.  Statistical 
tables  were  shown  illustrating  the  failures  that  had 
occurred  in  the  hands  of  different  surgeons  and  a  table 
was  given  showing  how  much  more  frequently  death 
had  followed  the  operation  of  opening  and  draining 
the  sinus  than  when  the  obliteration  method  had  been 
carried  out.  The  obliteration  operation  was  then 
considered,  and  the  better  results  thus  obtained  were 
demonstrated.  The  question  of  comparative  dis- 
figurement in  the  two  operations  was  discussed  and  il- 
lustrated by  results  of  operative  interference.  Finally, 
the  Killian  operation  was  described  and  its  merits  dis- 
cussed, and  the  hope  was  expressed  that  possibly  this 
procedure  might  come  to  be  recognised  as  a  distinct 
advance  in  dulling  with  these  troublesome  cases.  The 
paper  was  illastrated  by  a  large  number  of  lantern  slides 
and  stereoscopic  photographs. 


REPORT  OF  THE  OPHTHALMOLOGICAL 
SOCIETY  OF  THE  UNITED  KINGDOM 
ON  SIGHT-TESTING  BY  SPECTACLE- 
MAKERS. 
The  Ophthalmological  Society  of  the  United  King- 
dom, having  had  its  attention  called  to  the  fact  that 
the  Worshipful  Company  of  Spectacle-Makers  proposes 
to  include  the  subject  of  sight-testing  in  the  examina- 
tion for  its  diploma,  and  to  give  certificates  of  effi- 
ciency therein,  wishes  to  express  its  opinion  that,  while 
approving  of  any  measures  which  tend  to  increase  the 
efficiency  of  opticians  in  their  technical  work,  it  con- 
siders that  it  would  be  misleading  and  dangerous  to 
the  public  to  countenance  any  proposal  to  certify  as 
competent  to  advise  and  prescribe  for  defects  of  vision 
anyone  who  has  not  had  an  efficient  medical  and 
surgical  training.  A  diploma  such  as  the  Worshipful 
Company  of  Spectacle-Makers  proposes  to  grant  may 
lead  the  public  to  believe  that  its  possessor  is  com- 
petent to  diagnose  and  treat  diseases  of  the  eye,  and 
thus  grave  consequences  might  follow.  Errors  of  re- 
fraction often  occur  in  association  with  diseases  of  the 
eye.  The  mere  correction  of  the  former  by  means  of 
spectacles  would  ignore  a  condition  which  might  destroy 
sight,  or  even  leave  the  life  of  the  patieat  in  danger. 


Moreover,  many  errors  of  refraction  can  only  be  accu- 
rately measured  after  the  local  use  of  a  drug,  which 
should  only  be  employed  or  prescribed  by  a  medical 
man,  since  its  indiscriminate  use  is  calculated  to  excite 
one  of  the  gravest  diseases  to  which  the  eye  is  liable. 
Finally,  on  general  grounds  it  is  undesirable  and  dan- 
gerous to  encourage  the  public  in  the  belief  that  affec- 
tions of  any  organ  of  the  body  can  be  safely  treated  by 
anyone  unacquainted  with  its  anatomy  and  physiology, 
and  with  the  various  morbid  conditions  to  which  it  is 
liable. 

(Signed)    John  Tweedy, 
July  8th,   1904.  President. 

JSritisb   Dealtb  IResortd. 


[by  our  special  medical  commissioner.] 


II.— ILFRACOMBE. 

Ilfracombe  is  the  largest  and  most  popular  health 
station  and  holiday  resort  on  the  north  coast  of  Devon. 
It  lies  in  a  natural  basin  and  is  surrounded  by  high 
treeless  moorlands,  except  on  the  north  side,  which  lies- 
open  to  the  Bristol  Channel.  On  the  east,  protection 
is  afforded  by  Hillsborough  Hill,  some  450  feet  in 
height,  while  to  the  west  stretches  a  succession  of  undu- 
lating hills.  The  southern  limit  of  the  urban  sanitary 
district  of  Ilfracombe  is  constituted  by  a  range  of  hills 
600  to  800  feet  in  height.  The  marine  slope  ends 
more  or  less  abruptly  in  rugged  weather-worn  cliffs. 
The  scil  is  thin  and  the  rccks  are  wholly  shale  over 
sandstone  and  grit.  There  are  a  few  pockets  of 
mountain  limestone  and  a  small  amount  of  poor 
clay. 

The  climate  is  particularly  mild  and  equable,  due.  in 
great  measure,  it  is  claimed,  to  the  influence  of  the- 
Gulf  Stream.  The  Royal  Meteorological  Society  have- 
obtained  a  continuous  series  of  records  since  1875,  ^^^ 
according  to  the  last  report  of  the  medical  officer  of- 
health,  the  average  winter  temperature  is  44*9** ;  for 
the  months  of  February,  March,  and  April,  44*6'*  ; 
and  for  summer,  57°.  The  daily  range  of  temperature 
is  85°.  Dr.  E.  J.  Slade  King's  report  also  states 
the  birth-rate  as  17*9  per  1,000,  and  the  death-rate 
14*1  per  1,000  ;  but  excluding  the  deaths  of  visitors  the 
true  death-rate  api>ears  as  11*3  per  1,000.  The  infant 
mortality  is  equivalent  to  134*6  per  1,000  bom.  The 
district  shows  no  marked  prevalence  to  special  forms  ol 
disease.  Phthisis  is  comparatively  infrequent.  A 
system  of  voluntary  notification  of  consumption  is 
in  use.  The  isolation  hospital  is  modem  and  well- 
equipped,  but  scarcely  sufficiently  distant  from  the- 
newer  part  of  the  town.  The  sewerage  and  drainage 
have  recently  been  much  improved,  and  the  new 
water  supply  which  is  to  be  drawn  from  Challacombe, 
on  Exmoor,  appears  from  our  analysis  to  be  of  great 
purity  and  well  suited  for  drinking  purposes.  The 
inhabitants  are  chiefly  engaged  in  occupations  dealing 
with  the  provision  for  visitors.  There  are  large  numbers 
of  apartments  and  many  good  boarding-houses,  but  flrst- 
class  hotel  accommodation  is  limited.  The  marine 
walks  and  hill  paths,  together  with  the  public  pavilion, 
are  designed  to  meet  the  wants  of  the  holiday-maker 
rather  than  of  the  invalid.  The  beaches  afford  no 
sandy  stretches  and  are  generally  unsuited  to  the 
requirements  of  children,  but  afford  facilities  for  con- 
venient bathing  stations.  There  is  also  a  well-equipped 
public  swimming  bath. 

Ilfracombe  is  a  particularly  good  centre  during  the 
summer  season  for  coaching  and  steamer  excursions. 
It  is  thus  readily  seen  that  the  attractions  of  the  place- 
are  more  likely  to  appeal  to  the  young  and  vigorous 
than  to  the  aged  and  enfeebled. 

Ilfracombe,  however,  can  offer  not  a  few  conve- 
niences for  the  invalid.  Its  equable  and  bracing 
climate,  its  easily  accessible  walks  with  numerous 
shelters  and  resting-places  amidst  picturesque  sur- 
roundings, make  for  the  reinvigoration  of  convalescents- 
and  the  recreation  of  the  overworked.  Certain  cases  of 
neurasthenia  could  be  sent  here  with  advantage.  It 
claims  to  take  rank  as  a  winter  resort,  but  from  all  we 


July  20.  1904. 


FRANCE. 


The  Medical  Press.  65 


can  gather  the  prevalence  of  wind  would  militate 
against  its  usefulness  for  many  cases  at  that  season  of 
the  year.  Access  to  Ilfracombe  may  be  obtained 
by  a  number  of  different  ways.  A  direct  service  from 
London  (Waterloo)  is  provided  by  the  London  and 
South- Western  Railway,  and  during  the  summer  montk? 
a  through  carriage  is  run  from  Paddington  by  the 
Great  Western  Railway.  Visitors  from  the  North 
and  Midlands  travel  to  Bristol,  from  whence  they 
continue  by  rail  on  the  G.W.  system,  or  during  the 
summer  months  by  steamer.  Visitors  from  Wales 
may  often  conveniently  cross  the  Bristol  Channel  in 
weU-equipped  steamers  starting  from  Swansea.  In  the 
summer  season  the  comparatively  vigorous  traveller 
may  obtain  a  pleasant  mode  of  access  by  travelling  to 
Minehead  on  the  G.W.R.,  and  thence  proceeding  by 
coach  through  the  pleasant  resorts  of  Porlock  and 
Lynton  to  Ilfracombe. 

We  strongly  recommend  this  bright,  bracing  and 
attractive  town,  which  is  rich  in  facilities  for  the  build- 
ing up  of  the  natural  powers  of  resistance,  to  the  atten- 
tion of  physicians  and  all  interested  in  what  we  may 
term  the  **  prophylactic  influence"  of  a  wisely  selected 
holiday  resort. 

For  many  useful  particulars  see  : — 

(a)  Medical  Ofl&cer's  Report  of  the  Urban  Sanitary 
District    of    Ilfracombe. 

(6)  An  Official  Guide  to  Ilfracombe  is  also  published 
by  The  Health  Resorts  Association,  2  Gray's  Inn 
Road,  High  Holbom,  London. 

(c)  A  useful  handbook  to  Ilfracombe  and  district 
is  issued  by  Messrs.  Ward,  Lock  and  Co.,  London. 


continental  Dealtb  IRedortd. 


THE  BRENNER-BAD  IN  TYROL. 

An   Austrian   Health   Resort  New  to  Many  of 

Our  Readers. 

This  Alpine  Spa,  although  at  an  elevation  of  almost 
4,000  ft.  above  ocean  level,  is  really  very  accessible. 
It  is  located  immediately  on  the  main  line  of  railway 
running  from  Italy  to  Germany,  six  hours  from  Verona, 
five  hours  from  Munich,  and  by  express  trains  only  an 
hour  and  a  half  from  the  central  and  junction  station 
of  Innsbruck. 

This  route,  either  southward  or  northward  from 
Brenner,  is  one  of  the  most  picturesque  of  the  far- 
famed  Southern  Railroad  of  Austria,  noted  alike  for  the 
novelty  and  grandeur  of  the  countries  it  traverses  and 
for  the  comfort  of  its  carriages. 

Of  itself,  the  Brenner  ranks  deservedly  high  amongst 
the  most  celebrated  of  Alpine  Passes.  The  mineral 
springs,  baths,  and  hotels  are  located  at  the  most 
beautiful  position  in  this  notable  Pass,  and  at  the  centre 
of  attractive  excursions  by  foot,  carriage,  or  rail. 
Pleasant  hill-sides  and  woods  are  around  the  place,  rich 
pasture-lands,  swiftly  flowing  streams,  and  exquisite 
Alpine  flora.  It  has  thus  many  attractions  for  the 
artist  and  botanist. 

For  those  seeking  a  summer  sojourn  with  a  tem- 
perature unusually  mild  and  agreeable  for  so  high  an 
altitude,  and  for  those  desiring  a  rest  or  air  cure,  the 
excellent  hotels  and  novel  surroundings  at  Brenner- Bad 
have  many  inducements.  Completely  sheltered  by 
heights  from  northern  and  easterly  winds,  it  lies  open 
southwards  to  the  glorious  Italian  sun,  in  this  respect 
differing  greatly  from  many  mountain  health-resorts, 
which  are  usually  in  confined  valleys.  At  Brenner  is  a 
constantly  changing  air-current,  revivified  and  aroma- 
tised  by  passing  through  and  over  fields,  forests,  and 
sunny  peaks. 

Quite  apart,  therefore,  from  its  medicinal  waters, 
Brenner-Bad  has  good  claims  for  favourable  attention. 
Its  Mineral  Springs,  too,  have  enjoyed  for  several 
hundred  years  local  celebrity  because  of  their  un- 
questionable efficacy  in  even  chronic  cases  of  gout  and 
rheumatism  ;  in  many  cases  of  diseased  limbs  their  use 
is  specific. 

In  the  year  1608,  a  prominent  and  patriotic  patrician 
of  the  ancient  city  of  Sterzing  bequeathed  to  his 
ancestral  town  the  bath  buildings  he  had  erected  for 


public  benefit  at  Brenner.  Hotels  and  other  accom- 
modations were  gradually  added  thereto  by  the  muni- 
cipality of  Sterzing  which  owned  these  Thermal  Springs. 
In  1899,  the  property  was  transferred  to  the  present 
company,  who  have  erected  up-to-date  hotels,  and 
new  bath  buildings,  containing  the  latest  and  most 
approved  appliances  for  hydrotherapic  and  electro- 
therapeutic  treatment;  so  that  to-day  the  Brenner- 
Bad  offers  the  combined  advantages  of  an  exceptionally 
fine  Alpine  "  climaterique  cure  "  with  a  very  valu- 
able "  mineral- water  cure  "  added,  combined  with 
modern  comforts,  good  resident  medical  attendance, 
and  beautiful  Tyrolean  surroundings,  picturesque  and 
novel  in  life  and  characteristics. 

Professor  Barth's  analysis  of  the  solid  residuum  of 
I  lb.  (6,780  grains)  of  Brenner-Bad  mineral  water  : — 
Sulphate  of  potassium  ..     0,128862 

Sulphate  of  soda 0,110332 

Sodium  chloride 0,078276 

Magnesium  chloride  ..  ..     0,045755 

Sulphate  of  lime i, 217345 

Carbonate  of  lime 0,348989 

Carbonate  of  magnesia     ..  ..     0,343128 

Carbonic     protoxid     of     iron     . .     0,026726 
Silicated  argillaceous  earth  . .     0,005546 

Free  sUica 0,069085 

Phosphoric  argillaceous  earth       . .     0.002 1 1 5 


fvancc. 


[from  our  own  correspondent.] 


Parib.  July  17th.  1904. 
A  New  Sign  of  Pleuritic  Effusion. 

Prof.  Grocco  has  published  a  new  symptom  of  pleu- 
ritic effusion,  easy  to  discover  and  of  considerable 
value. 

When  a  liquid  of  any  kind  is  present  in  the  pleura, 
a  dull  zone  of  triangular  form  can  be  found  by  per- 
cussion on  the  opposite  side.  The  internal  edge  cor- 
responds to  the  vertebral  spinous  apophyses ;  the 
base,  from  one  or  two  inches  in  length,  corresponds  to 
the  point  where  the  normal  thoracic  sonority  ceases, 
while  the  external  edge  follows  an  oblique  ascending  line, 
intersecting  the  internal  side  of  the  triangle  at  the  upper 
limit  of  the  effusion.  This  dull  surface  varies  in  extent 
with  the  quantity  of  liquid,  and  diminishes  when  this 
liquid  tends  to  absorption.  The  dulness  is  more 
marked  near  the  median  line  and  the  base  of  the 
triangle;  a  decrease  in  the  vesicular  murmur  is  also 
perceived  by  auscultation. 

Badnel  and  Siciliano  experimentally  studied  Grocco's 
symptom  and  its  varieties  by  slowly  injecting  liquid 
into  the  pleural  cavity  of  corpses,  and  gave  the  following 
explanation — the  pleural  cul  de  sac,  distended  by  the 
effusion,  is  displaced  and,  passing  in  front  of  the  vertebrae, 
exceeds  more  or  less  the  median  line  ;  it  thus  pushes 
before  it  the  mediastinum  into  the  opposite  side  of  the 
thorax.  At  this  point  dulness  will  consequently  exist, 
provoked  by  the  presence  of  liquid  contained  iJk  the 
distended  pleural  cul  de  sac  and  the  displaced  thoracic 
organs.  The  compression  by  the  displaced  heart  of  the 
lung,  which  becomes  more  dense,  also  favours  the  pro- 
duction of  the  dulness. 

The  mediastinal  organs  are  much  more  displaced  by 
effusions  on  the  right  side  than  on  the  left.  The  aorta, 
as  everyone  knows  the  most  important  organ  of 
the  mediastinum,  is,  when  in  normal  position,  on  the  left 
of  the  median  line.  Consequently  in  effusion  into  the 
right  pleura,  the  artery  becomes  easily  displaced 
towards  the  left. bringing  with  it  the  whole  mediastinum; 
where  the^ left  pleura  is  affected,  the  aorta  can  only  be 
pushed  a  little  towards  the  right,  while  the  other 
organs  sliding  over  it  fell  to  the  right  side  of  the  thorax. 


66     The  Medical  Press. 


GERMANY. 


July  20.   1904- 


The  new  clinical  sign  described  by  Grocco  is  valuable 
for  diagnosing  slight  effusion  into  the  pleura.  It 
permits  particularly  to  distinguish  spleno-pneumonia 
from  pleurisy,  which  reveals  itself  by  identic  physical 
symptoms,  and  cannot  be  suspected  until  after  several 
small  operations  with  the  exploring  needle  have 
remained  without  result ;  the  absence  of  the  triangle 
of  Grocco  will  put  down  to  spleno-pneumonia  the 
symptoms  attributed  at  first  to  the  existence  of  a 
pleural  effusion. 

Adrenalin. 

A  very  interesting  study  of  adrenalin  by  H. 
J.  N06,  appears  in  the  Archives  Gin.  de  M^d.  for 
June  28th,  1904,  in  which  a  full  statement  is  made 
as  to  the  history,  the  process  of  extraction,  the  physical 
and  chemical  properties,  and  the  constitution  of 
adrenalin,  together  with  a  process  for  the  colorimetric 
■estimation  of  the  substance.  In  January,  1901 ,  Takamine 
first  announced  his  discovery  in  the  suprarenal  cap- 
sules of  the  base,  to  which  he  gave  the  name  adrenalin. 
Later  in  the  same  year  Von  Furth  perfected  his  process 
for  the  preparation  of  suprarenin,  and  obtained  an  iron 
compound  in  the  form  of  an  amorphous  violet  powder, 
and  after  elimination  of  the  iron  by  acid  he  produced 
a  substance  which  he  declared  was  the  same  as  Taka- 
mine's  adrenalin. 

Various  considerations  lead  to  the  supposition  that 
the  name  adrenalin  does  not  correspond  to  products 
always  identical  in  themselves  and  well  defined 
chemically.  These  considerations  led  M.  Canjon  in  his 
thesis  read  before  the  Paris  Faculty  of  Medicine  to 
«tate  that  **  all  these  products  differ  considerably  in 
their  physiological  action  and  in  their  toxicity.  The 
•different  methods  of  extraction  give  substances  very 
-dissimilar,  and  to  such  a  degree  has  this  come  that  very 
experienced  practitioners  who  have  had  occasion  to  use 
adrenalin  from  different  sources  either  experience 
remarkable  success  or  complete  failure.  The  active 
principles  of  the  capsules  of  different  animals,  oxen  and 
sheep,  for  example,  all  having  approximately  the  same 
appearance,  and  having  chemical  reactions  in  common, 
have  not  the  same  physiological  action."  Reviewing 
this  part  of  the  subject  M.  Noe  remarks  that  it  is  neces- 
sary, to  avoid  misconceptions,  to  make  use  only  of 
products  of  which  one  already  knows  the  effects. 

The  process  for  the  extraction  of  adrenalin  is  then 
considered,  and  considerable  space  is  devoted  to  the 
physical  and  chemical  reactions  of  the  base.  Adrena- 
lin is  very  soluble  in  acids  and  forms  salts  which 
•crystallise  with  difficulty  ;  the  hydrochloride,  sulphate, 
tartrate  and  benzoate  have  been  prepared,  but  the 
first  named  is  preferred  on  account  of  its  greater  solu- 
bility in  water.  With  regard  to  the  constitution  of 
adrenalin,  M.  N06  quotes  Jowett,  who  confirms 
Aldrich's  formula,  which  also  had  been  adopted  by 
Von  Furth  and  Pauly.  The  last  portion  of  the  paper 
•deals  with  a  colorimetric  process  for  estimating  the 
value  of  the  base,  proposed  by  Battelli ;  but  numerous 
-critics,  quoted  by  M.  Noe,  are  of  opinion  that  the 
process  is  very  unsatisfactory. 

eermani?. 

[from     our     own     correspondent.] 


Berlin,  July  17th,  1904- 
At  the  Free  Society  of  Surgeons,   Hr.  Braun  spoke 
-on 

Post-Operative  Distension  of   the  Stomach. 
He  had  seen  five  cases  of  acute  ectasis  of  the  stomach, 
two  of  them,  after  extirpation  of  the   vermiform   ap 
pendix,  two  after  laparotomy  for  ruptured  tubal  preg 


to  be  looked  upon  as  primary  atony  of  the  stomch 
made  worse  by  absence  of  vomiting;  what  was  the 
cause  of  the  reflex  nervous  phenomenon  had  not  been 
yet  explained.  He  had  made  experiments  on  the 
subject  which  were  not  yet  completed,  and  had  observed 
that  one  could  blow  up  the  stomach  of  a  chloroformed 
animal  through  a  gastric  fistula  without  exciting 
vomiting.  Vomiting  came  on  more  readily  when  the 
animal  had  not  been  anaesthetised. 

The  most  important  was  prophylaxis,  the  mere 
washing  out  of  the  stomach  as  soon  as  the  first  sym- 
ptom appeared. 

Hr.  Birchardt  reported  a  case  of  enormous  disten- 
sion of  the  stomach  after  nephropexy.  Death  took 
place  in  a  short  time. 

Hr.  Korte  had  done  gastro-enterostomy  in  a  case  of 
distension  of  the  stomach  coming  on  without  a  previous 
operation.  The  stomach  remained  distended.  Death 
took  place  from  necrosis  of  the  wall  of  the  stomach  and 
peritonitis.  The  case  was  one  of  atony  from  over- 
distension. 

At  the  Medical  Society  Hr.  Orth  showed 

A    Cvsticercus    of    the    Pi  a    Mater. 

He  had  been  interested  to  know  whether  there  wasany 
diminution  in  the  frequency  of  this  disease,  and  for  the 
purpose  of  ascertaining  he  had  gone  through  the 
registers  of  the  Pathological  Institute.  From  these 
he  had  learned  that  cysticercus  of  the  brain  had 
notably  diminished  since  1875,  ^^^  especially  during 
the  past  five  years.  He  had  only  found  one  case  during 
this  latter  period.  He  also  showed  an  echinococcus 
situated  in  a  branch  of  the  portal  vein,  and  thus  stuck 
fast  on  its  way  from  the  intestinal  canal  to  the  liver. 
He  had  made  similar  inquiries  in  regard  to  echinococcus 
as  he  had  done  for  cysticercus,  and  had  ascertained 
that  no  material  change  in  the  frequency  of  its  occur- 
rence had  taken  place  during  the  last  thirty  years. 

The  Deuisch.  med,  Zeits.,  No.  53,  relates  a 
Case  of  Purulent  Pericarditis  treated  Surgically. 

The  patient  was  a  man,  set.  28,  who  had  been  struck 
on  the  chest  by  a  beam.  After  this  he  had  a  rigor,  and 
his  breath  became  short.  The  latter  was  so  bad  that 
the  patient  had  to  maintain  the  sitting  position.  A 
phlegmonous  swelling  was  seen  on  the  right  side  of  the 
chest,  and  at  a  spot  between  the  second  and  third  ribs 
there  was  fluctuation.  The  lungs  were  healthy.  In 
view  of  the  excessive  dyspncea  and  lowered  blood 
pressure,  for  the  kidneys  were  scarcely  acting  at  all. 
pericarditis  per  coniinuitation  was  suspected.  The 
following  day  an  incision  ^was  made  at  the  level  of  the 
third  rib,  when  it  was  ascertained  that  there  was  a 
large  abscess  just  below  the  pectoral  muscles  and 
necrosis  of  the  rib.  As  the  swelling  bulged  forward  here 
a  scalpel  was  introduced  at  the  spot,  the  scalpel 
entering  the  pericardium  near  the  great  vessels.  Tlie 
cardiac  action  was  at  first  irregular,  but  as  the  abscess 
cavity  drained  the  pulse  became  more  regular  again. 
About  i\  litre  of  pus  was  evacuated.  The  heart 
was  floating  above  the  abscess.  Drains  were  inserted, 
but  the  cavity  was  not  washed  out.  On  the  twelfth 
day  the  drains  were  removed  ;  on  the  fifteenth  the 
patient  was  allowed  to  sit  up,  and  on  the  twenty-first 
he  was  discharged.  Three  months  later  the  cardiac 
dimensions  were  about  normal,  the  pulse  being  72 
to  76  when  at  rest,  but  rising  to  100  when  the  patient 
moved  about. 

At  the  Society  of  Charite  Aerzte,  Hr.  Ziehen  showed 
a  case  of 

Aphasia. 

The  patient  was  a  woman,  aet.  60,  who  had  a  hole  in 


nancy  and  one  after  a  gall-stone  operation.    This  was  |  her  bony  skull.     She  was  a  drunkard  and  probably 


July  20,  1904. 


AUSTRIA. 


The  Medical  Pkess.     6/ 


syphilitic.  Disturbances  of  speech  came  on  suddenly. 
In  going  on  to  speak  of  some  advance  in  our  knowledge 
of  aphasia  he  said  there  was  a  sharp  distinction  between 
the  sphere  of  acoustic  perception  and  that  of  acoustic 
recollection.  The  latter  could  be  disturbed  in  a  brain 
in  which  power  of  hearing  was  retained.  Perhaps  a 
-word  was  recognised,  whilst  for  understanding  it  other 
}>arts  came  into  consideration.  In  such  cases  it  was 
always  of  interest  whether  optic  receptivity  and 
recollection  were  retained.  In  the  case  before  them 
the  tract  to  the  optic  sphere  was  intact.  Total  loss 
of  both  was  very  rare.  Exhaustion  also  played  a  cer- 
tain part.  Transference  from  Broca's  centre  to  that  of 
\Veriiecke  was  absent.  When  it  took  place,  the  route 
need  not  be  direct,  a  circuitous  one  over  the  optic 
centre  was  always  possible.  In  reading  there,  came 
into  consideration — the  visual  sense,  the  reading  centrel 
(Naunyn),  the  sphere  for  sound  images  (Klangbilder) 
(Wemecke),  and  the  object  presentation  in  the  vis  ua 
sphere.  The  recording  centre  had  been  disputed,  but 
the  objection  was  not  justifiable.  The  reading  centre, 
however,  presented  only  the  optic  recollection  of  the 
image  of  the  letters.  There  was  a  difference  here  be- 
tween educated  and  ignorant  patients.  Such  dis- 
turbances as  were  present  in  the  case  before  them  were 
pathological — anatomically  perhaps  worse  than  they 
were  from  a  clinical  psychological  point  of  view. 

What  the  disease  was  was  difficult  to  say  :  perhaps 
there  was  a  tumour,  perhaps  syphilitic  changes. 

Hr.  Seiffer  showed 

Two  Cases  of  Peripheral  Paralysis. 

The  first  patient  had  influenza,  pneumonia,  and 
phlebitis  and  wasting  of  the  right  upper  arm,  the  latter 
from  paralysis  of  the  musculo-cutaneous  nerve,  from 
which  all  the  parts  supplied  by  the  nerve  were  afiected  ; 
only  ten  to  twelve  such  cases  were  known.  Trauma 
was  generally  the  cause,  but  in  two  it  was  caused  by 
infection. 

The  other  case  was  one  of  paralysis  of  the  deltoid 
from  paralysis  of  the  axillary  nerve.  It  followed  an 
operation  on  a  cervical  rib.  There  was  no  atrophy 
and  no  reaction  of  degeneration. 


anstria* 


[from  our  own  correspondent.] 


YimmsA,  July  17th,  1904. 
Pseudo-Hermaphrodism. 
At  the  Gesellschaft  der  Aerzte,   Swoboda  showed 
a  child,  aet.  i,  with  genitals  that  appeared  at  the  first 
glance  to  be  female,  but  a  closer  observation  revealed 
a  more  complicated  state  of  affairs  in  the  addition  of  I 
testicles  and  prxputium  arising  from  the  vulva  major.  ' 
The  urine  was   discharged   from  an  opening  at   the  | 
lower  part  of  the  penis.     Further  investigation   with  j 
sound  and  digit  failed  to  reveal  the  sex.     There  was  ' 
no  justification  for  opening  the  gland  for  microscopic  | 
purposes,  and  hence  the  case  was  left  undetermined  1 
whether  the  patient  was  male  or  female,  leaving  legis- 
lators to  provide  for  a  third  abnormal  sex.  I 
Foges  said  the  diagnosis  of  these  cases  was  a  very  | 
difficult  task  when  the  patient  was  so  young.    Happily,  , 
the  functions  of  such  glands  were  inactive,  which  further  ! 
added    to  the  difficulty,  but  he  considered  operative 
interference  unwise  at  the  present  time. 

Tearing  of  the  Mesentery.  '^ 

Schnitzler  exhibited  a  child,  set.  10,  on  whom  , 
he  operated  for  internal  rupture  after  being  run  over  | 
by  a  vehicle.  On  opening  the  abdomen  a  large  rent  \ 
was  found  in  the  mesentery  with  invagination  of  \ 
eight    centimetres     of    small    intestines,     of    recent 


origin,  which,  he  thought,  might  be  caused  by  the 
contused  wounding  of  the  bowel  producing  a  spasmodic 
action  and  final  invagination. 

Exner  differed  from  Schnitzler  in  presuming  the 
invagination  to  be  a  simple  spasm.  He  considered  it 
a  physiological  result  due  to  the  loss  of  co-ordination 
between  the  circular  and  longitudinal  muscular 
fibres  of  the  bowel. 

AcNEFORM  Tuberculides  of  the  Skin. 
Arising  out  of  a  previous  discussion  on  atrophia  cutis 
idiopathia,  Ehrmann  brought  forward  several  cases 
bearing  on  the  subject.  The  first  was  one  having  a 
variety  of  phenomena,  but  all  pointing  to  a  tuberculous 
form  of  the  cutis.  The  neoplastic  growths  ranged 
from  the  size  of  a  hempseed  to  that  of  a  pea,  having  a 
bluish  colour  with  a  necrotic  centre  ;  along  with  these 
were  larger  erythematous  indurations  about  the  size 
of  beans,  having  a  dark  red  colour  with  a  cheesy  centre. 
Alongside  of  these  cases  he  brought  a  few  of  atrophia 
cutis  idiopathia  for  comparison. 

Sternberg  said  he  had  made  a  microscopic  examina- 
tion of  the  patients  with  the  atrophia  cutis  idiopathia 
and  found  a  state  of  hemosiderosis  present. 

Uterine  Carcinomatous  Operations. 
Wertheim  next  treated  the  Society  to  a  long  history 
of  uterine  operations,  comparing  his  own  experience 
with  other  operators,  ancient  and  modern.  The  best 
measure  of  the  success  in  a  uterine  operation  was  the 
period  of  immunity  after  operation.  The  most  successful 
operators  removed  the  uterus,  parametrium  and  all 
the  glands  in  the  region  affected,  which  can  only  be  done 
by  the  laparotomy  method.  He  divided  the  period  of 
recurrence  into  three  for  comparison.  He  had  now 
fourteen  cases  over  four  years  since  operation,  or  29 
per  cent.  The  corresponding  numbers  given  by  other 
authors  are — Chrobak,  7*2  per  cent.;  Schauta,  5*1  per 
cent. ;  Zweifel,  9-5  per  cent.  ;  and  Pfannenstrel, 
6*8  per  cent. 

Those  recurring  between  three  and  four  years  in  his 
own  experience  was  27*5  per  cent,  survived  ;  while 
Chrobak  records  7*4  per  cent. ;  Schauta,  6*6  per  cent.  ; 
Zweifel,  10  per  cent.;  and  Pfannenstrel  7*1  per  cent. 
Surviving  after  two  years  were  Wertheim,  31  per  cent. ; 
Chrobak,  8*5  per  cent. ;  Schauta  8*6  per  cent. ;  and 
Zweifel,  11 '6  per  cent.  He  thought  these  results 
were  due  to  the  advantage  laparotomy  had  over 
vaginal  extirpation.  Discussion  on  the  subject  was 
reserved  for  a  future  meeting. 

Hemolysis. 
At  the  Congress  fur  innere  Medizin,  Koeppe  gave  the 
results  of  his  experiments  on  the  solution  of  red  blood 
corpuscles.  The  methods  adopted  in  this  inquiry 
go  under  different  names,  but  the  resulting  phenomena 
are  much  the  same.  Haemolysis  signifies  a  previous 
morbid  condition  which  has  hitherto  baffled  the  in- 
vestigation of  the  experimenter  as  to  the  proximate 
cause,  although  the  immediate  cause  is  a  rapid  decline 
and  death  of  the  cell.  In  examining  the  immediate 
causes  a  series  of  conditions  leading  to  dissolution  may 
be  cited  and  arranged  seriatim  : — (a)  water  haemolysis, 
(6)  caloric  haemolysis,  (c)  alkali  haemolysis,  (d)  acid 
haemolysis,  {e)  fatty  haemolysis ;  and  finally  the 
sera,  toxin  and  haemolysin  haemolysis.  The  true 
cause  of  these  changes  in  the  blood  cell  or  haemolysis 
is  the  wounding  or  solution  of  continuity  of  the  pellucid 
wall  of  the  red  blood  corpuscle.  This  membrane  . 
contains  a  fatty  or  lipoid  constituent  with  an  albu- 
minoid coagulating  substance.  The  water  or  hydro- 
haemolysis  is  more  of  a  mechanical  agent  than  chemical, 
as  it  distends  the  cell  by  an  internal  osmotic  pressure. 
Again  mechanical  injury  is  caused  by  cold  or  freezing, 
and  thawing  of  the  cell  wall  as  well  as  by  electric  shocks 


68    The  Medical  Press. 


OPERATING   THEATRES. 


July  20,  1904. 


In  caloric  haemolysis  it  seems  to  be  due  to  a  melting 
of  the  wall  or  solution  of  the  fatty  constituent.  In 
acid  haemolysis  the  fatty  constituent  of  the  wall  under- 
goes a  catalysis  in  the  alcohol  formed  from  the  acid, 
finally  splitting  up  the  fatty  constituent.  In  the 
alkali  haemolysis  a  saponification  in  the  alcohol  with  a 
resulting  fatty  salt  is  the  final  transformation.  In  all 
the  sera  haemolysis  the  albuminoid  constituent  of  the 
cell  wall  is  the  element  attacked. 


TLbc  ^peratina  Ubeatres. 


ST.  MARK'S  HOSPITAL. 

Abdominal  Fixation  of  the  Sigmoid  Meso-Colon 
TO  Rectify  Rectal  Prolapsus. — Mr.  Swinford 
Edwards  operated  on  a  man,  aet.  about  60,  who  was 
suffering  with  procidentia  recti,  which  had  followed  a 
Badenhauer's  excision  of  the  rectum  for  malignant 
disease  eighteen  months  previously.  The  patient  had 
been  put  to  great  discomfort  owing  to  the  rectum  pro- 
lapsing some  three  or  four  inches  from  the  sacral  anus 
on  the  slightest  exertion,  so  Mr.  Edwards  proposed  to 
sling  up,  as  it  were,  the  lower  part  of  the  large  intestine 
by  means  of  an  iliac  incision,  supplementing  this  opera- 
tion, after  the  lapse  of  a  week  or  two,'  by  the  repairing 
of  the  anus  as  is  carried  out  for  the  repair  of  a  ruptured 
perinaeum.  The  ordinary  incision  was  made  in  the  left 
iliac  region  as  for  an  inguinal  colotomy,  though  the 
incision  was  placed  a  little  nearer  to  the  middle  line 
and  somewhat  lower  down.  The  muscles  and  apo- 
neuroses having  been  divided  in  the  direction  of  their 
fibres,  the  peritoneum  was  incised  and  the  abdomen 
entered.  The  sigmoid  flexure  was  brought  out  of  the 
wound  and  pulled  taut  at  its  distal  end,  the  slaick  being 
passed  back  into  the  abdomen.  The  tautened  meso- 
sigmoid  was  now  sewn  by  fine  silk  sutures  to  the  peri- 
toneum, and  to  the  inner  surface  of  the  muscular  wall, 
about  half  an  inch  from  the  lower  lip  of  the  incision,  and 
the  abdominal  wound  closed  in  layers.  Mr.  Edwards 
said  that  he  should  not  rely  entirely  on  this  operation 
to  cure  the  procidentia,  although,  no  doubt,  it  would 
help  in  doing  so  ;  but  he  proposed,  if  all  went  well,  to 
lessen  the  size  of  the  sacral  anus  and  thus  bring  two 
forces  to  bear  for  the  relief  of  the  prolapsed  gut,  the 
one  being  on  the  principle  of  vis  ^  fronte  and  the  other 
on  the  principle  of  vis  ^  tergo.  He  remarked  that  he 
had  carried  out  a  somewhat  similar  operation  some 
little  time  previously  in  which  he  hawi  endeavoured  to 
fix  the  rectum  in  a  case  of  procidentia  recti  to  the 
tissues  about  the  coccyx,  but  as  this  was  not  attended 
with  any  success  he  had  discarded  it  in  favour  of  iliac 
fixation,  of  which  he  had  haul  two  successful  caises. 

The  patient  a  fortnight  after  operation  had  shown  no 
trace  of  any  prolapse,  but  then  he  was  still  confined  to 
his  bed,  and  Mr.  Edwards  proposes  to  do  the  second 
part  of  the  operation,  namely,  tightening  up  the  anus, 
immediately. 

CANCER  HOSPITAL. 
Gastro-enterostomy  Fifteen  Months  after 
Pyloroplasty. — ^Mr.  Bowreman  Jessett  operated 
on  a  woman,  aet.  46,  who  had,  in  January,  1903,  been 
admitted  for  symptoms  lasting  then  for  some  two 
years — constant  vomiting,  nothing  being  retained  on  the 
stomach,  and  the  woman  was  losing  flesh  rapidly.  The 
weight  at  the  time  of  the  first  pyloroplasty  in  January, 
1903,  was  seven  stones.  At  this  operation,  on  opening 


the  stomach  the  pylorus  was  found  tightly  strictured ; 
an  old  ulcer,  partly  cicatrised,  was  seen  at  the  posterior 
edge  of  the  pylorus.  Mr.'  Jessett  divided  the  pylorus 
longitudinally  for  about  three  inches,  and  then  sutured 
the  surfaces  together  laterally,  first  of  all  suturing  the 
mucous  membrane  with  catgut,  and  then  the  serous 
and  muscular  coats  with  fine  silk.  The  patient  made 
an  excellent  recovery,  and  was  discharged  about  three 
weeks  after  the  operation.  She  remained  well  for  some 
nine  months,  after  which  the  old  symptoms  began  to 
return,  but  in  November  of  the  same  year  she  had 
picked  up  four  stones  in  weight,  then  weighing  eleven 
stones.  Since  then,  she  had  been  gradually  losing 
flesh  again,  and  at  Christmas  vomited  up  about  one  and 
a  half  pint  of  dark  fluid.  In  March,  1904.  she  vras 
again  admitted  into  the  hospital,  her  weight  then  being 
nine  stones,  she  having  therefore  lost  two  stones  in  the 
four  months.  When  re-admitted  she  was  in  fairly  good 
health,  but  complained  of  a  good  deal  of  pain  after 
food,  most  of  which  she  vomited  shortly  after  talking  it. 
Mr.  Jessett  then  performed  gastro-enterostomy.  He 
opened  the  abdomen  along  the  left  line,  the  incisioo 
commencing  about  an  inch  and  a  half  below  the  costal 
cartilages,  and  extending  downwards  about  three 
inches.  The  stomach  was  drawn  out  and  a  loop  of 
jejunum  also  hooked  up.  He  then  proceeded  to  fasten 
the  jejunum  to  the  anterior  wall  of  the  stomach,  close 
to  its  greater  curvature.  He  at  first  applied  a  con- 
tinuous fine  silk  suture,  passing  through  the  serous  and 
muscular  coats  of  the  stomach  and  the  jejunum,  en- 
closing in  a  circular  form  a  space  some  three  inches 
long  by  two  wide,  leaving  the  ends  long  and.  ceaang 
about  two  inches  from  the  completion  of  the  ovaL 
He  next  incised  the  stomach  transversely  for  two 
inches,  and  the  jejunum  longitudinally  for  the  same 
distance,  and,  with  a  continuous  suture,  stitched 
together  the  cut  surfaces  of  the  stomach  and  jejunnis, 
completing  the  junction  and  thus  ensuring  a  frtt 
opening  between  the  two  viscera.  He  then  with  th« 
first  suture  continued  the  fastening  of  the  serous  and 
muscular  coats.  Mr.  Jessett  next  introduced  a  fet 
stitches  through  the  serous  and  muscular  coats  of  tht 
proximal  end  of  the  jejunum,  fastening  it  to  the  stomach 
wall  to  prevent  any  kinking  ;  finally,  he  brought  to- 
gether the  parietal  wound  in  four  layers,  t.e,,  three 
layers  of  buried  suture  and  one  for  the'skin.  Mr.  Jessett 
said  that  he  thought  this  case  illustrated  very  well  the 
effects  of  gastro-enterostomy  as  against  pyloroplasty. 
He  pointed  out  that  it  has  often  been  a  question  bov 
far  the  pylorus,  after  being  stretched  by  Loreto's 
operation  or  divided  and  enlarged  by  pyloroplasty, 
may  become  contracted  again  ;  the  present  case,  he 
thought,  illustrated  that  in  every  instance  of  pyloric 
obstruction  it  would  be  wiser  to  at  once  perform  gastro- 
enterostomy  in  preference  to  interfering  with  the 
pylorus.  Mr.  Jessett  also  drew  attention  to  the 
method  he  had  adopted  in  performing  the  gastro- 
I  enterostomy  ;  he  used  no  bobbins  or  Murphy's  buttons, 
but  simply  fastened  the  jejunum  to  the  stomach  by 
two  circular  continuous  sutures,  one  passing  througk 
the  serous  and  muscular  coats  and  the  other  fastening 
the  cut  edges  of  the  stomach  to  those  of  the  jejunuis. 
He  was  of  opinion  that  with  few  exceptions  any  short 
circuiting  of  the  intestines  or  intestinal  anastomoses 
i  might  be  performed  perfectly  safely  and  nearly  as 
quickly  by  the  means  he  had  employed  as  by  bobbins, 
plates,  or  buttons. 

The  patient  left  the  hospital  a  month  after  operation, 
and  is  now  in  the  enjoyment  of  fairly  good  health; 
the  vomiting  has  entirely  ceased  and  she  has  gained 
weight. 


July  20.  1Q04.. 


LEADING   ARTICLES. 


The  Medical  Press.     69 


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•'  SALUS  POPULI   SUPREMA  LEX." 


WEDNESDAY.  JULY  20,  1904. 

SIGHT-TESTING   BY   SPECTACLE-MAKERS. 
The  Ophthalmological  Society  of   the  United 
Kingdom,  albeit  somewhat  late  in  the  day,  has 
made  a  definite  public  announcement  with  regard 
to  the  proposed  inclusion  of  sight-testing  in  the 
examination    subjects    for    the    diploma    of    the 
Worshipful    Company    of    Spectacle-Makers.       It 
has  issued  a  report,  signed  by  Mr.  John  Tweedy, 
the    President,    stating    briefly    the    grounds    of 
objection  to  the  proposal  in  question.     The  first 
issue  raised  is  the  misleading  value  of    such    a 
diploma,  which  would  induce  the  public  to  believe 
its  owner  to  be  competent  to  diagnose  and  to 
treat  diseases  of  the  eye.     There  is  no  need  to 
point  out   to  medical  readers  the  disastrous  con- 
sequences that  must  infalUbly  dog  the  footsteps 
of   the  unqualified  dabbler  in  ophthalmic  work. 
There  is  no  branch  of  the  medical  art  that  demands 
greater  experience  and  technical  skill  than  that 
of  ophthalmology.     The  recognition  of  the  exact 
nature  of  the  earlier  stages  of  many  such  aflFections 
•demands  the  instant  application  of  various  highly 
specialised  methods  of  scientific  investigation.    It 
is   precisely  in  such  early  cases   that   a  sufferer 
would  be  hkely  to  go  to  an  optician,  who,  armed 
with    just   enough   knowledge    to    be  dangerous, 
would  waste    the  precious  moments  in  which  the 
sight  might  yet  be  saved  by  the  skilful  promptitude 
of  a  trained  ophthalmic  surgeon.     The  mechanic, 
for  that  is  the  position  of  the  optician  when  he 
is  not  a  tradesman  pure  and  simple,  cannot  be 
expected  to  recognise  the  signs,  symptoms  and 
purport  of  corneal  ulcer,  opacities  of  the  various 
media,  iritis,  gonorrhoeal  and  other  conjunctivitis, 
detached  retina,  and  glaucoma,  to  mention  a  few 
only  of  the  many  urgent  conditions  that  would 
infaUibly  come  sooner  or  later  under  his  notice. 
The  thin  end  of  the  wedge  of  the  Spectacle-Makers' 
Company  has  indeed  led  to  a  serious    chasm — 
one  that  is  fraught  with  danger  to  the  pubhc  and 


with  injustice  to  the  medical  profession.  As 
pointed  out  in  the  report,  errors  of  refraction 
often  occur  in  association  with  diseases  of  the 
eye.  The  mere  correction  of  the  former  by  means 
of  spectacles  would  ignore  a  condition  which 
might  destroy  sight,  or  even  leave  the  life  of  the 
patient  in  danger.  Considerations  of  that  kind, 
however,  are  not  wont  to  stay  the  hand  of  the 
amateur  in  medical  matters.  The  resulting  toll 
of  suffering,  disease  and  death  paid  annually  by 
the  inhabitants  of  the  United  Kingdom  must  be 
something  appalling.  The  efforts  of  the  con- 
stitutional law,  on  the  one  hand,  to  protect  the 
people  by  insisting  on  proper  qualification  for 
medical  practitioners  is  outweighed  on  the  other 
by  the  almost  absolute  licence  given  to  unqualified 
practitioners  and  patent  medicine  vendors.  The 
report  properly  points  out  that  on  general  grounds 
it  is  dangerous  to  encourage  the  public  in  the 
belief  that  affections  of  any  organ  of  the  body 
can  be  safely  treated  by  anyone  unacquainted 
with  its  anatomy  and  physiology,  and  with  the 
various  morbid  conditions  to  which  it  is  liable. 
It  is  to  be  hoped  that  the  widest  publicity  will 
be  given  to  this  document.  The  public  need 
education  in  the  matter,  not  only  of  their  eyes, 
but  of  the  rest  of  their  bodies,  by  the  comparison 
of  qualified  medical  practice  with  that  of  quacks. 
The  encroachment  of  the  Spectacle  -  Makers  is 
but  a  specimen  of  what  has  gone  on  in  a  thousand 
other  directions.  Any  sort  of  labourer  or  trades- 
man may,  like  the  spectacle-maker  or  vendor, 
imagine  he  has  the  divine  gift  of  healing.  The 
road  from  the  workshop  or  the  tradesman's 
counter  to  the  consultation  room  is  easy,  and  the 
rewards  lucrative.  Nor  is  it  possible  to  forget 
that  a  medical  man  has  only  recently  resigned 
the  position  of  examiner  for  the  diploma  issued  by 
the  Spectacle-Makers'  Company.  That  gentleman 
was  a  member  of  the  Ophthalmological  Society, 
a  body  that  could  have  put  an  end  to  such  an 
anomalous  position  long  since.  Had  the  Society 
faced  that  matter  squarely  and  fairly,  as  it  should 
have  done,  years  ago,  their  task  of  convincing  the 
public  would  not  have  been  so  hard  as  they  will 
find  it  to-day,  when  the  unpleasant  fact  of  that 
examinership  is  thrown  in  its  teeth.  The  battle 
of  the  Ophthalmological  Society,  however,  is 
that  of  the  medical  profession,  and,  as  such, 
deserves  the  hearty  support  of  every  medical 
man  in  the  United  Kingdom. 


GAS  POISONING. 
During  the  past  few  years  members  of  the 
medical  profession  in  Dublin  have,  from  time  to 
time,  drawn  attention  to  the  danger  to  pubUc 
health  which  results  from  a  change  in  the  nature  of 
the  gas  supplied  to  the  public  for  illuminant  and 
cooking  purposes  by  the  gas  company  of  that 
city.  Up  to  IQOO  the  gas  supplied  was  normal  coal 
gas  containing  the  normal  6  per  cent,  of  carbon 
monoxide,  but  in  February  of  that  year  the  com- 
pany altered  the  nature  of  the  gas  by  adding  a 
considerable  quantity  of  carburetted  water  gas. 
Water  gas  is  made  bv  passing  steam  over  red  hot 


70    The  Medical  Press. 


LEADING   ARTICLES. 


July   20.   1904. 


coke,  and  is  then  carburetted  by  being  charged 
with  vapour  of  petroleum  or  other  inflammable 
oil.     It  possesses  advantages  over  coal  gas  in  that 
it  is  cheaper  and  more  easily  produced  to  meet  an 
emergency,   while,   especially  when   mixed  with 
coal  gas,   it  makes   an   excellent  illuminant.     It 
possesses,  however,  one  very  serious  disadvantage — 
it  contains  30  per  cent,  of  carbon  monoxide.     Very 
shortly  after  it  was  introduced  by  the  Dublin  gas 
company,  without,  be  it  said,  any  warning    to 
consumers,  Dr.  Emerson  Reynolds,  then  Professor 
of  Chemistry  in  Trinity  College,  drew  public  atten- 
tion to  the   dangers  which    might    result.     He 
pointed  out  that  in  case  of  accidental  leakage  of 
gas,  through  untrustworthy  fittings  or  otherwise, 
the  danger  to  Ufe  was  far  greater  than  when  coal 
gas   alone   was   used.     His   prediction   has   been 
amply  verified,  for  we  find  that  during  the  past 
four  years  no  less  than  ten  cases  of  gas  poisoning 
have  occurred  in  Dublin,   with  seven  fatalities, 
.  while  in  the  previous  twenty  years  no  case  was 
recorded.     Dr.  McWeeney  has  collected  particu- 
lars of  the  several  cases,  and  published  (a)  them 
in  a  manner  which  should  focus  public  attention  on 
a  serious  danger.     In  all  the  cases  poisoning  fol- 
lowed on  an  accidental  leakage  of  gas,  though  in 
some  of  them  the  cause  of  the  leak  was  difficult  to 
trace.     In  the  first  occurrence,  for  instance,  gas 
was  not  laid  on  at  all  in  the  premises  where  the 
poisoning  occurred,  but  the  main  in  the  street  out- 
side became  broken,  and  the  gas  filtered  through 
the  soil  into  the  house.     Four  persons  suffered, 
with  one  death.      In  another  instance  a  whole 
family   was   sacrificed   in   a   clumsy   attempt   to 
defraud  the  gas  company  by  short-circuiting  the 
meter,  and  in  another  an  elderly  couple  from  the 
countrj'^,  while  staying  in  a  city  hotel,  probably 
poisoned  themselves  by  blowing  out  instead  of 
tummg  off  the  gas.     Again,  a  young  man,  apothe- 
cary in  one  of  the  city  dispensaries,  was  asphyxi- 
ated in  his  bath-room  owing  to  the  use  of  a  '*  gey- 
ser,"  which  was  probably  insufficiently  Ughted. 
At  present  the  gas  in  Dublin  contains  16  per  cent, 
of  carbon  monoxide  ;  up  to  1900  it  only  contained 
6  per  cent.     As  small  a  quantity  as  -2  per  cent, 
of  carbon  monoxide  in  the  air  is  dangerous,  and 
with  increased  quantities  Haldane  has  shown  that 
the  mortality  increases  as  the  cube  of  the  increase 
in  the  proportion  of  monoxide.     His  investiga- 
tions were  made  in  Boston  and  Chicago,  where  the 
introduction  of  water  gas  has  been  followed  by 
similar  results  to  those  that  have  occurred  in  DubUn. 
At  present,  however,  in  these  countries  the  public 
is  at  the  mercy  of  the  gas  manufacturers.     The 
sanitary  authority  in   DubUn,   which   has   been 
appealed  to,  professes  itself  powerless  to  interfere 
to  Umit  the  proportion  of  carbon  monoxide  sup- 
plied in  illuminant  gas.     If  this  is  so  there  is  urgent 
need  for  legislation,  but  in  the  meantime  we  beUeve 
the  sanitary  authority  has  power  to  insist  that 
all  .fittings  and  gas-cooking  apparatus  shall  be 
kept  in  proper  order,  and  that  gas  mains  shall  be 
laid  in  the  street  with  due  care  against  accidental 
breakage. 

;a)  D*b.  Jowm.  of  Med.  Nci.,  July,  1904. 


CENTRAL    MIDWIVES'    BOARD    AGAIN. 
The  doings    of    the  Central  Mid  wives'  Board 
since  it  came  into  being  have  been  such  as  to 
thoroughly  justify  all  that  was  formerly  predicted 
of  the  scheme  to  give  midwives  official  recognition. 
We  lately  called   attention   to  some   of    the  ill- 
judged    and    over-bearing    actions    that    it    has 
already    perpetuated,     and    showed,    how    those 
actions  were  judged  by  the  medical  profession. 
At  the  last  meeting  of  the  Board  a  motion  was 
brought  forward  by  Dr.  Cullingworth  that  a  list 
of  examiners  under  the  Act  should  be  prepared 
by   the  Board  from  those  who  were  willing  to 
serve  when  required.      Dr.  Ward  Cousins  moved 
a  very  proper  amendment  to  the  effect  that  no 
one  but  a  registered  medical  practitioner  should 
be  appointed  as  an  examiner.     This  amendment 
which  would  have   appeared  superfluous   in   the 
ordinary  way,  so  obviously  necessary  is  it   that 
the  examiners  should  be  medical  men,  was  sup- 
ported by  Mr.  Parker  Young  and  Dr.   Sinclair, 
but  after  some  debate    it    was  defeated  by  the 
votes  of  Dr.  Cullingworth  and  the  three  female 
members    of    the     Committee.     This   action,  we 
venture  to  think,  for  sheer  stupidity  and  offensive 
disregard  of  medical  opinion,  fittingly   caps   the 
egregious  performances  of  the  Board  up   to  the 
present    time.      It    is    a    deliberate    and     direct 
slight  to  the  profession  of  medicine,  and  it  cannot 
be  too  strongly  resented  by  those  who  hold  its 
dignity  dear.     Medical  men  have  all  along  been 
opposed  to  the  creation  of  a  sub-order  of  prac- 
titioners on  an  independent  footing,  and  it  was 
only  out  of  regard  to  the  welfare  of  the  poor — the 
question  resolving  itself  into  whether  they  should 
be  attended  by  trained   or  untrained  midwives— 
that  they  abated  their  opposition,  conditionally 
on  the  training  of  these  women  being  left  in  their 
hands.     The  Central  Midwives'  Board   was   con- 
stituted, and  it  has  persistently  endeavoured  to 
show  a  disregard  to  all  that  is  deemed  essential 
by    medical   opinion.     But    there    are    limits    to 
this  poUcy,  and  it  seems  not  unlikely  that  those 
hmits  will   soon   be   reached    unless    the    Board 
decides    to   mend   its   ways.     However   much  it 
may  wish  to  the  contrary,  it  is  only  by  and  with 
the  co-operation  of  the  profession  that  the  Act 
can  be  made  to  work,  and  if  it  continues  to  snub 
and    override  the  profession   it   will  find  that  its 
work  may  come  to  a  standstill  by  medical  men 
giving     it    the    cold-shoulder.      In    the    present 
instance  the  deliberate  opinion  of  the  majority 
of  the  Board  is  that  it  may  be  not  only  possible^ 
but  even  advantageous,  to  appoint  a  midwife  to 
sit  side  by  side  with  medical  men  to  examine 
candidates  for  admission  to  the  register,  candidates, 
be  it   remembered,   who  have  been   trained  by 
medical  men.     In  other  words,  the  Board  approve 
of  the  principle  that  a  person  who  has  had  three 
months'    "  training "    in   midwifery   shall   sit   in 
judgment  on  the  work  of  qualified  practitioners, 
and  sees  nothing  incongruous  in  a  professional 
man  acting  in  subordination  to  the  criticisms  of 
such    a    person.     The    medical    profession    will 
think  otherwise,  and,  if  we  mistake  not,  will  show 


July  20.   icod. 


NOTES    ON    CURRENT    TOPICS.        The  Medical  Press.     7 1 


its  aversion  in  a  very  practical  manner.  The  ■  among  the  Chinese  labourers  in  South  Africa,  our 
sp>ecious  plea  was  advanced  that  a  midwife  or  contemporary  Truth  does  a  public  service  in 
matron  would  know  about  nursing  what  a  medical  recalling  the  mismanagement  shown  by  the  Irish 
man  would  not.  Whence,  we  wonder,  have  the  Executive  during  the  epidemic  which  occurred  in 
nursing    profession    of     the    day    obtained  this  the   Richmond   Asylum,   in   Dublin,   some  years 


knowledge  in  training  except  from  the  hands  of 
medical    men  ?     The    pretext    is    too    flimsy    to 


ago.     The  first  cases  occurred  in  1894,  and  during 
that  year  no  less  than  174  cases  appeared,  with 


deserve  serious  consideration.  Nursing  is  essen-  twenty-five  deaths.  The  disease  then  apparently- 
disappeared,  but  recurred  in  1896,  and  in  that 
year,  and  during  the  first  half  of  1897,  over  200 
cases  occurred.  From  the  first  the  medical  staff 
pointed  out  to  the  authorities  at  Dublin  Castle 
the  impossibility  of  coping  with  the  outbreak 
while  the  asylum  was  as  scandalously  overcrowded 
as  it  was  at  that  time.  Of  this  overcrowding 
it  is  difl&cult  to  convey  an  idea,  but  in  most  of 
the  dormitories  there  was  barely  standing  room 
between  the  beds,  and  many  of  the  corridors  had 
to  be  converted  into  dormitories  by  placing  a 
continuous  row  of  beds  along  the  walls.  In  spite 
of  the  continual  protests  of  the  medical  staff,  the 
Press,  and  the  public,  it  was  not  till  August,  1897, 
that  accommodation  elsewhere  was  provided  for 
some  of  the  surplusage  of  patients.  We  trust 
that  the  Transvaal  authorities  will  take  to  heart 
the  lesson  taught  in  Ireland,  though,  up  to  the 
present,  the  official  telegrams  appear  of  an  un- 
warrantedly  complacent  nature,  and  hardly  show 
a  due  sense  of  the  seriousness  of  the  situation. 


tially  and  ultimately  a  medical  question,  and  the 
trained  nurse  is  taught,  and  generally  recognises, 
that  she  is  not  an  independent  professional  expert, 
but  an  assistant  and  subordinate    to  the  qualified 
practitioner.     No  good  nurse  wishes  to  be  any- 
thing  else  ;   she   learns   enough   during  her  pro- 
bation to  know  her  own  limitations.     It  is  not  so 
with  the  midwife   and  those  who  wish  to  push  her 
and  her  practice.     The  midwife  is  to  act  in  cases 
surrounded     and     attended    with     anxiety     and 
danger  on  her  o^m  initiative  and  responsibility, 
and  when  she  finds  things  are  getting  too  much 
for  her,  to  send  for  a  medical  man.     The  exalta- 
tion of  the  midwife    and  the  degradation  of  the 
medical  man   is   tacitly  the  underlying  aim  of  a 
number  of  philanthropically -minded  people  who 
have  interested  themselves  in  the  question,  and 
it  is  an  aim  which  is  being  fostered  and  forwarded 
by  the    action    of  the  Central  Midwives'   Board. 
The  doctor  is  to  be  ignored  as  long  as  possible, 
and  called  in — without  any  provision  being  made 
for  his  payment — when  the  midwife  scents  trouble 
ahead.    That  is  the  line  taken  by  the  Midwives 
Act,  and  the  spirit  of  the  .Midwives'  Board  per- 
petuates the  evil  tradition.     Let  the  doctors  do 
the  training,  and  the  midwives,  when  they  have 
had  the  benefit  of  it,  help  with  the  examining  and 
see  if  the  doctors  are  doing  their  work  properly, 
forsooth.     It  is  difl&cult  to  conceive  how  a  medical 
man  of  Dr.  CulHngworth's  eminence  can  be  found 
to  acquiesce  even  passively  in  such  a  proposition, 
and  we  can  assure  him  that  Dr.  Ward  Cousins 
spoke  no  more  than  the  truth  when  he  said  that 
he   was   convinced   that   the   medical   profession 
felt  very  strongly  on  the  point.     If  the  dangers 
to  the  poor  entailed  by  the  Act  are  to  be  obviated, 
it  is  only  by  leaving  the  whole  question  of  pre- 
paring midwives  for  their  work  entirel}'  in  medical 
hands,  and  enforcing  on  them  that  the  safety  of 
the  mothers  and  children  whom  they  attend  can 
be  attained  only  by  their  recognising  the  vast 
inferiority    of    their   knowledge    to    that    of    the 
practitioner.     Such  an  end  is  not  likely   to  be 
attained   by  putting  midwives   to  sit  cheek  by 
jowl   with   medical   men   on   examining   boards. 
Dr.  Cullingworth  has  incurred  a  great  responsi- 
bility by  deliberately  voting  for  the  subordination 
of  qualified  medical  men  to  mere  midwives,  and, 
if  we  mistake  not,  he  will  have  sooner  or  later  to 
be     called  upon    to    render   an   account    of   his 
stevirardship  to    the   medical  profession,  to  which 
he  owes  his  position. 


flotes  on  Current  Uopics. 

Beri-Beri  as  an  Epidemic. 
In  view  of  the  serious  outbreak  of  beri-beri 


Spontaneous  Bupture  in  Ascites. 
Not  the  least  complex  among  the  problems  of 
pathology  is  the  mechanism  of  the  production 
of  those  peritoneal  exudations  which,  accumulated 
in  any  quantity,  give  rise  to  the  condition  known 
as  ascites.  The  integrity  of  the  portal  circulation 
and  the  phenomenon  of  osmosis,  in  addition  to 
being  interdependent,  are  themselves  influenced 
by  other  factors  about  which  our  knowledge 
cannot  yet  be  said  to  be  complete.  The  removal 
of  ascitic  fluid  by  mechanical  means  is  a  frequent 
operation,  and  the  immense  relief  afforded  by  a 
timely  paracentesis  to  a  labouring  heart  is~a 
constant  source  of  satisfaction  to  the  physician. 
Too  often,  though,  the  abdomen  fills  up  again 
rapidly,  necessitating  repeated  tappings.  In  a 
few  instances  a  gradual  absorption  of  the  fluid 
undoubtedly  occurs,  especially  under  the  influence 
of  a  restricted  diet  and  the  application  of  graduated 
abdominal  pressure.  Spontaneous  rupture  of  the 
abdomen  with  escape  of  the  peritoneal  exudation 
is  an  accident  which  is  so  rare  that  the  case 
recently  reported  by  M.  A.  Cochez  (a)  before  the 
Soci6t6  M6dicale  des  Hopitaux  is  worthy  of  note. 
The  patient  was  a  man  of  fifty- two,  who  twenty 
years  ago  had  contracted  malarial  fever.  The 
liver  then  became  enlarged.  After  his  recovery 
he  developed  alcoholic  habits,  and  three  years 
ago  ascites  appeared,  the  liver  being  cirrhotic. 
He  was  tapped  frequently,  and  after  the  forty- 
eighth  puncture  a  small  vegetation  appeared 
just  below  the  umbilicus.  This  gave  way  to  a 
minute   patch   of   ulceration,    looking   more   like 


(a)  JtuU,  et  Mtm.  de  a  Soe.  Med,  det  Hop.,  Paris,  June  28rd,  1904^ 


72   The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


July  20,  1904. 


granulation  tissue  A  month  afterwards  he  was 
again  tapped,  and  a  weekjafter][this,  the  forty- 
ninth  "  paracentesis,  ascitic  fluid  was  suddenly 
ejected  through  an  ajjerture  in  the  centre  of  the 
ulceration  during  a  violent  fit  of  coughing.  The 
abdomen  emptied  itself  completely,  and  a  doctor 
who  was  hurriedly  summoned  closed  the  opening 
with  collodion.  The, accident  was  regarded  as  a 
departure  from  the  normal  process  of  peritoneal 
cicatrisation,  which  was  evidently  in  progress. 
M.  Cochez  considered  such  a  contingency  favour- 
able rather  than  otherwise,  as  indicating  an 
attempt  of  Nature  towards  a  spontaneous  cure. 
In  the  few  cases  of  accidental  rupture  recorded  in 
the  Uterature,  the  perforation  has  nearly  always 
been  preceded  by  a  gangrenous  ulceration  of  the 
abdominal  wall,  not  necessarily  connected  with 
the  scars  produced  by  puncture. 

Responsibilities  of  Nursing  Associations. 

An  apT)cal  case  of  considerable  importance 
with  regard  to  the  legal  responsibilities  of  nursing 
associations  was  decided  last  week  in  the  Ix)ndon 
Law  Courts.  The  Oldham  Nursing  Association 
sent  a  nurse  to  attend  at  an  operation.  By  her 
negligence  a  hot-water  bottle  was  allowed  to  lie 
in  contact  with  the  bare  skin  of  her  patient,  who 
was  burnt  thereby,  and  who  brought  an  action 
for  damages.  Plaintiff  was  awarded  ;f  300  damages 
by  a  jur>'  at  Manchester  assizes.  Defendants 
appealed  on  the  ground  that  they  were  not  in  point 
of  law  liable  for  the  acts  of  their  nurses,  who  were, 
they  contended,  at  the  time  of  the  alleged  negU- 
gence,  the  servants  of  the  lady  they  were  attending. 
The  Master  of  the  Rolls  granted  the  appeal,  finding 
the  Association  was  not  liable  for  any  want  of 
ordinary  care  and  skill  on  the  part  of  the  nurse 
they  suppUed.  For  the  purposes  of  nursing 
the  nurse  thus  sent  was  in  no  sense  the  servant  of 
the  Association,  which,  therefore,  was  not  liable 
for  her  carelessness.  Medical  men  should  note 
this  judgment.  A  special  contract  with  the  nur- 
sing home  would  tie  down  a  nursing  association 
to  a  proper  responsibiUty  for  its  nurses. 

The  Doctor  in  the  School. 

The  favourable  reception  which  the  petition 
in  favour  of  the  teaching  of  hygiene  in  schools 
met  with  at  the  Education  Office  is,  in  itself,  an 
evidence  that  the  urgent  need  of  such  instruction 
is  at  least  recognised  by  the  Government.  The 
medical  profession  as  a  whole  was  fully  repre- 
sented by  the  large  number  of  signatories,  and 
such  a  petition  could  hardly  fail  to  carry  weight 
with  those  in  authority.  But  it  is  not  only  by 
the  teaching  of  hygiene  and  alhed  subjects  by 
men  and  women  who  have  been  through 
certain  courses  of  instruction  themselves  that 
we  can  hope  to  stay  the  tide  of  physical  degenera- 
tion which  threatens  to  submerge  the  coming 
race.  The  need  for  a  qualified  medical  practitioner 
to  be  definitely  attached  to  a  school  or  group  of 
schools  has  been  urged  before  in  the  columns 
of  The  Medical  Press  and  Circular.  In 
connection    with    this    point    attention    may    be 


drawn  to  the  most  instructive  report  recently 
prepared  on  the  Public  Schools  of  Berlin  and 
Chariot tenburg  by  Mr.  George  Andrew  for  the 
Scottish  Education  Department.  In  these  cities 
the  fact  has  been  recognised  that  the  elementary 
school  is  incomplete  without  the  services  of  a 
medical  man.  Wiesbaden  was  the  first  place 
in  which  the  idea  was  adopted,  and  in  1901  ten 
doctors  were  appointed  for  this  purpose  in  Berlin. 
Our  own  countrymen  might  well  learn  some 
valuable  lessons  from  the  newer  schools  in  Char- 
lot  tenburg,  where  the  school  doctor  has  his  own 
room  in  the  school  buildings  in  which  weighing- 
machines,  and  instruments  for  testing  vision, 
&c.,  are  kept.  Periodical  examinations  of  each 
scholar  are  made  from  the  medical  point  of  view, 
the  parents  being  present  at  the  first  of  these ; 
records  are  taken  and  kept  of  the  child's  physical 
condition,  and  appropriate  suggestions  are  made 
by  the  medical  ofl&cer  in  charge  as  to  diet  and 
school  treatment  in  general.  A  weekly  bath  is 
also  given  to  each  scholar,  with  the  exception  of 
the  two  youngest  classes — a  most  excellent  plan, 
well  worthy  of  imitation.  It  is  sincerely  to  be 
hoped  that  some  such  system  as  this  will  ulti- 
mately find  its  place  in  every  Council  school  in  this 
countrv. 


Ocular  Gymnastics. 

The  avidity  with  which  medical,  or  more 
generally  pseudo-medical,  details  are  devoured 
by  the  public  is  one  of  the  characteristic  features 
of  the  present  age.  No  matter  whether  bone- 
setting,  pain-killing,  or  beauty-restoring  be  the 
theme,  whether  it  be  possible  or  impossible, 
plausible  or  ridiculous,  such  subjects  never  fail 
to  attract  hosts  of  the  superficial  readers  and 
thinkers  of  to-day.  The  marvel  is  that  the  editon 
of  our  newspapers  and  periodicals  admit  such 
articles  to  their  columns.  No  space  would  be 
granted  to  descriptions  of  irregular  methods  of 
legal  practice,  for  instance  ;  why,  then,  are  accounts 
of  quackery  and  specious  "  cures  "  tolerated  ? 
One  of  the  latest  of  these  extravagances  is  a 
method  for  "  restoring  "  sight  without  the  aid 
of  glasses  ;  nay,  further,  for  the  painless  and 
expeditious  relief  of  actual  cataract  without 
operation.  It  is  well  known  that  the  instillation 
of  atropine  into  the  eye  will  produce  considerable 
improvement  in  vision  in  certain  cases  of  cataract, 
but,  of  course,  this  is  only  temporary.  The 
celebrated  "  Professor  '*  of  the  new  method  does 
not,  apparently,  employ  even  this  drug.  He 
contents  himself  by  appljdng  pressure  to  the 
globe  by  means  of  a  special  apparatus,  which  has 
to  be  worn  at  frequent  intervals.  The  explanation 
of  such  treatment  is  said  to  consist  in  reducing 
permanently  the  antero-posterior  diameter  of  the 
globe.  We  are  also  informed  that  the  blood  is 
the  organ  of  sight*,  a  statement  which  is  indirectly 
true,  but  it  is  difficult  to  comprehend  how  an 
atrophic  optic  nerve  could  be  made  to  transmit 
visual  sensations,  however  greatly  increased  its 
vascular  supply  might  become.  Massage  of  the 
globe  is  also  performed,  we  presume  with  a  similar 


July  20,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.     73 


object  in  view.  These  gymnastics  and  "  series 
of  pressures "  might  be  fraught  with  alarming 
results  in  conditions,  for  example,  of  acute  glau- 
coma. It  is  a  pity  that  M.  De  Dion  did  not  confine 
his  attention  entirely  to  his  electrical  apparatus, 
in  -which  branch  of  science  he  has  met  with  acknow- 
ledged success. 


Tubercle  Bacilli  in  the  Breath. 

It  has  generally  been  held  and  taught  that 
pulmonary  tuberculosis  is  infectious  only  through 
the  medium  of  sputa,  and  that  persons  may  live 
in  close  contact  with  tuberculous  patients 
without  undergoing  any  risk  of  infection,  so  long 
as  they  are  not  exposed  to  contamination  with 
the  sufferers'  expectoration.  But,  like  most  of 
the  cherished  beliefs  in  medicine,  this  has  been 
called  severely  in  question,  and  Dr.  Koelzer  (a) 
has  recently  been  taking  steps  to  find  out  if  it 
is  not  possible  that  bacilli  are  exhaled  during 
quiet  respiration.  His  method  was  to  take 
patients  suffering  from  active  tuberculosis  of 
the  lung  and  get  them  to  hold  open  Petrie  dishes 
before  their  mouths  for  varying  periods,  without 
coughing  or  sneezing.  He  then  placed  covers  on 
the  dishes  and  examined  them  by  culture  and 
inoculation.  Out  of  fifteen  patients  so  tested 
he  found  tubercle  bacilli  in  one  dish  only,  and  in 
that  case  the  patient  was  suffering  from  advanced 
disease  with  lar3mgeal  ulceration.  There  is  an 
obvious  fallacy  about  the  single  Petrie  dish.  Though 
one  swallow  does  not  make  a  summer,  the  result 
is  nevertheless  sufficient  to  make  one  consider 
whether  Dr.  Koelzer's  conclusions  may  not  possi- 
bly be  justified.  In  his  opinion  it  is  possible  that 
during  quiet  breathing  tubercle  bacilli  may  be 
freed  from  the  muco-pus  in  the  finer  tubes  by 
the  bursting  of  the  small  bubbles  produced  by  air 
passing  through  them — those  bubbles  that  one  hears 
as  crepitations.  The  bacilli  thus  freed  may  be 
earned  out  in  the  expiratory  current,  just  as 
they  were  originaUy  carried  in  by  the  inspiratory 
current.  On  the  other  hand,  the  number  dis- 
engaged and  exhaled  in  this  manner  are  very 
few,  and  probably  are  not  factors  of  much  practical 
importance  in  the  spread  of  the  disease,  but  in 
cases  of  laryngeal  ulceration  the  numbers  are 
likely  to  be  considerably  larger  than  in  cases 
when  the  lung  only  is  affected.  It  seems  within 
the  bounds  of  possibility  that  Dr.  Koelzer  is 
right  ;  at  any  rate,  this  side  of  the  question  should 
always  be  borne  in  mind  in  cases  where  the 
patient  is  a  husband  or  wife,  and  is  often  in  close 
contact  with  a  healthy  person  for  many  hours. 
It  should  certainly  impress  on  medical  men  the 
duty  of  insisting  that  a  tuberculous  patient  should 
sleep  in  a  room  by  himself. 


The  L.GB.  and  Tramps. 

The  announcement  that  the  President  of  the 
Local  Government  Board  has  appointed  a  Depart- 
mental Committee  to  investigate  the  subject  of 
vagrancy  will  be  received  with  great  satisfaction 
by  readers  of  The  Medical  Press  and  Circular, 

(a)  ZeiU,  /.  ffuff-  u.  Inf^kt.  Krank.    Vol.  xliv,  p.  2. 


and  by    sanitarians    generally.     Time  and  again 
the  serious  medical  aspects  of  the  system  by  which 
tramps  are  allowed  to  roam  the  country  at  their 
own  sweet  wU  have  been  pointed  out   in   our 
columns.     These     "  sturdy     beggars,"     as     our 
Elizabethan  ancestors  would   have  called   them, 
have  been  shown  to  be  most  potent  agents  for 
disseminating  small-pox,  and  there  is  every  pro- 
bability that  variola  is  only  one  of  the  pests  for 
which  they  are  responsible.     From  the  economic 
point  of  view,  the  tramp  is  not  only   a  disgrace 
to  the  community,  but  he  exerts  an  evil  influence 
I  on    the   labouring   classes,    and    without    unduly 
j  infringing  the  liberty  of  the  subject  it  should  be 
I  quite  possible  to     restrict  his  activity  to  a  con- 
,  siderable     extent.      From     the     medical     point 
'  of    view    he   should  undoubtedly    be   subjected 
I  to  the  most  rigorous  supervision  and  regulation. 
I  Dr.  Armstrong,  of  Newcastle-on-Tyne,  has  been 
advocating  this  for   the  last  ten  years,  showing 
that  more  than  half  the  outbreaks  of  small-pox  are 
originated  by  the  unwelcome  presence  and  habits 
of   tramps,    and   various   authorities  have   been 
I  trying  to  get  the    Local    Government   Board  to 
I  take  the  matter  in  hand.     Everything  comes  to 
[  those  who  wait,  and  one  must  not  be  ungrateful 
now  that   this    tardy    inquiry    has    been  set  on 
foot.     It  would  have  been  more  reassuring  had 
the  Committee  contained  more  than  one  medical 
man,  but  here  again  we  must  be  thankful  that 
Dr.  Downes.  with  his  wide  experience  of  Poor- 
law   administration,    has   been    chosen.     Let    us 
hope  that  the  inquiry  will  be  thorough  and  the 
recommendations     unhesitating,     for     the     able- 
bodied  loafer  deserves  little  sympathy,   and  he 
has  no  right  to    constitute    himself  a  standing 
menace  to  the  health  of  useful  and  industrious 
people.     At  the  same  time,  it  is  impossible   to 
forget  that  the  tramp  is  a  product  of  society,  and 
that  his  legal  rights  to  maintenance  have  been 
recognised  by  the  law  of  the  land. 

Medioal  Men  and  Drizik  Legislation. 
*"  The  drink  question  has  recently  been  laid  before 
the  public  in  all  its  various  bearings  by  the  licens- 
ing proposals  of  Mr.  Balfour's  Government. 
There  can  be  hardly  any  one  great  social  question 
on  which  the  medical  profession  is  better  qualified 
to  speak  with  the  voice  of  authority.  The 
National  Church  has  spoken  with  a  somewhat 
wavering  voice  upon  the  matter,  but  on  the 
whole  its  support  of  temperance  interests  has  been 
emphatic.  Why  should  not  medical  men  speak 
out  their  collective  mind  as  to  whether  Mr. 
Balfour's  alterations  in  licensing  law  are  likely 
to  increase  the  facilities  for  drinking  amongst 
our  countrymen  or  the  reverse  ?  The  fact  that 
alcohol  lies  at  the  bottom  of  a  vast  mass  of 
disease,  crime,  misery,  and  avoidable  suffering 
amongst  mankind  is  brought  home  daily,  nay, 
hourly,  to  the  medical  man.  Why  should  he  not 
proclaim^  his  opinion  without  regard  to  politics 
or  creed,  to  brewers  or  any  other  class  upon  a 
point  that  touches  more  or  less  nearly  the  happiness 
of  every  man,  woman,   or  child  in   the  United 


74     Th»  Mbdical  Pmss.  notes    ON    CURRENT    TOPICS. 


Kingdom  ?  That  the  medical  profession  is  able 
to  take  such  a  step  was  shown  by  the  petition 
signed  by  17,000  medical  men  and  presented  to 
the  Education  Department  with  a  view  of  render- 
ing the  teaching  of  hygiene  compulsory  in  State 
schools.  There  is  little  use,  however,  in  allowing 
our  labouring  classes  to  sap  their  manhood  and 
bequeath  a  broken  constitution  to  their  offspring, 
and  then  to  trust  to  school  lessons  to  mend  matters. 
Regulate  the  parents'  drink  first,  and  teach  the 
children  afterwards.     Begin  at  the  foundation. 


JuLV  20,  1904. 


Caisson  Disease. 

Ever  since  it  has  been  the  custom  to  dig  in  the 
bowels  of  the  earth  in  atmospheres  of  high  pressure, 
something  has  been  known  of  the  condition  which 
at  present  goes  under  the  name  of  ''  caisson 
disease."  The  symptoms,  which  come  on  after 
the  release  from  the  high  pressure .  chamber,  are 
various,  and,  at  first  sight,  quite  disconnected. 
One  of  the  commonest  is  a  colicky  pain  which  has 
given  the  disease  its  nickname  of  the  "  bends  *' 
among  American  workmen.  Sometimes  the  joints 
swell,  and  there  may  be  a  violent  pruritus,  known 
in  the  vernacular  as  '*  fleas."  Sharp  muscular 
pains  are  common,  and  more  serious  symptoms 
are  stupor,  anaesthesia,  coma,  deafness,  blindness, 
sudden  death.  It  has  been  noticed  that  the  sym- 
ptoms do  not  occur  if  the  period  of  decompression 
be  gradual  and  prolonged,  and  with  this  precaution 
very  high  pressures  can  be  borne  without  injury. 
The  only  treatment  which  has  ever  been  effective 
is  an  immediate  return  to  a  high  pressure,  followed 
by  very  gradual  decompression.  The  pathology  of 
the  condition  was  for  long  ascribed  to  minute 
haemorrhages  occurring  in  the  spinal  cord  and 
-elsewhere,  but  this  view  is  now  abandoned.  The 
researches  of  Hoppe-Seyler,  Paul  Bert,  and  others 
showed  that  the  true  cause  was  the  sudden 
return  of  the  gas  dissolved  in  the  blood  and  tissues 
to  the  free  state,  owing  to  the  sudden  relief  of 
tension.  During  the  period  of  pressure,  the  blood, 
like  the  fluid  in  a  closed  soda-water  bottle,  con- 
tains large  quantities  of  gas  in  solution  ;  on  the 
pressure  being  diminished,  ebullition  occurs,  just 
as  when  the  cork  is  drawn  from  the  bottle.  The 
chief  gas  concerned  is  nitrogen,  for  the  absorption 
of  oxygen  is  but  little  altered  by  atmospheric 
pressure,  and  that  of  carbon  dioxide  not  at  all. 
The  frequency  of  the  disease  during  engineering 
operations  in  America  is  becoming  somewhat  of  a 
scandal,  and  as  it  can  absolutely  be  avoided  by 
reasonable  care,  it  is  time  that  the  authorities 
should  step  in  and  insist  on  the  necessary  precau- 
tions being  taken. 


A  Fcdth  Cure  by  Fire. 
A  DRAMATIC  episode  was  given  last  week  by  the 
Daily  Chronicle^  of  a  cripple  who  suddenly  re- 
covered the  use  of  his  limbs.  The  account  re- 
lates to  one  Pat  Shay,  who  for  four  years  had 
suffered  from  paralysis  of  the  legs,  which  com- 
pelled him  to  walk  about  on  crutches.  One 
night  he  saw  fire  issuing  from  a  shop  in  Seven 
Dials,  London.     With  the  help  of  another  man 


he  burst  open  the  door,  and  then,  flinging  away 
his  crutches,  he  dashed  upstairs  and  brought 
down  a  baby.  The  two  men  between  them 
rescued  the  rest  of  the  inmates.  This  case  appears 
to  the  Chronicle  writer,  as  it  would  to  the  ordinan,' 
man  in  the  street,  in  the  light  of  a  miracle.  If 
the  paralysis  were  muscular,  due  to  peripheral 
neuritis,  there  is  nothing  surprising  in  the  recovery. 
The  "  cripple  "  had  most  likely  been  using  crutches 
for  some  time  when  he  might  have  walked. 
Suppose  this  man  Shay  had  been  under  the 
notorious  "  miner  "  surgeon  or  other  unqualified 
person,  the  full  credit  of  the  **  cure  "  would  have 
been  acquired  in  a  case  where  cure  was  not  needed. 
In  a  great  proportion  of  instances  it  is  from  sufferers 
of  this  type  that  bone-setters  and  quacks  gain 
their  successes.  Obviously  the  man  Shay  was 
perfectly  honest  in  the  belief  that  he  was  unable 
to  walk  until  the  fire  showed  him  the  contrar>\ 
The  crippled  British  public,  however,  are  not 
likely  to  resort  to  fires  to  test  the  reality  of  their 
disablement,  although,  from  the  point  of  view 
of  the  medical  profession,  they  act  little  less 
foolishly  in  trusting  to  cancer-curers,  faith- 
healers,  unqualified  electricians,  bone-setters, 
herbahsts,  and  the  rest  of  the  harpies  that  batten 
on  the  life  blood  of  their  credulous  victims. 


Formalin  in  Milk. 
The  medical  superintendents  of  the  Poor-law 
infirmaries  have  been  acquainted  for  some  years 
past  with  a  form  of  skin  disease  that  occurs  in 
epidemic  form  at  irregular  intervals.  Savill  was 
the  first  to  describe  such  an  outbreak,  and  on 
each  occasion  there  has  been  reason  to  suspect 
milk  as  the  causative  agent.  Last  September 
one  of  these  epidemics  attacked  the  inmates  of 
the  Central  London  Sick  Asylum  at  Hen  don, 
and  Dr.  Monckton  Copeman  was  sent  by  the 
Local  Government  Board  to  investigate  and 
report.  The  recently  published  account  of  his 
inquiry  shows  that  sixty-eight  persons  were 
attacked  and  that  two  died,  and  although  this 
is  a  lower  mortality  than  usual,  it  is  sufficiently 
serious.  Acting  on  the  supposition  that  the 
milk  supply  was  at  fault,  the  patients  were  all 
put  upon  Swiss  milk,  and  from  that  date  they 
all  began  to  recover.  Attention  was  attracted  to 
the  fact  that  the  original  milk  remained  sweet  for 
a  long  time,  and  this  observation  led  to  a  search 
for  preservatives  in  it,  a  search  that  revealed  the 
presence  of  formahn.  In  the  absence  of  any 
well-established  action  of  formalin  on  the  skin 
it  cannot  be  demonstrably  proved  that  this 
antiseptic  was  the  etiological  factor,  but  there 
being  no  other  likely  cause,  the  probability  of 
formalin,  or  some  product  of  delayed  fermentation 
through  its  action  on  the  milk  being  at  the  bottom 
of  the  trouble  cannot  be  lightly  disregarded. 
The  subject  deserves  the  earnest  attention  of 
sanitarians.  The  policy  of  putting  preservatives 
in  milk  is  a  vicious  one,  and  the  difficulty  of 
securing  convictions  against  those  who  do  so  is 


July  20,  1904. 


SPECIAL  CORRESPONDENCE. 


Thb  Medical  Press.    75 


great,  for  the  defendants  in  an  action  can  nearly 
always  call  expert  evidence  to  show  that  nothing 
certain  is  known  on  the  subject.  If  it  could  be 
established  that  formalin  has  the  power  of  setting 
up  a  condition  of  the  kind  that  occurred  at 
Hendon,  the  strongest  measures  would  be  justified 
"with  a  view  to  putting  down  the  unwholesome 
practice.  During  the  present  hot  weather  for- 
malin solution  is  doubtless  being  drunk  by  the 
gallon  by  men,  women,  and — ^worse  still — ^by 
children,  and  with  Hendon*s  experience  before 
our  eyes,  we  cannot  regard  the  prospect  with 
equanimity. 


Exit  the  Slate. 
The  slate,  \vitb  all  its  associations  and  traditions, 
is  doomed,  and  in  the  course  of  a  generation  or 
so  it  will  be  as  extinct  as  the  dodo.  The  light 
of  hygienic  truth  is  slowly  filtering  through  the 
red-tape  barriers  of  the  Board  of  Education,  and 
for  such  fitful  gleams  as  gain  access  to  the  recesses 
of  its  pigeon-holes  we  must  be  duly  thankful. 
The  facts  that  slates  form  a  convenient  medium 
for  the  transfer  of  pathological  organisms  from 
one  child  to  another,  and  that  the  licking  of  slates, 
affording  as  it  does  the  easiest  and  most  ready 
method  of  deleting  mistakes,  is  a  dirty  and  in- 
sanitary habit,  have  often  been  pointed  out. 
But  custom  is  hard  to  break  with,  and  no  one  in 
authority  has  yet  had  sufficient  initiative  to 
attempt  to  replace  the  old-fashioned  slate  by 
the  obviously  more  convenient  and  cleanly 
substitutes — ^paper  and  pencils.  Perhaps  the 
future  school-boy,  with  his  smiling  morning  face, 
will  go  even  more  unwillingly'  to  school  when  he 
knows  that  he  will  be  deprived  of  the  amusement 
of  drawing  portraits  of  his  master  that  can  be 
erased  with  a  dab  of  saliva  should  the  dominie's 
eye  travel  in  his  direction,  but  it  is  hkely  that  his 
absences  from  school  will  not  be  so  frequent  when 
this  hoar}'  institution  is  relegated  to  the  limbo 
of  things  forgotten.  Lord  Londonderry  has  net 
shown  himself  a  brave  or  vigorous  administrator 
since  he  went  to  the  Board  of  Education,  and  there 
is  plenty  of  room  for  well-directed  zeal  in  his 
present  post,  but  this  little  reform  will  serve  to 
show  that  he  is  not  altogether  without  imagination. 
We  wish  he  could  have  given  a  more  decided 
and  encouraging  answer  to  the  medical  deputation 
that  waited  on  him  last  week  to  urge  that  elemen- 
tary hygiene  should  form  part  of  the  ordinary 
school  curriculum,  but  in  the  meantime  we  must 
take  the  abolition  of  the  slate  as  a  hostage  for 
good  intentions  for  the  future. 


PERSONAL. 


On  July  15th,  his  Majesty  the  King  visited  New- 
market Workhouse,  and  after  inspecting  the  hospital 
wards,  made  the  following  entry  in  the  visitors'  book  : 
"  It  is  nine  years  since  I  visited  this  union,  and  I  find 
it  vastly  improved  and  in  excellent  order." 


Christian,  has  been  operated  upon  for  appendicitis  at  the 
Prince  Victoria  Memorial  Home,  Windsor.  The 
accounts  of  the  progress  of  the  Royal  patient  are  satis- 
factory. 


Dr.  William  Murrell  has  been  appointed  Examiner 
in  Materia  Medica  in  the  University  of  Glasgow. 


M.  a.  Chauveau  has  succeeded  the  late  distinguished 
physiologist  Professor  Marey  in  the  Directorship  of  the 
Institut  Marey. 


His  Majesty  has  approved  the  appointment  of  Sir 
William  MacGregor,  M.D.,  K.C.M.G.,  C.B.,  at  present 
Governor  of  Lagos,  to  be  Governor  and  Commander-in- 
Chief  of  Newfoundland,  in  succession  to  Sir  Cavendish 
Boyle,  who  has  been  appointed  Governor  of  Mauritius. 

At  a  quarterly  meeting  of  the  Council  of  the  Royal 
College  of  Surgeons  of  England.  Mr.  John  Tweedy  was 
re-elected  President  for  the  ensuing  year,  and  Mr. 
A.  W.  Mayo  Robson  and  Mr.  Henry  T.  Butlin  were 
elected  Vice-Presidents. 


The  President  of  the  Local  Government  Board, 
after  consultation  with  the  Home  Secretary,  has 
appointed  a  Departmental  Committee  on  Vagrancy, 
consisting  of  the  Right  Honourable  J.  L.  Wharton. 
M.P.  (Chairman),  Sir  William  Chance,  Mr.  J.  S.  Davy, 
C.B.,  Dr.  Downes,  Captain  Eardley-Wilmot,  Captain 
Showers,  and  Mr.  H.  B.  Simpson,  with  Mr.  F.  L. 
Turner,  of  the  Local  Government  Board,  as  Secretary. 


On  the  14th  instant,  Mr.  Sydney  Stephenson  pre- 
sided over  a  large  and  distinguished  gathering  at  the 
Hotel  Cecil  on  the  occasion  of  the  annual  dinner  of  the 
Society  for  the  Study  of  Disease  in  Children. 


Mr.  John  Tweedy,  President  of  the  English  Royal 
College  of  Surgeons,  has  revived  the  annual  dinner  of 
the  Fellows  of  that  body,  and  presided  at  the  first 
dinner  held  on  the  July  7th,  under  the  new  arrangement 
in  the  Library  of  the  College. 

It  has  been  proposed  by  the  Berlin  Committee  for 
Cancer  Research  to  found  a  special  department  in  the 
new  buildings  of  the  Charit6  for  the  study  of  that 
malady  under  the  direction  of  Professor  von  Leyden. 

Dr.  E.  Modder,  Assistant  Colonial  Surgeon,  Ratua- 
pura,  Ceylon,  goes  to  Kalutara  in  place  of  Dr.  Spittal, 
who  is  now  medical  officer  of  Colombo. 


Professor  von  Esmarch,  of  Kiel,  has  just  met  with 
a  serious  accident  by  falling  out  of  bed  and  breaking 
his  collar-bone.  In  spite  of  his  advanced  age  his  con- 
dition is  said  to  be  satisfactory. 


The  list  of  the  Honorary  Medical  Staff  of  King 
Edward  VII.'s  Hospital  for  Officers  has  been  gazetted, 
the  appointments  being  for  five  years  from  January 
I  St,  is!o4.  Consulting  Surgeons,  Sir  Thomas  Smith. 
Bt.,  K.C.V.O.,  F.R.C.S.  ;  Sir  Frederick  Treves,  Bt., 
K.C.V.O..  C.B..  F.R.C.S..  and  a  staff  of  twenty-five 
other  well-known  physicians  and  surgeons. 


It  is  announced  that  Princess  Victoria  of  Schleswig-  | 
Holstein,  the  eldest  daughter  of  Prince  and  Princess 


Special  corredpondence* 

[from  our  own  correspondents.] 
SCOTLAND. 
Slander  Action  against  Sir  Patrick  Heron 
Watson. — Judgment  was  given  on  the  adjustment  of 
the  issues  of  this  trial  on  the  12th  inst.,  and  notice  of 
appeal  has  been  lodged.  Mrs.  Jones  or  McEwan  sues 
for  two  sums  of  3^2,500,  and  Mr.  Jones,  her  father,  for 
;£2,500.  The  issues  proposed  by  the  pursuers  were  to 
the  following  effect: — (i)  Whether  in  October,  1901, 
the  pursuer  employed  the  defender  as  her  confidential 
medical  adviser  to  advise  her  as  to  her  state  of  health, 
and  in  the  matter  of  an  action  for  judicial  separation 
about  to  be  instituted  by  the  pursuer  against  her 
husband,  and  whether  the  defender,  in  breach  of  hig 


76     The  Medical  Press. 


CORRESPONDENCK. 


July  20,  1903. 


confidential  employment  in  October,   1903,  disclosed 
to  pursuer's  husband,  his  law  agent,  and  the  counsel 
engaged  on  his  behalf  to  defend  the  action  for  separa- 
tion, matters  relative  to  the  pursuer's  health  ascer- 
tained in  the  course  of  the  said  confidential  employ- 
ment.    (2)  Whether  at  the  trial  of  the  separation  case 
the  defender,  in  breach  of  his  confidential  employment, 
voluntarily  gave  evidence  on  behalf  of  Mr.  McEwan, 
and  disclosed  matters  relative  to  the  pursuer's  health, 
to  her  detriment.     (3)  Whether  in  October,  1903,  the 
defender    falsely    and    calumniously    stated    to    Mr. 
McEwan,  his  agents,  and  his  counsel  that  in  October, 
1901,   the  pursuer  was  bent  on  inducing  premature 
labour  so  as  to  free  her  of  any  permanent  reminder  of 
his  marriage.      (4)  Whether  in  October,  1903,  defender 
voluntarily  made  a  similar  statement  in  open  court  in 
her  evidence  as  a  witness  on  behalf  of  Mr.  McEwan. 
For  the  defence  counsel  contended  that  as  regards  the 
first  issue,  the  alleged  breach  of  confidence,  being  a  dis- 
closure in  the  course  of  precognition  was    privileged 
equally  with  testimony  given  in  the  witness-box.     The 
whole  case  turned  on  the  question  of  privilege,  and 
absolute  privilege  with    regard    to    a  witness'  state- 
ments in  the  box  was  in  the  interests  of  the  public. 
If  defender  was  entitled  and  bound  to  give  the  evidence 
he  did  in  the  witness-box,  and  was  absolutely  privi- 
leged, he  could  not  be  held  liable  for  the  relative  pre- 
cognitions.    Moreover,  the  pursuer  was  not  entitled  to 
divide  the  wrong  from  which  she  said  she  had  suffered 
into  two  parts  and  claim  damages  for  each — for  the 
alleged  slander  and  the  alleged  breach  of  confidence. 
There  was  no  allegation  that  the  notes  which  the  de- 
fender produced  at  the  trial  were  other  than  genuine 
notes  of  his  impressions  two  years  previously,  and  how 
a  gentleman  producing  such  notes  could  be  accused  of 
acting  maliciously  counsel  could  not  understand.     In 
any  case,  even  if  his  lordship  should  allow  of  issues, 
he  asked  that  the  case  should  be  tried  without  a  jury. 
For  the  pursuer,  Counsel  stated  that  the  defender  was 
not  only  in  the  position  of  an  ordinary  confidential 
medical  adviser,  but  was  confidential  adviser  in  regard 
to   a   proposed   litigation.     It   was   common   ground 
between  the  parties  that  Dr.  Watson's  opinion  after 
he  had  examined  the  pursuer  was  adverse  to  her,  that 
he  was  not  asked  to  give  evidence  on  her  behalf,  that 
pursuer's  agents  got  intimation  that  the  defender  was 
to  examine  her  on  behalf  of  her  husband  and  as  a  pro- 
p>osed  witness  for  him  in  the  action  for  separation,  and 
that  the  pursuer's  agent  had  brought  pointedly  before 
Dr.  Watson,  before  he  made  his  second  examination 
of  Mrs.  McEwan,  that  he  had  previously  been  employed 
by  her  confidentially  in  connection  with   that  very 
action.     It  was  also  common  ground  that  the  defender 
disclosed  to  Mr.  McEwan  not  only  results  of  his  second 
examination,  but  the  results  of  the  first,  including  the 
contents    of    the    notes.     As    to    precognition    being 
privileged,  no  one  could  force  a  witness  in  precognition 
to  say  anything,  and  had  the  defender  adopted  that 
course   nothing   would    ever  have   been   heard   of   it, 
because  it  was  quite  evident   that  the  husband  would 
never  have  called  him  as  a  witness  without  knowing 
what  he  was  going  to  say.     Lord  Kincaimey,  in  giving 
judgment  approved  of  issues  (i)  and  (3).     After  re- 
viewing  the   circumstances   under   which    the   action 
arose,  he  said  that  though  the  pursuer  stated  that  the 
defender's  statements  were  made  maliciously,    there 
was  no  averments  from  which  malice  could  be  inferred, 
and  the  idea  of  actual  malice  seemed  preposterous  and 
not  in  the  case  at  all.     The  defender  pleaded  against 
the  duplication  of  issues,  but  he  saw  nothing    objec- 
tionable in  this,  there  being  a  sufficient  difference  in 
the  time  and  circumstances  in  which  the  words  objected 
to  were  spoken,  in  private  and  at  the  trial,  to  warrant 
a  separate  issue  for  each  occasion.     Further,  it  seemed 
legitimate  to  put  breach  of  confidentiality  in  one  issue 
and  defamation  in  another,  as  one  issue  might  fail, 
and  the  other  succeed,  or  the  damages  might  be  totally 
different  in  the  two  cases.    There  were,  therefore,  four 
issues  to  be  disposed  of.     He  had  little  difficulty  in 
disallowing  the  fourth — an  issue  for  defamation  for 
evidence  given  in  court  on  oath.     Nothing  was  more 


clearly  settled  than  that  in  such  a  case  the  protection  of 
a  witness  was  absolute,  whether  his  words  were  true 
or  false,  bona  fide  or  malicious.  He  saw  no  ground  for 
disallowing  the  third  issue  ;  the  pursuer  did  not  say 
that  it  referred  to  the  precognition  of  the  defender  hv 
pursuer's  husband,  and  he  did  not  see  that  that  could 
be  assumed.  Even  if  it  were,  however,  he  had  no 
doubt,  that  no  absolute  privilege  attached  to  words 
spoken  in  precognition,  and  he  was  not  prepared  to 
say  that  they  were  privileged  at  all.  He  did  not  think 
malice  could  be  added  to  that  issue.  The  second  issue 
was  covered  by  the  principle  which  afforded  absolute 
protection  to  a  witness,  and  was  disallowed.  The 
greatest  difficulty  was  as  to  the  first  issue,  but  he  thought 
it  must  be  allowed.  There  seemed  to  be  no  other 
Scottish  authority  than  a  case  in  1851,  which  was. 
however,  quite  conclusive,  and,  sitting  in  the  Outer 
House,  he  considered  he  must  follow  it.  The  judg- 
ment applied  to  the  action  of  Mr.  Jones,  the  issues  in 
his  case  being  the  same  a^  in  Mrs.  McEwan' s,  except 
that  the  issue  as  regards  confidentiality  was  omitted. 


Cortedpondence. 

[We  do  not  hold  ourselves  responsible  for  the  opinions  of  oar  Cor- 
respondents]. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  question  of  the  diminishing  birth-rate, 
which  is  so  universal  in  almost  all  civilised  European 
States  and  in  English-speaking  colonies,  is,  in  my 
opinion,  the  greatest  question  in  the  domain  of  hygiene. 
Notwithstanding  the  interesting  statistics  put  for- 
ward in  your  issue  of  July  13th,  by  Dr.  David  Walsh, 
I  think  it  is  now  well  ascertained  that,  in  the  -words  of 
Dr.  Billing,  late  Registrar-General  of  the  United  ' 
States,  the  recent  fall  in  the  birth-rate  in  civiUsed 
States  or  its  most  important  cause  is  **  the  deliberate 
and  voluntary  prevention  of  child-bearing  on  the  part 
of  a  steadily  increasing  number  of  married  people, 
who  not  only  prefer  to  have  few  children,  but  know- 
how  to  attain  that  wish."  Dr.  Billing's  views  are 
readily  seen  to  be  true  for  the  cities  of  the  United 
States,  for  the  "  Statesman's  Year-Book  of  1902  "  men- 
tions that  the  birth-rates  per  1,000  persons  in  1900 
were,  in  New  York,  22*50;  in  Chicago,  17*11  ;  in 
Philadelphia,  20*50  ;  in  Saint  Louis,  18*12  ;  in  Balti- 
more, 15*79  ;  in  San  Francisco,  14*75";  and  in  Cincin- 
nati, 17*26.  Compare  these  low  birth-rates  with  that 
of  London,  28*5  ;  and  recollect  that  in  New  2^aland. 
confessedly  the  most  prudent  of  all  countries  in  its  birth- 
rate, where  the  birth-rate  has  fallen  since  1880.  when 
it  was  40  per  1,000,  to  26  per  1,000  in  1900,  and  Dr. 
Walsh  may  perhaps  confess  that  Dr.  Billing's  account 
of  the  diminishing  birth-rate  is  the  true  one.  Ireland  is 
an  exception,  for  there,  curiously  enough,  the  mar- 
riage-rate is  extremely  low,  whilst  the  births  to  each 
marriage  are  very  high.  I  conclude  that  this  is  due  to 
the  power  of  the  Catholic  priesthood  in  Ireland,  which 
is  so  diminished  in  France  that  a  Bishop  of  that  church 
lately  had  to  petition  the  Vatican  to  forbid  French 
priests  to  threaten  communicants  with  censure  who 
employed  the  methods  referred  to  by  Dr.  BilUng  for 
keeping  their  families  within  their  means  of  feeding 
them. 

This  new  view  of  family  life  dates  from  1877,  when 
the  important  case  of  Reg.  v.  Bradlaugh  and  Besant 
came  before  the  courts,  and  when  I  gave  evidence  for 
the  defendants.  In  London,  since  then,  some  dis- 
tricts show  a  notable  diminution  in  their  birth-rates. 
Hampstead  and  Kensington,  which  in  1877  had  birth- 
rates of  over  35  per  1,000,  have  at  present  birth-rates  of 
from  about  18  to  20  per  1,000  inhabitants;  while 
indigent  districts,  such  as  St.  George's-in- the- East,  have 
birth-rates  of  over  40  per  1,000.  Now,  high  birth- 
rates in  our  cities  mean  high  infantile  mortality  and 
crowding  into  purlieus  like  those  of  London,  Dublin. 
Manchester,  and  Glasgow.  The  death-rate  from 
phthisis,  for  instance,  is  six  times  as  high  in  the  poor 
'  streets  of  Brussels  as  in  the  wealthy  classes  living  near 


July  20,  1904. 


CORRESPONDENCE. 


Th»  Mbdicax  Press.     77 


the  park  of  that  city,  according  to  the  late  Dr.  Janssens. 
I  notice  that  Dr.  Taylor,  of  Birmingham,  thinks  that 
the  health  of  the  wife  is  likely  to  suffer  if  she  has  only 
three  or  four  children  or  less.  But,  of  course,  infinitely 
greater  danger  to  the  health  of  mothers  and  children  is 
caused  by  large  families  when  wages  are  low.  In  the 
Metropolitan  Ftee  Hospital,  when  it  was  situated  in 
Whitechapel,  I  found  that  100  married  women  over  the 
age  of  forty-five  had  produced  720  children  as  a  rule  ; 
and  of  these  more  than  half  had  died  in  early  childhood. 
On  the  other  hand.  Dr.  Lutaud,  of  Paris,  has  shown  in  a 
letter  to  Mr.  Hausmeister,  of  Stuttgart,  that  the  wives 
of  100  medical  practitioners  of  Paris  gave  birth  to  only 
150  children— I.e.,  to  less  than  two  children  to  a  mar- 
riage. I  found  a  similar  state  of  things  to  exist  in  1878 
iK-hen  I  made  an  inquiry  among  French  medical  men 
on  this  point. 

I  submit  to  Dr.  Taylor  that  the  excellent  physicians 
and  surgeons  of  Paris  cannot  believe  with  him  that 
'Small  faimilies  are  very  hurtful  to  the  health  of  their 
wives  ;  but  even  were  there  a  good  deal  of  truth  in  his 
views  it  would  be  a  remedy  far  worse  than  the  disease 
to  recommend  more  children  to  persons  already  over- 
burdened with  the  care  of  those  they  were  responsible 
for.  I  may  perhaps,  add  that  the  health  of  children 
could  not  suffer  from  parental  prudence  if  the  three 
children  required  were  bom  in  the  early  years  of  the 
marriage.  As  to  men,  French  physicians  totally  deny 
any  injury  done  to  their  health  by  the  innocent 
means  they  adopt  to  keep  their  families  within  their 
means  of  educatmg  them.  Marriage  {pace  the  Catholic 
Church)  is  far  more  hygienic  than  singleness,  which, 
as  Sir  Benjamin  Brodie  once  said,  produces  "  so  many 
evils  that  he  could  not  mention  them,  but  which  were 
'even  greater  than  the  evils  caused  by  prostitution."  I 
presume  he  referred  to  masturbation  and  melancholia, 
etc. 

Economically,  however,  it  is  out  of  the  question  for 
the  people  of  any  European  State  Uke  ours  to  think 
of  having  large  families  with  impunity.  The  censuses 
■of  the  United  States  give  us  a  clear  proof  of  the  popula- 
tion law,  so  well  explained  in  1798  by  the  great  econo- 
mist T.  R.  Malthus  ;  for,  in  the  year  1800  the  population 
of  the  States  was  5,308,000  and  in  1830,  12,866,000; 
that  is,  it  far  more  than  doubled  in  thirty  years, 
although  between  1800  and  1830  there  was  scarcely 
any  immigration  from  Europe  into  the  States.  Since 
1800,  while  the  inhabitants  of  the  United  Kingdom 
increased  from  16,345,000  to  41,605,000  in  1901,  or 
only  about  two  and  a  half  times  in  a  century,  the 
population  of  the  United  States  increased  from 
5,308,000  in  1800  to  75,820.000  in  1900,  or  about 
fifteen-fold  in  that  century. 

The  evident  deduction  from  these  facts  is  that  we,  in 
old  countries  like  ours,  must  check  population  somehow, 
voluntarily  or  involuntarily  ;  and  the  only  question 
-we  have  to  solve  is  this — What  is  the  least  painful 
check  we  can  devise  ?  War,  pestilence,  and  famine  are 
intolerable ;  late  marriages  painful,  and  productive  of 
prostitution  and  venereal  contagion ;  emigration  a 
delusion,  as  it  removes  one  sex  to  the  colonies  and 
leaves  the  other  in  Europe,  and  because  it  tends  to 
make  people  trust  to  a  broken  reed,  besides  becoming 
yearly  more  and  more  unattainable.  Experience  shows 
that  we  are  even  more  crowded — as  are  the  Germans — 
than  ever  with  all  our  colonisation. 

Hence  we  are  now  in  the  position  to  confess  that  we 
had  better  make  up  our  minds  that  the  best  check  to 
population  consists  in  the  producing — by  all  classes — 
whether  rich  or  poor,  of  very  restricted  families  such 
as  four  children  as  a  maximum,  or  perhaps  three  or  less 
on  an  average  to  each  married  couple,  even  although 
that  restriction  may  occasionally  be  thotight  to  slightly 
deteriorate  the  health  of  a  few.  "Of  all  evils  choose 
the  least "  is  the  only  true  philosophy  of  the  homo 
sapiens,  and  morality  means  for  us  moderns  that  con- 
duct which  tends  towards  minimising  the  preventable 
sorrows  of  our  race.  I  am,  Sir,  yours  truly, 

C.  R.  Drvsdale, 
Consulting  Ph3rsician  to  the  Metropolitan  Hospital  of 
London. 


THE  LUNACY  QUESTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — What  we  want  to  do  now  is  to  arrange  properly 
between  doctors,  lawyers,  lunatics,  and  their  friends  or 
relatives.  Doctors  a  few  years  ago  were  afraid  to  sign 
certificates,  after  the  case  of  Weldon  v.  Whislow  and 
Semple,  and  many  feel  now  that  they  run  risks  in 
signing,  even  in  undoubted  cases.  Where  there  is  the 
least  doubt  no  medical  certificates  can  be  obtained. 
When  it  was'possible  for  a  patient  to  be  taken  off  to 
an  asylum  on  the  simple  showing  of  two  doctors' 
certificates,  and  nothing  more,  cases  of  malpractice  did 
occur.  Lunatic  asylums  were  not  nice  places  and 
Charles  Reade  showed  them  up. 

Thank  goodness,  "  tempora  mutantur  "  ;  but  how 
much  of  this  is  due  to  the  medical  profession  is  not  very 
clear.  Mrs.  Weldon  did  some  good,  perhaps,  but 
Dr.  Semple's  friends  felt  sorry  for  him.  All  that  a 
doctor  should  be  asked  to  do  is  to  give  a  certificate  of 
the  mental  condition  of  the  case,  much  in  the  same 
way  that  he'doesof  the  physical,  when  filling  up  a  form 
*  of  insurance.  There  should  be  no  doubt  in  the  mnds 
of  friends,  relatives,  or  lawyers  about  the  doctors' 
perfect  honour  and  honesty,  and  in  this  the  readers 
of  The  Medical  Press  will  agree. 

I  am  Sir,  yours  truly, 

R.  L. 

THE  MIDWIVES'  INSTITUTE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  accordance  with  the  request  contained  in 
the  paragraph  in  your  issue  of  14th  instant  headed 
"  The  Midwives'  Institute,"  we  are  instructed  to  say 
that  the  Incorporated  Midwives*  Institute  never  has 
been  in  any  way  connected  or  affiliated  with  the  Mid- 
wives'  Society  referred  to  in  such  paragraph  and  conse- 
quently has  not  been  absorbed  in  such  Society.  We 
are  also  instructed  to  request  that  you  will,  in  your 
next  issue,  give  publicity  to  this  letter. 

I  am,  Sir,  yours  truly. 
Brown,  Ringrose  &  Lightbodv. 
1 8th  July,   1904.     Abingdon  Street,  London,  S.W. 

[We   have   much   pleasure   in   inserting    the   above 

statement. — Ed.]  

THE    ANNUAL    TEMPERANCE    BREAKFAST. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — ^Will  you  kindly  allow  me  to  invite  the  atten- 
tion of  the  profession  to  the  Annual  Temperance 
Breakfast  which  willTbe  given  by  the  National  Tem- 
perance League  at  Oxford,  on  Thursday  morning,  28th 
inst.  The  occasion  will  this  year  be  of  exceptional 
interest,  in  view  of  the  recent  memorial  to  the  Educa- 
tional Department,  and  of  the  evidence  which  we  were 
enabled  to  present  to  the  Physical  Deterioration  Com- 
mittee of  the  Privy  Council.  I  shall  be  glad  if  those 
who  can  attend  will  kindly  apply  for  tickets  at  our 
table  in  the  Reception  Room. 

I  am,  Sir,  yours  truly,  John  Turner  Rae,  Sec, 

Presentation  to  Professors  Coffey  and  R  yan. 
Last  week  the  governing  body  of  the  Catholic 
University  School  of  Medicine  with  many  of  the  past 
and  present  students  met  for  the  purpose  of  presenting 
two  of  the  professors,  Drs.  Coffey  and  Ryan,  with  tokens 
of  friendship  on  the  occasion  of  their  approaching 
marriages.  Sir  Christopher  Nixon,  Dean  of  the  School 
presided,  and  while  regretting  that  his  colleagues' 
devotion  to  service  would  not  in  future  take  first  place  in 
their  affections,  he  expressed  the  "-  respect  which  all 
entertained  for  their  intellectual  attainments,  the 
admiration  felt  for  their  high  personal  character,  for 
their  unassuming  charm  of  manner  in  itself  an  attribute 
of  genius,  and  for  their  kindliness  of  manner,  which 
enforced  the  affection  of  all.  colleagues,  professional 
brethren,  and  students."  Addresses  were  read  to  both 
gentlemen  by  the  secretary  of  the  Students'  Committee 
and  replies  were  made.  Many  scientific  workers,  to 
whom,  the  labours  of  Dr.  Coffey  and  Dr.  Ryan  in  physi- 
ology and  chemistry  respectively  have  made  them 
known,  will  join  in  the  good  wishes  they  have  received 
from  their  immediate  associates. 


78     Thb  Medical  Press. 


LITERARY  NOTES  AND  GOSSIP. 


July  20.   1904- 


©bituars. 

DR.  W.  A.  M'KEOWN,  BELFAST. 
It  is  with  great  regret  we  record  the  death  of  William 
Alexander  M'Keown,  of  Belfast,  one  of  the  best-known 
medical  men  in  the  North  of  Ireland.  Though  in  in- 
different health  for  some  time,  a  serious  result  was  not 
expected,  and  his  sudden  death  on  the  9th  inst.,  was  a 
shock  to  many.  He  was  about  sixty  years  of  age,  and 
had  been  in  active  practice  as  an  ophthalmic  surgeon 
since  1870.  In  this  branch  of  surgery  he  made  some 
notable  advances,  which  are  invariably  connected  with 
his  name.  Of  these  the  most  important  were  the  intro- 
duction of  the  use  of  the  magnet  for  the  removal  of 
metallic  bodies  from  the  eye-ball,  and  more  recently 
his  operative  treatment  of  immature  cataract.  At  the 
time  of  his  death  he  had  just  accepted  an  invitation 
from  the  authorities  of  the  Johns  Hopkins  Hospital 
to  pay  a  visit  to  Baltimore,  and  demonstrate  his  method 
of  procedure  in  this  operation.  He  was  intimately 
associated  with  all  medical  organisations  in  the  North  of 
Ireland  and  had  been  President  of  the  Ulster  Medical 
Society  as  well  as  of  the  North  of  Ireland  Branch  of  the 
British  Medical  Association.  Outside  his  surgical  work. 
Dr.  M'Keown  was  well  known  on  account  of  the  keen 
interest  he  took  in  all  educational  matters.  On  most 
points  regarding  the  thorny  subject  of  Irish  education, 
primary,  intermediate,  and  university,  he  held  strong 
convictions,  and  he  took  care  that  they  were  known. 
Of  vigorous  courage  and  honesty  of  purpose,  he  was  an 
acute  controversialist,  a  hard  hitter,  and  a  good  fighter. 
He  was  fixedly  opposed  to  denominational  education  of 
every  kind,  and  was,  in  consequence,  a  strong  opponent 
of  any  scheme  for  the  establishment  of  a  Roman 
Catholic  University  in  Ireland,  while  at  the  same  time 
his  objection  to  the  clerical  management  of  schools 
often  brought  him  into  conflict  with  the  ministers  of  his 
own — the  Presbyterian — Church.  Not  only  by  his 
professional  brethren  and  the  public  of  the  North  of 
Ireland  is  his  death  deplored,  but  by  all  those  with 
whom,  whether  as  ally  or  as  opponent,  he  was  brought 
into  touch  in  public  Ufe. 

GEORGE  WILLIAMS  PARKER,  M.R.C.P. 
LONDON.. 
A  CABLEGRAM  from  Georgetown,  British  Guiana, 
states  that  Dr.  G.  W.  Parker,  who  arrived  there  from 
London  in  February  in  order  to  1  make  collections  of 
plants  for  Kew,  and  medicine  plants  for  the  British 
Pharmaceutical  Society,  has  succumbed  to  an  attack 
of  malaria.  Mr.  Parker  was  cruising  on  a  steam  yacht 
when  he  was  seized  with  fever.  He  was  brought  on 
shore  in  an  unconscious  condition,  and  died  four  hours 
later.  Dr.  Parker  was  formerly  Court  physician  to  the 
Queen  of  Madagascar.  He  was  educated  at  St. 
Thomas's  Hospital,  London,  and  took  the  L.R.C.P. 
Lond.  in  1872,  the  M.R.C.P.  Lond.,  in  1883,  and 
M.R.C.P.  Edin,  in  1878. 


GEORGE  ALDRIDGE  GEORGE,  M.R.C.S.,  L.R.C.P. 
We  regret  to  record  the  death,  at  Bournemouth,  of 
Dr.  G.  A.  George,  formerly  of  Dorchester.  He  had 
been  suffering  for  some  time  from  diabetes,  and  on 
Monday  week  went  to  London  to  consult  a  specialist. 
He  was  the  eldest  son  of  the  late  Mr.  Josiah  George, 
Jun.,  of  Romsey,  a  well-known  brewer.  He  himself 
early  in  life  had  experience  of  banking,  and  was  for  a 
time  manager  of  a  branch  bank  in  India.  The  failure 
of  that  banking  business  turned  his  attention  into 
another  channel — the  main  channel  in  which  the  current 
of  his  life  thereafter  flowed.  Coming  back  to  England, 
he  resolved  to  study  for  the  medical  profession,  and 
entered  University  College  Hospital,  London,  whre 
he  passed  as  Licentiate  of  the  Royal  Colleges  of  Sur- 
geons and  Physicians  in  1877. 

The  Cholera  in  Persia. 
According  to  a  Times'  telegram,  the  mortaUty  from 
cholera  in  Persia  is  graduallj'  decreasing,  but  there  are 
still  over  200  deaths  daily.     The  districts  surrounding 
Teheran  are  suffering  severely. 


XaboratorB  flotes, 

BOVININE. 

The  place  of  invalid  restorative  foodstuffs  in  the  sick- 
room is  now  one  of  the  commonplaces  of  medical 
practice.  We  have  pleasure,  therefore,  in  giving  the 
following  analysis  of  one  of  the  best  known  of  these 
products.  A  sample  obtained  by  us  yielded  the 
following  results : — 

Total  solids.  21*1  grammes  per    100  c.c. 
Mineral  matter,   1-5       „  „ 

This  mineral  matter  contained  a  little  common  salt,  and 
the  remainder  appeared  to  be  almost  entirely 
phosphate  of  calcium. 

The  total  solids,  or  residue  left  on  drying,  was  almost 
entirely  of  a  nitrogenous  nature,  and  an  estimation 
by  Kjeldahl's  method  showed  the  sample  to  contain 
1 8*2  grammes  per  100  c.c.  of  albuminoids.  As  it  was 
found  that  the  preparation  coagulated  on  heating,  it 
appears  to  be  a  meat  juice  prepared  by  the  cold  pro- 
cess, We  are  opinion,  considering  the  above  facts,  that 
this  preparation  should  be  of  high  nutrient  and  stimu- 
lating value,  and  we  therefore  have  pleasure  in 
commending  it  to  the  notice  of  our  readers. 


FRIEDRICHSHALL. 

Fribdrichshall  now  enjoys  a  classical  reputation 
in  the  field  of  medicine.  This  natural  mineral  water  is 
described  as  a  *'  pleasant,  mild,  and  certain  aperient." 
We  are  able  to  testify  to  this  from  personal  experience, 
and  a  use  of  it  extending  over  some  years  has  confirmed 
the  good  opinion  we  have  always  held  of  it. 

Its  action  depends  on  the  sulphates  and  chlorides  of 
sodium  and  magnesium  that  it  contains,  and  we  have 
now  again  analysed  it  with  results  that  differ  very  slightly 
indeed  from  an  analysis  we  made  some  years  ago. 
The  composition  of  the  water  is  roughly  as  follows: — 
There  are  about  two  and  one  half  per  cent,  of  solids,, 
which  consist  of  the  sulphate  and  chlorides  of  sodium 
and  magnesium. 

The  taste  is  far  from  disagreeable,  considering  the 
amount  and  character  of  the  salts  present.  However 
it  is  to  be  explained  the  fact  remairs  that  the 
mineral  salts  naturally  occurring  in  waters  of  this 
character  are  more  efficacious  and  less  unpleasant  to 
take  than  solutions  of  the  same  salts  artificially  pre- 
pared.   

ANGOSTURA  BITTERS. 

We  have  examined  a  '^  ample  of  this  well-known  brand 
of  bitters  procured  from  the  original  manufacturers. 
Messrs.  J.  G.  B.  Siegert  and  S  ns,  and  consider  that 
the  results  we  have  obtained  in  the  laboratory, 
combined  with  a  practical  experience  extending 
over  more  than  ten  years,  justify  us  in  stating 
that  the  claims  made  for  it  by  the  makers  are  in  no  way 
exaggerated.  As  many  imitations  of  these  well- 
known  "  bitters  "  are  put  up  by  chemists  and  other 
manufacturers,  some  of  which  contain  cinchona  pre- 
parations and  various  kinds  of  bitter  principles,  it  is 
obvious  that  a  standard  preparation  compounded  by 
the  original  makers  is  much  to  be  preferred  to  fictitious 
imitations.  The  original  preparation  has  frequently 
been  examined  and  approved  by  well-known  analysts, 
and  in  the  present  case  we  have  ourselves  carefully 
ana'ysed  and  searched  for  all  possible  'deleterious 
substances  and  have  found  them  entirely  absent. 
The  preparation  contains  alcohol  to  the  extent  of 
about  50  per  cent,  of  absolute  alcohol,  and  about  6  per 
cent,  of  solid  residue,  and  only  '05  per  cent,  of 
mineral  matter,  which  shows  that  the  bitters  are 
purely  vegetable  in  their  composition. 

Xiteraty  flotes  ano  609sip. 

"The  Queen  Newspaper  Book  of  Travel  "  (London  : 
Horace  Cox.  1Q04.  Price  2S.  6d.),  is  a  daintv  little 
volume,  handy  in  shape,  concise  in  matter,  eminently 
practical  in  service,  and  is  a  resumi  of  travel  information 
that  has  appeared  in  the  pages  of  the  Queen  from  1894 
up  to  the  present  year.  Useful  particulars  of  various 
health  and  holiday  resorts  in  the  United  Kingdom. 
Europe,    and   even    Africa,   are   given,     arranged    in 


July  20,   IQ04 


MEDICAL  NEWS. 


convenient  alphabetical  form.  It  is  evidently  a  guide 
book  for  the  wealthy  traveller,  but  also  contains  hints 
and  suggestions  which  should  be  of  value  to  many  a 
physician  when  selecting  a  suitable  resort  for  his 
patients.  ♦♦♦ 

We  understand  that  Dr.  Ralph  W.  Leftwich  has 
thoroughly  revised  his  "  Index  of  Symptoms,"  of  which 
a  third  and  considerably  enlarged  edition  will  be  pub- 
lished by  Messrs.  Smith,  Elder  and  Company  imme- 
diately. The  last  edition  had  a  somewhat  bald  appear- 
ance from  the  multitude  of  unbroken  columns.  This 
has  been  remedied  by  breaking  up  the  last  chapter  on 
"  Methods  of  Diagnosis,"  and  inserting  its  different 
parts  under  their  respective  headings. 
*** 

The  Royal  Statistical  Society  announces  that  the 
subject  of  the  essays  for  the  Howard  Medal,  which  will 
be  awarded  in  1905,  with  ;f20  as  heretofore,  is  *'  A 
Critical  Inquiry  into  the  Comparative  Prevalence  of 
Lunacy  and  other  Mental  Defects  in  the  United 
Kingdom  during  the  last  Fifty  Years." 
•** 

"  The  Seaside  and  Inland  ABC  HoUday  Guide  " 
(London  :  Wentworth  Publishing  Company),  is  a  well- 
arranged,  concise,  but  somewhat  scantily  illustrated 
handbook  of  useful  information  for  tourists  and  holiday 
seekers,  which  should  prove  of  much  service  to  those 
desirous  of  readily  gaining  trustworthy  information 
regarding  many  of  our  British  health  stations.  Medical 
men  will  find  this  little  manual  useful  for  purposes  of 
rapid  reference.  ♦♦* 

"  Where  to  Stay  "  (London  :  The  Gordon  Hotels, 
Limited)  claims  to  be  the  official  guide  to  the  best 
hotels  in  the  United  Knigdom  and  abroad.  It  is  an 
excellent  alphabetically  arranged  illustrated  guide, 
which  should  prove  invaluable  to  travellers ;  and  physi- 
cians having  to  advise  patients  in  the  choice  of  desirable 
residential  quarters  in  various  health  resorts  would  do 
well  to  have  a  copy  of  this  little  work  within  reach. 
♦«* 

New  editions  of  two  important  standard  works  have 
just  made  their  appearance — ^viz.,  a  fourth  editionjof 
Dr.  Dawson  Turner's  "Manual  of  Practical  Medical 
Electricity,"  and  a  second  edition  of  Messrs.  Robson 
and  Moynihan's  "  Diseases  of  the  Stomach  and  their 
Surgical  Treatment."  In  the  former,  Rontgen  rays, 
Finsen  light,  radium,  and  High-frequency  currents 
receive  fuller  treatment,  and  thirty  fresh  illustrations 
have  been  added  :  and  in  the  latter  volume  the  authors 
state  that  "the  whole  work  has  undergone  most  careful 
revision,"  and  many  new  illustrations  have  been 
added.  Both  works  are  issued  by  Messrs.  Bailliere, 
Tindall  and  Cox. 

*** 

The  Journal  of  the  Royal  Army  Medical  Corps, 
edited  by  Colonel  David  Bruce,  F.R.S.,  R.A.M.C.,  con- 
tains many  papers  of  scientific  and  literary  ex- 
cellence. Among  the  articles  may  be  specially  noted 
those  on  "  Enteric  Fever  "  by  Captain  E.  Blake  Knox, 
R.A.M.C.,  and  by  Captain  W.  S.  Harrison,  R.A.M.C. 
The  former  deals  with  the  spread  of  enteric  fever  by 
urine  and  its  prophylaxis,  and  the  latter  with  our  pre- 
sent position  with  regard  to  enteric  fever  in  India. 
These  papers  are  of  value  in  attacking  the  ever-present 
problem  of  enteric  fever  in  India.  A  paper  on  "  Sleep- 
ing Sickness  in  Uganda "  is  contributed  by  Colonel 
Bruce.  ♦♦♦ 

Nurse  Goldie's  "  Notes  on  Home  Nursing,"  is  a 
useful  repertory  of  practical  hints  compiled  for  the 
benefit  of  untrained  persons  who  are  called  upon  to 
render  first  aid  in  emergencies  or  nursing 
assistance  to  the  sick  in  their  own  homes.  In  such  a 
small  volume  the  author  could  not  possibly  attempt  to 
systematise,  but  she  has  managed  to  touch  on  all  the 
points  likely  to  be  of  interest  to  the  general  reader. 
We  have  our  doubts  as  to  the  utiUty  of  giving  directions 
for  bandaging  without  the  help  of  illustrations,  but  in 
such  a  dainty  volume  really  there  is  no  room  for  the 
latter.  In  short,  these  "  Notes "  constitute  a  very 
handy  portable  work  of  reference  for  family  and  general 


The  Medical  Pbess.    79 


A  paper  of  considerable  importance  was  com- 
municated at  the  last  meeting  of  the  Royal  Society  by 
Sir  Thomas  R.  Eraser,  M.D.,  F.R.S.,  of  Edinburgh, 
and  Major  R.  H.  Elliot,  of  the  Indian  Medical  Service, 
who  have  been  conducting  a  research  into  the  action  of 
snake  venoms.  They  find  that  the  most  deadly  of  all 
substances  of  this  nature  which  they  have  examined 
is  the  venom  of  the  sea-snake,  enhydrina  valahadien — 
resembling,  but  more  lethal  than,  that  of  the  cobra^ 
This  sea-snake  has,  of  course,  nothing  to  do  with  the 
so-called  sea-serpent,  and  is  chiefly  found  in  the  Indian 
Ocean. 

Society  for  the  Relief  of  Widows  and  Orphans  of 
Medical  Hen. 

At  the  quarterly  Court  of  Directors  of  this  Society- 
held  on  Wednesday  last,  the  President,  Mr.  Christopher 
Health,  being  in  the  chair,  two  new  members  were 
elected,  the  deaths  of  three  members  reported,  and  two 
gentlemen  had  ceased  to  be  members  of  the  Society.  A 
grant  at  the  rate  of  ;^5o  per  annum  was  made  on  the  ap- 
plication of  a  widow.  The  deaths  of  two  widows  were 
announced ;  one  aged  81,  had  been  in  receipt  of  grants 
since  January  1877,  and  had  received  £i,S40  from  the 
Society,  her  husband  had  only  been  a  member  ten 
years,  paying  20  guineas  ;  the  other,  who  had  just 
entered  her  loist  year,  had  received  ;£i,245,  having 
been  on  the  funds  of  the  society  since  January  1882, 
the  husband  had  paid  32  guineas  subscriptions.  The 
death  of  an  orphan  was  reported,  who  had  been  on  the 
Copeland  Fund  since  1866,  and  had  received  £4$^.  A 
legacy  of  ;f  i,cx)0  had  been  paid  by  the  executors  of  Mrs. 
Du  Pasquier.  The  expenses  of  the  quarter  amounted 
to  £$2  I2S.  6d. 

r  oyal  Univf  rRlty  of  Ireland. 

The  examiners  have  recommended  that  the  following 
candidates  be  adjudged  to  have  passed  the  First 
Examination  in  Medicine,  Summer,  1904  : — John  B. 
Aickin,  Thomas  P.  Carroll,  James  K.  P.  Clarke. 
Michael  Connell,  Victor  L.  Connolly,  Gertrude  C. 
Corscadden,  Nicholas  Cunningham,  George  Deery, 
Elliot  P.  Dewar,  Charles  Dickson,  WilUam  P.  Dunne, 
B.A.,  Michael  P.  Fitzgerald,  Hugh  J.  Grant,  Edmund  J. 
Harty  Joseph  Horan,  John  C.  Johnson,  Thomas 
Kennedy,  Peter  J.  Keogh,  Joshua  Keyms,  Alan  Kidd. 
William  C.  M.  Lewis,  William  P.  MacArthur,  Samuel  W. 
M'Combe  Thomas  C.  MacGcwan,  Mathew  J.  M'Grath,. 
Michael  M'Niflf,  Henry  H.  MacWiUiam,  Patrick  J. 
Mockler,  Kenneth  F.  Mulligan,  UUck  J.  G.  Mulligan, 
Daniel  F.  Mumaghan.  Harris  Newman,  Peter  H. 
O'ConneU,  William M.  J.  O'Connor,  WilUam  D.  O'Kelly, 
William  F.  O'Regan,  Alexander  Patton,  John  F. 
Rahilly,  Alfred  H.  Rentoul.  Robert  H.  Robinson,  John 
A.  Sinton,  William  Speedy,  Robert  S.  Taggaxt,  Gerald 
J.  W.  Tiemey,  William  Tyrrell,  Bruce  A.  West,  John 
M.  WUliams.  Joseph  A.  L.  Wilson. 

The  undermentioned  candidates  have  qualified  on 
their  answering  to  present  themselves  for  the  further 
examination  for  Honours  in  the  subjects  set  after  their 
names  Those  qualified  in  two  or  more  subjects  may 
present  themselves  for  the  Honour  exammation  in  all 
subiects :— James  K.  P.  Clarke,  zoology;  Charles 
Dickson,  chemistry  ;  William  P.  Dunne,  B. A.,  zoology 
and  physics  ;  Michael  P.  Fitzgerald,  botany  ;  Hugh  J. 
Grant,  chemistry  and  physics ;  John  C.  Johnson, 
botany,  chemistry,  and  physics ;  Joshua  Keyms, 
physics;  Alan  Kidd,  botany;  WiUiam  CM.  Lewis, 
chemistry  and  physics;  WilUam  P.  MacArthur, 
chemistr^;  Henry  H.  MacWiUiam,  botany,  zoology, 
chemistr^,  and  physics  ;  Kenneth  F.  Mulhgan,  botany, 
zoology  chemistiV;  Peter  H.  O'ConneU,  physics ; 
WiUiam  D.  O'KeUy.  botany,  zoology,  chemistry  and 
physics;  Alfred  H.  Rentoul,  botany  and  zoology: 
Robert  H.  Robinson,  botany  and  chemistry  ;  John  J. 
Shell  physics ;  John  A.  Sinton,  botany,  zoology,  and 
physics,  Bruce  A.  West,  botany  and  physics. 

The  examiners  have  recommended  that  the  foUow- 
inK  candidate  be  adjudged  to  have  passed  the  examina- 
tion for  Diploma  in  Sanitary  Science  :— Dennis  J. 
ColUns.  M.B..  B.Ch..  B.A.O.,  Royal  Army  Medical 
College,   London. 


8o     The  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


July  20,   1904- 


^^KtB  to 

JH^  OoRRSSFONDnTS  requiring  a  reply  in  this  column  are  partion- 
larly  requested  to  make  use  of  a  ditUnetive  Signahut  orlnUial,  and 
avoid  the  praotioe  of  signing  themselves  "Reader,"  "Subscriber," 
«'  Old  Subscriber,"  &c.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

OBieiNAL  Artiolu  or  LsTTRBS  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. 
CoHTBiBOTORB  are  kindly  requested  to  send  their  communications, 
resident  in  Bngland  or  the  Colonies,  to  the  Editor  at  the  London 
office  ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwaiding  from  office  to  office.  When  sendfaig  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 

Tus  Dail^  Chronicle  states  that  last  week  near  University 
CoUeifc  Hospital,  the  body  of  an  infant  was  found  wrapped  in  paper, 
on  which  was  written  :  "  To  the  Professor  of  Anatomy,  Middlesex 

t!^P  6'Comkoe,  in  his  Weekly,  quotes  the  following  verses  anent  a 
notorious  quack  of  the  last  century  from  the  "  Epitaph  on  a  Fair 
Patient  of  tit.  John  Long's.     "  St.  John  Long  was  a  Tipperary  man, 
one  O'Driscoil,  who  was  first  employed  by  Sir  Thomas  L*wrence,  then 
by  doctors  for  whom  he  prepared  anatomical  drawings,  and  th-jn  by 
a  irnllible  public  whom  he  doctored  himself.    The  young   lady  on 
whom  Ingoldsby  wrote  the  epitaph  died  from  the  exhaustion  of  a 
frightful  wound  in  her  back  produced  by  the  embrocation  : 
Hie  Jacet  va  terris 
Pulchra  puells : 
Yeluit  essemelior 

Dnm  fuit  weUa. 
Qu8B  causa  mortis 

lofelix  Virgo? 
Aqua  fortis 

Urensa  tergo  ! 
Medicus  ?    Neqaaquam . 
Sed  pictor  signorum, 
In  Tipperaria 

loops  bouonim. 
Nunc  dives  auri 
Sedet  sublimis 
In  curru,  celebratws 

Prosa  atque  rhymis  ! 
Ah  I  virgo  infelix ! 

Hie  intus  Jaoe 
In  longam  a  Longo 
Hequiescat  in  pace  I  «.    ,  ..     ^. 

"  T.P."  could  not  restet  adding  an  Engl  sh  epiUph  on  St.  John  him- 
self with  as  happy  a  pun  upon  his  name  as  •*  in  longum  a  Longo    : 
Behold,  ye  quacks  !  the  vengeance  strong 
On  deeds  like  youre  impingeing  ; 
For  here  below  lies  Si.  John  Long, 
yi  ho  vow  must  he  long  gtHgtt'ng. 
C.  H.  Sebs  (Brighton).— We  do  not  realU'recall  the  name  of  one 
really  famous  scientific  man  in  the  NewWorld  or  the  Old  who  does  not 
accept  Darwin's  theory  as  to  the  evolution  of  man  from  lower  forms 
of  life.    There  were  a  few  distinguished  scientists  in  opposition  some 
years  ago,  but  death  has  removed  them  from  the  scene. 
THE  INEBRIATES  ACT. 
A  SuBSCRiBiR.— Dipsomania  is  not  regarded  in  law  as  a  form  of 
insanity,  so  that  it  is  difficult  to  apply  compulsion.  Under  the  recent 
Act  means  are  provided  for  dealing  with  confirmed  inebriate,  but 
they  still  fall  short  of  requirements.    It  is  not  even  regarded  as  a 
sufficient  reason  for  Judicial  separation.         .    .,  ^        i.-      « 

A  Fourth  Ybar's  Mam.— (I)  Aillingham  s  "  Operative  Surgery 
wDuld    answer   vour    requircmente   admirably,   and     you  might 


A  SruDBHT  OF  Sociology.— Your  letter  will  appear  in  our  next 


^etings  of  the  ^odeUte,  JUtimte,  &t, 

Wbdhbsdat,  Jult  20th. 

Mbdical  Oraduatbs'  Oollsob  and  Polyclikic  (22  Chenies  Street, 
W  0.-4  p.m.     Mr.  J.  Smith  :  CUnioue.     tSurgi^O      .     „_    ^ 

Mbdical  Graduates*  College  amd  Poltclwic  (22  CJienies  Street, 
W  C  ).-i  D  nu  Mr.  Hutchinson  :  Clinique.    (SurgicaL) 
w.v..;.    4p.ni.  Thursday,  JULY  JSlst. 

Mnmrr  VXRMON  HOSPITAL  FOR  COBSUMPTION  AHD  DISEASES    OF  THE 

Oi«T  (7  ™S)y  Square.  W.)-6  p.m.  Dr.  H.  ScliarUeb:  The 
Admtnisteation  of  Aw©  sthetacs  in  Affections  in  »the  Eespiratory 
System.  


laranctcB. 


A^-r  District  Asvlum.— Assistant  Medical  Officer.— Salary  £120  per 
annum,  with  board,  furnished  apartments,  attendance,  and  wash- 
ing.  Applications  immediately  to  the  Medical  Supermtendent. 

Berkshire  ^ylum.  WaUingford  -Second  Assistant  Medical  Officer. 
Salary  £140  per  annum,  with  board,  furnished  apartments, 
attendance,  Ac.    Applications  to  Medical  Supe^ndent. 

Carlisle  Non-Provident  Dispensary.-Besident  Medical  Officer. 
Salary  £160  per  annum,  with  apartments  (not  board),  ^^f  PPl^o*; 
tions  to  the  Honorary,  Secretary,  Mr»  O.  A.  Lightfoot.  23 
Lowther  Street,  Carlisle. 


Combined  Sanitary  District  of  West  Sussex.- Medical  Officer  of 
Health.  Salary £6S0:perannum  to  include  all  travelling  expeues. 
Applications  to  A.  C.  Coole,  Solicitor  9  Carfax.  Horsham. 

Dorset  County  Hospital.  Dorchester.— House  Surgeon.— S*>ary  £100 
per  annum.  Applications  to  W.  E.  Groves,  Valctta,  loenway. 
Dorchester. 

Stirimg  District  Asylum,  Larbert.  N.B.— Assistant  Medical  Officer. 
Salary  £160  per  annum,  with  board,  &o.  Applicatloiis  to  the 
Medical  Superintendent. 

Township  of  Toxteth  Park.— Resident  Medical  Officer.  Salary  £100 
per  annum,  with  board,  washing,  and  apartments.  Applications 
to  J.  Moulding,  Clerk  to  the  Guardians,  15  High  Park  Street. 
Liverpool. 

Wolverhampton  and  Staffordshire  General  Hospital.— House  Sur- 
geon. Salary  £100  per  annum,  with  board,  lodging,  and  waabiog. 
Applications  to  Edmund  Fonter.  House  Governor  and  Secretaiy. 


Jlppointmenis. 


Bartlett,  R.  C  M.B.C.S.,  L.R.C.P.Lond.,  Certifying  Purgeon  under 

the  FW;tory  Act  for  the  Somsey  District  of    the  County  of 

Hants. 
BusiiNBLL,  F.  O.,   M.D.Lond.,  DJ^.H-Ouitab.,  Pathologist   to  the 

Sussex  County  Hospital. 
JoiiNSTOiv,    Hbnrt    M.,     B.A.,     M.B.,    Chief    Demonstrator    of 

Anatomy  in  Trinity  College,  Dublin. 
Taylt'R,  Gerrard  C,  M.D.(}antab. ,  D.P.H.,  Medical  Officer  cf  HealUi 

of  the  Urban  District  of  Finchley. 
Walker,  H.  J.  M.B..  M.S.Pdin..  Certifyi»'g  Surgeon  under  the  FSc- 

tory  Act  for  the  Brighton  District  of  the  County  of  Sussex. 


girths. 


Buzzard.— On  July  15th,  at  74  Grosvenor  Street.  W.,  the  wife  of 

E  Farquhar  Buszard,  M.D.,  of  a  daughter. 
Crocker.— On  July  ISth,  at  Gort  House,  Petersham,  Surrey,  the 

wife  of  J.  Hedley  Crocker,  M.D..  of  a  daughter. 
DixoK.— On  July  12th,  at  Lynwood,  Haven  Green,  Ealing,  the    wift 

B  Halstead  Dixon,  M.B  Lond.,  of  twin  daughters. 

Leogatt— \HDBR80B.— On  July  14th,  at  St.  Marv  Abbott's,  Kensing- 
ton.  Allen  Worth  Lefrgatt.  son  of  the  late  H.  Bethune  Leggatt, 
to  Lucy  Hosack,  second  daughter  of  Izett  Anderson,  M.D.Edin^ 
of  28  Arundel  Gardens,  W. 

Oliver— Bioos.— On  July  12th,  at  All  Saints' Church.  Peckham,  8.E. 
J.  Latham,  elder  son  of  John  B.  Oliver,  M.D.,  of  60  Parkflekl 
Road,  Liverpool,  to  Nellie  thi'd  daughter  of  C.  H.  W.  Biggm 
Esq.,  of  Glebe  Lodge,  Champion  Hill,  London,  S.E. 


^tath0. 


KBKjnr.— On '  July  10th,  at'  West  Coker,  near  Yeovil,  Jane  Kenny, 
widow  of  the  late  John  Kenny,  Esq.,  of  Dublin,  surgeon,  a«ed  87. 

Marshall.- On  July  13th,  at  Church  House,  Mitcham,  Edward 
Marshall,  M.R.C.8.E.,  L.S. A.,  aged  78 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— St.  Bartholomew's  (1.90  p.m.).  University  College 
(2  p.in.).  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m.).  Charing 
Cross  (S  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.).  King's 
College  C2  p.m.),  St.  George's  (Ophthalmic,  1  p.m.),  St.  Mary*s 
(2  p.m.).  National  Orthopedic  (10  a.m.),  St.  Peter's  (2  p.m.). 
Samaritan  (9.80  a.m.  and  2.80  p.m.),  Gt.  Ormond  Street  (9.30 
a.m.),  Gt.  Northern  Central  (2  SO  p.m.),  Westminster  (2  p.m.j. 
Metropolitan  (2.S0  p.m.),  London  Throat  (9.30  a.m.).  Cancer 
(2  p.m.).  Throat,  Golden  Square  (9.80  a.m.),  Guy's  (1.30  p.m.). 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  St.  Thomas's  (S.» 
p.m.).  University  College  (2  p.m),  Charine  Cross  (3  p.m.),  St. 
George's  (1p.m.),  London  (2  p.m.),  King's  College  (2p.m.),  Middle- 
sex (1.80  p.m.),  St.  Maria's  (2.80  p.m.).  Soho  Square  (2  p.m.), 
North-West  London  (2  p.m.),  Chelsea  (2  p.m.)  Great  Northern 
Central  (Gynsocological,  2.80  p.m.),  Metropolitan  (2.90  p.m.>. 
London  Throat  (9.80  a.m.),  St.  Mark's  (2  p.m.),  Samaritan  (9.90 
a.m.  and  2.80  p.m.).  Throat,  Golden  Square  (0.30  a. m.),  Guy's 
(1.80  p.m.). 

FRIDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.30  p-m.),  St. 
Thomas's  (3.30  p.m.),  Guy's  (1.30  p.m.),  Middlesex  (1.80  p.m.). 
Charing  Cross  (3  p.m.),  St.  George's  (1  p.m.).  King  s  College  (2 

S.m.),  St.  Marv's  (2  p.m.),  Ophthalmic  (10  a.m.).  Cancer  (2  pjm.) 
helsea  (2  p.m.).  Great  Northern  Central  (2  30  p.m.).    West 
London  (2  30  p.m.),  London  Throat  (0.80  a.m.),  Samaritaa  (9.90 
a.m.  and  2.80  p.m.).  Throat,    Golden  Square  (9.30  xm.).  City 
Orthopoxiic  (2.30  p.m.),  Soho  Square  (2  p.m.). 
SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (1  90 
p.m.),   St.  Thomas's  (2  p.m.),  Univesity    College  (9.15  a.m.). 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  ''t.  Mary's  (10  p.m.) 
Throat.  Golden  Square  (9.80  a.m.1,  Guy  s  (1.80p  m.). 
MONDAY.— London   (2  p.m.),  St.  Bartholomew's  (1.30  p-m.),  St. 
Thomas's  (3.80  p.m.),  St.  Georgs's  (2  p.m.),  St.  Mail's  (2.80 
p.m.),  Middlesex  (1.30  p.m.),  Westminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (Gynecological,  by  Physicians,  2  p.m.),  Soho 
Square  (2  p.m.).  Royal  OrthopsBdic  (2  p.m.),  City  OrthoptiKlic  (4 
p.m.).  Great  Northern  Central  (2  30  p.m ),  West  London  (2.90 
p.m.),  Ix>ndon  Throat  (9.80  a.m.),  Bo3'al  Free  (2  p.m.),  Guy's  (l^ 
p.m.). 
TUESDAY.- London  (2  p.m.),  St.  Bartholomew  s  (1.30  pjn.),   St. 
Thomas's  (8.80  p.m.),  Guy's  (L30  p.m.),  Middlesex  (1.90  pwm.), 
W^estminster  (2   p.m.).  West  London  (2.30  p.m.).    University 
College  (2  p.m.),  St.  George's  (1  p.m.),  St.  Blary's  (1  pjn.),  St. 
Mark^i(2.30  p.m.).  Cancer  (2  p.m.).  Metropolitan  (2.30  p.m.). 
i         London  Throat  (9.80  a.m.).  Royal  Ear  (8  p.m.),  Samaritan  (9.90 
I         a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (0.30  a.m.),  Soho 
Square  (2  p.m.) 


Mh  ^dm\  ^tm  wd  €ixmhx. 


'•SALUB    POPULI    SUPREMA    LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    JULY   27,    1904. 


No.   4- 


®tidinal  Communicationd. 
COLOTOMY  &  COLECTOMY,  (a) 

By  frank  T.  PAUL.  F.R.C.S., 
Snrg«on,  Royal  Inflimary,  Liverpool. 

The  operation  of  colotomy  has  always  attracted 
much  interest.  In  my  earlier  days,  when  laparotomies 
were  regarded  with  a  serious  suspicion,  colotomy  was 
the  most  popular  of  abdominal  operations,  and  rdnked 
in  the  apppreciation  of  surgeons  with  lithotomy  or 
the  ligature  of  large  arteries.  From  1878  to  1889, 
when  opportunity  offered,  I  did,  as  other  surgeons  did, 
the  classical  lumbar  operation  ;  but  when  H.  A.  Reeves, 
Harrison  Cripps  and  Herbert  Allingham  roused  our 
attention  in  tins  country  to  the  advantages  of  anterior 
colotomy,  I  followed  their  lead,  and  soon  became  con- 
vinced that  it  was  correct. 

There  id  no  need  now  to  revive  the  discussion  as  to 
which  is  the  better  operation.  The  first  place  was  soon 
conceded  to  anterior  colotomy,  and  year  by  year  its 
success  has  become  more  firmly  established. 

Some  ten  years  ago  the  value  of  colotomy  in  cases  of 
rectal  cancer  was  discussed  at  this  Society.  At  that 
time  several  of  the  most  experienced  members  of  our 
Medical  Institution  were  only  prepared  to  advocate  it 
as  a  means  of  giving  relief  when  the  most  urgent  and 
distressing  symptoms  were  present.  I  remember  it 
was  classed  with  gastrostomy  and  gastro-enterostomy 
for  malignant  stricture  as  dangerous  to  life,  and  pro- 
ducing other  ills  almost  if  not  altogether  as  unpleasant 
as  those  it  was  designed  to  relieve. 

We  may  truly  say  now  that  we  have  changed  all  this, 
not  only  for  colotomy,  but  for  gastrostomy  and  gastro- 
enterostomy as  well,  but  especially  as  regards  colotomy. 
And  one  feels  now  that  it  is  right  to  recommend  the 
latter  in  any  case  of  rectal  cancer  unsuitable  for  excision 
in  which  distressing  symptoms  are  present  or  are  indi- 
cated. Indeed,  enthusiasts  (and  I  may  include  myself) 
for  high  operations  in  extensive  rectal  cancer  seem  to 
be  inclining  again  to  substitute  a  permanent  iliac 
colotomy  for  these  very  serious  and  wide  operations  ; 
or  to  do  it  as  a  preliminary,  and  so  lessen  the  risk  of  the 
subsequent  proceeding. 

Modem  colotomy  has  unquestionably  gained  in 
favour,  and  this  gain  is  due  to  two  causes  : — 

1.  Lower  mortality. 

2.  Improved  artificial  anus. 

The  latter  has,  I  consider,  been  the  more  important 
factor,  for  when  a  patient  is  labouring  under  a  mortal 
disease  it  is  mcH'e  a  question  of  comfort  and  the  capacity 
to  continue  one's  daily  avocation  than  the  simple 
prolongation  of  a  more  or  less  miserable  existence.  In 
the  discussion  to  which  I  have  referred,  it  seemed  to  be 
strongly  felt  that  the  discomforts  of  the  artificial  anus 
were  frequently  as  great  as  those  of  the  malignant 
ulceration.  The  want  of  control  over  the  evacuations. 
the  dependence  upon  assistance  after  each  movement 
of  the  bowels,  and  the  rather  frequent  occurrence  of 
prolapse  certainly  rendered  the  life  of  a  colotomy 
patient   a  far  from   happy  existence.     Now  usually 

'^(a)  BmmI  at  the  Liverpool  Medicftl  Inttitution,  Fob.  12th,  1908. 


very  fair  control  is  established  in  most  cases,  and  pro- 
lapse hardly  ever  occurs ;  whilst  with  an  anterior 
opening  the  patient  can  attend  to  himself  a  condition 
of  independence  which  is  greatly  appreciated  by  the 
good,  hopeful,  deserving  class  of  patients.  I  have  no 
sympathy  with  those  who  give  in.  It  is  the  duty  of  all 
of  us  not  only  to  live  but  to  work  as  long  as  we  are  able  ; 
and  it  is,  as  we  all  know,  c^uite  possible  for  any  colotomy 
patient,  not  otherwise  disabled,  to  do  his  daily  work, 
whether  active  or  sedentary,  when  the  artificial  anus 
is  a  good  one. 

Among  the  various  suggested  methods  for  doing 
iliac  colotomy  it  must  be  conceded  that,  at  any  rate  in 
England,  Mr.  Harrison  Cripps'  is  that  which  has  met 
with  most  general  favour.  Indeed,  Mr.  Allingham, 
who  advocated  a  rival  method,  has  of  late  accepted  the 
former,  except  in  cases  in  which  the  sigmoid  mesentery 
is  long,  and  the  patient  may  be  expected  to  survive 
a  considerable  time.  In  my  judgment,  Mr.  Allingham 's 
present  position  is  a  wise  one.  The  variability  of  the 
anatomical  conditions  of  the  sigmoid  flexure  is  such  as  to 
render  it  impossible  that  the  same  method  of  dealing 
with  it  can  be  the  best  for  every  case.  And  it  certainly 
seems  the  fact  that  when  the  flexure  is  voluminous  and 
its  mesentery  long,  Cripps'  method,  however  carefully 
accomplished,  is  very  likely  to  be  followed  by  a  moist, 
patulous  anus,  over  which  it  is  difficult  to  create  any 
control,  and  through  which  prolapse  of  bowel  is  very 
probable.  Allingham's  procedure  is  undoubtedly  rather 
more  severe  ;  but  it  results  in  an  excellent  orifice,  and 
the  increased  comfort  when  the  operation  is  properly 
indicated  is  well  worth  the  increased  risk.    *    . 

One  desires  from  a  colotomy —  "^y 

1.  Relief. 

2.  Safety.  :> 

3.  Comfort. 

First,  as  to  relief.  In  cases  of  obstruction  immediate 
relief  is  urgent.  This  perhaps  applies  to  20  per  cent, 
of  the  cases  ;  less  when  the  disease  is  in  the  rectum, 
but  more  when  it  is  in  the  colon.  When  the  operation 
is  undertaken  with  the  necessity  of  giving  immediate 
relief,  I  urge  the  glass-tube  method,  and  I  may  do 
this  with  more  confidence  now  than  in  1891,  when  I  first 
introduced  it ;  for  not  only  has  my  personal  experience 
of  the  method  been  fairly  considerable  since  that  time, 
but  I  gather  that  it  is  now  generally  practised  under 
these  circumstances.  Cripps'  and  Allingham's  opera- 
tions do  not  provide  for  the  immediate  opening  of  the 
bowel,  but  I  have  practised  both  operations  many  times 
and  under  all  sorts  of  circumstances  in  conjunction  with 
the  glass  tube,  and  have  no  reason  to  think  that  these 
operations  are  rendered  appreciably  more  dangerous 
thereby.  If  this  experience  is  correct,  and  it  is  true 
— as  I  believe  it  to  be — that  opening  the  bowel  at  the 
time  of  the  primary  operation  does  not  appreciably  in- 
crease the  risk  of  life,  then  it  is  certainly  a  desirable 
addition  in  most  cases  ;  for  not  only  is  it  convenient 
that  the  bowel  should  be  open  and  free  for  the  passage 
of  flatus  and  faeces,  but  the  wound  in  the  atxlominal 
wall  may  be  smaller,  a  point  of  some  importance,  and 
the  operation  is  completed  at  one  sitting.  There  is  no 
occasion  for  the  subsequent  incision  and  later  paring  of 
the  mucous  membrane  required  in  Cripps'  operation, 


82    Tbs  Medical  Pkxss. 


ORIGINAL  COMMUNICATIONS. 


July  27,  1904. 


and  no  subsequent  clamping  and  removal  of  bowel  as  in 
Allinsham's.  I  therefore  distinctly  recommend 
that  m  doing  either  of  these  operations  the  glass  tube 
should  be  used  and  the  bowel  opened  at  once,  whether 
obstruction  is  present  or  not. 

Next  as  regards  safety.  When  the  patient  is  in  an 
exhausted  condition,  Cripps'  operation,  with  or  without 
the  tube,  should  be  selected,  as  the  removal  of  bowel, 
especially  if  the  mesentery  be  thick,  increases  the  risk. 
Should  obstruction  be  present,  in  introducing  the  tube 
every  precaution  must  be  taken  to  avoid  leakage.  In 
all  cases  both  the  bowel  and  the  tube  should  be  attached 
to  the  abdominal  wall,  the  bowel  by  passing  at  least 
two  green-gut  sutures  between  it  and  the  deep  muscular 
aponeurosis,  and  the  tube  by  passing  its  silk  ligatures 
through  the  skin  and  knotting  them.  Then,  if  the  tube 
is  accidentally  dragged  on,  it  is  well  and  safely  anchored, 
and  when  it  comes  away,  if  the  adhesions  between  the 
bowel  and  the  parietal  peritoneum  are  weak,  they  are 
backed  up  by  the  green-gut  sutures. 

As  regards  comfort,  the  essentials  are — (i)  A  high 
operation,  a  small  wound,  and  opening  the  highest  por- 
tion of  colon  available,  as  recommended  by  Harrison 
Cripps.  (2)  The  formation  of  a  good  spur.  (3)  Em- 
bodying the  principle  of  AUingham's  operation,  when- 
ever the  sigmoid  flexure  is  voluminous  and  its  mesentery 
long,  and  the  patient  sufficiently  robust  to  make  this 
wise.  (4)  The  use  of  a  good  plug,  and  the  cultivation 
of  a  regular  habit  of  bowels.  After  various  trials  with 
trusses  and  belts,  I  have  come  to  use  ^n  aluminum 
mushroom  plug  made  for  me  by  Mr.  Reynolds,  of 
Liverpool.  The  plug  or  stalk  is  slightly  bulbous,  and 
long  enough  to  pass  through  the  whole  depth  of  the 
abdominal  wall.  The  head  or  flange  is  oval-shaped  and 
wide  ;  it  is  slightly  concavo-convex,  to  fit  the  abdominal 
surface.  A  single  layer  of  soft  lint,  with  a  hole  in  the 
middle  for  the  stalk,  is  placed  under  the  flange,  and  a 
^oodjpad  of  cotton-wool  above  it,  the  whole  being  kept 


Aluminium  Colotomy  Plug. 
in  place  by  a  narrow  abdominal  belt  such  as  I  use  after 
appendicectomy.     This  is  the  cleanest  and  far  the  most 
comfortable  and  effective  apparatus  I  have  yet  tried. 

In  1898  I  designed  an  operation  to  give  better  control 
over  the  artificial  anus.  It  involved  using  Madelung's 
method  of  closing  and;  returning  the  rectal  end  of  the 
bowel  into  the  abdominal  cavity,  while  the  upper  end 
was  brought  out  at  a  distance  after  having  passed  be- 
tween the  muscles — in  fact,  after  the  principle  of  Hahn's 
or  Frank's  gastrostomy.  The  operation  was  effective 
but  dangerous.  It  was  unnecessarily  se"ere,  and  in 
passing  the  bowel  between  the  muscles  septic  infection 
was  liable  to  occur.  For  these  reasons  I  soon  aban- 
doned it,  and  I  think  now  that  sufficiently  good  con- 
trol can  be  obtained  by  ordinary  methods. 

The  details  of  a  colotomy  by  the  glass-tube  method 
are  as  follows  : — 

1 .  The  incision  is  made  in  accordance  with  accepted 
principles,  but  may  be  smaller,  that  is,  i|  to  2  inches, 
according  to  the  condition  of  the  abdominal  wall  and 
the  bowel. 

2.  If  the  mesentery  be  very  short,  the  bowel  is  firmly 
drawn  out  and  a  running  suture  of  medium  thick  silk 
inserted  round  an  oval  area  involving  as  much  of  the 
circumference  of  the  bowel  as  possible,  so  as  to  ensure 
its  posterior  wall  being  well  brought  up  to  the  surface 
to  form  a  good  spur.  The  enclosed  area  is  then  gripped 
with  two  catch  forceps,  incised,  the  tube  plugged  with 
wool  inserted,  and  the  ligature  tied.  A  second  silk 
ligature  is  then  simply  tied  over  the  first  to  render  it 
more  secure,  and  is  knotted  on  the  opposite  side  of  the 


tube.  Two  or  more  green-gut  sutures  are  next  passed 
between  the  outer  coats  of  the  bowel  and  the  deep 
tissues  of  the  wound,  and  finally  the  ends  of  the  silk 
ligatures  are  passed  through  the  skin  and  tied  so  as  to 
secure  the  tube  in  case  of  roughness  or  accident. 
Usually  the  wound  is  too  small  to  need  any  further 
sutures.  The  parts  being  septic  are  well  powdered 
with  iodoform,  and  dressed  with  cyanide  gauze  and 
wool  as  usual,  and  a  binder  split  to  transmit  the  tube 
is  firmly  applied.  If  the  bowel  be  empty,  la  light  plug 
of  wool  is  kept  in  the  tube.  If  loaded  with  formed 
motion  a  sponge  bag  containing  some  iodoform  wool 
or  wool  sprinkled  with  eucalyptus  oil  is  attached.  If 
with  loose  motion  a  short  piece  of  Down  Brothers'  thin 
wide  indiarubber  tubing  is  attached  to  the  glass  tube 
and  allowed  to  fall  into  a  basin  at  the  patient's  side. 

3.  If  the  mesentery  be  long  and  the  patient  in  good 
condition,  the  loose  loop  of  sigmoid  flexure  should  be 
drawn  out.  the  mesentery  ligatured  separately,  a  large 
tube  fastened  into  the  top  end  and  a  small  one  into 
the  bottom  end,  and  then  all  the  redundant  bowel  cut 
away.  It  is  better  not  to  ligature  the  mesentery 
together  with  the  bowel  to  the  tubes,  as,  unless  the 
grip  is  very  tight,  some  of  the  vessels  are  liable  to  draw 
out,  and  smart  haemorrhage  may  result.  It  will  be 
found  much  safer  to  tie  the  mesentery  in  two  or  three 
sections  by  itself.  When  the  sigmoid  mesentery  is  of 
medium  length  either  method  may  be  used,  but  in  all 
casfes  when  doing  Cripps'  operation,  care  must  be  taken 
to  insert  the  tube  into  the  highest  portion  of  bowel 
which  can  be  brought  out  of  the  wound,  and  to  include 
the  whole  or  almost  the  whole  circumference  of  the 
bowel. 

Usually  on  the  fifth  day  the  tube  is  ready  to  come 
away.  When  this  is  the  case,  indicated  by  leakage 
beside  the  tube,  the  silk  sutures  are  cut  and  it  is  with- 
drawn. 

4.  Subsequently,  the  patient  is  kept  in  bed.  the 
motions  being  passed  into  the  dressings  until  the  wound 
is  healed,  when  the  plug  and  belt  are  worn. 

Colotomy  in  other  regions. — For  some  time  I  mam- 
tained  it  was  our  duty  to  do  colotomy  as  low  down 
in  the  bowel  as  we  could,  consistently  with  being  wcL 
clear  of  the  disease.  Now  I  am  inclined  to  think  that 
there  are  only  two  good  colotomies.  sigmoid  and  traiLv 
verse.  In  the  few  cases  in  which  I  have  had  to  do  tb 
latter  it  has  answered  very  fairly  well.  Not  so  well  a* 
sigmoid,  but  decidedly  better,  i  consider,  than  the 
lumbar  operation.  Right  iliac  colotomy  I  do  not  lib 
at  all ;  the  motions  are  liquid,  and  quite  uncontroUabk. 
I  never  do  it  except  in  cases  of  obstruction,  and  then 
only  in  the  hope  and  expectation  that  subsequent 
enterectomy  or  short-circuiting  will  be  possible.  WhcE 
the  caecum  is  opened  only  a  small  tube  should  be  used, 
one  of  i  to  i  inch  diameter  being  sufficient. 

It  has  been  said  that  subsequent  trouble  will  result  if 
either  the  sigmoid  or  the  caecum  is  opened  and  attached 
in  the  middle  line.  I  have  had  to  do  this  occasionallv. 
and  in  practice  no  inconvenience  has  resulted.  One 
would  never  choose  this  position,  but  at  any  time 
there  may  be  urgent  reasons  why  one  should  accept  it. 

The  operation  of  colotomy  is  so  closely  associated 
with  that  of  colectomy  that  I  can  hardly  treat  of  one 
without  reference  to  the  other.  Often  when  colotomy 
only  is  intended  before  exploration,  colectomy  is  ulti- 
mately undertaken,  or  the  reverse  may  be  the  case; 
while,  as  I  have  stated,  it  is  no  unusual  thing  for  me 
to  cut  away  several  inches  of  colon,  with  the  simple 
object  of  improving  the  character  of  an  artificial 
anus.  When,  however,  the  original  intention  is 
colectomy,  there  are  a  few  additional  points  which  need 
careful  consideration.  The  chief  of  these  are,  the  exact 
location  of  the  disease  and  the  restoration  of  the  con- 
tinuity of  the  bowel. 

It  is  a  great  misfortune  that  malignant  disease  of  the 
colon  is  so  very  undemonstrative  in  its  early  stages. 
Recently,  in  one  week,  I  was  asked  to  see  three  cases, 
all  too  late  for  operation  ;  that  is,  in  all  the  tumoor 
was  hopelessly  adherent  to  neighbouring  important 
structures.  This  form  of  cancer  is  one  of  the  least 
malignant  with  which  I  am  acquainted  ;  and  could 
One  obtain  the  cases  early  enough,  as  happens  more  : 


July  27,  1004. 


ORIGINAL  COMMUNICATIONS. 


Thx  Medical  Press.     83 


frequently  in  the  rectum,  the  results  would  be  excellent. 
In  its  first  stage,  however,  it  apparently  sets  up  no 
recognisable  symptoms,  and  I  have  no  doubt  it  often 
exists  for  several  months,  or  a  year  or  two,  according 
to  the  type  of  growth,  before  any  evidence  whatever 
of  its  presence  is  afforded.  The  earliest  symptoms 
axe  frequently  those  of  intestinal  indigestion,  brought 
about  by  some  difficulty  in  the  contents  of  the  bowel 
passing  the  diseased  flart.  They  are  flatulence,  slight 
colicky  pains,  some  distension,  and  irregularity  of  the 
bowels.  In  other  cases  there  are  no  obstructive 
symptoms  at  first,  but  mucus  and  perhaps  blood  appear 
in  the  motions.  At  a  later  stage  some  obstruction  is 
usually  present,  characterised  by  increasing  constipa- 
tion, with  attacks  of  colicky  pain.  Loss  of  flesh  occurs, 
and  ultimately  a  tumour  is  discovered  in  some  cases, 
while  in  others  the  surgeon  is  called  in  because  com- 
plete obstruction  has  supervened.  The  clinical  details 
are  influenced  by  the  character  of  the  growth.  From 
35  to  45  or  50  the  disease  is  generally  of  the  f ungating 
tx'pe,  and  produces  more  of  a  tumour  than  an  ulcer. 
In  these  cases  there  is  often  no  obstruction,  but  plenty 
of  mucus  and  blood  in  the  motions.  The  abdomen 
is  not  distended,  and  if  carefully  palpated  the  tumour 
might  usually  be  discovered  much  earlier  than  it  is. 
Still  one  must  bear  in  mind  that  the  patient  suffers 
little,  and  frequently  makes  no  complaint  until  it  is  too 
late.  Indeed,  it  is  sometimes  the  discovery  of  the  tu- 
mour by  the  patient  himself  that  leads  him  to  consult 
his  doctor.  From  50  to  70  or  80  the  growth  is  usually 
of  the  chronic  ulcerating  type,  producing  the  ring 
stricture.  In  these  cases  the  symptoms  are  almost 
entirely  due  to  obstruction,  which  in  the  end  generally 
becomes  complete,  owing  to  the  narrow  lumen  at  the 
strictured  part  (often  only  transmitting  a  No.  10 
catheter)  becoming  blocked  by  some  coarse  undigested 
substance  in  the  faeces. 

When  distension  is  absent  a  tumour  is  often  present, 
and  in  this  way  the  disease  is  usually  located  in  the 
younger  class  of  patients  ;  but  after  obstruction  has 
once  set  in,  it  is  rare  to  be  able  to  detect  a  lump,  and 
one  must  be  guided  in  other  ways  in  locating  it.  Pro- 
babilities are  of  no  help.  One  must  never  cut  down 
over  a  particular  region  because  that  is  statistically  the 
most  probable  site  of  the  disease.  In  the  absence  of 
stronger  evidence  exploration  in  the  middle  line  should 
be  the  practice.  The  best  aids  to  diagnosis  are  the 
capacity  of  the  bowel  below  the  stricture,  the  condition 
of  the  caecum  and  colon  as  made  out  by  percussion  and 
palpation,  and  the  evidence  afforded  by  pain  and  peri- 
stalsis. The  patient  is  often  quite  conscious  of  the  site 
of  the  stricture,  having  many  a  time  felt  a  colicky  wave 
of  peristalsis  pass  away  at  a  particular  spot  with  a 
gurgling  sound,  as  gas  and  liquid  were  forced  through 
the  stricture.  And  when  the  bowel  is  much  hyper- 
trophied,  one  may  see  the  peristaltic  wave  gather  and 
run  on  until  it  comes  to  a  stop  at  the  stricture.  The 
enema,  too,  is  a  great  help  when  the  disease  is  low  down. 
As  the  result  of  experiment  on  the  dead  subject,  I 
believe  the  bowel  will  hold  something  like  two  pints 
with  an  obstruction  in  the  sigmoid  flexure  ;  but  in 
actual  practice  one  finds  that  half  a  pint  to  a  pint  is  all 
that  is  tolerated,  usually  the  former,  and  that  it  is 
returned  at  once  without  motion.  Under  these  circum- 
stances the  tumour  is  in  the  most  favourable  place  for 
operation.  When  it  is  higher  up  large  quantities  of 
injection  may  be  introduced  and  retained.  One  has 
then  to  be  guided  chiefly  by  palpation  and  percussion 
of  the  regions  of  the  large  bowel,  and  if  nothing  definite 
can  be  made  out  a  middle-line  exploration  should  be 
undertaken. 

When  the  tumour  is  located  it  must  be  freely  exposed, 
and  if  suitable  for  removal  the  mesentery  in  connection 
with  the  part  involved  is  carefully  divided,  so  that  the 
diseased  coil  of  bowel  may  be  brought  out  of  the  abdo- 
men. The  subsequent  steps  of  the  operation  depend 
upon  the  mode  of  union  to  be  attempted,  and  in  regard 
to  this  I  continue  to  difEer  strongly  from  those  who 
consider  primary  end-to-end  union  by  suture  or  button 
the  proper  course  to  adopt  as  a  routine  practice. 
That  it  is  the  neatest  and  most  satisfactory  to  the 
surgeon  when  the  patient  lives  I  do  not  doubt ;  but  it 


is  certainly  more  dangerous,  without  ultimately  being 
at  all  more  efficacious  than  when  the  ends  of  the  bowel 
are  brought  out,  and  the  continuity  of  the  canal 
subsequently  restored.  When  this  is  done  it  is  a  rare 
thing  to  lose  a  patient  who  is  not  at  the  time  of  the 
operation  seriously  depressed  as  the  effect  of  several 
days'  obstruction  of  the  bowels.  In  this  connection 
I  may,  as  a  surgeon,  warn  my  m  idical  friends  that  a 
patient  after  ten  days'  obstructio  1  in  the  lower  bowel 
is  in  much  worse  case  than  his  pulse  and  appearance 
seem  to  indicate.  One  is  asked  to  do  colotomy  under 
these  circumstances  with  the  assurance  that  the 
patient  is  in  excellent  condition.  It  is  true  that  he 
is  quite  fit  to  bear  the  operation,  but  when  he  dies  a 
few  days  later,  death  should  be  ascribed  to  the  absorp- 
tion of  toxins,  which  is  the  cause  of  it,  and  not  to 
the  operation,  which  has  had  nothing  to  do  with  the 
unfortunate  result. 

I  commenced  operating  by  bringing  out  the  ends  of 
the  bowel  in  1892,  and  after  ten  years'  experience  am 
strongly  confirmed  in  my  opinion  that  it  is  the  right  thing 
to  do.  I  know  nothing  against  it,  except  that  the 
patient  has  the  discomforts  of  an  artificial  anus  for  a 
few  weeks,  and  the  course  of  the  case  is  prolonged  by 
about  a  month — small  evils  compared  with  the  gravity 
of  the  disease  and  the  risks  of  end- to  end  union.  It 
has  been  sugggested  that  stricture  might  result  from 


incomplete  removal  of  the  spur,  but  such  has  not  proved 
to  happen  in  any  of  my  cases. 

After  dividing  the  mesentery  the  subsequent  steps 
of  the  operation  are  of  the  simplest.  The  tumour 
being  well  drawn  out  of  the  abdomen,  the  ascending  and 
descending  portions  of  the  colon  are  made  to  lie  side  by 
side,  like  the  barrels  of  a  double-barrelled  gun,  in  which 
relationship  they  are  lightly  sutured  together  for  quite 
three  inches  inside  the  abdomen.  Outside  the  abdomen 
a  colotomy  tube  is  ligatured  into  the  upper  end  and  a 
smaller  tube  into  the  lower  end,  when  the  diseased  part 
is  cut  away,  of  course  quite  bloodlessly.  A  few  fine 
sutures  may  be  used  to  attach  the  bowel  to  the  parietal 
peritoneum  at  the  bottom  of  the  wound,  and  if  the 
incision  has  been  long,  its  ends  are  brought  together 
with  fishing-gut  sutures. 

In  many  cases  the  operation  is  very  little  more 
severe  than  colotomy.  Five  or  six  days  later  the  tubes 
separate,  and  at  the  end  of  three  weeks,  as  a  rule,  the 


84    Thb  Mbdical  Press.  ORIGINAL  COMMUNICATIONS. 


carefully  prepared  spur  may  be  clamped.     I  once  had 
a  warning  that  this  should  not  be  done  too  hastily. 


July  27.   1904, 


know  almost  as  little  about  the  prognosis  as  about  the 
treatment  of  cancer,  (a) 


ON  THE 

NECESSITY    FOR 
HYGIENE. 


SCHOOL 


Clamp  for  Removing  Spur  after  Enterectomy. 

After  complete  obstruction  the  bowel  is  liable  to  be  in  a 
very  septic  and  irritable  condition,  and  so  long  as  the 
spur  feels  thick  and  hard  to  the  finger  I  believe  it  to  be 
unwise  to  apply  the  clamp.  As  a  rule  it  is  supple 
throughout,  and  under  these  circumstances  may  be 
clamped  at  any  time.  One  clamping  is  very  likely  to  be 
insufficient,  and  if  there  is  a  considerable  ridge  still 
apparent  at  the  bottom  the  clamp  should  be  applied 
again.  It  need  not  be  kept  on  each  time  until  it  comes 
away,  as  its  work  is  thoroughly  effected  in  forty-eight 
hours,  when  it  is  probably  safer  removed  than  left 
in  situ.  Messrs.  Down  Brothers  have  recently  made  me 
a  new  clamp,  which  has  proved  very  useful.  The  com- 
pression is  maintained  by  a  steel  spring  on  a  projecting 
arm,  which  can  be  disengaged  to  facilitate  introduction. 
As  soon  as  the  spur  is  completely  destroyed  the  artificial 
anus  is  closed.  The  entire  operation  has  been  com- 
pleted in  twenty-four  hours,  but  usually  six  to  eight 
weeks  must  be  allowed  for  it.  In  cases  of  malignant 
disease  of  the  colon  in  which  the  mesenteric  glands  are 
involved  I  used  to  give  a  most  depressing  prognosis, 
but  have  now  met  with  a  few  in  which  such  a  prognosis 
was  not  justified.  About  five  years  ago  I  removed 
a  cancerous  tumour  of  the  sigmoid,  together  with 
several  enlarged  glands  in  the  attached  portion  of  the 
mesentery.  The  glands  were  as  large  as  filberts,  and 
I  thought  the  case  quite  hopeless  ;  nevertheless  she  is 
still  in  excellent  health,  and  continuing  her  vocation  as 
a  domestic  nurse. 

Nearly  three  years  ago  I  removed  the  cxcum  and 
lower  part  of  the  ileum  nrom  a  gentleman,  xt.  37,  for  a 
soft  malignant  growth.  The  lump  was  the  size  of  a 
fist,  and  several  glands  were  enlarged,  one  measuring 
an  inch  and  a  half  m  diameter.  Here,  again,  I  gave  a  bad 
prognosis.  He  recovered  well  from  the  operation, 
and  a  year  later  was  in  such  excellent  health  that  his 
medical  friend,  Dr.  Heatherley,  refused  to  countenance 
any  longer  a  pessimistic  outlook.  He  came  to  me  and 
said,  in  effect — '*  Look  here,  you  must  do  something 
for  this  fellow.  He  must  not  be  condemned  to  die 
in  this  sort  of  way.  How  about  X-rays  ?  "  Well,  I 
do  not  think  we  have  at  present  any  information  which 
warrants  us  to  suppose  that  X-rays  would  influence  the 
course  of  such  a  case,  so  I  suggested  that  if  the  patient 
was  willing  to  lay  up  for  a  month  I  would  explore  the 
abdomen,  ascertain  what  the  present  condition  was, 
and  do  what  seemed  to  be  best  in  his  interests.  This 
was  decided  on  ;  and  one  day,  after  quite  half  an  hour's 
exploration,  I  succeeded  in  discovering  and  extracting 
one  small  gland  the  size  of  a  spUt  pea,  which  on  micro- 
scopical examination  showed  no  malignant  change. 
Another  year  and  a  half  passed  and  the  patient  is  still 
as  well  as  ever — so  well,  in  fact,  that  he  at  once  agreed 
to  come  here  with  Dr.  Heatherlev  to  show  us  that  we 


By  J.  C.  McWALTER,  M.A.,  M.D.,  D.P.H.Dub. 
The  sense  of  parental  responsibility  has  been  greatly 
lessened  by  the  operations  of  a  Compulsory  Education 
Act,  and  now  the  public  look  to  education^  authorities 
for  that  training  of  the  child,  both  mental  and  physical, 
which  may  fit  it  to  be  a  good  citizen.  The  need  for 
some  knowledge  of  reading  and  writing  is  surely  not 
more  pressing  than  the  necessity  for  the  development 
of  a  vigorous  and  healthy  frame,  for  sound  teeth,  for 
well-developed  muscles,  for  keen  eyes,  for  steady  nerves. 
As  all  these  can  be  obtained  or  improved  by  intelligent 
training,  an  obligation  rests  with  the  local  authorities 
to  supply  not  only  competent  instruction  in  literary  or 
technical  subjects,  but  skilled  advice  available  for  the 
proper  physical  development  and  examination  of  the 
pupils. 

Not  only  does  compulsory  education  demand  the 
possession  of  the  child  for  half  the  day,  but  it  monopo- 
lises it  for  all  the  period  during  which  the  parent  might 
otherwise  obtain  expert  advice  regarding  its  teeth,  its 
eyes,  its  nose,  its  tluroat,  its  chest,  its  spine,  &c..  and 
thus  the  parents  can  scarcely  be  blamed  if  they  neglect 
these  matters  and  allow  the  children  to  grow  up  com- 
paratively deteriorated  specimens  of  humanity. 

The  comparative  ease  and  cheapness  with  which  the 
examinations  of  a  medical  attendant  can  be  efifected 
in  a  school  should  be  a  sound  economic  argument  for 
their  more  universal  adoption.  It  is  possible  to  get 
the  services  of  an  ophthalmic  surgeon  of  considerable 
skill  to  overhaul  the  eyesight  of  every  scholar  in  a 
school  of  a  couple  of  hundred  in  a  comparatively  short 
time,  and  for  a  moderate  fee,  although  the  services  of 
such  a  specialist  would  normally  be  outside  the  powers 
of  the  family  of  any  one  of  the  scholars.  Skilled 
rhinologists  are  available  to  detect  the  various  abnor- 
malities of  the  naso-pharjmx,  and  so  save  a  lifetime's 
discomfort  to  many  a  child.  The  numerous  osseous 
abnormalities  which  deform  so  many  of  our  young 
scholars  are  notoriously  easy  of  rectification  or  pre- 
vention where  the  skill  of  an  orthopaedic  surgeon  or  of 
a  scientific  instructor  of  gymnastics  is  utilised. 

A  cry  has  gone  forth  from  almost  every  doctor  in 
the  kingdom  calling  on  the  Government  to  provide 
for  the  regular  scientific  teaching  of  young  scholars  in 
the  principles  of  temperance  and  hygiene,  and  thus 
the  foundation  of  healthier  and  happier  homes  must 
be  laid.  The  Socratic  principle,  that  vice  is  due  to 
ignorance,  and  not  to  innate  depravity,  is  becoming 
recognised  as  the  proper  guiding  rule  for  the  State 
when  it  takes  on  itself  the  training  of  children,  and 
this  principle  is  perhaps  even  more  potent  when  dealing 
with  physiological  than  with  psychological  sins. 
Habits  of  hygiene,  acquired  in  the  school  days,  are 
obvk)usly  of  much  more  influence  than  spasmodic 
efforts  to  attain  sanatorial  righteousness  when  at- 
tempted in  later  Ufe. 

The  researches  of  Dr.  Kerr  seem  to  incontrovertibly 
prove  that  a  grave  deterioration  occurs  in  the  health 
of  children  whilst  at  school,  for  which  the  system  of 
education  is  responsible.  Thus  he  found  that  whilst 
about  10  per  cent,  of  school  children  had  various 
defects  of  vision,  only  about  3  per  cent,  were  abnormal 
on  entry.  It  was  proved  that  the  vision  of  7  per  cent, 
of  school  children  had  become  affected  by  some  cir- 
cumstances of  their  training — circumstances  which 
should  be  avoidable  and  preventable  under  an  en- 
lightened scheme  of  examination  by  competent  medical 
ofl&cers. 


(a)  Dr.  Heatherley  tells  me  that  this  summer  he  made  fifty  nuu 
in  r  cricket  match— not  a  bad  performance  for  a  man  without  a 
cflBcum. 

(5)  A  Paper  read  at  the  Folkestone  Oongreis  of  the  Boyil 
Institute  of  PubUc  Hsalth,  July  2lBt,  1904. 


J^LY   27,    1904, 


ORIGINAL   COMMUNICATIONS.        The  Medical  Pees*.    85 


It  is  well  known  that  scarlet  fever,  measles,  whooping- 
cough,  mumps,  phthisis,  and  such  ailments  as  ring- 
worm, ophthalmia,  and  itch  ensue  on  the  aggregation 
of  children  at  the  most  susceptible  ages  in  ill-lighted, 
ill- ventilated,  and  often  dirty  school-rooms.  The 
deaths  from  measles  occur  almost  entirely  under  tlie 
age  of  five  years,  and  in  nine  cases  out  of  ten  epidemics 
may  be  traced  to  the  infant  departments  of  schools. 
Seventy  per  cent,  of  scarlet  fever  cases  are  stated  to 
occur  among  children  who  would  attend  such  schools. 
In  some  districts,  25  per  cent,  of  the  cases  of  diphtheria 
are  between  the  ages  of  three  and  five,  and  nearly  all 
the  cases  of  whooping-cough  occur  in  children  attending 
school.  Regarding  phthisis,  statistics  are  less  exact, 
but  there  is  little  doubt  that  numerous  deaths,  classed 
as  due  to  convulsions,  typhoid  fever,  brain  fever,  and 
the  like,  are  really  cases  of  tuberculous  meningitis, 
contracted  in  school-rooms,  whilst  the  larger  part  of 
deaths  classified  as  due  to  bronchitis,  under  the  age  of 
ten,  are  really  examples  of  broncho-pneumonia  of  a 
tuberculous  origin,  and  the  fons  et  origo  mali  is  a  source 
of  infection  in  the  school-room. 

In  his  Harben  Lectures  given  this  year.  Dr.  Hueppe 
asserts  that  the  three  factors  which  give  rise  to  con- 
sumption are  predisposition,  stimulus,  and  condition. 
Now  in  our  schools  children  come  together  from  all 
kinds  of  homes — ^from  the  most  depraved  and  filthy  to 
the  more  highly  respectable.  Some  of  them  are  half 
starved,  and  some  not  physically  fit  to  acquire  any 
"knowledge.  Where  such  a  crowd  of  children  is 
huddled  together,  there  is  a  slow  undermining  of  health 
from  the  want  of  fresh  air,  which  soon  estabUshes  a 
favourable  condition  for  the  development  of  phthisis  ; 
the  predisposition  is  only  too  often  in  the  family,  and 
the  immediate  stimulus  is  fairly  sure  to  be  brought  in 
unless  the  children  are  periodically  inspected  and  the 
more  delicate  ones  removed.  When  an  inspection  can 
"be  made  at  the  beginning  of  every  term,  every  child 
in  the  room  should  be  examined  by  a  medical  officer, 
and  those  suffering  not  only  from  infectious  disease, 
hut  from  itch,  ringworm,  vermin,  &c.,  those  apparently 
unfit  to  receive  instruction  through  delicacy,  or  those 
in  any  doubtful  condition,  could  then  be  sent  home 
and  not  readmitted  -antil  they  produced  a  certificate 
from  their  own  doctor  that  they  were  fit  to  resume. 
The  problem  of  excluding  phthisical  children  is  a  grave 
one,  but  is  best  dealt  with  by  a  periodical  weighing 
of  all  the  children,  which  can  easily  be  done  by  an 
intelligent  teacher  under  the  direction  of  the  medical 
officer.  If  a  periodical  progression,  according  to  a 
-given  scale,  be  not  observed,  the  child  must  be  sub- 
jected to  further  examination. 

Then  open-air  instruction  ought  to  be  availed  of  far 
more   freely  than  at  present.     Nothing  is  more  no- 
torious than  that  phthisis  and  other  communicable 
diseases  prevail  to  an  enormous  extent  in  many  parts 
of  the  country  where  all  the  natural  advantages  make 
for  the  most  perfect  health ;    but  the  healthiness  of 
dwellings  and  schools  is  often  in  the  inverse  ratio  to 
the  salubrity  of  a  locality.     The  worst  examples  of 
sanitation  in  schools  and  rooms  is  found  in  the  best 
parts  of  the  country.     I  am  constantly  shocked  by  the 
-number  of  cases  of  phthisis  which  I  find  in  a  seaside 
-village  which  ought  to  be  a  health  resort ;   even  a  few 
home  industries  there  appear  to  be  mere  foci  for  in- 
fection.    The   morbid   horror  which   certain   country 
people  exhibit  for  air  or  light  in  their  bedrooms,  and 
their  contemptuous  disregard  for  sanitation,   are  of 
course  the  cause.     If  the  teacher  of  the  village  school 
was  compelled  to  conduct  his  operations  in  the  open 
air,  where  practicable,  his  health  and  that  of  his  charges 
w^ould  alike  benefit. 

A  valuable  means  of  detecting  the  incipient  signs  of 
ill-health  is  obviously  the  weighing-machine.  No 
teacher  can  be  expect^  to  exhibit  such  proficiency  as 
to  enable  him  to  detect  diphtheria  or  adenoids  or 
astigmatism,  but  every  school  superintendent  is  com- 
petent to  take  the  weight  of  his  pupils  periodically, 
and  to  see  if  they  answer  to  a  certain  scale.  It  is,  of 
course,  well  ascertained  that  no  surer  sign  of  disease 
exists   than  insufficient  increase  in  the  weight  of  a 


growing  child,  and  there  is  always  a  proportionate  in- 
crease when  every  function  is  normal.  Children  who 
fall  below  their  average  can  easily  be  brought  under 
the  notice  of  the  medical  attendant  and  subjected  to 
a  more  thorough  examination. 

Again,  the  age  at  which  the  child  must  be  sent  to 
school  ought  to  be  not  five  but  six  years,  and  no  infant 
under  five  should  be  accepted.  It  is  thoroughly  proved 
that  children  who  start  schooling  at  six  or  seven  years 
rapidly  overtake  those  who  commenced  at  four  or  five, 
and  to  admit  infants  of  such  a  tender  age  is  merely  a 
concession  to  the  laziness  of  the  parents  who  seek  to 
get  rid  of  them  for  five  hours  a  day. 

Dr.  Martin,  of  Gloucester,  sagely  suggests  that  cases 
where  it  is  sought  to  exclude  children  from  school 
because  of  their  generally  dirty  or  verminous  con- 
dition should  be  treated  by  graduated  pressure.  First 
he  suggests  that  an  informal  notice  should  be  sent  the 
parents,  apprising  them  of  the  facts,  and  if  this  did  not 
avail  a  formal  intimation  that  the  child  would  be  ex- 
cluded until  the  trouble  was  remedied. 

When  one  speaks  of  a  systematic  examination  of  a 
school  the  question  of  cost  at  once  jumps  into  pro- 
minence. Dr.  Martin  proposes  to  give  the  medical 
officer  a  guinea  for  a  complete  examinatioo  of  a  school 
of  from  50  to  100  pupils,  and  two  guineas  where  the 
number  goes  up  to  300.  As  such  a  complete  examina- 
tion need  not  take  place  oftener  than  once  a  term,  its 
cost  is  not  prohibitive.  In  his  district  the  average 
attendance  is  87*5  per  cent.,  and  he  calculates  that  a 
gain  of  2  per  cent,  resulted  from  the  periodical  medical 
examination  of  the  scholars,  which  meant  in  that 
county  £1,600  a  year. 

Habits  of  cleanliness  are  of  far  more  educational 
value  to  the  children  who  attend  our  elementary  schools 
than  most  of  what  they  are  taught  to  learn.  It  should, 
therefore,  be  strenuously  insisted  on  that  every  school 
be  provided  with  an  adequate  lavatory.  To  have,  as 
is  so  often  the  case,  a  couple  of  towels  for  a  hundred 
pupils  is,  of  course,  to  propagate  disease  and  uncleanly 
ideas. 

The  Royal  Commission  on  Physical  Training  has 
already  recommended  that  provision  should  be  made 
for  the  regular  medical  examination  of  school  children  ; 
but  a  practical  and  complete  scheme  for  inspection  is 
still  wanting,  and  it  should  be  the  function  of  a  body 
so  representative  of  every  school  and  class  of  sani- 
tarians as  the  Royal  Institute  of  Public  Health  to 
supply  it.  Many  authorities  consider  that  a  child 
should  be  thoroughly  overhauled  at  least  three  times 
during  its  school  life,  but,  on  the  other  hand,  the  cost 
of  such  a  scheme  would  be  very  high,  as  it  is  calculated 
that  the  whole  time  of  a  medical  officer  of  health  would 
be  taken  up  examining  the  school  children  of  a  town 
of  100,000  (say  with  16,000  school  children).  But 
obviously,  a  Congress  such  as  this  will  lead  to  the  better 
informing  of  public  opinion,  when  the  cost  will  no 
longer  be  regarded  as  unprofitable. 

LARGE  FI BRO-CYS^^ 

OF  THE  UTERUS 

(WEIGHT    28 J    LBS.), 

REMOVED   BY    ABDOMINAL   HYSTERECTOMY; 

FOLLOWED    BY   GANGRENE    OF   THE    RIGHT 

LEG.   (fl) 

By  FRED.  BOWREMAN  JESSETT.  F.R.C.S., 

Surgeon  to  the  Cancer  HoBpital,  Brompton,  &c. 

E.  G.,  aet.  54,  married  33  years,  five  children,  youngest 
aet.  22  ;  has  not,  so  far  as  she  can  perceive,  reached 
menopause. 

Six  years  ago  an  exploratory  operation  was  per- 
formed at  a  London  hospital  for  "  flooding  and  tumour." 
According  to  the  report  from  the  surgical  registrar, 
"  a  large  uterine  fibroid  was  found.  Nothing  further 
was  done."  Soon  after  leaving  the  hospital  she  had 
two  floodings,  more  since.  Now,  the  abdomen  gets 
very  big,  no  pain,  but  patient  is  unable  to  get  alx)ut 
properly. 

(a)  Paper  read  at  the  British  QytUBCological  Society,  Jaly  14th 


1 


86   The  Mbdical  Pkess. 


ORIGINAL  COMMUNICATIONS. 


July  27,  1904- 


Varicose  veins  in  legs  for  last  three  years,  and  occa- 
sional ulcers.  General  health  fair,  but  is  losing  flesh. 
Constipated ;  menstruation  regular  every  four  weeks, 
lasting  about  a  week ;   loss  slight. 

On  Admission. — ^Florid,  but  thin.  Abdomen  enor- 
mously distended,  umbilicus  flattened,  old  median 
scar  below  it.  Large  mass  occupying  practically 
whole  abdomen,  dull  on  percussion,  no  thrUl,  not  tender. 
Superficial  veins  distended. 

Per  Vaginam, — Uterus  low  down  and  cervix  directed 
to  right.     Mass  felt  through  posterior  fornix. 

She  was  admitted  into  the  Cancer  Hospital  on 
Wednesday,  June  ist,  and  on  the  7th  Mr.  Jessett 
operated:  TAn  opening  about  three  inches  in  length  was 
made  in  theihiddle  line  below  the  umbilicus  for  explora- 
tion. The  tumour  was  found  to  be  firmly  adherent 
to  the  parietes,  but  by  using  some  considerable  force 
the  parietes  could  be  peeled  off.  The  whole  scar  tissue 
was  removed  by  an  elliptical  incision,  and  the  abdominal 
incision  enlarged  to  enable  the  hand  to  pass  round  the 
tumour,  when  it  was  found  to  be  quite  free  behind  and 
the  intestines  well  pushed  up  and  not  adherent.  Mr. 
Jessett  then,  by  bringing  his  hand  up  from  behind,  was 
enabled  to  peel  the  parietes  quite  free  from  the  tumour, 
which  was  then  readily  shelled  out,  not,  however,  until 
the  parietal  incision  had  been  prolonged  from  the  pubes 
quite  to  the  ensiform  cartilage.  The  omentum  was 
adherent  to  the  tumour  and  had  some  very  large  veins. 
This  was  ligatured  in  segments  and  cut  across.  The 
broad  ligament^  were  tnen  tied  and  divided ;  the 
uterine  arteries  secured,  and  the  cervix  uteri  cut  across, 
after  having  stripped  down  an  anterior  and  posterior 
flap  of  peritoneum.  There  was  a  considerable  amount 
of  oozing,  so  Mr.  Jessett  packed  the  cavity  with  iodo- 
form gauze  and  brought  the  end  out  of  the  lower  angle 
of  the  parietal  wound. 

The  patient  suffered  a  good  deal  from  shock  during 
the  operation  and  after  &ie  removal  of  the  tumour, 
which  weighed  28 J  lbs. ;  so  Mr.  Keyser  injected  four 
pints  of  saline  fluid  into  the  median  basilic  vein,  and  a 
subcutaneous  injection  of  strychnine  was  also  given. 
After  stitching  up  the  peritoneum,  two  pints  of  saline 
fluid  were  introduced  into  the  peritoneal  cavity  before 
finally  closing  the  parietal  wound. 

The  patient  was  returned  to  bed  and  seemed  as  well 
as  could  be  expected.  She,  however,  complained  of  a 
good  deal  of  pain  in  her  right  leg,  which  was  somewhat 
dusky  and  cold.  This  was  wrapped  in  cot  ton- wool 
and  flannel  bandages.  Had  a  fairly  good  night,  but 
showing  signs  of  some  collapse,  two  pints  more 
saline  fluid  were  given  by  the  arm,  and  small  quantities 
of  saline  fluid  and  brandy  and  beef- tea  administered 
by  the  rectum. 

June  Sth. — Pulse  small,  but  good ;  temperature 
normal.  No  distension ;  gauze  drainage  removed. 
No  sickness  or  vomiting.  Ordered  brandy,  milk,  and 
lime  water  by  the  mouth,  which  she  retained.  General 
aspect  fairly  good.  Leg  still  somewhat  discoloured  but 
warm.     Not  so  painful.     Rectal  feeding  continued. 

The  patient  gradually  improved  from  day  to  day, 
the  abdomen  keeping  quite  flaccid.  Bowels  opened, 
kidneys  acting  well,  and  she  takes  plenty  of  nourish- 
ment. 

June  13/A. — Patient  expresses  herself  better  and 
stronger,  takes  all  nourishment.  The  leg,  however,  is 
quite  gangrenous  from  the  knee  downwards,  being 
discoloured  and  cold,  due  undoubtedly  to  impeded 
blood  supply,  the  skin  being  dry  and  shrivelled.  No 
sensation  below  the  knee.  There  are  a  few  blebs. 
The  limb  is  kept  wrapped  in  boric  lint,  dusted  with 
boric  acid  powder  and  the  whole  enclosed  in  a  quantity 
of  cotton  wool. 

The  line  of  demarcation  is  just  above  the  patella,  I 
tending  downwards  and  backwards  to  about  two  inches 
below  the  joint  posteriorly.  The  patient  continued  to 
improve  daily,  and  on  June  21st,  fourteen  days  after 
the  operation,  with  the  assistance  of  Mr.  Churchill,  I 
amputated  the  leg  at  the  junction  of  the  upper  and 
middle  third  of  the  thigh.  She  bore  the  operation 
remarkably  well,  and  suffered  very  little  from  shock. 


Before  the  operation  she  had  a  nutritive  enema  oi 
brandy  5j.  beef-tea  5iij.  administered. 

June  22nd. — Has  passed  a  good  night  and  taken  a 
small  amount  of  nourishment.  She  has  also  been, 
sustained  by  nutritive  enemata.  Ordered  beef-tea,, 
egg  and  brandy,  milk  and  champagne. 

June  2$rd. — Stump  dressed,  a  good  deal  of  oozing 
from  the  drainage-tubes  ;  stump  looks  well.  Patient's 
condition  generally  satisfactory.  Pulse  good  quality, 
but  very  quick.     Temperature  normal. 

Patient  gradually  lost  ground  and  died  on  Sunday, 
the-  25th,  four  days  after  the  amputation,  and  nearly 
three  weeks  after  the  removal  of  the  tumour. 

Posi'Mortem.-^The  abdominal  wound  was  quite 
healed  and  firm.  There  was  some  suppuration  in  the 
stump.  The  external  iliac  was  found  to  have  a  firm 
clot  in  it  extending  from  its  junction  with  the  common 
iliac  for  about  one  inch  downwards. 

The  kidneys  were  both  much  diseased  and  degene- 
rated ;  this  was  not  suspected,  as  the  urine  was  tested 
before  the  first  operation,  and  only  showed  very  slight 
traces  of  albumin ;  possibly  the  pressure  of  the  tumour 
may  have  had  something  to  do  with  this. 

This  case  is  of  interest  on  account  of  the  size  of  the 
tumour  and  also  in  respect  to  the  gangrene  of  the  1^. 
That  this  was  caused  by  the  plugging  of  the  external 
iliac  there  can  be  no  doubt,  but  it  is  difficult  to  under- 
stand why  this  artery  was  plugged  as  there  was  no  sign 
of  its  being  involved  in  the  ligature  or  twisted.  Could 
it  have  been  caused  by  the  pressure  of  the  tumour  ? 
But,  even  then,  why  was  not  collateral  circulation 
established  ?  It  has  been  suggested  that  these  clots 
may  be  the  result  of  bacterial  infection.  In  this  case 
it  could  hardly  have  been  so,  as  the  patient  complained 
of  pain,  and  the  leg  was  somewhat  dusky  within  an 
hour  of  the  completion  of  the   operation. 

DETACHMENT   OF  THE 
CHOROID. 

By  ROBERT  DWYER  JOYCE,  F.R.C.S.,&c.,&c., 

Ophthalmic  and  Atiral  Surgeon  to  the  Richmond  Hospital,  DubMn* 
and  St.  Michael's  Hospital,  Kingstown. 

A  LADY,  aet.  59,  consulted  me  recently  for 
blindness  of  her  right  eye. 

The  patient  is  healthy,  no  cardiac  or  renal 
trouble ;  she  suffers,  however,  frequently  from 
constipation.  There  is  no  history  of  a  blow  or 
injury  of  any  sort  to  the  eye,  nor  was  it  ever  in- 
flamed more  than  the  ordinary  redness  from  a  cold ; 
but  the  patient  fell — not  very  violently  apparently 
— on  the  back  of  her  head  about  eighteen  months 
ago.  Patient  says  quite  distinctly  that  her 
right  eye  was  always  better  than  the  left  for 
distance  as  well  as  for  near  work  (she  used  to 
shut  the  left  when  threading  a  needle,  &c.),  but 
one  evening,  about  three  months  ago,  she  dis- 
covered that  it  (R.)  was  blind.  She  was  greatly 
frightened.  Her  sister  at  once  took  her  in  hand, 
and  poulticed  the  eye  with  bread  and  water 
continuously  for  a  whole  day  and  night  ;  without 
avail,  however,  as  she  did  not  succeed  in  making 
a  cure.  Patient  wears  — 1*25  sph.  glasses,  both 
eyes,  for  distant  vision. 

Present  condition  :— 'R.  eye  :  vision  =  o  (when 
full  sunlight  was  reflected  into  the  eye  she  said 
she  "  thought  she  saw  something  "). 

L.  eye  :  vision  =  ^*\y  >  J  with  —  1*5  sph.  O 
—  0*25  cyl.  ax.  hoz.  R.  eye  is  quite  normal 
superficially,  fbut  the  pupil,  4  mm.  in  medium 
light,  was  larger  than  the  other.  With  the 
ophthalmoscope  (direct  method,  t.c,  without 
any  intermediate  lens)  retinal  vessels  can  be 
seen  when  viewed  from  a  distance  of  about  ten 
inches  from  the  eye.  With  the  indirect  method, 
the  whole  fundus  is  seen  to  be  occupied  by  two 
large    bulging     abrupt    prominences,     separated 


July  37,  1904. 


TRANSACTIONS  OF  SOCIETIES.         The  Medical  Press.    87 


from  one  another  by  a  very  deep  furrow,  nearly 

vertical,  but  slightly    inclined  towards  the  nasal 

side,  above.     From  the  position  of  this  furrow  the 

optic  nerve  head  would  be  situated  in  it,  but  it 

^was    not    visible.     The    two    large    prominences 

were   almost  the  colour  of  the  ordinary  normal 

fundus,  but  were  slightly  more  yellow,  and  gave, 

in   places,  the  idea  of  translucency.     They  were 

covered  by  the  retina,  the  vessels  of  which  were 

perhaps    a   little    darker    than   normal.     Besides 

these,  however,  the  close  characteristic  network 

of    the  choroidal  vessels  could  be  seen  without 

difficulty  over  the  upper  and  also  over  the  inner 

part   of   the  nasal  prominence,   and    they    were 

situated  in  the  same  plane  as  the  retinal  vessels. 

I  was  unable  to  see  any  trace  of  choroidal  vessels 

elsewhere.     No    undulatory    movements    of    the 

prominences  were  visible  when  the  eye  moved,  bke 

those  seen  in  simple  detachment  of  the  retina. 

The  tension  was  down  ( — i).  I  could  detect 
no  disease  of  any  visible  part  of  the  retina,  but 
the  walls  of  the  retinal  vessels  were  thickened. 
The  anatomical  condition  in  this  case  is  evidently 
large  detachment  of  the  retina  corresponding  to 
the  two  prominences,  with  two  small  detach- 
ments of  the  choroid,  situated  at  the  places  where 
the  choroidal  vessels  were  visible. 

Detachment  of  the  choroid,  following  extensive 
loss  of  vitreous,  or  injury,  is  not  very  uncommon, 
but  pure  idiopathic  cases,  like  the  abqve,  are 
among  the  very  rarest  diseases  of  the  eye. 


Uransactions  of  Societies* 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  July  14TH,    1904. 


Dr.  H.  MacnaughtontJones,  Vice-President,   in  the 
Chair. 


Mr.  Christopher  Martin  exhibited  the  following 
Fpecimens — (i)  Bone  crochet  hook  removed  from  the 
abdominal  cavity ;  (2)  and  (3)  Two  specimens  of 
Arrested  Development  of  the  Uterus  ;  and  read  the 
following  notes  : — 

I.  My  first  specimen  is  a  foreign  body  which  I  re- 
moved from  the  abdominal  cavity  in  December  last.  It  is 
a  portion  of  a  bone  crochet  hook  about  five  inches  long. 
The  patient  was  a  widow,  aet.  48.  She  had  miss^ 
her  periods  for  a  few  months,  and  believed  she  was 
pregnant.  With  the  object  of  procuring  abortion  she 
got  a  bone  crochet  hook,  and  having  sharpened  it  to  a 
point,  pushed  it  up  into  the  uterus.  It  sUpped  from 
her  fingers  and  she  was  afterwards  unable  to  get  hold 
of  the  end  of  it.  It  worked  its  way  right  through  the 
uterus  and  became  free  in  the  periton^  cavity.  She 
became  alarmed,  and  consulted  her  own  medical  man. 
who  sent  her  to  me,  and  when  I  examined  her  a  fort- 
night after  the  occurrence,  I  could  feel  the  foreign  body 
lying  in  the  left  iliac  fossa  quite  apart  from  the  uterus. 
She  was  a  very  thin  woman,  so  that  it  was  quite  easy 
to  palpate  it.  She  was  not  pregnant.  I  opened  her 
abdomen  and  found  this  bony  rod  lying  in  the  left 
iliac  fossa,  completely  embedded  in  the  omentum.  It 
was  easily  removed,  and  she  made  a  good  recovery 
from  the  operation.  On  looking  at  the  uterus  I  could 
see  on  the  posterior  aspect,  just  above  the  level  of  the 
internal  os,  a  round,  depressed  scar — evidently  the 
spot  through  which  the  rod  had  passed.  There  were 
a  few  adhesions  between  the  omentum  and  the  small 
intestine,  but  there  were  no  signs  of  inflammation  in  or 
around  the  uterus  itself.  When  I  saw  her  she  was  in 
a  very  strange  mental  condition  bordering  on  insanity. 
She  was  firmly  convinced  that  she  was  pregnant  and 
that  she  would  still  have  to  be  confined,  and  would  have 
to  go  to  prison  for  attempting  to  procure  abortion.  I 
saw  her  again  about  two  months  ago,  and  then  found 


that  she  had  developed  cancer  in  the  breast,  which, 
however,  she  refused  to  have  removed. 

2.  The  next  specimen  illustrates  one  variety  of 
arrested  development  of  the  uterus.  The  patient 
was  a  single  girl,  aet.  18,  who  had  never  menstruated. 
About  the  age  of  fifteen  the  usual  external  signs  of 
puberty  appeared,  and  she  began  to  have  monthly 
attacks  of  pain  in  the  pelvis,  lasting  for  a  few   days. 

]  These  monthly  pains  gradually  increased  in  severity 
until  she  saw  me.  When  I  examined  her  I  found  her 
a  well-developed  girl  as  regards  figure  and  mammae. 
The  vulva  was  normal,  but  there  was  no  vagina  except 
a  small  cul-de-sac  about  half  an  inch  deep.  On  passing 
the  sound  into  the  bladder,  and  finger  into  the  rectum, 
it  was  evident  that  nothing  intervened  except  the 
vesical  and  rectal  walls.  I  opened  her  abdomen  and 
found  that  the  uterus  was  represented  by  two 
small  solid  muscular  bodies,  one  on  each  side  of  the 
pelvis.  Each  of  these  bodies  received  at  the  upper 
end  a  smaUl  Fallopian  tube  and  a  well-marked  round 
ligament.  Below,  each  body  faded  away  in  the  cellular 
tissue  between  the  bladder  and  the  rectum.  The  right 
body  was  better  developed  than  the  left.  The  ovaries 
were  well  developed  and  apparently  normal.  There 
was  no  structural  connection  between  the  uterine  body 
of  one  side  with  that  of  the  other;  they  were,  indeed, 
separated  by  a  gap  of  two  inches.  As  I  was  anxious 
to  stop  the  monthly  parox^ms  of  pain,  I  removed 
both  the  ovaries,  together  with  the  Fallopian  tubes 
and  the  representatives  of  the  uterus.  The  patient 
made  a  good  recovery ;  she  has  since  remained  well  and 
is  quite  relieved  of  her  old  pains.  It  is  evident  that  in 
her  case  the  two  ducts  of  MuUer  did  not  coalesce,  whilst 
the  uterine  and  vaginaU  portions  were  arrested  in  their 
development  and  did  not  form  mucous  canals.  A  week  or 
two  aigo  the  patient  came  again  to  see  me.  looking  very 
well,  and  she  informed  me  that  she  was  thinking  of 
getting  married,  and  was  anxious  to  know  if  I  could 
make  her  a  vagina. 

3.  The  third  case  is  one  in  which  the  uterus  was 
bicomuons — the  right  horn  being  distended  with 
menstrual  fluid  and  not  communicating  with  the  rest 
of  the  uterine  cavity.  The  patient  was  a  single  girl^ 
aet.  21.  anaemic  and  delicate,  who  consulted  me  on 
June  ist,  1904,  complaining  of  violent  pain  in  the  right 
lower  abdomen  at  each  period,  lasting  the  whole  of  the 
time  and  continuing  some  days  afterwards.  Menstrua- 
tion occurred  every  three  weeks,  was  scanty  and  only 
lasted  three  days.  On  examining  her  I  found  a  mass 
about  the  size  of  an  orange,  in  front  of  and  to  the  right 
of  the  uterus — a  mass  which  I  took  to  be  tubal  or 
ovarian.  I  took  her  into  the  hospital  and  on  June 
1 8  th  I  opened  her  abdomen.  I  found  the  mass  to  be  the 
right  horn  of  a  bifid  uterus.  It  was  tense  and  globular, 
and  evidently  contained  fluid.  It  was  separated  from 
the  rest  of  the  uterus  by  a  bridge  of  fibrous  and  muscu- 
lar tissue.  The  distended  right  horn,  right  tube  and 
ovary  were  very  adherent.  I  removed  them  by  dividing 
this  bridge  and  was  able  to  save  the  rest  of  the  uterus 
with  the  left  ovary  and  tube.  The  patient  made  a 
good  recovery  and  returned  home  on  July  loth. 

Dr.  Heywood  Smith  said  that  it  was  remarkable 
how  often  sounds  or  other  instruments  paissed  through 
the  uterine  wall  without  setting  up  any  mischief.  One 
lady  he  knew  had  brought  on  her  own  miscarriage 
thirty-five  times,  and  on  several  occasions  nearly  lost 
her  life  from  severe  flooding  ;  she  used  a  long  knitting 
needle  for  the  purpose.  Malformation  or  displace- 
ment of  the  kidney  was  so  often  associated  with  arrested 
development  of  the  uterus  that  he  would  like  to  know 
whether  Mr.  Martin  had  examined  the  position  of  the 
kidneys. 

Mr.  BowREMAN  Jessett  suggested  that  the  last  speci- 
men might  possibly  be  a  fibroid  or  myoma  of  the 
Fallopian  tube ;  it  did  not,  in  his  opinion,  resemble  a 
bicomual  uterus. 

Dr.  Robert  Bell  (Glasgow)  mentioned  a  case  he 
operated  upon  for  a  tumour  which  he  took  to  be  a 
subserous  fibroid  of  the  uterus  or  possibly,  as  its  attach- 
ment was  at  the  comu,  of  the  Fallopian  tube,  and  he 
removed  it  under  that  impression.  The  woman  had 
been  pregnant  two  years  previously,  and  the  pregnancy 

D 


88     The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


hikd  terminated  suddenly,  a  fact  which  he  did  not  ascer- 
tain till  after  the  operation.  On  a  section  being  made 
of  the  tumour  it  was  found  to  contain  a  four  and  a  half 
months  foetus  in  perfect  preservation.  The  tumour 
weighed  four  pounds  and  had  all  the  appearances  of  a 
fibroid. 

Dr.  H.  Macnaughton- Jones  (Chairman)  said  that 
it  was  remarkable  what  a  variety  of  instruments  could 
be  used  to  procure  abortion  ;  he  had  known  the  handle 
of  a  toothbrush  successfully  employed  for  the  purpose. 
One  of  the  unpleasant  consequences  which  might  follow 
such  attempts  was  that  imputations   quite  unfounded 
might  be  cast  on  the  ordinary  medical  attendant.     In 
a  uterus  examined  by  Mr.  Bland-Sutton  and  himself 
there  was  a  perforation,  and  a  portion  of  cotton  wool 
was  found  in  the  abdominal  cavity.     The  woman  had 
been  attended  by  a  midwife,  but  the  consequence  to  her 
ordinary    medical    man    was    very    disastrous.     Mr. 
Martin's  second  case  was  of  much  interest ;    among 
five  cases  of  total  absence  of  the  uterus  and  ovaries 
he  (Dr.  Macnaughton- Jones)  had  himself  published, 
two  were  in  children  and  in  one  of  them  he  had  suc- 
ceeded in  making  a  very  fair  artificial  vagina  ;   in  the 
other,  particulars  of  which  he  had  read  to  the  Society 
at  a  former  meeting,   the  abdomen  was  opened  for 
inflammation  of  the  appendix,  which  was  bound  down 
to  the  floor  of  the  pelvis.     Before  the  operation   he 
had    been    able    by   a   vesico-rectal    examination    to 
determine  the  absence  of  the  uterus  and  ovaries.     He 
might  refer  to  one  of  the  three  other  adult  cases  as  it 
had  a  bearing  upon  the  question  of  making  an  artificial 
vagina,  as  von  Ott  and  others  were  reported  to  have  done 
successfully.     In  his  own  case  he  had  not  been  able  to 
make  a  good  vagina  and  a  rectal  fistula  was  left.     He 
was  able  to  close  the  latter  successfully,  but  had  to 
-sacrifice  the  substitute  for  the  vagina  he  had  made. 
Before   the   operation    the   mental   condition   of    the 
patient  was  such  as  to  cause  grave  anxiety  ;    she  had 
become   hysterical   and   almost   delusional,    and   was 
;greatly  reduced  in  strength  ;   after  the  plastic  opera- 
tion her  health  improved  greatly  and  she  became,  and 
has  remained,  robust  and  well.     It  therefore  seemed 
that  the  production  of  even  a  small  artificial  vagina 
might  have  a  good  effect.     He  was  not  sure  that  Mr. 
Martin's  third  specimen  was  a  uterus,  and  suggested  that 
it  should  be  examined  by  a  pathologist. 

Mr.  Martin,  in  reply,  said  that  there  was  nothing  to 
lead  him  to  suppose  anything  anomalous  about  the 
kidnejrs.  and  examination  of  their  position  would  have 
involved  a  larger  incision  than  he  cared  to  make.  A 
section  had  now  been  made  of  the  third  specimen  and 
the  centre  evidently  consisted  of  inspissated  blood-clot, 
which,  he  held,  supported  his  view  that  it  was  the 
occluded  horn  of  a  bicomed  uterus  filled  with  retained 
menstrual  blood.  The  specimen  had  been  hardened 
by  formalin,  but  when  removed  the  tumour  was 
quite  flaccid.  Dr.  Macnaughton- Jones  had  referred 
to  the  medico-legal  aspect  of  the  first  case.  If  it  had 
proved  fatal,  it  might  have  been  his  duty  to  decline  to 
certify.  It  was  remarkable  how  little  trouble  the  very 
sharp  piece  of  bone  had  caused  ;  perhaps  it  had  been 
cleans^  of  any  infectious  germs  in  its  passage  through 
the  muscular  wall  of  the  uterus,  but  the  mental  state 
of  the  woman  might  partially  account  for  her  immunity. 
Insane  women  were  curiously  tolerant  of  abdominal 
injuries,  and  in  many  instances  had  opened  their  own 
abdomens  and  yet  recovered  without  any  bad  sym- 
ptoms from  conditions  that,  in  aUl  probability, would  have 
led  to  fatal  peritonitis  in  others.  He  was  convinced 
that  the  third  specimen  was  an  occluded  horn  with  re- 
tained menstrual  blood,  but  he  would  be  pleased  to 
have  it  examined  by  a  patholcmst,  as  suggested,  and 
would  submit  a  report  to  the  Society. 

Mr.  BowREMAN  JESSETT  reported  upon  a  case  of 

GANGRENE  OF   THE   LEG  AFTER   ABDOMINAL 
HYSTERECTOMY 

for  the  removal  of  a  large  fibro-cystic  tumour,  and 
showed  the  tumour  removed.  Notes  of  this  case  will 
be  found  on  page  85. 

Mr.  Jessett  also  showed  a 

MYOMATOUS      UTERUS.      REMOVED      BY]     ABDOMINAL 
HYSTERECTOMY, 


July  27,  1904.' 

illustrating  the  presence  of  sub-mucous,   interstitial 
and  sub-pentoneal  growths,  and  read  the  foUowing 

A.  H.,  aet.  50,  married,  no  children  or  miscarriaces 
was  seen  by  me  in  consultation  with  Dr.  Smyth 
Colebrook  Road,  on  June  2nd.  1904.  History :  For 
about  two  years  has  had  aching  pains  in  the  groins,  es- 
pecially  the  left  and  in  the  back.  Of  late  has  noticed  a 
swellmg  m  her  abdomen.  Has  had  a  brownish  discharge 
for  last  SIX  months.  Complains  of  morning  sickne^ 
nausea,  and  pains  in  the  upper  abdomen  after  meals! 
JNo  haematemesis ;  no  increase  in  micturition  ;  men- 
struation regular  monthly,  lastmg  a  week,  less  copious 
with  pam  for  one  or  two  days. 

Examinaiion.^The  abdomen  is  distended  at  the 
lower  part  by  a  large,  very  hard  mass,  extending  to 
withm  one  mch  of  the  umbilicus,  and  not  mobUe  • 
no  tenderness ;  a  hard  knob  is  felt  in  the  right  side' 
mobile.  Rest  of  tumour  smooth,  and  apparently 
wedged  into  the  pelvis.  Per  Vaginam  :  Cervix  high 
up  and  to  the  left.  Body  of  uterus  not  distinguishable. 
Mass.  filUng  both  fomices,  continuous  with  abdominal 
tumour.  On  bimanual  examination,  the  tissue  is 
very  fixed,  only  very  slightly  mobile.  On  June  14th 
I  opened  the  abdomen  by  the  usual  incision,  and  by 
means  of  a  Doyen  hysterectomy  screw,  with  some 
difficulty  lifted  the  tumour  out  of  the  abdomen  and 
removed  it  by  the  sub-peritoneal  method.  The  patient 
made  an  uninterrupted  recovery.  On  section  of 
tumour  it  was  found  to  contain  several  large  sub- 
mucous, intramural  and  sub-peritoneal  fibroids. 

Mr.  Charles  Ryall  said  that  Mr.  Jessett  was  to 
be  thanked  for  showing  the  giant  myoma  again,  and  for 
the  further  history  of  the  case,  especially  as  it  had 
turned  out  unsuccessfully,  for  much  more  was  generally 
to  be  learned  from  one  failure  than  from  many  successes. 
Apart  from  the  immense  size  of  the  tumour,  the  re- 
markable point  was  the  extent  and  extreme  intimacy 
of  Its  adhesions  to  the  abdominal  wall.  The  cause  of 
the  gangrene  was  very  obscure;  the  early  onset  of 
the  symptoms  contradicted  the  idea  that  it  was  due 
to  bacterial  invasion  at  the  time  of  the  operation. 
He  thought  that  the  gangrene  might  possibly  be  due 
to  thrombosis  of  the  common  iliac  extending  dou-n 
to  the  bifurcation  and  then  along  the  external  iliac, 
or  to  dislodgment  of  an  embolus  in  the  aorta,  owing  to 
the  manipulation  of  the  tumour  at  the  time  of  the 
operation. 

Dr.  Heywood  Smith  mentioned  that  many  years 
ago  a  patient  of  his  did  perfectiy  well  after  hysterec- 
tomy for  nearly  a  fortnight  after  the  operation,  and 
then  fell  back  dead  while  sitting  up  to  have  her  dinner, 
the  cause  of  her  death  being  a  pulmonary  embolus.  In 
that  case  the  tumour  had  been  a  very  large  one.  The 
occurrence  of  embolism  after  abdominal  operation 
was  a  question  of  deep  interest.  Possibly  it  was  more 
frequent  in  connection  with  large  tumours  where  the 
blood  supply  was  very  large,  and  the  vessels  subjected 
to  pressure,  and  perhaps  to  tension,  at  the  time  of  the 
operation. 

Dr.  J.  J.  Mac  AN  reminded  the  Fellows  that  though 
gangrene  was  uncommon,  if  not  unique,  after  ab- 
dominal operations,  it  was  by  no  means  so  after 
childbirth,  affecting  various  parts  of  the  body,  but 
most  commonly  the  lower  extremities.  In  a  recent 
number  of  the  CentrtUblatt  there  were  abstracts  of 
articles  on  the  subject  by  Schaeffer  and  Wormser,  and 
both  of  them  agreed  in  attributing  it  to  infection. 
In  Mr.  Jessett's  case  it  seemed  that  infection,  if  it  had 
any  influence,  must  have  existed  before  the  first 
operation. 

Dr.  Richard  Smith  asked  whether  there  had  been 
any  oedema  of  the  leg.  and  what  had  been  the  after 
treatment. 


Dr.  Macnaughton- Jones,  jun„  suggested  that  the 
pain  Qomplained  of  by  the  patient  two  hours  after  the 
opera^tion  could  hardly  have  been  due  merely  to  local 
anaemia,  and  that  there  might  have  been  some  pressure 
on  the  nerve  as  well  as  on  the  artery. 

Dr.  Robert  Bell  remarked  that  in  a  blood-vessel, 
so  far  as  he  understood  it,  coagulation  could  only  occur 


July  27.  iQO^. 


TRANSACTIONS  OF  SOCIETIES.        Ihb  Mbdical  Press,     89 


in  the  presence  of  a  foreign  body.  In  healthy  blood- 
vessels coagulation  would  not  take  place,  but  inflam- 
mation in  a  vein  or  artery  would  act  as  a  foreign  body, 
and  would  produce  tMfe  catalytic  effect  which  caused 
the  formation  of  a  clot.  In  a  case  such  as  the  one 
Mr.  Jessett  had  brought  before  them,  some  injury 
might  have  occurred  to  either  the  innominate  vein  or 
artery,  but  if  to  the  former  the  embolism  would  have 
been  in  the  pulmonary  artery  rather  than  in  the  iliac, 
and  he  therefore  thought  that  there  must  have  been 
some  lesion  of  the  iliac  artery  to  account  for  the  clot. 

Mrs.  ScHARLiEB  mentioned  a  case  in  which  arrange- 
ments had  been  made  to  remove  a  very  large  fibroid, 
but  two  days  before  the  proposed  operation  the  patient 
was  taken  exceedingly  ill  with  thrombosis  of  the  left 
femoral  vein,  and  the  operation  had  to  be  postponed 
sine  die.  The  patient  had  not  suspected  any  phlebitis 
or  other  trouble  in  her  leg,  and  there  had  not  been  any 
recent  operation  or  manipulation  in  her  case. 

Dr.  Bell  explained  that  he  by  no  means  suggested 
that  Mr.  Jessett  had  injured  the  artery.  Mrs.  Schar- 
lieb's  case  supported  his  own  theory  that  the  pressure 
of  a  large  fibroid  upon  the  iliac  vessels  might  cause 
sufficient  irritation  to  cause  the  formation  of  a  clot, 
and  thus  produce  the  same  effect  as  a  foreign  body. 

Dr.  Macnaughton- Jones  said  that  he  did  not 
conclude  that  there  had  been  any  injury  to  the  iliac 
artery  during  the  removal  of  the  tumour.  Large 
tumours  pressing  upon  the  great  vessels  of  the  pelvis 
undoubtedly  sometimes  affected  these  vessels  in- 
juriously, and  it  was  more  than  possible  that  in  the 
present  case,  especially  considering  the  co-existent 
kidney  disease,  there  had  been  an  obstructive  arteritis 
and  that  the  manipulation  necessary  during  the 
operation  had  loosened  a  clot  already  formed.  He 
had  himself  shown  pelvic  tumours  after  the  removal 
of  which,  there  had  been  oedema  of  the  leg,  inability  to 
walk  and  other  troubles. 

Mr.  Jessett,  in  reply,  said  that  there  had  not  been 
before  the  operation  any  swelling  of  the  legs,  such  as 
would  naturally  have  been  attributed  to  pressure  of  the 
tumour.  The  patient,  it  was  true,  had  varicose  veins, 
but  not  to  any  extent  worth  noticing.  Pressure 
sufficient  to  interfere  with  the  arterial  circulation  must, 
he  thought,  have  interfered  with  the  venous  also,  and 
would  then  have  caused  considerable  swelling  of  the 
legs.  Although  the  clot  in  the  external  iliac  extended 
about  an  inch  up  to  the  bifurcation,  the  internal 
iliac  was  free,  and  it  was  difficult  to  understand  why 
the  collateral  circulation  was  not  sufficient  to  carry  on 
the  nutrition  of  the  limb.  In  his  opinion,  the  only 
explanation  of  that  was  that  during  the  operation, 
perhaps  owing  to  nervous  shock,  the  woman  lost  very 
little  blood,  the  general  circulation  was  impeded,  and 
the  vis  a  tergo  was  insufficient  to  drive  the  blood 
through  the  leg,  and  a  clot  gradually  formed  which 
increased  the  ^fficulty.  It  had  also  crossed  his  mind 
whether  the  saline  solution,  of  which  the  patient 
received  a  considerable  quantity,  had  been  absolutely 
sterile.  There  was  no  moisture  in  the  gangrene 
whatever,  the  leg  was  simpl/  dried  up  for  want  of 
nourishment.  Dr.  Macnaughton- J  ones,  jun.,  had 
suggested  that  there  had  been  pressure  on  the  nerve 
as  well  as  on  the  blood-vessels  to  account  for  the  pain 
It  was  possible ;  we  were  all  familiar  with  the  sensation,  of 
"pins  and  needles"  which  supervened  on  the  removal 
of  pressure.  Still  in  his  own  opinion,  the  arrest  of 
the  blood  supply  was  the  cause  of  the  pain  from  the 
commencement. 

Dr.  Heywood  Smith  (Vice-President),  having  taken 
the  chair, 

Dr.  Macnaughton-Jones  read  a  paper  on 

ACCESSORY     FALLOPIAN     TUBES     AND     THEIR     RELATION 
TO    BROAD    LIGAMENT    CYSTS    AND    HYDROSALPINX, 

and  showed  some  specimens  illustrative  of  the  origin 
of  hydrosalpinx  from  accessory  Fallopian  tubes. 
Sampson  Handley  had  criticised  Kossmann's  view 
that  broad  ligament  cysts  are  neither  parovarian  nor 
cystic  dilatations  of  the  Wolfl&an  diverticula  or  ducts, 
but  are  derived  from  accessory  Mullerian  ducts 
(sacroparasalpinx    serosa).      Handley    and    Shattock 


I  had  demonstrated  from  specimens  in  the  College 
of  Surgeons  Museum  the  origin  of  accessory  hydro- 
salpinx from  the  pronephric  funnels  of  the  Mullerian 
duct.  Handley  also  showed  that  enuclcable  broad  liga- 
ment cysts,  developed  above  the  tube,  were  derivable 
from  accessory  Fallopian  tubes.  Alban  Doran  had 
anticipated  Kossmann  in  his  surmise  that  such  cysts 
were  of  Mullerian  origin.  Hamilton  Bell,  from  the 
examination  of  a  cyst  removed  by  Cullingworth, 
supported  Handley's  contention.  The  histological 
analogy  between  the  accessory  and  the  ordinary 
hydrosalpinx  was  complete. 

These  histological  analogies  were  typically  shown 
in  the  first  of  Dr.  Macnaughton-Jones'  specimens. 
The  cysts  were  derived  from  the  Fallopian  tube.  The 
ovarian  fimbria  was  absent,  and  its  place  was  taken  by 
two  cysts. 

The  second  specimen  Dr.  Hsmdley  reported  to  be 
undoubtedly  an  accessory  Fallopian  tube,  the  im- 
portant point  in  this  instance  being  that  both  the 
pedicle  of  the  cyst  and  its  wall  were  muscular,  and  the 
cyst  was  lined  with  ciliated  and  columnar  epithelium. 

The  third  specimen  was  very  interesting,  and  though 
not  microscopically  examined,  there  was  little  doubt 
of  the  nature  of  the  cysts.  When  one  of  these  was 
held  up  against  a  strong  light,  the  plicae  could  be  seen 
through  its  wall.  In  this  instance  there  was  a  cyst 
in  the  free  edge  of  the  broad  ligament,  attached  to 
which  were  two  small  flattened  cysts,  while  hanging 
from  the  peritoneal  folds  there  were  two  small  cysts 
and  an  accessory  Fallopian  tube.  These  latter,  Dr. 
Handley  considers,  represent  in  abnormal  number  the 
pronephric  funnels.  He  also  showed  with  the  epidia- 
scope other  specimens  illustrating  the  paper. 

He  exhibited  a  form  of  clip  to  which  a  small 
weight  was  attached  by  aluminium  bronze  wire, 
intended  to  supersede  the  use  of  forceps  in  keeping 
the  cut  edges  of  the  peritoneum  in  position  after 
opening   the  abdomen. 

Dr.  Heywood  Smith  said  the  only  criticism  he 
would  offer  of  the  cases  described  by  Dr.  Macnaughton- 
Jones  was  as  to  the  word  accessory.  When  speaking 
of  accessory  organs  one  had  in  mind  an  organ  parallel 
in  function  to  the  one  described,  such  as  an  accessory 
mamma  or  accessory  kidney.  He  suggested  that  in  the 
case  mentioned  by  Dr.  Macnaughton-Jones  the  word 
diverticulum  or  aneurysm  of  the  duct  should  be  used. 
They  were  really  excrescences  which  seemed  to  be  cut 
off,  but  evidently  had  the  same  foundation  as  the  tube 
itself. 

Dr.  Macnaughton-Jones  said  he  could  not  agree 
with  Dr.  Heywood  Smith  in  his  criticism. 

Dr.  Jervois  Aarons  showed 

A  NEW  uterine  MOP, 

reading  the  following  note  : — The  difficulty  and  length 
of  time  wasted  in  removing  the  wool  from  the  ordinary 
Playf air's  probe  after  it  has  been  used  led  me  to  try 
and  devise  some  means  by  which  the  mop  might  be 
more  easily  and  quickly  removed.  It  occurred  to  me 
that  a  cap  of  some  absorbent  material  which  would 
fit  over  a  conical  sound  would  serve  the  purpose,  and 
such  a  cap,  or  mop.  I  have  had  made  ;  this  slips  over  a 
conical  or  tapering  metal  sound,  and  is  held  in  position 
by  a  small  ring  catch,  which  effectually  prevents  it  from 
leaving  the  sound.  The  dry  mops  weigh  13  grains 
(79  grammes) ;  after  being  used  they  weighed  39 
grains  (2*5  grammes) ;  they  are,  therefore,  sufficiently 
absorbent  for  the  purpose.  The  advantages  over  the 
ordinary  Playfair's  probe  are :  ( i )  Ease  and  rapidity  of 
dressing  the  probe ;  (2)  ease  and  rapidity  of  removing 
the  mop  after  use ;  (3)  they  are  easily  sterilised  ; 
(4)  the  tapered  part  of  the  sound  being  made  of  plated 
copper  can  be  bent  to  any  desired  shape.  The  caps, 
and  the  probe  were  made  for  me  by  the  Galen  Manu- 
facturing Co.,  Ltd.,  and  I  am  indebted  to  them  for 
the  way  in  which  they  have  carried  out  my  ideas. 

Dr.  Heywood  Smith  concurred  as  to  the  difficulty 
in  getting  the  cotton  wool  off  the  Playfair  probe, 
unless  one  had  the  knack  of  rotating  it  in  a  direction 
contrary  to  that  adopted  when  putting  it  on.     The 


QO     Tbx  Medical  Pkbss. 


TRANSACTIONS  OF  SOCIETIES. 


July  27.  1904- 


present  device  was  useful  because  the  ring  got  on  in 
its  place. 

THE  SOCIETY  FOR  THE  STUDY  OF  DISEASE 
IN  CHILDREN. 


The  Provincial  Meeting  took  place  at  Bristol  on 
June  1 8th,  Dr.  Theodore  Fisher  in  the  Chair.  Prior 
to  the  meeting  clinical  cases  were  shown  at  the  Hospital 
for  Sick  Children,  St.  Michael's  Hill,  and  at  the  Medical 
Library,  University  College. 

Dr.  D.  S.  Gerrish  showed  some  remarkable  exam- 
ples of  '*  Progressive  Muscular  Atrophy"  of  the  family 
type.  He  had  been  able  to  trace  the  disease  back 
through  five  generations,  and  over  forty  members  of 
the  family  had  been  affected.  The  usual  history  was 
that  up  to  the  age  of  23  years  the  patients  had  been 
remarkable  for  their  physique  and  muscular  strength, 
but  after  that  age  the  extensor  muscles  of  the  leg 
began  to  waste,  chiefly  the  anterior  tibials  and  the 
peronei.  The  condition  slowly  and  steadily  increased, 
and  by  the  fiftieth  year  it  had  extended  to  the  extensor 
muscles  of  the  arms.  Sensation  had  never  been 
affected,  but  the  reaction  of  degeneration  was  present. 
Although  their  hands  were  affected  the  patients  re- 
tained their  grip,  but  extension  became  very  weak. 

Dr.  Bertram  H.  Rogers  read  notes  of  a  case  of 
"  Congenital  Stricture  of  the  (Esophagus."  An  infant, 
aet.  about  2,  began  to  suffer  from  vomiting,  the  con- 
dition getting  rapidly  worse,  and  being  accompanied 
by  emaciation.  No  definite  physical  signs  of  disease 
were  present  save  much  mucus  in  the  lungs,  and  over- 
distension of  the  cervical  veins  on  crying.  Test  meals 
showed  that  most  of  the  food  entered  the  stomach,  but 
part  seemed  to  be  retained  in  the  oesophagus.  The  use 
of  X-rays  and  an  oesophageal  tube  threw  little  light  on 
the  nature  of  the  case.  The  child  died  from  an  in- 
crease of  the  bronchial  trouble  and  dyspnoea.  At  the 
necropsy  there  was  found  a  fairly  tight  stricture  about 
an  inch  from  the  lower  end  of  the  oesophagus. 

Mr.  H.  Elwin  Harris  showed  three  cases — (i) 
"  Congenital  Absence  of  the  Left  Ear  with  Facial 
Paralysis  "  ;  (2)  "  Congenital  Absence  of  the  Left  Eye 
with  Cleft  Palate  and  Hare-lip  "  ;  and  (3)  "  Intra- 
uterine Amputation  of  Three  Extremities,  with  Webbed 
Fingers  on  the  Hand  of  the  only  Limb."  The  last 
case  was  a  very  remarkable  one,  as  both  legs  were 
absent  from  i J  inches  below  the  hip-joint,  and  the  left 
arm  was  removed  flush  with  the  shoulder-joint.  On 
the  stump  of  the  right  lower  extremity  was  a  very 
minute  leg  in  which  one  could  trace  a  rudimentary 
knee-joint,  ankle,  and  foot.  He  did  not  know  any 
satisfactory  explanation  of  such  deformities,  and  did 
not  think  that  the  theory  as  to  amniotic  adhesions  was 
conclusive. 

Mr.  Clement  Lucas  expressed  his  disbelief  m  the 
theories  current  as  to  intra-uterine  malformations  such 
as  maternal  impressions,  amputation  by  the  funis,  &c. 
He  thought  that  if  any  satisfactory  theory  could  be 
formed  it  would  be  one  in  which  the  nervous  system 
played  an  important  part. 

Mr.  George  Pernet  thought  that  such  a  theory  as 
that  of  maternal  impressions  was  a  nuisance  to  science, 
and  should  no  longer  be  tolerated.. 

Dr.  J.  MicHELL  Clarke  showed  a  case  of  "  Hydro- 
cephalus "  in  which  recovery  had  occurred.  The  illness 
probably  began  at  the  age  of  six  months,  and  the 
patient  had  been  under  observation  for  some  years. 
Intelligence  had  never  been  affected,  but  there  had 
been  marked  weakness  of  the  muscles  of  the  trunk 
and  lower  extremities.  After  three  years  improvement 
set  in,  and  the  only  traces  of  disease  visible  were  the 
lajge  size  of  the  head  and  some  signs  of  partial  de- 
generation of  the  pyramidal  tracts.  The  treatment 
had  been  by  small  doses  of  grey  powder,  continued 
over  long  p«*iods. 

Mr.  C.  A.  Morton  read  the  notes  of  a  case  of 

HYDROCEPHALUS    IN    WHICH  DRAINAGE    OF    THE 
VENTRICLES 

into  the  subdural  space  was  established.     The  method 
of   operation   was   that   introduced   by   Mr.    Watson 


Cheyne,  in  which  a  communication  is  established  be- 
tween the  distended  ventricle  and  the  subdural  space, 
so  that  the  fluid  may  be  readily  ^absorbed  by  the  menin- 
geal veins.  The  patient  was  aii  infant,  aet.  7  months, 
suffering  from  congenital  hydrocephalus.  The  first 
operation  consisted  in  turning  down  a  flap  on  the  right 
side  of  the  skull  below  the  anterior  fontanelle,  and 
introducing  a  piece  of  fine  rubber  tubing,  one  end  of 
which  was  passed  into  the  ventricle  and  the  other 
between  the  dura  mater  and  the  cortex.  The  flap  of 
dura  mater  and  membranous  skull  was  then  replaced 
and  stitched  carefully,  so  that  all  oozing  had  ceased  at 
the  end  of  twenty-four  hours.  On  the  eleventh  dav 
after  the  operation  the  head,  which  had  been  much 
smaller  as  the  result  of  the  operation,  again  showed 
signs  of  enlarging.  A  few  months  later  the  operation 
was  repeated  on  the  opposite  side,  the  head  still  in- 
creasing in  size.  A  small  rectangular  metal  tube  was 
first  employed,  but  as  the  fluid  would  not  flow  through 
it,  a  rubber  tube  was  inserted.  Some  leakage  from 
the  operation  wound  continued  for  a  few  days,  and 
the  cranial  bones  were  over-riding.  The  tempera- 
ture ran  up  to  105°  on  the  evening  of  the  tenth  day, 
and  the  baby  died.  At  the  necropsy  the  brain  was 
found  to  be  Ijring  about  an  inch  from  the  cranium  all 
round.  There  was  no  meningitis,  and  the  drainage- 
tubes  appeared  to  be  actini?  well.  Mr.  Morton  com- 
mented on  the  fact  that  although  the  drainage  of  the 
ventricle  had  been  maintained  continuously  for  twa 
months  after  the  first  operation,  yet  the  head  had  in- 
creased in  size  from  excessive  fluid  pressure. 

Dr.  James  Taylor  congratulated  Dr.  Clarke  on  the 
successful  result  in  his  case.  It  was  not  often  that 
one  saw  a  case  of  recovery  from  hydrocephalus,  even 
after  surgical  measures,  and  for  a  case  to  recover  after 
medical  measures  was  rarer  still.  He  had  noted  in 
some  cases  of  recovery  from  hydrocephalus  that  the 
child  seemed  abnormally  sharp  and  above  the  average 
in  intelligence. 

Dr.  G.  A.  Sutherland  thought  that  recovery  iir 
cases  of  congenital  hydrocephalus  was  not  so  very  un- 
common, the  commonest  underlying  cause  being- 
syphilitic  meningitis,  and  the  cure  being  effected  by  a 
prolonged  mercurial  course.  As  re;][ards  the  acquired 
cases,  many  of  which  dated  from  an  attack  of  non- 
tuberculous  basilar  meningitis  in  infancy,  he  thought 
that  medical  measures  were  useless,  and  that  the  most 
hopeful  line  of  treatment  was  by  surgical  intervention 
on  the  lines  described  by  Mr.  Morton. 

Mr.  Clement  Lucas  also  viewed  the  condition  of 
hydrocephalus  as  due  to  mechanical  obstruction,  and 
had  made  various  attempts  to  remove  the  ventricular 
fluid.  He  had  tried  to  drain  the  ventricle  into  the 
tissues  beneath  the  scalp,  but  had  not  found  absorption 
take  place  in  that  region.  As  regards  other  opera- 
tive measures,  it  seemed  impossible  at  present  to 
descend  to  the  base  of  the  brain,  but  he  thought 
advances  would  be  made  in  that  direction,  for  it  was 
only  necessary  to  let  the  fluid  communicate  sufficiently 
freely  with  its  proper  arachnoid  space  for  the  cases 
to  be  cured. 

Dr.  George  Carpenter  agreed  that  many  of  these 
cases  were  syphilitic  in  origin,  and  had  seen  at  least 
half  a  dozen  of  them  cured  by  mercury  and  chalk. 

Mr.  J.  Lacy  Firth  showed  a  case  of  "  Congenital 
Dislocation  of  the  Hip,"  which  had  been  under  treat- 
ment by  the  Lorenz  method  for  four  months. 

Mr.  A.  H.  Tubby  thought  that  this  method  would 
only  bring  about  cures  in  comparatively  slight  cases, 
namely,  those  in  which  the  head  was  quite  near  to 
the  acetabulum,  and  was  of  a  good  shape,  and  the 
acetabulum  was  widely  open.  The  results,  so  far  as 
they  had  gone,  might  be  classified  under  three  heads — 
(I)  actual  reposition,  (2)  good  or  fair  results,  (3)  no 
result  at  all.  He  could  not  state  the  actual  number 
of  repositions,  but  it  was  comparatively  small.  The 
results  which  were  good  or  fair  were  those  in  which 
the  posterior  displacement  had  been  altered  to  an 
anterior  displacement,  but  without  complete  reposition. 
Such  patients  walked  better,  some  shortening  dis- 
appeared, and  they  lost  the  lordosis.     If  anything  like 


July  27.  1Q04. 


FRANCE. 


The  Medical  Pkess.     9 1 


excessive  force  was  called  for  he  thought  that  it  was 
the  snrgeon's  duty  to  desist,  as  when  force  was  em- 
ployed it  was  almost  certain  to  result  in  a  bad  dis- 
location. 

Mr.  Paul  Bush  showed  a  child  with  extroversion  of 
the  bladder.  A  portion  of  the  mucous  membrane  had 
**  skinned  over  "  under  the  constant  application  of  a 
saturated  solution  of  boracic  acid.  He  proposed  doing 
the  old  operation  of  turning  over  an  upper  central  flap, 
-and  covering  this  by  sliding  two  lateral  flaps  over  it. 

JSritiBb  Dealtb  IResorte. 


III.— BUDLEIGH  SALTERTON. 


[BY    OUR    SPECIAL    MEDICAL    COMMISSIONER.] 


Along  the  semi-circular  sweep  of  the  southern 
-seaboard  bounded  by  Portland  Bill  on  the  east  and 
"Start  Point  on  the  west,  there  are  many  places  of 
merit  as  desirable  health  stations.  Among  these, 
Budleigh  Salterton  deserves  mention.  It  is  near  to 
the  estuary  of  the  Exe  and  close  to  the  mouth  of  the 
River  Otter,  and  only  five  miles  from  popular  Ex- 
anouth.  It  is  a  quiet  little  town  of  modem  construction, 
which  the  extension  of  the  South- Western  Railway, 
opened  in  1 897 ,  has  made  conveniently  accessible .  Well 
sheltered  on  the  north  it  is  less  open  to  the  south  and 
-south-east,  and  presents  the  usual  advantages  of  a  warm 
•southerly  seaside  resort.  The  climate  is  mild  and 
equable.  The  rainfall  is  moderate,  the  mean  average 
•of  seven  years  being  26*82  inches.  The  soil  is  good  and 
'the  roads  dry  speedily.  Much  sunshine  usually  prevails. 
Considerable  impiovement  has  been  made  to  meet  the 
meeds  of  the  health  seeker.  There  is  no  pier  or  ambi- 
tious pavilion,  but  the  front  is  conveniently  laid  out,  and 
the  visitor  needing  quiet  and  willing  to  lead  a  simple 
life  will  find  much  to  attract  on  its  cl&  paths  and  inland 
-wooded  lanes.  There  are  good  golf  links  near  at 
hand  and  the  district  is  rich  in  drives,  and  offers  many 
■attractive  walks.  The  water  supply  of  the  town  is 
good  and  it  is  proposed  to  increase  it.  The  drainage 
.appears  to  be  fairly  satisfactory  and  it  is  proposed  to 
carry  the  outfall  sewer  another  48  feet  from  the  shore,  (a) 

Budleigh  Salterton,  with  its  population  of  about  2,000, 
is  a  desirable  holiday  resort  for  the  wearied  worker  or 
town  dweller,  and  it  is  very  suitable  for  children.  At 
present  it  cannot  offer  any  very  particular  advantages 
for  the  luxury-loving  invalid ,  but  for  the  fagged  brain 
and  jaded  body  it  can  provide  rest  and  means  for  enjoy- 
able open-air  life. 

Dr.  T.  N.  Brushfield,  in  his  atrractive  Uttle  guide, 
claims  that  Budleigh  Salterton  is  well  fitted  for  the 
treatment  of  many  cases  of  pulmonary  consumption, 
the  equable  temperature  and  mild  winters  being 
particularly  suited  for  the  conduct  of  open-air  hfe,  so 
essential  for  the  patients.  "  The  chmate  benefits  many 
cases  of  spasmodic  asthma  often  modifying  and  lessening 
the  painful  attacks,  especially  in  those  who  come  from 
inland  places." 

Rheumatism  is  rare  and  rheumatic  subjects,  perhaps 
•owing,  at  least  in  part,  to  the  absence  of  a  clay  subsoil, 
do  well.  Cases  convalescing  from  zymotic  diseases 
•should  do  well  here.  Delicate  and  rapidly-growing 
children  will  find  ample  opportunities  for  health-giving 
occupation  out  of  doors.  Invalids  and  aged  will  find 
the  peace  and  quiet,  peculiarly  attractive.  Efforts  are 
being  made  to  develop  Budleigh  Salterton  as  a  winter 
resort. 

The  hotel  accommodation  is  at  present  somewhat 
limited,  but  furnished  apartments  in  good  positions  can 
usually  be  obtained.  Budleigh  Salterton  is  easy  of 
access.  It  is  170  miles  from  London  and  is  reached  by 
the  London  and  South- Western  Railway,  vid  Sidmouth 
Junction  and  Tipton  St.  John,  or  through  Exeter 
and  Elxmouth.  During  the  summer  months  a  fast 
train    leaves   Waterloo   at    11.20,    reaching   Budleigh 

(a)  '*  Summary  of  thaBeports  of  Medical  Offioen  of  Health  for 
tiouth  I>evon"  (1902).  By  William  Har*ey,  F.R.0.8.  Exeter  :  Deron 
Oounty  CoancilOfncet,  1908. 


Salterton  at  3.59.  Fortunately  for  the  peace  and  quiet 
of  this  desirable  resort  there  is  no  Sunday  service  of 
trains. 


J'rance. 


[from  our  own  correspondent.] 


Paris,  July  S4th,  1904. 
Poisoning  by  Camphorated  Naphthol. 

M.  Guinard  sounded  a  cry  of  alarm  at  the  meeting 
of  the  Soci^te  de  Chirurgie,  d  propos  of  injections  of 
camphorated  naphthol.  A  patient,  aet.  28,  of  otherwise 
healthy  appearance,  entered  the  hospital  for  a  volu- 
minous cold  abscess  on  the  right  side  of  the  neck. 
The  purulent  collection  was  tapped  with  Potain's 
apparatus,  giving  issue  to  a  certain  quantity  of  pus, 
which  was  immediately  replaced  by  an  ounce  and  a  half 
of  camphorated  naphthol,  introduced  by  a  cannula. 
Five  minutes  after,  the  patient  was  seized  with  epilepsy, 
initial  cry.  biting  of  the  tongue,  sanguineous  saliva  from 
the  lips,  clonic  spasms  followed  by  tonic  spasms,  with 
general  stiffness  and  threatening  asphyxia.  After 
several  struggles,  the  patient  succumbed,  in  spite  of 
every  artificial  means  used  in  such  cases. 

After  this  accident,  M.  Guinard  searched  in 
medical  literature  for  any  similar  cases,  and  found 
eight  deaths  and  fourteen  cases  of  grave  poisoning. 
Now  this  agent  is  very  frequently  employed  by  prac- 
titioners for  tuberculous  ganglions.  Of  the  eight  fatal 
cases  collected  by  M.  Guinard,  four  were  previously 
published,  and  in  no  case  was  it  possible  to  incriminate 
the  quality  of  the  liquid  injected  nor  the  dose  employed. 
In  the  fatal  cases  cited  the  dose  was  5  c.c.  in  two 
patients,  in  others  10,  20,  or  25  c.c,  and  in  one  only 
i  c.c.  was  used. 

The  symptoms  of  poisoning  were  generally  the  same, 
epileptic  seizures,  convulsions,  fainting,  face  congested, 
with  respiratory  trouble,  arythmic  pulsation  of  the 
heart,  death. 

These  symptoms  occurred  very  rapidly  after  the 
injection — from  a  few  minutes  to  three-quarters  of  an 
hour.  In  five  of  the  above  cases  they  were  observed 
two  minutes  after  the  injection.  Death  followed  in 
ten  minutes  in  one  case,  and  one,  two,  or  three  hours 
in  the  others. 

What  is  the  toxic  agent  ?  asks  Dr.  Guinard.  Is  it 
the  naphthol,  the  camphor,  or  the  mixture  of  both 
these  agents  ? 

Numerous  experiments  were  made  on  animals  to 
find  an  answer  to  this  question,  and  the  following  con- 
clusions were  arrived  at : — 

1.  Camphorated  naphthol  possesses  toxic  properties. 

2.  The  camphor  alone  produced  the  symptoms  of 
poisoning,  as  camphorated  naphthol  represents  an 
intimate  molecular  combination,  and  that  the  camphor 
was  more  soluble[than  naphthol ;  it  is,  therefore,  rational 
to  attribute  to  the  camphor  the  symptoms  observed. 

3.  It  is  demonstrated  that  camphorated  naphthol  is 
more  toxic  than  spirits  of  camphor,  camphorated  oil, 
or  naphtholated  spirit  taken  separately. 

4.  As  naphthol  alone  is  toxic  to  some  extent,  it  may 
be  inferred  that  when  combined  with  camphor  the 
toxic  properties'  are  greatly  increased. 

In  face  of  such  evidence,  M.  Guinard  rejects  syste- 
matically all  preparations  of  camphor  and  naphthol, 
regarding  them  as  highly  dangerous  and  by  no  means 
indispensable  to  the  cure  of  tuberculous  ganglions. 
Diagnosis  of  Ataxy. 

The  incipient  stage  of  ataxy,  says  Dr.  Milian.  is 
extremely  insidious,  or  hidden  behind  some  functional 
symptoms  leading  the  unwary  astray.     One  patient 


g2     The  Midical  Pmss. 


GERMANY. 


July  27.  1004. 


will  complain  of  lancinating  pains,  which  he  attributes 
to  rheumatism  ;  another  of  gastric  trouble  resembUng 
ulcer  of  the  stomach,  and  so  on.  Yet  it  would  be  of  the 
greatest  interest  to  the  patients  if  the  diagnosis  of  loco- 
motor ataxy  were  affirmed  at  the  outset,  as,  if  the 
mercurial  treatment  has  any  chance  of  success,  it  is  at 
this  stage  only.  To  reach  this  end  it  is  necessary  that 
the  syphiUtic  patient  be  followed  more  or  less  for  five, 
ten,  or  fifteen  years,  and  that  he  should  pay  periodic 
visits  to  his  physician  to  have  his  nervous  system  ex- 
amined. It  is  for  the  physician  to  watch  for  any  sym- 
ptoms of  ataxy. 

The  examination  should  bear  upon  the  sensitiveness 
of  certain  regions,  the  reflexes  and  the  condition  of  the 
muscles. 

Sensation  to  pain  is  the  most  important  symptom 
to  study,  and  a  simple  pin  is  sufficient  for  the  purpose. 
The  regions  more  or  less  insensible  to  pain  are  the 
little  finger,  the  soles  of  the  feet,  and  the  breast,  both  in 
man  and  woman.  There  is  generally  also  delay  in  the 
perception  of  the  sensations,  especially  observed  in  the 
points  furthest  from  the  centres. 

The  muscular  sensation  is  also  affected  at  the  incipient 
period  of  the  disease  ;  the  patient  loses  the  notion 
of  the  position  of  his  limbs.  In  placing  one  leg  over  the 
other  in  the  bed,  the  patient  is  unable  to  tell,  eyes 
closed,  their  respective  positions.  In  the  upright  posi- 
tion, the  loss  of  muscular  sensation  is  revealed  by  the 
impossibility  of  maintaining  the  equilibrium  with 
closed  eyes.  This  sign,  known  as  that  of  Rom- 
berg, can  present  every  degree,  from  simple  oscillation 
to  falling.  This  sign  affects,  but  to  a  lesser  extent,  the 
muscles  of  the  trunk  and  the  arms.  If  the  patient 
lies  on  his  back,  the  legs  and  thighs  drawn  up  and 
embraced  by  the  two  arms,  he  will  roU  to  the  right  or 
left  in  his  bed  as  soon  as  he  shuts  his  eyes. 

These  different  troubles  of  the  cutaneous  and  muscular 
sensitiveness  should  be  sought  for  with  care  as  they  are 
very  important  in  the  diagnosis  of  ataxy. 

As  regards  reflex  action,  that  of  the  skin  is  of  but 
indifferent  importance,  but  it  is  quite  otherwise  with 
the  tendons,  for  its  abohtionis  one  of  the  cardinal  signs 
of  the  malady. 

It  was  for  a  long*] time  believed  that  the  abolition  of  the 
patellar  reflex  (Westphal's  sign)  was  the  first  symptom 
of  ataxy,  and  to  a  certain  extent  the  idea  was  correct, 
but  Babinski  has  shown  that  the  abolition  of  the  reflex 
of  the  tendon  of  Achilles  was  still  more  important. 
It  consists  as  follows  :  The  patient  kneeling  on  a  chair, 
the  Achilles  tendon  is  smartly  struck  above  its  insertion. 
The  gastrocnemius  muscle  contracts,  producing  exten- 
sion of  the  foot.  One  should  not  be  contented  conse- 
quently, as  often  happens,  to  strike  the  knees  of  a 
patient,  and  because  the  patellar  reflex  is  present 
conclude  that  the  patient  is  not  ataxic.  An  individual 
can  be  affected  with  the  disease  with  the  patellar  reflex 
intact,  if  that  of  the  tendon  of  Achilles  be  abolished. 

The  examination  of  the  patient  terminates  with  the 
search  for  the  sign  of  Argyll-Robertson,  which  con- 
sists in  the  disappearance  of  the  contraction  of  the 
pupils  in  the  hght ;  this  sign  is  of  great  value.  Dufour 
performed  an  autopsy  on  a  man  who  had  presented  the 
sign  of  Argyll-Robertson  as  the  only  clinical  symptom 
of  locomotor  ataxy,  and  he  found  the  anatomical 
lesions  of  the  malady  of  Duchenne,  that  is  to  say, 
sclerosis  of  the  posterior  roots. 

With  this  systematic  exploration  of  the  patellar  and 
Achillian  reflex,  luminous  reflex,  sensitiveness  of  the 
sole  of  the  foot,  the  mammary  region  and  the  little  finger 
the  malady  can  be  recognised  at  its  outset. 


(3ermans« 

[from     our     own     correspondent.] 


Bbelim.  July  24tb,  1904. 

At  the  Surgical  Congress  Hr.  Beck,  Carlsruhe,  spoke 
on 
Chronic    Colitis    and    its    Treatment    based  on 

Surgical  Experience. 
He  said  that  in  chronic  colitis  the  accompanying  ner- 
vousness was  not  its  cause,  but  a  secondary  symptom. 
The  patient  could  not  maintain  the  diet  recommended. 
He  had  seen  and  treated  for  months  and  years  500 
cases  (170  men  and  330  women).  The  most  important 
thing  was  the  recognition  of  the  etiological  factor, 
and  the  treatment  must  correspond  to  this.  The 
causes  were  (i)  Diseases  of  the  appendix,  the  gall- 
bladder, the  other  abdominal  cont«;nts,  the  uro-genital 
organs.  He  had  seen  149  such  cases.  (2)  Circum- 
scribed diseases  in  the  colon,  such  as  carcinoma  (31 
times),  tuberculosis  (7  times),  actinomycosis  (twice). 
(3)  Acute  gastritis,  alcoholism,  nicotinism  and  other 
harmful  effects  on  the  stomach,  such  as  gastroptosis. 
The  majority  of  cases  were  those  of  women  suffering 
from  uro-genital  affections  and  changes  in  the  abdomi- 
nal interior  from  pregnancies;  257  cases  were  treated 
successfully  by  operation.  Of  the  243  cases  npt 
operated  on  operation  was  recommended  but  declined 
in  1 20.  No  improvement  had  taken  place  in  these 
cases.  Cases  caused  by  abuse  of  alcohol  and  tobacco., 
cirrhosis  of  the  liver  and  chronic  nephritis  were  not 
cured.  In  six  cases  the  whole  of  the  colon  was  put 
out  of  action  by  ileo-sigmoidostomy.  Five  of  these 
cases  were  cured;  one  in  which  Murphy's  button  was 
employed  died. 

At   the  Society  f.   innere  Medizin,    Hr.    A.    Plehn 
reported 
Two  Cases   of  Tumour  op  the  Central  Nervous 

System. 
The  first  was  that  of  a  young  woman,  aet.  23,  who  had 
passed  through  the  usual  illnesses,  had  suffered  from 
visual  disturbances  for  a  long  time  after  diphtheria, 
but  had  finally  lost  them.  From  her  childhood  her 
voice  had  been  nasal,  hearing  on  the  left  side  was  bad» 
and  she  had  been  anaemic  for  a  long  period.  In  January. 
1903.  she  had  a  child  which  was  healthy  but  had 
snuflles.  There  were  no  symptoms  of  syphilis.  Since 
March,  1903,  she  had  complained  of  headache,  which 
extended  from  the  forehead  to  the  occiput,  and  was 
accompanied  by  vomiting.  There  were  loss  of.  appe- 
tite, wasting  and  weakness  of  ^ight.  She  was  admitted 
into  hospital  in  September  last.  Examination 
showed  swelling  of  the  inguinal  glands  and  those  of  the 
neck,  slight  difference  in  the  pupillary  reaction  and 
broad  nodules  in  the  skin  of  the  abdominal  wall  and 
over  the  scapula,  which  were  believed  to  be  fibromata. 
The  nervous  system  was  otherwise  sound.  An  ophthal- 
mological  examination  showed  changes  in  the  fundus 
oculi,  the  papillae  were  only  recognisable  by  the  course 
of  the  vessels,  slight  clouding.  As  these  symptoms 
roused  a  suspicion  of  syphilis,  pot.  sod.  was  given,  and 
as  some  improvement  appeared  to  follow  it,  the  dose 
was  raised  to  7  grms.  pro  die  and  inunction  was  begun. 
After  this  the  general  symptoms  improved  very  much,, 
and  particularly  those  in  the  fundus  oculi.  Syphilis 
was  now  thought  certain.  The  patient  was  discharged 
from  hospital,  but  reappeared  two  months  later  with  the 
condition  very  much  worse.  She  complained  ot 
violent  headache,  especially  in  the  neck,  and  of  great 
disturbance  in  hearing  and '  seeing.  Examination 
showed  the  same  condition  as  before,  but  with  perfora- 
tion of   the   left  tympanum;  there  was  also  purulent 


July  27.  1904. 


AUSTRIA. 


The  Medical  Pkbss.     Q3 


catarrh  of  the  middle  ear.  although  there  was  none 
when  she  was  in  hospital  before.  The  former  diagnosis 
of  syphilis  could  not  therefore  now  be  maintained,  the 
symptoms  pointed  rather  to  tumour  in  the  brain  and 
probably  in  the  posterior  fossa.  Potassium  iodide 
was  again  given  as  it  was  also  useful  in  tumours  that 
were  not  specific,  with  improvement  in  the  symptoms. 
Lumbar  puncture  showed  an  intraspinal  pressure  of 
400  mm.  of  mercury,  which  sank  to  270  when  8  ccm. 
of  cerebro-spinal  fluid  had  been  drawn  off.  Still 
violent  headaches  and  vomiting  came  on.  On  puncture 
a  few  days  later  the  pressure  was  reduced  from  270  mm. 
to  1 10,  when  serious  trouble  arose.  In  one  night  fol- 
lowing there  was  extreme  collapse.  Two  days  later 
there  was  sudden  extreme  difficulty  of  swallowing  and 
bulging  forward  of  the  right  velum  palati  and  the  right 
part  of  the  wall  of  the  pharynx.  These  symptoms 
gave  rise  to  a  suspicion  of  pus  ;  they  subsided  to 
some  extent,  however,  later  and  remained  stationary 
from  February  to  June  22nd  last,  when  the  patient  died 
from  collapse.  During  the  whole  course  of  the  disease 
there  were  no  disturbances  of  the  nervous  system, 
except  towards  the  last  slight  facial  paralysis. 

The  second  case  was  that  of  a  man  who  was  admitted 
into  hospital  on  June  3rd  in  a  state  of  stupor.  So  far 
as  could  be  got  out  of  him  he  had  had  a  stroke  about 
three  weeks  before.  There  was  slight  left-sided  paresis, 
circumscribed  oedema  of  the  face,  nose,  forehead,  and 
both  eyelids,  the  veins  of  the  skin  in  the  parts  dilated 
and  tortuous.  Later  on  there  was  blocking  of  the 
ophthalmic  vein  at  the  base  of  the  orbit,  and  it  was 
assumed  that  the  compression  was  caused  by  a  neo- 
plasm. Lumbar  puncture  was  performed,  but  scarcely 
any  fluid  escaped,  possibly  ill  consequence  of  oblitera- 
tion of  communication  from  the  brain  to  the  cervical 
canal  by  a  tumour.  The  urine  was  normal.  Eventu- 
ally the  man  died. 

Hr.  Bender  observed  that  the  chief  interest  of  the 
cases  rested  on  the  slight  correspondence  between  the 
clinical  symptoms  and  the  anatomical  condition.  In 
the  first  cases  there  were  widespread  tumours  in  the 
peripheral  and  central  nervous  system,  and  in  the  second 
carcinose  necrosis  of  the  skull,  but  no  tumour  in  the 
brain  itself.  The  tumours  in  the  first  case  were  fibro- 
neuromata,  the  chief  tumour  being  in  the  meninges  of 
the  cerebellum. 


Hudtria* 


[from  our  own  correspondent.] 


YiavHA,  July  a4th,  1004. 
Theory  of  the  Streptococcus  Serum. 

At  the  Congress  for  innere  Medizin,  Menzer  drew 
attention  to  his  sera  of  streptococci,  which  he  had  not 
transmitted  through  animals  before  applying  them  to 
acute  rheumatism  with  excellent  results.  They  are 
especially  useful  in  that  form  of  transmissible  rheu- 
matism. He  has  recently  applied  some  of  this  serum 
in  mixed  tuberculous  cases  with  equally  good  results, 
but  he  would  like  to  have  more  experience  in  the  latter 
before  dogmatising  on  the  subject. 

Aronson  thought  that  the  febrile  reaction  obtained 
by  Menzer  was  due  to  the  transmission  of  a  toxin 
into  the  system.  The  serum  used  by  himself  caused 
no  fever. 

Wolff  was  of  opinion  that  the  fever  might  be  the 
result  of  an  endotoxin. 

Michaelis  asked  Menzer  if  he  used  the  same  serum 
for  articular  rheumatism  as  he  did  for  the  tuberculous 


cases. 


in  the  streptococci,  as  the  purulent  result  of  tubercle 
is  very  different  from  articular  rheumatism,  where  no 
pus  ever  occurs. 

Menzer  said  the  serum  from  the  same  animal  con- 
tained different  streptococci.     If  Aronson  got  no  re- 
action or  fever  with  his  serum  the  probability  is  that 
it  was  below  the  necessary  strength  ! 
Croupous  Pneumonia. 

Stuertz  gave  a  history  of  his  experiments  with  the 
sputa  of  croupous  pneumonia  on  white  mice,  which 
died  in  the  same  manner.  The  virulence  and  clinical 
symptoms  were  the  same  in  both  mice  and  men,  which 
led  him  to  believe  that  this  test  might  be  of  prognostic 
value  in  forecasting  the  result  of  a  case  when  the  atten- 
dant is  placed  in  the  difficult  and  doubtful  position 
of  depending  on  the  varying  symptoms  that  are 
usually  manifested  in  these  doubtful  cases,  where  one 
exacerbation  after  another  points  to  intervals  of  morbid 
progress  and  ultimate  exhaustion. 

Hepatic  Levulose  Ursa. 

Strauss  said  that  he  had  examined  upwards  of  a 
hundred  cases  with  levulose  in  the  urine,  and  found 
that  80  per  cent,  of  these  cases  suffered  from  hepatic 
disease,  which  left  20  per  cent,  for  genuine  alimentary 
levulose.  Sachs,  under  his  own  guidance,  had  de- 
monstrated that  with  levulose  in  the  muscles  no  distinc- 
tion could  be  discovered  between  glycogen  and  dextrose. 
Again.  Schrot  was  unable  to  isolate  levulose  from  a  mix- 
ture of  pancreas  and  muscle,  while  dextrose  was  easily 
distinguished.  He  concluded  from  these  results  that 
the  S3aiergia  of  muscular  movement  had  no  part  in 
the  production  of  levulose.  This  was  diametrically 
opposed  to  Schlesinger's  experiments  on  dogs.  He 
found  that  it  was  easier  to  obtain  the  levulose  product 
than  dextrose.  Whatever  the  cause  may  be  in  dogs, 
the  hypothesis  is  negatived  in  man. 

Ocular  Symptom  in  Diabetes. 

Krause  drew  attention  to  hypotonia,  or  peculiar 
ocular  symptoms  in  diabetic  coma  that  are  never 
generally  acknowledged,  which  appears  about  fifteen 
or  thirty-two  hours  before  death.  This  symptom  does 
not  appear  in  morbus  Basedowii,  Addisonii,  uraemia  or 
other  febrile  attacks  of  an  obscure  nature,  where  sudden 
comatose  conditions  often  arise  and  may  require  to  be 
differentiated.  It  presents  itself  in  both  bulbi,  but 
how  to  explain  it  Krause  would  not  presume  to  hazard 
an  opinion.  He  had  to  admit  exceptions,  as  in  eighty 
diabetic  cases  of  coma  that  ended  fatally  eighteen  had 
no  hypotonia  during  life.  He  suggested  that  the 
symptom  might  be  caused  by  low  pressure  in  the  blood- 
vessels produced  by  hydration  or  haematic  dyscrasia. 
This  hypothesis  could  not  be  borne  out  by  experiments 
on  animals,  as  dogs  treated  with  acetone,  acetic-acetone- 
ester,  iS-exybutyric  salts,  and  phlorodizin  never 
had  the  symptom  during  life,  although  the  drugs 
administered  had  been  used  differently,  sometimes  by 
the  mouth,  at  other  times  subcutaneously.  Other  dogs 
had  the  pancreas  removed,  the  animals  dying  of 
diabetes  ;  but  no  hypotonia  was  present  at  any  time. 
The  anatomical  examinations  of  the  bulbi  revealed  no 
morbid  condition  in  the  eye  itself. 

Motor  Functions  of  the  Vagus. 

Starck  gave  the  results  of  his  research  on  the  motor 
function  of  the  vagus.  The  elements  in  this  pheno- 
menon were  cardio-spasm,  paralysis  of  the  oesophageal 
muscles,  and  atrophy  of  the  vagus.  He  divided  his 
experiments  into  two  positions,  n>.,  resection  of  the 
nerve  above  the  hilus,  or  division  of  nerve  into  the  lung, 
and  that  below  the  hilus.  Section  of  the  nerve  always 
removes  the  inhibitory  action  on  the  cardia,  but  this  is 


^UJcu,   1.  iicuiua  LA9U1  ao  iic;  uxu   av/&    viic    i.ui.k»  viuiv/ua        icuiwco   l&ic  tuiiiuii.wj.jr   av^viv/ii  \/ii   1.11^  ^.^cuuia,   tju*.   i,iiAd  a^m 

If  this  were  so  there  must  be  a  great  difference     not  of  long  duration,  and  must  be  considered  temporary. 


94    The  Medical  Press. 


OPERATING    THEATRES. 


JXTLY    27.    1904. 


Resection  of  the  nerve  below  the  hilus  of  the  lung  pro- 
duced no  dilatation  of  the  oesophagus  ;  neither  did  it 
cause  any  weakening  of  the  heart.  When  the  section 
was  made  above  the  hilus,  on  the  contrary,  dilatation 
and  tachycardia  resulted.  Vagus  atrophy  may 
therefore  be  charged  with  producing  dilatation  of  the 
oesophagus  when  no  hypertrophy  of  the  muscle  is 
found,  as  a  paralysed  muscle  is  not  likely  to  become  so. 
He  concludes  with  the  assertion  that  when  we  meet 
with  hypertrophy  and  dilatation  in  the  oesophagus  we 
may  affirm  that  the  cause  is  not  degeneration  of  the 
vagus. 


ICbe  Operating  ICbeatred* 

CHELSEA  HOSPITAL  FOR  WOMEN. 
Abdominal  Panhysterectomy  for  Carcinoma  of 
THE  Body  of  the  Uterus. — Dr.  A.  Giles  operated  on 
a  woman,  st.  53,  with  the  following  history :  Six 
weeks  before  admission  she  had  been  under  the  care  of 
Dr.  Townsend  Barker,  complaining  of  hemorrhage, 
for  which  he  asked  Dr.  Giles  to  see  her.  The  uterus 
was  found  at  that  time  only  slightly  enlarged,  and  it 
was  decided  to  dilate  the  cervical  canal  and  explore 
the  uterine  cavity,  as  there  seemed  to  be  a  probability 
of  carcinoma  of  the  body  of  the  uterus.  This  was 
done,  and  some  rather  soft  fragments  were  removed 
by  the  curette ;  they  were  sent  for  microscopical 
examination  and  report  to  the  West  End  Pathological 
Laboratory,  and  Mr.  Eastes  reported  that  the  growth 
was  carcinoma.  It  was  then  decided  that  she  should 
go  into  hospital  for  hysterectomy.  The  patient, 
though  married,  had  had  no  children,  and  the  vagina 
was  rather  narrow.  In  view  of  this  fact  and  of  the 
situation  of  the  growth  in  the  body  of  the  uterus,  the 
abdominal  route  was  decided  upon.  The  operation 
performed  was  panhysterectomy  by  Mr.  Bland- 
Sutton's  method,  and  both  appendages  were  removed 
in  one  piece  with  the  uterus.  The  method  referred  to 
is  as  follows :  The  broad  ligaments  are  clamped  off 
with  forceps  in  the  usual  way  and  divided  up  to  the 
side  of  the  uterus,  the  uterine  arteries  are  seized  with 
forceps,  the  bladder  reflection  is  turned  down  in  front, 
and  a  small  peritoneal  flap  is  fashioned  behind.  The 
uterus  is  divided  just  above  the  point  where  the  uterine 
arteries  are  seized,  but  the  line  of  division,  instead  of 
being  carried  straight  across  the  uterus  as  in  the  ordi- 
nary supra- vaginal  amputation,  is  made  to  pass  down- 
wards and  inwards  on  all  sides,  so  that  eventually  the 
vagina  is  opened  and  all  that  is  left  behind  of  the  cervix 
is  a  thin  outer  shell,  and  the  portion  removed  shows  a 
tapering  lower  extremity  tipped  by  the  os  externum 
and  a  small  portion  of  the  vaginal  mucosa  surrounding 
it.  The  arteries  are  then  tied  off,  and  the  peritoneal 
flaps  brought  together  by  a  continuous  suture  of  fine 
silk.  The  abdomen  is  closed  by  the  usual  triple  layer 
method.  Dr.  Giles  said  that  this  case  was  a  very 
suitable  one  for  the  method  employed,  because  this 
allowed  for  the  complete  removal  of  the  uterus  and 
appendages  in  one  piece,  and  much  more  satisfactorily 
than  could  be  done  by  vaginal  hysterectomy.  When 
carcinoma  affected  the  cervix  it  was  of  course  necessary 
to  remove  the  whole  of  the  vaginal  covering  of  the 
cervix,  and  this  could  be  done  properly  from  the  vagina, 
but  in  a  case  where  the  growth  affected  the  body  of  the 
uterus  the  removal  of  the  vaginal  covering  was  less 
important  than  free  removal  of  the  broad  ligaments. 
The]  advantage  which  Mr.  Bland-Sutton's  method^of 
panhysterectomy  presented  over  other  methods  was 
that  as  the  dissection  was  carried  out  within  the  outer 
capsule  of  the  cervix,  there  was  no  possibility  of  injuring 
the  ureters  or  the  bladder.  The  method  was  devised 
for  dealing  with  uterine  fibroids,  but  was  useful  ailso 


for  cases  of  carcinoma  of  the  body  of  the  uterus.  The 
whole  organ  in  this  case  was  small,  affording  an  example 
of  that  interesting  class  of  case  in  which  carcinoma 
develops  in  an  atrophic  uterus  after  the  menopause. 

The  patient  made  an  uninterrupted  recovery,  and 
left  hospital  on  the  seventeenth  day  after  operation. 
ST.  GEORGE'S  HOSPITAL. 

Optical  Iridectomy. — Mr.  H.  B.  Grimsdaxe 
operated  on  a  girl,  act.  25,  who  had  been  suffering  from 
severe  recurrent  iritis,  as  a  result  of  which  the  iris 
became  totally  adherent  to  the  lens  and  the  pupil 
blocked  with  lymph.  Mr.  Grimsdale  pointed  out  that 
an  operation  was  necessary  for  two  reasons  :  in  the 
first  place,  to  re-establish  communication  between  the 
posterior  and  anterior  chambers  and  thus  to  prevent 
the  onset  of  secondary  glaucoma,  and,  in  the  second 
place,  to  form  a  new  pupil,  since  the  natural  one  was 
useless  for  visual  purposes  owing  to  the  lymph  on  the 
lens  capsule  ;  vision  had  been  reduced  in  each  eye  to 
recognition  of  the  movements  of  the  hand  at  two  feet 
distance.  He  also  said  that  this  necessity  governed 
the  choice  of  operation,  as  ordinarily  to  prevent  glau- 
coma the  surgeon  would  make  his  coloboma  in  that 
part  of  the  iris  which  would  be  covered  by  the  upper 
lid  ;  but  here  it  was  necessary  that  the  gap  in  the  iris 
should  be  exposed.  Mr.  Grimsdale  made  an  incision 
with  the  keratome,  having  an  extent  of  about  eight 
milhmetres  in  the  lower  and  outer  quadrant  of  the 
cornea  ;  he  then  introduced  a  pair  of  Dr.  Wecker's 
scissors  closed  through  the  wound  until  the  points 
reached  the  pupil.  Then  they  were  allowed  to 
open  slightly,  and  a  small  fold  of  iris  sprang  up  between 
the  blades.  On  closing  the  scissors  this  fold  was  cut 
off  and  withdrawn  with  them.  The  same  operation 
was  then  performed  on  the  other  eye.  A  drop  of 
atropine  solution  was  instilled  into  each  eye,  and  a  pad 
and  bandage  applied.  Mr.  Grimsdale  said  this  was  a 
form  of  operation  devised  by  Mr.  Brudenell  Carter,  but 
not  very  frequently  performed.  It  seemed  to  him  by 
far  the  most  suitable  for  such  cases  as  the  present. 
The  size  of  the  artificial  pupil  and  its  position  could  be 
selected,  and  varied  at  the  surgeon's  will.  It  was  most 
important  for  good  vision  that  the  iridectomy  should 
be  small,  and  he  reminded  the  onlookers  that  a  small 
iridectomy  suffices  in  secondary  glaucoma.  If  the  iris 
be  drawn  out  of  the  wound  with  forceps  the  fold  that 
is  cut  off  is  necessarily  larger  than  the  part  excised  in 
the  method  he  had  employed,  and,  further,  the  natural 
pupil  is  often  partially  freed  from  its  attachments  to 
the  lens  so  that  two  functional  pupils  remain,  giving 
rise  often  to  diplopia.  It  had  been  objected  to  the 
method  that  a  wound  of  the  lens  capsule,  and  conse- 
quent traumatic  cataract,  was  not  unlikely.  If  the 
points  of  the  scissors  were  allowed  to  enter  the  pupillary 
region  such  an  accident  might  occur,  but,  if  they  were 
kept,  as  he  advised,  outside  the  pupil,  it  was  difficult 
to  see  how  such  a  contretemps  could  happen.  As  to  the 
result  of  the  operation,  he  referred  to  a  case  which  had 
been  treated  in  this  way  two  months  previously.  The 
patient,  a  boy.  aet.  12.  had  a  similar  defect  in  his  left 
eye  to  that  of  the  present  patient.  His  vision  was 
only  capable  of  counting  fingers  at  two  feet  distance. 
A  fortnight  after  the  operation  it  had  risen  to  5. 

Exposing  a  Scarlet  Fever  Patient. 
At  Malvern.  Frank  Ganderton.  of  independent 
means,  residing  at  Malvern  Link,  was  summoned  at  the 
instance  of  the  District  Council  for  failing  to  notify 
that  his  son,  aged  five  years,  was  suffering  from  scarlet 
fever,  and  also  for  exposing  the  child  to  the  danger  of 
the  public  health.  The  evidence  showed  that  the  child 
was  in  bed  for  a  week,  was  sick,  had  sore  throat, 
swollen  glands,  and  rash.  Whilst  in  the  desquamating 
stage  the  child  was  sent  to  school.  The  parents  swore 
that  they  had  no  suspicion  of  scarlet  fever.  The 
Bench  inflicted  a  fine  of  £2  and  costs. 


July  27.  lood 


LEADING   ARTICLES. 


The  Medical  Press.      95 


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ITbc  /fteotcal  press   ano  Circulan 

"  SALUS   POPUU   SUPREMA  LEX." 

WEDNESDAY.  JULY  27,  1904. 


THE  DIMINISHING  BIRTH-RATE. 
The  birth-rate  of  any  given  community  clearly 
affords  data  of  great  value  as  regards  the  moral 
and  materia*  welfare  of  its  citizens.  It  does  not 
follow,  however,  that  the  significance  of  variations 
in  the  birth-rate^  is  always  rightly  interpreted. 
So  far  as  that  goes,  indeed,  the  whole  matter 
appears  to  be  on  the  borderland  where  laws  are 
beginning  to  loom  from  the  dense  mists  of  half 
knowledge  and  speculation.  Hence  it  is  in  the 
highest  degree  desirable  that  the  laws  which 
govern  the  birth-rate  should  be  freely  and  ade- 
quately discussed  by  competent  observers.  Un- 
fortunately, the  subject  has  been  generally 
tabooed  because  of  its  close  relationship  with  the 
prevention  of  conception  among  married  folk. 
If  that  be  a  great  social  evil,  as  many  moralists 
would  have  us  beUeve,  it  is  surely  a  mistaken 
policy  to  ignore  its  existence.  The  sounder 
attitude  of  our  moral  teachers  would  be  to  gauge 
as  far  as  maybe  the  true  inwardness  and  the  full 
relations  of  that  particular  practice  before  arriving 
at  a  working  decision.  The  Church  has  ignored 
prostitution,  but  that  vice  stalks  rampant  through 
our  streets,  and  exacts  a  terrible  toll  of  misery 
and  destruction  from  the  innocent  as  well  as  from 
the  guilty.  But  signs  are  not  wanting  that  the 
clergy  of  the  United  Kingdom  are  ready  to  speak 
out  upon  the  birth-rate  question.  The  Bishop 
of  Ripon  and  other  distinguished  churchmen 
have  spoken  publicly  upon  the  dechne  of  the 
birth-rate,  as  brought  forward  by  Dr.  Taylor, 
of  Birmingham,  in  an  address  published  in 
our  own  columns  in  March  of  the  present  year. 
The  pubUcation  of  that  article  has  given  rise  to 
universal  interest  and  discussion  in  all  classes  of 
society.  The  main  conclusion  was  that  the  decline 
of  the  national  birth-rate  was  due  to  practices  of 
prevention  among  married  persons,  and  that  the 
unfortunate  practice  in  question  was  attended  by 


evil  results  both  physical  and  moral.  Great 
credit  is  due  to  Dr.  Taylor  for  his  courage  in 
bringing  forward  a  difficult  subject  in  so  clear 
and  delicate  a  way.  His  article  raised  momentous 
issues,  and  was  clearly  inspired  by  a  strong 
personal  sense  of  social  and  moral  obligation. 
His  audience  was  primarily  medical,  and  his 
communication  published  in  a  medical  journal. 
His  views,  however,  have  not  been  allowed  to 
pass  unchallenged  by  his  own  profession.  His 
contentions  are  analysed  critically  and  discussed 
in  two  articles  by  Dr.  David  Walsh,  published  in 
the  issues  of  The  Medical  Press  and  Circular 
for  July  13th  and  20th.  It  is  impossible  to  enter 
at  length  into  the  various  points  raised  in  the 
second  paper.  Briefly,  Dr.  Walsh  admits  that 
there  has  been  a  fall  of  5-2  per  1,000  persons  living 
during  the  past  half  century.  At  the  same  time 
he  says  there  is  no  evidence  to  show  that  the  fall 
is  due  to  a  condition  exclusively  affecting  married 
Ufe.  A  similar  decrease  of  births  has  affected 
illegitimacy,  a  fact  not  considered  by  Dr.  Taylor ; 
yet  that,  taken  with  the  ever-increasing  later 
period  of  the  marriage  aige,  would  together  account 
for  a  great  deal  of  the  fall.  The  birth-rate  of 
1900,  again,  is  practically  the  same  as  that  of 
1840.  Thirty  years  of  rapid  increase  were 
followed  by  thirty  years  of  fall.  Is  it  possi- 
ble that  the  United  Kingdom  is  nearing  its 
hmit  of  supportable  population,  and  that  the 
falling  birth-rate  is  a  deUcate  index  of  waning 
prosperity  ?  There  is  Uttle  doubt  that  preventive 
methods  prevail  in  the  higher  ranks  of  society. 
Probably  it  is  only  a  question  of  time  for  similar 
practices  to  permeate  to  the  poorer  classes.  A 
crucial  question  is  how  far  this  kind  of  "  intel- 
lectual limitation "  of  famiUes  overlaps  the 
moral  obUgations  of  the  citizen.  The  subject  is 
one  of  the  most  complex,  and  at  the  same  time 
most  important,  that  could  engage  the  attention 
of  the  social,  the  scientific,  and  the  moral  re- 
former. In  our  opinion.  Dr.  Walsh  deserves 
careful  attention  when  he  suggests  that  the 
soundest  remedy  for  a  waning  birth-rate  may 
possibly  or  probably  be  found  in  laws  that  lead 
to  greater  equality  in  the  distribution  of  wealth, 
and  of  opportunity  to  the  individual  citizen. 

IS  A  homceopath  a  quack  ? 

An  interesting  libel  action  was  lately  tried 
in  Germany,  the  plaintiff  being  Dr.  Mende-Emst, 
a  homoeopathic  practitioner  of  Zurich,  and  the 
defendant  Dr.  Spartz,  the  editor  of  the  Muenchener 
medizinische  Wochenschrift.  Dr.  Spartz's  journal 
had  published  an  article  in  which  Dr.  Mende- 
Emst  was  referred  to  as  "  the  well-known  char- 
latan and  homoeopath,"  a  conjunction  of  designa- 
tions to  which  the  latter  look  strong  exception, 
so  much  so  that  even  after  Dr.  Spartz  had  pub- 
lished an  announcement  that  Dr.  Mende-Emst 
was  a  duly  quaUfied  medical  graduate  of  Zurich 
he  found  himself  sued  for  Ubel  by  the  indignant 
homoeopath.  A  number  of  witnesses,  including 
von  Winckel,  the  great  authority  on  forensic 
medicine,  were  called  by  the  defence  to  show  that. 


96    The  Medical  Peess.    NOTES    ON    CURRENT    TOPICS. 


July  27.  1904. 


however  well  a  man  might  be  qualified  in  the  view 
of  the  law,  from  the  point  of  view  of  scientific 
medicine  he  deliberately  placed  himself  on  a  level 
with  charlatans  when  he  embraced  and  practised 
the  exploded  system  of  Hahnemann,  von 
Winckel  quoted  the  amusing  dictum  of  MuUer 
that  the  principles  of  homoeopathy  seemed  to  him 
to  be  about  the  same  as  if  after  a  man  had  been 
run  over  by  a  wagon  he  should  be  treated  by 
having  a  toy-cart  run  backwards  and  forwards  over 
him  three  times  ;  and  he  showed,  moreover,  how 
homoeopathy  is  used  to  hoodwink  and  deceive 
the  public,  just  as  much  as  frank  charlatanism 
is.  Spartz,  in  his  evidence,  dwelt  on  the  fact 
that  homoeopaths  were  in  reality  worse  than  quacks, 
in  that  they  had  been  instructed  in  the  scientific 
basis  of  medicine  and  had  eschewed  it  in  favour 
of  ridiculous  doctrines,  such  as  that  the  '*  in- 
tellectual vital  force  was  dynamically  out  of 
time,"  and  that  it  was  inconceivable  that  any 
man  who  had  been  taught  pathology  could  act 
so  from  conviction.  The  other  scientific  witnesses 
spoke  to  the  same  effect,  saying  that  from  the 
point  of  the  profession  homoeopaths  rank  as 
quacks.  As  it  happens,  however,  the  Bavarian 
law  recognises  homoeopaths,  and  in  the  end  the 
editor  had  to  pay  a  nominal  fine  and  costs,  al- 
though it  was  clearly  established  that  there  was 
no  question  of  personal  malice.  For  a  long  time 
past  the  homoeopaths,  in  this  country  at  least, 
have  been  holding  out  the  olive  branch  to  those 
whom  they  are  pleased  to  call  **  allopaths,"  or 
**  antipaths,"  for  they  are  tired  of  being  cold- 
shouldered  by  the  self-respecting  members  of  the 
profession,  and  they  are  willing,  as  expressed  by 
the  mouths  of  some  of  their  leading  spokesmen, 
to  give  up  their  sectarian  character.  No  doubt 
it  would  suit  them  well  to  be  able  to  meet  scientific 
physicians  in  consultation  in  dangerous  cases, 
and  to  have  eminent  surgeons  to  operate  on  their 
patients  when  they  are  in  difl&culties,  so  long, 
that  is,  as  they  can  retain  the  hold  that  they  have 
on  the  section  of  the  public  who  see  magic  in  the 
blessed  word  *'  homoeopath."  But  the  homoeo- 
pathic practitioner  cannot  have  it  both  ways,  and 
while  he  professes  to  practise  a  hole-in- the-corner 
system  he  cannot  expect  scientific  men  to  meet 
him  and  recognise  him  as  one  of  themselves.  In 
this  country,  as  in  Germany,  it  may  not  be  legal, 
or  even  scientific,  to  call  a  homoeopath  a  "  quack," 
if  a  quack  is  taken  to  be  "a  boastful  pretender 
to  medical  skill  that  he  does  not  possess," 
but  the  gulf  that  separates  the  man  who 
holds  the  pathology  of  disease  to  be  the  basis  of 
rational  treatment  from  one  who  holds  that 
pathology  is  irrelevant  to  treatment,  and  that  the 
*'  vitality  of  symptoms  "  is  the  true  guide  to  the 
prescription,  is  one  that  cannot  be  bridged.  The 
homoeopath  of  to-day  is  certainly  very  far  re- 
moved from  the  enthusiast  who  held  that  the 
"  itch  was  the  cause  of  seven-eighths  of  all  chronic 
diseases  "  and  that  *'by  thetritrationandsuccussion 
of  drugs  there  is  an  actual  exaltation  of  medicinal 
power,  a  real  spiritualisation  of  the  dynamic 
property,    a     true,    astonishing     unveiling     and 


vivifying  of  the  medicinal  spirit."  They  have 
indeed  given  their  master  the  go-by  in  almost 
everything  ;  they  do  not  scruple  to  use  remedies 
that  confessedly  act  on  allopathic  principles, 
and  they  admit  the  virtues  of  such  a  radical 
antipathic  ally  as  surgery.  In  fact  the  homoeo- 
path now  is  very  much  of  an  eclectic,  and  when 
he  hears  a  method  of  treatment  is  doing  good 
he  does  not  wait  to  see  if  its  acts  on  the  "  similia 
similibus "  or  the  "  contraria  contrariis "  prin- 
ciple before  adopting  it  in  his  practice.  He 
reserves  his  globules  of  bryonia  and  his  pilules 
of  Pulsatilla  for  old  ladies  who  have  not  much 
wrong  with  them,  and  for  children  who  wiU  get 
well  if  not  treated  much  with  anything,  and  if 
taxed  with  inconsistency,  he  will  exercise  a  deal 
of  casuistry  to  show  that  a  potent  treatment, 
such  as  antitoxin  in  diphtheria,  is  quite  ad- 
missible under  homoeopathic  rules.  Indeed,  the 
most  wonderful  thing  about  the  modem  homoeo- 
path is  his  aptitude  for  sophistries,  and  the 
amount  of  ingenuity  he  can  expend  on  showing 
that  in  spite  of  all  appearances  he  remains  a 
homoeopath  is  worthy  of  a  better  cause.  But 
in  so  fax  as  the  homoeopath  is  removed  from  a 
quack  and  approaches  to  "  allopathic  "  standards, 
it  is  difficult  for  the  unsophisticated  to  believe 
in  his  disinterestedness,  and,  quack  or  no  quack, 
it  behoves  the  medical  profession  to  give  him  a 
wide  berth  while  he  continues  to  obtain  practice 
on  the  pretence  of  having  some  esoteric  principle 
up  his  sleeve.  When  he  confesses  that  he  is 
prepared  to  drop  his  sectarian  title  and  to  da 
what  is  best  for  his  patient,  irrespective  of  system 
or  creed,  it  may  be  feasible  to  absorb  him  into  the 
general  rank  of  the  profession.  But  that  day 
is  not  likely  to  come  in  this  generation. 


floted  on  Current  ICopicd. 

H3npnoti8m  in  the  Eeust. 
There  is  no  doubt  that  Oriental  medicine  has 
not  received  all  the  attention  it  deserves  from 
Western  inquirers.  Eastern  civilisation  has  been 
for  so  many  centuries  stationary  that  all  old  beliefs^ 
being  freed  from  that  healthy  spirit  of  scepticism 
which  is  necessary  for  the  preservation  of  truth  in 
its  purity,  have  naturally  become  crusted  over 
to  such  an  extent  as  to  render  their  meaning  ob- 
scure and  their  value  indeterminate.  To  multiply 
metaphors,  as  Sancho  Panza  does  proverbs, 
there  is  but  a  half  penny- worth  of  bread  to  an  in- 
tolerable deal  of  sack,  or,  in  plainer  language,  a 
grain  of  com  to  a  bushel  of  chaff.  Still,  to  the 
curious  there  is  often  much  interest  in  turning 
over  the  chaff  to  find  the  grain,  which  may  be, 
moreover,  a  good  sound  one  when  discovered. 
Several  of  what  in  these  countries  and  in  our  new 
civilisation  we  are  accustomed  to  consider  most 
modem  methods  of  treatment  have,  in  fact,  been 
known  in  the  East  for  ages.  Readers  of  *'  Kim  " 
will  remember  Mr.  Kipling's  description  of  massage 
as  practised  in  India,  and  as  it  was  practised  there 
centuries  before  its  introduction  into  Western 
therapeutics.     Indeed,  we  cannot  but  notice  the 


July  27,  1904* 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.    97 


similarity  between  the  treatment  undergone  by  j  on  the  evidence  he  found  ;  moreover,  that  it  was 


Kim  after  his  exhausting  journey  and  the  method 
of  treatment  associated  with  the  name  of  Dr.  Weir 
Mitchell.  Similarly,  the  induction  of  anaesthesia 
for  surgical  purposes  is  part  of  the  old  knowledge 
of  further  India,  while  many  of  the  phenomena  of 
hypnotism,  known  to  us  here  only  in  this  genera- 
tion, have  been  made  use  of  for  all  sorts  of  pur- 
poses "  east  of  Suez  "  as  far  back  as  history  goes. 
In  the  Malay  Peninsula  the  hypnotic  state  is 
known  under  the  name  of  lotah,  and  is  clearly 
recognised  by  the  natives.  Dr.  Percy  Gerrard 
has  recently  reported  (a)  an  interesting  case  which 
came  under  his  own  observation,  in  which  the 
hypnotic  state  could  be  easily  induced  by  giving 
the  patient  a  sudden  shock  of  any  kind.  An 
unexpected  clapping  of  the  hands,  a  shout,  or  a 
poke  in  the  ribs  was  sufficient  to  reduce  the 
patient,  a  young  and  intelligent  Javanese  woman, 
to  the  condition.  The  duration  of  her  paroxysm 
was  in  direct  proportion  to  the  period  of  continuance 
of  the  excitement,  but  usually,  when  left  alone,  she 
quite  recovered  herself  in  about  half  an  hour. 
While  in  the  condition  of  latah  she  scolded  and 
jabbered  in  violent  and  meaningless  language,  but 
was  entirely  amenable  to  commands  given  her  by 
bystanders.  We  hope  Dr.  Gerrard  will  be  able, 
as  he  promises,  to  pursue  his  researches  further 
into  this  interesting  condition,  and  its  occurrence  in 
the  Ma^ay.  

"  Sinffle  Cases  "  of  Lunaoy. 

The  report  01  an  inquest  at  Battersea  last  week 
shows,  if  demonstration  be  needed  at  all,  the 
necessity  for  some  such  measure  as  that  which 
the  Attorney-General  is  trying  to  pass  into  law 
this  Session.  This  Bill,  which  has  already  been 
commended  in  our  columns,  seeks  to  give 
power,  on  single  medical  notification,  for  a  patient 
who  shows  signs  of  mental  aberration  to  be  placed 
for  a  period  not  exceeding  six  months  in  the 
private  house  of  a  medical  man  for  observation 
and  treatment.  Such  a  measure  meets  those 
cases  of  shght  mental  disease  which  need  care 
and  supervision,  and  which  a  medical  man 
hesitates  to  certify  as  insane  and  send  to  an 
asylum.  In  the  instance  under  notice,  a  Miss 
Ellen  White  first  developed  some  delusions  on 
May  1 6th,  and  Dr.  Needham,  of  Clapham  Park, 
was  consulted.  He  advised  her  sister  that  she 
was  insane  and  should  be  removed  to  the  infirmary, 
but  the  sister  was  shocked  at  the  idea,  as  relatives 
always  are,  and  it  was  arranged  that  Dr.  Needham 
should  try  to  get  her  into  a  Ucensed  house.  This, 
however,  could  not  be  managed,  and  eventually 
she  was  taken  into  a  private  nursing  home  at 
two  guineas  a  week.  Under  a  course  of  bromide 
she  became  rational  in  the  course  of  a  fortnight, 
but  great  weakness  set  in,  and  she  was  eventually 
removed  to  the  infirmary,  where  she  died.  The 
Coroner  closely  examined  Dr.  Needham  as  to  the 
insanity,  and  he  stated,  in  reply  to  the  questions, 
that  he  was  not  certain  that  she  was  a  lunatic, 
and  that  he  did  not  care  to  fill  up  a  certificate 

(a)  Dub,  Joum.  M*d.  Sei,,  Jnly,  1904. 


a  common  custom  to  keep  patients  in  a  home 
prior  to  certifying  them.  After  hearing  the 
witnesses,  Mr.  Troutbeck  proceeded  to  make  some 
strong  remarks  as  to  the  propriety  and  legality 
of  keeping  a  lunatic  in  an  unlicensed  house,  and 
the  jury,  in  finding  that  the  death  was  from 
natural  causes,  expressed  the  opinion  that  a 
further  inquiry  should  take  place.  No  better 
example  of  the  difficult  and  delicate  situation  in 
which  medical  men  so  frequently  find  them- 
selves placed  could  be  given  than  this  ;  nothing 
shows  more  plainly  the  urgency  for  legalising  the 
practice  of  providing  a  half-way  house  for  slight 
and  incipient  cases  of  insanity.  The  fact  that  in 
this  particular  instance  some  doubt  is  thrown 
on  the  skilled  nature  of  the  nursing  does  not 
invalidate  the  general  proposition. 


A  Historic  Drufir  House. 
The  announcement  that  Messrs.  Francis  New- 
bery  and  Sons,  of  Charterhouse  Square,  have 
converted  their  business  into  a  limited  liability 
company  recalls  some  interesting  particulars 
with  regard  to  the  history  of  a  mercantile  concern 
which,  by  reason  of  its  antiquity,  is,  we  think, 
unique  in  the  drug  trade.  It  is  almost  one  hundred 
and  sixty  years  since  John  Newbery,  a  seller  of 
drugs  at  Reading,  came  to  London  and  started 
business  in  St.  Paul's  Churchyard.  In  the  same 
year  we  find  him  entering  into  a  contract  with 
Dr.  James  for  the  sale  of  his  famous  powder. 
He  and  his  son  Francis  seem  to  have  early  ac- 
quired a  reputable  name  among  the  citizens  of 
London,  and  we  find  them  on  terms  of  intimacy 
with  Dr.  Samuel  Johnson,  for  the  great  lexico- 
grapher is  noted  as  being  present  at  a  house- 
warming  given  in  1779  by  Francis  Newbery  on  his 
removing  into  another  house  in  St.  Paul's  Church- 
yard. This  was  the  second  move  made  by  New- 
bery's  business,  without  leaving  the  Churchyard, 
but  it  now  remained  in  the  same  house  for  exactly 
ninety  years.  Between  1869  and  the  present, 
however,  no  less  than  three  changes  have  been 
made  before  reaching  its  present  quarters.  The 
directors  of  the  new  company  are  the  great-grand- 
sons of  the  original  John  Newbery,  and  the  con- 
cern has  descended  regularly  from  father  to  son 
through  its  whole  history. 


Magnetic  Opium. 

The  subject  of  hypnotism  and  its  allies  has 
always  been  one  in  which  our  French  confrhes 
have  taken  the  keenest  interest,  and  mar- 
vellous indeed  were  the  tales — they  have  not  been 
so  common  of  late — that  used  to  emanate  from 
the  cliniques  of  their  neurologists.  Since  Mr. 
Ernest  Hart  went  over  to  investigate  some  of 
the  phenomena  that  were  reported,  and  returned 
home  with  a  somewhat  modified  opinion  of  the 
perceptive  acuity  of  their  authors,  things  have 
been  quieter.  But  now  and  again  astonishing 
stories  still  appear,  and  they  certainly  make 
interesting  reading,  if  nothing  else.  In  Wa^  Revue 
de   VHypnotisme  a  tale  is  told  of  a  young  woman 


9^     The  Medical  Pbess 


NOTES  ON  CURRENT  TOPICS. 


July  27,1904. 


— most  of  the  subjects  are  young  women — of  a 
restless,  impulsive,  jealous  disposition,  who  had 
taken  to  the  opium  habit.  Far  from  aggravating 
her  awkward  traits  of  character,  and  leading  her 
to  moral  ruin,  the  opium  seemed  to  act  like  a 
charm  ;  she  became  quiet  and  demure,  careful 
and  economical ;  in  short,  a  pattern  of  all  the 
virtues.  Instead  of  being  thankful  for  the 
change,  she  was  so  ungrateful  as  to  give  up  the 
drug,  and,  hey  presto  !  back  came  the  jealousy, 
the  restlessness,  the  extravagance.  Obviously 
this  was  a  disadvantage,  and  this  erratic  young 
woman  determined  to  subdue  her  evil  tendencies 
by  resorting  to  opium  once  more.  Welcome 
success  attended  her.  She  became  shrewd  and 
cautious,  quiet  and  sedate,  reason  and  reflection 
yet  again  characterised  her  dealings  with  her 
fellow-creatures.  The  Revue  ingenuously  points 
out  that  the  question  would  arise  in  the  psycho- 
logist's mind  whether  her  morphine  personality 
was  not  superior  to  her  natural  self.  But  why 
to  the  psychologist's  only  ?  Would  it  not  be 
patent  to  every  man  with  a  brain  in  his  head  that 
this  elegant  young  lady's  salvation  lay  in  her 
becoming  a  confirmed  morphinomaniac  ?  We 
fear  if  it  is  revealed  to  the  world  that  opium  has 
this  Dr.-Jekyll-and-Mr.-Hyde  effect,  a  good  many 
people  will  take  to  putting  laudanum  in  the  drinks 
of  their  objectionable  relatives  to  see  if  they  could 
not  be  transformed  into  amiable  and  lovable 
creatures,  just  as  anti-dipsomaniac  cures  are 
recommended  to  be  slipped  into  the  inebriate's 
glass  when  he  is  not  looking. 


Jaundice  and  the  Widal  Reaction. 

Ever  since  the  agglutination  test,  incorrectly 
ascribed  to  M.  Widal,  has  come  to  be  relied  on  in 
the  diagnosis  of  typhoid  fever,  exceptions  to  its 
application  have  been  noted.  On  ^the  one  hand, 
certain  cases  clinically  indistinguishable  from 
typhoid  fever,  but  failing  to  respond  to  the 
agglutination  test,  have  occurred.  These  have  now 
been  recognised  as  forming  a  distinct  entity,  not 
only  due  to  a  different  organism,  but  with  definite 
pathological  differences,  and  have  been  grouped 
under  the  common  term  *'  paratyphoid  fever." 
On  the  other  hand,  a  clumping  reaction  sometimes 
occurred  with  blood  which  came  from  patients 
to  all  appearance  free  from  typhoid  fever.  In 
some  cases  this  has  been  explained  by  the  fact 
that  the  patients  had  in  time  past  suffered  from 
th?  disease,  and  the  blood  had  retained  its  agglu- 
tinating power.  In  others  it  would  seem  that 
the  blood  has  congeni tally  an  agglutinating  action 
towards  the  typhoid  bacillus.  On  many  occasions, 
however,  the  positive  action  has  been  noted 
where  the  only  clinical  condition  calling  for 
attention  was  the  presence  of  an  attack  of  acute 
jaundice.  So  often  does  this  occur  that  it  has 
even  been  maintained  that  the  Widal  reaction 
is  present  as  a  rule  in  jaundice.  This  is  not  so, 
howevei^  for  many  cases  of  jaundice  occur  without 
the  reaction  being  present,  and  when  jaundice 
is  experimentally  induced  in  animals,  the  reaction 
is  always  absent.     Several  cases  of  jaundice  with 


positive  reaction  have  been  investigated  by 
Steinberg,  in  Germany,  and  by  Libman,  in  America, 
and  both  come  to  the  same  conclusion  that  where 
this  condition  occurs,  it  is  merely  an  atypical 
typhoid  infection.  It  is  held  that  the  jaundice 
in  such  cases  is  of  infectious  origin,  the  organism 
being  either  the  typhoid  bacillus  or  some  very 
closely  allied  organism.  In  several  of  Libman's 
cases,  indeed,  he  was  able  to  isolate  the  typhoid 
bacillus.  If  their  view  be  correct,  we  are  to 
look  on  what  has  been  regarded  as  an  exception 
to  the  principle  of  specificity  of  agglutinating 
reactions  rather  as  an  additional  fact  in  its 
favour. 


Noise  and  Sickness. 

To  sensitive  natures  there  are  few  things  harder 
to  bear  than  a  succession  of  unpleasant  auditory 
stimuli.  Under  certain  circumstances  the  healthy 
listener  can  hardly  tolerate  even  harmonious 
sounds,  much  less  discords  against  which  his 
whole  soul  rebels.  Men  of  less  sensitive  nerve 
centres  cannot  understand  or  appreciate  the  effects 
produced  by  noise  of  all  kinds  upon  their  more 
impressionable  brethren  whom  they,  therefore, 
consider  fussy  and  irritable.  It  cannot  be  denied 
that  there  is  a  good  deal  of  unnecessary  noise 
heard  in  the  streets  and  other  pubUc  places  of  large 
cities.  The  shouts  of  newsvendors,  the  shrieking 
of  locomotive-engines,  the  clanging  of  church  bells, 
and  the  grinding  of  street  organs  are  only  a  few 
of  the  unmelodious  sounds  that  might  be  more  or 
less  considerably  lessened.  That  modem  disease 
of  the  nervous  system,  neurasthenia,  owes  no 
small  part  of  its  origin  to  the  effects  produced  by 
noise  upon  the  receptive  organs  and  the  higher 
nerve  centres.  The  very  existence  of  a 
society  for  the  suppression  or  abolition  of  street 
noises  is  an  indication  that  civilised  humanity 
is  beginning  to  cry  out  against  some  of  the  paralys- 
ing influences  of  modem  hfe,  so  far  as  one  of  the 
special  senses  is  concerned.  Many  acute  diseases, 
especially  those  of  the  brain,  are  injuriously  affected 
by  noise,  and  patients  are  far  more  likely  to  do 
well  if  nursed  by  those  who  are  gentle  and  quiet 
in  their  ways  than  by  attendants  of  loud  voice  and 
blustering  habits.  Dr.  J.  A.  Guthrie,  of  the 
United  States  Navy,  has  recently  commented 
upon  the  great  value  of  the  "  silent  signal  "  in 
naval  manoeuvres,  the  orders  being  obeyed  with 
alacrity  and  without  confusion.  It  is  suggested 
that  electrical  methods  might  often  be  employed 
as  a  means  of  diminishing  unnecessary  noise. 


Registration  of  Nurses 
It  is  a  curious  fact  that  a  nation  like  our  own, 
which  depends  in  a  greater  degree  than  any  other 
oil  the  product  of  its  brains,  should  take  so  httle 
interest  in  educational  questions,  and  that  the 
interest  taken  is  mostly  by  way  of  hindering 
rather  than  of  advancing  the  educational  cause. 
This,  too,  when  the  other  progressive  nations  of 
the  world  are  spending  more  money  on  education 
every  year.  A  striking  commentary  on  this  state 
of  things  is  the  attitude  that  most  of  the  members 


July  27,    1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Pkess.    99 


of  the  medical  profession  have  taken  up  in  their 
evidence  before  the  Select  Committee  of  the  House 
of  Commons,  now  sitting  to  inquire  into  the  subject 
of  the  State  Registration  of  Nurses.  Dr.  Norman 
Moore,  of  St.  Bartholomew's  Hospital,  who  has 
had  fifteen  years'  experience  of  teaching  and  ex- 
amining nurses^  is  of  opinion  that  the  quaUties 
that  make  a  good  nurse  are  widely  distri- 
buted among  all  classes  of  the  community, 
and  therefore  that  any  steps  which  tend 
to  raise  the  standard  of  prehminary  education 
of  nurses  would  be  a  mistake,  as  it  would  cut  out  a 
number  who  were  otherwise  fitted  for  the  work. 
Compare  this  with  what  is  taking  place  in  America. 
In  the  Children's  Hospital  at  Boston  arrangements 
are  being  made  with  Simmons'  College,  a  neigh- 
bouring women's  technical  school,  by  which  all 
would-be  probationers,  before  joining  the  hospital, 
are  to  pass  through  special  courses  in  anatomy, 
physiology,  chemistry,  bacteriology,  and  sanita- 
tion for  four  months,  so  that  the  studies  in  these 
subjects  may  not  be  interfered  with  by  ward  work. 
After  the  four  months  have  elapsed  the  candidates 
are  to  go  into  the  Nursing  Home  for  two  months 
for  instruction  in  domestic  science,  cooking,  and 
the  essentials  of  practical  work  in  a  hospital. 
At  the  end  of  this  time  they  w'U  be  started  on 
their  three  years'  course  of  ordinary  hospital 
training.  With  every  regard  for  those  qualities 
that  make  a  nurse  acceptable  to  sick  people,  it  is 
impossible  to  overlook  the  fact  that  it  is  becoming 
more  necessary  every  day  for  nurses  to  have 
an  inteUigent  practical  acquaintance  with  the 
work  of  their  profession ;  and  with  plenty  of  can- 
didates always  coming  forward,  it  ought  not  to  be 
difficult  to  select  those  who  are  personally  suitable. 
For  our  own  part  we  are  all  in  favour  of  raising 
the  standard  of  their  training  and  education, 
and  of  giving  them  such  benefits  as  result  from 
registration,  both  for  their  sake  and  that  of  the 
public. 

Statin. 

A  NEW  drug  that  will  fill  ai  important  gap 
in  pharmacology  seems  likely  to  be  soon  within 
the  reach  of  physicians.  This  body  was  dis- 
covered accidentally  by  Landon,  who  was  working 
on  spleen-substance  with  a  view  to  proving  its 
usefulness  in  the  treatment  of  anaemia.  In  the 
course  of  his  studies  he  discovered  that  spleen- 
substance,  or  some  body  it  contains,  is  possessed 
of  great  haemostatic  powers,  and  that,  unlike  ad- 
renalin, it  produces  its  effect,  not  by  arterial 
contraction,  but  by  markedly  increasing  the  coagu- 
lability of  the  blood  itself.  It  is  now  generally 
recognised  that  valuable  as  adrenalin  is  for  ex- 
ternal application,  its  use  for  internal  haemorrhage 
is  frequently  contra-indicated,  as,  side  by  side  with 
the  diminution  of  volume  of  the  arterioles  it 
causes  increased  general  blood  pressure,  which 
tends  to  counteract  the  good  done  locally.  With 
stagnin,  as  Landon  has  named  his  new  product, 
this  is  not  so,  for  it  has  no  local  effect  on  the 
arteries,  and  in  conditions  like  menorrhagia  and 
haemoptysis,  when  the  only  chance  of  bringing 


about  haemostasis  is  by  acting  on  the  blood  itself, 
it  promises  to  have  a  wide  field  of  usefulness. 
Stagnin  is  prepared  from  the  fresh  spleens  of 
horses  by  mixing  the  scraped  pulp  with  salt 
solution  and  a  little  chloroform  and  alkali.  After 
extraction  for  twenty-four  or  fifty-eight  hours  at 
Z7°  C,  the  mixture  is  filtered  ;  the  filtrate  i3  then 
evaporated  and  precipitated  with  alcohol.  A 
dry  powder  is  eventually  obtained  which  dissolves 
readily  in  water  to  form  a  clear,  yellow  fluid. 
I  Stagnin  has  been  given  by  the  mouth  and  by  hypo- 
dermic injection,  but  its  most  marked  effects 
have  been  produced  by  the  latter  method.  With 
the  range  of  organo- therapy  developing  as  it  is, 
we  seem  likely  to  be  soon  in  possession  of  a  number 
of  most  valuable  additions  to  our  armamentarium. 


The  Dustman,  Old  and  New. 
In  spite  of  the  excellent  way  in  which,  on  the 
whole,  the  Public  Health  Acts  are  administered, 
there    are    many   weak    places  which  are    suffi- 
ciently obvious   even   to   the  man  in  the  street. 
I  The    methods     adopted   for   the    collection    and 
>  removal  of  house  refuse,  for   instance,  are   often 
I  primitive  as  those  of  the  Far  East.     In  a  certain 
I  set  of  lantern  shdes  which  are,  we  believe,  still 
I  exhibited  sometimes  by  health  lecturers,  there  is 
'  an  amusing  picture  of  a  public  official  who,  in 
'  strange  garb  and  bearing  a   disreputable-looking 
basket,  is  dignified  by  the  name  of  *'  A  London 
Dustman."      Such  a  spectacle  is  surely  at  relic  of 
past  times,  when  sanitation  was  in  its  infancy, 
and  it  is  to  be  hoped  that  official  has  changed 
greatly  since  this  particular  slide  was  prepared. 
Nevertheless,  there  is  still  much  to  be  desired  in 
the  manner  in  which  dust  and  other  refuse  is 
collected.     The  days  of  the  old  brick  dust-bins 
are,  happily,  ended,  at  least  so  far  as  the  metropolis 
is  concerned,  and  neater  and  more  compact   gal- 
vanised iron  receptacles  provided  with    tightly- 
fitting  Uds  have  supplanted  them  almost  entirely. 
The  householder's  premises  are  now    no    longer 
soiled  by  droppings  of  ashes   or  vegetable  debris 
from  the  dustman's  basket  during  his  weekly  or 
bi-weekly  visits,  as  was  formerly  the  case,  but, 
on  the  other  hand,  we  still  note  the  nuisance  of 
spilt  dust  when  bins  are  emptied  in  the  dust-cart. 
The  latter  is  frequently  a  source  of  much  amnoy- 
ance,  especially  in  windy  weather.    The  better 
collection  of  dust  was  the  subject  of  much  dis- 
cussion at  the  recent  Conference  of  the  London 
Sanitary  Authorities,  held  at  the  County  Hall, 
Spring  Gardens.     One  of  the  best  ways  of  removal 
<  of  house  refuse  would  be  for  the  full  bin  to  be  taken 
I  away  entirely  unopened,  and  a  clean  empty  one 
left  in  its  place.     The  caxt  bearing  the  full  bins 
could  then  proceed  directly  to  a  central  station, 
where  their  contents  could  be  appropriately  dealt 
with. 


Athletios  and  Hecdth. 

One  of  the  commonest  comments  made  by  the 

public  in  reference  to  the  domination  of  athletics 

over  the  youth  of  these  countries  and  of  America, 

is  that  a  devotion  to  athletics  is,  as  a  rule,  detri- 


100     The  Medical  Piut.  NOTES    ON    CURRENT    TOPICS. 


July  27,  1904. 


mental  to  longevity.     The  great  physical  strain 
undergone,  say,  in  a  boat-race  or  a  hard-fought 
sprint,   is  said   to  conduce   to  heart  disease    or 
heart  weakness,  and  wiseacres  are  always  ready 
to  back  up  their  opinion  by  a  reference  to  **  poor 
So-and-So."  who,  though  the  best  oar  of  his  time, 
died  before   thirty.     Those,   however,  who  have 
taken   the  trouble   to  investigate  for  themselves 
*  the  after-history  of   athletes  of  note  have  usually 
come    to    a   contrary    opinion.     In    England    an 
exhaustive  inquiry  into  the  health  of  past  members 
of  the  'Varsity  crews  has  shown  that  their  lives 
are,  in  an  insurance  sense,  '*  good  "  much  beyond 
the  average.     In  the  United  States  more  recently 
Dr.   Meylan;  of   the   Columbia  Gymnasium,   has 
examined  the  hves  of  one  hundred  and  fifty- two 
oarsmen  who  had  rowed  for  Harvard  in  the  forty 
years  185 2- 1892.     He  was  led  to  the  task  by  the 
statement  of  an  old  rower  that  all  the  other  men 
who  had  pulled  in  his  boat  had  died  young — a 
statement    proved,    on    careful    inquiry,    to    be 
entirely  fanciful.     Of  the     152  oarsmen,   123  are 
still   living,  and  have  most  of    them  been  inter- 
viewed by  Dr.  Meylan.     Of  those  who  died,  six 
were    killed  in  the  Civil  War,  one    in  a   railway 
accident,  and  one  in  a  carriage  accident — causes 
hardly  to  be  traced  to  the  ill  effects  of  athleticism. 
Of    those    who    died    of    disease,    heart   disease 
accounted  for  two,  pneumonia  for  three,  apoplexy 
for  two,  paresis  (?)  for  two,  cancer  for  one,  phthisis 
for    one.    Bright *s    disease    for   two,    alcoholism 
for  one,  while  the  causes  in  the  other  cases  were 
not  to  be  ascertained.     Certainly  from  such  a  list 
it  would  be  hard  to  trace  any  direct  relation  to 
athletics.     An   interesting   point  incidentally  dis- 
covered by  Dr.  Meylan  is  that  of  the  survivors  not 
one  has  made  a  failure  in  life,  and  most  of    them 
have   reached    the   class   that   was  so   frequently 
demonstrated   to  Martin  Chuzzlewit,   "  the  most 
remarkable  men  in  the  country." 


Heart    Massage. 

There  are  few  things  in  modern  surgery  which 
appeal  more  to  the  lay  mind,  which  delights  in 
sensations,  than  the  comparative  fearlessness 
which  now  marks  our  attitude  toward  the  heart. 
Time  was,  not  so  many  years  ago,  when  any 
wound  of  the  heart  was  regarded  as  necessarily 
fatal,  and  when  surgical  manipulation  of  that 
organ  would  have  been  regarded  as  an  act  of 
bravado  beyond  the  range  of  the  most  ambitious 
operator.  At  present,  however,  suture  of  the 
heart  has  been  practised  successfully  so  many 
times  that  it  is  regarded  as  the  direct  duty  of  the 
surgeon  in  cases  of  heart-wound.  Manipulation 
of  the  heart  in  another  condition  has  recently 
presented  itself  as  a  legitimate  procedure,  and 
calls  for  general  attention.  It  has  been  found 
that  in  cases  of  heart  failure  through  collapse,  and 
consequent  apparent  death,  the  heart  may  again 
be  excited  to  contract  by  grasping  it  in  the  hand 
and  performing  rhythmic  contractions.  This 
has  been  performed  successfully  in  some  cases,  and, 
as  the  patient  was  all  but  dead  at  the  moment  it  was 
undertaken,  no  question  of  added  risk  in  opening 


the  thoiax  need  arise.  Particularly  when  collapse 
occurs  during  the  course  of  a  severe  abdominal 
operation,  if  other  measures  for  restoring  cardiac 
activity  fail,  and  if  the  heart  cannot  be  grasped 
through  the  diaphragm,  it  would  appear  to  be  the 
duty  of  the  surgeon  to  incise  that  membrane, 
and  perform  rhythmic  contractions  of  the  heart 
It  is  possible,  too,  that  in  cases  of  apparent  death 
from  drowning,  heart  massage  may  succeed  where 
other  measures  fail.  This  is  certainly  the  case  with 
lower  animals,  as  Professor  Richet,  of  Paris,  is  in 
the  habit  of  demonstrating  in  the  case  of  dogs. 
It  is  hkely,  indeed,  that  the  ordinary  movements 
made  in  performing  artificial  respiration  act,  not 
only  on  the  lungs,  but  also,  by  pressure  on  the  heart 
walls,  as  a  mechanical  irritant  to  the  heart  itself. 

A  New  Disease. 
Dr.  Byrom  Bramwell  recently  brought  to  the 
notice  of  the  profession  a  curious  case  of  infantilism, 
which  he  believes  to  be  due  to  the  absence  or 
atrophy  of  the  pancreas,  or,  at  any  rate,  the  absence 
of  the  pancreatic  secretion.     When  first  seen  two 
years  ago,   the  patient,    a  lad  of    eighteen,    did 
not  appear  to  be  more  than  eleven  years  of  [age. 
He   was  well  proportioned,  bright,  and  intelligent, 
but  had  not  grown  during  the  previous  seven  years. 
He  suffered  from  chronic  diarrhoea  for  many  years  ; 
the  urine  was  free  from  sugar.     Several  tests  were 
employed  which  demonstrated  that  no   pancreatic 
juice  reached  the  intestine.     Dr.  BramweU  imme- 
diately started  treatment  with  pancreatic  extract, 
and   the  result  seems   to  support  his  diagnosis. 
The  diarrhoea  has  ceased,  and  the  bodily  develop- 
ment is  very  marked,  the  patient  having  increased 
five  and  a  half  inches  in  height,  and  a  stone  and  a 
half  in  weight.     The  sexual  organs,   which   two 
years    ago    were    infantile,    are    now    developing 
normally,  and  the  voice  has  become  masculine. 
Dr.  Bramwell  thinks  that  the  condition  has  not 
hitherto  been  recognised,  and  suggests  that  where 
it  has  occurred  it  has   probably  been    mistaken 
for   sporadic   cretinism,    though    the      points   of 
difference  are  obvious  enough. 


Nurses'  Slander  Aotion. 

An  action  was  heard  at  Londonderry  on  Juh'' 
2ist,  in  which  eight  nurses  employed  in  the  Derry 
Workhouse  Hospital  sought  to  recover  damages 
for  defamatory  words  stated  to  have  been  used 
by  a  female  guardian,  Mrs.  Morris.  This  person, 
since  her  election  to  the  Board  a  few  years  ago, 
appears  to  have  made  herself,  in  the  words  of 
her  own  counsel,  "  a  holy  terror  "  to  all  connected 
with  the  workhouse — guardians,  doctors,  and 
nurses.  The  slander  complained  of  consisted  of 
speaking  of  the  nurses  as  "  brazen-faced  strumpets" 
and  **  lying  tinkers,"  "  a  bad  lot,"  and  stating 
that  whereas  they  had  formerly  "  decent  nurses  *' 
in  the  hospital,  they  had  none  now.  Though 
denjdng  that  the  words  had  the  defamatory 
sense  attributed  to  them,  the  defendant  admitted 
that  she  had  spoken  of  some  of  her  feUow-guar- 
dians  as  *'  rotten  Catholics."  A  verdict  was 
brought  in  for    the  plaintiffs,  with  assessment  of 


July  27.  1004 


SPECIAL  CORRESPONDENCE.       The  Medical  Press.    lor 


damages  at  one  shilling  in  each  case  for  each 
plaintiff.  It  is  hard  to  see  what  principle  guided 
the  jury  in  fixing  the  damages  at  a  trivial  sum, 
unless  they  thought  that  the  words  of  such  a 
person  as  Mrs.  Morris  were  not  likely  to  carry 
sufficient  weight  to  injure  the  plaintiffs  to  any 
substantial  degree.  At  the  same  time  it  is  unfair 
that  the  nurses  have  to  pay  heavy  costs  for  the 
protection  of  their  characters. 


Intestinal  Diverticula. 
It  is  only  within  the  last  few  years  that  acquired 
diverticula  of  the  intestine  have  come  to  be  re- 
garded as  anything  more  than  pathological 
curiosities.  Recent  observations,  however,  show 
that  they  are  much  more  common  than  were 
formerly  supposed,  and  in  the  bowels  of  old  people 
they  are  probably  very  common  indeed.  They 
occur  both  in  the  small  and  large  intestine,  most 
commonly  in  the  latter,  and  vary  considerably 
in  position  and  size.  In  the  small  intestine,  the 
diverticulum  usually,  but  not  always,  penetrates 
between  the  two  layers  of  the  mesentery,  while 
in  the  large,  the  commonest  site  is  immediately 
beside  one  of  the  longitudinal  muscle-bundles. 
In  size,  they  are  rarely  larger  than  a  walnut, 
and  most  often  nearer  the  size  of  a  large  pea,  while 
they  are  commonly  multiple.  While  there  has 
been  a  good  deal  of  controversy,  and  some  incon- 
clusive experimentation,  as  to  the  producing  cause 
of  the  diverticula,  they  are  probably  due  to  the  pres- 
sure of  contained  faeces  acting  at  points  of  diminished 
muscular  strength.  That  pressure  is  really  the 
active  cause  seems  to  be  shown  by  the  fact  that 
in  some  cases  the  diverticulum  is  merely  a  pro- 
trusion of  the  mucous  through  the  muscular  coat 
of  the  gut,  while  in  others  all  the  coats  take  part 
in  its  formation.  Is  is  obvious  that  a  diverticulum 
of  the  intestine  may  give  rise  to  pathological 
conditions  of  very  various  nature,  of  great  im- 
portance, and  of  difficult  diagnosis.  Since  the 
wall  of  the  diverticulum  is  thinner  than  the  normal 
wall  of  the  gut,  it  is,  of  course,  easy  for  inflam- 
matory conditions  to  spread  to  the  peritoneum, 
and  many  such  cases  have  been  recorded.  Dr. 
Edwin  Beer,  of  New  York,  who  has  made  an 
exhaustive  examination  (a)  of  the  Uterature  of  the 
subject,  emphasises  the  frequency  with  which  such 
inflammations  have  been  mistaken  for  mahgnant 
disease,  the  error  occurring  even  on  the  operating 
table.  Among  the  other  complications  he  has 
noted  are  stenosis  oi  the  gut,  perforation  into  the 
peritoneum,  abscess,  and  fistula  leading  into  the 
bladder. 


PERSONAL. 


The  Marquis  of  Ripon,  as  Chancellor  of  the  Univer- 
sity of  Leeds,  will  inaugurate  the  first  full  session  of 
that  body  at  the  forthcoming  graduation  ceremony  on 
October  6th. 


The  proceedings  of  the  National  Temperance  League 


(a)  AmtT.youm,  Mtd,  Sei  ,  July,  1904. 


at  Oxford  promise  this  year  to  be  of  unusual  interest. 
The  annual  Association  meeting  breakfast  on  the  28th 
will  be  presided  over  by  Mr.  McAdam  Eccles. 

Golf-playing  members  of  the  medical  profession  at 
the  Oxford  meeting  should  note  the  address  of  Dr. 
Proudfoot,  43  St.  Giles,  Oxford,  who  has  charge  of 
the  golfing  arrangements.  There  is  an  excellent  course 
about  four  miles  from  the  city. 


Principal  Lang  presided  at  the  recent  meeting  of 
the  University  Court,  which  discussed  the  formal  pro- 
posals for  the  quarter-centenary  celebration  of  the 
University  of  Al^rdeen,  which  will  occur  in  1906. 


It  was  practically  agreed  by  the  Aberdeen  Court  to 
defer  the  proposed  installation  of  Lord  Strathcona  and 
Mount  Royal  until  the  year  following  that  of  the 
quarter-centenary. 


Dr.  Burgen,  of  Montreal,  has  been  elected  President 
of  the  American  Medico-Psychological  Society,  said  to 
be  the  oldest  medical  society  in  America. 


Dr.  Burt,  of  Ontario,  has  been  elected  President  for 
1905  of  the  Ontario  Medical  Association. 


Lord  Strathcona  has  presented  20,000  dollars  to 
the  University  of  Manitoba,  the  sum  to  be  expended 
on  the  Science  Department  of  the  University. 


We  offer  our  congratulations  to  Dr.  Kendal  Franks 
on  the  honour  of  knighthood  conferred  on  him  last 
week  by  the  King.  He  formerly  occupied  a  leading 
position  in  Dublin  medical  circles,  and  was  Surgeon-in- 
Ordinary  to  the  Viceroy  of  Ireland.  Ill-health,  how- 
ever, caused  him  to  resign  his  various  appointments, 
and  to  seek  the  more  congenial  climate  of  the  Cape. 
During  the  South  African  War  he  was  appointed 
Consulting  Surgeon  to  His  Majesty's  Forces. 

The  Home  Secretary  has  appointed  Mr.  Clinton 
Thomas  Dent,  F.R.C.S.,  to  the  post  of  Chief  Surgeon 
to  the  Metropolitan  Police,  rendered  vacant  by  the 
death  of  Mr.  A.  O.  McKellar. 


The  Empress-Dowager  of  China  has  presented  ten 
thousand  taels  towards  the  new  Medical  College  and 
Hospital  now  building  in  Pekin. 

On  the  occasion  of  the  recent  visit  of  the  Bristol 
Health  Department  to  Dartmouth,  an  interesting  pre- 
sentation was  made  to  Dr.  D.  S.  Davies,  the  well 
known  and  popular  Medical  Officer  of  Health  of  the 
first-mentioned  town.  The  presentation  took  the  form 
of  a  handsome  silver  salver. 


Special  (EorredponDence* 

[from  our  own  correspondent.] 


SCOTLAND. 
Care  of  Imbecile  Children. — ^The  Medical  Committee 
of  the  Edinburgh  Parish  Council  are  considering  the 
advisability  of  providing  a  home  at  the  new  Bangor 
Asylum  for  the  imbecile  children  of  the  city.  At 
present  those  who  have  to  deal  with  these  most  melan- 
choly cases  are  too  well  aware  of  the  great  difficulty 
of  inducing  the  parochial  authorities  to  do  anything 
for  them — and  this  is  not  unnatural,  for,  unless  the 
parents  are  in  a  position  to  pay  a  very  considerable 
sum  towards  their  support,  the  cost  to  the  parish  in 
maintaining  them  in  such  institutions  as  Larbert  is  very 
great.  Added  to  this  is  the  fact  that  accommodation 
for  imbeciles  at  the  lowest  scale  of  charges,  which  is  all 
that  the  parochial  author  ties  can  pay,  is  very  limited, 
and  practically  it  results  that  the  majority  of  imbeciles 
in  the  parish  must  remain  at  home,  a  trial  to  their 
families  and  deprived  of  even  the  slight  prospect  of 
improvement  which  suitable  institutional   treatment 


102   The  Medical  Press.       BRITISH    MEDICAL  ASSOCIATION. 


July  27.   1904. 


affords.  It  is  much  to  be  hoped  that  the  Parish 
Council  will  make  some  provision  for  these  patients, 
and  thus  reUeve  the  parents  of  one  of  the  cruellest 
burdens  which  can  aflSict  the  poor. 

Graduation  Ceremonial  at  Edinburgh  University.— 
The  University  Session  was  definitely  brought  to  an 
end  on  Saturday  by  the  usual  autumn  graduation 
ceremony  in  the  McEwan  Hall.  The  honorary  degree 
of  LL.D.  was  conferred  on  Emeritus  Professor  Butcher, 
who  so  recently  resigned  the  chair  of  Greek  in  this 
university,  on  Sir  Walter  Hely-Hutchinson,  Mr.  John 
Morley,  M.P.,  Sir  George  Reid,  ex-president  of  the 
Royal  Scottish  Academy,  and  Professor  William 
Thompson,  Registrar  of  the  Cape  University.  There- 
after the  ordinary  degrees  in  medicine  and  science 
were  granted,  and  the  prizes  distributed.  The  graduates 
were  then  addressed  by  Professor  Cunningham,  the 
text  of  his  remarks  being  the  evolution  of  the  gradua- 
tion ceremonial.  The  office  of  Promoter  for  the  year 
(as  the  professor  who  introduces  the  graduates  is  called) 
is  one  of  great  antiquity,  going  back,  as  it  does,  to  the 
earliest  period  of  university  life.  The  symbolic  part 
of  the  ceremony  is  a  survival  of  earlier  times,  but 
represents  only  a  small  part  of  the  imposing  display 
which  accompanied  the  conferring  of  degrees  in  the 
Middle  Ages.  In  those  days  preparations  were  made 
for  days  before  the  ceremony  took  place,  and  on  the 
day  of  the  ceremony  a  general  holiday  was  observed. 
Rector,  Promoter,  masters,  doctors,  and  masters  in 
arts,  all  with  their  insignia,  took  part  in  a  solemn 
procession  to  the  cathedral,  accompanied  by  the  noise 
of  drums  and  trumpets.  In  the  majority  of  universities 
not  more  than  one  candidate  was  publicly  promoted  to 
the  degree  of  master  or  doctor  in  the  year,  the  heavy 
cost  rendering  graduation  for  these  degrees  somewhat 
rare  occurrences.  In  only  a  few  of  the  modern  Euro- 
pean universities  has  much  of  the  old  graduation  ritual 
been  preserved  ;  in  France  there  is  practically  no  cere- 
monial ;  in  Germany  too,  it  has  been  abandoned.  The 
ancient  ritual  is  retained  more  or  less  intact  in  the 
Papal  University  of  Rome,  as  also  in  Spain  ;  and  in 
Coimbra  (Portugal)  the  ceremonial  survives  in  its 
purest  form.  Little  or  nothing  of  the  old  ceremonial 
survives  in  Oxford  or  Cambridge.  In  former  days  the 
new  graduate,  among  other  ceremonies,  had  to  receive 
the  kiss  of  peace  not  only  from  the  Promoter  and  the 
Chancellor,  but  also  from  the  other  doctors  and 
masters  present.  Lady  graduates  of  to-day  will  heave 
a  sigh  of  relief  to  learn  that  only  a  small  part  of  the 
ancient  customs  now  survive  in  Edinburgh.  The 
velvet  cap  placed  on  the  head  of  candidates  is  the  prin- 
cipal surviving  characteristic  ;  it  is  the  sign  of  liberty, 
and  originally  meant  the  emancipation  of  the  new  doctor 
from  the  thraldom  and  subjection  of  the  pupillary 
period. 

Edinburgh  Simpson  Memorial  Maternity  Hospital. — 
.  The  directors  have  appointed  Dr.  Lamond  Lackie  and 
Dr.  H.  Oliphant  Nicholson  to  be  Assistant  Physicians 
to  that  institution.  Both  gentlemen  are  well  known 
in  Edinburgh  and  their  appointments  are  cordially  wel- 
comed. 


SritiBb  AeDical  Bsdociatioti* 


[by  our  special  medical  reporter.] 


The    Seventy-Second    Annual    Meeting    of    the 

British   Medical   Association   is   being   held 

THIS  Week  at  Oxford,  from  Tuesday  to  Friday, 

July  26th  to  29TH. 

It  is  peculiarly  fitting  that  representatives  of  British 

medicine  should  congregate  in  one  of  our  most  ancient 

seats  of  learning,  rich  in  its  inheritance  from  out  the 

long-storied   past.     Oxford   has   done   much   for   the 

advancement  of  physic,  and  not  a  few  practitioners  of 

the  healing  art  have  brought  distinction  and  renown 

to  their  Alma  Mater.     The  University  may  well  be 

proud  of  its  association  with  medicine.     Its  graduates 

from  the  twelfth  century  till  now  have  been  eminent 

in  their  profession,  and  many  benefactions  have  come 

to  the  city  through  the  life  and  work  of  her  physicians. 


Oxford  will  do  well  to  keep  in  mind  the  names  of  her 
illustrious  medicals.  The  many  visitors  to  Oxford  will 
find  inexhaustible  stores  of  delight  in  its  ancient 
colleges  and  peaceful  pleasaunces,  its  ever  attractive 
river  and  glorious  countryside  ;  and  when  it  is  remem- 
bered that  extensive  preparations  have  been  made  for 
an  open-handed  hospitality  it  may  well  be  that  the 
purely  scientific  work  of  the  meeting  will  be  maintained 
chiefly  by  the  enthusiasts  and  progressives  of  the 
Association. 

The  New  President. 


Dr.  William  Collier  is  well  fitted,  both  by  p»ersonal 
characteristics  and  professional  position,  to  fill  worthily 
the  Presidential  Chair  of  the  British  Medical  Associa- 
tion. 

Dr.  Collier  was  educated  at  Sherborne  and  Jesus 
College,  Cambridge,  and  proceeded  to  his  M.A.  in  1881. 
As  an  athletic  blue  he  competed  in  the  Inter-University 
sports  in  "  the  mile  "  and  the  "  three  mile  "  during 
three  seasons  of  1875-78.  In  the  latter  year  he  entered 
King's  College  Hospital,  and  took  his  M.R.C.S.  and 
L.S.A.  in  1880.  In  1881  he  graduated  M.B.  of  Cam- 
bridge, and  in  1885  took  his  M.D. 

He  is  well  acquainted  with  the  details  of  hospital 
work,  having  held  resident  appointments  at  Adden- 
brooke's  Hospital,  Cambridge,  Wolverhampton  General 
Hospital,  and  the  Radcliffe  Infirmary,  Oxiord.  In 
1885   he  was  elected    Hon.   Physician   to   the   latter. 

In  1886  he  took  the  Membership  of  the  College  of 
Physicians  and  in  1892  was  elected  a  Fellow. 

Dr.  Collier  is  also  an  M.A.  of  Oxford.  He  is  now 
Litchfield  Clinical  Lecturer,  and  holds  other  important 
positions.  He  is  also  a  member  of  various  learned 
societies,  and  has  contributed  several  important 
articles  to  medical  literature,  the  best  known  of  which 
deal  with  problems  connected  with  cardiac  afiections. 

Dr.  Collier  occupies  a  unique  position  as  head  of  the 
great  body  of  associated  medical  practitioners  in 
Great  Britain,  and  may  be  trusted  to  sustain  the  dignity 


July  27,  1904. 


CORRESPONDENCE. 


The  Medical  Pkess.     103 


and  to  extend  the  influence  of  the  Presidentship  of  the 
British  Medical  Association. 

Religious  Services. 
Remembering  the  close  association  of  divinity  and 
physic  in  our  schools,  and  religion  and  the  healing  art 
in  daily  life,  it  is  peculiarly  fitting  that  religious  ser- 
vices should  mark  the  annual  gathering  of  medical 
practitioners.  On  Tuesday  morning,  services  were  held 
in  Christ  Church  Cathedral  and  St.  Aloysius  Catholic 
Church.  This  morning  services  are  being  conducted  in 
Mansfield  College  Chapel  and  at  Manchester  College. 

.  General  Arrangements  and  Representative 
Meetings. 

.  The  organisers  have  been  at  much  pains  to  arrange 
everything  for  the  comfort  and  convenience  of  the 
visitors.  The  reception  room  is  in  the  Examination 
Schools  in  the  High  Street,  where  also  the  general  and 
representative  meetings  are  to  be  held.  The  general 
addresses  are  to  be  delivered  in  the  Sheldonian  Theatre. 
The  sections  will  conduct  their  work  in  the  various  de- 
partments of  the  University  Museum,  with  the  excep- 
tion ,  of  the  Sections  of  Ophthalmology  and  Dental 
Surgery,  which  will  be  held  in  Keble  College.  The 
*'  doings  "  of  the  day  are  conveniently  defined  in  the 
•"  Daily  Journal."  The  stranger  will  find  much  of 
interest  in  the  excellent  handbook  to  Oxford. 

The  address  cf  the  President,  Dr.  William  Collier, 
^va?  given  last  f?vcning  before  a  large  and  representative 
audience.  The  reception  of  distinguished  guests  was 
a  feature  of  much  interest.  The  adoption  of  academic 
costume  on  this  and  other  occasions  does  much  to 
brighten  the  festive  scene,  and  it  is  thought  that  mere 
male  millinery  will  not  prove  prejudicial  to  the  scien- 
tific sense  of  the  gatherings.  Sir  William  Church  gives 
tbe  Address  in  Medicine  this  evening,  and  to-morrow 
afternoon  Sir  William  MacEwen  the  Address  in  Surgery. 

The  Work  of  the  Sections. 

Amidst  the  numerous  attractions  of  the  annual 
gathering  it  is  particularly  desirable  that  no  pains 
should  be  spared  to  maintain  the  scientific  work  of  the 
p>Toceedings.  This  year,  although  no  epoch-making  dis- 
covery may  be  announced,  or  great  departure  in  prac- 
tice be  initiated,  it  seems  probable  that  a  high  level  of 
excellence  in  the  work  of  the  fourteen  sections  may  be 
attained.  •  By  a  wise  arrangement,  special  discussions 
have  been  announced,  and  in  many  instances  abstracts 
of  the  introductory  papers  have  appeared  in  the 
Association's  official  publication. 

In  the  Section  of  Medicine,  a  consideration  of  the 
treatment  of  tuberculous  pleural  effusion  and  pneumo- 
thorax will  be  introduced  by  Professor  W.  Osier,  of 
Baltimore.  The  serum  treatment  of  disease  and  the 
management  of  chronic  Bright's  disease  will  also  furnish 
much  material  for  discussion. 

Surgeons  will  be  interested  in  the  discussion  on  the 
present  aspects  of  asepsis  and  antisepsis  ;  and  the 
indications  for,  and  methods  of,  performing  hysterec- 
tomy should  give  rise  to  a  free  expression  of  opinion. 

AU  the  Sections  have  prepared  attractive  programmes 
of  papers,  many  of  which  will  doubtless  do  much  to 
advance  our  knowledge  of  the  subjects  with  which  they 
deal.  We  hope  to  refer  to  the  more  important  dis- 
cussions and  papers  in  our  next  issue,  and  we  shall 
publish  abstracts  of  some  of  the  more  important  of  the 
communications. 

The  Pathological  Museum. 

This  year  a  praiseworthy  attempt  has  been  made  to 
present  as  far  as  possible  the  results  of  recent  investiga- 
tions in  medical  science.  The  collection  is  arranged  in 
the  large,  well-lighted,  readily  accessible  ground-floor 
rooms  of  the  Anatomical  Department.  We  under- 
stand exhibitors  are  to  be  given  an  opportunity  of  per- 
sonally demonstrating  their  specimens  or  apparatus  at 
definite  times.  Among  the  more  important  exhibits  are 
specimens  of  ankylostomiasis,  miners'  lung  disease, 
diseases  of  tropical  climates,  and  preparations  illus- 
trating congemtal  dislocation  of  the  hip  before  and 
after  treatment  by  Lorenz's  method,  the  estimation  of 
the  phagocytic  power  of  the  blood,  and  the  detection 
of  purin  bodies  in  the  urine.     General  satisfaction  is 


given  by  the  museum  being  kept  entirely  distinct  from 
the  trade  exhibits. 

The     Exhibition. 

A  collection  of  medical,  surgical,  dietetic,  and  sani- 
tary apparatus,  medical  books,  and  hospital  appliances 
has  been  brought  together  in  the  Examination  School, 
in  the  same  building  as  the  reception  room.  Much 
difference  of  opinion  exists  as  to  the  wisdom  of  pro- 
viding for  a  trade  exhibit  under  the  auspices  of  the 
Association,  but  while  much  can  doubtless  be  said  in 
favour  of  discounting  such  an  alliance  on  the  grounds 
of  expediency,  reasons  can  be  adduced  for  its  retention. 
Most  of  the  leading  medical  publishers  have,  however, 
abstained  from  exhibiting. 

Entertainments  and  Excursions. 

While  the  scientific  work  of  the  Association  must 
ever  be  accorded  first  place,  it  is  well  that  the  more 
festive  features  of  the  week  should  not  be  allowed  to 
lapse,  and  this  has  evidently  been  the  opinion  of  the 
Oxford  Committee,  who  have  prepared  a  very  attrac- 
tive programme  of  entertainments  and  excursions. 
The  annual  dinner  will  be  held  in  Christ  Church  Hall 
on  Thursday  evening.  On  Thursday  afternoon  an 
international  golf  match  is  to  take  place. 
Special  Meetings. 

The  annual  assembly  is  wisely  made  an  opportunity 
for  holding  other  meetings  at  which  matters  intimately 
concerned  with  medicine  or  pertaining  to  the  work*of 
medical  practitioners  may  be  discussed.  This  year 
several  important  gatherings  have  been  arranged  for. 
The  annual  medical  temperance  breakfast  is  to  be  held 
in  the  Town  Hall  on  Thursday  morning,  presided  over 
by  Mr.  McAdam  Eccles,  who  will  be  supported  by  the 
President,  Sir  William  Broadbent,  Sir  Thomas  Barlow, 
Sir  Victor  Horsley,  and  other  leaders  of  the  profession. 
The  forty-fifth  annual  meeting  of  the  New  Sydenham 
Society  is  to  be  held  on  Friday,  July  29th,  at  9.30  a.m. 
The  annual  luncheon  of  the  Continental-Anglo-Ameri- 
can Medical  Society  is  to  be  held  at  the  Clarendon 
Hotel  on  Thursday,  at  i  p.m. 


Corre0ponDence« 

[We  do  not  hold  ouraelvee  responsilile  for  the  opinions  of  our  Cor- 
respondents]. 


THE    DIMINISHING    BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — My  two  critics  to  some  extent  answer  each 
other.  My  thanks  are  due  to  Dr.  Drysdale  for  dealing 
with  the  first  part  of  Dr.  Walsh's  paper. 

If  the  chief  advocates  or  apologists  of  "  prevention," 
as  well  as  its  chief  opponents,  are  both  agreed  that  the 
diminishing  birth-rate  is  due  mainly  (in  the  words  of  Dr. 
Billings)  to  "  the  deliberate  and  voluntary  prevention 
of  child-bearing  on  the  part  of  a  steadily  increasing 
number  of  married  people,  who  not  only  prefer  to  have 
few  children  but  know  how  to  attain  that  wish,"  we 
need  not  trouble  ourselves  much  either  with  technical 
errors  of  classification  or  with  a  long  and  wordy 
discussion  on  subsidiary  causes  recognised  as  such  by 
myself  as  well  as  by  my  critics.  Dr.  Walsh  may  be 
technically  right  in  the  method  employed  by  him  for 
computing  the  birth-rate,  but  with  all  his  ingenuity 
he  cannot  turn  a  "  minus  "  into  a  "  plus,"  and  in  using 
it  he  falls  into  a  far  greater  fallacy  than  any  he  thinks 
he  is  exposing.  For  we  have  increasing  evidence  that 
the  habit  of  "  prevention  "  is  not.  as  I  hoped,  confined  to 
married  life  and  prostitution,  but  is  becoming  more 
and  more  used  by  the  unmarried,  and  this,  rather  than 
any  moral  improvement,  may  account,  and  probably 
does  account,  for  much  of  the  decrease  in  illegitimate 
births.  This  practically  disposes  of  the  first  twelve  of 
Dr.    Walsh's   so-called   conclusions. 

Dr.  Walsh's  later  conclusions  cover  more  debatable 
ground,  containing,  as  they  do,  references  to  one  of  the 
most  important  points  of  the  controversy — viz,,  the 
quality  as  well  as  the  quantity  of  the  children  born  to  the 
nation.  This  I  have  dealt  with  as  far  as  I  could,  not  by 
assumption  but  by  records  of  fact.     The  only  possible 


104    '^HB  Medical  Press. 


CORRESPONDENCE. 


July  27,  1904- 


justification  for  the  following  of  so  unnatural  a  practice 
as  that  of  sexual  congress  habitually  adjusted  to  a 
certainty  of  imperfection  would  lie  in  a  great  benefit 
accruing  to  posterity,  or,  in  other  words,  in  the  greater 
value  of  the  population  after  being  subject  to  such 
restriction.  This  "  greater  value  "  is  now  shown  to  be 
non-existent.  There  may  be  diversity  of  opinion  as  to 
how  this  result  is.  produced,  but  there  can  be  little  ques- 
tion of  the  fact.  Instead  of  a  greater  value  we  find  a 
lessening  value — a  deterioration  in  quality  as  well  as 
a  limitation  in  quantity — and  I  search  in  vain  in  the 
writings  of  my  critics  for  anything  but  vague  question- 
ings to  disprove  what  I  have  advanced  regarding  this 
decadency. 

Most  of  my  critics,  and  especially  Mr.  Wells  and  Dr. 
Walsh,  take  a  far  too  narrow  and  imperfect  view  of 
evolution.  They  appear  to  assume  that  the  process  is 
one  of  continuous  advance  for  all  nations  and  times. 
They  lose  sight  of  the  ebb  as  well  as  the  flow  of  progress. 
They  seem  to  forget  the  records  of  history,  the  vast 
periods  of  national  decadence  and  slow  destruction,  on 
which  and  through  which  we  have  slowly  climbed  to  our 
present  position.  They  have  not  adequately  recognised 
the  moral  basis  on  which  national  greatness  rests. 
And  it  is  small  comfort,  I  submit,  to  the  twentieth 
century  Englishman  to  know  that  the  human 
may  still  develop  in  power  and  energy  if  such  develop- 
ment must  rest  on  the  ruins  of  the  Empire  which  his 
fathers  made.  The  late  Dr.  Engelmann  of  Boston, 
wrote  as  follows,  in  1903,  (a)  and  I  agree  with  him  :— 

"  The  factors  are  the  same  which  have  been  active 
in  earlier  civilisations  as  they  are  to-day.  Increasing 
wealth  and  the  introduction  of  foreign  manners  are 
pointed  out  as  causing  in  ancient  Rome  the  lessening 
fertility  among  the  better  classes  which  preceded 
political  disruption.  Cause  and  effect  were  the  same, 
and  even  the  methods  employed  to  thwart  the  ten- 
dencies of  Nature  were  the  same  : — 
"  Sed  jacet  aurato  vix  ulla  puerpera  lecto 

Tantum  artes  hujus,  tantum  medicamina  possunt, 

Quae  steriles  facit,  atque  homines  in  ventre  necandos 

Conducit." 

(Juvenal :    Sat.  vi.,  594-7.)  (b) 

Both  of  my  critics  bring  forward  the  old  fallacy  that 
there  is  no  room  in  the  United  Kingdom  for  a  larger 
population.  There  may  be  no  room  for  the  drugged 
neurotic,  the  lunatic,  and  the  youthful  criminal — the 
very  classes  we  are  increasing  in  some  way  by  "  preven- 
tion " ;  there  is  always  room  for  the  healthy-minded, 
the  pure,  the  worker,  and  the  brave.  At  what  period, 
I  would  hke  to  ask.  were  the  old-world  cities  of  Tyre 
and  Sidon  too  small  for  the  Phoenicians,  who  had  founded 
their  prosperity  ?  '  Was  it  not  at  the  time  of  their 
greatest  power  and  influence  when  the  Phoenicians  were 
sweeping  the  Mediterranean  with  their  commerce  and 
establishing  their  colonies  in  Asia  Minor,  in  Cyprus,  in 
Greece,  in  Africa,  in  Crete,  in  Sardinia,  in  Spain,  and 
even  in  England  ? 

If  the  United  Kingdom  is  too  small,  the  British 
Empire  is  not.  Large  continents  with  inexhaustible 
lands  under  our  protection  or  influence  are  crying  out 
for  capable  colonists,  not  for  the  two  children  of  the 
"  prevented  "  family,  who  will  never  be  fit  to  leave 
their  mother's  leading-strings,  but  for  such  men  and 
women  as  made  the  Empire  from  Elizabeth  to  Victoria, 
men  and  women  who  are  manoeuvred  out  of  existence 
by  the  wickedness  of  to-day. 

Dr.  Walsh  suggests  that  the  cause  and  effects  of  the 
diminishing  birth-rate  may  be  best  ascertained  by  a 
Royal  Commission  of  Inquiry. 

Does  he  not  know  that  a  Royal  Commission  was 
appointed  by  the  New  South  Wales  Government  in 
August,  1903,  to  consider  and  report  upon  the  serious 
decline  in  the  birth-rate,  and  thatjtheir  report,  published 
one  month  after  my  address,  bears  out  in  a  striking 

(a)  '*  Cause  of  Race  Decline."    PojnUar  SeienM  Monthly 
{b)  Tmns.— *'  Few  children  are  bom  in  the  g^ilded  bed  to  the  wealth}- 

dame,  so  many  artificef  has  she,  and  so  many  drugs  to  render  women 

sterile  and  destroy  life  within  the  womb." 


degree  every  word  that  I  have  said  on  this  subject  ? 
I  take  the  following  from  the  Australasian  Medi- 
cal Gazette,  of  March  21st,    1904 : — 

"  We  consider  the  report  (of  the  Royal  Commission) 
a  masterpiece  of  exhaustive  examination  and  investi- 
gation of  a  subject  which,  it  is  admitted  on  all  hands, 
bristles  with  difficulties.  The  Commissioners  have 
found  as  a  result  of  their  investigations  that  the  decline 
of  the  birth-rate  is  due  in  very  large  measure,  not  to  any 
physical  degeneration  or  lack  of  fertility  in  the  present 
generation  of  Australian  women,  but  to  deliberate 
checking  of  the  procreation  of  children  by  various 
artificial  methods,  thus  nullifying  one  of  the  main 
objects  of  marriage  and  degrading  the  married  state 
from  one  of  honour  to  that  of  '*  monogynous  prostitu- 
tion." 

The  Commissioners  are  also  most  emphatic  in  their 
conclusions  that  the  adoption  of  these  practices  for  the 
limitation  of  families  tends  to  the  physical  and  moral 
degeneration  of  the  race.  They  point  out  that  the 
increase  of  insanity  is  going  pari  passu  with  the  decline 
in  the  birth-rate  ;  and  there  can  be  no  doubt  that  a  very 
large  amount  of  ovarian  and  uterine  disease  is  to  be 
attributed  to  the  use  of  various  instruments  which  are 
used  to  prevent  conception,  but  which  &vour  sepsis  and 
thus  predispose  to  chronic  disease  of  the  uterus  and  its 
annexa." 

Dr.  Walsh  has  appealed  to  a  Royal  Commission  ; 
to  this  Royal  Commission  I  refer  him,  asking  him  to 
note  that  through  the  whole  of  my  indictment  I  have 
striven  to  be  fair  and  S3rmpathetic,  and  that  nowhere 
in  my  writing  will  he  find  any  expression  so  deliberately 
offensive  as  this  of  "  monogynous  prostitution." 

But  I  have  something  more  to  say,  Sir,  to  Dr.  Walsh 
and  to  others  of  the  profession  who  are  rightly  inter- 
ested in  this  important  subject.  The  evil  exposed  by 
the  Royal  Commission  is  not  now  confined  to  married 
life.  It  is  spreading,  as  I  have  already  pointed  out,  to 
the  young  and  single,  and  the  statistics  of  illegitimate 
births  have  no  longer  any  necessary  definite  bearing  on 
morality.  Why  should  the  bond  of  marriage,  the 
new  generation  is  asking,  be  the  necessary  precursor 
to  sexual  life  when  there  need  be  no  danger  of 
pregnancy  ? 

My  tongue  is  tied  by  the  confessions  of  my  patients, 
but  I  do  not  care  to  be  the  deposit  of  shameful 
secrets  without  publicly  entering  my  protest  and 
declaring  my  belief  that  the  so-called  civilisation  which 
spreads  the  knowledge  of  "  artifices  for  making  women 
sterile "  in  almost  every  house  and  practically  en- 
courages the  living  lie  of  a  secret  immorality  in  the  un- 
married sisters  and  daughters  of  our  country  is  decadent 
and  corrupt.  Unless  it  can  be  cleansed  and  purified 
it  cannot  last,  and  deserves  to  be  swept  away  as  other 
civilisations  have  gone  down  before  it. 

But  is  it  too  late  to  alter  ? 

I  am,  Sir,  yours  truly, 
John  W.  Taylor. 

22  Newhall  Street,  Birmingham,  July  22nd, -1904. 


To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — Dr.  Walsh  seems  to  dispute  the  statement 
that  the  diminishing  birth-rate  can  be  due  to  the  arti- 
ficial sterility  of  married  couples.  The  effect  of  this 
cause  is,  however,  recognised  by  his  equals  in  scientific 
authority.  I  have  before  me  the  English  version  of  the 
recently  published  great  work  by  Professor  Metchni- 
koff,  of  the  Pasteur  Institute,  "  The  Nature  of  Man." 
edited  by  Dr.  P.  Chalmers  Mitchell.  In  an  introduction 
the  editor  writes  :  "  Metchnikoff  is  an  expert  of  experts 
in  the  science  of  life,  and  has  gained  the  right  to  a 
hearing  by  forty  years  of  patient  devotion  and  brilliant 
research."  At  page  loi,  Metchnikoff  writes:  "To 
the  human  race  belongs  the  distinction  of  having 
invented  modes  of  sexual  congress  which  are  neces- 
sarily barren,  .  .  .  There  are  many  wajrs  in  which  the 
spermatozoa  may  be  prevented  from  accomplishing 
their  function,  and  these  are  so  common  and  so  familiar 
that  it  is  unnecessary  to  enumerate  them.  In  civiUsed 
countries  procreation  is  limited  chiefly  by  such  means." 


July  27,  1904. 


CORRESPONDENCE. 


Tn«  Medical  Prsss.     105 


After  discussing  the  practice  of  artificial  abortion  and 
infanticide  among  primitive  races,  the  author  (page  105) 
remarks  :  "In  more  highly  civilised  nations,  the  rude 
proceedings  of  savages  have  been  replaced  by  clever 
devices  to  prevent  conception,  and  infanticide  has 
become  rare.  Artificial  abortion  is  excited  by  modem 
methods  suggested  by  the  progress  of  science.  The 
embryonic  membranes  are  pierced  not  by  ribs  of  seals 
or  hairpins,  but  by  sterilised  sounds,  and  the  operation 
is  performed  with  strict  asepsis.  In  averting  the 
natural  results  of  passion  the  woman  is  subjected  to 
the  smallest  possible  risk.  It  is  indubitable  that  more 
than  one  race  has  perished  because  of  its  lack  of  the 
instinct  of  family.  ...  It  is  plain  that  the  readiness 
with  which  devices  to  prevent  the  production  of  children 
have  been  adopted  shows  the  weakness  of  the  family 
instinct  in  man,  and  opens  up  a  problem  to  which  the 
attention  of  moralists  and  legislators  may  well  be 
directed." 

It  is  necessary  only  to  read  French  works  on  social 
problems  and  fiction,  and  to  mingle  in  French  society  of 
difierent  classes,  to  learn  at  first  hand  the  fact  as  to 
the  almost  universal  practice  among  married  couples 
of  limiting  the  offspring  to  a  number  previously  agreed- 
upon.  No  secret  is  made  of  this  custom,  nor  is  any 
shame  ascribed  to  it.  It  is  discussed  freely  in  family 
council  by  parents  and  betrothed  couples,  although 
delicate  details  may  not  be  entered  into  before  an 
ingenuous  maiden.  This  fact  is  very  well  brought  out 
in  a  recently  published  little  book  which,  although  com- 
posed in  lighter  vein,  deserves  and  has  received  praise 
from  serious  reviewers.  The  book  in  question  is  styled 
•*  My  French  Friends."  It  is  written  by  a  lady  who 
shows  a  complete  knowledge  of  French  life  and  social 
customs.  The  question  of  limiting  the  number  of 
children  is  referred  to  over  and  over  again  in  con- 
versation on  the  subject  of  marriage,  and  no  doubt  is 
left  as  to  the  custom  which  prevails.  French  parents 
would  consider  it  barbarous  and  cruel  to  bring  into  the 
world  a  number  of  children  whose  future  they  could 
not  provide  for.  The  provision  of  a  suitable  dot  for 
the  girl  is  the  first  consideration.  As  one  of  the 
characters,  a  model  French  mother  as  well  as  an  in- 
tellectual woman  of  the  world,  remarks :  ''  Happily 
the  problem  of  six  or  ten  children  in  the  family  which 
can  only  provide  suitably  for  two  or  three,  is  not  one 
we  often  give  ourselves  to  solve  here  in  France,  but  in 
all  cases  the  future  of  the  girl  is  regarded  as  of  equal 
importance  with  that  of  the  son." 

The  application  of  these  ideas  saves  boys  in  great 
part  from  the  fight  in  life  without  which  fine  manly 
character  can  rarely  be  attained,  and  makes  of  the 
girl  a  wife  and  mother,  however  ill-suited  she  be  for  this 
rSle. 

I  venture  to  affirm  that  not  a  particle  of  scientific 
evidence  has  ever  been  adduced  to  prove  that  pro- 
gressive civilisation  leads  to  the  evolution  of  an  in- 
fertile type.  On  the  other  hand,  the  evidence  is  over- 
whelming that  the  stagnation  of  population  in  France, 
allowing  for  the  effects  of  late  marriages  and  large 
preventable  infantile  mortality,  is  due  mainly  to  the 
artificial  prevention  of  conception  practised  by  the 
great  bulk  of  married  couples. 

On  numerous  occasions  when  you  have  allowed  me 
to  enter  into  the  discussion  of  this  subject,  I  have  given 
the  reasons  for  the  belief  that  a  nation  which  becomes 
imbued  with  the  form  of  narrow  egoism  which  con- 
stitutes the  foundation  of  the  custom  almost  universal 
in  France,  is  doomed  to  gradual  decay  and  destruction  ; 
and  I  need  not  repeat  those  reasons  now.  Finally,  I 
believe  that  the  diminishing  birth-rate  in  this  country 
is  very  largely  due  to  the  adoption  in  late  years  of 
French  ideas  and  practices,  and  that  the  resulting  ill- 
efi[ects  upon  the  moral  fibre  of  large  sections  of  the 
people  are  already  discernible  to  close  observation. 
I  am.  Sir,  yours  truly, 

A  Student  of  Sociology. 


minal  wall,  which  Dr.  Hastings  Tweedy  describes  in 
your  last  issue  and  appears  to  consider  "  so  far  as  he 
knows,  is  novel,"  is  m  reality  nothing  more  or  less 
than  an  adaptation  of  Nathaniel  Bozeman's  well- 
known  '-  button  suture,"  formed  of  leaden  discs, 
which  proved  so  successful  in  his  hands  nearly  a  quarter 
of  a  century  ago  in  the  treatment  of  vesico-vaginal 
fistuls  I 

Dr.  Tweedy  states  that  the  suture  he  uses  is  left  in 
"  for  fourteen  days,"  and  then  cut.  I  am  under  the 
impression  that  cutting  would  hardly  be  required  if 
silk- worm-gut  sutures  were  left  so  long  imbedded  in 
the  tissues  ;  perhaps  he  may  mean  that  part  of  suture 
tied  over  leaden  plate.  Dr.  Nathan  Bozeman,  the 
designer  of  this  form  of  suture,  from  whom  I  hold 
a  letter  on  the  subject,  also  considered  the  leaden  plate 
had  some  influence  on  the  healing  ;  I  should  imagine 
by  its  equable  pressure,  and  by  preventing  movement 
of  the  parts  and  cutting  also.  The  idea  of  a  perforated 
leaden  plate  as  a  splint  for  the  cut  surface  is  not  novel, 
but,  as  we  would  say  nowadajrs,  ancient  history. 
I  am.  Sir,  yours  truly, 

Alexander  Duke. 


SOME  OF  THE  NEWER  METHODS  OF  OPENING 

AND  CLOSING  THE  ABDOMEN. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — ^The  plan  of  closing  skin  wounds  in  the  abdo 


OUR  "  DAILIES." 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — It  is  probable  that  some  of  us,  when  looking 
through  one  of  the  *'  dailies  "  and  finding  the  report 
of  some  medical  conference  or  society,  cannot  help 
thinking  how  different  it  was  years  ago,  when  such 
subjects  would  have  been  thought  proper  only  in  one 
of  our  own  journals.  Science  is  now  fashionable,  and 
it  is  natural  that  those  who  are  interested  in  social 
questions,  into  which  medical  science  enters  more  or 
less  forcibly,  should  read  with  attention  the  report  of 
a  discussion  upon  any  subject  that  has  relation  to  the 
wide  and  important  one  of  public  health.  Health  and 
wealth  are  so  closely  associated  that  we  cannot  afiEord 
to  neglect  the  one  without  loss  of  the  other.  When 
matters  medical  are  introduced  to  the  public  through 
our  •'  dailies,"  or  other  non-professional  journals,  it  is 
necessary  to  make  some  allowance  for  the  difficulties 
of  giving  those  who  have  no  knowledge  of  medical 
science  correct  and  clear  ideas  of  the  questions  dis- 
cussed, and  of  the  conclusions  at  which  well-educated 
members  of  the  profession  arrive  when  dealing  with 
some  new  theory  or  discovery,  particularly  when  such 
is  subversive  of  the  views  or  doctrines  they  have  held 
and  believed  in  before.  We  hope  now  to  consider 
somewhat  carefully  the  work  that  is  being  carried  on 
by  the  society  engaged  in  the  research  into  the  origin, 
nature,  and  treatment  of  cancer.  This  disease  is  one 
of  those  that  can  be  traced  back  to  almost  prehistoric 
times,  and  it  seems  as  if  the  difficulties  of  solving  the 
question  of  its  origin  are  now  greater  than  ever.  We 
axe  deeply  impressed  with  the  importance  of  looking 
more  to  the  prevention  than  to  the  cure  of  cancer,  par- 
ticularly when  we  see  how  this  is  necessary  in  the 
interests  of  public  health.  No  class,  of  course,  takes 
precedence  of  infectious  diseases,  or  at  least  none  that 
requires  more  carefully  to  be  considered  by  our  Legis- 
lature. As  cancer  does  not  belong  to  this  class  it  is 
probable  that  its  treatment  will  be  of  far  greater  interest 
than  research  into  its  origin,  and  we  must  be  careful 
lest  we  indulge  too  much  in  hopes  that  may  be  held 
out  to  us  by  those  who  are  clever  enough  to  take  advan- 
tage of  poor  humanity. 

In  the  report  of  one  of  our  leading  "  dailies  "  of  the 
third  meeting  of  the  General  Committee  of  the  Cancer 
Research  Fund,  it  is  stated  that :  '*  The  public  and 
the  medical  profession  are,  therefore,  gravely  warned 
not  to  delay  to  take  advantage  of  the  surgeon's  aid  in 
the  hope  that  some  means  will  speedily  be  found  to 
replace  surgical  interference."  If  any  non-professional 
understands  this  we  must  say  we  should  feel  some  sur- 
prise, for  how  anyone  could  fly  to  the  surgeon  in  the 
hope  that  that  is  the  best  way  to  do  without  him  is 
difficult  to  understand.  The  public  and  the  profession 
are  both  treated  as  innocent  and  ignorant  questionists 
of  the  nature  and  treatment  of  cancer.  •-  The  report 
contained  one  weighty  warning.  •  No  sign  has  yet  been 


lo6    The  Medical  Pkess. 


LITERATURE. 


July  27.   1Q04 


discovered  by  which  the  physician  or  surgeon  may 
surely  recognise  the  presence  of  cancer."  Some  of  our 
readers  may  agree  with  this  opinion,  and  some  may 
not.  We  are  rather  inclined  to  think  that  no  one  is 
more  likely  to  be  correct  in  the  diagnosis  of  cancer 
than  the  physician  or  surgeon  who  has  given  up  his  life 
to  the  clinical  study  of  disease.  It  is  not  likely  that 
those  who  have  done  nothing  but  work  with  the  micro- 
scope and  in  the  laboratory  can  have  any  idea  of  the 
kind  of  knowledge  obtained  by  clinical  study  ;  and  if 
the  Cancer  Research  Society  is  going  to  assume  a 
superiority  over  the  profession  and  warn  it  and  the 
public  through  the  "  dailies  "  in  the  tone  of  the  report 
from  which  the  above  extracts  were  made,  we  think  it 
well  in  the  interests  of  the  public  first,  and  next  in  that 
of  clinical  medicine  and  new  students,  to  warn  them, 
the  public  and  the  profession,  against  the  warnings  of 
a  society  that  works  in  such  an  illogical  and  unscientific 
spirit.  As  far  as  we  can  make  out  there  is  nothing  left 
now,  according  to  the  report  of  the  Cancer  Research 
Fund,  but  for  the  poor  public  to  rush  ofF  to  the  sur- 
geons to  operate  for  fear  of  cancer,  and  to  be  kept  in 
most  painful  suspense  till  the  end  of  life  is  near  and 
the  difficulties  of  diagnosis  are  settled. 

I  am,  Sir,  yours  truly,  R.  L. 

CENTRAL  MIDWIVES*  BOARD  AGAIN. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Your  excellent  leader  on  the  Midwives' 
Board's  "  sheer  stupidity  and  egregious  performances  " 
appeals  to  every  sensible  member  of  the  profession. 
The  attempted  levelling  down  of  the  doctors  to  the  posi- 
tion of  man-midwife  seems  like  going  back  a  century. 
No  wonder  you  pertinenly  ask,  "  Whence  have  the 
nursing  profession  of  the  day  obtained  this  knowledge  in 
training,  except  from  the  hands  of  medical  men  ? "  some 
of  whom  apparently  have  for  years  made  a  "  good 
thing  "  out  of  it ;  and  perhaps  the  knowledge  of  this 
fact  impels  some  such  to  the  further  exaltation  of  the 
midwife  and  the  depreciation  of  the  medical  man.  Is  it 
likely  the  midwife,  recognising  her  power,  will  play 
second  fiddle  to  the  most  experienced  practitioner, 
unless  compelled  by  risk  of  losing  her  patient,  to  ask 
his  help  ?  Dr.  Ward  Cousin's  deserves  thanks  for 
voicing  the  profession,  "  who  feel  strongly  on  the  point," 
and  the  matter  cannot  be  allowed  to  rest,  nor  Dr. 
Cullingworth's  eminence  save  him  from  censure  by 
thus  lowering  his  own  profession. 

I  am,  Sir,  yours  truly, 

A.  D. 


©bttuarp. 

ARTHUR  K.  CROSSFIELD,  L.R.C.S.,  L.R.C.P.ED.. 
J.P..  DARTMOUTH. 
Mr.  Arthur  Kyffin  Crossfield  died  recently  at  his 
residence,  Dartmouth,  after  a  short  illness,  from  appen- 
dicitis. The  deceased,  who  was  in  his  fifty-second  year, 
was  the  son  of  the  late  Mr.  R.  Crossfield,  of  Douglas, 
Isle  of  Man.  He  was  educated  in  Edinburgh,  and  took 
the  qualifications  of  L.R.C.P.,  L.R.C.S.,  L.M.Edin.,  in 
1878.  After  holding  a  resident  appointment  at  the 
Isle  of  Man,  he  commenced  practice  at  Dartmouth. 
He  took  great  interest  in  the  volunteer  movement,  was 
surgeon-lieutenant-colonel  in  the  2nd  Devon  Royal 
Garrison  Artillery  Volunteers.  Mr.  Crossfield  was  a 
Justice  of  the  Peace  for  the  borough  of  Clifton-Dart- 
mouth-Hardness. His  loss  will  be  felt  among  a  wide 
circle  of  friends. 


SIR  JOHN  SIMON.  K.C.B.,  M.D.  DUB.,  F.R.S. 
F.R.C.S.,  LL.D..OXON.  LL.D.  CANTAB. 
We  regret  to  announce  the  death  of  Sir  John  Simon, 
K.C.B.,  on  Saturday,  the  23rd  inst.,  at  his  residence  in 
Kensington.  Bom  in  18 16,  he  became  an  Honorary 
Fellow  of  the  Royal  College  of  Surgeons  in  1844,  and 
was  the  first  appointed  Officer  of  Health  to  the  City  of 
London  in  1848.  For  many  years  he  acted  as  Surgeon 
to  St.  Thomas's  Hospital.  From  1855  to  1876  he  was 
Medical  Officer  to  tfie  Board  of  Health,  to  the  Privy 
Council,  and  to  the  Local  Government  Board.  He  was 
the  author  of  several  papers  on  physiology,  pathology^ 


and  surgery,  and  of  reports  and  other  official  papers 
relating  to  the  sanitary  state  of  the  people  of  England. 
The  University  of  Munich,  at  its  400th  anniversary, 
in  1872,  conferred  upon  him  the  honorary  diploma  of 
Doctor  of  Medicine.  So  far  as  his  scientific  work  was 
concerned,  he  may  be  regarded  as  one  of  the  gr^t 
pioneers  in  State  medicine,  and  the  series  of  official 
Reports  issued  under  his  presidency  are  models  of 
classical  style  and  valuable  records  of  original  investi- 
gation. He  was  made  a  C.B.  in  1876  and  a  K.C.B.  in 
1887,  and  was  one  of  the  Crown  members  of  the  General 
Medical  Council.  In  1878  he  was  elected  President  of 
the  Royal  College  of  Surgeons,  and  in  1879  of  the  Royal 
Society.  

Xtterature. 

HYDROTHERAPY,  (a) 

The  speedy  appearance  of  a  second  edition  affords 
the  surest  proof  that  the  first  issue  has  been  approved, 
and  certainly  in  the  present  case  Dr.  Baruch's  excellent 
treatise  on  the  therapeutic  and  hygienic  uses  of  water 
well  merits  the  appreciation  it  has  received.  The  new- 
edition  has  been  thoroughly  revised  and  brought 
up-to-date,  and  much  new  matter  has  been  added. 
The  work  still  retains  its  former  aspect.  The  prin- 
ciples of  hydrotherapy  are  first  discussed,  and  then 
follow  details  regarding  methods  and  particulars  con- 
cerning application  in  special  diseases.  In  the  new 
edition  a  chapter  on  reaction  affords  much  valuable 
material  as  to  the  physiological  basis  of  hydrotherapy. 
A  chapter  on  insanity  has  also  been  added,  and  in  it 
the  wisdom  of  a  rational  application  of  water  as  an 
alleviating  agent  is  clearly  indicated. 

The  work  is  written  in  a  judicial  and  scientific  spirit, 
although  full  of  the  energy  of  the  enthusiast.  The 
author  is  anxious  to  place  the  practice  of  hydrotherapy 
on  a  sound  and  rational  basis,  and  we  venture  to  think 
his  effort  should  go  far  to  divorce  it  from  the  slipshod, 
inexact,  and  quackish  procedures  which  only  too 
widely  prevail  in  so-called  hydropathic  estabUshments. 

Dr.  Baruch  may  be  congratulated  on  having  pro- 
duced a  book  which  has  found  favour  in  all  English- 
speaking  countries,  and  which  is  likely  to  influence 
beneficially  hydrotherapeutic  practice  in  both  America 

and  Europe.  

NOBLE  SMITH  ON  LATERAL  CURVATURE,   {h) 

This  is  a  short  but  practical  treatise  on  the  treat- 
ment of  what  usually  proves  to  be  a  very  intractable 
condition.  The  author  points  out  that  in  the  treat- 
ment of  spinal  curvature  the  real  cause  of  the  deformity 
is  inefficient  nutrition  of  the  various  structures  of  the 
body.  This  results  in  softening  of  the  bones  so  that 
lateral  curvature  is  produced.  He  describes  a  number 
of  exercises  with  a  view  to  correcting  the  abnormal 
curves,  and  especially  to  overcome  spinal  rotation 
which  is  usually  present  in  these  cases.  With  regard 
to  massage,  the  author  states  that  it  must  not  be  applied 
indiscriminately,  and  that  in  the  majority  of  cases  it  is 
quite  unnecessary.  He  then  goes  on  to  describe  the 
use  of  a  special  splint  which  he  claims  is  of  great  value 
in  the  treatment  of  lateral  curvature.  It  has  the  effect 
of  supporting  the  patient's  back,  and  yet  allowing  of 
perfect  freedom  of  muscular  movement. 

The  second  portion  of  the  book  deals  with  the 
management  of  stooping,  round  shoulders,  and  kjrphosis. 
The  effects  of  clothing  in  the  production  of  these  con- 
ditions are  clearly  pointed  out.  Regarding  the  much- 
talked-of  corset,  he  say's  that  there  is  no  great  harm, 
in  its  use  so  long  as  it  leaves  the  thorax  free  from 
pressure.  A  series  of  very  simple  exercises  for  the 
correction  of  stooping  is  given,  and  the  special  splint 
already  referred  to  is  once  more  recommended.     The 


(a)  "The  Principles  and  Practice  of  Hydrotherapy .  a  Caoide  to  the 
Application  of  Water  in  Disease.  For  Students  and  Practitioners  of 
Medicine."  By  Simon  Baruch.  M.D.,  Professor  of  Hydrotherapeutics 
in  the  New  York  Post-Graduate  Medical  School  and  Hosratal,  &c. 
Second  Edition,  revised  and  enlarged.  Pp.  496  and  74  figs.  Price  z6s. 
net.    London  :  Bailliere,  Tindall  and  Cox.     1904. 

(b)  "  The  Management  of  Lateral  Curvature  of  the  Spine,  Stooping 
and  the  Development  of  the  Chest  in  Phthisis."  By  E.  Noble  Smith. 
F.R.C.S.Edin.,  &c.,  Senior  Surgeon  to  the  City  Orthopaedic  Hospital. 
London.  Pp.  viii.,  133.  Price  2S.  6d.  Iond(Hi :  Smith  Elder  and 
Co.     Z904. 


July  27.  1904* 


LITERATURE. 


The  Medical  Press.     107 


book  concludes^  with  two  suggestive  chapters  on  the 
influence  of  diet  upon  physical  development,  and  on 
the  development  of  the  chest  in  respiratory  affections. 
The  author  writes  in  a  spirit  of  hopefulness  regarding 
the  lines  of  treatment  advocated,  and  certainly  his 
suggestions  are  worthy  of  careful  trial.  We  can  heartUy 
commend  this  short  treatise  to  those  interested  in  the 
physical  development  of  children.  It  is  undoubtedly 
a  valuable  contribution  to  the  literature  of  this  im- 
portant subject. 

ROLLESTON'S    CLINICAL   LECTURES    AND 
ESSAYS,  (a) 

This  is  a  collection  of  seventeen  lectures  and  papers 
on  a  variety  of  medical  subjects,  which  have  been  re- 
printed with  certain  additions  from  the  various  journals 
m  which  they  originaUy  appeared.  The  opening  lec- 
ture on  "  Vomiting  in  Diphtheria  "  is  most  instructive, 
as  is  also  that  on  the  "  Treatment  of  Typhoid  Fever. 
We  are  glad  to  renew  our  acquaintance  with  the  case 
of  persistent  hereditary  oedema  which  the  author 
broueht  to  the  notice  of  the  profession  a  short  time  ago. 
The  account  given  of  the  case  of  Reckhnghausen  s 
disease  is  extremely  interesting,  as  is  also  the  descrip- 
tion of  the  necropsy  which  the  author  was  fortunate 
to  obtain.  The  paper,  entitled  "  Some  Remarks  on 
the  Uses  and  Abuses  of  Arsenic  "  is  fuU  of  valuable 
information,  and  will  well  repay  careful  study. 

Taken  as  a  whole,  the  topics  dealt  with  m  this 
volume  are  of  interest  to  the  general  practitioner 
while  those  who  deUght  in  the  anomahes  of  clmical 
medicine  will  find  within  its  pages  much  to  ponder 
over  We  think  Dr.  Rolleston  is  to  be  congratulated 
on  having  such  a  rich  store  of  cUnical  material  at  his 
disposal,  and  on  his  extremely  facile  language  in  de- 
scribing the  conditions  referred  to  in  this  collecUon. 


MANN  ON  THE  PHYSIOLOGY  AND  PATHOLOGY 
OF  THE  URINE,  (h) 

In  this  excellent,  though  short  work,  the  author  en- 
deavours to  place  before  his  reader  the  latest  survey 
of  those  branches  of  biological  chemistry  which  are 
connected  with  the  physiology  and  pathology  of  the 
urine.  Though  the  book  is  primarily  intended  as  a 
clinical  guide  and  chief  prominence  is  given  to  methods 
of  examination  which  can  be  carried  out  in  the  clinical 
laboratory,  many  other  processes  which  are  beyond 
the  scope  of  a  clinical  laboratory  are  also  described  m 
order  to  prove  of  help  to  investigators  "  who  desire  to 
carry  their  researches  further." 

The  book  is  most  systematic  in  its  arrangement. 
Commencing  with  a  description  of  the  general  charac- 
teristics of  urine,  it  next  discusses  the  different  urinary 
inorganic  and  organic  constituents,  the  amido  and 
aromatic  acids,  carbohydrates,  proteids  and  mtro- 
genous  substances,  pigments,  and  bile  acids.  The 
special  characteristics  of  urine  are  then  discussed,  as 
well  as  urinary  sediments,  and  calculi,  the  volume 
ending  with  a  section  devoted  to  the  study  of  urine  in 
its  pathological  relations.  The  book  is  well  and  cleariy 
written,  and  we  can  cordially  recommend  it  to  any  one 
who  possesses  a  fair  knowledge  of  medical  chemistry, 
and  who  is  desirous  of  entering  more  fully  into  the 
special  branch  of  the  physiology  and  pathology  of  the 
urine. 

THE    NEW    SYDENHAM    SOCIETY    ATLAS    OF 
ILLUSTRATIONS,  (c) 
The  new  Fasciculus  of  this  beautiful  Atlas  deals  with 

(a)  "  Clinical  Lectures  and  Essays  on  Abdominal  and  other  Subjects." 
By  H.  D.  Rolleston,  M.A.,  M.D.Cantab.,  F.R.C.P.,  Physician  to  St. 
George's  Hospital,  &c.  Pp.  178.  Price  5s.  net.  London  :  Sidney 
Appleton.     1904. 

(b)  **  Ph3^iology  and  Pathology  of  the  Urine  with  Methods  of  Ex- 
amination." By  J.  Dixon  Mann,  M.D.,  F.R.C.P.,  Physician  to  the  Sal- 
ford  Royal  Hospital,  Professor  of  Forensic  Medicine  in  the  Victoria 
University  of  Manchester.  London  :  Charles  Griffin  and  Co.  Pp.  xi. 
and  272,  and  several  illustrations.     190^. 

(c)  "An  Atlas  of  lUttstrations  of  Chnical  Medicine,  Surgery,  and 
Pathology,  compiled  for  the  New  Sydenham  Society."  Fasciculus 
XVIII  (Double  Fasciculus),  being  Vll  and  IX  of  the  Clinical  Atlas. 
Eruptions,  &c.,  caused  by  Arsenic,  Uticaria  Pinnentosa,  lUustratioos  of 
the  phenomena  of  Leprosy.  London  :  The  New  Sydenham  Society. 
Agent,  H.  K.  Lewis,  1903. 


three  subjects — arsenical  poisoning,  urticaria  pigmen- 
tosa, and  leprosy.  The  falsciculus  is  a  double  one  and 
contains  a  large  number  of  original  plates,  including 
seven  reproduced  from  photographs  taken  during  the 
epidemic  of  poisoning  by  arsenic  in  Manchester  in  1901. 
There  are  some  especially  good  chromo-lithographs  of 
the  rare  condition,  urticaria  pigmentosa.  Each  article 
is  prefaced  by  very  full  introductory  remarks  on  the 
different  subjects  by  the  Editor,  and  altogether  the 
present  number  is  well  up  to  the  standard  that  has 
been  set  by  its  predecessors. 

ST.  BARTHOLOMEW'S  HOSPITAL  REPORTS,  (a) 
In  the  space  at  our  disposal,  we  can  do  no  more 
than  direct  the  reader's  attention  to  the  wealth  of 
information  this  Report  contains.  The  volume  opens 
with  an  In  Memoriam  notice,  W.  J.  Walsham,  which 
tells  of  the  combination  of  genius  and  industry  with  an 
unfortunately  delicate  heaath.  The  writer  tells  the 
story  with  the  sympathy  and  love  of  one  who  was  both 
a  pupil  and  a  friend.  The  special  features  of  the 
number  are,  however,  the  article  of  Dr.  J.  Graham 
Forbes,  "  Medical  Report  of  the  Anglo-French  Boun- 
dary Commission  on  the  Western  Frontier  01  the  Gold 
Coast  Colony/'  which  occupies  eighteen  pages  and  is 
beautifully  illustrated  with  photographs.  This  is 
followed  by  a  second  article  by  the  same  author. 
"  Native  Methods  of  Treatment  in  West  Africa."  and 
Dr.  Weber's  paper  "  Action  and  Reaction  in  Patho- 
logy and  Therapeutics."  Turning  to  the  ever- 
interesting  statistics  of  anaesthetics,  we  find  that 
chloroform  alone  was  administiered  2,847  times,  ether 
alone  181  times.  There  were  seven  casualties,  of 
which  detailed  accounts  are  given.  We  regret  that  we 
cannot  give  space  to  quotations  of  some  length  from 
Dr.  Forbes'  article  on  native  treatment.  We  must, 
however,  refer  to  the  Rotunda,  or,  as  some  will  say, 
Cr6d6's,  method  of  pressing  out  [the  placenta,  which 
has  been  practised  for  centuries  on  the  Gold  Coast. 
"The  placenta  is  expressed  immediately  after  the 
birth  of  the  child,"  and  a  little  further  on  we  read  that 
"Turning  by  abdominal  palpation  and  moulding  is 
practised  when  the  child  lies  '  across  the  belly '  to 
make  the  head  or  foot  come  first,  either  of  which  means 
of  delivery  is  considered  equallv  good."  Aseptic 
precautions  appear  to  be  the  rule,  ior  the  author  says 
No  attempt  for  any  reason  is  made  to  introduce  the 
fingers  into  the  vagina." 

STEVENSON'S  WOUNDS  IN  WAR.  (6) 
Thb  second  edition  of  this  excellent  book  will  be 
welcome  to  all  interested  in  military  surgery.  It  is  full 
of  original  and  accurate  information,  and  since  the 
appearance  of  the  first  edition  in  1897,  ^^^  author  has 
been  able  to  draw  from  the  rich  store  of  experiences 
accumulated  in  the  Boer  War  and  those  recorded  in 
the  statistics  of  the  Spanish-American  War.  The 
systematic  and  detailed  description  of  the  various 
injuries  due  to  projectiles  and  to  hand-weapons  involves 
a  great  amount  of  special  information,  just  as  the  treat- 
ment of  that  class  of  wounds  on  the  field  demands  a 
practical  acquaintance  with  the  conditions  of  cam- 
paigning. The  civil  surgeon  will  find  this  book  full  of 
interesting  and  suggestive  material.  The  grazing  of 
arteries,  for  instance,  by  bullets  of  high  velocity  gave 
rise  to  many  of  the  "  varicose  aneurysms  and  aneurys- 
mal varices  that  have  been  a  remarkable  feature  of  the 
surgery  of  the  Boer  War."  In  that  campaign,  again,  it 
was  for  a  short  time  supposed  that  the  men  were  using 
poisoned  bullets.  A  newspaper  scare  at  the  time  was 
silenced  only  by  the  discovery  that  the  supposed  poison 
was  nothing  more  than  verdigris  from  the  paraffin  used 
for  lubricating  the  copper  cartridge  cases.  Many  of 
the  illustrations  are  new  and  illuminating.  The  skia- 
grams are  for  the  most  part  excellent  specimens  taken 
in  the  Boer  war.     In  wounds  of  the  hip-joint  General 


la)  "Saiat  Bartholomew's  Hospital  Reports."    Edited  by  A. 


E. 
XXIX. 


Garrod,  M.D.,  and  Mr.  McAdam  Eccles,  M.S..  F.R.C.S.    Vol. 
London  .  Smith,  Elder  and  Co.     1904. 

(b)  "  Wounds  in  War,"  By  Surgeon-General  W.  F.  Stevenson,  C.B,, 
A.M.S.,  Professor  of  BAilitary  Surgery,  Netley,  &c.  Second  Edition. 
London  :  Longmans.  Green  and  Co.    Price  155.    1904. 


lo8    Thb  Medical  Pkess. 


MEDICAL  NEWS. 


July  27,   1904. 


Stevenson  very  properly  insists  upon  the  importance 
of  accurate  diagnosis  at  the  earliest  possible  moment. 
This  is  in  accordance  with  the  teaching  of  modern 
scientific  surgery,  and  is  happily  now  brought  within 
reach  of  the  army  surgeon  by  means  of  his  Rontgen-ray 
equipment.  The  value  of  the  present  edition  is  consider-  1 
ably  enhanced  by  a  clear  description  of  localisation  by  1 
Mackenzie  Davidson,  undoubtedly  the  greatest  living 
authority  upon  that  subject.     It  is  impossible  to  do  I 
justice  to  General  Stevenson's  book  within  the  limits  [ 
of  a  short  notice,  but  it  may  be  cordially  recommended 
to  readers  interested  in  surgery  as  a  classical  and  valu-  i 
able  work.  I 


DEGENERATES,  (a) 

Many  startling  statements  are  met  with  in  this 
pamphlet  by  Dr.  Rentoul.  A  remedy  he  suggests  for 
checking  the  spread  of  lunacy  is,  that  would-be  suicides 
should  be  allowed  to  take  their  own  lives  without  inter- 
ference from  the  law.  He  also  holds  that  *'  at  present 
we  are  engaged  in  the  apparently  pleasant  pastime  of 
manufacturing  lunatics  and  others  of  this  class,"  and 
asks  whether  many  of  our  philanthropic  and  other 
charitable  societies  do  not  work  indirectly  for  the 
survival  of  the  unfit.  He  also  points  out  how  Nature 
would  reduce  the  number  of  lunatics  to  the  smallest 
proportions  were  she  not  persistently  and  deliberately 
thwarted,  and  appears  to  deplore  that  we  do  all  in  our 
power  to  prevent  suicide,  by  building  palatial  resi- 
dences and  appointing  immense  stafis  to  protect 
lunatics  from  tneir  mental  impulses.  He  tlmiks  it 
fortunate  that  although  thousands  of  pounds  are 
expended  yearly  upon  the  care  of  lunatics.  Nature's 
method — that  of  smcide — goes  on  and  not  only  so,  but 
increases.  Nature,  he  states,  will  not  forgive  us  for 
endeavouring  to  prevent  lunatics  and  other  degenerates 
from  committing  suicide. 

"  In  the  eight  years,  1895-1903,  8,933  lunatics  were 
discharged  as  recovered  from  the  asylums  under  the 
London  County  Council,  but  of  this  number  2,285  ^^® 
re-admitted  within  one  year,"  and  he  asks,  "Is  it  right 
and  just  to  others  that  so  large  a  proportion  of  recovered 
persons  should  be  permitted  to  return  to  ordinary  life 
there  to  beget  a  tainted  offspring  ? "  and  we  heartily 
agree  with  Dr.  Rentoul  that  this  is  a  most  serious 
problem,  because  they  cannot  be  kept  in  asylums  after 
they  become  sane,  and  females  are  often  discharged 
from  an  asylum  recovered,  to  return  within  twelve 
months  suffering  from  insanity  of  pregnancy  or  the 
puerperium. 

The  treatment  he  suggests  is  the  sterilisation  of 
mental  and  physical  degenerates,  and  doubtless  by 
some  such  treatment  much  could  be  done  to  decrease 
mental  and  physical  degeneracy,  although,  even  in 
this  our  day,  we  fear  this  line  of  treatment  will  be  re- 
ceived by  many  with  much  disfavour. 

Apart  from  the  startling  statements  already  quoted, 
there  is  much  in  this  pamphlet  which  makes  it  worthy 
the  perusal  of  medicsU  men. 


Aebical  ticxos. 

Central  MIdwives'  Board.- The  Number  of  Examinations. 
At  an  adjourned  meeting  of  the  Central  Midwives 
Board,  held  at  the  offices  on  the  14th  inst.,  the  con- 
sideration of  the  examination  scheme  drafted  by  Dr. 
Cullingworth  was  continued.  The  question  of  the 
number  of  examinations  to  be  held  in  a  year  was  then 
raised,  and  its  reconsideration  was  moved  by  Dr. 
Cullingworth,  seconded  by  Miss  Paget,  and  carried. 
Dr.  Sinclair  moved  a  resolution  that  the  examinations 
should  not  take  place  more  often  than  twice  a  year  ; 
he  objected  to  the  policy  of  "  providing  facilities  for 
failures  "  to  come  up  again,  but  no  seconder  was  forth- 
coming. Dr.  Cullingworth  said  that  since  the  last 
meeting  he  had  received  representations  from  institu- 
tions engaged  in  the  training  of  midwives  showing  if 
examinations  were  held  only  twice  a  year  very  great 
inconvenience  would  be  felt  by  the  schools,  involving 

(a)  "The  Proposed  Sterilisation  of  Certain  Menta].  and  Physical 
D^enerates."  By  Robert  Reid  Rentoul,  M.D.  The ,  Walter  Soctt 
Publishing  Co.,  Limited. 


difficulties  in^management  which  would  militate  against 
the  efficiency  of  the  training.  He  considered  the 
reasons  given  so  conclusive  that  he  had  altered  his 
opinion.  After  some  further  discussion,  in  the  course 
of  which  Dr.  Champneys  expressed  the  opinion  that  the 
training  would  be  beltter  if  pupils  were  turned  out 
more  frequently  in  small  batches.  Dr.  Sinclair  begged 
the  Board  to  think  of  "  highly- trained  nurses,"  not  of 
"charwomen."  A  resolution  in  favour  of  examina- 
tions being  held  four  times  a  year  simultaneously  in 
London  and  the  provincial  centres  was  moved  by  Dr. 
Cullingworth,  seconded  by  Miss  Paget,  and  carried. 
Dr.  Champneys  and  Miss  Oldham  also  voting  for  it. 
The  final  consideration  of  the  scheme  was  deferred  until 
October.  The  following  institutions  for  the  training 
of  midwives  under  section  C  of  the  rules  were  approved  : 
The  Belfast  Union  Workhouse,  the  County  and  City 
of  Cork  Lying-in  Hospital.  Miss  Paget  gave  notice  of 
a  resolution  she  wished  to  bring  up  at  the  next  meeting, 
that  midwives  should  be  required  to  renew  their  licence 
annually.  Mr.  Ward  Cousins  asked  leave  to  postpone 
a  motion  limiting  appointment  as  inspectors  under  the 
Board  to  members  of  the  medical  profession. 
Westminster  Hospital  Medical  School. 

The  annual  distribution  of  prizes  to  the  students  of 
this  school  took  place  on  the  15th  inst.  Colonel  Sir 
Frederic  Cardew,  K.C.M.G.,  late  Governor  of  Sierra 
Leone,  who  presided,  after  presenting  the  prizes  spoke 
to  the  students  of  some  of  the  problems  that  they 
might  help  to  solve  in  their  future  career,  especially 
that  r^^ding  the  physical  health  of  the  people  and  its 
bearing  on  the  manning  of  the  army  and  navy.  The 
teaching  and  experience  of  the  medical  profession  must, 
he  said,  be  one  of  the  greatest  determining  factors  in 
its  solution.  In  the  course  of  his  address.  Sir  Frederic 
also  touched  on  the  great  opening  for  medical  men  in 
the  development  of  the  various  parts  of  the  Empire, 
especially  m  the  Tropics.  The  Army  Medical  Corps, 
however,  now  offered  an  attractive  career  to  the  medical 
practitioner  and  had  the  advantage  of  a  pension 
during  old  age.  Dr.  AUchin,  senior  physician  to  the 
hospital,  having  proposed  a  vote  of  thanks  to  Sir 
Frederic  Cardew,  which  was  carried  by  acclamation, 
prizes  were  presented  to  the  following  gentlemen  : — 
G.  R.  Ward,  scholarship  of  no  guineas  and  Treasurer's 
prize  ;  H.  Austin  Smith,  scholarship  of  ^£60  ;  A.  Davies, 
scholarship  of  £60  ;  R.  Brown,  scholarship  of  ;£40  and 
prizes  for  medicine  and  surgery  ;  C.  F.  Dawson-Smith, 
scholarship  of  £^0  ;  H.  Kingston,  scholarship  of  £60  ; 
R.  Asplen,  scholarship  of  ;f40  ;  G.  F.  Carr,  prizes  for 
practical  chemistry,  ph5rsics  and  biology ;  E.  G. 
Foote,  prize  for  practical  chemistry  ;  L.  White,  mid- 
wifery prize  ;  J.  J.  W.  Evans,  histology  prize  ;  C. 
Fletcher,  pharmacology  prize ;  R.  S.  DoUard,  the 
Sturges  prize  for  clinical  medicine  and  the  forensic 
medicine  prize  ;  and  G.  G.  James,  prizes  for  anatomy 
and  physiology. 

London  School  of  Tropical  Medicine. 

Of  the  thirty-nine  students  who  attended  the  above 
school  during  the  Session,  May  to  July,  1904,  the  fol- 
lowing (all  of  the  Colonial  service),  have  passed  the 
examination  at  the  end  of  the  course  with  distinction  : 
J.  Currie,  A.  King,  E.  Maples,  P.  N.  Gerrard,  C.  A. 
Suvoong. 

The  Barker  Anatomical  Prize. 

This  prize  of  thirty  guineas,  offered  annually  and 
open  to  all  students  in  any  medical  school  in  the 
United  Kingdom,  has  just  been  awarded  to  Mr.  Charles 
Cooper,  a  student  of  the  Royal  College  of  Surgeons. 
Ireland.  This  is  the  fifth  year  in  succession  that  this 
open  prize  has  been  conferred  on  students  of  the  Dublin 
College. 

Trinity  Collesre.  Dublin. 

At  the  examinations  during  Trinity  Term,  1904, 
Mr.  John  S.  Joly  won  the  Surgical  Travelling  Prize,  and 
Mr.  James  G.  Wallis  the  FitzPatrick  Scholarship. 
The  following  gained  medical  scholarships : — In  ana- 
tomy and  institutes  of  medicine  :  Thomas  O.  Graham 
(Trinity  College)  and  Francis  O'B.  Elhson  (Stewart). 
In  physics,  chemistry,  botany,  and  zoology,  the  follow- 
ing :  Allman  J.  Powell  (Trinity  College)  and  George  F. 
Graham  (Stewart). 


July  27.  1904- 


PASS  LISTS. 


Thb  Medical  Press.    109 


The  Purser  Medal  was  awarded  to  Mr.  Francis  R. 
Coppinger. 

Royal  CoUesre  of  Physicians  aod  Surreons. 

The  following  candidates  have  passed  the  Second 
Professional    Examination  : — 

With  Honours.— D.  Adams,  V.  Clifford,  J.  D' Alton, 
P.  G.  M.  Elvery,  J.  B.  Hanafin,  P.  M.  Keane.  C. 
Sheahan,  T.  Sheehy,  G.  F.  Shepherd. 

Passed  in  all  Subjects— ^F/ Blake,  H.  C.  Garden.  W. 
Carroll.  N.  E.  Cussen.  D.  J.  rfanafin.  F.  M.  Hewson.  E. 
Montgomery.  J.  B.  M'Glancy,  D.  O'Sullivan. 

Completed  Examination — R.  J.  Bonis,  L.  L.  Davys, 
M.  R.  J.  Hayes.  J.  Humphreys.  W.  St.  L.  Moorhead.  F. 
J.  Morris.  D.  T.  O'Flynn. 

University  of  Aberdeen. 
1^"  At  the*  graduation  ceremony  on  Wednesday  last,  the 
following  degrees  were  conferred  : — 

Degree  of  M,D. — ^Middleton  Connon,  M.B.,  CM., 
James  Cran,  M.B.,  CM.,  Ernest  King  Gawn,  M.B., 
CM.,  Henry  Gibbons,  M.B.,  CM.,  Peter  Harper,  M.A., 
M.B.,  CM.,  {David  Albert  Hutcheson,  M.B.,  Ch.B., 
•?-Arthur  Hugh  Lister,  B.A..  M.B.,  CM.,  'Hugh 
MacLean,  M.B.,  Ch.B..  John  Smith  Purdy,  M.B..  CM., 
♦Arthur  Westerman,  M.B.,  Ch.B.,  JGeorgeNicol  Wilson, 
M.B..  CM.  * "  Highest  Honours "  for  Thesis. 
t  "  Honours  "  for  Thesis.  J  ■'  Conmiendation  "  for 
Thesis. 

Degrees  of  M.B.  and  Ch,B. — Cyril  Moore  Smith,  with 
second-class  honours.  (Passed  Final  Examination 
•*  with  Distinction.")  Ordinary  Degrees. — Catherine 
Emslie  Anderson,  John  Anderson,  Wm.  Robert  Cat  to, 
William  G.  Gunn,  Alexander  A.  Hendry,  Thomas 
Christie  Innes,  Henry  Williams  Jeans.  John  Jenkins, 
M.A.,  Frederick  Leonard  Keith,  Helen  M'Glashan, 
Roderick  Mackay.  M.A.,  James  Reid,  M.A.,  Michael  B. 
H.  Ritchie,  Fife  Slater,  James  Hutcheon  Thomson, 
Robert  J.  B.  Wright. 

The  John  Murray  Medal  and  Scholarship  was  awarded 
to  James  Clark.  M.B.,  Ch.B.,  and  the  Alexander  Ander- 
son Scholarship  to  Bertie  R.  G.  Russell.  M.B.,  Ch.B. 

Diploma   in  Public  Health.^Hugh  Johnston,  M.B., 
Ch.B.,  WUliam  Mackie,  M.A..  M.B.,  CM. 
University  ef  Cnasgow. 

The  following  have  passed  the  fourth  (final)  pro- 
iessional  ezaaiination : — 

(A.) — ^For  M.B.,  CM.— Stewart  Dunbar.  Ernest 
Milton  Watkins. 

(B.) — ^For  M.B..  Ch.B. — ^Bethia  Shanks  Alexander, 
Archibald  Craig  Amy.  Henry  Grxme  Anderson.  James 
Richard  Sunner  Anderson.  Robert  Daniels  Bell.  M.A.  ; 
David  Blackley .  Forrest  Brechin.  Charles  Brown,  George 
Yuille  Caldwell,  Roberta  Campbell.  Thomas  Mur- 
doch Campbell,  M.A. ;  Peter  Carrick.  M.A. ;  Robert 
Buchanan  Carslaw,  M.A.  j'James  Alexander  Cowie,  B. A. 
B.Sc.  ;  Thomas  Thornton  Macklin  Dishington,  Charles 
MilUgan  Drew,  M.A. ;  Hugh  Harvey  Fulton,  John 
Graham.  B.Sc. ;  George  Munn  Gray.  John  Cochrane 
Henderson,  James  Rutherford  Kerr.  John  Kerr.  Ethel 
MacLeod  Lochhead.  Peter  Lowe,  M.A.,  B.Sc.  ;  Thomas 
Symington  Macaulay,  John  Duncan  M'Callum,  M.A.  ; 
Donald  Carmichacl  M'Cormick.  Neil  M'Dougall,  James 
Boston  M'Ewan.  Tom  Duncan  M'Ewan.  Duncan 
Macfayden,  John  M'Farlane,  Alexander  Stuart  Murray 
Macgregor,  James  M'Houl,  Ronald  Mackinnon,  Andrew 
Brown  M'Pherson.  James  Roy  M'Vail.  James  Marshall, 
Andrew  Meek,  Margaret  Walker  Millar,  David  Robertson 
Mitchell,  John  Muir,  John  Murdoch.  Alexander 
Harper  Napier,  George  Clement  Nielson.  Thomas  Orr. 
Charlotte  Reid  Park,  Howard  Henderson  Patrick, 
Jon  Clegg  Pickup,  Andrew  McLean  Pollock,  James 
Porter,  William  Murdoch  Rae,  William  Rankin,  M.A.  ; 
Donald  Ronald  Reid,  Berkeley  Hope  Robertson,  M.A.. 
B.Sc.  ;  Lawrence  Drew  Shaw,  George  Golde  Smith, 
B.Sc,  Jessie  Marie  Stewart,  William  Craig  Stewart, 
Murray  Ross  Taylor,  William  Templeton,  James  White 
Thomson,  William  Young  Turner,  M.A.  ;  Hugh 
Fleming  Warwick  ;  Robert  M*Nair  Wilson,  Annie  May 
Yates,  Hugh  Young. 

The  following  candidates  passed  with  distinction  in 
the  subjects  indicated  : — 


In  (a)  Surgery  and  Clinical  surgery,  (6)  Practice  of 
Medicine  and  Clinical  Medicine. — Thomas  Orr.  In  (a) 
Practice  of  Medicine  and  Clinical  Medicine,  (6) Midwifery 
— Robert  Buchanan  Carslaw.  M.A.  In  Surgery  and 
Clinical  Surgery — Margaret  Hardy,  Arthur  Innes, 
Ethel  MacLeod  Lochhead,  John  Duncan  M'Callum,  M.A 
George  Goldie  Smith,  B.Sc.  ;  Robert  M'Nair  Wilson 
In  Practice  of  Medicine  and  Clinical  Medicine — Robert 
Daniels  Bell,  M.A.  ;  David  Blackley,  Hugh  Harvey 
Fulton,  Tom  Duncan  M'Ewan,  John  Murdoch,  Andrew 
Maclean  Pollock,  William  Rankin,  M.A.  ;  Donald 
Ronald  Reid,  William  Templeton,  William  Young 
Turner,  M.A.  In  Midwifery — Forrest  Brechin,  Peter 
Carrick,  M.A.  ;  Louis  Leisler  Greig,  Margaret  Walker 
Millar,  David  Robertson  Mitchell.  Howard  Henderson 
Patrick,  David  Penman,  William  Craig  Stewart,  John 
Unsworth. 

Conjoint  Examination  Board  in  Ireland. 

The  following  candidates  have  passed  the  first 
Professional  Examination  by  the  Royal  College  of 
Ph5rsicians  and  the  Royal  College  of  Surgeons : — 

(a)  Honours— T.  C  Boyd.  T.  P.  Cormack,  J.  C  L. 
Day,  C  Hyland,  G.  Patton,W.G.  Ridgway.  A.  Sheridan, 
H.  W.  White. 

{b)  In  all  suhjects. — G.  E.  Beggs,  G.  Collins,  J.  J. 
Cuskelly,  G.  A.  Finegan,  J.  A.  J.  Flannery,  M.  J. 
Hawkshaw,  F.  N.  Holden,  D.  J.  Hurley,  H.  W.  Kay, 
W.  J.  P.  Lillis,  D.  J.  Lyne,  T.  J.  Lyons,  J.  McHugh. 
J.  T.  McKee.  P.  Maguire,  J.  P.  Morgan,  T.  N.  Neale, 
E.  Ryan,  M.  J.  Saunders,  H.  B.  Sherlock,  J.  M.  Smyth. 
C  H.  Stringer,  W.  C  Townsend. 

{c)  Completed  Examination. — S.  W.  Hudson,  T.  J. 
McDonnell. 

Royal  College  of  Physicians  and  Surgeons  and  Faculty  ef 
Physteians  and  Surgeons,  Glasgow. 

At  the  quarterly  examination  of  the  Conjoint  Board, 
held  in  Edinburgh,  and  concluded  on  July  22nd.  the 
following  candidates  passed  the  Final  Examination 
and  were  admitted  L.R.CP.E.,  L.R.CS.E.,  and 
L.F.P.  &  S.E.  :— Charles  Henry  Thomas,  Canada; 
William  Herbert  Boalth,  Kampti,  India ;  Broderick 
Edward  Middleton  Newland,  Bangalore ;  Bernard 
Beaumont  Westlake,  Chippenham  ;  Eyre  Vincen; 
Smith,  Kingston,  Jamaica  ;  Bertram  Ingram,  Victoria  ; 
James  Watson,  Edinburgh  ;  Arthur  George  Thompson, 
Ontario ;  Franklin  Christian  Richards,  South 
Dakota;  Frederick  Etherington,  Ontario;  Edward 
Rainsford  Mumford,  Norwich ;  Charles  Richard 
Whittaker,  Lancashire ;  Charles  Grange  McGreer, 
Ontario ;  Annjuta  Kellgren  Cyriax,  London  ; 
Daniel  Michael  Donovan,  Cork ;  James  Grieve 
Cormack,  Anstruther ;  William  Boyd,  Co. 
Derry ;  Lambert  Kenneth  Rodriguez,  Travancore ; 
Eileen  Josephine  FitrGerald,  Melbourne ;  Henry 
Gordon  Campbell,  Dundee ;  Dwarkanath  Dharmaji 
Kamat,  Bombay  ;  Alexander  Douglas  Fox,  Brighton  ; 
Ramchandra  Kashinath  Dhuru,  Bombay,  Nigel  Oli- 
phant,  St.  Andrews  ;  David  Arnold  Hastings,  Ireland  ; 
Vasantio  Dinanath  Madgavkar,  Bombay  ;  Narindra 
Singh  Sedhi,  Punjab ;  Sorabji  Jamasji  Bhathena, 
Bombay  ;  William  Vincent  Saint  John  Sutton,  Cork  ; 
and  Joseph  Simon  de  Souza,  Bombay  ;  and  five  passed 
in  Medicine  and  Therapeutics,  nine  in  Midwifery,  and 
five  in  Medical  Jurisprudence.  Fifteen  other  candi- 
dates passed  the  First  Examination,  eighteen  passed 
the  second  Examination,  and  sixteen  passed  the  Third 
Examination  at  the  recent  meetings  of  the  Board. 
Society  of  Apothecaries  of  London,  July,  1904. 

The  following  candidates  having  passing  the  neces- 
sary examinations,  have  received  the  L.S.A.  diploma 
of  the  Society,  entitling  them  to  practise  medicine, 
surgery,  and  midwifery  : — L.  F.  Cope,  C  Kellgren,  and 
T.  R.  Waltenberg. 

Boyal  College  of  Surgeons  in  Ireland. 
Fellowship  Examination. — Mr.  C  W.  H.  Fleming, 
L.M.  and  S.  Dublin  University,  having  passed  the 
necessary  examination,  has  been  admitted  a  Fellow  of 
the  College.  Miss  S.  H.  Commissariat,  L.M.  and  S. 
Bombay  University,  has  passed  the  primary  part  of 
the  Fellowship  examination. 


no    The  M«dical  P»ess.       NOTICES  TO  CORRESPONDENTS. 


July  27,  1904. 


(JTotreBpottbettts,  ^hort  %ctUxs,  itc 

Hf^f  CoERnPOHDnrs  requiring  a  reply  in  this  oolnmn  are  partton 
larly  requested  to  make  use  of  a  dUtincHve  Sigwatwre  vr  Iftitial,  and 
avoid  the  practice  of  signing:  themselves  "Beader,"  **  Subscriber/* 
•<  Old  Subscriber,"  te.  Much  confusion  will  be  spared  by  attention 
t    this  rule. 

Orioikal  Artiolm  or  Lvmuts  intended  for  publication  should  b® 
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. 

CoMTRiBinoRS  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
oiBce ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  aubecriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 

Publisher. 

BiPRiXTB.— Beprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

BoLTOKixnais.— Pettenkofer*8  theory  of  the  relation  of  ground 
water  to  enteric  fever  has  never  been  accepted  unreservedly  by 
British  authorities  upon  hygiene.  It  is,  of  course,  possible  that 
different  local  conditions  have  altered  the  case  in  Munich,  where 
Pettenkofer  made  his  observations.  In  that  city  the  soil  is  porous, 
and  the  high  ground  water  may  have  had  exceptional  opportunities 
of  working  mischief  from  the  piesence  of  an  enormous  number  of 
leaking  cess-pools.  The  point  should,  of  course,  always  be  borne 
in  mind  by  the  scientific  saniUrian  whatever  his  field  of  work. 

SUBQEBV  AND  SEBMONS. 
**  I  USED  to  give  him  advice  about  his  operations,  and  he  used  to 
criticise  my  sex  mens.  We  watched  his  first  performance  of 
tracheotomy  with  the  deepest  interest,  and  I  am  sure  his  remarks 
helped  me  with  my  sermons.*'  So  spoke  the  Bishop  of 
London  last  week  concemioe  his  early  friendship  with  a  hospital 
house  surgeon,  the  occasion  being  prize  day  in  connection  with  the 
Medical  School  at  St.  Bartholomew's  Hospital. 

Dr.  H.  T.  S.— It  would  be  more  satisfactory  to  both  parties  if  you 
referred  the  question  to  an  expert.  There  can  be  no  arbitrary 
standard  for  the  valuation,  the  value  of  practices  varying  according  to 
circumstances.  With  regard  to  the  other  points,  these  are  **  cut  and 
dried,"  and  afford  safeguards  alike  to  the  vendor  and  purchaser. 

Mr.  Harmav.— Your  foreign  diploma  does  not  confer  the  right  to 
practise  in  this  country  :  that  is  to  say,  it  does  not  convey  the  status 
of  a  registered  medieal  practitioner.  It  is  not  for  us  to  advise  vou 
how  to  evade  the  law,  nor  would  you  be  wise  to  attempt  it. 

Dr.  J-  W.  M.— Your  interesting  case  is  marked  for  early  insertion. 

Mr.  Olsmbnt  Skrs'  letter  is  unavoidably  held  over  for  want  of 
pace  :  but  enclosed commimication has  been  rejidand  posted  to  the 
gentleman  concerned. 

Dr.  Watsok.— a  similar  (question  ^-as  asked  and  replied  to  in  our 
last  week's  issue  under  the  signature  of  "  A  Subscriber,"  to  which  we 
would  referyou. 

Dr.  K.    See  reply  to  Dr.  J.  W.  M. 


S'  i®*?t  ^^^*  Union  Offices,  John  Street  West,  Blackfriars 


Ayr  District  Asylum.— Junior  Medical  Officer.— Salary  £120  per 
annum,  with  board,  furnished  apartments,  attendance,  and  wash- 
ing.   Applications  to  the  Medical  Superintendent. 

Carlisle  Non-Provident  Dispensarj'.— Besident  Medical  Officer. 
Salary  £150  per  annum,  with  apartments  (not  board).  Applica- 
tions to  the  Honorary  Secretary,  Mr.  O.  A.  Lightfoot.  28 
Lowther  Rtreet,  Carlisle. 

Btirlmg  District  Asylum,  Larbert.  N.B.— Assistant  Medical  Officer. 
Salary  £160  per  annum,  with  board,  &c.  Applications  to  the 
Medical  Superintendent. 

County  Borough  of  South  Shields.— Medical  Officer  of  Health.  Salan' 
£800  per  annum.  Applications  to  J.  Moore  Hay  ton,  Tou-n  Clerk, 
Court  Buildings.  South  Shields. 

Whitehaven  and  West  Cumber. and  Inflrmarv.— House  Surgeon. 
Salary  £160  per  annum,  with  rooms  and  attendance.  Appli- 
cations  to  the  Secretary. 

Breoon  and  Badnor  Asylum,  Talgarth.  R.S.O.— Assistant  Medical 
Officer.  Salary  £140  per  annum,  with  furnished  apartments, 
board,  attendance,  and  laundry.  Applications  inunediately  to 
the  Medical  Supermteodent 

Botherham  Hopsitsl  and  Dispensary.— Senior  House  Surgeon.  Salarv 
£110  per  annum,  with  rooms,  commons,  and  washmg.  Appli- 
cations  to  the  Secretary,  C.  S.  BayUs,  19  Moorgate  Street, 
Rotherhsm. 

Leighton  Buzzard  Union.— Medical  Officer.  Salary  £960  per  annum. 
Applications  to  Chas.  W.  B.  Calcott,  Solicitor,  Leighton, 
Buzzard. 

Shillelagh  Union.— Medical  Officer.  Salarv  £120  per  annum.  Appli- 
cations to  J.  Hopkins,  Workhouse,  Shillelagh,  Co.  Wicklow. 

House  Surgeon,  for  a  small  Hospital  in  the  Midlands.  Salary  £100 
per  annum  and  board.  Applications  to  Mr.  P.  W.  Walker,  18 
Waterloo  Street,  Birmingham. 

Southwark  llnion.  London.— Second  Assistant  Male  Medical  Officer 
at  the  Infirmary  EastJDulwich  Grove.  S.E.  Salary  £100  per  annum, 
iiith  board,  lodging,  and  washing.    Applicationj    to  Ho^iwxl 


Jlppomtmenis. 

CoLLiKB,  Ethklbrbt,  L.R.aP.Lond.,  M.B.C.S.,  Coroner  for  the 
Bishop's  Stortford's  District  of  East  Hertfordshire. 

MiMMitRT,  Prrct  LrcKHART,  B.C.Cantab.,  P.R.C.8.Eng..  Assistant 
girgeon  to  the  North-Eastem  Hospital  for  Children,  Hackney 

N»^h  *'-:p»M.ILC8..L.R^.P..  Clinical  Assistant  to  the  Chelsea 

Hospitalfor  Women,  S.W: 
Oaklrt^dam  R.    H,  L.R.C.P.,  L.R  C.8.Edin.,  Third    Honormrv 

Anaasthetist  to  the  London  Throat  Hospital,  Great  Portland 

Street. 

Turner,  P.p.  M.B.Lond.,  M.R.C.S.,  L.R.O.P.,  Medical  Officer  to 
the  Post  Office  and  Medical  Examiner  to  the  Board  of  Education 
at  Huddersfleld. 


j6irtk0. 

BuLLRiD  -  On  July  17th,  at  The  Old  Vicarage,  Mkisomer,  Norton. 

Somerset,  the  wife  of  Arthur  BuUeid,  L  if.aP..  P.S  A.,  of  a  son 
GuTCH— On  July  2Srd.  at  S8  Ponnereau  Road,  Ipswich,  the  wife   o' 

J'>hn  Gutch,  M.D..  B. C.Cantab  ,  of  a  daughter. 
Havjelock.— On  July  21st,  at  Sunnyside,  Montrose,  N.B  ,  the  wife  of 

John  G.  Havelock,  M.D.,  of  a  son. 
Manlovs.— On  July  21st,  at  78  Warrior  Rquare,  St.  Leonatds-on- 

Sea,  the  wife  of  J  E.  Manlove,  L.R.C.P.,  M.1l.ri.rj.,  of  a  son. 
Youno.— On  July  21st,  at  2  Palmeira  Terrace,  Hove.  Sussex,  to 

and  Mrs.  B.  J.  Erskine  Young,  a  daughter  (prematurely). 


Dr. 


4ttarrkgc0. 


PERciVAL-WARirRR -On  July  218t  at  St.  Peter's  Church.  New- 
oastle.on.Tyrie,  Archibald  Stanley, M. A.,  M.B.Oamb.,  youngest 
son  of  the  Iste  Stanley  Percival.  to  Winifred  Helen,  youngest 
dauehter  of  thelate  William  Warner. 

^<>^'^-^'^^^^T'--On  July  20th,  at  St.  Marj-'s  Chunjh,  Handt^- 
worth,  Yorks,  George  Trewdson  Thomas,  M.D.,  M.R.C.P..  of 
Sydenhijm.  only  son  of  George  E.  Thomas,  of  Swainswick,  Bath, 
to  Eveline  Mary,  elder  daughter  of  William  Atkinson,  The 
Birklands,  Bandsworth. 


MtMts. 


MAKH.-On  May  18th,  at  Kisumu,  British  East  Africa,  Harold  E. 
Mann,  M.R.O.8.,  L.R.C.P,  D.P.H.,  Medical  Officer  East  Africa 
Protectorate,  son  of  the  Ute  Major  General  Oother  F.  Mann, 
aB.,  R.E.,  aged  39. 

Simon.— On  July  23rd,  at 40  Kensington  Square.  London,  in  the  88th 
•^®^ *?'***•  *8^-  Sir  John  Simon,  K.C.B..  M.D.Dub.,  M.W.C.S  . 
F.R.S..  formerly,  Medical  Officer  of  H.M.  Privy  Council,  and 
Consulting  SurgcDu  to  St.  Thomas's  Hospital,  London. 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.-St.  Bartholomew's  (1.80  p.m.),  University  College- 
(2  p.m.),  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m.).  Charing 
Cross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.).  King's 
College  f2  p.m.),  St.  George's  (Ophthalmic,  1  o.m.),  St.  Marv's 
(2  pm.).  National  OrthopaBdic  (10  a.m.),  St.  Peter's  (2  p.m.), 
Samaritan  (9.30  a.m.  anci  2.30  p.m.),  Gt.  Ormond  Street  (9.90 
a.m.).  Gt  Northern  Central  (8  80  p.m.),  Westminster  (2  p.m.;. 
Metropolitan  (2.80  p.m.),  London  Throat  (9.30  o-m),  Cancer 
(2  p.m.).  Throat.  GoWen  Square  (9.80  a.m.),  Guy's  (1.80  p.m.). 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  Sh.  Thomas's  (3.«» 
p.m.),  University  College  (2  p.m),  (Sharing  Ooss  (8  p  m.),  St. 
George's  (1  p.m.X  London  (2  p.m.).  King's  College  (2  p.m.).  Middle- 
sex (1.80  p.m.),  St.  Mar3''8  (2.30  p.m.),  Soho  Square  (2  p.m.), 
North-West  London  (2  p.m.).  CJhelsea  (2  p.m.).  Great  Northern 
Central  (Gyn»colo$rical,  2.80  p.m.),  MetropoUten  (2.80  p  m.), 
London  Throat  (9.30  a.m.),  St.  Mark's  (2  p.m.),  SamariUn  (9^0 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Guy's 
(1.80  p.m.). 

FRIDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.80  p.m.),  St. 
Thomas's  (3.30  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (L80  p.m.), 
(Sharing  Cross  (8  p.m.).  St.  George  s  (1  p.m.).  King  s  College  (2 
p.m.),  St.  Mar>''s  (2  p.m.).  Ophthalmic  (10  a.m.).  Cancer  (2  pjn.) 
Chelsea  (2  p.m.).  Great  Northern  Central  (2  80  p  m  ),  West 
London  (2  80  p.m.),  London  Throat  (9.80  a.m.),  Samariton  (9.30 
a.m.  and  2.80  p.m.).  Throat,  Golden  Square  (9.80  a.m.),  City 
OrthopjBdic  (2.30  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (1  JO 
p.m.),  St  Thomas's  (2  p.m.).  University  College  (9.15  a.m.). 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  St.  Mary's  (10  p.m.) 
Throat.  Golden  Square  (9.80  a.mT),  Guy's  (1.30p.m.). 

MONDAY.- London  (2  p.m.),  St.  Bartholomews  (1.80  p.m.),  St 
Thomas's  (8.30  p.m.),  St.  George's  (2  p.m.),  St.  Mary's  (2.80 
p.m.),  Middlesex  (1.80  p.m.).  W^estminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (G3'niecological,  bv  Physicians,  2  p.m.),  Soho 
Square  (2  p.m.),  Boyal  OrthopaBdic  (2  p.m.).  City  OrthopsMlio  (4 
p.m.).  Great  Northern  Central  (2  SO  p.m ),  West  London  (2.80 
p.m.),  Ix)ndon  Throat  (9.80  a. m.),  Royal  Free  (2  p.m.),  Guy's (1.8(1 
p.m.). 

TUESDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.80  p.m.).  St 
Thomas's  (3.30  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.80  p.m.), 
Westminster  (2  p.m.),  West  London  (2.80  p.m.).  University 
College  (2  p.m.),  St  George's  (1  p.m.),  St.  Mary's  (1  p  m.)  St 
MarkNB(2.30  p.nL).  Cancer  (2  p.m.),  Metropoliton  (2.80  pjn.), 
London  Throat  (9.30  a.m.).  Royal  Ear  (3  p.m.),  Samaritan  (9.80 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Soho 
Square  (2  p.m.) 


r 


Mh  ^dia\  ^vt^a  mA  (^mht. 


"SALUS   POPUU    SUPREMA    LEX' 


Vol.  CXXIX. 


WEDNESDAY,    AUGUST    3,    1904. 


No-    5- 


(Ptfdinal  Communicatiottd. 

THE   TREATMENT   OF 

CHRONIC  RENAL  DISEASE,  {a) 

By  W.  HALE  WHITE,  M.D.Lond.,  F.R.C.P., 
PhysiciAii,  Guy'i  Hospital,  London,  d^.,  Ac, 

Dr.  Hale  White,  in  opening  the  discussion  on 
the  above  subject,  said  that  the  exigencies  of 
time  compelled  him  to  limit  it  to  the  treatment 
of  the  disease  usually  known  as  chronic  Bright's 
disease.  Many  physicians  have  based  their  treat- 
ment largely  upon  the  albuminuria,  but  this  is 
wrong,  for,  probably,  not  much  harm  follows  the 
mere  loss  of  albumen  in  the  urine,  the  amount  so 
lost  is  always  small  and  could  be  easily  com- 
pensated for  by  a  Uttle  more  in  the  food,  and, 
further,  in  many  diseases  such  as  cystitis,  large 
amounts  of  albumen  are  lost  in  the  urine,  but  no 
one  thinks  of  directing  the  treatment  directly 
against  the  albuminuria.  The  value  of  the 
albumen  in  the  urine  is  that  it  enables  us  to 
diagnose  the  disease,  and  to  estimate  the  progress  it 
is  making.  It  was  pointed  out  that  very  often 
towards  the  end  of  a  case,  when  the  patient  wa^ 
at  his  worst,  the  amount  of  the  albumen  in  the 
urine  was  less. 

Passing  to  the  cardio-vascular  symptom,  two 
conditions  are  met  with.  Some  patients  have  a 
hypertrophied  heart  and  high  tension  pulse, 
others  are  suffering  from  a  weak,  feeble  heart. 
The  first  group  must  keep  down  their  blood 
pressure,  for  they  run  considerable  risk  of  fatal 
hemorrhage,  physical  exercise  should  be  gentle, 
the  bowels  should  be  loosely  opened  once  a  day 
to  avoid  strain  at  stool,  meals  should  be  small, 
alcohol  should  not  be  taken,  and  very  little  meat 
or  soup  or  meat  essences  on  account  of  the  ex- 
tractives in  them.  There  should  be  no  excessive 
drinking  of  fluids,  and  digitalis  and  other  drugs 
which  raise  the  blood  pressure  should  not  be 
given.  Sometimes  the  weak,  feeble  heart  met 
with  in  chronic  Bright 's  disease  is  brought  about ; 
by  the  fact  that  the  patient  has  been  starved  ; 
under  the  impression  that  most  articles  of  food! 
irritate  the  kidneys,  he  has  been  kept  on  nothing ! 
but  milk.  It  is  surprising  how  such  patients! 
are  benefited  by  giving  them  a  little  meat  and ; 
sometimes  a  httle  alcohol  helps  them.  Often 
patients  with  Bright's  disease  are  not  allowed 
enough  exercise,  with  the  result  that  they  become 
fat,  and  this  is  very  bad  for  them  because  the 
already  enlarged  heart  is  not  capable  of  conveying 

(a)  Abstract  of  Paper  read  at  the  Oxford  Meetioff  of  the  British 
Medical  AssodatioD,  July,  1904. 


the  blood  properly  to  the  extra  amount  of  fat 
tissue,  hence  the  organ  dilates. 

Unless  the  heart  has  dilated,  severe  oedema  is 
not  a  common  symptom  of  chronic  Bright's 
disease,  although  it  is  frequently  met  with  in 
chronic  tubal  nephritis.  It  is  best  treated  by 
posture.  If  it  is  in  the  legs  they  should  be  raised  ; 
if  in  the  lungs,  the  patient  should  be  turned  from 
side  to  side.  Diaphoretics  do  not  often  help  much, 
but  on  the  other  hand  the  oedema  subsides  best 
when  but  Uttle  fluid  is  drunk.  Still,  the  most 
efficient  way  to  get  rid  of  oedema  is  to  puncture 
the  legs  with  needles.  The  amount  of  fluid  that 
will  drain  off  is  very  great,  and  this  relieves  the 
oedema  of  other  parts.  Great  care  must  be  taken 
to  see  that  the  punctures  in  the  legs  are  kept 
sweet,  for  the  tissues  of  patients  with  Bright's 
disease  are  particularly  Hable  to  septic  inflamma- 
tion. 

Many  methods  of  treatment  have  been  directed 
to  avoiding  substances  which  are  supposed  to  be 
harmful  because  they  irritate  the  kidneys.  Certain 
drugs  undoubtedly  do  this ;  for  example,  car- 
bolic acid,  cantharides,  and  turpentine.  Other 
drugs  are  excreted  with  difficulty,  such  as  mercury, 
lead,  and  digitalis.  There  is  much  difference  of 
opinion  about  morphine.  It  certainly  often 
beneflts  the  convulsions  of  uraemia,  but,  inasmuch 
as  the  subjects  of  chronic  Bright's  disease  are 
very  easily  poisoned  by  it,  it  should  be  very  rarely 
used.  We  know  really  very  httle  as  to  whether 
any  articles  of  diet  irritate  the  kidneys.  Ex- 
cessive drinking  of  alcohol  is  bad,  but  only  3  per 
cent,  to  5  per  cent,  of  alcohol,  when  only  a 
moderate  quantity  is  taken,  is  excreted  by  the 
kidneys.  Therefore,  a  little  alcohol  does  not 
irritate  the  kidneys  at  all.  The  guide  in  giving 
alcohol  in  Bright's  disease  is  the  pulse  ;  if  the 
tension  is  high  it  must  not  be  given,  if  the  tension 
is  low  it  is  often  beneficial.  As  we  are  very 
ignorant  as  to  the  kind  of  food  which  irritates 
the  kidneys,  probably  most  patients  with  chronic 
Bright's  disease  are  best  if  they  take  ordinary 
plain  simple  food  in  such  quantity  that  their 
weight  keeps  about  normal.  There  is  no  evidence 
that  one  form  of  meat  is  better  than  another, 
or  that  chicken  and  fish  are  better  than  beef  and 
mutton,  and  most  of  the  statements  with  regard 
to  the  dieting  of  patients  with  chronic  Bright's 
disease  are  based  upon  entirely  insufficient  evidence. 
Often  the  patients  are  over-dieted,  their  food  is 
unduly  restricted,  and  they  feel  very  much  better 
when  they  are  allowed  more  latitude.  This  is 
especially  true  of  chronic  tubal  nephritis.  Tea, 
coffee,  and  tobacco  should  all  be  used  with  great 
moderation  by  sufferers   from   chronic  nephritis. 


112    The  Medical  Peess. 


ORIGINAL  COMMUNICATIONS. 


August  3.  1904- 


as  we  have  already  seen  how  important  it  is  to 
keep  the  blood  tension  normal,  and  any  of  these 
three  will  render  the  pulse  irregular,  rapid,  and 
of  low  tension.  As  a  rule,  too,  much  water 
drinking  is  bad,  for  if  much  is  taken  oedema  will 
not  subside,  and  excessive  water  drinking  in- 
creases nitrogenous  metabolism,  and  also  a  large 
amount  of  water  raises  the  blood  pressure. 

There  can  be  little  doubt  that  uraemia  is  a  form 
of  poisoning.  What  the  poison  is  we  do  not 
know.  There  is  no  evidence  that  it  is  derived  i 
from  the  food,  for  the  onset  of  uraemia  has  not  1 
been  shown  to  be  associated  with  any  particular  j 
article  of  diet,  and  large  amounts  of  food  in  healthy  ^ 
persons  do  not  lead  to  uraemia.  Dr.  Hale  White 
quoted  a  case  which  was  observed  by  himself  ' 
and  Dr.  Spriggs,  in  which  5,000  kilocalorics  of  j 
food  were  taken  a  day  for  fifty-five  days,  at  least 
X20  grammes  of  nitrogen  were  retained,  but  the 
patient  had  not  uraemia.  Further,  there  is  no 
diminution  in  the  output  of  nitrogen  during 
uraemia.  As  there  is  no  evidence  that  uraemia 
is  connected  with  the  food,  it  is  supposed  that 
the  poison  is  produced  within  the  body.  As  we 
know  of  no  antidote  to  it  nor  of  any  way  of 
stopping  its  formation,  all  we  can  do  is  to  render 
the  excretory  channels  of  the  body  active.  There- 
fore, the  bowels  should  be  kept  open,  the  patient 
should  be  made  to  sweat,  and  any  diarrhoea  and 
vomiting  should  not  be  checked.  Often  benefit 
follows  transfusion,  probably  because  some  of  the 
poison  is  washed  out ;  bleeding,  too,  is  often 
beneficial.  As  this  treatment  is  correct  for 
uraemia,  it  is  well  for  a  patient  with  chronic 
Bright's  disease  always  to  keep  the  bowels  well 
open,  and  to  have  a  hot  bath  occasionally  so  as 
if  possible  to  ward  off  uraemia.  Inasmuch  as  in 
Egypt  the  heat  is  great  and  the  humidity  of  the 
air  is  low,  it  is  an  ideal  climate  for  sufferers  from 
chronic  Bright *s  disease,  for  they  perspire  quickly 
and  the  perspiration  rapidly  evaporates. 

Dr.  Hale  White  concluded  by  saying  that  he 
had  confined  himself  strictly  to  points  in  the 
treatment  of  which  he  had  had  personal  exper- 
ience, and  he  left  it  for  other  speakers  to  give 
their  views  upon  the  treatments  to  which  he  had 
not  alluded. 


OUR    SANITARY    NEEDS, 

WITH     SPECIAL      REFERENCE     TO     THE 
NATIONAL     HEALTH,  (a) 

By  Sir  W.  SELBY  CHURCH,  K.C.B.,  M.D., 

Physician,  St.  Bartholomew's  Hospital. 
After  a  brief  reference  to  the  condition  of 
medical  knowledge  in  1868,  when  the  Association 
last  met  in  Oxford,  it  was  pointed  out  that  the 
meeting  could  almost  be  taken  as  marking  the 
commencement  of  our  present  views  concerning 
febrile  and  some  other  diseases.  Lord  Lister 
having  the  year  before  read  at  Dublin  his  paper  on 
"  The  Antiseptic  Principle  in  the  Practice  of 
Surgery,"  and  the  medical  world  just  begin- 
ning to  recognise  the  infectivity  of  tubercle.  Allu- 
sion was  made  to  Sir  Wm.  Gull's  address  in  1868 
on  "  Medicine,"  and  our  present  knowledge  con- 
trasted with  his  statement  about  infectious 
diseases,  that  they  spread  by  emanations  from  the 
sick,  but  whether  as  amorphous  material  or  as 
germs  we  know  no  more  than  a  thousand  years 
ago.     The  importance  of  our  acquaintance  with 


(a)  Abstract  of  the  Address  on  Medicine  given  at  Oxford,  July 
28th,  1904. 


the  internal  secretions  of  organs  was  touched  upon, 
and  disappointment  expressed  that  expectations 
roused  by  the  success  of  thyroid  feeding  in  my- 
xoedema  had  not  as  yet  been  fulfilled  in  the  case  of 
diseases  of  other  organs. 

After  a  short  reference  to  the  condition  o€ 
medical  practitioners  in  Greece  and  Rome,  and 
the  evolution  of  the  profession  in  this  country 
during  mediaeval  times,  tjie  rise  of  sanitary  legisla- 
tion was  considered,  and  the  passing  of  the  Medical 
Act  of  1858  was  taken  as  marking  the  advent  of  a 
new  branch  of  medicine — Preventive  or  State 
Medicine.  The  need  for  codification  and  simplifi- 
cation in  our  sanitary  procedure  was  pointed  out, 
and  the  necessity  for  the  Medical  Department  of 
the  Local  Government  Board  having  more  power 
and  acting  as  an  advisory  as  well  as  a  supervising 
body.  The  need  for  a  much  closer  supervision  of 
the  manufacture  and  sale  of  food-stuffs  was  con- 
sidered, and  the  desirability  of  health  authori- 
ties having  greater  powers  than  they  at  present 
possess  in  preventing  the  overcrowding  of  locali- 
ties as  well  as  houses. 

The  mistake  of  rural  communities  municipally 
adopting  the  principles  of  liquid  sewage  disposal, 
notwithstanding  the  difficulties  that  are  known, 
was  referred  to,  and  the  disadvantages  attendant 
on  the  overgrown  size  of  buildings  in  our  towns 
was  alluded  to.  The  Registrar-General's  returns 
were  quoted  as  showing  that  the  mortality  in- 
creased with  the  denseness  of  the  population,  and 
that  this  was  especially  the  case  with  infant  mor- 
tality. In  conclusion,  the  Association  was  urged 
to  use  its  influence  to  spread  the  knowledge  of 
sanitation,  and  to  point  out  both  to  the  public 
and  the  Government  the  desirability  for  a  physi- 
cal census  of  the  nation  being  taken  from  time 
to  time,  and  the  necessity  for  the  registration  of 
the  physical  condition  of  the  children  in  our 
primary   and   secondary   schools   being   kept. 

THE  SEASIDE  CURE: 

ITS  INDICATIONS  AND  CONTRA-INDICATIONS. 

By    ALFRED    S.    GUBB.    M.D.    (Paris).    &c., 
Of  Mustapha  Superiear,  Al^riers,  and  Aix-lee-Bains. 

The  season  for  sea-bathing  has  returned,  and  prac- 
titioners in  general  will  be  asked  to  express  an  opinion 
on  the  advisability  of  going  to  the  seaside  for  the  re- 
storation of  health.  It  is  by  no  means  easy  to  formu- 
late an  opinion  on  the  subject  based  on  scientific  prin- 
ciples, because  the  "  sea-air  cure "  has  not  been 
methodically  investigated.  It  has  been  empirically 
employed  from  time  immemorial,  but  in  truth  more  on 
the  personal  initiative  of  the  patient  than  on  the  advice 
of  physicians  who  have  taken  the  trouble  to  think  the 
matter  out,  and  who  can  specify  its  indications  and 
contra-indications.  At  the  Thalassotherap>eutic  Con- 
gress, held  at  Nice  last  year,  a  number  of  papers  were 
read  on  the  subject,  some  of  them  of  considerable  value 
since  they  were  based  on  numerous  observations  which 
throw  fresh  light  on  an  obscure  subject. 

We  have  first  to  ask  ourselves,  What  is  the  action  of 
the  "  sea-cure  "  ?  This  comprises  two  divisions,  viz., 
the  action  of  sea-air,  i.e.,  the  purely  climatic  asp>ect, 
and,  secondly,  the  action  of  sea-baths.  Now  the  pro- 
perties of  sea-air  may  be  summarised  as  follows  :  The 
air  at  sea  level  attains  its  maximum  density,  and  the 
barometric  pressure  is  at  its  highest.  Under  these 
conditions  the  respiratory  movements  are  reduced  in 
number  but  increased  in  amplitude.  It  follows  that 
the  air  circulates  more  freely  in  the  respiratory  tract, 
and  that  the  circulation  of  blood  in  the  lungs  takes 
place  more  easily.  Moreover,  a  given  volume  of  sea- 
air  contains  a  larger  prop>ortion  of  oxygen  than  inland 
or  mountain  air,  and  this  determines  an  increase  in  the 


August  3,   1904. 


number  of  red  corpuscles  as  well  as  an  augmentation 
in  the  proportion  of  haemoglobin.  Then,  too,  sea-air 
is  markedly  freer  from  dust  and  consequently  from 
aerial  micro-organisms  than  land  air,  advantages  upon 
which  it  is  hardly  necessary  to  insist.  The  prevailing 
temperature  is  more  uniform,  but,  on  the  other  hand, 
the  winds  are  more  frequent  and  stronger.  Among 
their  effects  must  be  noted  that  they  promote  evapora- 
tion from  the  cutaneous  surface  and  cause  a  loss  of 
surface  heat  which  stimulates  organic  exchange. 

Light,  which  is  such  an  important  factor  in  a  climate, 
is  at  its  maximum  at  the  sea-shore,  and,  light  for  light, 
it  is  richer  in  chemical  and  therapeutically  active  rays. 
It  exerts  a  pronounced  stimulating  action  on  meta- 
bolism and  produces  a  beneficial  action  on  the  vaso- 
motor system,  which  Huchard  describes  as  *'  the  peri- 
pheral heart  which,  ramifying  beneath  the  skin,  regu- 
lates and  governs  the  function  of  the  central  heart." 
It  is  generally  admitted  that  sea-air  contains  a  larger 
proportion  of  ozone,  and,  along  with  this,  a  larger  pro- 
portion of  aqueous  vapour.  In  districts  immediately 
adjacent  to  the  seaboard  the  air,  especially  in  rough 
weather,  becomes  laden  with  fine  spray,  containing 
the  alkaline  chlorides,  bromides,  and  iodides,  though, 
according  to  Lalesque,  the  proportions  of  these  salts 
present  in  sea-air  has  been  much  exaggerated.  Gautier 
and  Duphil,  as  a  matter  of  fact,  only  found  22  and  15 
thousandths  of  a  miUigramme  per  litre  of  sea-air. 

It  will  be  seen,  then,  that  sea-air  is  made  up  of 
elements  which,  for  the  most  part,  are  stimulants.  It 
stimulates  metabolism,  at  any  rate  in  the  sick,  and  for 
a  limited  period — ^until  they  have  become  acclimatised 
— in  the  healthy.  Clinically  it  increases  the  appetite, 
and  indirectly  brings  about  an  increase  of  body  weight. 
The  circulatory  and  respiratory  functions  are  slowed, 
cutaneous  perspiration  and  diuresis  increase,  the  mus- 
cular strength  is  enhanced,  and  the  proportion  of  red 
corpuscles  in  the  blood  is  raised. 
Sea-Bathing. 
The  action  of  sea-baths  is  markedly  stimulating. 
They  influence  the  respiratory  and  general  exchanges, 
first  of  all  by  chilling  the  cutaneous  surface,  as  in  any 
application  of  cold  hydrotherapeutics,  and  these  effects 
are  enhanced  by  the  richness  of  the  water  in  mineral 
constituents  ;  lastly,  the  movements  of  the  bather  in 
swimming  and  the  mobility  of  the  water  itself  con- 
stitute a  genuine  massage  of  the  whole  body. 

Albert  Robin  and  Binet  explain  the  action  of  sea- 
baths  as  follows  :   "  The  various  elements  of  activity  in 
a  sea-bath  stimulate  the  peripheral  nerve  terminals, 
and  the  extensive  nervous  surface  of  the  integument, 
and  this  stimulus  is  transmitted  centripetally  to  the 
nerve  centres,  which  preside  over  general  nutrition." 
The  action  of  the  "  sea-treatment  "  cannot  be  better 
summarised    than   in    the   words    employed   by    Dr. 
Robin,  in  his  address  at  the  Congress  just  referred  to : 
"  Denser,  of  a  more  uniform  temperature,  rendered 
more  salutary  by  the  winds  and  the  waves,  saturated 
with  salt  iodised  vapours,  bathed  in  light,  it  stimulates 
all  the  vital  functions — the  appetite,  digestion,  assimi- 
lation, and  the  various  chemical  acts  of  elementary 
nutrition.     Respiration  finds  therein  purer  and  more 
stimulating    elements,    it    regulates    h^ematosis,    and 
molecular  regeneration."     Sea-baths,  moreover,  accen- 
tuate the  double  process  of  assimilation  and  disassimi- 
lation  which  together  constitute  nutrition,   this  prime 
manifestation  of  vital  energy.'     It  promotes  the  com- 
bustion of  the  residues  of  organic  activity  which,  in- 
stead of  stagnating  in  the  organism  and  by  their  re- 
tention engendering  functional  disturbances  which  are 
the  forerunners  of  actual  disease,  are  rendered  soluble 
and  their  eUmination  from  the  economy  thus  facilitated. 
Sea- air  and  sea-bathing,  these  powerful  modifying  agents 
of  intra-organic  exchanges,  are,  therefore,  a  means  of  re- 
generation, of  "  recorporation."  as  it  was  called  by  the 
ancients,  who   thought,  reasonably  enough,   that  by 
renovating  the  tissues  they  could  modify  inherited  and 
acquired  tendencies  and  wash  away,  so  to  speak,  latent 
morbid  predispositions  inherent  to  particular  organisms. 
Indications  and  Contra-indications. 
The  reply  to  the  question  as  to  the  special  diseases 


ORIGINAL  COMMUNICATIONS.       The  Medical  Press.     113 


likely  to  derive  benefit  from  the  "  sea-cure  "  is  to  be 
inferred  from  what  we  have  just  said,  i.e.,  all  diseases 
characterised  by  a  slowing  down  of  nutrition.  When- 
ever in  a  given  patient  we  wish  to  accelerate  general 
and  respiratory  exchanges,  we  should  send  him  to  the 
sea-side.  Formulated  in  this  general  way  the  con- 
clusion appears  simple  enough ;  but  in  practice  the 
point  is  often  difficult  to  decide  and  requires  for  its 
proper  appreciation  precise  observation  and  numerous 
distinctions.  Let  us  begin  by  asking  ourselves  what 
are  exactly  the  modifications  of  nutrition,  provided  by 
sea  stimulation.  According  to  Robin  and  Binet  the 
organic  exchanges  are  accelerated  en  bloc,  and  the  in- 
creased activity  bears  more  particularly  on  nitro- 
genous metabolism.  The  excretion  of  mineral  ele- 
ments is  reduced,  the  evolution  of  ternary  substances  is 
more  satisfactory,  the  proportion  of  uric  acid  dimi- 
nishes, the  assimilation  of  alimentary  phosphates  is 
more  perfect,  the  increase  in  the  proportion  of  earthy 
phosphates  to  the  phosphoric  acid  testifies  to  more 
active  changes  in  the  osseous  and  nervous  systems  ; 
^  the  solubility  of  the  fluids  for  uric  acid  is  enhanced,  the 
assimilation  of  nitrogenous  substances  is  markedly 
increased,  and  depends  not  upon  greater  organic  com- 
bustion, but  upon  a  better  assimilation  of  these 
principles. 

How,  then  are  we  to  establish  the  nutritive  budget  of 
the  patient  ?     To  do  so  not  only  takes  time  but  re- 
quires a  special  laboratory  and   a  chemical  expert. 
Robin,  however,  holds  that  it  is  sufficient  to  weigh  the 
patient  regularly.     The  amount  of  albumen  consumed 
per  kilogram  of  body  weight  in  the  twenty-four  hours 
is  estimated  by  noting  the  elimination  of  chloride  of 
sodium.     If  the  consumption  of  albumen,  thus  mea- 
sured, increases  or  even  remains  stationary,  while  at 
the  same  time  the  excretion  of  chloride  of  sodium 
diminishes,  the  patient  should  not  remain  at  the  sea- 
side.    A  further  consideration  has  to  be  borne  in  mind 
that  of  the  particular  station  to  which  the  patient  is  to 
be  sent.     The  seaside  climate  is  not  the  same  every- 
where.    We  have  discussed  its  fundamental  qualities, 
but  a  host  of  factors  associated  with  the  topography  of 
the  place,  its  exposure  to  winds,  its  relative  humidity, 
its  vegetation,  &c.,  modify  its  curative  action.     In  a 
particular  resort,  well  protected  from  north  and  west 
winds,  near  which  there  are  pine  forests,  we  shall  obtain 
sedative  effects,  whereas  in  another  resort,  which  is 
swept  by  the  winds  and  is  poor  in  vegetation,  the  effects 
will   be   purely   stimulating.     The   neighbourhood  .of 
Algiers,  for  instance,  shut  in  as  it  is  by  mountains; 
will  always  present  a  much  higher  hygrometric  record 
than  stations  hig:her  up  the  hills,  which  are  better  ven- 
tilated and  retain  less  cloud  and  damp.     Certain  re- 
sorts may  be  divided  into  zones  according  to  the  dis- 
tance from  the  sea-shore  of  its  various  districts,  their 
exposure  to  wind,  their  aspect  in  regard  to  the  sun.  and 
their  flora.     The  slopes  of  Mustapha  Superieur,  above 
Algiers,  will  prove  beneficial  to  many  categories  of 
patients  who  would  derive  anything  but  benefit  from 
a  sojourn  to  the  west  of  Algiers  at  St.  Eugene,  for 
example. 

In  addition  to  the  peculiarities  of  the  particular 
station  we  must  also  study  the  peculiarities  of  the 
patient.  The  inadequacy  of  the  nutritive  processes 
may  not  be  due  to  any  slowing  down  thereof,  but  to 
excessive  demands  thereon.  In  such  cases  the  seaside 
is  unsuitable,  for  it  would  accentuate  the  overstrain. 
The  stimulating  effects  of  sea-air  on  the  other  hand,  are 
not  produced  in  every  instance.  '  Seaside  practitioners 
meet  with  patients  in  whom  metabolism  is  exaggerated, 
who  nevertheless  bear  seaside  residence  very  well  and 
even  improve.  The  stimulant  effects  are  also  modified 
by  acclimatisation.  Lastly,  the  different  zones  of  a 
particular  station  may,  as  we  have  shown,  possess 
different  curative  quaUties  if  the  treatment  be  modified 
accordingly. 

Under  these  circumstances  the  seaside  treatment 
may  be  advised  in  respect  of  the  following  categories 
of  patients — anaemic  patients  with  slowed  nutrition, 
convalescents  from  febrile  diseases;  sufferers  from 
malaria,    patients    of    lymphatic    temperament,     the 


114    Thb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


August  3,  19Q4' 


strumous  and  in  certain  forms  of  neurasthenia  with 
imperfect  nutrition.  The  treatment  is  also  suitable 
for  rickety  subjects,  and  in  many  osseous  affections. 
Cases  of  chronic  tuberculous  adenitis  with  low  nutri- 
tion will  often  be  benefited  by  residence  at  the  sea- 
side. 

The  victims  of  pulmonary  tuberculosis  in  whom  the 
nutritive  exchanges  are  usually  over-active,  are  better 
at  a  distance  from  the  sea,  but  there  are  exceptions  to 
this  rule,  for  in  Algiers  we  are  familiar  with  instances 
in  which  great  and  permanent  benefit  has  followed 
residence  near  the  sea  in  such  cases.  This  question  has 
given  rise  to  much  discussion,  and  although,  as  a 
general  rule,  we  may  admit  with  Robin  that  our  object 
must  be  "  to  calm  the  tuberculous,  to  extinguish  the 
fire  that  is  consuming  them  and  not  blow  it  into  a 
flame  by  the  sea  breeze,"  that  does  not  prove  that 
these  patients  will  derive  no  benefit  from  the  seaside. 
We  have  shown,  indeed,  that  the  topography  of  certain 
Stations  attenuates  the  stimulating  efiects. 

According  to  Manquat  the  tuberculous  may  be 
classified  in  four  categories— (a)  torpid  tuberculosis  in 
persons  whose  nutritive  exchanges  are  normal  or  sub- 
normal, whose  circulation  is  calm,  whose  lesions  are 
circumscribed  and  stationary  ;  these  may  improve  at 
the  seaside  ;  (6)  those  whose  lesions  evolute  per  solium, 
%.e.,  acute  outbreaks  followed  by  periods  of  remission 
of  variable  duration.  These  should  be  sent  to  a  seda- 
tive station  and  residence  too  near  the  sea  must  be 
prohibited;  (c)  cases  of  acute,  rapidly-progressing 
tuberculosis  should  never  be  allowed  near  the  sea  ; 
id)  the  incurable  cases,  in  which  the  choice  of  a  climate 
is  of  less  importance  and  may  be  left  in  great  measure 
to  individual  taste.  . 

Persons  predisposed  to  pulmonary  tuberculosis, 
whose  nutritive  changes  are  unduly  active,  should  be 
kept  at  a  distance  from  the  sea.  According  to  Robm. 
the  great  majority  of  the  tuberculous  derive  no  benefit 
froni  the  seaside.  The  only  exceptions  to  this  rule  are 
( I )  the  tuberculous  whose  respiratory  exchanges  are  not 
in  excess,  i.e.,  about  8  per  cent,  of  such  cases  ;  (2)  the 
phthisical  who,  although  their  respiratory  exchanges 
are  in  excess,  eat,  digest,  and  assimilate  badly  in  such 
wise  that  the  excess  of  oxygen  which  they  consume 
hastens  the  consumption  of  their  own  tissues.  In 
these  a  temporary  stimulation  of  the  digestive  and 
assimilative  functions  will  divert  to  the  ingested  food 
a  portion  of  the  surplus  oxygen.  The  Mediterranean 
seaboard  may,  according  to  Huchard,  be  recommended 
to  cardiac  patients  in  winter  on  condition  that  they 
have  not  reached  the  period  of  asystole.  The  seaside 
on  the  other  hand,  is  contra-indicated  m  aneurysm  and 
dilatation  of  the  aorta,  in  coronary  angina  pectoris,  in 
pseudo-angina  pectoris  of  neuralgic  origin,  and  in 
cardiac  states  associated  with  the  phenomena  of  hyper- 
systole,  or  cardiac  excitement  with  frequent  attacks 

^  Rhemnatic^subjects  with  acute  or  subacute  attacks 
usually  find  their  state  to  be  aggravated  by  residence 
close  to  the  sea,  and  the  same  maybe  said  of  arthntics 
subject  to  neuralgic  attacks.  Neuralgics  and  the  so- 
called  •'  herpetics,"  are  oftener  than  not.  worse  near 
the  sea,  and  moist  chmates  in  general  are  injurious  to 

Arthritics,  whose  nutrition  is  merely  slowed  ;  the 
subjects  of  arterio-sclerosis  without  grave  comphca- 
tions  •  the  obese  by  nutritional  slowing  down  '  and 
the  Routy  and  hyposthenic  dyspeptic,  may  derive 
marked  benefit  from  the  seaside.  Certain  phospha- 
turic  neurasthenics  also  benefit  therefrom,  but  the  pure 
neurasthenic  wiU.  as  a  rule,  do  better  in  a  sedative 

^  *L^t1v,  hysterical  subjects  are  often  worse  near  the 
sea,  or  feel  so,  but  they  need  not  on  that  account  be 
sent  elsewhere.  According  to  Mendelsohn  these 
patients  often  complain  of  stimulating  phenomena  m 
no  ^^'ise  due  to  any  modification  of  the  special  excita- 
bilitv  of  the  sensory  and  motor  nervous  system.  Their 
state  is  due  rather  to  a  psychical  condition  brought 
about  bv  emotional  hyper-sensitiveness.  Should  this 
psychical  state  not  rapidly  yield  to  acclimatisation  or 


"  suggestion,"   it  is  preferable  not   to  insist,   but   to 
advise  removal  from  the  neighbourhood  of  the  sea. 

Indications   and   Contra-Indications    of   Sea- 
Baths. 

Sea-baths  are  suitable  for  the  rickety,  the  lymphatic, 
the  strumous,  the  subjects  of  osseous  and  glandular 
tuberculosis,  in  ansemia  with  slowed  nutrition,  in 
obesity  by  defective  metabolism,  in  those  predisposed 
to  gout,  in  chronic  auto-intoxication,  in  hyposthenic 
dyspepsia,  in  convalescence  after  febrile  diseases,  and 
for  diabetics  when  nutrition  has  begun  to  give  way. 


THE  PRINCIPLES  OF 

OPEN-AIR    TREATMENT 

OF 

TUBERCULOSIS. 

By  T.  CARSON  FISHER,  M.D..  &c., 
DunstoM  Pftrk  SAnatorium,  Paignton,  Deron. 

In  recent  years  much  interest  has  been  shown  by  the 
profession  and  the  public  in  the  "  open-air  "  treatment 
of  tuberculosis.  It  has  been  discussed  in  medical  and 
lay  papers,  in  crowded  congresses,  and  it  has  now  quite 
a  literature  of  its  own.  In  spite  of  this  publicity  there 
are  vague  and  conflicting  opinions  regarding  the  scope, 
limitations,  and  results  of  "  open-air  "  methods. 

The  writer  having  for  many  years  treated  consump- 
tion in  various  climates,  both  at  home  and  abroad, 
having  been  for  some  years  past  Resident  Physician  in 
various  home  sanatoria,  and  having  visited  many 
others,  endeavours  in  this  article  to  give  a  brief  sum- 
mary of  various  practical  points  in  open-air,  hygienic, 
or  sanatorium  treatment  of  tuberculosis. 

The  former  pessimism  about  consumption  has  passed 
away,  and  in  its  place  there  is  risk  of  somewhat  undue 
optimism.  It  is  certain  that,  according  to  pathological 
and  clinical  research,  the  disease  is  spontaneously 
curable  in  a  considerable  percentage  of  cases. 

Dr.  Bulstrode,  (a)  in  his  Milroy  Lectures,  quotes  an 
extract  from  one  of  Professor  C.  Allbutt's  addresses : 
"  I  am  guilty  of  no  extravagance  when  I  suggest  that 
one-third  of  you  who  hear  me,  wittingly  or  unwittingly, 
are.  or  have  been,  affected  with  tubercle." 

The  human  organism  is  refractory  to  the  tubercle 
bacillus.  Some  are  practically  immune.  Authors 
such  as  Flugge  state  that  the  cough  spray-drop  of  the 
phthisical  contains  tubercle  bacilli;  yet  doctors. 
students,  nurses,  and  others  inhale  these  daily  with 
apparent  immunity. 

The  power  of  resistance  in  most  people  is  greater  than 
was  imagined,  or  the  virulence  of  the  toxins  has  altered 
as  in  other  infective  diseases.  Opinion  is  unanimous 
that  "  open-air  "  or  hygienic  treatment  is  the  most 
potent  weapon  against  the  attacks  of  the  tubercle 
bacillus,  except  in  advanced  cases. 

To  aid  the  natural  immunity,  to  improve  the  power 
of  resistance,  and  promote  the  process  of  repair  are 
the  objects  of  this  treatment,  and  this  can  be  best 
attained  in  a  suitable  sanatorium. 

The  evolution  of  this  treatment  during  the  last  half- 
century  is  well  known.  It  was  foreshadowed  in  Eng- 
land by  Bodington  and  others  fifty  years  ago,  but  in 
Germany  it  was  developed  and  systematised,  and  the 
measures  for  the  control  of  the  disease  are  now  more 
complete  there  than  in  any  other  country.  (6) 

In  British  sanatoria.  German  methods  have  been 
modified  in  various  ways.  Without  detracting  from 
the  merits  of  the  foreign  system,  experience  shows  that 
some  details  can  with  advantage  be  altered  or  omitted 
as  unsuited  to  English  character  and  habits.  The 
general  principles  and  routine  of  treatment  in  most 
British  sanatoria  are  similar,  however  they  may  differ 
in  details.  The  main  factors  may  be  summed  up  as 
follows : — 

1.  Pure  air  always. 

2.  Abundant  sunlight. 

3.  Regulated  rest. 


^o)  LoMoeU  August  8th,  1903. 

7))  Bulstrode,  Larwet,  August  8th.  1003. 


(?') 


August  3,  1904. 


ORIGINAL  COMMUNICATIONS. 


Tbx  Mkdical  Pxess.    1 15 


4.  Graduated  exercise. 

5.  Abundant  nourishing  food. 

6.  Careful  medical  supervision. 

I.  Pure  Air, — The  history  of  Arctic  exploration 
shows  that  in  those  frigid  regions  there  is  remarkable 
immunity  from  rheumatic  affections,  catarrhs,  and 
common  colds.  The  doctor  to  the  Italian  expedition 
{a)  which  reached  the  furthest  North  comments  on  this 
significant  fact,  and  attributes  it  to  the  purity  of  the 
air  and  the  absence  of  micro-orgaiiisms,  the  cold  and 
the  continuous  and  intense  light  being  antagonistic  to 
their  development.  Other  Arctic  explorers  record 
similar  facts. 

The  microbes  to  which  are  due  catarrhs,  influenza, 
common  colds,  and  such  like  infest  ordinary  houses, 
but  do  not  exist  where  the  air  is  kept  pure.  In  open- 
air  sanatoria  such  ailments  are  unknown,  unless  they 
are  imported,  and  even  then  they  are  short-lived. 

The  first  aim  of  the  treatment  is  to  substitute  pure 
air  constantly  for  the  unclean  and  vitiated  atmosphere 
in  which  most  phthisical  patients  try  to  live  for  months 
or  years.  An  "  open-air  *'  life  is  the  first  essential  of 
hygienic  treatment. 

In  fine  weather  the  patient  can  spend  the  day  out  of 
doors  with  adequate  shelter  from  wind  or  hot  sun.  On 
wet  or  stormy  days  he  can  rest  in  a  suitable  shelter 
or  verandah.  In  most  sanatoria  huts  are  erected  in 
different  positions,  those  for  winter  facing  south,  and 
others  for  summer  facing  north.  Revolving  shelters 
are  very  useful.  Balconies  with  proper  protection 
from  wind,  rain,  or  glare  are  suitable  for  weaker 
patients.  At  night  the  head  of  the  bed  must  be  close 
to  the  open  window.  Shelter  from  strong  winds  or 
rain  can  be  secured  by  moving  the  bed  about,  or  by 
some  screen  arrangement.  The  larger  the  window 
space  the  better,  since  the  air  of  the  room  is  more  easily 
kept  pure,  and  there  are  fewer  spaces  for  stagnant  air. 
It  has  been  found  that  febrile  patients  do  better  in 
a  chalet  with  windows  on  all  sides  than  in  an  ordinary 
bedroom  with  open  windows.  The  furniture  must  be 
scanty;  carpets,  curtains,  wall-papers,  and  everything 
that  can  harbour  dust  should  be  abolished.  Hence 
the  walls  should  be  smooth,  varnished,  or  dis- 
tempered ;  the  utmost  cleanliness  is  essential,  and 
proper  precautions  taken  regarding  sputum  and 
disinfection. 

The  constant  purity  of  the  air  causes  night  sweats 
to  disappear ;    sleep  comes  readily ;   cough  and  fever 
lessen  ;  increased  appetite  comes,  and  at  the  end  of  the 
first  week  there  is  usually  a  gain  of  some  pounds  in 
weight.     Every  patient  should  have  a  separate  bed- 
room to  prevent  disturbance  by  talking,  coughing.  &c., 
and  to  ensure  privacy  and  rest.     Of  course,  in  public 
sanatoria  this  is  sometimes  difficult,  though  various 
simple  kinds  of  hut  can  be  erected  cheaply ;    but  in 
private  sanatoria  it  is  the  rule.     Personal  experience  of 
a  wooden  chalet  in  an  English  winter  convinces  the 
writer  that  it  is  then  fit  only  for  stronger  patients  with 
a   good    circulation.     Delicate   consumptives   require 
more  comfort  and  warmth  than  can  be  attained  in  a 
fragile   wooden  structure.     At  other  seasons  of   the 
year  it  has  its  advantages.     The  site  should  be  specially 
chosen  to  give  pure  air,  with  shelter  from  strong  or  cold 
winds.     Hence  it  should  be  in  the  country,  away  from 
dust,  smoke,  fog,  or  noise ;    isolated,  and  in  its  own 
grounds.     It  is  quite  out  of  place  in  or  near  a  town. 
An  elevation  of  some  hundreds  of  feet  above  sea- 
level  gives  bracing  and  invigorating  air  as  well  as  more 
ozone.     Anyone  who  has  lived  in  a  low-lying  place  and 
migrated  to  the  uplands  must  readily  admit  his  im- 
proved health,  energy,  and  sense  of  well-being. 

The  elevation  must  not  be  too  great  on  account  of 
severe  cold  and  gales  in  winter.  Visitors  to  British 
sanatoria  will  find  them  in  varied  positions,  and  doubt- 
less some  cases  do  best  in  low,  sheltered  places. 

It  is  possible  that  the  situation  may  be  too  shut  in 
\yy  hills,  trees,  hedges,  &c.,  so  as  to  prevent  free  circu- 
lation of  air,  especially  in  summer.  Nearness  to  the 
sea  is  not  an  advantage.     Practical  men  generally 


advocate  a  site  elevated  and  airy,  but  not  too  exposed 
or  wmd-swept.  ^ 

The    experts    who    advised    regarding 
Sanatorium  recommended  a  high  situation  on  the  slope 
of  a  hill  facmg  south,  with  adequate  shelter  from  pre- 
yaiUng  wmds.     An  ideal  position  is  hard  to  find,  free 


(a)  "  Yojftga  of  tha  Polar  Star/'    Bj  the  Due  d'Abruxzi. 


regarding    the    King's 

r.4  o  k;ii  4    '  :z rr  "  ©^  situation  on  the  slope 

of  a  hill  facing  south,  with  adequate  shelter  from  pre- 
vaiUng  wmds.  An  ideal  position  is  hard  to  find,  free 
from  every  drawback,  and  in  the  country  the  question 
of  supplies  has  to  be  considered.  The  nature  of  the 
sod  18  important      It  should  be  of  a  porous  nature. 

a^i^roid^r  ^^"^^  ^^'"P'  ^^^  ^'^y  -^« 

snniii^rif'''''  5«n/,-^A/.-A  high  situation  gets  more 
sunlight  than  a  low  one.  where  morning  and  evening 
mists  are  hable  to  prevaU  for  several  months  in  thf 
year.  A  number  of  places  in  the  British  Isles  «ret  a 
fair  amount  of  sunshine  even  in  winter. 

U  ^°,H^\^r'^'  ^^uP^  ?^*^'  '904,  p.  1071).  comparison 
Wh^f^*'^f^V^^'^'e*^'■  t^-^P^ature  chiefly  of  the 
?^^  n*^  ^u^^^^  *°^  *^^  ^*^*°  *°d  Rivieran  resorts, 
not  all  to  the  advantage  of  the  latter ;  while  as  regards 
diurnal  range  of  temperature  and  freedom  from  frost, 
the  English  places  are  superior.  The  aggregate  rainfall 
of  these  home  stations  was  lower,  though  there  were 
more  wet  days. 

Dr.  Gordon,  of  Exeter,  has  written  on  the  mjurious 
effects  of  wet  wmds  in  phthisis.  There  is  no  doubt 
that  bronchitic,  elderly,  and  some  febrile  cases  do  not 
improve  then  as  they  do  in  dry  weather,  but.  with  care 
ordinary  cases  make  fair  progress.  During  bright! 
frosty  weather  patients  do  well.  The  cUmate  of  Scot- 
land IS  not  a  choice  one.  yet  patients  in  sanatoria  there 
get  on  weU.  It  is  extremely  doubtful  if  dry  climates 
which  have  drawbacks  of  their  own.  such  as  hot  winds' 
dust,  sudden  changes  of  temperature,  «&c.,  are  generally 
beneficial,  except  for  a  few  months  in  the  ye^.  Hot 
semi-tropical,  or  relaxing  places  are  injurious. 

There  is  no  ideal  climate  for  tuberculosis  all  the  year 
round.  It  is  quite  certain  that  a  large  proportion  of 
cases  get  well  at  home,  notwithstanding  spells  of  wet 
or  sunless  weather.  The  cosmopolitan  observes  that 
many  vaunted  climates  have  disadvantages,  and  that 
patients  get  cured  in  the  most  diverse  places,  so  that 
some  Ignore  the  factor  of  climate.  This  is  doubtless  an 
extreme  view.  A  place  suitable  for  one  does  not 
benefit  another,  and  these  peculiarities  are  worthy  of 
study.  As  a  practical  rule,  the  consumptive  is  best 
cured  in  the  country  in  which  he  has  to  live.  Those 
who  migrate  to  sunnier  climes  do  not  always  show  the 
best  results  ;  in  fact,  some  have  returned  with  advan- 
tage to  British  sanatoria.  Good  authorities  state  that 
a  patient  who  does  not  improve  in  a  home  institution  is 
not  likely  to  get  well  abroad.  The  drawbacks  of  ex- 
patriation, disregard  of  proper  rtfgime  of  treatment,  &c.. 
are  apt  to  outweigh  the  advantage  of  more  hours  of 
sunshine.  The  means  and  social  position  of  the  patient 
also  have  to  be  considered. 

3.  Rest. — Most  cases  on  admission  require  prolonged 
rest.  The  fatigue  and  excitement  of  the  journey  are 
apt  to  draw  on  the  scanty  balance  of  strength  that 
remains  to  their  credit,  and  they  have  to  make  up 
arrears  of  long  standing.  Few  recognise  the  gravity 
of  their  condition,  and  some  are  rash  or  restless.  Igno- 
rant or  careless.  Pyrexia  and  fatigue  have  been  dis- 
regarded, and  the  excitement  and  distractions  of  busi- 
ness or  pleasure  have  prevented  the  requisite  repose. 
The  breathing  and  heart's  action  have  been  unduly 
hurried  by  day.  and  by  night  the  fever  and  cough  have 
caused  broken  sleep.  So  the  power  of  resistance  is 
gradually  undermined,  until  a  timely  surrender  is 
enjoined. 

In  a  sanatorium  all  this  stress  and  strain  is  vigilantly 
stopped.  AH  sources  of  excitement  or  worry  are  re- 
moved, and  in  the  quiet  routine,  pure  country  air, 
with  companionship  of  others  undergoing  like  treat- 
ment, the  patient  soon  learns  the  value  of  rest. 

Various  conditions,  such  as  haemorrhage,'  high  tem- 
perature, debility.  Sec.  indicate  complete  rest  in  bed 
or  on  a  couch.  The  effect  of  proper  rest  on  pulse  and 
temperature  is  generally  marked.  Patients  rest  lying 
down  during  the  hour  before  lunch  and  dinner,  talking 


Il6    The  Medical  PMS8.         ORIGINAL  COMMUNICATIONS. 


August  3,  1904- 


being  discouraged.  In  some  places  the  hour  after 
meals  is  also  thus  spent.  The  patient  thus  comes  to 
his  food  with  quiet  pulse  and  breathing ;  not  hot  or 
tired,  and  the  process  of  digestion  is  undisturbed. 
Liegehallen,  where  a  number  of  patients  rest  together, 
are  objectionable,  as  preventing  proper  quietude  during 
rest  hours.  However  beneficial  the  sociability  may 
be,  there  is  the  risk  of  undue  talking,  laughing,  argu- 
ments, or  even  petty  quarrels.  Hence  in  some  places 
the  patients  spend  the  rest  hours  either  alone  or  two 
together.  Experience  shows  that  proper  rest  and 
quiet  are  essential.  Some  authorities  have  advocated 
constant  rest,  but  this  is  not  now  adopted,  except  for 
some  cases. 

4.  Graduated  Exercise. — This  is  one  of  the  most  im- 
portant factors  of  the  treatment.  Brehmer  insisted  on 
this,  and  his  views  bear  the  test  of  trial.  There  is 
hardly  any  way  by  which  consumptives  do  more  harm 
to  themselves  than  by  injudicious  exercise.  Extension 
of  disease,  haemorrhage,  increased  pyrexia,  &c.,  are 
thus  caused.  Hence  exercise  is  given  gradually  and 
tentatively,  at  first  a  slow  short  walk  on  the  level  with 
frequent  rests.  The  effect  on  temperature  and  pulse 
are  noted.  Discussion  has  arisen  on  the  influence  of 
exercise  on  temperature,  and  the  relative  value  of 
rectal  and  oral  temperatures.  Dr.  Kelynack  (a)  has 
shown  that  for  all  practical  purposes  in  a  sanatorium 
the  oral  method  is  trustworthy.  Though  a  febrile  con- 
dition generally  indicates  rest,  some  such  patients  do 
not  improve  until  limited  exercise  is  taken.  Walking 
is  the  usual  exercise,  the  pace  being  regular  and  slow, 
two  to  two  and  a  half  miles  an  hour.  As  strength  is 
gained,  the  walks  are  longer.  Gentle  ascents  are  made, 
the  uphill  being  at  the  beginning,  and  the  downhill  at 
the  end,  in  order  to  lessen  fatigue.  The  extent  and 
direction  of  the  walk  are  daily  prescribed,  accordmg 
to  the  state  of  the  patient  and  weather  conditions. 
The  force  and  direction  of  the  wind  are  noted,  and  for 
weakly  patients  sheltered  walks  are  chosen.  Rests  are 
frequent,  at  the  furthest  point  of  the  walk,  and  if  there 
is  coughing  or  shortness  of  breath.  To  send  patients 
together  in  chattering  groups  is  objectionable.  The 
direction  can  be  varied  to  suit  individual  tastes  and 
capacities,  and  a  time  limit  is  advisable.  No  weather 
should  deter  the  stronger  patients,  but  resting  in  wet 
clothes  or  on  wet  seats  or  grass,  is  very  questionable. 
At  length,  walks  of  several  miles  are  given.  Hill 
climbing  is  encouraged,  and  some  simple  form  of  drill, 
with  breathing  exercises,  is  beneficial  when  the  disease 
is  quiescent.  An  upright  carriage  when  walking  is 
advisable  in  order  to  correct  the  slouching  gait  to 
which  consumptives  are  prone. 

There  is  no  doubt  of  the  good  effect  of  hill-climbing 
for  suitable  cases,  and  it  is  a  feature  of  the  treatment 
in  some  places.  To  apportion  the  due  exercise  to  each 
patient  requires  experience  and  judgment.  Most  of 
them  are  inclined  to  overdo  it,  and  if  left  to  themselves 
to  go  wrong.  Those  who  enjoy  their  exercise  generally 
derive  full  benefit  from  it.  but  there  are  some  who 
regard  quiet  country  walks  as  a  weariness  to  the  flesh. 
The  beneficial  effects  of  graduated  exercise  are  certain. 
The  general  condition  is  improved,  useless  fat  got  rid 
of,  respiratory  power  and  chest  capacity  increased,  and 
muscular  vigour  accompanies  gain  in  weight. 

5  Diet.— The  diet  should  be  specially  chosen.  It 
should  be  plentiful,  nutritious,  and  easily  digestible, 
containing  much  proteid  and  fat.  Three  good  meals 
a  day  are  usually  given,  with  a  half  to  a  whole  pint  of 
milk  at  each.  Milk  is  also  given  at  stated  intervals. 
Fats  such  as  butter,  cream,  honey,  are  insisted  on, 
equivalent  to  about  2  02s.  of  butter  daily. 

The  appetite  of  most  patients  is  uncertain  and 
capricious  :  they  are  often  fastidious  and  peculiar  in 
their  tastes.  The  disease  being  a  wasting  one,  it  is 
essential  that  much  nutritious  food  be  taken  daily, 
hence  firmness  is  required  to  induce  them  to  take 
enough.  Many  will  shirk  it,  if  they  can.  Hence  the 
doctor  prescribes  the  food,  and  sees  how  they  eat  it. 
The  indiscriminate  stuffing  once  in  vogue  is  now  not 

(a)  Brit.  M9d.  Jo«r».,  October  24th,  1908. 


generally  adopted.  To  fill  to  repletion  dyspeptic 
patients  with  indigestible  food  to  act  as  an  emetic 
does  not  commend  itself.  Experience  shows  that 
less  food  in  proper  proportions  gives  good  re- 
sults. Much  has  been  written  on  the  value  of  diffe- 
rent diets,  metabolism  in  consumption.  &c.  Cases  with 
active  disease  and  pyrexia  require  careful  and  syste- 
matic dieting.  Most  patients  soon  eat  well,  and  weak 
digestions  improve.  Such  medicinal  fats  as  cod-liver 
oil,  maJtine,  &c.,  are  very  rarely  required.  The  gain 
in  weight  is  usually  i  to  2  lbs.  weekly,  or  more,  though 
too  much  value  must  not  be  given  to  this,  for  it  is  an 
uncertain  index  of  real  progress.  The  disease  may 
progress,  though  the  patient  gets  heavier.  Even 
febrile  patients  will  gain  weight  if  they  eat  well  and 
are  kept  quiet.  More  weight  without  condition  is  not 
the  object  of  this  treatment.  Since  many  consump- 
tives have  bad  teeth,  and  some  pyorrhoea  alveolans, 
*he  services  of  the  dentist  are  required. 

6.  Medical  Supervision. — Some  writers  regard  this  as 
one  of  the  main  factors  in  the  treatment.  Dr.  Knopf, 
in  his  practical  essay  on  *'  Tuberculosis,"  records  that 
"  after  visiting  the  chief  sanatoria  in  Europe  and 
America  he  is  convinced  that  the  tuberculous  patient 
has  the  best  chance  of  getting  well  only  when  he  is 
under  constant  medical  supervision."  Dr.  Latham,  in 
his  prize  essay,  quotes  the  statement  of  Solly  to  the 
effect  that  "  in  the  beautiful  climate  of  Colorado  there- 
is  enormous  difference  in  the  mortality  among  con- 
sumptives under  medical  control  when  compared  with 
those  who  merely  consult  a  physician  when  they 
think  necessary." 

The  disastrous  effects  of  this  lack  of  medical  control 
are  frequently  seen  in  cases  when  admitted.  In  the 
patients'  interest  there  must  be  discipline,  which  insists 
on  essentials,  but  is  lenient  in  minor  details.  A  slavish 
adherence  to  routine  or  easy-going  laxity  are  extremes 
to  be  avoided.  To  quote  Dr.  Latham,  "  The  physician 
must  be  autocrat,  his  word  must  be  law.  He  must  be 
prepared  to  give  his  entire  energy  to  the  work,  for,  as 
Dettweiler  has  expressed  it,  "a  sanatorium  must  be  his 
religion,  his  politics,  his  despair,  and  his  delight." 

In  charitable  institutions  where  patients  err  through 
ignorance,  the  discipline  must  be  strict.  If  located 
near  a  town,  there  is  risk  of  temptation,  frequent 
visitors,  and  violations  of  the  canons  of  open-air  treat- 
ment. In  private  sanatoria  for  the  better  class,  to 
judiciously  relax  rather  than  tighten  the  bands  of  disci- 
pline, to  lessen  the  irksomeness  of  restraint,  while  in- 
sisting on  essentials,  seem  to  be  the  aims  of  thoughtful 
medical  superintendents.  "  All  sorts  and  conditions  of 
men  "  are  found  in  sanatoria,  and  in  ruling  them 
common  sense  and  tact  are  required.  The  office  is  no- 
sinecure.  To  quote  Dr.  Knopf  :  "  Consumption  is  not 
an  easy  disease  to  treat.  It  requires  a  thorough  know- 
ledge of  the  etiology,  pathology,  and  therapy,  and  a 
familiarity  with  all  the  symptoms  of  the  disease,  but 
also  a  great  deal  of  devotion  and  patience  combined 
with  strength  of  character."  He  leads  the  same  kind 
of  life  as  the  patients  ;  he  sees  them  regularly,  pre- 
scribes their  food,  exercise,  and  rest.  He  is  their  guide, 
philosopher,  and  friend,  and  encourages  friendly 
rivalry  in  well-doing.  He  prevents  undue  excitement,, 
and  discountenances  visits  of  talkative  friends.  Dr. 
Latham  wisely  warns  against  the  temptations  of  sexual 
excitement.  Among  young,  idle,  well-fed  patients 
some  will  be  erotic.  Hence  some  separate  the  sexes 
in  their  walks  and  rest  hours.  Sexual  excitement  in  a 
consumptive  is  such  a  bar  to  recovery  that  it  should 
be  prevented.  Anyone  who  knows  a  large  sanatorium 
will  admit  that  not  only  patients,  but  nurses  and* 
servants,  want  watching  in  this  regard.  Of  course., 
careful  discrimination  is  necessary. 

The  enforced  idleness  is  apt  to  cause  moral  deterio- 
ration. The  listless  lounging  and  vacuous  aspect 
occasionally  observable  may  be  prevented  by  quiet 
recreation  or  occupation.  A  gentle  game  of  croquet 
or  golf,  a  drive  or  picnic,  help  to  vary  the  monotony. 
Various  quiet  games,  hobbies  like  photography,  botany, 
natural    history,     &c.,     may    be    encoura;ged.      The- 


August  3,  1904- 


FRANCE. 


Thx  Medical  Press.     117 


musician  or  artist  need  not  quite  be  debarred  from  his 
vocation. 

The  poorer  class  of  patients  need  some  work  such  as 
gardening  or  quiet  household  tasks.  The  whole  sub- 
ject needs  careful  consideration. 

Duration  of  Treatment. 

The  usual  time  of  treatment  is  three  to  six  months, 
sometimes  longer.  When  there  are  marked  physical 
signs,  the  initial  stage  is  past,  and  the  extent  of  the 
disease  is  always  greater  than  shown  by  physical 
signs  (Gee).  Tuberculosis  is  mostly  a  slow  disease. 
The  element  of  time  is  necessary  for  the  process  of 
tissue  change  which  constitutes  complete  arrest. 
Trivial  causes  check  recovery.  Relapse  is  easy,  unless 
care  is  taken,  and  many  patients  forget  hygienic  rules. 
Hence  the  prognosis  should  be  guarded,  and  the 
optimism  that  predicts  a  speedy  cure  is  found  occa- 
sionally false. 

Unfit  Cases. 

Sanatorium  treatment  is  not  suitable  for  all  tuber- 
culous cases.    The  following  may  be  held  unfit : — 

1.  Age  below  puberty,  or  too  old. 

2.  Bad  family  history  and  i)hysique. 

3.  Temperament  unfit.  Irritable,  neurotic,  reck- 
less, or  alcoholic. 

4.  Chronic  bronchitic  cases,  with  tuberculosis. 

5.  Elderly  dyspeptic  cases. 

6.  Those  who  bear  cold  badly. 

7.  Advanced  cases  with  extensive  lesions. 

Some  sanatoria  do  not  admit  hopeless  cases,  which 
require  comfort  rather  than  cure.  All  unfit  cases  may 
be  treated  elsewhere  by  some  modification  of  open-air 
methods. 

Results. 

In  Germany  where  statistics  (a)  are  available,  85  per 
cent,  of  patients  are  improved,  16  per  cent,  unimproved, 
o*8  died  ;  only  one-sixth  did  not  recover  their  power 
of  work.  Those  in  the  so-called  first  sta^e,  with  con- 
solidation of  one  lobe  or  two  half  lobes,  without  cavity, 
show  the  best  results.  The  statistics  of  English  sana- 
toria are  not  available,  but  those  pubUshed  show  similar 
results.  Most  cases  except  those  in  an  advanced  stage 
show  great  improvement.  The  early  cases,  as  a  rule, 
leave  the  sanatorium  with  no  symptoms  of  the  disease, 
slight  physicsd  signs,  absence  of  bacilli  in  sputum,  and 
robust  in  appearance.  In  more  severe  cases  there  is 
reduction  of  fever  and  pulse  rate,  less  cough  or  night 
sweats,  better  breathing,  and  gain  in  weight  and 
muscular  power. 

It  is  quite  certain  that  results  will  be  better  still,  as 
more  suitable  cases  are  sent  and  the  unfit  eliminated. 
The  limitations  of  the  treatment  and  the  advantage  of 
sending  cases  in  the  early  stage  are  more  generally 
recognised.  Procrastination  or  a  late  diagnosis  do  not 
enhance  the  prestige  of  the  medical  adviser. 

Many  of  those  who  complete  sanatorium  treatment 
are  fit  to  enter  again  on  the  toils  and  joys  of  Ufe,  pro- 
vided they  follow  some  outdoor  calling,  free  from 
arduous  exertion  or  strain.  Some  have  even  gone 
back  with  impunity  to  employments  where  an  open-air 
regime  is  impossible.  Others  are  unfit  for  work,  owing 
to  lack  of  robustness,  but  with  care  and  out-door 
methods  they  may  live  to  old  age.  Occasionally  the' 
improvement  is  transient,  but  this  is  mainly  due  to 
carelessness,  over-exertion,  or  bad  hygiene. 

Sanatorium  treatment  is  no  spec&c  against  tuber- 
culosis. Many  details  are  mainly  empirical,  but  as  its 
main  principles  inculcate  a  return  to  a  natural  life. 
instead  of  the  artificial  modes  of  so-called  civilisation. 
even  for  its  educational  effect  it  is  of  great  value. 
Hygienic  treatment  is  beneficial  for  many  other  con- 
ditions of  ill-health  besides  tuberculosis.  Those  of  us 
who  live  the  free  open-air  life,  and  who  see  the  good 
effects  of  it  on  servants,  nurses,  and  others,  would  not 
readily  return  to  the  doubtful  blessings  of  ordinary 
life.  The  results  of  this  treatment  of  tuberculosis  far 
surpass  any  other,  in  the  cure,  arrest,  or  alleviation  of 
one  of  the  most  prevalent  of  the  "  ills  that  flesh  is  heir 
to." 


Sritisb  Dealtb  1Re0Ott0. 


IV.— BISHOFS-TEIGNTON. 


(a)  ru&«rcuIo«i«,    April,    1803.      Bulstrode,  Lanaet,    July    and 
Aar»*.  1908.    T.  WUlUmB,  lantfit,  Janaary  80th,  1904. 


[by  our  special  medical  commissioner.] 
Among  the  many  fair  villages  of  Devon  which  justly 
claim  the  attention  of  the  health-seekers.  Bishop' s- 
Teignton  deserves  to  occupy  a  foremost  place.  It  is 
charmingly  situated  on  the  north  side  of  the  Teign 
Valley,  about  200  ft.  above  sea  level,  and  can  be  easily 
reached  either  from  Teignmouth  or  Newton  Abbot.  An 
omnibus  runs  to  Teignmouth  (two  miles)  three  times  a 
day  (fare  6d.).  Teignmouth  (209  miles)  can  be  comfort- 
ably reached  from  London  by  the  Great  Western  Railway 
in  about  four-and-a-half  hours.  Passengers  may  also 
travel  from  Waterloo  to  Exeter  by  London  and  South- 
western Railway  in  3i^  hours,  and  thence  proceed  on  the 
Great  Western  system.  Bishop' s-Teignton  offers  many 
attractions.  It  is  sheltered  from  the  cold  winds  on  the 
north-east  by  the  heights  of  Haldon,  which  rise  to 
800  ft.  ;  this  renders  the  village  excellent  as  a  winter 
resort.  To  the  south  are  delightful  views  of  the  Teign 
Valley,  while  away  to  the  west  stand  out  the  highlands 
of  Dartmoor.  On  the  east  near  at  hand  lies  the  open 
sea.  The  place  is  well  exposed  to  sunUght,  pro- 
tected from  trying  winds,  and  combines  something  of 
the  advantages  of  moorland  breezes  with  the  invigo- 
rating elements  of  a  marine  climate.  The  village  is 
clean  and  picturesque,  and  over  all  there  prevails  a 
restfulness  peculiarly  soothing  to  the  invalid  and 
overwrought  worker.  In  these  days  of  stress  and  strain, 
Bishop' s-Teignton  can  offer  rest  for  body  and  goes  far  to 
secure  peace  of  mind.  We  particularly  recommend 
it  for  the  overworked,  the  convalescent,  the  invalid, 
and  the  aged. 

Good  apartments  can  be  obtained  in  the  village,  but 
the  visitor  who  is  in  search  of  health  will  do  well  to 
visit  the  well-known  hydro,  "  Huntly,"  conducted  by 
Mr.  C.  F.  Carpenter.  It  has  much  to  offer  for  the  jaded 
and  overworked.  The  situation  is  excellent,  and  the 
extensive  grounds  are  well  kept  and  afford  views  of 
great  beauty.  The  house  has  been  extended  from 
time  to  time,  and  now  an  extensive  suite  of  rooms  exist, 
and  they,  together  with  the  hall  and  corridors,  are  well 
heated  in  cold  weather.  Accommodation  is  provided  for 
about  forty  visitors.  Here  a  hygienic  life  can  be  lived 
which  should  allow  of  recreation  of  body  and  reju- 
venescence of  mind.  Carefully  selected  baths,  good 
food,  pure  air,  attractive  walks,  pleasant  drives,  and 
much  cheerful  society  supply  the  chief  therapeutic 
factors  for  re-invigoration.  Quiet  outdoor  pursuits  may 
be  enjoyed  in  plenty.  A  medical  attendant  provides 
for  the  requirements  of  the  really  sick. 

Natural  and  artificial  forces  have  combined  to  make 
Bishop' s-Teignton  a  very  desirable  health  station  for 
an  important  section  of  cases  requiring  medical 
direction,  and  we  have  no  hesitation  in  drawing  the 
attention  of  medical  men  to  its  advantages. 

Stance* 

[from  our  own  correspondent.] 

Paub,  July  Slst,  1904. 
Treatment  of  Lead  Colic. 

Prudence  should  be  observed,  says  M.  Feissinger, 
in  the  treatment  of  lead  colic,  for  in  reality  the  case 
might  be  one  of  appendicitis  inXwhich  drastic  purga- 
tives would  be  dangerous.  Hitherto,  beforejappen- 
dicitis  was  as  well-known  as  to-day ,^energetic  purga- 
tives were  recommended,  but  with  our  present  know- 
ledge, to  have  recourse  to  them  mightjsometimes  be 
disastrous. 

Saturnine  poisoning  does  not  always  appear  under 
the  classical  form  ;  the  diagnosis  is  sometimes  difficult . 
The  cardinal  symptoms  are  not  always  all  present ;  only 
one  may  remain — pain — while  the  others — constipa- 
tion, vomiting,  retraction  of  the  abdomen,  may  be 
absent.     Certain  patients  suffer  from   diarrhoea  and 


1 


Il8   Ths  Medical  Psess. 


GERMANY. 


August  3,  1904- 


tympanitis,  while  in  others  fever  is  present.  Contrary 
to  the  rule,  certain  colics  are  more  painful  to  deep 
than  to  superficial  palpation.  Renal  and  hepatic  colic 
are  easily  recognised  by  the  special  seat  and  character 
of  the  pain,  but  other  affections  might  be  taken  for 
lead  colic  and  of  these,  appendicitis  is  one  of  the  most 
difficult  to  distinguish  in  chronic  saturnism,  especially 
as  patients  have  been  known  to  have  attacks  of  both 
these  maladies  alternately. 

Consequently,  great  circumspection  should  be 
observed  in  the  treatment  of  lead  colic.  Drastic  pur- 
gatives should  be  excluded  ;  saline  purgatives,  sulphate 
of  soda,  or  magnesia,  associated  with  senna,  should  be 
preferred.  But  of  all  the  evacuating  agents,  olive  oil 
is  the  best,  given  either  in  one  dose  of  six  ounces  or  an 
ounce  and  a  half  each  morning.  Enemas  of  hot  water 
have  been  recommended  by  Tripier,  of  Lyons. 

To  ease  the  pain  injections  of  morphia  are  generally 
given,  but  opium  pills,  one  to  two  grains  in  the  twenty- 
four  hours,  are  equally  good.  The  Lyons  doctors 
associate  belladona  and  antipyrine,  the  belladona  in 
one-third  grain  pills,  three  or  four  times  a  day,  and 
from  twenty  to  sixty  grains  of  antip3Tine  in  the  twenty- 
four  hours. 

Where  gastric  intolerance  is  present,  suppositories 
of  opium  and  belladonna  will  be  ordered  ;  while  the 
abdomen  will  be  rubbed  over  with  belladonna  ointment. 
When  the  pain  has  ceased  a  mixture  of  sulphur  and 
honey  may  be  given  and  the  patient  recommended  to 
take  sulphur  baths. 

Treatment  of  Infantile  Syphilis. 

The  treatment,  according  to  Dr.  Leon  de  Keyser, 
should  be  at  first  maternal,  that  is  to  say,  through  the 
milk  of  the  mother,  who  will  continue  the  treatment 
begun  during  her  pregnancy,  and  if  this  had  not 
been  prescribed,  the  mother  will  immediately  be  placed 
under  the  influence  of  the  mercurial  treatment.  As 
to  the  child,  nibbing  in  of  mercurial  ointment  is  very 
efficacious,  and  well  borne,  as  it  rarely  produces  sali- 
vation. The  state  of  the  skin,  however,  should  be 
attended  to,  and  the  ointment  should  not  be  repeated 
on  the  samespot  before  a  few  days.  Each  day,  one  or 
two  frictions  should  be  made  with  a  piece  of  flannel 
coated  with  a  very  small  amount  of  mercurial  oint- 
ment, ten  to  twenty  grains.  If  diarrhoea  setsjin  or 
the  skin  gets  inflamed,  the  treatment  should  be 
suspended. 

If  internal  treatment  is  prescribed,  preference  should 
be  given  to  bichloride  of  mercury  or  calomel.  The 
former  is  given  in  Van  Swieten's  solution  or  1-1,000. 
From  half  to  one  drachm  of  this  mixture  might 
be  given  daily  in  milk,  in  three  or  four  doses,  and  con- 
tinued for  months.  Calomel  gives  excellent  results  at 
the  dose  of  one-fifth  of  a  grain  three  times  a  day. 
Monti  prescribed — 

Calomel,  ^  gr. 
Lactate  of  iron,  v.  gr. 
Sugar,  oz.  iss. 

Divide  into  ten  powders,  one  to  four  daily. 

Taylor  prescribes — 

Bichloride  of  hydrarge. 
Iodide  of  potassium,  iii  gr. 
SyTup  of  orange  water  oz.  ij. 

Five  to  ten  drops  three  times  a  day. 

[from  our  own  correspondent.] 

BBRLiir,  July  3Ut,  1904. 
In  the  Therapie  de  Gejenwart,  Dr.  Klienberger  has 
a  paper  on 

Rectal  Feeding  in  Ulcxjs  Ventricuu. 
A  wound,  he  says,  heals  up  the  more  rapidly  the  less  its 


edges  gape.  An  ulcer  of  the  stomach  heals  the  more 
rapidly  therefore,  when  the  stomach  is  contracted. 
It  is  in  a  state  of  greatest  contraction  when  hanger  is 
felt.  Although  there  is  difference  of  opinion  among 
physicians  how  long  the  stomach  should  be  kept  empty, 
it  is  quite  certain  that  no  food  whatever  should  be  given 
by  the  mouth  for  some  days  after  hemorrhage  from  the 
stomach.  It  has  been  shown  clinically  that  human  life 
can  be  kept  up  for  weeks  by  rectal  feeding.  Strauss 
mentions  a  case  in  which  a  man  was  fed  exclusively 
by  the  rectum  for  seventy  days.  If  a  combination 
is  made  of  *gg,  starch,  and  sugar  enemata  and  oil 
subcu'caneous  infusion  2,000  calories  may  be  given 
daily.  No  hyper-hydrochlorydria  is  present^ia'an 
empty  stomach.  The  usual  nutrient  enemata  do  not 
excite  gastric  secretion  but  it  would  be  as  well  to  omit 
red  wine  as  an  addition  to  the  enemata. 

It  has  been  concluded  by  some  that  the  abstinence 
cure  is  not  sufficient,  as  not  enough  account  has  been 
taken  of  the  anaemia  present.  The  author  looked  into 
this  question  in  the  case  of  thirteen  patients,  who 
were  being  treated.  The  blood  was  carefully  examined . 
The  treatment  had  consisted  in  absolute  rest  for  at  least 
three  weeks  after  the  abstinence  period  ;  occasionally, 
infusions  of  1,000  to  1,100  cc.m.  of  physiological 
saline  solution  were  given.  The  nutrient  enemata 
were  given  three  times  a  day,  and  they  consisted  of  20a 
to  400  cc.m.  of  milk,  two^tothreeeggs,'oneteaspoonful 
of  salt,  one  tablespoonful  of  sugar,  and  one  of  plasmon. 
If  required,  twenty-five  drops  of  tincture  of  opium  were 
added.  An  hour  before  the  enema  the  bowel  was 
washed  out  with  water.  Occasionally  in  the  evening 
the  saline  solution  was  given  by  the  bowel  instead  of 
subcutaneously. 

The  patients  were  under  treatment  for  two  months. 
Two  died,  one  a  girl,  from  haemorrhage  from  the  superior 
coronary    artery,    the    other,    a    young    man,  from 
hydrochloric  acid  cauterisation  ;  whilst  drunk  he  had 
swallowed  130  grms.  of  raw  hydrochloric  acid. 

The  examination  showed  that  during  the  extra-buccal 
treatment  the  body  weight,  blood  pressure,  and  pulse 
curve  sank  moderately.  The  lowering  of  blood  pr^- 
sure  did  not  usually  exceed  30  mm.  The  haemoglobin 
only  appeared  to  diminish  when  the  bleeding  continued. 
The  erythrocyte  cells  remained  constant  or  rose  slowly. 
They  only  sank  to  a  corresponding  degree  when  the 
haemorrhage  was  severe  and  continuous. 

The  blood  constituents  in  any  case  did  not  sufEer  from 
the  rectal  alimentation,  and  the  power  of  the  heart 
was  not  lowered. 

At  the  Medical  Society  meeting  Hr.  Immelmann 
gave  a  short  account  of 

Landon's  Latest  Experiments  with  Radium. 
A  bottle  was  filled  with  a  solution  of  radium  bromide 
and  was  brought  into  communication  with  another 
by  means  of  a  glass  tube.  In  this  second  vessel  were 
placed  various  objects,  such  as  glass,  iron,  lint.  He 
was  able  to  show  that  by  examination  the  properties  of 
the  radium  were  extended  to  these  objects.  Frogs 
and  mice  upon  which  these  emanations  acted,  died  and 
their  cadavers  were  photographically  active. 

At  the  Society  of  Charit6  Physicians  Hr.  Heubner 
showed  a  child  suffering  from  swelling  of  the  eyes, 
constipation  and  wasting.  It  showed  cachexia,  swelling 
of  the  face  and  dyspnoea.  On  the  right  side  of  the 
chest  was  a  projection  that  gave  a  dull  sound  on 
percussion.  This  reached  in  the  axillary  line  to  the 
fourth  rib,  and  towards  the  left  to  the  sternum.  The 
physical  condition  was  confirmed  by  radiogram. 
According  to  percussion  there  was  no  connection  with 
the  heart ;  the  breath  sounds  over  the  dulness  were 
weakened.     As  the  dulness  extended  on  expiration  it 


August  3.  1904. 


AUSTRIA. 


Thb  Medical  Pibss.     1 19 


might  be  taken  that  the  tumour  was  not  in  the  lungs. 
It  was  therefore  a  mediastinal  tumour,  probably  an 
enlarged  thymus.  The  urine  contained  albumin.  The 
swelling  of  the  face  was  caused  by  stasis  from  pressure 
of  the  tumour  on  the  superior  vena  cava.  The  paleness 
was  due  to  the  character  of  the  blood,  which  contained 
2,ocx),ooo  red  blood  corpuscles,  92,000  lymphocytes 
to  the  cubic  centimetre,  and  a  few  polynuclear  leuco- 
cytes. Nothing  would  do  good  except  extirpation  of 
the  tumour. 

Hm.  Kraus  and  Senator  were  of  opinion  that  opera- 
tion gave  absolutely  no  prospect. 

Another  case  shown  was  one  of 

Infantile  Myxcedema. 
It  was  the  case  of  a  child  of  two.  that  although  well 
nourished,  at  first  developed  slowly  both  mentally  and 
bodily.  For  example,  it  had  never  laughed,  it  was  not 
directly  weak-minded,  but  weak  in  reaction  and  abnor- 
mally quiet.  The  face  of  the  child  was  without  form, 
thick,  swollen  forehead,  narrow  ejrelid  fissures,  saddle- 
shaped  nose,  thick  lips,  and  scanty  hair.  The  skin  was  dry 
and  thickened  in  many  parts.  The  tongue  was  so  much 
swollen  that  it  appeared  between  the  lips,  and  there  was 
an  umbilical  hernia.  The  thyroid  could  not  be  felt  at 
all.  To  the  S3rmptoms  of  myxcedema  of  the  adult 
were  added  faulty  development  of  growth.  It  was 
like  a  cretin.  The  pulse  was  slow.  The  treatment 
consisted  of  Merck's  thyroid  preparation  in  doses  of 
0^025  to  0*05.  and  0"i  grm. 

There  was  a  diminution  in  the  formation  of  urea. 


anatria* 


[from  our  own  correspondent.] 

YnsvA,  Jaly  80th,  1904. 
Sudden  Deaths  in  Typhoid. 

At  the  Prague  meeting,  Velich  drew  attention  to  the 
recent  expressions  of  Koch  with  respect  to  sudden 
deaths  from  latent  typhoid,  which  he  affirmed  are  very 
frequent.  On  that  occasion  he  set  down  a  rule  that 
no  patient  should  be  released  from  isolation  till  no 
typhoid  germs  could  be  seen  after  three  examinations 
of  the  stools.  He  assured  the  meeting  that  this  was  not 
an  inconvenient  regulation  to  establish,  and  that  he  had 
performed  thirty-six  post-mortems  on  such  epidemi- 
logical  sudden  deaths,  and  found  twenty-seven  of  them 
suffering  from  heart  disease,  old  pleural  attachments, 
kidney,  liver,  brain,  or  lung  affections.  The  other  nine 
were  undefined  cases  which  might  come  under  Koch's 
description,  but  might  be  due  to  other  causes  as  they 
had  previously  been  confined  to  bed,  to  house,  or 
hospital.  Again,  many  cases  of  typhoid  are  so  slight  as 
to  escape  attention,  and  therefore  distribute  the  disease 
more  widely  than  the  small  number  that  may  die.  He 
thinks  the  vigilance  of  the  past  is  better  than  the 
present  proposal  to  confine  a  few  unduly  on  suspicion. 
Bromo-derma  Tuberosum. 

Samoerger  exhibited  an  epileptic,  aet.  12,  with  a 
large  swelling  oyer  the  triceps  brachii,  depressed  in 
the  centre  and  covering  an  area  as  broad  as  the  palm 
of  the  hand  at  the  base,  and  tapering  to  the  size  of  a 
florin  at  the  apex.  Around  the  upper  margin  were 
small  pustules,  while  the  whole  growth  tended  to  in- 
crease as  is  usual  in  these  cases. 

Congenital  Prominence  of  Scapula. 

Jedlivka  showed  a  girl,  aet.  13,  on  whom  he  had 
operated  for  a  projecting  scapula  on  the  left  side. 
From  the  inner  side  of  the  shoulder  blade  a  hard  bony 
connection  was  observed  that  held  the  scapula  up  along- 
side •the  neck.  In  the  operation  to  relieve  the  band 
Maydl  found  that   the   bony  connection  was  firmly 


incorporated  with  the  sixth  cervical  vertebrae  with  a 
cartilaginous  articulation  at  the  scapular  margin. 
On  dividing  the  bony  attachment  at  the  arch  of  the 
vertebrae  the  spinal  canal  was  opened  and  the  dura 
mater  injured.  With  careful  attention  the  wound 
healed  and  the  scapula  fell  to  its  normal  level,  leaving  the 
patient  strong,  with  a  free  movement  at  the  shoulder 

He  also  showed  a  boy.  set.  10,  who  underwent  a 
similar  operation  for  the  same  sort  of  bony  connection. 
Maydl  considers  this  a  supernumerary  rio  springing  from 
the  last  cervical  vertebrae  and  to  remove  the  deformity 
nothing  short  of  extirpating  the  abnormal  bony 
connection  is  available.  On  looking  through  the 
literature  on  the  suoject,  Maydl  finds  the  term  Sprengel's 
deformity  attributed  to  this  malformation,  which  was 
in  existence  and  recognised  long  before  Sprengel's  time. 
Experimental  Endocarditis. 

Prochazka  then  gave  the  Society  a  history  of  his 
efforts  to  produce  endocarditis  in  animals.  The 
question  has  often  arisen  is  the  microbe  the  chief 
factor  in  the  production  of  endocarditis,  or  is  it  a  second 
agent  in  the  train  of  symptoms.  Leube  some  time  ago 
affirmed  that  the  primary  factor  was  a  toxin  that  first 
acted  on  the  endothelial  cell  and  so  weakened  its 
vitality,  that  the  secondary  infection  had  an  easy  task 
in  producing  the  inflammation. 

In  order  to  test  this  theory  with  practical  facts 
Prochazka  commenced  his  experiments  by  injecting 
ten  dogs  repeatedly  with  toxins  of  different  microbes, 
till  a  condition  of  toxaemia  was  produced,  when  a 
specific  microbe  would  then  be  introduced,  into  the 
blood  by  the  veins  with  the  hope  of  producing  endo- 
carditis. Of  the  ten  dogs  operated  on  only  one  survived 
the  ordeal  of  the  intravenous  injection  of  the  microbe, 
while  all  the  control  animals  or  those  treated  with  the 
toxin  recovered.  Eight  of  the  nine  died  from  septi- 
caemia and  only  one  was  free  from  endocarditis  at  the 
post-mortem  ;  some  were  of  the  verrucous  form,  others 
assumed  the  ulcerative  form,  while  others  had  both 
forms  in  combination. 

Nonejof  those  treated  with  the  toxin  treatment 
only  had  any  sign  of  endocarditis.  He  therefore  con- 
cludes that  the  toxins  are  the  predisposing  factors  in 
the  production  of  endocarditis.  He  pointed  out  that 
the  same  microbe  may  first  provide  the  toxin  in  the 
blood  till  toxaemia  is  produced,  and  then  with  its  actual 
presence  excite  the  inflammatory  endocarditis.  This 
form  of  production  is  now  known  by  the  method  of 
"  Homogenic  Infection,"  the  other  method  is  when  a 
toxin  has  prodt^ced  the  toxaemia  and  a  foreign  microbe 
is  introduced  with  the  same  result  that  it  receives  the 
name  of  *'  Heterogeneous  Infection."  It  is  worthy  of 
note  that  the  lesions  induced  in  these  animals  were 
located  to  the  same  areas  as  described  in  pathological 
works,  which  is  probably  due  to  mechanical  causes  in 
the  course  of  the  endocarditis,  such  as  rubbing  or  impact 
on  the  blood  in  the  cardiac  contractions. 

Velich  remarked  that  dogs  were  not  suitable  animals 
to  perform  experiments  of  this  kind  on,  as  60  per  cent, 
of  the  healthy  dogs  would  be  found  to  have  endocarditis, 
more  particularly  if  they  were  advancing  in  years  and 
with  urethral  discharge. 

Ottokar  Kose  expressed  surprise  at  these  results  as 
he  had  experimented  in  the  same  manner  with  twenty- 
six  dogs  and  only  in  one  single  case  had  he  a  positive 
result,  and  strange  to  say  this  was  with  a  streptococcus 
culture  ! 

Prochazka  in  replying,   said   that  Velich  must  be 
confounding  degeneration  and  atheromatous  changes  in 
the  heart  for  acute  endocarditis,  which  he  recognised. 
Sulpho-carbidb  Poisoning. 
Vanysek  showed  two  patients  whom  he  had  treated 


120    The  Medical  Piess. 


OPERATING   THEATRES. 


August  3,  1904- 


for  sulpho-carbide  poisoning.  The  patients  were 
engaged  at  an  indianibber  works,  where  vulcanising 
was  carried  on  in  a  very  confined  room,  which  was  badly 
ventilated.  The  symptoms  were  motor  enfeeblement  of 
the  lower  extremities,  paresthesia,  impotence,  and 
mental  depression.  The  objective  examination  re- 
vealed polyneuritis,  tremor  in  hands  and  head,  increased 
vaso-motor  reflex  which  was  present  in  the  muscles  also, 
muscular  weakness,  tactile  anaesthesia  of  the  skin, 
parsesthesia,  and  increased  patellar  reflex.  One 
of  them  had  the  pseudospastic  paresis  of  Nonne. 

He  further  recorded  the  history  of  two  other  similar 
cases  with  Erb's  symptom,  expiratory  retardation  of  the 
pulse  with  orthostatic  tachycardia.  These  last 
symptoms  he  contended  had  never  been  recorded  as 
being  associated  with  sulpho-carbide  poisoning. 
Myasthenia. 

Haveroch  showed  a  few  cases  of  progressive  paralysis. 
One  female  knew  she  had  it,  but  could  not  tell  when  it 
commenced.  A  young  girl  with  myaesthenia  could 
walk  a  short  distance,  but  had  to  stand  unable  to  move 
when  the  muscles  were  tired  ;  if  she  held  out  her  right 
arm  her  left  became  paralysed.  There  was  no  pain 
anywhere,  only  loss  of  motor  power  causing  her  to 
stand  like  a  statue  when  the  muscular  power  ran  out. 
Her  father  was  afflicted  with  the  same  malady. 


XCbe  ®perattnd  XCbeatres. 


GREAT  NORTHERN  HOSPITAL. 
Removal  of  Appendix. — Mr.  Peyton  Beale 
operated  on  a  man,  aet.  about  30,  who  had  been  ad- 
mitted one  week  before  with  an  acute  attack  of  appen- 
dicitis. The  patient  had  a  history  of  three  or  four 
similar  attacks  previously.  At  the  time  of  operation, 
all  acute  symptoms  had  passed  off,  but  there  was  a 
swelling  to  be  felt  in  the  pelvis  on  the  right  side,  and 
this  swelling  appeared  to  extend  towards  the  inguinal 
canal.  It  was  supposed  to  be  a  case  of  enlarged 
appendix,  possibly  bound  down  by  adhesions.  The 
abdomen  was  opened  so  as  to  expose  the  caecum.  This 
was  brought  out  with  considerable  difficulty  owing  to 
adhesions  binding  it  down  in  all  directions.  A  large 
mass  was  found  behind  the  caecum  involving  the  base 
of  the  appendix,  which  contained  a  small  quantity  of 
pus.  This,  Mr.  Beale  pointed  out,  was  quite  unex- 
pected, seeing  that  all  acute  symptoms  had  been  in 
abeyance  for  four  or  five  days  previous  to  operation. 
This  pus  was  carefully  washed  away  and  the  rest  of 
the  appendix  sought  for.  There  was  considerable  diffi- 
culty in  finding  it,  as  it  was  behind  the  caecum  and  very 
much  bound  down  by  adhesions.  When  it  was  found 
it  was  seen  to  be  firmly  adherent  to  the  spermatic  cord, 
from  which  it  was  separated  with  great  difficulty.  Its 
various  adhesions  having  been  ligatured,  the  appendix 
was  removed  in  the  ordinary  way  and  the  wound  closed. 
Mr.  Beale  said  that  this  case  was  remarkable,  first, 
because  pus  was  actually  found  at  the  time  of  opera- 
tion, although  every  acute  symptom  had  passed  off 
some  days  previously.  This  was,  of  course,  not  really 
a  very  uncommon  occurrence,  and  he  believed  that  in 
many  of  the  cases  of  recurrent  appendicitis  a  small 
abscess  such  as  waB  found  here  persisted  between  the 
attacks  and  that,  however  long  the  surgeon  waited 
before  operating,  he  could  never  be  certain  from  the 
patient's  symptoms  and  general  condition  that  pus  was 
not  present.  It  was  of  course  encapsuled,  but  none 
the  less  must  necessarily  be  a  source  of  considerable 
danger  when  an  operation  for  the  removal  of  the 
appendix  is  undertaken.     The  case  was  of  interest 


secondly,  he  thought,  because  of  the  adherence  of  the 
appendix  to  the  spermatic  cord  ;  he  had  not  previously 
come  across  this  condition,  and  at  first  sight  it  w2ls  not 
at  all  easy  to  realise  that  the  structure  wais  the  sper- 
matic cord,  or  to  see  how  the  appendix  could  have 
become  adherent  to  it.  Such  a  condition  could,  he 
supposed,  only  occur  when  the  appendix  was  behind 
and  below  the  caecum,  and  of  unusual  length,  as  it 
turned  out  to  be  in  this  case.  The  patient  had  suffered 
no  unusual  pain,  nor  were  there  any  symptoms  beyond 
those  of  an  ordinary  recurrent  acute  appendicitis. 

NORTH-WEST  LONDON  HOSPITAL. 
Operation  for  Acute  Intestinal  Obstruction 
Following  an  Accident. — Mr.  Mayo  Collier  ope- 
rated on  a  case  of  obstruction,  the  history  of  which  was 
as  follows  : — Five  days  previously  the  patient,  a  pub- 
lican, aet.  64,  fell  down  the  steps  of  his  cellar  on  to  some 
barrels.  When  examined  by  his  local  medical  atten- 
dant, a  fractured  fifth  rib  was  discovered.  This  was 
efficiently  strapped  and  bandaged,  and  the  patient 
advised  to  keep  his  bed.  The  following  day  the  man 
felt  very  sick  and  vomited  once  or  twice.  There  was 
complete  anorexia  and  some  commencing  distension  of 
the  abdomen.  This  state  of  things  becoming  gradually 
worse,  the  case  was  admitted  into  the  hospital.  On 
admission  the  pulse  was  120  ;  there  had  been  constant 
coffee-ground  offensive  vomiting  for  two  days  ;  the 
abdomen  was  enormously  distended  and  t3anpamtic 
all  over,  and  respiration  was  much  impeded.  The 
tongue  was  extremely  foul,  and  the  patient's  general 
condition  was  very  grave.  Mr.  Collier  decided  on 
immediate  abdominal  section.  An  incision  w^as  made 
above  the  umbilicus  about  four  inches  in  extent.  On 
opening  the  peritoneal  cavity  a  much  distended 
stomach  protruded  into  the  wound.  The  stomach 
apparently  filled  the  whole  upper  part  of  the  abdominal 
cavity.  After  puncturing  with  a  fine  needle  and  letting 
out  a  great  quantity  of  offensive  gas,  Mr.  Collier  was 
enabled  to  introduce  his  finger  into  the  peritoneal 
cavity  above  the  small  curvature.  This  was  followed 
by  the  outflow  of  at  least  half  a  pint  of  blood  and 
serum.  The  rest  of  the  abdominal  cavity  was  care- 
fully explored,  and  the  distended  small  intestine  punc- 
tured in  several  places  with  a  small  needle,  much  gas 
escaping.  Nothing  abnormal  was  discovered  in  the 
rest  of  the  abdominal  cavity.  Having  carefully  sponged 
the  region  between  the  pylorus  and  the  liver,  Mr. 
Collier  closed  the  abdomen,  and  the  patient  was  re- 
turned to  bed.  Mr.  Collier  said  this  was  an  extremely 
interesting  case.  The  man  was  perfectly  well  before 
the  accident,  but  yet  symptoms  of  acute  obstruction  of 
the  bowels  supervened  slowly  after  the  fall.  From  the 
condition  of  the  stomach,  its  acute  distension,-  the 
coffee-ground  vomiting,  that  took  place  before  the 
operation,  and  the  amount  of  blood  in  the  upper  part 
of  the  peritoneal  cavity  near  the  small  curvature, 
this  wsLS  evidently,  he  pointed  out,  a  case  of  acute 
obstruction  due  to  ileus  following  a  blow  in  this  region. 
The  distension  was  so  acute  at  the  time  of  the  opera- 
tion, he  said,  that  a  considerable  time  had  to  be  spent 
with  a  fine  hj'podermic  needle  in  removing  the  gaseous 
contents  of  the  bowels  before  the  finger  could  be  intro- 
duced to  examine  the  abdominal  cavity.  This  pro- 
cedure was,  in  fact,  he  considered,  the  most  important 
part  of  the  whole  operation,  as  it  was  in  order  to  allow 
the  bowels  to  recover  themselves  and  to  take  off  the 
pressure  of  the  distended  stomach. 

From  the  time  of  operation  the  sickness  ceased,  the 
distension  subsided,  and  the  patient  made  an  unin- 
terrupted progress  towards  recovery. 


August  3,  1904. 


LEADING   ARTICLES. 


The  Medical  Psess.      121 


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SALUS  POFULI  SUFREMA  LEX." 


WEDNESDAY.  AUGUST  3.  1904. 


THE  BRITISH  MEDICAL  ASSOCIATION 
MEETING. 
The  Annual  Meeting  of  the  British  Medical  Asso- 
ciation at  Oxford  has  been  the  occasion  of  a  more 
than  usually  brilliant  gathering.  This  ancient 
University  town  has  witnessed  three  such  meet- 
ings since  the  first  one  held  within  its  gates  in 
1835,  attended  by  some  300  members.  The  pro- 
gress of  the  Association  has  been  rapid,  and  hun- 
dreds have  been  converted  into  thousands,  so  that 
the  total  number  of  members  now  reaches  19,000. 
The  possibilities  of  such  an  organisation  are 
incalculably  great,  and  signs  are  not  wanting 
that  its  fulness  of  power  will  shortly  be  exerted 
in  defending  the  material  interests  of  a  profession 
that  is  sadly  in  need  of  protection.  The  president 
of  the  1904  meeting.  Dr.  William  Collier,  found 
at  hand  a  fruitful  and  interesting  theme  on  which 
to  base  his  discourse,  namely,  "  The  Growth  and 
the  Development  of  the  Oxford  Medical  School." 
The  teaching  of  medicine  in  that  ancient  seat  of 
learning  has  been  continuous  since  the  great  scien- 
tific Englishman,  Roger  Baconi  lectured  within  its 
walls.  Since  his  days  the  names  of  such  famous 
men  as  Linacre.  Harvey,  Sydenham  and  Rad- 
cliffe  have  become  famous  in  connection  with 
the  study  of  medicine  at  Oxford.  It  is  only 
within  comparatively  recent  times,  however, 
that  science  has  been  established  on  a  firm  footing 
in  the  University.  Indeed,  the  revival  of  the 
Oxford  Medical  School  may  be  said  to  date  from 
the  building  of  the  museum  in  1855.  Since  that 
date  science  has  been  simply  revolutionised,  a 
fact  noted  by  Sir  William  Church  in  delivering  the 
Address  on  Medicine.  The  last  meeting  in  Oxford 
took  place  in  1868.  It  was  only  the  year  pre- 
viously that  Lister  read  at  Dublin  his  paper  on 
*'  The  Antiseptic  Principle  in  the  Practice  of 
Surgery."  At  that  time  the  probability  of  the  in- 
iectivity  of   tubercle  was  beginning   to  be  esta- 


blished. Sir  William  pointed  out  that  the  exact 
knowledge  furnished  by  bacteriology  and  other 
branches  of  scientific  research  have  had  a  greater 
influence  ,on  state  or  preventive  than  upon 
clinical  medicine.  Perhaps  the  most  important  part 
of  his  address  was  that  which  dealt  with  the  rela- 
tions between  medical  ofiScers  of  health  and  the 
administration,  both  local  and  central.  He  in- 
stanced the  attitude  of  the  medico- poUtical  and 
public  health  committees  of  the  Association  in 
their  proposed  Bill  to  reform  the  public  health 
department  of  the  Local  Government  Board. 
The  chief  clause  urged  that  the  medical  element 
should  exercise  greater  weight  and  authority  at 
Whitehall,  and  that  "  the  medical  officers  of 
health  throughout  the  country  should  be  re- 
sponsible to  the  Local  Government  Board,  as  well 
as  to  the  local  authorities."  Under  existing 
conditions  the  medical  officer  of  health  in  the 
majority  of  cases  simply  courts  dismissal  if  he 
acts  fearlessly  and  progressively  in  the  sanitary 
interests  of  the  community.  Other  points  in 
this  most  interesting  Address  will  repay  careful 
reading,  not  only  by  medical  men,  but  by  the 
outside  public,  to  whom  preventive  medicine 
is  a  matter  of  profound  and  vital  importance. 
Turning  to  the  "  Address  on  Surgery."  we  find 
an  able  address  from  Sir  William  MacEwen.  who 
worthily  maintains  the  illustrious  traditions  of 
Scotch  surgery  for  brilliance  and  originality. 
The  main  part  of  his  remarks  he  devoted  to 
the  choice  of  suitable  material  for  ligatures  and 
sutures,  to  their  absorption  and  to  the  absorption 
of  catgut  and  chicken-bone  drainage  tubes. 
Attention  to  details  of  this  sort,  it  need  hardly  be 
remarked,  are  absolutely  necessary  to  operative 
success.  A  novel  feature  in  the  Oxford  pro- 
gramme was  the  delivery  of  a  popular  lecture  by 
Dr.  Ferguson,  of  Cheltenham.  He  chose  as  his 
subject,  "  Disease  Germs,"  and  discussed  their 
nature  and  significance  in  disease,  together  with 
their  appropriate  preventive  and  curative 
methods.  On  the  whole,  the  scientific  side  of  the 
meeting  has  been  well  up  to  the  average,  while  the 
social  side  of  the  annual  meeting  has  been  of  an 
unusually    brilliant    character. 


SEASIDE  THERAPEUTICS. 
The  seaside  is  probably  the  most  ancient  of 
health  resorts.  People  have  flocked  to  it  in  the 
hot  weather  from  time  immemorial  in  spite  of  diffi- 
culties of  transport,  ostensibly  for  the  purpose  of 
restoring  their  shattered  energies,  with  results 
that,  on  the  whole,  may  be  assumed  to  have  been 
satisfactory  since  the  practice  still  obtains.  The 
choice  of  a  seaside  resort  is  usually  decided  on 
grounds  of  expediency  rather  than  of  judicious 
selection,  and  the  matter  is  perhaps  not  one  of  much 
importance  so  far  as  the  healthy  are  concerned. 
When,  however,  we  aim  at  obtaining  certain 
definite  effects  from  the  air  or  in  the  water  in 
disease  it  is  necessary  to  form  a  clear  idea  of  what 
we  require  and  the  likelihood  of  obtaining  it.  All 
seaside  resorts  are  not  alike,  therapeutically 
speaking  ;  far  from  it,  a  point  that  is  clearly  shown 


122    Ths  Medical  P&sst. 


LEADING  ARTICLES. 


August  3.  1904- 


in  the  communication  (a)  which  we  publish  on 
"  Seaside  Therapeutics."  Apart  from  certain 
general  characteristics,  such  as  uniformity  of  tem- 
perature, atmospheric  density  and  moJBture,  free- 
dom from  dust,  and  comparative  richness  in  oxy- 
gen, the  curative  properties  of  seaside  resorts  vary 
greatly,  accordingly  as  they  are,  or  are  not,  pro- 
tected from  wind,  are  sunny  or  otherwise,  and, 
last  but  not  least,  according  to  the  configuration 
of  the  neighbouring  country,  whether  wooded  or 
bleak.  Each  description  of  resort  has  curative 
qualities  of  its  own,  but  no  one  resort  is  suitable 
for  all  classes  of  patients,  even  if  we  exclude  those 
whose  morbid  predispositions  are  such  as  to  render 
residence  in  the  vicinity  of  the  sea  undesirable 
or  injurious.  The  popular  practice  of  sending 
people  with  "  weak  chests  "  to  the  seaside  is  fraught 
with  many,  to  the  physician,  obvious  risks,  and 
the  wise  would  no  more  think  of  adopting  this 
course  without  obtaining  medical  advice  thereon 
than  they  would  administer  particular  medica- 
ments on  their  own  responsibility.  It  is  not 
a  matter  of  indiflEerence,  it  cannot  truthfully  be' 
asserted  that  if  it  does  no  good  it  will,  at  any  rate, 
do  no  harm.  The  perturbations  induced  in  the 
human  organism  by  transfer  to  the  seaside, 
especially  before  the  system  has  had  time  to  be- 
come acclimatised,  are  often  very  marked,  and, 
in  the  delicate,  may  be  attended  by  grave  dis- 
comfort, if  nothing  worse.  In  the  article  to  which 
we  have  referred,  sundry  practical  data  are  given 
on  which  an  opinion  can  be  formed  as  to  the  suita- 
bility of  a  particular  resort  in  individual  cases, 
for  nothing  should  be  left  to  chance.  Medical 
men  as  a  rule  are  famiUar  with  the  general 
principles  that  underlie  what  may  be  termed 
seaside  therapeutics,  but  what  they  lack  is  a  classi- 
fication of  seaside  places  into  categories  according 
to  their  local  climate  and  topography.  There  is 
room,  indeed,  for  a  guide  to  watering-places,  not 
based  on  the  claims  advanced  by  those  who  are 
interested  in  their  future,  but  reasoned  out  in 
accordance  with  the  well-kHown  principles  of 
climatic  therapeutics.  Much  useful  work  has  been 
done  in  this  direction  by  the  committee  of  the  Royal 
Medical  and  Chinirgical  Society,  but  its  reports 
are  not  accessible  to  the  general  pubUc  or  even  to 
members  of  the  medical  profession.  Were  it  not 
that  the  curriculum  is  already  over-crowded,  we 
should  be  tempted  to  suggest  the  propriety  of 
requiring  some  knowledge  of  balneotherapeutics, 
a  branch  of  medicine  which  for  some  reason 
has  been  persistently  neglected  in  this  country, 
though  highly  appreciated  elsewhere.  To  some 
extent,  however,  in  late  years  the  gap  has  been 
filled  by  the  Balneological  Society  of  London. 


SUPERSTITION  AND  PSYCHOLOGY. 
There  has  been  much  fluttering  in  the  journa- 
listic dove-cots  over  the  remarkable  dream  that 
Mr.  Rider  Haggard  has  thought  fit  to  publish 
to  the  world  in  a  letter  to  the  Times.  Probably, 
there  are  few  people  to  whom  the  circumstances 

(a)  See  *' Original  CommaniefttionB,"  page  112. 


are  not  now  familiar,  but  it  may  be  well  for  the 
sake   of  those   who   have   not   fully   acquainted 
themselves  with  its  details  to  recapitulate  them 
briefly.     One  night  Mr.  Haggard  was  awakened 
by  his  wife  from  a  confused  nightmare  in  which 
uncomfortable  sensations  such  as  those  of  drown- 
ing prevailed.     Between  the  time  of  his   being 
aroused  and  the  time  that  he  became  fully  con- 
scious he  dreamed  that  a  favourite  dog  was  lying 
among  rough  growth  beside  water,  and  that  bis 
(Mr.  Haggard's)  personaUty  was  rising  out  of  the 
dog.     The  dog  seemed  to  be  trying  to  speak,  but 
could    not,    yet    it    somehow   conveyed   to   Mr. 
Haggard  that  it  was  dying.      Then    he    awoke. 
The  subsequent  facts  may  be     summed   up    by 
saying  that  the  dog  appears  to  have  been  run 
over  by  a  train    some  three  hours    before    Mr. 
Haggard's  dream,  and  to  have  fallen  over  a  railwray 
bridge  into  some  water,  where  he  was  discovered 
two  days  later  by  strangers.     The  exact  time  of 
its  death  cannot  certainly  be  determined,  but  the 
general  probabilities  point  to  the  accident  having 
occurred  well  before  the  dream  ;  the  only  alter- 
native being  is  that  it  was  killed  at  least  twenty- 
four  hours  after  the  dream,  as  a  Sunday,  on  which 
no  trains  ran,  intervened.     These,  then,  are  the 
facts,  and  it  is  quite  extraordinary  the  hubbub 
that  they  have  created.     Making  an   allowance 
for  the  dreamer's  personality  being    that    of    a 
popular  novelist,  and  for  the-  approaching  advent 
of  the  '*  silly  season,"  there  remains  a  large  gap 
in  the  reputation  of  the  Britisher  for  stolidity 
that  it  is  difficult  to  fill  up.     In  every  country 
there  exists  side  by  side  with  the    work-a-day 
individuals    a     complement    of    idle    quidnuncs , 
and  these  are  only  too  glad  of  any  trifling  passing 
sensation,  but  when  journals  of  the  acumen  and 
culture  of  the  Spectator  take  to  debating  seriously 
the  solution  of  the  "  mystery,"  it   is  excusable  to 
remark    that   they   might   be    better    employed. 
Medical  men  are  frequently  accused  of  materialism, 
and  no  doubt  scientific  training  tends   in   that 
direction,  but  what  is  valuable  in  scientific  train- 
ing is  that  it  never  encourages  its  foUowers  to  fly 
to    supernatural    or    praeter-natural  explanations 
for  phenomena,  till  they  become  inexplicable  on 
natural  hypotheses.     The  gain  that  the  scientific 
method    has    been    to    medicine   is    inestimable, 
and  not  the  least  of  its  benefits  has  been  that  it  has 
entirely   eliminated    the   crudities   of    demonism 
and  supernatural  interventions  from  its  pathology. 
Fortunately  for  themselves,  sick  persons  at  the 
present  day,  even  if  they  cannot  be  directly  cured, 
are  spared  the  infliction  of  undergoing  painful 
and  even  brutal  rites  such  as  were  entailed  by  the 
practice  of  exorcisms.     To  find,  then,   so  small 
an  impression  has  been  made  by  science  on  those 
of  our  fellow- workers  who  represent  in  journalism 
much  that  stands  for  the  best  in  thought  and 
culture,  that,  in  this  year  of  grace,  the  Spectator 
gravely  brings  forward  a  theory  of  the  migration 
of  the   spirit   during   sleep   to   account   for  Mr. 
Haggard's  dream,  is,  to  say  the  least,  disappointing. 
The  physiology  of  sleep — ^the  diastole  of  the  brain, 
as  oster  has  called  it — ^is  admittedly  not  fully 


August  3,  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.    123 


understood,  but  on  the  analogy  of  other  tissues, 
it  is  only  reasonable  to  assume  that  the  most 
highly  differentiated  of  all  tissues  needs  its  periods 
of  rest,  and  the  cortical  cells  of  the  brain  might 
be  naturally  expected  to  require  longer  time  for 
recovery  from  stimulation  and  irritation  than 
more  lowly  organised  structures  such  as  the  cells 
of  the  salivary  glands  or  pancreas.  The  dis- 
turbances of  the  function  of  sleep,  hke  the  dis- 
turbances of  any  other  function,  are  dependent 
on  some  structural  vice  of  the  tissues,  and  the 
phenomena  of  the  hypoh5rpnotic  state— dreams, 
somnolentia,  night-terrors  and  so  on — have, 
naturally,  a  psychical  as  well  as  an  organic 
side.  In  dreams  ideas  and  emotions  succeed  one 
another  by  association,  but  without  correlation, 
and  judgment  and  reasoning  power  are  in  abey- 
ance. An  idea  has  only  to  be  conjured  up  for  a 
train  of  associated  ideas  to  follow  inconsequentially 
on  its  heels,  and  thus  we  get  the  juxtapositions 
of  persons  and  places  taking  place  in  dreams 
that  make  food  for  mirth  when  we  sit  down  to 
breakfast.  A  nightmare,  such  as  Mr.  Haggard 
had,  is  a  hypohypnotic  disorder,  and  practically 
always  is  attributable  to  some  more  or  less  remote 
irritation ;  it  would  be  interesting  in  his  case  to 
hnd  out  whether  he  was  subject  to  nightmares, 
and  whether  he  has  any  temporary  or  permanent 
source  of  irritation.  That  he  presented  some 
symptoms  of  somnolentia  we  should  be  inclined 
to  deduce  from  the  fact  that  his  wife  woke  him 
up,  which  she  was  not  Ukely  to  do  in  the  middle 
of  the  night  unless  he  was  exhibiting  motor 
phenomena  of  some  sort.  Then,  too,  we  have  the 
admission  of  the  telepathists  and  the  spiritualists 
that  Mr.  Haggard's  experience  of  '/  communica- 
tion "  with  an  animal  is  almost  if  not  quite  un- 
precedented, together  with  the  fact  that  the  dog, 
if  dead,  must  have  been  so  for  at  least  three 
hours,  for  it  is  inconceivable  that  a  dog  that  had 
been  run  over  by  a  train  could  Uve  many  minutes. 
Is  there  anything  in  the  whole  story  that  is  not 
quite  reconcilable  with  the  simple  hypothesis 
that  Mr.  Haggard  had  an  ordinary  nightmare 
dependent  on  usual  causes,  and  that  somewhere 
about  the  same  time  his  dog  happened  to  be 
killed  ?  The  admittedly  unique  character  of  the 
dream  is  in  itself  strong  evidence  of  coincidence, 
and  we  think  it  a  vast  pity  that  fantastic  super- 
stitions should  be  indulged  in  by  influential 
journals,  superstitions  that  tend  to  put  back  the 
hands  of  the  clock  from  1900  a.d.  to  1900  b.c,  or 
earlier. 


notes  on  Cntrent  XCooics. 

School  Dentistry. 

There  is  no  disguising  the  fact  that  in  matters 
of  school  hygiene  and  medical  supervision  we  in 
this  country  have  much  to  learn.  The  Medical 
Press  and  Circular  has  constantly  striven 
to  enlist  the  interest  of  the  profession  in  this 
topic,  which  is  rendered  doubly  important  now 
that  the  influence  of  school  life  and  habits  is 
being  recognised   as   one  of  the   most  powerful 


factors  of  the  national  physique.  The  need  for 
the  appointment  of  an  inspecting  medical  officer 
who  should  preferably  be  attached  to  every  Board 
and  Council  school  in  this  country  has  many 
times  been  emphasised  in  these  columns,  and  we 
offer  no  excuse  for  once  more  bringing  the  subject 
forward.  This  time,  however,  it  is  to  call  attention 
to  the  excellence  of  the  arrangements  adopted  in 
several  German  and  other  Continental  cities  by 
which  the  teeth  of  school  children  are  regularly 
and  systematically  inspected.  The  statistics 
of  our  own  London  School  Board  examiners  have 
shown  conclusively  that  bad  teeth  are  alarmingly 
prevalent  among  the  scholars  of  all  ages  and  both 
sexes,  and  a  similar  state  of  affairs  has  been  found 
in  Darmstadt  and  Stuttgart.  In  both  these  towns 
a  fully-equipped  dental  room  has  been  fitted  /Up 
in  one  or  more  of  the  central  schools  in  which 
the  teeth  of  each  child  are  examined  and  appro- 
priately treated  by  extraction  or  stopping  by  a 
duly-qualified  dentist,  who  gives  his  whole  time 
to  the  work.  When  the  evils  which  result  from 
th«  presence  of  carious  teeth  upon  the  digestive 
system,  and  also  their  UabiUty  to  produce  toxic 
symptoms,  such  as  those  of  pernicious  anaemia, 
are  remembered,  such  measures  as  these  are  the 
reverse  of  extravagant,  thej*^  are  salutary  in  the 
extreme.  England  must  not  be  behindhand  in 
giving  her  children  the  benefits  of  modem  science 
which  can  no  longer  be  considered  as  luxuries 
but  as  actual  necessities. 


The  Treatment  of  Gkistroptosis. 

That  malposition  of  the  stomach  which  results 
in  a  downward  displacement  of  the  whole  organ 
is  more  common  than  is  usually  supposed.  Meinert, 
of  Dresden,  found  the  condition  in  from  80  to 
90  per  cent,  of  all  young  women  and  girls.  Defor- 
mities of  the  lower  part  of  the  chest,  whether 
natural  or  acquired,  are  among  the  most  potent 
causes  of  a  falUng  of  the  stomach.  Later  in 
life,  the  condition  may  be  associated  with  ptosis 
of  the  whole  abdominal  viscera,  then  known  as 
Glcnard's  disease,  in  which  there  is  supposed  to 
be  a  general  relaxation  of  the  suspensory  folds 
of  peritoneum,  which  normally  support  the 
stomach  and  intestines.  Movable  or  floating 
kidney  may  be  present  at  the  same  time.  A  certain 
amount  of  gastric  dilatation  frequently  accom- 
panies its  displacement,  and  this  again  is  some- 
times definitely  connected  with  disorders  of  th 
nervous  system.  Dr.  A.  Rose,  of  New  York,  (a) 
describes  cases  in  which  migraine  was  associated 
with  gastroptosis.  As  regards  the  treatment  of 
this  troublesome  condition,  special  attention  to  the 
mode  in  which  the  gastric  functions  are  performed 
is  necessary,  while  lavage,  systematically  employed, 
may  be  useful  in  helping  to  overcome  the  accom- 
panying dilatation.  The  increase  in  size  of  the 
abdomen  and  consequently  in  the  capacity  of  its 
vessels  has  an  important  bearing  upon  the  whole 
circulation,  for  in  conditions  of  ^rterio-sclerosis 
there  may  be  so  much  blood  contained  in  the 
splanchnic  reservoirs  that    the    nutrition  of  the 


ifl)  MedUal  Newt,  July  16th,  1904. 


124     Ths  Msdical  Puss. 


NOTES   ON    CURRENT    TOPICS. 


August  3,  1904- 


] 


brain  may  be  seriously  compromised.  It  is  not 
enough  in  such  cases  merely  to  provide  an  ab- 
dominal belt.  What  is  required  is  an  actual 
diminution  in  the  size  of  the  stomach  itself.  Dr. 
Rose  finds  that  strapping,  intelligently  appUed  over 
the  abdomen,  will,  in  many  cases,  brace  up  the 
organ,  so  that  its  true  secretory  functions  are 
once  more  restored.  In  selected  cases,  massage 
over  the  same  area  might  also  be  of  service. 


Hospitals  and  Post-mortems. 
The  recent  performance  of  a  post-mortem 
examination  unauthorised  either  by  the  friends  of 
deceased  or  by  the  Coroner,  has  given  rise  to 
some  public  comment.  In  this  particular  case, 
a  child  swallowed  a  cherry  stone  and  was  taken  to 
the  hospital,  where  tracheotomy  was  performed. 
The  acting  house  surgeon,  who  operated,  sub- 
sequently conducted  a  post-mortem  examination 
with  the  help  of  the  Registrar  of  the  hospital. 
At  the  first  hearing  in  the  Coroner's  Court,  he 
stated  that  it  was  not  usual  to  obtain  the  per- 
mission of  the  friends  to  a  post-mortem,  an  asser- 
tion that  later  was  emphatically  disproved.  The 
reason  for  this  belief  may  probably  be  found  in  the 
fact  that  some  of  the  large  hospitals  make  it  a 
condition  of  admission  that  a  post-mortem  exa- 
mination shall  be  made,  if  considered  necessary, 
in  case  of  death.  Were  it  otherwise  the  progress 
of  medical  science  would  be  lamentably  handi- 
capped. In  poor-law  infirmaries,  where  consent 
of  friends  is  necessary,  a  post-mortem  examination 
may  be  stopped  by  a  person  who  is  not  even 
related  to  the  deceased.  In  that  way,  the  final 
pathological  test  of  miany  obscure  illnesses  has 
been  lost,  and  the  sum  of  human  knowledge  has 
been  the  poorer.  It  is  impossible  totally  to  dis- 
regard sentiment  even  in  its  most  unreasoning 
forms,  especially  when  hnked  with  affection,  but 
it  smacks  of  ingratitude  when  a  post-mortem 
examination  that  may  furnish  information  of 
value  to  the  living  is  denied  by  the  friends  of  a 
hospital  patient. 


Fatty  Defeneration. 
For  many  years  one  of  the  points  emphasised 
in  the  differentiation  of  fatty  infiltration  and  fatty 
degeneration  was  that  the  origin  of  the  fat  in  the 
former  case  was  extra-cellular  and  in  the  latter 
intra-cellular.  This  distinction  was  due  to  Vir- 
chow,  who  explained  the  formation  of  fat  in  fatty 
degeneration  as  being  due  to  some  combination  of 
the  non-albuminous  constituents  of  the  cell, 
sphtting  of  the  cell  into  albuminous  and  non-al- 
buminous groups  having  first  taken  place.  It  is 
curious  that,  as  long  as  this  view  has  held  the  field, 
transcribed  by  one  authority  from  another, 
the  evidence  in  its  favour  has  been  so  slight,  while 
the  objections  to  it  are  many  and  strong.  On  the 
other  hand,  Recklinghausen  showed  that  both  in 
causation  and  morphology  fatty  degeneration 
and  fatty  infiltration  presented  many  common 
features,  while,  on  the  other  hand,  Pfiiiger  main- 
tained that  chemically  there  is  little  basis  for  the 
assumption  that  fat  can  be  formed  by  the  aseptic 


decomposition  of  proteid.  The  experiments  of 
Rosenfeld,  too,  with  phloridzin  poisoning  in  dogs 
fed  with  mutton  fat,  showed  that  the  fat  occurring 
in  degeneration  exhibits  the  characteristics  of  the 
fat  taken  in  the  food,  or,  in  other  words,  that  the 
fat  deposited  in  degeneration  and  in  infiltration 
are  of  the  same  nature.  In  view  of  such  facts, 
the  current  opinion  among  modem  pathologists 
is  somewhat  adverse  to  Virchow's  doctrine,  and 
there  is  a  tendency  to  discard  the  term  "  de- 
generation "  as  assuming  a  theory  no  longer  ad- 
mitted. At  the  same  time  it  is  to  be  remembered 
that  the  process  is  associated  with  degenerative 
changes  in  the  cell,  and,  whether  quite  accurate 
or  not,  the  distinction  between  *•  fatty  infiltration 
tion  "  and  "  fatty  degeneration  "  is  still  a  con- 
venient one. 


Hadwen  v.  Price. 
The  result  of  the  action  for  libel  brought  by 
Dr.  Hadwen,  the  Gloucester  antivivisectionist » 
can  hardly  be  regarded  by  him  as  encouraging. 
The  trial  arose  from  the  remark  made  by  the 
defendant  medical  man.  Price,  to  the  effect  that  a 
child  certified  by  Dr.  Hadwen  to  have  died  from 
brain  fever  might  possibly  have  died  from  small- 
pox. Adverse  comment  of  any  kind  from  one 
practitioner  upon  the  opinion  of  another  is  at  any 
time  undesirable,  even  when  the  person  criticised 
holds  views  such  as  homeopathy  and  antivac- 
cination,  that  have  been  tried  in  the  balance  of 
orthodox  medical  practice  and  found  wanting. 
In  this  instance  the  person  aggrieved  was  awarded 
a  farthing  damages  by  the  jury,  and  the  judge 
ordered  that  each  side  should  pay  its  own  costs. 
The  actual  costs  paid  by  Dr.  Hadwen  are  stated 
to  have  been  over  a  hundred  pounds,  a  .sum  that 
has  been  amply  covered  by  a  cheque  for  £iS4  i/s- 
I  id.  collected  by  Lieu  tenant-General  Phelps, 
the  president  of  the  Antivaccination  League,  and 
presented  to  Dr.  Hadwen. 


The  Bisks  of  Professional  liife. 
Among  the  various  risks  attached  to  the  daily 
life  of  the  medical  man,  not  the  least  serious  is  that 
of  being  attacked  by  a  lunatic  patient.     Many 
are  the  experiences  on  record  where  the  medical 
attendant  has  had  to  fight  for  his  life  with  some 
madman,  who  has  probably  locked  the  door  and 
perchance  thrown  the  key  into  the  fire  or  out  of 
the    window.     Recently    a    startling    experience 
of  this  kind  fell  to  the  lot  of  Dr.  Shuter,  of  Chis- 
wick,  happily  without  serious  results,  so  far  as  he 
himself  was  concerned.      He  was  called    to  an 
engineer,  whom  he  saw  in  his  bedroom  in  an  excited 
condition,  and  who  announced  the  fact  that  he  was 
going  to  blow  his  brains  out.     The  man  thereupon 
whipped  out  a  revolver  and  pointed  it  at  the 
doctor.     The  latter  told  him  to  put  the  weapon 
down,  but  without  effect,  for  he  immediately  fired, 
and,  missing  his  mark,  lodged  a  bullet  in  the  ceiling. 
An  instant  later  he  put  the  pistol,  to  his  forehead 
and  blew  out  his  brains.     At  the  inquest  the  jury 
returned  the  usual  verdict  of  suicide  whilst  of 


r 


August  3.  1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Peess.  125 


unsound  mind,  and  the  Coroner  complimented 
Dr.  Shuter  on  his  pluck.  His  medical  brethren 
throughout  the  kingdom  will  warmly  join  in  con- 
gratulating him  on  his  escape  from  so  terrible  a 
jeopardy. 

An  Eventful  Career. 
Most  of  us  are  familiar  with  the  heroine  of  the 
melodramatic  novelette  who,  at  the  same  moment 
sw^allowed  the  deadly  draught,  discharged  the 
revolver  at  her  head,  and  plunged  the  fatal  knife 
into  her  breast,  leaped,  with  a  wild  shriek,  from 
tbe  dizzy  height  into  the  yawning  darkness  below, 
but  **  her  hour  was  not  yet."  Strange  as  were 
her  adventures,  they  were  quite  hum-drum  com- 
pared with  the  career  of  a  popular  actor  of  the 
present  d.ay.  Ludovic  Branay,  the  famous  Hun- 
garian tragedian,  has  recently  compiled  statistical 
tables  of  his  own  stage  adventures,  and  they  are 
worth  quoting.  In  his  professional  life  he  has 
been  married  1,721  times,  and  suffered  death  1,120 
times.  "  I  was  stabbed,"  he  says,  "  61  times, 
killed  by  lightning  51  times,  drowned  22  times, 
p>oisoned  166  times,  beaten  to  death  86  times, 
died  of  heart  disease  192  times,  assassinated  109, 
and  executed  133  times.  Finally.  I  committed 
suicide  314,  and  died  a  natural  death  55  times." 
The  list  is  interesting  as  showing  the  forms  of 
death  which  appeal  as  picturesque  to  the  theatre- 
going  public.  Yet  we  have  seen  somewhere  that 
art  should  hold  the  mirror  up  to  nature  ! 


Lime-juice  in  Scnrvy. 
~  Surely  in  no  science  is  there  less  room  for 
dogmatising  and  appealing  to  canonical  faith 
than  in  medicine.  There  is  hardly  an  article  of 
the  medical  creed  that  is  not  periodically  taken 
up,  trounced,  and  left  to  perish  by  the  wayside, 
till  it  becomes  exceedingly  difficult  to  be  certain 
that  any  real  knowledge  capable  of  being  called 
"medicine"  exists.  From  one's  earliest  days 
the  efficacy  of  lime-juice  in  the  prevention  and 
cure  of  scurvy  has  been  regarded  as  a  point  about 
which,  however,  many  theories  of  scurvy  might 
revolve,  would  still  remain  unmoved  and  im- 
movable. Far  from  this  being  the  case,  from 
several  sources  lately  news  has  been  coming  in 
that  all  lime-juice  is  not  good  for  all  scurvy,  or 
that  all  lime-juice  is  not  good  for  some  scurvy. 
In  which  of  these  the  truth  Ues  it  is  not  possible 
to  say,  for  different  observers  speak  differently. 
Government  hme- juice  is  certainly  not  always 
efficacious,  and  both  in  the  South  African  war 
and  the  Somaliland  Expedition  it  was  difficult 
even  to  get  the  men  to  drink  it,  so  acrid  and  raw 
was  its  taste.  And  even  when  taken  it  is  not 
always  successful.  In  the  Bengal  jails  there  is  a 
form  of  scurvy  in  which  some  patients  have  been 
freely  dosed  with  Government  lime-juice  without 
effect,  and  in  SomaUland  similar  experiences 
have  prevailed.  Fresh  Ume- juice  certainly  seems 
more  efficacious  and  pleasant,  but  what  the  active 
ingredient  is  that  gives  it  anti-scorbutic  properties 
is  not  certain.  A  recent  writer.  Lieutenant 
Fleming  Bamardo,  of  the  Indian  Medical  Service, 


recommends  that  lime-juice  should  be  left  out  of 
the  equipment  of  a  military  force,  and  f.  that 
tabloids  of  citrate  of  potash  and  calcium" chloride 
should  be  substituted.  Undoubtedly  much  of  the 
failure  of  lime-juice  has  been  due^toTits  'gross 
adulteration.  We  hope  this  important  matter 
may  be  thoroughly  sifted. 


The  Hygiene  of  Pculdling. 

Now  that  the  seaside  watering-places  are  daily 
becoming  more  and  more  frequented  by^hohday 
makers,  the  old  question  has  once  more  arisen 
as  to  the  advisability  of  allowing  children  to 
paddle  in  the  sea.  This  is  a  subject  upon  which 
society  papers  and  health  journals  love  to  dilate, 
and  it  is  not  surprising  that  many  and  contrary 
opinions  thereon  have  been  freely  expressed. 
The  practice  of  paddling,  so  dear  to  the  child's 
heart,  cannot  be  condemned  wholesale,  because  a 
few  cases  of  illness  have  been  traced  to  its  influence. 
The  danger  of  contracting  rheumatism  in  this 
manner  has  probably  been  much  exaggerated. 
In  this,  as  in  other  things,  the  exercise  of  common 
sense  will  prevent  gross  indiscretions.  The  chief 
dangers  to  guard  against  in  paddling  are  cerebral 
congestion  and  chill.  One  of  the  reflex  effects  of 
cold  water,  especially  when  applied  to  the  ex- 
tremities is  to  produce  a  certain  amount  of 
congestion  in  the  internal  organs.  In  cases  where 
the  stabiUty  of  the  cerebral  circulation  is  upset  by 
slight  causes,  as  in  epileptic  conditions,  it  might 
then  be  inadvisable  to  stand  about  for  long  periods 
in  the  wet.  The  direct  effects  of  the  sun's  rays 
in  very  hot  weather  have  also  to  be  considered, 
and  it  is  certainly  unwise  to  allow  young  children 
to  run  about  all  day  with  no  covering  upon  their 
heads,  whether  their  feet  be  in  the  water  or  not. 
A  good  straw-hat  or  sun-bonnet  will  act  as  a 
sufficient  screen,  so  that  anxiety  should  be  re- 
moved upon  this  point.  A  child  who  is  perspiring 
freely  should  not,  of  course,  be  allowed  to  paddle, 
as  it  is  quite  easy  to  contract  a  chiU  in  that  way! 
Provided  these  simple  precautions  be  observed, 
there  can  be  no  harm  whatever  in  indulging  in 
this  particular  form  of  amusement,  which  is 
specially  associated  with  a  visit  to  the  sea-side. 
We  do  not,  of  course,  refer  to  cases  in  which 
there  is  obvious  organic  disease  present  of  the 
heart  or  brain,  when  greater  care  and  circum- 
spection will  be  needed. 

Municipal  Medical  Attendance. 

Switzerland,  the  birthplace  and  centre  of 
municipal  life,  seems  determined  to  apply  the 
social  contract  system  to  medical  attendance. 
It  has  recently  been  announced  that  the  Canton 
authorities  have  resolved  to  levy  a  new  annual 
tax  of  3s.  6d.  per  head,  to  be  called  the  "  Zurich 
Medical  Tax."  In  return  for  that  contribution 
the  inhabitants  will  be  entitled  to  free  medical 
attendance  from  State-paid  medical  officers. 
There  is  much  to  be  said  on  both  sides  of  this  new 
departure.  So  far  as  the  public  are  concerned^ 
they  are  Hkely  to  get  more  equahty  of  practice 
as  well  as  more  scientific  treatment,   the  latter 


126     The  Medical  Press.  NOTES  ON  CURRENT  TOPICS. 


likelihood  being  due  to  the  absence  of  any  in- 
centive on  the  part  of  the  medical  man  to  humour 
the  fancies  of  his  patient.  Clearly  it  would  not  do 
for  the  patients  to  have  the  right  of  choosing  their 
medical  attendant,  for  in  that  case  the  popular 
mail  would  be  overwhelmed  with  work,  for  which 
he  would  obtain  ino  corresponding  advantage 
by  way  of  emolument.  After  all,  there  is  not  such 
a  very  great  difference  between  the  Swiss  muni- 
cipal service  and  the  British  medical  club  service. 
Neither  the  one  nor  the  other  is  likely  to  make 
any  serious  inroad  upon  the  income  of  the  medical 
man  in  high-class  private  or  consulting  practice. 

The  Progress  of  Sanitary  Science. 

The   increasing  amount   of  interest   taken   in 
sanitary  affairs  generally,  is  shown  by  the  large 
number  of  delegates  from  the  home  counties  and 
foreign  governments  who  attended  the  twent^'- 
second    Congress    of    the    Sanitary    Institute    at 
Glasgow.   In  the  course  of  his  Presidential  Address 
rx>rd  Blythswood  remarked  that  science  *'  saved 
those  who  were  a  burden  to  themselves  and  a 
danger  to  others."     Such,  indeed,  is  the  whole  aim 
of   medical   science   of   which   hygiene   forms   so 
large   a  part.     If  we  look  around   at  the  work 
done  by  such  bodies  as  the  Sanitary  Institute  and 
the  Royal  Institute  of  Public  Health,  the  Congress 
of  which  was  held  simultaneously  at  Folkestone, 
we  cannot  fail  to  see  advance  and  improvement 
in  every  direction.     The  care  and  treatment  of 
the  consumptive,  the  prevention  of  consumption 
itself,  the  prophylaxis  of  infectious  diseases,  the 
health  of  School  children,  the  examination  into 
the  alleged  causes  of  physical  degeneration,  and 
the  adoption  or  recommendation  of  means  whereby 
it  may  be  prevented  when  proved  to  exist — these 
are  only  some  of  the  items  of  a  gigantic,  scientific 
programme   which   is    gradually,    though  slowly, 
being  carried  out.     The  education  of  the  masses 
in  sanitary  science  takes  time,  and  old  prejudices 
cannot  be  overcome  in  a  day,  nor  even  in  a  genera- 
tion.    It  is  a  significant  fact,  however,  that  the 
death-rate  in  Glasgow  has  been  reduced  by  one- 
half  through  the  introduction  of  sanitary  measures, 
and  this  in  the  face  of  an  ever-increasing  population. 
A  similar  result  has  also  taken  place  in  the  case 
of  other  large  cities.     With  regard  to  the  smoke 
nuisance,  the  President  of  the  Sanitary  Institute 
expressed  the  hope  that  the  subject  would  be 
taken  up  in  earnest  during  the  coming  session, 
and    that    the    conservatism    of    manufacturers 
would  not  be  allowed  to  stand  in  the  way  of  a 
plentiful  provision  of  pure,  unadulterated  air  for 
the  workers  in  populous  centres. 

The  Danfirers  of  Iced  Drinks. 

Thf.  weakness  of  human  nature  is  such  that  a 
certain  amount  of  pleasure  is  always  experienced 
in  rushing  to  extremes.  The  sensation  of  ice- 
cold  liquids  careering  down  the  gullet  and  be- 
numbing the  pharynx  is  so  delightful  in  the  hot 
weather  that  minor  inconveniences  in  the  shape 
of  toothache,  loss  of  appetite,  or  gastric  pain  are 
not   minded.     More   cautious   individuals   try   to 


August  3,  1904. 

be  a  Uttle  careful  both  as  to  the  nature  of  their 

frigid  draughts,   and   also   as  to  their   place  of 

purchase.     HappUy  for  the  health  of  the  poorer 

population,   the  introduction  of  more   stringent 

by-laws    respecting    the    ice-cream     traffic,     the 

danger    of    contamination    of    these    refreshing 

commodities  has  been  greatly  minimised.     We  are 

not,  as  a  rule,  in  the  habit  of  consuming  iced 

liquors  the  whole  day  long,  but  there  is  no  doubt 

that  in  hot  weather  a  considerable  proportion  of 

the  cases  of  dyspepsia  that  occur  owe  their  origin 

to  such  practices.     If  drunk  when  the  system  is 

I  much  overheated,  or  weakened  by  over-exertion, 

I  and  in  large  quantity,  the  immediate  effects  upon 

I  the   circulation   may   be  alarming.     This   fact   is 

I  pretty   generally  known,   but   one   or   two   cases 

;  in   which  the  result  of  the  ingestion  of  a  large 

i  amount,    suddenly,    of    ice-cold   liquid    into    the 

stomach  has  been  fatal  may  sometimes  be  heard 

of    during    a    spell    of    tropical    heat.     There    is 

another   danger   of   a   more   insidious    character, 

because,   as   a  rule,   unsuspected,   attending   the 

consumption  of  iced  drinks,  and  that  is  the  ice 

itself   may    contain    germs    of    disease.     Natural 

ice  is  not  always  free  from  impurities  ;    in  fact, 

it  is  frequently  grossly  contaminated,   but  that 

which   is   artificially   prepared   may   be    actually 

infected  with  pathogenic  organisms.     The  recent 

occurrence  of  several  cases  of  enteric  fever  in  the 

Lausanne  district  has  led  the  municipal  authorities 

there  to  issue  warnings  to  excursionists  and  others 

against    drinking    iced    or    snow    waiter,    or    any 

beverages  which  have  been  mixed  with  ice.      This 

is  by  no  means  an  isolated  instance  of  the  danger 

that  may  lurk  in  an  innocent-looking  lump   of 

ice. 


Phosphoric  Acid  in  Gastric  Medication. 

In  the  many  different  clinical  types  of  dyspepsia 
it  is  often  a  matter  of  no  smaU  difficulty  to  select 
a  remedy  that  will   not  only  relieve  subjective 
symptoms,  but  will  also  enable  the  gastric  juice 
to   act   with   the  greatest   efficiency.     Sometimes 
it  is  alkalies,  and  at  other  times  acids  which  bring 
about  the  desired  result,  or  it  may  be   necessarv 
to  combine  one  of  these  vnth  some  preparation  of 
pepsin  itself.     In  states  of  hyperchlorhydria  the 
administration  of  acids  is  obviously  not  called 
for,  but,  unless  a  chemical  examination  of  the 
gastric  contents  be  made,  it  is  not  always  easy 
to    detect    the    minor    degrees    of    hyperacidity 
It  IS  a  significant  fact  that  the  gastric  juice  nor- 
mally contains  acid,  and  that  a  mineral  one,  and 
it  is  probably  for  this  reason  that  the  dilute  nitro- 
hydrochloric  acid  has  long  been  a  favourite  in- 
gredient of  many  so-called  indigestion  mixtures 
When  an  acid  is  given  internally,  it  acts  to  some 
extent  as  an  antiseptic,  it  excites  the  flow  of  the 
normal  digestive  juices,  and  it  assists  the  action 
of   the   stomach   ferments.     M.   A.   Martinet  (a^ 
finds  that  phosphoric  acid  is  in  many  ways  pre- 
ferable to  the  dilute  nitric  or  hydrochloric  acids 
In  the  first  place  it  is  a  less  powerful  acid,  and  it 

(a)  La  Prene  Med.,  July  28rd,  1904. 


August  3.  '904- 


NOTES    ON    CURRENT    TOPICS. 


lat  Mbdical  Press.     127 


is  neutralised  in  the  intestines  with  the  formation 
of  sodium  phosphate.  It  is  not  irritating  to  the 
delicate  renal  epitheUum,  and  by  the  kidney  it  is 
eliminated  as  the  acid  sodium  phosphate,  the 
salt  to  which  the  normal  acidity  of  urine  is  due. 
The  ordinary  mineral  acids  sometimes  cause 
irritability  of  the  stomach,  which  phosphoric  acid 
is  said  not  to  do,  while  it  is  also  credited  with 
certain  tonic  effects  upon  the  nervous  system. 
This  latter  function  is  not  improbable,  when  we 
consider  the  role  played  by  phosphorus  itself  in 
the  nutrition  of  ner\'Ous  tissue. 


BathinfiT  DarisfiT  Menstruation. 

A  CARDINAL  maxim  of  all  gynaecologists  is  that 
no  risk  of  a  chill  should  be  incurred  by  women 
during  the  menstrual  period,  and  in  connection 
with  this  a  very  widespread  tradition  has  sprung 
up  that  the  daily  bath  should  be  given  up  whilst 
the  monthly  flow  continues.  Dr.  Clifton  Edgar, 
of  New  York,  has  lately  circularised  the  leading 
gynaecologists  as  to  their  views  on  the  matter, 
and  has  classified  their  replies.  The  general 
consensus  of  opinion  seemed  to  be  that  bathing 
was  largely  a  matter  of  habit,  and  could  be 
practised  by  its  devotees  with  impunity  during 
menstruation,  but  that  this  did  not  hold  with  all 
women,  and  in  any  case  sea-bathing  should  cer- 
twnly  be  eschewed.  The  daily  tepid  sponge 
bath  (f?5^  to  92°  F.)  should  be  encouraged,  for 
besides  being  innocuous,  it  was  demanded  by  the 
rules  of  hygiene.  If  omitted  on  the  first  day, 
practically  all  women  could  take  such  a  tepid 
bath  on  the  second  or  third  day  after  the  flow 
was  estabUshed,  and,  finally,  that  in  most  women 
the  habit  of  taking  a  tepid  shower  or  sponge- 
bath  could  and  should  be  acquired.  With  these 
opinions  we  generally  concur,  for  they  are  emin- 
ently sane  and  rational,  and  it  is  a  pity  that  so 
necessary  an  adjunct  to  cleanliness  at  the  time 
when  it  is  most  needed  should  be  omitted  through 
a  mistaken  notion  of  its  harmf  ulness. 

The  Dancrer  of  Fublic-Houaes. 

It  has  long  been  known,  and  the  insurance  offices 
have  noted  the  fact  in  a  practical  fashion,  that 
the  public-house  trade  is  an  unhealthy  one  for 
the  employes.  The  great  danger  naturally  is 
that  of  alcoholism,  but  in  the  wake  of  alcoholism 
comes  tuberculosis,  and  the  mortality  of  people 
engaged  on  licensed  premises  from  tuberculous 
disease  of  the  lungs  has  always  been  high.  Dr. 
Allen,  Medical  Ofl&cer  of  Health  for  Westminster, 
in  his  Isist  annual  report,  points  out  the  mechanism 
by  means  of  which  the  connection  between  the 
two  is  probably  effected.  Persons  disabled  by 
consumption  from  pursuing  their  occupation 
turn  naturally  to  the  pubUc -house  to  while  away 
the  day,  and,  as  is  the  habit  with  public-house 
habitues,  spit  freely  on  the  floor.  In  one  public- 
house  in  which  the  consumption  rate  was  especially 
high.  Dr.  Allen  took  specimens  of  the  expectorated 
matters  on  the  floor  of  the  bar,  and  had  them 


stained  for  tubercle  bacilli.  The  bacteriologist 
reported  that  the  organisms  were  present  and  in 
an  active  condition.  Now,  it  is  no  difficult  matter 
to  understand  how  in  a  hot,  stuffy,  ill- ventilated 
public-house,  whose  bar  is  thronged  with  goers 
and  comers  all  day  and  half  the  night,  expectorated 
matters  become  dried  and  pulverised.  Converted 
into  dust,  they  are  freely  inhaled  by  those  whose 
constitutions  are  apt  to  be  impaired  by  the  close 
air  and  indulgence  in  alcohol,  so  that  the  con- 
ditions for  breeding  tubercle  could  not  be  more 
favourable.  Dr.  Allen  suggests  that  some  adequate 
disinfectant  should  be  used  to  moisten  the  floor 
of  the  bar,  so  that  the  dust,  with  its  bacilli  should 
be  kept  from  rising,  and  the  organisms  themselves 
gradually  killed.  This  plan  may  modify  the 
evil,  but  so  long  as  people  persist  in  frequenting 
premises  where  every  condition  is  adverse  to 
health,  so  long  will  they  render  themselves  liable 
to  the  inevitable  consequences. 


Prevention  of  Perineal  Rupture. 
One  of  the  boasts  of  the  present  age,  and  espe- 
cially of  the  present  moment  when  health  congresses 
and  sanitary  beanfeasts  are  in  full  swing,  is  that 
preventive  medicine  is  making  unprecedented 
strides,  and  that  disease  and  death  aire  being  kept 
at  arm's  length  through  the  science  of  hygiene. 
But  a  perusal  of  trans-Atlantic  literature  casts 
somewhat  of  a  bUght  over  the  rising  spirits  of  the 
enthusiast,  for  it  impresses  him  with  the  saddening 
reflection  that  he  is  but  a  babe  in  these  matters, 
whilst  his  fellow  Anglo-Saxon  scientist  is  forging 
ahead.  Let  him,  if  he  doubt  this,  glance  at  the 
proceedings  of  the  annual  meeting  of  the  American 
Gynaecological  Society  in  May  last,  and  he  will 
find  how  far  he  is  from  reaching  the  pitch  of 
anticipation  in  obstetrical  science  that  has  been 
there  attained.  Dr.  Lapthom  Smitt,  of  Montreal, 
spoke  of  the  importance  of  perineal  ruptures 
during  parturition,  and  showed  how  even  small 
tears  are  liable  to  become  the  seats  of  septic 
infection  and  absorption.  Besides  this  immediate 
danger,  large  tears  involved  the  probability  of 
prolapse  of  the  pelvic  organs  from  weakening  of  the 
support  normally  maintained  by  the  flow.  If 
ruptures  occurred,  they  should  be  sutured  at  once, 
but  far  better  than  waiting  till  the  tear  occurred, 
was  to  anticipate  it.  This  might  be  best  aiccom- 
plished  by  putting  in  the  stitches  before  the  head 
passed  the  perinaeum,  whilst  the  patient  was 
anaesthetised,  and  the  parts  in  their  proper 
positions.  Two  or  three  sutures  having  been 
inserted,  they  should  be  caught  loosely  in  Peau 
forceps,  until  the  placenta  was  deUvered,  and  then 
quickly  tied  so  that  the  apposition  of  the  edges 
might  be  as  accurate  as  possible.  Dr.  Lapthorn 
Smitt  evidently  takes  a  gloomy  view  of  his  skill 
in  preventing  rupture.  We  wonder  what  he  says 
to  the  patient  whose  perinaeum  remains  intact, 
and  who  finds  sutures  and  forceps  fastened 
thereto  after  the  completion  of  labour.  The 
situation  must  be  a  rather  delicate  one. 


128     The  Medical  Press. 


CORRESPONDENCE. 


August  3,  1904. 


PERSONAL. 


The  King  has  been  graciously  pleased  to  confer  the 
decoration  of  the  Royal  Red  Cross  upon  Miss  J.Brad- 
bury, Miss  C.  Addison,  Miss  S.  Ruiter,  Miss  E.  M.  Early, 
in  recognition  of  the  services  rendered  by  them  in  tend- 
ing the  sick  and  wounded  at  the  Volunteer  Hospital,  at 
Intombi,  during  the  late  war  in  South  Africa. 

The  Marquis  of  Ripon,  K.G.,  President  of  the 
Western  Ophthalmic  [Hospital,  Marylebone,  London, 
recently  opened  a  new  out-patient  department,  which 
has  been  added  to  that  institution  at  a  cost  of  £s,Soo. 

Dr.  W.  H.  Symons,  the  well-known  medical 
officer  of  Bath,  has  presented  a  local  institution  with 
an  excellent  geological  model  of  Bath  and  surrounding 
district.  

Mr.  John  F.  Sydney  Colohan,  of  Blackrock,  has 
been  appointed  a  Justice  of  the  Peace  for  the  County 
of  Dublin,  on  the  recommendation  of  the  Right  Hon. 
the  Earl  of  Meath. 


On  the  24th  ultimo.  Dr.  John  Keys,  of  Dublin, 
was  presented  with  a  handsome  testimonial  of  silver 
plate  and  other  valuable  articles  on  the  occasion  of 
his  recent  marriage. 

The  Earl  of  Radnor,  in  his  presidential  address  at 
the  Folkestone  meeting  of  the  Royal  Institute  of 
Public  Health,  dwelt  chiefly  on  the  necessity  of  better 
sanitation  of  country  in  its  relation  to  town  supplies. 


Mr.  Alfred  Willett  will  be  presented  with  a  gold 
medal  in  recognition  of  his  long  and  valuable  services  to 
St.  Bartholomew's  Hospital,  and  a  silver  "  Willett  " 
medal  will  be  awarded  annually  to  the  candidate 
attaining  highest  marks  in  the  Brackenbury  Surgical 
Scholarship.  

Dr.  H.  G.  Hayman,  delivered  a  most  interesting 
address  as  President  of  the  annual  meeting  of  the 
Western  Counties  Branch  of  the  British  Dental  Asso- 
ciation, held  last  week  at  Frome. 


Dr.  G.  Pocock  Goldsmith,  of  Bedford,  was  enter- 
tained at  dinner  last  week  by  his  fellow  medical 
practitioners  on  the  occasion  of  his  retirement  from 
practice.  For  thirty  years  Dr.  Goldsmith  was  actively 
engaged  as  surgeon  on  the  stafi  of  the  Bedford  Infirmary, 
and  was  afterwards  appointed  consultant  surgeon. 

Sir  Michael  Hicks-Beach  recently  opened  a  large 
and  handsome  home  for  the  nurses  of  the  County 
Infirmary  at  Gloucester,  and  delivered  a  most  inter- 
esting speech  upon  that  occasion. 

Dr.  Ernest  Clarke,  Chandos  Street,  Cavendish 
Square.  London,  while  passing  through  Walton  last 
week  on  a  motor-car,  was  struck  on  the  neck  by  a 
shot  apparently  from  a  gun,  but  no  trace  of  the  offender 
can  be  found.  Dr.  Clarke,  fortunately,  was  not 
seriously  hurt. 


The  Middlemore  triennial  prize  for  the  best  thesis 
on  ophthalmology  was  presented  in  the  Shelboume 
Theatre  at  Oxford,  at  the  inaugural  reception  of  the 
British  Medical  Association,  to  Mr.  John  Herbert 
Parsons,  M.B.,  B.S..  F.R.C.S. 


Dr.  Thomas  A.  Dowse  has  been  appointed  Govern- 
ment Medical  Officer  at  Levuka.  Fiji,  and  Dr.  Charles 
E.  Maguire,  District  Medical  Officer  of  Suva. 

Sir  Thomas  Barlow,  M.D..  and  Dr.  A.  D.  Waller 
have  been  appointed  representatives  of  the  University 
of  London  at  the  International  Congress  of  Medicine 
to  be  held  at  Lisbon  in  April,  1906. 


Mr.  a.  B.  Kempe,  Secretary  of  the  Royal  Society, 
represented  that  body  at  the  funeral  of  the  late  Sir 
John  Simon,  on  Wednesday  last. 


Correspondence* 


(We  do  not  hold  ourselves  responsible  for  the  opinions  of  our  Cor 
respondents]. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Dr.  Drysdale  writes  : — "  Economically,  it  is 
out  of  the  question  for  the  people  of  any  European 
State  like  ours  to  think  of  having  large  families  with 
impunity.'*  It  would  be  very  interesting  if  he  would 
attempt  to  establish  the  truth  of  this  statement  by  an 
examination  of  the  economical  position  of  France  io 
relation  to  the  population  question — France,  whose 
people  have  carried  to  a  logical  conclusion  the  ideas 
developed  by  Dr.  Drysdale  and  his  school.  France, 
with  the  most  fertile  soil — a  soil  capable  of  sustaining 
many  more  millions  than  at  present  subsist  upon  it — 
the  most  magnificent  climate,  and  the  most  intelligent 
populace  of  Europe,  has  not  enough  men  for  her  home 
requirements.  Her  numbers  are  kept  up  only  by  immi- 
gration of  Italians,  Swiss,  and  Germans.  She  cannot 
spare,  and  virtually  she  does  not  send,  any  emigrajits 
to  occupy  and  develop  the  vast  possessions  misnamed 
Colonies  —  even  to  beautiful  Algeria  close  to  her 
shores — which  she  has  acquired  mostly  within  ate 
years  ;  so  that  to  the  onlooker  these  seem  but  a  useless 
burden,  expense,  and  source  of  weakness  to  the  State. 
It  cannot  be  doubted  that  these  territories  will  in  time 
either  by  peaceful  or  warlike  conquest  be  overrun  and 
acquired  by  stronger  and  more  prolific  races,  white  or 
yellow.  France  is  already  one-third  less  in  population 
than  Germany^  and  the  disparity  will  soon  be  much 
greater,  so  that  the  resumption  of  her  once  dominant 
position  in  Europe  seems  for  ever  hopeless.  Besides 
limiting  the  population,  the  French  are,  in  fact,  carrying 
out  a  gigantic  system  of  artificial  selection  which, 
whilst  ensuring  the  survival  of  the  first  bom  and  their 
progeny,  ensures  at  the  same  time,  to  a  large  extent, 
survival  of  the  comparatively  unfit.  It  is  not  prudence 
alone  which  guides  the  modem  French  parent,  but  the 
narrowest  form  of  anti-social  egoism,  the  egoism  which 
sacrifices  everything  in  pursuit  of  ease  and  pleasure, 
and  regards  toil  and  self-sacrifice  as  the  sources  merely 
of  pain  and  unhappiness.  The  population  question  in 
later  generations  has  become  invested  with  a  meaning 
very  different  from  what  it  expressed  to  the  old  political 
economists  like  Malthus,  to  whom  Dr.  Drysdale  refers. 
With  these  islands  getting  their  food  supply  from  the 
remotest  parts  of  the  globe,  and  with  those  supplies 
inexhaustible,  with  Canada,  Australasia,  Africa,  and 
other  vast  colonies  crying  out  for  population,  and  able 
to  sustain  countless  millions,  there  should  be  for  many 
a  long  year  no  useless  surplus  of  men  and  women  in 
Britain.  Instead  of  attempting  to  limit  population, 
statesmen  and  practical  sociologists  should  rather 
direct  their  efforts  towards  removal  of  social  diseases 
which  keep  so  large  a  part  of  our  people  physically, 
mentally,  and  morally  inferior.  Our  surplus  popula- 
tion is  composed  of  these  inferior  classes,  mostly  a 
burden  upon  the  State,  far  below  the  standard  fit  for 
emigration  to  the  rich  lands  beyond  the  seas  where, 
among  kith  and  kin,  comfort  or  wealth  awaits  the  efforts 
of  every  competent  citizen. 

I  am.  Sir,  yours  tmly, 
July  26th,  1904.  A  Student  of  Sociology. 

To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — It  seems  to  me  that  both  Dr.  Taylor  and  "  A 
Student  of  Sociology "  have  hardly  appreciated  the 
point  of  Dr.  Walsh's  admirable  paper  on  "  The 
Diminishing  Birth-Rate."  Dr.  Walsh  does  not  deny  that 
a  portion  of  the  loss  in  births  is  due  to  the  practice  of 
methods  that  are  admittedly  artificial,  nor  does  he 
advocate  their  employment  as  Dr.  Drysdale  does  in 
your  issue  of  the  20th  inst.  In  their  dislike  of  these 
practices  Dr.  Taylor  and  "  A  Student  of  Sociology  " 
will  have  many  sympathjisers,  but  that  is  not  the  issue. 
The  question  is — Are  artificial  methods  for  preventing 
conception  the  cause  of  much  modem  crime,  lunacy, 
and  suicide,  or  are  these  methods  a  symptom  of  the 
same  disease  of  the  body  politic  as  that  which  gives 


August  3,  1904. 


BRITISH   MEDICAL  ASSOCIATION.     The  Medical  Press.    129 


rise  to  those  other  deplorable  manifestations  ? 
Dr.  Walsh's  paper  is  irrefutable  on  this  point. 
If  artificial  methods  are  the  root  cause  of  all 
this  misery,  I  would  put  it  to  his  critics  that  if 
one  takes  away  that  cause,  the  consequences  dis- 
appear. Will  they  affirm  that  if  every  married 
•couple  in  this  England  fell  to  producing  as  many  chil- 
dren as  time  and  opportunity  gave  them  occasion, 
•our  gaols  would  empty,  our  lunatic  asylums  be  con- 
verted into  country  houses,  and  felo  de  se  be  unheard  of 
in  the  land  ?  I  have  only  to  submit  the  issue  in  this 
form  to  show  how  untenable  their  position  is.  Dr. 
Walsh  rightly  deprecates  sensational,  alarmist  state- 
ments and  hasty  generalisations,  and  pleads  for  a 
philosophic  review  of  the  situation.  Let  us  admit 
that  we  are  more  likely  to  arrive  at  the  truth  by  the 
latter  method,  and  that,  however  much  we  may  detest 
a  particular  symptom  of  a  disease,  it  is  not  by  attacking 
it  that  wc  shall  cure  the  patient.  The  treatment  must 
be  specific  and  must  be  adapted  to  the  sufferer  ;  not 
-symptomatic  and  arbitrary.  We  must  in  this  matter 
^'eigh  things  in  their  due  proportions,  and  not  be  like 
•Gribouille,  qui  se  jette  dans  Veau  dt  peur  de  la  pluie. 
I  am,  Sir,  yours  truly, 
July  28th,  1904.  Quid  Plura. 


MEDICAL    MEN    AND    DRINK    LEGISLATION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  your  annotation  on  this  question  you  ask, 
"^  Why  should  not  medical  men  speak  out  their  collec- 
tive mind  as  to  whether  Mr.  Balfour's  alterations  in 
licensing  law  are  likely  to  increase  the  facilities  for 
•drinking  amongst  our  countrymen."  Having  taken 
great  interest  in  this  question,  I  shall  be  glad  ii  I  may 
for  one    answer. 

In  the  first  place  there  can  be  no  doubt  the  teetotal 
section  is  responsible  for  taking  the  initiative  in  setting 
the  law  in  motion  in  lieu  of  following  Shakespeare's 
advice  to  allow  sleeping  dogs  to  lie.  And  the  initiative 
consisted  in  the  high-handed  conduct  of  certain  (I 
presume)  bigoted  magistrates  in  depriving  publicans 
of  their  licences  without  means  or  compensation  and 
for  no  fault  of  their  own.  It  is  inevitable  that  in  a 
procedure  of  this  kind  public  opinion  would  demand  a 
•change  of  law.  On  the  other  hand  had  the  teetotalers 
trusted  to  the  gradual  reduction  and  minimising 
•effects  of  public  houses  and  depended  on  the  simple 
method  of  refusing  new  licences,  except  in  urgent  cases, 
although  this  method  might  require  more  patience 
and  be  less  drastic,  the  law  would  then  have  remained 
quiescent.  It  follows,  therefore,  if  the  remedy  offered 
by  the  new  Act  should  eventually  turn  out  {Tempus 
-omnia  revelat)  unsatisfactory  the  teetotalers  have  them- 
selves only  to  blame — their  chief  aim  appears  to  consist 
in  straining  every  nerve  to  embarrass  the  trade  and  in- 
convenience the  public  to  the  utmost,  charging  them 
with  what  they  conceive  to  be  an  overstepping  of  the 
mark,  and  getting  more  than  they  bargained  for ;  hence, 
with  the  aid  of  the  Bishops  who  fire  off  their  guns  blind- 
fold, they  have  attempted  to  wreck  the  measure  by 
insisting  on  a  time  limit. 

Now  it  is  certain  this  time  limit  must  result  in  one  of 
two  things.  Either  the  licensing  authorities  would 
cease  to  reduce  licences,  there  being  no  compensation  to 
meet  the  difficulty — in  which  case  the  Act  must  become 
a  dead  letter — or  if  they  did  reduce  without  compensa- 
tion, in  response  to  the  clamour  of  the  teetotal  section, 
■only  the  most  God-forsaken  and  demoraUsed  specimens 
of  humanity,  who  would  not  shed  a  tear  if  a  licence  were 
panted  one  hour  and  taken  away  the  next,  would 
occupy  the  throne.  The  question,  therefore,  is 
melted  down,  according  to  my  view,  to  the  choice  of  one 
of  two  alternatives — either  the  aceptance  in  future  of 
Mr.  Balfour's  respectable  publicans'  measure  without  a 
time  limit  or  the  Bishops'  unfair  scheme  with.  I 
venture  to  predict  the  vast  majority  of  medical  men 
would  prefer  the  former,  and  hence  vote  in  favour  of 
the  new  Act. 

I  am.  Sir,  yours  truly, 

Clement  H.  Serb. 

Brighton,  July  22nd,  1904. 


SOME  OF  THE  NEWER  METHODS  OF  OPENING 

AND  CLOSING  THE  ABDOMEN. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  this  week's  issue  of  your  journal  Dr. 
Alexander  Duke  writes  that  the  method  described  by 
me  for  closing  the  skin  wound  in  abdominal  sections 
is  in  reality  that  employed  by  Professor  Bozemann 
many  years  ago,  to  whom  the  credit  for  its  introduction 
is  due. 

I  am  obliged  to  Dr.  Alexander  Duke  for  information 
as  to  the  inventor  of  surgical  leaden  plates.  I  have 
known  of  them  since  my  student  days,  and  they  have 
been  conspicuous  objects  in  all  instrument  makers' 
establishments  for  years. 

These  so-called  Bozemann  plates  are  placed  at 
intervals  across  a  wound,  and  are  intended  for  the 
application  of  interrupted  sutures  ;  while  the  plate 
described  by  me  extends  the  entire  length  of  the 
wound,  and  serves  as  a  means  for  tightly  fastening 
a  sub-cuticular  suture.  To  Sir  Kendal  Franks  is  due 
the  credit  of  applying  the  latter  form  of  suture  to 
surgery,  and  it  certainly  was  not  known  at  the  time 
of  the  first  appearance  of  the  leaden  plates,  nor  would 
it  be  possible  to  employ  these  with  the  sub-cuticular 
suture.  Under  these  circumstances  it  seems  needless 
to  discuss  the  subject  further. 

Dr.  Alexander  Duke  has  betrayed  amazement  at 
my  statement  that  silk-worm  gut  is  capable  of  remain- 
ing for  fourteen  days  in  a  wound  without  cutting  out 
or  exciting  inflammatory  reaction. 

To  me  it  is  a  matter  of  wonder  that  in  spite  of  the 
many  excellent  post-graduate  courses  now  obtainable 
a  practitioner  can  be  found  so  little  conversant  with 
the  elementary  result  of  modern  aseptic  surgery. 
I  remain,  Sir,  yours  truly, 

E.  Hastings  Tweedy, 

Master,  Rotunda  Hospital. 

Kotunda  Hospital,  Dublin. 
July  29th,  1904. 


Sritisb  AeMcal  Hseociatfom 


SEVENTY-SECOND        ANNUAL 
OXFORD,   1904. 


MEETING. 


[Second  Article.] 


[by  our  special  medical  reporter.] 
The  Oxford  Meeting  has  proved  a  conspicuous 
success.  Upwards  of  two  thousand  members  and 
delegates  have  attended.  Visitors  came  from  all 
parts  of  the  Empire,  and  many  distinguished  guests 
from  afar.  The  weather,  it  is  true,  has  damped 
much  of  the  festive  .  proceedings,  but  both 
gown  and  town  extended  an  open-handed  hos- 
pitahty  to  the  Association.  The  University  threw 
open  wide  its  doors,  the  President  was  indefatig- 
able in  the  conduct  of  his  onerous  duties,  local  members 
of  the  profession  were  loyal  and  untiring,  resi- 
dents have  assisted  in  many  ways,  the  Press  has  admir- 
ably reported  the  proceedings,  the  scientific  work  of 
the  sections  has  been  good,  the  pathological  museum 
excellent,  and  the  exhibition  of  medical  material 
thoroughly  satisfactory.  Altogether  the  gathering 
has  proved  of  exceptional  interest,  and  all  concerned 
in  the  success  of  both  professional  proceedings  and 
social  functions  may  well  be  congratulated. 
Oxford — The  City  and  University. 
This  ancient  seat  of  learning  is  truly  a  garden  city 
of  delight.  Oxford  is  rich  in  all  that  makes  for  the  joy 
of  life.  It  offers  unique  attractions  for  all  sorts  and 
conditions  of  men.  Countless  objects  of  interest  are 
ever  at  hand  and  the  environment  is  one  which  pecu- 
liarly appeals  to  the  student  of  human  afiairs.  The 
University  has  offered  all  possible  faciUties  to  its  medi- 
cal visitors.  The  Examination  Schools,  the  Univer- 
sity Museum,  and  the  Sheldonian  Theatre  have  all 
been  placed  at  the  disposal  of  the  Association.     Many 


130  Th»  Medical  Pmss.      BRITISH   MEDICAL  ASSOCIATION. 


August  3,  1904. 


of  the  Colleges  with  their  chapels  and  halls  and  time- 
worn  courts  and  Venerable  gardens,  were  thrown 
open.  The  Municipal  Buildings  have  also  been  avail- 
able. Every  member  of  the  Association  was  furnished 
with  a  copy  of  the  special  edition  of  Alden's  admirable 
Oxford  Guide,  which,  with  its  key-plan  of  the  Univer- 
sity and  city  proved  invaluable  to  strangers. 
Special  Assemblies. 

The  official  programme  was  from  Tuesday,  July 
26th,  to  Friday,  July  29th,  but  not  a  few  visitors 
extended  their  visit  by  additions  at  both  ends.  A 
special  service  was  held  in  Christ  Church  Cathedral  on 
Tuesday  morning,  when  the  Master  of  University 
College,  the  Rev.  J.  Franck  Bright,  D.D.,  son  of  the 
famous  Guy's  Hospital  physician,  preached  from  St. 
John's  Gospel  v.,  17,  "  My  Father  worketh  hitherto 
and  I  work."  A  special  Mass  was  also  said  at  the 
Church  of  St.  Aloysius.  Religious  services  were  held 
on  Wednesday  morning  at  Mansfield  College  Chapel  and 
at  Manchester  College  Chapel. 

A  large  and  brilliant  gathering  assembled  in  the 
Sheldonian  Theatre  on  the  evening  of  the  26th  to  hear 
the  Presidential  address  and  to  witness  the  reception 
of  distinguished  guests.  Dr.  Collier  dehvered  an  appro- 
priate and  interesting  address  on  "  The  Growth  and 
Development  of  the  Oxford  Medical  School." 

On  Wednesday,  the  27th,  the  Conferment  of  hono- 
rary degress  attracted  much  interest.  The  degree  of 
D.Sc.  honoris  causa,  was  conferred  on  Professor  Clifford 
Allbutt,  Mr.  Andrew  Clark.  Dr.  F.  D.  Griffiths,  Mr. 
Jonathan  Hutchinson,  Sir  William  MacEwen,  Sir 
Patrick  Manson,  Sir  John  William  Moore,  and  Professor 
William  Osier. 

The  Address  in  Medicine  was  delivered  by  Sir  William 
Selby  Church,  who  dealt  with  sanitation,  particularly 
in  reference  to  national  health.  The  Address  in 
Surgery  was  given  by  Sir  William  MacEwen,  who 
treated  of  cerebral  invasion  by  pathogenic  and  pyo- 
genic organisms  and  other  matters  connected  with 
surgical  technique. 

A  desirable  innovation  was  furnished  in  the  popular 
lecture  illustrated  by  some  ninety  lantern  slides,  given 
in  the  Town  Hall  on  Thursday  evening  by  Dr.  G.  Bagot 
Ferguson,  who,  in  an  attractive  manner,  presented 
the  more  important  points  relating  to  "  disease  germs  " 
to  the  large  and  appreciative  audience. 

The  annual  medical  temperance  breakfast  which  this 
year  received  due  recognition  on  the  official  programme 
of  the  Association,  was  held  on  Thursday  morning  in 
the  Assembly  Room  of  the  Town  Hall,  and  was  largely 
attended.  Mr.  McAdam  Eccles  presided,  and  was 
supported  by  many  influential  members.  The  Presi- 
dent of  the  Asso  ciation  spoke,  and  Dr.  T.  N.  Kelynack 
gave  an  address  on  "  The  Medical  Aspect  of  Alco- 
holism." 

The  General  and  Representative  Meetings. 

Under  the  new  regime,  the  purely  business  part  of 
the  Association  is  localised  and  concentrated,  and  its 
conduct,  under  the  able  chairmanship  of  Sir  Victor 
Horsley,  is  greatly  facilitated.  The  details  of  the  work 
accomplished  are  duly  published  in  the  Official  Journal, 
and  much  time  and  temper  is  saved  by  the  new  method 
of  procedure,  and  we  believe  the  usefulness  and  dignity 
of  the  Association  is  hardly  likely  to  suffer  by  the  in- 
coming of  the  new  dispensation.  The  question  of 
medical  defence  gave  rise  to  much  discussion,  and  the 
matter  is  to  be  thoroughly  investigated  during  the  year. 
Hospital  reform  and  contract  practice  also  received 
consideration. 

The  Work  of  the  Sections. 

The  real  scientific  work  of  the  meeting  was  conducted 
in  fifteen  separate  sections,  the  majority  of  which  found 
excellent  quarters  in  the  splendid  and  in  every  way 
convenient  University  Museum  Buildings.  The  attend- 
ance was  generally  good.  Much  interest  was  taken  in 
the  various  set  discussions,  which,  although  far  from 
epoch  making,  were  nevertheless  usually  helpful  and 
suggestive  and  characterised  by  a  sound  practical 
directness.  Many  of  the  papers  presented  were  of 
considerable  value.  The  more  important  subjects 
dealt  with  we  hope  to  summarise  in  our  pages. 


Section  of  Medicine. 

A  discussion  on  the  "  Treatment  of  Chronic  Inter- 
stitial Nephritis,"  introduced  by  Dr.  W.  Hale  White. 
a  full  abstract  of  whose  paper  will  be  ioand 
in  another  column,  aroused  much  interest.  Albumi- 
nuria was  considered  of  insignificant  importance,  but 
cardio-vascular  conditions  needed  much  management. 
Professor  von  Noordan  advised  the  employment  of 
well-regulated  exercise,  deprecated  the  excessive 
use  of  fluids,  and  would  not  withhold  a  meat 
diet.  Professor  Osier's  opening  paper  to  the 
discussion  on  *'  Tuberculous  Pleurisy  and  Pneumo- 
thorax "  admirably  summarised  the  best  modem 
views  of  dealing  with  these  conditions.  A  dis- 
cussion on  the  *'  Serum  Treatment  of  Disease " 
was  opened  by  Dr.  £.  Goodall.  Many  papers  of  value 
were  presented,  including  those  by  Drs.  Mackenzie 
and  Nicholson,  on  the  "  Maternal  Heart  in  Preg- 
nancy," Dr.  Gibson  on  "  Bradycardia,"  and  Mr. 
Hastings  Gilford  on  "  Ateleiosis."  Some  of  the 
communications  were  illustrated  by  lantern  slides. 
The  attendance  at  this  section  was  very  good. 
Section  of  Surgery. 

The  question  of  "  Asepsis  and  Antisepsis,"  intro- 
duced by  Mr.  F.  F.  Burghard,  afforded  useful  oppor- 
tunity for  the  comparison  of  present  day  methcKls  of 
surgical  technique.  The  discussion  on  "  Hysterectomy 
Retroperitoneal  Tumours  and  Cervical  Fibroids " 
attracted  many  gynaecologists.  A  number  of  papers 
were  also  presented. 

Section  of  Obstetrics  and  Gynaecology. 

Sir  Arthur  Macan  opened  the  first  day's  discussion 
on  the  "  Treatment  of  Accidental  Haemorrhage." 
Dr.  Herman  and  many  others  also  contributed  to  the 
"  Study  of  the  So-Called  Ovarian  Pains."  A  number 
of  papers  of  gynaecological  interest  were  also  pre- 
sented. 

Section  of  State  Medicine. 

Here  many  matters  concerned  with  personal  and 
public  hygiene  were  discussed.  Dr.  J.  S.  Haldane 
dealt  with  '*  Standards  of  Ventilation."  "  Poverty 
and  Public  Health "  were  ably  presented  by  Mrs. 
Bosanquet,  Mr.  T.  P.  Whit  taker,  M.P.,  and  Alderman 
Hugh  Hall.  The  co-operation  of  laymen  offers  a 
procedure  which  merits  much  approbation. 

Section  of  Psychological  Medicine. 

Dr.  Charles  A.  Mercier  in  his  presidential  address 
reviewed  the  subject  of  "  Crimmal  Responsibility 
and  Degeneracy."  The  discussion  on  "  Heredity  in 
its  Biological  and  Psychiatrical  Aspects"  gave  rise 
to  much  of  interest,  and  the  contributions  of  Dr.  J. 
Beard  and  Dr.  W.  Konig  were  listened  to  with  much 
attention.  Dr.  Conolly  Norman  opened  a  discussioo 
on  "  Dementia  Praecox." 

Section  of  Pathology. 

Dr.  James  Ritchie,  the  President  of  the  Sectioo. 
concisely  presented  the  various  views  promulgated  as 
to  "  Immunity,"  and  several  papers  dealing  with  the 
subject  were  read.  Professor  von  Noordan  opened  a 
discussion  on  the  "  Chemical  Pathology  of  Gout." 
and  Dr.  Lovell  GuUand  and  Professor  Muir  dealt 
with  the  "  Physiological  and  Pathological  role  of  the 
Lymphocyte." 

Section  of  Ophthalmology. 

The  meetings  of  this  section  were  held  in  Keble 
College.  The  President,  Mr.  Marcus  Gunn,  opened 
this  discussion  on  "  Retro-Ocular  Neuritis."  "  Intra- 
ocular Haemorrhage  and  Systemic  Disease,"  and 
"  Keratitis  Profunda,"  were  also  subjects  which  gave 
rise  to  considerable  discussion. 

Section    of   Laryngology    and    Otologv. 

Dr.  Urban  Pritchard  dealt  with  the  ever  interesting 
matter  of  the"  Treatment  of  Non-Suppurative  Diseases 
of  the  Middle  Ear."  The  etiology,  treatment,  and 
prognosis  of  innocent  growths  of  the  larynx  and 
intra-nasal  disease  as  a  determining  factor  in  the 
production  of  laryngeal  and  pulmonary  affections 
offered  much  fruitful  matter  for  discussion.  A  con- 
siderable number  of  papers  were  also  presented. 
Section  of  Navy,  Army  and  Ambulance. 

Many  questions  of  Imperial  interest  were  dealt  with„ 


August  3,  1904. 


BRITISH  MEDICAL  ASSOCIATION.     The  Medical  Press.     131 


including  the  "  Sanitation  of  Camps,**  "  Malta  Fever," 
*'  Mediterranean  Fever,"  "  The  Medical  Equipment 
and  Transport  for  Volunteer  Brigades." 

Section  of  Tropical  Diseases. 

The  more  important  subjects  considered  include 
'*  Trypanosomiasis,"  *'  The  Prophylaxis  of  Malaria," 
and  "The  Significance  of  the  Leishman-Donovan 
Bodies."  A  number  of  papers  dealing  with  various 
tropical  diseases  were  also  read. 

Sections  of  Anatomy  and  Physiology. 

These  sections  appealed  chiefly  to  teachers  in  our 
medical  schools.  Important  discussion  took  place  on 
the  *•  Thalamic  Region."  "  Chloroform  Anaesthesia," 
and  "Giants  and  Dwarfs." 

Section  of  Dermatology. 

Discussion  took  place  on  Pruritus  Ani ;  the  Com- 
parative value  of  old  and  new  methods  of  treating 
lupus  and  other  skin  diseases,  and  the  relative  impor- 
ance  of  the  bacterial  and  other  factors  in  the  causation 
of  skin  diseases. 

Section  of  Dental  Surgery. 

A  discussion  on  oral  sepsis  attracted  considerable 
interest,  and  numerous  physicians  and  surgeons  took 
part. 

The  Pathological  Museum. 

Special  efforts  had  been  made  to  secure  a  thoroughly 
representative  collection  which  should  illustrate  the 
b^t  results  of  recent  investigations,  and  Dr.  James 
Ritchie  and  Dr.  E.  W.  Ainley  Walker  and  their  Com- 
mittee may  well  be  congratulated  on  the  high  standard 
of  excellence  attained.  The  carefully-prepared  cata- 
logue of  80  pages  gave  p>articulars  of  1,028  exhibits. 
The  Anatomical  Department  of  the  University  Museum 
afforded  admirable  quarters,  and  the  display  of  speci- 
mens and  drawings  allowed  of  ready  and  convenient 
inspection.  The  collection  is  undoubtedly  the  best  for 
many  years  past,  and  it  is  to  be  regretted  that  it  has 
to  be  dissipated  so  speedily. 

The  products  of  photography  occupied  much  space. 
Many  photo-micrographs  were  on  view,  and  the  results 
of  colour  photography  attracted  much  attention. 
Stereoscopic  work  was  well  represented,  and  there  was 
also  a  large  collection  of  radiographs. 

There  were  many  excellent  drawings  illustrating 
dermatological  and  other  clinical  cases. 

Among  the  numerous  specimens  special  attention 
deserves  to  be  called  to  the  preparations  illustrating 
the  most  recent  work  connected  with  the  pathology 
of  new  growths  ;  the  causation  of  so-called  "  sleeping 
sickness,"  and  various  neurological  studies. 

The  "  pickles "  were  of  considerable  importance, 
especially  the  collection  of  preparations  illustrating  the 
morbid  conditions  affecting  the  vermiform  appendix  ; 
the  surgical  treatment  of  gastro-intestinal  lesions  ;  and 
the  pathology  of  the  prostate. 

Many  specimens  of  exceptional  importance  were 
found  in  the  section  of  obstetrics  and  gynaecology. 
The  collection  of  preparations  illustrating  laryngology 
and  otology  was  somewhat  meagre.  A  feature  of  real 
value  was  that  which  dealt  with  apparatus  and  methods. 
The  arrangement  by  which  workers  were  enabled  to 
actually  describe  and  explain  their  methods  in  after- 
noon demonstrations  is  to  be  highly  commended. 

An  excellent  collection  of  ophthalmological  speci- 
mens was  open  to  inspection  at  Keble  College. 

The  University  Herbarium  situated  at  the  Botanic 
Gardens  was  also  open  to  members. 
The  Exhibition. 

We  can  well  imagine  the  horror  which  certain  dons 
of  the  University  would  have  experienced  could  they 
have  seen  their  magnificent  Examination  Schools  given 
over  to  the  purposes  of  a  trade  show  and  invaded  by  . 
meat  extracts,  infants'  foods,  mineral  waters,  and  the 
like.  This  year's  Exhibition,  however,  has  been  well 
arranged  and  extensively  visited,  its  location  in  the 
same  building  as  the  reception  room  making  it  par- 
ticularly convenient  of  access.  The  arrangements  have 
been  entirely  in  the  hands  of  the  headquarters  staff, 
and,  generally  speaking,  the  arrangements  were 
judicious. 

The  catalogue  formed  a  bulky  volume  of  220  pages., 
and    there    were    116    exhibitors.     Drugs    and    new 


synthetic  preparations  were  not  so  conspicuous  as 
usual.  Surgical  instruments  and  apphances  were  pre  - 
sent  in  great  abundance.  There  was  also  a  fair  show  of 
sanitary  appliances.  Foods  and  food  products  were 
extensively  represented,  and  many  exhibitors  of 
mineral  waters  and  beverages  had  been  found  a  place. 
A  few  publishers  of  medical  works  had  stalls,  but 
some  of  the  largest  and  most  important  houses  were 
conspicuous  by  their  absence. 

We  propose  next  week  to  deal  with  some  of  the  more 
important  exhibits. 

The  Entertainments. 

The  purely  festive  features  of  the  Oxford  meeting 
have  been  notable.  The  unsettled  nature  of  the 
weather  added  much  to  the  perplexities  of  manage- 
ment, but  throughout  the  arrangements  for  the  com- 
fort and  enjoyment  of  the  visitors  were  excellent. 
On  Wednesday  afternoon  the  President  and  members 
of  the  Oxford  division  gave  a  reception  in  the  charming 
Wadham  College  gardens  ;  and  at  the  same  time  a 
duelling  and  fencing  exhibition,  with  epee  contest 
between  Oxford  and  Cambridge,  was  held  in  the  Town 
Hall.  In  the  evening  a  largely  attended  soiree  at  the 
Museum  was  given  by  the  Vice-Chancellor  and  mem- 
bers of  the  University,  at  which  there  were  many  attrac- 
tive exhibits  and  scientific  demonstrations.. 

On  Thursday  garden  parties  were  given  by  Dr.  and 
Mrs.  Neil  at  the  Wameford  Asylum,  and  Mr.  and  Mrs. 
G.  H.  Morrell  at  Headington. 

The  annual  dinner  was  held  in  the  ancient  and  famous 
great  hall  of  Christ  Church  ;  and  on  the  same  evening 
a  particularly  delightful  reception  was  held  by  the 
Ladies'  Committee  in  the  New  College  Gardens  and 
Hall. 

On  Friday  the  Duke  of  Marlborough  gave  a  garden 
party  at  Blenheim  Palace,  and  in  the  evening  the 
Mayor  of  Oxford  (Dr.  E.  A.  Severs)  held  a  reception 
in  the  city  buildings. 

During  the  week  promenade  concerts  were  given 
in  the  gardens  of  St.  John's  College  and  Worcester 
College. 

Many  visitors  availed  themselves  of  numerous 
opportunities  for  river  excursions,  visits  to  the  Claren- 
don Press,  inspection  of  the  various  colleges  and  many 
other  buildings  of  interest  in  Oxford. 

Excellent  arrangements  were  made  for  visitors. 
Many  resided  in  the  colleges.  The  Reception  Room 
was  well  managed,  and  comfortable  reading,  writing, 
and  smoking  rooms  were  provided.  Special  rooms  were 
available  for  ladies. 

The  Excursions. 

The  picnic  aspect  of  the  meeting  cannot  be  neglected. 
Many  practitioners  are  obliged  to  make  the  yearly 
gathering  an  important  part  of  their  annual  holiday, 
and  it  is  well  that  the  purely  pleasurable  side  should 
not  be  allowed  to  suffer  neglect. 

On  Saturday  a  large  party  visited  Leamington,  and 
later  attended  a  gsirden  party  given  by  the  Countess  of 
Warwick.  Others'  took  part  in  a  river  excursion  to 
Reading  and  Henley,  while  not  a  few  continued  their  * 
rambles  about  the  quiet  courts  and  quaint  College 
precincts  of  this  ancient  seat  of  learning. 
Miscellaneous. 

The  Oxford  Meeting  has  been  characterised  by  a 
delightful  combination  of  utility  and  festivity,  pro- 
fessional industry  and  social  enjoyment.  The  com- 
bination of  ancient  environment  and  modern  methods 
has  heightened  the  interest  of  the  gathering.  Even 
in  the  entertainments  science  has  not  been  ousted. 
At  the  Vice-Chancellor's  Conversazione  many  ex- 
hibits of  high  value  attracted  attention  especially 
the  performances  of  the  mice  bred  by  Mr.  A.  D.  Darbi- 
shire,  by  crossing  a  race  of  Japanese  "  waltzing  "  mice 
with  ordinary  European  albinos,  and  illustrating  the 
failure  of  "  Mendel's  Laws." 

The  enterprising  firm  of  Burroughs  Wellcome  and 
Company  issued  to  members  a  dainty  little  pocket 
manual,  "  Oxford  Medical  Lore,"  which  contained 
much  information  of  historical  interest. 

Various  important  meetings  were  held  during  the; 
week,  and  served  to  rally  those  members  interested  in 
the  work  of  the  New_ Sydenham   Society,   the  Irish 


132     The  Medical  Press. 


LITERATURE. 


August,  3,  1904. 


Medical  Schools'  and  Graduates'  Association,  the 
Continental  Anglo-American  Medical  Society,  and  the 
United  Kingdom  Police  Surgeons'  Association. 

Next  year's  meeting  of  the  Association  is  to  be  held 
at  Leicester,  the  President-Elect  being  Mr.  George 
Cooper  Franklin,  F.R.C.S.,  Surgeon  to  the  Leicester 
Infirmary. 

HUGH  WILLIAMS,  L.R.C.S.  &  P.Ed.,  LIVERPOOL. 
The  death  took  place  on  the  26th  ult.,  at  his  resi- 
dence in  Liverpool,  of  Mr.  Hugh  Williams,  one  of  the 
best-known  men  in  Everton.  Deceased,  who  was  59 
years  of  age,  had  spent  practically  all  his  life  in  this 
city,  and  for  many  years  carried  on  a  large  practice. 
He  was  extremely  popular  among  the  poor,  to  whom 
he  always  showed  a  generous  disposition.  Although 
taking  no  prominent  part  in  public  affairs,  the  deceased 
was  keenly  alive  to  all  that  was  taking  place  around 
him.  Some  time  ago  Dr.  Williams  proceeded  to 
Egypt  for  the  benefit  of  his  health,  which  showed  signs 
of  breaking  up.  He  did  not,  however,  overcome  the 
disease  from  which  he  was  suffering.  Deceased  leaves 
a  widow  and  several  children.  His  professional  educa- 
tion was  conducted  at  the  Liverpool  Medical  School. 
In  1878  he  qualified  as  Licentiate  of  the  Royal  Colleges 
of  Physicians  and  Surgeons  at  Edinburgh. 

FREDERICK  FLINT.  M.D.ABER.,  M.R.C.S.ENG. 
SCARBOROUGH. 
We  regret  to  announce  the  death,  on  the  25th  ult., 
at  Kirbymoorside,  of  Dr.  Frederick  Flint,  of  Scar- 
borough. Dr.  Flint  had  been  ailing  for  some  time 
past,  and  on  the  advice  of  Sir  Thomas  Barlow  took 
up  his  residence  at  Kirbymoorside  some  three  weeks 
ago.  The  deceased  gentleman,  who  was  in  large 
practice  at  Scarborough,  was  62  years  of  age,  and 
leaves  a  widow,  three  sons  and  six  daughters.  He  had 
practised  in  Scarborough  for  the  past  thirty  years — 
during  the  last  seventeen  years  of  that  period  in  con- 
junction with  Dr.  Ross.  For  a  number  of  years  he 
was  senior  deacon  at  Bar  Congregational  Church.  He 
has  left  a  wide  circle  of  friends  to  mourn  his  loss.  Dr. 
Flint  was  educated  at  King's  College.  London,  whence 
he  took  the  M.R.C.S.Eng,  in  1866.  In  1870,  he  gra- 
duated M.D.  at  Aberdeen  University. 


JOHN  JOSEPH  CRANNY.  M.A.,  M.D..  F.R.CS.T. 
We  regret  to  announce  the  death  of  Dr.  John  Joseph 
Cranny,  of  17,  Merrion  Square,  on  the  27th  of  July, 
at  the  age  of  59.  He  was  one  of  the  best  known  and 
most  popular  as  well  as  the  most  scientific  medical 
men  in  Dublin.  Apart  from  his  professional  reputation, 
he  was  widely  known  as  a  benevolent  and  philanthropic 
man,  although  of  so  modest  a  disposition  that  the 
origin  of  many  of  his  benefactions  remained  unknown. 
He  took  his  B.A.  degree  in  the  University  of  Dublin 
in  1869,  together  with  the  degree  of  Bachelor  of 
Medicine.  He  then  practised  at  the  Rotunda  Hospital ; 
took  his  Fellowship  at  the  Royal  College  of  Surgeons 
in  1870,  and  his  degree  of  medical  doctor  in  Trinity 
College  in  1872.  Since  that  time  he  had  been  amongst 
the  leaders  of  his  profession  in  Dublin.  He  was  one 
of  the  surgeons  attached  to  Jervis  Street  Hospital, 
an  Examiner  in  Midwifery  of  the  College  of  Surgeons, 
an  Assistant  Physician  of  the  Rotunda  Hospital,  a 
Fellow  of  the  Royal  Academy  of  Medicine,  a  member 
of  the  British  Medical  Association,  of  the  Royal  Dublin 
Society,  and  the  Royal  Irish  Academy.  His  culture 
however,  was  of  a  versatile  type  that  extended 
far  beyond  the  confines  of  his  own  profession.  Among 
his  contributions  to  medical  literature  may  be  men- 
tioned "  On  Polypus  of  Uterus  and  use  of  Sea  Tangle 
Tents,"  and  "  Obstruction  of  Bowels  successfully 
treated  by  Laparotomy,"  published  in  the  Dublin 
Journal  of  Medical  Science  in  1889. 

D.    F.    B.    REARDON,    L.R.C.P.I.    AND    L.M.,    OF 
BRUFF. 
With  much  regret  we  announce  the  death  of  Dr. 
D.   F.   B.   Reardon,   of  the  Hermitage,   Bniff,   which 


took  place,  after  a  short  illness,  at  the  Whitwortli 
Hospital,  Dublin,  at  the  early  age  of  45  years,  and  in 
the  22nd  year  of  a  distinguished  medical  career.  His 
early  and  unexpected  demise  has  caused  intense 
grief  to  his  afflicted  family  as  well  as  to  a  large  circle 
of  friends.  Dr.  Reardon  had  endeared  himself  to  all 
who  knew  him  by  his  straightforward  principles. 
kindliness,  and  sympathetic  disposition,  especially 
towards  the  poor,  who  have  every  reason  to  mourn 
his  loss.  He  was  a  long  standing  subscriber  and 
supporter  of  The  Medical  Press  and  Circular. 
His  medical  education  was  conducted  at  the  Royal 
College  of  Surgeons,  and  Led  wick  School,  Dublin, 
whence  in  1880  he  took  the  qualification  of  L.R.C.S.I. 

Xiteratute* 

THE  TRYPANOSOMIASIS  EXPEDITION  TO 
SENEGAMBIA.  (a) 
This  monograph  is  a  credit  alike  to  English  scientific 
work  in  general,  to  the  Liverpool  School  of  Tropical 
Medicine  in  particular,  as  well  as  to  Drs.  Dutton  and 
Todd,  its  authors.  The  stay-at-home  reviewer,  whose 
opportunities  for  observing  trypanosomiasis  are  a 
neligible  quantity,  may  be  pardoned  if,  nolike 
arm-chair  strategists,  he  abstains  from  criticism  of  a 
piece  of  work  bristling  with  new  and  interesting 
facts,  and  tries  merely  to  give  a  brief  general  summary 
of  the  author's  results.  Trjrpanosomes,  then,  were 
found  in  man,  horses,  rats,  mice,  tortoises,  snakes, 
and  frogs  ;  this  report  contains  a  great  deal  (and  the 
promise  of  more)  about  the  first  two  of  these  forms, 
and  a  shorter  account  of  the  others.  Section  I.  deals 
with  laboratory  methods,  and  here  we  must  thank  the 
authors  for  having  taken  the  trouble  to  define  the 
meanings  of  the  various  names  of  leucocytes  used  in 
their  differential  counts,  for  almost  nothing  (and  ve 
speak  from  a  not  inconsiderable  experience  of  the 
literature  of  blood  diseases)  is  a  greater  source  of 
confusion  than  the  vague  way  in  which  the  terms 
"  lymphocyte  "  and  ■ '  mononuclear  leucocyte  "  are 
used  by  different  writers ;  this  the  authors  have 
realised,  and  their  work  is  in  consequence  the  freer 
from  ambiguity.  Section  II.  deals  with  the  human 
trypanosome,  which  was  found  in  six  out  of  1,043 
natives  examined  (a  number  probably  below  the  real 
frequency).  No  evidence  was  found  that  infection 
was  favoured  by  any  particular  type  of  locality.  A 
clinical  description  of  two  European  and  six  native 
cases  is^given.  from  which  it  would  seem  that  the 
disease  is  so  mild  as  readily  to  escape  notice.  Besides 
the  parasite,  the  blood  shows  eosinophilia  and  increase 
of  mast-cells  and  mononuclears,  the  last  containing 
deep  lake-coloured  granules  when  stained  by  t 
modification  of  Romanowsky's  method.  In  Section 
III.  the  equine  form  of  the  disease  is  described,  the 
horse  being  the  only  animal  in  which  a  pathogenic 
trypanosome  has  been  found  ;  it  was  found  in  ten  oat 
of  thirty-six  animals.  The  disease  is  chronic,  occurs 
generally  throughout  the  Colony,  and  is  possibly 
more  prevalent  near  the  river,  especially  in  the  rainy 
season.  The  morphology  of  the  human  and  equine 
tr3rpanosome  is  described  in  Section  IV,  and  in  Section 
V.  are  given  the  details  of  a  series  of  attempts  to 
transmit  the  disease  to  rats  and  mice  by  tsetse-fiies. 
In  this  the  authors  were  unsuccessful,  possibly  because 
the  excessive  lack  of  moisture  in  the  air  (in  the  dry 
season)  prevented  the  trypanosomes  from  living  on 
the  proboscis  of  the  tsetse-fly.  From  the  results  of 
inoculation  of  mice  and  rats  the  writers  believe  that 
human  and  equine  trypanosomiasis  are  different 
diseases.  The  last  section  gives  a  description  of  the 
species  of  flagellata  met  with  in  other  animals.  The 
report  is  fully  illustrated  with  maps,  charts,  photo- 
graphs and  coloured  plates,  for  all  of  which,  especially 
the  last,  the  publishers  deserve  much  praise.  A 
second  report,  treating  of  the  more  purely  pathological 
aspects  of  trypanosomiasis,  is  promised. 

(a)  "  First  Report  of  the  Trypanosomiasis  Expedition  to  Se&egamiba 
(1902.)"  By  J.  Everett  Dutton,  M.B.,  and  John  L.  Todd,  M.D.,  Livxi. 
pool  School  of  Tropical  Medicine.  Memoir  XI.  Landon,:  Longmans. 
Green  and  Co.     1903.     4^1  PP-  57. 


AuGVST  3,  1904. 


LITERATURE. 


The  Mkdical  Press.     133 


THOMSON'S  MANUAL  OF  SURGERY  (a) 
In  the  preparation  of  this  work,  the  authors,  as 
stated  in  the  preface,  have  endeavoured  to  furnish  a 
systematic  view  of  the  present-day  aspects  of  surgery 
in  sufficient  detail  to  render  it  useful  to  the  prac- 
titioner, without  at  the  same  time  carrying  it  beyond 
the  scope  appropriate  to  a  manual  for  students.  They 
have  curtailed  as  far  as  possible  theoretical  and  de- 
batable matter,  and  have  only  described  pathological 
processes  in  so  far  as  they  bear  directly  on  diagnosis 
and  treatment. 

Chapter  II..  dealing  with  conditions  which  interfere 
with  repair,  gives  some  very  instructive  temperature 
charts  illustrating  the  various  ways  surgical  cases  "  go 
wrong."  In  the  treatment  of  bums  the  authors  find 
the  application  of  a  watery  solution  of  picric  acid  most 
satisfactory,  it  yields  the  best  results  in  the  more  super- 
ficial burns,  but  is  useful  as  a  primary  dressing  in  all. 
The  treatment  recommended  for  shock  does  not  corre- 
spond with  recent  work  on  the  subject,  for  strychnine 
is  recommended  as  the  best  of  all. 

The  chapters  devoted  to  the  injuries  of  bones  and 
joints  are  very  good.  With  regard  to  fractures  of  the 
internal  condyle  of  the  humerus,  the  authors  say  :  "It 
is  sometimes  necessary  to  fix  the  small  fragment  in 
position  by  a  nail  inserted  through  the  skin."  This 
seems  to  us  to  be  a  barbarous  method  of  treating  such 
an  injury,  for  the  risks  are  equal  to  those  of  an  open 
operation  without  the  advantages  of  the  latter.  A 
similar  procedure  is  recommended  in  some  cases  of 
T-shaped  h'acture  of  the  same  bone,  and  in  fractures 
through  the  neck  of  the  femur. 


but  the  authoress,  judiciously  and  philanthropicaUy, 
gives  "  a  serious  warning  as  to  the  danger  incurred  by 
women  attempting  to  treat  themselves  in  any  way 
beyond  the  moderate  limits  here  laid  down."  There  is 
a  great  deal  of  excellent  information  and  advice  given 
with  regard  to  menstruation  and  its  disorders,  which 
should  certainly  prove  valuable  to  most  female  readers^ 
but  especially  to  those  of  the  rising  generation.  The 
volume  before  us  is  well  written,  and  within  the  limits 
imposed  by  the  authoress  herself,  we  cordially  recom- 
mend it  to  both  mothers  and  daughters. 

LEFTWICH'S  INDEX  OF  SYMPTOMS,  (a} 
This  is  the  third  edition  of  a  useful  lit  tie  book  for  use 
on  the  consulting  room  table.  The  rapid  sale  of  a  former 
edition  proves  that  the  author's  book  fills  a  genuine 
gap  in  medical  Uterature.  The  attempt  to  systematise 
so  complex  a  subject  could  never  be  completely  success 
ful.  At  the  same  time  much  can  be  done  to  lighten 
the  pathway  of  diagnosis,  which  often  lies  in  deep 
shadow.  The  author  has  wisely  drawn  attention  by 
means  of  an  asterisk  to  the  more  probable  diseases,  out 
of  the  many  that  often  follow  a  single  symptom.  An 
interesting  illustration  of  the  multiple  significance  of 
a  single  symptom  may  be  taken  in  "  headache."  which 
may  arise  from  any  one  of  a  formidable  list  of  causes. 
Dr.  Lef  twich  has  added  a  variety  of  useful  and  accurate 
information  to  the  main  motive  of  his  book. 


_^  We  have  received  from  the  Scientific  Press  another 

We~axe  glad^^tosee  '  contribution   to  the  evergreen  subject  of  "  Medical 
^    '        '  -I  Tuberculosis  :    Its  Natural  Cure,"  written  by  R, 

Searle,      L.R.C.P.,     M.R.C.S.,       L.S.A.,     Bteyor 


Bennett's  fracture  of  the  base  of  the  first  metacarpal 

bone  fully  described  and  iUustrated,  although  a  fairly  1  ^®^/®'      iT'^'^V^'  M.K.c.b.,       u 

common  injury,  it  is  frequently  omitted  in  surgical ;  A^artmouth.      The  most    chantable 

works.                                                                                      make    concemmg  *'""'    "~-* —    ■- 


B. 

L.S.A.,     Mayor    of 
remark   we  can 
,^^^^^  make    concerning    this    venture    is    that    it    is   an 

"we'  should  Uke  to  see  the  following  statement  |  amusing  Uttle  monograph,  which  can  hardly  be 
omitted  :— "  The  best  method  of  treating  a  fracture  of  j  considered  a  serious  contribution  to  the  Uterature 
the  patella  is  stiU  sub  judice,"  as  undoubtedly  operative  I  ^^  progressive  medicine.  Mr.  Searle  writes  with  the 
measures  give  the  best  results  in  all  cases  in  which  I  enthusiasm  and  dogmatism  of  the  unscientific  faddist, 
there  is  any  displacement  of  the  fragments.  A  simple  I  *°^  ^^^^^s  no  reliable  evidence  for  the  remarkable 
method  of  ambulatory  treatment  is  given  for  fractures 
in  the  region  of  the  ankle-joint,  which  should  be  of 
great  use  in  hospital  cases.  In  the  treatment  of  1 
tuberculous  joints  the  authors  speak  highly  of  injec- 


tions of  iodoform  and  the  artificial  production  of  venous 
congestion. 

The  volume,  which  concludes  with  an  excellent 
chapter  on  "  Deformities  of  the  Extremities."  is  illus- 
trated with  wood  cuts,  the  majority  of  which  are  ex- 
ceedingly good.  We  must  congratulate  the  authors 
on  the  way  they  have  begun  their  task,  and  we  await 
with  pleasure  the  second  volume.  We  can  strongly 
recommend  the  first  to  practitioners  and  senior  students. 


AILMENTS  OF  WOMEN  AND  GIRLS,  (h) 
In  this  volume  the  authoress  again  enters  the  medico- 
literary  field  bearing  the  excelsior  standard  of  the 
ph3rsical  improvement  of  her  sex.  We  think  it  is  well 
to  hear  a  woman's  voice  sometimes,  in  the  description 
of  conditions  and  sensations  regarding  which  her 
evidence  is  first-hand,  while  that  of  man  can  never 
reach  beyond  the  "  hearsay  "  stage.  There  is  but  too 
much  sad  truth  in  the  quotation  given  in  the  opening 
sentence  of  the  preface  :  "  The  past  generations  of 
women  were  taught  to  suffer  in  silence.  .  .  ."  ;  but 
it  is  consoling  to  be  told  by  the  same  author  that 
**  suffering  is  not  woman's  necessary  lot."  The  pre- 
sent volume  is  apparently  the  outcome  of  a  laudable 
desire  to  contribute  to  the  diminution  of  this  suffering. 
The  merit  of  such  aim  cannot  be  called  in  question. 
Of  course,  the  enormous  scope  included  prevents  the 
thorough  treatment  of  any  of  the  subjects  dealt  with  ; 

(a)  "  Manua]  of  Surgery."  By  Alexis  Thomson.,  M.D.,  F.R.C.S.Ed.. 
Assistant  Surgeon  Edinburgb  Royal  Infirmar>' ;  Surgeon  to  the 
Deaconess  Hospital,  Edinburgh  ;  and  Alexander  Miles.  M.D.,  F.R.C.S. 
Ed.,  Assistant  Surgeon  Edinburgh  Royal  Infirmary  :  Sureeon  to  Leitb 
Hospital.  Volume  I. — General  Surgery.  With  262  wood  engravings. 
Pp.  763  and  xvii.    Edinburgh  and  London:  YoungJ.  Pentland.     1004. 

(b)  ^  AOmentM  of  Women  and  Qirls."  By  Florence  Staepoole. 
liectnrerfor  the  National  Health  Sooietj,  4e.  Bristol :  John  Wrirht 
MftdCa    1904.    Price, cloth, to. net 


conclusions  at  which  he  arrives.  He  would  treat  tuber- 
culosis by  the  introduction  of  the  typhoid  bacilli,  and 
their  toxins,  a  procedure  which  we  believe  cannot  be 
supported  as  justifiable  by  either  experience  or  ex- 
periment. Much  of  the  pathology  in  this  pamphlet  is 
bizarre,  as,  for  instance,  the  declaration  that  cancer 
"  may  be  looked  upon  as  a  malignant  variety  of  tuber- 
culosis." We  think  the  author  has  been  ill-advised  in 
publishing  his  views  in  such  a  form.  His  manner  and 
method  of  presentation  are  not  likely  to  further  scientific 
medicine.  We  are  of  the  opinion  that  such  a  work  as 
this  is  likely  to  produce  incalculable  harm  should  it 
fall  into  the  hands  of  ignorant  and  suffering  laymen. 
*** 

The  "  Edinburgh  Stereoscopic  Atlas  of  Anatomy," 
by  David  Waterston,  M.D.,  Lecturer  and  Senior 
Demonstrator  in  Anatomy  in  the  University  of  Edin- 
burgh, marks  a  new  departure  in  the  teaching  of  that 
subject.  By  means  of  photographs  viewed  stereo- 
scopically  a  most  lifelike  picture  is  given  of  dissections 
of  the  chief  parts  of  the  body.  It  is  needless  to  remark 
that  nothing  can  ever  take  the  place  of  actual  dis- 
secting, but  at  the  same  time  it  is  impossible  to  dissect 
away  from  the  medical  school.  The  student  or  the 
practitioner  by  reference  to  the  steroscopic  atlas  can 
at  any  time  refresh  his  mind  by  means  of  a  valuable 
objective  reproduction.  The  idea  is  an  excellent  one, 
and  the  Atlas  is  likely  to  score  a  big  success.  It 
is  to  be  produced  in  a  series  of  250  stereographs  at 
£6  5s.  net.  The  publishers  are  Messrs.  T.  C.  and  E.  C. 
Jack,  of  Edinburgh. 

**« 

"  The  Livingstone  College  Year-Book  for  1904 " 
(Leyton :  Livingstone  College),  in  addition  to  par- 
ticulars concerning  the  aims  and  objects  of  the  in- 
stitution and  report  as  to  its  recent  work,  contains  a 
series  of  hints  for  the  preservation  of  health  in  the 


{'»)  "An  Index  of  Sy 
Assistant  Physician  K 
Smith,  Elder  and  Co. 


By  R.  Winnington  Leftwich,  M.D.,  late 
t  London  Children's  Hospital. 


nptoms, 
ist  Lon< 
London  : 


Price  6?.  net.     1904. 


Third  edition. 


134    I'm  Medical  Prssi^. 


MEDICAL  NEWS. 


August    3,   1904- 


tropics  which  will  be  of  suggestive  value  to  medical  |  mous   rise  In  the  prices  of  provisions,  have  fled  into 


men  and  others  interested  in  the  selection  and  exami- 
nation of  missionaries  and  those  who  are  called  upon 
to  live  in  tropical  regions. 


have 
Each 


NEW  TABLOID  PREPARATIONS. 

Messrs.  Burroughs  Wellcome  and  Co. 
brought  out  a  "  tabloid  "  of  calomel  and  opium, 
disc  contains  Calomel,  gr.  i  ;  powdered  opium, 
"  Tabloid  "  calomel  and  opium  will  be  found  a  good 
means  of  securing  the  combined  action  of  the  two 
drugs.  Each  product  is  prepared  with  pure  drugs 
presented  in  a  condition  to  disintegrate  quickly  after 
administration  and  promptly  produce  the  therapeutic 
effect.  This  preparation  is  likely  to  be  appreciated, 
in  view  of  the  well-known  tendency  of  calomel  pills  to 
become  hard. 

Ethyl-morphinb  hydrochloride,  issued  under  the 
name  of  Dionin,  is  said  to  have  been  recently  submitted 
to  clinical  trial  with  satisfactory  results.  From  the 
published  reports  this  agent  appears  to  possess  definite 
analgesic  properties,  and  at  the  same  time  to  be  free 
from  the  disadvantages  so  often  associated  with  the 
employment  of  morphine  and  its  salts.  No  instance 
of  euphoria  or  euphoric  s3rmptoms  following  the  use  of 
Dionin  has  been  recorded.  It  possesses  the  further 
advantage  of  being,  with  the  single  exception  of  codeine 
phosphate,  the  most  soluble  of  the  morphine  deriva- 
tives. The  properties  of  Dionin  render  it  specially 
useful  in  ophthalmic  work.  It  is  used  in  iritis,  kera- 
titis, glaucoma,  vitreous  opacities,  corneal  opacities, 
and  sympathetic  ophthalmia ;  but  is  contra  indicated 
in  arterial  sclerosis  of  the  aged. 

There  is  no  need  to  remind  medical  readers  that 
combinations  of  sodium  bicarbonate  with  calomel  and 
with  grey  powder  respectively  are  usually  prescribed 
in  the  form  of  powders.  There  are,  however,  certain 
disadvantages  associated  with  the  administration  of 
medicines  in  that  form.  Messrs.  Burroughs  Wellcome 
and  Co,  have  now  introduced  these  useful  remedies  in 
"  tabloid  "  form,  so  that  in  future  medical  men  will 
be  assured  that  their  patients  will  obtain  full  and 
accurate  doses  of  absolutely  trustworthy  drugs.  The 
two  new  tabloids  are  "  tabloid  "  calomel  and  sodium 
bicarbonate,  and  "  tabloid  "  grey  powder  and  sodium 
bicarbonate,  made  up  in  varying  doses. 

Another  "  tabloid  "  issued  by  the  same  firm  is  tha* 
of  the  three  valerianates — Quinine  valeriante,  gr.  i  ' 
(0065  gm.)  ;  iron  valerianate,  gr.  i  (0065  gm.)  ;  zinc 
valerianate,  gr.  i  (0065  gm.).  A  combination  highly 
praised  in  some  quarters  as  an  efficient  tonic.  Still 
another  "  tabloid  "  is  the  valerianate  of  zinc  in  com- 
bination with  i-6oth  gr.  of  arsenious  acid  and  i  gr.  of 
reduced  iron. 


AeMcal  Views* 


Therapeutical  Society. 
An  informal  meeting  of  this  society  was  held  in  the 
gardens  of  the  Royal  Botanic  Society,  Regent's  Park, 
by  permission  of  the  secretary,  J.  Bryant  Sowerby,  Esq. 
Dr.  F.  de  Havilland  Hall  was  in  the  chair,  and  fifteen 
Fellows  attended  the  meeting.  Dr.  Brown,  the  secre- 
tary of  the  Therap>eutical  Society,  showed  specimens 

of  the  seeds  of  the  Sapola  cedron,  sent  by  J.  H.  Hart,  ^  ^^^^^,^^  ^^  ,,.^  ^^^, ^^ ^  .^ 

F.L.S.,   from  Trinidad,   and  some  Chinese  medicinal '  examination  at  the  very  beginning  of  illness. 

roots  from  Miss  Florence  Cooper,  of  Lo'nguong  City,  jyie  Royal  University  of  Ireland. 

Fouchow.     China,   both  persons  being  corresponding;      j„g  Senate  met  on  Thursday.  July  28th,  the  Right 


the  country.  The  measures  taken  by  M.  Grube,  the 
Russian*  Financial  Agent,  with  the  assistance  of  the 
Russian  Legation,  have  averted  disturbances.  By  the 
flight  of  the  inhabitants  the  cholera  has  been  carried 
into  the  surrounding  country,  and  it  is  now  raging  in 
the  villages.  When  these  people  return  to  the  city 
there  is  a  possibility  of  the  epidemic,  as  in  1892,  again 
assuming  a  dangerous  character." 

AettoxL  for  llalprazii. 

An  action  was  heard  at  Belfast  on  July  21st  and 
22nd,  before  Mr.  Justice  Wright,  in  which  Mr.  Alfred 
Ernest  Inghan,  a  minor,  sought  to  recover  £250,  on 
account  of  personal  injuries  alleged  to  be  due  to  the 
negligence  of  Dr.  C.  K.  Darnel),  of  Bangor  the  de- 
fendant. The  alleged  negligence  was  in  the  prescription 
of  belladonna  liniment,  as  a  result  of  which  it  was  said 
the  'plaintiff's  life  ^^became  in  danger,  and  he  sufiered 
extreme  pain,  becoming  delirious  for  some  time.  De- 
fendant denied  negligence  on  his  part,  and  stated  that 
any  injuries  that  had  occurred  were  solely  caused  by 
the  negligence  of  the  plaintiff's  friends.  Several 
expert  witnesses  were  examined,  and  the  jury,  after 
considerable  deliberation,  disagreed,  and  were  dis 
charged. 

The  London  Hcepital  lledloal  OoUegii. 

The  following  distribution  of  prizes  was  made  last 
week  to  the  successful  students  during  the  session 
1903- 1904.  "Price"  scholarship  in  science,  ^^120, 
Mr.  W.  H.  Palmer  ;  "  Price  "  scholarship  m  anatomy 
and  physiology,  ;^6o.  H.  S.  Souttar  ;  entrance  science 
scholarship.  ^60.  J.  E.  Scudamore  ;  entrance  science 
scholarship,  £^S'  J-  P-  Johnson  ;  •-  Buxton  "  scholar- 
ship, arts,  £30,  J.  G.  Watson  ;  **  Buxton  "  scholarship. 
arts,  ;^2o,  G.  S.  Candy  ;  Epsom  scholarship  for  students 
of  Epsom  College.  D.  G.  Evans  :  clinical  medicine,  £20 
scholarship,  J.  Lambert  ;  clinical  surgery,  ^^20  scholar- 
ship, E.  Ward  and  J.  Lambert  ;  clinical  obstetrics 
£20  scholarship,  A.  J.  Walton  ;  *'  Andrew  Clark' 
prize,  ;£26  (biennial).  A,  J  Walton;  *' Letheby* 
prize,  senior,  £20,  G.  S.  Candy  ;  "  Letheby  "  priie. 
junior,  £10.  F.  Hitch  ;  "  Sutton  "  scholarship.  £20. 
A.  J.  Walton  ;  anatomy  and  physiology,  £2$,  R.  C 
Roberts;  anatomy  and' biology,  £20,  J.  P.  Johnson. 
Together  with  several  minor  prizes  and  hon.  certificates. 
The  Prevention  and  Treatment  of  Canoep. 

In  view  of  the  increasing  prevalence  of  cancer,  the 
Committee  of  the  Liverpool  Cancer  Research  deem  it 
their  duty  to  call  attention  to  what  may  be  done  to 
combat  this  increase.  No  specific  cure  for  cancer  is 
yet  known,  but,  as  with  consumption,  the  earlier  the 
treatment  is  commenced  the  greater  is  the  chance  for 
its  success.  Unfortunately,  a  large  number  of  people 
put  off  seeking  the  advice  of  their  doctor  instead  of 
going  to  him  immediately  they  notice  anything  wrong. 
It  may  be  pointed  out  that  certain  organs  are  more 
often  affected  than  others.  In  men,  cancer  of  the 
gullet,  stomach,  and  intestines  ;  in  women,  cancer  of 
the  breast  and  the  womb,  account  for  about  two- thirds 
of  all  cases  of  cancer.  There  are,  of  course,  many  other 
only  slight  ailments  of  these  organs.  The  Committee 
feel  that  they  cannot  too  strongly  state  how  important 
it  is  that  the  disease  should  be  recognized  at  the  earliest 
possible  moment.  This  recognition  can  only  be 
attained  by  the  patient  going  to  his  or  her  doctor  for 


Fellows  of  the  Therapeutical  Society.  Mr.  Bryant 
Sowerby  showed  various  specimens  of  medicinal  plants 
and  drugs,  and  also  a  very  fine  plant  of  the  Victoria 
Regia  in  full  bloom,  and  numerous  other  medicinal 
plants  and  trees  growing  in  the  garden.  The  Fellows 
present  afterwards  had  tea  in  the  club  in  the  gardens. 
The  Cholera  in  Persia. 
A  rei'ter's  telegram  states  : — "  The  Transcaspian 
Review  states  that  the  cholera  at  Teheran  has  lost  its 
menacing  character.  The  mortality  has  decreased 
from  1,500  deaths  daily  to  300.  There  is  panic  only 
among  the  natives,  who,  in  consequence  of  the  cnor- 


Rev.  Monsignor  Molloy.  D.D.,  D.Sc,  Vice-Chancellor 
of  the  University,  in  the  chair.  The  secretaries 
reported  the  deaths  of  the  following  members  of  the 
Senate  : — William  A.  McKeown,  M.D.,  on  July  9^^ 
and  Edmund  Dease,  M.A..  on  July  17th.  The  follow- 
ing resolution  was  proposed  by  Sir  Christopher  Nixon, 
seconded  by  Rev.  Dr.  N,  McA.  Brown,  and  passed 
unanimously : — "  The  Senate  desires  to  record  its 
deep  regret  at  the  death  of  William  Alexander 
McKeown,  M.D.,  and  to  express  its  high  appreciation 
of  the  zeal  and  energy  with  which  he  devoted  himself 
to  the  interests  of  the  University,  especially  to  those 


August    3,    1904- 


PASS  LISTS. 


Thb  Medical  Press.    135 


of  the  Medical  Faculty,  from  the  time  of  his  appoint- 
ment as  Senator  at  the  foundation  of  the  University." 
The  following  resolution  was  proposed  by  His  Honour 
Judge  Shaw,  seconded  by  His  Grace  the  Most  Rev.  Dr. 
Healy,  Archbishop  of  Tuam,  and  passed  unanimously:— 
— "  The  Senate  desires  to  record  its  deep  regret  at 
the  death  of  Edmund  Dease,  M.A..  who  has  been  a 
member  of  the  Senate  since  the  foundation  of  this 
University ;  and  to  express  its  sense  of  the  benefits 
which  the  University  derived  from  the  wide  experience 
of  public  affairs,  the  high  sense  of  duty,  the  un- 
swerving integrity,  and  the  unfailing  courtesy  which 
Mr.  Dease  brought  to  the  deliberations  of  the  Senate." 
IHsh  Medical  Schools*  and  Graduates*  Association. 
The  summer  general  meeting  of  the  above  Asso- 
ciation was  held  on  Wednesday,  July  27th.  at  the 
University  Museum,  Oxford,  the  President.  Surgeon- 
General  Sibthorpe.  C.B..  in  the  chair.  Among  those 
present  were  Sir  Charles  A.  Cameron,  C.B.  (Dublin)  ; 
Lieut.-Colonel  Boileau,  M.D.,  A.M.S.  (Trowbridge)  ; 
Dr.  James  Little  (Dublin)  ;  Dr.  Percy  V.  Dodd  (Folke- 
stone) ;  Dr.  William  Douglas  (Goudhurst)  ;  Dr.  Robert 
Esler ;  Dr.  T.  Gelston  Atkins  (Cork) ;  and  the  pro- 
vincial hon.  secretary.  Dr.  James  Stewart  (Clifton).  The 
following  resolution,  proposed  by  Dr.  Atkins,  and 
seconded  by  Sir  Charles  Cameron,  was  passed  unani- 
mously : — "  That  a  copy  of  the  two  resolutions  adopted 
at  the  Special  General  meeting  of  May  2Sth  be  sent 
to  the  Chairmen  of  the  various  Boards  of  Guardians 
throughout  Ireland,  together  with  any  additional 
statements  the  Council  may  think  fit  to  forward, 
with  a  view  to  strengthening  the  case  of  the  Irish 
Poor-Law  medical  officers."  The  meeting  then  ad- 
journed. 

UnlTonitj  of  London. 
The  following  candidates  have  passed  the  M.D. 
examination  :— Hugh  Barber.  Helen  Beatrice  Hanson, 
Arthur  Charles  Haslam,  Septimus  M.  Hebblethwaite. 
Norris  A.  Houghton,  Colin  Dunrod  Lindsay,  John  Ford 
Northcott,  Claude  Rundle,  Richard  Hamilton  Town- 
end.  William  Ferris.  B.S.,  passed  in  Mental  Diseases 
and  Psjrchology.  The  following  have  passed  in  Mid- 
wifery and  Diseases  of  Women  : — James  Cole  Marshall, 
Richard  Maxwell.  Thomas  M.  Pearce,  George  S. 
Robertson.  Myer  Coplans  passed  in  State  Medicine. 
The  following  have  passed  the  M.S.  Examination  : — 
William  Henry  Bowen.  David  Leighton  Da  vies,  M.D., 
Walter  Fedde  Fedden,  Sydney  Richard  Scott,  Robert 
Gordon  Strange. 

Soral  OoUeces  of  Pfayaiolaai  and  Surgeons  of  Edlnbargh, 
and  Faculty  of  f  byaloiaBS  and  Snrgeoni  of  Glasgow. 
At  the  July  sitting  of  the  Scottish  Conjoint  Board, 
held  in  Glasgow,  the  following  candidates  passed  the 
respective  examinations  : — 

First  Examination  five  years*  course — Alexander 
M'Murray,  Belfast  ;  John  M'Kelvey,  Belfast  ;  Ernest 
Gibson,  Cork  ;  William  G.  Forde,  Cloyne  ;  Henry  W. 
Turner,  Glasgow  ;  Osmonde  R.  Belcher,  Cork  ;  Thomas 
B.  Ferguson,  Kirkmaiden ;  Frank  H.  A.  Riddle, 
Madras ;  Patrick  J.  Taaffe,  Liverpool ;  John  G. 
Buchanan,  Tiree ;  David  Welsh,  Wilsontown  ;  Karl 
F.  Gover,  Demerara. 

First  Examination  four  years'  course — George  V. 
Edwardes,  Keatley. 

Second  Examination  five  years'  course, — John  R.  D. 
Holtby,  Belfast  (with  distinction)  ;  John  A.  Smith, 
Glasgow  ;  Fred.  G.  Allan.  Whaley  Bridge  ;  John  M. 
Muir,  Kilmarnock  ;  Joseph  H.  Patterson,  North  Ber- 
wick. 

Third  Examination — Alexander  Brown,  Galston  ; 
Percival  Henderson.  Skelmersdale  ;  John  Macnamara, 
Leitrim  :  John  M* Arthur  Falderbank  ;  John  M. 
Moriarty,  Kerry  ;  William  F.  H.  Ives.  London  ;  Henry 
E.  Bolton,  Dublin ;  Joseph  B.  N.  Raphael-Tom, 
Trinidad  :    John  H.  R.  Bodedern,  Anglesea. 

Final  Examination  (and  admitted  licentiates  of  the 
three  co-operating  authorities) : — James  B.  Patterson. 
Carluke  ;  Archibald  F.  G.  Spinks,  Southport  ;  Robert 
Crothers,  Banbridge  ;  Thomas  G.  Campbell,  Glasgow  ; 
William  A.  Magill.  Belfast  ;  George  H.  Waugh,  Belfast  ; 
Llewellvn  C.  Nash,  New  Sheldon  ;   Percy  J.  Thomson, 


L.D.S.,  Glasgow  ;    Thomas  A.  Fall,  Partick  ;     Henry 
E.  Strathy,  Pitlochry  ;   Reginald  W.  Towney.  Oswald- 
twistle  ;  Mat  bias  A.  L.  dos  Santes  Vaz  ;  John  H.  Fyfe. 
L.D.S.  ;   Laurence  Gavin,  and  David  Haig. 
Boyal  Colleges  of  Physielans  and  Snrgeons  in  Ireland. 

Third  Examination. — Candidates  have  passed  this 
examination  as  understated — Passed  in  all  subjects — 
T.  A.  Burke.  M.  Cohen,  E.  G.  Condon,  P.  F.  Foran,  W. 
Glennon,  C.  W.  Greene,  W.  P.  Kelly,  T.  H.  Massey. 
M.  O'Cgnnor.  J.  R.  Tobin,  and  C.  H.  Wilson. 

Completed  Examination. — R.  Calnan,  C.  J.R.Clarke, 
S.  C.  Clarke.  T.  W.  Conway,  J.  Corboy,  J.  B.  Dwyer, 
T.  J.  Golding.  P.  E.  Hayden,  R.  F.  Hayes,  H.  Hosty, 
A.  E.  S.  Irvine,  L.  F.  Kelly,  M.  J.  C.  Kennedy,  F.  G. 
M'Caughey.  T.  J.  Madden,  R.  V.  Murphy  J.  O'Donnell, 
W.  D.  Sammon,  P.  D.  Sullivan.  W.  G.  Wright. 

First  Examination  in  all  subjects. — P.  J.  Timoney. 
University  of  Birmingham. 

The  following  candidates  have  passed  in  the  Faculty 
of  Medicine  : — 

Degree  of  Doctor  of  Medicine. — (a)  Official :  John 
Douglas  Stanley  ;  (6)  Under  Ordinary  Regulations  : 
Jordan  Lloyd. 

Degree  of  Master  of  Surgery. — Official :  John  Thomas 
Hewetson  and  Thomas  Wilson. 

Degrees  of  Bachelor  of  Medicine  and  Bachelor  of 
Surgery. — (a)  Associate:  Alex.  Wathen  Nuthall.  (&) 
Past  students  of  Birmingham  Medical  School ;  Tom 
William  Beazeley,  Charles  York  Flewitt,  Sidney 
Cameron  Lawrence,  and  William  Arthur  Loxton.  (c) 
Under  Ordinary  Regulations  ;  Alfred  Ernest  Remmett 
Weaver  (scholarship),  William  Cook,  Cuthbert  Keay 
Gettings,  and  Leonard  George  Joseph  Mackey. 

Degree  of  Bachelor  of  Dental  Surgery. — Henry  Percy 
Pickerill. 

Diploma    in    Public    Health. — Parts    I.    and    II. 
Thomas  Dawson. 

Conjoint  Examinations  In  Ireland  -Final  Examination. 

Candidates  have  passed  this  examination  as 
undernoted  : — 

With  Honours. — James  S.  Sheill. 

Passed  in  All. — Miss  Alice  M.  Barry,  Mat  hew 
Campbell,  William  I.  Cowell,  Michael  Keane,  William 
F.  B.  Loughnan,  William  L.  Murphy,  Arthur  Lanigan 
O'Keeffe. 

Completed. — Andrew  J.  Bracken,  George  P.  A. 
Bracken.  Alfred  N.  Crawford,  Christopher  A.  Cusack, 
Benjamin  D.  Gibson,  George  A.  D.  Harvey,  Patrick 
Kinsella,  Francis  J.  Lennan,  William  J.  O' Sullivan. 
James  Parker,  and  Thomas  J.  Ryan. 


The  President  of  the  Royal  College  of  Physicians 
of  Edinburgh.  Dr.  T.  S.  Clouston,  recently  announced 
the  postponement  of  the  consideration  of  a  suitable 
dress  for  licentiates  of  the  College.  It  is  somewhat 
difficult  to  understand  why  this  subject  should  be  so 
persistently  shelved  by  the  authorities  of  that  body 
The  recently  formed  association  of  Scotch  diplomates 
has  urged  the  Scottish  Colleges  to  take  some  steps  in 
this  easily-arranged  matter,  and  offered  further  to 
submit  the  design  of  a  dress  for  approval.  The 
Colleges  declined  that  offer,  but  have  not  produced 
their  own  pattern.  Licentiates  and  Fellows,  however, 
will  doubtless  get  that  and  other  things,  if  they  wait — 
and  organise.  The  Hon.  Sec.  of  the  Scottish  Diplo- 
mates' Society  is  Mr.  Heather  Bigg,  Harley  Street, 
London,  W. 

H.M.  THE  King  has  appointed  Sir  William  Mac- 
Gregor,  M.D.,  K.C.M.G.,  C.B.  (Governor  of  Lagos), 
to  be  Governor  and  Commander-in-Chief  of  the  Island 
of  Newfoundland  and  its  Dependencies. 

Under  the  will  of  Mr.  Henry  Evans,  banker,  of 
Highfields,  Derby,  who  died  suddenly  last  week,  the 
Derbyshire  Royal  Infirmary  receives  ten  thousand 
pounds  for  the  equipment  of  a  permanent  ophthalmic 
department. 

Dr.  Urban  Pritchard  delivered  his  valedictory 
address  at  Bordeaux,  on  Monday  last,  at  the  inter- 
national Congress  on  Otology,  at  which  Dr.  Moure 
was  unanimously  elected  President.  All  the  countries 
of  Europe  and  the  United  States  of  America  were 
represented. 


1 


136     The  Msdical  Psess.       NOTICES  TO  CORRESPONDENTS. 


August    3,  1904. 


c^taa  to 

J|9*  COBKiSPOifAXinB  requiring  a  reply  In  this  column  are  particu- 
larly requested  to  make  use  of  a  distincHv  Signatwrt  or  /niMoI,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
**  Old  Subscriber,"  Ace.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Orioinal  Abticlis  or  Lbttbrs  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. 

THE  HUMANE  SLAUGHTERING  OP  ANIMALS. 

The  recently  published  report  of  the  Ck>mmiltee  appointed  to  con- 
sider the  Humane  Slaughtering  of  Animals  has  pronounced 
emphatically  in  favour  of  public  as  against  private  slaughter- 
houses. (1)  '*  In  the  interests  not  only  of  humanity."  it  says  "  but  of 
sanitati  n,  order  and  ultimate  economy,  it  is  highly  desirable  that, 
where  circumstances  permit,  private  slaughter-houses  should  be 
replaced  by  public  abattoirs,  and  that  no  killing  should  be  permitted 
except  in  the  latter,  under  official  supervision.  (2.;  The  Committee 
no  less  emphsticall^  condemns  the  Jewish  system  of  s'anghtering 
as  at  present  practised,  and  reports  that  '  until  some  method  is 
devised,  and  adopted,  for  rendering  the  animals  unconscious, 
previous  to  the  *  casting  '  and  throat-cutting  operations,  the  Jewish 
system  of  slaughtering  cattle  should  not  be  permitted  in  any 
estalishments  under  Government  control." 

Pharmacist  (Newcastle).— Yes— a  remarkably  good  action  has  been 
claimed  for  large  doses  of  digitalis  (4  grms. daily  of  the  infusion)  in  the 
treatment  of  pneumonia.  Tne  introducer  of  this  method,  Bragaenola 
attributes  the  good  effect  to  the  antitoxic  action  exerted  by 
digitalis  against  the  metabolic  products  of  Fraenkel's  bacillus.  The 
method  deserves  a  trial. 

Sttjdbnt.— Yellow  fever  can  be  conveyed  across  the  sea  by  ships 
that  have  no  disease  on  board.  It  is  distributed  from  person  lo 
person  bv  a  species  of  mosquito  (Styomyia  Fasciata),  which 
harbours  in  water  tanks  and  damp  places.  See  an  excellent  note  on 
the  subject  in  the  recently  published  Annual  Report  for  1903  of  the 
Medical  Officers  of  Health  of  the  Bristol  Port  SaniUry  District. 

K.  H.  BEMHsnr. — If  when  an  assistant  you  signed  an  agreement  not 
to  practise  within  aradiusof  four  miles  of  your  principal's  residence 
you  are  practically  excluded  from  practice  In  London.  A  clause  of 
the  kind  under  such  circumstances  is  most  unfair,  and  no  assistant 
should  be  asked  to  put  his  name  to  anything  of  the  sort. 

A  VBRY  distioguisned  doctor  (writes  a  correspondent)  tells  the 
Daily  News  that  the  medical  profession  appears  to  be  under- 
manned only  because  of  the  diffieuly  at  this  time  of  the  year  in  find- 
ing "  loci  tenentes."  What  a  pitfa  1  is  this  turning  about  of  familiar 
Latin  phrases,  as  the  lady  proved  who  talked  of  **  omnibi,"  or  as  that 
other  showed  us  who  talked  of  "  a  state  of  doubtful  ebriety  '* !  Let 
us  hope  that  the  medical  profession  will  not  long  have  to  deplore 
the  want  of  "  loci  tenentes,"  or  someone  is  sure  to  remind  us  very 
soon  of  what  we  seem  to  have  heard  before,  that  the  medical  pro- 
fession used  to  be  a  very  different  thing.  As  the  brilliant  Fellow  of 
All  Souls'  remarked  when  deploring  the  decline  of  intellect  in  the 

younger  Fellows, "  D it.  We  use  to  be  iXLtgtneris.'^^Mamchattr 

Guardian. 

J,  Percival  (London).— We  do  not  know  of  any  book  dealing 
with  the  subject  you  mention.  The  genera]  opinion  of  the  medical 
profession  Is  undoubtedly  unfavourable  to  consanguineous  marriages. 
ft  is  imp-'ssible  to  approve  of  first-cousin  marriages  from  the  pomt 
of  view  of  the  interests  of  offspring. 

Ayr  District  Asylum.— Junior  Medical  Officer.  Salary  £120  per 
annum,  with  board,  furnished  apartments,  attendance,  and  wash- 
ing.   Applications  t.o  the  Medical  Superintendent. 

Brighton  1  hroat  and  Ear  Hospital  Church  Street.  Queen's  Road.— 
Non-resident  House  Surgeon.  £>alary  £75  per  annum.  Appli- 
cations to  Secretary,  Mr.  E.  W.  Pilbeam,  10  Black  Lion  Street, 
Brighton. 

House  Burgeon,  for  a  small  Hospital  in  the  Midlands.  Salary  £100 
per  annum  and  buard.  Applications  to  Mr.  P.  W.  Walker,  18 
Waterloo  Street,  Birmingham. 

Humberstone  Asylum,  Leicester.— Assistant  Medical  Officer.  Salary 
£200  per  annum,  with  furnished  quarters  and  board.  Applica- 
tions to  Medical  Superintendent 

Ingham  Infirmary  and  South  Shields  and  Westhoe  Dispensary.— 
Junior  House  Surgeon.  Salary  £75  per  annum  and  residence, 
board  and  washing.  Applications  to  James  B.  Wheldon,  Secre- 
74  King  Street,  bouth  Shields. ' 

Kent  CSounty  Lunar ic  Asylum,  Banning  Heath,  near  Maidstone. — 
Chief  Medical  Officer  and  Superintendent.  Salary  £800  per 
annum,  with  unfurnished  house,  coal,  gas,  milk,  garden  produce 
and  washing  for  self  and  familv.  Applications  to  Francis  R. 
Hewlett,  Clerk,  to  the  Sub-Committee,  9  King  Street,  I 
Maidstone. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  of  the  Chest, 
Hampstead  and  Northwood.— Resident  Medical  Officer.  Salary 
£80  per  annum,  with  board  and  residence.  Applications,  to 
William  J.  Morton,  Secretary  7  Fitroy  Square,  W. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  of  the  Chest, 
Hampstead  and  Northwood. — Honorary  Dental  Surgeon.  Appli- 
cations to  William  J.  Morton^Secretary, 7  Fitsroy  S<]uare,  W, 
North  Gambrklgeshire  Hospital,  Wisbech.— Resident  Medical  Oflloer. 
Salary  £100  per  annum,  with  furnished  rooms,  attendance, 
coals,  gas,  and  washing.  Applications  to  William  F.  Bray, 
Secretary. 
Rotherham  Hospital  and  Dispensary.— Senior  House  Surgeon. 
Salarv  £110  per  annum,  with  rooms,  commons,  and  washing. 
Applications  immediately  to  the  Secretary,  C.  S.  Bay  lis,  19 
Moorgate  Street,  Rotherham. 


The  Aberamau  and  District  Workmen  Doctors  Fund  Committee- 
Qualified  Gentleman  to  take  charge  of  a  large  Colliery  Dii^tiot 
Practice.  Salary  £400  per  annum,  with  free  house,  coal,  aae«. 
tants,  dispenser,  drugs,  •  ftc.    Applications  to  Secretary. 


JlfrjrointmeniB. 


Cownni,  William  P.,  L.R.O.P.  &  8.Edin.,  House  Surgeon  to  the 

Royal  Westminster  Ophthalmic  Hospital. 
Dally,  J.  F.  Halls,  MA,    M.B.,    B.C.CAntob.,  M.R.C  S.,  Em., 

L.R.C.P.Lond.,  Senior  Resident  Medical  Officer  to  the  Royal 

National  Hospital  for  Consumption  and  Diseases  of  the  Chest. 

Ventnor,  I.W.  ^ 

Dbht.  Clihtos  T.,  F.R.C.8.Eng.,  Chief  Surgeon  to  the  Metiopo'iUa 

Police. 
Donald,  C.  W.,  M  D.,  F.R.C.S.E.,    Surgeon  to  Cumberland  and 

Westmoreland  Countv  Constubulary. 
DupOHT,  J.  M.,  MB..    Ch.B.Edin.,    Assistant   Resident  Medical 

Officer  to  the  Royal  Natiooal  Hospital  for  Consumption  tod 

Diseases  of  the  Chest,  Ventnor.  I.W. 
Nicholson,  Habrt  Oliphaht,  M.D.Aberd.,  F.R.C.P.Edin.,  Assistant 

Physician  to  the  Royal  Maternity  and  Simpson  Memorial  Hospi- 
tal, Edinburgh. 


J9irth«. 


CooKE.— On  July  26th,  at  Church  Square,  Haddenham.   Bucks,  the 

wife  of  Frederick  A.  Cooke,  M.D  ,  M.B.C.8.,  L  B.C.P  ,  of  a  son. 
Fihlat.— On  July  28th,  at  No.  10  Clarendon  Road,  Eceles,  Laaoi. 

the  wife  of  G.  L.  K.  Finlay.  B.A.,  M.B.,  CM.,  of  a  dau^ter. 
Harper.— On  July  27th,  at  7  Chiswick  Place,   Bastboume,  the  wife. 

Alexander  Harper,  M.D.,  of  a  daughter. 
Harvxt.— On  July  21st,  1904,  at  7  Gardiner's  Bow.  Rutland  Square. 

Dublin,  the  wife  of  B.  J.  Hen'ey,  F.R.aS.I.,  of  a  son. 


^BtormgeB. 


WiCHERr-PBRBLRS.-On  Julv28th,at  St  Alban's  Church.  Windle- 
sham,  Barold  Waeher,  M.B.,  eldest  sen  of  Frank  Wacher  of 
Monastery  House,  Canterbury,  to  Violet  Amy.  daughter  of  the 
late  Robert  Davie  Peebles,  of  the  Priory,  Heene,  Worthinff.  and 
ofMrs.  Peebles,  of  Fosters,  Windleshara. 

WiirrTiHoiJAM— DvKss.— On  July  27th,  at  St.  Micha»l*B,  Boun^ 
mouth,  Edwin  Parton.  eldest  son  of  Edwin  Whittinffham.  of 
Bournemouth,  to  Amy  Barbara,  only  daughter  of  the  Ukte  W.  P 
Dukes,  M.B.C.S..  of  Spitalfields,  and  Mrs.  Dukes,  ofChTi<- 
ohurch. 


Cranht.- On  July  27,  at  17  Merrion  Square,  Dublin,  John  Josepb. 

Cranny,  M.D^F.B.C.S.I„  eldest  son  of  the  late  Patrick  CEannT, 

of  Muckross  Park,  aged  69years. 
Crocker.— On  July  18th,  at  West  Mailing.  Kent.  Henry  Leonaid. 

fourth  son  of  the  late  Surgeon-General  Alfred  Crocker,  Army 

Medical  Department. 


OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— St.  Barthotomews  (l-,80  p.m.).  University  College 
(2  p.m.).  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m.),  Chariar 
Cross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.),  Kinr's 
College  r2  p.m.),  St.  George's  (Ophthalmic,  Ip.m.),  St.  Mary's 
(2  p  m.).  National  Orthopndic  (10  a.m.),  St.  Peter's  (2  pjn.), 
Samaritan  (9.80  a.m.  and  2.30  p.m.),  Gt.  Orroood  Street  {9.9i 
a.m.),  Gt  Northern  Central  (2  30  p.m.),  Westminster  (2  p.m.j, 
Metropolitan  (2.30  p.m.),  London  Throat  (9.80  a.m.),  Chuicer 
(2  p.m.).  Throat,  Golden  Square  (9.30  a,m.),  Guy's  (1.30  p.m.). 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  St.  Thomas's  (3.80 
p.m.),  University  College  (2  p.m).  Charing  Cross  (3  p.m.),  8t. 
George's  (1p.m.),  London  (2p.m.).  King's  College  (2p.m.),  Mkidle- 
sex  (1.80  p.m.),  St.  Mary's  (2.80  p.m.).  Soho  Square  (2  p.m.). 
North- West  London  (2  p.m.),  Chelsea  (2  p.m.)  Great  Northern 
Central  (Oynascoloflrical,  2.30  p.m.).  Metropolitan  (2.30  pm.). 
London  Throat  (9.30  a.m.),  St.  Mark's  (2  p.m.),  Samaritan  r9.S() 
a.m.  and  2.30  p.m.).  Throat,  Golden  Square  (9.30  a.m.),  Gay's 
(1.30  p.m.). 

FRIDAY.— London  (2  p.m.),  St  Bartholomew's  (X.80  p.m.),  St. 
Thomas's  (3.30  p.ra.),  Guy's  (1.30  p.m,),  Middlesex  (1.80  p.m.), 
Charing  Cross  (3  p.m.),  St.  George's  (1  p.m.),  King  s  College  {i 
p.m.),  St.  Mary's  (2  p.m.).  Ophthalmic  (10  a.m.),  Cancer  (2  p.m.) 
Chelsea  (2  p.m.).  Great  Northern  Central  (2.80  p.m  ),  West 
London  (2  80  p.m.),  London  Throat  (9.30  a.m.),  Samaritan  (9  90 
a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Citr 
OrthopsBdic  (2.80  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.-^Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (1  30 
p.m.),  St.  Thomas's  (2  p.m.),  University  College  (9.15  a.m.). 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  9t  Mary's  (10  p.m.> 
Throat.  Golden  Square  (9  30  a.m.),  Guy  s  (1.80p.m.). 

MONDAY.^ London  (2  p.m.).  St.  Bartholomew  s  (1.80  p.m.),  St. 
Thomas's  (8.80  p.m.),  St.  Georare's  (2  p.m.),  St.  Mary's  (2.30 
p.m.),  Middlesex  (1.80  p.m.).  Westminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (Gyn»oological«  by  Physicians,  2  p.m.),  Soho 
Square  (2  p.m.),  Royal  Orthopedic  (2  p.m.).  City  Orthopsdic  ii 
p.m.),  Great  Northern  Central  (2  30  p.m.).  West  London  (2.30 
p.m.),  liOndon  Throat  (9.30  a.m.),  Royal  Free  (2  p.m.),  Guy's  (1.30 

TUESDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.80  p.m.),  SL 
Thomas's  (3.80  p.m.),  Guy's  (1.30  p.m.),  Middlesex  (1.30  p.m.), 
Westminster  (2  p.m.),  West  London  (2.80  p.m.),  Universitr 
College  (2  p.m.),  St  George's  (1  p.m.),  St  Mary's  (1  p.m.).  8l 
Markka  (2.90  p.UL),  Cancer  (2  p.m.).  Metropolitan  (2.80  p.m.), 
London  Throat  (9.30  a.m.),  Royal  Ear  (3  p.m.),  Samaritan  (9.30 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Soho 
Square  <2  p.m.) 


Mt  ^dioA  ^tm  mH  €ixmht 


''8ALUB   POPULI   SUFRElfA   LEX' 


Vol.  CXXIX. 


WEDNESDAY,    AUGUST    lo,    1904.  No.   6. 


Original  Commnnications* 

A     CONSIDERATION    OF     SOME     OF    THE 
DIFFICULTIES   MET  WITH   IN  THE 

EXPERIMENTAL  TREATMENT 
OF  CANCER,  (a) 

By    SKENE    KEITH.    M.B.,    F.R.C.S.Ed.     . 

It  is  said  that  every  young  lawyer  has  visions  of 
.-sitting  one  day  on  the  WoolMck,  and  it  is  probable 
that  the  dream  of  discovering  a  cure  for  cancer  occurs 
at  one  time  or  another  to  every  medical  student.  He 
•<lream8  of  the  benefit  to  humanity  and  of  the  glory  to 
iiimself. 

It  is  a  subject  we  have  all  to  consider,  and  I  have 
tried  to  put  together  some  things  about  it  which  have 
•occurred  to  me,  not  from  the  scientific  investigator's, 
but  from  the  practical  experimenter's,  point  cS  view. 
One  turns  the  subject,  over  and  over,  and  perhaps 
'Comea  to  think  that  one  has  at  last  settled  m  one's 
•own  mind  something  definite.  Then  comes  recon- 
sideration, and  at  once  doubt  appears.  Still,  for 
experimenting  I  believe  that  one  must  take  up  a 
> definite  line.  Once  there  is  a  commencement,  it  is 
not  so  very  difficult  to  progress  and  to  improve.  Take, 
for  example,  the  X-rays  ;  at  first  the  difficulty  was  to 
prevent  a  bum.  Experts  can,  I  understand,  prevent 
this,  and  a  bum  now  means  either  ignorance  or  care- 
lessness. Nothing  shows  more  clearly  the  state  of 
ignorance  we  are  in  than  the  apparently  almost 
universally  held  idea  when  radium  was  discovered 
that  here  was  the  cure  so  long  sought,  and  this  before 
:anyone  knew  hardly  anything;  at  all  about  the  subject. 

There  are  many  difficulties  in  the  experimenter's 
way.  One  great  one  is  that  it  comes  to  few  to  have 
the  opportunity  of  making  practical  experiments. 
An  occasional  patient  turns  up.  and.  if  the  growth  is 
•capable  of  bemg  removed,  no  experiment  can  be 
tried.  If  the  disease  is  far  advanced,  it  may  seem 
unkind  to  suggest  increasing,  perhaps,  the  already 
-sufficient  miseries.  Even  in  hospitals  this  difficulty 
also  prevails,  because  it  is  impossible  to  admit  any 
but  the  smallest  number  of  those  who  are  beyond 
•operative  interference,  simply  for  the  sake  of  experi- 
ment, when  there  are  so  many  for  whom  something 
can  be  done,  or  at  least  attempted. 

If   this  difficulty   has   been  surmounted,   a  much 

.greater  one  immediately  appears,  for  what  is  cancer  ? 

how  does  it  come  ?  why  does  it  kill  when  there  is  no 

*  exhausting  discharge,  and  when  situated  in  a  part  of 

the  body  not  necessary  to  existence  ? 

Cancer,  or  widely  malignant  disease,  is  divided 
pathologically  into  two  main  groups — viz.,  those 
-spreading  through  the  blood  and  those  spreading 
through  the  lymphatics.  Does  this  help  us  for  treat- 
ment ?  Are  we  to  take  pathology  into  account  in 
experimenting,  or  are  we  to  ignore  it  ?  The  amount 
-of  success  which  has  been  obtained  by  the  adminis- 
tration of  the  toxins  of  erysipelas   and  the   Bacillus 


(a)  RMd  before  the  Cftmbridge  Medloal  Society,  Febrosiy  6th,  1004. 


prodigiosus— Coley's  fluid— in  the  treatment  of  sar- 
comata seems  to  point  to  the  advisability  of  at  least 
considering  whether,  for  treatment,  it  may  not  be 
well  to  divide  the  cases  into  groups.  But  on  the 
whole,  pathology,  even  the  latest  discoveries  of  the 
conditions  of  the  cells,  does  not  at  the  present  time, 
at  all  events,  seem  to  help  us  much. 

Already  there  are  several  who  claim  credit  for  first 
making  the  discovery  that  ■'  the  cells  in  malignant 
disease  undergo  a  reductive  division  similar  to  that 
occurring  in  the  formation  of  sexual  cells,  whereby 
germinal  tissue  is  formed."  It  would  take  an  expert 
to  decide  this  question  of  priority,  but  it  seems  pro- 
bable that  Dr.  George  Beatson  was  the  first  to  come 
to  this  conclusion  as  to  the  nature  of  the  cells,  the 
result  of  practical  experiments,  his  experiment  of 
the  removal  of  the  ovaries  for  inoperable  cancer  of  the 
breast  being  based  on  physiological  grounds ;  and  the 
clinical  observations  he  made  induced  him  to  come  to 
the  conclusion  that  cancer  was  due  to  a  local  conversion 
of  the  cells  affected  into  germinal  tissue.  Here 
pathology  is  following,  as  so  often  has  been  the  case; 
m  the  treatment  of  diseases. 

How  does  it  come  ?  why  has  it  come  ?  to  me  ate 
common  questions.  People  can  realise  the  infection 
from,  say.  scarlet  fever,  or  an  attack  of  pleurisy,  or 
pneumonia,  the  result  apparently  of  a  chiU,  but  they 
do  not  understand,  if  there  has  been  no  injury  and  no 
family  history  of  the  disease,  why  cancer  should  come  to 
them.  We  also  are  faced  with  the  same  difficulty. 
In  some  cases  doubtless  there  seems  to  be  a  distinct 
connection  between  a  prolonged  irritation  and  the 
occurrence  of  the  disease,  but  surely  there  must  be 
something  more,  or  why  does  not  a  similar  irritation 
produce  it  in  all  ?  Women  often  trace  a  connection 
with  a  blow,  especially  on  the  breast,  but  every  woman 
who  has  cancer  of  the  breast  does  not  know  of  any 
injury,  and  many  must  be  injured  in  that  region 
without  the  disease  resulting.  No,  the  irritation  or 
injury  theory  is  not  enough. 

Heredity — this  Question  opens  up  so  many  fallacies 
that  it  is  impossible  to  dogmatise  on  the  subject,  for 
the  same  thing  occurs  here  as  with  injuries  ;  all  who 
have  a  family  history  of  the  disease  do  not  have  it, 
and  some  have  it  where  there  is  no  known  family 
history.  My  own  opinion  is  that  it  is  the  rule  rather 
than  the  exception  that  the  tendency  to  the  disease 
is  handed  down  from  one  generation  to  another. 
How  many  people,  even  in  good  circumstances,  can 
tell  the  cause  of  death  for  two  generations,  especially 
where  there  is  a  large  family  ?  But  to  go  back  two 
generations  is  probably  not  enough,  especially  if  we 
are  to  accept  as  a  fact  that  a  disease — for  example, 
syphilis— can  be  traced  through  five  generations.  There 
are  some  who  do  not  believe  that  heredity  plays  any 
part,  but  they  do  not  advance  any  theory  to  take 
its  place.  Is  it  caused  by  a  germ  or  a  parasite  ?  This 
question  is,  like  most  others  connected  with  the 
subject,  still  only  a  conjecture.  What  is  there  in  the 
disease  to  cause  death  ?  Why  is  there  the  steady- 
loss  of  vitality  ?  A  satisfactory  answer  to  this  question 
might  help  in  our  search  for  a  remedial  agent. 

Is  the  disease  in  the  beginning  a  local  one,  or  is  the 
growth  a  local  manifestation  of  a  general  condition. 


138    Tbb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


August  10,  1904. 


or  is  it  sometimes  one  thing  and  sometimes  the  other  ? 
If  it  were  local,  is  it  probable  that  there  would  be  so 
often  a  return  after  removal,  or  is  it  that  a  return 
always  means  incomplete  or  too  late  operation  ?  If 
the  latter,  why  should  the  disease  lie  dormant  for 
years,  and  then  apparently  start  into  existence,  some- 
times with,  sometimes  without,  any  exciting  cause  ?. 
Whichever  theory  is  held,  in  practice  it  must  be 
evident  that  the  hope,  at  least,  is  that  it  is  a  local  dis- 
ease. An  operation  performed  with  the  expectation  of 
accomplishing  a  permanent  cure  points  to  the  local 
theory.  If  the  local  theory  is  held,  then  all  idea  of 
heredity  must  go,  unless  it  is  believed  that  the  disease 
is  due  to  the  improper  development  or  arrangement 
of  some  of  the  embryonic  cells,  and  that  the  tendency 
to  have  such  can  be  inherited,  the  offspring  of  a  person 
bom  prematurely  being  more  prone  to  such  conditions. 
The  possibility  of  this  amount  of  heredity  was  sug- 
gested to  me 'by  Mr.  Richard  Cowen,  and  the  idea 
seems  to  be  a  novel  one.  Otherwise  the  disease  must 
have  something  general  in  its  nature  if  it  is  to  be  handed 
down.  The  experiments  we  have  heard  most  of 
lately  all  attack  the  disease  locally ;  the  X-rays  and 
bromide  of  radium  are  both  local  in  their  action,  and, 
as  far  as  is  at  present  known,  have  no  power  of  pre- 
venting the  disease  appearing  in  other  parts.  At 
present  their  use  seems  to  be  limited  to  cases  of  rodent 
ulcer  and  to  the  removal  of  small  nodules,  either  by 
absorption  or  by  a  caustic  action,  but  it  is  a  great 
misfortune  that  so  many  patients  have  had  the  pain 
of  an  X-ray  bum — a  different  thing  to  an  prdinary 
bum — added  to  the  sufficient  miseries  connected 
with  the  close  of  life  by  cancer.  It  is  known  that  the 
injection  of  quinine  and 'other  substances  increases 
the  beneficial  action  of  the  rays,  so  it  may  be 
that  in  this  or  in  some  other  way  their  action  may  be 
extended  to  deeper  parts.  I  do  not  think  that  the 
theory  of  a  general  condition,  and  with  this  the  influence 
of  heredity,  should  be  ignored.  It  frequently  happens 
that  after  an  apparently  satisfactory  oi>eration  the 
disease  returns  as  quickly  as  if  the  original  growth 
had  not  been  removed.  One  has  seen  so  many  dis- 
appointing cases  of  this  kind  that  one  must  feel  inclined 
to  accept  this  theory  of  a  general  condition  unless  the 
middle  course  is  to  be  taken,  and  we  are  to  believe  that 
thexe  are  two  distinct  causes  at  work,  the  local  and 
the  general.  This  would  be  a  simple,  but  very  un- 
satisfactory, way  out  of  the  diiEailty. 

There  is,  however,  one  point  on  which  everyone 
is  agreed,  and  that  is  that  with  the  amount  of  know- 
ledge we  possess  at  present  it  is  impossible  for  anyone 
to  feel  sure  one  way  or  the  other. 

We  come  to  another  matter  which  may  bear  much 
on  the  subject.  It  is  the  great  difference  there  may 
be  in  two  apparently  identical  cases  in  malignancy. 
One  case  runs  its  course  in,  perhaps,  a  year  ;  in  another 
the  disease  may  exist  for  two,  three  or  more  years. 
This  may  be  partly  explained  by  age,  in  the  young 
the  course  being  usually  more  rapid  than  in  the  old, 
but  this  is  not  the  whole  explanation.  The  elucidation 
of  this  point  would  also  help  us  towards  a  cure. 

So  far  I  have  dealt  with  difficulties  more  perhaps 
theoretical  than  practical,  but  they  have  been  con- 
sidered because  they  lead  up  to  the  great  practical 
difficulty  of  deciding  or  suggesting  what  line  experi- 
ments are  to  take.  A  form  of  treatment,  if  we  come 
to  the  conclusion  that  the  disease  is  a  local  one,  and 
which  then  might  be  sensible  and  appear  right,  could 
not  do  so  if  we  take  the  line  that  the  local  growth  is  the 
result  of  something  else. 

A  very  practical  matter  has  now  to  be  considered. 
At  the  present  time  the  recognised  method  of  treating 
the  disease  is  by  operation.  It  is  recognised  in  all 
the  books  and  at  all  the  medical  schools  that  surgery, 
especially  if  the  case  is  seen  early,  may  cure  either 
temporarily  or  permanently,  and  at  present  no  one 
doubts  that  this  is  a  proper  view  to  take.  It  is,  how- 
ever, a  view  which  renders  all  experiment  difficult, 
almost  hopeless,  because  the  patient,  when  he  comes 
to  the  experiment  stage,  is  saturated  with  the  disease 
and  the  vital  powers  are  so  much  reduced  that  the 


action  of  drugs  seems  often  to  be  modified.  In  cases 
of  this  nature  also,  the  patient  and  the  doctor  are  both 
ready  to  clutch  at  straws  and  to  be  encouraged,  by 
slight  improvements,  into  the  belief  that  a  curative 
agent  on  the  disease  is  being  iis^  when  it  is  one  which 
only  alleviates  symptoms  caused  by  the  disease.  This 
can  often  be  easily  accomplished.  Such  treatment 
would  not  affect  the  disease  in  the  early  stages  and 
before  it  has  existed  long  enough  to  affect  the  general 
health.  It  is,  however,  in  the  early  stages  that  one 
would  expect  that  a  remedy  which  actually  combated 
the  disease,  and  not  the  results  of  the  disease,  would 
have  most  chance  of  effecting  a  cure,  and  as  an  example 
of  this  the  following  cases  may  be  mentioned.  The 
two  cases  were  those  of  a  husband  and  wife,  both  being 
just  under  forty  years  of  age.  The  mother  of  the  wife 
had  died  of  cancer  of  the  stomach.  On  the  husband's 
side  there  was  no  history  of  cancer,  as  far  as  he  could 
ascertain.  The  lady  had  noticed  a  lump  in  her  right 
breast  some  months  before  she  first  consulted  a  doctor. 
By  this  time  there  were  two  ulcerated  patches,  said 
to  be  roughly  the  size  of  a  shilling,  on  the  breast.  The- 
first  doctor  consulted  gave  the  opinion  that  no  opera- 
tion was  possible,  as  there  was  a  mass  connected  with 
the  ribs.  A  hospital  surgeon  gave  a  similar  opinion, 
and  this  was  confirmed  by  a  third.  At  the  first  visit 
the  lump  in  the  breast  was  the  size  of  half  a  hen's 
egg  7  the  mass  connected  with  the  ribs  was  very  large. 
It  felt  about  an  inch  thick*  and  was  fully  four  inches- 
in  diameter.  There  was  little  pain,  but  great  loss  of 
strength  and  weight.  In  such  a  case,  an  experiment 
would  be  recognised  by  ever3^one  as  being  a  fair  thing- 
to  try,  and  a  form  of  treatment  by  hypodermic  in- 
jection of  various  drugs,  and  which  my  brother  and 
myself  have  been  ezperimentiag  with  .since  the  begin- 
ing  of  last  year,  commenced.  The  case  improved 
steaxtily,  the  ulcecations  healed,  the  mass  in  the  breast 
disappeared,  and  the  one  connected  with  the  ribs  was 
much  reduced.  At  this  time,  after  the  wife  had  had 
twenty-seven  injections,  the  husband  came  to  show 
his  tongue,  as  it  had  been  painful  at  night  and  had 
looked  ulcerated  for  five  weeks.  An  irregular  nloera- 
tion  with  a  hard  base  three-quarters  of  an  inch  kxig  and 
a  quarter  of  an  inch  wide  was  seen  on  the  edge  of  the 
tongue.  There  was  no  history  of  syphilis — the  patient 
fuUy  realised  the  necessity  of  being  truthful  on  this 
point — nor  were  there  any  evidences  of  it  to  be  found.. 
To  be  on  the  safe  side  -fg  gr.  of  perchloride  of  mercury 
was  ordered  to  be  taken  three  times  a  day.  For  about 
one  week  the  ulceration  looked  cleaner,  but  continued' 
to  increase  in  size,  and  after  three  weeks  of  this  treat- 
ment the  ulcer  was  over  an  inch  in  length.  The  treat- 
ment now  lay  between  removal  of  half  of  the  tongoA 
back  to  the  hyoid  bone,  or  a  trial  of  an  experiment 
somewhat  similar  to  what  his  wife  had  been  under- 
going. Eleven  injections  removed  entirely  the  hard 
base,  and  healed  the  ulcer,  while  at  the  same  time  the 
pain  was  relieved  completely.  For  the  time  being  the 
case  is  cured,  but  as  time  alone  will  show  if  the  cure 
is  permanent  I  only  bring  it  forward  at  present  as  an 
indication  of  how  much  greater  and  qiiicker  the 
results  may  be  expected  when  experimenting  on  early 
cases ;  nor  do  I  wish  to  enter  into  the  question  of  whether 
one  is  justified  in  advising  an  experiment  in  a  case- 
suitable  for  operation.  My  object  is  rather  to  suggest 
the  advisabiUty  of  experimenting  on  cases  of  cancer 
of  the  hver,  es|>ecially  when  they  are  seen  in  the  early 
stages  of  the  disease,  or  in  any  other  part  where  an^ 
operation  is  neither  possible  nor  advisable  for  any 
reason.  For  example,  the  removal  of  deeply  seated 
malignant  growths  in  the  neck  is  seldom  a  satisfactory 
operation,  and  an  experiment  on  such  a  case  might 
be  considered  to  be  as  likely  to  do  good  as  an  attempt 
at  removal.  The  only  objection  there  seems  to  be  to 
doing  this  is  that  it  is  by  no  means  easy  to  make  the 
diagnosis  in  the  early  stages,  especially  when  the 
disease  is  situated  in  an  internal  organ  of  the  body. 
In  other  respects  there  does  not  seem  to  be  any  objec- 
tion, because  the  patient  does  not  lose  any  valuable 
time,  and  thu.s,  while  an  experiment  may  do  no  good, 
it  need  not  result  in  any  harm. 


August  io,  1904. 


ORIGINAL  COMMUNICATIONS.       Thb  Medicai,  P«b».    139 


Until  quite  recently  it  might  almost  seem  that  hope 
of  discovering  a  cure  for  this  dread  disease  had  been 
abandoned,  and  that  all  attention  was  being  con- 
centrated on  improving  the  methods  for  its  removal. 
In  this  direction  there  can  be  no  doubt  that  there  has 
been  a  decided  advance,  though  the  pendulum  has 
S'wung  too  far.  an..1  now,  instead  of  removing  too  little, 
the  operations  are  sometimes  unnecessarily  too  severe. 
£ven  the  public  institutions  specially  devoted  to  the 
treatment  of  cancer  appear  to  have  contented  them- 
selves with  doing  their  t>est  for  the>  individual  patient 
l>y  improving  their  methods,  but  always  on  the  same 
lines. 

Privately,  it  is  probable  that  many  experiments 
liave  been  made,  but  in  so  far  that  they  have  come  to 
Tiothing  there  has  been  no  occasion  to  say  anything 
a.bout  them.  My  brother  and  mjrself  have  been  ex- 
perimenting for  a  number  of  years  both  with  possible 
remedies  we  had  ourselves  thought  of,  and  also  with 
those  suggested  by  others.  Some  day  we  hope  we 
may  be  able  to  bring  forward  the  details  of  something 
satisfactory,  but  failure,  repeated  time  and  again  for 
over  fifteen  years,  teaches  one  to  be  in  no  hurry  to  be 
enthusiastic,  and  the  more  one  works  at  the  subject 
the  more  difficult  it  seems  to  be  to  know  when  a  cure 
oan  be  claimed,  or,  indeed,  to  feel  at  all  sure  that  one 
knows  anything  very  definite  about  the  subject. 

The  question  of  the  greatest  practical  difficulty 
"has  been  already  referred  to — viz.,  that  of  not  getting 
the  cases  early.  Patients  come  after  they  have  tried 
to  believe  in  the  so-called  Christian  Science,  but  their 
faith  has  probably  been  weak — after  X-rays,  high 
frequency ,  and  operations,  with  a  quick  pulse,  a 
yellow  skin,  and  all  the  symptoms  of  an  early  parting 
of  the  ways — and  they  ask  can  nothing  further  be 
tried  for  them.  It  is  distressing  to  have  to  say  that 
there  is  no  treatment  for  such  a  case,  but  what  is  the 
use  of  trying  to  cure  any  patient  in  the  last  stages  of  the 
■disease  ?  The  question  of  the  curability  of  cancer 
has  been  taken  up  by  the  daily  papers.  This  publicity 
is  not  altogether  a  misfortune,  because,  by  making 
patients  think  that  a  cure  may  be  found  out  some  day, 
or  may  be  in  the  process  of  being  found  out,  they  are, 
jat '  least  in  our  experience,  more  anxious  to  try  an 
experiment  than  they  were  before  the  special  cancer 
hospitals  and  the  Ro3ral  Colleges  began  to  experiment 
and  investigate.  As  experiments  cannot  be  made 
without  money,  the  public  have  had  to  be  taken  into 
the  confidence  of  the  profession.  These  public  appeals 
have  given  rise  to  hope  ;  patients  who  formerly  would 
have  been  resigned  when  told  that  nothing  could  be 
done  for  them  are  now  inclined  to  try  something — 
anything.  So  long  as  the  experiments  are  properly 
carried  out,  and  the  patieht  fully  realises  that  it  is 
experimental,  no  harm  need  be  done.  But  it  is 
different  when  a  treatment  about  which  we  understand 
iittle,  such  as  exposure  to  the  X-rays,  is  undertaken 
by  incompetent  persons.  Much  harm  may  and  has 
been  done,  and  many  painful  bums  and  a  number  of 
deaths  have  resulted  from  the  careless  or  ignorant  use 
of  the  rays.  It  is  apparently  forgotten  that  every  care 
must  be  taken  to  prevent  an  experiment  doing  harm. 
I  do  not  wish  it  to  be  understood  that  I  would  not 
approve  of  the  X-ray  experiments  being  continued. 
Very  far  from  it,  but  I  would  ask  that  unqualified 
persons  should  not  be  allowed  to  treat  patients  with 
a  force  which  not  only  may  cause  most  painful  burns, 
but  which  has  actually  caused  death  in  a  number  ot 
instances,  from  sudden  absorption  of  the  breaking 
down  tissues  of  the  growth  itself. 

When  one  writes  of  a  cure  being  discovered,  nothing 
sudden  is  meant.  It  is  difficult  to  see  hpw  it  is  possible 
to  discover  a  cure  without  some  years  of  patience, 
for  one  cannot  fairly  say  that  any  patient  is  cured 
until  some  years  after  treatment.  It  is  on  this  question 
that  one  can  legitimately  complain  of  the  lay  papers. 
Cures  have  been  reported ;  for  example,  one  doctor 
was  stated  to  have  announced  that  he  had  cured  several 
cases  by  the  use  of  radium,  and  we  all  know  that 
radium  has  been  discovered  for  months  rather  than 
-years  ;  someone  else  has  discovered  the  cure  in  salt ; 


another  in  molasses,  and  so  on.  It  is  not  Ukely  that 
any  doctor  with  any  reputation  to  lose  has  given  out 
statements  of  such  a  kind. 

I  have  shown  that  the  treatment  of  cancer  has  been 
almost  entirely  directed  to  the  cure  of  the  local 
condition.  It  would  be  foolish  to  say  that  everything 
has  been  done  locally  that  can  ever  be  done,  but  I 
would  suggest  that  more  attention  be  given  to  experi- 
menting as  if  the  disease  were  a  local  manifestation 
of  a  general  condition.  If  we  knew  why  the  disease 
caused  loss  of  strength,  loss  of  weight,  and  deteriora- 
tion of  the  blood,  it  might  be  that  we  would  be  near 
to  the  discovery  of  a  curative  agent.  At  present, 
investigations  have  not  reached  this  point  of  the 
subject. 

Our  own  experiments,  passing  by  the  more  scientific 
aspects  of  the  question  and  limiting  ourselves  simply 
to  attempts  to  discover  a  curative  agent,  have  been 
directed  since  the  beginning  of  last  year  to  attacking 
the  disease  through  the  general  condition. 

Experiments  may  be  divided  into  the  following 
groups : — First,  cure  of  the  disease  ;  second,  reUef  of 
S3nnptoms  ;  and  third,  improvement  in  the  general  or 
local  condition,  or  of  both,  so  as  to  bring  an  inoperable 
case  within  the  range  of  surgery,  to  be  followed  by 
further  treatment  in  the  hope  of  effecting  a  permanent 
Recovery.  An  example  of  the  first  has  been  already 
given,  the  cure  at  present  being  a  cure  only  in  so  far 
that  there  are  no  symptoms  and  no  sign  of  disease. 
An  example  of  the  second  was  a  case  of  extensive 
cancer  of  the  liver,  where  there  was  severe  pain,  great 
loss  of  strength,  and  deep  jaundice  with  distressing 
skin  irritation.  Though  the  treatment  was  begun 
less  than  three  weeks  ago,  the  pain  has  been  entirely 
relieved,  the  strength  has  come  back  so  much  that  the 
patient  can  walk  out  alone,  which  she  had  not  done  for 
some  months.  The  jaundice  is  less  and  the  irritation 
is  almost  completely  relieved.  In  other  words  the  life 
of  the  patient  will  not  only  be  prolonged,  but  yrUl  be 
prolonged  in  comfort.  An  example  of  the  third  wa^ 
that  of  a  lady,  aet.  55,  who  had  known  of  the  presence 
of  a  fibroid  tumour  of  the  uterus  for  nine  years.  In 
October,  1902,  she  was  told  that  she  had  cancer  of  the 
womb  and  that  an  operation  was  impossible.  This 
was  confirmed  some  months  later.  I  saw  her  in  the 
beginning  of  December,  1903.  The  patient  was 
greatly  emaciated,  very  anaemic,  and  very  yellow. 
The  pulse  was  108,  running  up  to  120.  After  con- 
sultation with  my  brother,  it  was  agreed  to  try  pre- 
liminary treatment,  and  then,  if  possible,  remove  the 
uterus.  The  pulse  came  down  to  a  steady  92,  the 
anaemic  condition  improved,  and  the  yellow  dis- 
coloration of  the  skin  disappeared,  and  I  was  able  to 
operate  in  the  end  of  January  of  this  year.  In 
December  an  operation  would  have  been  indefensible. 

So  far  as  we  have  gone,  results  have  been  very  satis- 
factory, but  I  have  purposely  not  entered  into  tietaiils, 
because  in  the  past  investigators  have  been  far  too 
ready  to  proclaim  success  which  time  has  shown  to 
have  been  premature,  and  we  think  that  it  would  be 
better  for  everyone  in  the  long  run  if  experimenters 
were  allowed  to  go  on  quietly  until  they  had  something 
definite  to  say,  and  something  which  had  stood  the 
test  of  several  years  rather  than,  as  at  present,  of  only 
a  few  weeks. 

(Note,  July  23rd. — There  has  been  no  return 
of  the  disease  in  the  four  cases  referred  to.) 

THE  PRESENT  POSITION  OF 

RADIUM  IN  THERAPEUTICS, 

WITH   A  RESUME  OF   THE  FINSEN  LIGHT 
AND  X-RAY  TREATMENT,   (a) 
By  C.  M.  O'BRIEN,  M.D.,  L.R.C.P., 

Physician  to  the  City  Hospital  for  Diseases  of  the  Skin  and  Cancer, 
DubUn. 

In  December,  1902,  I  had  the  honour  of  reading  a 
paper  before  this  Academy  on  a  year's  experience  of 


(a)  Read  before  the  Section  of  Medicine  in  the  Boyal  Academy  of 
Medicine  in  Ireland.  Friday,  May  13th,  1V04.I 

C 


140    Thb  Medical  Pm»8, 


ORIGINAL  COMMUNICATIONS. 


August  io,  1904. 


the  light  treatment  in  which  I  described  my  method 
of  applying  both  the  Finsen  light  and  X-rays, 
discussing  in  brief  the  conditions  in  each  case  which 
appeared  to  me  favourable  to  the  adoption  of  one  or 
other  or  both  the  methods.  I  found  it  difficult  then, 
and  it  would  be  much  more  difficult  now.  to  discuss 
either  method  separately,  for  in  the  general  routine  of 
hospital  non-selected  cases  the  two  methods  of  treat- 
ment markedly  overlap,  and  with  best  results. 

Times  beyond  count  the  physician  is  confronted  with 
the  crux  in  this  new  case,  Which  method  should  he 
employ — the  Finsen  light  or  X-rays  ?  and  frequently  the 
question  founded  on  experience  irresistibly  suggests  the 
answer  "  use  both."  In  all  such  cases  (and  they  are 
many,  especially  in  lupus),  needless  to  say  sentiment 
and  hero-worship  must  be  suppressed  and  the  best 
method,  or  a  combination  of  the  best  methods,  only 
employed  in  the  interest  of  humanity.  In  the  dis- 
cussion that  ensued  on  that  paper  it  was  suggested  that 
I  should  again  bring  forward  the  cases  then  exhibited, 
and  in  compliance  with  that  suggestion  I  have  the 
honour  of  now  submitting  for  your  inspection  a  few 
who  were  within  easy  reach,  while  holding  written 
replies  of  a  reassuring  nature  from  most  of  those  who 
have  retumedto  the  provinces,  where  they  are  at  present 
pursuing  their  avocations  on  terms  of  equality  with  other 
members  of  the  community,  some  after  a  lapse  of 
twenty-eight  years. 

Case  I. — A  girl,  xt.  24.  Condition  on  admission  to  the 
Skin  HospitalinMay.  1902 :  She  presented  an  extensive, 
yellowish,  dark  incrustation,  involving  the  alae  nasi,  tip 
and  bridge  of  nose,  the  prominences  of  both  cheeks  and 
greater  part  of  upper  lip,  the  nasal  cavity  being  much 
encroached  upon  by  lupoid  vegetation.  The  lupus 
was  of  four  years'  standing.  She  had  been  operated 
upon  four  times  under  chloroform  prior  to  her  admission 
to  the  light  treatment.  She  received  the  Finsen  light 
to  the  face  and  X-ray  exposures  to  the  nose. 

Case  II. — A  girl,  aet.  31.  Condition  on  admission 
to  the  Skin  Hospital  in  December.  1901 :  The  lupus  had 
involved  both  cheeks  with  considerable  destruction  of 
the  alae  nasi  and  septum ;  connecting  the  patches  on  both 
cheeks  a  band  of  ulceration,  horseshoe  in  shape,  was 
perceptible,  involving  the  greater  part  of  the  bridge  of 
nose.  The  disease  was  of  sixteen  years'  standing  and 
had  been  surgically  treated  twelve  times  before  her 
admission  to  the  light  treatment,  which  included  both 
the  Finsen  light  to  the  face  and  X-rays  to  the  nose. 

Case  III. — A  girl,  set.  21.  Condition  on  admission  to 
the  Skin  Hospital  in  April.  1902  :  She  presented  a  small, 
well-defined  ulcer  involving  right  ala  nasi,  and  extend- 
ing up  right  nasal  cavity,  the  mucous  membrane  of 
which  was  swollen,  granular,  and  bled  easily.  The  lupus 
was  of  five  years'  standing,  and  had  been  operated  on  four 
times  under  an  anaesthetic  prior  to  her  admission  to  the 
light  ireatment.  She  received  ]x)th  the  Finsen  light 
and  the  X-rays. 

Case  IV. — A  boy,  aet.  1 3.  Condition  on  admission  to 
Skin  Hospital,  December.  190 1 :  He  presented  a  circular 
ulcer  something  larger  than  one  shilling  situated  on  left 
cheek ;  the  edges  of  ulcer  were  infiltrated  and  its  base 
contained  typical  ^pple-jelly  nodules.  The  disease  was 
of  nine  years'  duration  and  had  been  surgically  operated 
upon  under  anaesthetics  six  times  before  his  admission 
to  the  light  treatment — he  received  the  Finsen  light 
only. 

Memo. — Of  the  foregoing  cases  presented  to  you  for 
re-examination  this  evening,  and  whose  histories  were 
given  in  greater  detail,  with  illustrations,  in  my 
former  paper,  no  treatment  has  been  given  for  nearly  a 
year  with  the  exception  of  Case  I,  in  whom  the  disease 
recurred  in  the  mucous  membrane  of  nose  and  to 
whom  the  high  frequency  current  is  at  present  being 
applied. 

The  foregoing  resum^  of  the  light  treatment 
brings  me  to  the  subject  of  my  paper  to-night — radium, 
the  latest  therapeutic  remedy  upon  which  medical 
science  has  been  called  on  to  adjudicate.  This  remedy 
has  already  received  so  much  notoriety  in  the  lay  press 
that  I  consider  it  both  opportune  and  necessary  that  its 
therapeutic  results  should  be  -ecorded  at  once  with 


accuracy  by  operators  who  have  tried  it,  and  who* 
method  of  procedure  has  been  open  to  the  inspectioo 
and  investigation  of  the  profession.  Thus  we  spare 
public  feeling  the  pain  of  disappointment  so  often  the 
outcome  of  sensational  exaggeration,  while  at  the  same 
time  safeguarding  from  disfavour  and  probably  disuse 
a  method  I  believe  we  are  justified  in  assuming  is  potent 
of  promise. 

I  shall  not  tire  you  with  the  history  which  led  to 
the  discovery  of  radium,  with  which  the  names  of 
Madame  and  Monsieur  Curie  are  so  inseparably  asso- 
ciated ;  but  what  appears  to  me  the  most  chau-acter- 
istic  feature  associated  with  it,  andwithmostof  thegreat 
discoveries  of  our  own  times,  is  the  sequence  with  which 
the  one  led  up  to  and  followed  the  other,  compeUing^ 
Nature,  as  it  were,  to  divulge  her  secrets,  while  at  the 
same  time  serving  as  finger-posts  to  future  research. 

In  1882  Koch  discovered  the  cause  of  consumption, 
and  eight  years  later  he  declared  he  had  found  its  cure 
by  injecting  tuberculin. 

In  1894  Finsen,  after  years  of  patient  experiment, 
proclaimed  that  by  concentrating  certain  rays  of  the 
solar  spectrum  he  could  kill  the  bacillus  which  Koch 
had  found,  but  failed  to  conquer. 

In  1895  R5ntgen  convulsed  all  Germany,  and.  indeed, 
the  scientific  world  generally,  by  his  statement  that  he 
had  discovered  rays  which  could  render  the  human 
body  transparent. 

In  1896  Becquerel  discovered  that  uranium  emitted 
rays  akin  to  the  Rontgen  rays,  but  weaker,  and  it  was 
doubtless  this  important  link  in  that  chain  which  led 
to  the  discovery  of  radium  by  the  Curies  two  years 
later. 

I  shall  not  dwell  on  the  physical  or  chemical  proper- 
ties of  this  great  metal,  excepting  so  far  as  they  apply  to 
practical  medicine.  The  power  possessed  by  raidium 
of  emitting  rays  which  manifest  different  penetrative 
and  therapeutic  effects  is  the  one  property  of  all  others 
which  most  strongly  appeals  to  the  physician.  Whether 
or  not  these  rays  are  identical  with  X-rays  is  a  matter 
upon  which  much  diversity  of  opinion  at  present  exists. 
I  am  indebted  to  Dr.  Reginald  Morton  for  a  copy  of 
a  paper  kindly  sent  me,  in  which  he  discusses  this  difficult 
and  important  question  most  clearly  and  concisely. 

An  approximate  knowledge  of  the  penetrative  power 
of  radium  rays  may  be  obtained  oy  the  ordinary 
X-ray  screen  in  a  dark  room.  With  my  own  specimen 
of  5  milligrammes,  all  I  could  possibly  procure  last  Sep- 
tember of  a  trustworthy  standard,  this  specimen  when 
held  half  an  inch  behind  a  bar  of  metal,  i  j^  inch  thick 
caused  distinct  fluorescence  of  the  ordinairy  X-ray 
screen,  and  when  held  at  a  distance  of  three  or  foar 
inches  behind  the  screen,  and  thel  hand  interposed 
between  the  radium  and  screen,  the  general  contour  of 
the  hand  becomes  manifest  but  to  a  much  lesser  extent 
than  in  the  case  of  X-rays.  These  experiments  are 
not  only  interesting,  but  easy  to  make. 

Unfortunately  the  supply  of  radium  is  so  limited 
that  even  in  the  out-patient  departments  of  large  slds 
cliniques  much  difficulty  is  experienced  in  procuring 
suitable  cases  for  this  method  of  procedure.  Hence 
operators  are  precluded  even  now  from  dogmatising 
on  its  therapeutic  merits. 

The  method  and  duration  of  its  application  were 
additional   difficulties   which    early   workers    had  tc^ 
encounter,   and   the  difficulty  in   definitely    fixing  a 
period  of  application  which  will  apply  equally  to  aB  is 
well  illustrated  in  the  history  of  my  cases  given  below. 
Where  different  patients  with  like  disease,  similarly 
situated,  had  the  same  specimen  of  radium  applied 
under  like  conditions  to  patches  of  lupus  of  equal 
size  and  depth,  neither  of  which  were  previously  treated, 
in  the  one  case  twenty  applications  of   ten    minutes' 
duration  were  sufficient  to  establish  a  cure,  while  in 
the  other  twenty  applications  of  ten  minutes'  duratioo 
were  insufficient  to  create   any  alteration,  excepting 
slight  redness  and  itching.      It  may  be  that  personal 
susceptibility  of  patient,  so  important  a  factor  in  the 
Finsen  light  and  X-ray  methods,  may  also  have  to  be 
reckoned  with  in  the  treatment  by  radium  ravs. 
Case  I. — A  male,  aet.  30,  unmarried,  clerk,  has  beea 


August  io,  1904. 


ORIGINAL  COMMUNICATIONS. 


Tbx  Medical  Pkbss.    141 


the  subject  of  extensive  lupus  of  the  lace  for  twenty 
years,  during  which  time  he  has  been  applying  nitrate  of 
silver  and  other  caustics  weekly,  and  has  had  it  scraped 
under  an  anaesthetic  seven  times.  He  is  at  present 
receiving  both  the  Finsen  light  and  X-rays,  and  is 
steadily  yielding  to  this  course.  About  two  years  ago 
he  developed  a  patch  the  size  of  a  sixpenny  piece  over 
right  eye-brow,  close  to  the  orbital  margin  and  inner 
angle  of  the  orbit.  The  patch  was  circular  in  shape, 
with  irregular  edges,  which  were  slightly  raised  above 
surrounding  skin,  and  capped  with  a  yellowish  crust 
in  centre.  The  position  at  once  suggested  treatment 
by  radium  because  of  the  extreme  difficulty  of  applying 
cither  the  Finsen  light  or  X-rays. 

On  December  i6th,  1903.  having  removed  the  crust, 
I  applied  in  close  apposition  with  the  patch  five 
milligrammes  of  radium  bromide  in  a  vulcanite  capsule, 
with  a  circular  window  of  mica,  for  easy  transmission 
of  the  radium  rays. 

From  December  i6th,  1903.  to  February  10th,  1904, 
he  had  in  all  twenty  applications  of  ten  minutes' duration. 
Nothing  perceptible  had  occurred  in  the  progress  of  the 
case  until  the  end  of  the  fifth  week,  when  the  edges 
of  patdi  became  more  prominent,  slightly  redder  and 
an  itchy  sensation  was  complained  of,  with  a  slight  dis- 
charge from  the  patch  for  the  first  time.  The  further 
treatment  was  persisted  in  and  five  additional  applica- 
tions given,  of  the  usual  duration  and  at  intervals  as 
before. 

On  February  loth,  the  date  of  last  application,  the 
edges  of  patch  were  more  swollen  and  redder,  and 
although  the  itching  had  practically  ceased,  the 
patient  complained  of  stiffness  of  the  muscles,  which 
became  more  manifest  on  wrinkling  the  brow.  The 
discharge  referred  to  before  meantime  increased. 
The  treatment  was  now  stopped,  swelling  and  dis- 
charge subsided,  and  three  weeks  later  the  patch, 
although  still  red,  had  assumed  the  appeiorance  of  a 
healthy  scar  ;  no  external  applications  of  any  kind  were 
applied  prior  to,  during,  or  since  the  treatment  above 
described. 

Case  II. — A  girl,  aet.  16,  was  admitted  to  the  Skin 
Hospital,  December  2  ist,  1903,  suffering  for  about  seven 
years  iit>m  a  patch  of  lupus,  the  size  of  a  sixpenny  piece, 
of  a  reddish  colour,  with  raised  edges  covered  with 
branny  scales.  Patient  suffered  no  pain ;  she  sought 
treatment  only  because  she  thought  it  was  begin- 
ning to  spread  and  becoming  more  unsightly.  On 
December  21st,  1903,  five  milligrammes  of  radium 
bromide  were  applied  in  direct  contact  with  patch, 
there  being  no  discharge  from  sore  in  this  as  in  the 
former  case  which  could  in  any  way  diminish  the  radio- 
activity of  specimen  employed.  Between  December 
2ist,  1903,  and  March  i8th,  1904,  sixty-one  applica- 
tions were  given. 

First  month,  five  applications  weekly  of  ten  minutes' 
duration  without  manifesting  any  visible  change, 
excepting  a  slight  redness. 

Second  month,  twenty  applications  of  thirty  minutes' 
duration  were  given,  the  redness  of  margin  becoming 
more  pronounc^,  accompanied  by  itching  but  no  dis- 
charge. February  13th,  duration  of  appUcation  was 
increased  to  forty-five  minutes,  of  which  fifteen  such 
applications  were  given,  with  the  result  the  edges  of 
patch  became  swollen,  with  the  sensation  of  pins  and 
needles  in  part,  and  a  discharge  on  pressure.  Treat- 
ment was  still  continued  and  six  further  applications 
were  given  of  sixty  minutes  each,  the  last  on  March 
1 8  th,  when  the  treatment  was  stopped.  A  week  later 
the  pain,  swelling,  and  discharge  had  diminished. 
The  base  of  ulcer  was  clean  and  healthy-looking,  but 
the  edges  somewhat  raised. 

No  treatment  or  external  applications  of  any  kind 
were  applied  prior  to,  during,  or  since  the  treatment 
mentioned. 

CoNciuDiNG  Remarks. 
Radium,  to  be  of  practical  use  in  the  cure  of  disease 
or  the  alleviation  of  human  suffering,  must  be  forthcom- 
ing in  much  larger  quantities,  of  a  recognised  standard 
of  activity  and  at  a  very  much  cheaper  rate. 


From  my  own  experience  of  the  metal.  I  prefer  detail- 
ing what  I  have  already  achieved  and  how  I  achieved 
it.  rather  than  expressing  an  opinion  on  its  merits  which 
might  in  any  way  circumscribe  its  sphere  of  application 
or  prevent  others  from  putting  it  to  the  test. 

For  diagnostic  purposes  it  is  very  doubtful  if  radium 
can  ever  be  of  much  use.  With  the  X-rays  we  have 
much  ground  for  hope  in  both  lupus  and  rodent 
ulcer,  and  combined  with  Finsen  light  the  results 
recorded  are  becoming  more  universal  and  more  re- 
assuring. 

In  my  previous  paper  I  expressed  the  belief  that  the 
Finsen  light  for  circumscribed  superficial  lupus  had 
no  equal ;  now,  after  eighteen  months  further  experi- 
ence, I  am  more  convinced  than  ever  of  its  efficacy.  But 
it  will  be  for  you,ladiesand  gentlemen,  to  say  whether  or 
not  I  have  claimed  for  the  method  more  than  my  results 
justify. 


NEW 

METHODS  OF  TREATMENT,  (a) 

(i)  SCROFULOUS  FISTULA ;  (2)  SCROFU- 
LOUS GLANDS  ;  (3)  ANAEMIA  AND  CHLO- 
ROSIS ;  (4^  SPASMODIC  CONVULSIVE  AF- 
FECTIONS. 

By   LUCIEN    WEYLL     M.D.. 
Bftd-EchwalKach. 

For  all  affections  of  the  external  organs  or  affec- 
tions accessible  to  external  treatment,  permanent 
local  baths  are  of  indisputable  value. 

(1)  For  many  years  surgical  and  gynaecological 
affections  have  been  treated  successfully  by  this 
method  ;  there  is  only  one  affection  for  which 
this  treatment  is  not  yet  sufficiently  recognised, 
that  of  open  scrofulous  glands.  A  great  number 
of  these  glands  treated  by  this  method  have, 
unr'er  my  rare,  cicatrised  in  a  short  time. 

Submaxillary  glands  open  for  about  one  and  a 
half  years  (although  already  operated  on)  were 
radically  cured  within  a  fortnight. 

Sublingual  glands,  running  for  several  months 
too.  healed  within  a  short  time. 

The  local  baths  were  taken  hot  (temperature 
about  S6°  F.),  one  to  two  hours,  with  a  minimum 
of  subhmate,  so  that  the  concentration  was  of 
1-100,000. 

(2)  For  closed  scrofulous  glands  I  recommended 
at  the  Congress,  as  I  had  done  before  in  the 
Therapeut.  Mnnatss,  of  i960  vaporised  siibh- 
mate  inhalations;  concentration,  1-100,000  (the 
limit  of  antiseptic  effect  of  sublimate  being 
1-500,000). 

(i)  Submaxillary  gland,  walnut  size,  inhalation 
of  sublimate  vapours  three  times  a  day  for  half  an 
hour.     Within  six  weeks  radically  reduced. 

(ii)  Submaxillary  glands  on  either  side,  walnut 
size.     Within  two  months  almost  entirely  re  luced. 

(iii)  Sublingual  gland,  walnut  size,  reduced  after 
a  fortnight's  treatment. 

Glands  of  greater  dimensions  are,  of  course, 
not  so  easy  to  reduce,  the  most  susceptible  to 
this  kind  of  treatment  being  the  soft  and  small 
ones  of  children ;  if  particularly  obstinate  they 
may  be  made  to  suppurate,  and  then  treated  by  the 
method  of  bathing  mentioned  before. 

What  concerns  sublimate  vapours  inhalation 
in  cases  of  initial  catarrhal  affection  of  lungs  ?  (See 
my  article  on  this  subject,  Therap,  Monatss,, 
\rcoi,  v.  Liebreich.)  Sublimate  i- 100.000,  not 
pulverised  but  vapourised,  and  so  entering  into 
the  finest  branches,  will  be  found  to  be  a  really 


(a)  Oonter  Oooffren  of  Intera.  Medicine,  L9ipKic,  1001. 


142    Thb  Medical  Pibss.         ORIGINAL  COMMUNICATIONS. 


rational   method,    the   antiseptic  effect  here  not 
being  diminished  by  the  circulation. 

(3)  Subcutaneous  injections  of  ferrum  lacticum 
(i  per  cent.)  in  cases  of  obstinate  anaemia  or 
chlorosis. 

(i)  Anaemic  girl,  aet.  20,  treated  for  six 
months  with  internal  ferruginous  medicaments, 
without  success ;  after  ten  injections  red-coloured 
cheeks. 

(ii)  Lady,  aet.  25  ;  very  anaemic  ;  ferruginous 
medicaments  and  water  useless  ;  after  twenty  in- 
jections coloured  cheeks,  &c. 

Injections  being  sometimes  painful,  they  ought 
to  be  mixed  with  cocaine. 

(4)  Spasmodic  corvulsive  affections,  by  which 
I  mean  choleUthiasis,  asthma,  epilepsy,  and 
whooping-cough ;  1  hough  these  affections  do 
not  seem  to  have  anything  in  common, 
being  different  in  their  origin,  asthma  and 
epilepsy  sometimes  breaking  out  without 
any  organic  cause,  while  cholelithiasis  and  whoop- 
ing-cough are  occasioned  by  grave  organic 
or  infectious  alterations,  yet  finally  they  reveal 
themselves  as  an  expression  of  cerebral  irritation, 
whooping-cough,  asthma  and  cholelithiasis 
attacking  the  deeper  vagus  regions,  whi!st  epilepsy 
is  more  concerned  with  the  superficial  motor  centres. 


SOME  OBSERVATIONS 

ON  THE  MODE  OF 

ORIGIN  OF  NASAL   POLYPI,  {a) 

By  EUGENE  S.  YONGE.  M.D.Edin., 

Honorary  Aatistant  Phyficisii,  Xuiohester  Hospital  for  OoniDm|>- 
tion  and  Dismaes  of  the  ThroAt. 

The  central  idea,  in  this  investigation,  was  to 
endeavour  to  find  some  of  the  processes  which 
immediately  preceded  polypus  formation,  and 
to  trace  the  progression  of  the  disease  from  normal 
mucousmembrane  up  to  the  fully- formed  "  growth.'* 
Observations  were  made  both  on  the  cadaver  and 
on  specimens  obtained  from  clinical  cases. 

The  cases  from  which  specimens  were  ob- 
tained for  microscopic  examination,  or  which 
were  otherwise  investigated,  may  be  divided  as 
follows  : — 

1.  Cases  in  which,  the  Nasal  Tissues  were  not 
Diseased, — Obtained  post-mortem.  Foetus,  in- 
fant, young  adult,  &c.  Also  mucous  membrane 
from  all  the  accessory  sinuses. 

2.  A  Case  of  Early  Nasal  Polypus.— ^o  acces- 
sory sinus  disease.     Obtained  post-mortem. 

The  outer  walls  of  both  nasal  cavities  were 
examined,  and  a  number  of  sections  were  cut  in 
successive  antero-posterior  planes. 

There  was  a  condition  of  chronic  inflammation 
of  the  various  turbinal  and  meatal  tissues,  with 
the  exception  of  the  inferior  meatus,  which  was 
practically  normal.  The  mechanical  process  of 
polypus  formation  could  apparently  be  traced 
from  smooth  (non-polypoid)  mucous  membrane 
to  structures  which  showed  the  characteristics 
of  ordinary  mucous  polypi.  The  tissues  were 
oedematous  in  the  areas  generally  selected  by 
mucous  polypi  for  their  site  of  origin,  and  the 
vast  majority  of  the  mucous  glands  were  degenerate 
and  dilated.  Other  appearances,  such  as  enor- 
mously thickened  vessels  in  the  middle  and  in- 
ferior turbinal  regions,  were  also  noted. 

It  was  further  observed  that  polypi  appear  to 

(•)  Bead  at  the  Annual  Meeting  of  the  British  Medical  Ataooiaftion, 
held  at  Ozfoid,  July,  1904. 


August  10,  1904. 

owe  their  shape,  their  number,  and  other  charac- 
teristics principally  to  the  manner  of  the  initial 
process  of  their  formation— t;i>.,  oedema  of  the 
mucous  membrane  of  the  part  affected,  which,  in  a 
normal  condition,  is  folded.  These  folds,  when 
cedematous — that  is  to  say,  when  sharing  in 
the  general  cedema  of  the  mucous  membrane— 
gradually  assume  the  appearance  of  blunt,  finger- 
like processes  which  correspond  in  structure  to 
incipient  mucous  polypi. 

3.  Clinical  Cases  of  Nasal  Polypus,  at  various 
stages,  in  which  certain  of  the  tissues  were  ex- 
amined. 

These  included  (a)  polypi  associated  with  acces- 
sory sinus  suppuration  ;  (b)  polypi  not  so  asso- 
ciated ;  (c)  tumours  having  a  similar  macroscopic 
structure  to  the  usual  mucous  polypi,  but  grow- 
ing from  the  inferior  turbinal. 

The  groups  (a)  and  (b)  seemed  to  have  a  simOar 
mode  of  origin.  Cystic  degeneration  of  the  glands 
was  more  marked  in  the  sinus  polypi  than  in  the 
other  variety,  whilst  simple  fatty  degeneration  was 
observed  in  both.  The  inferior  turbinal  polypus 
differed  from  the  middle  turbinal  and  meatal 
pol3rpus  in  the  same  manner  as  the  histological 
structures  of  the  parts  differed  from  each  other, 
so  that  the  former  variety  was  composed  of  a 
much  firmer,  thicker  and  denser  tissue.  Dilated 
glands  were  observed  in  both. 

4.  Cases  of  Chronic  Inflammatory  Conditions 
of  the  Nose  unattended  by  Polypus. — Chronic 
catarrhal  rhinitis  may  be  taken  as  a  type.  The 
conditions  observed  in  the  middle  turbinal  and 
meatal  regions — which  may  be  regarded  as  the 
usual  sites  of  polypi — differed  from  the  appearances 
seen  in  the  same  regions  when  polypi  were  present 
in  an  early  stage,  chiefly  in  the  following  particu- 
lars : — 

(i)  A  mucous  membrane  which,  especially  in 
its  superficial  (sub-epithelial)  layer,  was  not  oede- 
matous. 

(ii)  Active  glands  as  opposed  to  degenerated 
and  dilated  glands.  In  a  few  instances,cloudy  swell- 
ing was  noted  in  a  few  glands  in  the  section, 
but  usually  they  were  normal. 

On  the  other  hand,  the  instances  of  chronic 
catarrhal  rhinitis  resembled  those  of  polypus,  is 
all  the  signs  of  chronic  inflammation,  and,  so  far 
as  the  writer  could  judge,  in  every  other  condition 
except  in  the  two  respects  noted  above. 

5.  A  Case  of  Chronic  Atrophic  Rhinitis, — Ob- 
tained post-mortem. 

6.  Instances  of  **  Polypus  "  in  other  Parts  of 
the  Body  (stomach,  uterus,  rectum,  and  middle 
ear). — The  writer's  observations  seem  to  point 
to  the  conclusion  that  the  excrescences  which  are 
found  in  the  stomach,  in  the  rectum,  and  in  the 
middle  ear,  and  which  are  generally  classed 
as  "  polypi,"  have  one  point — the  name — and 
occasionally  a  second — the  shape — in  common 
with  nasal  polypi,  but  that  otherwise  they 
differ  radically  from  the  growths  found  in  the  nose. 
In  polypus  of  the  cervical  portion  of  the  uterus, 
however,  there  is  a  close  resemblance  in  structure 
to  the  corresponding  condition  in  the  middle 
turbinal  region,  except  that  in  the  former  the 
tissues  are  somewhat  less  cedematous  than  in  the 
latter. 

Aural  polypi  are  composed  in  every  instance  of 
ordinary  or,  later,  of  organised  granulation  tissue 
(Lake) ;     and    their    structure    is,    consequently, 


August  io,  1904. 


CLINICAL  RECORDS. 


Tbs  Medical  Puss.     143 


fundamentally  different  from  nasal  mucous  polypi, 
properly  so  called. 

Provisional  Conclusions. 
As  a  result  of  his  observations,  the  writer  sug- 
gests the  following  conclusions  : — 

1.  Mucous  polypi  of  the  nose,  in  the  large  ma- 
jority of  instances,  are  consequent  upon  inflamma- 
tion of  the  mucous  membrane  of  the  nasal  cavity. 

2.  The  process  of  polypus  formation  is  partly 
mechanical  and  partly  degenerative. 

3.  The  primary  process  is  a  localised  oedema 
of  the  inflamed  mucous  membrane,  which  oedema, 
chiefly  on  account  of  certain  known  structural 
peculiarities  of  the  lining  membrane,  does  not, 
in  the  greater  number  of  cases,  occur  in  any  intra- 
nasal area,  but  that  of  a  Hmited  portion  of  the 
middle  turbinal  and  of  the  middle  meatal  re- 
gions. Analogous  structural  pecuUarities  are 
present  in  the  mucous  membrane  of  some  of  the 
accessory   tissues. 

4.  The  determining  cause  of  the  occurrence  of 
the  oedema,  in  the  regions  specified,  is  the  de- 
generation and  dilatation  of  the  mucous  glands. 
The  following  evidence  appears  to  be  in  favour  of 
this :  (i)  The  abundance  of  degenerated  and 
dilated  glands  in  the  mucous  membrane  sub- 
jacent to  and  in  the  immediate  neighbourhood 
of  ]X)lypi.  (ii)  The  definite  and  proportionate 
ratio  between  the  amount  of  glandular  degenera- 
tion and  the  amount  of  oedema,  (iii)  The  presence 
of  abrupt  and  isolated  patches  of  oedema,  which 
exactly  correspond  with  isolated  groups  of  under- 
lying degenerated  glands,  (iv)  The  presence  (in 
some  sections  showing  two  surfaces  of  a  turbinal) 
of  oedema  on  one  side  and  firm  non-oedematous 
tissue  on  the  other — the  cedematous  side  being 
supplied  with  degenerated  glands  and  the  firm 
tissue  with  active  glands,  (v)  The  absence  of 
oedema  (a)  when  the  glands  are  healthy  and,  gener- 
ally speaking,  in  the  areas  where  there  are  no  glands 
present ;  (b)  in  cases  of  chronic  rhinitis  where  the 
glands  are  not  degenerated,  (vi)  The  concurrence  of 
this  sign  in  both  varieties  of  polypus  ("  sinus  "  and 
"  non-sinus  "  polypus),  (vii)  Lastly,  the  possibility 
of  explaining  the  oedema,  on  the  hypothesis  of 
these  glandular  changes,  on  account  of  the  peculiar 
arrangement  of  the  glandular  blood-vessels,  com- 
bined with  the  peculiar  histological  disposition 
of  the  tissues  in  which  the  glands  of  the  "  polypus 
regions  "  lie. 

5.  The  peculiar  shape  and  some  other  charac- 
teristics which  polypi  assume  is  due  to  their 
mechanical  inception  as  oedema  of  the  normal 
folds  of  the  mucous  membrane. 


THE    CARE   OF   CHILDREN'S 
MOUTHS,  ia) 

By  SIDNEY  SPOKES,  M.R.C.S.,  L.D.S. 
An  examination  of  io,oco  children  of  an  average 
age  of  twelve  years  showed  that  only  1 5  per  cent, 
had  sound  tfeeth.  Dental  caries  must  be  regarded 
as  the  most  frequent  departure  from  the  normal 
physiological  standard.  Periodical  inspection  and 
early  treatment  are  the  best  methods  in  default 
of  absolute  prophylaxis.  Especially  should  the 
first  permanent  molars  receive  attention.  They 
are  situated  in  the  jaws  where  the  fimctional 
capacity  is  greatest.  They  "  keep  up  the  bite  " 
at  the  back  of  the  mouth  during  the  transitional 

(a)  Alstrmct  of  Paper  retd  in  Section  of  Dental  Surgery,  British 
Medical  Aaaooiation,  Oxford.  July,  1901. 


period  from  the  temporary  to  the  permanent 
dentition  and  should  be  carefully  watched  from 
the  seventh  year  upwards.  It  is  rare  to  find  caries 
of  the  other  perma-.ent  teeth  before  the  twelfth 
year.  A  periodical  inspection  also  allows  of  the 
opportunity  for  observing  any  commencing 
irregularity  in  position  which  itself  threatens  to 
promote  decay,  and  it  also  enables  an  opinion  to 
be  formed  as  to  the  extent  to  which  the  tooth-brush 
is  properly  used.  In  many  parochial  schools  this 
system  of  inspection  and  early  treatment  is  now 
carried  out  with  good  results,  and  as  it  appears 
probable  that  Board  School  children  will  soon  be 
medically  inspected,  it  is  to  be  hoped  that  they 
may  also  receive  dental  supervision,  and  in  this 
respect  enjoy  the  same  advantages  as  the  children 
immediately  beneath  them  in  the  social  scale. 
Boys  in  the  great  public  schools  should  pay  a  visit 
to  the  dentist  early  in  the  hoUdays  in  order  to  allow 
sufficient  time  for  any  treatment  which  may  be 
found  necessary,  but  it  is  well  that  there  should 
also  be  an  officially  appointed  dental  surgeon  on 
the  staff  of  all  such  schools  to  examine  and  report 
upon  the  teeth  of  new  arrivals  and  to  deal  with 
any  cases  which  may  occur  through  neglect  and 
urgency.  This  prompt  treatment  of  early  caries 
prevents  a  vicious  circle  being  established  through 
the  increased  acidity  of  the  mouth  which  accom- 
panies untreated  cavities  of  decay  and  thus  pro- 
motes decay  in  other  teeth  as  yet  unaffected. 
Here  again,  it  is  most  important  that  cavities,  if 
existing,  should  be  discovered  and  treated  in  the 
early  stage.  If  a  tooth  has  "  ached  "  through 
irritation  of  its  pulp  the  best  time  for  stopping  iS» 
cavity  has  already  passed,  but  by  prompt  treat- 
ment and  systematic  inspections  until  adult  age  is 
reached  it  vrill  be  found  that  the  tendency  to  decay 
seems  in  many  instances  to  become  considerably 
less. 


Clfntcal  1lecot&0» 


CASES  IN  HOSPITAL  PRACTICE. 

By  John  W.  Martin,  M.D., 
Hob.  Medical  Officer,  Jassop  Hospital  for  Women,  Sheffield. 

Bad  Hamorrhoids. — Severe  Bleeding  with  and  between 
Motions. — Retroflexed  and  Retroverted  Uterus. — 
Both  Ovaries  enlarged,  cystic  ;  prolapsed, — Opera- 
tion.— Recovery. 

C.  H.,  St.  37,  married,  four  children,  the  last  set.  4. 
Notes  taken  May  24th,  1904. — ^This  patient  first  came 
under  my  notice  in  the  autumn  of  1903,  when  she  was 
suffering  severely  from  piles  and  a  constant  loss  of 
blood  with  and  between  the  motions.  She  was  worn 
to  a  shadow  and  very  anaemic.  She  had  seen  no 
periods  for  four  years.  I  operated  upon  the  piles  with 
clamp  and  cautery,  and  she  made  a  good  recovery,  the 
operation  being  successful  for  the  object  in  view. 

She  had  then  retroflexion  of  the  uterus,  and  both 
ovaries  were  enlarged  and  prolapsed.  The  rest  in 
hospital  whilst  under  treatment  for  the  piles  seemed 
to  reUeve  her  of  a  good  deal  of  her  pelvic  troubles, 
pain  in  the  back  and  iliac  regions. 

She  again  came  under  my  care  in  the  early  part  of 
May,  and  was  admitted  into  hospital.  She  could  not 
wear  the  pessaries  with  which  an  attempt  was  made 
to  retain  the  uterus  in  its  proper  position.  There  was 
both  retroflexion  and  retroversion  present.  The 
ovaries  were  both  much  enlarged  and  prolapsed,  and 
very  tender  to  pressure.  Suffering  a  good  deal  from 
pain  in  the  lumbar,  h3rpogastric,  and  iliac  regions. 
The  pains  extended  down  the  legs.  She  had  suffered 
a  good  deal  from  diarrhoea  before  she  came  in,  but  the 
bowels  became  constipated  after  admission.  Her 
general  health  was  very  poor. 


144     '^^B  Medical  Press. 


FRANCE. 


As  she  could  not  wear  an  instrument,  and  as  treat- 
ment had  been  tried  for  some  time  before  admission. 
I  operated  on  Friday,  May  27th,  1904.  I  found 
both  ovaries  very  much  enlarged  and  cystic,  and  re- 
moved them.  I  did  a  ventro-fixation.  The  patient 
made  an  uneventful  recovery. 

July  20th,  1904. — I  saw  the  patient  to-day.  She  is 
looking  much  stronger  and  better.  She  is  putting  on 
flesh.  She  is  quite  free  from  pain,  and  feels  cheerful 
and  active,  and  says  that  it  is  years  since  she  felt  so 
well. 


Xritteb  Dealtb  IResotte. 

v.— TEIGNMOUTH. 


[by    our    special    medical  commissioner.] 

Teignmouth  is  "  the  first  of  the  true  West  Country 
ports."  (a)  It  is  admirably  situated  at  the  junction 
of  the  picturesque  estuary  of  the  River  Teign  with  the 
English  Channel.  The  greater  part  of  this  attractive 
little  town,  of  8,540  inhabitants  lies  open  on  the  east 
to  the  sea.  On  the  north  and  north-west  it  is  sheltered 
by  the  heights  of  Haldon.  It  is  well  equipped  with 
sea  coast  promenade,  pier,  lawns  and  walks.  Not 
only  is  it  linked  to  the  past  (6)  by  memorable  asso- 
ciations, but  forms  a  delightful  centre  for  the  require- 
ments of  the  present,  {c) 

Dr.  F.  Cecil  H.  Piggott,  the  present  M.O.H.,  has 
furnished  us  with  valuable  detsuls  concerning  much 
that  makes  for  the  well-being  of  the  health  seeker. 
The  birth-rate  is  15*5  ;  the  net  death-rate  17*08, 
but  allowing  for  the  mortality  of  non-residents  is  only 
1 5 '45  ;  the  zymotic  death-rate  is  0*58  ;  the  infantile 
death-rate,  however,  is  127*82.  The  water  supply 
until  recently  has  been  "  intermittent  and  somewhat 
h'mited."  {d) 

An  agreement  has  now  been  arrived  at  with  the 
Paignton  U.D.C.,  whereby  a  constant  supply  of  pure 
water  will  be  brought  from  Dartmoor,  Eftorts  ar^ 
being  made  to  secure  a  greater  degree  of  purity  of 
the  Teign  estuary. 

The  meteorological  returns  throw  much  light  on 
climatic  conditions.  The  mean  temperature  of  the 
past  year  was  51*5  ;  the  mean  temperature  for  the 
past  thirty  years,  as  taken  from  the  records  of  Dr. 
W.  C.  Lake,  was  50*6 ;  the  maximum  temperature 
was  77*1  ;  the  minimum  26*0  ;  the  rain  fall  for  1903 
was  40*07  inches,  but  eighteen  years'  average  is  given 
as  34*8,  with  156  as  the  number  of  wet  d^ys. 

Teignmouth  is  a  particularly  desirable  holiday 
resort.  It  offers  opportunities  for  excellent  and  safe 
bathing,  boating,  fishing,  and  the  usual  delights  of  a 
marine  residence.  It  is  a  remarkably  convenient 
centre  for  railway,  steamer,  driving  and  walking 
excursions.  The  proximity  to  the  bracing  highlands 
of  Dartmoor  should  be  remembered.  Access  to 
Torquay  and  other  well-known  Devon  resorts  is  easy, 
and  the  Dart  can  be  readily  reached,  (e) 

It  will  be  seen  that  Teignmouth,  while  principally 
appealing  to  the  town  dweller  seeking  recuperation  and 
restoration  and  relief  from  the  rush  and  worry  of  a 
wearing  life,  can  also  ofier  much  that  is  desirable  for 
the  convalescent  and  the  invalid.  High,  cold  and- 
dry  east  winds  are  said  to  prevail  in  the  spring,  but 
even  then  protection  can  be  afforded  by  the  sheltered 
"  coombes."  The  hotel  accommodation  is  somewhat 
limited,  but  there  are  numerous  apartments  suited  to 
the  requirements  of  the  health  seeker.  For  cases 
desiring    a    bright,    warm,    picturesque  South  Coast 


August,   10,  1904. 


(a)  **  Highways  and  Byways  in  Devon  and  Cornwall."  By 
Arthur  H.  Norway.    London :  1888. 

(M  '•  Teignmouth :  its  Past  History  and  Present  Interests." 
By  Beatrix  F.  Cresswell.  London :  The  Homeland  Association- 
1901. 

(«)  See  "South  Devon  and  South  Cornwall.'*  By  0.  S. 
Ward  and  M.  J.  B.  Baddeley.  London:  1902.  Black's  "  Guide 
to  Devonshire."    London  :  1886. 

(d)  "The  Climates  and  Baths  of  Great  Britain."  Vol.  i. 
London :  1895. 

(#)  Consult  Devonian  the  official  organ  of  the  Un!ted  Devon 
Association.   July,  190k 


marine  resort  with  opportunities  for  enjoying  touch 
variety  m  out-door  life.  Teignmouth  is  most  suitable, 
in  summer  the  place  is  frequented  by  children  and 
holiday-makers,  and  there  is  much  to  attract  those 
who  need  to  be  "  taken  out  "  of  themselves.  Teign- 
mouth  IS  some  209  miles  from  London.  ComforUble 
through  carriages  run  from  Paddington  on  the  G.  W. 
Kailway  in  about  five  hours.  Access  may  also  be 
had  by  the  L.&  S.  W.  Railway,  Waterloo  to  Exeter,  in 
three  and  a  quarter  hours,  and  thence  over  the  G.  W 
system.  There  are  now  excellent  arrangements 
for  travellers  from  the  North  by  means  of  the  Midland 
and  London  and  North -Western  railway  systems. 


France. 

[from  our  own  correspondent.] 

Pakib,  Aagnsl  7th,  1904. 
Treatment  of  Phlebitis. 
The  treatment  of  phlebitis,  says  Dr.  Huchard,  is  one 
of  the  questions  which  particularly  interests  prac- 
titioners. Death  by  thrombus  is  rather  frequent  in  the 
first  stage,  before  even  the  diagnosis  of  the  afiection 
can  be  made ;  consequently,  it  is  at  this  period  that  rest 
should  be  enjoined.  In  every  woman  recently  con- 
fined, in  every  patient  recov^ng  from  an  infections 
malady,  or  even  outside  these  conditions,  every  pain 
felt,  in  the  inner  part  of  the  thigh,  in  Hunter's  canal 
beneath  Poupart's  ligament,  or  in  the  calf  of  the  leg. 
especially  if  the  pain  is  accompanied  with  a  sensation 
of  weight  and  impotence*  increasing  in  the  nprigfat 
position,  demands  an  attentive  examination  of  the 
principal  venous  trunks  of  the  limb.  The  slightest 
oedema  or  cylindric  induration,  or  even  a  smart  pain 
on  pressure  over  the  course  of  the  vein,  should  make 
the  attendant  suspect  the  existence  of  phlebitis  at  the 
obliterating  period,  and  without  waiting  for  further 
developments  he  should  not  leave  the  patient  before 
placing  the  limb  in  a  position  of  absolute  rest. 

Let  us  suppose  one  of  the  most  ordinary  cases — one 
limb  alone  is  affected.  A  series  of  sufficiently  hard 
cushions  should  be  procured,  with  which  is  formed  a 
perfectly  even  inclined  plane.  A  sheet  doubled  two 
or  three  times  is  placed  on  the  cushions  so  as  to  form 
a  good  splint,  over  which  is  spread  oilskin  or  mackin- 
tosh, and  on  this  a  layer  of  cotton  wool  large  enough  to 
completely  envelop  the  limb.  The  leg  is  laid  gently 
on  this  cotton  and  covering,  and  when  well  enveloped 
a  bandage  is  applied. 

With  this  apparatus,  complete  extension  should  be 
adopted  for  fear  of  subsequent  stiffness  of  the  joints  ; 
the  sole  of  the  foot  should  be  supported  by  a  vertical 
board  and  the  weight  of  the  bedclothes  kept  off  the  toes. 

As  local  treatment,  concentrated  solution  of  hydro- 
chlorate  of  ammonia  as  compresses  has  given  but 
little  result.  It  is  otherwise  with  certain  sedative  oils, 
belladonna,  hyoscyamus,  &c.  They  should  be  renewed 
three  times  a  day  and  covered  with  oilskin. 

As  general  treatment,  the  tincture  of  hamamelis 
virginica,  five  or  six  drops  twice  a  day,  and  continued 
for  months,  will  be  of  some  benefit  and  encourage  the 
patient.  CoUargol  spread  on  as  an  ointment  (15  per 
cent. )  can  be  employed  in  infectious  phlebitis.  Against 
pain  in  phlebitis  of  rheumatic  origin  M.  Oddo  recom- 
mends aspirin  in  doses  of  30  to  40  grs.^laily.  Veronal. 
10  to  12  grs.  at  night,  exercises  a  sedative  action  on 
the  cramps.  Valerianate  of  ammonia  or  the  bromides 
calm  the  nervous  excitement,  and  if  the  oedema  is  ven* 
considerable  salt  should  be  proscribed. 

The  duration  of  the  forced  immobility  depends  on 
the  state  of  the  clot.     From  the  sixth  day  the  clot  is 


August  io,  1904, 


AUSTRIA. 


Tbb  Mbixcal  Pkbss.     ^43 


solidly  attached  to  the  wall  of  the  vein,  but  frequently 
otber  segments  of  the  veins  are  seized,  and  although 
pa.in  be  absent  the  temperature  rises.  Consequently, 
from  the  first  stage  of  phlebitis  the  temperature  should 
be  taken  morning  and  evening,  for  the  slightest  rise  will 
indicate  fresh  trouble.  The  patient  will  not  be  allowed 
to  move  the  leg  before  the  twenty-first  day  after  the 
last  rise  of  the  temperature. 

At  the  same  time  that  mobility  is  allowed,  massage 
commences,  at  first  exceedingly  light,  and  far  from 
the  affected  veins.  After  eight  days,  the  massage  may 
be  a,  little  more  pronounced  so  as  to  encourage  the  circu- 
lation in  the  collateral  veins,  and  thus  act  on  the  oedema. 
At  the  same  time  slight  movements  are  permitted,  com- 
mencing first  in  the  toes,  then  in  the  ankle,  and  eight 
<iays  after  in  the  knee,  but  flexion  on  the  thigh  cannot 
be  allowed  for  a  long  time  as  any  motion  in  the  hip  is 
very  dangerous  as  regards  thrombus. 

At  the  end  of  from  twenty  to  thirty  days  of  the 
treatment,  the  patient  may  quit  the  bed  for  a  reclining 
chair  and  a  fortnight  later  he  can  stand  up ;  but  the 
leg  must  be  bandaged  with  a  Velpeau  bandage. 

A  cure  at  Bagnoles  de  TOme  will  terminate  the  treat- 
ment. 

Treatment  of  Bleeding  Piles. 
The  following  will  be  found  very  effective : — 
Chloride  of  ^cium,  chemically  pure,  2^  drachms; 
Water,  3I  ounces. 

Injection  into  the  rectum  of  five  drachms  by  means 
of  a  small  rectal  syhnge.  The  haemorrhage  ceases  in 
a  few  hours. 

Prof.  Boas,  who  has  treated  twenty-five  patients 
with  this  sohition,  recommends  it  strongly.  The  in- 
jection may  be  repeated  if  necessary. 


'[FROM   OUR   OWN   CORRESPONDENT.] 

YmvA,  AuffUtt  7th,  1904. 

Physiological  Catalysors  in  Treatment. 
At  the  Naturforscher  meeting  Poehl  gave  the 
members  a  long  dissertation  on  the  physiologic  a 
catalysors  as  a  means  of  cure  in  the  practice  of  medi- 
cine. He  first  commenced  with  the  process  of  nutrition, 
which,  he  said,  depended  upon,  and  was  preserved  by 
this  very  natural  process.  A  certain  amount  of  mate 
rial  is  taken  into  the  body,  and  must  remain  a  given 
time  to  admit  of  this  catalytic  influence  in  order  that 
the  necessary  energy  may  be  developed  to  invigorate 
and  support  Ufe.  He  divides  the  catalysors  into  two 
principal  groups,  t/i>.,  "  positive  "  and  "  negative,"  or, 
in  reference  to  the  body,  "  general "  and  "specific"  ; 
the  former  influencing  the  whole  of  the  body,  while 
the  latter  only  affects  a  single  organ.  The  positive 
includes  all  the  catalysors  that  stimulate  the  organs 
and  tissues  to  greater  activity,  while  the  negative  re- 
press or  inhibit  the  action  of  special  organs,  of  which 
he  gave  as  examples  spcrmin  (positive)  and  adrenal 
(negative).  Spermin  hastens  the  oxidising  process  or 
respiration  of  the  tissues,  which  neutraUses  or  destroys 
the  depressing  properties  of  the  leucomaines.  Adrenal, 
on  the  other  hand,  is  a  reducing  catalysor,  and  becomes 
a  dangerous  toxin  when  carried  into  th€f  circulation. 

It  is  only  recently  these  catalysors  have  been  acknow- 
ledged as  therapeutic  agents,  and  are  yet  in  a  very 
premature  state  for  general  use.  Those  in  use  may  be 
described  as  special  catalysors  and  directed  towards' a 
special  organ,  whose  functions  or  tissue  change  it  is 
desired  to  alter.  Those  for  therapeutic  use  he  would 
designate  as  the  synergetic  group,  in  opposition  to  the 
leucomaines,  such  as  cerebrinum,  extracted  from  the 


grey  matter  of  the  brain ;  thyroidinum,  from  the 
thyroid  gland ;  ovarinum,  from  the  ovaries ;  mamminum' 
from  the  breasts.  &c.  Thyroidinum  catalytically 
afiects  the  fat.  skin,  and  nerve  system ;  cerebrinum 
affects  the  excretions  or  metabolism  depending  on 
nerve  changes,  and  exhibits  its  beneficial  effects  in  cases 
of  epilepsy,  neurasthenia,  and  alcoholism ;  ovarinum 
is^useful  in  the  climacteric  period  ;  and  mamminum  in 
uterine  fibromata  as  well  as  some  other  female  diseases. 
«k  The  negative  catalysors  are  not  yet  recognised  suffi- 
ciently to  define  their  therapeutic  value.  These  com- 
prise the  toxins,  among  which  the  plasma  toxin 
is  a  good  example.  The  latest  observations  of  Professor 
Tarchanoff,  that  these  organo-therapeutics  all  contain 
a  large  amount  of  radio-activity,  were  further  estab- 
lished by  Poehl's  own  personal  experience. 
■  In  the  discussion  that  followed,  Naunyn  said  that 
he  would  like  more  evidence  on  this  hypothetical  sub- 
ject before  advancing  a  dogma  on  any  of  the  questions 
put  forward,  particularly  in  the  reducing  property  of 
urine  on  photographic  plates  after  the  use  of  adrenalin, 
as  well  as  the  general  effects  of  the  leucomaines.  The 
action  of  Poehl's  isolated  substances  on  the  organism 
was  not  to  his  mind  sufficiently  proved. 

Klemperer  said  that  he  had  never  observed  the  blood 
becomii^g  more  alkaline  after  the  use  of  spermin,  which 
would  of  necessity  result  according  to  Poehl's  theory. 
Poehl,  in  his  reply,  would  not  accept  Klemperer's 
logic,  firmly  believing,  as  he  did,  in  his  own  hypotheses. 
The  Pest  Infection. 
Schottelins  expressed  himself  as  opposed  to  the 
generally  accepted  term  that  the  pest  was  transmitted 
through  the  atmosphere,  and  took  its  origin  from  the 
lungs.  He  was  firmly  convinced  that  the  pest  was 
transmitted  by  local  wounds  taking  up  the  infection, 
and  thus  transmitting  it  to  the  circulation.  Scratches, 
abrasions,  or  slight  fissures  of  the  mucous  membrane 
are  fruitful  sources  of  infection.  He  presented  a  few 
wax  models  he  had  taken  while  resident  in  Bombay 
ta  prove  his  assertions.  All  of  them  had  some  primary 
centre  through  which  the  poison  ha^  passed — some- 
times the  skin,  sometimes  the  mouth,  and  others  in 
the  isthmus  faucium.  Slight  abrasions  on  the  mucous 
membrane  were  not  uncommon.  From  the  deeper 
cervical  glands  the  infection  is  conveyed  to  the  lungs, 
which  gives  rise  to  the  doubt  as  to  origin.  Again,  the 
white  race  is  immune  to  the  pest  virus,  as  witnessed 
by  the  number  of  European  doctors,  nurses,  and  visi- 
tors that  never  take  the  disease,  though  dangerously 
exposed  to  the  virus.  The  general  condition  of  health 
and  individual  social  hygiene  are  potent  factors  in  its 
distribution,  as  the  underfed  and  unclean  are  the  first 
to  suffer. 

Kraus  remembered  a  case  of  this  nature  that  im- 
pressed him.  A  slight  reddening  occurred,  causing  a 
running  from  the  nose,  and  finally  malignant  diphtheria 
with  bubos  in  the  neck,  which  confirmed  the  diagnosis 
as  one  of  bubonic  plague. 

Rumpf  concurred  with  Schottelins  that  the  virus 
was  easily  taken  in  by  the  isthmus  faucium. 

Rumpel  said  that  he  had  attended  forty  cases  of 
bubonic  plague  in  Oporto,  and  never  could  discover  a 
primary  lesion  through  which  the  virus  could  be  con- 
veyed to  the  circulation. 

Antistreptococcus  Serum  and  Rheumatism. 
Schmidt  gave  a  history  of  fifteen  cases  which  he 
had  treated  with  antistreptococcus  serum  with  varying 
success.  Eight  of  these  were  subacute  that  had  re- 
sisted all  other  treatment,  four  were  acute,  and  three 
chronic.  The  injections  consisted  of  15  to  2'j  cubic 
centimetres  daily  for  eight  days.     The  injections  were 


146    The  Medical  Pksss. 


OPERATING   THEATRES. 


August  10,  1904. 


used  over  the  affected  joints,  causing  reddening, 
swelling,  erythema,  &c.,  in  proportion  to  the  rapidity 
of  action,  and  no  injurious  effects  were  observed.  In 
six  cases  locomotion  was  early  restored  ;  in  four  the 
subjective  symptoms  were  improved,  while  five  had 
no  change.  He  cannot  say  there  was  any  specific  action, 
but  thinks  that  the  treatment  is  adapted  for  the  sub- 
acute cases  when  other  remedies  fail. 

Kraus  agreed  with  Schmidt  in  this  opinion,  as  the 
greatest  benefit  is  observed  where  it  releases  the  move- 
ments of  the  limbs. 

Chronic  Interstitial  Pneumonia. 

Damsch  gave  a  history  of  four  caises  of  interstitial 
pneumonia  having  no  fever  or  trustworthy  symptom 
to  herald  its  approach.  Tubercle  was  excluded.  There 
was  no  shrinking  of  the  pulmonary  tissue,  only  the 
hardening  over  the  affected  part.  The  consequent 
danger  of  these  cases  lies  in  the  ti^osting  of  the  heart 
and  producing  functional  insufficiency. 

Litten  said  that  he  had  also  met  with  such  ca.ses 
without  fever,  bronchiectasis,,  or  shrinking. . 

Rumpf  had  seen  such  cases,  but  tubercle  usually 
commenced  to  develop  later  at  one  of  the  apices. 

Dnngan?* 

[from  our  own  correspondent.] 

BvDAPBR,  Au^iist  7th.  1004. 
At  a  recent  meeting  of  the  Budapest  Interhospital 
Association,  Dr.  Temesviry  Rezsd  reported  a  case  of 
Dysmenorrhcea  Successfully  Treated  by 
Electricity. 
A  single  woman,  aet.  23,  who  began  to  menstruate 
normally  at  fourteen,  at  nineteen  commenced  to  suffer 
from  dysmenorrhoea,  without  any  cause  except  slight 
anaemia.  For  the  last  four  years  menstruation  had 
been  irregular  and  extremely  painful,  with  frequent 
menorrhagic  crises.  For  the  last  two  years  she  had 
had  to  stay  in  bed  for  several  days  at  each  period,  and 
morphine  injections  were  necessary.  Ordinary  medical 
and  gynaecological  treatment— drugs,  local  injections, 
mechanical  dilatation  of  the  cervix  with  curettage  of  the 
uterus  and  massage — had  been  tried  without  perma- 
nent result.  The  patient  was  very  anaemic,  haemo- 
globin being  60  per  cent,  below  the  normal.  All  the 
pelvic  organs  except  the  uterus  were  normal.  The 
cervical  canal  was  tortuous  and  stenosed.  After 
fifteen  applications  of  the  constant  current  twice  a 
week  for  ten  minutes,  the  tortuosity  and  stenosis  of  the 
cervical  canal  disappeared,  and  menstruation  became 
regular  and  free  from  pain. 

Dr.  Waldmann  B61a  read  a  paper  on  the  prevention 
of  recurrences  in 

Syphilitic  Diseases  of  the  Eye. 
By  the  following  treatment  recurrence  in  syphilitic 
ocular  disease,  he  had  found,  could  be  prevented  : 
(i)  In  syphilitic  disease  of  the  choroid,  mercurial  in- 
unction should  be  undertaken  for  two  years,  the  place 
of  inunction  being  varied  daily.  (2)  The  dose  should 
not  exceed  30  gr.,  and  according  to  the  age  and  con- 
stitution of  the  patient  doses  of  8  gr.  or  15  gr.  are 
better.  After  every  ten  inunctions  a  pause  of  four  days 
may  be  made.  The  best  basis  for  the  mercurial  oint- 
ment is  lanolin.  (3)  Longer  pauses  than  three  weeks 
should  not  occur  in  the  whole  two  years.  A  pause  of 
three  months  completely  nullifies  the  treatment.  (4) 
Potassium  iodide  has  no  curative  influence  on  ocular 
syphilis,  but  is  directly  injurious  on  account  of  the 
conjunctivitis  to  which  it  predisposes,  and  should 
accordingly  not  be  given  in  the  majority  of  cases. 
Potassium  iodide  has  only  one  use  in  the  treatment 


of  ocular  syphilis,  namely,  to  counteract  the  injurious 
influences  of  large  doses  of  mercury. 

The     Radical     Treatment     of     Ulcers. 

Dr.  Prater  Trure  says  that  though  some  ulcers 
On  the  leg  heal  with  almost  any  dressing,  as  iodo- 
form, airol,  orxeroform,  the  greater  number  resist  such 
treatment,  or,  if  they  heal,  quickly  relapse.  For  such, 
skin-grafting  after  thorough  disinfection  of  the  ulcer  is 
by  far  the  best  local  treatment,  but  whenever  extensive 
varices  are  present  this  is  also  unsatisfactory.  The 
only  radical  treatment  in  such  cases  is  to  ligature  the 
saphenous  vein  according  to  Trendelenberg's  method 
before  proceeding  to  the  transplantation  of  skin. 

Siegel  related  a  case  of 

Primary  Sarcoma    of    the    Small    Intestine. 

A  boy,  aet.  3 J,  had  suffered  for  three  months  with 
symptoms  of  obstruction,  which  occasionally  alternated 
with  diarrhoea.  As  a  tumour  could  be  felt  in  the 
ileo-caecal  region  intussusception  was  diagnosed.  Lapa- 
rotomy was  performed,  and  a  hard  nodulated  tumour 
was  found  on  a  coil  of  jejunum.  The  mesenteric 
glands  were  enlarged.  The  tumour  and  12  inches  of 
the  small  intestine  were  resected.  The  child  died  three 
weeks  later  with  general  metastasis,  which  had  involved 
the  pancreas.  A  small  collection  of  pus  was  found 
near  the  site  of  the  sutures,  but  there  was  no  peritonitis. 
The  tumour  was  a  small  lound-ceUed  sarcoma,  and  had 
probably  started  from  the  l3rmphatics  of  the  sub- 
mucosa. 

These  tumours  are  rare,  the  writer  having  collected 
thirty-four  cases;  the  greater  number  occnrred  in 
males.  The  case  is  chiefly  interesting  because  it  is 
opposed  to  the  usually  accepted  view  that  absence  of 
obstruction  is  characteristic  of  intestinal  sarcomata. 
They  give  rise  neither  to  pain  nor  tenderness. 

Xtbe  9petattiid  Ubeattes* 

ST.  MARY'S  HOSPITAL. 
Richtsr's  Hernia  Simulating  Chronic  Intes- 
tinal Obstruction. — ^Mr.  Warren  Low  operated  on 
a  woman,  aet.  about  55,  who  had  been  sent  up  to  the 
hospital  by  Dr.  Alfred  Benson.  There  was  a  history 
of  the  patient  gradually  getting  thin  for  several 
months,  and  having  attacks  of  pain  in  the  abdomen. 
Some  four  days  before  admission  the  pain  was  very 
much  worse,  and  she  vomited.  The  vomiting  con- 
tinued off  and  on  till  she  came  to  the  hospital,  bat* 
the  bowels  were  opened  with  enemata  the  day  before 
admission.  On  admission  she  was  feeble,  but  not 
collapsed  ;  the  vomiting  was  faecal ;  under  the  thin 
abdominal  wall  were  seen  hypertrophied  coils  of  in- 
testine along  which  occasionally  a  peristaltic  wave 
passed  ;  there  was  no  tenderness,  and  nothing  could 
be  felt  per  rectum.  Although  she  had  w^orn  a  double 
truss  for  some  years,  no  lump  could  be  felt  in  either 
groin,  and  the  woman  said  neither  of  the  hemiae  had 
been  down  for  some  years.  The  abdomen  was  opened 
in  the  middle  line,  and  underneath  the  incision  were 
found  congested  and  distended  coils  of  small  intestine, 
of  which  the  muscular  coats  were  obviously  hyper- 
trophied. On  passing  the  hand  into  the  right  iliac 
fossa,  the  caecum  was  found  collapsed,  as  were  also 
the  lowest  coils  of  the  ileum.  These  collapsed  coils 
were  examined,  and  at  the  distance  of  some  three  or 
four  feet  from  the  ileo-caecal  valve  a  coil  of  intestine 
was  found  to  be  apparently  attached  to  the  abdominal 
waU  in  the  region  of  the  right  internal  abdominal  ring: 
a  further  examination  showed  that  part  of  the  lumen 
of  the  bowel  was  tightly  constricted  in  the  aperture^ 


August  io,  1904. 


LEADING  ARTICLES. 


Th»  Medical  Peess.      147 


With  a  little  difficulty  this  was  carefully  disengaged 
and  brought  out  of  the  abdominal  wound.     A  ring  of 
ecchymosis  demonstrated   the  actual  area  of  gut  in- 
volved, constituting  about  two-thirds  of  the  lumen 
The   strangulated  gut  was  elastic  and  began  to  gra- 
dually recover  its  normal  appearance,  and  was  obviously 
in   a  condition   to  return   to  the    abdominal  cavity  ; 
moreover,  the  gas  in  the  distended  coils  began  to  find 
its  way  past  the  constriction    and  the  coils  hitherto 
collapsed  were  now  distended  with  gas.     The  intestine 
was  returned    and  the  abdominal  wall  sewn  up.     Mr. 
Low  said  that  the  case  was  interesting  as  it  illustrated 
a  fact  of  which  several  examples  had  occurred  lately 
at   St.  Mary's   of  the  often  insidious    onset  in   these 
cases  of  partial  hernia.     This  woman  was  not  in  the 
least  collapsed    and   the  obstruction     could    not    be 
called  absolute  till  the  day  before  admission,  although 
she  certainly  was  suffering  from  a  strangulated  hernia, 
and,  in  fact,  with  her  history,  she  presented  all  the 
appearances  of  a  case  of  obstruction  to  the  gut  by  a 
growth   which    had    suddenly    become    blocked,    her 
sjrmptoms    being    those    of   obstruction    rather    than 
of  strangulation.    Another  point,  he  said,  was  that  the 
hernia  was  not  demonstrable  from  the  outside,  even 
with  one  hand  in  the  abdomen  at  the  aperture  of  the 
ring.     He  pointed  out  that  he  had  to  be  very  delicate 
in  drawing  the  nipped  piece  of  intestine  out  of  the 
sac,  as  he  was  unable  to  prophesy  in  what  condition 
he  would  find  it.     This  process  occupied  some  minutes 
and  almost  necessitated  an  incision  over  the  region  of 
the  hernia.     He  said  a  few  words  of  caution  a^  to 
disengaging  a  hernia  from  the  abdominal  side,  as  in 
such  a  case  the  constricting  neck  of  the  sac  had  not 
been  divided,  as  is  usually  the  case  in  operating  in  the 
ordinary  way.     He  had  had  under  his  care  two  or 
three    examples  of    Richter's   hernia ;    they    had    all 
occurred  in  women.     In  each  case  there  had  been  the 
same  insidious  origin,  and  the  patients  had  not  been 
brought   to  hospital   till   the   hernia  had   perforated 
and    peritonitis    had    occurred.     Judging    by    these 
examples  he  thought  that  in  quite  a  large  proportion.of 
partial  hernia  the  symptoms  were  rather  those  of 
obstruction  than  of  strangulation. 

A  week  after  operation  the  patient-  was  doing 
perfectly  well ;  the  bowels  had  been  opened  and  there 
had  been  no  sickness. 


The  Plague. 

The  following  telegram  from  Hong-kong  from 
Governor  Sir  M.  Nathan  has  been  received  at  the 
Colonial  Office : — "  Seventeen  cases  of  bubonic  plague, 
17  deaths,  for  week  ended  July  39th." 

Oxford :    Doctors  at  St.  Aloyslus. 

On  Tuesday,  July  26th,  a  special  service  was  held 
in  this  church  for  the  benefit  of  Catholic  doctors 
attending  the  meeting  of  the  British  Medical  Asso- 
ciation. Some  twenty  or  thirty  medical  men  were 
present,  including  the  President  of  the  Irish  College 
of  Surgeons,  who  wore  his  robes.  During  the  Mass, 
the  choir  boys,  assisted  by  the  young  ladies  from 
St.  Ursula's  Convent,  sang  very  tastefully  an  appro- 
priate selection  of  hymns.  Father  Arthur  Day,  S.J., 
delivered  a  short  discourse,  basing  his  remarks  on  the 
text  of  St.  Paul :  "  Knowledge  puffeth  up :  charity 
edifies."  The  dignity  of  the  medical  profession,  as 
distinguished  from  that  of  the  veterinary  surgeon,  rests 
on  the  admission  of  the  immortality  of  the  human 
soul.  A  materialist  doctor  must  often  in  kindness 
hesitate  to  prolong  human  misery.  Science  is  very 
necessary  to  surgeon  and  ph3^cian,  but  without  deep 
reUgious  belief  neither  can  rise  to  the  full  nobility  of 
his  vocation.  Learning  alone  is  apt  to  inflate ; 
animated  with  supernatural  charity  it  becomes  a 
powerful  engine  for  good  ;  and  the  Christian  doctor 
almost  an  apostle. — Tablet. 


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Pufaliahed  every  Wedneeday  morning,  Pdoe  5d.     Poet  free.  6^. 

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"  SALUS  POPULI  SUPRBMA  LEX." 


WEDNESDAY.  AUGUST  10,  1904. 


THE  CHLOROFORM  COMMITTEE  REPORT. 
The  British  Medical  Association  do  well  in  em- 
ploying some  of  their  resources  for  the  furtherance 
of  general  scientific  knowledge,  and  there  is- 
certainly  no  question  that  they  could  undertake 
to  investigate  with  more  hope  of  practical  benefit 
than  that  of  the  dosage  of  chloroform.  A  Com- 
mittee was  appointed  three  years  ago  to  examine 
the  subject  from  different  points  of  view,  and  their 
third  annual  report  has  just  been  issued.  The 
previous  researches  of  various  observers  on  the 
action  of  chloroform  have  produced  var3ring  results, 
and  whilst  week  after  week  reports  of  deaths  from 
chloroform  anaesthesia  continue  to  come  in,  the 
profession  cannot  but  feel  their  position  in  the 
matter  to  be  an  invidious  one.  Although  the 
employment  of  ether  and  some  of  the  newer  bodies, 
has  rendered  the  use  of  chloroform  less  generally 
needful,  it  must  nevertheless  be  borne  in  mind  that 
not  a  few  deaths  occur  under  ether,  while  none 
of  the  new  anaesthetics  is  absolutely  safe. 
There  remain  a  number  of  cases  in  which 
chloroform  is  still  indispensable,  and]  from  the- 
patient's  point  of  view  it  is  by  far  the  pleasantest 
anaesthetic  to  take.  For  a  long  time  past  the 
comment  has  been  made  in  various  quarters  that 
whilst  the  dosage  of  drugs  is  rigorously  respected 
and  enforced  by  medical  men,  yet  when  they  deal 
with  a  highly  dangerous  medication,  such  as 
chloroform  vapour,  they  administer  an  unmeasured 
quantity  to  the  patient.  This  comment  is  not 
without  its  force.  The  only  reply  that  can  be 
made  to  it  is  that  we  are  still  ignorant  of  the  quan- 
tity, or  rather  the  percentage,  that  can  be  Safely 
given.  The  fatal  dose,  indeed,  is  usually  small. 
Several  instruments  have  been  devised  from  time 
to  time  by  which  the  amount  of  chloroform, 
administered  can  be  measured,  and  the  weighing 
of  definite  quantities  of  air  and  chloroform  vapour 
be    placed   under   the   control   of   the   operator.. 


148    Trk  Medical  Pkksi. 


LEADING  ARTICLES. 


August  10,  1904. 


Of   these,    Krohne's     apparatus     was    the    first, 
and-  demonstrated  the  extremely  small  quantity 
of  chloroform  vapour  that,  judiciously  adminis- 
tered, can  induce  sound  anaesthesia.     Mr.  Vernon 
Harcourt,  F.R.S.,  a  member  of  the  British  Medical 
Association    Committee,    has,    however,   devised 
a  more  accurate  apparatus  than  any  that  have 
yet  been  put  forward,  and  during  the  past  year 
he  has  improved  on  his  original  pattern  by  intro- 
ducing into  it  a  carefully  graduated  conical  bottle 
to  hold  the  chloroform.     By  this  means  he  is  able 
to  compensate,  by  an  increased  superficial  area, 
for  the  diminution  in  the  evaporation  that  results 
from  the  sinking  of  the.  chloroform  in  the  bottle 
as  it  passes    into    vapour,  and    throughout   the 
whole  administration  he  can  secure  that  almost 
exactly  the  same  percentage  reaches  the  patient 
with    the   inspired    air.     Another    advantage    of 
his  method  is  that  the  rate  and  depth  of  respiration 
have  hardly  any  appreciable  effect  on  the  actual 
quantity  of  chloroform  inhaled,  as  in  rapid  re-, 
spiration,  although  more  air  passes  over  the  chloro- 
form, it  takes  up  less  of  the  anaesthetic,  whilst  in 
slow,   deep  breathing  the  opposite   is  the   case. 
It  remains  to  be  shown  that  chloroform  adminis- 
tration will  be  rendered  safer  by  the  employment  of 
graduating  apparatus,  the  use  of  which,  we  believe, 
has  not  been  unattended  with  fatal  results.     Side 
by  side  with   the   evolution  of  Mr.  Vernon  Har- 
court's  apparatus  Professor  Sherrington  and  Miss 
Sowton  hs^ve  been  pursuing  a  smes  of  investigations 
into  the  action  of  chloroform  on  the  isolated  mam- 
malian heart.     The  report  of  their  work  deals  with 
•experiments  in   perfusing  the  heart  with  small 
doses  of  chloroform  in  various  solutions,  and  con- 
trasting   the   effects   thus    produced   with   those 
wrought    by    similar   doses    exhibited    in    blood. 
Comparing  the  action  on  the  heart  of  chloroform 
in  saline  solution  with  the  action  of  chloroform 
in  blood,  they  found  that  the  depressant  effect 
of  the  latter  was  only  one-twelfth  that  produced 
by  the  chloroform  in  saline  solution,  and  also  that 
when  the  quantity  of  chloroform  was  increased 
permanent  damage  to  the  cardiac  muscle  resulted 
much  earlier  when  the  anaesthetic  was  exhibited 
in  saline  solution  than  when  exhibited  in  blood. 
Very  interesting  to  compare  with  these  conclusions 
are  those  arrived  at  by  Mr.  Byles,  Mr.  Harcourt, 
and  Sir  Victor  Horsley,  who  undertook  the  work 
of  estimating  the  effect  of  chloroform  on  the  blood 
itself.     Briefly  summed  up,  their  conclusions  are 
that   blood    has    a    specific    power    of    retaining 
chloroform,  and  that  it  is  in  the  corpuscles,  not 
in  the  plasma,  that  this  ability  resides,  but  that  it 
is  necessary  for  the  corpuscles  to  remain  intact 
if  they  are  to  keep  this  power.     The  amount  of 
chloroform  retained  by  the  corpuscles  was  about 
20  per  cent.,  and  thus   it   is    obvious    that   the 
anaesthetic  must  have  far-reaching  effects  on  all 
the  fixed  tissues.     Perhaps,   however,   the   most 
important  of  the  whole   series   was  the   closing 
experiment  on  a  dog,  anaesthetised  by  means  of 
Mr.    Harcourt 's   inhaler,    from   which    quantities 
of    blood    were    withdrawn    at    intervals,    whilst 
the  amount  of  chloroform  was  gradually  increased 


to  the  lethal  point.  Without  going  into  all  the 
details,  it  may  be  said  that  the  quantity  of  chloro- 
form in  the  blood  at  the  time  of  death  was  almost 
exactly  twice  that  found  in  the  blood  at  the  mo- 
ment that  anaesthesia  was  complete.  We  hope 
that  this  experiment  and  similar  ones  on  other 
animals  will  be  repeated,  for  it  shows  how  small 
a  margin  exists  between  safety  and  danger. 
Dogs  are  notoriously  susceptible  to  chloroform 
poisoning,  and  results  obtained  from  experiments 
on  them  by  no  means  apply  equally  to  man,  but  j 
anything  that  can  throw  light  on  the  limits  of 
safe  chloroform  administration  is  greatly  to  be 
welcomed.  We  trust,  therefore,  that  the  Com- 
mittee will  be  able  to  pursue  its  labours  for  several 
years,  as  it  can  hardly  be  expected  that  the  full 
facts  will  be  established  without  a  long  period 
of  hard  work.  If  in  the  end  the  Committee  are 
able  to  demonstrate  how  chloroform  fatalities 
can  be  avoided,  they  will  earn  the  gratitude  of  all 
their  colleagues. 


THE    LORD    CHANCELLOR    AND    THE 
MEDICAL     PROFESSION. 

Our  readers  will  remember  that  more  than  once 
during  the  past  year  or  two  we  have  had  to 
comment  on  the  attitude  one  of  the  London 
coroners  has  seen  fit  to  adopt  toward  the  general 
practitioners  in  his  district,  and  the  manner  in 
which  he  is  in  the  habi^  of  exercising  his  public 
duties.  As  the  facts  must  be  already  known 
to  our  readers,  it  is  sufficient  to  recall  that  it  is 
the  custom  of  Mr.  Troutbeck,  the  coroner  in 
question,  in  conducting  inquests,  to  ignore  as 
far  as  possible  the  evidence  of  practitioners  who  , 
had  attended  the  deceased  during  Ufe,  or  who  had  j 
been  called  in  immediately  after  death,  and. 
further,  whenever  a  post-mortem  examination 
has  been  thought  necessary,  its  conduct  has  been 
committed  to  one  individual  practitioner  who 
has  no  claim  to  be  considered  a  pathological 
expert.  In  many  cases  where  valuable  clinical 
evidence  could  have  been  brought  forward,  it  has 
not  been  obtained,  and  verdicts  have  been  re- 
turned on  evidence  obviously  incomplete  and 
insufficient.  It  is  more  than  twelve  months 
since,  having  failed  to  obtain  any  satisfaction 
from  Mr.  Troutbeck  himself,  four  well-known 
medical  societies — the  British  Medical  Associa- 
tion, the  South- West  London  Medical  Society, 
the  Medical  Defence  Union,  and  the  London  and 
Counties'  Medical  Protection  Society — united  in 
sending  a  joint  deputation  to  the  Lord  ChanceUor 
to  draw  his  attention  to  the  manner  in  which 
Mr.  Troutbeck  exercises  his  magisterial  functions. 
They  presented  a  terse  memorandum  embodying 
their  views,  and  supported  it  by  reference  to 
several  specific  cases.  This  memorandum  was 
then  submitted  by  the  Lord  Chancellor  to  Mr. 
Troutbeck,  and  a  copy  of  his  observations  thereon 
was  transmitted  to  the  Medical  Societies,  but  no 
expression  of  the  Lord  Chancellor's  opinion  was 
given.  The  medical  societies  then  formulated  a 
detailed  criticism  on  Mr.  Troutbeck's  observations, 
and    sent  it  to  the  Lord  Chancellor,  receiving  in 


August  io.  1904. 


LEADING   ARTICLES. 


Tab  MiDicAi.  Press.     149 


return  a  formal  acknowledgment  from  his  secretary. 
During  the  past  twelve  months  his  Lordship's 
attention  has  further  been  called  to  several  cases 
as  they  occurred,  in  which  Mr.  Troutbeck  either 
neglected  material  evidence,  or  went  out  of  his 
way  to  attack  medical  men  who  had  not  been 
summoned  to  attend.  Up  to  the  present,  however, 
the  Lord  Chancellor  has  refrained  from  committing 
liimself  on  any  of  the  points  put  before  him.  His 
Lordship  should  remember  that  high  as  is  the  dignity 
appertaining  to  the  office  he  holds,  that  dignity 
only  belongs  to  himself  in  so  far  as  he  fulfils  the 
duties  of  his  office.  He  is,  like  many  humbler 
persons,  as  far  as  the  performance  of  his  public 
duties  go,  a  servant  of  the  State,  and  one  of  the 
most  important  of  these  duties  is  the  supervision  of 
the  performance  of  their  functions  by  the  magis- 
trates of  the  land.  In  the  present  instance  various 
charges  have  been  laid  against  one  of  these 
magistrates,  the  Coroner  for  Westminster,  and 
bis  defence  has  been  heard,  but  both  complainant 
and  defendant  are  stiU,  after  twelve  months, 
waiting  for  a  decision.  Under  the  circumstances 
the  only  course  open  to  the  Medical  Societies  is 
the  one  they  have  taken,  to  publish  the  entire 
correspondence.  The  British  Medical  Association, 
however,  has  advanced  matters  by  furnishing 
the  Lord  Chancellor  with  a  carefully  drawn 
statement  of  proof  pf  all  charges  made  against 
Mr.  Troutbeck.  together  with  a  distinctive  analysis 
of  that  gentleman's  defence  and  counterK:harges. 


THE  IRISH  POOR-LAW  MEDICAL  SERVICE 
AND  ITS  OLD  FRIEND  "  THE  MEDICAL 
PRESS  AND  CIRCULAR." 
A  REMARKABLE  letter  appears  in  the  columns  of 
our  contemporary  the  Journal  of  the  Irish  Medical 
Association^  from  the  pen  of  Surgeon-General 
Evatt.  on  the  subject  of  the  organisation  of  the 
Irish  Medical  Association.  Surgeon-General  Evatt 
has  recently  visited  Ireland  as  special  commissioner 
of  the  British  Medical  Association,  and  has  em- 
bodied the  result  of  the  information  he  acquired 
there  in  the  form  of  a  very  long  and  elaborate 
report.  This  report  we  noticed  on  its  appearance, 
when  we  had  the  greatest  pleasureindrawingatten- 
tion  to  its  many  good  points,  and,  we  may  say,  in 
also  refraining  from  excessive  criticism  of  its  weak 
ones.  Perhaps  its  most  curious  point  was  the 
utter  failure  to  recognise  that  the  majority  of  the 
matters  to  which  it  called  attention  in  the  condi- 
tion of  the  Irish  Poor-law  Medical  Service  had 
been  already  emphasised  and  brought  before  the 
public  time  after  time  in  the  columns  of  The 
Medical*  Press  and  Circular,  and  that  it  was 
to  the  insistance  of  this  journal  that  much  of  the 
light  of  publicity  which  has  fallen  on  Irish  Poor- 
law  matters  in  the  last  twenty  years  was  due. 
In  short,  to  judge  from  Surgeon-General  Evatt's 
report  it  would  appear  that  no  journal  other  than 
the  organ  of  the  British  Medical  Association  had 
ever  worked  for  the  betterment  of  the  Irish  Poor- 
law  Medical  Service.  We  did  not  at  the  time  draw 
attention    to    this    curious    omission.     Surgeon - 


General  Evatt  had  been  sent  over  by   another 
journal,  and  was  for  the  time  being  its  servant,  and 
why  should  he  see  good  in  the  work  accomplished 
by  a  rival  even  though  that  work  was  spread  over 
some  half  century,  and  that  the  disdain  of  his 
employers  for  mere  Irish  matters  during  that  time 
was  great  ?     His  recent  letter,  to  which  we  now 
refer,  cannot,  however,  be  allowed  to  pass,  in  that 
not  content  with  the  mere  ignoring  of  the  existence 
of  The  Medical  Press  and  Circular,  it  proceeds 
to  make  serious  mis-statements.     We  are  quite 
willing  to  believe  that  these  are  the  result  of  sheer 
ignorance  of  the  facts  of  the  case,  but,  even  if  that 
excuse  is  made  for  them,  they  require  correction. 
"  In    Ireland,"     says     Surgeon-General     Evatt, 
**  when  a  doctor  wants  a  locum  tenens,  there  is 
now,  so  far  as  I  am  aware,  no  organised  centre  to 
which  he  can  apply  by  telegraph,  &c.,"  and  then 
he  proceeds  to  recommend  that  such  ah  office  should 
be  established.     If  Surgeon-General  Evatt  had  not 
ignored  the  existence  of  a  Journal  which  is  still  older 
than  the  one  he  represeYited,  and  whose  work  for 
the  improvement  of,  and  whose  knowledge,  of  the 
Poor-law  Service  is  and  has  been   immeasurably 
greater,  he  would  in  the  course  of  his  visit  to  Ireland 
have  discovered  that  such  an  office  has  been  in 
existence  for  tfiany  years,   a  fact    that  is  well 
known.     Agaiifk,  Surgeon-General  Evatt  by  impli- 
cation suggests  ^at  there  is  no  "Students*  Number 
published  to  give  the  Irish  medical  student  full 
information,  and  to  warn  him  of  the  drawbacks 
of  Irish  medical  life."     We  all  know  what  English 
ignorance  of  Irish  conditions  of  life  is,    and  what 
have  been  its  fruits  in  the  past,  but,  while  such 
ignorance  can  be  excused  amongst  those  who  re- 
main at  home,  it  can  scarcely  be  excused  amongst 
those  who  go  abroad  to  seek  information  and  who 
consider    they    have    found    it.     Will    Surgeon- 
General  Evatt  consult  the  Students*  Numbers  of 
this  journal?  will  he  read  the  advice  to  the  young 
student  that  they  have  contained  now  for  many 
years  ?  and  will  he  write  and  inform  us  whether  he 
still  considers  that  another  Irish  Students'  Number 
is    required  ?     Will  he  then  cast  his  eye  over 
previous  issues  of  this  journal  and  its  special  Irish 
Poor-law  Supplement,  and  will  he  tell  us  what  he 
expects  to  gain  by  creating  imitations  ?     Surgeon - 
General  Evatt  hints  that  a  misfortune  of  Irish 
medical  life  is  redundancy  and  want  of  coalescence, 
and  yet  he  advocates  the  duplication  of  everything 
that  is  now  done  by  The  Medical  Press  and 
Circular.     Perhaps  if  he  were  to  go  a  littie  more 
behind  the  scenes  he    would  learn  that  all  the 
resources  of  this  journal  had  been  offered  to  the 
Irish  Medical  Association  for  the  special  purpose  of 
avoiding  duplication,  and  of  furthering  the  interests 
of  the  Poor-law  Service  :  he  would  thus  understand 
how  easy  a  thing  it  would  be  for  the  Irish  Medical 
Association  to    make    itself  a  more  effective  or- 
ganisation, if  it  pleased  to  do  so. 


The  address  on  Surgery  at  the  Vancouver 
meeting  of  the  Canadian  Medical  Association 
will  be  delivered  by  Mr.  Mayo  Robson. 


150     Thx  Medical  Pxus. 


NOTES   ON    CURRENT    TOPICS. 


August  io,  1904. 


flotcd  on  Cnttent  XTopic^* 


A  New  Method  of  Teetinfir  the  Heart. 
A  NEW  method  of  testing  the  functionating  power 
of  the  heart  has  been  lately  presented  to  the 
Verein  fur  innere  Medizin,  in  Berlin,  by  a  M.  Kat- 
zenstein.  The  information  which  it  affords  is 
said  to  be  of  special  value  in  cases  in  which  the 
heart  is  about  to  be  subjected  to  a  severe  strain, 
as  in  certain  surgical  procedures,  and  as  it  is  com- 
paratively easy  of  performance  it  is  worthy  of 
attention.  The  procedure  is  based  on  the  ob- 
servations made  on  animals  to  the  effect  that  the 
ligature  of  large  vessels  results  in  an  increased 
cardiac  activity,  characterised  by  a  rise  in  the 
blood  pressure  without  any  change  in  the  pulse- 
rate.  To  apply  the  test,  the  patient  is  placed  in  a 
recumbent  position  and,  when  quiet,  the  pulse- 
rate  and  blood  pressure  are  determined.  Com- 
pression of  both  femoral  arteries  is  then  made 
and  kept  up  for  from  two  to  five  minutes,  and 
then  the  changes  in  the  blood  pressure  and  pulse- 
rate  are  noted.  If  the  heart  is  acting  normally, 
the  pressure  causes  a  rise  in  the  column  of  mercury 
of  from  five  to  fifteen  millimetres,  while  the  pulse - 
rate  remains  the  same,  or  is  slightly  lessened. 
If  the  heart  is  hyper trophied,  a  rise  of  forty  milli- 
metres occurs,  and  the  pulse-rate  remains  the  same, 
or  is  slightly  increased.  Slight  cardiac  insuffi- 
ciency is  accompanied  by  increased  pressure,  the 
pulse-rate  remaining  unchanged  or  increased. 
Marked  cardiac  insufficiency  is  accompanied  by 
a  lowering  in  the  pressure  and  an  increase  in  the 
pulse-rate.  These  results  are  said  to  be  very 
constant  and  trustworthy,  and  only  to  be  affected 
by  excitement  or  nervousness  on  the  part  of  the 
patient. 


The  Poflition  of  GynsBOoIoffy. 

We  are  pleased  to  see  that  Dr.  Haultain,  of 
Edinburgh,  has  drawn  attention  in  the  columns 
of  the  British  Medical  Journal  to  the  extraordinary 
arrangement  by  which  a  discussion  on  hysterec- 
tomy came  before  the  Section  of  Surgery  at  the 
recent  meeting  of  the  British  Medical  Associa- 
tion at  Oxford.  As  our  readers  know,  we  had 
already  called  attention  to  the  anomaly  which 
brought  a  purely  gynaecological  subject  before 
the  Section  of  Surgery,  and  we  trust  that  Dr. 
Haultain's  letter  will  be  a  forerunner  of  further 
protests.  He  had  expressed  the  hope  that  even 
at  the  last  moment  the  discussion  might  be  allo- 
cated to  its  proper  place,  but  this  was  not  done. 
An  effort  should  now  be  made  to  determine  who 
is  responsible  for  the  arrangements,  and  how  it 
came  about  that  this  slight  was  offered  to  the 
Section  of  Obstetrics  and  Gynaecology.  If  a 
satisfactor>'  answer  is  not  obtained  from  the 
Council^ of  the  Association,  and  an  undertaking 
given  that  at  future  meetings  gynaecological  sub- 
jects will  be  referred  to  the  Gynaecological  Section, 
it  would ,  be  well  for  gynaecologists  to  consider 
if  it  is  wo^h  their  while  to  support  the  meetings 
of  the  Association. 


Degenerates  Again- 
Dr.  F.  J.  Smith,  who  read  a  paper  on  '*  Criminal 
Responsibility  of  Homicidal  and  Dangerous 
I-unatics  "  in  the  Forensic  Medicine  Section  of 
the  British  Medical  Association,  is  evidently 
what  would  be  called  in  the  political  jargon  of  the 
day,  a  "  whole-hogger."  He  thinks  that  'we  arc 
far  too  humane  to  our  lunatics,  and  he  would 
have  them  destroyed,  not  by  judicial  hanging,  but 
by  the  use  of  a  lethal  chamber.  Few  people  will 
doubt  that  this  is  the  rational  method  of  dealing  | 
with  individuals  who  are  not  only  useless  but 
dangerous.  The  man  Prince,  who  created  such  ' 
a  painful  sensation  by  stabbing  the  actor,  Mr. 
William  Terriss,  and  was  committed  to  Broadmoor. 
"  during  His  Majesty's  pleasure,"  signalised  hB 
sojourn  there  by  perpetrating  a  murderous 
assault  on  his  attendant.  What  use  can  it  be  to 
a  community  to  preserve  a  depraved  creature  of 
this  kind,  whose  existence  consists  in  playing 
billiards  and,  when  opportunity  offers,  killing 
a  useful  citizen  ?  The  only  reply  that  can  be 
given  is  that  the  trend  of  public  feeling  is  all  in  i 
the  direction  of  humanitarianism — often  mistaken 
— and  that  humanitarianism,  like  religion,  is  I 
not  confined  within  the  bounds  of  strict  ratiocina- 
tion. Dr.  Smith,  then,  follows  Dr.  Rentoul  in 
advocating  the  srterilisation  of  lunatics,  alcoholicsL 
and  the  victims  of  other  drug  habits.  Here  again 
it  is  impossible  to  argue  that  his  proposals  are  not 
eminently  sane,  but  the  favour  that  they  axe 
likely  to  meet  with  was  evidenced  by  the  dis- 
position of  his  audience  at  the  meeting,  where* 
they  were  generally  described  as  revolutionary 
and  impracticable.  Difficult  as  the  solution  of 
these  questions  is  in  the  present  temper  of  society.  1 
it  is  well  that  they  should  be  kept  to  the  front, 
for  the  condition  that  allows  propagation  from 
the  loins  of  criminals  and  lunatics  of  broods  of 
tainted  offspring  discloses  a  weakness  fatal  to  iu 
ultimate  success. 


Identification. 
The  case  of  Mr.  Adolf  Beck  that  has  lately  been 
before  the  public  cannot  conduce  to  the  feeling  of 
security  that  is  the  right  of  every  self-respecting 
citizen.  In  1896  this  unfortunate  gentleman 
was  sentenced  to  seven  years'  penal  servitude 
for  a  series  of  heartless  frauds  on  women,  and 
again  this  year  he  was  arrested,  tried,  and  con- 
victed of  similar  offences.  Fortunately,  befor? 
sentence  was  passed,  another  man  was  arrested 
through  the  exertions  of  a  Mn  Glenville,  On 
further  inquiry  enough  evidence  was  accumulated 
to  justify  an  immediate  appeal  to  the  Home  Secre- 
tary for  a  free  pardon  for  Mr.  Beck,  and  this  was 
granted  with  commendable  promptitude.  The 
prisoner,  who  has  passed  under  various  aliases, 
somewhat  resembled  Mr.  Beck  in  app>earance. 
and  their  handwritings  were  similar,  but  the 
astonishing  fact  remains  that  no  less  than  fifteen 
different  women  identified  Mr.  Beck  as  the  man 
who  defrauded  them,  ten  at  his  first  trial  and  fiw 
at  his  second.  In  the  face  of  such  evidence  it 
is   hardly  surprising   that   a-  conviction   followed 


August  io,  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.    151 


in  both  cases,  and  it  is  difficult  to  attach  any  blame 
to  the  poUce  authorities  under  the  circumstances. 
In    the  best  regulated  States  justice  must  occa- 
^ionaUy  be  led  astray ;    happily  in  this  country 
its  miscarriages  are  few.      Mistakes  in  identifica- 
tion, when  the  identification  rests  in  the  hands 
of  the  pohce,  should,  however,  be  practically  im- 
possible   at    the    present    day.    The    wonderful 
accuracy  of  M.  Bertillon's  methods  of  measuring 
and  classifying  features  is  beginning  to  be  recog- 
-nised  over  here,  whilst  in  France  all  detectives 
are    regularly    trained    in    his    system.      Besides 
identification  by  the  pattern  of  the  whorls  of  the 
thumb,  M.  Bertillon  has  a  system  of  describing 
the  characters  of  the  leading  features  in  a  few 
abbreviated  words  that  is  fully  sufficient  to  instruct 
any  detective  as  to  the  detailed  appearance  of  a 
suspect.      The  combination  of  all  these  charac- 
teristics puts  any  reasonable  chance  of  error  out  of 
<:ourt  entirely.     The  feature  on  which  most  re- 
liance is  placed  is  the  ear,  which  is  perhaps  the 
most   generally  neglected  characteristic,   but  all 
.the  other  points  in  the  appearance,  such  as  the 
size,  inclination,  and  shape  of  the  nose,  the  colour 
and  shape  of  the  eyes,  and  so  on,  are  all  included 
in    these   *'  word-portraits,"    as   they   are   called. 
The    old  haphazard  rules  of  thumb  that  used  to 
govern  the  police  in  identification  have  been  super- 
-seded  by  practical  appUcations  of  the  science  of 
anthropometry  ;   we  can  only  hope  that  Scotland 
Yard  is  fully  abreast  of  its  latest  developments, 
for  accurate  identification  is  the  basis  of  all  success- 
ful criminal  procedure. 

Execution  by  Electricity. 
An  increasing  number  of  people  are  to  be  found 
who    object  to  capital  punishment  in  toto,  and  it 
is  not  altogether  unUkely  that  the  lapse  of  another 
half    century    may    find    public    opinion    in    this 
country  generally  opposed  to  executing  criminals. 
Whether  individuals  are  in  favour  of  its  retention 
or  not,  all  are  agreed  that  the  process  of  destruc- 
tion should  be  certain,  instantaneous,  and  painless, 
although,  curiously  enough,  the  mental  agony  of 
the  condemned  man,  who  is  allowed  to  wait  for 
.  weeks  in  his  cell  after  sentence  has  been  passed, 
is    seldom    taken   into    account.     The   horror    of 
anticipation  under  this  set  of  circumstances  must 
be  immensely  more  distressing  than  even  the  most 
ph)rsically  painful  execution.     The  American  me- 
thod of  destroying  life  by  passing  a  strong  electric 
current  through  the  body  of  the  victim  was  hailed 
.as  a  great  advance  on  the  old-fashioned  process 
of  using  the  guillotine.     At  the  time  of  the  inau- 
guration of  electrocution   there  were  reports   of 
difficulties    in    securing    instantaneous    death    in 
one   or   two  cases,  but   the  impression  generally 
prevails     that    with    greater     experience      these 
difficulties  have  been  overcome,  and  that  the  con- 
demned   man    passes    from    Ufe    to    death    \\dth 
unerring  certainty  when  the  current  is  switched  on. 
This,  however,  is  far  from  being  the  case.   In  May, 
and   again  in  June  of  this  year,  instances  of  failure 
were  reported,  the  criminad  in  the  former  case  re- 
quiring five  shocks,  and  in  the  latter  three.  Various 


explanations  were  put  forward  to  account  for 
these  horrible  catastrophes,  such  as  that  the 
prisoner  was  thin,  that  his  skin  was  thick  and  oily, 
or  that  he  was  a  bad  "  conductor."  The  point 
has  been  raised  in  connection  with  these 
cases  as  to  whether  electrocution  does  always 
kill  its  subjects  outright,  or  whether,  as  happens 
in  lightning-stroke,  the  person  is  not  sometimes 
the  subject  of  profound  shock  from  which  re- 
suscitation is  possible.  If  so,  the  real  cause  of 
death  in  the  criminals  so  treated  is  the  knife  of 
the  pathologist  who  performs  the  post-mortem. 
The  very  idea  is  so  revolting  that  it  may  well 
be  hoi)ed  that  our  own  antiquated  method  of 
execution  may  not  be  superseded  by  any  other 
tin  at  least  absolute  certainty  of  result  is  secured. 


Dangers  of  the  Drinking  Cup. 

The  possible  perils  of  the  Communion  cup  from 
the  hygienic  point  of  view  have  already  been  dis- 
cussed in  the  medical  and  lay  press,  and  we  are  glad 
to  think  that  in  many  quarters  attempts  are  now 
being  made  to  cope  with  the  difficulties  that  sur- 
round the  introduction  of  any  innovation,  however 
beneficial,  into  religious  observances.  But  there 
exists  another  danger  from  infection  in  the  use  of 
ordinary  drinking  cups  by  school  children  and 
others.  In  the  case  of  the  drinking  fountains 
found  in  public  parks  and  other  places  it  is  a  wonder 
that  more  disease  is  not  disseminated  by  this 
means,  considering  the  filthy  state  of  some  of  those 
who  drink  from  them.  The  purity  of  the  original 
water  supply  is  often  thus  compromised  by  indi- 
viduals who  make  improper  use  of  the  drinking 
cups,  or  who  are  themselves  affected  by  some 
infectious  disease  of  the  face  or  lips.  From  the 
annual  report  of  the  Medical  Officer  of  Health  for 
Poplar,  Dr.  F.  W.  Alexander,  it  would  appear  that 
the  drinking  facilities  for  school  children,  especially 
during  the  present  hot  weather,  are  in  much  need  of 
supervision.  He  rightly  points  out  that  the  children 
themselves  cannot  be  expected  to  take  many  pre- 
cautions, especially  those  in  the  younger  classes, 
and  he  approves  of  a  method  adopted  by  some 
schools  in  having  the  water  in  the  schoolroom, 
where  it  is  served  out  by  the  teachers  as  occasion 
requires.  It  is  not  a  pleasant  reflection  to  think 
that  two  or  three  cups  do  duty  for  a  school  of 
several  hundred  children,  as  has  been  observed,  but 
now  that  public  attention  has  been  called  to  the 
whole  question  it  is  to  be  hoped  thaf  such  primitive 
arrangements  will  no  longer  be  in  vogue.  The 
enormous  prevalence  of  impetigo  of  the  face  in 
certain  quarters  of  the  metropolis  may  possibly 
be  accounted  for  through  infection  by  mean*^  of  the 
drinking  cup.  

Popular  Medical  Phraseolofiry. 

The  avoidance  of  technicalities  in  the  witness- 
box  or  in  writing  a  medical  report  destined  for  the 
consideration  of  the  judicial  mind  is  a  necessity 
early  impressed  upon  the  student  of .  forensic 
medicine.  Plain  Anglo-Saxon  terms  and  phrases 
are  to  be  preferred  under  such  circumstances  rather 
than  the  most  accurate  classical  description.  To 
the  medically  trained  mind  it  appears,  no  doubt. 


152     Tbk  Medical  Peess. 


NOTES  ON  CURRENT  TOPICS. 


far  more  pathologically  correct  to  describe  the 
consequences  of  a  blow  upon  the  orbit  as  "  an 
extravasation  of  blood  accompanied  with  sub- 
conjunctival ecchymoses "  than  to  express  the 
same  in  the  homely  language  of  the  man  in  the 
street.  Nevertheless,  the  term  "  black-eye " 
and  all  that  it  implies  is  at  once  understood  by 
those  to  whom  a  more  scientific  description  would 
be  absolutely  unintelligible.  Recent  magisterial 
comments  upon  the  subject  of  medical  phraseology 
show  how  important  it  is  not  only  for  medicsd 
witnesses  to  describe  symptoms  in  language  that  is 
"  easily  understood  of  the  people,"  but  also  that 
the  wording  of  medical  certificates  should  be  as 
simple  as  possible.  In  the  case  to  which  we  refer, 
exception  was  taken  to  the  use  of  the  word  "  epis- 
taxis,"  from  which  a  drunken  man  was  certified  to 
be  suffering.  The  term  is  certainly  more  impres- 
sive than  its  English  equivalent,  but  it  does  not, 
unfortunately,  find  a  place  in  poUce-court  parlance. 
It  so  happens  that  this  symptom  is  equally  well 
defined  by  both  the  popular  and  the  scientific 
designation,  but  there  are  many  other  instances  in 
which  the  use  of  the  Latin  or  Greek  name  is  infi- 
nitely preferable,  either  on  the  grounds  of  propriety 
or,  more  commonly,  because  much  wearisome 
circumlocution  is  thereby  avoided.  There  are  times 
and  places,  however,  when  only  one  of  the  two 
modes  of  expression  is  permissible. 

Milk'Supplies. 

We  are  glad  to  see  more  interest  being  taken, 
both  inside  and  outside  the  medical  profession, 
in  the  all-important  matter  of  town  milk-supplies. 
The  subject  has  been  given  considerable  space  in 
the  "  dailies,"  and  has  formed  a  topic  of  dis- 
cussion at  the  various  summer  medical  gatherings. 
Out  of  the  attention  thus  directed  to  it,  it  is 
sincerely  to  be  hoped  that  practical  schemes  will 
arise  to  place  the  whole  matter  on  a  satisfactory 
footing.  People  have  a  touching  faith  nowadays 
in  the  power  of  the  legislature  to  remedy  all 
their  evils,  but  they  might  well  realise  that,  ready 
to  their  o\vn  hands,  lie  many  methods  far  more 
speedy  and  far  more  efficacious.  An  example 
of  what  may  be  done  with  regard  to  improving  the 
milk  supply  has  lately  been  given  by  the  citizens 
of  New  York,  who  found  that,  in  spite  of  all  the 
regulations  and  inspections  of  the  Departments 
of  Health,  the  milk  that  reached  the  houses  was 
foul  vnih  dirt  and  bacteria.  A  Milk  Commission, 
made  up  of  physicians  from  the  County  Medical 
Society,  was  formed  to  offer  the  dairymen  and 
milk  dealers,  first,  free  instruction  in  the  principles 
of  producing  clean  milk,  and  secondly,  a  public 
guarantee  if  their  conditions  were  complied  with. 
The  practical  effect  of  this  guarantee  amounted 
to  a  condemnation  of  all  non-guaranteed  milk, 
a  fact  which  people  soon  discovered  for  them- 
selves. A  bacteriologist,  Dr.  Belcher,  was  ap- 
pointed to  visit  the  farms,  instruct  the  farmers, 
suggest  alterations  in  their  premises  and  methods, 
and  to  test  the  milk.  Needless  to  say,  he  found 
a  great  deal  of  instruction  needed,  for  some  of  the 
farms  were  as  filthy  and  badly  kept  as,  let  us  say. 


August  id.  1904. 


our  own.  Now  that  matters  are  in  working  onicr,. 
the  milk  is  regularly  analysed,  and  the  conditions 
of  the  farms  kept  under  the  eyes  of  an  inspector. 
The  milk  is  sold  in  two  classes,  '*  certified  milk," 
which  is  guaranteed  to  have  conformed  to  very 
stringent  regulations,  and  is  therefore  rather 
dearer,  and  "  inspected  milk,"  which  is  bought 
with  an  assurance  of  having  been  produced  under 
conditions  of  strict  cleanliness.  A  self-hdping 
plan  of  this  kind  is  likely  to  work  well,  and  iro 
commend  the  idea  to  sanitarians  on  this  **  side." 


Newspaper  Medical  Discovery. 

The  correspondent  of  a  leading  London  news- 
paper last  week  telegraphed  the  news  of  what  he 
evidently  regarded  as  a  marvellous   discovers— 
namely,  the  cure  of  some  forms  of  idiocy  by  thyroid 
gland.     Needless  to  say,  the  cure  of  cretinism  bjr 
that  drug  has  been  well  known  to  medical  scienor 
for  years  past.     The  discovery  of  the  marvellos 
action   of   thyroid   gland   was   made    by    Engtisb 
observers,  and  is  one  of  which  our  countrymcs 
may  be  justly  proud.     It  is  somewhat   amusing. 
therefore,    to    find    a    presumably    well-informed  I 
London  journal  gravely  announcing  that  a  Vienna' 
physician    has    succeeded    in    bringing    cretinism 
within  the  category  of  curable  diseases.    Following 
the    "bad    form"    which    characterises    modem 
lay  journalism  in  these  matters,  th«?  correspondent 
proceeds  to  publish  details  of  cases  thus  treated. 
The  incident  appears  to  partake  of  the  ineradicable 
modem  leaning  towards  things   "  made   in   Ger- 
many."    Surely,  it  would  be  more  in  accord  witk 
the    imperialistic    sense    of    pride,    of  which    the 
journal  quoted  is  a  strong  advocate,  were   honour  1 
given   to  English  medical  men   where   it    is   daei 
instead  of  to  belated  Continental  imitators.    Whyl 
should  not  a  wealthy  London  newspaper  submitl 
medical  and  scientific  stuff  to  a  qualified  medical  ' 
sub-editor  ? 


Hospital  Amalfiramation. 

At  a  time  when  the  rivalry  of   the    medical 
charities  has  well-nigh  reached  a  breaking  strain, 
it  is  comforting  to  find  two  large  institutions  of  the 
kind  coming  to  a  friendly  amalgamation.     Man- 
chester   requires     an    immense     public     medical 
service,  owing  to  the  large  industrial  population. 
The  Victoria  University  of  the  city  found  that  the 
practical    requirements    for    instruction    of    mid- 
wifery were   not   adequately   provided    for.     The 
University      authorities,       therefore.       negotiated 
with   the   management    of    two    large    hospitals, 
St.  Mary's  and  the  Southern,  with  the  result  that 
amalgamation  has  been  resolved  upon,  subject  to 
the  approval  of  the  governors.     The  newly  formed 
hospital,  to  be  called  St.  Mary*s,  \v\\l  be  devoted 
exclusively  to  maternity  cases  so  far  as  the  wards 
are  concerned,  but  it  is  proposed  to  establish  an 
out-patient  department  for  diseases  of  women  and 
children.     The  principal  advantage  of  the  amalga- 
mation is  that  it  allows  the  provision  of  a  maternity 
hospital   and   a   training  institution   in  midwifery- 
such  as   hitherto   have  not   existed.     When  the 
amalgamation  of  the  two  hospitals  is  com{^eted 


August  io,  1904. 


NOTES  ON  CURRENT  TOPICS. 


Thk  Medical  PjtKts.  153 


there  will  be  225  beds  available  for  instruction  in 
midwifery  and  the  diseases  of  women  and  children. 
There  will  also  be  a  school  for  the  education  of 
medical  students,  midwives,  and  midwifery 
nurses.  Another  advantage  is  that  all  danger  of 
overlapping  ynU.  be  removed,  and  that  the  sick 
poor,  for  whom  the  institutions  primarily  exist,  will 
be  further  benefited.  Thus  equipped,  the 
teaching  of  midwifcrj'  in  Manchester  should  be 
second  to  none  in  the  United  Kingdom.  Londoners 
will  note  with  regret  that  they  possess  no  institu- 
tion comparable  with  the  proposed  one  at  Man- 
chester. Their  hospitals  are  all  in  a  condition  of 
fierce  rivalry,  and  any  attempt  at  amalgamation 
is  bitterly  resented. 


Millinery  and  Soience. 

The  excellent  work  of  the  Sanitary  Congress  at 
Glasgow  was  marked  by  a  new  feature,  namely, 
a  Woman's  Health  Conference,  presided  over  by 
a   great  Scotch   noblewoman.     The    departure  is 
most    praiseworthy,    on    most    grounds,   ^except, 
perhaps,  that  which    appears  to  ha\e  commended 
itself  chiefly  to  the  attention  of  a  local  journal. 
The  following  amusing  passage,  culled  from  that 
source,  would  not  be  unworthy  the  attention  of  our 
esteemed  friend  and  contemporary  Punch.     (We 
have  suppressed  names.)     "  Her  Grace  the  D —  of 
M — ,  who    presided,  wore    a    black  gown,    with 
a  bolero   trimmed   with   fine    tucks,  and  relieved  1 
by  a  lace  yoke,  and  by  touches  of  white  cord  and 
lace.     Her  small  toque  was  violet,  with  a  cluster  of 
white   flowers.     Lady   H —   G —   wore   pale   grey 
with  flecks  of  white,  and  a  white  silk  and  lace 
front  and  revers.     She  had  a  large  hat  of  rose  pink, 
with  black  plumes.     Lady  G —  C —  had  a  dark 
blue    trottoir   costume    and   bolero,    with   a   hat 
trimmed  with  roses  and  Neapolitan  violets.     Lady 
P —  was    in  brown  cloth,  faced  with  white,  em- 
broidered in  brown  and  red,  and  wore  a  brown  hat. 
with  cream  lace.     Mrs.  F —  wore  a  pale  grey  gown, 
with  a  black  hat,  and  Miss  I —  was  in  black.     Mrs. 
M —  wore  black  and  white  foulard,  with  a  black 
velvet  picture  hat.     Dr.  E —  P — 's  blue  gown  of 
boucle  cloth  was  smartly  strapped  with  white, 
and  a  hat  of  blue  straw  with  white  silk  was  worn  to 
match.     Miss  J.  E.  S —  was  in  pale  green,  with 
strappings  of  fawn  and  green,  Mrs.  O —  was  in 
-grey,  with  a  black  picture  hat.     Mrs.  C —  M — 
wore  green,  with  cream  lace.     Mrs.  B —  F —  was 
gowned  in  black,  accordion-pleated,  and  trimmed 
with  chiflon,  with  touches  of  rose  pink.     Black 
was  also  worn  by  Mrs.  G — ,  with  white  facings, 
and  a  black  crinoline  hat." 


had  he  had  no  power  to  interfere.     In  spite  of  this, 
we  trust  that  members  of  ParUament  will  continue 
to  bring  the  many  unwarrantable  proceedings  of 
the  Midwives'  Board  to  the  notice  of  the  House, 
as  sooner  or  later  the  amending  Act  will  have  to  be 
passed,  and  it  is  well  that  the  necessity  for  such  an 
Act  should  be  brought  home  to  the  Government 
and  the  members  generally.     The  decision  that 
the  Board  should  be  free  to  select  anyone  whom  it 
chooses  from,  as  Dr.   Sinclair  put  it.  "a  high^ 
gifted  chambermaid  "  upwards,  to  examine  the 
candidates  for  its  diploma,  was  made  in  spite  of  the 
protests  of  several  members.     With  the  greatest 
respect  for  Dr.  CuUingworth's  high  position  in  his 
profession,  his  jaction  in  supporting  this  decision  ap- 
pears  to  us  to  be  most  wrong,  and  to  be  prejudicial 
not  alone  to  the  interests  of  his  own  profession  but 
to  those  of  the  women  who  shall  present  themselves 
for  examination  and  of  the  public  at  large.     When 
discussing  the  question  of  examinations,  Miss  Paget 
with     charming     naivete,    asked,     "  Surely    for 
the  first  examination  you  will  not  be  too  strict  > 
Surely  medical  examinations  begin  gently  ?  "  Miss 
Paget  does  well  to  make  these  requests  ;  she  in 
conjunction  with  other  members  of  the  Board  have 
shut  the  door  in  the  face  of  the  highly  qualified 
nurse,   and  have  opened  it  to  those  who  have 
attended  twenty  cases  under  the  auspices  of   any 
general    practitioner.     Her    prot6g6es    will     un- 
doubtedly require  to  be  dealt  with  gently.   It  is^ 
however,  a  poor  consolation  for  those  who  had 
hoped  for  an  improvement  in  the  "  Gamp  "  to 
learn  that  the  Board  entrusted  with  the  carrying, 
out  of  that  improvement  is  compelled  to  deal  gently 
with  the  incapable  because  it  has  seen  fit  to  reject 
the    competent.       The  nurses  who  would  have 
presented  themselves   from  the   Irish   maternity 
hospitals    would   not  have  required  any  favours, 
from  the  examiners  other  than  a  fair  examination.. 
The  first  examination  will  be  held  in  May,  1905,. 
but  whether  it  is  to  imitate  the  Board  itself  in  its. 
procedure  and  to  partake,  as  Miss  Paget  apparently 
wishes,  of  the  nature  of  a  conversation,  is  not  stated . 
Subsequently  examinations    will    be    held    twice 
a  year  in  London  and  the  provinces  simultaneously 
"  or  more  frequently  if  necesssary,"  in  order,  we 
understand,  that  the  woman  who  fails  at  one  ex- 
amination may  be  able  to  present  herself  for  re- 
examination at  the  earliest  date  possible. 


The  Examinations  of  the  Central  Midwives' 
Board. 

The  action  of  the  Central  Midwives  Board  in 
appointing  or  deciding  to  appoint  unqualified 
women  to  examine  candidates  for  registration 
under  the  Midwives  Act  was  brought  before 
Parliament  last  week  by  Dr.  Thompson  in  the  form 
of  a  question  to  the  Secretary  of  State.  Mr. 
Akers  Douglas  rephed  that  he  did  not  think  that 
the  Board  had  taken  such  action,  but  even  if  they 


Gfrerm-Ijaden  Railway  Oarriaffes. 

For  some  years  past  the  sanitary  dangers  of  the 
unclean  railway  carriage  have  been  before  the 
public.  British  minds,  however,  like  the  poet's 
"  mills  of  God,"  "  grind  slowly,"  although  in  the 
long  run  it  must  be  admitted  they  grind  "  exceed- 
ing small."  In  other  words,  the  next  generation 
of  our  countrymen  will  most  likely  be  provided 
with  railway  carriages  built  upon  scientific  sanitary 
methods  and  systematically  cleansed.  The  rough 
surfaces  and  upholstery  of  our  first  and  second- 
class  cairiages  form  an  inviting  rest  and  shelter  for 
unwholesome  germs.  The  scuffle  of  the  foot  along 
the  carpet,  or  a  pat  on  a  cushion  raises  a  cloud  of 


154  Thk  Medical  Press.       BRITISH    MEDICAL  ASSOCIATION. 


August  io.  1904* 


dust  that  might  well  make  the  stoutest  sanitarian 
turn  pale.  Dust  spells  disease,  especially  in  a 
railway  carriage,  and  that  form  of  **  matter  out  of 
place  "  has  been  shown  again  and  again  to  foster 
the  microbes  of  consumption  and  other  deadly 
maladies.  In  the  bare  unfurnished  type  of  third- 
class  carriage  the  chief  lurking  place  of  these  evil 
germs  appears  to  be  on  the  rough  floor.  Why 
should  not  railway  carriages  be  furnished  through- 
out with  smooth  surfaces  capable  of  thorough 
and  efficient  cleansing  ?  The  filthy  condition  of 
many  a  smoking  carriage  is  nothing  short  of  an 
outrage  on  society,  which  is  obtainmg  some  sort 
of  first-standard  School  Board  sanitary  reform  in 
other  directions.  Why  should  not  railway  carriages 
be  systematically  inspected  by  some  central  State 
authority  ? 

PERSONAL. 


On  the  occasion  of  the  King's  recent  visit  to  Liver- 
pool, the  loyal  address  from  the  University  was  read 
to  His  Majesty  by  Dr.  A.  W.  W.  Dale,  the  Vice- 
Chancellor  of  the  University.  Dr.  Dale  was  presented 
to  the  King  and  Queen  by  the  Earl  of  Derby. 

The  Queen  has  consented  to  become  patron  of  the 
Association  for  Promoting  the  Training  and  Supply 
of  Mid  wives,  the  object  of  which  is  to  organise  and 
assist  the  training  of  women  to  act  as  midwives  among 
the  poor,  and  so  meet  the  requirements  of  the  new 
Act. 


his  valedictory  address  on  August  ist.  to  the  Inter- 
national Congress  of  Otology  at  Bordeaux,  and 
cordially  welcomed  his  successor,  Dr.  Moure,  of     Paris. 

Dr.  J.  F.  Payne,  the  Harveian  Librarian  of  the 
London  Royal  College  of  Physicians,  %vill  deliver  the 
FitzPa trick  Lectures  in  the  College,  on  November  8th 
and  I  ith.  The  titles  of  the  lectures  will  be  "  Gilbertus 
Anglicus  and  Medicine  in  the  Anglo-Norman  Period " 
and  "  Ricardus  Anglicus,  and  the  History  of  Anatomy 
in  the  Middle  Ages." 


Dr.  F.  F.  Caiger  will  deliver  the  Bradshaw  Lecture 
of  the  London  Royal  College  of  Physicians  on  November 
1 5th,instead  of  November  3rd,  as  previously  announced. 

Dr.  Frederick  Roberts  has  been  nominated 
Harveian  Orator  of  the  London  Royal  College  of 
Physicians  for  1905. 

The  Duchess  of  Montrose  presided  at  a  con- 
ference of  women  on  hygiene  at  the  22nd  Congress  of 
the  Sanitar  y  Institute  recently  held  at  Glasgow. 

The  Campbell  Hospital  for  Infectious  Diseases, 
presented  to  the  public  by  Dr.  Campbell,  Convener  of 
the  County  of  Banff,  was,  on  the  30th  ult.,  formally 
opened  by  the  Dowager  Countess  of  Seafield. 

Dr.  J.  W.  E.  Cole  has  become  a  District  Surgeon  in 
the  Administration  of  North-Eastem  Rhodesia. 


Dr.  Leslie  has  been  selected  by  the  Royal  Univer- 
sity Graduates'  Association  as  a  suitable  person  to  be 
appointed  to  the  vacancy  on  the  Senate  of  the  Univer- 
sity caused  by  the  death  of  Dr.  William  McKeown. 
Representations  to  that  effect  have  been  made  to  the 
Government,  with  whom  the  appointment  rests,  and 
they  have  promised  to  take  them  into  consideration. 

Sir  John  W.  Moore,  late  President  of  the  Royal 
College  of  Physicians  of  Ireland,  received  the  honorar)* 
D.Sc.  degree  from  the  University  of  Oxford  on  the 
occasion  of  the  recent  meeting  of  the  British  Medical 
Association.  

Colonel  F.  Howard,  Army  Medical  Service  (re- 
tired), has  been  appointed  President  of  a  Medical 
Board  to  examine  candidates  for  the  Royal  Military 
Academy  and  Royal  Military  College. 

The  Fishmongers'  Company  have  given  ;f500  to 
King  Edward's  Hospital  Fund,  and  twelve  other  smaller 
amounts  to  hospitals. 

Sir  Riley  Lord,  when  Mayor  of  Newcastle,  suc- 
ceeded in  raising  by  public  subscription  ;£  100.000 
towards  the  new  Infirmary.  Lord  Armstrong  and 
Mr.  John  Hall,  shipowner,  each  gave  / 100.000  to  the 
same  object.  Sir  Riley  has  now  announced  his  inten- 
tion to  present  a  white  marble  statue  of  Queen  Victoria, 
to  be  placed  in  front  of  the  Newcastle  Royal  Infirmary. 

Dr.  Frederick  Roberts  has  been  appointed 
Harveian  Orator  for  1905,  on  the  nomination  of  the 
President  of  the  Royal  College  of  Physicians  of  London. 

jBritisb  AeMcal  asBociatfon. 


Dr.  J.  M.  L.  Brown.  Medical  Officer  of  Lagos,  has 
resigned  his  appointment. 

George  MacKay,  M.D.,  F.R.C.S.Ed.,  of  Edin- 
burgh, has  been  elected  President  of  the  Cale- 
donian Medical  Society  for  the  ensuing  year. 

Mr.  H.  R.  Johnston,  M.B.Dub.,  has  received  a 
handsome  testimonial  from  the  officers  and  staff  of 
the  Infirmary  of  St.  Olave,  Rotherhithe,  on  the  occasion 
of  his  retirement  from  the  medical  superintendent- 
ship  of  that  institution,  a  post  which  he  has  held  for 
eighteen  years. 

The  Senate  of  the  University  of  Vienna  has  recently 
celebrated  the  retirement  of  Professor  v.  Vogl  on 
attaining  his  70th  birthday. 


Dr.  Bentley.  of  Kirkliston,  Scotland,  has  been 
publicly  presented  with  a  horse  and  brougham  for 
himself,  and  other  articles  for  his  wife  and  daughter, 
as  a  token  of  esteem  from  friends  and  patients. 

Dr.    Pritchard,    the   London   otologist,    delivered 


SEVENTY-SECOND  ANNUAL  MEETING, 
OXFORD,    1904. 


[Third   Article.] 


[by  our  special  .medical  reporter.] 

The  Annual  Exhibition. 
The  annual  display  of  surgical  and  scientific  instru- 
ments, sanitary  appliances,  foods  and  food  products, 
medical  publications  and  other  material  pertaining 
to  the  realm  of  the  healing  art  has  for  long  been  a 
particularly  valuable  feature  of  the  great  yearly 
gathering  of  British  practitioners.  There  is  need, 
however,  that  special  precautions  should  be  taken  to 
maintain  a  high  standard  in  the  conduct  of  this  periodic 
exhibition.  We  are  strongly  of  opinion  that  the 
scientific  rather  than  the  trade  spirit  should  be  domi- 
nant in  the  selection  and  arrangement  of  the  exhibits. 
Too  often,  it  has  appeared  to  us.  exhibitors  have 
adopted  methods  more  likely  to  impress  a  gullible 
public  than  influence  discriminating  practitioners. 
We  consider  demonstrations  should  as  far  as  possible 
replace  mere  verbal  presentations.  All  mere  vulgar 
forms  of  touting  should  be  rigorously  discountenanced. 
It  would  be  well  if  greater  care  was  taken  in  the  selec- 
tion of  material  exhibited  ;  wines,  tobacco,  and  goods 
not  strictly  medical  or  bearing  directly  on  a  practi- 
tioner's life  and  work,  should  be  excluded.  The 
catalogue  might  be  made  a  much  more  valuable 
manual  for  reference  if  it  contained  illustrations  and 
descriptions  of  new  appliances.  At  present  the 
contents  are  in  great  measure  a  mere  enumeration  of 
old   or   would-be   favourites.     This  year's   exhibition 


August  lo.  1904. 


BRITISH  MEDICAL  ASSOCIATION.     The  Mbdical  Press.    155 


reached  a  high  level  of  excellence,  and  as  far  as  we 
were  able  to  see  the  exhibitors  were  generally  judicious 
and  courteous  in  urging  the  claims  of  their  respective 
preparations.  In  most  instances,  the  various  stalls 
were  arranged  to  attract  professional  notice,  but  one 
well-known  extract  of  meat  company,  trading  under 
distinguished  directors,  adopted  a  method  of  attract- 
ing public  inspection,  which,  to  say  the  least,  was  not 
Oxonian  in  its  scientific  modesty. 

Mr.  Guy  Elliston,  as  manager,  has  accv^mpUshed  a  1 
particularly  difficult  task  with  much    tact  and  judg-  ' 
ment.     In   the  future  we  shall  expect   even  greater 
advantages  to  accrue  from  the  new  poUcy  of  directing 
and    controlling    the   annual    exhibition    from    head- 
quarters. 

Surgical  Instruments. 
A  number  of  well-known  makers  were  represented. 
Messrs.  Down  Bros,  showed  many  new  models.  Messrs. 
S.  Maw,  Son  and  Sons  exhibit^  a  good  selection  of 
instruments.  John  J.  Griffin  and  Sons  demonstrated 
the  advantages  of  the  new  Harcourt  Chloroform 
Inhaler.  John  Weiss  and  Son  displayed  their 
products  ;  and  Mayer  and  Meltzer  had  a  good  collection 
of  laryngological,  aural  and  other  instruments.  Messrs. 
Alien  and  Hanbury  had  a  very  extensive  display, 
and  J.  Gardner  and  Son.  F.  Davidson  and  Co..  Brady 
and  Martin,  and  the  Holbom  Surgical  Instrument 
Co.  all  had  interesting  exhibits.  Arnold  and  Sons 
exhibited  a  number  of  particularly  valuable  new 
inveBtaoBS. 

Hospital  Equipment. 
The  exhibition  was  particularly  rich  in  material 
connected  with  hospital  construction  and  equipment. 
Messrs.  Dcmlton  and  Co.  showed  lavatory  and  bath 
fittings ;  Geo.  Gale  and  Sons  showed  various  forms  of 
their  "  LawBon  Tait "  bedsteads  and  other  hospital 
furniture ;  the  Marshall  Sanitary  Mattress  Co.  ex- 
hibited mattresses  and  a  convenient  **  Handy-Cosy  " 
folding  bed  ;  the  Longford  Wire  Co.  had  useful  forms 
of  bed  fittiiq^ ;  W.  H.  Bailey  and  Son  showed  various 
novelties  and  useful  types  of  operation  tables ;  Messrs. 
Allen  and  Hanbury  had   aseptic  hon>ital  fumitnre  in 

Shoephor  bronze,  German  silver,  and  enamelled  steel; 
lessrs..  Phihp  Harris  and  Co.,  of  Birmingham,  also 
had  a  good  display.     Indeed  it  would  seem  now  that 
aJl  the  best  instrument  makers  and  many  famishing 
firms  make  the  matter  of  hospital  equipment  a  leading 
feature ;    and   certainly,    judging   by   the   admirable 
display,    at    Oxford,    the    modem    has   innumerable 
advantages  over  the  ancient  equipment  of  a  few  jrears 
ago.     Frank  A.  Rogers  had  a  well-arranged  exhibit 
of  his  sprays  and  other  convenient   pharmaceutical 
preparations.     G.  H.  Neal  had  an  extensive  display  of 
clinical  thermometers,  including  the  useful  "  Repello." 
Aseptic  and  antiseptic  dressings  were  shown  by  such 
firms  as  Petol,  Ltd.,  Cuxson,  Gerrard  and  Co.,  Peat 
Products  Co.,  and  the  Sanitary  Wood-Wool  Co.     The 
Berkefeld  Filter  Co.  demonstrated    the  use  of  their 
different  forms  of  filter. 

Electrical  Apparatus. 
Excellent  exhibits  of  X-ray  apparatus,  high  fre- 
quency appliances,  and  medical  electrical  equipment 
were  made  by  Harry  W.  Cox,  the  Marconi  Wireless 
Telegraph  Co.,  the  Medical  Supply  Association,  and 
Isentbal  and  Co.  Various  models  of  the  Hodgkinson 
electro-neurotome  were  demonstrated. 

The  Dowsing  Radiant  Heat  and  Light  Co.  had  an 
elaborate  exhibit  of  arrangements  illustrating  their 
system  of  treating  certain  diseases  by  hot  air,  the 
Finsen  light,  &c. 

Drugs  and  Pharmaceutical  Preparations. 

Many  well-known  houses  made  excellent  displays  of 
old-established  preparations.  A  few  new  synthetical 
liodies  were  exhibited,  but  the  novelties  were  rather  in 
the  direction  of  elegance  and  convenience  of  form 
tnan  actual  originality  in  composition. 

Burgoyne,  Burbidges  and  Co.,  showed  a  number  of 
the  nseful  Heyden  pharmaceutical  products,  including 
acoine,  creoso'tal,  salocreol,  and  xeroform ;  C.  de  Trey 
and  Co.  exhibited  the  new  anaesthetic  sdmnoforme'; 
Wyleys,  of  Coventry,  had  an  attractive  show  of  theii 


elegant  elixirs,  syrups,  pastilles  aud  other  well-known 
preparations ;  Hedley  and  Co.  reminded  us  of  the  use 
of  ethyl  chloride  as  an  anaesthetic  ;  Oppenheimer,  Son 
and  Co.  showed  that "  palatinoids  "  may  be  employed 
as  a  serviceable  form  of  administering  many  of  the 
new    drugs ;    Parke,    Davis    and    Co.     exhibited    a 
collection  of  their  standardised    drugs,   an  excellent 
collection   of   sera,    and    a    series    of    lantern   slides 
illustrating  biological  and  pharmacological  processes 
now    employed    m    the    preparation    of    therapeutic 
material;   the  Bayer  Co.   displayed  many  synthetic 
compounds,  including  the  serviceable  veronal,  somatome, 
citarin,  aspirin,  and  heroin ;    Mr.  W.  Martindale  dis- 
played many  of  his  elegant  pharmaceutical  prepara- 
tions, and  reminded  the  profession  that  a  new  edition 
of  his  invaluable  "  Extra   Pharmacopoeia  '*  had  just 
been  issued  ;    the   Charles   H.    Phillips  Chemical  Co. 
called  attention  to  their  Milk  of  Magnesia  and  other 
American  preparations ;  A.  and  M.  Zimmerman   had 
a    collection    of    Schering's    and    other  Continental 
manufacturers'       well-known  •   products ;      Fairchild 
Brothers  and  Foster  showed  their  various  digestive 
products;  J  eves'  Sanitary  Compounds  Co.  drew  atten- 
tion to   Cyliin,  their  new  name  of  an  old  favourite 
disinfectant  (creolin)  ;  Angier's    Emulsion    was    also 
prominently  displayed ;  Duncan,  Flockhart  and  Co. 
had  a  good  exhibit  of  anaesthetics,  soaps,  compressed 
tablets,  and  oth^sr  special  preparations;  Arthur  and 
Co.  showed  various  cosmetics  and   other  novelties ; 
C.  J.  Hewlett  and  Son  were  well  represented  by  a  good 
display  of  their  well-kntywn  mixtures  and  some  new 
synthetic   remedies ;    Andrus   and   Andrus   exhibited 
fonnol>T)tol  and  hamaboloids ;  H.  and  T.  Kirby  and 
Co.    advertised    the    merits   of  Purgen ;    Brady  and 
Martin,  of  Newcastle-upon-Tyne,  also  made  a  good 
display  of  many  elegant  preparations.      The  Denver 
Chemical  Manufacturing  Company  has  an  extensive 
display    of     Antiphlogistine    a    siUcate     compound 
which    is   coming    into    extensive    use    as    a    new 
form    of     ponltice   or    compress    in   swollen    joints, 
for  which  it  forms  a  firm  bat  flexible  support.     It  has 
also  proved  its  utility  when  employed  in  deep-seated 
inflammations,  and  seems  likely  to  attain  therapeutic 
eminence;   and    the    Ferroleam    Co.     showed    their 
much-lauded    emulsion  of    cod-liver    oil,    iron    and 
phosphorus. 

Foods,  Drinks,  and  Food  Products. 
As  usual,  these  found  place  in  rich  abundance,  and 
oftentimes  occupied  positions  altogether  beyond  their 
merits.  It  is  certainly  desirable  that  the  exaggerated 
claims  made  by  the  manufacturers  of  many  milk» 
food  and  meat  preparations  should  not  appear  to 
receive  endorsement  by  the  profession.  Much  dis- 
cernment and  discrimination  is  necessary  in  the 
selection  of  preparations  coming  under  this  head,  and 
we  are  not  convinced  that  sufficient  sifting  has  been 
employed  in  the  admission  of  some  to  this  year's 
"  show." 

Liebig's  Extract  of  Meat  Co.  made  a  somewhat 
unusual  display  of  Oxo  considering  the  character  of 
the  audience  appealed  to  ;  the  International  Plasmon 
Co.  exhibited  various  preparations  of  Plasmon ; 
the  Maltico  Food  Co.  showed  their  different  specialities; 
Callard  and  Co.  had  a  good  display  of  starchless 
foods;  the  Shredded  Wheat  Co.  demonstrated  the 
delights  of  their  biscuits;  Reynold's  Wheatnieal 
Brown  Bread  advertised  its  digestive  distinction ; 
the  Cheltine  specialities  were  also  well  to  the  fore; 
Cosenza  and  Co.  reminded  visitors  of  the  convenience 
and  comfort  of  Maggi's  Consomm6  ;  the  Galak  dry 
milk  claimed  to  be  a  veritable  food  of  high  excellence ; 
M.  Hoff  showed  his  well-known  malt  extract ;  Mellin's 
valuable  dietetic  preparations  were  prominent ; 
Cadburv  Bros.,  of  Boumcville,  showed  much  tasty 
chocolate ;  Irven  and  Co.  exhibited  their  Klonat  brand 
of  dried  milk;  Armour  and  Co.  had  an  elaborate 
display  of  their  animal  products,  digestive  ferments, 
and  glandular  extracts  in  tablet  and  powder  form ;  the 
Aylesbury  Dairy  Co.  showed  samples  of  their  well- 
known  humanised  milks  ;  Nestl6  reminded  visitors  of 
his  claims  for  Milo  food  and  the  Viking  unsweetened 


15^     The  Medical  Press. 


CORRESPONDENCE. 


August  io,  1904 


milk ;  Brand  and  Co.  exhibited  their  juices  and  jellies 
^nd  other  specialities  for  invalids  ;  Virol  and  Bovril 
also  had  prominent  exhibits ;  Albene,  a  vegetable 
lat,  was  shown  by  Broomfield  and  Co  ;  the  Manhu 
<liabetic  foods  were  also  exhibited,  and  Van  Abbott 
and  Sons  showed  their  gluten  bread  and  ST)ecial 
foods  for  obesity,  diabetes,  and  various  dyspeptic 
states. 

The  claims  of  "  waters  "  seems  to  be  limitless.  C. 
Oppel  and  Co.  displayed  Friedrichshall ;  Ingram 
and  Royle  showed  many  natural  mineral  waters ; 
Arabella  water  at  least  attracted  by  its  name  ; 
Idris  and  Co.  made  an  attractive  grouping  of  their 
table  waters  and  lime-juice  preparations  ;  the  Apol- 
linaris  Co.  demonstrated  the  purity  of  the  source  whence 
the  Apollinaris  water  is  derived,  and  the  value  of  the 
now  well-known  aperient  water  Apenta  ;  Alexander 
Riddle  and  Co.,  and  Feltoe  and  Smith  showed  lime 
and  lemon  juice  preparations ;  Camwal  aerated  waters 
were  prominently  displayed ;  Allsopps  exhibited 
their  lager  beer  ;  Stephen  Smith  and  Co.  advertised 
Hall's  Wine  ;  Coleman  and  Co.  showed  Wincamis  ; 
and  Keinheimer  and  Co.  displayed  their  Nektar 
wines. 

Medical  Publications. 

We  coald  wish  that  nwans  could  be  found  whereby 
all  the  recently  published  works  could  be  brouehit 
together  and  conveniently  grouped  in  the  form  of  a 
temporary  library.  At  the  present  time  the  display 
of  medical  literature  is  incomplete  and  inconvenient, 
and.  we  imagine,  does  little  for  the  publisher,  as 
fividenced  by  the  absence  of  most  of  the  leading 
houses,  and  still  less  for  the  serious  student. 
The  firms  exhibiting  this  year  were  John  Bale.  Sons 
and  Danielsson  ;  Macmillaii  and  Co.,  H.  K.  LeMris, 
Cassell  and  Co.,  John  Wright  and  Co.,  J.  B.  Lippincott 
Company,  and  W.  B.  Saunders  and  Cx>. 
Miscellaneous. 

It  is  impossible  in  the  limited  space  at  our  disposal 
to  indicate  all  the  stands  found  in  the  annual  ex- 
hibition. In  addition  to  those  already  mentioned 
reference  may,  however,  be  made  to  various  forms  of 
orthopaedic  tapparatus  and  appliances  for  the  lame, 
shown  by  the  O'Connor  Extension  Company,  N. 
Bletchley,  Messrs.  Salt  and  Sons,  and  F.  Gustav  Ernst. 

W.  and  A.  K.  Johnson  exhibited  a  series  of  diagrams 
on  Hygiene.  "  Ronuk,"  Ltd.,  showed  their  well-known 
sanitary  polishes  for  hospital  floors.  The  Trading 
and  Manufacturing  Co.,  of  Temple  Bar  House,  de- 
monstrated the  advantages  of  their  card  index  systems. 
The  Cellular  Clothing  Co.  exhibited  their  Aertex 
underclothing.  The  Boroughs  of  Leamington,  Harro- 
gate, and  Buxton  drew  attention  to  the  value  of 
their  respective  towns  as  desirable  health  resorts. 

In  conclusion,  we  would  again  congratulate  all 
concerned  in  the  preparation  and  conduct  of  this 
year's  exhibition.  We  would,  however,  suggest  that 
in  future  the  usefulness  of  the  catalogue  might  be 
increased  if  a  subject  index  could  be  added  in  addition 
to  that  of  exhibitors  and  advertisers. 


Special  (£orre9pon&ence« 

[from  our  special  correspondent.] 


BELFAST. 
Medical  Appointments  in  Belfast. — Dr.  W.  M. 
Killen  has  been  appointed  attending  surgeon  to  the 
Benn  Ulster  Eye,  Ear,  and  Throat  Hospital,  in  place  of 
the  late  Dr.  W.  A.  McKeown.  In  consequence  of  this 
appointment,  Dr.  Killen  has  given  up  general  practice, 
and  has  resigned  his  post  of  medical  attendant  to  the 
Royal  Irish  Constabulary.  For  this  post  there  arc  said 
to  be  about  twenty  candidates,  who  are  all  hard  at 
work  bringing  influence  to  bear  on  the  police  authorities. 
The  appointment  will  be  made  in  the  course  of  the 
next  few  days.  Another  post  rendered  vacant  by 
Dr.  McKeown' s  death  is  that  of  lecturer  on  ophthalmo- 
logy and  otology  at  Queen's  College.  No  appoint- 
ment can  be  made  till  the  session  opens  in  October, 


but  it  is  understood  that  there  will  be  at  least  four 
candidates  for  the  post.  The  appointment  rests  in 
the  hands  of  the  College  Council. 

Health  of  the  City  of  Belfast. — ^The  report  of  the 
Medical  Officer  of  Health  for  1903  has  just  appeared, 
but  offers  no  novel  points  for  comment,  being  the  same 
hopelessly  insufficient  document  as  in  past  3rears.  chiefly 
remarkable  for  its  omissions.  The  number  of  cases  of 
typhoid  and  simple  continued  fever  notified  fell  from 
1774  in  1902  to  1,432  in  1903,  and  the  deaths  from  the 
same  affections  from  181  to  144.  The  rainfall  increased 
from  37  inches  to  over  44,  and  probably  the  thorongh 
flushing  of  the  sewers  had  not  a  little*  to  say  to  the 
decrease  in  these  diseases.  The  deaths  from  phthias 
and  diseases  of  the  respiratory  organs  were  2,675,  ^^f 
lowest  since  1897.  Considering  the  increase  of  popo- 
lation  this  shows  considerable  improvement,  though 
the  deaths  from  these  largely  preventaole  diseases  are 
still  fearfully  numerous.  Three  pages  of  the  report  a« 
devoted  to  a  detailed  history  of  fifteen  cases  of  sraB- 
pox,  which  occurred  in  the  last  three  months  of  i^oy 
which  is  rather  ancient  history  now,  as  we  have  had  a 
extensive  outbreak  since  then.  No  maps  of  the  dty 
to  show  the  incidence  of  various  diseases  are  given,  n 
mention  is  made  of  the  refuse  destructor  or  its  workini 
and  we  find  no  reference  to  the  important  subject  d 
the  inspection  of  food  and  seizure  of  unsound  meat,  ic 
We  commend  these  points  to  the  careful  attentkn  cf 
the  new  chairman  of  the  Public  Health  Commitie 
Dr.  King-Kerr,  and  to  his  medical  colleagues  on  that 
committee,  Dr.  A.  Browne  and  Dr.  O'Neill. 

Proposed  Sanatorium  for  Consumptives.- Tk 
question  of  the  proposed  sanitorium  was  under  dis- 
cussion at  the  monthly  meeting  of  the  Belfast  Coc- 
poration  held  last  week,  and  some  idea  of  the  proposal 
was  sketched  by  the  chairman  of  the  Public  Health 
Committee.  The  estimated  cost  of  building  and  fii- 
nishing  is  about  ;£20,ooo,  and  it  is  to  be  of  such  a  si» 
that  300  to  400  patients  can  be  passed  through  it  eact 
year,  at  a  cost  of  £6,000.  which  will  be  paid  by  our 
penny  in  the  pound  on  the  rates.  The  Board  aj 
Guardians  will  send  the  more  curable  cases  from  tk  ] 
Union  Infirmary,  and  will  pay  half  the  cost  of  mai 
tenance.  It  is  also  proposed  to  take  paying  patiei& 
Some  thirty  or  forty  sites  have  been  offered  to  tk 
Corporation,  and  at  present  these  are  being  examined 
and  plans  being  perfected,  and  the  whole  scheme  «^ 
shortly  be  presented  to  the  Corporation  for  fai 
discussion  and  decision. 

The  Small-pox  Epidemic— There  is  a  distiaci 
falling  off  in  the  number  of  small-pox  cases  notified  io 
the  last  month  in  Belfast.  In  the  month  endiK 
July  1 6th,  there  were  twelve  cases,  but  none  ancc 
There  has,  however,  been  an  outbreak  in  Arina^. 
Two  cases  were  reported  on  August  3rd,  and  remowJ 
to  the  fever  hospital,  where  one  has  since  died,  and 
four  more  cases  were  admitted  the  next  day.  Thf 
house  in  which  the  first  case  appeared  had  been  used 
as  a  lodging-house  for  some  of  the  extra  police  draftd 
into  Armagh  during  the  recent  disturbances  there,  and 
it  is  feared  that  these  men  may  have  been  exposed  tc 
the  infection.  A  number  of  known  "  contacts  "  havf 
been  isolated. 


Corre0pon&ence. 

[We  do  not  hold  ourselves  responsive  for  the  opinions  of  ourCsr 
respondents]. 


THE  DIMINISHING  BIRTH-RATE. 
To  thg  Editor  of  The  Medical  Peess  and  Cibcoui 
Sir, — I  am  a  country  medical  practitioner,  anii 
have  read  Dr.  Walsh's  able  and  philosophical 
articles  with  the  deepest  interest.  With  the  greatest 
industry  and  economy  I  can  provide  for  my  rent. 
keep  a  horse  and  trap,  and  pay  my  way.  Mr 
wife  is  a  lady  by  birth,  and  accepts  her  share  of  house- 
hold drudgery  without  complaint.  We  have  one  chiM 
a  son,  five  years  of  age,  whose  schooling  will  soon  hare 
to  be  provided  for,  but  I  fear,  unless  things  take  a 


August  io,  1904. 


OBITUARY. 


Thb  Medical  Press.     137 


•considerable  turn  for  the  better,  he  will  not  have  that 
public  school  training  which  has  been  a  tradition  in  my 
family  for  generations.  Ihe  position  is  this  :  Here  is 
a  struggling  professional  man  just  able  to  make  both 
ends  meet  by  the  help  of  his  wife,  a  refined  lady  who 
-does  the  work  of  a  fsreneral  servant,  and  yet  has  to  keep 
up  appearances,  ^liat  would  happen  if  we  went  on 
multiplying  children,  as  Dr.  Taylor  tells  us  it  is  our 
■duty  to  do  ?  Why,  my  wife  would  soon  be  dead,  and 
the  children  motherless.  How  could  I,  deprived  of 
their  mother,  hope  to  clothe,  feed,  and  educate  those 
children  and  send  them  out  into  the  world  with  any 
chance  of  comfort  and  success  ?  No.  Give  me  the 
prudence  of  prevention  rather  than  the  selfish  reck- 
lessness of  over-production.  A  living  neurasthenic  is 
l>etter  than  a  wife  in  her  grave. 

I  am,  Sir.  yours  truly, 

A  Country  Practitioner. 
Bucks.  August  8th,  1^4. 

To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — I  do  not  wish  to  press  any  advantage,  but  on 
referring  to  the  Parliamentary  Report,  I  find  that  there 
is  a  very  serious  discrepancy  between  the  actual  facts 
and  the  figures  given  by  Dr.  Walsh  which  «annot  be 
ignored. 

*-»From  Table  III,  p.  Ixxxiii,  of  the  64th  Annual 
Report  of  the  Registrar-General.  I  take  the  following 

£gu>^^  • — 

Births  to  i.ooo  Living. 
TotallnEnglMd 
Mid  WalM.  LeffiUmftte.        lUegitimate. 

Tn    1884 33-6      32*0      1-6 

In   1901    28*5      27*4      I'l 

Loss  S'l  4*6  '5 

Dr.  Walsh  states  in  The  Medical  Press  and 
Circular  for  July  13th  that  the  total  birth-rate  in 
1884  stood  at  "  31,"  and  builds  his  main  argument  on 
this  !  I  am  sorry  he  has  made  this  mistake,  for  it  has 
given  not  only  him  and  myself,  but  also  a  kind  corre- 
spondent who  has  written  to  me  on  the  subject,  a  lot 
of  unnecessary  trouble.  The  ille^timate  births  have 
diminished  with  the  general  diminishing,  but  are 
almost  a  negligible  quantity. 

I  am,  Sir,  yours  truly. 

John  W.  Taylor. 
22   Newhall  Street,  Birmingham. 
August  3rd,   1904. 

To  iHe  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  am  the  wife  of  a  curate,  who,  thanks  to  the 

inequalities  of  incomes  in  the  E.stablished  Church,  has. 

at  the  age  of  forty,   to  be  thankful  for  his  luck  in 

-securing  an  annual  income  of  ;i2  50.     On  that  sum  I 

have  to  keep  house,  to  feed,  clothe,  and  educate  two 

boys  and  one  girl.     That  means  I  must  myself  do 

sewing,  mending,  housework,  while  the  household  is 

pinched  and  starved  merely  to  ensure  the  necessaries 

of  life.     What  would  have  happened  had  my  children 

been  unrestricted — say,   eight  or  ten,  as  Dr.  Taylor 

"Says  they  should  be  ?     The  prospect  is  appalling.     I 

should  have  had  to  feed  them  on  bread  and  onions, 

and   turn  them  out  into  the  world  hopelessly  handi- 

■capped  in  body  and  mind — that  is  to  say,  had  I  lived 

through  the  toil  and  worry  and  the  physical  drain  of 

multiple  child-bearing.     Purity  and  high  thinking  and 

-social  culture  do  not  pay  for  boots  and  frocks  and  food 

■and  housing.     Why  should  I  bring  children  into  the 

world  on  the  strength  of  social  and  intellectual  qualifi- 

'cations   that   fail    to    furnish    the    decencies   of   life 

reasonably   demanded   by   my   husband's   station   in 

•society  ?     Does  Dr.  Taylor  think  I  should  have  pro- 

•dnced  those  additional  children  or  not  ? 

I  am,  Sir,  yours  truly, 

A  Poor  Curate's  Wipe. 
Manchester,  August  6th,   1904. 

PREVENTION  OF  PERINEAL  RUPTURE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir.  —This  well-worn  subject,  on  which  you  comment 


in  your  last  issue,  re  Dr.  Lapthorn  Smith's  treatment, 
should  raise  a  smile.  "  A  little  nonsense  now  and 
then  is  relished  by  the  best  of  men."  Dr.  Lapthorn 
Smith  evidently  believes  in  "  a  stitch  in  time,"  but  on 
the  same  principle  every  adult  male  should  have  the 
prostate  gland  removed  so  as  to  avoid  the  inevitable 
"  hypertrophy,"  with  all  its  accompan3dng  troubles, 
later  on  in  life. 

The  simple  plan  proposed  by  me  years  ago  (and  which 
I  have  never  found  to  fail  should  I  be  called  to  the 
case  tn  time)  is  simply  drawing  back  the  perineum 
forcibly  during  each  pain.  The  late  Dr.  Parvin,  of 
Philadelphia,  alludes  to  it  in  his  work.  "  Science  and 
Art  of  Obstetrics,"  page  410,  and  I  make  bold  to  say 
it  will  be  found  the  best  preventive  treatment  (no 
anaesthetics  required)  of  laceration  of  female  perineum. 
I  am,  Sir.  yours  truly. 

Alexander  Duke. 

PROPOSED   STERILISATION   OF  CERTAIN 

DEGENERATES. 

To  the  Editor  of  TrtE  Medical  Press  and  Circular. 

Sir, — In  reviewing  the  above  work,  your  reviewer 
attempts  to  give  the  impression  that  I  advocate 
suicide  as  a  means  of  checkmg  degeneracy.  X  do  not. 
Nature  attempts  to  deal  wjtn  insanity  in  this  way. 
but  her  efiorts  are  not  successful.  It  is  in  this  respect 
Nature  requires  our  help-sterilisation.  If  any  of 
your  readers  will  refer  to  page  10  of  the  above,  they 
will  find  the  following : — '*  K^ep  everjrthiiig  siiye. 
For.  if  to-morrow  every  degenerate  were  killed,  but 
the  causes  of  their  being  deg^erates  were  ua«Lt tended 
to.  then  as  large  a  number  of  degenerate^  would  t^e 
their  place.  There  is  no  real  cure  so  long  as  the  causes 
remain  ignored." 

I  am  glad  to  see  your  reviewer  denounce  our  pr^ent 
"  Christian  "  custom  of  allowing  "  cured  "  lunatics  to 
marry,  or  to  return  to  conjugal  relations, 
I  am,  Sir,  yours  truly. 

Robert  R.  Rbntoul. 

Liverpool. 


SOME  OF  THE  NEWER  (?)  METHODS 
OF  fOPENING  AND   CLOSING   THE   ABDOMEN. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir. — Dr.  Tweedy  states  in  his  letter,  in  reply  to 
mine  on  above  subject,  rather  dogmatics^y :  "  These 
so-called  '  Bozemann  plates '  are  placed  at  intervals 
[italics  mine]  across  a  wound."  Dr.  Bozemann  states 
in  his  letter  to  me :  *'  There  is  certainly  no  object  in 
having  a  window  through  which  to  view  the  reparative 
process— the  adhesion  of  the  wound  would  go  on  just 
as  well  in  the  dark"  From  the  tone  of  his  letter  I 
conclude  Dr.  Tweedy  is  not  quite  pleased  that  the  plan 
to  which  he  called  attention  and  stated  "  (so  far  as 
he  knew)  was  novel,"  is  Nathan  Bozemann's  pure  and 
simple,  and  perhaps  it  would  not  be  too  early  for  him 
to  act  on  his  own  advice  as  regards  a  post-graduate 
course  ! 

I  am.  Sir,  yours  truly, 

A.  D. 

London,  W. 


T.  GILBART  SMITH.  M.D.DtJB.,  M.A.,  F.R.C.P. 
LOND. 
With  much  regret  we  announce  the  sudden  death  of 
Dr.  T.  Gilbart  Smith,  at  Twerton,  Devon,  where  he 
was  taking  a  bicycling  tour  with  his  son  by  way  of  a 
summer  holiday.  Death  was  due  to  heart  failure,  and 
took  place  at  the  comparatively  earlv  age  of  56. 
Deceased  was  for  many  years  on  the  staff  "of  the  London 
Hospital,  as  assistant  physician,  and  afterwards  as 
physician.  Among  other  appointments  he  held  that 
of  physician  to  the  Royal  Hospital  for  Diseases 
of  the  Chest.  He  was  well  known  and  popular  as  a 
teacher  of  sound  as  well  as  of  brilliant  qualities. 
Socially,  his  kind  and  genial  disposition  made  him 
the  centre  of  a  large  circle  of  friends  both  inside  and 
outside  his  own  profession.     His  medical  education  was 


158    The  Medical  Press. 


LITERATURE. 


August   10,   1904. 


conducted  at  Dublin  University,  and  at  St.  Bartholo- 
mew's. In  1 87 1,  he  took  the  English  diploma  of 
M.R.C.S.,  and  in  1885  the  Fellowship  of  the  same  body. 
He  became  bachelor  of  medicine  of  Dublin  University 
in  1869,  and  graduated  M.D.  T.C.  in  1873.  ^^' 
Gilbart  Smith  was  a  member  of  many  learned  societies, 
and  made  numerous  contributions  to  medical  literature. 
His  death  deprives  the  distinguished  knot  of  Irishmen 
in  London  of  a  well-known  and  esteemed  figiure. 

STAFF-SURGEON  HENI^Y  SCANLAN.  M.B., 

CM.,  Univ.  GlasGow. 
We  regret  to  announce  the  death  of  Mr.  Henry 
Scanlan,  M.B.,  Stafi  Surgeon  of  the  Royal  Navy, 
retired,  on  the  31st  ult..  at  the  residence  of  his  brother, 
Kerswell,  Broadclyst,  Devon,  at  the  age  of  fifty-five. 
After  taking  the  M.B.  and  CM.  Degree  from  the 
University  of  Glasgow  in  1871,  he  entered  the  Navy 
as  a  Surgeon  in  March,  1872,  and  became  a  Staff 
Surgeon  in  March,  1884.  serving  with  the  Royal 
Marine  Battalion  at  Suakim  during  the  operations 
in  the  Eastern  Soudan  in  1884-5,  ^or  which  he  had  the 
medal  with  clasp  and  the  Khedive's  bronze  star. 
He  was  placed  on  the  retired  list  in  March,  1885. 

Xfterature* 


PREVENTION  OF  DISEASE  IN  ARMIES,  (a) 
The  fact  that  this  little  volume  has  brought  its 
author  the  Parkes  Memorial  Prize  and  Bronze  Medal 
should  give  it  a  special  interest  at  the  outset,  as  it 
proves  in  the  most  conclusive  way  the  high  estimate 
which  has  been  formed  of  its  contents  by  those  who 
are,  presumably,  among  those  who  are  best  qualified 
to  form  an  opinion  on  the  subject.  On  this  fact  by 
itself  we  cordially  congratulate  the  author  and  his 
publishers.  Major  Caldwell  tells  us  in  his  preface 
that :  -'  This  little  book  has  been  written  in  the  hope 
that  what  is,  in  the  main,  a  record  of  sanitary  expe- 
rience in  the  field  may  possibly  prove  of  some  interest 
to  those  whose  attention  is  particularly  drawn  to  the 
physical  well-being  of  the  soldier  on  service."  But 
the  great  merit  of  the  volume,  to  over-read  reviewers 
and  journalists,  is  indicated  in  the  next  sentence : 
"  I  must  apologise  for  the  constant  introduction  of  the 
personal  element  on  the  ground  that  I  have  endea- 
voured to  fonnulate  my  own  conclusions  from  my  own 
experience,  and  to  avoid  the  repetition  of  well-known 
matter."  The  way  in  which  Major  Caldwell  has 
followed  out  the  lines  of  the  chart  thus  indicated  would, 
in  our  opinion,  have  earned  for  him  the  merit  of  a 
foremost  place  in  any  series  of  contributors  to  the 
literature  of  scientific  medicine.  And,  in  the  present 
instance,  a  glance  at  the  title-page  will  show  what 
excellent  opportunities  he  has  had  for  forming  opinions 
based  upon  ripe  experience,  gathered  in  widely-sepa- 
rated regions  of  the  earth's  surface.  The  award  of  the 
Parkes  Memorial  Prize  shows  what  the  judges  thought 
of  the  value  of  his  opinions,  and  we  heartily  endorse 
their  view  of  the  sterling  merit  of  his  volume. 

The  contents  are  arranged  in  six  chapters : — I. — 
Introduction.  II. — Diseases  of  Soldiers  in  the  Field. 
III. — Administrative  Matters  Affecting  the  Health  of 
Troops  in  the  Field.  IV. — Sanitary  Measures  in  the 
Field.  V. — ^The  Sanitary  Organisation  of  a  Field 
Force.  VI. — General  Conclusions  and  Recapitulation, 
The  contents  are  of  special  interest  at  the  present  date, 
giving,  as  they  do,  so  excellent  a  summary  of  sanitary 
and  insanitary  methods  and  experiences  connected 
with  the  recent  war  in  South  Africa — accentuated,  of 
course,  by  the  increasing  war  and  rumours  of  wans  in 
the  Far  East  at  the  present  date.  Strange  recollec- 
tions of  infection  are  necessarily  interspersed  in  the 
wide  experience  of  Major  Caldwell.     The  occurrence  of 


Cid< 


a)  **  The  Pnvention  of  Disease  in  Annies  in  tlie  Field."  By  Robert 
Idwell,  F.B.O.S..  D.P.H..  Major  R.A.M.O.  Member  of  the  late 
War  Office  Committee  on  Field  Sanitation  in  connection  with  the 
tettth  African  Oampaign;  late  Member  Sanitary  Committee, 
Idapdof  St.He]Bna;  Senior  Medical  Offion-,  Zolnland ;  Modioal 
Officer  in  Charge  of  Isolation  Hospital  and  District  Laboxatory.  Fbst 
Army  Corps.  London :  Bamiere,  Tindall  and  Cox.  1904.  Crown 
8vOi  pp.  vtti  and  182.  and  28  illustrations.    Fxlce6s.net. 


a  case  of  ague  in  St.  Helena  is  an  instance.  Endemic 
malaria  is  unknown  in  that  island ;  and  the  patient 
had  never  in  his  life  been  exposed  to  possible  mosquito 
contact,  except  on  the  occasion  of  his  return  from  a 
visit  to  England.  He  then  passed  so  "  close  to  the 
land  while  near  Cape  Verde — '  so  near  that  the  pas- 
sengers could  plainly  distinguish  trees  and  human 
habitations.'  Shortly  after  landing  in  St.  Helena  he 
was  seized  with  a  severe  attack  of  ague.  .  .  ."  The 
only  possible  explanation,  according  to  the  theory  of 
malarial  contagion  now  established  by  scientific  re- 
search, is  that  some  of  the  mosquitoes  were  wafted  on 
board  from  the  tainted  AMcan  coast.  Of  the  excellent 
illustrations  which  accompany  Major  Caldwell's  text 
we  must  specially  point  out-^"  Fig.  i.  Scene  near 
Summit  of  Drakensberg.  The  surroundings  were 
typically  healthy,  and  the  water  was  of  excellent 
quality,  and  drawn  from  rock  springs.  In  spite  of 
these  advantages,  enteric  fever  occurred  (in  a  mild 
form)  among  the  troops  in  the  district."  The  explana- 
tion— the  only  possible  one — is  furnished  on  the  next 
page  :  "  The  camp  had  been  occupied  for  some  months 
before  the  disease  broke  out,  and  although  every 
possible  sanitary  precaution  was  most  faithfully  carried 
out.  the  avoidance  of  soil  pollution  was  a  matter  of 
impossibility."  We  will,  make  no  further  extracts, 
and  close  this  notice  of  an  admirable  thesis  by  recom- 
mending its  pages  to  the  attention  of  ail  our  readers. 


MIDWIFERY  FOR  MIDWIVES.  (a) 
The  aspirant  midwife  is  receiving  more  than  her 
share  of  attention  at  the  present  time,  and  numerous 
indeed  are  the  works  submitted  for  her  approval  by 
authors,  lay  and  medical.  Dr.  A.  B.  Calder's  **  Ques- 
tions and  Answers  on  Midwifery  for  Midwives  "  is  2 
highly  condensed  synopsis  of  the  information  required 
by  the  candidate  for  the  L.O.S.  certificate.  First  we 
have  brief  anatomical  details  of  the  female  reproduc- 
tive apparatus,  followed  by  a  fairly  full  description  of 
normal  labour.  In  thii^  connection  we  should  like  to 
know  what  practical  bearing  the  following  remark  can 
have :  "  Iz  ante-partum  eliminations  have  been 
thoroughly  aseptic,  no  douche  will  be  required."  Who 
can  answer  that  question  ?  And,  failing  an  answer,  is 
the  douche  to  be  given  or  not  ?  Then  we  have  de- 
finitions of  the  normal  and  abnormal  child  and  the 
normal  and  abnormal  labour,  the  author  having  over- 
come the  difficulty  experienced  by  the  originators  of 
the  Midwives  Bill  in  distinguishing  between  the  two. 
Finally,  model  answers  to  questions,  together  with  a 
selection  of  questions  actually  put.  This  little  volume 
is  a  perfect  epitome  of  what  to  do  and  what  not  to  do 
in  the  lying-in  room,  and  a  candidate  who  had  assimi- 
lated its  contents  even  approximately  would  not  fail 
to  carry  all  before  her.  It  is,  in  fact,  a  Liebig's  Extract 
of  obstetrical  principles  for  midwives'  and  nurses'  use. 


SIR  JAMES  SAWYER  ON  INSOMNIA,  {b} 
Sir  James  Sawyer  has  recently  published  an'  in- 
teresting collection  of  clinical  lectures  under  the  title 
of  "  Contributions  to  Practical  Medicine,"  and  the 
work  before  us  comprises  the  first  two  chapters  of  those 
essays.  Insomnia  is  a  subject  which  always  attracts  a 
good  deal  of  attention,  although  it  cannot  be  regarded 
as  a  disease.,  and  is  simply  a  symptom  of  some  under- 
lying functional  or  organic  disturbance.  The  author 
arranges  the  different  clinical  varieties  into  groups, 
which  he  calls  respectively  "  psychic,"  "  toxic,"  and 
"  senile."  A  most  interesting  and  graphic  sketch  is 
given  of  intrinsic  insomnia  as  met  with  in  general  prac- 
tice, the  illustration  employed  being  that  of  a  young 
professional  roan  without  adequate  means  waiting  for 
the  advent  of  clients.  Attention  is  directed  to  the 
causal  association  of  a  nervous  temperament  with  this 


(a)  "Questionn  and  Answers  00  Midwiferr  for  Midwivee."  By 
A.  B.  Calder,  H.6.,  M.B.C.S.  Pp.  148.  Price  Is.  6d.  net.  London : 
fiidlliere,  TfndaU  and  Cox. 

(b)  **  iDwunnia :  its  Cauws  and  Ciwe.*'  Br  Sir  Jamet  Sawjer. 
M.D.,  F.R.O.8.,  Senior  Consulting  Physician  to  the  Queen's  HospitUr 
Birmiiigham] 


August    io,    1904. 


LITERATURE. 


The  Mepicax  Pawa.    159 


fonn  of  insomnia  and  .stress  is  laid  on  the  importance 
of  re(x>gnising  and  stndying.  that  individual  peculiarity 
of  physical  organism  by  which  the  manner  of  acting, 
feeling,  and  thinking  of  every  peccoa  is  peonanently 
affected.  Under  the  head  of  the  senile  variety,  it  is 
pointed  out  that  the  broken  and  short  sleep  of  many 
old  persons  is  the  result  mainly  of  degeneration  of  the 
smaller  cerebral  arteries.  ThiiB  is  the  explanation  of 
the  exaggerated  appreciation  of  the  merits  and  value 
of  early  rising  so  often  observed  as  age  advances.  In 
the  second  chapter,  which  is  devoted  to  the  "  Cure  of 
Insomnia,"  much  valuable  advice  is  given  respecting 
the  routine  employment  of  hypnotics.  "  Prescribe 
hypnotics  only  in  exceptional  cases."  "  Never  allow 
a  patient  to  dose  himself  with  hypnotics."  This  is 
good  advice,  and  there  are  many  equally  useful  hints 
in  this  admirable  work.  We  find  a  reference  to  tar- 
water  and  to  the  writings  of  the  Rt.  Rev.  Dr.  George 
Berkeley,  Lord  Bishop  of  Cloyne.  What  we  miss, 
however,  is  some  reference  to  the  frequent  toxic  action 
of  sulphonal  on  the  kidneys  when  taken  in  even  com- 
paratively small  doses.  There  have  been  so  many 
deaths  from  this  cause  that  it  is  difHcult  to  ignore  the 
danger.  Sir  James  Sawyer  has  written  a  most  in- 
teresting, and,  if  we  may  venture  to  say  so,  arousing 
book,  containing  much  good,  sound,  practical  advice, 
which  will  be  found  useful  to  everyone  in  practice. 


THE  THERAPEUTICS  OF  MINERAL  SPRINGS 
AND  CLIMATES.  {1) 
Dr.  BrRNEY  Ybo  has  produced  an  admirable  work 
on  mineral  springs  and  climates  founded  on  many  yeatrs' 
practical  experience  revised  and  brought  thoroughly 
up  to  date  as  the  result  of  a  long  self-imposed  winter 
holiday.  It  is  not  everj'  phj'sician  in  active  practice 
who  can  afford  the  necessary'  time  to  visit  the  various 
places  he  describes,  and  too  often  the  knowledge  is 
obtained  second  hand,  and  is  little  more  than  an 
abstract  of  the  information  given  in  guide-books  and 
pamphlets  published  locally.  There  is  a  distinct  de- 
mand for  a  good  and  thoroughly  trustworthy  work  of 
this  description,  for  it  appeals  not  only  to  medical  men, 
but  to  the  vast  army  of  valetudinarians  who  spend  the 
l^reater  part  of  the  year  travelling  from  one  health 
resort  to  another.  "  Where  to  go  "  is  a  common  topic 
of  conversation,  and  the  practitioner  who  is  not 
thoroughly  acquainted  with  the  subject  finds  himself 
at  a  disadvantage.  Macpherson's  "  Baths  and  Wells 
of  Europe  "  is  an  excellent  work,  but  it  is  out  of  date, 
and  requires  revision,  and  the  same  may  oe  said  of  the 
"  Mineral  Waters  and  Health  Resorts  of  Europe,"  by 
Sir  Hermann  Weber  and  Dr.  F.  Parkes  Weber.  The 
"  Climates  and  Baths  of  Great  Britain,"  published  by 
a  Committee  of  the  Royal  Medical  ancl  Chirurgical 
Society  of  London,  although  good  in  intention,  failed 
to  attract  the  notice  which  from  the  reputation  of  the 
«)ntributors  it  deserved.  Dr.  Yeos  book,  which  is  in 
the  main  arranged  alphabetically,  deals  not  only  with 
climates  and  climatic  resorts,  but  with  mineral  springs. 
His  introductory  chapter  on  the  nature,  composition, 
and  classification  of  waters  is  practical  and  to  the  point. 
A  large  proportion  of  our  medicinal  waters  come  from 
Germany  and  Austria,  and  the  number  in  Great 
Britain  is.  unfortunately,  comparatively  small.  The 
subject  of  table  waters  has  of  late  occupied  much 
attention,  and  the  author  treats  fully  of  ApoUinaris, 
St.  Galmier.  and  the  seltzers.  He,  however,  as  far  as 
we  have  been  able  to  discover,  omits  all  mention  of 
Source  Perrier  from  Vergeze.  in  the  department  of  Gard, 
France,  a  water  now  extensively  used  on  the  Continent, 
and  universally  drunk  on  the  Riviera.  Source  Perrier 
is  a  first-rate  table  water ;  it  is  absolutely  pure  and 
free  from  contamination,  and  is  strongly  effervescing 
with  its  own  natural  carbonic  acid  gas.  This  is  but  a 
small  omission,  and  will  doubtless  be  remedied  in 
future  editions.  Among  the  bitter  or  purgative  vi'aters 
Apenta  comes  in  for  a  large  share  of  attention,  but, 
curiously  enough,  Hunyadi  Janos  is  dismissed  in  four 

(a^  "  Thi  Therapeutics  of  Mineml  Spnngs  mnj  0!im*t9B.''      By  J. 
Borney    T#o,  M.t..  P.K.C.8.,   ConMlttng     Phywcian   to    Kings 
'  CoUeirs  Hospital.    Loodon :  Cassell  aad  Co.,  Lhnited. 


lines  of  small  type,  and  ^scnlap  is  equally  summarily 
dealt  with.  This  is  to  be  regretted,  for  it  gives  one  the 
ideaof  want  of  proportion.-  ^  We  have  looked  for  some 
information  on  Arabella  Water  from  Kelenfold,  in 
Hungary,  but  do  not  find  it  mentioned.  A  good  account 
is  given  of  th6  mode  of  treatment  adopted  at  Harro- 
gate, and  justice  is  done  to  the  im|>rovenient9  recently 
effected  at  this  popular  English  health  resort.  Going 
further  afield,  we  find  an  excellent  description  of 
Hammam  R'Irha,  in  Algiers,  but  surely  the  place  from 
which  it  is  most  conveniently  reached  is  Bou  Medfa, 
and  not  "  Bon  Medfa." 


SAUNDERS'  YEAR-BOOK,  (a) 
There  is  no  other  book  in  the  English  ton^iie  which 
exactly  corresponds  in  scope  and  aim  with  *'  Saunders' 
Year-Book  of  Medicine  and  Surgery."  which  has  re- 
cently reached  us.  "^  It  is  described  on  the  title-page  as 
a  "  yearly  digest  of  scientific  opinion,"  and  it  is  only 
just  to  say  that  It  is  something  more  than  a  mere 
abstract  of  articles  that  have  appeared  during  the  year. 
The  general  editor,  Br.  George  Gould,  has  been  aided 
by  a  large  group  of  collaborators,  each  of  whom  is  to  be 
regarded  as  of  authority  in  the  particular  subject  which 
has  been  entrusted  to'  him.  We  may  specially  men- 
tion as  men  whose  names  are  well  known  and  respected" 
on  this  side  of  the  Atlantic,  Dr.  Alfred  Stenge.  of 
Philadelphia!  who  edits  the  section  of  General  Medi- 
cine, Dr.  David  Riesnian,  who  writes  on  Pathology, 
and  Dr.  G.  tJ.  Stewart  on  Physiology.  As  Is  necessary 
in  a  work  of  this  kind,  there  is  but  little  room  for  the 
expression  of  individual  opinion,  since  it  is  necessarj' 
to  find  place  for  a  mention  at  least  of  anything  new 
that  has  appeared  during  the  year.  At  the  same  time, 
a  considerable  amount  of  selective  care  is  required 
from  the  editors,  not  merely  in  Judging  what  views  lure 
worthy  of  notice,  but  in  deciding  the  relative  space  to 
be  allowed  to  each.  In  addition,  each  chapter  opens 
with  a  short  summary  of  the  most  noteworthy  ad- 
vances made  during  'the  year.  This  feature  is  of 
immense  convenience  to  the  casual  reader,  who,  not 
being  bent  on  following  any  particular  lines  of  study, 
wishes  to  grasp  in  short  any  new  and  interesting  facts 
which  have  arisen.  Should  he  wish  to  pursue  his  read- 
ing further  ample  help  is  given  by  reference  to  the 
original  articles.  As  is  perhaps  natural,  there  is  some- 
what an  unnecessary  preponderance  of  reference  to 
American  rather  than  to  English  and  foreign  journals, 
though  this  is  less  marked  in  the  sections  devoted  to 
pure  science,  such  as  those  of  anatomy  and  physiology, 
than  in  those  devoted  to  clinical  and  practical  work. 
Coming  to  the  discussion  of  particular  subjects,  and 
choosing  a  few  sections  almost  at  random,  we  find  an 
excellent  though  concise  description  of  paratyphoid 
fever,  our  principal  knowledge  of  which  comes  from 
the  States.  It  is  interesting  to  note  that  the  editors 
maintain  a  sceptical  attitude  with  regard  to  Council- 
man's discovery  of  a  small-pox  parasite,  thereby 
placing  themselves  rather  in  line  with  European  opinion 
than  with  what  appears  to  be  received  in  their  own 
country.  They  are  also  unconvinced  as  to  the  neces- 
sity of"  believing  in  the  parasitic  origin  of  carcinoma. 
Having  noted  the  general  lines  of  investigation  in 
pathology,  the  editors  draw  attention  in  particular^ 
fields  to  three  recent  developments  which  they  regard 
as  of  prime  interest.  They  are  the  results  attained  oy 
Poyntan  and  others  in  the  investigation  of  the  bac- 
teriology of  acute  rheumati.sra.  the  inoculation  by 
Tomasczewski  of  a  monkey  with  Ducrey's  soft  chancre 
bacillus  and  the  inoculation  of  a  monkey  with  syphilis 
by  Roux.  It  is,  of  course,  impossible  for  us  to  do 
more  than  suggest  in  the  vaguest  way  the  scope  and 
style  of  the  book,  which  in  truth  covers  every  subject 
of  medical  interest.  It  is  alike  invaluable  to  the  busy 
practitioner,  who  must  acquire  his  knowledge  in  con- 
centrated doses,  and  to  the  student  who  will  regard 
it  as  a  critical  guide  to  the  original  documents.     It  is 

furnished  with  a  full  and  excellent  index. 

■ — Ti)  -Sauodew'  YearBo  -kof  Medicine  and  Surjrerj."  Under  the 
K'^neU  editorial  c^banre  of  Geo«eir.  Gould.  M.D.  Loodoo  aid 
PhUadelphU  :  W.  B.  Saunders  and  0>.    19W.    %  vols.     Ifc.  net. 


X60     TBS  MkDICAL  Pkkst. 


MEDICAL  NEWS. 


August    io.  1904. 


TEXT-BOOK  OF  LEGAL  MEDICINE,  (a) 
TwBLVB  months  ago  the  first  volume  of  this  ex- 
cellent'text-book  was  reviewed  in  our  cohinuis»  and 
we  a^e  pleased  to  be*  able  to  say  that  this,  the  second 
volume,  maintains  the  high  standard  attained  by  its 
predecessor*  The  book  consists  of  a  series  of  wdl- 
written  nionographs  by  the  best-known  American 
specialists,  which  have  been  inserted  without  change 
by  the  editors.  For  convenience  of  reference  the 
volume  is  divided^into  twoparts,  of  which  the  section 
on  toxicology  forms  one.  Tne  roeuier  must,  in  consult- 
ing the  volume,  keep  well  in.  mind  that  throughout  the 
work  American  law  and  nomenclature  is  referred  to 
and  quoted,  and  not  British  law ;  "and,  further,  that 
the  American  law  is  modified  in  some  of  the  common- 
wealths. The  nomenclature  of  drugs  and  chemicals 
used  is  that  adopted  by  the  United  States  "  Pharma- 
copoeia." The  illustrations  are  numerous,  well  selected, 
original,  and  helpful.  Many  of  them  are  coloured, 
and  that  which  shows  the  spectra  of  human  blood  iB 
a  modd  of  accuracy  and  beauty.  There  are  many 
black  and  white  illustrations  and  diagrams ;  but,  after 
all,  the  value  of  the  book  lies  in  the  letterpress.  The 
articled  on  non-alkaloidal  poisons,  gaseous  poisons, 
food  poisoning,  and  ptomaines  bring  before  the  reader 
the  most  recent  discoveries  in  aiuilytical  chemistry, 
baeteriolo^,  and  pathological  anatomy.  The  toxi- 
cologist  will  find  in  them  a  good  and  full  summary  of 
our  most  recent  knowledge  on  the  subject.  Few  pawes 
are  taken  up  with  the  subject  of  malpractice,  which 
contains  many  valuable  hints  for  the  general  prac- 
titioner ;  and  we  cannot  but  wish  that  some  o!  the 
decisions  quoted,  especially  of  English  Judges,  were 
more  generally  known  and  more  frequently  acted  on, 
as  they  would  tend  to  restrain  quackery,  the  tolerance 
of  which  is  one  of  the  greatest  of  modem  evils. 

AeMcal  flews. 

Royal  College  of  Physieians*  London. 

At  a  meeting  of  the  College  held  on  July  28th,  the 
following  appointments  were  made  :— Censors  :  Dr. 
Thomas  Henry  Green.  Dr.  William  Henry  AUchin,  Dr. 
Norman  Moore,  and  Dr.  Frederick  Taylor.  Treasurer  ; 
Sir  Dyce  Duckworth.  Emeritus  Registrar :  Sir  Henry 
Alfred  Pitman.  Registrar :  Dr.  Edward  Liveing. 
Harveian  Librarian:  Dr.  Joseph  Frank  Payne. 
Assistant  Registrar :  Dr.  Oswald  Auchinleck  Browne. 
Elected  Members  of  the  Library  Committee :  Dr. 
Philip  Frank,  Dr.  Norman  Moore,  Dr.  William  Henry 
Allchin,  and  Dr.  Archibald  Edward  Garrod.  Curators 
of  the  Museum  :  Dr.  William  Howship  Dickinson,  Dr. 
Henry  Charlton  Bastian,  Dr.  William  Cayley,  and  Dr. 
John  Abercrombie.  Finance  Committee  :  Dr.  George 
Fielding  Blandford,  Dr.  James  Frederick  Goodhart,  and 
Sir  Isambard  Owen.  Examiners :  Chemistry  and 
Chemical  Physics :  Mr.  Harold  B.  Dixon.  F.R.S.,  Mr. 
John  Millar  Thomson,  F.R.S.,  Mr.  Frederick  Daniel 
Chattaway.  Ph.D.,  D.Sc.,  Mr.  Alexander  Mitchell 
Kellas,  F.C.S.,  and  Mr.  John  Addjrman  Gardner, 
F.C.S..  F.I.C.  Materia  Medica  and  Pharmacy:  Dr. 
Frederick  Willcocks,  Dr.  Walter  Essex  Wynter.  Dr. 
Henry  Albert  Caley,  Dr.  Francis  Whit  taker  Tunni- 
clifie,  and  Dr.  James  Purves  Stewart.  Physiology : 
Dr.  Ernest  Henry  Starling.  Dr.  Bertram  Louis  Abra- 
hams, and  Dr.  Leonard  Erskine  Hill.  Anatomy  :  Dr. 
Bertram  C.  A.  Windle.  F.R.S.,  and  Dr.  Robert  Howden. 
Medical  Anatomy  and  Principles  and  Practice  of 
Medicine  :  Dr.  Samuel  Hatch  West,  Dr.  Theodore  Dyke 
Acland,  Dr.  George  Newton  Pitt,  Dr.  Sidney  Philip 
Phillips,  Dr.  William  Pasteur,  Dr.  William  Collier,  Dr. 
Norman  Dalton,  Dr.  Frederick  John  Smith,  Dr.  Francis 
George  Penrose,  and  Dr.  John  Rose  Bradford,  F.R.S. 
Midwifery  and  Diseases  Peculiar  to  Women  :  Dr.  Alfred 
Lewis  Galabin.  Dr.  Francis  Henry  Champneys,  Dr. 
George  Ernest  Herman.  Dr.  William  Rivers  Pollock. 

(•)  ••  A  Ttxt  Book  o(  Legal  Medicine  ud  Toxicology. "  Edited  by 
Vtederick  Petenon,  M.D.,  President  of  the  New  York  Bute  Com. 
mteion  in  Lon«oy ;  Olinical  ProfesMr  of  Psychbttrr,  Oolambi*  Uni- 
versity. New  York  :  and  Walter  8.  Haines,  H  D..  Professor  of 
Chemistry.  Fharmaor.  and  Tozioolofry  to  the  Bush  Medioal  Oolleto, 
Chioaco;  Professorial  Lecturer  on  Tosioology  in  the  University  of 
Chicago.  In  S  vols.  Vol.  II.  Philadelphia,  New  York,  London  : 
W.  B.  Baundersaad  Co.    1904. 


and  Dr.  Edward  Malins.  Public  Health  :  Part  I.— 
Dr.  Arthur  Pearson  Luff.  Part  II.— Dr.  Williafly 
Heaton  ItM&er  . 

B«FBl  VftNc4a»y  Orttogi,  BAtnlrarglt. 

As  it  has  now  been  definitely  settled  to  transfer  "the 
new  veterinary  College  "  frbm  Edinb«iigh  to  Liverpool, 
in  October,  the  origmal  "  Royal  Veterinary  College.*" 
founded  by  the  late  Professor  Dick  eighty  years  ago, 
will  henceforth  be  the  only  one  for  veterinary  students 
in  the  Northern  capital,  the  rivalry  of  the  "  new " 
college  will  cease,  and  we  hope  it  will  again  attain  the- 
former  success  which  marked  its  progress  in  years  gone 
by,   the  opinion  being  generally  expressed   that   the 

Eofession  is  too  small  to  support  two  mstituticms  of  the 
nd  in  Scotland.  The  Royal  or  Dick's,  as  it  is  more- 
familiarly  called,  covers  an  ejTtensive  site  in  Edinburgh, 
and  is  provided  with  more  complete  laboratories, 
dissecting  roomf,  class  rooms,  museum,  and  anatomical 
department*  than  any  similar  Institution  in  the  United* 
Kingdom,  with  a  professional  staff  of  both  veterinary 
and  medical  pxaetitioners  of  considerable  eminence. 
.Senate  of  the  loTAl  Univwsity  of  Ireland. 

Mr.  Charles  Craig,  last  week,  in  the  Commons, 
asked  the  Chief  Secretary  to  the  Lord  Lieutenant 
of  Ireland  whether  his  attention  had  been  called  to  a 
meeting  of  the  Royal  University  Graduates'  Asso- 
ciation held  in  Belfast  on  July  i8th,  at  which  Dr. 
Leslie,  was  unanimously  selected  as  the  candidate 
whose  claims  should  be  brought  before  the  Government 
for  appointment  to  the  vacancy  on  the  Senate  of  the 
Roysu  University  caused  by  the  death  of  Dr.  WiUiam 
McKeown  ;  and  whether,  having  regard  to  the  fact 
that  the  Royal  University  Graduates'  Association 
represented  the  opinions  of  a  lajqge  proportion  of  the 
graduates  of  the  Royal  University  and  of  the  public 
in  the  North  of  Ireland  and  that  the  late  Dr.  McKeown 
was  the  representative  of  this  opinion  in  the  Senate.. 
the  Government  would  appoint  Dr.  Leslie  to  the  vacant 
seat  to  preserve  the  continuity  of  representation  of 
this  opinion.  Mr.  Wyndham  said  : — "  Representa- 
tions have  been  made  in  favour  of  the  appointment 
of  Dr.  Leslie  to  fill  the  vacancy  on  the  Senate  caused 
by  the  death  of  Dr.  McKeown.  These  will  be  con- 
sidered by  the  Government." 

Management  of  Horton  Luaatle  Asylum. 

Mr.  Whitmore,  in  the  Commons  last  week,  asked* 
the  President  of  the  Local  Government  Board  whether 
his  attention  had  been  called  to  the  case  of  R.  S.  Clarke- 
and  others,  tried  at  last  assizes  at  Guildford,  on  July 
19th,  and  to  the  finding  of  the  jury  that  they  were  of 
opinion  that  the  Horton  Lunatic  Asylum  had  been 
grossly  mismanaged  and  that  the  conduct  of  the  persons 
responsible  for  the  administration  of  the  Asylum 
should  be  at  once  seriously  incjuired  into  ;  and  whether 
he  proposed  to  take  any  action  in  the  matter.  Mr. 
Akers-Douglas  said  : — "  My  right  honourable  friend 
has  |ELsked  me  to  answer  this  question.  I  am  informed 
by  the  Commissioners  in  Lunacy  that  the  matter  is 
receiving  careful  consideration  and  that  they  are 
awaiting  the  report  of  a  sub-committee  appointed  by 
the  Asylums  Committee  of  the  London  County  Councif 
to  inquire  into  the  question. 

Death  tpom  Anthrax. 

Mr.  Macdona  asked  the  Secretary  of  State  for  the 
Home  Department  whether  he  was  aware  that  at  an 
inquest  recently  held  in  Liverpool  upon  a  man  who 
had  died  from  anthrax  it  came  out  in  the  evidence 
that  the  deceased  was  shaved  by  a  barber  in  Liverpool 
shortly  before  his  death,  who,  at  deceased's  request, 
cut  open  the  swelling  upon  the  deceased's  face,  thus 
causing  a  serious  risk  of  anthrax  being  further  spread, 
and,  if  so,  whether  he  would  take  steps  to  prevent  a 
recurrence  of  such  action.  Mr.  Akers-Douglas  replied  : 
— "  I  am  informed  that  the  facts  are  as  stated  m  the 
first  part  of  the  question.  The  matter  is  entirely 
outside  the  scope  of  the  Factory  Act  and  I  have  no 
power  to  take  any  action,  but  I  may  say  that  I  am 
advised  that  the  risk  of  anthrax  being  spread  in  this 
way  would  be  small." 

An  Irish  Question. 

Mr.  Havden  asked  the  Chrief  Secretary  to  the  Lord 


August  io,  1904. 


PASS  USTS. 


Tbb  MsmcAL  Plica.    161 


Lieutenant  of  Ireland  whether  he  could  state  the 
total  number  of  assistant  medical  officers  of  lunatic 
asylums  in  Ireland  and  of  these  how  many  were 
married.  Mr.  Wyndham  said  : — "  The  total  number 
of  assistant  medical  officers  in  district  asylums  is 
thirty-five.  No  married  man  can  be  appointed  to 
this  positioii.  I  have  no  information  as  to  marriages, 
if  any.  contracted  subsequently  to  appointment." 
University  of  Durham. 

A  MESTiNG  of  members  of  the  University  of  Durham 
was  held  on  July  25th.  in  the  Owens  College  Union 
Rooms,  for  the  purpose  of  forming  a  "  Manchester 
Association  of  Members  of  the  University  of  Durham." 
Further  information  may  be  had  from  Mr.  Bennett. 
Secretary,  509,  Waterloo  Road.  Manchester. 
Cbiekon-Poz. 

Thb  London  County  Council  has  decided  that 
chicken  -pox  shall  be  a  notifiable  disease  for  a  further 
period  of  three  months. 

Boyal  College  of  Physletoni.  London. 

Trb  following  candidates,  having  passed  the  re- 
quisite examinations,  were  admitted  Members  of  the 
College  on  July  28th : — John  Frederick  Gordon  Dill. 
M.A.,  M.D.Cantab.  ;  Edward  Henry  Douty.  M.A., 
M.D.CanUb..  L.R.C.P.Lond.  ;  Wilfred  Stephen  Fox. 
M.A.Cantab.,  L.R.C.P.Lond. ;  Ernest  Edward  Glynn. 
M.A..  M.B.Cantab..  L.R.C.P.Lond. ;  Henry  Lawrence 
McKisack.  M.D.R.U.I.  ;  Geofirey  Richard  Slade.  M.A.. 
M.D.Cantab..  L.RC.P.Lond. ;  and  Thomas  Grainger 
Stewart.  M.B.Edin. 

At  the  same  meeting  the  L.R.C.P.Lond.  was  granted 
to  I T  5  gentlemen  who  had  passed  the  required  examin- 
ation. 

Diplomas  in  Public  Health  were  also  granted  to  the 
following: — Charles  Thomas  Blackwell  (Major 
R.A.MX.).  M.D.Durh.,  L.R.C.P.  &  S.Edin. ;  Dunstan 
Brewer.  L.R.C.P.Lond..  M.RC.S.Eng.  ;  John  Catto, 
M.B..  B.S.Aberd.  ;  Basanta  Kumar  Chatter jee. 
L.R.C.P.  &  S.Edin.,  L.F.P.S.Glasg. ;  Stanley  Cornell 
Clapham.  L.R.C.P.Lond.,  M.R.C.S.Eng.,  M.B.,  B.S. 
Dujh. ;  John  Matthewson  Clements,  M.B.,B.Ch.R.U.I. ; 
Walter  Ernest  LleweUyn  Davies.  L.R.C.P.Lond.. 
M.R.C.S.£ng.  :  Thomas  Stokoe  Elliot.  L.S.A. ;  Norman 
Faichnie  (Major  R.AJM.C).  M.B..  B.S.Durh. ;  Henry 
William  Grattan  (Captain  R.A.M.C.),  L.R.C.P.Lond., 
M.R.C.S.Eng. ;  John  A^Uiam  Gromitt.  L.R.C.P.Lond., 
M.R.C.S.Eng.  ;  Hugh  LleweUyn  Jenkins,  M.B.,  Ch.B. 
Vict.  ;  John  Isaac  Pratt,  L.R.C.P.Lond.,M.R.C.S.Eng., 
M.B.Toronto ;  Morgan  James  Rees.  L.R.C.P.Lond., 
M.R.C.S.Eng.,  M.B.Lond. ;  Frank  Ernest  Rock. 
L.R.C.P.Lond.,  M.R.C.S.Eng.,  M.D.Lond.  ;  Godfrey 
William  Simpson.  L.R.C.P.Lond.,  M.R.CS.Eng.  ; 
Charles  Augustus  Spooner.  L.R.C.P.  A  S.Edin..  L.F.P.S. 
Glasg.  ;  John  Charles  Baron  Statham  (Captain 
R.A.M.C.>,  L.RC.P.Lond..  M.R.C.S.Eng.  ;  John 
Robert  Steinhaeuser.  L.RC.P.Lond.,  M.RC.S.Eng., 
M.B.  &  B.S.Lond.  ;  Robert  Lewis  Thomley,  L.R.C.P. 
Lond..  M.R.C.S.Eng.,  M.D.Lond.  ;  Philip  Vickers, 
M.B.,  Ch.B.Edin.  ;  and  William  McConnel  Wanklyn, 
L.R.C.P.Lond.,  M.R.C.S.Eng. 

Royal  College  of  Surgeons  of  Idlnlmrgh. 

At  a  meeting  of  the  College  held  on  July  28th.  the 
following  gentlemen,  having  passed  the  necessary 
examinations,  were  admitted  Fellows  of  the  College  : — 
David  Macrae  Aitken,  M.B.,  Ch.B.,  Robert  Gordon 
Bell,  M.D..  Chiranjiva  Bharadwaja.  L.R.C.S.E.,  William 
Thomas  Chenhall,  M.D.,  Frederick  Gardiner,  M.D., 
Alfred  Griffiths.  M.B..  CM.,  Arthur  Gwyther.  M.B., 
CM.,  Captain  I.M.S..  Thomas  Dufour  Halahan,  M.B., 
Claude  Somerville  Hawkes,  M.R.C.S.Eng.,  Edmund 
Moritz  Illington.  M.R.CS.Eng.,  Captain  I.M.S..  James 
Frederick  MerriUees.  M.B..  Ch.B.,  Thomas  Mill,  M.B., 
Ch.B..  Philip  Henry  Mnles.  M.B.,  L.R.CS.E.,  Lionel 
Charles  Peel  Ritchie,  M.B.,  Ch.B.,  Oscar  Bteigster 
Trumper.  M.B..  Ch.B.,  and  Henry  Woolmington 
Webber.  M.D.,  M.R.CS.Eng.  The  medal  and  set  of 
books  forming  the  "  Bathgate  Memorial  Prize,"  pre- 
sented to  the  College  by  Colonel  William  Lorimer 
Bathgate  in  memory  of  his  late  father,  William  McPhune 
Bathgate,  Fellow  of  the  College,  was  awarded  to  Mr. 
Robert  Macnaught  Glover,  Carlton  House.  Dumfries. 


Univofslty  of  Uvarpool. 

The  following  candidates  (arranged  alphabetically) 
have  passed  the  second  M.B.  and  Ch.B.  examination  : — 

A.  .4^itomy  and  Pkynology. — J.  W.  Cropper,  and 
G.  W.  Williams. 

B.  Materia  Medica  and  Pharmacy. — ^T.  T.  Apsimon, 

E.  R,  Armstrong,  A.  C  Edwards.  S.  J.  C  Holden, 
A.  Jones.  T.  Martlew.  W.  R.  Pierce,  J.  H.  Rawlinson, 
A.  M.  M.  Roberts,  R.  S.  Taylor,  and  S.  V.  Tinsley. 

The  following  have  passed  the  final  M.B.  and  Ch.B, 
examination : — 

Part  /.—J.  F.  Edmiston,  B.  T.  J.  Glover.  T.  E. 
Jones,  J.  F.  McCann,  J.  McClellan,  S.  W.  McI-eUan, 
R.  H.  Mole.  L.  D.  Napier.  T.  W.  Parrv.  C  H.  Smith. 

F.  H.  Storey.  C  YoAe.  and  W.  Yorke." 

Pirt  2L — ^The  foUowing  candidates  have  passed 
the  final  examination  for  the  Degrees  of  Bachelor  of 
Medicine  and  Bachelor  of  Surgery  with  Second  Class. 
Honours  :— P.  Hick,  and  T.  E.  Walker. 

The  following  candidates  have  passed  the  final 
examination^  for  the  Degrees  of  Bachelor  of  Medicine 
and  Bachelor  of  Surgery : — A.  E.  Grisewood,  W.  L. 
Hawksley,  G.  J.Keane,  W.  A.  Kidd.  and  G.  C  Scott. 

The  following  candidate  lias  passed  the  examination 
for  th^  Dipk>ma  in  Public  Health  :— D.  T.  Barry.  M.D. 

The  following  candidates  have  passed  the  examina- 
tion for  the  Diploma  in  Tropical  Medicine : — ^T.  M. 
Clayton.  M.B.,  B.S..  Saidnzzafor  Khan,  M.B..  P. 
Hehir,  Major  I.M.S..  M.D.,  F.R.C.S..  A.  R.  Maclurkin, 
M.B.,  Ch.B.,  J.  E.  Nicholson,  Lieut.-Coloncl  R.A.M.C. 
M.R.C.S.,  L.R.CP.,  N.  Phillipson,  L.R.C.P.,  and  S. 
Edin. 

Army  Modleal  Sorvieo. 

The  following  is  an  official  list  of  candidates  who 
were  successful  at  the  recent  examination  in  London 
for  Commissions  in  the  R.A.M.C  (arranged  in  the  order 
of  merit),  for  which  40  candidates  entered. 

William  Byam,  M.R.C.S.Eng.,  L.RCP.Lond. 

Charles  Ryley.  M.RC.S.Eng.,  L.R.C.P.Lond..  D.P.H. 

Harry  Theodore  Wilson,  M.R.CS.Eng.,  L.R.C.P. 
Lond. 

Lionel  Victor  Thurston.  M.RC.S.Eng..  L.RCP. 
Lond. 

Walter  Hyde  Hills,  M.B.,  B.C.  and  B.A.Cantab. 

Patrick  Dwyer,  M.B..  B.Ch.RU.Irel. 

PhiUip  Claude  Davy,  M.RCS.Eng..  L.R.C.P.,  M.B. 
Lond. 

John  Forbes  Cock  Mackenzie.  M.B.,  B.S.Melboume. 

Arthur  William  Gater.  M.R.CS.Eng..  L.R.C.P.Lond. 

George  Alfred  Duncan  Harvey.  L.R.CP.  &  S.Irel. 

Harold  Charles  Winckworth,  M.R.C.S.Eng.,  L.R.C.P. 
Lond. 

lames  Campbell,  M.B.,  B.Ch.R.U.Irel. 

Richard  Collis  Hallowes,  M.B.,  B.Ch..  B.A.O.. 
B.A.Dub. 

Harry  William  Russell,  M.B.,  B.Ch. Vict. 

George  Richard  Painton,  M.R.C.S.Eng.,  L.R.C.P. 
Lond. 

Meurice  Sinclair,  M.B.,  B.Ch.Ed. 

Evelyn  John  H.  Luxmore,  M.RC.S.Eng.,  L.R.CP. 
Lond. 

Kenneth  Alan  C  Doig,  M.R.C.S.Eng.,  L.R.C.P.Lond. 

Herbert  Owen  M.  Beadnell,  M.R.CS.Eng..  L.R.C.P. 
Lond. 

Herbert  St.  Maur  Carter,  M.D.,  M.B.,  B.Ch.,  B.A. 
Dub.- 

Robert  Harry  L.  Gardner,  M.R.CS.Eng.,  L.R.CP. 
Lond. 

John  Patrick  Lynch,  L.R.CP.  &  S.Irel. 

Alastair  Norman  Eraser,  M.B.,  B.Ch.Ed. 

Nelson  Low,  M.R.C.S.Eng..  L.R.C.P.Lond. 

Percy  Arnold  Jones,  M.R.CS.Eng..  L.R.C.P.,  B.A^ 
Cantab. 

Cecil  Roy  Millar.  L.R.C.P.  &  S.Irel. 
.    Augustine  Thomas  Frost,  M.D..  B.Ch. R.U.I. 

George  Herbert  Richard.  M.RC.S.Eng.,  L.R.CP. 
Lond. 

Harry  Christopher  Sidgwick,  M.R.C.S.Eng.,  M.B.  & 
B.A.Cantab. 

John  St.  Aubyn  Maughan.  L.R.CP.  &  S.Edin., 
L.F.P.  &  S.Glasg. 


i62    Tii«  Medical  P»em.       NOTICES  TO  CX>RRESPONDENTS. 


August    lo,  1904 


^oxxtBfonltntB,  ^hort  %tttztB^  &£. 

f9*  odBKBPOXDBiTS  requiring  a  reply'  in  this  column  are  partion- 
larly  requested  to  make  uw  of  a  di$tineHve  StgwUwn  or  Imtiai,  and 
avpid  the  practice  of  Bigninff  themflelves  **  Reader,"  "Sutocriber/* 
«'  (Md  Subaoriber,"  ko.  Much  oonfualoD  will  be  apared  by  attention 
to  tUarule. 

Oeisinal  Aeticlbs  or  LdnncRa  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, ut  as  evidence  of  identity. 
Mb.  Milvb  is  thanked  for  his  communication. 
A  PEOV15CUL  Practitioher.— The  title  of  the  Journal  referred  to 
was  chantired  in  the  hope  of  a  wider  field  ;  it  did  not  however  succeed, 
and  was  finally  discontinued  some  two  or  thi4fe  years  since. 

Edixburoher.— The  book  is  an  excellent  one,  you  cannot  do  better 
than  study  its  contents  before  going  up  for  your  final. 
THE  LANGUAGE  OF  MEDICINE. 
[Th*?  doctor  certified  that  he  was  suffering  from  epistaxls.— Police 
Heport] 

Of  doctor's  language  £  must  hold 

That  there  is  this  to  claim  for  it, 
That  when  I  have  a  lieastly  cold, 

I  like  some  other  name  for  it. 
And  oh !  how  soothing  doctocs  are 
To  call  it  bronchial  catarrh. 

With  new  and  active  sympathies 
^ends  look — or  so  we  aream  -  at  us, 

To  learn  we  have  a  skin  disease, 
We  fear,  is  exanthemotous. 

But  how  their  pity  'd  fade  to  find 
'  'Twas  measles— of  the  German  kind. 

We  must  feel  pnde  on  learning  how 

Distressing  our  ingultus  is : 
We  like  the  new  complaint,  but  vow 

The  one  way  to  insult  us  is 
To  hint  it  is  that  voilgar  thing 
I'ar  better  known  as  hiccoughing. 
And  Polysyllables  of  size. 

In  *itiB"  if  they  terminate, 
Impress  with  sorrow  and  surprise 
beven  hearers,  I  affirm,  in  eight. 
So  delicately  each  reveals 
The  pains  that  Little  Mary  feels. 
When  to  such  terms  the  doctor  lends 

His  countenance  and  signet,  he 
Wakes  envy  in  the  patient's  friends 

And  gives  disease  such  dignity, 
Thatt  mortals  yearn  and  sigh  for  still 
The  happiness  of  being  ill. 

U.-DaUy  GhronicU, 
Dr.  J.  E.  R.— The  appeal  by  Mr.  Labouchere  in  the  case  of  **  Dakyl 
v.Labouchere"fora  new  trial  on  the  ecjre  of  misdirection  has 
succeeded,  but  this  will  not  come  on  before  the  Autumn  sittings  of 
the  Court.  The  costs  in  the  appeal  case  will  carry  those  of  the  first 
trial  whatever  the  ultimate  verdict. 


Devon  County  Asylum.— AsfisUnt  Medical  Ofilcer.    Salary  £126  per 

annum,  with  board  and  lodgings.    AppUcations  to  the  Medical 

Superintendent,  Asylum,  Exminster. 
Dumfries  and  GaUowi^.  Boyal  Infirmary.    Assistant  Medical  Oflioer. 

Salary  £80  per  annum,  with  board  and  washing.     Applications 

to    Mr.  Bymons,  Secretary  and  Treasurer,    14,  Irish  Street, 

Dumfries. 
Hubne    Dispensary,  Dale    Street,  Stretfoid  Boad,  Manchester.— 

House  burgeon.      Salary  £160  per  annum,  with  apartments, 

attendance,    coal,   and  gas.      Applications,  to  the   Honorary 

Secretary  Medical  Committee. 
Hereford   County   and  City  Asylum.-Senior    Assistant    Medical 

Officer.     Salary  £160    per  annum,  with    boani,  lodging,  and 

laundry.    Applicati-jns  to  the  Medical  Superintendent. 
Mount  \  ernon  Hospital  for  Cousuniption  aud  Diseases  of  the  Chest, 

Hanipetead  and  Northwood.-Kesident  Medical  Officer.    HaUry 

Z^.^1^'  *o"u»n»  with  board  and  rsbidenoe.    Applications,  to 

William  J.  Morton.  Secretary,  7  Fitroy  Square.  W. 
Royal    Lancaster    Infirmary.— ttouse  Surgeon.     Salary  £100    per 

annum,   with    residence,  boarJ,    attendance,    and    washing. 

Appbcations  to  the  Secretarj-. 
County  Asylum,  RainhiU.  near  Liverpool. -AssisUnt  Medical  Officer. 

Salary  £150  pet  annum,  together  with  furnished  apartments. 

board,  attendance,  and  washing.  Applications  to  the  Medical 

Superintendent. 
South  shields  Union.— Assistant  ( Beside  nt)  Medical  Officer.    Salary 

£200  per  annum.    Applications  to  J.   W.  Coulson,  Clerk  to  the 
Guaruians,  Union  Offices,  South  Shields. 


S^fpomtmtnxB. 


Blackall,  J.  J.,  M.D.,  aL.!i.(^.V.I.,  Certifj-iag  Surgeon  under  the 

Factory  Act  for  the  Killadysert  District  of  the  oountv  of  Clare 
Burtok    H.,L.B.C.P.L,  L.B.CS.Eng.,  Certifying  Surgeon  under 

the  Factory  Act  for  the  Marple  District  of  the  county  of  Chester 
DWAN,  J.  H.,  L.R.C.P.I.,  L.R.C.S.I..  Certifying  Surgeon  under  thi 

Factory  Act  for  the  Rathgormuck  District  of  the  county  of 

Waterford. 
Bames,  E  S.  B.,  M.E.C.S.,  L.R.C.P.Lond.,   Certifying    Surgeon 
^     under  the  Factory  Act  for  the  Uffculme  District  of  the  county  of 

Devon.  v«*"vj  w 


Forbes,  Jambs  Graham,  M.O,  D.P.H.C«ntab^  M  R.O.P.IkhmI., 
Asshtant  Physician  t)  the  Metropolitan  Hospital,  Kiogslsod 

^^^'j"  ^'*  I-B.CPm  F.E.C.8.Fdin  ,  Certifying  Suxvreoo  uader 
the  Factory  Act  lOrthe  Leven  District  of  Oie  ooumtr  of  Fife. 

Hahdlwt,  W.  Sampsoh,  M.S.Lond.,  F.B  C.B.,  a  Hunteriaa 
Em?^        Patholoi:y  in  the  Eoyal  College  of  Bargeam  eC 

^^^l^  J.  Lamokd,  M.D..    P.RO.P.B.,    AssisUnt    Phycioian  to 

Slf.  J^y^^     Maternity    and    Shupson    Memorial     Hoapit.l, 

Edinburgh,  and   Examiner  in  Obstetrics,   Unirersitjr    of  St. 

Andrews. 
Lbicbsteb,  M^.  M  D..Brux.,    JUB.C.P..    LJLCBJSdin.,   I-.8.A.. 

Medical    Officer  for    the    No.     8    District    of    the    Uskesid 

(Oomwain  Union.  -     - 

MacDobau),  p.  J.,  M.B.,  M-aAbeW,  Certifying  Bui^ebn  under  the 

Factory  Aot  for  the  Stumowa^*  Discriot  of  the  oountj-  of  Bosi 

and  Cromarty. 
McEhibt,  D.,  L.BC.8.,  L.BC.P.Edin..  Certifying  Pur^eon  under 

the  Factory  Act  for  the  Ballymicarbery  District  of  the  county  of 

Waterford. 
Maobath.  H.  G.»  L.B.C*P.»  L  R.C.S  Edin..  L.F.P,8.01asir..      erti- 

fying  Surgeon  under  the  Factory  Act  for  the  Oranborne  District 

of  the  countyi  of  Dorset. 
McSwiket,  M.,  M.B.,  MA  OR  U  I..  Certifying  Surgeon  under  the 

Factory  Act  for  the  Johnstown .  District    of    the  county   of 

Cork. 
Quibke,  J.  LB.0.P.T..L.BCI.8I..  Certifying  RurgeoB  under  the 

Factory  Act.  for  the  PUtown  District  of  the  county  of  Kilkenov. 
Spom.  Habrt  James,  MB.O.S.Eng,  L.B.O.P.,  D.P.H.Citfnb.,  Sur- 
geon to  the  Surrey  Dispensary. 

DuKA  -^On  August  3rJ,  at  Lismore,  New  South  Wales,  the  wife  o* 
Albert  Theophilus  Duka,  M  A.CanUb.,  M.acA,  L..K.CJP.. 
D.8.O.,  of  s  son.  (By  Telegram.)  V       ^ 

Mbldoic.— On  August  4th,  at  123  ^Orehf>mpton  Boad.  the  wife  of  Dr. 
Pugin  Meldon,  ol  a  daughter. 

Booers.— On  Auffust  1st,  at  Charlton,  Wimbome  Boad,  Bourne- 
mouth, the  wife  of  Surgeon  Major  F.  A.  Bk^rs,  Indian  Medical 
Service,  of  a  daughter. 


4Btecriagea 


BOTOOTT--Aao.-On  August  4th,  at  St.  Matthew's  Ohuitih,  Westmia- 
™  •  ^«w»o>"  Bdwin  Boycott,  M.D.Oxon,  second  surviving  son  of 
yuiiam  Boycott,  Hereford,  to  Constance  Louisa,  second 
daughter  of  the  late  Colonel  W..  Agg,  and  of  Mrs.  Agg  of  Chci- 
tennara. 

CooPBR— BDTi.BR.^On  Jttly  '27th.  at  Tiimham  Green,  Willisai 
Bertram  Cooper,  M.B.aS.Eng.,  L.B.O.P.  Lond..  of  Chiswick, 
youngest  son  Of  the  late  W.  O.  Cooper,  of  Kensington,  to  Esther 
Maud.8tell«),eldest  daughter  of  the  late  J.M.BuUer  and  uf 
1^.  Butler  of  Ohi&wick. 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.-St.  Barthok>mew's  a.«)  p.m.X  University  College 
(2  p.m.),  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m.L  Chariiw 
Cross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.).  King's 
College  (^2  p.m.),  St.  George's  (Ophthalmic,  1  P.m.),  St.  Mary's 
(2  pm.).  National  Orthopedic  (10  a.m.),  St.  Peter's  (2  p.nL). 
Samaritan  (9.80  a.m.  and  2.80  p.m.),  Gt  Ormond  Street  (9.80 
a.m.),  Gt  Northern  Central  (2  80  p.m.),  WestnUnster  (2  p.m.;, 
Metropolitan  (2.30  p.m.),  London  Throat  (9.30  a.m.),  Cancer 
(2  p.m.).  Throat;  Golden  Sqnare  (0.80  a.m.).  Guy's  (1.80  p.m.), 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  St.  Thomas's   (8.80 

g.m.),  University  College  <2  p.m),  Charing  Cross  (8  p  m.),  St. 
eorge's  (Ip.m.)^  London  (2p.m.).  King  S  College  (2  p.m.),  Middle- 
sex  (^1.80  p.m.),.St.  Mary's  (2.80  p.m.),  Soho  Square  (2  p.m.), 
North- West  London  (2  p.m.),  Chelsea  {t  p-.m.)  Great  Northern 
Central  (Qyuscoloffical,  2.80.  p.m.).  Metropolitan  (2.80  p.m.), 
London  Throat  (9.80  a.m.),  St.  Mark's  (2  p.m.),  Samarttau  (9J0 
a.m.  and  2.80  p.m.).  Throat,  Golden  Square  (9.80  a.m.),  Guy's 
(1.80  p.m.). 

FRIDAY.— London  (2  p,m.),  St.  Bartholomew's  (IJJO  p.m.),  St 
Thomas's  (8.80  p.m.),  Guy's  (1.30  p.m  ),  Middlesex  (1.80  p.m.). 
Charing  Cross  (8  p.m.).  St.  George  s  (1  p.m.),  King  s  Oollr^  (f 
p.m.),  St.  Mary's  (2  p.m.),  Ophthalmic  (10  a.m.),  Cancer  (2  pjn.) 
Chelsea  (2  p.m.).  Great  Northern  Central  (2  80  p.m),  West 
London  (2  SO  p.m.),  London  Throat  (9.80  a.m.),  Samaritan  (9.30 
a.m.  and  2.80  p.m.).  Throat,  Goklen  Square  (9.80  a.m.),  Citv 
Orthopedic  (2.80  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.— Boyal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (1  80 
p.m.),  St  Thomas's  (2  p.m.),  University  College  (9.15  a.m.). 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  -^t.  Mary's  (10  p.m.) 
Throat.  Golden  Square  (0.80  a.m.),  Guv's  (1.30p  m.). 

MONDAY.- London  (2  p.m.),  St.  Bartholomew  s  (1.30  p  m.),  St. 
Thomas's  (3.30  p.m.),  St.  Geowpe's  (2  p.m.),  St.  Mary's  (2.30 
p.m.),  Middlesex  (1.30  p.m.),  ^stminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (Gyneecological,  hy  Physicians,  2  p.m.),  Soho 
Square  (2  p.m.),  Royal  Orthopasdic  (2  p.m.).  City  Orthopaedic  (4 
p.m.).  Great  Northern  Central  (2  30  p.m ),  West  London  (2.30 
p.m.),  I^ndon  Throat  (9.80  a.m.).  Royal  Free  (2  p.m.),  Gu.v's (1.9U 
p.m.). 

TUEdDAY.— London  (2  p.m.),  St.  Bartholomew's  (L80  p.m.);  St 
Thomas's  (3.30  p.m.).  Guv's  (1.30  p.m.),  Middlesex  (1.30  p.m.), 
Westminster  (2  p.m.).  West  London  (2.30  p.m.),  Universi^jr 
College  (2  p.m.),  St.  George's  (1  p.m  ),  St.  Mary's  (1  p.m.).  St. 
Market  (1S.30  p.m.),  Cancer  (2  p.m.).  Metropolitan  ^2.80  p.m.), 
London  Throat  (9.30  a.m).  Royal  Ear  (8  p  m.),  Samaritan  (9JS0 
a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Soho 
Squarfc  (2  p.m.) 


^h  ^(dial  ^tm  mA  €ixm\m. 


"SALUS   POPUU   SUPBEMA   LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    AUGUST    17,    1904.  No.   7. 


Original  Commnnications. 

THE 

STUDY    OF    BIONOMICS 

IN  RELATION  TO    THE 

DIMINISHING     BIRTH-RATE. 

By  W.   R.  MACDERMOTT,  M.B. 

I  HAD  written  a  criticism  of  Dr.  J.  W.  Taylor's 
article  on  the  declining  birth-rate  intended  for  this 
journal  and  laid  it  by,  only  to  find  it  anticipated  in 
material  respects  by  Dr.  David  Walsh.  Not,  how- 
ever, completely  or  to  the  exclusion  of  what  I 
thought  the  most  essential  point.  That  point  I 
find  well  stated  in  a  leading  article  in  The  Medical 
Press  and  Circular  of  July  27th,  1904,  to 
the  effect  *'  that  the  whole  matter  appears  to  be  on 
the  borderland  where  laws  are  beginning  to  loom 
from  the  dense  mists  of  half  knowledge  and  specula- 
tion.** This  statement  recalled  to  my  mind  the 
article  I  had  written,  as  it  put  tersely  the  position 
I  had  taken  in  it.  But  the  question  further 
occurred  to  me  why  this  should  be  the  case,  whether 
from  the  inherent  diflftculty  of  the  subject  itself  or 
from  a  vicious  method  of  studying  it,  a  method 
vitiated  by  n  on -scientific  deference  to  traditional 
preconceptions. 

In  Ireland  the  birth-rate  has  fallen  more  than,  I 
venture  to  say,  in  any  country  in  Europe.  Again, 
it  has  fallen  most  in  rural  districts,  least  in  the 
cities.  Thus,  in  the  report  of  the  Registrar- 
General  for  the  quarter  ending  March  31st,  1904, 
the  birth-rate  for  DubUn  is  32*4,  while  the  average 
rate  for  the  Leinster  counties  is  about  22.  The 
rate  for  Belfast  is  31*5  ;  for  Ulster,  including 
Belfast,  24-4. 

I  am  sure  every  Irish  medical  man  will  agree 
with  me  in  saying  that  the  practices  to  which  Dr. 
Taylor  ascribes  the  fall  in  the  birth-rate  are  unknown 
in  Irish  rural  districts,  exactly  where  the  rate  is 
lowest,  and  that  in  the  cities,  where  it  is  highest, 
they  cannot  prevail  to  such  an  extent  as  to  mate- 
rially affect  it. 

I  believe  it  would  be  found  on  examination  that 
the  same  thing  holds  true  for  wide  areas  in  Great 
Britain,  and  even  in  France  and  America,  namely, 
that  in  these  areas  there  is  not  so  much  a  falling, 
as  a  permanent  low  natality  due  to  causes  among 
which  the  practices  in  question  are  conspicuously 
absent. 

The  birth-rate  stated  as  a  fraction  per  i  ,000  of 
population  is  a  striking  example  of  the  fallacy  to 
which  statistics  so  easily  lend  themselves.  The 
number  of  both  married  and  marriageable  in  a 
thousand  persons  is  variable  both  as  regards  time 


and  place.  If  the  number  of  persons  under  20 
and  over  45  increase  at  any  time  or  in  any  place 
relatively  greater  than  those  between  these  hmits, 
the  fact,  as  far  as  it  goes,  will  mean  a  falling  birth- 
rate. For  example,  I  saw  it  stated  in  a  late 
number  of  Nature  that  50  per  cent,  of  those  bom 
die  before  they  reach  20.  If,  now,  there  being 
14,647,783  of  that  age  or  under  in  the  EngUsh, 
population,  32,527,843  (1901),  if  there  is  ever  so 
small  an  increase  in  the  mass  of  life  at  20  and  under 
it  will  find  marked  representation  in  apparently 
lowering  the  birth-rate,  and  a  relative  increase  in  the 
number  over  45  in  proportion  will  have  the  same- 
effect. 

Primarily  the  rate  is  a  potential  function  of  the 
number  of  females  between  20  and  40,  that  is,  it 
depends  on  a  numerical  variable  whatever  other 
factors  may  intervene.  Women  under  and  over 
these  ages  bear  children,  and  this»  from  a  certaia 
point  of  view,  i.«.,  as  obtaining  ultimate  repre- 
sentation in  vital  status,  is  a  most  important  f  ax;t. 
The  number  of  children  so  borne  being,  however,, 
negligible,  the  apparent  fomv  of  the  birth-rate  can 
be,  immediately,  httlc  affected  by  it. 

Fall  in  the  real  birth-rate  would  follow  only  from 
women  of  the  age  period  20-40  bearing  fewer  chil- 
dren ;  it  would  be  illicit  reasoning  to  ascribe  any 
such  change  to  flux  in  the  number  of  such  women 
in  a  population  undergoing  variation.  I  am  here 
only  indicating  necessary  points  for  study  ;  space 
would  not  allow  me  to  discuss  the  variation  in  the 
number  which  has  occurred  in  the  United  Kingdom. 
It  is  enough  to  say  that  Dr.  Taylor's  position,  to  be 
either  strengthened  or  weakened,  needs  the 
variation  in  the  relative  number  of  child-bearing 
women  to  be  taken  into  account. 

The  statistical  form  of  the  apparent  birth-rate 
is  the  expression  of  variables  lying,  say,  between 
the  limits  30  and  20.  Thus,  while  the  birth-rate 
for  Dublin  is  32,  that  for  many  of  the  Irish  counties 
is  20  or  under.  In  general  the  rural  is,  and 
always  has  been,  below  the  urban  rate,  and,  there- 
fore, if  the  urban  population  increases  or  the  riural 
decreases,  or  both  circumstances  happen  to  concur^ 
the  apparent  birth-rate  may  rise  while  the  real,  the 
relative  number  of  children  borne  by  women  of  age 
period  20-40,  may  be  stationary  or  falling.  The 
rise  in  the  apparent  rate  for  the  United  Kingdom 
beginning  in  1840  actually  concurred  with  a  great 
increase  in  the  urban  population,  that  in  which  the 
real  rate  is  highest,  going  with  a  decrease  in  the  rural 
population,  in  which  it  is  lowest.  When,  however, 
the  rural  population  becomes  relatively  insignifi- 
cant, as  it  has  in  the  British  Islands,  or  when  the 
flux  of  population  in  favour  of  the  high  rate  attains 
a   maximum,   the   apparent   birth-rate   tends   ta 


164     Thx  MXDICALPmXSS. 


ORIGINAL  COMMUNICATIONS. 


August  17,  1904- 


become  stationary  or  even  to  fall.  It  is  evident 
that  a  great  increase  in  an  element  of  population 
in  which  ab  initio  there  is  a  high  birth-rate  cannot 
be  taken  as  indicating  a  flux  in  the  real  birth-rate 
itself.  .    ' 

Apparent  local  birth-rates  are  worthless,  as  a  rule, 
for  purposes  of  inference  unless  they  cover  large 
numbers.  Where  they  cover  populations  of,  say, 
100,000,  discrepancies  are  to  be  noted  from  place 
to  place  which  cannot  be  accounted  for  by  the 
•causes  medical  men,  and  Dr.  Taylor  in  particular, 
assign  from  a  limited  point  of  view  as  determining 
relative  natality.  Recent  change  in  the  British 
birth-rate  is  probably  due  to  a  greater  extent  to 
the  South  African  War  than  to  the  growth  of  the 
practices  Dr.  Taylor  dwells  on.  In  general,  the 
rate,  apparent  and  real,  has  been,  in  the  main, 
determined  by  an  impersonal  non- volitional  cause 
— 1.^.,  the  growth  of  a  great  urban  industrial  class, 
a  growth  which  varies  with  the  well-being  of  the 
class.  This  vast  increase  of  industrial  life  is  an 
economic  phenomenon  almost  mechanical  in  its 
nature,  but  it  gives  the  importance  of  absolute 
mass  to  the  personal  equation  ;  a  greater  mass  of 
personal  frailty  and  vice  comes  into  the  field  to 
strike  our  minds.  But  the  personal  equation 
covers  what  works  for  good  as  well  as  what  works 
for  evil,  and  it  may  be  doubtful  in  the  first  place 
that  there  is  any  relative  increase  in  the  mass  of 
vice,  and  in  the  next  place  whether  it  is  not  com- 
pensated for  by  an  increase  in  the  mass  of  virtue 
or  right  conduct. 

My  object  here  is  to  insist  that  medical  men 
should  recognise  the  unity  of  vital  status  or 
bionomics,  and  not  make  desultory  raids  on  it  as 
political  economists,  clergymen  and  lawyers  do 
from  varying  points  of  view.  The  economy  of 
human  life  is  the  end  or  purpose  of  the  economy  of 
wealth,  of  morality-  and  jurisprudence.  The 
science  of  the  production  and  distribution  of 
wealth,  morality,  and  jurisprudence  are  mere 
abstractions  in  themselves  saturated  in  the  actual 
field  with  the  gross  fallacies  which  attend  deduc- 
tion from  the  abstract.  The  concrete  reality  is 
human  hf e,  beginning  with  the  hfe  of  the  individual. 
To  use  a  much  abused  term,  theory,  in  the  sense  in 
which  Coleridge  uses  it,  we  should  aim  at  a  theory, 
a  mere  true  description  of  the  actual  nature  of  the 
life  of  the  individual  and  how  he  actually  maintains 
it  by  the  formation  and  regulation  of  social  aggre- 
gates, the  regulation  of  his  own  conduct,  the  pro- 
duction and  preservation  of  wealth,  his  means  of 
subsistence,  and  so  on. 

Now  the  first  fact  that  presents  itself  when  such 
description  is  barely  entered  on  is  that  the  action 
of  the  individual  is  grossly  at  fault  with  reference 
to  his  primary  object,  the  maintenance  of  his  Ufe  ; 
lie  is  inconsequent,  ignorant  and  irrational.  For 
ages  his  mental  ability  to  oppose  the  powers  of 
Nature,  to  master,  to  use  them,  lay  dormant.  For 
ages  he  has  allowed  the  devices  originally  arising  to 
safeguard  life  and  enhance  its  value  to  be  turned 
against  it.  This  fact  is  represented  in  the  de- 
scription or  theory  of  human  life.  The  moment 
man  began  to  describe  himself  he  fell  into  gross 
error  and  placed  a  bar  in  the  way  of  describing 
himself  in  true  terms,  though  these  would  be  the 
simplest.  He  lied  to  himself,  whether  consciously 
or  unconsciously  does  not  matter,  and  became  a 
slave  to  complex  and  contradictory  systems  of 
falsehood.  He  realised  the  powers  of  Nature  as 
divine  and  remained  their  slave  as  long  as  he  did. 
He  described  himself  as  a  god,  the  descendant  of  a 


god  ;  he  made  his  dead  fathers  and  living  kings 
gods,  and  in  so  doing  built  up  interests  which  com- 
mitted him  deeper  and  deeper  to  falsehood. 

But  every  fact  could  not  be  closed  to  true  de- 
scription, and  truth  in^oe  direction  led  to  a  general 
perception  of  tru-Hi,  by  originating  a  method  of 
pursuing  it.  Bionomics,  limiting  a  term  uBed  in  a 
wider  sense  to  human  life,  not  only  remains  barred 
in  every  direction  by  ancient  error  and  the  ideals 
and  interests  created  by  such  error,  but  by  the  non- 
application  of  scientific  method  to  its  subject 
matter.  "Compared,"  Alfred  Wallace  says, 
"  with  our  astounding  progress  in  ph3rsical  science 
and  its  application,  our  system  of  government,  of 
administrative  justice  and  of  national  education, 
our  entire  social  and  moral  organisation  re- 
mains in  a  state  of  barbarism."  It  would  be  still 
more  to  the  point  to  say  that  the  mere  description 
of  our  moral  and  social  organisation  remains  in  the 
"dense  mists  of  half  knowledge  and  speculation," 
and  greatly  in  the  hands  of  those  whose  interest  it 
is  that  it  shall  remain  so. 

In  a  particular  study  of  insanity  in  Ireland, 
referred  to  in  an  article  in  the  Westminster  Review 
(March,  1903),  I  took  in  a  continuous  area  all  the 
permanent  families  and  investigated  their  life 
history  as  far  as  I  could  go.  I  found  at  once  that 
the  method  carried  me  far  beyond  my  particular 
study,  among  other  matters  to  the  birth-rate  and 
marriage  in  connection  with  it.  In  400  families 
only  in  one  instance  had  I  reason  to  suspect  the 
practices  Dr.  Taylor  refers  to.  In  217  births  I 
found  only  5  to  be  illegitimate  ;  in  one  of  these  last 
the  mother  was  a  weak-minded  girl ;  the  other  four 
did  not  belong  to  my  permanent  families  ;  were, 
indeed,  servant  girls.  The  apparent  birth-rate  for 
the  area  (iQOi)  was  17  per  1,000  ;  it  had  fallen 
within  thirty  years  from  28,  and  is  falling  every  year, 
or  rather  fluctuating  wildiy,  as  must  be  the  case 
where  small  numbers  are  under  observation.  It 
would  take  periods  of  ten  years  at  least  to  show 
the  fall  beyond  doubt.  The  only  practices  used 
to  prevent  child-bearing  arc  protraction  of  the 
period  of  lactation  and  absolute  continence  in 
married  life.  The  last,  I  believe,  is  more  common 
than  is  generally  supposed,  particularly  among 
the  elderly.  Ill-health,  abnormal  states  of  the 
uterus  and  ovaries  short  of  pronounced  disease, 
sexual  indifference  and  personal  indifference 
amounting  often  to  positive  dislike,  are  by  no 
means  negligible  factors  and  increase  with  age  of 
marriage. 

Other  points  of  even  greater  weight  occurred  to 
me  in  this  study.  •  My  object  here  is,  however,  not 
to  give  my  conclusions  but  to  show  that  wide  and 
careful  observation  of  the  personnel  of  family  life 
is  the  essential  base  of  human  bionomics  and  that 
that  observation  is  peculiarly  within  the  province 
of  the  practising  physician.  It  seems  to  me  that 
both  Dr.  Taylor  and  his  critics  have  a  far  finer  field 
for  such  observation  than  I  have,  but  forsake  it  for 
crude  statistics  and  the  inconsequent  morality 
cherished  in  another  profession.  What  is  the  use 
of  trotting  out  potential  fecundity,  the  Malthusian 
bugbear,  when  it  is  a  ghost  even  to  herrings  ?  I 
would  leave  Count  Tolstoi  to  condemn  marriage  as 
an  immoral  and  improper  institution,  the  clerg>' 
and  lawyers  to  taboo  illegitimacy  and  excuse 
ceUbacy  only  when  they  practise  it.  What  are 
we  the  wiser  when  we  find  Mill  and  his  disciples 
declaiming  against  early  and  improvident,  and 
physiologists  against  deferred  and  provident 
marriages  ?     We  are  left  in  a  state  of  senseless 


August  17,  1904. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Piess.    165 


muddle,  left  worse  even  than  the  mindless  creatures 
of  convention  and  custom  who,  at  least,  have 
something  .to  go  by.  But  the  field  of  actual 
circumstance  is  open  before  us,  we  know  the 
method  of  scientific  investigation,  and  surely  we 
ought  to  know  that  until  we  enter  it  with  that 
method  we  must  remain  in  the  dense  mists  of  half 
knowledge  and  speculation. 


ACETOZONE: 

A  NOTE  ON  ITS  VALUE  AS  AN 
ANTISEPTIC  AND  GERMICIDE. 
By  JAMES  BURNET,  M.A.,  M.B.,  M.R.C.P.Edin., 
Clinical  Tutor,  Sztramuml  Wards,  Boyal  InflrmaTv 


Begittrar. 
Soyal  Hospital  for  Sick  Children;  and  I'liysician  to  tlie  Mai  shall 
Street  Dispensary,  Edinbuxigrh. 


ence  of  its  value  warrants  me,  I  think,  in  publishing 
the  results  of  my  more  extended  observations  in 
order  that  others  may  benefit  thereby.  The  cases 
in  which  acetozone  was  employed,  and  of  which 
I  kept  a  record,  number  fifty-three  in  aU.  They 
were  of  a  most  varied  description,  ranging  from 
whitlows  and  septic  wounds  to  actual  gangrene. 
It  is,  of  course,  absolutely  impossible  to  pubUsh 
notes  of  all  these  cases.  There  are,  however,  two 
very  interesting  clinical  histories  which  I  mav 
briefly  place  on  record. 


One  of  the  earliest  uses  to  which  I  put  acetozone 
was  in  the  case  of  a  child  of  five  years.  The  little 
finger  of  his  left  hand  had  been  severely  crushed 
and  lacerated  by  being  trampled  on  by  another 
boy  while  at  play.  He  was  brought  to  me  imme- 
This  chemical  compound  was  brought  to  the  «^ately  after  the  accident.  The  finger  was  split 
notice  of  the  profession  in  this  country  about  two  ^^^*  "P  ^T  ™T^^  °^  *^  palmar  aspect,  and  the 
veare  ago,  although  it  had  already  been  successf ullv  ^^  T^^  formed  were  covered  with  mud  and  dirt, 
ised   for  some   time  in   America.     The   chemical  *  ^^®    termmal    nhal;^nv    wpq    KroV^«      T1.0    r.^^. 


title  for  this  substance  is'  benzoyl-acetyl- peroxide, 
and  *  its  formula  may  be  expressed  as  C.Hj 
C0OOC0CH3.  Benzozone  was  the  term  at 
first  appUed  to  it,  but  as  this  closely  resem- 
bled the  names  of  other  antiseptics  already  in  use, 
it  was  soon  altered  to  acetozone.  Novy  and  Freer, 
of  the  University  of  Michigan,  carried  out  a  series 
of  observations  upon  the  action  of  a  number  of 
organic  peroxides  on  bacteria.  They  called  atten- 
tion to  the  fact  that  acetozone,  which  is  one  of  these 
peroxides,  when  brought  into  contact  with  water, 
splits  up,  giving  rise  to  the  peroxides  of  acetyl 
hydrogen  and  benzoyl  hydrogen.  These  peroxides, 
when  in  solution,  are  very  energetic,  and  act  power- 
fully as  germicides.  It  was  claimed  for  acetozone 
that  it  was  probably  the  most  powerful  bactericidal 
agent  in  existence. 

A  few  preliminary  remarks  on  the  nature  and 
properties  of  this  substance  may  not  be  amiss. 
Acetozone  occurs  in  the  form  of  fine  acicular 
crystals,  and  melts  at  the  ordinary  body  tempera- 
ture. If  heated  suddenly  decomposition  takes 
place  almost  instantaneously,  and  an  explosion  may 
result.  It  is  soluble  to  a  small  extent  in  oils, 
stightly  so  in  alcohol,  and  fairly  soluble  in  ether 
and  in  chloroform.  In  water  its  solubility  varies 
from  I  :  1,000  to  i  :  10,000,  according  to  temp)era- 
ture  and  other  circumstances.  Alkalies  and  all 
forms  of  organic  matter  readily  decompose  it.  It 
is  marketed  as  a  powder  consisting  of  equal  parts 
of  itself  and  another  inert,  absorbent  substance. 
In  this  form  it  may  be  handled  with  the  greatest 
freedom.  As  regards  its  germicidal  power,  it  is 
stated  to  be  very  much  more  active  than  corrosive 
subUmate,  while  at  the  same  time  it  is  non-toxic, 
and  may  be  freely  administered  internally  in  aqueous 
solutions. 

My  methods  of  employing  acetozone  were  two  in 
number.  Most  frequently  it  was  used  as  a  watery 
solution  containing  2f  grains  to  every  four  ounces. 
After  thoroughly  agitating  there  resulted  a  hazy 
solution,  and  this  was  employed  almost  immediately 
after  its  preparation  and  never  later  than  48  hours. 
Occasionally,  I  found  the  addition  of  one  part  of 
acetozone  to  250  parts  of  talc — i.e.,  about  one  grain 
to  the  half  ounce — very  useful  as  a  dusting  powder. 
I  have  made  use  of  acetozone  in  something  like 
sixty  cases,  and  always  with  the  most  satisfactory 
results.  Already  I  have  communicated  a  note  on 
acetozone  to  another  journal,  (a)  but  further  experi- 

(a)  The  Mgdt'cai  Timet,  October  18th,  1902. 


I  The   terminal   phalanx   was   broken.     The   parts 
were  first  carefully  washed  with  acetozone  solution 
(5  grs.  :  8  ozs.).     The  finger  was  then  dressed  with 
Unt  wrung  out  of  the  lotion  and  covered  over  with 
gutta-percha  tissue.     The  whole  hand  was  then 
placed  on  a  splint  and  absorbent  cotton  wool  and  a 
bandage     applied.     Next     morning,     when     the 
dressings   were  removed,  the  soft  parts  were  quite 
black  and  cold.     They  smelt  badly,  and  seemed 
as  if  about  to  become  gangrenous.     Nevertheless, 
the  finger  was  kept  in  a  small  basin  containing  a 
solution  of   acetozone  for  fully  fifteen   minutes. 
I  then  further  bathed  the  parts  very  carefully  and 
reapplied    the    dressings.     This    process    was   re- 
peated again  the  same  evening.     On  the  third  day 
the  parts  presented  a  healthier  appearance,  and 
had   to  some  extent  lost  their  former  evil  odour. 
The   wound   was   dressed   three   times.     On   the 
fourth  morning  the  gangrenous  appearance  was  al- 
most entirely  gone,  and  the  tissues  when  pressed 
bled  quite  freely.     Wet  dressings  were  continued 
until  the  sixth  day,  when  they  were  withdrawn 
altogether,   and    a    dusting  powder  consisting  of 
acetozone  and  zinc  oxide  (2  grs.  :  J  oz.)  was  freely 
applied.      This,     however,    caused      considerable 
burning  and  smarting  pain,  and  consequently  the 
amount   of   acetozone   was  reduced  by  one-half. 
On  the  eighth  day,  as  the  granulations  which  were 
now  beginning  to  spring    up   were  still  raw  and 
fresh,  they  were  gently  scraped  and  the  flaps  brought 
together  by  means  of  a  couple  of  horsehair  sutures. 
The  parts  were  then  dusted  over  with  the  powder 
as  before.     There  had  been  too  great  delay  id 
bringing   the   flaps   into   apposition,    and   conse- 
quently the  tissues  towards  the  finger  tips  refused 
to  be  connected,  so  that  this  portion  remained  as 
a    raw,    granulating    surface.     I    was,    however, 
afraid   to   use   sutures   earher   lest   their   tension 
might  lead  to  suppuration  in  a  wound  which  was 
by  no  means  healthy-looking  to  commence  with* 
At  the  end  of  a  fortnight  the  finger  was  practically^ 
healed,  except  the  small  piece  at  the  tip.     The 
fracture  of  the  terminal  phalanx  had  united,  and 
the  child  had  no  longer  an  ugly,  unshapely  finger 
such  as  had  been  anticipated.    The  mother,,  bow- 
ever,  was  told  to  continue  dressing  it  for  a  sbort 
time.     Unfortunately,  in  spite  of  my  instructions 
to  move  the  joints  regularly, she  neglected  to  do  so; 
and   consequently,   though  the   child's   finger  is 
perfect  so  far  as  shape  goes,  it  wiU  presumably 
always  remain  stiff  and  flexed.    This  is  a  case 
where  amputation  at  first  seemed  almost  inevit- 
able, and,  indeed,  there  was  no  small  risk  incurred 


l66    Thx  Mkdical  Press. 


ORIGINAL  COMMUNICATIONS. 


August  17,  1904. 


in  thus  temporising  with  a  finger  in  such  a  septic 
and  gangrenous-like  condition. 

The  second  case  to  which  I  wish  to  refer,  and 
which  is  of  more  than  passing  interest,  is  that  of  a 
woman,  aet.  49.  She  had  some  pain  in  the  left 
forefinger.  She  imagined  the  condition  to  be  a 
commencing  whitlow,  and  applied  a  piece  of  hnt 
soaked  in  pure  carbolic  acid,  covering  it  over  with 
gutta-percha  tissue.  This  dressing  was  kept  on 
from  Friday  morning  till  late  on  Saturday  after- 
noon. As  she  felt  the  finger  cold  and  numb  she 
removed  the  dressing,  and  to  her  surprise  found 
the  finger  purplish-black  in  colour  from  its  tip 
right  up  to  the  middle  of  the  second  phalanx.  I 
was  accordingly  se.it  for,  and  found  the  parts  quite 
anaesthetic.  On  pushing  a  needle  deeply  into  the 
finger  at  different  places  no  blood  oozed  out.  In 
other  words,  the  patient  was  suffering  from  the 
condition  known  as  carboUc  gangrene.  Moist 
dressings  of  acetozone  were  applied  and  the  finger 
well  covered  up  with  a  thick  wrapping  of  cotton- 
wool. The  patient  passed  a  restless  night.  She 
had  great  pain  over  the  second  phalanx  of  the 
affected  finger.  In  the  morning,  on  removing  the 
dressings,  it  was  noted  that  a  fairly  well  marked 
line  of  demarcation  was  already  beginning  to  form. 
I  placed  the  finger  in  a  solution  of  acetozone,  and 
kept  it  there  for  fully  half  an  hour.  The  moist 
dressings  were  then  reappUed.  This  process  was 
repeated  in  the  afternoon,  and  again  in  the  evening. 
Next  morning,  the  patient  experienced  sensation 
slightly  over  the  second  and  to  some  extent  also 
over  the  third  phalanx.  When  these  parts  were 
pricked  with  a  needle  bright  red  blood  oozed  out. 
The  treatment  with  acetozone  was  kept  up  for 
a  week,  and  at  the  end  of  that  time  only  the  very 
tip  of  the  finger  remained  anaesthetic.     The  skin 


over  the  other  parts  was  beginning  to  assume  a 
more  natural  appearance.  The  parts  about  the 
terminal  phalanx,  however,  still  looked  far  from 
healthy,  and  although  it  was  now  evident  that 
amputation  of  the  finger  was  no  longer  called  for, 
it  was  thought  that  in  all  probability  the  terminal 
phalanx,  or  at  least  part  of  it,  would  eventually 
perish.  In  the  course  of  a  few  weeks  all  the  un- 
healthy skin  and  most  of  the  underlying  soft  parts 


were  removed,  and  the  remaining  tissues  kept 
constantly  under  the  influence  of  acetozone 
Finally,  the  bulk  of  the  nail  was  taken  off,  leaving 
only  the  matrix  behind.  The  photograph  shows 
very  well  the  condition  of  the  finger  two  months 
after  the  commencement  of  treatment.  After 
the  finger  was  photographed  the  projecting  part 
of  the  terminal  phalanx  was  removed,  and  at  the 
present  time  the  patient  has  as  perfect  a  finger 
as  she  could  well  wish  for.  Its  movements  are 
not  at  all  impaired,  and  the  fact  that  it  is  slightly 
shorter  than  the  corresponding  one  of  the  other 
hand  is  scarcely  noticeable.  This  case  proves  the 
possibiUty  of  treating  carbolic  gangrene  without 
amputation. 

I  have  mentioned  these  two  cases  in  some  detail 
because  they  were  serious  ones,  at  all  events  they 
involved  the  probable  loss  of  a  finger.  Acetozone. 
however,  has  been  chiefly  employed  in  the  treat- 
ment of  ordinary  affections  such  as  whitlows, 
abscesses,  and  small  septic  wounds  in  general. 
After  freely  incising  a  whitlow  or  other  abscess  the 
apphcation  of  moist  acetozone  dressings  brings 
about  a  rapid  cure,  and  this  mode  of  treatment  is, 
moreover,  devoid  of  the  risks  involved  where 
carboUc  acid  or  lysol  is  used.  So,  too,  with  boils 
and  carbuncles.  Abscesses,  even  when  extensive, 
cause  Uttle  trouble  if,  after  incising  them  and 
squeezing  out  the  purulent  contents,  the  cavity  is 
flushed  out  with  acetozone  solution,  and  then 
stuffed  with  gauze  saturated  with  the  same. 
Wounds  which  are  already  septic  speedily  become 
healthy  when  dressed  with  lint  wrung  out  of  a 
watery  solution  of  acetozone  and  covered  over 
with  gutta-percha  tissue. 

In  a  case  of  cystitis  due  to  urethral  stricture, 
acetozone  was  found  of  great  value.  The  patient 
was  50  years  of  age,  and  had  a  very  tight  stricture. 
To  relieve  this  he  had  been  passing,  or  at  least  at- 
tempting to  pass,  a  very  septic-looking  gum- 
elastic  catheter.  After  reUeving  the  stricture  the 
cystitis  remained.  Many  internal  remedies  were 
used  for  its  reUef ,  but  these  only  gave  shght  results. 
Accordingly  the  bladder  was  thoroughly  washed 
out  with  a  weak  solution  of  acetozone.  This 
was  followed  by  marked  improvement.  A  week 
later  the  washing-out  process  was  repeated,  and 
from  that  time  the  cystitis  rapidly  disappeared. 
So  far  as  I  am  aware,  acetozone  has  never  been 
used  in  this  way  before,  and  consequently  it  might 
be  worth  trying  in  similar  cases.  In  this  patient's 
case  it  certainly  had  a  very  definite  and  speedy 
effect.  This  leads  me  to  suppose  that  acetozone 
would  be  valuable  in  puerperal  septicaemia.  It 
might  not  only  be  used  as  an  intra-uterine  douche 
in  such  cases,  but  might  also  be  given  internally  in 
the  hope  that  it  might  thus  counteract  the  evil 
effects  of  the  toxins  circulating  in  the  blood. 
Already  it  has  been  used  with  some  success  in 
appendicitis,  as  well  as  in  dysentery  and  in  enteric 
fever ;  and  elsewhere  I  suggested  its  use  as  an 
intestinal  antiseptic  in  cholera  and  in  tuberculous 
affections. 

There  are  one  or  two  points  which  must  be 
carefully  noted  in  using  acetozone.  If  used  in  too 
great  strengths  it  causes  considerable  smarting 
and  pain.  On  the  other  hand,  it  may,  within 
certain  Umits,  be  administered  internally  in  com- 
paratively large  amounts.  In  fact,  to  obtain  good 
results  from  its  internal  administration  acetozone 
must  be  given  freely  and  in  heroic  doses.  This  is 
especially  so  in  cases  of  enteric  fever.     Solutions 


August  17,  1904. 


ORIGINAL  COMMUNICATIONS.       The  Medical  Press.    167 


should  always  be  freshly  prepared,  and  only  water 
should  be  used  as  a  solvent.  I  do  not  think  the 
action  is  quite  so  powerful  when  hot  water  is  em- 
ployed in  making  the  solution  as  when  cold  is 
made  use  of.  I  noticed,  at  all  events  on  several 
occasions,  that  when  a  standard  solution  had  been 
prepared  and  before  use  was  diluted  to  the  neces- 
sary strength  with  hot  water  the  results  obtained, 
so  far  as  therapeutic  effect  was  concerned,  were 
not  quite  so  good  as  when  the  dilution  was  made 
with  cold  water.  The  reason  may  be  that  hot 
water  causes  too  rapid  a  disintegration  of  this  com- 
pound. So  far  as  my  experience  goes  acetozone 
may  be  stated  to  have  no  deleterious  effect  on 
metal  instruments.  Its  very  pleasant  odour  is 
another  recommendation  of  no  Uttle  consequence 
in  many  instances.  Time  alone  forbids  a  further 
consideration  of  the  many  possibihties  of  this  new 
preparation,  but  these  imperfect  notes  may  serve 
as  an  introduction  to  those  as  yet  unacquainted 
with  the  virtues  of  this  antiseptic  and  germicide. 


A  CASE   OF 

SUPPURATIVE    KNEE-JOINT, 

By  A.   R.   BRACKETT,   M.A..  M.D. 

R.  J.,  aet.  10,  family  history  good,  robust,  healthy 
boy.  While  playing  marbles  on  the  floor,  thrust  into 
bis  knee-ioint  a  needle  which  lay  unobserved  upon  the 
Hoor.  The  needle  was  threaded  with  about  six  or  eight 
inches  of  ordinary  black  cotton  thread.  It  penetrated 
the  joint  eye  first,  carrying  the  thread  with  it.  The 
joint  was  penetrated  on  its  internal  aspect,  about  one 
and  three-fourths  inches  posterior  to  the  patella,  the 
needle  breaking  in  two  pieces,  the  larger  of  which  was 
withdrawn  at  once.  The  smaller  portion  with  the  eye 
remained  in  the  joint,  the  ends  of  the  thread  which  it 
carried  hanging  out  several  inches.  At  the  request  of 
the  child,  "  because  it  puUed,"  the  mother  cut  the 
threads  flush  with  the  skin,  allowing  the  remaining  part 
of  the  thread  attached  to  the  needle  (which  proved  to 
be  over  two  inches  long)  to  disappear  under  the  skin, 
thus  transforming  the  proposition  to  a  "  hunt  for  a 
needle  in  a  haystack."  Infection  promptly  occurred. 
At  the  end  of  a  week,  when  called  to  see  the  case  in 
consultation,  the  child  was  suffering  from  an  intensely 
septic  S3movitis,  decided  general  toxaemia,  and  great 
pain.  The  temperature  stood  at  104^®  F.  Pulse,  130  ; 
respirations  were  correspondingly  rapid,  but  were  not 
counted  ;  had  had  several  chills,  followed  by  sweating. 

Operation  was  advised  at  once,  but  the  practitioner 
in  charge  objected.  The  parents,  however,  becoming 
alarmed,  brought  him  to  the  hospital  the  following  day. 
Before  operating  an  X-ray  picture  was  secured,  both 
in  the  antero-posterior  axis  of  the  limb  and  in  the 
lateral  axis.  The  shadow  of  the  needle  fragment  was 
readily  seen.  Taking  the  planes  shown  by  these  two 
pictures  as  a  guide,  the  joint  was  freely  opened*  first 
on  the  internal  aspect,  v  By  good  fortune  our  fi»t  in- 
cision came  within  the  width  of  a  knife  blade  of  the 
foreign  body,  exposing  also  a  portion  of  the  thread. 
Following  this  up  made  the  fragment  of  needle  easy  to 
find.  It  was  imbedded  nearly  a  quarter  of  an  inch  in 
the  internal  condyle  of  the  femur.  After  its  removal 
the  joint,  which  was  full  of  pus,  was  opened  on  the 
external  surface  by  an  incision  parsdlel  to,  and  equal 
in  length  (about  three  and  a  half  inches),  to  the  opposite 
one ;  with  a  dull  periosteotome  the  patella  was  elevated 
sufficiently  to  allow  of  complete  through-and-through 
irrigation  of  the  joint.  This  was  done  with  dioxygen, 
pure,  and  repeated  until  the  reaction  was  very  slight. 
Drainage-tubes  were  inserted,  plain  gauze  dressing 
applied,  thickly  covered  with  absorbent  cotton,  fixa- 
tion secured  by  a  fenestrated  splint,  and  the  patient  put 
to  bed. 

His  temperature  rapidly  came  down,  his  pulse  also  ; 
pain  ceased  except  when  limb  was  moved.  The  follow- 
ing- morning  the  temperature  by  rectum  was  99°  F., 


pulse  90.  The  knee  was  uncovered,  and  a  second 
thorough  irrigation  of  the  joint  was  made.  At  the 
end  of  seventy-two  hours,  temperature  and  pulse  were 
entirely  normal,  and  the  little  fellow  was  begging  for 
food,  and  to  be  allowed  to  get  up.  The  drainage-tubes 
were  now  removed,  the  sutures  that  had  been  inserted 
but  not  tied  were  drawn  together,  closing  the  wound, 
not,  however,  without  some  misgiving  as  to  the  possi- 
bility that  re-opening  and  re-draining  might  be  neces- 
sary. Our  fears  were  groundless,  for  primary  union 
promptly  followed.  In  ten  days  the  little  patient  was 
out  of  bed  and  the  splints  removed  ;  on  the  sixteenth 
day.  in  spite  of  orders  to  the  contrary,  the  patient 
walked  some  distance  from  the  hospital  with  a  very 
slight  limp  ;  on  the  eighteenth  day  he  went  home. 
Now,  two  years  after  the  injury,  he  hskB  a  flexible  and 
perfect  knee-joint.  The  infection  in  this  case  was 
prompt  in  developing  and  virulent  in  its  character, 
manifested  both  locally  and  constitutionally,  conse- 
quently our  prognosis  could  not  be  other  than  un- 
favourable. Under  such  conditions  a  "  stiff  knee- 
joint  "  would  ordinarily  be  considered  a  good  result. 
That  we  did  not  have  such  a  result  is  due  to  two  factors  : 
First,  the  thorough  drainage  established  ;  and  second, 
to  the  equally  thorough  and  beneficent  action  of  the 
antiseptic  solution  that  was  used.  I  am  by  no  means 
tied  to  any  one  technique  nor  to  any  one  of  the  many 
antiseptic  preparations  that  have  become,  so  to 
speak,  classic.  But  after  a  fairly  extensive  experience 
covering  a  number  of  years,  I  am  unable  to  name  any 
reagent  that  can  so  satisfactorily  accomplish  what  is 
demanded  of  it  as  dioxygen.  Other  reagents  are 
germicidal,  but  they  are  also  tpxic.  They  accomplish 
antisepsis,  it  is  true,  but  they  are  more  or  less  irritating 
and  frequently,  as  in  the  case  of  "  corrosive  sublimate  " 
so  commonly  used,  have  a  destructive  action  on  the 
cellular  structures  in  living  tissue,  even  to  the  extent 
of  a  superficial  necrosis.  Many  of  them  are  dis- 
agreeable in  odour,  consequently  distasteful  to  patients 
— ^no  unimportant  factor  in  the  presence  of  sensitive 
stomachs  and  pain-racked  nerves.  None  of  them 
develop  by  their  action  a  • '  mechanical  force  "  (if  we 
may  use  the  term)  that  materially  assists  in  dislodging 
and  clearing  out  ingrained  particles  of  infectious  sub- 
stances, as  seen  in  the  bubbling  of  applied  dioxygen. 
which  is  non- toxic,  non-irritating,  and  germicidal.  In 
giving  ofl  its  oxygen  it  seems  really  to  vivify  the  struc- 
tures with  which  it  is  brought  in  contact  and  hasten 
constructive  metabolism. 


THYROID    GRAFTING 

IN 

HUMAN     BEINGS, 

By    H.  CHRISTIANI,  M.D.; 
Professor  at  the  Fscolty  of  Medidae  of  Geneva. 

The  attempts  at  thyroid  grafting  hitherto  performed 
in  man  may  be  divided  into  two  distinct  groups,  e,g., 
heterothyroid  grafts,  that  is  to  say,  the  transplantation 
of  thyroid  grafts  from  animals  to  man,  and  homo- 
thyroid  grafts,  viz..  transplantation  of  human  thyroid 
gland. 

Most  of  the  experiments  in  the  direction  of  trans- 
planting thyroid  grafts  from  animals  to  man  have  been 
done  with  sheep's  thyroid,  following  the  example  set 
by  Sir  Victor  Horsley.  An  entire  lobe  or  large  portions 
of  the  gland  are  removed  from  the  animal  and  are 
buried  in  the  connective  tissue  of  this  or  that  region. 
All  these  experiments  gave  immediate  good  results,  but 
in  all.  after  a  variable  space  of  time,  the  thyroid  tissue 
showed  signs  of  atrophy,  the  longest  period  being  two 
months. 

Grafts  of  human  thyroid  were  made  in  1883  by 
M.  Kocher  and  others,  the  material  having  been 
obtained  for  the  most  part  from  human  thyroid  glands 
that  had  been  extirpated.  The  results  of  this  method 
of  implantation  were  not,  on  the  whole,  more  favourable 
than  those  obtained  by  grafts  of  animal  thyroids. 

These  results  offered  so  little  encouragement  that 
certain  observers  recently  engaged  in  the  problem  of 


I68    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


August  17.  i904' 


thyroid  medication  have  been  tempted  to  relegate 
thyroid  implantation  to  the  limbo  of  impracticable 
therapeutical  projects. 

Nevertheless,  if  we  review  all  these  experimental 
investigations  and  compare  the  results  of  direct  ex- 
periment, we  find  ourselves  in  a  position  to  draw  con- 
clusions somewhat  less  negative  in  character.  It  must 
be  admitted  that  Shiff's  experiments  in  thjrroid  im- 
plantation, which  were  the  starting-point  of  this  line  of 
research,  yielded  no  persistent  results,  and  various 
physiologists,  pursuing  the  same  line,  were  not  more 
fortunate.  When,  fifteen  years  ago,  I  first  took  up 
the  study  of  the  thyroid  gland,  the  general  opinion  was 
that  the  transplanted  gland  would  either  undergo 
necrosis  and  sp^dy  absorption  or  grow  for  a  time,  only 
to  disappear  later  on — invariably  in  a  comparatively 
short  space  of  time — by  slow  atrophy. 

But  in  these  investigations  the  anatomical  factor 
seems  to  have  been  lost  sight  of,  attention  having  been 
directed  exclusively  to  the  physiological  side  of  the 
question.  Von  Eiselsberg  was  the  first  to  show,  not 
only  that  th3rroid  grafts  in  ecthyroidised  animals  might 
save  life,  but  also  that  the  transplanted  thyroid  was 
capable  of  maintaining  its  distinctive  structure.  My 
earliest  observations,  published  at  about  the  same  time, 
confirmed  Eiselsberg's  researches,  and  more  recent  in- 
vestigations demonstrate  conclusively  that  it  is  possible 
to  obtain  permanent  grafts  and,  incidentally,  to  explain 
why  previous  grafts  had  failed  to  gain  a  stable  footing. 
It  thus  became  possible  to  formulate  certain  rules  to 
be  observed  in  practising  these  grafts,  rules  which  we 
are  fain  to  observe  under  penalty  of  failure.  It  is  un- 
necessary here  to  give  details,  but  these  rules  may  be 
summarised  as  follows :  ( i )  The  graft  must  be  homo- 
thyroid  ;  (2)  only  normal  living  tissue  must  be  trans- 
planted ;  and  (3)  small  multiple  grafts  should  be  made, 
taking  care  to  implant  them  in  very  vascular  regions. 
By  following  these  rules  I  have  been  uniformly  success- 
ful in  obtaining  positive  and  durable  results  both  from 
the  anatomical  and  the  physiological  points  of  view. 
When,  on  the  contrary,  I  transplanted  the  thyroid 
tissue  of  an  animal  belonging  to  a  difierent  species,  I 
invariably  noted  more  or  less  prompt  cytolysis,  with 
disappearance  of  the  graft.  Similarly,  if  the  graft 
were  dead  or  had  undergone  changes,  it  was  rapidly 
phagocytosised,  destroyed,  and  absorbed. 

If  the  thyroid  fragment  be  too  large,  we  usually  find 
a  more  or  less  extensive  zone  of  necrosis  at  the  centre 
which  cannot  p|OSsibly .  undergo  regeneration  ;  more- 
over, the  sclerotic  process  which  sets  in  may  jeopardise 
the  vitality  of  the  portion  of  the  graft  which  has  so  far 
maintained  its  vitality.  It  is  also  very  important  at 
the  time  of  making  the  graft  to  form  a  clear  idea  of 
the  approximate  requirements  of  the  organism  in  the 
matter  of  thyroid  function.  If  this  requirement  be 
non-existent,  as  in  the  case  of  an  animal  possessed  of  a 
normal  gland,  the  graft  may  take,  but  its  vitality  will 
be  low  in  accordance  with  the  principle  that  all  useless 
organs  undergo  atrophy. 

In  animals  partially  ethyroidised,  the  grafts  readily 
take  root  and  manifest  remarkable  vitality  with  a 
tendency  to  hypertrophy,  whereas  in  animals  whose 
thyroid  requirements  are  too  pronounced  (as  from  total 
thyroidectomy  at  one  sitting),  especially  if  only  small 
grafts  are  made,  these  grafts  run  the  risk  of  being  sub- 
jected to  an  excessive  strain  from  the  onset.  Inas- 
much as,  at  the  commencement,  that  is  to  say.  soon 
after  transplantation,  the  regeneration  of  these  "  neo- 
thyroids  "  is  necessarily  incomplete,  their  embryonic 
vascularity  falls  short  of  requirements,  consequently 
these  neo-organs  may  succumb  to  the  burden  thrown 
upon  them,  and,  instead  of  the  characteristic  thyroid  | 
hypertrophy  we  may  get  signs  of  degenerative  lesions 
with  consequent  sclerosis  and  atrophy.  | 

When  we  pass  from  the  experimental  to  the  clinical 
domain,  other  difficulties  present  themselves.  In 
animals  we  usually  transplant  grafts  of  normal  thyroid 
tissue  to  normal  animals  or  animals  who  have  been 
deprived  of  a  part  of  or  the  whole  of  their  thyroid 
gland.  This  was  not  always  the  case  in  the  experi- 
ments of  grafting  in  human  beings.  The  persons  in 
whom  the  grafts  were  made  were,  on  the  contrary. 


usually  suffering  from  the  effects  of  partial  or  total 
destruction  of  the  thyroid  gland. 

Now  it  must  be  borne  in  mind  that  if  we  practise 
transplantation  on  organisms  completely  deprived  of 
thyroid  gland  it  may  happen,  especially  if  the  p^ts 
be  small  in  size  and  few  in  number,  that  they  fall  victims 
to  the  fate  that  overtakes  experimental  grafts  made 
under  similar  conditions  (overstrain  and  degeneration). 
Moreover,  it  may  be  that  disturlmnces  of  general 
nutrition  render  the  tissues  of  the  organism  unsuitable 
to  act  as  graft  beds  ;  the  tissues  of  myxoedematous 
patients,  for  instance,  are  often  ill-adapted  to  the 
purpose  of  graft  reception. 

In  addition  to  the  numerous  difficulties  that  present 
themselves  in  the  attempt  to  graft  the  thyroid  in 
man  there  is  another,  not  the  least  important,  viz., 
the  difficulty  of  obtaining  normal  human  thyroid  sub- 
stance. It  is  obviously  of  the  greatest  importance  to 
utilise  histologically  normal  gland  for  our  grafts,  since 
those  who  have  so  far  employed  human  grafts  have 
invariably  made  use  of  altered  thyroid  tissue — grafts 
of  goitrous  gland,  for  instance — and  the  pathological 
characters  of  the  thyroid  grafts  may  not  have  been 
altogether  foreign  to  the  failures. 

In  order  to  protect  ourselves  against  these  numerous 
sources  of  error,  and  in  order  to  avoid,  in  the  study  of 
therapeutical  thyroid  grafts,  the  groping  inseparable 
from  the  empirical  methods  hitherto  followed  in  in- 
vestigations of  this  kind,  I  have  systematically  pro- 
ceed^ on  scientific  Unes  just  as  in  my  experimental 
researches.  The  first  point  to  establish  was  whether 
normal  thyroid  tissue  could  be  successfully  grafted  in 
man.  Considerable  time  elapsed  before  I  could  verify 
this  possibility ;  indeed,  it  was  not  until  an  oppor- 
tunity occurred  in  M.  Hummer's  service  in  the  course 
of  a  deep  operation  on  the  neck  of  a  girl  that  I  was 
enabled  to  place  under  the  skin  two  sm^l  fragments  of 
normal  thyroid  gland.  These  two  small  implantations 
proved  a  valuable  starting-point  for  my  subsequent 
attempts  at  implantation  in  man. 

We  next  investigated  the  fate  of  different  human 
thyroid  tissues,  normal  and  diseased,  when  g^rafted  on 
diseased  organisms,  hyper-  or  dysthyroidian.  At  the 
onset  we  met  with  certain  difficulties,  not  that  the 
ptatients  objected  to  such  grafts,  for  they  are  usually 
perfectly  willing  to  consent  to  any  measure  which  holds 
out  promise  of  ameliorating  their  unhappy  plight,  and 
even  to  provide  the  thyroid  grafts  themselves  ;  but 
the  real  difficulty  was  to  study  the  ultimate  fate  of 
these  grafts.  Nevertheless,  we  managed  to  investigate 
the  course  of  a  series  of  grafts  of  different  kinds,  and 
to  examine  some  of  them  after  extirpation.  Each  of 
the  patients  having  received  a  numb^  of  grafts,  there 
could  be  no  objection  to  our  subsequently  removing 
one  or  two. 

Here,  briefly  narrated,  are  the  three  observations  on 
which  our  conclusions  are  based  : — A  girl,  aet.  20,  who 
underwent  an  operation  on  the  neck  for  a  non-thyroidal 
affection  and  whose  gland  was  found  to  be  normal, 
provided  the  grafts,  made  on  September  19th,  1902, 
one  on  herself  in  the  supra-clavicular  fossa  and  two  on 
the  following  patient. 

A  myxoedematous  boy,  aet.  about  12,  presented  in 
the  region  of  the  left  th3a'oid  body  a  small  friable  goitre, 
of  a  whitish  tint  on  section.  This  had  been  extirpated. 
The  left  lobe  was  small,  pale,  and  its  consistence  re- 
sembled that  of  the  goitrous  lobe.  He  was  grafted 
(i)  with  the  normal  thyroid  body  of  the  girl  just  re- 
ferred to ;  (2)  with  thyroid  substance  from  the  next 
patient ;  and  (3)  with  fragments  of  the  left  lobe  of 
his  own  thyroid. 

The  next  patient  was  a  woman,  a?t.  34,  in  good 
health  in  spite  of  the  fact  that  she  had  a  gottre  on  the 
left  side,  which  was  extirpated,  while  the  right  lobe 
appeared  to  have  undergone  little  change.  Two  series 
of  grafts  were  made  in  this  case — (i)  with  the  right 
lobe  of  her  own  thyroid,  and  (2)  with  the  left  thyroid 
lobe  of  the  previous  patient. 

For  the  purpose  of  these  grafts,  then,  we  made  use  of 
three  classes  of  thyroid  :  first,  normal  thyroid  sob- 
stance  (first  patient)  ;  slightly  altered  substance 
(third  patient) ;   and  manifestly  altered  as  in  the  third 


August  17, 1904. 


ORIGINAL  COMMUNICATIONS.  The  Medical  Peess.    169 


case.  The  recipient  organisms  were  normal  as  in  first 
case,  apparently  normal  as  in  second  case,  distinctly 
diseased  as  in  third  case.  By  combining  these  different 
elements  our  grafts  paved  the  way  to  the  following 
eventualities :—-{ I)  Graft  of  normal  thyroid  substance 
in  a  normal  organism  ;  (2)  graft  of  thyroid  tissue  mani- 
festly altered  in  a  normal  organism ;  (3)  graft  of 
thyroid  tissue  apparently  but  slightly  altered  in  an 
apparently  normal  organism ;  (4)  graft  of  normal 
thyroid  tissue  in  an  organism  clearly  diseased  ;  (5)  graft 
of  manifestly  diseased  thyroid  tissue  in  a  manifestly 
diseased  organism ;  and  (6)  graft  of  slightly  changed 
thyroid  tissue  in  a  manifestly  diseased  organism. 

Six  months  later  I  removed  from  the  first  patient,  I 
the  girl,  one  of  the  grafts  made  with  her  own  thyroid  ! 
(first  eventuality).     Two  months  later  we  removed  from  | 
the  lad.   our  second  patient,   graits  from   the   third 
patient  (sixth  eventuality) ;   and  fifteen  months  after 
we  removed  from  the  last-mentioned  grafts  of  her  own 
th3rroid    (third   eventuality).     These   fragments   were 
subjected  to  histological  examination  with  the  following 
results ! — 

Normal  Thyroid  Graft  in  Normal  Organism, — ^Micro- 
scopical examination  of  this  graft  demonstrated  that 
the  neo-thyroid  organ  possessed  the  same  structure  as 
the  original  gland.  The  alveoli  were  large,  within 
proper  limits,  and  were  filled  with  colloid  substance. 
Vascularisation  was  normal,  and  the  neo-vascular 
formations  presented  the  appearance  of  stability.  No 
trace  of  infiltration  such  as  one  meets  with  in  young 
^[Tafts  nor  of  the  degeneration  or  atrophy  met  with  in 
-grafts  which  are  undergoing  absorption.  We  found, 
in  short,  that  a  thyroid  graft  of  normal  gland  in  a 
-normal  organism,  six  months  later  presented  all  the 
appearances  and  characteristics  of  normal  thyroid 
gland. 

Graft  of  Siiehtly-Ckanged  Thyroid  Tissue  in  an  Appa- 
rently Normal  Organism. — When  the  graft  was  made 
the  tissue  did  not  present  a  normal  structure,  there 
being  obvious,  though  not  very  advanced,  lesions,  e.g., 
dilatation  of  the  follicles,  resulting  in  some  parts  in 
coalescence  of  the  alveoli.  The  grafts  were  taken  from 
the  periphery  of  thf^  organ  and  included  fragments  of 
the  capsule.  Removed  and  examined  fifteen  months 
later,  its  structure  presented  a  closer  resemblance  to 
normal  thyroid  gland  than  did  the  original  graft,  but 
in  the  adult  alveoli  some  epithelial  buds  were  seen 
similar  to  those  met  with  in  grafts  undergoing  develop- 
ment or  hypertrophy.  We  find  then  that  thjrroid 
tissue  which  is  distinctly  not  normal  but  does  not 
-present  grave  structural  changes  may,  when  grafted, 
not  only  give  birth  to  neo-thyroids  capable  of  per- 
sistent vitality,  but  may  undergo  a  process  of  pro- 
•gressive  metamorphosis  which  tends  to  bring  back  the 
'Changed  thyroid  structure  to  that  of  the  normal  gland. 

Graft  of  Slightly-Chanced  Thyroid  on  a  Manifestlv 
Diseased  Organism. — ^The  graft  was  two  months  old, 
-and  presented  a  frankly  thyroid  appearance,  but  the 
.-alveoli  were  small  and  contained  comparatively  little 
•colloid  substance.  There  was  some  inflammatory  in- 
Ultration  in  the  perialveolar  connective  tissue  which, 
liowever,  did  not  differ  from  that  often  met  with  in 
experimental  grafts  performed  under  normal  conditions. 
Tn  any  event  it  was  noted  that  the  grafted  tissue  had 
-undergone  certain  modifications,  and,  as  in  the  pre- 
ceding observation,  in  the  direction  of  restoration  to 
the  normal  gland  structure. 

It  should  be  added  that  in  this  case  the  recipient 
•organism,  in  spite  of  the  large  number  of  grafts  (seven- 
teen, of  which  eight  were  taken  from  the  pathological 
thyroid,  which  probably  all  underwent  atrophy),  had 
not  received  the  quantity  of  thyroid  tissue  necessary  to 
the  proper  discharge  of  the  function.  The  relatively 
less  vitality  of  the  grafts  in  this  subject  may  possibly 
be  explained  by  the  myxoedematous  state  of  the  tissues, 
which  diminished  their  aptitude  to  nourish  the  im- 
planted tissue,  and  also  to  a  sort  of  overstrain  of  the 
young  grafts  imposed  before  they  had  undergone  com- 
plete development.  Nevertheless,  both  mentally  and 
physically,  the  subject,  last  seen  upwards  of  three  years 
safter  the  operation,  pcesented  a  remarkable  improve- 


ment. He  had  grown  and  his  intelligence  was  markedly 
greater. 

The  grafts  of  manifestly-changed  thyroid  tissue  in  an 
apparently  normal  organism  (second  eventuality),  and 
grafts  of  the  same  manifestly-changed  tissue  in  an 
obviously  diseased  organism  (fifth  eventuality),  could 
not  be  identified  two  months  after  implantation. 
Admitting  that  the  discovery  of  these  grafts  presents 
considerable  difficulty,  so  that  it  cannot  be  positively 
asserted  that  these  grafts  had  actually  undergone 
absorption,  their  disappearance  in  both  these  obser- 
vations— the  enfeebled  vitality  of  the  engrafted  tissue 
and  its  obviously  pathological  structure — ^render  this 
hypothesis  plausible. 

By  grouping  the  facts  just  stated  we  justify  the  con- 
clusion that  thyroid  grafts  are  possible  in  man.  and  that 
by  this  means  we  can  obtain  permanent  neo-thyroid 
glands.  The  results  from  an  anatomical  point  of  view 
are  excellent,  provided  normal  gland  be  employed  ;  they 
are  positive  even  when  moderately  changed  gland  sub- 
stance is  employed  as  in  cases  of  slight  goitrous  de- 
generation. They  are  negative,  on  the  other  hand, 
when  obviously  diseased  gland  is  used,  and  further 
observation  will  be  required  to  establish  within  what 
limits  goitrous  tissue  may  be  employed  with  this  object 
in  view. 

From  a  clinical  point  of  view  we  may  conclude  that 
the  preventive  thyroid  graft,  that  is  to  say,  a  graft 
made  in  cases  where,  after  too  radical  extirpation  of 
the  organ,  the  subject  is  threatened  with  cachexia 
strumipriva.  may  avert  the  impending  manifestations. 
In  idiopathic  myxoedematous  hypothyroidea  grafts  are 
equally  apt  to  develop  and  persist,  provid^  always 
that  the  tissues  employed  have  not  undergone  too 
marked  changes. 

In  the  present  state  of  our  knowledge  it  would  be 
imprudent  to  dogmatise  upon  the  clinical  value  of  this 
procedure,  which  will  only  command  general  assent 
after  years  of  observation  in  numerous  similar  cases. 
But  since  experiments  on  animals  show  that  the  thyroid 
organ,  when  it  persists  with  its  normal  histological 
characters,  is  perfectly  capable  of  fulfilling  the  function, 
there  is  no  obvious  reason  to  question  the  probability 
of  a  similar  result  when  it  persists  in  man. 

Thyroid  grafting,  then,  deserves  to  be  withdrawn  from 
the  obscurity  into  which  it  has  been  allowed  to  fall,  for, 
carried  out  with  due  regard  to  technical  requirements, 
it  may  once  again  acquire  a  position  among  thyroidal 
medications,  among  which,  indeed,  it  is  quite  possible 
it  may  one  day  occupy  a  foremost  place. 

Our  researches,  so  far  as  they  go,  authorise  the  hope 
that  we  may  be  enabled  to  simplify  the  procedure  so  as 
to  place  it  within  reach  of  practitioners  in  general.  We 
are  working  with  the  two-fold  object  of  avoiding  the 
transplantation  from  Ixxly  to  body,  a  manoeuvre  which 
is  not  free  from  drawbacks,  and  to  facilitate  the  im- 
plantation by  depriving  it  of  the  character  of  a  surgical 
operation. 

With  the  object  of  avoiding  the  immediate  trans- 
plantation of  the  organ  from  the  donor  to  the  recipient 
we  have  investigated  the  preservation  of  thyroid  tissue 
in  various  liquids  and,  so  far  as  they  go,  these  researches 
tend  to  show  that  this  preservation,  at  any  rate  in 
respect  of  the  thyroid  of  the  rat  and  the  rabbit,  is 
possible  in  artificial  serum  and  in  the  blood  serum  of 
certain  animals,  but  only  for  a  comparatively  short 
period  of  time  (rather  under  an  hour  instead  of  ten 
.seconds  in  the  air).  Our  latest  observations  justify 
the  inference  that  ere  long  it  may  become  possible  to 
prolong  this  period  in  a  marked  degree. 

With  regard  to  the  simplification  of  the  implantation 
we  propose,  at  M.  Kummer's  suggestion,  to  intercalate 
portions  of  thyroid  gland  without  the  necessity  for 
cutaneous  incision.  Thyroid  tissue,  reduced  into  very 
small  fragments,  by  the  aid  of  a  sharp  knife  and  with 
every  precaution  to  avoid  crushing,  which  would 
destroy  its  vitality,  may,  so  to  speak,  be  emulsified  in 
the  preservative  liquid  and  injected  into  the  selected 
organism  through  a  trocar  or  large  hollow  needle. 
These  experiments,  which  are  still  in  progress,  have  not 
as  yet  given  results  sufficiently  conclusive  to  allow  of 
our  formulating  a  definite  conclusion.     In  any  event. 


1 


17^    Ths  Medical  Pkess. 


BRITISH  HEALTH  RESORTS. 


August  17.  J904» 


it  is  evident  that  if  we  are  successful  in  rendering  this 
procedure  practicable  the  operation  of  grafting  will 
become  hardly  more  complicated  than  an  ordinary 
injection  of  serum. 

Whatever  be  the  future  of  this  procedure  it  is  not 
to  be  supposed  that  it  will  ever  absolutely  take  the 
place  of  palliative  thyroid  medication.  Not  only  does 
the  latter  method  of  treatment  remain  indicated  in 
cases  where  grafting  is  impracticable,  but  it  may  be 
required  as  a  preliminary  step  to  grafting,  in  order  to 
prepare  the  soil,  in  presence  of  grave  disturbances  of 
nutrition,  and  indirectly  to  assist  in  the  development 
of  the  transplanted  thyroid  tissue  by  avoiding  the  risks 
inherent  to  too  early  and  exaggerated  functional 
demands. 


TTbe  (Snt^'patient  Bepattments. 

GREAT  NORTHERN  CENTRAL  HOSPITAL 

Medical  Cases  under  the  Care  of  H.  W.  Syers,  M.A., 

M.D. 

Case  I. — A  boy,  aet.  9. — The  history  was  that  the 
child  had  been  in  his  usual  good  health  until  ten  days 
before  he  was  brought  to  the  hospital.  At  that  time 
he  was  somewhat  indisposed,  but  the  symptoms  were 
mainly  those  of  gastric  derangement  and  caused  no 
anxiety.  His  skin  was  noticed  to  be  rather  hot  when 
put  to  bed  just  nine  days  before  he  was  seen,  and  he 
slept  badly.  Next  day,  on  rising,  it  was  found  that 
the  right  upper  extremity  was  paralysed.  He  was 
unable  to  move  the  limb  at  the  shoulder- joint  in  any 
way  whatever,  and,  in  fact,  the  only  movements  which 
could  be  effected  were  those  of  pronation  and  supi- 
nation of  the  fore-arm,  together  with  flexion  and  ex- 
tension of  the  fingers.  The  febrile  symptoms  rapidly 
disappeared,  and  nothing  abnormal  remained  except 
the  loss  of  power  already  described.  The  sphincters 
were  not  afiected,  and  no  pain  was  complained  of, 
except  some  slight  discomfort  in  the  affected  limb  and 
trifling  stiff  neck  on  the  right  side.  The  child  was 
somewhat  pale,  but  fairly  nourished.  The  right  upper 
limb  hung  quite  helpless  at  the  side  of  the  body. 
There  was  not  the  smallest  power  of  moving  it  at  the 
shoulder  or  elbow-joint.  The  muscles  of  the  fore-arm 
generally  were  soft  and  flaccid  and  were  apparently 
slightly  wasted.  The  grasp  of  that  hand  was  almost 
nil.  Sensation  was  perfectly  normal  all  over  the 
paralysed  limb.  No  response  could  be  obtained  from 
the  elbow  and  wrist  taps.  The  lower  portions  of  the 
trapezius  and  the  serratus  magnus  muscles  were  also 
affected,  and  the  angle  of  the  right  scapula  was  unduly 
prominent,  especially  when  the  limb  was  lifted  up 
above  the  head.  There  was  no  evidence  of  loss  of 
power  in  any  muscles  other  than  those  referred  to. 
The  gait  was  perfectly  normal,  and  all  movements  could 
be  performed,  both  as  regards  the  left  upper  extremity, 
the  trunk  and  the  lower  limbs,  yet  the  knee-jerk  was 
absent  on  both  sides.  The  affected  limb  was  very 
slightly  colder  than  that  of  the  opposite  side.  No 
vaso-motor  changes  could  be  made  out. 

Dr.  Syers  pointed  out  that  all  the  muscles  supplied 
by  the  brachial  plexus  were  to  a  greater  or  lesser  extent 
involved,  and  he  diagnosed  the  case  as  one  of  anterior 
polio-myelitis,  in  which  the  symptoms  were  limited  to 
one  limb,  and  that  alone.  Such  cases,  he  remarked, 
were  decidedly  rare,  as  in  the  great  majority  of  in- 
stances the  malady  selected  certain  muscles  or  groups 
of  muscles,  passing  over  others,  and  also  involved  more 
than  one  limb,  being  sometimes  of  a  hemiplegic  type, 
or  affecting  one  lower  extremity  and  the  upper  limb 
of  the  opposite  side. 

Case  II. — The  patient,  a  boy,  aet.  6,  was  brought 
to  the  hospital  with  the  following  history: -.He  had 
been  in  good  health  until  about  a  week  before  being 
seen.  At  that  time,  and  without  apparent  cause,  he 
first  complained  of  pain  in  the  abdomen,  chiefly  about 
the  umbilical  region.  The  pain  was  not  increased  on 
pressure,  and,  as  far  as  could  be  gathered,  was  of  a 
colicky  nature.  There  was  slight  diarrhoea,  the  bowels 
acting  two  or  three  times  a  day,  and  there  was  loss  of 
appetite.     There  was  no  cough,  and  no  history  was 


given  of  any  symptoms  pointing  to  chest  disease  being 
present.  The  condition  remained  the  same,  constant 
griping  pain  being  complained  of,  until  the  patient 
was  brought  to  hospital. 

The  child  was  well  grown  and  well  nourished.  A 
most  careful  examination  of  the  abdomen  revealed  no 
abnormality  whatever ;  the  wall  of  the  abdomen  was 
flaccid,  and  nothing  in  the  nature  of  a  mass  could  be 
felt  anywhere.  It  was  obvious  that  the  mischief  was 
not  situated  in  the  abdominal  cavity,  and  the  facial 
aspect  was  strongly  indicative  of  thoracic  disease. 
The  face  was  somewhat  dusky,  the  alab  nasi  moving 
slightly  during  respiration,  and  the  child  was  distinctly 
short  of  breath.  Physical  examination  revealed  the 
fact  of  the  presence  of  a  considerable  pleural  effusion 
at  the  right  base,  where  there  was  marked  dulness  on 
percussion,  and  the  breath-sounds,  though  by  no 
means  lost,  were  yet  distinctly  more  feenle  than  on  the 
left  side.     The  temperature  was  10 1**. 

Dr.  Syers  remarked  upon  the  great  importance  of 
this  case.  He  emphasised  the  fact  that  the  history  and 
symptoms  are  not  infrequently  most  misleading  in  the 
case  of  young  children,  and  the  present  case  pxoved 
this  in  a  very  marked  fashion.  Everything  in  the 
history  of  the  child's  illness  pointed  to  the  lesion  beinf^ 
situated  in  the  abdomen,  and  there  was  absolutely 
nothing  to  lead  to  the  suspicion  that  the  case  was  one 
of  pleural  effusion.  The  practical  deduction  to  be 
drawn  from  this  case  was  pointed  out  by  Dr.  Syers, 
and  it  was  that  never,  under  any  circumstances,  should 
an  examination  of  the  whole  of  the  organs  and  systems 
be  neglected,  and  this  especially  in  children.  If  this 
be  not  done,  disaster  will  certainly  ensue  either  sooner 
or  later. 

The  tendency  of  symptoms  to  be  referred  to  a  dis- 
tance is  by  no  means  unusual  in  children,  and  this 
should  ever  be  borne  in  mind.  It  was  found  that  the 
right  pleural  cavity  was  practically  filled  with  dear 
fluid. 

Case  III. — The  patient,  a  boy,  apt.  6.  His  illness 
had  commenced  a  year  and  a  half  before  being  seen. 
The  first  sjrmptom  was  a  weakness  of  gait  and  a  ten- 
dency to  stumble.  This  had  continued,  and  had 
become  more  marked.  In  other  respects  the  child  had 
remained  in  his  usual  health.  There  was  no  family 
history  of  nervous  or  other  disease. 

The  child  was  rather  pallid,  but  not  unhealthy- 
looking.  His  gait  was  peculiar  ;  the  legs  were  widely 
separated,  and  in  walking  he  swayed  from  side  to  side, 
the  movements  of  progression  being  feebly  performed. 
The  upper  limbs  were  quite  healthy,  all  their  move- 
ments being  normal.  The  muscles  of  the  lower  ex- 
tremities, with  the  exception  of  those  of  the  calves, 
were  considerably  wasted  and  flabby.  This  was 
especially  marked  as  regards  the  thigh  muscles.  The 
knee-jerks  could  not  be  obtained.  The  calf-muscles 
were  considerably  increased  in  size,  and  were  abnor- 
mally hard  and  firm  to  the  grasp.  The  increase  in 
size  was  quite  obvious,  even  on  superficial  examina- 
tion. 

Dr.  Syers  x>ointed  out  that  the  case  was  an  instance 
of  that  rare  malady,  pseudo-hypertrophic  paralysis: 
He  called  attention  to  the  wasting  of  the  muscles  of  the 
lower  extremities,  with  the  exception  of  those  of  the 
calves,  and  remarked  that  the  diagnosis  would  be  con^ 
firmed  by  placing  the  child  on  the  ground  and  observinj^ 
if  he  assumed  the  erect  posture  in  the  manner  which  is 
so  characteristic  of  this  disease.  The  child  was  placed 
flat  upon  the  ground,  and  the  manceuvTes  which  are 
decisive  of  the  existence  of  pseudo-hypertrophic  parar 
lysis  were  carried  out  in  a  perfectly  typical  manner.. 

XritiBb  Dealtb  IResorts. 


VI.— MULLION     (CORNWALL) . 
[by    our   special    medical    commissioner.] 


MuLLTON  has  long  been  prized  by  the  favoured  few 
as  one  of  the  most  delightful  of  Cornwall's  many  charm- 
ing  health  and  holiday  stations.     Through  the  eatep^ 


August  17.  1904. 


FRANCE. 


The  Memcal  Pkess.     17I 


prise  of  the  Great  Western  Railway  it  has  now  been 
rendered  easily  accessible.  Mullion  is  situated  on  the 
eastern  side  of  the  famous  Mount's  Bay.  that  great 
natural  recess  on  the  southernmost  boundary  of  "  The 
I>electable  Duchy."  The  nearest  railway  station  is 
Helston,  some  eight  miles  distant.  The  drive  from 
Helston  to  Mullion  along  Cornish  lanes  crowded  with  a 
rich  and  varied  flora  is  peculiarly  attractive.  An 
omnibus  runs  between  the  two  places,  and  now  travellers 
may  journey  rapidly  and  comfortably  by  motor  car. 

Mullion  is  a  simple  little  rural  district,  picturesque 
and  peaceful,  offering  opportunities  for  a  "  rest  cure  " 
particularly  needful  for  the  jaded  brain-worker  and 
wearied  town-dweller.  It  is  an  ideal  resort  for  the 
recuperation  of  brain  and  nerve.  Convalescents, 
invalids  and  delicate  adults  will  here  find  much  that 
is  healing  and  health-reviving. 

Climatically,  it  offers  many  advantages.  In  winter 
the  climate  is  exceptionally  mild,  due,  doubtless,  in 
great  measure  to  the  influence  of  the  Gulf  Stream. 
In  summer,  invigorating  breezes  supply  a  bracing 
character  which  is  absent  in  many  of  the  southern 
resorts  of  the  county.  We  have  been  favoured  with 
special  meteorological  returns  of  the  district  taken  in 
1 899.  from  which  it  appears  that  the  average  tempera- 
ture in  winter  is  46*89'',  in  spring,  52*34,  and  in  summer, 
59-92°,  the  mean  daily  range  for  the  whole  year  being 
9-29°.  In  the  winter.  November  to  February  in- 
clusive, 290*6  hours  of  sunshine  were  registered  ;  in 
the  spring,  March  to  June,  inclusive,  871*39  hours  ;  and 
in  sununer,  July  to  October,  inclusive,  941*52  hours. 
The  total  rainfall  is  given  as  2<>*6i  inches;  15*32  in 
winter  ;  5*67  in  spring;  and  7*62  in  summer. 

Mullion  offers  many  delights  for  the  artist  and 
naturalist.  Admirable  golf  links  are  near  at  hand. 
The  vigorous  will  find  ample  opportunities  for  sea 
bathing,  boating,  sea  fishing  and  other  sport.  The 
neighbouring  country  is  well  suited  for  driving  and 
cycling,  and  offers  endless  charms  for  the  pedestrian. 

In  the  immediate  neighbourhood  there  are  numerous 
attractions.  The  district  is  particularly  fine  in  its 
natural  rugged  sea-coast  outline,  the  cliffs  are  bold 
and  imposing,  and  the  grandeur  of  the  rolling  sea 
will  forcibly  appeal  to  many.  The  psychological 
influence  of  this  district  should  be  known  to  physicians. 
There  are  many  cases  needing  the  mental  stimulus 
which  Mullion  can  so  well  supply. 

This  is  not  a  resort  for  the  fashion-loving  invalid, 
but  a  peaceful  retreat  for  Nature's  true  lover.  The 
visitor  needing  constant  medical  attention  will  choose 
some  well-known  spa  or  journey  to  a  much-advertised 
town  resort ;  but  the  patient  requiring  simply  a 
hygienic  environment  and  restful  mental  life  will  find 
aU  that  can  be  desired  in  this  somewhat  isolated  land 
of  enchantment  in  the  Lizard. 

The  visitor  will  obtain  excellent  accommodation 
at  the  Polurrian  and  Poldu  Hotels,  both  admir- 
ably conducted  under  the  same  management. 
The  former  is  situated  immediately  above  Polur- 
rian Cove,  from  whence  good  views  of  Mullion 
Island  may  be  obtained.  The  island  is  of  much 
interest  to  geologist  and  ofnithologist.  Poldhu 
Hotel  is  situated  on  the  cliffs  within  sight  and  sound 
of  the  invigorating  sea.  It  is  of  modem  construction 
and  peculiarly  fitted  for  those  desiring  to  live  in  accord- 
ance with  strict  hygienic  methods.  It  is  well  designed 
for  patients  requiring  to  follow  "  open-air "  pro- 
cedures. The  Mullion  Cove  Hotel  is  situated  imme- 
diately above  Mullion  Cove,  and  is  quite  modern. 
A  limited  number  of  apartments  may  be  obtained  in 
the  adjacent  village  of  Mullion  Church  Town. 

Medical  practitioners  needing  relaxation  and  change 
from  the  routine  of  the  daily  round  of  professional 
fatigue  and  anxiety  may  w^ell  turn  to  this  unspoilt 
and  altogether  unsophisticated  <listrict  of  Cornwall's 
most  fascinating  land  ;  and  to  it  they  may  safely 
send  many  of  their  cases  for  mental  rest  and  physical 
recreation. 

The  total  number  of  small-pox  patients  under 
treatment  in  Belvidere|Hospital  Glasgow,  in  the  middle 
week  was  twenty-three. 


fvmcc. 

[from  our  own  correspondent.] 

Parifl,  Aixflrnst  llth,  I90<^ 
Treatment  of  Renal  Insufficiency. 

"Professor  Teissier,  of  Lyons,  treating  the  question 
of  opotherapy  in  renal  insufficiency,  renders  testimony 
in  a  remarkable  article  to  the  value  of  such  means  in 
the  therapcutic^treatment  of  urxmia,  and  reviews  the 
means  employed  to  aid  the  weakened  renal  function 
and  to  replace  the  r^e  of  the  suppressed  internal  secre- 
tion. The  study  of  these^measures  is  interesting  not 
only  as  to  the  variety"of  their  mode  of  action,  but  also 
as  to  the  light  thrown  on  the  extent  of  the  therapeutic 
effect  and  on  the  indications  for  treatment. 

Teissier  speaks  first  on  the  effect  of  the  glycerine 
extract  of  the  kidney  employed  in  subcutaneous  in- 
jections for  the  most  painful  complications  of  renal 
insufficiency — dyspnoea,  uraemic  cephalalgia,  and  gastro- 
intestinal troubles.  The  benefits  obtained  from  this 
treatment  were  such  that  frequently  the  patients 
prayed  that  the  injections  should  not  be  sus- 
pended.  It  might  be  asked,  he  adds,  what  were  the 
motives  which  retarded  the  diffusion  of  a  method  which, 
after'  all,  was  easy  in  application  and  inexpensive  ? 
The  reason  was,  perhaps,  that  the  treatment  was  only 
suggested  when  the  nephritis  had  arrived  at  the  ulti- 
mate phase  of  its  evolution.  Glycerine  extract  did  not 
have  any  pretension  to  regenerate  the  parenchjrma 
destroyed,  its  introduction  into  the  economy  exercised 
but  very  slight  action  on  the  glandular  functions,  and 
should  not  be  considered  as  possessing  a  real  curative 
effect.  But  by  its  means,  the  disorders  caused  by 
the  toxic  substances  01  ieic»tion  can  be  checked  tem- 
porarily, until  the  kidney,  becoming  more  permeable 
will  allow  them  to  filter  through  it. 

The  second  means  indicated  by  M.  Teissier  is  the  in- 
jection of  a  certain  quantity  of  the  serum  drawn  from 
the  renal  vein.  The  serum  employed  was  drawn  from 
the  vein  of  a  goat  at  the  Veterinary  School  of  Lyons, 
and  employed  systematically  during  the  last  four  or 
five  years. 

In  one  case  of  scarlatina,  the  patient  was  taken  with 
all  the  symptoms  of  uraemia,  abundant  albumin,  cylin- 
drical casts,  headache,  vomiting,  &c.  ;  death  seemed 
imminent.  An  injection  of  five  drachms  of  serum  into 
the  right  fiank  produced  a  kind  of  resurrection  the 
same  day,  and  in  three  or  four  days  afterwards  the 
patient  was  convalescent.  The  casts  had  dis- 
appeared, and  the  urine  reached  three  quarts  in  the 
twenty-four  hours.  Several  cases  cited  in  the  thesis 
of  Lignovolles  proved  the  powerful  effects  of  this  treat- 
ment. The  injection  is  well  tolerated,  but  frequently 
provokes  a  considerable  rise  in  the  temperature.  The 
effects  are  very  rapid.  The  vomiting,  dyspnoea,  and 
headache  become  alleviated  in  a^few  hours  in  spite  of 
the  febrile  reaction,  while  the  albumin  diminishes  in 
quantity  and  the  diuresis  increases  considerably,  with 
immediate  decrease  of  the  toxins. 

The  third  method  employed  to  aid  the  functional 
insufficiency  of  the  kidney  consists  in  directly  utilising 
the  pulp  of  the  raw  kidney,  as  recommended  by  Prof. 
Renaud,  of  Lyons,  and  of  which  a  full  account  has 
already  appeared  in  The  Medical  Press  and  Circu- 
lar. This  method,  it  will  be  remembered,  consisted  as 
follows  :  Two  fresh  pork  kidneys  were  cut  up  fine  and 
thoroughly  washed  so  as  to  remove  all  traces  of  urine. 
They  were  then  pounded  into  pulp,  and  a  pint  of  cold 
salt  water  (a  teaspoonful  of  salt)  poured  over  them.  After 
macerating  four  hours,  the  liquid  was  decanted,  and 
the  patient  drank  it  in  four  or  five  doses  in  the  day. 


^ 


172    Tbb  Medical  PxBfts. 


AUSTRIA. 


August  17.  i904« 


mixed  with  some  vegetable  soup  {f-ouf-e  julienne),  each 
day  for  ten  days,  fresh  kidneys  being  procured.  This 
treatment  certainly  gave  good  results,  but  very  many 
patients  could  not  overcome  their  repugnance  to  it  and 
it  had  to  be  suppressed.  M.  Teissier  thinks  that  this 
trouble  might  be  avoided  by  substituting  dry  prepara- 
tions ot  the  organ,  presented  in  the  very  prac- 
ticable form  of  lozenges,  as  prepared  by  certain 
intelligent  chemists,  and  if  the  medical  attendant  felt 
some  hesitation  in  employing  them,  he  could  always 
have  recourse  to  the  glycerine  extract,  a  method  much 
more  easy  in  its  application  than  injections  of  serum 
of  the  renal  vein. 

In  concluding.  Prof.  Teissier  sa^'s  that  renotherapy, 
systematically  applied  and  continued,  appears  particu- 
larly indicated  in  patients  suflcring  from  mixed  or 
parenchymatous  nephritis.  As  to  the  preparations 
mentioned,  the  physician  will  choose  the  one  best 
adapted  to  his  patient.  If  he  will  bear  in  mind  that 
the  method  is  not  to  be  regarded  as  absolutely  curative 
but  as  an  adjunct  of  considerable  value  to  other 
means,  he  will  experience  but  little  difficulty  in  employ- 
ing it.  When  he  ursemic  complications  have  subsided 
it  is  frequently  useful  to  inject  daily  for  ten  or  fifteen 
days  snvall  doses  (a  Pravaz  syringe)  of  thenephrin. 

Bnstrfa* 


[from  our  own  correspondent.] 

VlBVirA,  August  ISth,  1004. 
Elephantiasis  Congenita. 
At  the  meeting    fiir  Innere  Medizin,  Swoboda  re- 
lated the  history  of  four  cases  of  congenital  elephan- 
tiasis, two  of  whom  he  exhibited. 

Escherich  asked  if  he  had  applied  the  Rontgen  rays 
to  all  or  any  of  these  cases,  as  he  had  often  found 
lymphangioma  in  the  internal  organs. 

Hochsinger  thought  that  the  two  cases  presented  to 
them  had  all  the  appearance  of  hypertrophy  of  the 
osseous  structure,  particularly  in  the  lower  extremities, 
where  the  tibia  showed  undeniable  signs  of  exostosis, 
as  the  surface  of  the  bone  was  very  irregular.  The 
Rontgen  rays  would  be  very  instructive  in  these  cases. 
Swoboda  replied  that  he  had  applied  the  Rontgen 
rays  purposely  for  the  bones,  and  found  no  changes  in 
these  structures. 

Pneumothorax — Recovery. 
Schrotter  gave  the  history  of  a  case  of  pneumothorax 
which  had  arisen  in  consequence  of  the  presence  in  the 
lung  of  circumscribed  tubercle.  The  patient  was  a^t.  17. 
and  had  developed  the  morbid  condition  without  any 
symptom  of  adhesion,  although  the  lung  was  retracted 
at  the  hilus  of  the  right  side.  In  order  to  develop  the 
lung,  Schrotter  practised  the  "  biparietal "  method  of 
pressure  internally  and  aspiration  externally.  He 
punctured  the  pleura  and  by  a  system  of  pressure 
bottles  forced  oxygen  into  the  vesicles  of  therightlung. 
while  extracting  the  air  from  the  pleura,  and  in  order 
to  keep  the  lung  in  this  distended  condition  he  plugged 
the  right  bronchus  with  a  firm  tampon,  thus  holding 
the  lung  firmly  distended.  The  tampon  was  attached 
to  a  fine  silver  catheter,  which  lay  in  the  mouth  and 
trachea,  and  could  be  withdrawn  at  will. 

At  the  first  sitting,  when  tapping  the  pleura,  2,200 
cubic  centimetres  of  air  were  extracted  from  the  pleural 
cavity,  which  allowed  the  mediastinum  and  heart  to 
return  to  their  proper  position,  and  vesicular  breathing 
could  be  heard  over  the  lung.  After  this  the  frequency 
of  the  respirations  fell  from  thirty  to  sixteen  per 
minute,  and  with  more  comfort,  as  the  patient  could  | 
now  recline  in  sleep.     Radiography  showed  a  greater  | 


volume  of  lung  to  the  right  of  the  middle  line,  though 
not  complete.  At  the, second  sitting  500  cubic  centi- 
metres of  gas  were  extracted,  and  an  equal  amount  of 
oxygen  injected  through  the  catheter  and  tamponed 
as  before.  After  this  operation  the  Rontgen  ra>'s 
showed  the  pleural  space  quite  filled  except  a  small 
portion  at  the  base  and  apex. 

To  accompli.sh  the  full  expansion  the  oxygen  was 
repeated  till  the  full  tension  was  acquired  and  all  the 
air  expelled  from  the  pleura. 

Both  of  the  major  operations  were  unattended  by 
fever  or  any  other  disturbance. 

Amceboid  Enteritis. 
VoUbracht  showed  a  patient  with  a  few  preparations 
of  amoeba  which  he  had  taken  from  the  fasces. 

The  patient  was  a  waiter,  aet.  20,  and  was  always 
healthy  till  August,  1903,  when  he  was  suddenly 
attacked  with  severe  pains  in  the  abdomen  which 
brought  on  diarrhoea  that  lasted  three  days.  After  this 
time  he  had  two  or  three  watery  stools  daily,  for  which 
•he  went  to  the  local  hospital  about  the  end  of  the  year, 
where  he  was  greatly  improved  and  left.  Eight  days 
after  his  return  home  the  watery  stools  recommenced . 
accompanied  with  blood  this  time.  He  again  returned 
to  hospital,  where  he  remained  a  month,  but  left  having 
made  little  or  no  improvement. 

In  March,  1904.  or  eight  months  after  the  first 
appearance,  he  came  to  Vienna.  According  to  the 
history  ehcited,  the  patient  had  never  been  beyond  the 
confines  of  Lower  Austria,  nor  had  any  similar  com- 
plaint been  known  in*his  neighbourhood,  home  out  by 
local  medical  testimony.  The  microscopic  examina- 
tion of  the  stools  offered  nothing  unusually  striking  in 
the  faecal  parts,  but  the  mucoid  portion  revealed  a  large 
number  of  pus  cells  as  well  as  swollen  epithelial  cells, 
bacteria,  and  many  amoebae.  The  latter  resembled  in 
size,  morphology,  movement,  and  general  behaviour 
those  described  by  Loesch  as  amoeba  coli,  which  in- 
corporate red  blood  corpuscles.  VoUbracht  then  re- 
viewed the  history  of  dysentery,  and  thought  that  the 
labours  of  Schaudinn  had  done  much  to  clear  up  the 
pathology-  of  dysentery.  He  discovered  two  kinds  of 
amoebae,  one  benign  and  the  other  malignant.  The 
former  agreed  with  the  amoeba  described  by  Loesch, 
which  he  named  "  Entamoeba  coli  of  Loesch,"  while  the 
other,  which  attacked  and  destroyed  the  tissues,  he 
termed  "  Entamoeba  histolytica." 

These,  according  to  Schaudinn's  opinion,  are  the  true 
pathological  causes  of  tropical  dysentery.  The  prin- 
cipal difference  between  these  two  amoeboc  are  that 
the  former  is  fissiparous,  the  other  gemmiparous.  in 
reproduction.  The  vegetation  of  the  histolytica  hdS 
been  followed  on  animals  with  the  same  result. 
9  Schaudinn  experimented  on  eight  animals  with  the 
entamoeba  coli  and  failed  to  obtain  the  characteristic 
results  of  the  second,  although  morphologically  the 
two  amoebae  are  the  same,  though  they  may  differ  in 
their  behaviour  through  the  different  functions  of  the 
nucleus  and  ectoplasm. 

When  the  same  experiments  were  carried  out  with 
the  entamoeba  histolytica]  the  characteristic  action 
was  immediately  apparent  within  a  few  hours.  The 
amoeba  rapidly  increased,  the  mucoid  tissue  was  quickly 
destroyed,  and  the  life  of  the  animal  sacrificed  within 
a  very  short  space  of  time  by  the  ravages  of  the  proto- 
zoon. 

Congenital  Muscular  Defects. 

Neumann,  as  well  as  VoUbracht.    exhibited  a  few 

cases   of   congenital    malformation   in    the    muscular 

apparatus.     One  of  Neumann's    cases  had   complete 

absence   of   the   right   pectoralis   major,    minor,    and 


August  17,  1904. 


OPERATING   THEATRES. 


The  Meuical  Press.     173 


ipartisU  defect  of  the  left,  besides  a  very  rudimentary 
forooation'of  the  anciUahs.  In  spite  of  these  defects 
the: patient  was  able  to  carry  on  work  as  a  washer,  and 
moved  the  right  arm  with  as  much  freedom  as  his  left. 
The  strength  Of  the  one  arm  was  as  powerful  as  the 
•other  when  tested  with  the  machine,  as  the  develop- 
ment of  the  brachial  muscles  testified.  The  adduction 
of  the  right  arm  was  very  little  less  than  the  left. 
Notwithstanding  this  functional  activity  he  obtained 
military'-  exemption. 

The  ettcHogy  was  congenital,  but  no  defect  of  any 
kind  is  to  be  traced  in  the  family  history.  The  mother 
'testifies  to  the  flat  side  of  the  chest  after  birth. 

VbUbracht  had  a  similar  case  to  this  with  the  absence 
•of  the  serratus  major  in  addition,  who  could  perform 
•ordinary  laboviring  work. 


t>ttn0ain?« 


[from  our  own  correspondent.] 


Bi'OArarr,  Augrust  ISfch,  1904. 

It  is  always  an  event  in  the  Hunsrarian  medical  world 
when  a  ne^w  work  is  published,  which  is  not  to  be 
wondered  at,  considering  the  fact  that  most  of  the 
Hungarian  doctors  only  speak  German,  and,  con- 
sequently, read  the  much  cheaper  German  medical 
books.  Lately,  three  new  works  have  been  published 
in  Budapest :  the  first  one  is  the  "  Clinical  Phar- 
macopoeia," edited  by  Dr.  Miller  Vilmos,  whose  name 
is  as  well  known  in  Hungary  as  in  Austria,  since 
he  initiated  the  inoculations  against  tuberculosis 
with  the  Marmorek  serum.  His  book  comprises  the 
prescriptions  of  the  Budapest  clinics.  Instead  of 
writing  praises  about  the  book,  I  shall  quote  a  few 
prescriptions  of  standard  value  : — 

Prof.  Korinyi  prescribes  for  appendicitis  opium 
-suppositories,  a  liquid  diet,  rest,  ice-cold  lemonade, 
champagne.  After  cessation  of  the  acute  symptoms, 
the  diet  may  again  be  as  before.  For  the  promotion 
•of  resorption.  Preissnitz  fomentation,  brushing 
with  tincture  of  iodine,  or  with  the  following  mixture  : 
— R,  Ichthyol  sulfammon.,  5*00  grs.  ;  collodii  flexilus, 
15.00  grs. 

In  cholelithiasis  Prof.  Koranyi  prescribes,  besides  a 
Carlsbad  cure,  the  following  formula : — h,  Ennatsol 
<oleic  acid  soda),  100  grs.  ;  tinct.  valerian,  ajth.,  5*00 
grs.  :  aq.  menth.  pip.,  iSo'o  grs.  ;  essent.  ananas, 
2'oo  grs.       M. ;  fouf  tablespoonfuls  to  be  taken  daily. 

The  book  has  interesting  chapters  also  on  pediatrics, 
gynaecology,  surgery  and  the  other  main  branches  of 
medicine.     The  preface  is  written  by  Prof.  Korinyi. 

Hr.  Doktor  Sender  has  revised  the  obstetrical 
manual  of  the  late  Prof.  Kermarski  Tivadar,  whom 
he  greatly  respected  as  his  teacher  and  loved  as  a 
friend.  Kernxarski's  book  is  well  known  both  in 
Hungary  and  Austria,  but  K^rmirski  himself  is  well 
known  beyond  these  two  countries.  His  clinic 
embraced  and  welcomed!  many  foreigners  because, 
shaving  been  built  up  in  190 1,  it  is  one  of  the 
handsomest  institutions  of  the  world,  built  and  arranged 
.after  the  best  cUnics  on  both  sides  of  the  Atlantic. 
The  book  is  considered  an  able  work,  many  parts  of 
•it  having  been  re-written  by  Dr.  Sandor,  whose  pen 
-and  knowledge  have  been  put  at  the  service  of  even 
non-medical  papers. 

Every  page  of  the  book,  besides  showing  the  strictest 
science,  is  a  proof  of  the  grand  estimation  he  has  for 
his  principal.  The  book  is  adorned  with  K^rm^rski's 
photograph,  and  two  pages  ^re  devoted  to  the 
'biography  of  K^rmdrski.  He  was  for  thirty  years 
^he  teacher   of  obstetrics.      He    learned    his   art   in  j 


Budapest,  Berlin.  Paris  and  London.  Among  hi** 
foreign  teachers  he  was  fondest  of  Spencer  Wells 
and  Baker  Brown,  and  the  impressions  which  he  brought 
back  from  England  left  traces  on  his  whole  working 
and  function. 

Hr.  Doktor  Sdndor  has  done  really  a  very  appreciable 
work  in  undertaking  the  republication  of  this 
renowned  work. 

The  third  work  which  I  desire  to  report  is  Dr.  Rona 
Samuel's  work  on  sexual  diseases.  Prof.  Rona  is  also 
well  known  beyond  Hungary,  for  he  has  been  constantly 
present  at  Congresses  held,  not  only  on  sexual  diseases, 
but  also  on  other  branches  of  medical  science. 
His  book  is  full  of  practical  information  based  on  a 
very  large  hospital  practice,  so  that  his  cases  outnumber 
those  of  any  Vienna  clinic.  Prof.  Rona  begins  his 
work  with  an  historical  review  of  syphilology,  upon 
which  he  has  bestowed  very  careful  attention.  A  special 
feature  of  his  book  is  the  novel  method  of  dealing  with 
the  subject  from  a  sociological  point  of  view.  In 
every  chapter  allusions  are  made  to  internal  and 
constitutional  diseases  which  may  be  associated  or 
accompanied  by   venereal  diseases. 

It  is  really  a  pity  that  our  able  works  can  be  read 
only  by  a  few  million  people,  as  the  Hungarian  lang^iage 
can  be  read  by  only  ten  millions. 


TTbe  (Sperattno  XEbeattes* 

NORTH-WEST  LONDON  HOSPITAL. 
Amput.^ticn  at  the  Hip- Joint  for  Sarcoma  of 
THE  Femur. — ^Mr.  Thomson  Walker  operated  on  a 
woman,  set.  27,  who  had  been  admitted  for  a  swelling' 
of  the  right  knee.  Fourteen  months  before  admission 
the  right  knee  was  noticed  to  be  enlarged.  There  was 
no  history  of  injury,  and  she  had  not  suffered  from 
rheumatic  or  other  joint  disease.  The  family  history 
was  unimportant.  The  knee  continued  to  enlarge  very 
slowly,  in  spite  of  local  rest  and  counter-irritation.  It 
was  painless  ;  there  was  no  tenderness  on  palpation  or 
movement.  Two  months  before  Mr.  Thomson  Walker 
saw  her,  she  went  to  the  seaside,  and  the  knee  began 
rapidly  to  increase  in  size.  Dr.  Moorhead,  of  Bridge, 
then  asked  Mr.  Walker  to  examine  the  patient  with  a 
view  to  operation.  On  admission  to  the  hospital  the 
following  condition  was  found :  The  patient  was 
healthy-looking  and  well-nourished,  there  was  a  large 
swelling  of  the  right  knee,  which  consisted  of  a  rounded 
prominence  on  the  inner  side  and  an  obliteration  of  the 
outlines  on  the  front  and  outer  side.  Only  a  slight 
degree  of  flexion  was  possible.  The  patella  could  be 
felt  on  the  front  of  the  mass  and  was  movable.  The 
skin  was  unchanged.  The  mass  was  firm  and  in  places 
hard,  and  carefiU  palpation  showed  that  it  was  con- 
nected with  the  lower  end  of  the  femur,  the  upper  end 
of  the  tibia  being  apparently  unaffected.  Although 
parts  of  the  enlargement  were  of  almost  bony  hardness, 
no  egg-shell  crackling  could  be  felt.  Fluctuation  v/as 
not  detected,  and  there  was  no  tenderness  on  palpation. 
The  lymphatic  glands  in  the  groin  were  not  palpable. 
A  diagnosis  of  periosteal  sarcoma  of  the  lower  end  of 
the  femur  was  made,  the  points  considered  important 
in  diagnosis  being ;  the  size  and  asymmetry  of  the 
swelling,  the  varying  consistency  of  the  growth,  and 
the  extreme  hardness  of  parts  of  its  surface,  and  its 
connection  with  the  femur.  The  absence  of  aching  or 
pain  and  of  egg-shell  crackling,  the  rapid  growth,  and 
the  peculiar  outline  were  the  points  in  favour  of 
periosteal  as  compared  with  endosteal  .sarcoma.  'An 
X-ray  photograph  showed  the  shadow  of  a  large  rounded 
mass  connected  with  the  inner  condvle  of  the  femur 


174    I'BX  Mbdical  Pkbss. 


LEADING  ARTICLES. 


August  17 »  i904- 


the  circumference  of  this  shadow  showed  an  appearance 
like  spicules  of  bone  radiating  from  the  centre.     Ampu- 
tation at  the  hip-joint  was  performed.     The  method 
used  was  that  knovt^  as  the  anterior  racquet  incision. 
The  femoral  vessels  were  first  exposed  by  a  vertical 
incision  commencing  over  Poupart's  ligament.     The 
artery  was  first  ligatured  in  two  places,  and  subse- 
quently the  vein  ;   these  vessels  were  then  cut  across  : 
some  venous  bleeding,  owinf(  to  a  high  junction  of  the 
deep  femoral  vein,  gave  a  little  trouble.     The  incision 
was  then  carried  across  the  inside  of  the  thigh,  four 
inches  below  the  genito-crural  fold,   then  round  the 
back  of  the  thigh  and  passed  round  the  outer  side, 
three   inches  below   the   upper   border   of   the   great 
trochanter.     No  further   bleeding  of  importance  oc- 
curred.    There  was  a  little  difficulty  in  the  actual  dis- 
articulation of  the  head  of  the  femur,  but  by  freeing 
the  great   trochanter  and  by  external  rotation   pnd 
flexion  of  the  limb  this  difficulty  w^as  overcome.     A 
drain  was  inserted  reaching  to  the  acetabulum  and 
protruding  from  the  lower  end  of  the  antero-posterior 
wound.     The  principal  feature  of  this  amputation,  Mr. 
Walker  said,  was  the  control  of  the  haemorrhage  by 
ligation  of  the  main  vessels  at  the  commencement  of 
the  operation  ;   this,  he  pointed  out,  dispenses  with  the 
use  of  a  tourniquet,  which  is  difficult  to  keep  in  position 
in  this  situation.     The  operation  of  Furneaux  Jordan's, 
he  said,  was  that  usually  recommended  at  the  present 
time,  but  the  operation  he  (Mr.  Walker)  had  just  per- 
formed appeared  to  him  to  have  many  advantages  in  a 
case  such  as  the  present  one,  especially  with  regard  to 
the     control     of     haemorrhage.     Furneaux     Jordan's 
method  of  amputating  through  the  thigh  low  down  and 
then  shelling  out  the  femur,  he  pointed  out,  is  that 
usually  recommended  at  the  present  time  for  disarticu- 
lation at  the  hip-joint.     The  grounds  on  which  this 
preference  is  based  are  the  slighter  degree  of   shock 
and  easy  control  of  the  haemorrhage,  the  position  of 
the  drainage-tube  on  the  outer  side  away  from  the 
genitals  and  anus,  and  the  longer  and  more  mobile 
stump.     The  amount  of  shock  in  the  case  Mr.  W^alker 
had  just  operated  on  was  not  great,  and  he  doubted  if 
it  would  have  been  less  by  the  Furneaux  Jordan  method. 
The  easy  control  of  haemorrhage  he  thought  the  special 
feature  of  the  anterior  racquet  method.  The  preliminary 
ligation  of  the  femoral  vessels  relieves  the  mind  of  the 
surgeon  at  once  of  any  anxiety  in  regard  to  haemorrhage, 
and  permits  of  rapid  completion  of   the  operation. 
The  sciatic  artery  is  very  small  at  the  point  at  which 
it  is  severed,  and  the  gluteal  vessels  are  not  disturbed. 
The  lower  angle  of  the  antero-posterior  wound,  he  con- 
sidered, was  an  ideal  position  for  drainage,  and  this 
is  not  so  near  the  anus  that  ordinary  care  cannot  pre- 
vent soiling  of  the  wound.     There  was  no  advantage 
in  his  mind  in  having  a  longer  stump  if  it  carries  no 
bone.     If  an  artificial  limb  can  be  fitted  at  all  it  will, 
he  thought,  be  as  useful  on  the  stump  of  an  anterior 
racquet  amputation  as  on  that  of  a  Furneaux  Jordan's. 
The  former  method,  therefore,  appeared  to  him  to  be 
preferable  in  cases  like  this  when  the  hip-joint  is  not 
diseased.     The  prognosis  in  a  case  such  as  this  was 
somewhat    doubtful.     Some  slightly    enlarged    glands 
were  found  in  the  groin   during  the  amputation,  but 
under  the  microscope  they  contained  no  tumour  cells. 
Microscopic  examination  of  the  tumour  showed  a  few 
giant-cells,  and  these  are  usually  considered  to  repre- 
sent the  slower-growing  and  less  malignant  endosteal 
sarcoma.     It  is  not,  however,  certain,  he  said,  that  the 
presence  of  these  cells  is  distinctive,  and  the  absence  of 
expansion  of  the  bone  and  the  other  characteristics  led 
him  to  believe  that  the  original  diagnosis  of  periosteal 
sarcoma  was  correct.     The  prognosis  in  this  case  was 


therefore  less  hopeful.  After  the  operation  the  patient 
showed  signs  of  collapse,  and  a  pint  and  a  half  of  saline 
solution  was  infused  into  the  left  median  basiHc  vein. 
It  was  not,  however,  necessary  to  repeat  the  inlusioD, 
and  the  convalescence  was  uninterrupted.  The  drainage- 
tube  was  gradually  shortened  and  finally  rcmored  on 
the  eighteenth  day.  The  temperature  rose  to  if>i*, 
and  continued  at  this  level  for  a  week-  It  then  fell 
and  remained  normal. 

Six  weeks  after  the  oi)eration  the  stump  was  firm 
and  could  be  tilted  fonvard  by  the  patient.  The  scar 
had  contracted  lengthwise  and  lay  in  the  anterior 
surface  of  the  stump. 

BMiimBD  poft  TBAMmunoii  An*AV. 

TTbe  AeMcal  pteB0  an&  Cttcular. 

PuUldied  erery  W«dne«U7  inonili«,  Prioe  6d.     Poet  frM.  6id. 

Ohv   ImnnoR  :— Whole  Vmg^,  £6    Oe.     (M.  ;     HaU  Pife^ 
£2  lOe.  Od. ;  Quarter  Pa^,  £1  6e.  Od. ;  One-eighth,  12e.  «d. 

OonsMemble  Beduotiont  from  the  foregotng  scale  are  made  whei 
an  order  is  griven  for  a  series  of  insertions.  Terms  on  applies - 
tion  to  the  Publisher. 

SmaU  annoancements  of  Practices,  Assistanoies,  Vacancies,  Books, 
Ac-Seren  lines  or  under  (70  words),  4s.  6d.  per  insertioa  ; 
8d.  per  line  beyood. 

SniORIPTIONB. 

Sabseriptlons  may  oommence  ac  any  period  of  the  year.  It  paid  ia 
advance  (be  ooat  is  «>niy  21s.  per  annum,  pott  free.  An  editioir 
is  printed  on  thin  plate  paper  for  foreign  and  Ctolonial  sub- 
scribers at  21s.  per  annum,  post  free,  if  paid  in  advance,  or 
SSs.  ed.  credit  rate. 


TTbe  AeMcal  press  an&  Circular* 


SALUS   POPULI   SUPREMA  LEX.' 


WEDNESDAY.  AUGUST  17,  1904. 


MEDICAL  MEN  AND  LITERARV 
COMPOSITION. 
The  literary  acquirements  of  medical  men,  as 
a  broad  and  general  rule,  are  notoriously  want- 
ing in  the  essentials  of  good  craftsmanship.  As  with 
their  handwriting,  good  matter  is  spoiled  and  un- 
readable because  of  the  defective  methods  of  ex- 
pression. In  this  way  many  a  skilful  surgeon 
and  many  a  learned  physician  fail  when  they 
endeavour,  pen  in  hand,  to  convey  ta  others  the 
knowledge  gathered  from  wide  reading  and  long 
experience.  On  the  other  hand,  not  a  few  of  the 
names  that  have  become  household  words  in  the 
history  of  the  profession  owe  their  pre-eminence 
in  no  small  degree  to  the  possession  of  a  sound 
literary  style.  Yet  the  elementary  principles 
of  English  composition  are  easy  of  acquisition, 
and,  so  far  as  that  goes,  should  be  included  in  the 
scope  of  every  liberal  education.  The  fact  of  the 
matter  appears  to  be  that  medical  men  are  so 
engrossed  in  the  practice  of  an  exacting  profession 
that  they  have  little  leisure  or  inclination  for 
the  art  of  letters.  For  aH  that,  the  busy  prac- 
titioner will  ^find  both  relaxation  and  profit  ia 
the  study  of  English  composition.  He  will  find 
an  admirable  essay  on  the  subject,  compact  with 
valuable  information,  in  a  Uttle  book  recently  pub- 
lished by  Professor  Clifford  AUbutt  under  the  title. 


August  17,  1904. 


LEADING  ARTICLES. 


The  MiDzcAL  F&ess.     175 


"  Notes  on  the  Composition  of  Scientific  Papers." 
In  the  course  of  each  year  the  author  is  called  upon 
to  peruse  some  sixty  or  seventy  theses  for  the 
diegree  of  M.B.,  and  about  twenty-five  for  that  of 
M.D.  "  The  matter  of  these  theses  is  often  ex- 
cellent, but  their  prevailing  defect  is  such  as  to 
obscure,  to  perplex,  and  even  to  hide  or  travesty 
the  sense  itself.  Meritorious  in  substance  as 
these  productions  may  be,  they  are,  as  they  stand, 
unfit  for  the  printer."  This  picture  will  be  recog- 
nised by  editors  of  medical  journals  as  represent- 
ing the  attitude  of  the  average  contributors. 
It  is  not  merely  such  disfigurements  as  the  split  in- 
finitive and  the  misplaced  "only  "  that  offend  his 
eye,  but  also  the  frequent  occurrence  of  errors  of 
grammar  and  of  offences  against  the  elementary 
rules  of  composition.  The  misuse  of  relative  pro- 
nouns is  a  fruitful  cause  of  confusion.  Dr.  AU- 
butt*s  illustration  from  a  recent  thesis  runs  thus  : — 
"He  said  to  his  patient  that  if  lie  did  not  feel  better, 
he  thought  he  had  better  return  to  say  how  he  was." 
The  ambiguities  remind  us  of  the  well-known 
examples,  "  No  one  had  yet  demonstrated  the 
structure  of  the  human  kidneys,  Vesalius  having 
examined  them  only  in  dogs."  The  author's  rule 
in  this  particular  case  is  admirable  :  "On  the 
revision  of  a  manuscript,  pause  at  every  such  pro- 
noun till  you  are  sure  that  its  particular  ante- 
cedent is  unmistakable."  False  concords  are 
plentiful  as  blackberries  in  ordinary  medical 
manuscript,  as,  for  instance,  "  The  shame  and 
pain  to  which  his  failure  expose  him  "  ;  "  Nothing 
but  his  poverty,  modesty  and  dififidence  ptevevt  "  ; 
•'  Neither  of  these  boys  tr^r^ •  remarkable  "  ;  "Of 
these  persons  none  (no  one)  were  robust."  An 
amusing  error,  often  committed  even  by  good 
writers,  is  that  of  the  intrusive  "  not."  The  com- 
plete logical  subversion  of  meaning  that  may  be 
thereby  caused  is  shown  in  the  following  sentences  : 
"  I  ran  to  see  if  I  could  (not)  get  a  seat "  ;  "  I^t 
us  see  if  we  can  (not)  help  him  "  ;  "  I  cannot  say 
what  disease  she  may  (not)  have";  "Mr.  Jones 
asked  if  both  lungs  might  (not)  be  diseased."  An 
extremely  common  inelegance  among  unpractised 
writers  is  the  use  of  short  suspensions  within 
larger  periods  :  "To  improve,  as  much  as  possible, 
the  general  health,  &c.,"  would  read  better  by 
changing  the  position  of  the  two  clauses.  "  He 
made  many  sketches  of,  and  gave  close  attention 
to,  the  village  churches  of  the  county  "  diverts  the 
emphasis  to  the  unimportant  words  "  of "  and 
•*  to."  A  more  correct  and  logical  rendering 
would  be,  "  He  paid  close  attention  to  the  churches, 
and  made  many  sketches  of  them."  Neglect  of 
the  proper  order  of  words  leads  to  numberless 
comical  effects,  as  :  "  They  followed  the  party  step 
by  step  through  telescopes  "  ;  "  Ford's  theatre 
is  for  sale  where  Lincoln  was  assassinated  for 
religious  purposes  "  ;  "A  clever  magistrate  would 
see  whether  he  was  l>nng  a  great  deal  better  than  a 
stupid  jury  "  ;  "I  understand  that  when  he  died 
Cardinal  Mezzofanti  spoke  at  least  fifty  languages." 
This  book  of  Dr.  Allbutt's  is  stuffed  from  cover 
to    cover   with   information    of   interest    and    of 


practical  importance  to  all  members  of  the  medical 
profession  who  wish  to  reduce  their  thoughts,, 
wishes,  aspirations  or  experiences  to  Hterarj'  form. 


HOLIDAY  EXERCISE. 
At  this  season  of  the  year,  when  every  town- 
dweller  to  whom  the  opportunity  presents  itself 
makes  for  the  country  or  the  sea-side,  the  question 
of  appropriate  exercise  becomes  an  eminently 
practical  one.  A  hohday  has  been  defined  by 
advocates  of  the  "  strenuous  "  life  as  a  change  of 
occupation,  and  to  the  average  man,  so  long  as 
the  change  involves  an  abandonment  of  brain 
fatigue,  and  a  substitution  of  physical  for  mental 
exercise,  the  medical  man  will  not  be  inclined  to 
quarrel  with  the  definition.  It  may,  however,, 
be  well  to  protest  against  the  attitude  of  mind  of 
those  who  consider  a  hoUday  wasted  unless  its- 
precious  hours  are  filled  by  the  pursuit  of  fresh 
knowledge  and  experience.  A  symposium  of 
opinions  of  some  leading  Members  of  Parliament 
recently  taken  by  one  of  the  leading  morning 
papers  contained  the  views  of  several  represen- 
tatives of  manufacturing  towns,  who  held  that 
the  ideal  holiday  of  a  young  Londoner  was  to  be 
found  in  a  visit  to  some  Yorkshire  or  Lancashire 
town  to  study  the  processes  of  manufactures 
carried  on  there.  With  all  respect  for  the  legiti- 
mate desire  of  men  to  improve  themselves  on 
every  suitable  occasion,  we  cannot  but  think  that, 
for  a  young  clerk  or  business  man  to  spend  his- 
short  fortnight  or  three  weeks'  vacation  in  an 
atmosphere  of  looms  and  machinery  is  to  court 
disaster.  To  all  mentally  hard-worked  men  the 
hohday  should  be  emphatically  a  period  when  the 
mind  lies  fallow,  and  when  tte  body  is  given  the 
chance  that  it  so  rarely  gets  of  moderate,  healthy 
exercise.  It  is  obviously  foolish  for  the  man 
whose  muscles  are  flabby  and  whose  circulating 
and  respiratory  mechanism  is  out  of  tone  to 
attempt  herculean  feats  as  soon  as  the  black  coat 
is  changed  for  flannels,  and  much  damage  is  often 
inflicted  on  themselves  by  enthusiasts  who  try  by 
means  of  sudden  and  violent  exertion  to  get  as- 
much  "  good  "  as  possible  out  of  their  hohday. 
All  violent  exercise  must  be  preceded  by  a  period 
of  training  if  the  strain  is  to  benefit  the  S)rstem,. 
and  for  the  average  vacation  the  gentle  cult  of 
dolce  far  niente  is  infinitely  preferable  to  fatiguing 
bicycle  rides  or  exhausting  expeditions  that  tax 
the  powers  of  endurance  of  their  subjects  to  the- 
uttermost.  Some  interesting  observations  re- 
cently made  by  Dr.  PhiUp  Hawk,  Demonstrator 
of  Physiological  Chemistry  in  the  University  of 
Pennsylvania,  tend  to  show  the  comparative  value- 
of  various  forms  of  bodily  exercise,  and  in  them 
the  physician  may  find  a  scientific  basis  for  advicft 
he  may  be  called  upon  to  give  as  to  the  best 
hoUday  pursuit  for  his  patients.  The  method 
adopted  by  Dr.  Hawk  was  to  examine  the  blood  of 
athletes  before  and  after  exercise,  making  counts, 
of  the  red  corpuscles  with  the  haemocytometer. 
His  observations  showed  that  the  blood  of  the- 
average  college  athlete  in  good  training  contained^ 


176     Thi  Mbdical  Pebsi. 


LEADING  ARTICLES. 


August  17,  1904- 


1 


over  a  million  more  red  cells  than  that  of  the  aver- 
age individual,  namely,  5,600,000  corpuscles  per 
•cubic  millimetre,  as  compared  with  four  and  a  half 

•  or  five  million.  Such  an  observation  is  of  great 
'value,  as  it  demonstrates  the  fact  that  the  pro- 
perly-prepared athlete  differs  structurally  from  the 
untrained  man,  and  that  he  may  therefore  be 
assumed  to  be  capable  of  deeds  that  would  be 
beyond  the  powers  of  the  latter.  An  ordinary 
individual,     then,     whatever     his     potentialities, 

:  should  regard  himself  as  being  incompetent  to 
undertake  feats  of  endurance  or  strain  without 
thorough  preparation   as   he   would  be,   say,   to 

•  appear  for  his  county  at  cricket  without  weeks 
of  careful  practice  at  the  nets.  Dr.  Hawk  found 
that  the  immediate  effect  of  exercise  was  to  in- 
crease rapidly  the  number  of  red  corpuscles  in  the 
blood,  but  that  this  increase  readily  fell  as  the 
exertion  was  continued  beyond  a  certain  point. 
He  attributes  this  to  the  necessity  of  calling  into 
play  numbers  of  cells  that  have  been  accumu- 
lating or  lying  in  reserve  during  periods  of  inimical 
action,  and  to  the  rapid  depletion  of  this  supply 
when  the  demand  is  sustained.  So  far  his  obser- 
vations are  not  complete,  for  he  is  endeavouring 
to  find  out  what  is  the  effect  on  the  blood  when 

-exertion  is  continued  to  extreme  degrees,  but  his 
results  as  to  the  comparative  increase  of  corpuscles 
under  various  forms  of  athletics  are  suggestive. 
Thus  he  found  the  percentage  of  gain  after  a 
hundred  yards'  sprint  to  be  24*8  of  the  total  num- 
per  of  corpuscles,  whilst  the  hundred  and  twenty 
yards  hurdle  race  produced  a  21*5  increase  ;  the 
half  mile,  17-9  ;  the  mile,  13-9  ;  two  miles,  8-8  ; 
broad  jump  (after  six  jumps),  15  ;  three  minute 
water  polo  game,  27*  Here  it  will  be  seen  that 
-while  the  short,  sharp  strains  produced  a  sudden 
high  increase,  the  more  leisurely  and  longer-con- 
tinued exertions  showed  distinctiy  smaller  gains, 
and  examinations  on  bicyclists  and  pedestrians 
•confirmed  these  results,  the  initial  increase  rapidly 
diminishing  as  the  exertion  progressed  till  it  dis- 
appeared altogether.  Reviewing  his  observations. 
Dr.  Hawk  concluded  that  summing  is  the  ideal 
sport.  This  form  of  muscular  exercise  was  found 
to  produce  an  average  increase  of  21  per  cent.,  as 
-compared  with  an  increase  of  i6*6  per  cent,  after 
sprinting,  12-8  per  cent,  after  walking,  and  of  12 
per  cent,  attained  as  the  result  of  bicycling. 
Short  swims,  averaging  three  minutes  in  duration, 
produced  an  increase  of  22*  5,  as  compared  with 
1 3-9  per  cent,  found  after  swims  of  a  quarter  of  an 
hour's  average  duration,  during  which  period 
the  subject  was  putting  out  as  large  a  share  of 
activity  as  possible.  This  method  of  Dr.  Hawk's 
for  examining  the  effect  of  exercise  on  the  organism 
would  seem  to  be  a  valuable  one,  and  it  certainly 
teaches  the  lesson  of  the  unwisdom  of  persisting 
in  an  exercise  that  is  making  too  great  demands  on 
the  reserve  of  corpuscles.  We  hope  he  will  con- 
tinue his  observations  and  that  these  may  embrace 
some  tests  of  athletes,  such  as  Holbein  and  Weid- 
mann,  before  and  after  some  of  their  prodigious 
•efforts.     To  the  plain  man,  however,  the  conclusion 


is  clear,  that  the  holiday  should  be  a  time  for 
accumulating  a  higher  percentage  of  corpuscles 
and  that  arduous  and  fatiguing  exercises,  far 
from  doing  this,  will  only  destroy  any  reserve  that 
he  may  be  already  possessed  of. 


THE        TREATMENT       OF       ACCIDENTAL 
H.^MORRHAGE. 
Sir     Arthur    Macan's    valuable    paper,  read 
before     the      recent    meeting    of     the     British 
Medical  Association,    on    the    subject    of     acci- 
dental  haemorrhage   during    pregnancy,  and    the 
discussion     to    which    it    led,  may    be    said    to 
point    a     moral   and     adorn     a    tale    that    will 
not  perhaps  be  useless  to  the  coming  generations 
of  English  obstetricians.     The  tale  is  very  similar 
to  that  related  to  the  Obstetrical  Society  of  London 
by  Dr.  Teacher,  in  his  now  classical  paper  on 
"  Deciduoma  Malignum,'*  and  its  burden  is  that 
preconceived   and   settied  ideas,   when   not  sup- 
ported by  facts,  hinder  progress.     The  moral  is, 
if  we  may  express  ourselves  in  the  vulgar  fashion, 
to  beware  of   "  cock-sureness."       Past  students 
of  the   London    medical  schools   will   remember 
how  a  well-known  London  writer  on  obstetrical 
subjects  openly  stated  that  he  would  "  plough  " 
any  student  who  told  him  that  in  cases  of  acci- 
dental haemorrhage   he  would  plug  the   vagina. 
Many  of  the  same  students  came  to  Dublin  to 
learn  their  midwifery  in  the  Dublin   maternity 
hospitals.     They  saw  there  the  treatment,  which 
London  had  condemned,  adopted  with  the  result 
that  the  mortahty  of  accidental  haemorrhage,  in- 
stead of  being  40  to  60  per  cent.,  as  they  had  been 
taught,  was  something  between  3  and  8  per  cent., 
and  they  were  confessedly  puzzled.     The  question 
immediately  occurred  to  them — ^why  should  Pro- 
fessor So-and-So  in  London  state  that  the  mor- 
tahty of  accidental  haemorrhage  was  40  per  cent., 
and  that  plugging  would  kill  the  patient,  when  in 
Dublin  the   mortahty  is  inappreciable,    and  the 
vagina   is   always   plugged  ?    This   condition   of 
affairs  was  the  rule  ten  years  and  more  ago,  and 
yet  it  is  but  within  the  last  year  or  two  that  the 
London  obstetrical  school  has  come  to  recognise 
that  dogmatism  and  truth  do  not  always  go  to- 
gether.    The  London  Obstetrical  Society  laid  down 
that  the  tumour  known  as  deciduoma  malignum 
was  nothing  but  a  sarcoma  of  the  uterus.     As  a 
result,  the  majority  of  EngUsh  obstetricians  and 
pathologists  took  no  further  interest  in  the  growth. 
Everything  was  known  about   it,   the  Obstetrical 
Society  h^d  told  them  so.     However,  it  was  sub- 
sequentiy    found    that    the    Obstetrical    Society 
had  told  them  wrong.     Similarly,  with  regard  to 
the  treatment  of  accidental  haemorrhage,  London 
opinion  laid  down  three  "  laws  "  :  that  the  student 
who  suggested  the  plugging  of  the  vagina  would 
be  "  ploughed  "  ;  that  the  medical  practitioner  who 
used  the  plug  would  kill  his  patient ;  and  that  the 
plug  would  convert  an  external  into  an  internal 
haemorrhage.     The  two  last  "  laws  "  were  proved 
to  be  wrong,  but  still  the  first  remained,  and  as  a 
result  the  spread  of  the  knowledge  of  the  treat* 


August  17,  1904. 


NOTES    ON    CURRENT    TOPICS.      Thb  Mbdicai.  Prbss.    177 


ment  was  delayed,  and  many  lives  were  sacrificed. 
At  last  a  change  came.     The  younger  generation 
of  obstetricians  decided  to  think  for  themselves, 
and  to  cast  off  the  hereditary  shackles  by  which 
they  had  been  bound.     The  Obstetrical  Section  of 
the  British  Medical  Association  agreed  to  discuss 
the    treatment   of   accidental   haemorrhage.     The 
chief  active  opponent  of  the  treatment  by  plugging 
remained  away  from  the  discussion  ;  the  chief  pas- 
sive opponent  confessed  that  he  had  always  thought 
well  of  the  treatment,  but  out  of  regard  for  the 
examination  prospects  of  his  students  he  had  re- 
frained   from    mentioning    it  ;     and    Sir    Arthur 
Macan's  paper  was  heartily  accepted  by  the  meet- 
ing.    We  trust  that  as  a  result  of  the  change  of 
opinion   the   pendulum   will   not   now   swing   too 
far  in  the  opposite  direction,  and  cases  be  treated 
by  plugging  for  which  such  a  treatment  is  un- 
suitable,   and   so    discredit   be     brought    on    the 
method.     Plugging  the  vagina  is  the  best  treat- 
ment that  has  as  yet  been  suggested  for  cases  of 
accidental  haemorrhage  in  which   the   patient   is 
not  in  labour  and  in  which  the  bleeding  is  external. 
It  is  a  useless  line  of  treatment  in  cases  of  severe 
concealed     accidental     haemorrhage,     unless    the 
uterine  wall  has  commenced  to  react  against  a 
further  increase  in  the  uterine  contents.     It  is  an 
unnecessary  line  of  treatment  in  cases  in  which 
the  patient  is  in  advanced  labour  and  the  uterine 
contractions  are  strong.     As  the  present  appears 
to  be  a  favourable  time  for  the  upsetting  of  pre- 
conceived ideas,  we  would  venture  to  suggest  that 
the  supremacy  of  Marion  Sims'  position  in  gynae- 
cological examinations  and  operations  should  be 
attacked.  We  think  that  we  are  right  in  saying  that 
England  is  the  only  country  which  still  adheres 
to  this  position,  and  that  the  use  of  the  more 
generally  adopted  dorsal  position  does  not  favour 
the   occurrence  of  parametritis,   as  was  recently 
stated  by  an  English  writer. 


sentiments  should  in  future  be  couched  in  pure- 
English,  and  that  they  should  be  influenced,  if 
not  altogether  guided,  by  the  dictates  of  common» 
sense  and — truth.  Perhaps,  however,  he  is  what 
the  Scots  call  a  "  puir  body." 


A  Post-Daited  Medical  Gortificate. 

It  is  difficult  to  imagine  any  set  of  circumstances* 
under  which  the  post-dating  of  a  medical  certificate- 
could    conceivably    be    prudent    and    altogether 
defensible.     Certainly  not  when  the  document  was . 
drawn  up  to  excuse  the  attendance  of  a  juror  at 
a  trial  to  be  held  nine  days  after  the  date  of  signa- 
ture.    Yet  that  is  the  kind  of  certificate  recently 
presented  to  Mr.  Commissioner  Lawrence,  K.C.,. 
at  Liverpool  Assizes.     The  j  udge  stated  it  had  come 
to  his  knowledge  that  a  certificate  had  been  handed 
in  from  a  Liverpool  practitioner  to  the  effect  that  a-, 
certain  juror  was  unable  to  attend',. and  post-dated 
by  thirteen  days.     The  reason  that  had  been  offered 
for    adopting   that  course-  was  the  fact  that  the- 
doctor  was  going  out  of  town,,  and  that  his  pro- 
fessional skill  enabled  him  to  say  that  the  jury- 
man would  not  be  able  to  attend.  That  was,  to. 
the  judge's  mind,,  a  mode  of  dealing  with  the- 
matter  that  was  highly  reprehensible,  and  was  a- 
view  of  the  duties  of  the  medical  profession  which 
he  could  not  congratulate  the  gentleman  upon  enter- 
taining.    Judges,  he  remarked,  had  been  in  the 
habit  of  treating  medical  gentlemen  as  gentlemen 
who  could  be  impUcitly  relied  upon,  and  any  de- 
parture from  that  course  on  the  part  of  a  member 
of  the  profession  was  pot  only  calculated  to  injure 
the   profession,   but   was   also   a   serious   offence- 
against  the  State.    We    agree  that  any  medical 
man  acts  foolishly  who  tampers  with  certificates. 
At  the  same  time^it  would  be  better    were  the- 
legislature,  which  expects  so  much,  to  pay  medical! 
men  for  certificates  on  a  scale  commensurate  with 
the  fees  enjoyed  by  the  legal  profession. 


notes  on  Current  XEopics* 

The  Administration  of  the  B.A MC. 

A  RECK  NT  writer  in  the  Westniinster  Review  has 
made  a  discovery  which  is  so  good  that  we  desire 
to  reproduce  it  in  his  own  words  : — "  The  latent 
talent  for  administration  possessed  by  the  Anglo- 
Saxon  is  neutralised  in  the  R.A.M.C.  by  the  Irish 
and  Scotch  members  who  form  the  bulk  of  its 
members.  The  racial  and  national  peculiarities 
of  these  two  preclude  them  from  being  successful 
administrators.  The  excessive  vanity  of  the  one 
and  the  inordinate  conceit  of  the  other  are  quite 
antagonistic  to  that  calm  discussion,  gentle  spirit 
of  compromise,  and  firm  perseverance  which  render 
pure  Englishmen  of  any  rank  and  any  degree  of 
education  such  wonderfully  successful  and  able 
administrators  and  organisers."  It  seems  to  us 
that  nothing  but  a  combination  of  "  excessive 
vanity  "  and  '*  inordinate  conceit  "  could  make 
anyone  so  willing  to  display  bis  ignorance  of  the 
nationality  of,  we  think  we  may  say,  the  majority  I 
of  the  great  administrators  of  the  Empire.  We  | 
would  suggest  to  this  "pure  Englishman "  that  his 


Self-Certifidd  LunatiGSi 
The  judicial  \dew  of  what  constitutes  attenuated' 
responsibility  in  criminals  suspected  of  mental' 
aberration  is  in  startling  conflict  with  that  of 
medico-legists  and  psychological  experts.  The 
judge's  directions  to  a  jury  in  a  recent  case  of 
murder  by  an  otherwise  well-conducted  -but 
hereditarily  damnable  youth,  emphasise  this 
divergence  of  opinion  to  such  a  degree  that  it 
becomes  a  reductio  ad  ahsurdum.  He  warned  the 
jury  against  accepting  the  theory  of  "uncontrollable* 
impulse,"  of  which,  he  added,  medical  men  were 
very  fond,  and  he  laid  it  down  that  every  person 
was  assumed  to  be  sane  until  the  contrary  was* 
proved,  and  that  it  lay  with  the  prisoner  to  esta- 
blish this.  But  how  is  a-  prisoner  to  prove  this 
except  by  acting  as  a  lunatic  ?  When  a  wealthy 
person  indulges  in  petty  theft  it  is  mercifully'  de- 
scribed as  kleptomania,  and  probably  in  most 
instances  with  due  reason.  When  a  previously 
well-conducted  youth  commits  murder  without 
adequate  motive  surely  he  has  done  all  that  could 
reasonably  be  expected  of  him  to  establish  his  un- 
soundness, of  mind..    We-  must  confess  that  we  are* 


178    Tbb  Mbdxcal  P&bss. 


NOTES  ON  CURRENT  TOPICS. 


August  17,  1904- 


1 


unable  to  understand  the  dogged  resistance  of 
the  judicial  mind  to  the  medical  theory  of  atten- 
uated responsibility.  In  murder  cases,  at  any 
rate,  there  is  no  risk  of  the  accused  being  let  loose 
on  society  to  perpetrate  further  acts  of  violence  ; 
it  is  merely  a  question  whether  he  should  be 
^'  treated  "  in  prison  or  in  an  asylum.  Surely  the 
medical  man  is  the  best  judge  of  cases  suitable  for 
admission  to  hospital.  The  fact  is,  that  in  presence 
of  purposeless  acts,  especially  if  corroborated  by 
a  neurotic  family  history,  the  assumption  ought 
to  be  exactly  in  the  opposite  direction.  It  is 
satisfactory  to  find  that  in  this  particular  instance 
the  jury  were  not  led  away  by  the  judge's  so- 
phisms, and  found  that  the  prisoner  was  insane. 

Suture  of  an  Artery. 

In  the  "  Annals  of  Surgery  "  for  July  is  re- 
corded a  remarkable  case  of  suture  of  the  brachial 
artery,  which  was  so  successful  that  it  merits  wide 
publicity.  The  patient  was  a  boy  of  seventeen 
years  of  age  whose  upper  arm  was  severely  lacerated 
by  a  crush  from  the  wheel  of  a  car.  The  muscular 
structures  of  the  outer  side  were  torn  in  various 
directions  and  the  humerus  was  exposed  to  view. 
The  woimd  was  treated  in  the  usual  way,  but  to- 
wards the  end  of  the  week  profuse  haemorrhage 
supervened.  The  radial  pulse  could  not  be  felt, 
and  the  w^hole  arm  below  the  wound  was  cold, 
dark,  and  oedematous.  Gaston  Torrance,  under 
whose  care  the  case  was  admitted,  opened  up  the 
wound  and  found  a  funnel-shaped  ulcer  about  the 
size  of  the  point  of  a  pencil  in  the  wall  of  the 
bracliial  artery.  At  each  beat  of  the  heart  arterial 
blood  was  shot  through  the  aperture,  and  the 
patient's  condition  was  one  of  some  anxiety. 
Torrance  attempted  to  close  the  opening  by  suture, 
but  his  first  attempt  made  with  the  arm  extended 
was  futile,  as  the  stitch  tore  out  when  it  was 
tightened,  and  the  haemorrhage  proceeded  with 
unabated  force.  He  then  tried  to  relieve  the 
tension  on  the  stitch  by  bending  the  arm,  and  the 
relaxation  being  secured,  he  inserted  a  purse- 
string  suture  around  the  margin  of  the  ulcer  with 
a  fine  curved  intestinal  needle.  When  the  suture 
was  drawn  together  it  was  found  that  the  bleeding 
was  completely  controlled.  In  order  to  give  added 
security,  a  piece  of  muscle  was  dissected  up  and 
grafted  over  the  anterior  portion  of  the  artery. 
In  four  hours  the  pulse-beat  was  easily  perceptible 
in  the  radial,  and  after  two  weeks  in  bed  and  two 
months  subsequent  use  of  a  spUnt,  the  boy  went 
home  vnth  a  thoroughly  useful  limb.  Suture  of  a 
large  artery  in  its  continuity'  is  seldom  called  for. 
but  this  case  illustrates  particularly  well  the  hope- 
fulness of  the  method  when  appUed  with  skill  and 
intelligence. 


An  International  Medical  Lanfiruagre. 

In  these  days  of  international  congresses  and  free 
exchange  of  scientific  ideas  the  need  for  a  common 
language  of  intercommunication  is  badly  felt. 
Many  praiseworthy  and  ingenious  attempts,  from 
Volapuk  downwards,  have  been  made  to  establish 
a  universal  language,  but  no  sooner  is  a  good 


tongue  invented  than  along  comes  another  with 
still  greater  claims  to  attention.  People  conse- 
quently become  bewildered,  and  awaiting  universal 
approbation  nothing  is  done.  From  the  point  of 
view  of  medicine  a  lingua  franca  is  undoubtedly 
a  great  desideratum.  Science  has  no  home  and 
no  country,  and  with  the  ever-increasing  volume 
of  observation  and  experiment  carried  on  in  every 
land  the  medical  man  becomes  more  and  more 
unable  to  keep  as  well  abreast  of  current  know- 
ledge as  he  would  wish  to  do.  It  seems  a  thousand 
pities  that  Latin  has  fallen  from  its  place  as  the 
recognised  medium  for  medical  writings,  for  not 
only  is  Latin  the  basis  of  most  of  the  occidental 
languages,  but  it  is  one  peculiarly  well  adapted  to 
the  purposes  of  science.  One  cannot  help  noting 
it  as  a  curious  fact  that  coincidentally  with  the 
widening  of  education  and  the  consequently  great 
diffusion  of  classical  knowledge,  Latin  has  gradu- 
ally become  less  and  less  familiar  to  the  phys- 
cian  of  culture.  It  is  doubtful  if  at  this  moment 
10  per  cent,  of  the  Fellows  of  the  College  of  Physi- 
cians could  read  or  write  a  medical  paper  with  any- 
thing approaching  facility  in  the  Latin  language, 
and  it  is  quite  certain  that  not  i  per  cent,  of 
readers  of  a  medical  journal  would  attempt  to 
decipher  it.  A  hobby  of  one  of  our  contemporaries 
is  to  push  the  claims  of  modern  Greek  as  the  lan- 
guage for  general  medical  purposes,  but,  in  all  sym- 
pathy, we  fear  that  their  dream  will  not  be  realised 
in  our  generation.  The  solution  would  seem  to  be 
a  natural  one,  namely,  the  adoption  by  other 
nations  of  the  language  of  the  race  which  attains 
the  greatest  pre-eminence  in  the  political  and 
scientific  world,  and  we  incUne  to  believe  that 
English  will  eventually  prove  to  be  that  language. 
At  any  rate,  it  is  not  hkely  to  be  Japanese  for 
another  century  or  two. 


The  Diffeetibility  of  White  Bread. 

It  is  not  always  the  medical  and  scientific  journals 
which  single  out  the  various  articles  of  food  in  turn 
for  the  purposes  of  "  attacking  '*  them,   as  the 
lay    mind    loves    to    think.     That    they    expose 
adulteration  and  fraud  everybody  will  recognise, 
and  in  this  capacity  they  render  valuable  aid  to 
the  community  at  large  by  calling  attention  to 
the  composition  or  quality  of  the  different  food- 
stuffs and  to  the  risks  of  possible  contamination 
which  the  consumers  run  when  the  laws  of  hygiene 
are   infringed.     A   certain    section    of   the    daily 
press  is  apparently  fond  of  adopting  the  same 
policy,  presumably  because  it  is  found  that  the 
pubUc  are  pleased  by  the  admission  of  medical 
or  rather  pseudo-medical  details  into  the  columns 
of  their  morning  paper.     A  correspondent  of  the 
Times  has  recently  stated  that  the  present  craze 
for  white  bread  constitutes  a  danger  to  the  public 
health.     If  it  be  true  that  the  alleged  practice  of 
bleaching  the  flour  by  means  of  ozone  and  nitrous 
acid,  which  is  said  to  be  adopted  by  many  bakers, 
is  really  universal,  it  might  be  conceived  that  the 
bread  baked  from  such  flour  might  have  injurious 
effects,  unless  special  precautions  be  taken.     All 


August  i7»  I9Q4- 


NOTES  ON  CURRENT  TOPICS. 


Thk  Medical  Pmass.  179 


in- 


white  bread,  however,  is  not  necessarily  an. 
digestible,  non-nutritive  food,"  though  the  pre- 
sence of  mineral  matter  or  an  excess  Jofjstarch 
renders  it  unfit  for  those  possessed  of  deUcate 
stomachs.  The  inclusion  in  the  flour  of  the  central 
portion  of  the  wheat-kernel  is  generally  held  to  be 
incompatible  with  snoviy  whiteness,  but  there 
can  be  neither  rhyme  nor  reason  for  sacrificing 
the  phosphates  and  other  nutritive  principles 
merely  for  the  sake  of  appearance.  Many  patent 
breads  now  on  the  market,  including  the,  aerated 
variety,  are  praiseworthy  and  successful  attempts 
to  preserve  the  nutritive  properties  of  the  flour, 
while  combining  it  with  a  pleasing  appearance. 
The  connection  between  the  consumption  of 
white  bread  and  the  prevalence  of  appendicitis 
need  only  be  mentioned  to  be  denied  in  toto. 

Examination  of  Sputa  in  Children. 
Whatever  may  be  the  faults  and  drawbacks 
of  young  children,  there  is  one  nuisance  which 
they  are  never  guilty  of— that  is,  the  spitting 
nuisance.  However  fortunate  it  may  be  for  their 
fellow-creatures  that  they  do  not  spread  their 
maladies  by  expectoration,  their  medical  attendants 
•are  sometimes  considerably  handicapped  in  making 
their  diagnosis  by  being  unable  to  obtain  specimens 
of  sputum  for  examination.  In  suspected  cases 
of  early  tuberculosis  the  staining  of  the  sputum 
is  of  paramount  importance,  and  delay  in  the 
resolution  of  pneumonias,  or  the  development 
of  some  located  empyemata,  often  make  the  prac- 
titioner anxious  to  check  the  diagnosis  by  appeal 
to  the  sputum.  Several  plans  have  been  devised 
from  time  to  time  to  obtain  expectoration  for 
examination,  notably  that  used  by  Hirt  of  passing 
a  stomach  tube  and  collecting  the  mucus  that 
adheres  to  it.  A  simple  and  satisfactory  method 
has  been  put  forward  by  Findlay,  who  learned  it 
from  the  French  hospitals.  This  consists  in  cover- 
ing the  finger  with  gauze  and  passing  it  into  the 
ai^rture  of  the  glottis.  The  irritation  thus 
excited  induces  cough,  and  as  the  mucus  is  ejected 
it  is  caught  on  the  gauze  and  reserved  for  examina- 
tion. The  device  is  so  simple  and,  withal,  so 
efficacious,  that  it  will  be  welcomed  as  a  boon  by 
many  practitioners. 

Kyphosis  of  Muscular  Origin. 

The  influence  of  osseous  changes  in  the  pro- 
duction of  deformities,  especially  those  in  which 
the  spinal  column  is  involved,  so  far  outweighs 
that  exerted  by  other  tissues  of  the  body  that 
the  possibility  of  a  given  malposition  being  due 
to  causes  other  than  bony  is  apt  to  be  overlooked. 
The  contractions  which  appear  as  a  result  of 
paralysis  of  the  limbs  are  quite  familiar,  such  de- 
formities having  their  origin  in  muscular  contrac- 
tion induced  by  chronic  irritation  of  a  nerve-cell 
or  nerve-trunk.  Most  of  the  deformities  affecting 
the  spine  arise  from  actual  changes  in  the  bodies 
of  the  vertebrae  themselves.  With  the  exception 
of  lateral  curvature,  alterations  of  the  normal 
antero-posterior  curves  of  the  spinal  column 
are  generally  due  to  absorption  of  the  vertebral 


bodies  from  the  deposit  therein  of  tuberculous 
material.  The  case  related  by  MM.  Brissaud  and 
Grenet  (a)  of  kyphosis  due  entirely  to  muscular 
action  is,  therefore,  of  some  interest.  The  patient 
was  a  man,  aged  thirty-seven,  who  had  suffered 
for  three  years  from  severe  pains  in  the  back, 
ascribed  to  rheumatism.  He  had  a  regular  ky- 
phosis which  was  less  on  rising  in  the  morning. 
The  arms  were  held  in  semi-flexion.  There  was  no 
joint -affection,  and  the  vertebrae  appeared 
to  be  quite  normal.  The  reaction  of  the  spinal 
muscles  to  faradism  was  not  diminished, 
neither  was  there  any  reaction  of  degenera- 
tion. The  condition  was  greatly  improved  by  the 
continuous  application  of  a  Sayre's  jacket.  The 
observers  considered  that  the  case  was  aUied  to 
the  condition  described  by  Forestier  as  "  vertebral 
rheumatism,"  or  rheumatic  spondylosis.  Similar 
kyphotic  states  have  also  been  seen  as  the  result 
of  occupation,  as,  for  example,  in  vine-dressers. 
The  long-drawn-out  antero-posterior  curve  which 
occurs  as  a  special  type  in  the  aged  is  sometimes 
the  partial  effect  of  muscular  shortening. 


Inflation  in  Acute  Intussusception. 
The  treatment  of  acute  intussusception  in 
3roung  infants  still  constitutes  one  of  the  critical 
problems  of  surgery.  In  spite  of  the  most  ap- 
proved methods  of  treatment  the  mortality  from 
this  affection  remains  almost  what  it  was  twenty 
years  ago.  The  best  possible  chance  of  recovery 
appears  to  be  afforded  by  the  immediate  perform- 
ance of  laparotomy  and  actual  manual  reduction  of 
the  bowel.  This  procedure  requires  some  con- 
siderable force,  so  that  the  bowel  stands  in  some 
danger  of  being  torn  across.  A  slight  tear,  in- 
volving only  the  muscular  and  peritoneal  coats, 
is  not  of  much  importance,  as  peritonitis  is  said 
not  to  occur  under  such  conditions,  but  should  the 
mucous  coat  be  lacerated  and  the  lumen  of  the  gut 
exposed,  the  matter  is  far  more  serious.  Rapid 
resection,  if  possible,  is  then  the  best  course  to 
pursue.  The  other  method,  that  of  inflation, 
whether  with  fluid  or  air,  is  the  one  still  adopted 
by  the  majority  of  practitioners,  for  it  has  the 
advantage  of  being  a  less  formidable  undertaking 
than  abdominal  section.  Mr.  F.  J.  Steward,  (6) 
of  Guy's  Hospital,  has  coUected  several  groups 
of  cases  together,  showing  the  results  of  inflation, 
and  he  concludes  that  this  mode  of  treatment 
must  be  regarded  as  a  failure.  In  the  first  place, 
it  is  unsaie  to  employ  the  amount  of  force  which 
is  necessary  to  reduce  the  intussusception  on 
account  of  the  danger  of  rupture  of  the  bowel. 
If  the  condition  extends  higher  than  the  ileo- 
caecal  valve,  inflation  must  fail,  because  it  has 
been  proved  experimentally  that  the  injection  of 
water  or  gas  cannot  pass  beyond  this  point. 
Complete  reduction  may  only  apparentiy  take 
place,  which  again  is  a  most  undesirable  occurrence. 
The  greatest  drawback  of  all,  perhaps,  is  that  the 
effects  of  inflation  are  invisible,  and,  therefore, 
the  method  is  both  unscientific  and  uncertain. 

(a)  Nouv,  Icon,  </e  la  Salpetriere,  No  2. 1904. 

(b)  Guy's  HonnUU  Gasettt,  July  80th,  1004. 


l8o  Tbb  Medical  Pxbss. 


NOTES    ON    CURRENT    TOPICS. 


The  earlier  laparatomy  be  performed  in  these 
cases,  the  more  chance  will  there  be  of  ultimate 
success. 


An  Allegred  UnauthoriBed  Post-Mortem. 

It  is  obviously  inadvisable  to  make  a  post  mortem 
examination  on  the  body  of  a  patient  without 
having  obtained  the  consent  of  the  friends  of  the 
deceased  or  an  order  from  the  coroner.  In  both 
cases  to  act  without  authority  is  to  invite  conse- 
quences of  a  most  unpleasant  nature.  Mr.  John 
Shaw  Carleton,  a  surgeon  practising  at  Newnham, 
Gloucestershire,  has  had  to  appear  before  the 
Littledean  Petty  Session,  because  he  conducted 
a  post-mortem  on  a  body  without  consent  of 
friends,  and  in  the  absence  of  a  direct  written 
direction  from  the  coroner.  It  appears  that  he 
regarded  as  sufficient  authority  a  letter  from  the 
Deputy  Coroner  directing  him  to  examine  the 
body  if  requisite,  and  if  an  inquest  were  held. 
Unfortunately  for  him  an  inquest  was  not  con- 
sidered requisite.  *The  magistrates  dismissed 
the  summons,  as  they  did  not  think  on  the  evi- 
dence that  a  jury  would  convict.  The  charge 
was  drawn  up  in  a  formidable  manner  under  the 
Anatomy  Acts.  There  were  three  summonses  as 
under  :  (t)  That  he,  upon  July  25th,  being  a  person 
lawfully  qualified  to  practise  medicine,  unlaw- 
fully did  practise  anatomy  without  having  ob- 
tained a  licence  in  pursuance  of  2  and  3  William  IV.. 
c.  75,  empowering  him  to  do  so.  (2)  That  on  the 
same  date,  being  qualified  to  practise  medicine, 
unlawfully  did  examine  anatomically  the  body  of 
John  Price  without  the  permission  or  the  direction 
of  the  surviving  wife.  (3)  That  he  did  unlawfully 
carry  on  anatomy  at  a  place,  to  wit,  the  house  of 
Emily  Price,  there  situate,  without  having  given 
at  least  one  week's  notice  thereof  before  the  first 
receipt  or  possession  of  the  body  for  such  purposes 
to  His  Majesty's  Secretary  of  State  for  the  Home 
Department. 


Headache  Powders. 

With  the  medical  paragraphs  of  the  ordinary 
lay  newspaper  it  is  impossible  to  feel  the  least 
sympathy.  As  a  rule,  they  form  a  sort  of  com- 
post of  sensationalism,  of  mis-statement,  and  of 
false  science,  dished  up  by  a  journalist  absolutely 
ignorant  of  medicine  but  wotting  well  the 
wants  of  his  public.  As  a  rule  the  evil  done 
b}'  these  slipshod  efforts  to  popularise  one  of  the 
most  highly  technical  of  all  sciences  is  simply 
incalculable.  The  only  other  thing  with  which  it  is 
at  all  comparable  is  the  crop  of  disaster  sown  far  and 
wide  by  quack  advertisements.  In  that  particular, 
again,  with  modem  lay  journalism  lies  the  head 
and  front  of  the  offending.  Who  can  even  faintly 
estimate  the  total  sum  of  human  suffering  and 
sorrow  caused  by  the  fraudulent  enterprises  of 
curers  of  kidney  disease,  of  cancer  and  of  a  host  of 
other  more  or  less  deadly  maladies  ?  Curiously 
enough,  the  average  mind  seems  always  to  have  a 
comer  open  for  the  quack,  even  among  folk  of 
culture  and  of  position  in  society.     The  only  item 


August  17;  i904> 

on  the  other  side  of  the  ledger  with  which  we  caa 
credit  modem  journalism  is  an  occasional  crusade 
against  "  headache  powders  "  and  drug- taking 
generally.  Even  such  exposures  are  conducted 
in  a  way  that  must  necessarily  furnish  a  great  and 
unnecessary  amount  of  dangerous  detailed  infor- 
mation to  weak-minded  readers. 


An  Unideasant:  Expariance.  * 

The  ways  of  British  administrative  law  are  at 
times  apt  to  press  heavily  on  the  individual,  how- 
ever much  there  may  be  to  admire  ih  them  as  a 
whole.     That  they  are  capable  of  improvement  is  a 
more  or  less  self-evident  proposition.     That  view, 
at  any  rate,  is  hkely  to  be  held  positively  by  Mr. 
A.  B.  Avame,  a  Blaenavon  surgeon,  who  recently 
had   a   most   unpleasant   experience   of   adminis- 
trative red-tapeism  in  Cardiff.     It  appears   that 
his  luggage  was  stolen  at  the  railway  station  of 
that  town,  through  which  he  was  passing  on  his 
way  to  a  hoUday  on  the  Continent.     The  thief 
was  caught,  brought  up  at  the  police  court  next 
morning,    and    charged    with    the    offence,    and 
remanded  for  a  week.     The  whole  of  Mr.  Avame-s 
kit  was  contained  in  the  stolen  luggage,  which 
the  Court  took  into  custody.     His  very  reasonable 
request   that  he  should  be  allowed  to  use  some  of 
his  clothes  was  refused  by  the  Bench.     This  weak 
point  in  the  administrative  law  is  clearly  due  to 
the  remand  system.     If  the  prisoner  had  been  sum- 
marily  sentenced  or  committed  for  trial,  as  should 
have  been  done,  the  stolen  property  could  have- 
been  restored   forthwith  to  its   owner.     The  re- 
mand was  doubtless  due  to  the  gross  injustice  of 
the  British  law,  which  seeks  to  punish  a  culprit 
afresh  for  former  offences,  and,  with  that  end  in, 
view,  remands  him  again  and  again  so  that  the 
police  may  trace  his  former  career. 


Lifirbt  Treatment  of  Small-Pox. 

With  every  desire  to  be  fair  and  to  preserve* 
an  open  mind  with  regard  to  new  therapeutical 
methods,  it  is  often  difficult  to  credit  the  state- 
ments that  come  from  even  highly  reputable 
quarters  as  to  the  efficiency  of  this,  that,  or  other 
treatment.  A  certain  healthy  scepticism  with 
regard  to  medical  novelties  is  by  no  means  to  be 
deprecated,  and  in  the  interests  of  the  patient  who* 
is  hkely  to  form  the  corpus  vile  of  the  experiment,, 
it  is  even  to  be  welcomed.  The  red  hght  treat- 
ment of  smaU-pox  has  been  reported  on  several 
times  from  Scandinavian  sources,  always  in  glow- 
ing terms,  and  although  it  is  really  ft  resuscitation 
of  one  of  the  crudities  of  the  Middle  Ages,  the  fac* 
that  this  plan  is  based  on  empirism^  is  no  valid 
argument  against  its  adoption  if  really  beneficial 
to  patients.  As  the  treatment  of  sufferers  in.what  is-- 
practically  a  "  dark  room  "  can,  at  the  worst,  have 
but  little  effect  on  their  comfort  and  well-being,, 
it  is  satisfactory  to  know  this  method  has  been 
thoroughly  tried  over  here.  Dr.  Rick3tts,  the 
Medical  Superintendent  of  Joyce  Green  Small- Pox 
Hospital,  decided  to  test  its  efficiency,  and  his. 


August  17,  1904. 


NOTES    ON    CURRENT    TOPICS.      The  Medicul  Press.    181 


-experience,  published  in  the  Annual  Report  of  the 
Metropolitan  Asylums  Board,  should  settle  the 
matter  once  and  for  alL  A  small  ward  was  set 
apart  for  the  purpose,  the  windows  being  covered 
with  ruby  fabric  and  the  ward  doors  hung  with 
thick  curtains  of  Turkey  twill.  Illumination  was 
supplied  by  a  red  lamp.  In  this  room  one  or  two 
patients  were  placed  at  a  time,  all  of  whom  were 
subject  to  careful  selection.  Those  chosen  were 
in  the  early  papular  stage  of  attacks  that  seemed 
likely  to  run  an  ordinary  suppurative  course.  In 
:all  some  twelve  cases  were  treated,  in  none  of  which 
-was  the  development  of  the  stages  of  the  papules 
dn  any  way  different  from  what  might  have  been 
maturaUy  expected.  Three  patients  died  and  several 
were  badly  pitted.  Dr.  Ricketts'  reputation  for 
•scientific  insight  and  care  is  a  sufl&cient  guarantee 
that  the  treatment  was  accurately  and  conscien- 
tiously carried  out,  and  it  may  be  unhesitatingly 
pronounced  a  dead  failure.  We  are  glad  that  the 
little  experiment  has  been  made,  as  the  question 
may  now  be  relegated  to  the  region  of  chases  fugiss, 
and  we  are  left  to  wonder  how  such  an  unlikely 
wild-cat  plan  came  to  gain  such  a  reputation. 
We  can  only  surmise  that  what  our  Scandinavian 
friends  need  for  the  treatment  of  small-pox  is 
mot  the  light  of  a  ruby  globe,  but  the  light  of 
common  sense.  For  the  future  the  doctor's  red 
lamp  will  be  of  more  service  outside  his  front 
•door  than  inside  the  bed-rooms  of  his  small-pox 
patients.  

The  Medical  Profession  in  Germany. 
The  condition  of  the  medical  profession  in  Ger- 
many can  be  gauged  by  a  warning  to  those  thinking 
of  entering  the  profession  recently  issued  by  the 
German  Practitioners'  Association.  The  Central 
Committee,  who  are  responsible  for  the  form  of  the 
-warning,  describe  the  condition  of  the  medical 
profession  as  "  difficult  and  perhaps  unfavourable  " 
and  its  prospects  as  sad.  They  attribute  this  to 
three  causes,  the  overcrowding  of  the  profession, 
the  abolition  of  amti-quackery  laws,  and  recent 
legislation  dealing  with  workmen's  insurance. 
The  number  of  medical  men  has  doubled  since 
1876,  while  the  number  of  unqualified  people  who 
practise  medicine  has  enormously  increased. 
According  to  the  Committee  members  of  the 
criminal  class  are  largely  concerned  in  bogus 
practice,  and  not  only  collect  patients  by  unscrupu- 
lous advertisements,  but  actually  get  up  meetings 
for  the  purpose  of  publicly  vihfying  medical  men. 
It  is  somewhat  strange  that  in  a  country  such  as 
Germany  whose  people  are  supposed  to  be  clear- 
headed, logical,  and  intelligent,  swarms  of  even 
cultivated  persons  flock  to  these  quacks.  Should 
the  State  continue  to  refuse  to  intervene  to  protect 
the  interests  of  those  whom  they  have  licensed, 
one  of  two  results  are  bound  to  follow.  Either 
the  number  of  those  who  seek  to  become  qualified 
will  greatiy  diminish,  with  the  result  that  a  smaller 
body  of  professional  men  wUl  be  able,  owing  to  the 


absence  of  undue  competition,  to  maintain  the 
status  of  the  profession,  or,  the  numbers  entering 
will  be  kept  up,  but  the  intelligent  and  well- 
educated  student  will  cease  to  join  the  profession. 
In  the  latter  case,  the  status  of  the  medical  pro- 
fession in  Germany  will  become  poorer  each  year, 
and  the  general  public  will  be  the  first  to  suffer. 

The  Froteotion  of  the  Holiday  Maker. 

August  is  the  great  holiday  month  for  the 
million.  Custom  and  convenience  have  established 
this  period  of  the  year  as  the  season  for  life's 
physical  renewal.  Judged  from  the  physiological 
and  hygienic  standpoint  much  might  be  said  in 
favour  of  a  re-arrangement  of  the  year's  recreation 
days.  But  at  least  in  this  matter  the  wishes  of  the 
majority  must  be  respected.  Life,  it  would  seem, 
cannot  be  controlled  in  all  its  bearings  by  the  stern 
commands  of  science.  But  whoever  the  holiday 
maker  may  be,  and  wherever  he  may  choose  to  go 
for  his  mental  rest  and  bodily  renewal,  science 
may  well  insist  that  reliable  measures  should  be 
taken  to  protect  him  from  the  evil  results  of  his  own 
ignorance  and  folly.  At  present  much  disaster 
accrues  to  many  from  the  non-hygienic  commis- 
sions and  omissions  of  the  holidaj^.  Even  the 
strictest  and  most  careful  of  would-be  sanitarians 
at  this  season  of  the  year  oftentimes  seems  to 
throw  discretion  to  the  winds  and  plunge  into 
extravagances  and  excesses  unwarranted.  But 
the  sowing  of  reck  lessness  speedily  brings  a  harvest 
of  regrets.  The  conduct  of  a  holiday  calls  for  much 
discrimination,  wise  discernment,  and  painstaking 
arrangement.  We  bdieve  medical  men  might  well 
exert  a  greater  influence  in  instructing  those  to 
whom  they  stand  in  the  responsible  position  of 
medical  advisers  as  to  the  management  and 
control  of  a  hygienicaUy-directed  holiday.  The 
haphazard  method  of  selecting  a  resort,  taking 
rooms,  travelUng  thither  and  then  drifting  with 
the  tide  of  a  vulgar  multitude  in  the  pursuit  of  so- 
called  enj  oyment,  cannot  be  too  strongly  condemned. 
Every  medical  man  knows  that  the  annual  holiday 
is  a  fruitful  season  for  the  propagation  of  many 
forms  of  infectious  disease,  the  initiation  of  not  a 
few  serious  morbid  conditions  and  the  wasteful 
expenditure  of  much  human  energy.  An  injudi- 
ciously-conducted holiday  oftentimes  requires  a 
second  rest  and  recreation  period  under  medical 
supervision  to  rectify  ills  which  might  well  have 
been  avoided. 


Sundown  Literature. 
A  PAPER  which  was  recently  read  before  a 
Medical  Editors'  Association  in  America,  with  the 
suggestive  title  of  "  Sundown  Journalism,"  con- 
tains several  important  truths  on  the  causation 
of  much  of  the  weakness  of  medical  liteiature  at 
the  present  day.  Sundown  work  is  work  done 
after  and  in  addition  to  the  ordinary  labours  of  the 
day ;  it  may,  in  the  case  of  the  budding  medical 


l82    Tbx  Medical  Pkbss. 


PERSONAL. 


AlKHTST    17 »    1904- 


man,  be  started  at  a  "  sundown  college  "  and  after 
he  has  become  qualified  may  be  continued  in 
"  sundown  literature."  **  It  is  the  work  done  when 
the  brain  and  body  are  debilitated  and  below  par 
from  the  strains  and  labours  of  the  day."  Accord- 
ing to  the  writer,  many  of  the  American  journals 
and  medical  works  contain  marked  examples  of 
sundown  hterature  stimulated  by  drugs,  and 
characterised  by  a  jarred  and  exclamatory  style 
from  the  effects  of  alcohol,  or  by  the  softer  notes 
and  the  assertive  confidence  in  which  conclusions 
are  stated  under  the  influence  of  morphia.  "  The 
cocainist  influences  on  these  contributions  are 
more  pronounced  than  that  of  any  other  drug, 
particularly  in  the  endless  repetitions  and  involved 
explanations,  and  movement  in  a  dreamy,  hazy 
mass  of  words."  -  We  further  learn  that  one  of  the 
popular  text-books  on  the  market  is  notoriously 
a  midnight  work,  stimulated  by  opium  and  cocaine, 
while  another  with  a  large  sale  has  drug  writing 
and  drug  work  on  every  page.  We  can  quite 
believe  that  the  evil  of  which  the  writer  complains 
is  by  no  means  infrequent,  but  we  doubt  that  it  is  as 
universal  as  he  seems  to  think.  In  these  countries 
it  is  certainly  the  isolated  exception.  In  America, 
where  hfe  is  altogether  more  hurried  and  more 
feverish,  it  is  only  reasonable  to  suppose  that  resort 
to  stimulants  of  various  kinds  will  be  more  frequent. 
The  necessary  end  of  such  a  course  is  visible  from 
the  start,  and  is  one  against  which  it  should  not  be 
necessary  to  warn  the  medical  man. 


A    OhioafiTO    Ooulist*8    "Cure"  for 
Intemperance. 

In  these  modern  days  medical  science  has  de- 
veloped a  marvellous  faculty  for  detecting  the 
remote  origin  of  this,  that,  or  the  other  sign, 
symptom,  or  abnormal  mental  or  bodily  condition. 
One  man  studies  uric  acid  with  rapt  attention, 
until  he  ends  by  ascribing  every  woe  that  afflicts 
humanity  to  the  presence  of  that  evil  substance 
in  the  tissues.  Another  detects  gout  in  every 
patient  who  consults  him,  and  writes  a  terrified 
treatise  on  "  Gout  in  its  Protean  Aspects."  A  third 
finds  an  explanation  for  nineteen-twentieths 
of  all  disease  in  disordered  nerves  and  nerve  action, 
including  the  hereditary  taint  of  inebriety.  The 
most  comprehensive  and  persevering  faddist 
of  latter  days,  however,  is  the  oculist  who  traces 
a  myriad  maladies  to  errors  of  refraction.  Hath 
a  patient  epilepsy,  asthma,  herpes,  migraine,  tic, 
neurasthenia,  headaches,  baldness,  dyspepsia, 
tremors,  with  a  number  of  other  complaints, 
ranging  from  deafness  to  dementia  ? — then  let  him 
forthwith  seek  relief  and  cure  in  suitable  spectacles. 
The  only  thing  hitherto  sacred  to  the  ocuUst 
has  been  drunkenness,  but  he  has  now  stormed  the 
last  fort.  A  Chicago  oculist  has  lately  published 
his  discovery  that  inebriety  is  merely  a  question 
of  sight.  The  man  whose  sight  is  perfect  does  not 
get  drunk,  and  vice  versd.  The  matter,  perhaps 
fortunately,  can  be  determined  absolutely  one  way 
or  the  other  by  actual  experiment.     Two  sets  of 


patients,  one  with  normal  and  the  other  with  ab- 
normal eyeballs,  can  be  supplied  with  full  doses 
of  alcohol,  and  the  results  carefully  noted.  In 
order  to  avoid  possible  complications  the  experi- 
ments should  be  conducted  in  wards  with  carefully 
secured  doors  and  windows. 


Under  the  will  of  Mr.  C.  J.  Shaw,  of  Leamington, 
the  Birmingham  General  Hospital  and  the  Wame- 
ford  and  Leamington  General  Hospital  each  receive 
a  legacy  of  ;£2,ooo  ;  and  the  Midland  Home  for 
Incurables,  ;f  1,000.  The  Stroud  General  Hospital 
and  the  Gloucester  General  Hospital  each  receive 
jf300,  under  the  will  of  Mrs,  Winterbotham,  of 
Dursley. 

PERSONAL. 
From  a  trustworthy  source  we  learn  that  Sir 
William  Turner  intends  shortly  to  resign  the  Presidency 
of  the  General  Medical  Council,  and  that  its  next 
meeting  will  probably  be  the  last  under  his  (^lairman- 
ship. 


It  is  announced  that  Sir  Thomas  Barlow  and  Dr. 
H.  D.  Waller  have  been  appointed  representatives  of 
the  University  of  London  at  the  International  Medical 
Congress  to  be  held  at  Lisbon  in  April,  1906. 

Professor  Konig  is  about  to  vacate  the  Chair 
of  Surgery  in  the  Berlin  University,  the  succession  to 
which  has,  we  understand,  been  declined  by  Baron  von 
Eiselsberg,  the  Vienna  Professor. 


The  report  that  Professor  von  Ley  den  intends  to 
resign  his  Chair  in  the  University  of  Berlin  has  been 
contradicted. 


Dr.  Albert  S.  Grunbaum,  Lecturer  in  Experi- 
mental Medicine  at  the  Liverpool  University,  has  been 
appointed  Professor  of  Pathology  and  Bacteriology 
in  Leeds  University  (Yorkshire  College)  in  the  place 
of  Professor  Trevelyan,  who  is  retiring  at  the  end  of 
September. 

We  understand  that  Mr.  Mayo  Robson  was  sent  for 
to  operate  on  M.  Waldeck- Rousseau,  late  Prime 
Minister  of  France.  He  had,  however,  left  London 
On  his  way  to  America  at  the  time,  and  the  operation 
was  performed  by  Dr.  Kehr,  the  German  specialist, 
assisted  by  Mr.  Armour,  Mr.  Robson's  -assistant. 
Unfortunately,  the  illustrious  patient  was  in  too  feeble 
a  condition  to  combat  the  effects  of  the  operation,  to 
which  he  shortly  succumbed. 

Dr.  William  Gayton  has  been  presented  by  his 
colleagues  with  a  handsome  testimonial  on  his  retire- 
ment from  the  medical  superintendency  of  the  North- 
west London  Fever  Hospital,  after  thirty-four  years 
service  under  the  Metropolitan  Asylums  Board. 


The  Duke  of  Westminster  has  subscribed  ;fi,ooo» 
towards  the  fund  being  raised  for  paying  oft  the  build- 
ing debt  in  connection  with  the  Alexandra  Hospital 
at  Rhyl. 

Mr.  W.  a.  H.  Navlor.  F.I.C.  F.C.S.,  of  London, 
is  the  new  President  of  the  British  Pharmaceutical 
Conference,  which  has  just  held  its  forty-first  annua? 
meeting,  under  the  Presidency  of  Mr.  T.  H.  W.  Idri?,. 
J.P..  L.C.C. 

A  consulting-room  thief  kst  week  paid  a  pro- 
fessional visit  to  Sir  Stephen  Mackenzie,  of  Cavendish 
Square,  but  was  quickly  run  to  earth  in  a  mews  hard 
by  on  bolting  from  Sir  Stephen's  house. 

Professor  Osler  will  preside  at  a  Congress  to  be 


August  17,  1904. 


CORRESPONDENCE. 


The  MEDiciUL  Press.     183 


held  in  the  Medical  Department  of  the  World's  Fair 
at  the  St.  Louis  Exposition  on  September  20th. 
There  are  twelve  sections,  presided  over  by  distinguished 
men  from  various  countries. 


Madame  Albani  will  give  a  concert  in  aid  of  the 
Royal  Hants  County  Hospital,  on  October  7th.  The 
institution  is  one  of  the  oldest  of  the  kind  in  existence. 


Mr.  W.  T..  CuRRiE,  of  Glasgow,  presided 
over  the  eighteenth  annual  meeting  of  the  Federa- 
tion of  Local  Pharmaceutical  Associations,  held 
last    week    in  Sheffield. 


.  Special  aorre0pon&ence* 

[from  our  special  correspondent.] 


BELFAST. 

Medical  Attendant  on  the  Royal  Irish  Con- 
stabulary.— Dr.  Alexander  Montgomery  has  been 
appointed  one  of  the  medical  attendants  to  the  police 
force  in  Belfast,  in  place  of  Dr.  H.  M.  Killen,  resigned. 
As  mentioned  in  this  column  last  w^eek,  there  was  great 
competition  for  the  appointment,  which  is  said  to  be 
worth  about  ;f200  per  annum.  The  selection  of  Dr. 
Montgomery  for  the  post  is  a  very  popular  one. 

Portrush  Cottage  Hospital. — A  two-day  bazaar 
was  held  in  Portrush  last  week  to  provide  funds  for  the 
furnishing  and  equipment  of  the  new  Cottage  Hospital, 
which  has  been  provided  mainly  by  the  generosity  of 
one  lady.  The  Provost  of  Trinity  College,  Dublin,  was 
in  the  chair  at  the  opening  ceremony,  and  made  an 
excellent  speech  on  the  subject  of  the  necessity  which 
had  arisen  for  small  hospitals  in  country  districts,  as 
well  as  large  institutions  in  the  towns.  Dr.  J.  C.  Martin 
also  spoke,  and  pointed  out  that  Dr.  Traill  was  the 
first  medical  man  to  occupy  the  important  post  of 
Provost  of  Trinity.     . 

The  Small- pox  Epidemic  in  Ulster. — During  the 
past  week  four  fresh  cases  of  small-pox  occurred  in 
Armagh,  and  were  promptly  isolated,  and  all  contact 
cases  looked  after.  One  case  has  occurred  in  Monaghan. 
and  the  local  authorities  there,  too,  are  anxiously 
watching  suspects.  The  people  are  coming  in  hundreds 
for  re  vaccination,  and  for  a  few  days  many  had  to  be 
refused  owing  to  the  small  supply  of  lymph.  A  plenti- 
ful supply  is  now  to  be  had.  Only  one  new  case  has 
been  discovered  in  Belfast  during  the  last  ten  days, 
and  it  is  hoped  that  the  worst  of  the  outbreak  is  now 
past.  Eight  cases  remain  under  treatment  at  Purdys- 
burn  Hospital. 

Proposed  Memorial  to  Dr.  McKeown. — A  meeting 
was  held  in  Belfast  last  week  to  consider  the  question 
of  a  memorial  to  the  late  Dr.  McKeown.  and  it  was 
decided  that  such  a  memorial  was  desirable,  and  a  small 
committee  was  appointed  to  make  arrangements  for  it. 
The  senior  members  of  the  medical  profession  are  mostly 
on  holiday  just  now.  and  the  meeting  was  chiefly  a  lay 
one.  Emphasis  was  laid  on  Dr.  McKeown's  services 
to  the  cause  of  education  in  Ireland,  and  specially  to 
his  efforts  to  improve  the  conditions  of  the  national 
schools. 


Cotte0pon&ence« 

[We  do  not  hold  ounelves  responsible  for  the  opinions  of  our  Cor- 
respondents]. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  diminishing  birth-rate  is  a  matter  for 
scientific  investigation  and  full,  fair,  and  orderly  dis- 
cussion. Dr.  Taylor  has  advanced  the  theory  that  the 
fall  in  question  is  due  to  "  preventive  methods  "  among 
married  folk,  and  that  these  methods  are  harmful  alike 
to  parents  and  to  their  non-prevented  offspring.  My 
articles  in  your  issues  of  July  13th  and  20th  examined 
the  grounds  up>on  which  Dr.  Taylor  based  his  conclu- 
sions.    I  am  no  advocate  of  preventive  practices — 


Heaven  forbid  ! — ^but  my  investigation  showed  to  my 
own  satisfaction  that  there  was  not  sufficient  evidence 
either  that  in  the  United  Kingdom  the  fall  watS  due  to 
preventive  practices,  or  that  parents  and  non-prevented' 
offspring  suffered  from  the  practices  in  question. 

Your  correspondents.  Dr.  Drysdale  and  "  A  Student 
of  Sociology,"  go  outside  the  issues  raised  in  the  dis- 
cussion, although  their  letters  are  interesting  and 
valuable. 

Dr.  Taylor  implied  that  it  was  the  duty  of  married 
people  to  produce  children  indefinitely,  regardless  of 
means,  of  bodily  or  mental  ^tness.  or  of  any  other 
factor  of  environment. 

Dr.  Taylor  on  July  27th  wrote  thanking  Dr.  Drysdale 
for  dealing  with  the  first  part  of  my  pai)er.  Dr. 
Drysdale  supported  the  view  that  the  fall  m  the  total' 
birth-rate  is  altogether  due  to  preventive  practices.  I 
venture  to  say  that  he  does  not  dispose  of  my 
argument  that  the  fall  is  due  mainly  to  other 
causes.  Dr.  Taylor,  however,  classes  me  with  Dr.. 
Drysdale  as  an  advocate  of  preventive  methods,  which 
is  unfair  and  unjust.  He  then  says  I  fall  into  a  greater 
fallacy  than  that  which  I  think  I  am  exposing. 
The  "  fallacy  "  which  he  seeks  to  place  upon  my 
shoulders  in  tu  quoque  fashion  I  fail  to  comprehend, 
but  gather  it  has  something  to  do  with  the  sug- 
gestion appropriated  from  my  paper  that  the  fall  in 
illegitimacy  may  be  more  or  less  due  to  the  use  of 
preventive  methods.  In  any  case,  there  is  no  need 
for  him  to  introduce  fresh  matter. 

Such  grounds,  Dr.  Taylor  says,  dispose  of  the  "  first 
twelve  of  my  so-called  conclusions."  I  venture  to- 
think,  however,  that  a  scientific  question  cannot  be  dis- 
missed in  that  cavalier  fashion  by  blinking  awkward 
criticisms  and.  so  to  speak,  knocking  together  the  heads* 
of  one's  opponents.  Nor  are  Dr.  Taj'lor's  other  thrusta 
and  parries  more  convincing. 

I  suggested  the  question  of  the  falling  birth-rate  in 
the  United  Kingdom  might  well  be  investigated  by  a 
Royal  Commission.  Dr.  Taylor  asks  if  I  do  not  know 
a  Royal  C-ommission  has  sat  on  the  subject  in  New^ 
South  Wales.  He  might  as  well  refer  me  to  any  other 
Royal  Commission  of  Inquiry  on  any  other  subject  in 
any  part  of  the  world.  Social  and  economic  conditions 
in  New  South  Wales  and  in  the  Mother  Coimtry  are  as 
chalk  to  cheese. 

Then,  again,  in  your  issue  of  August  loth,  Dr.  Taylor 
expresses  sorrow  for  the  unnecessary  trouble  caused  to 
himself  and  to  a  "  kind  correspondent  "  by  Dr.  Walsh's 
mistake  in  giving  31  as  (approximately)  the  total 
birth-rate  for  the  United  Kingdom  in  1884.  That  state- 
ment Dr.  Taylor  and  his  friend  seek  to  controvert  by 
quoting  the  total  birth-rate  for  England  and  Wtdes  in 
1884,  namely,  33*6.  It  grieves  one  to  see  so  much 
sorrow  run  to  waste.  It  is  still  more  saddening  to  find 
inaccuracy  of  the  kind  shown  by  Dr.  T  aylor  andJ 
his  friend  figuring  in  the  columns  of  a  scientific  journal. 

Truth  is  truth.  The  laws  that  govern  the  rise  and 
fall  of  birth-rates  will  doubtless  one  day  emerge  from 
the  mist  of  futilities  in  which  they  are  now  enshrouded 
into  the  full  light  of  knowledge.  Meanwhile,  irrele- 
vancy and  intellectual  slovenliness  will  not  mend 
matters.  If  Dr.  Taylor's  view^s  are  right  they  are 
capable  of  proof  oy  ordinary  recognised  methods  of 
formal  argument.  It  is  for  him  to  make  good  his  case- 
against  all  comers. 

I  am.  Sir,  vours  truly, 

Davh>  Walsh.- 

Hanover  Street,  London,  W. 

SUPERSTITION  AND  PSYCHOLOGY. 
To  the  Editor  of  The  Medical  Press  and  Circular- 
Sir,— The  letter  by  Mr.  H.  Rider  Haggard  to  the- 
Times  on  "  Telepathy  between  a  Human  Being  and 
a  Dog,"  which  you  criticised  in  an  able  leader  oiv 
August  3rd,  has  been  followed  by  another  lengthy 
communication  in  the  same  newspaper  of  August  9th. 
If  the  name  appended  to  these  letters  had  not  held  a- 
place  in  literature  it  is  hardly  possible  they  would' 
have  found  admission  to  the  pages  of  your  great  con- 
temporary.      They  may    be     literature,     they    are- 


t84    Tbv  Medical  Prbss. 


OBITUARY. 


August   17,  1904- 


♦certainly  npt  science.  From  the  scientific  point  of  view 
both  th^' letters  are  equally  beneath  serious  attention. 
The  point  of  interest,  as  these  letters  once  more  show, 
is,  thB.t  there  exist  vast  masses  of  the  people,  hardly 
less  numerous  among  the  so-called  cultured  than 
among  the  uneducated  classes,  who  are  absolutely 
ignorant  of  science  and  of  scientific  methods,  and  as 
'Credulous  in  all  questions  of  natural  phenomena  as 
their  ancestors  who  believed"in  witchcraft,  and  in  the 
•constant  occurrence  of  miracles  in  the  events  of  daily 
life.  Mr.  Rider  Haggard  apparently  sticks  to  his 
•opinion  that  the  circumstances  of  his  dog's  death 
were  communicated  to  him  by  telepathy  in  some 
form,  and  seriously  discusses  the  following  suggestions 
to  account  for  the  fact : — 

(i)  That  his  own  spirit  or  sub-consciousness  travelled 
to  the  place  and  saw  the  things  happen. 

(2)  That  the  telepathic  information,  considerably 
delayed  in  transmission,  came  from  the  brain  of  a 
human  being  who  witnessed  the  death  of  the  dog. 

(3)  That  this  is  an  instance  of  deferred  telepathy, 
'the  communication  coming  from  the  dog  and  acting 
upon  his  mind  hours  afterwards  in  his  sleep. 

(4)  That  his  own  clairvoyance  was  the  cause. 

(5)  That  the  dog's  astral  shape  visited  him. 

Mr.  Rider  Haggard,  after  critically  examining  these 
hypotheses  seriatim,  rejects  them  all  in  favour  of 
his  previously  expressed  opinion,  that  "  This  curious 
happening  must  have  been  due  to  some  non-bodily 
but  surviving  part  of  the  life  or  of  the  spirit  of  the 
dog."  Mr.  Rider  Haggard  declares  that  his  dog  Bob 
was  superior  to  some  degraded  human  beings,  and 
if  these  beings,  as  he  believes,  are  -'  possessed  of  an 
immaterial  part  called  a  spirit "  he  does  not  know 
why  Bob  "  should  not  have  a  spirit  also,"  and  why 
that  spirit  as  it  departed  hence  should  not  have  re- 
produced in  Mr.  Haggard's  consciousness,  "  with , 
which  in  life  he  was  so  familiar,  the  dramatic  cir- 
cumstances of  his  end,  or  as  much  of  them  as  he 
•considered  necessary  and  important "  ! !  Mr.  Rider 
Haggard  "  does  not  say  that  this  is  so,"  he  can  only 
say  he  can  see  no  overpowering  religious  or  practical 
reason  to  the  contrary.  Everyone  will  agree  that  if 
an  argument  is  built  upon  a  foundation  of  pure  hypo- 
thesis unsupported  by  a  single  scientific  fact,  and 
mostly  revolting  to  a  trained  intellect,  it  matters  not 
what  crowning  absurdity  be  accepted  to  conclude 
the  argument ;  and  if  we  accept  Mr.  Haggard's  facts 
and  hypotheses  we  can  all  admit  the  possibility  of 
causation  of  his  nightmare  to  lie  in  a  visitation  by 
the  spirit  of  his  faithful  dog-friend  Bob. 

I  am.  Sir,  yours  truly, 

August  loth,  1904.  H.  S. 


facilitated,  and  this,  I  think,  is  an  additional  advantage 
besides  that  of  prevention  of  perineal  rupture. 

I  am  glad  to  know  that  my  own  practice  is  eadorsed 
by  such  a  valued  authority  as  Dr.  Duke. 
I  am,  Sir,  yours  truly, 

JA.MES  BURNBT. 

20  Pol  wart  h  Crescent,  Edinburgh. 
August  loth,  1904. 

METEOROLOGY  AND  HEALTH  RESORTS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  before  me  an  article  on  '*  Meteorology  " 
(July  3rd,  1889)  in  The  Medical  Press  and  Circular. 
In  this  present  week's  number  of  this  journal,  August 
loth,  1904,  there  is,  on  p.  144,  a  report  upon  Teign- 
mouth  as  a  health  resort ;  and  on  p.  1 59  ^  notice  of 
Dr.  Bumey  Yeo's  book  on  the  '■  Therapeutics  of 
Mineral  Springs  and  Climates."  The  most  important 
point  to  be  attended  to  when  dealing  with  the  climate 
of  a  place  is  the  nature  of  the  soil.  In  the  article  on 
meteorology  we  read,  "  In  evidence  of  this  we  observe 
that  a  committee  has  been  appointed  by  the  Medico- 
Chirurgical  Society,  Ac,"  and  in  the  notice  of  Dr.* 
Yeo's  book  we  read  that  the  report,  "  although  good 
in  intention,  failed  to  attract  the  notice  which  from 
the  reputation  of  the  contributors  it  deserved."  The 
report  did  not  deserve  notice,  for  it  did  not  follow 
the  principles  laid  down  in  the  article  of  July,  1889, 
and  was  practically  of  no  value  ;  hence  its  fate. 

It  is  to  be  regretted  that  under  the  heading  "  British 
Health  Resorts  "  there  has  been  shown  the  same  want 
of  scientific  and  practical  knowledge  which  is  abso- 
iately  necessary  for  those  who  attempt  to  analyse 
the  value  of  health  resorts.  It  is  to  be  regretted  that 
this  subject  is  so  little  understood  and  is  so  feebly 
treated. 

I  am,  Sir,  yours  truly, 

Kensington,  August  I2th»  1904.  R.  L. 


PREVENTION  OF  PERINEAL  RUPTURE. 

To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— Like  Dr.  Duke,  I  regarded  Lapthorn  Smith's 

method,  referred  to  in  your  issue  for  August  3rd,  as 

ridiculous  in  the  extreme.     My  object  in  writing  now 

is  to  endorse  your  correspondent's  treatment  of  the 

perinaeum  with  the  object  of  preventing  rupture.     I 

was  not  aware,    until  I  read  Dr.  Duke's  letter,    that 

-anyone  had  actually  suggested  a  plan  of  treatment 

which  I  have  always  employed.     There  must  surely 

T)e  a  good  deal  of  intuition  in  the  practice  of  medicine, 

for  I  adopted  the  method  of  retracting  the  perinaeum 

-on  my  own  initiative. 

I  go  further,  however,  than  Dr.  Duke,  for  I  not  only 
retract  the  perinaeum  duriftg  the  uterine  contractions, 
but  also  between  the  pains.  The  perinaeum  being  a 
very  elastic  structure,  it  yields  readily  to  traction, 
and  my  plan  is  to  pull  upon  it  with  either  two  or  three 
fingers  in  the  vagina.  When  the  perinaeum  is  at  all 
rigid  (which  is,  after  all,  quite  an  exceptional  occurrence) 
^he  administration  of  a  little  chloroform  greatly  aids 
the  carrying  out  of  this  procedure,  as  thereby  the 
parts  are  made  more  yielding. 

The  result  obtained  by  the  retraction  method  is'that 

the  head  is  not  forced  down  on  the  perinaeum  during 

the  pains  to  such  an  extent  as  it  is  when*theperina;um 

^"is    not    retracted.     The  passage  of  the^head  is  thus 


SIR  WILLIAM  MITCHELL  BANKS,    K.C.B..  M.D., 
F.R.C.S. 
Great  regret   was  occasioned  in  Liverpool  on  the 
receipt    of  a  telegram    announcing    the  sudden  death 
from  angina  pectoris,  of  Sir  William  Mitchell  Bankt 
the  distinguished  surgeon,  who  was    spending  a  holi- 
day on  the    continent.    Sir  William  Mitchell  Banks. 
M.D.,  F.R.C.S.    and   a    Justice  of  the  Peace  for  the 
city  of  Liverpool,  was  in  his  sixty-second  year  at  the 
time  of  his  death.     He  was   the  son  of  Mr.  Peter  S.. 
Banks,  a  well-known  Edinburgh  solicitor,  his  mother 
being  the  daughter  of  a  Liverpool  merchant.     The 
future  surgeon  was  educated  in  Edinburgh  Academy' 
and  University.     In  1864  he  took  the  degree  of  M.D. 
with  honours,    gaining    the     University  Gold   Medal 
for  an  anatomical  thesis  on  the  Wolffian  bodies.     He 
obtained  his  degree  at  Edinburgh  of  LL.D.  in  1899. 
He  acted  as  Demonstrator  of  Anatomy  in  the  Glasgow 
University  for  two  or  three  years,  and  then  settled  in 
Liverpool  as  an   operating  surgeon   and   teacher  of 
anatomy.     He  soon  made  his  mark,   and  for  many 
years  he  has  been  regarded  as  one  of  the  foremost 
surgeons  in  the  Kingdom.     In  addition  to  an  extensive 
private   practice,    he   was   surgeon   to   the  Liverpool 
Royal  Infirmary,  in  the  establishment  of    which  he 
spent  much  time,  and  gave  a  great  deal  of  valuable 
help  in  a  variety  of  ways.     The  University  College, 
now  the  Liverpool   University,   is  another  local  In- 
stitution which  benefited  extensively  from  his  advice 
and  assistance.     Other  directions  in  which  Sir  William 
found  an  outlet  for  his  great  skill  were  on  the  General 
Medical  Council  and    on    the    Council  of  the  Royal 
College  of  Surgeons  of  England.     One  of  his   most 
notable   works   was   in   connection   with   the   recent 
development  of  the  Medical  School  of  Liverpool.     He 
took  little  or  no  active  part  in  public  a£Eairs.  C  His 
name  is  especially  associated  with  the  advocacy  of 
extensive    operative    measures    for    the    removal   of 
cancer  of  the  breast  and  with  attempts  to  discover  the 
most  suitable^operation  for]|the'radicarcure  of  rupture. 


August   17,    1904. 


LITERATURE. 


Tn  Mbdioai.  Pum.    I&S 


SIR  FREDERICK  BATEMAN.   K.C.B.,   M.D.. 
LL.D.,    J. P. 

It  is  with  sincere  regret  we  announce  the  death  of 
Sir  Frederick  Bateman»  in  the  8ist  year  of  his  age. 
on  the  loth  instant,  at  his  residence,  70  St.  Giles*  Street, 
Norwich.  Death  was  due  to  heart  failure,  apparently 
connected  with  the  recent  hot  weather.  Two  days 
before  his  death  he  introduced  his  successor  at  the 
Norwich  Bethel  Hospital,  an  institution  with  which 
he  had  been  connected  for  more  than  thirty  years. 
He  was  the  son  of  a  leading  Norwich  citizen.  His 
first  professional  post  was  that  of  resident  surgeon  to 
the  Norfolk  and  Norwich  Hospital,  to  which  he  was 
appointed  surgeon  in  1851,  and  where  he  was  a  student 
in  earlier  years.  In  one  capacity  and  another  he 
was  connected  with  the  institution  for  over  sixty 
years,  and  he  held  the  position  of  consulting  physician, 
an  appointment  conferred  upon  him  at  the  close  of  his 
term  of  duty  as  senior  physician.  Up  to  the  time  of  his 
death  he  was  also  consulting  physician  to  the  Eastern 
Counties  Asylum,  at  Colchester,  an  institution  in 
which. he  took  the  warmest  interest,  the  Norfolk  and 
Norwich  Eye  Infirmary,  the  Jenny  Lind  Infirmary  for 
Sick  Children,  the  Norwich  City  Asylum,  and  the 
Bethel  Hospital—in  the  case  of  the  latter  for  thirty 
years.  For  a  long  time  he  was  prominently  connected 
with  the  public  life  of  his  native  town.  In  1872  he 
was  appointed  Sheriff,  and  in  1892  he  received  the 
Queen's  Birthday  Honour  of  Knighthood.  In  1855 
he  married  Miss  Emma  Brownfield.  He  leaves  three 
sons,  all  living,  and  all  holding  honoured  positions 
in   the  medical   profession.     Sir   Frederick   Batemau 


supported  in  an  "eminent  degree  the  traditions  that 
have  made  Norfolk  famous  in  the  annals  of  medical 


science.  

WILLIAM  HOLLOWAY,  M.D.Lond.,  A.M..  M.R.C.S. 

We  regret  to  announce  the  death  of  Dr.  William 
George  HoUoway,  of  Hertford  Street,  Mayfair,  an 
authority  on  diseases  of  the  throat  and  nose,  at  the 
early  age  of  forty-three  years.  Educated  at  Sidney 
Sussex  College,  Cambridge,  and  at  St.  Mary's  Hospital 
Medical  School,  he  took  his  B.A.,  with  a  first  class 
in  the  natural  science  tripos  in  1883.  and  his  M.B. 
with  a  first  class  in  the  second  examination  in  1886. 
He  was  a  scholar  of  St.  Mary's  Hospital  in  1884-85, 
was  admitted  a  member  of  the  Royal  College  of 
Surgeons.  En^nd,  in  1885,  and  was  prizeman  and 
scholar  of  St.  Mary's  in  several  subjects  in  1885-86. 
In  1890  he  proceeded  to  the  M.D.  degree.  Dr. 
Hollowey  had  been  house  surgeon  to  the  St.  Leonards 
and  East  Sussex  Hospital  and  house  physician  to  the 
General  Lying-in  Hospital,  Lambeth.  He  was  sub- 
sequently for  many  years  connected  with  the  Central 
London  Throat,  Nose,  and  Ear  Hospital  as  clinical 
assistant,  afterwards  as  pathologist,  registrar,  and 
anaesthetist,  and  finally  as  senior  assistant  surgeon. 
He  was  a  fellow  of  the  British  Laryngological  and 
Rhinological  Association  and  a  member  of  the  Harveian 
Society  of  London  and  of  the  British  Medical  Asso- 
ciation.   

JOHN  RUXTON.    M.D.Aberd..  OF  BL.\CKPOOL. 

Dr.  Ruxton  died  suddenly  on  August  5th  at  his 
residence,  North  Shore,  Blackpool.  The  deceased, 
who  was  56  years  of  age  and  married,  went  to  Blackpool 
about  twenty-one  years  ago.  He  was  one  of  the  con- 
sulting surgeons  at  the  Victoria  Hospital,  Blackpool. 
Dr.  Ruxton  lived  a  somewhac  retired  life,  and  took 
no  part  in  public  affairs.  His  medical  education  was 
conducted  at  Aberdeen,  where  he  graduated  M.B., 
CM.,  in  1869,  and  M.D.  in  1883. 

JOHN  HENRY  GREENWAY,  R.A.M.C. 
The  death  is  announced  of  Major  John  Henry 
Greenway,  of  the  Royal  Army  Medical  Corps,  who 
died  on  August  8th,  at^Wynberg  Camp,  Cape  Town. 
Major  Greenway,  who  was  born  in  1857,  after  com- 
pleting his  education  at  Guy's  Hospital  and  taking 
the  degrees  of  L.S.A.  and  M.R.C.S.Enj;.,  joined  the 
Army  Medical  Corps  in  1885,  and  attained  the  rank 
of  Major  in  1897.  He  served  in  the  Orange  River 
Colony  during  the  South  African  War. 


.Xttetatute« 


ORGANIC  NERVOUS  DISEASES,  {a) 

The  need  of  3  thoroughly  trustworthy  work  ons 
diseases  of  the  nervous  system^  dealing  exhaustively 
and  critically  with  the  subject,  has  long  been  fell.  It  is^ 
the  most  difficult  and  complex  portion  of  the  medical 
curriculum,  and  its  literature  is  scattered  widely  over 
isolated  papers  in  monographs  not  alWays  easy  of 
access.  Dr.  Allen  Starr  is  a  neurologist  of  repute, 
whose  contributions  have  for  many  years  attracted' 
attention,  and  whose  name  is  as  familiar  in  London* 
as  it  is  in  New  York.  There  is  no  one  better  fitted., 
either  from  familiarity  with  the  history  of  the  subject 
or  from  personal  experience,  to  fill  the  hiatus,  and  the 
result  of  his  attempt  is  a  bocric  of  750  pages,  profusely 
illustrated  with  original  engravings  and  plates  in- 
colours  and  monochrome.  A  good  way  of  judging  of 
the  value  of  a  work  on  any  special  subject  is  to  select 
jsome  particular  disease,  preferably  one  of  common* 
occurrence,  and  by  careful  examination  to  ascertain* 
how  far  it  comes  up  to  one's  ideal.  We  take  as  an* 
example  locomotor  ataxy,  tabes  dorsalis,  or  posterior- 
sclerosis.  The  first  thing  we  notice  is,  that  the  author 
enters  into  no  discussion  as  to  the  relative  advantages- 
of  these  terms,  and  that  there  is  no  section  devoted  to* 
nomenclature.  This  is  but  a  small  omission,  and  is 
perhaps  hardly  worth  mentioning.  Much  more  im- 
portant are  the  questions  of  morbid  anatomy  and* 
pathology,  both  of  which  are  admirably  rendered,  all> 
the  most  recent  observations  and  theories  being  de- 
scribed in  detail.  Under  the  head  of  etiology  there 
are  references  to  the  influence  of  syphilis  in  the  pro- 
duction or  causation  of  tabes,  and  the  author  adduces, 
many  arguments  against  its  being  of  syphilitic  ( ?  para- 
syphilitic)  origin,  although  a  predisposing  influence  ins 
a  large  number  of  cases  is  admitted.  It  is  rare  to  find 
tabes  in  Japan  or  in  China  or  among  the  negro  races,, 
and  yet  syphilis  is  common  enough  among  these  people. 
The  symptomatology  of  tabes  is  given  at  considerable- 
length,  and  we  have  never  before  met  with  an  equally 
comprehensive  account  of  the  subject.  The  loss  of 
knee-jerk  is,  of  course,  referred  to,  but  is  not  spoken* 
of  as  Westphal's  sign.  The  term  "  iridoplegia "  is 
not  mentioned  as  a  synonym  of  the  Argyll-Robertsom 
phenomena.  Th6  Various  crises  are  well  described, 
including  the  laryngeal  vertigo  of  Charcot.  The  author 
has  not  seen  the  gastric  crises  of  the  French  writers, 
and  does  not  mention  the  clitoridectian  crisis  which* 
accounts  for  the  curious  perverted  sexual  manifes- 
tations sometimes  met  with  in  erotic  women.  The 
Charcot  joints  ard  illustrated  and  an  excellent  engraving 
is  given  of  the  perforating  ulcer  of  the  foot.  The* 
author  speaks  of  subluxation  with  reference  to  certaim 
joints,  but  does  not  employ  the  term  hjrpotonia.  The- 
mental  condition  is  described  at  some  length,  the  author- 
recognising  that  there  is  a  close  connection  between^ 
tabes  and  general  paresis.  A  useful  section  is  devoted 
to  the  rarer  symptoms  of  the  disease,  which  might  well 
form  the  bases  of  a  good  examination  question.  The 
pages  on  the  treatment  of  this  common  and  intractable- 
disease  are  not  only  thoroughly  practical,  but  are  more* 
complete  than  will  be  found  in  any  other  treatise.  We 
have  applied  a  somewhat  severe  test,  and  Dr.  Alleui 
Starr  has  more  than  answered  our  expectations. 

Turning  now  to  another  subject,  we  find  no  mention* 
of  Morvan's  disease  in  the  index,  but  under  the  head' 
of  "  Syringomyelia,"  there  is  not  only  a  reference  to> 
Morvan's  original  paper,  but  a  full  description,  with 
an  excellent  and  typical  series  of  illustrations  showing: 
the  trophic  change  in  the  hands. 

Gilles  de  la  Tourette's  disease  we  do  not  find  men- 
tioned, but  it  is  probably  excluded  on  the  ground  that 
it  is  not  due  to  a  gross  organic  lesion,  and  is  purely 
functional  in  character. 

The  difficult  subject  of  neuritis  is  dealt  with  at  con> 
siderable   length.      Multiple    neuritis    first     receives- 


{a)  "Ortanic  Keryou» DUeuet."  By  K.  Allen  Starr,  M.D..  LL.D. 
Profeflflor  of  DiseMes  of  the  Mind  and  'Nervous  S^ttem  in  the 
College  of  Phyucians  and  SarireoDB  of  Golunbia  University,  Newr 
York.    London:  BaiUieie.Tindall and  Cox.    Ift04..  PrJcetts.net. 


1 86    The  Medical  Pkess. 


LITERARY  NOTES  AND  GOSSIP. 


August  17,  1904 


consideration,  and  attention  is  then  devoted  to  alcoholic 
neuritis,  arsenical  neuritis,  the  multiple  neuritis  due  to 
poisoning  by  lead,  and  other  analogous  forms.  We 
are  glad  to  find  that  the  neuritis  which  sometimes 
follows  the  administration  of  sulphonal  and  trional  is 
alluded  to.  Under  various  headings  are  considered 
the  multiple  neuritis  of  diphtheria,  the  form  accom- 
panying or  following  attacks  of  influenza,  leprous 
neuritis,  and  the  epidemic  multiple  neuritis  known  as 
beri-beri  or  kakke.  All  these  are  described  and  dis- 
cussed at  considerable  length,  and  much  attention  is 
devoted  to  their  treatment. 

Other  useful  chapters  deal  with  such  subjects  as 
the  diagnosis  and  location  of  brain  diseases,  syphilis  of 
the  nervous  system,  and  the  muscular  dystrophies. 

We  are  greatly  pleased  with  this  work,  which  is 
probably  the  best  and  most  comprehensive  volume  on 
organic  nervous  diseases  in  any  language. 

SURGICAL  BANDAGING,  (a) 

The  author  in  writing  this  small  work  has  en- 
deavoured to  provide  a  ready  and  complete  pocket 
reference  book  for  junior  students  and  nurses  in  surgical 
wards. 

The  book  opens  with  a  chapter  on  the  modem  treat- 
ment of  wounds.  The  older  methods  of  treatment  are 
briefly  alluded  to  and  contrasted  with  those  in  use  at 
present.  The  bacteriology  of  the  subject  of  wound 
infection  is  gone  into  sufficiently  to  make  the  treat- 
ment of  wounds  and  the  reasons  for  asepsis  and  anti- 
sepsis quite  clear.  The  various  antiseptics  in  use  are 
mentioned  and  discussed  ;  we  would,  however,  like 
to  see  lysol  included  in  the  list.  Full  details  of  the 
methods  of  sterilising  dressings  and  instruments  are 
given.  The  following  occurs  on  page  21  : — "  During 
the  process  of  sterilisation  the  thermometer  should 
make  a  heat  of  120®  F.  at  least."  We  did  not  know 
before  that  a  thermometer  was  capable  of  producing 
heat,  but  we  would  like  to  see  the  minimum  tempera- 
ture considerably  over  120°  F. 

The  author,  in  Chapter  VI,  dealing  with  the  pre- 
paration of  the  patient  for  operation,  says  :  "  The  usual 
steps  having  been  taken  to  empty  the  lower  boweL" 
He  seems  here  to  forget  that  he  is  describing  things 
for  the  uninitiated. 

Several  chapters  are  devoted  to  bandaging  and 
splints.  The  various  methods  and  forms  are  well 
illustrated  and  described. 

In  the  chapter  on  '*  Nursing  in  Cases  of  Injury," 
much  useful  information  is  given  for  injuries  of  the 
different  parts  of  the  body. 

The  book  concludes  with  a  chapter  on  "  The  Tem- 
perature and  Pulse,"  in  which  the  following  requires 
some  explanation  : — "  The  pulse  should  not  always  be 
taken  on  the  same  side.  In  some  cases  the  pulse  on 
the  right  side  is  slower  or  more  rapid  than  that  on 
the  left  side,  and  there  may  be  other  irregularities." 

On  the  whole  the  book  for  its  size  is  complete,  and 
one  which  junior  students  and  nurses  will  find  ery 
handy  and  useful. 

LAKE  ON  DISEASES  OF  THE  EAR.  (6) 
This  is  an  excellent  handbook  for  advanced  students 
and  general  practitioners,  and  is  published  at  a  very 
moderate  price.  Mr.  Lake  wisely  restricts  his  first 
chapter  to  a  "  brief  description  of  the  more  important 
anatomical  points,"  neither  plunging  into  too  profuse 
descriptive  details,  nor  yet  scamping  the  really  im- 
portant ones.  The  next  two  chapters  are  devoted  to 
the  general  and  special  examination  of  the  patient, 
and  under  the  latter  heading  the  author  sounds  a  note 
of  warning  as  to  a  cautious  prognosis  of  the  curative 
effect  of  intra-nasal  surgery  on  aural  diseases.  During 
past  years  intra-nasal  surgery  appeared  to  be  a  panacea 


la  **  Pnctical  Guide  to  Surgical  B«odaffii>ir  •ad  DressingB."  By 
Wm.  Johnson  Smith,  F.R.O  S.,  Priodpal  Medical  Officer,  Seamea's 
HoHpital,  Greenwich.  Pp.  167  and  viii,  with  70  iliustraUona.  London : 
The  Scientific  Frees,  Limited.  FhUadelphia :  J.  P.  Lippincott  Co. 

(ft)  **  Handbook  of  Diseases  of  the  Ear  for  the  Use  of  Students  and 
PractiUonen."  By  Richard  Lake,  F. B.  C.  B,^ag,,  Surgeon,  Royal  Ear 
Hoepitai,  Lecturer  on  Practical  Otology,  Medioal  Graduates'  College. 
Pp.  z  and  vS2.  54  illustrations  and  three  coloured  pUtes.  Crown 
8vo.    Price  6s.  net. 


for  most  human  ills,  but  we  are  glad  to  find  that  the 
tide  is  turning  and  that  it  is  being  Umited  to  its  own 
sphere  of  undoubted  usefulness.  The  "  estimation  of 
the  acuteness  of  hearing  "  and  "  the  use  of  instru- 
ments "  are  very  well  done,  but  the  forceps  for  cleansing 
the  ear  (Fig.  2 1 )  would  be  more  useful  if  curved  as  in 
the  illustration  of  Griiber's  carrier  (Fig.  24),  so  that 
the  hand  of  the  operator  holding  it  may  be  kept  well 
out  of  the  path  of  the  light  from  his  head  mirror. 
Diseases  and  malformation  of  the  external  ear,  diseases 
of  the  middle  ear.  acute,  chronic  suppurative  and  non- 
suppurative, have  each  chapters  in  which  their  various 
forms  are  described  as  fully  as  the  Jimits  of  the  book 
allow.  Two  very  good  coloured  plates  are  given  of 
chronic  non-suppurative  and  suppurative  diseases  of 
the  middle  ear  ;  and  the  intra-cranial  complications 
of  the  latter  have  a  chapter  to  themselves,  as  has  the 
influence  of  diseases  of  the  middle  ear  on  life  assurance. 
A  useful  appendix  and  index  are  added.  The  print- 
ing, binding,  &c.,  are  well  done. 

Xttetaty  floteB  and  Gossip* 

Dr.  Arthur  H.  Rideai  has  had  reprinted  from 
the  Army  and  Navy  Gaaieite  of  February  13th  last, 
his  article  on  "  National  Physique  and  an  Ideal 
Army."  '  The  scheme  he  suggests  is  that  all  boy^ 
should  be  compulsorily  trained  with  a  view  to  their 
military  usefulness  as  Volunteers  in  the  event  of 
national  danger.  He  calculates  that  in  eight  years 
from  the  initiation  of  the  scheme  there  would  be  more 
than  a  million  well-trained  young  men  at  the  service 
of  the  country  in  case  of  need,  and  that  in  course  of 
time  every  able-bodied  man  in  the  Kingdom  would  be 
sufficiently  trained  to  take  up  arms  at  once  in  defence 
of  the  Empire. 

♦♦• 

Recent  mishaps  as  regards  the  leaving  of  instru- 
ments in  the  aMominal  cavity  have  caused  much 
commotion,  both  inside  and  outside  the  medical 
profession.  As  it  seems  clear  that  the  surgeon  cannot 
trust  the  ordinary  methods  of  checking  instruments 
used  at  an  operation,  it  vrill  be  wise  to  adopt  some 
system  whereby  exact  written  dates  can  be  referred 
to  at  a  glance.  Such  a  plan  is  offered  in  the  "ABC 
Instrument  Check  Book"  designed  by  A.  E.  S.  Waters, 
M.R.CS.Eng.,  and  published  by  Sharman  and  Co., 
of  March.  It  has  a  heading  space  for  name  of  patient, 
date,  and  other  details,  followed  by  a  list  of  instru- 
ments, with  their  number,  both  before  and  after 
operation.  At  the  foot  is  a  blank  space  for  the  signa- 
ture of  the  person  responsible  for  the  instruments. 
The  idea  is  a  good  one  and  well  carried  out. 
•♦♦ 

Messrs.  W.  B.  Saunders  and  Co.  announce  that 
the  new  (second)  edition  of  Pusey  and  Caldwell's 
work  on  '-  Rontgen  Rays  in  Therapeutics  and  Diagno- 
sis "  will  be  ready  in  about  two  weeks,  the  first 
edition  being  exhausted.  The  new  edition  will  be 
increased  by  about  100  pages,  and  the  case  histories 
will  be  brought  down  to  date.  The  price  of  the  work 
will  remain  as  heretofore,  21s.  net.  The  same  firm 
will  also  publish  in  the  autumn  an  important  new 
work  on  the  *'  Vermiform  Appendix  and  its  Diseases," 
by  Dr.  Howard  A.  Kelly. 

%♦ 

It  is  officially  announced  that  the  Lon'fon  University 
Gazette  wiU  appear  at  longer  intervals  than  hitherto. 
Eleven  numbers,  instead  of  twenty,  will  be  published 
in  the  course  of  the  Academic  year,  on  Wednesdays, 
at  average  intervals  of  four  weeks.  The  first  will  be 
issued  on  September  28th,  1904 ;  and  the  dates  of  the 
other  numbers  will  probably  be, — November  9th, 
December  7th,  December  28th,  February  8th,  "MsLich. 
8th,  April  5th,  May  31st,  June  21st,  Jiily  19th,  and 
August  9th. 

♦♦• 

We  have  received  three  interesting  booklets  in 
paper  covers  from  the  "  Simple  Life  Series,"  published 
by  A.  C.  Fifield.  of  Fleet  Street,  Ix)ndon.  No.  IX 
is  the  classical  "  Walden,  My  Life  in  the  Woods,"  by 


August  17,  1904. 


PASS  USTS. 


Ths  Medical  Piess.     187 


H.  D.  Thoreau  ;  No.  X.  "  Tolstov  as  a  Schoolmaster," 
by  Emest  Crosby;  aud  No.  Xl'"  Master  and  Man." 
by  Leo  Tolstoy.  The  price  of  each  volnme  is  sixpence 
only,  yet  the  printing,  paper,  and  publishing  are  of 
tirst-rate  excellence.  Our  readers  could  hardly  make 
a.  better  investment  as  regards  cheap  reproductions 
of  good  literature.  No.  XIII  of  the  same  series  costs 
threepence.  It  is  the  well  known  essay  of  Ralph 
Waldo  Emerson  upon  "  Culture." 

%♦ 

The  Orthops  Test  Chart  is  a  convenient  combination 
for  the  consulting  room.  It  measures  forty  inches  by 
twenty-five  inches,  and  contains: — {a)  An  arc  of 
radiating  bars ;  (6)  a  series  of  Snellen's  test  types  ; 
(c)  a  revolving  astigmatic  diamond,  and  (d)  a  muscle 
test.  The  arrangement  and  size  of  the  bars  and  the 
spaces  between  them  on  the  revolving  disc  and 
radiating  arc  are  such  that  a  small  degree  of  astig- 
matism can  be  made  manifest,  and  the  principal 
meridians  determined  with  great  exactitude.  The 
figures  of  the  muscle  test  are  printed  on  one  side  in 
r^  and  the  other  in  green.  The  chart  being  a  com- 
bination of  various  charts,  it  occupies  a  minimum  of 
wall  space.  The  chart  has  been  designed  by  Mr. 
Lionel  Laurance,  and  is  published  by  Messrs.  Storey 
and  Co.,  of  Leeds. 


Xaboraton?  notes* 

DIGITALONE. 
Medical  men  frequently  complain  of  irritation 
following  the  hypodermic  injection  of  digitalin.  More- 
over the  preparations  placed  on  the  market  as 
digitalin  vary  greatly  in  composition  and  in  physio- 
logical activity,  some  of  the  commercial  products 
consisting  of  digitoxin,  or  mixtures  of  digitoxin  and 
digitalin.  To  overcome  these  defects  and  to  provide 
a  preparation  perfectly  suitable  for  hypodermic  use, 
Parke,  Davis  and  Co.  have  introduced  digitalone,  a 
non-alcoholic,  non-irritating,  aseptic  and  permanent 
solution,  representing  all  the  principles  of  digitalis,  of 
uniform  physiological  activity,  and  standardised  by 
physiological  assay.  The  solution  is  sold  in  one 
ounce  bottles,  equal  in  strength  to  one-tenth  that  of 
the  fluid  extract,  or  four-fifths  that  of  tinct.  digitalis 
B.P.,  the  dose  hypodcrmically  being  eight  to  fifteen 
-minims.  It  supplies  a  real  everyday  want  of  the 
busy  practitioner,  to  whose  notice  it  may  be  cordially 
reconunended. 


AeDical  Vlew9« 


■orpbia  PolMBlDff. 

A  YOUNG  medical  practitioner,  named  Dr.  Benjamin 
Cowing,  has  died  at  the  Belle  Hotel,  Maidenhead, 
under  singular  circumstances.  Dr.  Gowing  had  been 
missing  from  his  home  near  Swansea  for  nearly  a  week, 
and  at  the  inquest  on  Saturday  it  was  stated  that  it 
was  not  known  what  led  him  to  go  to  Maidenhead. 
unless  it  was  to  see  his  stepmother,  who  was  on  a 
visit  to  the  district.  A  brother-in-law  said  that  Dr. 
Gowing  was  in  pecuniary  difi&culties,  and  was  paying 
the  purchase  money  of  his  practice  by  instalments. 
The  jury  returned  a  verdict  of  death  through  taking  an 
overdose  of  morphia  by  misadventure. 

8mall-pox  in  a  Prison. 
Small-pox  has  broken  out  in  the  county  prison  at 
Worcester,  and  two  prisoners  affected  with  the  disease 
have  been  removed  to  the  isolation  hospital. 

Cholera  la  St.  Pttoroburg. 

The  Petit  Parisien  says  that  there  have  been  about 
1 50  cases  of  cholera  in  St.  Petersburg  during  the  last 
two  days,  and  much  alarm  exists  among  the  population. 
The  Prefect  of  Police,  General  Foulon,  has  taken 
severe  measures  to  crush  out  the  epidemic,  which, 
however,  is  asserted  not  to  be  Asiatic  cholera  bnt  a 
relatively  benign  form  of  the  malady. — Times. 


Small-pox  at  Buxton. 

The  Buxton  Chronicle  announces  that  six  cases  of 
small-pox  have  broken  out  at  Hyde,  and  one  of  the 
patients,  an  old  lady  in  her  8oth  year,  has  died  ;  the 
other  patients  are  expected  to  recover.  This  is  one 
of  the  most  extensive  outbreaks  that  Hyde  has  ex- 
perienced for  several  years,  as  the  town  has  generally 
been  very  free  from  the  scourge.  The  sanitary 
authorities  have  .taken  steps  to  confine  the  outbreak. 
After  immunity  for  several  weeks,  a  fresh  case  has 
been  discovered  in  the  Ashton  district. 

PASS    LISTS. 


Univepfllty  of  London. 

The  following  candidates  have  passed  the  general 
Intermediate  Examination  for  internal  students  in 
the  Faculty  of  Medicine  (alphabetically  arranged) : — 
KUa  Mabel  Barker,  Charles  Anthony  Basker,  Harold 
Garfield  Bennett,  Sylvia  Rose  M.  Blackstone,  Mary 
Alice  Blair,  Harry  Blakeway,  Gerald  Tyler  Burke, 
Thomas  Wm.  Higgins  Bume,  AngeL  Camacho,  Thomas 
E.  Ashdown  Carr,  Henry  Joseph  Gates,  Herbert 
Stanley  Chate,  Bertram  Walter  Cherrett.  Arthur 
Beauchamp  Coomber,  Herbert  Rees  Davies,  Kenelm 
Hutchinson  Digby,  Reginald  Lionel  Ernest  Downer, 
Sheldon  Francis  Dudley,  Robert  Cecil  Turle  Evans. 
Marmaduke  Fawkes,  Allan  Baines  Feamley,  Wm, 
Stephen  Fenwick,  Janet  Marcia  Fishe,  Alexander 
Fleming,  Sidney  Frank  Fouracre,  Ernest  William 
Giesen,  Sidney  Wilfred  Grimwade,  Edith  Mary  Guest, 
John  Hadwen,  Eric  Henry  Rhys  Harries,  Henr>' 
John  Henderson,  Tom  Shadick  Higgins,  John  Ernest 
Hodson,  Hendrik  Houwink,  Douglas  Walter  Hume. 
Mary  Sophia  Jevons,  Elizabeth  Herdman  Lepper, 
Clifford  Anthony  L.  Mayer,  Marian  Mayfield,  Minnie 
Merrificld,  Ethel  Mary  Morgan,  Wm.  Poole  Henley 
Munden,  Frederic  Miller  Nciid,,  Henry  John  Nightin- 
gale, Humphrey  Nockolds,  Edgar  Lionel  Robert 
Norton,  Charles  Aubrey  Pannett,  Walter  Patey, 
Catherine  Payne,  August  Frederick  Perl,  Arthur 
John  Scott  Pinchin,  Edward  John  Price,  Mona  Dew 
Roberts,  Richard  Cadwaladr  Roberts,  Henry  Charles 
Samuel,  William  Octavius  Sankey,  Marie  Simpson, 
Eliza  Macdonald  Smith,  Henry  Joste  Smith,  George 
French  Stebbing,  Alfred  K.  B.  R.  W.  Taylor,  Douglas 
Compton  Taylor,  Alfred  Chas.  Foster  Turner,  James 
Richard  Henry  Turton.  Winifred  Emmeline  Watts, 
Harry  Gordon  Webb,  Leonard  Henry  Wootton,  Carl 
Ernst  Znndd. 

The  following  have  passed  the  Intermediate  Exa- 
mination in  M^icine  for  external  students : — 

Laurence  Ball,  Sydney  Herbert  Booth,  Ernest 
Frederick  Finch,  Robert  Applegarth  Hendry,  James 
Ernest  Bliddlemiss,  Edward  Sclby  Phipson,  Harry 
Richardson  Rawlings.  Arthur  Toulmin,  Arthur 
Henry  Turner  and  Joseph  Wm.  James  Willcox. 

Soelet/of  Apotheoarios  of  London.— Ausost,  1904. 

The  following  candidates  passed  in  : — 

Surgdry.— R.  H.  Cooper  (Sec.  II),  A.  W.  S.  De  Vine 
(Sec.  I  and  II),  E.  F.  W.  Hoare  (Sec.  I  and  II),  A.  C. 
Story  (Sec.  I  and  II),  and  R.  H.  Terry  (Sec.  I). 

Medicine,— G,  B.  Messenger  (Sec.  I),  C.  S.  Scott 
(Sec.  II),  I.  C.  Thorbum  (Sec.  I  and  II),  A.  B.  S.  Todd 
(Sec.  II),  and  S.  H.  R,  Welch  (Sec.  I  and  II). 

Forensic  Medicine,— C.  W.  S.  Boggs.  E.  F.  W.  Hoare, 
J.  E.  Jones,  I.  C.  Thorbum.  and  H.  M  Waller. 

Midwifery,— VV.  G.  H.  Cable,  and  W.R.  Elliott. 

The  Diploma  of  the  Society  was.  granted  to  the 
following  candidates,  entitling  them  to  practise 
Medicine,  Surgery,  and  Midwifery  — R.  H.  Cooper, 
A.  C.  Story,  A.  B.  S.  Todd,  and  S.  H.  R.  Welch. 


Baron  Henri  de  Rothschild,  of  Paris,  an 
M.D.  of  the  University  of  Paris,  who  has  attained 
celebrity  as  a  physician  in  that  city,  and  for  several 
year?  has  been  a  subscriber  to  The  Medical  Press 
AND  Circlilar,  has  been  promoted  to  be  a  Knicht 
of  the  Legion  of  Honour. 


l88    Tbe  Mmmcal  PtMs.      NOTICES  TO  CORRESPONDENTS. 


ff^  CtoBUHPOHMHfS  requirinfir »  reply  In  this  oolomn  are  pwrticu- 
vAj  requested  to  make  om  of  a  disUneUv  SigruUiurt  wrltdH^  and 
aroid  the  praotioe  of  signing  themselves  "Reader/*  ^* Sabeoriber/' 
**  Old  Subeoriber,'*  fto.  Mach  confusion  wIU  be  spared  by  attention 
to  this  rule. 

Obioihal  ABTiOLn  or  Lnniu  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  anthenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica 
tion,  but  as  evidence  of  identity. 

Cohtbibutorb  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
-  oOioe ;  if  resident  in  Ireland,  to  the  I>ublin  office,  in  order  to  save  time 
in  re*forwarding  from  office  to  office.  When  sending  subeoriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

RvpBDCTS.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  prootB. 

Pb.  Schbeb  (Algiers).— Your  interesting  case  of  "neurasthenia 
and  deep  conscious  troubles  of  tensilNlity  accompanying  a  very 
•light  and  old  hemlplef  ia  "  is  marked  for  early  insertion. 

Mb.  R.  Stsvbbs.— The  population  of  London  officially  estimated 
to  the  middle  of  the  present  year  is  given  as  4,648,960,  but  this 
refers  only  to  the  inner  circle ;  including  the  suburbs  it  reaches 
e,9t7,O0O.  From  offidrl  souroea  we  also  learn  that  at  the  sameperiod 
of  computation  Glasgow  had  a  population  of  798,000,  Liverpool 
723,000,  Manchester  667,000,  Dublin  3/8,000,  Belfast  368,000,  and  Edin- 
burgh 881.000 ;  all  are  increases  on  previous  censuses,  notwithstand- 
ing the  "  diminishing  birth-rate." 

KOT  YET  EARNED. 

"This  Is  the  billfromyourooulist,"  said  the  collector  to  Mr.  Grimly 
on  calling  for  payment. 

••Just  take  Ti  back  to  him  and  tell  him  that  I  can't  read  it  with 
those  glasses  he  ordered  me." — N.  A.  Muttcai  Rtrhto. 

Db.  H.  S.  E.— (a)  Monro's  Manual  of  Medicine  is  the  most  practical 
single  volume  work  on  the  subject  with  which  we  are  acquainted, 
(b)  Whitla's  Therapeutics,     (c)  Moore's  Meteorology. 

Mbdicus  Etohirhsis.— The  latest  improvement  in  the  incubator 
rearing  of  premature  infants  is  to  supplr  oxygen  more  or  less  con- 
tinuously. The  chances  of  the  survival  of  one  of  these  fractional 
vitalities  would  obviously  be  multiplied  in  that  way,  We  read  lately 
that  in  New  York  a  tea-party  had  baen  arranged  for  all  the  chiklren, 
who  had  been  introduced  to  the'world  via  incubator.  On  this  side 
of  the  Atlantic  such  a  gathering  would  be  extremely  small.  The 
dramatio  nature  of 'the  method  evidently  appeals  strongly  to  the 
Instincts  of  our  transatlantic  consins.  There  is  no  particular  reason 
why  our  country  practitioners  should  not  mount  to  name  and  fame  on 
the  top  of  an  incunator-quite  the  reverse. 

BLEEPING  POTION  FOR  THE  KING. 

Zimmerman,  who  was  very  eminent  as  a  physician,  went  from 
Hanover  to  attend  Frederick  the  Great  in  his  lant  sickness.  One  day 
the  king  said  to  him  :  **  You  have,  I  presume,  sir,  helped  many  a 
maa  into  another  world?"  .This  was  rather  a  bitter  pill  for  the 
doctor,  but  the  dose  he  gave  the  king  in  rstnm  was  a  ludioious  mix- 
ture of  truth  and  flattery.  **  Not  ao  many  as  your  majesty,  nor  with 
so  much  honour  to  mymSi^'—MotUm  Eloqutnce. 

G.  H.  S.~The  sabject  demands  most  careful  and  delicate  handling. 
At  the  same  time  It  to  obvious^  true  that  many  acts  of  relkrious 
fervour,  historical  and  otherwise,  have  arisen  from  a  disordered 
brain.  Supernatural  visions,  prophesies,  and  a  host  of  irrational 
objectiveland  subjective  phenomena  may  be  traced  to  insanity.  The 
reigned  science  is  not  yet  altogether  established  in  this  Inranch  of  the 
wond's  mocal  and  intellectual  development. 

Padhtow,  L.  L.  8.— It  is  open  to  you  to  point  out  to  your  patient  that 
he  is  paying  7s.  6d.  a  bottle  for  his  patent  medicine  the  actual  value 
of  which  is  about  sixpence.  The  fonnuU  of  the  stuff  is  readily 
obtainable. 

R.  K.  Dtxkvob.— Women  medical  ptudents  are  not  allowed  to 
attend  the  University  classes  in  Edinburgh  and  Glasgow,  as  they  axe 
at  Aberdeen  and  St.  Andrews,  nor  will  the  Oolleges  of  Physksiana  and 
Surgeons  admit  women  to  fellowship.  A  special  oommittee  of  kdy 
doctors  practising  in  Scotland  has  been  appomted  to  promote  the 
reforms  desired.  ^ 

Aberaman,nearA.berdare.— A  fully  qualified  Medical  Man  to  take 

Charge  of  a  large  Colliery  District  Practice.     Salary  £400  per 

annum,  with  a  free  house,  coal,  assistants  dispenser,  drugs,  Jkc. 

No  private   practice  allowed.    Applieants  must  be   married. 

Applications    to  the  Secretary,  James  Phillips,    10  Pleasant 

View,  Godre  Aman,  Aberdare. 
North  Cambridgeshire  Hospital,Wisbech.—Reskient   Medical  OfHcer 

(unmarried).  Salary  £100  per  annum,  with  furnished  rooms, 

attendance/  coals,  gas,  and  washing.    Form  of   applteation  to 

William  F.  Bray,  Secretary. 
St.  Bartholomews  Hospital.— Physician  on  the  Staff.     Candidates 

must  be  Fellows  of  the  Royal  College  of  Physicians  of  London. 

AppUcaUons  to  W.  H.  Cross,  Clerk.    ,„,,,„,        „,_ 
Bootle,  Liverpool,  General  Hospital.— Senior  Resident.    Salary  £100 

per  annum,  with  board  and  laundry.    Apply  by  letter  to  the 

Secretary,  Borough  Hospital,  Bootle. 


August    17,  1904 

Royal    Lancaster ,  Inflcmary.^eouse  Smgeoo.     Salary'  £]|0Q  per 

annum,    with    peaidence.  board,    attendance,    and    washiSJ. 

AppU^tions  to  be  made  only  on  a  form  to  be  obtained  from  ths 

Hon.  Hecretaiy. 
Ebbw  Vale  Workmen's  Medical  Fund  Committee.-Senior  Surgeon 

for  the  distnct  of  Victoria,  near  Ebbw  Vale.     Salary  £500  per 

imnum.    Applications  to  Dr.  Keith  Campbell,  Ebbw  Vale.  Men. 
CumbwUnd  Sanatorlnm  tor  Consumption,  near  ThrelkeM,  Keswick. 

-Resident  Medical   Superintendent.    Salary  £ifiO  per  annom. 

Apply  Hon.  Sec,  2  Brunswick  Street,  Carlisle. 
County  Asylum,  Ralnhffl.  near  Uverpool. -Assistant  Medical  Ofltecr 

to  act  as  Locum  Tencfns  for  a  few  wieeks.   Salary  £4  4a.  per  wwk, 

with  furaished  apartments    and    board.    Applications  to  the- 

Medical  Superintendent. 
Birkenhead    and    WIrral    ChUdren's    Hospital.— House    Surgecs. 

Salarv  £400  per  annum,  with  board,  residence,  and    laundry. 

he^  I  to  E.  H.  Tllbey,  Hon.  Sec.,  69  Temple  Rood,  Biiken- 

^^?2B^**""iy,  Asylum.— Required  at  once,  an  Aaaistont  Medka 
Officer.  Salary  commencing  at  £126  per  annum,  with  board  and 
lodgings.  Apply  to  the  Medical  Superintendent,  Avylxm, 
Eixmiossei*. 

Open^jlr  Sanatorium  for  Consumptives,  Limpley  Stoke,  near  Bath. 
-To be  opened  November  next-Resident  Medical  (^eer.  Salarr 
£200  per  annum,  with  annual  increment  £20  to  £800.  Exp«i. 
1^^  t*"  ^1^1**  Treatment  essential.  Applioatums  to 
*'  Chairman."  N.A.P.O.,  84  Park  Street,  Bristol. 

JlptromtmeniB. 

Blatb,  Jobv,  M.DJLU.I..  Honorary  Assistant  Medioal  Offioer  to  ti» 

Royal  Albert  Edward  Infirmary.  Wigan. 
BuBTow.  H.,  M.D.Durh.,  M.R.C.8.Eng.,  L.R.C.P.i.,  L.S.A  .  Certi- 
fying Surgeon  under  the  Factory  Act  for  the  Marple  Bistrict  of 

the  county  nf  Chester. 
CLBV1L4BD.  J.  W.,    M.R.C.S.,  L.R.C.P.Lond.,  House  Burveon  to  the 

Royal  Berkshire  Hospital.  Reading.  ^ 

F'oABHEBY,  J.  G.,  L.11.0.P.,  L.ac.8.L,  C^rtlfyfog  Surgeon  under  the 

FkM^ry  Act  for  the  Tubbercurry  District  of  the  oountr  of 

SUgo. 
Gbbbne,  Abvold  J.,  M.R.C.8.Eng.,  L.R.C.P.,  Assistant    Medical 

Oflloer  to  the  Royal  Albert  Edward  lofirmarr,  Wigan. 
Kb  IIP,  W.,  M3^  O-*;^^":.,  Oertifyinff  Surgeon  under  the  B^ctOfy 

Act  for  the  Castleford  District  of  the  county  of  York. 
Leb,  R    H.,  House  Physician  to  the  Richmond,  Whitworth.  antf 

Harwicke  Hospitals. 
MacCobvac,  Hbkbt.  M.B.,  Cb.B.Edin.,  Assistant  Resident  Medical 

Officer  to  the  Royal  National  Hospital  for  Consumption  and 

Diseases  of  the  Chest,  Ventnor.  I.W. 
Mackmk.  T.  T.,  M.D  Glss..  Certifying  Suigeon  under  the  Pactoiyict 

for  the  Whalley  District  of  the  county  of  lAncaater 
Maclbaw.  Ewbb  J..  M.D.,  M.ILC.P.Lond.,  F.R.S.Edin.,  Lecturer  on 

MidwiferjrCuoder  the  Midwive*  Act)  to  the  University  OoUege- 

of  South  wales  and  Monmouthshire.  Cardiff. 
Pebbib,  E.  Ay'M.p.LondyCertirj'ing  Surgeon  under  the  YwsUxry  Act 

for  the  Whitchurch  District  of  the  county  of  Salop. 
PoTHTOv,  F.  J.,M.D.Lond.,  F.R.CJ'.Lond.,  8ub>Dean  of  the  nundt? 

of  Medicine,  University  GollMre.  London. 
Rbes,  FBRDnrABD,  M.D.GIksg..  Honorary  Assistant  Medical  Offioer 

to  the  Royal  Albert  Edward  Infirmary,  Wlgan. 
RtrniBBroBn,  J.  W.,  House  Surgeon  to  the  Btohmond,  Whitworth. 

and  Harwicke  Bospitals. 
Shblpok.  Huoh,  F.,  M  RCS.,  L.R.C.PXond.,  CivU  Surgeon  to  the 

Military  Hospital,  PotchefStroom,  TransvaaL 


$irth0* 


Bbvak.— On  August  6th,  at  Kensington  Garden  Terrace,  W.,  the  wile 

of  Arthur  Bevsn.  M.D.LpBdn  of  a  daughter. 
Falcon AR.— On  August  fttl.-at  tlKgenna  House,  Shirebampton,  near 

Bristol,  the  wife  of  H.  BarclBy  Fa'conar.  Surgeon,  of  a  daufliiter. 
Habbisov.— On  August  6th  at  the  Priory,  St.  Neots,  Hunts,  t£e  vito 

of  Ernest  Henry Saiftoen,  M.B..  SjO.,  l3.A.C«ntob.,  of  a  son 
WALKBB.-On    August    9th,  at  Wilford  Lodge,  Eaher.  the  wife  of 

Reginald  F.  Wdker,  M.R.e.S.,  LJLC.P.,  cf  a  son. 

BuLLEW--CooKE.-On  August  10th,  at  All  Saints'.  Margaret  Stieet 
London,  W.,  Chas.  Hy.  Bullen,  M.D.Lond.,  TettenSu,  wSw- 
hMnptoB,  eWeat  son  of  C.  H.  Bullen,  Ashl^y-de-la-feouoh,  to 
^[g«t  BWe,  second  daughter  of  John  Cooke,  M.B..  F.R.C.8, 

^^^7^^'-^  August  »th,  at  St,  Michael's  Chur«h,  Kingstown, 
DJ.  Ooffey.  M.A  Al  B.,r.ku.l..  son  of  the  late  John  ^^, 
Tralee,  to  Maud,  fifth  daughter  of  the  kte  Captain  M.  J.  J.  Quisl 
of  Aubrev,Shanganagh,co.  DubUn.  •      t     ^ 

Edlbstoh— WBBNCH.-On  August  11th,  at  St.  Anne's.  Bastow.. 
Derbyshh^,  B.  Sbafto  C.  Bdleston,  M.B.C.S.,  LB.OP.,  Naat^ 
wick,  to  A.  B.  M.  (Nancy),  daughter  of  E.  M.  Wrench,  F.R,C.8.. 
J.P.,  ol  Chatsworth. 

^"?Jr:?**'^ — ?°  August  13th,  at  St.  Mary  Magdalene's.  Enfield. 
MhMlesex,  CharlM  HaU  Pennv.  M.D.,  of  EnflaS,  to  Kate,  widw 
of  J.  J.  Bell,  of  Gaiiiooh,  EnfleH.  ' 

THO11P801V-.BUTHEBFOBD.— On  August  4th,  at  Methodist  Cbureh, 
Manorhamilton,  J.  Henry  Thompson,  M.B ,  Chandlers  Ford, 
?^S-4>^  ?!.•*'»  «^<^««*  daughter  of  R  A.  Butherfoid.  J.P., 
L.B.C  JP.  and  S.,  EarlsfieM,  MiTnorhamllton.  ' 


^tattis. 


Bbacii.— On  August  6th,  at  Winchester  House,  Kingston  Hill,  SniT«y 
Emily  Dora,  wife  of  Dr.  Fletcher  Beach,  in  her  46th  year. 

Btxtok.— On  August  5th,  at  4  Brighton  Parade,  Blackpool.  Joba 
Ruxton,  MJ)iAberd.,  Consulting  Surgeon,  to  th  Vict^A 
Hospitali  Blackfoolregsd.  56. 


Wkt  ^dial  ^tm   mA   ^itmUt 


'•8ALU8    POPULI    8UPREMA    LEX" 


Vol,  CXXIX. 


WEDNESDAY,    AUGUST   24.    1904.  No.   8. 


(^ridinal  CommunicattonB* 

SOME  POINTS  IN  THE 

OPERATIVE    TREATMENT    OF 

TUBERCULOUS    DISEASE 

OF  THE   KNEE-JOINT. 

By  K.  W.  MONSARRAT,  M.B.,  CM.,  F.R.C.S.E., 
SuTgwvn,  the  D»vid  Lewii  Kortharn  HosfpiUl,  LiverpooL 
During  the  last  three  years  of  the  cases  of 
tuberculous  disease  of  the  knee-joint  which  I  have 
had  under  observation,  I  have  had  occasion  to 
operate  on  some  fourteen.  Of  these  I  have  been 
able  to  follow  the  subsequent  history  in  eleven, 
and  to  estimate  the  result  of  the  operative  pro- 
cedure. I  wish  to  make  these  cases  the  subject 
of  some  remarks  relative  to  one  or  two  points  in 
the  operative  treatment  of  the  condition.  The 
extent  and  localisation  of  the  disease  present  in 
these  cases  when  first  seen  are  shown  in  Table  I. 

Table  I. 


No.    of 
Caae. 


5 
6 

7 
8 

9 
10 
11 


"DiBease  present  when  first  seen. 


Internal  condyle  of  the  femur.  Internal  tuberosity 

of  the  tibia,  svnovlal  membrane. 
Internal  cohdyie  of  the  femur. 
External  condyle,  outer  tuberosity  of  the  tibia, 

synovial'membrane. 
Synovial  membrane,  erosion  of  cartilage  coverinir 

the  femur. 
Synovial  membrane. 
Synovial  membrane. 

Synovial  membrane,  fibrous  oapsule,  and  Ugiments. 
Outer  tuberosity  of    the  tibia,   patella,  synovial 

membrane,  capsule,  and  femoral  cartilage. 
Ssmovial  membrane,  capsule,  and  ligaments. 
Outer  part  itf  the  lower  femoral  epiphysis. 
Synovial  membrane. 


A  summary  of  the  table  shows  in  three  cases 
synovial  membrane  alone  ;  in  two  cases  synovial 
membrane,  capsule,  and  ligaments  ;  in  one  case 
synovial  membrane,  with  ulceration  of  the  carti- 
lage ;  in  two  cases  femoral  epiphysis  alone  ;  in 
two  cases  femur,  tibia,  capsule,  and  synovial 
membrane  ;  and  in  one  case  tibia,  patella,  synovial 
membrane,  ulceration  of  femoral  cartilage  and 
cap>sule.  In  six  cases  the  disease  was  primarily 
synovial,  and  in  five  cases  it  was  primarily  osseous. 
This  proportion  is  not  representative,  according 
to  some  surgeons  whose  experience  of  the  disease 
has  been  large.  Mr.  Rushton  Parker,  in  his 
article  in  the  **  International  Text-book  of  Surgery," 
says,  "  practically  always  the  primary  focus  is  in 
the  bones "  ;  Mr.  W.  Watson  Cheyne  says  the 
primary  centre  occurs  "  probably  more  frequently 
in  the  bone  "  ;  Mr.  A.  E.  Barker  says,  "  in  the 
very   young   the    femur  is    most   frequently   the 


starting-point,  next  the  tibia,  then  the  synovia 
membrane,  lastly  the  patella ;  the  older  the 
patient  the  greater  the  probabiUty  of  the  synovial 
membrane  being  first  affected."  Whatever  the 
actual  proportion  may  be,  it  is  plain  that  in  a  large 
number  of  cases  arthritis  is  secondary  to  osteo- 
myehtis.  It  is  in  connection  with  this  that  I 
wish  to  make  the  first  point  of  my  remarks — ^the 
great  importance  of  the  early  recognition  of  tuber- 
culous foci  in  the  neighbourhood  of  the  lower 
epiphysis  of  the  femur,  and  the  great  value  of 
early  surgical  interference  dealing  with  it.  In 
Cases  2  and  10  this  ws^  the  Hmit  of  the  disease 
when  first  seen,  and  I  will  briefly  relate  the  history 
of  each. 

Case  2. — ^The  patient,  a  boy,  aet.  3,  was  brought 
to  hospital  in  February,  1900.  In  the  previous 
September  the  mother  noticed  that  the  right 
"  knee  "  was  swollen,  although  the  child  com- 
plained only  occasionally  of  sUght  pain.  When 
examined  the  whole  of  the  lower  end  of  the  femur 
was  enlarged,  particularly  that  part  corresponding 
to  the  internal  condyle.  Pressure  over  the  front 
of  the  condyle  caused  considerable  pain.  The 
depressions  around  the  patella  and  the  general 
outlines  of  the  joint  were  normal.  The.  diagnosis 
was  tuberculous  osteomyelitis  in  the  lower  femoral 
epiph5rsis.  The  limb  was  fixed  on  a  Thomas's 
knee  splint  of  the  ordinary  pattern,  and  the  child 
attended  the  hospital  as  an  out-patient,  but: 
irregularly,  until  the  following  November.  The 
condition  appeared  to  improve,  for  a  time  at  any 
rate,  and  his  symptoms  became  quiescent,  but 
before  admission  in  November  the  disease  had 
insidiously  invaded  the  joint.  On  November 
29th,  I  performed  an  arthrectomy  and  found  an 
irregular  cavity  in  the  internal  condyle  of  the 
femur  communicating  with  the  joint,  and  collateral 
destruction  of  the  cartilage  covering  the  inner 
tuberosity  of  the  tibia  ;  the  synovial  membrane 
was  but  little  affected.  The  bone  disease  was 
removed  with  the  spoon,  and  the  surface  of  the 
cavity  was  rubbed  with  liquefied  carbolic  acid  ; 
the  synovial  membrane  was  also  removed  by 
dissection.  Two  months  later  it  was  necessary 
again  to  open  the  joint ;  unhealthy  granulation 
tissue  was  removed  from  the  cavity  in  the  internal 
condyle,  and  carbolic  acid  was  again  used.  The 
result — fibrous  ankylosis — ^was  satisfactory.  The 
child  developed  tuberculous  vertebral  disease 
later,  from  which  he  has  also  recovered. 

Case  10. — The  patient,  a  boy,  aet.  4,  was  ad- 
mitted to  hospital  on  June  4th,  1902.  For  about 
a  month  he  had  complained  of  pain  in  his  knee, 
and  the  mother  had  noticed  sweUing  in  it  forthe 
same  period.     On  admission,  the  lower  extremity 


•"1 


IQO    The  Medical  Pekss. 


ORIGINAL  COMMUNICATIONS. 


August  24*  '904- 


of  the  right  femur  was  enlarged,  particularly  the 
outer  condyle  :  it  was  tender  on  handling,  and 
the  skin  covering  it  had  a  glazed  appearance. 
The  child  was  well  nourished  and  had  a  healthy 
appearance.  I  decided  to  temporise,  and  fixed 
the  limb  in  plaster.  By  the  end  of  three  months 
it  was  evident  that  the  disease  was  not  quiescent, 
although  the  joint  remained  unaffected.  I  there- 
fore decided  to  attack  the  disease  in  the  epiphysis, 
and  did  so  on  September  20th.  Some  weeks 
after  primary  healing.  I  removed  some  unhealthy 
granulation  tissue  by  reopening  the  wound.  The 
present  condition  is  satisfactory,  and  the  joint 
remains  sound  and  unaffected. 

This  case  supplies  a  suitable  commentary  on 
the  first.  Had  I  in  the  first  attacked  the  disease 
at  once  when  it  was  confined  to  the  epiphysis,  the 
child  might  now  have  a  movable  instead,  of  an 
ankylosed  joint.  I  think  it  is  sound  surgery  to 
deal  with  such  a  focus  as  soon  as  the  diagnosis  is 
clear,  without  any  temporising  or  treatment  by 
rest,  and  for  the  following  two  reasons  : — (i)  It 
is  difficult  to  estimate  in  any  given  case  how  near 
to  the  joint  the  disease  has  encroached,  and  a 
short  delay  may  just  make  the  difference  between 
escape  and  involvement  of  the  joint ;  and  (2)  the 
focus  is  as  a  rule  accessible  and  can  be  thoroughly 
dealt  with. 

The  recognition  of  this  condition  of  tuberculous 
epiphysitis  is  simple  :  the  symptoms  biing  enlarge- 
ment of  t\ie  fenoral  extremity,  usually  chiefly 
affecting  the  inner  part,  with  some  swelling  of  the 
overlying  soft  parts  ;  complaint  of  dull  aching 
pain  ;  tenderness  on  handUng  or  percussing  the 
epiphysis,  and  a  normal  distinctness  of  the  para- 
patellar depressions.  Passive  movement  of  the 
joint  is  at  the  same  time  either  unattended  by 
pain  or  causes  this  to  only  a  slight  degree.  I  ask 
the  question  whether  treatment  by  rest  and  general 
hygienic  measures  is  not  attended  by  unfortunate 
results  in  a  considerable  number  of  cases  similar  to 
the  above.  The  indications  for  early  op3rative 
treatment  in  a  tuberculous  focus  of  this  situation 
differ  from  the  indications  for  such  interference 
when  the  disease  is  in  the  neighbourhood  of  the 
upper  epiphyseal  line,  the  difference  being  chiefly 
due  to  anatomical  considerations.  The  tuber- 
culous focus  in  the  neck  of  the  femur  can  in  most 
cas3s  be  reached  only  through  the  joint,  though 
cases  are  on  record  where  such  a  focus  has  been 
reached  and  eradicated  through  the  great  tro- 
chanter. On  the  other  hand,  the  focus  in  the 
neighbourhood  of  the  lower  growing  line  is  acces- 
sible 'N\'ithout  encroaching  on  the  joint,  and 
favourably  situated  in  regard  to  drainage,  though 
perhaps  in  most  cases  the  latter  will  not  be  called 
for. 

Among  hospital  patients  it  is,  unfortunately, 
the  exception  to  meet  with  these  cases  before  the 
joint  is  infected,  and  Table  I  illustrates  the  fact. 
This,  no  doubt,  is  to  some  extent  due  to  delay  on 
the  part  of  parents  in  bringing  children  for  treat- 
jnent,  but  also,  I  think,  to  a  too  great  confidence 
in  the  efficacy  of  treatment  by  rest,  and  to  the 
inadequate  carrying  out  of  instructions  given  by 
medical  men. 

Anatomically,  the  most  important  point  in 
operating  on  such  a  case  is  the  outline  and  limits 
of  the  synovial  membrane.  I  have  ■  constructed 
Figs.  I  and  2  from  examinations  on  the  cadaver, 
which  show  the  following  points  : — (i)  That  in 
extension  the  lateral  reflexion  leaves  uncovered 
tie  greater  part  of  the  lateral  and  posterior  aspect 


Fig.  I. 


Fig.  2. 


Fio.  1.— Line  of  reflexion  of  the  synovial  membrane  in 

extennion. 

Fio.  2.~Line  of  reflexion  of  the  synovial  membrane  In 

flexion. 

in  spirit  ;  haemorrhage  may  be  checked  by  tight 
gauze  packing  for  a  few  minutes,  and  the  wound 
may  then  be  entirely  closed  without  drainage. 

I  wish  next  to  refer  to  the  results  of  treatme.t 
in  the  ten  cases  in  which  the  knee-joint  ws 
opened  :  first,  as  to  the  recovery  from  the  disease ; 
and  secondly,  as  to  the  subsequent  functional 
value  of  the  limb.  The  results  as  to  recovery  are 
shown  in  Table  II. 

By  recovery  I  mean  present  freedom  from  local 
disease.  In  three  case?  in  which  recovery  ulti- 
mately ensued  I  had  to  perform  erasion  twice; 
in  one  case  (No.  5)  the  joint  went  to  the  bad 
altogether,     owing     to     septic     infection.      The 


of  the  femoral  condyle  both  externally  and  in- 
ternally ;  and  (2)  that  on  flexion,  these  aspects 
are  almost  entirely  covered. 

In  Case  10  I  gained  access  to  the  focus  from  the 
outer  posterior  aspect ;  a  two-inch  incision  was 
made  parallel  with,  and  in  front  of,  the  biceps 
tendon  downwards  as  far  as  the  lower  extremity 
of  the  outer  condylar  ridge  ;  inwards  and  down 
wards  from  this  incision  the  surface  of  the  bone 
was  reached  to  the  inner  side  of  the  outer  head  of 
the  gastrocnemius.  In  a  similar  case  I  would  in 
future  make  an  incision  through  the  skin  over  the 
outer  side  of  the  condyle,  and  having  exposed  the 
capsule,  strip  this  and  the  synovial  membrane 
forwards  :  I  have  found  on  the  cadaver  that  by 
this  means  ready  access  may  be  obtained  to  the 
outer  aspect  of  the  condyle  without  penetrating 
the  synovial  membrane.  Inasmuch  as  the  tuber- 
culous focus  is  more  commonly  situated  in  the 
neighbourhood  of  the  inner  condyle,  a  route  from 
the  inner  side  will  more  often  be  called  for.  Mr. 
W.  Watson  Cheyne  recommends  a  curved  in- 
cision, with  its  convexity  upwards  at  the  junction 
of  the  condyle  with  the  shaft ;  this  outlines  a  skin 
flap  which  is  turned  up,  and  a  vertical  incision 
through  the  muscular  fibres  towards  the  back 
of  the  condyle  exposes  the  capsule,  which  is 
stripped  downwards.  I  have  found  on  the 
cadaver  that  simple  vertical  incision,  similar  to 
that  which  I  have  described  for  the  outer  aspect 
of  the  joint,  gives  quite  satisfactory  access  to  the  | 
postero-intemal  aspects  of  the  condyle.  After 
exposing  the  bone,  the  outer  compact  layer  may 
be  penetrated  by  a  gouge  or  a  spoon,  and  th; 
disease  focus  thoroughly  scraped  out.  The  cavity 
remaining  should  be  treated  with  some  satisfactory' 
antiseptic,    such  as  i  in  500  biniodide  of  mercury 


August  24,  1904. 


ORIGINAL  COMMUNICATIONS. 


Thb  Mbdxcal  Pkbss.    19^ 


history  of  this  case  is  as  follows.     The  primary 
«rasioii  was  done  on  Prebruary  14  th,  1900,  and 

Table  II. 


No.    of 
Caae. 

Interval  since 
operation. 

Ultimate 
Result. 

Remarks. 

1 

Erasion. 

2  yrs.  ft  8  mths. 

Recovery. 

2 

„       (2) 

2     „     8      „ 

" 

Pott's  disease; 
recovery-. 

3 

{2)2      ,.     ixnth. 

ti 

4 

2       „      1     „ 

5 

.,       (2)2yr8. 

Amputa*n. 

6 

(2);iyr.  &10mth». 

Recovery. 

7 

|1      .,     10    „ 

8 

Excision-    il  yr. 

9 

Erasion.      10  mths. 

i> 

11 

10     „ 

the  patient  was  discharged  with  the  limb  in 
plaster  on  March  9  th,  primary  healing  having 
taken  place.  Unfortunately  he  was  not  brought 
again  to  the  hospital  until  the  following  May 
25  th,  and  when  the  plaster  was  removed  the 
wound  was  found  to  have  reopened,  and  was 
obviously  infected.  In  spite  of  a  second  erasion 
it  was  never  afterwards  clean,  and  I  performed 
amputation  through  the  middle  of  the  thigh  on 
April  5  th,  1902.  with  a  satisfactory  result  as  far 
as  his  general  condition  is  concerned.  With  regard 
to  the  other  cases,  freedom  from  disease  has  been 
verified  by  the  tuberculin  test  in  Cases  2,  4,  and 
1 1  ;  and  the  others  with  one  exception  I  have  seen 
-within  the  last  few  months,  and  there  are  no 
signs  of  recurrence.  The  exception  is  Case  7, 
which  remained  under  observation  for  seven 
months  after  operation,  up  to  which  time  no 
return  of  the  disease  had  taken  place.  All  that 
I  wish  to  remark  about  these  results  is,  that  they 
show  that  erasion  is  a  satisfactory  operation  as 
far  as  recovery  from  disease  is  concerned,  even  if 
it  be  found  necessary  to  repeat  it.  Such  repetition 
must  be  due  to  the  overlooking  of  some  of  the 
disease  at  the  first  operation.  It  is  hardly  neces- 
sary to  say  that  asepsis  is  all-important,  and  that 
a  knee-joint  the  subject  of  mixed  infection  is 
practically  doomed. 

The  second  aspect  of  the  result  is  the  after- 
usefulness  of  the  limb  for  purposes  of  locomotion. 
The  present  state  of  the  limb  in  these  cases  is 
shown  in  Table  III. 

Table  III. 


"^as^f    Present  State  of  the  Limb 


8 

11 


Ankylosis. 
Fibrous  ankylosis. 
Bony  ankylosis. 
Fibrous  ankylosis. 

Fibrous  ankylosis 

FibroiLs  union- 
FibroiLs  ankylosis. 


Remarks. 


Flexion  corrected. 
No  flexion. 
Flexiim  corrected. 

No  flexion. 


Flexion  corrected. 


It  is  almost  of  the  nature  of  a  surgical  axiom 
that  what  is  to  be  aimed  at  after  erasion  or  excision 
of  the  knee  is  firm  ankylosis  of  the  joint.  With 
regard  to  excision,  this  is  not  only  undoubtedly 
always  the  desired  end,  but  also  in  most  cases 
attained  without  difficulty.  With  regard  to 
erasion,  the  question  is  more  complicated.  In 
the  first  place,  after  this  operation,  and  in  spite 
of  a  long  subsequent  immobilisation  of  the  limb, 
an  ankylosis,  that  will  resist  all  tendencies  to 
flexion,  is  not  easily  obtained  ;  in  fact,  unless  the 
union  is  one  of  bone  to  bone  it  must  always  remain 
in  doubt.     With  regard  to  the  retention  of  mobility 


Mr.  W.  H.  A.  Jacobson  says  : — "  The  frequency 
with  which  this  has  been  obtained  and  its  ad- 
vantage have  been  in  my  opinion  much  exag- 
gerated. I  have  no  doubt  whatever  that  a  large 
number  of  published  cases  will  show  that  where 
movement  is  sought  for,  the  risk  is  run  of  a  certain 
degree  of  permanent  flexion,  of  attacks  of  pain 
and  swelling,  and  of  the  formation  of  troublesome 
sinuses.  The  argument  against  attempting  to 
retain  mobility  in  the  joint  is  based,  therefore,  on 
two  grounds  :  first,  the  risk  of  permanent  flexion  ; 
and,  second,  the  risk  of  recurrent  disease  ;  and  if 
these  two  risks  can  be  avoided,  it  may  conceivably 
be  justifiable  to  endeavour  to  obtain  a  functioning 
joint." 

With  regard  to  the  question  of  flexion,  I  may 
compare  Cases  6  and  9  with  Cases  2,  4  and  11. 
In  the  one  group  there  was  never  from  beginning 
to  end  any  tendency  to  flexion  ;  in  the  second, 
flexion  occurred  and  had  to  be  corrected.  In  the 
first  group  I  erased  the  joint  by  transection  of  the 
patella,  with  reunion  of  the  fragments  ;  in  the 
second,  I  opened  the  joint  by  dividing  the  liga- 
mentum  patellae.  From  this  comparison  and 
on  general  grounds  I  believe  that  flexion  is  always 
likely  to  occur  when  the  integrity  of  the  extensor 
is  interfered  with,  and  can  be  largely  discounted 
by  leaving  this  intact.  If  the  extensor  is  thrown 
out  of  action  the  muscular  balance  is  disturbed, 
and  the  hamstrings  and  the  gastrocnemius  are 
given  unnatural  advantage,  the  only  resistance  to 
flexion  being  the  insecure  scar  tissue  uniting  the 
severed  portions  of  the  patellar  ligament.  Tran- 
section of  the  patella  avoids  this,  provided  firm, 
bony  union  is  obtained,  and  another  method 
which  also  avoids  it  is  Kocher's — i,e,,  incision 
of  the  capsule  on  each  side  of  and  close  to  the 
patella,  and  division  of  the  patellar  attachments 
of  the  vasti.  Transection  of  the  patella  affords 
ready  access  to  all  parts  of  the  joint,  and  is  only 
open  to  the  objection  that  it  introduces  the  com- 
plication of  a  transverse  fracture,  which,  if  bony 
union  is  not  primarily  obtained,  damages  the 
extensor  to  as  great  an  extent  as  section  of  the 
ligament. 

Kocher's  method  I  have  performed  only  on  the 
cadaver.  I  have  found  it  very  difficult  to  obtain 
by  it  satisfactory  access  to  the  tibial  surface  and 
the  posterior  synovial  recesses.  I  wish  to  direct 
attention  to  a  method  of  exposing  the  joint  which 
I  think  combines  the  advantages  of  giving  free 
access  to  every  part  and  of  leaving  the  extensor 
entirely  intact.  A  long  median  incision  is  made, 
commencing  half  an  inch  below  the  tubercle  of 
the  libia  and  reaching  upwards  to  about  thres 
inches  above  the  upper  border  of  the  patella. 
(Fig.  3.)  This  exposes  the  quadriceps  expansion, 
the  patella,  and  the  ligamentum  patellae  ; 
the  ligamentum  patellae  is  then  split  exactly  in 
the  middle  line,  the  periosteum  of  the  patella  is 
incised  in  the  same  direction,  and  the  extensor 
aponeurosis  is  incised  to  the  full  extent  of  the 
skin  incision,  the  muscular  fibres  beneath  it  being 
separated  with  the  handle  of  the  scalpel.  We 
then  have  a  long  incision  commencing  two  inches 
above  the  patella,  which  divides  the  quadriceps, 
the  periosteum,  and  the  ligament.  The  patella 
is  then  sawn  through  in  the  same  direction  and 
the  joint  is  thus  opened.  The  upper  part  of  the 
incision  is  deepened  with  scissors  so  that  the  whole 
of  the  suprapatellar  pouch  is  opened  up  and  the 
quadriceps  is  split  well  above  it.     Perfect  access  to 

D 


192    Thb  Mkdical  P&xss. 


ORIGINAL  COMMUNICATIONS. 


August  24.  1904. 


the  upper  limits  of  the  synovial  menbrane  is 
thus  obtained.  When  this  upper  part  has  been 
dealt  with  the  lateral  pouches  are  readily  cleared, 
after  which  the  joint  must  be  flexed,  and  at  the 
same  time  each  half  of  the  bisected  extensor, 
patella,  and  ligament  is  retracted  laterally  until 
the  halves  of  the  patella  lie  outside  the  line  of  the 


Fig.  3.— Showing  median  incision, 
femoral  condyles  (Figs.  4  and  5) ;  the  tibial  surface  1 
and    the    posterior    synovial    reflexion    are    thus  I 
exhibited,  and  dealt  with  as  may  be  required.  | 
When  all  disease  has  been  removed,  the  joint  is 
again  extended  and  the  halves  of  the  patella  fall 
naturally  together  and  may  be  flxed  with  a  single 
wire  suture.     Continuous  sutures  above  and  below 
the  patella  bring  together  the  halves  of  the  quad- 
riceps,   and    the    ligament.     I    think    that    this 
procedure   fulfils   the   requirements   I    have   laid 
down — i.e,y  free  access  to  the  joint  and  preser- 
vation of  the  extensor. 

By  preserving  the  extensor  opposition  to  the 
hamstrings  and  gastrocnemius  1  think  that  we 
can  discount  the  first  objection  to  an  attempt  to 
retain  mobility — the  tendency  to  permanent 
flexion.  The  second  objection  above  noted  was 
the  risk  of  recurrent  disease.  Now,  it  is,  of  course,  | 
necessary  to  keep  the  joint  fixed  after  erasion  asj 
long  as  there  is  any  doubt  as  to  complete  recovery 
from  the  disease.  We  are  able  to  judge  of  this 
early  and  accurately  by  the  use  of  the  tuberculin 
test.  I  employed  this  test  in  Cases  2,  4,  and  1 1  to 
determine  the  absence  of  disease  before  forcibly 
straightening  the  joint ;  in  each  no  reaction  was 
obtained,  and  I  broke  down  the  adhesions  knowing 
that  I  was  running  no  risk  of  setting  up  recurrence 
of  the  disease  process.  This  test  might  also  be 
used  in  cases  where  the  retention  of  mobility 
was  in  question,  and  by  its  use  I  think  the  danger 
of  recurrent  disease,  the  second  objection,  could 


Fio.  4.— Showing  patella  bisected. 


Fig.  6.— Showing  the  knee-joint  flexetl  jmd  the  femoral 
condyles  exposed. 


August  24,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Pebss.     193 


also  be  discounted.  I  do  not  Mdsh  to  go  further 
than  this  in  discussing  the  question  of  attempting 
to  obtain  a  movable  joint  after  erasion,  and,  to 
recapitulate  what  I  have  said,  such  attempts 
should  be  confined  to  cases  where  the  extensor 
is  intact,  and  where  the  tuberculin  test  does  not 
produce  reaction,  and,  in  the  third  place,  where  the 
X)ossibiHty  of  obtaining  a  useful  joint  has  not  been 
excluded  by  removal  of  the  crucial  ligaments  and 
joint  capsule.  Supposing  these  structures  have 
been  severed,  and  supposing  for  other  reasons 
that  the  question  of  attempting  to  retain  mobility 
is  answered  in  the  negative,  how,  after  erasion, 
is  firm  union  to  be  obtained  ?  In  a  case  in  which 
at,  the  operation  it  is  clear  that  ankylosis  is  desirable, 
the  joint  cartilages  should  be  removed  and  exposed 
bone  should  be  brought  into  apposition  with 
exposed  bone,  a  thin  sUce  off  each  femoral  condyle 
and  the  upper  tibial  surface  ensuring  that  this 
apposition  is  sufficient. 

Lastly,  a  word  as  to  indications  for  operative 
interference,  (i)  Cases  of  tuberculous  foci  in  the 
neighbourhood  of  the  lower  epiphysis  of  the 
femur  should  be  operated  on  as  soon  as  the  dia- 
gnosis is  estabUshed.  (2)  Cases  of  joint  disease 
by  extension  from  the  femur  should  be  operated 
upon  as  soon  as  possible  if  this  extension  is  recent, 
and  if  not  recent,  then  when  the  disease  does  not 
definitely  retrograde  after  about  two  months' 
fixation  of  the  joint.  (3)  Cases  of  primary  syno- 
vial disease  should  be  operated  on  when,  after 
about  three  months  of  rest,  no  distinct  improve- 
ment has  taken  place. 

Note. — Since  writing  this  paper  I  have  heard 
that  the  patient  in  Case  10  has  had  recurrence  of 
the  disease,  but  to  what  extent  and  in  what 
situation  I  am  unable  to. state. 


NOTES  ON 


THE    KLOSOWSKI    ANTIMONY 
POISONING  CASE,  (a) 

By  Dr.  F.  J.  WALDO, 
Coroner  for  the  City  of  London,  and  Soathwark. 
Antimony  has  been  used  as  the  agency  for  various 
famous  murder  cases.  Often  by  medical  men — as 
Pritchard  and  Palmer — or  by  persons  who  have  had 
a  semi-medical  training.  Severino  Klosowski, 
alias  George  Chapman,  was  a  Pole  who  had  passed 
several  years  as  a  hospital  attendant.  He  de- 
serted his  wife  and  afterwards  as  a  publican  lived 
successively  with  three  women,  who  passed  ais  his 
wives,  and  who  died  one  after  the  other.  The  lasfR 
was  Maud .  Marsh,  who  Uved  with  Chapman 
(Klosowski)  for  a  year  before  her  death.  She 
became  ill,  was  treated  for  a  time  at  Guy's  Hospital 
and  afterwards  at  the  public-house  where  she  kved 
with  Chapman,  under  the  care  of  a  local  surgeon. 
On  October  21st,  deceased's  mother  called  her 
own  family  attendant  from  Croydon  in  consulta- 
tion. The  second  medical  man,  on  his  way  home, 
suspected  poisoning  by  arsenic,  and.  next  day, 
hearing  of  the  death  of  Maud  Marsh,  telegraphed 
his  suspicions  to  the  local  medical  attendant. 
The  last-mentioned,  after  receipt  of  the  tele- 
gram, held  a  post-mortem  examination  on  the  body 
of  deceased  and  removed  part  of  the  viscera, 
in  which  a  quantity  of  antimony  was  found  on 
chemical  anal3rsis.  Subsequent  re-examination  and 
analysis  on  my  order  as  Coroner,  by  Sir  Thomas 

(a)  Abntraot  of  Paper  read  in  State  Medioiae  Section,  British  Medi. 
c^  AMOdation  at  Oxford,  July  27th,  1904. 


Stevenson,  discovered  7 J  grains  of  metallic  anti- 
mony, equivalent  to  20 i  grains  of  tartar  emetic  in 
body  generally,  and  particularly  in  intestines.  It 
was  shown  that  Klosowski  frequently  administered 
food  and  medicine  to  deceased  with  his  own  hands^ 
and  that  such  administration  was  followed  by 
sickness  and  diarrhoea.  Prisoner  was  also  proved 
by  an  entry  in  the  Poisons  Book  to  have  purchased 
an  ounce  of  tartar  emetic  at  Hastings  in  L897/ 
Exhumation  of  the  two  women  who  had  died  pre- 
viously revealed  the  remarkable  preservation  of 
bodies  characteristic  of  antimony  poisoning, 
though  one  had  been  buried  five  years  and  :the 
other  about  eighteen  months.  In  each  case  Sir 
Thomas  Stevenson  recovered  large  quantities  ^oi 
the  metal  mentioned.  The  death  of  the  firtrt 
victim  was  wrongly  attributed  to  intestinal  ob- 
struction, and  that  of  the  second  to  lung  consump- 
tion. Chapman  obtained  ;f700  from  the  first  of 
his  three  victims,  but  no  adequate  motive  is 
discoverable  in  the  other  two  cases. 

Points  to  be  noted  :  Of  three  deaths,  two  were 
unsuspected,  the  third  vaguely  at  the  last  moment. 
Symptoms  of  antimony  poisoning  simulate  various 
diseases.  Chemists'  Poison  Register  sometimes 
affords  valuable  evidence.  In  all  cases  of  suspected 
poisoning  it  is  open  to  medical  men  to  ask  advice 
of  the  Coroner.  Such  application  should  be  made 
invariably  by  letter  and  not  by  word  of  mouth. 
Many  cases  of  poisoning  generally  would  be 
detected  were  the  medical  attendant  to  insist  (i) 
on  removal  of  patient  to  fresh  quarters,  and  (2) 
to  analyse  the  excretions  and  secretions  of  patient. 
Common  law  duty  of  all  those  about  anyone 
dying  under  suspicious  circumstances  to  report 
death  at  once  to  Coroner  whilst  body  is  fresh  and 
in  situ,  not  generally  known  by  the  pubhc,  and 
disregarded  in  present  case  by  the  local  medical 
attendant. 

Offence  not  a  statutory  one  and  not  indictable. 

pari9  Clinical  Xecturee. 
ABDOMINAL    ABSCESSES 

AS  AN  EARLY  SYMPTOM  OF 

INTESTINAL  CANCER. 

By  Dr.  TUFFIER, 
Surgeon  to  the  Paris  Hospitals. 

Although  the  evolution  of  intestinal  cancer  is  novr 
well  established  from  the  anatomico  -  pathologicar 
point  of  view,  it  remains  in  many  respects  mysterious- 
and  obscure  in  its  clinical  aspects.  When  we  get  the* 
complete  symptomatology,  i.e.,  when  we  have  a^ 
patient  upwards  of  fifty  years  of  age  who  complains 
of  alternating  attacks  of  diarrhoea  and  constipation, 
or,  it  may  be,  merely  of  steadily  progressive  constipa- 
tion, who  gives  a  history  of  blood  mixed  with  the' 
motions  or  of  melaena,  whose  abdomen  gradually  be- 
comes more  and  more  distended,  and,  lastly,  when,  on* 
palpation,  we  make  out  the  presence  of  a  tumour  in- 
the  region  of  the  left  angle  of  the  colon  or  the  sigmoid 
flexure,  the  diagnosis  is  easy. 

But  it  is  exceptional  for  all  these  signs  and  sym- 
ptoms to  present  themselves  together,  and,  in  particular, 
all  trace  of  tumour  formation  may  be  conspicuously- 
absent.  It  is  common  knowledge  that  one  variety 
of  intestinal  cancer  takes  the  form  of  a  thick,  hard  band' 
or  ring  involving  exclusively  the  intestinal  wall,  which' 
it  gradually  contracts,  thus  reducing  the  lumen  of  the' 
canal,  though  absolutely  inaccessible  to  physical  exa- 
mination. In  even  more  obscure  cases  the  history- 
of  the  patient's  antecedents  may  reveal  neither 
haemorrhage    nor    alternations    of    constipation    and' 


194    Th«  Medical  Pusf.        ORIGINAL  COMMUNICATIONS. 


diarr hoDa.  A  t  most  there  exists  some  degree  of  obstinate 
constipation  and  it  may  be  that  only  on  closely  ques- 
tioning the  patient  do  we  obtain  an  account  of  com- 
paratively mild  attacks  of  intestinal  obstruction ;  in 
short,  the  cx>ndition  of  things  is  first  revealed  by  an 
attack  of  acute  intestinal  obstruction.  I  have  seen 
numbers  of  these  ill-defined  cases,  and  in  view  of  the 
numerous  errors  of  diagnosis  of  which  I  was  guilty  in 
my  early  years,  I  have  come  to  the  conclusion,  in 
patients  above  fifty  years  of  age,  to  adopt  a  conven- 
tional limit — all  acute  intestinal  obstruction  is  the 
result  of  intestinal  cancer.  Though  this  law  may  not 
be  strictly  accurate,  it  is  clinically  trustworthy,  and 
if  we  apply  it  to  all  cases  we  shall  certainly  be  right  in 
ninety  out  of  a  hundred. 

To-day  I  should  like  to  call  your  attention  to  a  mode 
of  onset  less  frequently  met  with,  more  insidious  and 
consequently  less  familiar  to  you.  To  enable  you  to 
judge  of  its  clinical  importance,  I  \vill  relate  the  history 
of  a  patient  whom  you  saw  in  our  wards  some  months 
since.  The  man,  aet.  54,  was  first  admitted  in  May, 
1903,  for  some  trouble  in  the  right  iliac  fossa.  Six 
weeks  prior  to  his  admission,  while  still  apparenly 
in  perfect  health,  he  noticed  some  slight  pain  in  the 
lower  right  abdomen.  He  went  on  working, 
thinking  that  it  was  merely  a  strain,  but  in 
the  course  of  the  next  few  days  the  pain  in- 
creased in  severity  and  ultimately  obliged  him 
to  relinquish  work.  It  was  then  that  he  came  to 
see  us.  I  discovered  a  circumscribed  tumour  in  the 
iliac  fossa  reaching  down  to  the  pubic  arch,  and  half- 
way to  the  false  ribs  above,  extending  laterally  to 
within  three  fingers*  breadth  of  the  linea  alba.  The 
tumour  was  fixed  on  its  base,  was  closely  adherent  to 
the  iliac  aponeurosis,  but  did  not  involve  the  skin, 
which  was  normal.  Its  surface  was  smooth  and  re- 
gular ;  it  was  hard  and  rather  painful  on  manipula- 
tion without  obvious  fluctuation  ;  in  short,  we  evidently 
had  to  deal  with  a  subacute  abscess  in  the  iliac  fossa. 
The  digestive  functions  had  given  no  trouble  before 
the  first  attack  of  pain,  but  since  that  time  there  had 
been  occasional  vomiting  after  meals.  There  had 
never  been  any  h^ematemesis,  melsena  or  marked  con- 
stipation. The  urine  was  normal,  and  the  patient,  a 
strong,  robust  man,  had  only  begun  to  lose  flesh  within 
the  last  few  weeks. 

T^OvLT  diagnosis,  then,  was  that  of  subacute  abscess  of 
the  iliac  fossa,  and  as  such  suppurative  lesions  are 
almost  always  of  appendicular  origin  it  hardly  seemed 
worth  while  discussing  the  probable  upshot  of  the 
trouble.  Nevertheless  I  had  the  blood  examined, 
with  the  following  result : — Red  corpuscles,  4,154,000; 
white  corpuscles,  10,710  ;  haemoglobin,  75  per  cent. 
The  leucocytes  comprised  71  per  cent,  polynuclear; 
large  and  medium  mononuclear  19*5  per  cent.  ;  lym- 
phocyctes,  8  per  cent.  ;  eosinophile  cells,  i  '5  per  cent. 
These  figures  did  not  point  conclusively  to  deep  sup- 
puration, but  it  would  be  a  mistake  to  suppose  that 
the  differential  diagnosis  between  suppuration  and 
new  growth  in  the  2iac  fossa  is  always  easy.  In  a 
former  lecture  {La  Semiine  MHicile,  190 1,  p.  209), 
I  showed  you  what  valuable  assistance  haematology 
can  be  made  to  yield  in  doubtful  cases  where  the 
chronic  evolution  of  the  lesion  leaves  it  open  to  ques- 
tion whether  we  are  dealing  with  an  abscess  or  with  a 
new  growth. 

In  May,  1903,  I  opened  the  abdomen  by  an  incision 
parallel  to  and  above  the  pubic  arch.  The  abdominal 
walls  were  somewhat  oedematous  and  infiltrated,  and 
deep  down  in  the  iliac  fossa  I  came  upon  an  enormous 
abscess  filled  >\'ith  thick,  vi.scid  pus.  The  walls  of  the 
abscess  cavity  were  thickened  like  those  of  a  chronic 
abscess,  but  nowhere  could  I  make  out  any  special 
induration  of  a  kind  to  raise  the  suspicion  of  the  ex- 
istence of  a  malignant  growth.  I  carefully  avoided 
looking  for  the  appendix  and  simply  provided  for  free 
drainage.  In  the  course  of  several  weeks  all  that 
remained  was  a  small  fistulous  tract.  The  patient's 
general  condition  had  greatly  improved,  and  he  was 
discharged.     I  may  add  that  during  his  stay  in  the 


August  24.  I904« 

hospital,  and  the  following  five  montlis,  he  suSered 
from  no  digestive  disturbance  of  any  kind. 

In  October,  five  months  after  the  operation,  he 
came  back,  and.  to  my  surprise,  I  found  the  riaht 
side  occupied  by  a  smooth,  hard  tumour,  the  size  of  the 
fist»  adherent  to  the  deep  tissues.  The  orifice  of  the 
fistula  had  degenerated  mto  two  ulcers  with  irregular 
granulating  margins  resembling  epithelioma,  and  on 
microscopical  examination  this  diagnosis  was  confirmed. 
On  introducing  a  sound  through  the  sinus  it  passed 
down  to  a  spongy,  friable  mass,  bleeding  readily. 
The  situation  of  the  growth,  the  good  general  condition 
of  the  patient  and  the  absence  of  any  digestive  dis- 
turbances induced  me  to  attempt  its  removaL 

On  October  14th  I  carried  out  the  following  opera- 
tion :  Having  first  of  all  applied  the  actual  cautery 
to  the  ulcers  to  destroy  and  sterilise  the  granulations.  I 
shut  off  the  fistulous  tract  by  means  of  a  .subcutanecus 
suture.  I  then  made  two  elliptical  incisions  enclosing 
the  ulcerating  region ;  I  drew  outside  the  adherent 
mass  as  a  whole  and  dissected  it  from  the  neighbour- 
ing structures.  Below,  I  carefully  isolated  the  tu- 
mour, which  comprised  the  caecum,  the  omentum,  and 
a  loop  of  small  intestine.  Adhesions  to  the  femoral 
artery  and  vein  and  to  sundry  large  glands  obliged 
me  to  dissect  off  these  vessels.  '  I  isolated  and  resected 
the  diseased  structures,  including  the  caecum,  to 
within  two  fingers*  breadth  of  the  ileo-caecal  valve,  and 
on  the  other  side  1  removed  six  inches  of  small  intestine. 
I  sealed  up  the  divided  intestinal  ends  of  the  colon 
and  ileum,  and  performed  lateral  anastomosis  of  the 
small  intestine  with  the  colon  just  above  the  blind  ends. 
The  subsequent  course  was  uneventful,  and  the 
patient  was  still  in  good  health  four  months  after  the 
last  operation. 

This  is  a  very  good  example  of  the  occurrence  of 
what  was  apparently  an  ordinary  abscess  of  the  iliac 
fossa,  which  appeared  to  be  due  to  subacute  appendi- 
citis, but  which,  in  reality,  was  the  first  manifesta- 
tion of  cancer  of  the  intestine.  Alongside  this  first 
case,  which,  being  one  of  cancer  of  the  caecum,  a 
somewhat  special  form  of  cancer,  may  not  be  thought 
to  prove  my  point,  I  will  now  relate  two  others,  the 
clinical  history  of  which  presents  a  remarkaole  simi- 
larity. 

On  October  loth,  1901,  I  was  called  to  see  a  stout, 
healthy  woman,  aet.  67,  who  had  been  operated  upon 
two  years  previously  for  a  unilocular  cyst  of  the  ovary. 
Quite  recently  her  alarm  was  excited  by  the  gradual 
development  of  a  tumour  in  the  right  lumbar  region, 
as  to  the  nature  of  which  opinions  were  divided.     In 
two  months  the  tumour  had  attained  the  size  of  a  foetal 
head  ;    it  was  rounded,  smooth,  adherent  to  the  ab- 
dominal wall   behind,    and   passed   upwards   beneath 
the  false  ribs  below  the  liver,  reaching  below  to  the 
middle   of   the   iliac   fossa.     SUghtly   tender   on   pal- 
pation, it  was   not  connected  with    the  liver  ;    it  was 
resonant  in  front  and  partially  fixed,  its  movements 
following    those    of    the    posterior    abdominal    wall. 
Since  the  tumour  had  made  its  appearance  the  patient 
had  lost  her  appetite,   and    had    become  somewhat 
thinner.     Her  evening  temperature  was  98*8^  F.     It 
had  been  thought  to  be  an  inflamed  gall-bladder  or  a 
tumour  of  the  liver  or  the  kidney.     Personally  I  in- 
clined to  the  view  that  it  was  a  case  of  subacute  peri- 
nephritic  abscess,  though  the  origin  of  such  an  abscess 
left  me  in  doubt,  for  I  could  find  nothing  in  the  patient's 
antecedents  to  suggest  renal,  hepatic,  or  even  intestinal 
infection.     The    haemotological    examination    on    Oc- 
tober 17th  gave  3,900,000  red  corpuscles,  and  11,470 
white,  including  89  per  cent,  polynuclear  cells ;    3  per 
cent,  large  mononuclear  ;   4  per  cent,  myelocytes,  and 
3  per  cent,  eosinophile  cells  ;    a  second  examination, 
3,627,000  red,   19,212  white,  with  81  per  cent,  poly- 
nuclear, 10  per  cent,  small  mononuclear,  10  per  cent, 
large  mononuclear,  and  6  per  cent,  eosinophile  cells.    A 
third  and  last  enumeration  gave   3,813,000  red,  and 
15,941  white  corpuscles,  with  85  per  cent,  polynuclear; 
2  per  cent,    small  mononuclear,   6*5   per  cent,  large 
mononuclear,  5  per  cent,  myelocytes,  and    1*5    eosino- 
phile cells. 


August  24.  1904.    INTERNATIONAL  CONGRESS   OF   OTOLOGY  fm  Medical  P»ess.     195 


These  figures  were  therefore  in  favour  of  the  dia- 
gnosis of  a  neoplasm,  but  I  adhered  to  my  original 
diagnosis,  and  proposed  evacuation  of  the  abscess 
through  the  lumbar  region.  This  I  proceeded  to 
carry  out  on  October  24th,  giving  exit  through  the 
perirenal  regions  to  a  large  quantity  of  rather  foetid  pus. 
Kxamination  of  the  walls  of  the  cavity  revealed  the 
presence  of  pronounced  induration  on  the  anterior 
"wrall.  but  not  greater  than  one  meets  with  in  the  walls 
of  certain  abscess  cavities  of  slow  formation.  It  was 
drained,  and  in  a  few  weeks  all  that  remained  was  a 
fistulous  tract  the  size  of  the  thumb,  running  from 
above  downwards.  The  discharge,  however,  remained 
foetid,  though  it  contained  no  trace  of  faecal  matter. 
On  introducing  the  finger  one  came  upon  a  hard,  irregu- 
lar mass  of  woody  consistence,  which  bled  readily  on 
being  touched.  I  again  had  the  blood  examined, 
and  found  3,606,230  red  corpuscles  and  11,439  white — 
viz.,  85  per  cent,  polynuclear,  i  per  cent,  small  mono- 
nuclear, 3  per  cent,  large  mononuclear,  6  per  cent,  in- 
terrnediate,  3  per  cent,  myelocytes,  and  i  per  cent.^ 
eosinophile  cells.  The  amemia  had  therefore  persisted 
and  the  leucocytosis  remained,  whereupon  we  arrived 
at  the  conclusion  that  it  was  a  case  of  cancer.  Before 
long  fsecal  matter  began  to  come  away  in  the  dis- 
charge, and  a  few  weeks  later  large  cancerous  granula- 
tions, recognised  as  such  under  the  microscope, 
sprouted  from  the  bottom  of  the  wound,  the  patient 
dying  four  months  after  with  a  large  malignant  growth 
of  the  large  intestine. 

In  this  case  also  the  first  symptom  of  the  existence 
of  an  intestinal  neoplasm  was  a  pericolic  suppuration, 
the  intestinal  origin  whereof  there  was  nothing  to 
suggest.  The  blood  examination  albne  threw  some 
donbt  on  the  diagnosis  of  abscess. 

The  most  noteworthy  case  of  pericolic  abscess  of 
cancerous  origin  is  that  of  a  man,  aet.  47,  who  eighteen 
months  ago  was  in  our  wards.  He  was  an  ex-soldier, 
who  bad  suffered  from  d3rsentery  in  China,  and  the 
disease  had  persisted  as  chronic  enteritis.  He  came 
complaining  of  a  large  swelling  in  the  supra-umbilical 
region,  the  exact  nature  of  which  was  very  difficult  to 
make  out.  There  was  nothing  in  his  history  to  suggest 
any  intestinal  lesion,  for  his  intestinal  functions  were 
in  the  same  state  as  they  had  been  for  years  past ;  in 
*hort,  he  had  suffered  from  neither  constipation  nor 
hapmorrhage.  The  swelling  in  question  had  been  of 
comparatively  rapid  formation,  and  was  accompanied 
by  rather  severe  attacks  of  pain,  the  temperature,  how- 
ever, not  having  shown  any  marked  rise.  The  tumour 
occupied  the  epigastric  and  umbilical  regions,  reach- 
ing two  fingers*  breadth  below  the  navel.  It  was  about 
twice  the  size  of  the  fist.  The  skin  over  it  was  healthy, 
but  the  tumour  was  adherent  to  the  structures  below 
it,  its  surface  somewhat  irregular  ;  it  was  of  putty-like 
rather  than  woody  consistence,  it  was  dull  on  per- 
cussion, a  zone  of  resonance  separating  the  dull  area 
from  the  liver. 

The  patient's  antecedents,  the  persistence  of  the 
colitis  for  upwards  of  twenty  years,  the  rapidity  with 
which  the  swelling  has  developed,  the  pain  and  the 
absence  of  any  pressure  symptoms  led  me  to  conclude 
in  favour  of  its  being  a  pericolic  abscess  situated  in  the 
transverse  colon,  due  in  all  probability  to  dysenteric 
ulceration  of  old  standing.  The  examination  of  the 
blood  gave  3,990,000  red,  and  12,652  white  corpuscles, 
including  73  per  cent,  polynuclear,  16*3  large  and  small 
mononuclear,  10  per  cent,  lymphocytes,  and  7  per  cent, 
eosinophile  cells. 

On  November  7th,  1902,  I  cut  down  on  the  abscess 
through  a  median  incision  four  fingers'  breadth  long, 
starting  from  the  umbilicus.  The  omentum  was  ad- 
herent to  the  abdominal  wall,  and  behind  it  I  cut 
through  some  lardaceous  tissue  which  led  me  into  a 
cavity  the  size  of  an  orange,  filled  with  grumous  pus 
free  from  foetor.  The  walls  of  the  abscess  cavity 
were  thick  and  indurated.  I  drained,  and  a  few  days 
later  traces  of  fseciil  matter  appeared  in  the  discharge, 
a  circumstance  which  excited  no  surprise,  since  it  was 
quite  possible  that  an  intestinal  ulcer  had  opened  into 
the  cavity.     He  was  placed  on  a  dry  diet,  and  the  faecal 


discharge  ceased,  his  general  condition  improved,  and 
he  appeared  to  be  on  the  road  to  recovery.  He  went 
on  all  right  for  three  months,  although  the  fistulous 
tract  persisted,  when  once  more  faecal  matter  began  to 
come  away,  along  with  a  blood-stained,  foetid  discharge, 
and  though  there  was  no  digestive  disturbance  the 
patient  began  to  lose  flesh.  At  the  same  time  we 
noted  the  formation  of  a  tumour  hard  to  the  touch 
and  irregular  in  outline,  which  rapidly  increased  in  size. 
Unhealthy-looking  granulations  projected  through  the 
wound,  the  patient  became  cachectic,  and  died  on 
February  22nd,  1903. 

Post-mortem.—  C^ncer  of  the  transverse  colon  was 
found  which  had  involved  the  omentum,  the  stomach 
and  the  liver. 

It  was,  as  you  see,  a  third  instance  of  pericolic  ab- 
scess that  had  formed  round  a  neoplasm  of  the  large 
intestine.  The  diagnosis  presented 'peculiar  difficulty 
in  this  case  because  the  long-standing  chronic  dysentery 
led  one  to  suspect  the  source  of  the  trouble  to  oe  an  in- 
testinal ulcer.  In  this  case  also  there  was  complete 
absence  of  any  digestive  disturbances,  and  the  first  in- 
dication was  the  formation  of  a  x)eri-intestinal  collec- 
tion of  pus. 

It  is  highly  probable  that  the  three  cases  I  have 
related  are  by  no  means  exceptional,  and  that  now  that 
I  have  called  attention  thereto,  many  other  instances 
may  be  brought  forward.  The  mode  of  progression  in 
these  cases  is  not  difficult  to  imagine.  The  peri-intes- 
tinal suppuration  starts  in  a  breaking-down  gland 
consequent  upon  epithelioma  of  the  intestine,  a  form 
of  glandular  inflammation,  due  to  mixed  infection, 
similar  to  that  often  met  with  in  connection  with 
cancer  of  the  tongue,  even  at  a  period  when  the  can- 
cerous lesion  is  of  small  dimensions.  The  comparison 
is  the  more  justifiable  since  intestinal  like  buccal 
ulcers  are  in  contact  with  a  highly  infective  secretion, 
so  that  the  intestinal  lymphatics  may  convey  not  only 
the  cancerous  elements,  but  also  the  pyogenous  germs. 
The  suppuration,  moreover,  can  be  explained  by  the 
anatomical  form  of  these  neoplasms.  We  are  aware, 
as  a  matter  of  fact,  that  in  certain  forms  of  epithelioma 
there  is  a  tendency  to  early  perforation.  If  the  per- 
foration takes  place  on  a  part  of  the  intestinal  wall 
covered  bv  peritoneum,  adhesions  form,  out  if  on  a 
part  uncovered  by  peritoneum,  suppuration  is  set  up 
in  the  connective  tissue  and  an  abscess  results.  The 
first  hypothesis  agrees  with  observed  facts,  for  the 
passage  of  fajcal  matter  takes  place  only  some  days  or 
weeks  after  the  evacuation  of  the  abscess  contents. 
This  fact  suggests  that  the  perforation  of  the  intestine 
occurs  later. 

The  exact  mode  of  production  of  these  collections  of 
pus,  however,  is  a  matter  of  secondary  interest.  The 
point  to  which  I  wish  more  particularly  to  call  atten- 
tion is  that  certain  peri -intestinal  suppuration  of  un- 
certain origin,  even  in  the  absence  of  any  digestive 
disturbance,  should  raise  in  our  minds  the  possibility 
of  their  being  due  to  the  presence  of  a  cancerous  lesion 
of  the  intestinal  mucosa. 


ZEbe  Scvcntb  Jnternattonal  Congress  of 

©tOlOiJfi* 


BORDEAUX,  August  ist  to  August  4th. 
President,  Dr.  MOURE. 

At  the  opening  meeting  the  President  delivered  an 
address  upon  the  history  of  otology  in  France,  com- 
mencing ^^-ith  the  work  of  Duverney  in  the  seventeenth 
century. 

The  Choice  of  a  Simple  .\nd  Practical  Acoumetric 
Formula. 

A  joint  report  upon  this  subject  was  presented  by 
Politzer,  Delsaux,  and  Gradenigo,  who  form  a  per- 
manent committee,  meeting  once  a  year,  for  studying 
the  points  still  undecided.  Quix  (Utrecht),  Pause 
(Dresden),  Tr6tr6p  (Anvers)  and  Bonnier  (Paris)  read 
papers  on  the  same  subject. 


196    Thb  Mkdical  Pkis>.  INTERNATIONAL   CONGRESS  OF  OTOLOGY  August  24,  1904. 


The  Diagnosis  and  Treatment  of  Suppuration  of 
THE  Labyrinth. 

Three  co-reporters,  (i)  Brieger  (Breslau)  said  that 
the  radical  mastoid  operation  might  lead  to  the  spon- 
taneous cure  of  a  suppuration  in  the  labyrinth  ;  or, 
on  the  other  hand,  the  suppuration,  latent  before, 
might  become  active  after  the  operation  and  provoke 
a  fatal  meningitis.  Operation  on  the  labyrinth  is  in- 
dicated in  acute  otitis  media,  when,  with  collapse  or 
fever,  there  is  serious  disturbance  of  equilibrium, 
■nystagmus,  and  lapidly  progressive  deafness ;  or 
when,  with  labyrinthine  symptoms,  signs  of  meningitis 
appear.  In  chronic  cases  there  are  various  indications, 
which  the  author  gives  at  length,  as  well  as  a  description 
of  the  modes  of  procedure.  (2)  Von  Stein  (Moscow) 
distinguishes  para-labyrinthitis,peri-labyrinthitis,  endo- 
labyrinthitis,  and  panta-labjTinthitis,  according  as  the 
bony  capsule,  the  peri-lymphatic  space,  the  endo- 
lymphatic space,  or  all  these  structures  together  are 
affected.  (3)  Dundas  Grant  spoke  of  the  relations  of 
labyrinthitis  to  meningitis  and  to  cerebellar  abscess. 
He  dealt  with  prophylaxis,  the  early  detection  of 
labyrinthine  trouble,  and  the  indications  for  operation. 
PoUtzer  (Vienna)  described  the  pathological  changes  in 
the  labyrinth  which  are  produced  in  serious  suppura- 
tions of  the  middle  ear,  and  showed  preparations. 
Panse  (Dresden)  showed  preparations  and  original 
drawings  of  ten  cases  of  labyrinthine  suppuration. 
Escat  (Toulouse)  reported  three  cases  of  necrosis  of 
the  cochlea  with  spontaneous  elimination.  Two  of 
these  occurred  in  the  course  of  chronic  otorrhoea.  the 
third  was  of  special  interest.  A  young  man,  srrt.  21, 
during  an  attack  of  scarlatina,  presented  the  signs  of 
acute  labyrinthitis,  while  the  tympanic  cavity  remained 
intact.  The  latter  was  affected  later  with  a  secondary 
suppuration,  and  the  whole  of  the  necrosed  cochlea 
came  away.  The  necrosis  was  probably  due  to  septic 
thrombosis  of  the  cochlear  artery.  Moure  (Bordeaux) 
showed  by  means  of  the  cinematograph  the  characteris- 
tic staggering  gait  of  a  number  of  patients  with  affec- 
tions of  the  labyrinth. 

The  Technique  of  the  Opening  and  the  After- 
tre.\tment  of  Otogenous  Cerebral  Abscess. 

Three  co-reporters,  (i)  Knapp  (New  York)  showed 
the  encephaloscope,  recently  devised  by  Whiting  (New 
York),  a  useful  instrument  for  examining  the  walls  of 
the  absce.ss-cavity.  He  advised  cautious  irrigation,  if 
the  flow  of  pus  is  abundant.  When  the  opening  gapes 
there  is  no  need  of  a  drainage-tube.  Hernia  cerebri  is 
caused  by  a  secondary  abscess.  Secondary  abscesses 
inside  the  cranium  axe  not  rare,  they  cause  aggravation 
of  all  the  symptoms  and  death  by  encephalitis  or 
meningitis.  (2)  Schmiegelow  (Copenhagen)  advises 
that  the  operation  should  be  planned  so  as  to  make  it 
.possible  to  explore  both  cerebrum  and  cerebellum, 
and  should  commence  by  a  free  opening  of  the  middle 
ear.  The  anaesthetic  should  be  given  with  great 
caution,  owing  to  the  risk  of  failure  of  respiration. 
(3)  Botey  (Barcelona):  The  operation  should  always  be 
commenced  by  an  exploration  of  the  mastoid  and 
tympanum,  passing  thence  to  the  intra-cranial  cavity. 
He  advises  that,  as  a  rule,  the  brain  should  be  punctured 
through  the  intact  dura  before  incising  the  latter,  so 
as  to  make  certain  of  the  existence  of  an  abscess  ; 
for,  when  the  dura  has  been  incised  by  a  knife  the 
brain  and  meninges  are  much  more  exposed  to  infec- 
tion. He  condemns  irrigation  of  the  abscess  cavity, 
and  advises  drainage  by  means  of  several  small  tubes. 
Gradenigo  (Turin)  described  a  special  form  of  intra- 
cranial complication  with  the  following  association  of 
symptoms: — Acute  otitis  media,  severe  pain  in  the 
corresponding  side  of  the  head,  especially  in  the  tem- 
poro-parietal  region,  and  paralysis  or  paresis  of  the 
external  rectus  on  the  same  side,  without  other  ocular 
disturbance.  He  has  himself  observed  six  cases.  The 
symptoms  are  due  to  a  circumscribed  focus  of  lepto- 
meningitis. MacEwen  (Glasgow) :  Besides  treating 
the  aural  and  cerebral  foci,  it  is  necessary  to  attend  to 
the  morbid  tract  leading  from  the  one  to  the  other. 
Neglect  of  this  precaution  is  a  frequent  cause  of  re- 
currences.    The  instruments  for  exploring  the  brain 


should  be  used  with  great  gentleness.  If  after  having 
incised  the  dura,  no  adhesions  are  found  in  the  sub^ 
arachnoid  space,  the  author  leaves  a  carbolic  dressing 
in  place  for  twenty-four  hours,  and  then  incises  the 
brain  ;  by  that  time  adhesions  will  have  formed.  As 
an  anajsthetic,  chloroform  is  preferable  to  ether,  which 
causes  oedema  of  the  brain.  After  the  incision,  which 
is  made  as  free  as  possible,  the  author  irrigates  very 
gently  ;  he  uses  no  drain  at  all  or,  at  the  most,  some- 
times a  strand  of  gauze. 

Among  the  numerous  communications  presented 
were  the  following  : — 

Lermoyez  and  Bellin  (Paris) :  "A  Contribution  to 
the  Surgical  Cure  of  Acute  Otogenous  Meningitis." — 
Two  cases  of  recovery  from  general  meningitis  arising 
from  the  ear.  The  first,  a  girl,  aet.  19,  with  old  otorrhoea, 
after  a  month  of  vague  general  symptoms  suddenly 
developed  intense  headache,  stiffness  of  the  neck,  facial 
paralysis,  and  Koernig's  sign.  Lumbar  puncture 
showed  lymphocytes,  58  per  cent.,  polynuclear  cells. 
40  per  cent.  A  large  operation  upon  the  petrous 
bone  was  performed;  the  labyrinthine  wall  was 
carious,  the  dura  covered  with  granulations.  The 
following  day  the  temperature  fell  to  normal.  Koernig's 
sign  persisted  for  several  days.  A  week  later  lumbar 
puncture  showed  very  abundant  lymphocytes,  but 
hardlj'  i  per  cent,  of  polynuclear  cells.  Two  weeks  later 
the  spinal  fluid  was  normal.  The  local  cure  was  slow- 
on  account  of  a  large  sequestrum  of  the  labyrinth. 
Eighteen  months  after  the  cure  is  perfect. 

In  the  second  case,  a  girl,  aet.  ig,  with  old  otor- 
rhoea,  developed  Bezold's  mastoiditis  after  a  chill. 
At  the  operation  an  eburnated  mastoid  was  found  full 
of  thick  pus ;  the  dura  mater  was  healthy.  Ten  days 
later  the  signs  of  meningitis  suddenly  appeared. 
Intense  headache,  stiff  neck,  yomiting,  and  fever. 
I^umbar  puncture  gave  a  turbid  liquid  with  intense 
polynucleosis.  The  dura  was  then  incised,  no  pus  was 
found  in  the  meninges,  and  exploration  of  the  temporal 
lobe  was  fruitless.  The  symptoms  of  meningitis  then 
disappeared,  but  there  was  a  relapse  a  week  later.  A 
lumbar  puncture  was  followed  by  improvement.  .\ 
second  relapse,  with  inequality  of  the  pui)ils,  occurred 
after  another  week.  But  the  c^rebro-spinal  fluid 
became  normal.  From  this  time  the  general  condition  im- 
proved, the  fever  fell  gradually,  and  the  headache  became 
intermittent,  but  the  pupils  remained  unequal  for  a 
long  time.  A  sequestrum  of  the  labyrinth  delayed 
the  local  healing,  but  eight  months  later  the  patient 
was  quite  well.  

Delie  (Ypr^s)  :  "  Tobacco  and  Audition." — A  report 
of  twelve  cases  with  nerve-deafness,  tinnitus,  and 
vertigo  caused  by  the  abuse  of  tobacco. 

Broockaert  (Ghent) :  "  Upon  Injections  of  Paraffin 
while  Cold." — ^The  author  showed  a  new  and  con- 
venient syringe. 

MoUer  (Copenhagen) :  "  The  Report  of  an  Autopsy 
in  a  Case  of  Oto-sclerosis." 

Molini6  (Marseilles) :  "  Two  Cases  of  Occlusion  of 
the  Pharyngeal  Orifice  of  the  Eustachian  Tubes." 
apparently  caused  by  a  rash  use  of  the  galvano-cautery. 

Cauzard  (Paris)  :  "  A  Case  of  Caries  of  both  Petrous 
Bones,"  in  which  sequestra  came  away  from  the 
naso-pharynx. 

Botey,  R.  (Barcelona) :  "  The  Prevention  of 
Stenosis  of  the  Meatus  after  Radical  Operations  on  the 
Ear." — None  of  the  plans  hitherto  proposed  for  pre- 
venting this  complication  give  a  certain  result.  The 
author  makes  an  incision  through  the  antero-superior 
part  of  the  membranous  meatus  as  far  as  the  auricle, 
passing  between  the  superior  edge  of  the  tragus  and  the 
root  of  the  helix,  where  the  cartilage  is  wanting.  At 
the  conclusion  of  the  operation  a  metallic  cone,  slightly 
flattened,  is  introduced  and  left  in  place  for  five  or  six 
weeks.  The  dressing  for  the  deeper  parts  is  introduced 
through  the  cone.  The  results  of  this  plan  have  been 
uniformly  good  ;  the  patients  remain  with  a  very  large 
meatus  almost  concealed  by  the  tragus. 

Mignon  (Nice) :  "A  Grave  Form  of  Eczema  of  the 
Ear,"  &c. 


August   24,    1904. 


EGYPT  AS  A  HEALTH  RESORT.      Thk  Medical  Pmss.    197 


A  museum  of  pathological  specimens,  models,  and 
instruments  was  arranged  in  one  of  the  rooms  at  the 
"School  of  Medicine,  where  the  Congress  was  held. 

A  proposal  that  in  future  the  Congress  should  be 
field  at  intervals  of  three  instead  of  four  years  was  .not 
<:anied.  The  next  Congress  will,  therefore,  be  held  at 
3u  da-Pest  in  tqo8. 

During  the  Congress  the  President  gave  a  delightful 
•garden-party  and  banquet  to  the  members  at  his 
•charming  chateau  at  Carbon  Blanc.  The  delegates 
Avere  also  hospitably  entertained  by  the  French  Society 
of  Otology  and  the  French  Committee  of  Organisation, 
by  the  Mayor  of  Bordeaux  and  by  the  United  Syndi- 
cates of  the  Wine  Growers  of  the  Gironde. 

Chichelk  Nourse. 


Xritidb  Dealtb  IRedortd. 


VII.— KYNANCE  (Cornwall), 
[by    our   special    medical    commissioner.! 


The  Lizard  district,  Cornwall's  almost  island  pro- 
montory,  has  long  been  known  to  the  adventurous 
explorer,  the  enthusiastic  naturalist,  and  the  Nature- 
loving  artist,  but  it  can  hardly  claim  conspicuous  dis- 
tinction as  a  health  station.  It  consists  of  a  tableland 
elevated  a  few  hundred  feet  above  the  sea,  very  bald 
and  treeless,  and  without  hills  to  break  its  uniformity. 

The  uplands  of  the  peninsula,  while  offering  much  of 
interest  to  the  botanist  and  tourist,  afEord  but  little 
that  is  suited  to  the  needs  of  the  invalid.  The  district 
is  bracing,  but  the  lack  of  protection  from  winds, 
especially  those  from  the  east,  limits  its  usefulness  as 
a  resort  for  the  health  seeker,  and,  indeed,  renders  it 
unsuitable  for  many  cases  except  during  the  summer. 

"  The  Lizard  may  be  regarded  as  a  bracing,  healthy, 
and  interesting  resort  for  the  summer  and  early  autumn, 
hut  is  not  suited  for  invalids  in  the  winter  and  early 
spring."  (a) 

The  coastline  of  the  Lizard  is,  however,  peculiarly 
fascinating,  and  many  of  its  sheltered  bays  and  but 
little-known  coves  afford  protection  and  furnish  climatic 
conditions  well  suited  to  the  needs  of  the  feeble.  The 
district  at  present,  it  is  true,  is  more  adapted  to  the 
requirements  of  the  active  holiday  maker  desirous  of 
-using  wisely  a  brief  period  of  respite  from  the  stress 
and  strain  of  daily  routine  than  to  the  more  elabo- 
rate and  carefully  formulated  demands  ot  the  invalid. 
The  prophylactic  value  of  a  judiciously  selected  holiday 
resort  is  now  being  recognised,  and  medical  practi- 
tioners would  do  well  to  acquaint  themselves  with  the 
merits  of  the  Lizard's  much  indented  sea-line,  both  for 
themselves  and  those  who  may  be  guided  by  their 
advice. 

We  have  visited  much  of  the  coast  of  this  district, 
and  can  fully  endorse  the  opinion  of  Mrs.  Craik  :  "  For 
-grandeur,  for  solitariness,  and  for  the  sense  of  immen- 
-sity  which  says  '  Be  still !  '  to  all  worldly  care,  there  is 
-no  coast  like  the  Cornish  coast,  and  no  sea  like  the 
Cornish  sea."  And  certainly  among  the  many  charm- 
ing coves  of  the  Lizard,  Kynance  has  first  place.  The 
late  Lord  Leighton,  conscious  of  the  psychical  influence 
•of  the  spot,  wrote  :  "  Kynance  is  perfectly  unique  ;  it 
is  a  lovely  picture,  and  the  finest  cove  in  the  kingdom." 

This  is  not  the  place  to  describe  the  fascination  of 
colour  afforded  by  sky,  sea,  sand,  rocks,  and  verdured 
cliffs.  With  the  ebb  and  flow  of  tide  an  ever  varying 
round  of  charms  is  offered  to  the  naturalist  and  lover 
of  Nature.  At  low  water  the  wonderful  caves  in  the 
many  hued  serpentine  furnish  endless  delights  for  the 
explorer.  The  visitor  to  Kynance  Cove  will  find  no 
aggressive  hydro,  vulgar  hotel,  or  commonplace  lodging- 
houses,  but  a  simple,  primitive  existence  and  strict 
hygienically  directed  life,  free  from  the  trammels  of 
fashionable  society  and  the  infinite  irritations  of  a 
popular  resort,  which  may  be  enjoyed  at  the  unsophisti- 
cated little  cottage  boarding-house  kept  by  the  kindly 
local  serpentine  worker. 

Sf  "The  CliniAtes  and  Baths  of  Great  firitain  ;  beioff  the  Report  of 
mmittee  of  the  Royal  Medical  and  Chinirgical  Society  of  Lon< 
doiu"     VoLI.    London.    1806. 


It  is  not  for  us  here  to  describe  the  many  merits  of 
Kynance,  but  rather  to  draw  attention  to  its  many 
advantages  as  an  altogether  unspoilt  natural  retreat 
for  the  overworked  in  body  and  the  overwrought  in 
mind.  It  is  far  removed  from  the  rush  of  present-day 
so-called  civilisation  and  sheltered  from  much  of 
Nature's  inclemency.  It  is  freely  exposed  to  vitalising 
sunlight  and  health-bearing  sea  breezes,  and  offers 
excellent  opportunities  for  bathing.  The  naturalist  will 
find  much  material  and  unceasing  opportunities  for 
study.  We  haVe  visited  Kynance  in  the  spring  and  found 
it  an  ideal  spot,  and  we  learn  from  those  well  fitted  to 
express  an  opinion  that  even  in  the  winter  it  is 
comparatively  sheltered  .warm,  and  allows  of  the  conduct 
of  an  enjoyable  open-air  life.  The  inaccessibility  of 
Kynance  is  not  the  least  of  its  advantages,  and  yet 
by  a  little  careful  arrangement  even  an  invalid 
mav  travel  thither  with  a  minimum  of  discomfort. 

The  Great  Western  Railway  now  run  fast  and  in  every 
way  convenient  trains  to  Helston,  which  is  323^  miles 
from  Paddington,  in  about  seven  hours.  From 
Helston  motor  cars  and  coaches  travel  to  Lizard 
Church  Town,  which  is  only  an  easy  walking  distance 
from  Kynance  for  the  vigorous.  Delicate  visitors 
should  drive  by  carriage  from  Helston  to  Kynance, 
a  distance  of  about  ten  miles.  Kynance  may  also 
be  .reached  by  invalids  staying  at  Falmouth  by  an 
interesting  drive  of  some  twenty  miles. 

EGYPT  AS  A  HEALTH  RESORT. 


UPPER  EGYPT  {continued  from  page  16). 


[by    our    special    travelling    CORRESPONDENT-! 


Cairo  might  well  be  described  as  the  Paris  of  the  East. 
The  city  is  full  of  avenues,  gardens,  promenades,  caf6s, 
&c.  It  also  possesses  some  of  the  most  attractive  hotels, 
such  as  the  Ghezireh  Palace  Hotel  (the  ancient  palace 
of  that  luxurious  prince,  Ismail  Pasha),  Shepheard's 
Hotel,  and  H6tel  Savoy.  They  are  well  situated,  and 
adapted  with  the  necessaries  for  convalescents  and 
those  needing  the  open-air  treatment.  As  a  medical 
man  I  would  specially  recommend  the  Ghezireh  Palace 
Hotel,  with  its  beautiful  landscape,  situated  out  of  the 
town,  and  encircled  by  lovely  gardens.  The  luxurious 
comforts  of  these  hotels  are,  broadly  speaking,  attain- 
able only  by  well-to-do  people,  but  for  those  whose 
resources  are  limited,  similar  accommodation  can  be 
obtained  at  the  Pension  Tewfick,  Pension  Margosches, 
or  by  inserting  a  notice  ii  the  Egyptian  Gaiette,  some 
time  before  leaving  home,  requesting  board  and 
lodging  with  a  private  family,  with  terms,  &c.,  in  the 
usual  way. 

Cairo  has  some  splendid  hospitals — the  Kasr-el- 
Aini,  having  at  its  head  the  well-known  surgeon  of 
the  Levant,  Dr.  Milton,  and  to  which  a  medical  college 
is  attached.  Though  the  hospital  is  of  considerable 
size  and  fitted  with  the  latest  modern  improvements, 
it  is  chiefly  for  the  use  of  Egyptians,  and  the  nursing 
being  in  the  hands  of  the  latter,  renders  it  unsuitable 
for  Europeans  requiring  proper  nursing.  The  smaller 
English  hospital  is  very  neatly  kept,  with  good  sanita- 
tion and  under  the  guidance  of  an  excellent  physician. 
Dr.  Murison.  The  Deaconess'  or  Prussian  hospital  is 
a  pretty  little  building  attended  by  Dr.  Wildt 
(German)  and  Dr.  Sandwith  (English). 

About  a  hundred  yards  distance  from  Shepheard's 
Hotel  there  exists  a  bathing  establishment,  having  the 
latest  and  most  improved  requirements  of  hydro-  and 
electro- therapeutic  treatment,  w^ith  massage,  &c.,  and 
under  the  direct  supervision  of  German  specialists,  who 
are  annually  brought  out  to  Egypt  by  the  proprietors 
during  the  autumn  and  winter  seasons  for  the 
purpose  of  superintending  the  establishment ;  and 
on  the  whole  it  may  be  said  of  Cairo,  coupled 
with  its  climate,  temperature  during  autumn  and 
winter,  and  the  mode  of  living  and  the  pic- 
turesque and  kaleidoscopic  sight  of  the  different 
nationalities  and  Eastern  manners,  that  it  constitutes 
for    convalescents  and    those    suffering    from     chest 


198 


Tbe  Medical  Peess. 


GERMANY. 


August  24,  1904. 


diseases,  as  well  as  for  rheumatic  and  gouty  subjects^ 
a  most  invigorating  and  attractive  health  resort. 
With  regard  to  sanitation,  much  has  yet  to  be 
accomplished.  Cairo,  in  those  quarters  occupied 
by  Arabs,  is  filthy  and  unhealthy,  but  Cairo, 
the  centre,  is  clean  and  healthy.  Anyone  desir- 
ing medical  attendance  can  safely  choose  among 
the  following  well-known  physicians  and  surgeons  : — 
Dr.  Milton.  Dr.  Foster,  Dr.  Toller,  Dr.  Murison,  Dr. 
Sandwith,  Dr.  Wildt,  Dr.  Coumanos  Pasha,  and 
Professor  Fomario.  Half  an  hour's  distance  from 
Cairo  is  Helouan,  with  its  well-known  mineral  spring. 

Luxor  is  about  twenty  hours'  run  from  Cairo.  It 
contains  ancient  temples.  There  are  only  two  hotels  — 
the  Hotel  Luxor,  which  generally  has  an  EnglisH 
ph3rsician  for  the  season,  and  Mr.  George  Coromilla's 
hotel.  Excepting  the  antiquities  there  is  nothing  attrac- 
tive here,  and  nothing  worthy  of  note.  The  climate  in 
summer  is  necessarily  warm,  but  in  winter  it  is  dry  and 
bracing.  Life,  however,  is  very  monotonous,  and  there 
are  no  British  residents. 

Assouan  is  a  healthy  little  town  possessing  an 
attractive  hotel  (Pagnon's  Hotel).  There  are  historical 
ancient  temples,  the  climate  is  invigorating,  dry,  and 
temperate  during  the  winter,  but  exceedingly  warm 
during  the  summer.  Medical  attendance  can  be 
obtained  from  the  English  medical  officer  attached  to 
the  Assouan  hospital.  The  climate  is  indicated  as 
particularly  suitable  for  patients  suffering  from  nervous 
and  constitutional  diseases. 

Wady  Halfa  is  about  six  hours'  run  from  Assouan. 
There  are  only  one  or  two  small  hotels  worth  men- 
tioning. Medical  attendance  can  be  had  from  medical 
officers  attending  the  military  hospitals  only  by  favour. 
The  town  is  dull  and  monotonous,  but  the  climate  is 
temperate,  healthy,  and  bracing,  and  those  suffering 
from  hepatic  disorders  caused  by  irregular  living  cannot 
choose  a  better  place  or  climate  for  a  season. 


jfrancc* 


[from  our  own  correspondent.] 


Paris,  AuflTUSt  2l8t,  1901. 
Experimental  Treatment  with  Nucleinate  of 
Soda. 
Nucleinic  acid,  says  Prof.  Huchard.  has  been 
employed  by  a  few  physicians  for  gout  as  a  dis- 
solvent of  uric  acid,  as  a  general  tonic,  and  as  an  anti- 
tuberculous  agent.  Seeing  that  nucleinic  acid  pro- 
voked hyperleucytosis  when  injected  into  animals, 
he  charged  his  house  physician  to  try  nucleinate 
of  soda  as  an  anti-infectious  agent  producing  in  the 
organism  hyperphagocytosis.  M.  Huchard  employed  this 
in  six  cases  in  daily  injections  of  twenty  drops  of  a  5 
per  cent,  solution,  representing  one  grain  of  the  drug. 
No  pain  or  local  inflammation  was  ever  observed  during 
the  treatment,  proving  it  to  be  absolutely  innocuous. 
Of  the  six  cases  treated,  three  experienced  no  benefit 
from  it,  but  the  success  in  the  remainder  was  very 
remarkable.  The  first  of  these  patients  had  already  been 
in  the  ward  two  months,  suffering  from  pulmonary 
phthisis.  A  large  vomica  was  situated  in  the  right 
apex,  emaciation  was  considerable  and  progressive, 
while  the  temperature  rose  in  the  evening  to  103°. 
On  July  6th,  the  patient  had  arrived  at  the  last  stage 
of  the  disease — ^pallor,  cyanosis,  haemoptysis,  dyspnoea, 
with  all  the  signs  of  impending  dissolution.  As  a  last 
resort  injection  of  nucleinate  of  soda  was  ordered.  The 
following  day,  to  the  astonishment  of  all,  the  patient  was 
still  alive,  and  eight  days  subsequently  the  patient  was 
able  to  take  strong  nourishment — eggs,  beef-tea,  milk, 
raw  meat.  The  dyspnoea  had  entirely  disappeared  and 
tbe  patient  was  able  to  get  up  and  walk  about  the 
ward.     The  improvement  continued  each  day. 


The  second  case  was  a  man  who  entered  the  hospital 
for  pneumonia.  This  patient,  who  had  had  a  cough  for 
some  time,  had  got  thin,  but  nevertheless  was  able  to  con- 
tinue his  trade  as  a  baker.  The  day  before  he  entered 
the  hospital  he  was  seized  with  pain  in  the  side.  On 
examination  intense  dulness  was  found  over  the  right 
apex  with  crepitant  rdUs  without  wheezing.  The 
temperature  was  104°.  Pneumonia  of  the  apex 
of  the  right  lung  of  perhaps  bacillary  origin  was  the 
diagnosis  made.  The  next  day  the  patient  was  plunged 
in  stupor,  in  a  half  comatose  state,  answering  questions 
put  to  him  with  difliculty.  Although  the  pulse 
was  good  (96)  the  dyspnoea  was  intense,  the  face  pale 
and  drawn,  eyes  sunken,  the  weakness  was  extreme. 
An  injection  of  caffein  and  another  of  nucleinate  of 
soda  were  ordered  and  a  stimulating  mixture.  After 
the  third  injection  of  nucleinate  of  soda,  the  symptoms 
began  to  rapidly  amend,  so  that  on  the  seventh  day  the 
patient  was  able  to  get  up  and  take  ordin^iry  food. 

The  third  and  last  case  was  that  of  a  nurse,  fpt.  20. 
suffering  from  typhoid  fever  of  a  very  grave  type ;  in  a 
delirious,  semi-comatose  state,  with  high  temperature 
and  profuse  and  foetid  diarrhoea ;  pulse  1 20 ;  congestion 
of  both  lungs,  dyspnoea,  intestinal  haemorrhages.  After 
ten  daily  injections  of  nucleinate  of  soda  the  patient, 
in  spite  of  her  very  unfavourable  condition,  was  con- 
valescent. It  should  be  added  that  the  usual  treatment 
— caffein,  ergotin  and  intestinal  antiseptics — was  con- 
tinued concurrently  with  the  injections. 

Professor  Huchard  concludes  bv  saying  that  he 
intends  to  continue  the  experiments  with  this  drug, 
believing  the  treatment  to  be  quite  rational  and  in  am' 
case  it  exposed  the  patients  to  no  danger. 


Oennans. 


[from  our  own  correspondent.] 


Berlin,  August  20th,  190i. 

At  the  Society  of  Charite  Physicians,  Hr.  Konig 
spoke  on 

Cholecvstotomy  .and  Cholecystectomy, 
and  showed  some  cases.  One  of  the  cases  was  of  interest 
from  the  fact  that  it  had  been  mistaken  for  a  movable 
kidney,  so  that  nephrorraphy  was  first  performed,  and 
afterwards  the  gall-bladder  was  opened.  Violent  pain 
came  on  again  later,  and  necessitated  another  opera- 
tion, when  a  stone  was  found  in  a  diverticulum  of  the 
duct ;  the  gall-bladder  was  now  removed.  The  latter 
operation  should  be  performed  when  the  calculi  were 
difficult  to  remove,  or  a  tumour  was  present,  otherwise 
cholecystotomy  would  be  sufficient. 

Hr.  Milner  spoke  on 
Circulatory  Disturbances  after  Compression  of 
THE  Thorax. 

Such  disturbances  sometimes  came  on  after  severe 
pressure  on  the  thorax.  They  were  accompanied  by 
cyanosis,  oedema  of  the  face,  and  especially  of  the 
eyelid,  there  might  be  even  haemorrhages  into  the 
fundus  oculi.  There  were  cases  in  which  the  blood 
was  forced  backwards  out  of  the  thorax  along  with 
reflex  closure  of  the  glottis. 

At  the  Free  Society  of  Surgeons,  Hr.  Kroner  gave 
notes  of  a  case  of 

Intra-peritoneal    Torsion    of    the  Omentum. 

A  patient  who  had  a  reducible  inguinal  hernia  found 
one  day  that  he  could  no  longer  replace  it,  and  had 
slight  abdominal  pain  with  vomiting.  The  following 
day,  however,  he  felt  quite  well.  On  the  tenth  day 
after     this    he    was     admitted    into    hospital    with 


August  24.  1904. 


AUSTRIA, 


The  Mbdical  Pmss.     199 


irreducible  hernia,  but  with  no  accompanying  symptoms 
of  incarceration.  At  the  operation,  dark-looking 
adherent  omentum  was  found  in  the  sac,  although  the 
ring  was  not  tight  enough  to  cause  constriction.  It 
"was  formed  into  a  cord,  and  an  extension  of  the  opera- 
tion showed  that  it  had  the  cord-like  character  as  high 
up  as  the  transverse  colon,  and  that  it  was  several  times 
twisted  on  itself.  The  whole  omentum  was  bluish  red, 
with  necrotic  spots  in  places.  A  length  of  36  cm.  was 
removed,  and  the  abdomen  closed,  the  patient  doing 
"well.  The  slight  character  of  the  symptoms  accom- 
panying such  serious  changes  was  remarkable.  No 
explanation  of  the  twisting  could  be  made  out. 

Hr.  Sonnenburg  had  been  able  to  untwist  the  omen- 
tum in  a  recent  case,  and  saw  how  it  regained  its  normal 
colour  as  this  was  done.  He  had  also  noticed  the  slight 
character  of  the  symptoms  presented. 

Hr.  Schroeder  showed  some 

Foreign  Bodies 
removed  in  operation.  The  first  were  foreign  bodies 
from  the  vermiform  appendix,  among  them  two 
oxyurides  vermiculares,  a  splinter  of  steel,  a  fragment  of 
walnut  shell,  a  crushed  cherry-stone,  the  two  latter  in 
a  perityphlitic  abscess.  Probably  they  were  quite 
accidental,  and  had  nothing  to  do  with  the  disease 
etiologically,  except,  perhaps,  in  the  case  of  the  piece 
of  steel.  Further,  a  cofiee-bean  from  the  trachea,  re- 
moved from  a  child  by  tracheotomy,  a  plate  of  teeth 
removed  from  the  oesophagus,  an  iron  ring  a  pound  in 
weight,  that  a  man  had  drawn  over  his  penis  six  days 
before,  the  penis  swelling  very  much  afterwards  ;  two 
Rontgen  pictures  of  projectiles  that  set  up  no  reaction, 
and  a  piece  of  cartilage  from  the  knee-joint  of  a  girl 
who  some  time  before  had  fallen  on  her  knees. 

He  also  showed  a  man  who,  after  a  radical  operation 
on  his  ear,  had  complete  paralysis  of  the  facial  nerve 
as  a  consequence.  The  paralysis  had,  however,  been 
materially  improved  by  plastic  transplantation  of  a 
portion  of  the  accessory  nerve. 

Hr.  Rinni  spoke  on 
Talma's  Operation  for  Cirrhosis  of  the  Liver. 

He  had  performed  the  operation  three  times,  but 
two  of  the  patients  were  in  a  desperate  condition,  and 
died  a  few  days  afterwards  ;  in  the  third  case  a  com- 
p>aratively  favourable  result  was  obtained.  The 
patient  was  shown.  She  was  admitted  into  hospital 
in  November  last  with  excessive  ascites  and  brown 
discoloration  of  the  skin.  The  liver  dulness  was 
small,  the  spleen  very  much  enlarged.  Laparotomy 
revealed  an  atrophied  liver,  a  large,  hard  spleen  with 
a  strongly  thickened  fibrous  capsule.  Suture  of  the 
omentum  between  the  peritoneum  and  musculature  in 
two  large  pockets.  The  ascites  quickly  reformed,  and 
then  began  to  diminish  spontaneously,  and  had  not 
again  returned.  The  general  condition  had  improved 
very  much,  and  the  discoloration  of  the  skin  had  dis- 
appeared. Probably  congenital  syphilis  was  the  cause 
of  the  illness. 

Hr.  Borchardt  had  performed  the  operation  in  two 
cases  of  syphilitic  cirrhosis  of  the  liver,  but  without 
any  benefit. 

Hr.  Martens'related  a  case  of 

Renal  Surgery. 

A  boy,  aet.  13,  had  suffered  from 'renal  colic  of  the 
ieft~side  with  passage  of  gravel  and  small  calculi. 
After  some  time  the  urine  became  quite  clear,  but  the 
pain  still  persisted.  Catheterisation  of  the  ureters 
showed  that  the  left  kidney  was  much  less  active  than 
the  other.  Nephrotomy  was  performed  in  November 
last,  when  it  was  found  that  the  left  kidney  was  con- 
tracted,  but   there  was  no  stone.     The  kidney  was  I 


sutured,  but  the  capsule  was  left  open  in  order  to 
lessen  the  pressure  on  the  kidney.  Since  then  there 
had  been  no  more  pain. 

In  a  similar  case  shown  some  time  ago,  the  pain 
had  ceased  as  in  the  one  related. 

The  same  speaker  also  related  the  case  of  a  married 
woman,  aet.  28,  who  had  fever  after  separation  of  the 
plac^enta,  with  vomiting,  and  a  painful  resistance  on 
the  left  side.  The  urine  contained  pus  corpuscles  and 
blood.  Catheterisation  of  the  ureters  showed  that 
both  kidheys  were  diseased.  As  the  case  went  on 
endocarditis  developed,  but  after  some  months'  illness, 
the  patient  eventually  recovered. 


Bnstrfa* 


[from  our  own  correspondent.] 

ViraiTA,  Aogost  21st,  1904. 
OSTEO-ARTHROPATHICA   TaBBS    VERTEBRALIS. 

Rudinger  exhibited  a  tabetic  patient  to  the  Society 
for  innere  Medizin,  with  kyphosis  in  the  three  first 
lumbar  vertebrae,  and  notwithstanding  this  morbid 
condition  of  the  osseous  structure,  the  functional 
activity  of  the  cord  was  unimpaired  by  the  lesion. 
This  freedom  of  movement  eliminated  several  etio- 
logical factors  in  the  diagnosis,  such  as  heteroplastic 
neoplasms  in  the  canal  itself.  By  this  observation 
tumours  or  aneurysms  of  the  dura  mater  were  excluded, 
which  might  be  supported  by  the  duration  of  the 
disease,  which  had  been  under  operation  for  at  least  four 
years,  and  the  absence  of  any  myelitic  symptom. 
Then,  against  tuberculous  spondylitis  the  evidence  of 
no  pain,  either  subjective  or  objective,  and  free  func- 
tional movement  in  the  cord  excluded  any  other  dia- 
gnosis than  osteo-arthropathia  tabes  vertebralis. 

The  Rontgen  rays  showed  the  sacral  and  lumbar 
bones  in  a  normal  condition  with  the  exception  of.  the 
second  and  third  lumbar  vertebrae.  The  second  was 
broken  on  the  left  side,  while  the  third  was  broken  on 
the  right  side,  thus  making  two  wedges,  bending  the 
column  sharply  above  and  below  the  lesions. 
Gastric  Anthrax. 

Schmidt  next  showed  a  few  microscopic  preparations 
taken  from  a  patient  who  subsequently  died  of  the 
disease.  The  patient  first  came  under  his  observation 
nine  days  before  the  exitus.  From  the  clinical  obser- 
vation he  appeared  to  be  suffering  from  a  very  severe 
form  of  general  poisoning,  as  the  abdominal  symptoms 
were  the  most  prominent.  The  epigastrium  was  tender 
and  swollen,  with  sickness  and  vomiting,  which  led  to 
the  first  diagnosis  of  gastritis  phlegmonosa,  although 
the  possibility  of  anthrax  w^as  taken  into  account 
owing  to  the  resemblance  of  some  of  the  symptoms, 
and  by  reason  of  his  trade,  a  cabinet-maker,  which 
brought  him  into  contact  with  the  hair  of  animals. 
There  was  no  diarrhoea  or  colic  with  the  sickness  that 
lent  a  strong  suspicion  to  anthrax. 

An  examination  bacteriologically  was  undertaken  to 
confirm  the  diagnosis  of  gastritis  phlegmonosa,  but 
nothing  could  be  found  in  the  contents  of  the  stomach 
to  justify  anthrax,  neither  could  anything  be  found  in 
the  blood.  Shortly  after  this  the  patient  suddenly 
collapsed  and  died. 

The  post-mortem  revealed  a  large  necrotic  inflam- 
matory ulcer  in  the  mucous  membrane  of  the  stomach, 
but  not  a  single  trace  of  an  ulcer  could  be  found  in 
the  bowel  lowerTdown.  Sections  of  this  ulcer  were 
taken  and  stained  by  Gram's  method,  with  the  result 
that  anthrax  bacilli  were  found  for  the  first  time.' 

How  the  infection  was  carried  into  the  stomach  alone 
is   not  yet  quite   clear,  although   the   patient  always 


200  Thk  Mbdical  P&ssa. 


OPERATING   THEATRES/ 


August  24,  1904. 


blamed  the  eating  of  a  sausage  for  bringing  on  the 
illness  which,  strangely  enough,  commenced  the  follow- 
ing day. 

Constipation  and  Hypnotic  Suggestion. 
At  the  Naturforscher,  Delius  proposed  hypnotics  for 
constipation.  He  commenced  by  discussing  the 
physiology  of  alimentation,  and  said  that  defaecation 
did  not  depend  entirely  upon  the  stimulus  of  the  faecal 
mass  in  the  bowel,  or  the  innervation  of  the  mucous 
membrane  of  the  rectum.  There  is  also  a  central 
automatic  influence  to  be  considered  in  addition,  as 
the  faith  of  the  patient  is  always  a  potent  factor  in  the 
gastric  movements,  and  particularly  in  defaecation. 

When  the  bowels  first  become  sluggish  we  know  it  is 
due  to  a  loss  of  innervation  of  the  sympathetic.  By 
the  hypnotic  suggestion  the  automatic  movements  are 
stimulated,  and  a  stronger  innervation  wave  produced 
along  the  whole  alimentary  tract,  which,  if  repeated, 
will  soon  put  the  bowel  in'*a  normal  condition.  The  1 
reverse  takes  place  in  functional  diarrhoea,  and  the 
deeper  the  hypnosis  the  more  effectual  is  the  remedy. 
He  tells  us  that  out  of  eighty-four  cases  treated  in 
this  manner,  only  4  per  cent,  failed,  ijj  per  cent,  im- 
proved, and  79  per  cent,  were  perfectly  cured. 

Schmidt  said  that  he  would  rather  discourage  this 
treatment  altogether.  The  primary  disturbance  of  con- 
stipation is  to  be  sought  for  in  the  motor  sphere,  and 
by  careful  attention  to  feeding  all  can  be  accomplished 
that  Delius  claims  for  hypnotic  suggestion.  For  the 
argument  of  increased  decomposition  by  bacteria.^when 
long  detained  in  the  bowel,  is  without  any  force  as 
the  bacteria  are  not  increased  by  constipation. 

Naunyn  thought  the  speaker  in  presenting  this 
subject  to  the  meeting  had  made  a  mistake,  as  the  faeces 
in  constipation  do  not  increase  in  bacteria  though  long 
detained  in  the  bowel,  which  is  certainly  opposed  to 
the  accepted  opinion  that  the  longer  the  faeces  are 
detained  in  the  bowel  the  greater  will  be>he  decom"- 
position. 

Schmidt  said  that  he  would  further  emphasise  this 
fact  by  saying  that  indol  and  sulphuric  ether  are  even 
reduced  in  constipation,  which,  he  thinks,  may  be  used- 
up  intestinal  ferments. 

Baumler  thought  the  hypnotic  remedy  a  good  one, 
and  likely  to  be  successful. 

Fisch  thought  he  had  a  better  agent  than  hypnotism 
for  constipation  in  carbonic  acid  baths  when  given  in 
proper  doses.  The  latest  addition  to  this  subject  shows 
that  the  dosing  must  be  gradually  increased  to  be 
effectual.  These  baths  act  on  the  haematic  circulation 
as  proved  by  their  efficacy  in  chlorosis,  anaemia, 
debility,  and  convalescence. 

Raether  thought  the  baths  may  be'very  good  in  their 
way,  but  the  new  system  was  far  too  expensive  for 
practical  use.  Each  bath,  according  to  the  latest  tariff, 
is  three  marks, while  a  Sandow  only  costs  one  mark  and 
twenty  pfennings.  He  thought  the  new  system  was 
prohibitive. 

XCbe  ®peratina  Zbcattcs. 

GREAT  NORTHERN  HOSPITAL. 
Inflamed  Appendix  in  the  Sac  of  a  Femoral 
Hernia. — Mr.  Warren  Low  operated  on  a  married 
woman,  aet.  al>out  30,  who  had  been  admitted  for  a  tender 
swelling  in  the  right  groin.  She  stated  that  she  had 
had  a  swelling  there  since  the  birth  of  her  last  child, 
a  year  ago,  but  that  it  had  not  given  rise  to  any  incon- 
venience. Three  days  before  admission  she  noticed  that 
the  swelling  became  tender  and  she  vomited.  The 
tenderness  and  pain*  in  the  swelling  continued,  but  the 


vomiting  ceased.  The  bowels  were  opened  on  the  night 
before  admission  by  means  of  a  laxative.  On  admissioQ 
she  was  not  collapsed  and  did  not  appear  very  ill; 
she  had  been  sick  since  the  onset  pf  the  attack,  and 
there  was  no  evidence  of  intestinal  obstruction.  In  the 
region  of  the  right  femoral  ring  there  was  a  tender  swel- 
ling  over  which  the  skin  was  red  and  oedematous.  The 
patient  stated  that  there  had  been  so  me  attempt  made 
at  reduction  by  taxis.  The  patient  was  prepared  fpr 
operation  with  the  view  that  the  hernia  was  an  irre- 
ducible femoral  hernia,  with  an  inflamed  sac.  On 
exposing  the  tumour  the  sac  of  the  femoral  hernia  was 
found  in  the  usual  position  ;  on  carefully  incising  this 
some  foul-smelling  pus  escaped,  which  further  examina- 
tion proved  to  have  arisen  from  a  small  abscess  outside 
the  apex  of  the  appendix,  which  was  adherent  to  the 
sac  of  the  hernia,  and  in  which  there  was  a  small  perfora- 
tion. The  pus  was  carefully  wiped  away  and  the 
interior  of  the  hernial  sac  disinfected  before  drawing 
down  the  caecum  to  remove  the  appendix.  This  was 
effected  in  the  usual  manner  by  turning  down  a  cuff  of 
muscle  and  peritoneum  and  ligaturing  the  mucons 
and  submucous  coats  and  afterwards  invaginating  the 
stump  into  the  cjpcal  wall.  The  sac  of  the  hernia 
was  then  tied  and  removed,  the  external  wound  partly 
closed,  a  drainage-tube  being  left  in  position  down  to 
the  closed  sac.  Mr.  Warren  Low  said  that  the  diagnosis 
in  this  case  was  that  of  an  inflamed  hernia,  a  condition 
sometimes  due  to  injury  to  the  sac  or  its  contents  from 
prolonged  taxis.  The  diagnosis  was  correct  but  the 
cause  of  inflammation  lay  in  the  peculiar  contents  of  the 
sac  of  the  hernia — namely,  the  appendix  vermiformis, 
which  was  undergoing  an  ordinary  attack  of  appendicitis. 
He  had  often  met  with  the  appendix  in  the  right  in- 
guinal hernia  of  young  children,  but  he  had  never  yet 
operated  upon  a  case  in  which  the  appendix  was  in  a 
condition  of '  inflammation,  though  this  complication 
had  been  found  by  other  surgeons.  It  was  important, 
he  thought,  in  such  a  case  to  carefully  cleanse  the  sac 
and  the  external  wound  before  drawing  down  the  base 
of  the  appendix  in  order  to  effect  its  removal  as. 
although  no  adhesions  had  shut  off  the  sac  from  the 
peritoneal  cavity,  no  general  infection  of  the  latter  had 
taken  place  at  the  time  of  operation.  Bearing  in  mind 
the  possible  infection  of  the  wound  by  the  foul  contents 
of  the  sac,  no  attempt  at  a  radical  cure  could  be  made 
by  bringing  up  a  flap  of  pectineal  fascia  to  Poupart's 
ligament.  For  a  similar  reason  a  drainage- tube  was 
left  in  the  external  part  of  the  wound,  though  it  was 
considered  safe  to  close  the  peritoneal  cavity.  The 
patient  left  the  hospital  about  three  weeks  after 
operation,  never  having  had  an  adverse  symptom. 

ST.  PETER'S  HOSPITAL. 

Case  of  Nephro-lithotomy. — Large  Calculus.— 
Mr.  SwiNFORD  Edwards  operated  on  a  caseof  a  man,  at . 
about  40.  who  came  to  the  hospital  complaining  of  right 
lumbar  pain,  with  a  deposit  of  pus  in  the  urine,  and  occa- 
sional attacks  of  haematuria.  He  had  undergone  operation 
for  stricture  some  years  previously  by  Mr.  Edwards. 
After  the  lapse  of  a  few  days,  Mr.  Edwards  examined 
the  bladder  with  the  cystoscope  under  an  anaesthetic. 
The  right  ureteral  orifice  was  patent  and  somewhat 
protruding  ;  pus  was  seen  to  be  coming  down  the 
ureter.  On  the  left  side  the  ureteral  orifice  appeared 
normal.  The  bladder,  which  was  somewhat  fascica- 
lated,  was  otherwise  normal  and  contained  n(^  growth 
or  stone.     An  X-ray  photograph  was  then  taken,  and 


August  24,  1904. 


LEADING  ARTICLES. 


The  Midical  Pkess.     201 


a  large  shadow  or  series  of  shadows  appeared  in  the 
right  lumbar  region  and  seemed  to  indicate  the  pre- 
sence of  a  large  stone  or  of  several  stones.  Examina- 
tion of  the  abdomen  showed  increased  resistance  in  the 
right  flank,  muscular  rigidity,  and  an  increase  in  the 
area  of  dulness.  The  temperature  was  raised  so  that 
a  perinephritic  abscess  in  addition  to  calculous  pyelitis 
was  suspected.  The  patient  looked  very  ill  when 
brought  into  the  operating  theatre.  He  was  placed 
on  the  left  side,  and  the  right  flank  made  prominent  by 
placing  a  large  sandbag  under  the  opposite  flank. 
After  section  of  the  abdominal  wall,  there  was  a  sudden 
lush  of  pus  from  a  large  perinephritic  abscess,  the 
cavity  of  which  Mr.  Edwards  carefully  examined  with 
liis  finger.  He  detected  the  kidney  at  the  bottom  of 
the  cavity  with  a  fragment  of  stone  projecting  from  itg 
surface.  The  opening  through  which  this  came  was 
ililated  with  the  finger  ;  it  was  soon  apparent  that  a 
Jarge  branched  calculus  was  present.  Its  removal 
necessitated  an  incision  through  the  posterior  convex 
border  of  the  kidney  in  its  entire  length.  The  stone 
was  extracted  in  two  parts  with  a  certain  amount  of 
difficulty  and  with  free  haemorrhage,  to  restrain  which 
the  kidney  was  packed  with  gauze  after  the  surgeon 
had  made  sure  that  the  ureter  was  patent.  Two  large 
rubber  drains  were  inserted  into  the  perinephritic 
abscess  cavity,  and  the  wound  closed  in  the  usual  way. 
The  patient  bore  the  operation  better  than  could  have 
been  expected.  Mr.  Edwards  said  it  was  curious  that 
this  patient  should  not  have  applied  before  for  relief, 
as  he  must  have  had  the  stone  in  the  kidney  for  some 
years.  If  was  a  question,  Mr.  Edwards  remarked,  as 
to  whether  he  had  done  right  in  leaving  the  kidney, 
for  it  was  problematical  how  much  secreting  substance 
remained.  If  the  wound  did  not  heal  up  fairly  quickly 
the  operator  proposed  to  do  a  secondary  nephrectomy, 
as  he  thought  this  was  a  better  course  than  sacrificing 
the  kidney  at  once.for  after  all  it  might  not  be  necessary. 
He  thought  from  the  size  of  the  stone  that  the  weight 
would  probably  be  well  over  two  ounces  ;  its  length 
was  four  inches,  the  central  part  was  a  kind  of  waist 
which  had  occupied  the  pelvis  of  the  kidney,  and  from 
the  upper  and  lower  part  of  the  central  portions  pro* 
jected  elongated  knobs  or  excrescences,  which  were  evi' 
dently  casts  of  the  caUces  ;  hence  could  be  understood 
the  great  difficulty  in  extracting  these  portions  of  the 
stone  which  were  thoroughly  grasped  by  the  kidney 
substance  surrounding  each  calyx. 

A  month  after  operation  the  patient  was  progressing 
in  a  very  satisfactory  manner,  only  a  very  small  sinus 
remaining. 


Nuns  as  Nurses. 
Mr.  Sloaxe  last  week  asked  the  Chief  Secretary  to 
the  Ix>rd  Lieutenant  of  Ireland  whether  he  was  aware 
that  at  the  meeting  of  the  Newry  Board  of  Guardians 
three  nuns  from  the  Convent  in  Wexford  were  ap- 
pointed as  nurses  to  Newry  Workhouse  ;  if  he  could 
say  where  these  nurses  were  trained  and  what  was 
their  qualification ;  and  why  these  appointments 
were  given  to  members  of  a  reUgious  order.  Mr. 
Wyndham  answered  that  three  nuns  who  were  em- 
ployed in  the  workhouse  infirmary  had  recently  re- 
igned, and  the  guardians  had  elected  three  other  nuns 
in  their  places.  The  latter  had  had  several  years'  ex- 
perience as  nurses  in  union  infirmaries,  including 
that  at  Wexford.  Protestant  patients  at  Newry 
vere  in  charge  of  a  Protestant  nurse. 


RMiamio  FOR  TsAKuiiasiOH  Abboad. 

XCbe  Aebtcal  press  an&  Circular. 

PuMiAbed  erery  W^dnewlaj  mominir.  PHoe  5d.     Po«t  lr«e.  6id. 

IDVBBTIBBimfTS. 

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OoMiderable  ReduotiooB  from  the  foregoing  Boale  are  made  whea 
an  order  is  given  for  a  Beries  of  inaertionB.  Terme  on  applica- 
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SUBSO&IPTIONS. 

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is  printed  on  thin  plate  paper  for  foreigrn  and  Oolooial  sub- 
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XTbe  AeMcal  press  an&  Circular* 


SALUS  POPUU  SUPREMA  LEX." 


WEDNESDAY,  AUGUST  24,  1904. 


THE    LAST    GREAT    SACRIFICE    FOR 
HONOUR. 

The  annals  of  civiUan  life  are  from  time  to  time 
illuminated  by  the  record  of  some  heroic  act  of 
self-sacrifice.  Away  from  the  glamour  of  military 
pomp  and  the  stir  of  battle,  some  citizen  engaged 
in  the  pursuits  of  private  life  makes  the  last  great 
sacrifice  of  his  life  in  response  to  the  call  of  duty. 
What  greater  proof  could  be  given  of  human 
faithfulness  to  high  ideals  ?  The  bra,very  of 
the  nav\'y  who  was  killed  in  saving  an  express 
train,  and  of  the  driver  who  stopped  his  engine 
deliberately  at  the  cost  of  his  own  life,  stand 
blazoned  in  an  undying  roll  of  fame.  The  recent 
death  of  Lady  McNeill  in  an  attempt  to  rescue 
a  little  boy  visitor  from  drowning  adds  another 
name  to  the  list  of  honour.  The  tragedy  of  that 
event  has  suggested  to  a  contemporary — the 
Daily  News — the  question  whether  such  sacrifice 
is  "^ worth  while."  To  put  the  matter  in  other 
words,  was  it  justifiable  for  a  highly-trained 
member  of  society  to  risk  her  own  valuable  life 
for  the  sake  of  that  of  a  little  child  whose 
value  to  the  community  was  entirely  potential  ? 
In  a  matter  of  this  sort  the  man  of  action  does  not 
stop  to  think.  He  dives  into  the  water  without 
waiting  to  ask  what  is  the  social  status  of  the 
person  he  is  attempting  to  save.  To  the  brave 
man  all  human  life  is  sacred,  and  in  most  cases 
he  is  ready  to  run  any  reasonable  risk  in  order 
to'save  the  lives  of  others.  To  incur  the  certainty 
of  death  with  a  remote  chance  of  saving  life 
savours,  perhaps,  somewhat  too  strongly  of 
recklessness  to  constitute  bravery  of  the  highest 
kind.  But^there  is  no  need  to  chop  moral  philo- 
sophy over  this  matter.  Happily,  the  nobler 
qualities  of  man  survive  the  sordid  struggle  for 
existence  into  which  he  is  for  the  most  part 
plunged  by  the  necessities  of  the  case.  So  long 
as  human  nature  retains  its  present  characteristics  • 


202     Trb  Medical  PiBst. 


LEADING  ARTICLES. 


August  24,  1904. 


so  long  will  men,  women,  nay,  children  also 
be  willing  to  risk  their  own  hv^s  in  the  attempt 
to  save  their  fellowi.  Civilian  bravery  of  this 
kind  often  puts  in  the  shade  that  of  the  soldier, 
whose  trade  it  is  to  deal  with  life  hazards,  and  to 
whom  every  definite  risk  connotes  rewards  on  an 
equally  definite  scale.  The  miner  who  heads  a 
rescue  party,  the  railway  man  who  averts  dis- 
aster from  an  excursion  train,  the  lad  who  drags 
his  comrade  out  of  a  canal,  and  the  thousand 
and  one  civihans  who  cheerfully  risk  their  lives 
do  it  for  the  sake  of  mere  homespun  duty  and 
bravery.  To  them  there  looms  no  peerage  or 
Westminster  Abbey  in  the  background.  It  is 
only  of  recent  years  that  a  Civilian  Order  has  been 
created  to  distinguish  civilians  who  have  saved 
life  under  circumstances  of  great  bravery.  Com- 
pare that  with  the  list  of  honours,  titles,  orders, 
commissions,  promotions,  pensions,  decorations 
and  rewards  bestowed  on  the  British  army  in  the 
course  of  war  waged  against  two  small  riepublics 
in  a  distant  part  of  the  world.  The  soldier, 
however  devoted  and  brave,  is  simply  dis- 
charging the  service  which  he  has  contracted  to 
render  to  the  State.  The  civihan  is  bound  to 
no  one  to  rescue  his  fellows  from  situations  of 
jeopardy  by  the  consideration  of  reward  past, 
present  or  future.  There  can  be  no  greater 
attribute  of  man  than  this  readiness  to  make 
the  last  great  sacrifice  of  risking  or  of  sacrificing 
his  life  for  another.  In  the  medical  profession 
the  call  arises  now  and  then  amid  the  grey  routine 
of  daily  work.  It  is  answered,  as  we  all  know, 
in  a  w^y  that  has  made  us  proud  of  the  pro- 
fession to  which  we  belong.  Among  strictly 
professional  dangers  encountered  in  that  way 
the  most  frequent  has  been  the  clearing  of  a 
choked  tracheotomy  tube  in  diphtheria  cases  by 
the  direct  process  of  sucking  the  open  end.  Many 
a  brass  tablet  in  hospitals,  and  many  a  stained 
glass  window  in  infirmary  chapels,  records  the  tale 
of  such  self-sacrifice,  but  the  heroism  of  many 
stands  unrecorded  to  this  day.  It  would  be  an 
act  of  grace  were  the  medical  men  of  to-day  to 
commemorate  the  names  of  these  heroes  who  have 
fallen  in  the  face  of  one  of  the  most  formidable 
of  all  infections.  In  almost  all  instances,  more- 
over, the  life  of  the  highly-trained  medical  man 
has  been  sacrificed  in  the  endeavour  to  save  that 
of  a  child  or  of  some  individual  of  less  value  to 
the  general  community.  The  tradition  of  such 
men  deserves  to  be  kept  green  in  the  mcmorv'^ 
of  their  fellows. 


TEXT-BOOKS  ON  OBSTETRICS. 
A  CRITICAL  review  on  some  recent  American 
obstetrical  text-books  appears  in  thejcurrent 
number  of  the  Scottish  Medical  *and  f  Surgical 
Journal  from  the  pen  of  Professor  Stephenson 
of  Aberdeen.  The  review  taken  as  a  whole  may, 
we  fancy,  be  said  to  express  the  opinions  of  most 
British  obstetricians,  though  perhaps  there  are 
some  points  in  which  Professor  Stephenson's 
criticisms  are  a  Uttle  over-elaborated.  Shortly 
summarised,  he  objects  to  the  modem  American 


obstetrical    text-books    on    the    ground   of  their 
number,    their    size,    the    arrangement    of  their 
subject-matter,  the  unnecessary  multiplicatioa  of 
illustrations,   the  use  of  micro-photographs,  the 
needless  display  of  the  nude,  and  the  encyclopaMtic 
character  of  the  books.     It  is  difficult  to  blame  a 
writer  of  a  book,  which  purports  to  be  complete, 
because  he  says  too  much,  unless  he  wastes  space 
in  mere  verbosity,  and  the  latter  is  unfortunatehr 
a  charge  to  which  certain  of  the  works  alluded  to 
are  open.     As  Professor  Stephenson  says,   "we 
miss  the  graphic  description,  the  literary  restraint, 
and  the  matured  opinions  of  the  old  masters.    The 
zeal  for  science  is  great,  so  great  that  it  is  difficult 
at  times  to  repress  the  feeling  that  much  is  intro- 
duced  for  rivalry  and  show."     We  also  miss  tiro 
other    matters    to    which    Professor    Stephenson 
does  not  allude — the  style  of  the  older  writers  and 
the  use  of  the  King's  English  "  as  she  is  spelt." 
The  illegitimate  phrases  and  words  that  replace 
in  American  books  the   lawfully  derived  English 
originals  are  pitiable,  and   are  used  and  adopted 
not     only   by  native-bom     Americans,  but    also 
by  resident  Englishmen.     We  are  glad,  however, 
to  be  able  to  say  that  the  best  of  the  works  which 
appear    on  Professor  Stephenson's    list   is   singu- 
larly free  from  American  peculiarities.     We  cannot 
follow  Professor  Stephenson  in  his  condemnatioD 
of    micro-photographs.     We    confess     to    ha\'ing 
formerly  held  an  opinion  identical  with  his — that 
such  illustrations  are  not  successful  or  instructive, 
but    look    learned.     It    is    true    that    it    requires 
exp)erience     to    interpret     them,  but    once   that 
experience     is     gained   the  photograph    becomes 
instructive    in     the    highest    degree  —  provided 
that  it  is  a  good  one.      Students   of   the  future 
will  find  that  it  is  necessary  to  learn  to  read  micro 
photographs,   and   having  done  so,   we  shall  no 
longer  hear  that  they  are  not  instructive.     We 
can  go  with  Professor  Stephenson  thus  far,  that 
we   consider   the   value   of  the  micro-photograph 
will  be  much  enhanced  by  having  beside  it  a  key- 
drawing,  which  diagrammatically  represents    the 
essential  points  of  the  photograph.     The  origin  of 
the  American  text-book  might,  we  fancy,  be  found 
in  the  dogged  persistence  with  which  English  works 
adhere  to  old  theories   and   old  technique.      Its 
present  form  is   the  result  of  the  swing  of  the 
pendulum  shghtly  too  far  in  the  opposite  direction, 
and   of   the   intense   desire   of   certain   American 
writers  "  to  go  one  better  "  than  their  predecessors. 
It  is  the  tacit  approval  with  which  English  writers 
regard  repeated  vaginal  examinations,  and  their 
scant    allusions     to     the    necessity    for    aseptic 
and  antiseptic  precautions,   that  has  led  American 
writers   to  write   as   if  condemning    aU    vaginal 
examinations  during  labour.     On  this  side  of  the 
Atlantic,  the  danger  associated  with  such  examina- 
tions has  been  so  persistently  under-estimated  by 
the  older  school,  is  it  any  wonder  that,  with  the 
existing   obstetrical  mortality,  a   younger  school 
should  tend  to  the  contrary  error  of  over-estima- 
tion ? 


ST.  JOHN  AMBULANCE  ASSOCIATION. 
A  PAPER  of  great  practical  interest  was  read  by 


AuGUsr  24,  igo4. 


NOTES  ON  CURRENT  TOPICS.  ThbMedicalPmm.  203 


Dr.  Hamilton,  of  Newport  (Mon.)*  in  the  Naval 
and  Military  Section  of  the  British  Medical  Asso- 
ciation meeting  at  Oxford.     This  paper  contained 
a  number  of  friendly  criticisms  on  the  work  of 
the  St.   John     Ambulance  [Association,   and  we 
agree    with    Dr.    Hamilton    that    this    valuable 
association    would    be    of    considerably    greater 
service  to  the  public  if  some  of  its  methods  were 
subjected  to  revision.     Great  credit  is  due  to  the 
association,  and  to  two  or  three  energetic  medical 
men   who    early    aUied    themselves   with   it,    for 
having   demonstrated   first   of   all    the   practical 
utility  of  such  work,  and,  secondly,  the  ease  with 
which  its  application  could   be   acquired   by  lay 
persons  of  no  great  general  education.     It  is  the 
fashion   in    many   professional   quarters    to   scoff 
at  the  enthusiastic  first-aider  who  arrives  panting 
at  the  scene  of  an  accident,  armed  perhaps  with  a 
medallion,  and  offers,  on  the  strength  of  a  few 
lectures  and  demonstrations  in  the  use  of  splints 
and  bandages,  to  take  charge  of  the  patient.     No 
doubt  there  are  cases  in  which  zeal  outruns  dis- 
cretion, and  we  have  even  heard  of  instances  in 
which  an  unobtrusive  doctor  has  found  himself 
supplanted  by    these   ardent   amateurs.     But  we 
believe  these  occasions  to   be    rare,  and  in  busy 
industrial    centres    and    on    great     railways    the 
practical  value   of  instruction  in   the  immediate 
treatment  of  accidents  given  to  se-v?nts  has  been 
shown  over  and  over  again.     So  long  as  the  first- 
aider  recognises  his  limitations,  he   will   do  little 
harm,  and   he  has  already  undoubtedly  averted 
much  suffering,  and  on  some  occasions  even  death 
itself.     When  it  is  remembered  that  a  life  of  the 
value  of  Nelson's  was  retained  for  his  country's 
service  through  the  timely  application  of  a  scarf 
by  his  Ueu tenant,  it  behoves  one  to  be  chary  in 
joining  in  the  chaff  bestowed  on  those  who  give 
up  their  leisure  time  to  attain  skill  in  the  art  of 
acting  judiciously  in  emergencies.     On  the  other 
hand.   Dr.    Hamilton   is   quite   right   in   drawing 
attention    to    the    low    standard    of    proficiency 
required  by  many  of  the  examiners  of  the   St. 
John   Ambulance   Association,    and    to    the    still 
more  urgent  need  of  continuing  the  training  of 
the  candidates  after  the  first  certificate  has  been 
gained.     The  course  of  instruction  mapped  out 
is  a  good  one  on   the  whole,  but    the  number  o' 
lectures    is    quite  inadequate  for  any  teacher  to 
onvey  to  persons  unacquainted  with  the  elements 
of  anatomy  and  physiology  a  tithe  of  the  ideas 
on  which  aione  correct  treatment  can  be  founded. 
The  association    naturally  wish    to    s:?cure    good 
returns  at  the  end  of  the  year,  so  they  spread  their 
net  widely  in  the  effort  to  attract  candidates  for 
instruction,    and   it   is   doubtless   satisfactory    to 
them  to  be  able  to  show  a  high  percentage  of 
passes  in  their  examinations.     But  it  is  a  matter 
of  grave  doubt  whether  the  certification  of  a  large 
number  of  imperfectly  trained  persons  as  com- 
petent to  render  first  aid  is  not,  as  it  stands,  a 
positive  danger  to  the  community.     Hundreds  of 
holders  of  certificates  will  honestly  confess  in  a 
couple  of  years  after  they  have  passed  the  exami- 
nation that  they  have  forgotten  in  toto  all  that  they 


had  learned,  and  even  those  recently  passed  make 
mistakes  that  would  be  ludicrous  if  they  were 
not  apt  to  be  attended  with  serious  consequences. 
In  his  paper  Dr.  Hamilton  cites  a  number  of 
instances  of  misapplied  ingenuity  that  have 
come  within  his  purview,  and  most  readers  will 
be  able  to  supplement  these  from  their  own 
experience.  Now  the  discredit  thrown,  and 
rightly  thrown,  on  instruction  that  produces 
these  effects  is  likely  to  prejudice  the  whole  of 
this  useful  movement,  and  we  think  the  St.  John 
Ambulance  Association  would  do  well,  while 
pushing  their  classes  in  every  legitimate  manner, 
to  make  their  courses  longer  and  more  thorough, 
and  their  examinations  more  searching.  The 
number  of  candidates  would  probably  fall  oflf, 
but  the  general  utility  of  the  movement  would 
rise.  It  cannot  be  gainsaid  that  the  pubUc  would 
be  better  served  by  a  quarter  of  the  present 
number  of  first-aiders  if  trained  to  the  standard 
of  the  teams  that  take  part  in  the  annual  com- 
petitions. The  efficiency  of  these  teams  to  act  in 
emergencies  is  as  far  beyond  dispute  as  is  the 
uselessness  of  half  the  lackadaisical  young  ladies 
who  entertain  themselves  on  winter  evenings  by 
listening  to  the  oratorical  efforts  of  perspiring 
young  practitioners  who  see  in  ambulance  classes 
a  legitimate  avenue  to  local  fame.  Candidates 
who  are  "  keen  "  will  take  trouble  to  make  them- 
selves efficient ;  those  who  are  careless  need  not  be 
encouraged.  They  will  be  no  loss  to  anyone.  The 
classes  for  instruction  should  certainly  be  taught 
for  a  much  longer  period  than  at  present,  and  the 
question  of  diagnosis  of  injuries  should  be  more 
strongly  insisted  on.  The  examiners,  taking 
their  cue  from  the  teachers,  should  make  their 
tests  more  practical,  and  should  assure  themselves 
not  only  that  the  candidate  knows  how  to  apply 
prompt  treatment,  but  that  he  is  likely  to  recognise 
the  nature  of  the  injury  which  a  patient  may  be 
suffering  from  when  he  is  called  upon  to  help. 
As  things  stand,  most  candidates  have  never 
examined  an  injured  person,  and  when  confronted 
with  an  accident,  stand  but  a  poor  chance  of 
diagnosing  a  fracture  from  a  dislocation,  or  an 
epileptic  fit  from  opium-poisoning.  Moreover, 
as  Dr.  Hamilton  insists,  it  is  of  vital  importance 
that  the  holders  of  certificates  should  assemble 
at  intervals  for  practice  in  their  art,  lest  their 
little  store  of  knowledge  evaporate  altogether, 
and  their  efforts  become  a  source  of  danger  to 
their  patients.  No  art  can  be  retained  without  dint 
of  constant  practice.  The  St.  John  Ambulance 
Association  have  done  well  in  the  past  ;  that, 
however,  is  no  reason  why  they  should  not  do 
a  great  deal  better  in  the  future. 


flotes  on  Current  XCopicd. 

A  New  Field  for  Pharmaceutioal  Ohemists. 
It  appears  that  a  new  field  of  work  is  in  process 
of  exploitation  by  chemists,  with  the  direct  help  of 
the  Pharmaceutical  Society.  As  our  readers  know, 
a  society  known  as  the  Spectacle-Makers'  Company 
has  formed  itself   for  the  granting  of    diplomas 


204    The  Medical  Press.        NOTES    ON    CURRENT    TOPICS. 


to  anybody  who  passes  certain  examinations, 
such  diplomas  testifying  that  the  holder  is  specially 
capable  of  diagnosing  various  conditions  of  the  eyes, 
fitting  glasses,  &c.  Chemists  have  turned  longing 
glances  towards  the  increased  profits  that  might  be 
made  by  exhibiting  the  diploma  of  the  Spectacle- 
Makers'  Company  and  by  fitting  glasses  on  the 
public,  but  unfortunately  they  did  not  feel  inclined 
to  pass  "  in  the  subjects  of  mathematics  and  heat  in 
the  special  examination  for  the  diploma  in  general 
and  visual  optics  "  of  the  Company.  Accordingly 
a  new  Society  was  formed — the  Society  of  Chemist- 
Opticians,  and  during  the  first  week  of  its  existence 
it  succeeded  in  obtaining  from  the  Spectacle-Makers' 
Company  the  important  privilege  that  qualified 
chemists  may  obtain  the  diploma  in  general 
and  visual  optics  **  without  the  necessity  of  adding 
to  their  knowledge  on  the  subjects  of  mathematics 
and  heat."  Further,  the  new  Society  has  succeeded 
in  interesting  the  lecturer  on  Chemistry  at  Blooms- 
bury  Square  and  the  Council  of  the  Pharmaceutical 
Society,  with  the  result  that  special  apparatus  is  to 
be  obtained  for  the  purpose  of  teaching  the  coming 
chemist  how  to  prescribe  glasses.  Personally,  we 
are  believers  in  the  old  proverb— ne  sutor  ultra 
crepidam. 

Hygienic  Aspects  of  Beli^on. 

Endless  discussion  occurs  over  the  so-called 
conflict    of   science    and    religion.      In    the    past 
vigorous  combat  has  been  waged  by  the  respective 
disciples,  and  it  cannot  be  denied  that  many  would- 
be  scientists  have  trespassed  from  the  region  of  the 
known   into   the   realm   of  the   unseen   and   dis- 
countenanced much  that  was  pecuUarly  dear  to  the 
faithful.     But  history  is  full  of  evidences  of  the 
mischief  wrought  by  religious  fanatics  who,  in  their 
ignorance,  have  used  every  effort  to  hamper  the  pro- 
gress of  science,  and  particularly  to  curtail  the  service 
of  the  heaUng  art.     ReHgion,  however,  in  all  lands 
and  in  every  age  has  played  an  active  part  in 
directing  public  and  personal  hygiene.     The  im- 
portance of  health  matters  has  always  been  insisted 
upon  by  the  Jews,  and  the  health  of  other  peoples 
has   been    extensively  influenced    by  the  injunc- 
tions of  their  reUgious  code.     It  is  well  to  recog- 
nise religion  as  an  essential  factor  in  the  evolution 
not  only  of  a  people  but  of  each  individual.     We 
have  no  wish  to  cast  reflections    upon  any  reli- 
gious system  which  is  held  in  reverence,  either  in 
this  or  other  lands,  but  we  are  strongly  of  opinion 
that  medical  practitioners,  whatever  may  be  their 
individual  rehgious  views,  have  an  absolute  duty  to 
discountenance  an  all  too  prevalent  sacerdotahsm 
which  not  only  encourages  but  insists  upon  the 
carrying  on  of  non-hygienic  procedures  as  necessary 
religious   functions.      We  are  most  reluctant  to 
say  one  word  which  should  bruise  the  sensibilities 
of  even  the  most  sensitive,  but  it  is  necessary  to 
remind    dogmatic  exponents  of    certain  religious 
beliefs   that  they  are  advocating  measures  which 
seriously  threaten  health,  and  oftentimes  are  active 
in  the  propagation  of  actual  disease.     And  we  hold 
that  what  is  scientifically  wrong  is  also  religiously 
wrong. 


August  24,  1904, 

The  Disease  of  the  "Elffo.*' 

The  consciousness  of  the  "  ego  "  may  be  classed 
as  one  of  the  prominent  symptoms  of  our  times 
The  psychical  phenomenon  of  which  this  form  of 
self-consciousness  is  the  immediate  manifestatioa 
is,  of  its  nature,  morbid.  The  healthy,  nonnal 
individual,  whose  muscular  system  predominates 
over  his  cerebral  functions,  experiences  no  more 
concern  about  his  ego  than  about  his  heart  or 
digestion,  in  fact,  in  a  state  of  perfect  health  and 
equiUbrium  all  the  functions  pursue  the  noiseless 
tenour  of  their  way  without  attracting  attention  or 
criticism.  When  one  becomes  aware  of  the 
existence  of  an  organ,  in  other  words,  when  an 
organ  obtrudes  itself  on  our  attention,  there  is 
primd  facie  reason  to  suspect  disease  or,  at  any 
rate,  disturbance.  Similarly,  when  a  man  turns 
his  eyes  inwards  and  begins  to  scrutinise  his 
psychical  entity  he  is  probably  on  the  borderfine 
of  neurasthenia.  It  is  a  sort  of  mental  *'  globus 
hystericus,"  a  subjective  sensation  which  has  no 
anatomical  basis,  a  projection  on  to  the  field  of 
consciousness  of  the  result  of  disturbed  cerebral 
circulation.  Only  the  strongest  brains  can  endure 
this  sustained  process  of  introsj>ection  without 
permanent  damage  and,  fortunately,  the  pastime 
is  one  which  the  average  mind  finds  Uttle  induce- 
ment to  indulge  in. 


Leishman-Donovan  Bodies. 

No  department  of  things  medical  has  of  recent 
years    expanded  at  such  a    bewildering   rate  as 
that  of  tropical  medicine,  and  the  stay-at-home 
practitioner  finds  himself  at  a  loss  to  keep  pace 
with  the  new  discoveries  and  theories  that  come 
crowding  into  the  medical  journals  every   week. 
The  whole  subject  of  tropical  diseases  has  bee: 
revolutionised   during  the   last   decade,    and  the 
workers  in  this  great  field  are  rewarded  for  their 
efforts  in  a  manner  that  dazzles  the  patient  plodder 
in  the  prosaic  laboratories  at  home.     It  is  little 
over  a  year  since  Majors  Leishman  and  Donovan 
independently  discovered  the  bodies  that  are  now 
known  by  their  joint  names  ;  yet  fresh  facts  with 
regard  to  their  nature  are  reported  home  by  almost 
every  mail.    These  bodies  were  just  obtained  by 
puncture  of  the  spleen  of  patients  suffering  from 
chronic  cachexial  fevers,  though  they  could  not  be 
demonstrated  in  the  circulating  blood.     Stained 
by    the    Romanowsky   method,    they   are   found 
partly  free  and  partly  enclosed  in  the  red  blood 
corpuscles,  and  show  at  one  end  a  mass  of  chromatin 
united  often  by  a  thin  process  to  a  smaller  mass. 
They  contain  no  pigment,  but  the  larger  mass  often 
shows   signs  of  fission.     The  parasite   has  been 
regarded    as    a    Pyrosoma,     the    best    example 
of  which  is  the  organism  that  causes  Texas  fever, 
the  epidemic  hgemoglobinuria  of  cattle.     Another       ] 
is  the  parasite  found  in  the  tick  fever  of  the  Rocky       ! 
Mountains.     The  Leishman-Donovan  bodies  have 
been   widely   searched   for   and  have   now  been 
demonstrated  in  a  large  number  of  morbid  condi- 
tions.    In   Kala-Azar,  the"]  wide- spread   cachexial       i 
fever  of  Assam,  they  have  been  found  in  the  hyper- 
trophied  spleen,  and  in  "  Delhi  sore  *'  the  ulcers 


August  24,  1904. 


NOTES    ON    CURRENT    TOPICS.         The  Medical  Prbss.    205 


tlxemselves  have  been  shown  to  con  tarn  these  bodies, 
as  have  the  spleen,  liver,  intestine,  lymph-glands, 
and  bone-marrow.  The  sensational  announcement 
of  Captain  Rogers  of  his  ability  to  cultivate 
trypanosomes  from  the  Leishman-Donovan  bodies 
throws  a  new  and  unexpected  Ught  on  their  nature, 
as  it  would  now  appear  that  man  is  the  intermediate 
host  for  the  asexual  cycle  of  these  parasites,  the 
adult  form  being  the  trypanosome  which  attains 
maturity  in  the  lower  animals.  It  is  to  be  hoped 
that  this  interesting  subject  may  soon  be  thoroughly 
understood,  as  in  the  parasitology  of  these  patho- 
genic forms  Ues  the  key  to  most  of  the  unheal thi- 
ness  of  tropical  countries. 

Quinquaud's  Sign. 
A  NEW  sign  of  chronic  alcoholism  has  been  lately 
brought  to  notice  from  several  quarters,  and  as  it 
appears  to  be  well  authenticated  medical  men  may 
be  glad  to  avail  themselves  of  such  information  as 
it  afiords.  The  sign  was  first  discovered  by 
Quinquaud,  but  was  not  pubUshed  to  the  world 
till  s  ven  years  after  his  death.  Since  then  Maridort 
and  Furbringer  have  both  directed  attention  to  it. 
The  sign  is  eUcited  by  making  the  patient  place  the 
tips  of  his  fingers,  well  spread  out,  perpendicularly 
against  those  of  the  examiner,  when,  if  the  patient 
is  of  alcoholic  habits,  the  examiner  feels  a  number 
of  slight  shocks  as  if  the  phalanges  of  the  patient 
were  rapidly  pressed  against  each  other  and  against 
the  palm  of  the  examiner.  The  sensation  experi- 
enced by  the  examiners  is  said  to  be  similar  to  that 
of  crepitus  such  as  is  felt  in  arthritis  deformans, 
but  it  has  also  certain  indescribable  peculiarities 
of  its  own.  This  crepitus  can  be  heard  by  the 
steth-^scope  and  sounds  like  friction,  though 
in  autopsies  on  patients  who  have  exhibited  it,  no 
undue  dryness  or  roughness  of  the  articular  ends 
of  the  bones  has  been  found.  Nor  has  it  any  rela- 
tionship with  alcoholic  tremor,  for  whereas  Fur- 
binger  found  marked  tremor  in  only  7  per 
cent,  of  drinkers,  he  found  Quinquaid's  sign  pre- 
sent in  nearly  92  per  cent.  The  pathology 
of  the  condition  that  produces  this  creaking  is  very 
obscure,  and  after  discussing  it,  Furbringe* 
concludes  that  it  must  be  a  neurosis,  but  this  result 
is  arrived  at  more  by  excluding  organic  causes  than 
by  any  positive  evidence  of  nervous  derangement. 
The  sign  is  not  likely  to  be  of  much  practical  value, 
but  it  is  certainly  an  interesting  clinical  pheno- 
menon. 


Paracentesis  in  Pericardial  Effusions. 

The  tolerance  which  most  of  the  closed  cavities 
of  the  body  exhibit  towards  an  accumulation  of 
fluid,  esi)ecially  when  gradual,  affords  a  remarkable 
illustration  of  the  indifference  shown  by  living 
tissues  to  foreign  bodies  as  long  as  the  latter  do  not 
possess  any  markedly  irritating  properties.  The 
pericardium,  which  normally  contains  only  just 
suffiicient  fluid  for  lubrication,  may,  like  other 
serous  "membranes,  hold  a  large  amount  of  exuda- 
tion without  causing  much  inconvenience.  Peri- 
cardial effusions  have  attained  as  much  as  4,000  ex. 
(seven  pints),  but  such  an  enormous  quantity  is 


phenomenal.  When  of  large  size  they  are  as  a 
rule  purulent  in  character.  The  diagnosis  of 
fluid  within  the  pericardium  is  often  a  matter  of 
difficulty,  the  condition  being  sometimes  mistaken 
for  pleural  effusion.  The  shape  of  the  area  of  dul- 
ness  is  the  most  conclusive  sign.  The  question  of 
paracentesis  will  become  more  and  more  urgent  as 
the  gravity  of  the  case  increases.  Small  effusions 
may  occasionaUy  be  caused  to  disperse  by  means  ol 
counter-irritation  in  the  form  of  leeches  or  blisters 
applied  to  the  praecordium  combined  with  the 
administration  of  diuretic  and  cathartic  drugs,  but 
actual  mechanical  removal  of  the  fluid  is  the  only 
possible  mode  of  treatment  for  a  large  effusion. 
When  cardiac  embarrassment  is  well  marked  no 
time  should  be  lost  in  inserting  a  fine  trocar  and 
cannula.  Dr.  W.  S.  Thayer,  (a)  of  the  Johns 
Hopkins  University,  has  reported  two  cases  of 
tuberculous  pericarditis  with  effusion  in  which 
paracentesis  was  performed.  In  one  case  over 
i,250c.c.  of  purulent  fluid  were  withdrawn  with 
considerable  benefit.  The  dangers  of  this  pro- 
cedure are  not  great  in  careful  hands,  the  risk  of 
infecting  the  pleura  being  inconsiderable,  except  in 
very  large  effusions.  Puncture  of  the  heart,  an 
accident  to  be  avoided,  is  not  necessarily  attended 
with  serious  consequences.  The  seat  of  election 
for  insertion  of  the  needle  is  in  the  fourth  or  fifth 
left  intercostal  space,  close  to  the  sternal  border. 


Fatal  Kindness  of  a  Hospital  Visitor. 
The  recent  disclosures  at  an  inquest  upon  a 
poor  girl  who  died  in  a  provincial  hospital  from 
perforation  of  a  gastric  ulcer  serve  to  illustrate  the 
supreme  importance  of  diet  as  a  factor  in  certain 
forms  of  disease.  The  deceased,  a  domestic  servant^ 
was  lying  in  a  ward  seriously  ill  and  had  been  placed 
on  a  rigid  diet.  Through  the  mistaken  kindness 
of  a  feUow-servant  she  drank  a  bottle  of  lemonade, 
a  liquid  which  can  hardly  be  considered  an  ideal 
beverage  in  a  case  of  gastric  ulcer,  with  the  result 
that  she  died.  The  circumstances  which  allowed 
such  a  breach  of  discipline  to  take  place  will» 
probably,  never  be  fully  understood,  but  it  is  a 
lamentable  fact  that  cases  of  a  similar  nature  occur 
under  the  most  vigilant  circumstances  every 
•*  visiting"  day.  Patients'  friends  smuggle  apples 
and  buns  into  hospital  wards,  in  spite  of  printed 
warnings  and  the  sharp  eyes  of  the  nurses  in  charge. 
Popular  ignorance  respecting  the  why  and  where- 
fore of  "  low  "  diet  is  so  widespread  that  persons, 
who  should  know  a  great  deal  l>etter  sometimes 
protest  the  most  loudly  against  the  "  cruel  starva- 
tion," as  they  call  it,  endured  by  such  a  course. 
Life  or  death  may  hang  absolutely  upon  the 
regular  administration  of  a  minute  quantity  of 
fluid  nourishment,  and  any  abrupt  departure  from- 
this  mode  of  feeding  may  be  fraught  with  disastrous 
results,  to  wit,  in  cases  of  enteric  fever.  A  case 
occurred  not  long  ago  in  a  London  hospital  where 
an  irate  and  utterly  irrational  parent  insisted  upon 
removing  her  son,  who  was  suffering  from  typhoid^ 
from  the  ward  and  giving  him  a  hearty  meal,  with 

(a)  Bull.    Johns  Hofkins  Unhxrsityx  XCay,  1904- 


206     ThI   MIDICAL  PSBSft. 


NOTES    ON    CURRENT    TOPICS. 


the  consequeDcei  that  might  be  expected.  Such 
fools'  kindness  is  simply  criminal,  and  in  the  case 
of  the  domestic  the  jury's  censure  might  have  been 
far  stronger  than  it  actually  was.  The  lemonade 
killed  the  patient,  and  the  fooUsh  woman  who 
broke  the  rules  and  gave  that  lemonade  was 
directly  responsible  for  the  ensuing  death. 


The  Glass  House  Besidenoes  of  Medical 
Writers, 

A  CORRESPONDENT  who  has  had  the  pleasure  of 
submitting  to  Professor  CHfford  AUbutt  theses  for 
the  M.B.  and  M.D.  degrees  of  the   University  of 
Cambridge  writes  to  us  as  follows:      "We  Cam- 
bridge men  are  all  proud  of  our  Regius  Professor 
of  Physic,  and  have  derived  not  only  real  profit 
from  his  medical  writings  but  infinite  pleasure  from 
their  literary  form.     We  owe  him,  too,  a  debt  of 
gratitude  for  his  efforts  to  turn  out  Cambridge 
medical  graduates  who  possess  scholarly  as  well  sls 
scientific  attainments — men  of  letters  as  well  as 
good    doctors.     But    humanum    est    errare—ewen 
in  literary  composition — and  I  fancy  that  Professor 
AUbutt's  sly  humour,  which  lends  such  a  charm 
to    his    writings,  will    appreciate    a    little    riposte 
from  one  of  the  thesis- writers  whom  he  so  justly 
hauls  over  the  coals  in  the  pamphlet  you  describe 
in  your  instructive  leader  of  this  week.     In  com- 
position it  is  difficult  at  all  times  to  avoid  that  kind 
of  fault  which    one   recognises    as    soon    as  it  is 
pointed   out — faults   which   are   specially   apt   to 
creep   into    what    I    believe    the    Americans    call 
"  sun-down  "   literature — namely,  writing  under- 
taken in  addition  to  the  ordinary  routine  of  the 
day,  and  executed  when  the  rest  of  the  world  is  in 
bed.     But  what  I  should  like  to  draw  your  atten- 
tion to,  sir,  is  the  following  sentence  from  a  letter 
of  Professor  AUbutt  to  the  Editor  of  the  British 
Medi:al  Jourvai    of  May   2Sth,    1904.     Professor 
Allbutt  is  writing  about  the  Government  Lunacy 
Bill,  and  he  appeals  to  his  own  experiences  when 
Lord  Chancellor's  visitor  in  lunacy.     The  sentence 
runs — "  Let  us  be  thankful  that  in  the  obscurity 
of  these  English  homes  I  found,  or  rarely  found, 
any  positive  evil."     The  meaning  is  obvious,  but  if 
Professor  Allbutt  had  inserted  one  of  those  negatives 
that  his  pupils  use  so  freely,  his  sentence  might 
have  been  more  correct  from  the  literary  point  of 
view.     Or  was  the  omission   of  the  negative   a 
passive  protest  against  the  redundancy  in  vogue 
among  thesis- writers  ?  " 


August  24.  1904. 

which  the  veterinary  profession  could  give 
valuable  assistance,  and  he  was  glad  to  know  that 
many  specimens  of  value  from  their  body  had 
reached  those  who  were  doing  the  work  of  the 
Commission.  He  concluded  by  referring  to  the 
present  position  of  the  Royal  Veterinary  College 
of  Ireland,  which  four  years  ago  had  only  existed 
on  paper.  A  paper  on  "  Epizootic  Lymphangitis  " 
was  then  read  by  Captain  Martin,  A.V.D.,  and 
another  by  Professor  Woolridge,  on  "  Hemo- 
globinuria in  Bo  vines." 


Work  of  the  National  Veterinary 
Association. 

The  annual  meeting  of  the  National  Veterinary 
Association  was  held  in  Dublin  during  the  peist 
week.  Dr.  Charles  Allen,  the  President,  delivered 
an  interesting  address,  in  the  course  of  which  he 
referred  to  the  recent  report  of  the  Commission 
appointed  to  investigate  the  whole  question  of 
the  transmission  of  tuberculosis.  The  whole 
subject  constitutes  one  of  the  most  supreme 
interest  to  the  veterinary  world.  The  President 
next  referred  to  the  work  at  present  being  done 
by  the  Cancer  Commission.     It  was  a  work  in 


Copper  Sulphate :  Friend  or  Foe? 

For  some  reason  or  other  the  Health  authorities 
seem  to  have  taken  particular  umbrage  against 
the  presence  of  copper  in  preserved  peas.     Why 
they  should  pass  by  in  comparative  neglect  the 
wholesale  adulteration  of  the  daily  food   of  the 
people   to   concentrate    their   attack    on    a   com- 
paratively   unimportant    article    of    consumption 
is  somewhat  of  a  mystery.     A  recent  police-court 
prosecution  resulted  in  the  conviction  and  fine  of 
a  grocer  for  selling  peas  and  French  beans  adul- 
terated with  sulphate  of  copper  to  the  extent  in 
the  beans  of  3 '402,  and  in  the  peas  of  4-00  grains 
to  the  pound.     The  Departmental  Report  of  1899, 
by  a  minority  report,  recommended  that   in  no 
case  should  more  than  half  a  grain   of  metallic 
copper  be  permissible  to  the  pound  of  preserved 
peas.     The  prosecuting  Medical  Officer  of  Health 
admitted  he  knew  of  no  case  where   injury  had 
resulted  from  coppered  peas.     He  stated  that  the 
ordinary  dose  of  sulphate  of  copper  as  an  astrin- 
gent was  from  half  to  two  grains.     Anyone,  there- 
fore, taking  a  pound  of  the  particular   peas  in 
question    would    swallow    double    the    medicinal 
dose.     Phyllocyanate  of  copper  was  formed  when 
copper  was  added  in  small  quantities  to  peas,  a 
substance  that  in  minute  quantity  paralysed,  and 
ultimately   killed   dogs.     That    fact,    apart    from 
the  mere  question  of  adulteration,  suggests  that 
copper  should  be  used  with  extreme  caution  as 
a  medicinal  agent.     Indeed,   its   therapeutic   use 
is    nowadays   extremely  limited,  as  of    late  years 
other  remedial  methods  and  non-toxic  astringent 
drugs  have  been  introduced  into  practice.     Mean- 
while it  is  to  be  hoped  that  the  sanitary  authorities 
will  regard  the  prosecution  of  the  sellers  of  coppered 
peas  as  merely  a  step  in  the  right  direction. 


The  Medical  Inspection  of  Schools  in 
Ireland. 

An  important  paper  bearing  on  the  above  subject 
was  read  by  Dr.  Edward  Magennis  at  the  recent 
Congress  of  the  Royal  Institute  of  Public  Health, 
at  Folkestone.  The  pith  of  the  paper  is  that  the 
present  neglect  of  the  elementary  principles  of 
hygiene  in  the  National  schools  through  the 
country  constitutes  a  very  serious  danger  to  the 
life  of  both  teacher  and  pupil,  and  that  the  best 
method  of  remedying  this  unfortunate  state  of 
affairs  would  be  to  attach  a  Sanitary  Depai;tment 
to  the  Board  of  Education  with  medical  oflScers 
to  examine  and  certify  cver>''  school.  We  learn 
that  there  is  a  daily  average  of    something  like 


August  24,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Meutcal  Press.     207 


850,000  children^attending  the  different  primary 
•schools  through  Ireland;  and  that  the  school 
accommodation  is  only  sufl&cient  for  736,000  even 
when  each  child  is  limited  to  the  apparent  minimum 
•of  ten  square  feet  of  floor  space.  If  the  figure  of 
the  air-circulation  through  these  places  was  also 
known,  it  would  be  shown  that  there  was  an 
•even  greater  discrepancy  between  the  necessary 
minimum  of  fresh  air  and  the  actual  amount 
supphed.  We  have  ourselves  frequently  passed 
rschools  crammed  with  children,  and  without  any 
apparent  means  of  ventilation,  save  what  was 
afforded  by  the  chimney  and  the  cracks  beneath 
the  windows  and  door.  We  have  no  hesitation 
in  saying  that  no  ^theatre,  music-hall,  or  other 
place  of  amusement  would  be  sanctioned  by  the 
•sanitary  authorities  which  deprived  its  audience  of 
space  and  of  air  in  the  manner  that  is  done  by  the 
Irish  school  authorities.  Yet  no  one  is  obliged 
to  go  to  a  theatre,  while  children  are  com- 
pelled to  spend  the  best  hours  of  their  childhood 
in  the  pestilent  atmosphere  of  the  National  school. 
Educationalists  and  politicians  wrangle  over  the 
particular  form  of  history  or  geography  to  be 
taught,  and  spend  hours  discussing  whether  a 
language  is  of  living  commercial  value  or  of  dead 
respectabihty  ;  statisticians  and  sanitarians  lament 
the  terrible  ravages  wrought  by  tuberculous 
disease  in  Ireland,  yet  the  Irish  National  schools 
continue  to  perform  their  deadly  work  on  one 
•generation  after  another  of  *'  scholars."  If  Dr. 
Magennis  succeeds  in  rousing  the  Board  of  Educa- 
tion, he  will  have  accomplished  a  most  valuable 
task. 


The  Bailway  Lavatory. 

At  this  season  of  the  year  everyone  is  "  at  home  " 
■on  the  railway.  All  sorts  and  conditions  of  people 
collect  at  our  stations  and  travel  in  our  trains. 
Oftentimes  a  departure  platform  is  a  veritable 
liospital  where  disease  in  manifold  variety  may 
be  demonstrated.  Tuberculous,  syphilitic,  can- 
cerous, all  congregate  at  the  booking  office  and 
no  one  can  deny  them  the  privileges  of  the  traveller. 
JMany  of  the  railway  companies  have  done  much 
ior  the  safety  and  protection  and  comfort  of  their 
passengers,  but  during  the  present  year  in  traveUing 
over  a  considerable  portion  of  the  railway  system  of 
this  country  we  have  been  struck  by  the  many 
•glaring  sanitary  deficiencies  and  hygienic  defects 
which  abound.  At  the  present  time,  however, 
Ave  would  draw  attention  only  to  one  which  we 
"believe  is  Uable  to  lead  to  much  physical  disaster. 
Lavatories  are  essential  to  the  mental  comfort  and 
"bodily  well-being  of  railway  passengers.  In  large 
stations  excellent  conveniences  are  usually  avail- 
a.blc,  but  in  country  districts  and  wayside  stations 
arrangements  are  oftentimes  most  primitive  and 
altogether  insanitary.  In  many  stations  we  have 
recently  visited,  the  urinals  are  ill-constructed, 
badly  drained,  imperfectly  cleaned,  and  dis- 
gusting to  the  senses.  It  would  be  well  if  medical 
oflScers  of  health  paid  more  attention  to  the 
sanitary-  deficiencies  of  railway  stations  in   their 


districts.  Lavatories  are  now  to  be  found  on 
practically  all  our  long-distance  trains,  but  even  in 
first-class  carriages  we  have  constantly  found  the 
closets  ill-constructed,  imperfectly  supplied  with 
necessities,  oftentimes  dirty  and  frequently  of  such 
a  form  that  all  excreta  is  deposited  upon  the  line, 
it  may  be  in  a  busy  station.  At  this  hoUday  season 
of  the  year  there  is  urgent  need  that  the  sanitarian 
should  insist  on  the  carrying  out  of  prophylactic 
measures,  and  foremost  among  them  we  would 
place  reform  of  the  railway  lavatories. 


Medioal  and  Dental  Companies. 

The  extent  to  which  the  evil  of  permitting 
the  registration  of  companies  for  the  practice  of 
medicine  and  dentistry  has  gone  is  shown  by  a 
list  of  such  companies  published  by  our  con- 
temporary, the  Chemist  and  Druggist.  In  England 
alone,  there  are  sixty-two  companies  registered 
for  the  practice  of  dentistry.  In  Ireland,  there 
are  twenty-two ;  and  in  Scotland  thifee.  In 
England,  there  are  fifteen  companies  similarly 
registered  for  the  practice  of  medicine,  but  in 
Ireland  and  in  Scotland  there  are  none.  The 
recent  decision  of  the  Chief  Baron  of  Ireland 
has  had  the  effec^  of  checking  the  registration 
of  such  companies,  and  steps  are  being  taken  to 
deal  with  those  already  registered.  It  is  obviously 
impossible  that  half  a  dozen  men  acting  in  a 
corporate  capacity  can  be  allowed  to  perform 
acts  that  would  be  illegal  for  any  of  them  acting 
in  an  individual  capacity,  and  to  set  at  n^iught 
the  Medical  and  Dental  Acts.  The  Irish  Dental 
Association  deserves  the  entire  credit  of  having 
been  the  means  of  bringing  about  a  stoppage  in 
the  registration  of  these  companies,  and  we  trust 
that  it  will  continue  its  efforts  until  those  already 
registered  have  been  compelled  to  discontinue 
their  operations. 


Abdominal  Venosity,  "  Good  Capon  Lined." 

Abdominal  venosity  is  a  convenient  euphemism 
for  the  condition  induced  in  the^viscera  by  a  too 
great  laxity  of  the  abdominal  walls,  and  it  enables 
the  medical  attendant  to  discuss  the  evils  of  a 
state  brought  on  by  high  living  and  sedentary 
existence  without  offending  the  susceptibilities  of 
his  patient.  The  man  who  w'ould  not  care  to 
have  his  "  Httle  Mary  "  described  as  a  "  pot-belly  " 
rejoices  in  being  able  to  tell  his  friends  that  his 
sufferings  are  due  to  abdominal  venosity.  In 
fact,  the  term  is  as  great  a  God-send  to  the  family 
practitioner's  vocabulary  as  the  suggestion  of 
"  adipose  deposit  "  for  "  superfluous  fat."  To  the 
home  and  Continental  spas  abdominal  venosity 
has  brought  many  a  sheckel,  for  the  plethoric 
man  feels  it  a  duty  to  his  conscience  to  make  some 
sort  of  effort  to  appease  outraged  Nature — that 
is,  if  the  effort  does  not  incommode  him  unduly. 
A  well-known  physician  has  lately  suggested  a 
plan  which,  if  faithfully  carried  out,  should  render 
recourse  to  a  spa  unnecessary,  as  every  sufferer  has 
the  apparatus  required  for  the  treatment  ready  to 
hand.  The  object  aimed  at  is  to  strengthen  the 
muscles  of  the  abdominal  wall  in  order  that  more 


n 


208    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


support  may  be  given  to  the  enclosed  viscera. 
There  is  no  exercise  so  well  adapted  to  this  end 
as  rowing,  but  every  city  man  cannot  repair  regu- 
larly to  the  river  and  disport  himself  in  an  "  eight " 
or  a  skiff.  A  stay-at-home  method  has  therefore 
been  devised.  The  patient  has  to  divest  himself  of 
all  superfluous  clothing,  open  his  window,  and 
pull  out  the  bottom  drawer  of  his  chest  of  drawers. 
He  then  lies  at  full  length  on  the  floor,  his  feet 
tucked  under  the  pulled  out  drawer  and  his  arms 
extended  over  his  head.  The  victim  proceeds  to 
raise  himself  into  a  sitting  posture  by  means  of  his 
abdominal  muscles,  taking  care  not  to  advance  his 
arms  in  front  of  the  line  of  the  trunk.  Having 
gained  the  sedentary  position  he  lets  himself  down 
again,  and  repeats  the  performance  till  the  calls  of 
bath  and  breakfast  make  themselves  heard. 
Next  day  he  returns  to  his  diversion,  and  thus  he 
continues  till  his  waist  assumes  enviable  proportions. 
We  have  no  doubt  that  the  exercise  is  a  splendid  one 
for  the  purpose,  but  we  should  think  that  no  man 
would  appear  less  of  a  hero  to  his  own  valet  than  a 
City  Alderman  in  light  attire  wrestling  with  a 
chest  of  drawers  before  breakfast.  If  he  could  be 
induced  to  do  so,  the  benefit  hkely  to  accrue  would 
doubtless  be  great.  , 


August  24,  1904. 


An  IrrefiTolar  Method  of  Dispensioff . 

A  CURIOUS  case  was  heard  recently  before  the 
City  Magistrates  at  Birmingham.  A  man  called 
Heath,  a  chemist  and  druggist,  was  asked  by  a 
messenger  from  the  Health  Department  to  make 
up  a  prescription  containing  twenty-four  doses  of 
a  quinine  mixture,  each  dose  of  which  was  to  con- 
tain ten  grains  of  quinine  and  ten  minims  of  dilute 
sulphuric  acid.  The  defendant  made  up  the 
mixture  and  charged  two  shiUings  for  it.  On 
anal3rsis,  it  was  found  that  the  bottle  contained 
altogether  only  twenty- three  grains  of  quinine 
and  141  minims  of  dilute  sulphuric  acid.  The 
defendant  stated  that  he  would  not  think  of  putting 
half  an  ounce  of  quinine  into  a  six-ounce  mixture, 

'  that  if  he  had  done  so  he  would  have  charged  five 
shillings  for  the  bottle,  that  he  thought  a  mistake 
had  been  made  in  writing  drachms  instead  of  grains 
and  that  the  prescription  was  so  well  written  that 
he  did  not  think  a  medical  man  had  written  it. 
The  magistrates  considered  that  up  to  a  certain 
point  the  defendant  had  exercised  a  proper  dis- 
cretion, but  that  he  should  have  obtained  the 
name  of  the  writer  of  the  prescription  and  com- 
municated with  him.  They  considered  that  he 
was  negligent  and  imposed  a  penalty  of  forty  shil- 
lings. The  decision  appears  to  us  to  be  warranted 
by  the  facts  of  the  case.  Ten  grains  of  quinine 
is  a  large  dose,  but  how  many  Anglo-Indians  and 
men  who  have  lived  for  long  in  malarial  climates 
would  think  nothing  of  twice  as  much  ?  The  price 
of  the  twenty-three  grains  placed  in  the  mixtu  re 
was  about  a  penny,  while  that  of  the  240  grains 
which  were  ordered  would  have  been  about  nine- 

p2nce  :  where,  then,  did  the  difference  of,  thre  e 
shillings  in  the  price  of  the  mixture  come  in  ?  The 
point  regarding  the  hand- writing  is  absurd,  and. 
if  it  suggested  the  need  for  caution,  such  caution 


could  have  readily  been  exercised  in  the  manner 
suggested  by  the  magistrates. 

Multiple  Teets  for  DrunkennesB. 

Of  a  truth  there  is  nothing  sacred  to  the  hand 
of  science.  All  the  deeply-rooted  beliefs  of 
mankind  are  being  ruthlessly  torn  up  and  cast 
into  the  oven.  Take  the  test  of  a  drunken  man. 
Our  forefathers  did  well  enough  by  asking  him 
to  say  "  truly  rural,"  and  to  walk  a  Une  chalked 
along  the  floor.  But  the  medical  man  to-day 
will  have  no  parley  with  rough  and  ready  methods 
of  that  kind,  fitted  only  for  the  ruder  efforts  of  a 
pre-scientific  age.  Nowadays,  even  the  am- 
bulance student  knows — ^in  theory,  at  any  rate- 
how  to  tell  the  unconsciousness  due  to  alcohol 
from  that  of  brain  mischief.  As  to  the  police 
surgeon,  his  tests  have  become  simply  multi- 
tudinous, if  we  may  judge  from  the  report  made 
last  week  by  a  London  gentleman  upon  the 
soberness  of  a  warehouseman  charged  with 
singing  and  dancing  on  the  public  footway  while 
drunk.  The  surgeon  confirmed  the  police  charge, 
and  stated  he  found  fifteen  symptoms  of  inebriety. 
From  a  scientific  point  of  view  it  would  be  of 
interest  to  learn  how  many  of  those  symptoms 
were  due  absolutely  to  alcohol,  and  how  many 
were  capable  of  a  different  interpretation.  Science 
is  a  good  thing  in  its  way,  medical  science,  perhaps, 
especially  so,  but  with  multiple  symptoms"  at 
command  the  question  naturally  arises,  how  is  it 
that  persons  are  so  often  allowed  to  die  in  police 
cells  under  the  impression  they  are  drunk?  The 
proof  of  the  pudding  is  in  the  eating.  We  doubt 
if  a  trustworthy  system  of  detecting  drunkenness 
in  pohce  cells  has  yet  been  devised. 


The  Scottish   Diplomates'  Association  and 
the  Title  of  "Doctor.'* 

One  of  the  avowed  objects  of  the  newly-formed 
Association  of  Scottish  Diplomates  is  to  secure 
for  its  members  legal  recognition  of  their  right 
to  the  title  of  "Doctor.*'  This  desire,  in  the 
eyes  of  the  Hospital,  is  no  less  foolish  than  un- 
justifiable, and  an  intimation  to  that  effect  has 
been  recently  published  in  the  columns  of  that 
journal.  It  is,  of  course,  well  recognised  by  all 
who  are  really  within  the  medical  circle  and  are 
thus  acquainted  with  the  trend  of  professional 
thought  that  a  considerable  injustice  is  inflicted 
upon  medical  diplomates  by  restricting  the  title 
of  **  Doctor"  to  the  holders  of  University  degrees. 
The  acquired  modern  sense  of  the  word,  to  the 
man  in  the  street,  is  that  of  a  practitioner  of 
medicine,  and  it  matters  not  to  the  average 
citizen  one  jot  whether  his  medical  attendant  was 
educated  within  the  walls  of  a  university  or  of  a 
less  assuming  medical  school.  The  underl>-ing 
moral  of  the  whole  thing  is  that  there  should  be 
one  portal  of  admission  to  the  practice  of  medicine, 
and  one  distinguishing  title  for  all  who  have 
passed  that  portal.  The  feeling  of  the  Scotch 
diplomates  on  this  point  is  perfectly  natural  and 
laudable,  and  they  will  do  well  to  educate  the 
British  public  somewhat  as  to  the  precise  value 


August  24,  1904. 


SPECIAL  CORRESPONDENCE. 


Thx  Medicai.  Press.     209 


and  meaning  of  the  present  multitudinous  medical 
qualifications.  In  its  desire  to  pour  cold  water 
on  the  policy  of  the  Scottish  Diplomates'  Asso- 
ciation the  Hospital  appears  to  overlook  the  fact 
that  the  title  of  its  members  forms  a  small  detail 
in  a  wide  and  comprehensive  programme. 


PERSONAL 


His  Majesty  the  King  has  been  pleased  to  approve 
the  appointment  of  Dr.  William  Osier,  D.Sc,  F.R.S., 
to  be  Ke^us  Professor  of  Medicine  at  Oxford,  in  suc- 
cession to  Sir  John  Burdon  Sanderson,  Bart.  In  1889 
Dr.  Osier  was  appointed  Professor  of  the  Principles 
and  Practice  of  Medicine  in  the  TTniversity  of  Pennsyl- 
vania and  Physician  to  the  Johns  Hopkins  Hospital, 
Baltimore. 


Mr.  C.  Molesworth  Tuke,  M.R.C.S.,  has  been 
elected  President  of  the  West  London  Medico-Chirurgi- 
cal  Society  for  the  ensuing  session.  1904-5. 


Dr.  Bertram  Abrahams  has  l^en  appointed 
Examiner  in  PhysioloRy  to  the  Conjoint  Board  of  the 
Royal  Colleges  of  Physicians  and  Surgeons  of  England. 

The  War  Office  authorities  are  desirous  of  communi- 
cating with  three  ladies,  Miss  M.  C.  Bakkes,  Mrs. 
Rutherford,  and  Miss  M.  B.  HorsweU,  with  reference  to 
the  services  performed  by  them  as  nurses  in  the  Boer 
refugee  camps  in  South  Africa  during  the  period  1901- 
1903.  Any  information  as  to  the  present  addresses  of 
these  ladies  should  be  addressed'  to  the  Secrctarv, 
War  Office,  Pall  Mall,  London,  S.W. 

The  Commission  for  the  Investigation  of  Pneumonia 
in  New  York  will  consist  of  the  following  well-known 
physicians :  Dr.  William  Osier  and  Dr.  W^illiam  H. 
Welch,  of  Johns  Hopkins  University  ;  Dr.  Edward  C. 
Janeway,  of  New  York  T'niversity  ;  Dr.  J.  Mitchell 
Pnidden  and  Dr.  L.  Emmett  Holt,  of  the  New  York 
College  of  Physicians  and  Surgeons ;  Dr.  Frank 
Billings,  of  the  Rush  Medical  College  of  Chicago  ;  Dr. 
John  H.  Musser,  of  the  I  University  of  Pennsylvania  ; 
and  Dr.  Theobald  Smith,  of  Harvard. 


Dr.  Lorpain  Smith,  Professor  of  Pathology  at 
Queen's  College,  Belfast,  who  has  been  recently  ap- 
pointed Professor  of  Pathology  at  Victoria  l^niver- 
sity,  Manchester,  is  an  alum  nit  of  the  IJniversity  of 
Edinburgh. 


It  is  announced  that  the  King  of  Greece  has  bestowed 
the  Gold  Cross  of  the  Royal  Order  of  the  Saviour  ujxjn 
Sir  William  Bennett,  K.C.V.O.,  F.R.C.S. 

Dr.  George  F.  Shradv  has  resigned  the  editorship 
of  the  New  York  Medical  Record,  after  thirty-eight 
years'  service  in  that  capacity.  He  is  succeeded  by  his 
former  assistant  editor,  Dr.  Thomas  L.  Stedman. 


Mr.  J.  Henderson  Smith,  M.B.Edin.,  has  been 
appointed  to  the  Philip  Walker  Studentship  in  Patho- 
logy at  Oxford  University  for  a  period  of  three  years. 

Charles  Gibson,  M.D.,  has  been,  recently  com- 
missioned by  the  Lord  Chancellor  as  a  Justice  of  the 
Peace  for   Harrogate. 

Dr.  D.  J.  Coffey,  Professor  of  Physiology  at  the 
Cecilia  Street  School  of  Medicine,  Dublin,  was  pre- 
sented by  the  Keating  Branch  of  the  Gaelic  League 
with  a  handsome  collection  of  Gaelic  works,  on  the  occa- 
sion of  his  recent  marriage.  The  books  consisted  of 
Dr.  O'Donovan's  edition  of  the  "  Annals  of  the  Four 
Masters,"  and  Sir  O' Grady's  "  Silva  Gadelica." 

Mr.  John  Tweedy,' President  of  the  Royal  College 


of  Surgeons  of  England,  has  promised  to  take  the  chair 
at  the  annual  dinner  of  past  and  present  students  of  the 
Medical  Faculty  of  University  College,  London,  on 
Monday,  October  3rd. 

The  Paris  Municipal  Council  has  voted  a  grant  of 
;fi20  to  Professor  Grancher  in  furtherance  of  his 
researches  as  to  the  means  of  preventing  tuberculosis  in 
schools. 


Special  <[otredpon&ence. 

[from  our  special  correspondent.] 


BELFAST. 

Resignation  of  Professor  Lorrain  Smith. — 
The  members  of  the  medical  profession  in  Belfast 
have  heard  with  great  regret  that  Professor  Lorrain 
Smith  is  resigning  the  chair  of  Pathology  in  Queen's 
College,  having  been  appointed  to  Owens  College, 
Manchester.  Though  some  formalities  remain  to  be 
carried  out  before  the  actual  resignation  takes  place,  it  is 
understood  that  Dr.  Smith  will  leave  Belfast  before  the 
winter  session  opens.  He  came  to  Belfast  about  eight 
years  ago  as  Lecturer  on  Pathology  and  Bacteriology, 
and  when  the  late  Sir  James  Musgrave  founded  the 
chair  of  those  subjects,  Dr.  Smith  was  its  first  occupant. 
His  keen  interest  in  scientific  medicine  has  made  his 
name  well  known  far  beyond  Ulster,  and  his  great 
personal  kindliness  and  readiness  to  help  in  every  way 
m  his  power  have  made  him  a  universal  favourite  in  tho 
profession.  Considering  the  intimate  relations  which 
subsist  between  the  leading  pathologist  of  the  school  and 
its  other  members  in  the  city,  the  choice  of  his  successor 
must  be  a  matter  of  deep  interest  to  them.  It  is 
believed  that  Dr.  Thomas  Houston  will  be  a  candidate 
for  the  chair.  He  has  been  for  several  years  Professor 
Smith's  right  hand  man,  while  he  has  held  the  Royal 
University  Studentship  in  Pathology,  and  the  British 
Medical  Association  Research  Scholarship.  His 
excellent  work  on  the  blood  in  pernicious  annpmia  and 
allied  diseases  has  attracted  much  attention,  and  his 
candidature  for  the  chair  is  favourably  commented 
on  by  the  members  of  the  Belfast  school. 

The  Small-pox  Outbreak. — Small-pox  has  now 
broken  out  in  a  number  of  towns  in  Ulster,  as  was  only 
to  be  expected  when  it  was  prevalent  in  Belfast.  So 
far,  the  worst  town  is  Armagh,  where  there  are  fourteen 
cases  under  treatment,  as  well  as  a  number  of  suspects 
under  observation.  The  beds  in  the  small-pox  hospitals 
arc  all  occupied,  and  if  any  further  cases  occur  they 
will  be  treated  in  the  wards  of  the  fever  hospital.  A  case 
was  discovered  in  Clones  and  removed  to  the  fever 
hospital,  where  the  patient  died.  Cases  have  also 
occurred  in  Omagh  and  Monaghan.  There  was  only 
one  new  case  in  Belfast  last  week,  and  none  for  a  fort- 
night before,  so  the  worst  of  the  outbreak  seems  over 
as  far  as  this  city  is  concerned. 

The  annual  report  of  the  President  of  the  Queen's 
College,  Cork,  has  been  issued  during  the  past  week. 
The  report  states  that  the  number  of  students  attending 
the  College  during  the  last  session  was  225,  as  against 
190  during  the  session  IQ02-3.  The  number  of  new 
students  was  68,  of  whom  52  came  from  the  Royal 
University  of  Ireland,  9  from  other  colleges  and 
universities,  while  7  were  not  matriculated.  The 
President  alludes  to  the  great  improvement  that  has 
taken  place  in  the  pathological  department  since  the 
appointment  of  Dr.  Moore  as  Lecturer  in  Pathology 
The  latter  gentleman  has  instituted  post-graduate 
classes  in  addition  to  reforming  the  method  of  teaching. 
The  President  has,  however,  to  regret  that  there  is  a 
decided  indisposition  on  the  part  of  students  of  the 
college  to  read  for  honours  at  the  Royal  University 
examinations.  It  appears  that  the  claims  of  the 
College  to  obtain  an  examinership  in  chemistry  at  the 
Royal  University  have  been  laid  before  the  Senate, 
but  that  so  far  the  claims  have  not  been  satisfied,  in 
*spite,  as  the  President  points  out.  of  the  unquestioned 
distinction  of  Dr.  Dixon,  the  Professor  of  Chemistrv. 


210     The  Medical  Press. 


CORRESPONDENCE. 


August  24,  1904 


CorrceponOcnce. 


[We  do  not  hold  ounelves  responsiUe  for  the  opinions  of  our  Cor- 
respondents.] 


THE  DIMINISHING  BIRTH-RATF. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Challenged  with  having  stated  that  '*  in  1884 
the  total  birth-rate  stood  at  31,"  whereas  the  birth-rate 
•of  England  and  Wales  of  that  year  was  33*6,  Dr. 
Walsh  explains  that  it  was  the  birth-rate  of  the  United 
Kingdom,  and  not  that  of  England  and  Wales,  that  he 
quoted.  But  that  will  not  do,  for  the  birth-rate  of  the 
United  Kingdom  for  1884  was  32*2  and  not  31,  and  was 
lower  than  that  of  England  and  Wales  only  by  the 
inclusion  of  Ireland  which,  as  Dr.  Walsh  very  well 
knows,  has  always,  for  special  reasons,  had  a  birth-rate 
much  lower  than  the  other  parts  of  the  United  Kingdom. 
In  1884  the  birth-rate  for  England  and  Wales  was  33  6  ; 
that  of  Scotland  337,  that  of  Ireland  2  30.  The  argu- 
ment which  Dr.  Walsh  founded  on  the  assumption  that 
the  birth-rate  in  1 884  was  only  3 1  o  therefore  falls  to 
pieces. 

Dr.  Walsh  falls  into  other  extraordinary  blunders. 
Let  me  give  one  as  an  example :  he  actually  declares 
that  had  there  been  no  decline  in  illegitimacy  "  we 
should  have  had  a  birth-rate  of  practically  30*0  in 
1904,  compared  with  31*0  in  1884."  I  have  imfor- 
tunately  no  fore-knowledge  of  what  the  returns  for 
1904  may  be,  and  for  the  moment  I  have  not  access  to 
the  vital  statistics  of  the  United  Kingdom,  but  the 
figures  for  England  and  Wales  for  1902,  when  com- 
pared with  those  for  1884,  are  strangely  at  variance 
with  Dr.  Walsh's  aUe<»ation.  leaving  illegitimate 
births  out  of  the  question,  the  birth-rate  for  1884  was 
32  o,  and  for  1902  it  was  27*4.  During  the  period 
covered  by  these  dates  the  illegitimate  birth-rate  fell 
from  1  6  to  I'l.and  it  has  therefore  affected  the  general 
birth-rate  to  the  extent  of  0*5,  so  that  if  there  had  been 
no  decline  in  illegitimacy  the  general  birth-rate  would 
have  stood  in  1902  at  29*0,  against  33*6  in  1884.  This  is 
apparently  what  Dr.  Walsh  calls  "  not  far  off  a  level." 
But  all  that  Dr.  Walsh  says  about  the  illeG:itimate 
birth-rate  really  strenijthens  Dr.  Taylor's  position  and 
weakens  his  own.  Be  the  fall  in  that  birth-rate  what  it 
may,  it  may  be  due  to  the  increasing  morality  of  our 
people,  but  it  may  also  be  due  to  their  increasing  addic- 
tion to  those  practices  which  Dr.  Taylor  has  denounced, 
which  are  more  likely  to  be  resorted  to  outside  wedlock 
than  in  it.  The  loose  way  in  which  Dr.  Walsh  handles 
figures  puts  him  almost  outside  the  pale  of  statistical 
•controversy. 

Referred  to  the  Report  of  the  Royal  Commission  on 
the  Decline  of  the  Birth-rate  and  on  the  Mortality  of 
Infants  in  New  South  Wales,  Dr.  Walsh  disposes  of 
it  by  a  novel  and  elegant  metaphor,  affirming  that 
"  Social  and  economic  conditions  in  New  Sonth  Wales 
and  in  the  J^Iother  Country  are  as  chalk  is  to  cheese." 
They  who  know  our  Premier  Colony  a  little  better  than 
he  does  will  probably  assure  him  the  difference  between 
it  and  the  Mother  Country  is  not  greater  than  that 
between  Cheddar  and  Double  Gloucester,  and  that 
human  nature  in  its  sexual  relations  is  pretty  much  the 
same  in  London  and  Sydney.  At  any  rate,  he  should 
study  the  Report,  a  most  weighty  and  convincing  public 
document,  in  which  he  will  find  a  complete  and  crush- 
ing refutation  of  some  of  his  own  fallacies.  The  Com- 
mission, composed  of  fifteen  of  the  most  eminent  men 
in  New  South  Wales,  included  six  medical  men,  and 
took  the  evidence  of  all  the  leading  members  of  the 
profession  in  the  colony.  The  conclusions  at  which 
it  has  unanimously  arrived  are  well  calculated  to  disturb 
the  smug  complacency  in  which  Dr.  Walsh  would  have 
lis  wrap  ourselves  up. 

I  am,  Sir,  yoiu-s  truly. 

August  19th,  1904.  LL.D. 


that  it  is  almost  impossible  to  add  aught  thereto  that 
has  not  been  already  said  by  previous  writers.  Perhaps, 
however,  you  will  permit  me  to  preface  the  brief  re- 
marks I  propose  making  by  giving  the  Registrar- 
General's  summary  for  the  last  week  for  London.  It 
runs  thus  : — '*  Allowing  for  increase  of  population,  the 
births  were  394  and  the  deaths  33  below  the  average." 
Similar  official  reports  are  given  weekly,  varying  only 
in  numbers,  from  which  it  is  proved  to  demonstration 
that  a  diminishing  birth-rate  is  a  reality  and  not  a 
fiction.  The  same  may  be  affirmed  without  contra- 
diction of  the  death-rate,  so  that  the  loss  on  the  one 
hand  is  counteracted  to  a  certain  extent  by  a  gain  on 
the  other ,'which  gives  us  a  greater  proportion  of  adult 
to  infant  life.  "  So  far  so  good,"  but  a  continuation 
of  these  proportions  must  necessarily  be  limited,  and 
a  diminishing  birth-rate  eventuate  in  a  greatly  reduced 
manhood.  Of  course,  it  may  be  said  that  the  Metro- 
poUs  is  not  the  TTnited  Kingdom,  and  that  for  accurate 
comparison  statistics  of  the  whole  shguld  be  given : 
but  as  Greater  London  contains  a  population  of  about 
one-sixth  of  the  home  territory,  it  may  be  admitted 
as  a  fair  basis  to  go  upon.  We  then  arrive  at  the  two 
points  of  discussion :  First,  Dr.  Taylor's  contention 
that  there  is  a  serious  and  continuous  falling  off  in  the 
birth-rate,  attributable  to  the  prudential  motives 
of  modern  married  folk,  which  will  eventually  prove 
destructive  to  the  British  race ;  secondly,  the  view 
held  by  Dr.  Walsh  and  others  that  this  diminution 
applies  to  extra-marital  as  well  as  marital  conditions, 
and  is  only  in  part  due  to  preventive  practices. 
Other  correspondents,  again,  think  prevention  is 
incumbent  upon,  nay,  even  necessary  to,  the 
well-being  of  the  nation  at  large.  I  candidly  con- 
fess my  sympathy  with  Dr.  Taylor's  view,  believing 
as  he  does  that  a  stagnant  population  becomes  a  de- 
cadent one.  Present  indications,  however,  hardly 
point  to  this  conclusion,  but  rather  to  degeneracy  than 
disease  ;  and  herein  there  opens  up  a  wider  and  more 
absorbing  question  than  the  mere  increase  or  decrease 
of  births,  the  solution  of  which  the  Government  and 
thoughtful  minds  generally  are  now  endeavouring  to 
read.  Unfortunately  the  decreasing  birth-rate  is 
clearly  traceable  to  the  ranks  of  the  great  middle-class, 
whose  ancestors  made  our  nation  strong ;  whilst  the 
feeble,  the  degenerate  and  the  criminal  sections  in- 
crease and  multiply  regardless  of  consequences,  and 
in  this  lies  the  national  danger.  On  prudential 
grounds  individualism  is  justified  in  not  bringing  more 
children  into  the  world  than  parents  can  reasonably 
hope  to  keep  and  educate  ;  but  such  motives,  com- 
mendable as  they  are  in  the  abstract,  are  entirely  one- 
sided and  tend  to  the  ultimate  replacement  of  the 
morally  and  physically  strong  by  the  mentally  and 
physically  weak. 

I  am,  Sir,  yours  truly, 

Cantab. 


To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — So  much  has  been  already  written  on  this  very 

important,  I    might  venture  to  say  national,  subject 


To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  watched  from  my  obscure  corner  in 
this  great  city  the  Titanic  combat  at  present  being 
waged  in  your  columns,  and  much  as  I  sympathise 
with  Dr.  Taylor's  good  intentions.  I  must  confess  that 
it  seems  to  me  the  honours  of  the  contest  fall  to  Dr. 
Walsh.  May  I  put  the  matter  into  what  I  conceive  to 
be  a  logical  nut-shell  ?  Dr.  Taylor  has  laid  down 
a  universal  affirmative  proposition — artificial  preven- 
tion is  anathema  under  all  circumstances.  You  have 
received  letters  from  two  correspondents — "  A  Country 
Practitioner  "  and  "  A  Poor  Curate's  Wife."  These 
letters  give  concrete  examples  of  particular  cases 
which  appear  (to  me)  to  conflict  with  Dr.  Taylor's 
^  proposition.  WillDr.  Taylor  tell  us,  without  circumlocu- 
tion or  qualification,  whether : 

(a)  "  Country  Practitioner  "  (to  whom  a  wife  was 
practically  a  necessity)  and  *'  Poor  Curate  "  (whose 
marriage  certainly  relieved  him  from  the  sin  of  com- 
mitting adultery  in  his  heart)  did  wrong  to  marry  ? 

(6)  If  they  did  right,  or,  at  any  rate,  finding  them- 
selves married  at  the  present  time  : — 


August  2>i,  1904. 


LITERATURE. 


The  Medical  Press.     211 


1.  Should  they  seek  to  bring  as  many  children  as 
possible  into  the  world  ? 

2.  Should  they  use  artificial  means  to  prevent  or 
limit  conception  ? 

3.  Should  they  persistently  violate  their  natural 
instincts  and  abstain  from  doing  what  marriage 
{vide  the  opening  sentences  of  the  marriage  service  m 
the  Prayer-Book)  was  ordained  for  ? 

If  Dr.  Taylor  will  be  good  enough  to  answer  these 
questions  I  for  one  shall  respect  his  motives,  even  if  I 
do  not  approve  of  his  judgment. 

I  am,  Sir,  yours  truly. 

Qualified   Assistant. 
Glasgow,  August  20th,  1904. 

EXPERIMENTAL  TREATMENT  OF  CANCER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Dr.  Skene's  Keith's  article  recently  published  in 
your  columns  gives  an  excellent  summary  of  the  present 
position  with  regard  to  the  treatment  of  cancer, 
although,  from  my  point  of  view,  he  is  too  pessimistic 
with  regard  to  the  future  possibilities  of  radio-active 
methods.  I  am  somewhat  surprised,  however,  to 
find  that  I>r.  Keith  has  omitted  to  publish  full  details 
of  his  method.  He  merely  states  generally  that  he 
has  obtained  good  results  from  the  hypodermic  ad- 
ministration of  certain  substances.  The  omission  of 
this  particular  information  in  an  article  published  in  a 
scientific  journal  must  clearly  have  been  due  to  an 
oversight.  It  is  inconceivaolc  that  a  gentleman  of 
Dr.  Keith's  standing  could  knowingly  have  violated 
one  of  the  most  stringent  traditions  of  professional 
conduct.  Meanwhile,  we  are  all  most  anxious  to  know 
what  is  the  substance  that  in  Dr.  Keith's  hands  has 
relieved  the  sufferers  from  a  terrible  malady. 
I  am,  Sir,  yours  truly, 
Bexhill,  August  i6th,  1904.  Duns    Scotus. 

EPIDEMIC  DIARRHOiA  AND  DIRTY 

FEEDING-BOTTLES. 

To  the  Editor  of  The  Medical  Press  and  Circul\r. 

Sir. — During  the  past  three  weeks  we  have  had 
many  cases  of  diarrhoea  and  vomiting  occurring  in 
children,  mostly  between  the  ages  of  one  and  three 
years.  I  think  that  we  are  too  prone  to  attribute 
these  attacks  to  the  addition  of  preservatives  to  milk, 
when  possibly,  by  personal  investigation,  we  might 
discover  a  simpler  cause.  During  the  past  week  I 
have  seen  seven  cases  of  sickness  and  diarrhoea  occur- 
ring in  children  aged  from  six  to  eighteen  months.  In 
no  fewer  than  five  cases  an  examination  of  the  feeding 
bottle  revealed  the  cause.  The  bottle  itself  was  in  a 
filthy  condition,  and  the  milk  curdled  in  three  cases. 
In  two  cases  in  which  bottles  with  a  long  rubber  tube 
connected  the  bottle  with  the  teat,  although  the  milk 
in  the  bottle  was  perfectly  sweet,  the  tubing  stank 
horribly,  and  thus  the  milk,  on  passing  through, 
became  contaminated.  A  preliminary  purge  and  care- 
ful supervision  of  the  bottles  ended  in  rapid  recovery. 
It  would  be  an  excellent 'step  towards  checking  these 
epidemics  of  diarrhoea  in  infants  if  we  could  ( i )  Abolish 
the  use  of  the  feeding-bottle  with  long  septic  rubber 
channels  for  the  conduction  of  the  milk  ;  (2)  if  we  could 
impress  upon  all  mothers  the  necessity  of  thoroughly 
cleansing  the  bottles  after  each  feed.  In  two  of  the 
cases  the  tubing  was  absolutely  black  with  flies, 
which  doubtless  aided  the  contamination.  I  think 
in  the  present  day  we  are  too  apt  to  pass  over  the  more 
common  causes  of  disease,  attributing  it  to  some 
cause  which  is  uppermost  in  the  public  mind  through 
articles  in  the  lay  press. 

I  am.  Sir,  yours  trulv, 

S.    J.    Ross,    M.D. 

Bedford,  August  22nd,   1904. 


Royal  CoHeges  of  Physicians  and  Surgeons  in  Ireland. 
The  preliminary  examination  for  the  Conjoint  Di- 
plomas of  the  Royal  Colleges  of  Physicians  and  Surgeons 
in  Ireland  is  fixed  to  take  place  on  Monday,  Septem- 
ber 26th.  Entrance  forms  and  medical  students' 
guide  now  ready. 


(Pbftuars. 

SURGEON-MAJOR  GENERAL  TIPPETTS. 

Surgeon-Major  General  A.  M.  Tippetts.  late  of 
the  Army  Medical  Service,  has  died  at  Soutlisea  at 
the  age  of  seventy-two.  He  qualified  as  a  member  of 
the  Royal  College  of  Surgeons  in  1853,  and  joined 
the  Medical  Service  of  the  Army  as  an  assistant  surgeon 
in  April,  1854,  serving  in  the  Eastern  campaign  of  that 
and  the  following  year  with  the  7th  Fusiliers.  He  took 
part  in  the  affair  of  Bulganac,  in  the  battles  of  Alma  and 
Inkerman,  and  in  the  siege  of  Sebastopol.  for  which  he 
had  the  medal  with  three  clasps  and  the  Turkish  medal 
As  a  surgeon-major  he  also  took  part  in  the  Afghan 
War  of  1878-80.  accompanying  the  expeditions  into  the 
Bazar  and  Hissarik  Valleys,  for  which  he  was  mentionerl 
in  despatches  and  received  his  second  medal.  He 
became  deputy  surgeon-general  in  November,  1884. 
and  retired  in  April,  1892,  as  a  surgeon-major-general. 
Major-General  Tippetts  had  been  in  receipt  of  a  dis- 
tinguished service  reward  since  October,  1901. 
MR.  D.  A.  HUGHES.  M.R.C.S. 

As  the  Great  Western  12.15  train  was  about  to 
leave  Barmouth  Junction  one  day  last  week,  Mr.  D.. 
Arthur  Hughes,  a  well-known  medical  practitioner  at 
Barmouth,  was  observed  to  be  running  to  catch 
t  he  train.  He  reached  a  carriage^door  and  fell  exhausted. 
He  was  put  into  a  compartment,  but  when  the  train 
arrived  at  Barmouth  life  was  pronounced  to  be  extinct. 
Deceased  held  the  post  of  Medical  Officer  of  Health 
for  the  united  districts  of  Barmouth. 


Xiterature. 


ANDREWES'   DISINFECTION   AND 
STERILIS.\TION.  {a) 

This  work,  the  author  tells  us,  is  primarily  intended 
for  nurses  and  for  medical  men  who  have  had  no- 
opportunities  for  systematic  bacteriological  study. 
**  The  book  is  written  for  those  who  know  no  bacterio- 
logy, but  who  need  suflficient  acquaintance  with  its 
principles  and  methods  to  be  able  to  understand  what 
they  are  doing  when  they  attempt  to  carry  out  pro- 
cesses of  disinfection."  We  consider  that  the  author 
has  succeeded  in  carrying  out  this  aim,  that  the  book  is 
a  timely  contribution  to  science,  and  should  appeal  to 
those  who  have  to  carry  out  disinfection  practically. 

The  work  is  divided  into  two  parts,  the  first  of  which 
is  comprised  in  ten  lessons,  of  which  the  first  is  intro- 
ductory and  deals  with  the  nature  of  bacteria,  yeasts, 
and  moulds,  the  second  with  the  growth  of  bacteria 
and  their  distribution  in  Nature.  Following  this  is  an 
account  of  the  chemical  activities  of  bacteria  and  their 
power  of  producing  disease.  The  fourth  section  deals 
with  cultivation  in  artificial  media,  and  section  five 
deals  with  the  thermal  death-point  of  bacteria. 

Disinfection  by  chemicals  is  considered  in  section  six, . 
and  the  two  following  sections  are  concerned  with 
aerial  disinfection  and  the  sterilisation  of  fluids,  and 
disinfection  in  surgery  and  midwifery.  Sections  nine 
and  ten  contain  accounts  of  the  nature  of  contagion 
and  the  various  specific  bacteria. 

In  Part  II  we  have  an  excellent  account  of  exer- 
cises and  demonstrations  of  a  highly  valuable  and  prac- 
tical character.  In  the  section  dealing  with  disinfection 
by  heat  the  author  explains  the  difficulty  of  disinfecting 
large  masses  of  tightly-packed  material,  such  as  horse- 
hair, and  mentions  that  some  steam  disinfectors  have 
an  arrangement  whereby  the  air  is  exhausted  from  the 
material  to  be  disinfected  before  the  steam  is  admitted. 
The  importance  of  this  is  not  by  any  means  clearly 
explained,  as  the  removal  of  the  air  is  of  the  greatest 
consequence,  and,  in  fact,  makes  all  the  difference 
between  the  effective  action  or  otherwise  of  a  steam 
disinfector.  The  Washington  Lyon  Disinfector  is 
illustrated,  but  the  Thresh  and  the  Equifex  types  are 
not,  though  they  both  possess  the  advantage  that  the 


(a)  "  Lessons  in  Diginfection  and  Steriiisation.'*  By  F.  W. 
Andrewes,  M.A.,  M.D.Oxon..  F.RC.P.Loud.,  D.P.H.CanUb.  Pii. 
2i2,  with  31  iltiutrations.  Price  3«.  net.  London:  J.  and  A.. 
Chorchill. 


212    The  Medical  Press. 


LITERATURE. 


August  24.  1904. 


residual  air  is  removed  to  a  degree  seldom^attained  by 
the  Washington  Lyon  machine  as  ordinarily  used. 

In  section  six,  disinfection  by  chemicals  is  considered, 
and  the  author  very  rightly  insists  on  the  necessity  of 
a  given  strength  and  a  given  time  for  any  particular 
chemical  to  be  able  to  kill  bacteria. 

In  fact,  the  whole  of  this  section  shows  the  most 
careful  consideration,  and  should  be  read  several  times 
by  the  student  of  disinfection.  We  would  speciadly 
commend  (on  page  89  et  seq.)  the  paragraphs  dealing 
with  the  criteria  by  which  a  disinfectant  should  be 
judged  for  practical  purposes. 

Pages  190-198  contain  an  excellent  account  of 
chemical  disinfection,  and  the  student  who  desires  to 
follow  up  this  most  entrancing  and  important  subject 
can  find  full  details  to  guide  him  in  the  classical  work 
of  Rideal  and  Ainslie  Walker,  who  have  now  succeeded 
in  placing  this  difl&cult  subject  on  a  proper  footing. 

Dr.  Andrewes'  work  is  commendably  free  from 
quotations  of  contradictory  experimental  work  on  the 
germicidal  action  of  various  chemicals  and  proprietary 
articles,  which  are  usually  found  to  the  perplexment 
of  students. 

The  experiments  on  testing  the  power  of  disinfec- 
tants, described  by  Dr.  Andrewes,  are  well  detailed, 
but  it  may  be  doubted  whether  the  organisms  men- 
tioned (Staphylococcus  pyogenes  aureus  and  Coli 
communis)  are  so  suitable  as  Bacillus  typhosus. 

The  book  concludes  with  practical  tests  of  disin- 
fection, the  testing  of  filters,  &c.,  and  we  are  satisfied 
that  it  meets  a  need  which  is  a  real  one,  namely,  while 
moderate  in  price  and  simple  in  language,  it  affords 
an  intelligent  explanation  of  the  why  and  wherefore 
of  the  problems  of  disinfection  in  general. 

It  should  appeal  in  particular  to  practitioners  in  the 
country  and  to  hospital  nurses. 

GALBRAITH  ON  EPOCHS  OF  WOMAN'S  LIFE."  {a) 
The  four  epochs  discussed  in  this  manual  are 
maidenhood,  marriage,  maternity,  and  the  menopause. 
It  is  a  little  difficult  to  determine  the  precise  class  of 
reader  for  whom  the  book  is  intended.  Much  of  it 
consists  of  sensible  advice  which  all  women  might  with 
profit  read  and  follow ;  on  the  other  hand,  a  good  deal 
is  more  suited  to  the  medical  than  to  the  lay  reader, 
with  regard  to  both  the  technical  character  of  the 
phraseology  and  to  the  nature  and  extent  of  the 
subjects  treated  of.  The  best  section  of  the  book  is 
that  on  maternity ;  the  least  satisfactory  is  that  on 
marriage.  The  authoress  has  evidently  set  out  with  the 
intention  of  inculcating  higher  ideals  in  the  married 
life,  and  she  points  out  the  disastrous  effects  of  excesses. 
There  is  no  doubt  that  it  is  of  the  greatest  importance 
that  women  should  know  more  than  they  generally 
do  about  the  ethics  of  the  marriage  state,  and  we 
cannot  therefore  but  commend  the  authoress'  intention ; 
but  this  section  would  be  improved  if  it  were  con- 
siderably condensed.  We  could  wish  that  the 
authoress  would  somewhat  recast  the  book,  so  as  to 
make  it  frankly  a  book  for  the  ordinary  woman  rather 
than  for  the  medical  woman,  omitting  at  the  same 
time  much  of  what  we  must  regard  as  unnecessary 
detail. 


AIDS  TO  SURGERY,  (b) 
This  book,  which  is  one  of  the  Students'  Aids  Series, 
is  intended  as  a  help  for  students  preparing  for  examina- 
tions. We  can  strongly  recommend  it  to  the  busy 
student  for  this  purpose,  for  it  is  complete,  thoroughly 
up  to  date,  and  the  whole  subject  is  condensed  into  a 
sufficiently  small  volume  to  fulfil  its  object  without  at 
the  same  time  omitting  anything  of  importance.  The 
only  point  we  can  take  exception  to  is  the  paragraph 
on  actinomycosis,  where  the  author  conveys  the  im- 
pression that  it  is  not  a  dangerous  disease,  for  he  says  : 
"  Large  doses  of  potassium  iodide,  up  to  one  drachm 
doses  three  times  a  day,  for  prolonged  periods,  will  cure 


va)  "The  Four  Epochs  of  Womsn's  Life:  a  Study  in  Hygiene." 
By  Anna  M.  Oalbraitta,  H.D.  Second  Edition.  Philadislphia : 
Saunders  and  Oo.    1908. 

(*)  ••  Aidn  to  Sundry,"  By  Joseph  Cunning,  M  B..  F.E  C.S.Eng. , 
Senior  Resident  Medical  Officer,  Hoyal  Free  Hospital  Fp.  39i. 
Price  is.  6d     London :  Bailliere,  Tindall  and  Cox.    1904. 


these  cases.  In  addition,  if  the  sinuses  are  in  a  position 
where  vigorous  scraping  can  be  done  the  process  of  core 
is  hastened." 


WATSON'S  EXAMINATION  OF  THE  URINE,  [a) 
This  little  book  is  intended  for  nurses;  the  author 
says  : — "  The  examination  of  the  urine  is  not  of  neces- 
sity required  of  the  nurse,  but  it  is  advisable  that  she 
should  have  an  elementary  knowledge  of  urine  testing, 
since  she  can  often  put  such  knowledge  to  use  and 
assist  thereby  the  doctors  under  whom  she  is  working." 
The  book  is  divided  into  three  parts,  the  first  gives  an 
elementary  knowledge  of  the  organs  which  are  con- 
cerned in  the  excretion  of  urine  ;  the  second  deals  with 
the  physical  characters  in  health  and  disease  ;  the 
third  with  the  collection  and  examination  of  the  urine. 
The  various  tests  are  described  simply  and  clearly,  and 
a  table  is  given  showing  the  more  important  chaxacters 
of  the  urine  in  some  of  the  commoner  diseases.  The 
book  is  one  which  should  prove  a  useful  addition  to  the 
nurse's  bookshelf. 


BROWNE  AND  STEVENSON  ON  SQUINT  IN 
CHILDREN.  (6) 
This  little  volume  is  an  interesting  and  thoughtful 
contribution  to  the  subject  of  convergent  strabismus 
in  childhood,  and  yrWl  repay  perusal.  The  authors 
strike  emphatically  the  true  note  in  the  preface, 
where  is  is  said,  "  That  which  has  borne  the  test  of 
years,  and  is  well  established,  is  of  more  value  in 
practical  medicine  than  yesterday's  inventions,  which 
may  be  failures."  Nothing  could  be  truer  of  much  of 
the  so-calltfd  medical  advance  in  the  present  day  than 
this.  There  is  the  feverish  rush  to  bring  out  "  hall- 
baked  "  theories,  and  to  introduce  novelties  in  ideas 
and  practice,  merely  for  the  sake  of  the  notice  which 
they  may  attract.  On  the  other  hand,  it  is  nowadays 
but  seldom  that  a  well-digested  contribution  to  medical 
literature,  based  upon  the  past  experience  of  many 
years,  and  enriched  with  valuable  suggestions,  comes 
under  the  notice  of  the  reviewer.  In  this  category, 
however,  the  volume  before  us  should  be  classed.  The 
scientific  etiology  and  treatment  of  this  deformity 
have  only  of  late  received  the  attention  which 
their  importance  deserved,  mainly,  no  doubt,  on 
account  of  the  good  results  which  the  empirical  method 
of  treatment,  introduced  by  Dieflfenbach,  of  dividing 
the  internal  rectus,  were  instrumental  in  obtaining. 
That  something  was  wrong  in  this  form  of  treatment, 
however,  was  often  in  earlier  days  proved  by  the 
subsequent  divergence  which  ensued  as  the  result  of 
the  operation.  The  tendency  in  the  present  day  is  to 
avoid  operative  interference  in  case  of  convergent 
strabismus  in  children  as  much  as  possible,  and  in  this 
book  the  reasons  for  this  plan  of  practice  and  the 
methods  by  which  it  can  be  accomplished  are  clearly 
and  convincingly  laid  down.  To  general  practitioners, 
by  whom,  no  doubt,  the  early  stages  of  convergent 
strabismus  are  frequently  first  seen,  this  book  should 
prove  invaluable  for  the  sound  advice  it  contains  on 
the  subject,  but  ophthalmic  surgeons  also  will  find 
in  it  hints  here  and  there  which  will  repay  them  for  its 
perusal. 

JULER    ON    OPHTHALMIC    SCIENCE    AND 
PRACTICE,  (c) 

In  this  new  edition — the  third— of  his  work,  the 
author  informs  us  that  the  text  has  been  revised,  but 
he  does  not  point  out,  for  the  assistance  of  the  reviewer, 
in  which  special  directions  additions  and  improve- 
ments have  been  effected.  We  observe  that  he  still 
retains  the  obsolete  expression  "  strumous,"  and  speaks 
of  "  strumous "  keratitis.  Inasmuch  as  the  word 
"  strumous  "  has  now  no  significance  as  a  systemic 

{a)  "The  Examination  of  the  Urine."  By  J.  K.  Wateon.H.D. 
Edin.,  M.B.,  O.M     Pp.  80.    London :  The  Scientifie  Press,  Limited. 

{b)  "Squint  Occarrinf  in  Children:  an  Essay."  By  Kdnr  A. 
Browne.  F.B.C.S.Edln.,  assisted  bv  Edg^r  Stephenson,  M.D.,]I.Ch. 
Aberd.    London:  Bailliere.  Tindall  and  Cox.    1904. 

(e)  "A  Handbook  of  Ophthalmic  Science  and  Praotioe.*'  By 
Henry  E.  Joler.  F.B.C.S.  With  illustrations.  Third  Edition; 
Uevised  and  Enlarged.    London  :  Smith,  Elder  andOo.    1901. 


August  24.  1904. 


MEDICAL  NEWS. 


The  Medical  Press.  213 


condition  in  general  medicine  and  surgery,  how  can 
it  be  correct  to  use  it  in  the  special  departments  of 
our  art  ?  The  so-called  "  strumous "  keratitis  is 
merely  phlyctenular  keratitis,  aggravated  by  a  septic 
condition  of  the  conjunctival  sac,  which  is  the  common 
feature  of  **  poor  and  ill-fed,"  and  consequently 
neglected,  children.  In  the  operation  of  tattooing 
the  cornea,  the  author  recommends  the  use  of  epilation 
forceps  for  fixing  the  globe.  Epilation  are  certainly 
Detter  than  fixation  forceps,  but  it  is  much  better  to 
use  no  forceps  at  all,  the  fingers  being  all  that  are 
necessary  for  the  purpose.  Detailed  criticism,  how- 
ever, is  superfluous  in  respect  to  a  work  whose  popu- 
larity has  been  proved  by  the  fact  that  it  has  reached 
a  third  edition.  We  can  cordially  recommend  this 
handbook 'as  a  useful,  practical  guide  to  ophthalmic 
science ;  it  represents  much  matured  experience  on 
the  part  of  the  author,  and  the  present  edition  has 
been  enriched  by  some  excellent  plates,  illustrating 
the  normal  and  pathological  histolog\'  of  the  eye, 
contriouted  by  Mr.  George  S.  Keeling  in  an  appendix! 

At&tcal  ticvos. 

West  London  Medico-Ohlrurfflcal  Society. 

The  following  gentlemen  have  been  elected  ofi&cers 
and  members  of  Council  of  this  Society  for  1904- 190  5  : — 
President :  Mr.  C.  M.  Tuke.*  Vice-Presidents :  Mr. 
C.  B.  Keetley,  Mr.  W.  P.  Barrett,  Dr.  G.  H.  D.  Robin- 
son, Mr.  J.  R.  Lunn,  Dr.  E.  Fumiss  Potter,  Dr.  E. 
Bromet,*  Dr.  G.  P.  Shuter,*  Mr.  H.  Webb.*  Council : 
Mr.  R.  Pollock,  Dr.  A.  M.  Ross  Sinclair,  Mr.  G.  A. 
Garry  Simpson,  Mr.  Percy  Dunn,  Mr.  McAdam  Epcles, 
Mr.  E.  P.  Paton,  Dr.  A.  Saunders,  Dr.  A.  J.  Rice 
Oxley,  Dr.  J.  A.  Mansell  Moullin,*  Dr.  A.  Morrison.* 
Dr.  A.  E.  Russell,*  Dr.  C.  Buttar.*  Treasurer :  M. 
T.  Gunton  Alderton.  Secretaries  :  Dr.  Andrew  Elliot, 
Dt.  W.  H,  Walter.*  Librarian  :  Mr.  H.  W.  Chambers. 
Editor  of  Journal :  Dr.  Leonard  Dobson.  Editorial 
Secretary  :  Mr.  J.  G.  Pardoe  .  *  Did  not  hold  similar 
office  last   year. 

ChlorofoFm  Fatality. 

A  WOMAN,  aged  thirty- three  years,  was  admitted  to 
the  Dalston  Hospital,  London,  last  week  suffering  from 
appendicitis.  Two  and  a  half  drachms  of  chloroform 
hiad  been  administered  previous  to  operation,  when  she 
died.  After  death  she  was  found  to  have  fatty  degenera- 
tion of  the  heart. 

Sanitary  Reorganisation  for  .the  Army. 
Sir  Gilbert  Parker  last  week  asked  the  Secretary 
of  State  for  War  whether  a  scheme  for  sanitary  organisa- 
tion had  yet  been  prepared  for  the  army  or  proposed 
by  the  Medical  Advisory  Board  ;  if  so,  whether  there 
was  included  in  it  the  sterilisation    of    all  fluids  em- 
ployed as  drinks  at   manoeuvres,  on  service  abroad, 
and  during  active  service,  and  by  what   means  this 
sterilisation  was  to  be  secured ;  whether  steps  had  been 
taken   to   secure    the   instruction,  practical    training, 
and  examination  of  non-medical  officers  of  all  ranks, 
in  their  respective   units    or    commands,  in  methods 
of  camp  sanitation,  especially  with  a  view  to  the  pre- 
vention of  enteric  fever,  dysentery  and  cholera ;    and 
whether,    after   such   training   and   exaniination,    the 
comparative  responsibility  of  such  non-medical  officers 
for  the  occurrence  of  these  diseases  in  their  respective 
commands  or  units  was  to  be  recognised.     Mr.  Brom- 
ley-Davenport,  replying  for   the  Secretary  of  State, 
said  that  the  Board  reconmiended  the  appointment 
of  special  sanitary  officers  to  army  corps  and  comniands, 
and  there  were  eleven  of  these  appointments  at  home 
and  eight  in  Eg^/pt  and  Colonies,  in  addition  to  the  five 
already    existing    in    India.     Instructions    regarding 
the  sterilisation  of  all  fluids  employed  as  drinks  which 
are  applicable  to  manoeuvres,  service  abroad,  and  active 
service  had  been  included  in  the  manual  of  combined 
training ;   heat,  and  in  some  cases  filtration,  were  the 
means  recommended.     Lectures  were  regularly  given 
to  cadets  at  Sandhurst    and  Woolwich,  and  a  more 
advanced   course   in   military   hygiene   was   provided 
for  officers  at  the  Staff  College.'    Instructions  in  hy- 


gienic matters  were  also  given  by  the  specialist  sanitary 
officers.  The  regulations  were  also  being  revised 
in  the  direction  of  devolving  more  responsibiUty  upon 
non-medical  officers  in  the  supervision  of  sanitary 
services  in  barracks  and  camps. 

The  Plaerue. 

The  following  telegram  from  Lord  Milner  was  re- 
ceived at  the  Colonial  Office  on  August  6th : — "  My 
telegram  of  July  31st,  No.  211.  Plague  return  should 
have  been  no  change.  As  there  has  Dcen  no  change 
since  July  9th,  no  further  telegrams  will  be  sent  unless 
recrudescence  occurs."  A  further  telegram  from  Lord 
Milner,  received  on  August  T3th,  says  : — "  Transvaal 
is  now  officially  certified  as  clean  of  plague  in  terras  of 
Venice  Convention."  The  following  telegram  has 
been  received  at  the  Colonial  Office  from  Sir  M.  Nathan, 
Governor  of  Hong-Kong  : — "  Five  cases  of  plague,  five 
deaths,  for  the  week  ending  August  13th." — Times. 

Wills  and  Bequests. 
Sir  John  Simon,  K.C.B..  of  40  Kensington  Square, 
formerly  consulting  surgeon  at  St.  Thomas's  Hospital, 
left  estate,  so  far  as  can  at  present  be  ascertained, 
valued  at  ;£26,635  gross,  with  net  personalty  £26, $4$ - 
Subject  to  numerous  annuities  to  relatives  and  friends, 
and  the  Ufe  interest  in  a  special  trust  fund  of  his  adopted 
daughter,  the  testator  left  the  ultimate  residue  of  his 
estate  to  St.  Thomas's  Hospital,  and  should  the  income 
of  the  said  special  trust  fund  exceed  ;f 300,  then  the 
surplus  is  also  to  be  paid  to  St.  Thomas's  Hospital. 

Forty  Thousand  Deaths  ft*om  Chdlepa. 

News  from  the  cholera  districts  of  Persia  is  reassuring. 
The  disease  has  wholly  disappeared  in  many  places, 
and  is  losing  its  maUgnancy  in  all.  But  in  Teheran 
between  twenty  and  twenty-five  thousand  deaths 
occurred  during  six  weeks,  and  in  the  environs  al>out 
the  same  number.  At  present  the  mortality  from  that 
cause  in  the  capital  is  computed  at  thirty-five  daily, 
whereas  the  environs  are  exempt  from  the  scourge. — 
Daily  Telegraph. 

PASS  LISTS. 
Foytl  Colleir*  of  Supgaons,  Biiffland. 
The  following  candidates,  having  passed  the  neces 
sary  examinations,  have  been  admitted  members  of 
the  College.     The  names  are  arranged  alphabetically : 
F.   Alcock.  E.  F.  Alford,  H.   R.  AlUngham,  J.  Aylen, 
F.  Barnes.  C.  E.  Bartlett,  J.  E.  L.  Bates,  L,  Bathurst, 
J.  H.  Bletsoe,  H.  G.  W.  Beckett,  H.  J.  Brewer,  F.  M. 
Boclet.  J.  Bowen-Jones,  F.  A.  Brodribb,  E.  M.  Brown, 
F.  M.  Bulley.  W.  Byam,  P.  D.  Mad.  Campbell.  T.  W. 
ChafE.  J.  R.  A.  Clark-Hall.  C.  Colmer,  G.  H.  Colt,  P.  C. 
Coombes,  H.  Cooper,  W.  F.  Corfield.  W.  I.  Cumberlidge, 
F.  W.  Daniels,  W.  B.  Davy,  W.  R.  E.  Drawbridge, 

E.  P.  H.  Dudley,  H.  D.  Duke,  H.  E.  Dyson,  W.  S. 
Edmond,  N.  C.  Fletcher,  T.  H.  Fowler,  H.  Prankish, 
J.  D.  Galloway,  H.  T.  George,  S.  H.  Gibson,  H.  J. 
Gibbs,  D.   R.  Gilder,   J.  L.  Gilkes,   J.  W.  F.  GiUies, 

F.  G.  Goble,  R.  E.  G.  Gray.  M.  Greenwood,  P.  Gully, 
C.  M.  Halsall.  J.  M.  Hamill,  R.  O.  Handcock,  A.  E. 
Hay,  A.  L.  Heiser.  J.  W.  Hele.  F.  C.  Hepburn,  G.  W. 
Heron,  E.  C.  Hughes,  H.  Irving,  S.  D.  Jacobson,  T 
Jays,  H.  A.  Kisch,  H.  H.  Jenkins,  O.  S.  Kellett, 
W.  R.  Kirkness,  J.  L.  Lawry,  H.  Leach,  H.  C.  Lees, 

G.  M.  L.  Lester,  T.  Lewis,  E.  G.  R.  Lithgow,  J.  H. 
McAllum.  E.  J.  C.  McDonald,  G.  H.  McLaren,  J.  B. 
McVail.  H.  T.  Mant,  P.  J.  Marett,  W.  N.  May,  W.  O. 
Meek,  R.  Milne,  E.  L.  Moss.  R.  C.  Mott,  M.  J.  Mottram, 

B.  N.  Murphy,  F.  Neale,  H.  Nicol,  S.  A.  Owen,  G.  R. 
Painton,  W.  F.  Peach,  E.  G.  Perodeau,  E.  E.  M.  Price, 
T.  P.  Puddicombe,  C.  E.  Reynolds,  R.  I.  Ritchie, 
T.  H.  F.  Roberts,  G.  C.  F.  Robinson,  W.  E.  Robertson, 
E.  J.  H.  Rudge.  A.  P.  Salt,  H.  B.  Scott,  T.  Sanders. 
S.  G.  Scott,  P.  H.  Seal.  A.  W.  K.  Straton,  K.  Takaki, 
A.  Witehead-Smith,  H.  M.  Thomas,  H.  S.  Turner. 
M.    K.   Varughese.   W.   T.    Wallace.    H.    B.    Walters, 

C.  S.  WOiite,  H.  T.  M.  Wilson,  K.  S.  Wise,  and  S.  C. 
Yin. 


214    Tm  Mxdical  p»ess.      notices  TO  CORRESPONDENTS. 


S^itts  to 
€ont&poxtbtnts,  ^\mt  JEjtiins,  &c. 

9^"  OoRRnpoKDFKfB  requiring  a  reply  In  this  column  are  partlcu 
larly  requested  to  make  use  of  a  dUHiutlve  SigruOwrt  wlniHal,  an 
avoid  the  practice  of  signing  themselves  '* Reader,"  "Subscriber," 
**  Old  Subscriber/'  te.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Abticlbb  or  Lmiuis  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. 

Contributors  are  kindly  requested  to  send  their  communications, 
if  resident  In  England  or  the  Colonies,  to  the  Editor  ai  the  London 
office ;  if  resident  in  Ireland,  to  the  JDublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  s^me  rule  applies  as  to  office.;  these  should  be  addressed  to  the 
Publisher. 

Rrpructs.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

M.D.,  Vict.— The  Annual  Report  of  the  Reg.-Oen.  for  England  and 
Wales  Ur  U02  is  now  pubhshed  and  in  it  you  wiJl  find  the  informa- 
tion you  requirr .  The  births  registered  in  the  two  countries  for  that 
year  were  940,600,  equal  to  an  annual  bitth-rate  of  28*6  per  1000  of 
the  population.  The  figures  are  identical  with  those  of  the  preceding 
year,  but  show  a  fall  of  1-1  when  compsred  with  the  ten-yearly 
aveiage  for  1802-1901.  '       ^ 

Dr.  FixroERALD.— The  finding  of  the  Court  was  in  our  opinion 
more  than  justified.  The  thinking  medical  man  should  find  no  little 
focd  for  r^  flection  in  the  conflict  of  scientific  evidence.  One  set  of 
witne8ses  swear  that  disastrous  effects  are  produced  on  lower  animals 
by  the  administration  of  a  particular  drug.  Another  set  of  experts 
teRtify  that  the  ordinary  medicinal  dose  of  thatsubstanoe  is  far  lai^er 
and  that  it  is  administered  over  long  periods.  Can  any  candid 
practitioner  seriously  defend  the  use  of  such  a  remedy  under  these 

conditions  ^        Y<>t  nrPOiiU>lv  Rlinilnp  v«mnv>1ra  anm1»  4-rv  uo  .iy^.is  Am^^^wt,  ... 

daily  use. 


Yet  precisely  similar  remarks  apply  to  various  drugs  in 


M.  B.  (Worcester).— Is  thanked  for  his  letter  and  appreciation  of 
policy.  The  diminishing  birth-raie  as  a  subject  for  discus-ionis  looked 
on  askance  by  most  of  the  medical  journals.  It  nevertheless  involves 
the  very  foundations  of  our  social  system.  There  is  no  reason  whythe 
medical  profession  should  net  investigate  in  a  calm  and  scientific 
spirit,  the  laws  that  determine  the  rise  or  fall  of  the  national  birth- 
rate. •  Hardly  auy  subject  could  be  of  greater  definite  and  vital 
importance  to  the  community. 

A  DAILY  MEDICAL  JOURNAL'. 

A  LAY  contemporaiy  announces  that  a  daily  medical  paper,  which 
IS  to  be  made  up  of  six  >«ges  of  ordinary  newspaper  size,  is  to 
appear  in  New  York,  and  that  a  first  edition  of  100,000  copies  has 
been  already  subscribed  for.  What  a  rich  feast  of  symptoms  that 
100,000  must  be  looking  forward  to  !  Strangely  enough,  the  chosen 
home  of  the  patent  medicine  is  not  the  first  country  to  possess  a 
medical  ••  daiiy,"  .America  having  been  preceded  on  this  occasion  by 
Italy,  where  the  "  Rifoi  ma  Medica  "  is  published. 

A.  B.  C— We  fear  there  is  no  other  course  open  to  our  co/xes- 
pendent  but  to  pay  the  tax. 

Mr.  E,  Wathoh.— The  city  which  has  the  largest  population  next 
to  London  Is  New  Yoik,  and  not  Paris  as  is  generally  supposed.  For 
further  information  on  populations,  see  reply  lo  Mr.  R.Stevens  in 
our  last  issue. 

NATIONAL  DEGENERATION. 

As  a  contribution  to  the  moot  question  of  the  degeneracy 
of  our  race  Mr.  Walter  Burns  of  Belfast  writes  us  that  he  is  now  80 
yearn  of  age  and  has  ••  neither  gout,  rheumatism,  pain,  nor  ache. 
He  can  walk  as  quickly  as  ever,  and  has  neither  shake  in  his  hand 
nor  wrinkle  in  his  skin.''  He  asks  "  how  can  the  race  be  anythine 
but  degenerate  when  »he  large  majority  of  men  and  womeu  both 
drink  alcohol  and  smoke  tobacco  ?  "  He  does  neither,  and  says  his 
legacy  to  his  countrymen  for  health  is,  ••  take  exercise  in  the  open 
air  every  day  wet  and  dry,  keep  the  feet  and  body  dry  and  the  head 
cool ;  no  heavy  dinners,  and  no  heavy  suppers,  and  no  alcohol  or 
smoking,  and  with  a  faurly  good  constitution  there  need  be  no  fear 
of  national  decay. '  i/k.  .'. 

[Probablj'  the  possession  of  a  sound  constitution  has  more  to  do 
with  the  robust  health  of  our  correspondent  than  even  his  abstention 
from  alcohol  and  tobacco.  We  can  point  to  many  men  of  his  age 
equally  jobust,  although  non-abstamers,  having  pursued  a  simple 
and  healthy  course  of  living.— Ed.] 


laranaes. 


Devon  County  Asylum.— Assistant  Medical  Officer.  Salary  com- 
mencing at  4126  per  annum,  with  boaid  and  lodgings.  Apply 
to    the    Medical  buperintendeut,    Asylum,  Exmmster. 

Carlisle  Non-Provident  Dispensary.— Resident  Medical  Officer. 
Salary  £160  per  annum,  with  apartments  (not  boardi.  Applica- 
tions to  the  Honorary  Secretary,  G.  A.  Lightfoot,  Esq.,  "'3 
Lowther  btreet,  Carlisle. 

Stockport  lofirniary.— Junior  Assistant  House  Surgeon.  Salary 
£i40  per  annum,  with  board,  washing  and  residence.  Applica- 
tions to  the  secretary. 

Macclesfield  General  I otirmary.— Junior  House  Surgeon.  Salary 
£i60  per  annum,  with  board  and  residence  at  the  Institution. 
Applications  to  the  Chairman  of  the  House  Committee. 


August   24,  1904^ 

^^l???Sr°a3«  wt?K^iyST?;-S««i<»'  House  Sm^on.^r 
Aiiu  per  annum,  with  board,  lodtrinir.  and  waahinc  IimlMCkH/a 

fIS;ii!i"i"^'*'*i,'*.r*  '"lly  qoalifled  Medical  Man  uxik. 

^^L  ^^!L  '"fl'ma'.v.-Bouse  Burgeon.  Salarv  £100  » 
?"° «™'..  wiUi  residence,  board,  attendance^Sd  iwuhilf 
Applications  to  the  Hon.  »e^Vy.'  ^^■»- 

^J^El^rJ^^  Children's' Hospital . -House  Fu,^ 
A^nHLHi?2?*'B.*Er"'il!r.u**i?  ^^^'  residence,  and  lauSrv 
Applications  t3  E.  H.  Tilby,  Hon.  Sec.,  69  Temple  Road.  BirSl 

^^"  To»S?Ji!i?l!i"J?  '""  Con8umptives,Ximp'ey  Stoke^near  Bath 
-To  be  opened  November  nex  t -Resident  Mil  ical  oh        -  ■ 


ence     In     Sanatorlal    TYettment    essential.      --^i---^^^*^ 


-Resident  Medical  Officer.  SaJvv 
Applications  to 


Oount^M'^^'l:"  N.A.P.O.,  84  Park  Street.'  Bristol. 

men?  m  3^r  tC^^?*?"  Inspector  in  the  Public  Health  Depatv 
ment  uLder  the  Midwives  Act,  1902.  Salary  £150  risinrS^ 
SHhi'SS^Si^^r^^^^'i!^  amaxinmmofls^:  ;;|SK 
?"nHt^o«?,^..'^™:.!f  ^    o»>^"«l  'rom   the   Cle?t^' 


London  County  Council. 


^omivxtras. 

MOHTOOMERT,  ALEXANDER,  M.B.,  B.8  R  K  T     M»A\oa\     Art^nHan*  ♦ 

NoRMij,  A.  S„  L.R.C.P.LoDd.,  M  R.O.8.E1W..  CerUfvinK  Enmrn 

Richards,  W.  Huktbr,  M.B.,  M.S  Durh     fi  R  G  s  PnS*  w5^;«..^ 
ConsultingObstetric  Phy'slcianto  Se  F^-^y^tco^n^aU 

SMnTi,WiLLiAM,  Medical  Officer  for  the  Hawkesbury,  Alderlv  BadmiiK 
tonand  Acton  Turville  districts  of  Chipplug sSbu?,  (oi^S^ 

SoPKR,  Gerald  Morgan,  L.R  C.P.Lond.    M  RC  S     MmIIpO  nm«. 


jUirtkB. 

Stabr.— On  August  19th,  at  Harleston.  T,>rquay,  the  wife  of  W  W 

Stabb.  M.D.,  of  a  daughter. 
Vatjqhax  — On  August  16th,  at  St.  Petroc,  Coal\-ille,  Leicesterahiwi 

the  wife  of  A.  W.  Vaughan,  L.R.C.P.,  L.B.C.8.,  of  adaught^ 

^^^^r'^o^^v^^^'-On  August  20th,  Ambrose  Heal.  Jun..  of  The 
Fives  court.  Pinner,  to  Edith  Florence  Digby  Todhunter  elder 
daughter  of  Dr.  Todhunter,  M.D.,  of  Orchardcrof  t,  BedfmdPuk, 

LEoai:-MACK.-On  August  18th,  at  St.  Giles,  Sherroanbun-,  Thomw 
Morison  Legge^.D.,  to  Norah  Elisabeth,  second  daughter  of 
J.  A.  MacA,  of  The  Gnnstead,  Partridge  Green,  Sussex. 

STEELE-PARDON.-On  August  17th,  at  »t,  Clement's  Boscombe. 
S*!llf  •'  5*S^**%"Sl*®^iS'*  ^'*®'®«  >ouDg|st  sjn  of  William  Stott 
Steele,  M.D.,  of  St.  Marys  Church,  Devon,  to  Elsie  Jorce 
Pardon,  youngest  daughter  of  John  Pardon.  Esq.,  of  Culms, 
Boecombe.  Hants.  ^^  ^ 

T*rB8HAW-PEKKi»B.-Oo  August  18th,  at  St.  Peters,  Pwllheli.  Wil- 
fred Trubshaw,  Assistant  Prosecuting  Solicitor  to  the  Corpora- 
tion of  LiveijiooJ,  eldest  son  of  Alfred  Trubshaw,  M.R.C.8\,  of 
Pendre.  Mold,  to  Bessie  Andre,  third  daughter  of  W.lter 
Edward  Perkins,  J  P.,  of  Bodegioes,  Pwllheli,  and  The  GraoKe, 
Astwood  Bank,  Worcestershire. 

TuRNBB— DENSiiAM-On  Ausust  18th,  at  St  Luke's  Church,  Grey, 
giott,  Surrey,  Francis  John  Turner,  B.A.MC,  son  of  the  late 
?®^:  ^-  J-  Tnnier,  to  Mary  Theodora,  youngest  daughter  of 
Benjamin  Densham,  of  Hindhead,  Surrey 

UssHER-CoMYH.-On  August  18th  at  St  Paul's  Church,  Southaes, 
Litut.  Wm.  A.  Ussher,  B.N.R  ,  H.M.S.  Apollo,  eldest  son  of  the 
late  James  Ussher.  solicitor.  Florence  Villa.  Lurgan,  Ireland,  to 
Sophie  Honoria,  only  daughter  of  Surgeon-General  J.  S.  Comyn, 
B.A.M.C.  (retired),  of  Woodstock,  Galway,  and  of  21  A»h- 
burton  Road,  Southsea. 

^taths. 

AsHER.— On  August  21st,  at  the  Nursing  Home,  Warrington  Lodj^e, 

Philip,  elder  son  of  the  late  Ather  Asher,<M.D.,  aged  8& 
HsNSMAX.— On  August  I6th,  at  Nurthdown.  Margate.  Ruby,  second 

daughter  of  Lieutenant-Colonel  William  ilensman,R.AM.C.,  uf 

Cannesfield,  Taunton,  aged  26. 
Stewart.— On     August   16th   at     Dunmurrj',    Eneyd  Park,  near 

CliftDU.  Glo's,  Hamilton  Stewr-art,  younger  s^nof  Jimes  8tew«it^ . 

B.  A.,  F.R.C.P.Ed.,  of  the  same  address. 


Wkt  ^^ilial  '^m  mA  (E!itml»t 


••SALUS  POPnU   SUPBEHA   LEX-' 


Vol.  CXXIX. 


WEDNESDAY,    AUGUST   31,    1904- 


No.   9* 


^tidinal  Communications* 

THE 

PREVENTIVE  TREATMENT 

OF 

SCARLET  FEVER 

BY  ISOLATION  (AGGREGATION)  HOSPITAI.S. 

By  HUBERT  E.  J.  BISS,  M.A..  M.D.Cantab..  D.P.H., 
SMtbourne ; 
Late  Awiateat  Madioal  Offloer,  Metropolitan  Asylums  Board. 

PART    I. 
ScARLST  fever  is  a  disease  of  very  wide  prevalence 
in  this   country  at   the  present   day.     There  is  no 
district,   urban  or  rural,   that  does  not  suffer  to  a 
greater  or  less  extent  from  its  incidence.     It  is,  then, 
only  natural  that  the  community  should  wish  to  take 
steps  to  rid  itself  of  this  malady,  especially  as  it  is 
generally  regarded  as  a  highly  dangerous  one.     Some 
twenty-five  years  ago,  after  obtaining  the  best  medical 
advice,  certain  towns  erected  hospitals  for  the  special 
treatment  of  infectious  diseases,  scarlet  fever  being 
the  one   specially  aimed  .at.    The  idea  prevailed   at 
that  time  that  as  scarlet  fever  was  infectious  by  direct 
or  proximal  contact,  removing  the  patients  suffering 
from  it   to  a  building  to  which  general  access  was 
barred  would  eradicate  the  centres  from  which  the 
disease  spread.     By  diligently  practising  this  plan  of 
treatment  it  was  supposed    that  scarlet  fever  would 
either  die  out  or  become  markedly  less.    Since  the 
inauguration  of  this  method,  urged    by  the   medical 
profession   and  pressed    by  the  Local    Government 
Board,  nearly  every  sanitary  authority  has  built  a 
fever  hospital.     The  country,  therefore,  has  had  con- 
siderable   experience  of  its  working,  and  it  may  not 
be  oat  of  place  to  look  round  at  the  results  that  have 
ensued.     To  those  to  whom  truth  is  the  prime  object 
to  be  followed  by  sanitary  as  by  every  other  science, 
it  comes  as  a  sad  reflection  that  a  propKi^al  to  this  effect 
should   meet   with   vehement   opposition,   but   when 
three  or  four  years  ago  Dr.  Dean  A^aniott,  of  Notting- 
ham, and  Dr.  Killick  Millard,  then  Medical  Officer  of 
Health  for  Burton-on-Trent   and  now  for  Leicester, 
came  forward  with  a  good  deal  oi  evidence  to  show  all 
was  not  going  as  well  with  the  system  as  was  generally 
supposed,  and  suggested  more  extended  inquiry,  their 
proposal   was   scoffed   at.     Since    then    from    many 
quarters  further  evidence  has  been  forthcoming,  and 
at  the  present  moment  the  necessity  for  an  inquiry 
into  the  fever  hospital  system,  as  applied  to  the  pre- 
ventive treatment  of  scarlet  fever,  has  been  admitted 
by  nearly  all  the  leading  organs  of  the  profession,  and 
by  many  societies  of  medical  sanitarians. 

But  the  demand,  for  such  it  really  amounts  to.  has 
not  been  sufficiently  unanimous  to  secure  its  object. 
To  myself  it  seems  a  pity  that  this  question  should  be 
Tegarded  as  polemical ;  it  ought  to  be  looked  upon  as 
a  strictly  scientific  one,  which  if  examined  on 
strictly  scientific  lines  must  lead  to  fresh  know- 
ledge about  a  puzzling  disease.  My  present  con- 
tribution to  this  debate  aims  only  at  suggesting  some 
Primd  facie  considerations,   first,   as   to    why  scarlet 


fever  en  masse  might  be  expected  to  be  little  amenable 
to  hospital  treatment,  and,  secondly,  as  to  certain 
obvious  disadvantages  of  the  system.  I  shall  confine 
my  remarks  strictly  to  the  subject  of  scarlet  fever, 
for  that  is  the  disease  which  the  hosp»itals  were  in  the 
main  erected  to  cope  with,  and  which  occupies  the 
bulk  of  their  beds.  It  may  or  may  not  be  that  certain 
of  the  arguments  apply  equally  to  some  of  the  other 
infectious  diseases,  but  of  them  I  do  not  wish  to  speak. 
At  the  same  time,  it  must  be  remembered  that  it  by 
no  means  necessarily  follows  that  because  a  certain 
plan  of  treatment  has  been  successful  or  unsuccessful 
with  one  disease,  that  it  will  be  successful  or  unsuccess- 
ful with  another.  Every  disease  has  its  own  charac- 
teristics en  qros,  just  as  it  has  en  detail,  and  the  pre- 
ventive means  appropriate  to  each  will  often  vary  as 
much  as  the  clinical  treatment.  No  one,  for  instance, 
would  be  found  to  agree  that  hospital  treatment  had 
been  effectual  in  "  stamping  out "  diphtheria,  for  it 
is  notorious  that  that  malady  has  increased  by  leaps 
and  bounds  during  recent  years.  Small-pox,  on  the 
contrary,  seems  to  -a  certain  extent  to  be  amenable 
to  institutional  infiuences,  but  here  we  have  the  question 
complicated  by  the  protection  afforded  by  vacanation. 

In  writing  of  an  epidemic  affection  it  is  usual  and 
convenient  to  speak  of  the  disease  as  though  it  had 
a  separate  corporate  existence ;  thus  we  speak  of 
scarlet  fever,  diphtheria,  and  so  on,  ?itbicking  people, 
invading  towns,  giving  rise  to  mortality,  much  as 
we  would  of  an  army  or  a  destroying  angeL  This  is 
neither  correct  nor  scientific.  No  disease  exists  or 
can  exist  apart  from  the  patient ;  the  subject  in  whom 
the  disease  manifesto  itself  furnishes  by  means  of  the 
tissue  changes  wrought  in  him  the  maUries  morbi  of  the 
disease.  But  so  long  as  we  bear  in  mind  that  such  is 
the  case,  we  can  speak  of  the  disease  objectively  con- 
sidered as  "  scarlet  fever,"  **-  diphtheria,"  or  what-not, 
without  violating  our  pathological  convictions.  Prac- 
tically, too,  we  gain  by  avoiding  cumbersome  cir- 
cumlocutions. Another  point  I  should  like  to  make 
before  passing  to  my  principal  thesis:  custom  and 
misconception  have  sanctified  the  term  "  isolation 
hospital "  to  our  institutions  for  fever  patients ; 
common  sense  and  accuracy  cannot  lend  their  cachet 
to  the  description.  An  isolation  hospital,  a  hospital 
where  the  patient  is  isolated,  does  not  exist  in  this 
country.  The  fever  hospital  is  an  institution  where 
patients  are  segregated  from  their  fellows  and  aggre- 
gated together,  and  as  it  seems  to  be  this  very  aggre- 
gation (want  of  isolation)  that  is  responsible  for  much 
of  the  mischief  of  the  system,  it  does  not  seem  fair  to 
^eak  of  an  isolation  hospital  when  we  really  mean 
&n  aggr^ation  hospital  There  is  a  real,  essential 
difference. 

Now,  in  order  to  assess  the  effect  of  the  ag^egation 
hospital  as  a  factor  in  scarlet  fever  incidence,  it  will  be 
necessary  to  consider  in  some  detail  what  is  meant  by 
this  scarlet  fever  ;  what  are  the  charactfscs  of  the  disease 
as  met  with  when  it  affects  communities  and  when  it 
affects  individuals ;  we  must  look  at  its  history,  its 
natural  course,  and  its  present  condition.  These 
points  I  should  like  to  review,  and  further  to  speak  of 
the  necessarily  entailed  evils  of  the  aggregation  policy, 
but  the  main  topic — the  effect  of  hospital  treatment 


2l6    The  Medical  Pkksi.        ORIGINAL  COMMUNICATIONS, 


as  a  preventive  of  scarlet  fever  incidence — I  shall 
leave  to  Br.  Killick  Millard;  who  has  worked  so  assi- 
duously and  energetically  at  the  subject. 

I  would  begin,  then,  by  taking  a  backward  glance 
over  the  course  that  scarlet  fever  has  followed  since  it 
appeared  in  this  country.     Here,  however,  one  is  faced 
by  a  great  practical  difficulty,  and  one  not   without 
its  significance ;  I  mean  the  impossibility  of  distin- 
guishing scarlet  fever  from  diphtheria  and  other  throat 
inflammations  in  the  early  accounts  that  have  come 
down   to  us.     We  may  form   theories,   hazard   con- 
jectures, promulgate  views,  but  in  actual  fact  it  is  not 
possible  to  speak  with  certainty.      The  Greek  Kwdyxv, 
the  lAtin  -'-  angina,"   the  Spanish  "  garrotillo,"    the 
American  •-'  throat  distemper,"  the  Irish  -'  plague  of 
the   throat,"   the  mediaeval   "  pestis    gutterosa " — all 
seem  in  one  description  to  point   to  scarlet  fever,  in 
another  to  diphtheria,  in  a  third  to  tonsillitis.     Now.  a 
full-blown  scarlatina  rash  is  a  disease  phenomenon  at 
once  obvious  and  striking  ;  the  contrast  between  the 
rosy,  angry  skin  of  scarlet  fever  and  the  pale,  waxy 
cuticle  of  diphtheria  would  immediately  arrest   the 
most  casual  observer's  eye.     How,  then,  does  it  happen 
that  whpn  we  seek  to  penetrate  into  the  true  nature  of 
an  epidemic  of  throat   disease  as  described  by  the 
older  p)n:etologists  we  are  lost  in  an  impenetrable  jungle  ? 
Is  it  the  physicians  were  careless  and  stupid,  or  is 
it    that    two,    aye,    and    three,    diseases   were   often 
mingled  in  the  same  outbreak  ?     Personally,  I  incline 
to  the  latter  view,  and  it  is  one  taken  by  an  epidemio- 
logist of  the  eminence  of  Creighton.     Doubtless,  the 
clinical  manifestations  of  the  two  diseases  were  not  at 
all  clearly  distinguished,  for  even  after  Bretonneau  had 
established  the  leading  features  of  diphtheria  he  was 
forced  to  protest  against  his  chosen  name  being  used 
indiscriminately  for    all    diphtheria-like  appearances 
of  the  throat.     It  is,  however,  difficult  to  read  accounts 
such  as  those  given  by  Dr.  J.  Wall  and  Dr.  J.  Johnstone 
of  the  epidemic  of  throat-disease   at    Kidderminster 
betwixt     1748-50    without     the     conviction     being 
borne  in    on    one    that    this     outbreak    was    not 
a   uniform,   unalloyed   one,    but   that   both   diseases 
played  a  r^  in  it,  scarlet  fever,  perhaps,  the  more 
prominent  one.    The  same  holds  good  for  many  other 
epidemics,  such  as  the  morbus  strangulatorius  of  Starr, 
in  Cornwall,  in  1750,    the  throat-disease  of  Hexham, 
in  Plymouth,  in  175 1,  the  ulcerated  or  malignant  sore 
throats  described  by  Fothergill,  Fordyce,  Withering, 
and  others.     Hexham,  for  instan9e,  is  quite  clear  as  to 
the  sloughing  of  the  throat  and  the  rash,  but  he  gives 
a  vivid  description  of  the  tracheal  casts  spat  up  by  the 
•  patients — an   event    that   never    happens   in    scarlet 
fever  pur  ei  simple.    Far  from  this  view  being  an 
unreasonable  one,  in  the  light  of  what  we  now  know 
of   the  cross-infection  of  patients  in  hospital,  it  is 
an  eminently  reasonable  view.     It  is  probably  also  the 
right  one.     There  is  another  fact  that  is  also  most 
striking  in  reading  the  history  of  scarlet  fever,  and  that 
is  the  remarkable  variations  in  the  severity  of  the  out- 
breaks, and  even  of  the  same  outbreak  at  different 
times  in  adjacent  places.     Naturally  enough  the  mild 
epidemics  received  less  treatment  at   the  hands  of 
contemporary  writers  than  the  malignant  ones,  and 
it  is  safe  to  assume  that  in  an  age  when  the  cacoHhes 
scrihendi  had  not  the  vogue   that  it  enjoys  at   the 
present  day.  many  a  mild  outbreak  passed  unrecorded. ' 
Still,  this  difference  in  type,  as  it  is  called,  is  sufficiently 
well  established  by  what  has  come  down  to  us  to  place 
it  beyond  doubt  that  far  from  the  modem  benignity 
of  scarlet  fever  being  an  isolated  phenomenon,  it  is  qnite 
en  pi?ce  with  the  behaviour  of  that  erratic  disease. 
Examples  of  malignancy  are  furnished  by  the  outbreak 
at  Kingston,  in  New  England,  in  1735,  and  the  country 
districts  of  New  Hampshire  ;  in  these  places  it  carried 
off  one-third  to  one-sixth  of  those  attacked,   whilst 
of  the  1746  outbreak  in  Bromley-by-Bow  it  is  recorded 
that  **  so  many  children  died  suddenly,  some  losing 
all  and  others  the  greater  part  of  their  families,  that 
people  were  reminded  of  the  plague."  On  the  other  hand, 
the  epidemic  at  Chesham  in  1788,  described  by  Ramsey, 
**  carried  off  but  few  considering  the  great  numbers 


August  31,  1904. 


affected  by  it,"  and  the  outbreaks  in  London,  1807-0S 
and  1 8 14,  are  described  as  being  "  generally  mild, 
presenting  the  eruption  with  slight  sore  throat" 
Again  in  the  same  epidemic  thfc  two  types  of  the  disease 
may  be  present  side  by  side,  as  occurred,  for  cxampfe. 
in  an  outbreak  related  by  Dn  James  Sims  in  1798. 
Much  more  often  an  epidemic  of  considerable  malig- 
nancy was  succeeded  by  years  of  wide  prevalence  of  a 
benign  form  of  the  disease.  Such  a  change  of  type 
is  recorded  by  Dr.  Levison  in  1778.  The  very  violent 
epidemic  of  scarlet  fever  which  prevailed  in  London 
and  the  surrounding  villages  in  1777  abated  in  Novem- 
ber, but  was  succeeded  in  the  following  year  by  a  van- 
mild  type  of  the  disease  that  affected  many  p^^sons. 
In  1 8 10- 1 1  malignant  scarlet  fever  scourged  Nottingham 
and  Debenham,  but  its  virulence  abated  and  remained 
in  abeyance  till  183?,  though  a  mild  form  of  the  m^iad- 
was  common  enough  in  the  interval.  The  most  dear 
and  striking  account  of  this  variation  in  type  is  the  weD- 
known  one  we  read  of  in  Graves'  "  Clinical  Lectures." 
In  that  classical  work  he  tells  us  after  the  fearful 
epidemic  in  1801-04  "^  Dublin,  *'  although  scarlatisi 
epidemics  recurred  very  frequently  during  the  next 
twenty-seven  years,  yet  it  was  always  in  a  simple  and 
mild  form."  In  1834  the  disease  again  assumed 
virulent  guise,  and  committed  ravages  similar  to  those 
of  1 80 1.  It  is  in  this  connection  that  Graves  speab 
those  pregnant  words  which  will  bear  quotation  even 
once  again.  "  In  spite,"  says  he,  **  of  our  boasted  1 
improvements,  we  have  not  been  more  successful  is 
1834-35  than  were  our  predecessors  in  1801-02."  One 
cannot  help  reflecting — ^Are  we  any  more  successful 
in  1904  ? 

Having  seen,  then,  that  it  is  the  habit  of  scarlet 
fever  to  vary  widely  both  in  its  prevalence  and  in  its 
character,  we  may  next  consider  what  was  the  con- 
dition of  this  country  with  regard  to  the  disease  before 
the  advent  of  the  aggregation  hospital.     Now.  after 
a  generation  of  mild  but  widely  disseminated  scarlet 
fever,   the  middle   of    the    nineteenth    century  was 
characterised  by  many  severe  epidemics,  and  it  would 
hardly  be  too  much   to  say   that  between  1840  and 
1874  the  country  was  scourged  by  the  disease.    The 
figures   for  each  of   the  decennial  periods    1841-so, 
1851-60,  1861-70,   and   1871-80  show  great  mortalitr 
from  scarlet  fever,  the  highest  peaks  being  reached 
in  1848,  1858-59,  1863-64,  1868-70,  and  1874.     In  the 
years  1863-74  scarlet  fever  was   the  cause   of  4  to  6} 
per  cent,  of  the  deaths  from  all  causes  in  England  and 
Wales.     1863  was  the  year  of  highest  mortality  with 
30,475  deaths,  and  1874  the  lowest  (except  1868)  with 
24,922.     Naturally,     scarlet    fever     became     greatly 
dreaded,  and  it  is  not  in  the  least  surprising  that  with 
this  record  well  within  the  memory  of  living  people 
the  disease  should  be  regarded  as  a  pestilence  to  be 
combated  by  every  available  means.     But  the  natural 
swing  of  the  pendulum,  particular  virulence  abating 
to  give  place  to  wide  prevalence  of  the  malady  in 
benign  form,  took  place  after  1874,  and  from  that  date 
the  mortality  has  been  steadily  on   the  decline— a 
condition  of  things  that  the  well-informed  epidemio- 
logist could  have  foretold  with  no  little  certainty  at 
the  time.     It  has  been  claimed  that  this  drop  in  the 
death  figures  was  due  to  the  introduction  of  the  aggre- 
gation hospital,  but  this  claim  can  hardly  be  seriously 
maintained ;  indeed,  it  is  not  made  by  the  more  re- 
sponsible   epidemiologists  and  medical    statisticians. 
The  change  of  type  was,  historically  speaking,  due  at 
the  time  it  set  in,  as  similar  changes  had  been  due  and 
had  fulfilled  their  destinies  time  after  time  in  past 
years.     Moreover,  this  alteration  was  not  confined  to 
this  country  alone,  but  occurred  about  the  same  time 
in  America,  Germany,  and  Norway,  where  the  aggrp* 
gation  principle  has  not  been  adhered  to  as  it  has  in 
Great  Britain.     It  is  difficult  to  see  how  it  can  be 
thought   that   the   establishment  of  a  few  hospitals 
in  isolated  centres  could  have  affected  the  type  of  the 
disease  in  its  general  incidence,  for  it  must  be  re- 
membered that  anything  approaching  general  segrega- 
tion in  hospital  has  only  been  attained  during  the 


August  31,  1904. 


ORIGINAL  COMMUNICATIONS. 


Thb  Medical  Press.    217 


HMpiUl 

Home 

Death-rate. 

Death-ral 

411 

I'Si 

2-51 

roi 

2*99 

I '43 

373 

ro8 

3*53 

1-28 

last  fifteen  years  or  so.  The  only  possible  way  by 
vrhich  hospitals  could  reduce  the  total  mortality  of  the 
disease  would  be  by  a  vast  superiority  of  hospital 
treatment  over  home  treatment.  In  the  absence  of 
any  specific  treatment  for  scarlet  fever  it  is  not  reason- 
able to  attribute  any  change  in  mortality  to  any 
particular  pUm  of  treatment,  especially  as  there  is 
none  for  which  such  claim  has  been  made.  Com- 
X>arative  mortality  figures  for  home  and  hospital 
treatment  are  difficult  to  obtain,  and  for  various 
obvious  reasons  are  open  to  great  fallacy  when  they 
are  obtained  and  compared.  I  have,  however,  cal- 
culated the  scarlet  fever  death-rate  for  those  removed 
to  hospital  and  for  those  who  remained  at  home,  in 
London,  for  the  five  years  1 898-1903.  These  figures 
are  the  largest  available  ;  the  returns  for  towns  of 
average  size  deal  with  so  small  a  number  of  deaths 
that  the  transference  of  one  or  two  cases  from  one 
column  to  another  affects  the  percentage  very  con- 
siderably, and  gives  an  erroneous  idea  oi  the  signifi- 
cance of  the  factors  involved.  In  taking  the  figures 
for  London  I  have  not  included  the  cases  admitted  to 
the  London  Fever  Hospital,  which  were  few  in  number, 
and  I  have  calculated  the  death-rates  on  the  total 
admissions  to  the  Metropolitan  Asylums  Board  hos- 
pitals, instead  of  on  half  the  sum  of  the  total  admissions, 
discharges,  and  deaths  as  ordered  by  the  Registrar- 
General.  This  it  was  necessary  to  do  in  order  to  make 
the  figures  comparable  with  those  of  home-treated 
cases  ;  the  difference  is  very  small,  and  such  as  it  is 
would  make  for  a  higher  rate  for  the  hospital  cases. 

Tmt.  NotifloaUons. 

1898  16.894 

1899  18,089 
T900             13.800 

1901  18,381 

1902  18.252 

I  do  not  wish  to  press  the  significance  of  these  rates 
unduly.  They  are  subject  to  selective  influences 
on  both  sides — the  home  and  hospital;  but  I  think  it 
may  fairly  be  said  that  they  indicate  pretty  con- 
clusively that  there  is  no  general  therapeutical  gain 
to  patients  treated  in  hospitals  even  under  the  very 
favourable  conditions  they  enjoy  in  the  Metropolitan 
Asylums  Board's  institutions.  It.  is  as  unreasonable 
to  attribute  the  fall  in  the  death  figures  for  scarlet 
fever  to  the  institution  of  aggregation  hospitals,  as  it 
is  to  attribute  to  the  same  influence  the  undoubted 
change  in  the  degree  of  severity  of  attacks  of  the  disease 
which  occurred  in  the  last  quarter  of  the  nineteenth 
century.  The  fall  in  the  death  figures  is  the  direct 
reflection  of  the  change  in  type  of  the  disease,  and  both 
are  natural  variants  in  its  epidemic  history  that 
have  occurred  wherever  the  disease  has  been  prevalent 
for  any  length  of  recorded  time.  The  question  naturally 
arises — to  what  are  these  changes  in  the  character  of 
the  disease  due  ?  why  is  it  limited  and  savage  here 
to-day,  wide  and  benign  there  to-morrow  ?  Every 
one  of  those  influences  that  are  supposed  to  affect  the 
malignity  and  benignity  of  diseases  has  been  can- 
vassed over  and  over  again  by  epidemiologists,  and' 
the  net  result,  honestly  stated,  is  that  no  one  knows. 
The  mystery  is  just  as  deep  as  is  that  of  the  original 
habitcU  of  scarlet  fever.  At  the  present  day  we  find 
the  disease  principally  manifesting  itself  in  endemic 
form  in  the  temperate  zones,  but  it  can,  and  has  often, 
prevailed  widely  in  the  tropics.  The  virus,  however, 
does  not  find  so  congenial  a  milieu  in  the  hot  and  cold 
cUmates  as  it  does  in  the  temperate  ones  ;  consequently 
it  is  more  firmly  established  in  those  districts  of  North 
America,  Australia,  and  Europe  which  enjoy  a  mean 
temperature  at  neither  extreme  of  the  thermometer. 
But  in  these  districts  neither  heat  nor  cold,  dryness 
nor  wetness,  healthy  surroundings  nor  unhealthy 
surroundings,  richness  nor  poverty  have  been  shown 
to  exercise  any  influence  on  the  type  of  the  disease 
that  prevails,  or  the  class  of  society  that  it  attacks. 
True  endemic  scarlet  fever  has  a  seasonal  rise  and 
fall,  in  England  the  maximum  height  of  its  'Curve 
being  attained  in  the  late  autumn  and  the  minimum 


in  early  spring.  Any  help  that  might  be  expected 
from  the  study  of  this  phenomenon  is.  however,  negatived 
by  the  paradoxical  fact  that  the  New  York  mortality 
curve  is  the  inverse  of  the  London  one.  Attempts  to  fix 
the  responsibility  for  the  character  of  scarlet  fever  out- 
breaks on  this,  that,  or  the  other  factor  have  so  far 
been  failures.  Hirsch,  after  a  critical  inquiry,  sums 
up  the  situation  by  saying:  "  We  are  completely  in  the 
dark  as  to  the  conditions  that  make  scarlet  fever 
epidemics  assume  a  good  or  bad  type."  The  same 
holds  good  with  regard  to  the  conditions  that  bring 
about  scarlet  fever  prevalence.  •  Beyond  the  fact 
that  milk  is  a  recognised  agent  in  sometimes  spreading 
the  disease,  and  that  scarlet  fever  is  more  common 
in  the  fall  of  the  ye-ar,  our  knowledge  of  the  factors  that 
initiate  scarlet  fever  outbreaks  amounts  practically 
to  nothing.  Every  variation  in  the  weather  and 
every  insanitary  condition  has  been  charged  at  some 
time  or  another  with  the  responsibility  of  setting  up 
epidemics  of  scarlet  fever,  but  none  of  these  has 
as  yet  been  shown  to  be  necessary  or  even  deter- 
minative, either  alone  or  in  combination. 

It  is  only  just,  then,  to  admit  that  whilst  of  the 
history  and  geography  of  scarlet  fever  we  have  a  fair 
amount  of  information  showing  the  disease  to  be  a  very 
variable  one  both  as  to  prevalence  and  intensity,  we 
know  nothing  of  any  value  of  the  causes  of  these 
phenomena.  When,  therefore,  we  essay  to  fight  the 
disease,  we  take  up  arms  against  a  sea  of  troubles,  and 
it  is  hardly  rational  to  suppose  that  with  so  little 
information — and  that  so  untrustworthy — of  the  causes 
of  the  malady  we  can  hope  to  make  any  successful 
progress  with  its  preventive  treatment.  The  theory 
that  by  removing  the  personal  element  of  infection  we 
shall  eradicate  the  chief  propagating  factor  of  the 
disease  leaves  out  of  account  practical  difficulties  so 
momentous  that  it  is  hard  to  believe  that  the  advocates 
of  en  masse  removal  to  hospital  could  have  had  much 
personal  experience  of  the  clinical  manifestations  of 
scarlet  fever.  The  whole  essence  of  success  in  the 
aggregation  policy,  if  it  can  ever  be  attended  with 
success,  is  early  and  accurate  diagnosis,  audit  is  just 
this  early  and  accurate  diagnosis  that  is  one  of  the  most 
elusive  features  of  scarlatinal  infection.  The  fully- 
developed  case  of  scarlet  fever,  with  its  throat  and  skin 
symptoms  well  marked,  causes  the  average  practitioner 
but  little  hesitation,  but  side  by  side  with  such  cases, 
and  independently  of  them,  occur  numerous  others 
in  which  a  Uttle  fever  or  malaise,  a  fleeting  rash,  or 
slight  pharyngitis,  is  all  the  diagnostician  has  to  guide 
him.  The  greater  his  range  of  experience  the  greater 
is  his  puzzle,  and  from  the  administration  point  of 
view  he  has  to  choose  between  certifying  dozens  of 
doubtful  cases,  or  leaving  half  the  scarlet  fever  ones  he 
sees  unremoved.  Many  cases  are  with  our  present  ap- 
paratus undiagnosable,  and  yet  we  hear  people  speak 
of  scarlet  fever  as  if  it  were  as  distinctive  and  recog- 
nisable from  other  maladies  as  among  warships  a 
torpedo-boat  is  from  a  cruiser.  In  m^ical  writings 
one  sees  it  often  stated  that  the  scarlatina  of  Sydenham 
is  the  classical  description  of  the  disease,  and  one  is 
left  to  deduce  that  something  approaching  finality 
was  attained  by  that  admirable  physician.  But 
Sydenham  does  not  even  mention  sore  throat  as  one 
of  the  symptoms,  and  he  regarded  the  malady  as  a 
trivial  complaint  hardly  worthy  of  the  name  of  disease 
(hoc  morbi  nomen,  vix  enim  altius  assurgit) — fatal  only 
through  the  too  great  assiduity  of  the  medical  atten- 
dant. The  later  writers — ^Trousseau.  Graves.  Watson 
— all  recognise  the  multiform  varieties  of  scarlet  fever, 
and  the  difficulty  of  determining  the  nature  of  those 
slight  cases  of  illness  which  present  no  characteristic 
conjunctions  of  sjrmptoms.  Their  scarlatina  latens 
finds  its  modem  homologues  and  congeners  in  con- 
ditions described  under  various  names  by  various 
writers.  In  recent  literature  one  finds  scarlatina  sine 
eruptions,  scarlatina  apyr^tique,  scarlatinette,  am- 
bulatory scarlatina,  scarlatina  minima — all  these 
terms  used  to  designate  those  ephemeral  attacks 
which,  clinically,  are  merely  interesting,  but  from 
the  epidemiological  point  of  view  disastrous  to  any 
•-  isolation "    system.     They    are    perfectly    definite, 

C 


2i8    The  Medical  PaEss.         ORIGINAL  COMM  UNICATIONS. 


August  3t,  1904. 


indisputable  occurrences,  these  attacks,  thoroughly 
well  known  to  an  observer  of  the  disease,  but  often 
only  revealing  their  nature  by  collateral  or  circum- 
stantial evidence.  I  need  not  detail  their  characters  ; 
suflEicient  is  it  to  say  that  with  no  criterion  to  which 
reference  can  be  made  there  is  not  a  case  of  tonsillitis 
or  of  erythema  of  the  skin  of  the  chest,  that  one  meets 
with  in  every  day  practice,  of  which  one  can  say 
with  certainty  whether  or  not  it  is  an  instance  of 
scarlatinal  infection.  Observation  will  sometimes 
help  to  solve  the  prpblem.  but  it  has  been  one's  ex- 
perience time  and  again  to  have  a  suspected  patient 
under  daily  supervision,  and  at  the  end  of  six  or 
eight  weeks  to  have  to  discharge  him  without  any 
satisfactory  diagnosis  having  been  made.  No  system 
of  isolation  can  afiord  to  neglect  these  cases.  They 
are  as  scarlatinal  as  the  most  severe  attacks,  and  as 
instinct  with  infection.  Without  presuming  any  care- 
lessness or  want  of  skill  on  the  part  of  the  practitioner, 
it  seems  to  me  to  follow  necessarily  that  if  scarlatina  is 
to  stand  a  chance  of  eradication  by  isolation,  a  pro- 
digious number  of  cases  .of  slight  sore  throat,  of 
anomalous  blushes  of  the  skin,  of  ill-defined  shagginess 
of  the  fingers,  must  be  swept  into  hospital,  or  a  large 
proportion  of  actual  and  potential  sources  of  infection 
be  left  to  stalk  unrestrained  through  the  land.  Such 
a  procedure  is,  of  course,  impracticable.  It  would 
entail  imprisonment  and  serious  loss  to  enormous 
numbers  of  persons  not  suffering  from  scarlet 
fever,  but  whose  illness  could  not  be  diagnosed 
with  certainty.  Any  system  that  seeks  to 
eliminate  the  personal  element  in  scarlet  fever 
infection  must  rest  for  its  success  on  the  separation  of 
all  cases,  or  of  such  a  large  percentage  that  a  very 
sensible  reduction  in  the  totad  number  of  infections 
would  be  apparent.  Such  can  never  be  the  case  till 
the  diagnosis  has  improved  to  such  a  point  that 
practically  all  cases,  however  mild,  are  recognised  and 
dealt  with  in  hospital  or  at  home.  Till  some  new  fact 
is  introduced  into  our  knowledge  of  the  disease,  it 
seems  to  me  impossible  to  hope  for  any  satisfaction  in 
seeking  to  control  scarlet  fever  by  personal  isolation. 
It  is  even  doubtful  in  the  light  of  its  past  history 
whether  individual  elimination  is  likely  ever  to  be  of 
much  service  as  aprophylatic  measure.  It  is  axiomatic 
in  most  human  affairs  that  the  policy  of  shutting  the 
stable-door  after  the  horse  has  been  stolen  is  futile. 


HOSPITAL   ISOLATION    AND 
SCARLET  FEVER : 

THE   STATISTICAL   ASPECT. 
By  C.    KILLICK   MILLARD,   M.D.,    D.Sc, 

Medical  Officer  of  Health  for  Leicester ;  late  Medical  Superinten- 
dent, Birmingham  Fever  Hospitals. 

Whilst  the  question  of  the  utility  or  otherwise 
of  fever  hospitals  requires  to  be  carefully  looked  at 
from  every  point  of  view,  it  can  only  be  j&nally 
settled  by  appealing  -to  statistics.  It  is  well 
known,  of  course,  that  the  use  of  figures  may 
easily  involve  fallacies,  and  so  lead  to  erroneous 
conclusions,  but  this  is  no  argument  against  their 
legitimate  use.  As  Dr.  Newsholme  has  well  said, 
"  While  so  many  are  ready  to  say  that  *  an5rthing 
can  be  proved  by  statistics,'  but  few  realise  that 
without  statistics  nothing  can  be  proved,  and  that 
unless  complete  ignorance  is  to  persist,  even  de- 
fective statistics  must  be  used  to  the  full  extent 
of  their  value." 

In  the  case  of  hospital  isolation  the  problem 
specially  lends  itself  to  statistical  consideration 
as  all  the  essential  data  are  obtainable.  Thanks 
to  compulsory  notification,  which  has  now  been  in 
force  in  most  of  our  larger  towns  for  at  least  ten 
years,  and  in  many  for  a  much  longer  period,  we 
know,  with  approximate  accuracy,  the  number 
of  cases  of  scarlet  fever  occurring  year  by  year. 
The  estimated  population  for  each  year  being  also, 


of  course,  known  enables  us  to  calculate  the  attack- 
rate  per  1,000  population,  or  prevalence  of  the 
disease,  so  that  differences  arising  from  variations 
in  population  are  eliminated.  The  death  returns, 
which  go  back  for  a  much  longer  period,  enable  us 
to  calculate  mortality ,  whilst  the  number  of  attacks 
and  the  number  of  deaths  together  yield  the  pro- 
portion  of  cases  pro\ing  fatal,  or  fatality. 
Methods  of  Using  Statistics. 

Whilst  the  essential  purpose  of  all  statistics 
is  comparison,,  there  are  two  different  methods 
of  making  comparisons*  applicable  to  the  present 
problem.  The  first  is  to  consider  each  town  or 
district  separately,  comparing  its  condition  with 
regard  to  scarlet  fever  since  the  policy  of  hospital 
isolation  was  started  with  what  existed  previously. 
The  second  is  to  compare  towns  with  other  towns 
which  differ  from  them  as  regards  the  practice  of 
hospital  isolation. 

The  first  method  is  a  good  one  as  far  as  it  goes, 
but  it  has  certain  limitations.  Thus,  in  ver\' 
many  towns  compulsory  notification  only  came 
into  force  simultaneously  with,  or  subsequently  to, 
the  practice  of  hospital  isolation,  so  that  in  these 
cases  it  is  impossible  to  make  any  comparison  as 
regards  the  relative  prevalence  of  the  disease. 
Then,  in  the  case  of  mortality,  although  this  is 
known  for  a  sufficiently  long  period,  we  are  met 
with  this  difl&culty,  that  everywliere  the  mortalitx 
from,  scarlet  fever  has  been  on  the  decline  owing  to 
the  change  which  has  taken  place  in  the  type  of  the 
disease.  It  is  now  admitted  that  this  change,  from 
a  very  severe  to  a  very  mild  type,  has  taken  place 
quite  independently  of  hospital  isolation,  for 
(a)  the  change  set  in  about  1860-70 — i.^.,  before 
hospital  isolation  was  thought  of  ;  (h)  it  has  been 
quite  as  marked  in  towns  and  country  districts 
which  have  never  practised  hospital  isolation; 
(c)  it  has  taken  place  in  other  countries,  including 
those  where  hospital  isolation  is  practically  un- 
known. 

Unfortunately  these  facts  have  only  recentlj- 
become  recognised,  (a)  and  many  sanitarians, 
influenced  no  doubt  by  a  very  natural  desire  to 
justify  the  great  outlay  which  the  erection  and 
maintenance  of  fever  hospitals  entailed,  fell  into 
the  error  of  ascribing  the  reduction  in  scarlet 
fever  mortality  which  they  observed  in  towns 
where  hospital  isolation  had  long  been  practised 
to  result  of  such  hospital  isolation. 

There  can  be  little  doubt  that  in  this  way  the 
belief  was  propagated  that  the  practice  of  hospital 
isolation  rested  on  a  sound  basis  of  statistical  proof. 
A  good  illustration  of  the  exaggerated  ideas  which 
prevailed  only  a  few  years  ago  as  to  the  results 
accomplished  by  hospital  isolation  is  furnished 
in  the  Final  Report  of  the  Royal  Commission 
on  Vaccination.  On  page  45  the  Commissioners 
say,  referring  to  the  dechne  in  scarlet  fever  mor- 
tahty,  "  We  think  that  the  steps  which  have  been 
taken  in  various  ways  to  isolate  persons  suffering 
from  scarlet  fever  have  largely  contributed  to 
this  dechne  "  ;  whilst  in  the  Minority  Report,  the 
dissentient  Commissioners  go  even  further,  say- 
ing, in  reference  to  scarlet  fever  and  some  other 
diseases  :  **  The  recent  development  of  proper 
hospital  isolation  has  been  most  strikingly  effectual 
in  reducing,  almost  to  insignificance,  the  mortality 
from  these  diseases."  Such  unreser\'ed  state- 
ments are  all  the  more  remarkable  in  that  their 

(a)  They  were  clearly  pointed  out  by  Dr.  J.  T.  Wilson  in  1897,  bat 
did  not  at  first  receive  the  attention  which  their  importance  mentM* 


August  31. 1904. 


ORIGINAL  COMMUNICATIONS. 


Thb  Mbdical  Putss.     2Xg 


principal  expert  witness  on  this  subject,  the  late 
Sir  Thome  Thome — ^than  whom  no  one  was  better 
qualified  to  speak — had  in  his  evidence  emphati- 
cally dissociated  himself  from  these  optimistic 
views,  saying  :  "  I  know  that  some  people  attribute 
it  (the  decline  in  scarlet  fever  mortality)  to  hospital 
influence  ;  but  wherever  we  have  been  able  in  a 
given  large  town  to  inquire  how  far  any  diminution 
has  been  due  to  isolation,  we  cannot  make  out  that 
the  diminution  has  in  any  sensible  way  been  due 
to  that  practice." 

It  must  be  clear,  from  what  has  been  stated 
above,  that  a  diminution  in  the  mortality  of  the 
disease  cannot  any  longer  be  regarded  as  evidence 
of  the  value  of  fever  hospitals,  and  the  fact  that 
such  a  serious  fallacy  was  able  to  exist  for  many 
years  is  certainly  rather  disquieting. 

Turning  now  to  those  large  towns  in  which 
compulsory  notification  was  in  force  for  a  con- 
siderable period — say  ten  years  or  thereabouts — 
before  hospital  isolation  was  begun,  or  at  least 
before  it  was  practised  to  any  extent,  we  find 
no  evidence  as  regards  the  prevalence  of  the  diseckse 
thcU    any    appreciable    dimintUion    has    occurred. 

Derby,  Nottingham,  Bolton  and  Halifax  are, 
I  believe,  the  only  towns  in  this  class  (among  the 
larger  towns),  and  in  none  of  them  can  it  be  said 
that  scarlet  fever  has  shown  any  real  tendency 
to  decrease  since  the  practice  of  hospital  isolation 
was  inaugurated.  Among  the  smaller  towns 
the  experience  is  similar  ;  if  there  are  any  ex- 
ceptions they  have  not  been  published.  Of 
course,  if  too  short  a  period  be  taken  for  compari- 
son the  result  might  easily  be  misleading,  for 
scarlet  fever  is  a  disease  which  naturally  tends  to 
fluctuate.  Indeed,  this  tendency  to  fluctuate 
is  one  of  the  reasons  why  comparisons  made 
with  previous  years  in  individual  towns  can  scarcely 
be  conclusive,  especially  as  the  number  of  towns 
in  which  a  satisfactory  comparison  can  be  made 
at  all  is  so  small. 

We  must  turn,  therefore,  if  we  really  wish  to 
settle  this  question,  to  the  second  of  the  two 
methods  referred  to — viz,,  to  institute  comparisons 
between  different  towns — ^between  those  which  do 
not  isolate  at  all,  or  only  to  a  small  extent,  and 
those  which  have  practised  the  measure  largely. 
Now,  it  is  obvious  that  if  the  practice  of  hospital 
isolation  has  any  marked  eflect  in  reducing 
either  the  prevalence  of  or  mortahty  from  scarlet 
fever  we  should  expect  those  towns  which  have 
practised  the  measure  much  to  sufler  less  from 
the  disease  than  those  which  have  neglected  it. 
It  would,  however,  be  quite  fallacious  to  pick  out 
for  comparison  one  single  town  which  isolated 
much  and  another  which  isolated  little.  There 
might  be  local  conditions  in  the  one  town,  quite 
apart  from  the  question  of  hospital  isolation, 
which  would  account  for  a  higher  scarlet  fever 
prevalence. 

It  would  also  be  unsafe  to  take  too  short  a 
period  for  comparison,  as  the  presence  or  absence 
of  epidemics  might  swamp  any  eflect  due  to  hos- 
pital isolation .  But  both  these  obj  ections  can  be  got 
over  very  largely,  if  not  entirely,  by  taking  a  num- 
ber of  towns  or  districts  and  grouping  them  so 
as  to  get  an  average  result,  each  group  being  made 
as  large  as  possible,  and  the  period  covered  as  long 
as  possible — at  least  ten  years.  To  make  the 
comparison  still  fairer,  the  larger  towns  may  be 
considered  separately  from  the  smaller,  and  urban 
districts  from  rural.  There  is  an  important  con- 
sideration,   however,    which    certainly    ought    to 


make  any  such  comparison  tell  in  favour  of  the 
isolating  groups,  for  we  may  safely  conclude  that 
those  towns  or  districts  which  have  made  the 
most  serious  and  determined  efforts  to  stamp  out 
scarlet  fever  by  "  pushing "  hospital  isolation 
have  also,  with  very  few  exceptions,  been  active 
as  regards  other  preventive  measures  as  well. 
Moreover,  the  mere  fact  that  a  sanitary  authority 
picks  out  one  disease  for  hospital  treatment  is 
certainly  calculated  to  raise  the  importance  of  that 
disease  in  the  eyes  of  the  pubhc,  and  so  to  make 
them  more  careful  than  they  would  otherwise  be. 
This  is  certainly  one  of  the  indirect  advantages 
of  hospital  isolation.  On  the  other  hand,  those 
towns  which  have  neglected  hospital  isolation 
have  also,  in  many  cases,  been  very  backward  and 
indifferent  about  disease  prevention  in  general. 

In  spite  of  this  consideration  it  will  be  found,, 
if  large  enough  groups  be  taken — ^the  one  isolating,, 
and  the  other  not — ^that  the  average  attack-rate 
and  mortality  over  a  period,  say,  of  ten  years 
will  come  out  almost  exactly  the  same  in  each 
group. 

The  advocates  of  hospital  isolation  object  to 
any  comparison  being  made  on  the  lines  we  have 
recommended.  Comparisons  are  proverbially 
odious — to  those  who  suffer  by  the  comparison — 
but  it  is  difiicult  to  believe  that  much  objection 
would  have  been  taken  if  the  isolating  towns  had 
shown  a  marked  superiority. 

The  "  Control  "  Experiment. 

The  importance  of  the  "  control "  experiment 
is  well  known  to  every  student  of  modem  science. 
Without  it,  it  is  impossible  to  determine  whether 
a  given  result  is  due  to  the  supposed  cause  or  not ; 
and  there  are  numberless  instances  where  the 
employment  of  a  *'  control  "  has  revealed  the  most 
unexpected  fallacies.  In  the  case  of  the  problem 
before  us,  a  "  control  "  experiment  is  furnished  by 
those  towns  which  have  refused  to  follow  the  pre- 
vailing fashion  and  have  not  provided  fever  hos- 
pitals, or,  where  a  hospital  does  exist,  have  only 
used  it  to  a  very  small  extent.  If  we  find  that  in 
thess  towns — the  bad  isolators — the  prevalence 
of  or  mortaUty  from  scarlet  fever  is,  speaking 
generally,  no  greater  than  in  the  towns  which  we 
may  regard  as  good  isolators,  the  obvious  con- 
clusion which  most  unbiassed  people  must  come 
to  is  that  hospital  isolation  is  accomplishing 
very  httle.  We  are  justified  in  saying  that  if 
a  non-isolating  town  builds  a  fever  hospital  and 
enters  upon  an  isolating  career  it  must  not  expect 
to  see  any  appreciable  diminution  in  the  diseaser 
even  in  ten  or  fifteen  years'  time  ;  and  the  same 
applies  to  towns  which  enlarge  existing  hospitals- 
and  increase  the  percentage  of  cases  isolated. 

On  the  other  hand,  we  have  good  grounds 
for  assuming  that  if  an  isolating  town  were 
to  abandon  isolation,  partially  or  even  entirely^ 
and  utilise  its  fever  hospitals  for  other  pur- 
poses, nothing  very  dreadful  with  regard  to' 
scarlet  fever  would  happen.  As  a  matter  of  fact, 
necessity,  which  has  so  often  been  the  mother  of 
invention,  has  already  provided  several  striking 
examples  of  this — notably  at  Oldham,  in  1893, 
in  Leicester,  in  1892,  and  again  more  recently 
in  1903,  and  in  Derby,  in  1903.  In  these  cases^ 
owing  to  epidemics  of  small-pox,  the  fever  hos- 
pital had  to  be  reserved  for  that  disease,  and 
scarlet  fever  had  to  be  treated  at  home — with, 
very  satisfactory  results  ! 

In  this  brief  article  no  attempt  has  been  made 
to  give  detailed  statistics.     In  the  space  at  our 


220    Trb  Msdical  Prsss. 


ORIGINAL  COMMUNICATIONS. 


August  31.  1904. 


disposal  only  selected  figures  could  have  been  given, 
and  selected  figures,  which  must  necessarily  be 
one-sided,  are  open  to  objection.  The  question  is  too 
vast  and  too  important  to  be  settled  off-hand, 
but  needs  to  be  made  the  subject  of  an  organised 
inquiry  by  an  impartial  and  authoritative  tribunal. 
In  the  meantime,  sufficient  has  been  said  to  show 
that  there  are  good  grounds  for  dissatisfaction 
with  the  results  which  are  being  obtained  in  return 
for  the  great  expenditure  of  pubhc  money  which 
the  hospital  isolation  of  scarlet  fever  entails. 
These  results,  we  may  safely  say,  are  very  small 
indeed  compared  with  the  sanguine  expectations 
which  were  raised  when  the  measure  was  first 
introduced. 


THE  ORGANISATION  OF  THE 

BACTERIOLOGICAL    SECTION 

OF  THE 

KING   INSTITUTE,   MADRAS. 

By  LiEUT.-CoLONEL  S.  R.  CHRISTOPHERS,  M.B.. 

Ch.B., 

Indian  Medical  Service  ; .  Superintendent  of  the  King  Institute  of 

Preventive  Medicine,  Madras. 

An  important  circular  letter  has  recently  been  dis- 
tributed throughout  the  Madras  Presidency  by  Lieut.- 
Colonel  W.  G.  King,  C.I.E.,  I.M.S.,  Sanitary  Commis- 
sioner for  Madras.     It  calls  attention  to  the  fact  that 
Government  has  gone  to  the  expense  of  supplying 
public  facilities  for  securing  bacteriological  diagnosis. 
The  laboratory  throws  open  its  doors  to  no  less  than 
six  qualified  medical  men  who  may  wish  to  carry  out 
independent  investigations.     The  bacteriological  sec- 
tion is  amply  provided  with  requisite  apparatus,  which 
will  be  at  the  disposal  of  private  as  well  as  of  official 
workers.  Lieut. -Colonel  King  has  appended  to  his  letter 
the  following  article  of  mine  as  explaining  the  general 
scheme  of  the  Institute.     The  departure  is  likely  to 
interest  public  health  workers  at  home  in  the  United 
Kingdom,  as  well  as  m  tropical  countries. 
I. — Public  Health. 
The  importance  of  bacteriological  study  in  relation 
to  sanitation  needs  no  comment.     In  the  large  labora- 
tories of  Europe,  and,  indeed,  throughout  the  world, 
the  most  diverse  investigations  in   this  relation   are 
in  progress,  and  questions  regarding  the  bacteriology  of 
water,  milk,  sewage  and  food    are    constantly    being 
determined.     Even    agricultural   methods   and    trade 
processes  are  becoming  more  and  more  based  on  bac- 
teriological data.     In  India  and  the  tropics  generally, 
where   the  bacteriological  fauna  is  very  imperfectly 
known,  there  lies  open  an  enormous  field  for  research. 
Properly  equipped  laboratories  are  necessary  for  such 
work,  and  a  large  central  laboratory  in  active  working 
order  has  an  importance  scarcely  to  be  over-rated. 
Such  an  institution  should  be  the  means  not  only  of 
encouraging,  stimulating,  and  assisting  men  occupied 
in  private  research,  but,  especially  by  reporting  upon 
material  sent  in  for  examination,  should  be  of  use  to  all 
engaged  in  clinical,  sanitary,  veterinary  or  medico-legal 
work. 

It  will  be  obvious  that  the  full  extent  and  scope  of 
the  work  of  such  a  laboratory  can  only  be  roughly 
indicated. 

In  regard  to  matters  more  directly  relating  to  public 
health  we  may  instance  the  following  as  probably  em- 
bracing the  more  ordinary  investigations  likely  to  be 
carried  on : — 

The  Bacteriological  Examination  of  Water. — ^The  satis- 
factory condition  of  a  water  supply,  the  efficiency  of  a 
filtering  system,  and  such  like  points  can,  as  a  rule,  be 
roughly  determined  by  the  local  sanitary  officer,  who 
can  be  readily  supplied  by  the  Institute  with  agar 
•  tubes  and  sterile  Petri  dishes.  It  ynW,  however,  in 
most  cases  be  unlikely  that  this  officer  will  have  the 
means  of  undertaking  more  than  an  enumeration  of 
colonies.    When,  from  the  Dumber  or  appearance  of 


these,  suspicion  arises  as  to  the  presence  of  contamina- 
tion, and  a  further  qualitative  examination  is  called 
for,  it  can  be  carried  out  from  samples  forwarded  to 
the  Institute. 

In  order  that  reports  on  such  samples  may  be  of 
value,  it  is  essential  that  they  should  be  collected  and 
bottled  with  the  greatest  care.  The  use  of  an  nn- 
sterilised  bottle  may  quite  prevent  any  idea  being 
arrived  at  as  to  the  bacteriological  condition  of  the 
water  when  collected.  For  most  purposes,  an  ordinary 
small  stoppered  bottle  of  a  few  ounces  capacity  may  be 
used.  It  should  be  immersed  in  water  and  boiled  for 
thirty  minutes  in  a  covered  vessel,  which  should  be  kept 
closed  until  cool.  As  soon  as  the  water  is  cool,  the 
bottle  should  be  emptied  and  at  once  closed  with  the 
stopper.  In  collecting  samples  with  the  object  of 
testing  a  water-supply,  all  the  usual  precautions  shouki 
be  adopted.  In  cases  where  it  is  suspected  that  the 
water  contains  the  cholera  vibrio,  it  is  well  to  include 
some  water  from  the  actual  surface  instead  of,  as  in 
most  cases,  plunging  the  bottle  to  some  depth  before 
allowing  water  to  enter. 

The  bottle  when  filled  with  water  should  be  at  once 
closed  and  the  stopper  firmly  tied  down.  Samples 
should  be  forwarded  with  the  utmost  despatch. 
Where  possible,  the  bottle  should  be  surrounded  in 
ice.  When  this  is  not  obtainable,  sawdust  packing 
will  serve  as  a  fairly  efficient  non-conductor  of  heat. 
When  sawdust  is  used,  the  bottle  should  be  carefully 
wrapped  in  paper. 

The  Bacteriological  Examination  of  Milk. — ^Milk 
suspected  of  containing  tubercle  bacilli  should  be  for- 
warded in  a  sterilised  (boiled)  bottle.  If  possible,  the 
sample  should  be  packed  in  ice. 

Milk  suspected  of  being  profoundly  contaminated 
can  always  be  examined  bacteriologically  and  the 
number  of  organisms  compared  with  that  in  ordinary 
specimens.  It  is  essential  in  this  case  that  the  milk 
should  be  forwarded  at  once  and  packed  in  ice. 

The  Bacteriological  Examination  of  Sewage.— 
Sewage  effluents  should  be  sent  under  similar  conditions 
to  those  already  noted  for  samples  of  water.  For 
important  investigations  on  matters  relating  to  sewage 
the  Institute  possess  a  septic  tank,  filtering  beds,  Ac 
The  Bacteriological  Examination  of  Food, — Food 
suspected  of  causing  ptomaine  poisoning  should  be 
forwarded  for  examination  Full  reasons  should 
always  be  given  for  considering  the  food  to  be  the  cause 
of  the  outbreak. 

The  Action  of  Disinfectants. — At  a  time  w^hcn 
disinfectants  of  all  kinds  are  being  advertised,  it  is 
important  that  their  efficacy  should  be  proved  before 
they  are  used.  Samples  of  disinfectants  sent  to  the 
Institute  will  be  tested  as  regards  their  action  on  micro- 
organisms. A  report  explaining  their  good  and  bad 
qualities  will  be  sent  at  the  expiration  of  the  experi- 
ments. 

Soil. — ^Soil  suspected  of  containing  tetanus  or  anthrax 
should  be  forwarded  in  a  jar  or  wide-mouthed  bottle. 

Plague. — No  disease  in  India  is  of  greater  importance 
to  the  sanitarian  than  plague.  In  no  other  instance 
does  so  much  depend  upon  the  detection  of  the  first 
case  in  any  town  or  village.  In  many  cases  officers, 
not  very  conversant  with  the  disease,  have  to  decide 
whether  or  not  such  a  case  is  cholera,  and  on 
this  opinion  may  hang  enormous  potentialities. 
It  is  then  not  a  small  matter  that  in  every  suspicious 
case  of  sickness  or  death  a  direct  answer,  as  a  result  of 
microscopical  examination,  can  be  given.  The  examina- 
tion of  blood  is  not  of  much  use  except  in  the  final  stages 
of  fatal  cases,  but  smears  from  the  puncture  of  swollen 
glands  in  the  bubonic  cases  and  from  sputum  in  the 
pneumonic  will  enable  a  diagnosis  to  be  at  once  arrived 
at.  In  th&case  of  bodies  found  dead  and  suspected  of 
being  cases  of  plague,  it  is  well  to  send  smears  of  the 
spleen  pulp,  as  in  every  form  of  the  disease  this  organ 
contains  the  bacilli. 

To  enable  films  for  the  above  purposes  to  be  sent  on 
the  least  suspicion,  slides  have  been  supplied  to  all 
medical  officers  in  the  Presidency  of  Madras. 
The  most  satisfactory  way  of  making  films  of  gland 


August  31,  1904. 


ORIGINAL  COMMUNICATIONS. 


fas  IfXDICAL  PKB8S.      221 


fluid  or  sputum  is  by  the  use  of  a  needle  as  described 
later  in  this  paper.  When  spleen  pulp  is  in  question, 
the  edge  of  another  slide  will  be  found  most  useful.  In 
all  cases  the  slide  should  be  wrapped  in  clean  paper  and 
securely  packed. 

When  plague  is  suspected  in  rats,  a  recently  dead 
animal  should  be  opened  and  smears  made  of  the 
spleen,  liver  and  of  any  inflammatory  condition  noted. 
II. — Clinical  Diagnosis. 
Houtine  bacteriological  and  pathological  examina- 
tions of  clinical  material  are  undertaken  at  home  in 
I  several  institutions,  notably  the  Pathological  Diagnosis 
I  Society  of  London,  and  a  similar  one  at  Liverpool. 
I  At  the  Pasteur  Institute  at  Kasauli  also  such  specimens 
I  are  received  and  reported  upon.  The  bulk  .of  material 
sent  to  these  institutions  consists  of  sputum  from 
suspected  cases  of  phthisis,  of  blood  for  the  determina- 
tion of  the  Widal  reaction,  and  swabs  from  diphtheritic 
throats.  At  the  same  time,  urinary  deposits,  tumours 
and  many  other  miscellaneous  materials  are  snbmitted 
for  report.  In  starting  a  similar  institution  in  Madras, 
we  recognise  that  there  is  a  far  vrider  and  more  varied 
field  for  such  work  than  at  home.  Malaria,  filaria, 
and  other  parasitic  diseases  are  enormously  prevalent. 
Tropical  medicine  indeed  largely  deals  with  p|arasites. 
Its  tendency  is  to  show  definite  causes  for  disease  in 
parasites  of  different  nature,  both  bacterial  and  proto- 
zoal, and  to  care  less  for  the  secondary  clinical  manifesta- 
tions. On  this  account,  microscopical  and  bacteriologi- 
cal methods  of  diagnosis  are  becoming  necessary. 
Many  diseases  indeed  are  unrecognisable  apart  from 
microscopical  examination,  and  the  diagnosis  of  many 
others  must  always  be  uncertain  without  it.  In  their 
differentiation  the  microscope  will  play  a  large  part. 
We  may  instance  in  this  respect  the  startling  discovery 
by  Donovan  of  a  new  disease  equal  in  importance  to 
tubercle  or  cancer.  Spirillum  fever  can  scarcely,  as 
appears  at  present,  be  confined  to  Bombay.  It  is 
not  by  any  means  certain  that  human  trypanosomiasis 
is  confined  to  Africa.  Such  points  and  the  differentia- 
tion of  entirely  new  diseases  are  almost  certain  to  follow 
upon  widespread  examination  of  the  blood  and  tissues 
of  obscure  cases.  The  Institute  ought,  then,  to  be  of 
use  in  the  diagnosis  of  obscure  and  difficult  cases,  in 
still  further  clinching  the  diagnosis  of  malaria  and 
typhoid,  and  in  leading  possibly  to  the  discovery  of 
entirely  new  causes  of  disease.  The  field  for  useful  work 
on  these  lines  is  very  great,  but  we  may  indicate  roughly 
the  more  usual  examinations  which  it  is  proposed  to 
make  and  to  report  upon.  ^  A  ^  *^ 

1.  The  Examination  of  Material  for  Tubercle,  the 
Gonococcus,  the  Pneumococcus,  the  Leprosy  Bacillus,  the 
Micrococcus  Melitensis,  the  Vibrio  of  Cholera,  and  other 
well-known  micro-organisms.  In  this  respect  the 
presence  of  human  anthrax  should  be  borne  in  mind, 
also  that  scrapings  from  ulcers  of  all  kinds  are  likely  to 
yield  in  many  cases  evidence  of  an  unsuspected  condi- 
tion— i.e.,  leprosy,  infection  with  Donovan  bodies,  &c. 

2.  The  Examination  of  Blood  for  Specific  Serum 
Reactions. — ^For  useful  purposes  these  are  practically 
confined  to  reactions  with  the  typhoid  bacillus  and  the 
M.  melitensis.  Capillary  tubes,  &c.,  can  be  obtained 
gratis  from  the  Institute. 

3.  The  Examination  of  Films  of  Blood  and  Smears 
from  Different  Organs. — It  is  expected  that  the  greatest 
help  will  accrue  ^om  the  result  of  blood  examinations. 
By  the  examination  of  peripheral  and  splenic  blood  it 
will  be  possible  to  determine  the  presence  of  the  malaria 
]>arasite,  filaria,  Donovan  bodies,  trypanosomiasis, 
spirilla,  the  plague  bacillus,  the  Malta  fever  organism 
and  others.  In  smears  from  ulcers  and  abscesses, 
faeces.  &c.,  the  amceba  coli,  balantidium,  ova  of  worms, 
&c..  will  be  notified.  By  a  blood  examination  also  the 
condition  of  leucocythxmia,  eosinophilia,  and  other 
changes  will  be  made  apparent. 

4.  The  Examination  of  Tumours  and  Diseased  Tissues. 
— In  this  respect  there  is  an  unlimited  field  for  research. 
In  practice  in  the  tropics,  conditions  are  constantly 
being  encountered  unlike  anything  seen  at  home. 
As  a  rule,  these  are  dismissed  after  a  rough  diagnosis 
has  placed  them  in  some  general  group.     By  forward- 


ing properly-preserved  specimens,  a  great  deal  more 
might  be  learned  regarding  their  real  nature. 

In  transmitting  tumours  or  pieces  of  tissue  for  exami- 
nation only  small  pieces,  never  larger  than  a  bean, 
should  be  placed  in  absolute  alcoHol  for  two  hours  and 
then  transferred  to  70  per  cent,  alcohol.  In  case  abso- 
lute alcohol  is  not  at  hand,  the  pieces  of  tissue  should 
be  placed  in  rectified  spirit.  Specimens  should  be 
transmitted  in  weak  alcohol,  70  per  cent.  In  some 
cases  it  may  be  advisable  to  send  the  whole  tumour. 
It  should  be  forwarded  in  rectified  spirit,  freshly  added 
before  despatch,  or  in  formalin  5  per  cent. 

5.  The  Examination  of  Urinary  Deposits,  Feeces, 
Vomit,  <S^. — All  specimens  of  this  kind  should  be  sent 
with  a  crystal  or  two  of  thymol  to  prevent  further 
changes.  For  the  amoeba  coli  films  should  be  made  of 
the  faeces  immediately  they  are  passed.  Urine  sus- 
pected of  containing  hxmoglobin  can  be  sent  for 
spectroscopic  examination. 

6.  The  Identification  of  Mosquitoes,  Especially  of 
Anopheles. — All  biting  flies  are  of  extreme  interest  and 
they  should  be  forwarded  for  identification.  Even  if 
the  specific  name  cannot  be  at  once  given  the  genus 
in  most  cases  can  be  notified  to  inquirers.  All  blood- 
sucking animals^ ticks,  fleas,  lice — are  of  great  interest, 
and  if  they  are  not  identified  by  the  Institute,  steps 
will  be  taken  to  have  all  specimens  forwarded  to 
authorities  at  home. 

Worms  and  specimens  of  faeces  containing  ova 
should  be  sent  for  identification.  The  possibility  of 
new  species  of  parasites  should  be  constantly  borne  in 
mind. 

Tubercle. — In  the  case  of  sputum,  the  morning 
expectoration  should  oe  made  direct  into  a  small, 
wide-mouthed  bottle  containing  a  little  i  in  20  carbolic 
and  the  bottle  at  once  vigorously  shaken.  The  bottle 
itself  may  be  sent  by  post ;  or  films  may  be  made  from 
the  emulsion,  and  these  only  forwarded. 

For  tubercle  bacilli  in  urine,  the  deposit  should  be 
mixed  with  a  little  i  in  20  carbolic  and  forwarded 
without  delay. 

Leprosy. — Smears  from  open  sores,  or  from  scrapings 
of  the  leprous  lesions,  will  enable  a  diagnosis  of  leprosy 
to  be  at  once  confirmed.  Pieces  of  tissue  removed 
post-mortem  should  be  sent  for  report.  The  splenic 
condition  is  interesting  and  smears  from  this  and  other 
viscera  will  be  valued. 

Infective  Granulomata. — Smears  from  ulcers  suspected 
of  being  due  to  yaws,  syphilis,  and  possibly  other 
undescribed  causes  should  be  sent  for  examination. 
Even  if  no  result  is  obtained  in  many  cases,  there  are 
sure  to  be  instances  where  the  diagnosis  may  have  to  be 
revised. 

The  Gonococcus. — Suspected  discharge  should  be 
spread  in  as  thin  a  film  as  possible  upon  a  clean  sUde, 
by  means  of  a  needle  as  in  making  a  blood  film.  Several 
slides  should  always  be  sent,  as  it  is  necessary  to  stain 
in  several  ways  for  diagnosis  of  the  organism.  Dis- 
charge from  ophthalmia  suspected  of  being  due  to  the 
gonococcus  may  be  similarly  treated. 

The  Pneumococcus. — Films  of  sputum  or  smears 
from  the  lungs,  meninges,  &c.,  will,  in  cases  of  pneu- 
mococcus infection,  often  enable  a  certain  diagnosis  to 
be  arrived  at. 

Plague. — The  glands  in  plague,  when  swollen,  contain 
the  bacillus  in  large  numbers.  A  little  fluid  should  be 
drawn  off  by  means  of  a  hypodermic  needle  and  a  few 
smears  made  as  described  above. 

In  the  pneumonic  form  sputa  should  be  forwarded 
(film).  Attention  is  also  directed  to  the  possibility  of 
bacilli  being  present  in  the  saliva  in  cases  of  submental 
glandular  enlargement.  In  fatal  cases  films  from  the 
viscera  and  glands  should  be  made.  Splenic  puncture 
in  doubtful  cases  promises  to  be  of  great  diagnostic 
value. 

Anthrax. — In  cases  of  suspected  malignant  pustule, 
a  little  fluid  should  be  drawn  by  means  of  a  hypo- 
dermic syringe  from  the  tissues  just  beyond  the  slough. 
A  smear  should  be  made  of  this  and  the  remainder 
placed  in  a  sterile  capillary  tube  for  instant  despatch. 
The  tube  should  be  carefully  sealed. 


222    The  Msdical  Puts. 


ORIGINAL  COMMUNICATIONS. 


August  31.  1904. 


The  occurrence  of  pneumonic  and  intestinal  anthrax 
should  be  borne  in  mind.  Such  cases,  as  well  as  cases 
simulating  acute  specific  fevers  or  plague,  may  be  readily 
overlooked. 

Diphtheria. — Smears  of  the  throat  mucus  should  be 
forwarded.  But  for  any  definite  answer  to  be  given, 
a  swab  must  be  forwarded.  Sterilised  swabs  in  tubes 
for  this  and  other  similar  purposes  can  be  obtained 
from  the  Institute. 

Cholera. — ^Films  of  some  mucoid  flakes  should  be 
forwarded.  A  carefully  sealed  capillary  tube  of  the 
faeces  should  also  be  despatched  at  once. 

Dysentery. — Films  of  dysenteric  motions  made 
immediately  the  motion  is  passed  will,  in  cases  of 
amoebic  dysentery,  show  the  amoeba  coli.  Non- 
amoebic  dysentery  is  to  be  suspected  when  such  an 
examination  is  negative.  A  capillary  tube  of  faecal 
matter  may  be  sent  for  the  possible  isolation  of  virulent 
organisms. 

Typhoid. — Serum  reaction  as  a  diagnostic  test  for 
typhoid  has  met  with  a  good  deal  of  criticism.  This 
has  been  largely  due  to  a  want  of  confidence  between 
the  bacteriologist  and  the  clinician.  In  deciding  upon 
the  result  of  a  serum  test,  several  very  important  facts 
must  be  considered.  Since  a  reaction  is  practically 
never  obtained  prior  to  the  fourth  or  fifth  day,  and 
often  not  until  the  seventh,  allowance  must  be  made  for 
negative  results  in  the  early  stages  of  undoubted 
typhoid.  Towards  the  third  week  the  reaction  becomes 
very  intense,  and,  unless  at  this  time  the  test  acts  in 
considerable  dilution,  grave  doubt  should  be  enter- 
tained as  to  its  specific  nature.  In  some  cases  it  is 
difficult  to  say  whether  the  reaction  is  of  sufficient 
degree  to  raise  it  certainly  above  the  possibility  of 
normal  serum  action.  If  such  a  reaction  occurred  on 
the  sixth  day,  it  would  be  very  suspicious  of  typhoid 
infection  and  a  later  development  of  a  more  intense 
reaction.  If  the  same  degree  of  reaction  took  place 
in  the  third  week,  it  would  mean  little.  In  reporting 
upon  blood  sent  for  the  purpose  of  the  Widal  test  it 
will  be  necessary  to  fix  a  limit  of  dilution,  which  at  the 
same  time  will  detect  the  early  onset  of  agglutinative 
action  and  will  be  removed  from  all  possibility  of  normal 
serum  action.  This  is  pretty  generally  recognised  to 
be  a  I  in  50  dilution  with  most  laboratory  cultures  of 
the  typhoid  bacillus.  Specimens  of  blood  for  the  Widal 
reaction  should  be  taken  in  small  pipettes  which  may 
be  obtained  from  the  Institute. 

In  cases  of  cystitis  or  abscesses  suspected  to  be  due 
to  the  B.  typhosus,  a  capillary  tube  full  of  the  fluid 
should  be  sent  for  bacteriological  examination. 

Malta  Fever. — Undoubtedly  the  best  way  to  detect 
Malta  fever  is  to  grow  cultures  from  blood  obtained 
from  the  spleen.  Microscopical  examination  of  such 
blood  would  in  default  of  this  be  of  value.  As  a 
matter  of  fact,  no  attempt  has  been  made  to  do  either 
of  these  in  cases  reported  from  India.  Such  cases  have 
been  diagnosed  on  the  serum  reaction.  Unfortunately 
what  we  have  said  regarding  typhoid  serum  reaction  is 
still  more  the  case  when  we  come  to  deal  with  the  M. 
melitensis.  Owing  to  the  fact  that  attenuation  has  in 
most  cultures  of  M.  melitensis  greatly  increased  their 
susceptibiUty  to  normal  serum  action,  the  limit  of 
specific  reaction  has  to  be  raised  to  i  in  100  or  more. 
The  neglect  of  this  precaution  has  probably  led  to 
some  mistakes  in  the  diagnosis  of  Malta  fever,  and  to  a 
suspicion  of  the  value  of  the  serum  test  in  general. 
There  is,  however,  no  reason  why  with  greater  pre- 
cautions the  serum  test  for  Malta  fever  should  not  be  of 
value. 

Malaria. — Perhaps  no  test  is  of  greater  value  in 
tropical  medicine  than  the  blood  examination  in  an 
obscure  case  for  the  malaria  parasite.  In  sending 
specimens  of  blood  for  this  purpose  as  good  a  film  as 
possible  should  be  made.  It  is  generally  advisable  to 
send  several. 

The  shdes  used  should  be  rubbed  perfectly  clean, 
after  dipping  in  water,  with  a  soft  cloth,  and  protected 
at  once  from  dust.  Before  taking  specimens  of  blood 
the  prepared  slides  may  be  placed  in  a  small  pocket 
slide  box  or  merely  wTapped  in  a  clean  sheet  of  note 


paper.  A  packet  of  half  a  dozen  prepared  slides 
wrapped  in  a  sheet  of  note  paper,  which  is  afterwards 
transfixed  vrith  a  surgical  needle,  is  a  most  convenient 
form  of  carrying  the  necessaries  for  taking  specimens 
at  the  bedside.  The  needle  should  be  an  ordinary 
triangulair  pointed  surgical  needle.  The  last  phalanx 
of  the  finger  is  taken  l^tween  the  finger  and  thumb  of 
the  left  hand  of  the  operator  and  gently  pressed  to 
force  the  blood  towards  the  pulp  of  the  finger.  A  slight 
prick  with  the  needle  causes  a  drop  of  blood  to  exade. 
When  the  drop  reaches  the  size  of  the  hesui  of  a  pin. 
a  slide  is  held  in  the  right  hand  and  lowered  on  to  the 
drop.  Care  should  be  taken  not  to  '  dab  '  the  slide  on 
the  skin.  If  the  drop  is  too  large,  wipe  it  away  and 
squeeze  a  ^esh  one.  The  drop  should  be  transferred 
to  the  slide  about  one-third  of  an  inch  from  the  end. 
The  slide  is  then  changed  to  the  left  hand,  the  finger 
and  thumb  grasping  the  end  nearest  to  the  drop.  The 
right  hand  again  takes  the  needle  and  holding  it  by  the 
pointed  end,  lays  the  cylindrical  shaft  transveraely  to  the 
slide  and  across  the  drop  of  blood.  After  waiting  about  a 
second — i.e.,  until  the  blood  spreads  to  the  extent  of 
one-third  inch  between  the  slide  and  the  needle,  the 
needle  is  evenly  and  not  too  quickly  carried  to  the  right 
and  so  along  the  whole  length  of  the  slide.  The  right 
amount  of  pressure  is  very  easily  learnt,  and  the 
making  of  a  useful  and  good  film  is  far  easier  in  this 
way  than  in  any  other  way  known  to  us.  Immediately 
the  film  is  made  it  should  be  waved  to  and  fro  until  dry 
in  the  air. 

The  slide  when  made  should  be  carefully  preserved 
from  dust  and  wrapped  at  once  in  clean  note  paper. 
Notes  can  be  written  in  ink  on  the  back  of  the  sUde  or 
by  writing  on  the  film  itself  with  a  needle. 

To  obtain  blood  from  the  spleen  use  an  ordinary 
hypodermic  needle.  A  large  needle  is  unnecessary  and 
liable  to  be  followed  by  haemorrhage.  Splenic  punc- 
ture should  be  done  in  all  cases  showing  enlargement  of 
the  organ  and  a  puncture  of  this  organ  would  not  be 
amiss  in  any  obscure  case  of  disease  accompanied  by 
rises  of  temperature.  The  following  points  should  be 
observed  in  films  sent  for  the  detection  of  malaria  :  (i) 
it  is  not  necessary  to  take  the  blood  only  when  the 
temperature  is  high  ;  (2)  in  sending  films  for  a  leucocyte 
count  it  is  best  to  take  the  blood  in  an  apyretic  interval 
as,  at  this  time,  the  increase  in  the  large  mononuclear 
leucocytes  is  greatest ;  (3)  films  should  be  thinly  spread 
and  should  be  forwarded  at  once  without  fixing. 

Filaria. — Blood  should  be  taken  in  the  evening. 
The  films  should  be  made  a  good  deal  thicker  than  when 
detection  of  the  malarial  parasite  is  desired. 

Trypanosomes.  —  Films  as  for  malaria  should  be 
made.  It  is  well  to  remember  that  trypanosomes 
are  often  found  in  oedema  fluid  when  they  are  very 
scanty  in  the  blood. 

Donovan  Bodies. — For  forms  in  the  spleen  make 
films  ais  in  the  case  of  malaria.  To  determine  the 
presence  of  the  bodies  in  ulcers  snip  ofl  small  pieces  of 
granulation  tissue  with  a  sharp  scissors  and.  after 
crushing,  make  a  film,  using  the  edge  of  a  glass  slide  to 
spread  the  material. 

Relapsing  Fever. — ^Blood  films  should  be  taken  at 
intervails,  when  the  presence  of  the  spirillum  is  sus- 
pected, ais  it  at  times  disappears  from  the  blood. 

Examination  of  the  peripheral  blood  for  plague  and 
other  acute  infective  diseases  is  not  of  much  use  except 
possibly  in  the  last  stages.  The  examination  of  splenic 
blood  is,  however,  of  the  greatest  possible  value  not 
only  in  such  diseases  but  in  the  study  of  infective 
diseases  generally. 

Mosquitoes  and  Flies. — ^These  should  be  captured  in 
tubes,  specimen  or  test  tubes,  and  killed  with  tobacco 
smoke.  When  dead  they  should,  with  as  great  care  as 
possible,  be  turned  out  on  to  a  clean  sheet  of  paper. 
They  should  never  be  touched  with  fingers  or  forceps. 
They  should  be  placed  upon  their  dorsal  surface  and 
transfixed  with  a  fine  entomological  pin  No.  20.  which 
has  first  been  pushed  through  a  piece  of  thin  Bristol 
board.  The  specimen  whenever  possible  should  be 
I  mounted ;  if  no  fine  pins  are  at  hand  it  is  better  to  place 


August   31,   1904. 


BRITISH  HEALTH  RESORTS. 


The  Medical  Pres5.     223 


the  insects  in  a  piece  of  glass  tubing  or  between  two 
-sheets  of  tissue  paper  in  a  box.  * 

Fleas,  ticks,  Uce  are  best  forwarded  in  spirit.  All 
-soft  parasites  should  be  given  a  plentiful  supply  of 
rectified  spirit  and  labelled  by  placing  a  piece  of  paper 
in  the  tulMS  with  pencil  writing  upon  it. 

[Ed.  Note. — ^The  third  part  of  this  interesting  paper 
•deals  with  veterinary  diagnosis,  and  has  been 
omitted  here  as  it  deals  mainly  with  matters  of 
interest  to  tropical  readers.] 

XTbe  (Put^patfent  S^epartments. 

TOTTENHAM  HOSPITAL. 

Uermatological  Cases  under  the  Care  of  G.  Norman 
Meachen,    M.D..    M.R.C.P. 

Case  I. — Accidental  Vaccinia. — A  little  boy,  at. 
6,  was  brought  by  his  mother  with  a  "  sore  place  '* 
on  his  forehead,  which  hjid  been  there  about  six  days. 
There  was  no  history  whatever  of  injury,  but  the 
mother  stated  that  the  child's  baby  brother  of  a  few 
months  old  had  been  vaccinated  a  fortnight  ago,  and 
that  they  had  been  playing  about  together.  On 
inspection,  there  was  seen  on  the  left  temple  a  typical 
^vaccinia  pustule  with  a  central  scabby  portion,  and 
much  local  congestion  in  its  immediate' vicinity.  The 
eyelids  were  swollen  and  oedematous,  and  the  pre- 
auricular lymphatic  gland  was  enlarged  upon  the 
same  side.  No  other  lesions  were  present.  The 
boy  had  been  vaccinated  when  an  infant.  From  the 
clinical  aspect  alone,  there  should  have  been  no 
diAicuity  in  recognising  the  nature  of  this  case,  apart 
from  any  history  that  would  lead  one  to  suspect 
accidental  vaccinia.  Tliis  lesion  was  said  to  have 
begun  as  a  *'  small  pimple  "  which,  in  all  probability, 
■was  really  inoculated  upon  the  site  of  an  unnoticed 
abrasion  of  the  skin  upon  the  temple.  The  clearly 
defined  circular  shape  of  the  pustule  with  the  accom- 
panying inflammatory  reaction  and  the  central  part 
beginning  to  dry  up  would  suffice  to  distinguish  it 
from  an  impetigo  or  a  furuncle.  Enlargement  of 
neighbouring  lymphatic  glands  almost  always  occurs. 
The  hands  are,  naturally  the  parts  of  the  body  more 
usually  subject  to  accidental  contamination  with 
the  vaccine  virus,  but  typical  lesions  have  been  ob- 
served upon  the  female  genitals,  and  upon  the  nasal 
mucous  membrane.  The  interest  of  the  present  case 
lay  in  the  fact  that  previous  vaccination  upon  the 
usual  site  six  years  ago  did  not  appear  to  have  di- 
minished the  patient's  susceptibility  to  a  fresh  inocu- 
lation. A  simple  lotion  of  boracic  acid  was  ordered 
for  external  application. 

Case  II. — Bromidrosis  of  the  Feet  Js90ciaied  with 
Eczema. — The  patient  was  a  boy,  aet.  14,  an 
assistant  in  a  public  library,  and,  therefore,  upon  his 
feet  the  greater  part  of  the  day.  His  complaint  was 
a  painful  soreness  of  the  toes  which  rendered  walking 
very  difficult.  He  had  been  thus  troubled  for  about 
three  weeks.  On  examination,  the  skin  of  the  toes 
of  both  feet  was  sodden,  red,  and  weeping.  The 
back  of  the  heels  were  eczematous,  and  the  soles  were 
affected  to  a  less  extent  with  papules  and  minute 
pustules.  The  discharge  had  soaked  through  into 
his  .socks,  and  altogether  he  was  in  a  pitiable  plight. 
The  left  foot  was  much  worse  than  the  right.  He 
stated  that  when  he  was  well  his  feet  always  sweated 
a  good  deal.  The  hands  were  affected  with  a  drier, 
squamous  eczema.  Otherwise  he  was  in  good  health. 
There  was  also  slight  acne  of  the  forehead.  The  boy 
said  that  he  could  not  stay  away  from  his  work,  so  that 
the  treatment  was  not  quite  so  satisfactory  as  if  he 
had  rested  the  feet  in  the  horizontal  position.  How- 
ever, he  was  given  a  weak  tar  lotion  for  bathing  the 
affected  parts  with,  followed  by  dusting  the  toes  well 
with  an  antiseptic,  astringent  powder  composed  of 
five  grains  of  tartaric  acid,  ten  of  boric  acid  and  equal 
parts  of  starch  and  zinc  oxide  to  the  ounce.  An 
ointment  of  zinc  and  boric  acid  was  also  ordered 
for  application  to  those  parts  which  were  more 
sore    than    the    rest.     Strict    cleanliness    as    regards 


foot-gear  was  enjoined  at  the  same  time.  When  seen 
a  week  afterwards  the  local  conditions  had  much  im- 
proved. 

Case  III. — Dermawgraphia  of  a  Severe  Type. — ^The 
patient  was  a  girl,  ajt.  18.  She  complained  of  intense 
irritation  of  the  skin,  which  appeared  to  "  come  up  in 
a  rash  "  whenever  she  became  heated.  The  affection 
had  been  present  ever^0hce  she  was  a  small  child,  and 
now  the  slightest  frictin  with  the  clothes  or  rubbing 
of  any  kind  would  produce  a  wheal.  She  had  had  no 
previous  illnesses.  On  examination,  the  skin  appeared 
to  be  normal  with  the  exception  that  there  were 
several  erythematous  areas  where  the  clothing  had 
pressed.  On  passing  a  blunt-pointed  pencil  or  the 
finger-tip  hghtly  over  the  skin  of  the  back,  a  vivid 
wheal  was  produced  after  an  interval  of  ten  to  twenty 
seconds,  which  was  speedily  surrounded  by  a  red  halo. 
The  sensation  experienced  was  one  of  heat  or  slight 
burning.  She  was  pale,  but  the  cardio- vascular  system 
was  normal.     The  bowels  were  .somewhat  constipated. 

Dr.  Meachen  remarked  that  urticaria  factitia  was 
one  of  the  commonest  manifestations  of  the  so-called 
neuroses  of.  the  skin.  This  group  of  cutaneous  dis- 
orders had  been  specially  observed  by  Van  Harlingen, 
Savill,  and  others,  and  the  generally  accepted  view  was 
that  the  vaso-motor  system  was  at  fault.  Many 
varieties  of  erythema,  morbid  blushing,  and  the  con- 
dition known  as  dermatographia,  of  which  this  patient 
was  such  a  good  example,  were  included  under  this 
category. 

Acting  upon  the  supposition  that  the  intra-cutaneous 
capillaries  were  impaired  in  tone,  five  grains  of  the 
supra-renal  extract  were  prescribed  three  times  a 
day.  Careful  regulation  of  the  bowels  was  also  strictly 
enjoined.  A  simple  anti-pruritic  lotion  of  calamine 
was  ordered  for  local  application. 


StitfBb  f)ealtb  IResorts. 


VIII. -ST.  IVES  (CORNWALL). 


[by  our  special  medical  commissioner.] 


The  quaint  little  fishing  town  of  St.  Ives  has  long 
been  beloved  by  art?st  and  antiquary.  Situated  on 
the  northern  coast  of  the  Cornish  peninsula,  it  occupies 
a  peculiarly  picturesque  position  on  an  isthmus  which 
separates  a  small  promontory  from  the  mainland,  and 
looks  eastward  across  the  beautiful  bay  of  St.  Ives. 
The  ancient  town,  with  its  narrow  and  roughly  paved 
streets,  solid,  grey,  irregularly  placed  houses,  has  much 
the  aspect  of  an  old-world  Breton  or  Flemish  town. 
St.  Ives  is  a  port  and  fishing  centre  of  great  antiquity. 
Even  still,  in  spite  of  the  modem  builder's  efforts  and 
the  tourist's  invasion,  old  custom  and  long-estabUshed 
tradition  rule  and  regulate  the  toil  and  delights  of  the 
simple,  strong,  peace-loving  fishermen  and  hard-working 
and  patient  watching  wives  of  the  harvestmen  of  the 
sea. 

St.  Ives  deserves  to  take  high  rank  among  our  Western 
health  resorts.  It  seems  suited  to  the  needs  of  many 
classes  of  visitors  needing  quiet,  shelter,  and  yet  pleasing 
occupation  for  the  mind.  We  have  stayed  at  St.  Ives 
in  the  springtime  and  consider  it  a  peculiarly  suitable 
resort  for  this  period  of  the  year.  Its  position  also 
ensures  conditions  which  make  it  a  pleasing  summer 
station.  And  in  the  winter  it  can  offer  much  that  is 
particularly  welcome  to  the  invalid,  for  the  climate  is 
warm,  equable  and  considerable  sunshine  is  enioycd. 

Dr.  J.  M.  Nicholls,  the  Medical  Officer  of  Health,  has 
kindly  furnished  us  with  copies  of  his  reports  for  recent 
years.  In  1901,  the  population  of  the  St.  Ives  Urban 
55anitary  District,  having  an  area  of  1,100  acres,  was 
6,697,  *  density  of  population  per  acre  of  6*69.  Th#^ 
birth-rate  in  1003  was  26*13  and  the  death-rate  14*18. 
The  cancer  mortality  is  returned  at  -59  per  1,000  of 
population  and  that  from  phthisis  as  '74  per  1,000. 
The  water  supply  has  been  improved  and  progress  is 
being  made  in  sanitary  reform.  The  mean  temperature 
according  to  the  report  for  1003  was  52*22°,  the  highest 


224     Thb  MBDiCi^L  Press. 


FRANCE. 


August  31.  1904. 


maximum  being  71 '3**,  in  July,  and  the  lowest  29' $°, 
in  January.  The  rainfall  was  39*51  mches.  The 
number  of  rainy  days  is  returned  as  209  and  sunshiny 
days  as  9.og. 

The  invaJid  visitor  will  not  lack  comfort  and  may 
even  secure  luxury  in  St.  Ives. 

The  Tregenna  Castle  Hotel^dmirably  conducted  by 
the  Great  Western  RailwayXompany,  is  quite  un- 
hotel  like  in  appearance  and  well  provides  the  comforts 
of  a  country  mansion  after  a  manner  peculiarly  welcome 
to  the  visitor  seeking  mental  rest  and  bodily  relaxation. 
From  personal  experience  we  can  hiehly  recommend 
this  charmingly  situated  residence.  St.  Ives  is  not 
rich  in  hotels,  but  apartments  can  be  found  well  suited 
to  the  requirements  of  the  invalid.  The  immediate 
neighbourhood  of  St.  Ives  offers  numerous  advantages. 
Sandy  bays  of  Porthminster  and  Carbis  provide  safe 
playgrounds  for  children.  The  golf  links  at  Lelant 
have  justly  gained  much  distinction  and  attract 
enthusiasts  from  all  parts  of  the  country.  The  bay  h 
ever  at  hand  for  boating  and  bathing ;  and  the  near 
highland  supplies  bracing  opportunities  for  the  pedes- 
trian. 

We  consider  St.  Ives  a  particularly  suitable  resort  for 
the  artistic  invalid  needing  a  warm,  light,  sheltered  and 
yet  peaceful  resort.  It  undoubtedly  meets  the  require- 
ments of  many  overworked  professional  men  and  is 
well  suited  to  the  special  needs  of  sufferers  from 
respiratory  weakness.  Convalescents  from  acute  dis- 
eases and  those  recovering  from  prostrating  affections 
may  be  expected  to  do  well  at  St.  Ives.  Through  the 
enterprise  of  the  Great  Western  Railway,  St.  Ives, 
although  324  miles  from  Paddington,  can  be  reached  in 
a  little  over  7  houri ;  a  through  carriage  can  be  taken 
to  St.  Erth  Station  on  the  main  line,  which  is  only 
4 J  miles  distant  from  St.  Ives. 


f  ranee* 

[from  our  own  corrsspondsnt.] 

Paris,  August  28th,  19M. 
Treatment  of  Coma. 
Coma  is  a  state  of  somnolence  characterised  by  the 
more  or  less  complete  loss  of  intelligence,  sensibility, 
and   mobility. 

Apoplexy  is  not  synonymous  with  coma  ;  it  precedes 
it,  and  is  constituted  by  ictus  or  sudden  loss  of  the 
cerebral  functions.  After  a  very  short  period,  when  this 
condition  persists,  coma  follows.  The  treatment  of 
coma  varies  with  the  affections  which  gave  rise  to  it, 
says  M.  Fiessinger.     It  is  met  with  in — 

(a)  Affections  of  the  brain  and  its  membranes. 
(6)  In  certain  nervous  affections, 
(c)  In  certain  intoxications. 
{d)  In  infectious  maladies. 

Diseases  of  the  Brain  and  its  Membranes. 
Traumatic  Usians  of  the  cranium  produce  coma 
from  compression  by  an  osseous  fragment  or  from 
haemorrhage.  Surgical  treatment  in  such  cases  is  clearly 
indicated.  If  the  case  is  one  of  cerebral  tumour,  the 
patient  will  be  placed  on  the  specific  treatment  in  the 
hope  that  the  neoplasm  may  be  of  syphilitic  nature.  In 
case  of  failure  surgical  treatment,  consisting  in  trephin- 
ing and  the  extirpation  of  the  tumour,  especially  if  a 
limited  paralysis  indicates  the  exact  place  of  the  opera- 
tion, will  be  adopted .  Before,  however,  having  recourse 
to  this  operation,  lumbar  puncture  might  be  tried,  which 
is  an  excellent  palliative  for  vomiting  and  headache ;  it 
can  also  act  on  the  coma  when  it  is  due  to  an  excess  of 
cerebral  tension,  as  might  occur  in  cases  of  tumour.  Care 
should  be  taken  not  to  remove  more  than  two  or  three 
drachms  of  the  liquid.  The  evacuation  may  be 
renewed  every  two  days. 

Coma  with  contractions  m  a  child  or  in  an  habitual 
drinker  indicates  haemorrhage  of  the  membranes.  The 
treatment  is  jhat  of  ordinary  encephalic  affections: 


local  or  general  blood  letting,  ice  to  head,  calomel, 
mustard  to  the  extremities.  Almost  the  same  treatment 
is  used  for  cerebral  hamarrhage  and  softening  of  the 
brain.  The  coma  in  these  two  affections  is  difficult  to 
differentiate  one  from  the  other. 

Embolus  produces  rapid  coma  without  vertigo  or  pre- 
monitory symptoms.  The  co-existence  of  a  cardiac 
or  aortic  lesion  will  clear  up  the  diagnosis.  Diffusible 
stimulants,  injections  of  ether,  camphorated  oil.  dry 
frictions,  sinapisms,  should  comprise  the  treatment. 

Thrombosis  of  the  sinus,  sometimes  preceded  by 
hemiplegia,  monoplegia,  Jacksonian  epilepsy,  may 
provoke  rapid  and  complete  coma.  Thrombosis  may 
be  suspected  in  a  patient  cachectic  from  dysentery, 
cancer,  chlorosis,  tuberculosis,  or  who  has  suffered 
from  otorrhoea.     Here  treatment  is  powerless. 

Sometimes  acute  mania  terminates  by  delirium 
followed  by  coma.  As  it  is  a  case  of  encephalitis 
with  congestion,  lumbar  puncture  may  be  tried. 
Abscess  of  the  brain  frequently  follows  tuberculous 
osteitis  of  the  petrous  portion  and  is  usually  terminated 
by  coma.  It  is  for  the  practitioner  to  judge  if  the 
patient  can  support  an  operation.  The  coma  of 
general  paralysis  succeeds  to  apoplectiform  seizures. 
It  is  generally  of  short  duration.  The  mercurial  treat 
ment  appears  to  give  «ome  good  results.  For  a  , 
long  time  M.  Huchard  places  a  seton  at  the  back  of  the 
neck  as  a  prophylactic  treatment  of  the  complications  of 
general  paralysis  as  well  as  in  the  majority  of  comatose 
accidents  in  other  cerebral  affections.  The  seton  is 
left  in  place  from  three  to  six  months ;  it  is  not  very 
cleanly,  but  efficacious. 

Insolation  is  accompanied  by  coma.  Application  of 
ice  to  the  head,  blood  letting  (12  ounces)  and  a  drastic 
purgative  is  the  treatment  habitually  employed. 
Nervous  Affections. 
Epilepsy  is  a  frequent  cause  of  coma.  It  forms  a 
part  of  the  attack  and  follows  the  convulsive  stage. 
Active  treatment  is  not  necessary :  the  epilepsy  should 
be  treated  and  not  the  coma,  which  is  rather  favourable 
to  the  patient  by  furnishing  to  the  organism  the  means 
to  recuperate  the  energy  spent  on  the  paroxysm. 

Hysteria  is  accompanied  by  sleep  rather  than  coma. 
The  limbs  are  slightly  contracted,  maintaining  some- 
times the  cataleptic  attitude  given  to  them.  Children 
are  sometimes  seized  with  coma  from  a  reflex  cau%. 
Worms  may  be  suspected  in  such  ca.<%es  and  treated 
accordingly. 

Intoxications. — ^Besides  the  coma  produced  by  such 
poisons  as  opium,  belladonna,  carbonic  oxide,  and  alco- 
hol, there  exist  others  produced  by  certain  maladies— 
as  diabetes,  uraemia,  dyspepsia,  and  cancer.     Thecoma 
of  diabetes  is  observed  in  the  gravest  forms  of  the  malady. 
Sometimes,  and  especially  in  children,  coma  is  the  first 
sign  of  diabetes.     A  good  deal  has  been  written  on  thi? 
complication.     The  alkaline  treatment — one  to  three 
ounces  of  bicarbonate  of  soda  in  the  24  hours — ^hasbeeo 
recommended,  but  without  much  resuU.     Preventive 
treatment  is  the  surest — absolute  suppre^.sicn  of  meat, 
large  doses  of  bicarbonate  of  soda,  drastic  purgatives. 
The  treatment  of  uramic  coma  is  that  of  coma  from 
oedema  of  the  brain,  as  observed  in  Bright's  disease. 
Infectious  Diseases. 
Two  kinds  of  coma  are  observed  in  infectious  mala- 
dies— coma  vigil  (typhoid  fever)  and  profound  roma  with 
immobility  and  complete  insensibility  of  the  patient 
(eruptive  fevers,  paludism,  acute  articular  rheumatism). 
The  treatment  varies  with  the  nature^of   the  causal 
affection,     but     generally     speaking,     warm     baths 
(pneumonia,  cholera),  cold  baths  (typhoid  fever),'^sub« 
cutaneous  injections  of  caffein,  ether  or  camphorated 


August  31,  1904. 


HUNGARY. 


Tbb  Medical  Pkess.     225 


oil  prove  sofiGicient.  At  the  same  time  the  patient  will 
absorb  cooling  drinks  in  abundance,  and  if  he  is  strong 
enough  to  bear  it,  from  six  to  eight  ounces  of  blood 
may  be  taken  from  the  arm. 


Hu5tiia« 


[from  our  own  correspondent.] 


YlBSXA,  AagiMt  27th,  1904. 

At  the  meeting  in  Prague,  Lielebaen  reported  on  a 
few  cases  of  oesophagotomy,  which  he  had  performed 
on  patients  for  obstruction  in  the  oesophagus, that  were 
quite  out  of  proportion  to  the  size  of  the  foreign  bodies 
impacted. 

The  first  was  a  child,  set.  i|,  who  had  swallowed  a 
button  23  millimetres  in  diameter.  It  was  observed 
by  the  oesophagoacope,  but  all  ordinary  efforts  failed 
to  lift  it.  Surgical  bleeding  commenced  that  led  to 
immediate  operation.  When  the  gullet  was  opened, 
the  wall  of  the  tube  was  found  quite  gangrenous  and 
thin,  which  led  to  a  fatal  termination  within  twelve 
hours  after  the  operation,  owing  to  an  acute  attack  of 
lobular  pneumonia. 

The  second  was  a  child,  a)t.  5,  who  swallowed  a  piece 
of  pipe  stem  25  millimetres  in  diameter.  Every  effort 
to  remove  it  by  probing,  &c.,  failed,  although  it  was 
only  14  centi  metres  beyond  the  back  teeth.  The 
speaker  saw  the  case  a  week  after  the  accident,  but  he 
failed  to  remove  the  obstruction,  although  discernible 
with  the  cesophagoscope.  He  operated  and  left  the 
opening  without  a  stitch  for  twelve  days,  through 
which  he  passed  a  tube.  The  wound  finally  healed,  and 
the  patient  recovered. 

He  related  a  third — a  servant,  aet.  17,  who  swallowed 
a  small  bone  while  eating  duck.  She  was  unable 
to  swallow  fluids,  had  great  pain,  and  right-sided 
torticollis.  The  operation  revealed  part  of  a  duck's 
cervical  vertebra  impacted  in  the  wall.  The  patient 
rapidly  recovered. 

Keratoconus. 

Bosser  exhibited  a  female,  set.  21,  who  had  suffered 
from  the  malady  for  two  and  a  half  years.  The 
treatment  consisted  in  cauterising  the  membrana 
Descemeti  till  perforation  was  produced,  which  was 
accomplished  after  the  third  application.  Before 
the  operation  she  was  only  able  to  discern  fingers 
one  metre  distant,  now  she  was  able  to  do  so  at  ^, 

He  also  showed  an  interesting  condyloma  sclerae. 
which  might  easily  be  mistaken  for  a  gumma.  The 
man  was  £t.  25,  but  had  no  sign  of  secondaries  such  as 
papules  in  mouth,  &c. 

Hemianopsia  in  Uremia. 

Pick  gave  a  long  and  exhaustive  history  of  a  case  of 
hemianopsia  coming  under  his  care.  The  patient  was 
a  tripara  in  her  ninth  month  of  pregnancy,  with  all  the 
symptoms  of  uraemia  and  eclampsia.  Labour  was 
prematurely  induced,  which  improved  the  uraemic 
symptoms,  but  this  was  followed  suddenly  by  amaurosis 
that  prevented  the  patient  distinguishing  between  light 
and  darkness.  After  a  time  this  improved  and  two  weeks 
after  she  was  so  much  better  that  she  left  the  hospital, 
but  after  a  short  time  at  home  she  felt  her  right  arm  had 
grown  quite  weak,  which  induced  her  to  seek  medical 
advice. 

On  examination,  she  was  found  suffering  from 
chronic  nephritis,  hypertrophic  cardia.  hemiparesis 
dextra,  and  distinct  right-sided  hemianopsia,  with  slight 
retinitis  and  albuminuria. 

The  paralysis  soon  improved  but  the  hemianopsia 
continued.  Pick  recollected  another  similar  case  he 
attended  in  1897  which  died.  The  post-mortem  revealed 


a  soft  circumscribed  centre  in  the  second  occipital 
convolution,  which  presumably  had  its  origin  in  an 
embolus.  In  many  cases,  however,  of  uraemia  the 
amaurosis  is  observed  to  be  very  transitory,  passing  off 
in  one  or  two  days  and  not  exceeding  a  week. 
He  considered  the  case  he  had  shown  was  one  of  a 
toxic  origin  which  had  produced   the  cerebral  lesion. 

In  the  discussion  that  followed,  Luksch  and  others 
considered  the  real  cause  of  the  amaurosis  to  be  due 
to  emboli  rather  than  toxin,  or  a  toxin  lesion  of  the 
cerebral  substance. 

Anthelmintics  in  Children. 
Ritter  drew  attention  to  the  difficulties  and  dangers 
of  using  Filix  mas,  which  he  had  used  for  the  last  four 
years  in  the  Franz  Josefs.  He  considers  the  Floreo 
kusso  to  be  much  better,  although  it  was  not  a  trust- 
worthy drug  in  its  results.  In  twenty-eight  cases  he 
had  used  the  FUix  mas  and  only  succeeded  in  six  cases 
to  securing  the  scolex. 

The  "  junq  clause  "  preparation  of  semina  cucurbitae 
was  a  much  more  efficacious  drug  for  taenia.  This  is  an 
extract  of  the  seed  having  a  dark,  thick  consistence 
and  an  agreeable  taste.  One  dose  represents  300 
seeds.  In  eleven  cases  he  had  only  three  failures  to 
obtain  the  scolex.  Its  great  advantage  lay  in  its  agree- 
able taste,  efficacy,  and  freedom  from  any  danger  to 
the  patient.  After  a  very  short  interval  the  appetite  is 
good,  and  it  may  be  repeated  without  any  danger. 

The  mode  of  prescribing  it  should  be  observed.  The 
night  before,  a  dose  of  opening  medicine  or  an  enema 
should  be  given  to  clear  the  bowel,  after  which  a  little 
soup  or  coffee  should  be  given  as  supper.  In  the 
morning  the  "  junq  clause  **  may  be  given,  followed 
in  two  hours  by  castor  oil  or  other  aperient. 

Dunoats* 

[from  our  own  correspondent.] 


BUDAPHT,  Aofuflt  27th,  1904. 

Hvperbmesis  Gravidarum. 

Dr.  Odon  (Tuszkai.  Professor  of  Gynaecology, 
Budapest,  whose  contribution  on  hyperemesis  gravi* 
darum  appeared  in  these  columns  about  a  year 
ago,  now  concludes  his  investigations  in  the  following 
summary : — 

I. — Hyperemesis  produced  solely  by  gravidity  is 
one  of  the  rarest  complications  of  pregnancy. 

II. — ^We  have  strictly  to  distinguish  between 
vomitus  gravidarum  occurring  during  gestation,  and 
between  hyperemesis  gravidarum  specifica.  Also  we 
have  carefully  to  discern  by  exclusion  those  diseases 
which  cause  vomiting  in  pregnant  women,  too  ;  thus  : 
gastric  troubles,  meningitis,  peritonitis,  hydrops,  &c. 

III. — ^The  diagnosis  of  h)rperemesis  gravidarum  can  be 
made  with  certainty  under  the  following  conditions: 
(a)  If  we  were  able  certainly  to  exclude  the  diseases 
mentioned  under  II.,  va.,  with  the  adoption  of  all  the 
diagnostic  and  therapeutic  methods  and  means. 
{b)  If  after  these  we  find  all  the  characteristic  clinical 
symptoms,  vu.,  great  local  tenderness  of  the  peri- 
toneum and  of  the  uterus,  which  tenderness  not  only  in- 
creases on  bimanual  examination,  but  also  gives 
rise  to  vomitings  or  violent  retching  and  nausea,  (c) 
If  the' frequent  and  severe  vomitings  occur  also  with- 
out taking  food,  amd  show  within  a  short  period  the 
symptoms  of  inanition. 

1.  The  quick  decrease  of  the  body  weight,  the  daily 
quantity  of  urine,  its  chlorides  and  the  red  blood  cor- 
puscles of  the  blood. 

2.  The  increase  of  the  quantity  of  urine,  its  specific 
gravity,  also  the  alkalinity  of  the  blood,  and  the  pulse- 
rate. 


226    Ths  Medical  Press. 


OPERATING   THEATRES. 


August  31,  1904, 


3.  The  appearance  of  albumin  and  kidney  elements 
in  the  urine,  and  the  presence  of  normoblasts  and 
uninuclear  megaloblasts  in  the  blood. 

4.  The  sudden  fall  of  the  morning  temperature,  and 
in  opposition  to  this,  the  febrile  or  subfebrile  rise  of 
the  same.    ^    ^ 

IV. — The  symptoms  of  hyperemesis  gravidarum 
were  explained  from  the  irritation  of  the  perimetrium, 
which  most  probably  originates  on  account  of  its  in- 
dividual and  occasional  properties  from  a  local  atrophy* 
and  thus  it  is  in  causal  nexus  with  gravidity. 

V. — Prognosis  is  evidenced  from  the  degree  of  inani- 
tion, in  relation  to  the  bodily  condition  of  the  indi- 
vidual. Evidence  is  gained  by  the  above-describedi 
biochemical  reactions.  *    i0  Vjffl 

VI. — On  these  grounds  we  shall  be  in  the  position  to 
employ  causal  treatment,  which  in  the  forefront  is  con- 
servative (local  cold,  heat,  complete  rest,  large  doses 
of  opium),  and  only  in  cases  of  entire  failure  do  we 
interrupt  pregnancy,  when  the  life  of  the  mother  is 
endangered.  This  operation  can  be  performed  very 
easily  and  comfortably  by  the  method  described  above. 


Ube  ^petattttd  XCbeattes/ 

ROYAL  FREE  HOSPITAL. 
Gastrostomy. — Mr.  T.  P.  Legg  operated  on  a 
man,  aet.  46,  who  had  suffered  from  difficulty  in  swallow- 
ing solid  food  for  nine  months,  and  during  the  last 
three  months  had  been  getting  very  much  thinner. 
For  the  past  week  the  patient  had  been  unable  to  take 
either  solid  or  liquid  food.  He  had  also  had  a  good 
deal  of  pain  in  the  mid-dorsal  region.  On  admission 
he  was  considerably  emaciated  and  at  once  regurgitated 
any  liquid  which  he  attempted  to  swallow.  There  were 
several  enlarged  firm  glands  in  the  supra-clavicular 
spaces  on  both  sides  of  the  neck.  He  had  no  cough. 
A  full-sized  oesophageal  bougie  could  not  be  passed 
further  than  nine  and  a  half  inches.  A  small  bougie 
<No.  12)  passed  seventeen  and  a  half  inches,  but  was 
tightly  gripped  about  nine  inches  from  the  teeth.  A 
No.  1 5  bougie  was  stopped  nine  and  a  half  inches  from 
the  teeth.  The  diagnosis  was  obviously  one  of 
carcinoma  of  the  oesophagus,  and  a  modified  Franck's 
method  of  gastrostomy  was  performed.  A  vertical 
incision  two  and  a  half  inches  long  was  made  just  to  the 
left  of  the  middle  line  ;  the  rectus  sheath  was  opened 
and  the  fibres  of  the  muscle  separated ;  the  peritoneal 
cavity  was  opened  in  the  same  line  and  the  stomach 
at  once  brought  into  view,  and  a  cone-shaped  portion 
brought  out  of  the  wound.  To  the  apex  of  the  cone 
a  couple  of  silk  sutures  were  fixed.  A  second  incision 
one  inch  long  and  parallel  to  and  an  inch  and  a  half  to 
the  left  of  the  previous  incision  was  then  made ;  this 
incision  opened  the  sheath  of  the  rectus  near  the  outer 
margin  of  the  muscle,  the  fibres  of  which  were  split  into 
an  anterior  and  a  posterior  flayer  by  passing  a  blunt 
dissector  from  the  second  to  the  first  incision  through 
the  substance  of  the  muscle.  A  pair  of  forceps  was 
next  passed  through  the  gap  in  the  muscle  thus  made, 
and  the  guide  sutures,  which  had  previously  been  fixed 
to  the  stomach,  were  seized  and  drawn  through.  The 
cone  of  the  stomach  wall  was  then  made  to  occupy  the 
space  between  the  layers  of  the  rectus  muscle,  the  apex 
being  drawn  through  as  far  as  the  second  incision,  to 
which  it  was  fixed  by  four  sutures  passed  through  the 
serous  and  muscular  coats  of  the  stomach  and  the  skin 
and  rectus  sheath.     The  base  of  the  cone  lay  in  the 


first  incision  and  was  fixed  to  its  right  margin  by  three' 
or  four  stitches  which  united  the  fibres  of  the  rectos, 
the  posterior  layer  of  the  sheath  and  the  peritoneom 
to  the  sero-muscular  layer  of  the  stomach.  The  apex 
of  the  cone  was  incised  and  the  mucous  membrane 
fixed  by  a  couple  of  su  tures  to  the  muscular  coat .  A  No. 
10  catheter  was  passed  into  the  opening  thus  made  and- 
to  prevent  it  slipping  in  or  out,  a  silkworm-gut  suture 
was  passed  through  it  and  the  skin  a  short  distance 
away  from  the  opening  in  the  stomach.  Four  ounces  of 
peptonised  milk  were  passed  through  the  catheter  into 
the  stomach  before  the  patient  was  taken  back  to  bed. 
Mr.  Legg  said  there  were  two  chief  methods  of  doing 
gastrostomy,  and  the  one  adopted  here  was  only 
possible  when  the  stomach  was  suf&ciently  large  to 
allow  a  cone-shaped  piece  to  be  easily  drawn  out  of  the 
wound  ;  this  was  not  always  the  case,  and  under  these 
conditions  an  operation  known  as  Witzel's  had  to  be 
done.  The  operation  of  gastrostomy,  as  had  just  be«n 
performed,  was,  he  thought,  most  satisfactory,  for  even 
on  coughing  there  was  practically  no  escape  of  tlw 
gastric  juice  and  contents  of  the  stomach,  which  had 
such  an  irritating  effect  on  the  skin,  the  cone  of 
stomach  being  entirely  surrounded  by  muscle  fibres, 
which  act  as  an  efficient  sphincter.  Mr.  Legg  thought 
it  best  to  open  the  stomach  at  once  and  to  give  the 
patient  food  at  the  completion  of  the  operation  ;  there 
was  no  risk  of  the  contents  of  the  stomach  infecting 
the  peritoneum,  and  the  patient  does  not  vomit  as  a 
rule.  Another  reason  for  opening  the  stomach  at 
once,  he  pointed  out,  was  that  the  patient  not  infre- 
quently had  been  unable  to  take  sufficient  nourishment 
by  mouth  for  some  time  previous  to  the  operation. 
At  best,  he  remarked,  gastrostomy  can  only  be  con- 
sidered as  a  palliative  measure  ;  the  patient  frequently 
puts  on  flesh,  recovers  some  degree  of  strength,  and  is 
able  to  swallow  naturally,  at  least  for  a  time.  Whether 
life  is  prolonged  or  not  to  any  appreciable  extent 
was,  he  considered,  doubtful,  but  the  rest  of  the  patients 
existence  was  rendered  far  more  comfortable  and  bear- 
able. The  method  of  feeding  of  patients  after  the 
operation  was,  he  considered,  very  important.  Ws 
usual  plan,  he  said,  was  to  give  four  ounces  of  pepton- 
ised milk  with  half  an  ounce  of  brandy  every  four  hoars, 
increasing  the  quantity  to  six,  eight  and  ten  ounces 
from  time  to  time  and  diminishing  the  amount  of  pep- 
tonisation.  If  he  can  swallow  it  was  a  great  comfort  to 
the  patient  to  supplement  the  artificial  feeding  by 
natural  means ;  one  often  finds  that  the  patient  is 
able  to  take  bread  and  milk,  milk  pudding  and  mince- 
meat when  previous  to  the  operation  he  had  been  quite 
unable  to  swallow.  The  only  objection,  however,  to  this 
being  allowed  was  the  irritation  of  the  growth  in  the 
oesophagus. 

A  week  after  the  operation  was  performed  the  patient 
was  getting  up  and  after  a  fortnight  was  going  out 
daily  into  the  hospital  square,  feeling  much  stronger 
and  putting  on  fiesh,  while  no  longer  looking  so 
emaciated. 


Medical  Communism. 

An  interesting  medical  innovation  has  just  been 
made  by  the  town  of  Zurich.  It  has  created  a  medical 
tax  of  3s.  7|d.  per  head  of  the  population  with  a  view 
to  raising  ;£20,ooo.  Forty  doctors  in  the  town^will 
share  this  money,  each  receiving  an  annual  sum  of 
£500.  In  return  for  this  salary  they  will  be  expected 
to  give  their  services  to  "  all "  the  inhabitants  ot 
Zurich. — A  dvertiser. 


August  31,  1904. 


LEADING  ARTICLES. 


The  Mbdical  Press.     227 


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'  SALUS   POPULI  SUPREMA  LEX.*' 


WEDNESDAY.  AUGUST  31,  1904. 


MEDICAL  MEN  AND  ADMINISTR\TIVE 
JUSTICE. 

No  section  of  the  community  comes  habitually 
into  closer  contact  with  the  inner  life  of  the  nation 
than  the  medical  profession.    Their  duties  carry 
practitioners  of  medicine  into  the  homes  of  all 
classes    as    well    as    into   workhouses,    hospitals, 
schools,  prisons,  and  reformatories.     In  this  way 
they  become  acquainted  with  the  histories  of  a 
vast  number  of  persons,  who,  in  many  instances, 
confide  their  private  affairs  as  a  matter  of  course 
to  the  ear  of  their  medical  attendants.     They  are 
therefore   in   a  position    to    know   as   much    as 
most    people      how   administrative   justice   deals 
with  accused  persons  in  all  parts  of  the  United 
Kingdom.     As  a   rule,    the    average   Briton  who 
comes  across  a  miscarriage  of  justice  shrugs  his 
shoulders  and  says  nothing  more  about  it.      From 
a   prolonged  experience   of  police   administration 
he  knows  that  Uttle  satisfaction  on  the  one  hand 
and  a  vast  amount  of  trouble  and  annoyance  on 
the  other  are  likely  to  result  from  any  personal 
intervention  of  his  own  in  any  matter  of  individual 
injustice.     In  New  York,  where  Tammany  rules 
the  roist,  citizens  live  under  a  reign  of  police 
terror,  in  which  blackmail,  intimidation,  organised 
conspiracy  and  legaUsed  violence  appear  to  be  the 
recognised  weapons.      Here  in  the  United  King- 
dom,  police  administration,  although  marred  by 
many  gross  defects,  is,  on  the  whole,  perhaps  the 
best   system  of  civilian  peace  administration  in 
the  world.    The  system,  however,  has  not  kept 
pace  with  the  times,  and  of  late  years  there  have 
been  many  signs  that  the  patience  of  the  public 
has  become  str  a  red  to  the  last  point  of  endurance, 
and   that  reforms  will  have   to  be  prompt  and 
thorough  in  all  branches  of  the  criminal  executive. 
The  savage  sentences  of  many  years  of  penal  ser- 
vitude constantly  passed  upon  prisoners  for  trifling 
offences  against  property  in  themselves  constitute 


a  standing  blot  upon  our  criminal  code.  The  ad- 
ditional punishment  of  a  man  for  offences  purged 
by  previous  penalties  is  another  gross  injustice. 
The  whole  system  of  criminal  administration 
and  procedure,  in  short,  requires  vigorous  over- 
hiuUng  and  reconstruction  in  the  light  of  modem 
humanity  and  social  justice.  The  shock  to  the 
public  confidence  caused  by  the  revelations  of  the 
Beck  case  must  be  followed  by  a  reaction  of  in- 
dignation and  clamour  that  will  place  the  British 
courts  of  criminal  justice  absolutely  above  sus- 
picion. Until  recently  the  vast  majority  of  our 
countrymen  would  have  scoffed  at  the  idea  of 
anyone  being  sentenced  to  two  terms  of  penal 
servitude  and  being  oppressed  by  the  police  for 
offences  committed  by  another  man.  The  in- 
wardness of  the  police  attitude  in  continuing  the 
second  prosecution  with  the  full  knowledge  that 
the  identity  of  the  accused  in  the  first  trial  had 
been  mistaken  demands  searching  inquiry.  That 
there  have  been  many  more  kindred  instances  of 
miscarriage  of  justice  who  can  doubt  ?  Dr.^Bell 
Taylor,  of  Nottingham,  a  gentleman  whose  tes- 
timony may  be  regarded  as  absolutely  unbiassed 
and  responsible,  comes  forward  with  no  less  than 
three  instances  in  which  his  own  personal  in- 
terposition has  procured  the  release  of  persons 
f  om  gaol  for  offences  they  had  never  committed. 
In  the  first  instance,  when  attending  to  give 
evidence  he  went  by  accident  into  the  wrong 
court  and  heard  enough  of  what  was  going  on  to 
interest  him  in  the  case.  On  medico-legal  groimds 
he  came  to  the  conclusion  that  the  accused,  who 
was  sentenced  to  eight  years'  penal  servitude, 
was  innocent,  and  he  ultimatdy  secured  the 
release  of  the  prisoner  by  the  authorities.  In  the 
second  instance  he  was  taken  by  chance  to  the 
wrong  cell  in  a  convict  prison,  when  making  a 
professional  visit,  and  heard  enough  to  convince 
him  the  prisoner  was  being  punished  for  murder- 
ing a  wife  whose  death  was  due  to  disease.  That 
convict  was  also  released.  In  the  third  instance 
he  was  struck  by  the  inconsistency  of  evidence 
in  the  account  of  a  criminal  tr'al  read  casually 
in  a  newspaper  left  on  his  table.  Once  more  his 
intervention  secured  the  release  of  an  innocent 
man.  These  cases,  it  must  be  remembered,  were 
not  sought  for ;  they  came  by  chance  into  the 
path  of  a  busy  medicad  man.  The  reflection 
naturally  arises  that  many  more  such  cases  must 
have  come  within  the  knowledge  of  members  of 
the  medical  profession.  If  so,  it  is  surely  their 
duty  to  speak  out,  especially  now  that  the  time 
is  ripe  for  setting  straight  the  crooked  ways  ot 
criminal  administration.  The  first  great  reform 
wanted  is  a  court  of  ciiminal  appeal,  of  such  a  kind 
that  every  kind  of  sentence,  however  trifling, 
should  be  subjected  to  an  automatic  revision. 


DIET  IN  RELATION  TO  DENTAL  DISEASES. 
We  have  in  these  columns  often  urged  the  im- 
portance of  taking  serious  note  of  the  wholesale 
decay  of  the  teeth  of  the  nation.  The  subject 
is  accorded  but  scant  attention  by  many  to  whom 


228     Thx  Medical  PKxst. 


LEADING  ARTICLES. 


August  31.  1904. 


the  physical  degeneration  of  the  race  is  a  source 
of  anxiety ;  yet  it  seems  probable  that  not  only 
are  the  two  questions  intimately  blended,  but 
that  the  teeth  give  the  direct  clue  to  much  of  the 
ill-health  and  stunted  development  of  citizens  of 
to-day.  The  condition  of  the  mouths  of  the 
present  and  of  the  rising  generations  is  described 
by  some  authorities  as  simply  appalling  ;  the 
abysmal  depths  of  degeneration — we  might  even 
say  devastation— that  the  teeth  of  the  British 
nation  has  reached  is  unreaUsed  by  those  who 
have  its  welfare  at  heart.  In  giving  evidence 
before  the  Royal  Commission  on  Physical  Train- 
ing, Dr.  Leslie  Mackenzie  stated  that  out  of  six 
hundred  Edinburgh  school  children  examined, 
five  hundred  and  twenty-one  had  decayed  teeth  of 
the  first  set,  and  a  hundred  and  ten  of  the  second 
set ;  whilst  Professor  Hay,  in  Aberdeen,  found 
that  of  a  similar  number  of  children  three  hundred 
and  eighty-one  had  decayed  teeth  of  the  first, 
and  three  hundred  and  eighty-eight  of  the  second 
set.  The  British  Dental  Association  examined 
ten  thousand  Poor-law  children,  and  discovered 
dental  caries  in  no  less  than  86  per  cent,  of  them. 
It  may  safely  be  said,  then,  that  the  number  of 
persons  who  reach  the  age  of  twenty  without  de- 
cayed teeth  must  be  so  small  as  to  be  practically 
negligible.  Surely  no  one  can  deny  that  we  are 
here  faced  with  a  fact  of  the  gravest  moment. 
This  universal  destruction  of  the  teeth  can  be 
accounted  for  only  by  the  operation  of  some  uni- 
versal cause,  and  that  cause  should  be  diligently 
and  persistently  sought  out  and  removed.  The 
mouth  is  the  very  gateway  of  the  body,  and  with 
it  in  a  constant  condition  of  unhealthiness,  one 
must  indeed  be  optimistic  or  blind  to  expect  sound 
physique  and  hearty  vigour  in  the  possessor. 
A  thoughtful  paper  was  read  by  Dr.  Sim  Wallace 
at  the  recent  annual  meeting  of  the  British  Dental 
Association  at  Aberdeen  on  the  connection  between 
physical  degeneration  and  dental  caries,  in  which 
an  original  line  of  reasoning  was  followed  with  the 
object  of  showing  that  it  is  to  the  food  of  the  people 
that  their  dental  troubles  must  be  attributed. 
Without  committing  ourselves  to  Dr.  Sim  Wal- 
lace's conclusions,  we  may  say  that  his  paper  was 
suggestive,  and  deserves  to  be  well  pondered. 
He^began  by  pointing  out  that  there  is  no  evidence 
that  the  ill-developed  classes  of  society  have  teeth 
more  susceptible  to  decay  than  those  of  good 
physical  development,  but  that  admittedly  con- 
ditions of  malnutrition  and  emaciation  act 
prejudicially  to  the  proper  growth  of  the  teeth. 
So  long  as  the  teeth  are  defective  it  is  hopeless 
to  expect  physical  development  to  go  on  satis- 
factorily. The  two  developments  are  intimately 
correlated.  He  then  dealt  with  the  evils  resulting 
from  infected  cavities  in  the  teeth  and  from 
viti  ation  of  the  oral  secretions  by  the  products 
of  bacterial  action,  and  showed  that  much  as 
these  undoubtedly  lowered  the  resistance  of  the 
mouth  and  throat  to  disease  onslaughts,  an  even 
more  serious  result  is  the  chronic  absorption 
into  the  blood  of  septic  matter.     In  these  ways 


the  lower  classes,  even  though  they  set  out  better 
equipped  dentally  than  their  superiors,  sufier 
greater  impairment  of  health,  for  they  are 
far  less  careful  of  their  mouths  than  their  more 
fortunately  circumstanced  fellows.  But  the  most 
interesting  part  of  Dr.  Wallace's  paper  was  that 
which  discussed  the  cause  of  the  modem  inferiority 
of  teeth  to  those  of  our  forebears.  Dr.  Wallace 
had  often  been  struck  by  the  superior  quality  of 
the  teeth  of  those  who  ate  the  least  soft  and  re- 
fined food,  and  by  the  fact  that  such  people  pos- 
sessed better  digestions  than  those  brought  up 
on  refined  and  apparently  physiologically  diges- 
tible food.  It  is  his  deliberate  opinion  that  food 
demanding  thorough  mastication  in  the  mouth  is 
not  only  best  for  the  teeth  but  for  the  stomach 
and  intestines  also-,  and  that  the  early  decay  of 
teeth  and  the  sluggish  action  of  the  alimentary 
canal,  which  is  evidenced  by  indigestion  and  con- 
stipation, are  the  direct  outcome  of  the  habit  of 
eating  refined,  soft  food.  Such  foods  allow  the 
function  of  mastication  to  fall  into  desuetude, 
and  the  child,  when  he  finds  a  lump  in  his  food, 
falls  into  the  habit  of  swallowing  it  whole  ;  the 
teeth  decay  and  the  digestive  functions  become 
perverted.  All  these  circumstances  lead  to  a 
demand  for  still  softer  and  more  nutritious  foods 
and  the  evils  are  perpetuated  in  geometrical 
progression.  Dr.  Sim^  Wallace  is  prepared  to 
attribute  to  this  unnatural  tendency  not  only 
dental  caries,  but  also  diseases  such  as  appendix 
citis,  rickets,  neurasthenia,  adenoids,  and  anaemia. 
We  are  inclined  to  agree  with  him  that  the  p^^ 
paration  and  quaUty  of  food  used  at  the  present 
day  are  some  of  those  circumstances  of  civilisatioa 
that  operate  differently  to  what  might  have  been 
expected.  It  is  a  well-known  fact  that  the  physio- 
logically perfect  products  of  the  laboratory  com- 
bined in  theoretically  perfect  quantities  fre- 
quently fail  to  nourish  those  to  whom  they  are 
administered,  whilst  natural  foods  thjat  contain 
much  that  appears  unnecessary  and  harmful,  1 
agree  well.  No  one  can  regard  with  pleasure 
the  consumption,  now  so  fashionable,  of  artificial,  1 
concentrated  food  products,  and  it  is  quite  possible  I 
that  the  indigestible  parts  of  natural  food  may 
have  a  useful  function  to  perform  in  the  economy. 
One  of  these  functions  may  certainly  be  that 
of  keeping  the  teeth  in  healthy  order,  and,  if 
this  be  so,  while  the  present  dietetic  arrangements 
in  the  community  persist,  it  is  not  likely  that 
any  amelioration  in  the  teeth  of  the  race  will  take 
place.  Evidence  telling  in  favour  of  Dr.  Sim 
Wallace's  theory  should  be  eagerly  sought,  for 
there  must  be  a  good  deal  capable  of  being  brought 
forward  if  it  be  the  true  one.  At  any  rate,  the 
whole  subject  is  one  of  so  much  moment  that  no 
efforts  to  ascertain  the  facts  should  be  neglected. 
Dental  caries  has  been  lightly  regarded  far  too 
long ;  it  is  now  assuming  dimensions  that  are 
more  or  less  alarming. 

THE   PRIME  MINISTER  ON  MATTER. 
It  is,  perhaps,  useful  that  the  opening  address 
to  a  conference  of  men  of  science  should  be  gives 


August  31,  1904. 


NOTES    ON    CURRENT    TOPICS.        Thb  Medical  P«bss.    22Q 


by  one  who  is  not  himself  a  man  of  science.     The 
priesthood  of   science  is,  like  other  ecclesiastical 
orders,  inclined  to  be  somewhat  narrow,  and  to 
arrogate  to  itself  a  dogmatism  which  is  in  essence 
qtiitc    nnscientific.       Absorbed     in     some    par- 
ticular branch  of  stcdy,  and  necessarily  heedless 
of  much  outside  that  branch,    a  man  of  science 
is  almost  bound  to  lose  to  some  extent  his  sense 
of  proportion,  and  this   all  the  more,  the  more 
he  is  absorbed  in  his  work.     It  alwa3^  helps  to 
restore,  at  any  rate  to  some  extent,  this  sense  of 
proportion  to     hear     problems    of    science    dis- 
cussed by  a  sympathetic  and  inteUigent  outside 
observer.     This     is,    we    think,     Mr.     Balfour's 
position  as  regards  science,  and  we  doubt  not  but 
that  some  such  considerations  as  these  were  in 
the  minds  of  the  members  of  the  British  Associa- 
tion  when    they   invited    him    to    become    their 
President.     It  has  been  said  of  the  Prime  Minister 
that   he    cannot    discuss    any    subject   without 
bringing  in   metaphysical  considerations,  so  that 
it    is     hardly    to    be  wondered    at   that,    care- 
fully   as      he      attempted     to    guard     himself, 
his  "  Reflections  Suggested  by  the  Nr ./  Theory  of 
Matter,"     sometimes    transcended  the  limits  of 
ph3^ca]   science.     Indeed,  it  would  be  hard  for 
any  discussion  on  the  nature  of  matter  to  be 
anything  else  than  transcendental,  since  matter 
is  the  datum  of  physical  science.     Just  as  mathe- 
matics   cannot    proceed    unless    certain    funda- 
mental principles,  to  wit,  the  axioms,  are  assumed, 
so,   without   the  assumption    of    matter    as    its 
ultimate  principle,  is    physics  non-existent.     Mr. 
Balfour,    however,    seems    to    forget    that    any 
physical  theory  of  matter,  however  far  back  it 
may   explain     what    we    see   and    feel,    leaves 
matter  still  there.     He  seems  to  give  an  undue 
weight    to     modem     discoveries,     which    have 
altered  our  conception  of  matter  by  showing  that 
the  atoms,  which  we  formerly  regarded  as  ulti- 
mate,   are    themselves    composite.     *'  There    are 
those  .  .  .  who     think     that     the     elementary 
atom   of   the   chemist,   itself  beyond   the   Umits 
of  direct  perception,  is  but   a   connected  system 
of  monads  or  sub-atoms,  which  are  not  electrified 
matter,  but  are  electricity  itself."     What  then  ? 
We   have    merely   carried    the    analysis    a    little 
further  back  and  we  deal  with  "  monads  or  sub- 
atoms,"  instead  of  atoms.     But  how  does  it  help 
us   to    call    them  "  not    electrified    matter,    but 
electricity  itself  "  ?     We  can  have  no  conception 
of  electricity'    apart   from   its   action   on  atoms, 
or  monads,  or    whatever   other   name    we    care 
to  give  to  the  units    of    matter.     And    by    no 
juggle    of    words    can    we   do    away   with  this 
supposition  of    matter.     But    like    Mr.    Balfour 
we  fear  we  are  becoming  metaphysical.     In  the 
concluding  part  of  his  address  Mr.  Balfour  gives 
an  interesting  explanation,   based   on   the   prin- 
ciple  of  natural  selection,  of  the  inevitableness 
of  our  shortcomings  in  the  field  of  knowledge.  ««So 
far  as  natural  science  can  tell  us,  every  quahty 
of  sense  or  intellect  which  does  not  help  us  to 
fight,  eat,   and  to  bring  up  children  is  but  a  by- 
product of  the  qualities  which  do.     Our  organs 


of  sense-perception  were  not  given  us  for  purposes 
of  research,  nor  was  it  to  aid  us  in  writing  out 
the  heavens  or  dividing  the  atom  that  our  powers 
of  calculation  and  analysis  were  evolved  from 
the  rudimentary  instincts  of  the  animal."  As 
this  is  true  of  our  perceptive  faculties,  so  much 
more  is  it  true  of  our  speculative  powers,  and 
the  fact  goes  far  to  explain  to  us  the  limits  of  our 
powers.  Rightly  understood,  however,  a  know- 
ledge of  our  limits  should  not  be  an  incentive 
to  pessimism,  since  it  helps  to  guide  us  to  a  useful 
activity.  At  the  same  time  it  teaches  science 
and  philosophy  alike  that  they  have  Umits 
which  they  cannot  transgress.  "  There  are  more 
things  in  heaven  and  earth  than  are  dreamt  of  in 
your  philosophy"  seems  to  be  the  lesson  Mr. 
Balfour  wished  to  impress  on  the  members  of  the 
British  Association,  and  through  them  on  students 
of  science  generally. 


flotes  on  Current  XEopfce^ 

Scarlet  Fever  and  Hospital  Isolatioii. 

In  the  present  issue  of  The  Medical  Press  and 
Circular  we  publish  two  important  articles 
dealing  with  the  hospital  treatment  of  scarlet  fever. 
For  some  years  past  the  belief  has  existed  that  the 
system  of  hospital  isolation  has  not  proved  a 
success  so  far  as  the  diminution  of  incidence  or  of 
case-mortahty  has  been  concerned.  The  writer 
of  one  of  the  articles  mentioned,  Dr.  Kilhck 
Millard,  has  been  one  of  the  earUest  and  most 
persistent  critics  of  isolation  hospitals  in  regard  to 
scarlet  fever.  One  of  his  chief  contentions  appears 
to  be  that  the  isolation  hospital  fails  to  isolate. 
Our  second  writer.  Dr.  H.  Biss,  contributes  a  full 
and  scholarly  article,  of  which  the  first  part  deals 
mainly  ^ith  the  impossibility  of  diagnosis  of 
anomalous  cases  of  that  specific  infection,  where 
the  characteristics  of  rash,  sore  throat,  tempera- 
ture, may  be  altered  beyond  recognition  or 
altogether  absent.  Under  such  circumstances  it 
is  clear  that  it  would  be  impossible  to  devise  an 
absolute  system  for  the  notification  of  all  cases 
of  the  malady.  It  follows  that  any  form  of  isola- 
tion would  be  impossible,  because  many  cases 
would  escape  identification.  The  superiority  or 
otherwise  of  hospital  over  home  treatment  of  the 
disease  forms  another  branch  of  the  discussion. 
Readers  of  these  excellent  articles  will  doubtless 
bear  in  mind  that  the  majority  of  pubUc  health 
authorities  maintain  that  the  hospitals  furnish 
the  only  possible  solution  to  the  problem  of 
how  to  deal  with  scarlet  fever. 


A  Bacteriologiocd  Inetitate  in  Madras. 

The  subject  of  tropical  medicine  offers  a  wide 
and,  to  a  great  extent,  unexplored  territory  to  the 
scientific  investigator.  The  enormous  social  and 
economic  importance  of  this  special  branch  of 
knowledge  can  only  be  dimly  realised.  Hitherto 
it  has  been  customary  to  reproach  the  medical 
profession  in  tropical  countries  with  the  laxity 
and  the  conservatism  of  their  scientific  methods. 


230 


Tbx  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


August    31,  1904- 


The  brilliant  discoveries  of  recent  years,  however, 
have  done  much  to  wipe  away  that  reproach. 
At  the  same  time  it  may  be  generally  asserted 
that  the  level  of  scientific  public  health  adminis- 
tration in  our  tropical  colonies  is  still  in  a  back- 
ward state.  In  India,  for  instance,  in  army  as 
well  as  in  civiUan  life,  the  facilities  for  bac- 
teriological research  were  non-e^dstent,  and  the 
only  work  done  in  that  direction  was  that  of  a 
small  knot  of  scientific  enthusiasts.  Nowadays 
all  that  is  changed.  The  keynote  of  present 
medical  administration  in  India  is  the  predominant 
necessity  of  the  bacteriological  and  the  chemical 
laboratory.  One  of  the  most  recent  additions 
to  the  strength  of  the  advanced  scientific  army  in 
India  is  the  King  Institute  in  Madras.  By  the 
energy  and  persistency  of  Lieut.-Colonel  W.  G. 
King,  C.I.E.,  I.M.S.,  a  fully-equipped  Government 
laboratory  has  been  established  in  Madras.  The 
departure  is  full  of  interest,  as  it  furnishes  an 
example  not  only  to  all  British  colonies  and  de- 
pendencies, but  one  that  may  suggest  serious 
reflections  to  sanitary  administrators  in  the  United 
Kingdom.  An  account  of  the  King  Laboratory 
work  will  be  found,  by  Colonel  Christophers, 
among  the  Original  Communications. 


Another  Drink  Core. 
It  is  a  thousand  pities  that  ministers  of  religion, 
in  conmion  with  many  other  well-meaning  people, 
take  so  Uttle  trouble  to  enlist  the  sympathies  of 
the  medical  profession  in  many  of  their  philan- 
thropic schemes.  They  cannot  be  unaware  of 
th3  enormous  amount  of  charitable  work  cheer- 
fully performed  year  in  and  year  out  by  medical 
men,  and  if  they  would  take  the  trouble  to  inquire 
into  the  subject  they  could  easily  find  out  why 
the  medical  profession  preserves  the  code  of  ethics 
laid  down  by  Hippocrates.  That  code  is  the 
guarantee  to  the  citizen  that  in  consulting  a 
medical  man  his  highest  and  best  interests  will 
be  scrupulously  respected.  Yet  ever  and  again 
we  find  clergyman  deliberately  flouting  all  that 
the  medical  profession  hold  dear,  and,  from  mis- 
taken motives  of  philanthropy,  running  counter 
to  those  traditions  that  should  be  regarded  as 
inviolate.  The  vicar  of  St.  Luke's,  Camberwell, 
the  Rev.  Hugh  B.  Chapman,  has  been  stirred 
by  the  wonders  of  some  drink  "  cure  "  to  start  a 
campaign  to  exploit  this  remedy  on  his  own  account. 
We  have  no  knowledge  of  Mr.  Chapman.  How- 
ever willing  we  may  be  to  believe  in  the  personal 
disinterestedness  of  his  action,  we  cannot  con- 
demn in  too  strong  terms  the  form  that  his 
appeal  has  taken.  Two  months  ago  he  wrote  to  the 
press,  saying  "  that  he  had  come  across  a  strik- 
ing remedy  f:r  dipsomania,  and  since  then  he  has 
had  1,800  letters  of  inquiry  on  the  subject."  With 
the  rashness  of  a  tyro  he  has  himself  undertaken 
the  treatment  of  eleven  most  distressing  cases, 
need  we  say,  with  complete  success  ?  So  great 
is  his  confidence  in  the  "  remedy  "  that  he  has  now 
written  to  the  lay  papers  again,  asking  that  all 
applicants  for  relief  from  alcohohc  habits  should 
communicate  with  him,  and  that  he  will  be  pre- 


pared to  undertake  their  treatment.  The  g^iaoos 
proprietor  of  the  **  cure  " — **  a  purely  vegetable 
drug,  guaranteed  perfectly  harmless "  — bas 
placed  a  supply  at  Mr.  Chapman's  disposal  ior  a 
nominal  sum,  seeing,  no  doubt,  a  splendid  adver- 
tisement for  his  goods  by  so  doing.  Mr.  Chapman 
admits  that  his  object  is  to  bring  this  remedy 
within  the  reach  of  all  and  secure  it  for  the  com- 
mon good.  Has  he,  we  wonder,  acquainted  him- 
self with  the  life-history  of  a  hundred  and  one  of 
these  "  drink  cures  ''  that  have  had  their  little 
day,  and  disappeared  when  their  credit  was  gone 
and  their  owners  sufficiently  enriched  at  the  hands 
of  their  victims  ?  Mr.  Chapman  should  knov 
that  the  medical  profession  refuses  to  prescribe 
esoteric  drugs  that  are  exploited  as  private  ven- 
tures, because  it  considers  such  a  proceeding 
detrimental  to  the  interests  of  its  patients,  and 
because  secret  remedies,  like  secret  societies  and 
secret  dealings  of  all  kinds,  are  contrary  to  public 
pohcy. 


A  Stranere  Oon^ess. 
Man  is  a  gregarious  animal.  Whenever  oppor- 
tunity offers  or  excuse  admits,  he  foregathen 
with  those  of  his  fellows  to  whom  he  is  bound  by 
some  tie,  real  or  imaginary.  Every  species  of 
humanity  has  its  club,  its  congress,  its  annual 
dinner.  Sometimes  such  gatherings  are  organised 
on  the  plea  of  mutual  edification ;  at  other 
times  frankly  on  that  of  good-fellowship.  Bui 
the  general  result  is  usually  a  **  good  time." 
A  curious  reunion  in  Paris  was  that  lately  called 
into  existence  to  promote  the  interests  of,  and 
cultivate  friendly  feelings  among,  fat  men,  the 
qualification  for  entry  being  the  possession  of  so 
many  stones  of  bodily  weight.  Surely,  however, 
a  stronger  aggregation  never  took  place  than  tha: 
recently  held  at  Coney  Island  to  welcome  **  gradu- 
ates "  reared  by  infant  incubators.  To  this  con- 
gress repaired  no  less  than  fifty  infants  and  young 
children  who  owed  their  presence  on  earth  to  the 
invention  of  Dr.  County,  including  in  their 
ranks  the  famous  Cohen  triplets,  now  in  the  blush 
of  their  third  summer.  These  latter  infants  were 
bom  in  a  tenement  house  in  New  York,  and  to- 
gether weighed  at  birth  as  much  as  on^  healthy 
child,  but  after  a  process  of  incubation  at  the 
Pan-American  Exhibition  at  Buffalo,  they  all 
managed  to  attain  presentable  proportions.  Dr. 
Wallace  Lee,  who  first  installed  the  system  of 
incubation  at  the  Omaha  Exposition  in  1897,  ^^^^ 
the  assembled  crowds  that  whereas  97  per  cent, 
of  the  class  of  infants  now  successfully  reared  by 
the  incubators  used  to  perish  before  their  iatro- 
duction,  up  to  the  present  he  had  only  lost  thirteen 
out  of  a  hundred  and  twenty -six.  In  this  year's 
infant  colony  at  Coney  Island  there  are  no  less 
than  three  sets  of  twins  and  one  of  triplets,  all 
flourishing.  The  proceedings  of  the  Congress 
were  apparently  marked  by  great  cordiality,  but 
in  the  report  of  the  meetings  it  is  not  mentioned 
that  any  of  the  '*  graduates  "  related  the  experi- 
ences of  his  early  up-bringing.  Perhaps  they  are 
being  reserved  for  some  imaginative  noveUst.    Al 


August  31,  IQ04. 


any  rate,  the  time  passed  pleasantly,  and  if  the 
^nenu  of  the  annual  dinner  was  a  simple  one,  it  was 
probably  better  suited  to  the  digestive  organs  of 
the  guests  than  the  elaborate  concoctions  -^^ 
French  chefs  usually  are. 


NOTES    ON    CURRENT    TOPICS.  Thk  MKmcAL  Press.     2^ 


of 


Neurosis  of  the  (Esophafirus. 
The  functional  diseases  affecting  the  oesophagus 
have  not  received  much  attention  from  clinical 
observers,  probably  on  account  of  their  compara- 
tive insignificance.      Nevertheless,  many  distres- 
sing morbid  conditions'^may  result  from  neuroses 
of  this  portion  of  the  ahmentary  canal.     The  so- 
called  **  globus  hystericus  **  is,  perhaps,  the  most 
familiar    of    all    functional    disturbances    of    the 
oesophagus,  and  one  which  is  specially  associated 
with  hysteria.     The  sensation  of  something  slowly 
rising  in  the  throat  which  threatens  to  choke  the 
patient  is  a  symptom  at  once  seized  upon  by  the 
physician  as  proof  positive  of  the  existence  of 
functional    nervous   disorder,    and"  valerian   and 
assafoetida   are    forthwith  prescribed.     Knott,  in 
his   classic  monograph  upon  the  subject,   states 
that  the  phenomenon  of  globus  is  directly  produced 
by  spasmodic  contraction  of  the  muscular  fibres 
of  the  gullet,  though  he  does  not  specify  which 
layer.     Dr.  A.  L.  Benedict  has  found  that  spasm 
of  the  oesophagus  may  be  induced  physically,  as, 
for  instance,  by  attempts  at  swallowing  when  the 
throat  is  dry,  or  by  cutting  short  a  fit  of  laughter  by 
sudden    deglutition.     In    states    of    passion    or 
great   emotion   the  functions  of   the  oesophagus 
are  often  much  perverted,  swallowing  being  some- 
times absolutely  impossible  under  such  circum- 
stances.    Cases  of  spasmodic,   intermittent  dys- 
phagia have  been  described  by  Graves,   Paget, 
Brinton,  and  others,  in  which  there  was  not  the 
slightest   evidence   of   any    hysterical   condition, 
but  the  subjects  were  neurotic.     The  recognition 
of  such  cases  is  a  matter  of  no  small  difficulty 
as    they  sometimes  occur  in  elderly  patients  in 
whom  the  suspicion  of  malignant  disease  may  be 
entertained.     The  cautious  exploration  by  means 
of  the  oesophageal  sound  will  determine  the  pre- 
sence or  otherwise  of  obstruction,  and  in  functional 
cases  the  mere  passage  of  the  instrument  may 
have  a  curative  effect. 


The  Wisdom  of  Swimmingr. 
We  teach  in  our  public  schools  much  that  is 
useless  for  the  true  development  of  the  mind  and, 
it  may  be,  in  many  cases,  actually  damaging  to 
the  body.  Our  sins  of  commission  are  great, 
but  our  errors  of  omission  are  greater.  At  this 
season  of  the  year  the  desirability  of  making  swim- 
ming a  compulsory  part  of  school  training  is 
occasionally  discussed,  but  the  fact  remains  that 
a  vast  number  of  our  school  children  are  alto- 
gether devoid  of  any  knowledge  of  the  art  of 
swimming.  It  is  true  that  many  excellent  public 
baths  are  springing  up  in  cities  and  urban  districts, 
but  the  greater  number  of  the  smart  towns  and 
villages  of  our  country  offer  no  facilities  for  swim- 
ming, and  even  opportunities  for  bathing  for 
cleansing  purposes  a^e  scanty.     We  contend  that 


in  the  interests  of  the  physical  development  of 
our  people,  and  as  a  wise,  prophylactic  measure 
for  the  safeguarding  of  valuable  human  Uves, 
swimming  should  be  made  a  compulsory  element 
in  every  public  school  education. 

Life  Losses  on  the  Alps. 
The  Alps  have  been  well  called  "  the  playground 
of  Europe,"  but  formany  a  life  rich  in  distinction 
and  promise  for  humanity  they  have  proved  the 
graveyard.  This  year  the  number  of  moun- 
taineering disasters  hai  been  exceptionaUy  large. 
Some  of  the  accidents  are  such  as  may  be  considered 
inseparable  f  om  the  risks  of  high  sport,  but  many 
others  are  the  outcome  of  recklessness.  The 
neglect  of  elementary  principles  of  hygiene, 
the  excessive  exertion  of  untrained  bodies,  the 
absolute  lack  of  mountaineering  knowledge, 
lose  many  a  valued  life.  And  'warning  is 
needed  by  all  sorts  and  conditions  of  men  and 
women.  We  write  from  personal  knowledge  of 
the  ways  of  the  average  Englishman  and 
Englishwoman  when  the  keen  glacier  air  has 
whetted  the  natural  appetite  for  feats  of  strength 
and  endurance.  Many  a  teacher  and  many  a 
student  seek  recreation  among  the  mountains 
without  a  thought  or  care  for  their  own  fitness  for 
the  exercise  proposed.  Ropes  are  tested  and  axes 
examined,  but  the  climber  ra-ely  thinks  it  neces- 
sary to  wait  for  a  physical  examination  into  his 
own  powers  of  endurance  or  ability  to  meet  the 
stress  and  strain  of  prolonged  exertion.  It  is 
useless  to  agitate  for  a  study  of  hygiene  in  our 
schools  if  the  teachers  neglect'  the  first  steps 
to  secure  a  rational  method  both  of  work  and  of 
play.  The  heavy  death  roll  of  the  mountains 
duriig  the  past  few  weeks  is  sufl&cient  argu- 
ment for  our  contention  that  a  thorough  medical 
examination  should  be  made  of  everyone  who 
intends  to  woo  the  delights  and  dangers  of  pro- 
longed exertion  among  the  beautiful  evil  Alps. 

The  Treatment  of  the  Summer  Diarrhcsa 
of  Infants, 

That  veritable  scourge  among  the  infantile 
population,  summer  diarrhoea,  has  once  more 
appeared  in  our  midst  coincidently  with  the  fall 
of  the  atmospheric  temperature.  In  many 
localities,  it  is  already  alarmingly  prevalent^  while 
m  certain  districts  of  the  metropolis  it  seems  to  be 
of  an  unusually  virulent  type.  One  curious 
point  about  the  disease  is  its  deceptive  character, 
for  many  severe  cases  are  discharged  from  hospital 
as  convalescent,  only  to  undergo  a  sudden  and 
rapidly  fatal  collapse.  The  reason  for  this  is 
somewhat  obscure.  Of  all  the  methods  adopted 
for  the  treatment  of  this  complaint,  none  can  be 
considered  truly  specific.  The  administration  of 
drugs  must  be  influenced  by  the  clinical  features 
that  predominate  in  a  given  case.  In  those  which 
present  a  parched  skin,  hyperpyrexia,  and  much 
restlessness,  small  doses  of  opium  in  the  form  of 
the  aromatic  chalk  powder  are  indicated,  but  as 
the  whole  system  is  suffering  from  the  effects  of 
'  loss   of  fluid,   rectal   or  subcutaneous  injections 


232    Thb  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


of  normal  saline  or  tresh  sheep's  serum  are  often 
of  signal  benefit.  Warm  baths  are  useful  in 
almost  all  cases.  Many  physicians  pin  their 
iaith  to  an  initial  dose  of  castor  oil  or  grey  powder 
followed  up  by  such  intestinal  astringents  as 
tannic  acid  or  bismuth.  Others  prefer  to  ad- 
minister intestinal  antiseptics,  such  as  the  sulpho- 
cajfbolate  of  zinc  or  the  salicylate  of  bismuth. 
Alcohol  is  generally  given  as  a  stimulant,  though 
it  is  questionable  if  minute  doses  of  strychnine 
would  not  be  more  beneficial.  Lavage  of  the 
bowel  is  one  of  the  most  important  of  the  more 
modem  therapeutic  methods.  Milk  feeding  is 
better  dispensed  with  altogether  from  the  first,  its 
place  being  taken  by  albumen-water  or  whey. 
When  the  acute  condition  has  subsided,  small 
quantities  of  raw  meat- juice  may  be  given  with 
advantage,  a  gradual  return  being  made  to  milk. 


Concemiocr  Quacks. 

"  There  be  three  things  which  are  toowonderful 
ior  me — ^yea,  four  which  I  know  not."  If  the 
wisest  of  men  had  lived  in  modern  days  he  would 
have  found  it  necessary  to  extend  his  list  con- 
siderably, for  even  he  could  not  have  compre- 
hended the  infinite  variety  of  wiles  and  dodges 
by  which  mountebanks  manage  to  prey  on  the 
credulous.  We  suppose  it  is  because  the  wings 
of  the  American  eagle  are  so  broad  that  that 
land  of  the  free  has  become  the  special  home  of 
quackery  and  charlatanism.  At  any  rate  we 
think  there  is  no  other  country  in  the  world 
which  could  boast  such  a  variety  of  gross  super- 
stitions at  the  present  day  as  those  to  which 
Professor  Osborne  of  Yale  has  drawn  atten- 
tion in  a  recent  address,  (a)  With  some  of 
these,  such  as  Eddyism,  Dowieism,  Osteopathy, 
we  are  more  or  less  familiar  in  these  countries, 
though  happily  the  attempts  to  gain  many 
converts  have  been  so  far  unsuccessful.  Of 
others  we  know  less,  and  it  is  with  some  surprise 
that  one  finds  what  a  thriving  profession  that  of 
miraculous  healer  may  be  in  the  States.  Thus, 
one  "  magnetic  healer,"  who  undertook  to  heal 
by  absent  treatment,  was  for  some  time  in  receipt 
of  an  income  of  five  hundred  pounds  a  day  in  fees 
of  one  pound  per  case.  Another  gentleman,  esta- 
blished in  Chicago,  promises  by  the  exercise  of 
forceful  thought  addressed  to  disease  germs  to 
drive  them  from  the  bodies  of  the  sick  for  fees 
varying  from  two  to  fifty  dollars  a  head.  We 
learn,  too,  from  Dr.  Osborne,  of  the  existence  of  a 
cult  called  "  Ralstonism,"  which  "  is  the  lever  that 
has  been  designed  by  the  Creator  for  the  work 
of  uplifting  the  world."  The  Ralstonites  are, 
however,  an  exclusive  sect,  and  keep  their  posi- 
tive doctrines  secret.  Among  the  more  weird 
cults  are  mentioned  many  at  whose  tenets  or 
methods  we  cannot  even  guess— Phenopathists 
and  Venopathists,  Cereopathists  and  Chiropathics, 
Viticulturists  and  Vitaphysicists,  Somatothera- 
pists  and    Esoteric  Vibrationists,   the    Koreshan 


(«)  J<mm,AfMr.  Med.  Ataoe.,  July  Snd.  1904. 


August  51.1904. 


Universology,  the    Fire-Baptized    Holiness  Asso- 
elation,  and,  lastly.  The  Holy  RoUers. 

Sentimentality  Amon^r  Qnardians. 
Every  year  or  two  notices  a  sudden  outbreak 
of  sentimentality  among  guardians  of  the  poor 
with  regard  to  the  disposal  of  the  bodies  of  those 
who  have  died  while  under  their  care.  One  does 
not  notice. an  equal  anxiety  as  to  the  comfort  of 
those  who  have  not  yet  died.  From  time  to  time, 
however,  some  guardian  discovers  with  a  feeling 
of  pained  surprise  that  the  bodies  of  the  un- 
claimed poor  are  made  serviceable  for  anatomical 
purposes,  and  he  immediately  exerts  himself  to 
prevent  such  a  "  scandal."  It  is  only  a  few  months 
since  an  attempt  of  this  sort  was  made  in 
Dublin,  and  the  other  day  there  was  a  warm  de- 
bate among  the  Hull  guardians  following  ob 
the  discovery  by  one  of  their  number  that  un- 
claimed bodies  were  occasionally  sent  to  Cam- 
bridge for  dissection.  It  is  curious  how  difiicult 
it  is  to  convince  people  that  the  supply  of  bodies  is 
a  necessity  of  medical  education,  and  that  the 
ultimate  object  of  medical  education  is  the  treat- 
ment of  the  sick  and  not  the  aggrandisement  of 
the  physician.  And  if  medical  education  of 
proper  sort  be  lacking,  it  is  not  the  rich  but  the 
poor  who  will  inevitably  suffer.  The  rich  can 
obtain  the  best  medical  advice,  wherever  it  has 
to  be  brought  from,  but  the  poor  must  be  content 
with  what  is  at  hand.  Guardians  of  the  poor 
have  surely  enough  serious  business  with  which 
to  occupy  their  time  without  devoting  them- 
selves to  the  resuscitation  of  injurious  and  mean- 
ingless superstitions. 

Phsnsioal  Deterioration  Committee. 
The  appendix  just  issued  to  the  report  of  the 
Committee  on  Physical  Deterioration  contains 
much  valuable  information,  and  though  some  of 
the  returns  therein  presented  are  more  imaginan* 
than  one  had  been  led  to  expect,  others  give  cause 
for  grave  anxiety.  Thus  one  finds  that  at  St 
George's  Barracks,  London,  where  nearly  one- third 
of  all  recfuits  are  examined  medically  before  en- 
listment, 374  per  1,000  are  rejected  as  unfit, 
while  in  Manchester  the  proportion  is  even  higher, 
namely,  490  per  1,000.  The  standard  for  recruits 
is  not  a  high  one,  and  it  is  significant  that  in  two 
of  the  largest  centres  of  industry  nearly  a  third 
of  presumably  healthy  young  men  cannot  attain 
to  it.  Curiously  enough,  in  Birmingham  and  Edin- 
burgh the  returns  were  much  more  favourable, 
only  192  failing  in  the  former  town,  and  173  in  the 
latter.  Whilst  in  Edinburgh  it  is  comprehensible 
that  a  large  number  of  countrymen  may  present 
themselves  for  army  service,  and  thereby  raise 
the  general  level  of  fitness  among  the  applicants, 
it  is  difficult  to  understand  the  marked  difference 
between  Birmingham  and  Manchester,  unless  it 
depends  on  the  personal  equation  of  the  medical 
officer.  The  effect  of  good  hygienic  conditions 
on  the  physique  of  children  is  well  shown  in  a 
set  of  tables  prepared  by  Dr.  Eichholtz,  in  which 
he  compares  the  elementary  school  children  of 


August   31,    1904. 


NOTES    ON    CURJRJENT    TOPICS.       Th«  Medical  Pmss.    233 


the  open,  healthy  suburb  of  Wandsworth  with 
those  of  the  slum  district  of  Lambeth.     At  four 
years  of  age  the  Lambeth  children  are  on  an 
average    about   seven   inches   shorter    than    the 
Wandsworth  ones,  and  at  fourteen  years,  three 
and  a  half  inches.    The  lamentable  fact  is  brought 
out,  the  poorest  class  of  Lambeth  child  is  worse 
developed   than  similar  children  in  other  large 
towns,  such  as  Manchester  and  Leeds,  and  the 
difierence  between  the  poorer  and  richer  classes 
is  marked  indeed.     There  is,  however,  one  com- 
fort! ng    fact,    namely,    that    from    photographs 
taken  of  children  attending  Lant  Street  Board 
School  in  the  Borough  in   1875-78,  evidence  is 
iorthcoming  to  show  that  the  physique  of  the 
poorest  class  of  children  is  somewhat  better  to-day 
than  it  was  twenty-five  years  ago.    The  whole 
of  this  appendix  tells  one  decisive  lesson — ^physical 
development  depends  on  hygienic  conditions  of  life. 


Infantile  Alcoholism. 
The  gradual  spread  of  the  temperance  move 
ment  in  this  country  and  the  consequent  lessenings 
of  disease  due  to  alcoholism  are  matters  for  uni- 
V  ersal  satisfaction.  1 1  is  somewhat  disquie  ting,  how- 
ever, to  learn  that  in  certain  quarters  parents 
are  so  Uttle  alive  to  their  responsibihties  as  to 
give  alcohol  to  babes  and  sucklings.  For  in- 
«tance,  the  evidence  at  a  recent  inquest  upon  a  boy 
of  four  showed  that  he  had  a  regular  allowance  of 
beer.  This  child  ultimately  died  of  alcoholic 
poisoning  as  a  result  of  drinking  a  mixture  of 
rum  and  beer.  It  is  well  known  that  gin,  or 
other  strong  spirits,  is  sometimes  given  to  infants 
at  the  breast  to  "  settle  the  milk,"  as  it  is  thought, 
but  really  for  the  purpose  of  pacifying  fretfulness. 
Can  it  be  wondered  that  serious  internal  mischief 
is  produced,  to  say  nothing  of  damage  to  the  ner- 
vous system  which  at  this  period  of  life  is  parti- 
cularly susceptible  ?  According  to  the  Alliance 
News,  the  children  of  Normandy  are  in  a  very  bad 
way.  At  a  tender  age  they  are  given  eau-de-vie, 
or  "  Calvados,"  a  spiritoous  liquor  allied  to  gin, 
while  brandy  is  frequently  included  in  the  daily 
rations  of  school  children.  The  writer  has  there 
seen  little  girls  intoxicated  in  the  afternoon, 
utterly  unfit  to  pursue  their  studies.  We  are 
glad  to  think  that  such  a  disgraceful  state  of 
affairs  is  not  permitted  in  this  country,  though 
among  the  poor  it  is  to  be  feared  that  infantile 
alcoholism  is  prevalent  to  a  greater  extent 
than  is  usually  believed.  .  More  beer  is  drunk,  un- 
fortunately, than  milk,  and  this  latter  commodity 
is  often  so  diluted  with  water  as  to  be  of  Uttle 
real  nutritive  value.  There  is  still  much  scope 
for  tactful  visitation  by  ladies  and  other  workers 
who,  by  simple  and  kindly  precept,  will  convince 
parents  of  the  folly  and  wickedness  of  giving 
strong  drink  to  their  offspring. 


Pneumonia  and  Publio  Health* 

The  appointment  by  the  New  York  Board  of 

Health  of  a  Conmiission  of  Experts  to  inquire  into 

the  prevalence  of  pneumonia  in  that  city  draws 

pubUc   attention  to  the  ravages  made  by  that 


disease.  We  are  so  accustomed  to  regard  tuber- 
culosis as  the  principal  foe  which  attacks  the 
chest,  that  it  comes  on  us  as  a  shock  to  find 
that  in  several  large  American  cities  the  deaths 
from  pneumonia  during  the  winter  half  of 
the  year  are  more  than  double  those  from 
phthisis.  In  considering  this  proportion,  how- 
ever, it  is  to  be  remembered  that  the  death-rate 
from  phthisis  is  much  lower  than  it  was  some 
years  ago,  owing  to  thfe  success  of  preventive 
measures,  and  the  question  at  present  is  whether 
pneumonia  can  be  tackled  with  equal  success. 
The  case  of  the  two  diseases  is  very  similar. 
Each  is  dependent  on  a  special  organism,  which 
for  its  growth  and  multiplication  requires  a  par- 
ticular soil.  A  priori,  there  are  two  methods  of 
attacking  such  a  disease.  We  may  either  attempt 
to  produce  a  soil  where  the  organism  cannot 
grow  or  we  may  attempt  to  eradicate  the  orga- 
nism itself.  In  neither  of  the  two  diseases  we 
are  discussing  can  we  apply  the  first  method 
further  than  by  developing  a  state  of  general 
good  health.  Our  principal  attack  must  be 
directed,  therefore,  against  the  organism  itself, 
and  the  means  adopted  will  be  similar  in  the  case 
of  pneumonia  to  those  that  have  been  so  far  suc- 
cessful in  the  case  of  tuberculosis.  Every  attempt 
must  be  made  to  prevent  the  spread  of  infection 
by  destro)dng  with  rigour  all  material  where  the 
contagium  vivum  may  lurk.  Nor  will  it  be  neces- 
sary to  destroy  the  sputum  of  the  obviously 
sick,  but  strictest  regulations  against  expecto- 
ration in  public  places  must  be  enforced.  This 
is  impressed  on  us  all  the  more  by  the  fact 
that  many  minor  ailments,  such  as  rhinitis  and 
tonsilitis,  are  in  causation  pneumococdc,  and 
infection  from  them  may  start  a  typical  pneumonia 
in  other  persons. 


Stature  and  Sioknees. 
Among  physical  characters  there  are  few, 
perhaps,  which  influence  the  incidence  of  disease 
to  such  an  extent  as  the  stature  of  the  individual 
Those  folk  who  quarrel  with  their  height  and 
devise  some  fresh  means  for  altering  it  hardly 
realise  the  system  of  compensation  which  may  be 
traced  everywhere  in  Nature.  In  attempting  to 
add  cubits  to  their  stature  they  ignore  the  fact  that 
the  balance  of  the  whole  being  may  be  endangered 
by  so  doing.  An  interesting  paper  upon  this 
subject  was  read  before  the  British  Association 
at  Cambridge  by  Dr.  P.  C.  Shrubsall,  who  stated 
that  individuals  of  high  stature  were  more  Ukely 
to  be  affected  by  heart  disease,  rheumatism,  and 
tonsihtis,*! whereas]  short  people  were  more  often 
found  suffering  from  tuberculosis,  cancer  and 
nervous  diseases.  Such  generalisations  have 
not,  of  course,  been  made  without  careful  ob- 
servation and  measurement  of  a  large  number 
of  patients,  though  it  may  not  appear  at  first 
that  there  is  any  special  connection  between  stature 
and  disease-incidence.  From  the  Ufe  assurance 
point  of  view  the  height  of  the  proposer  may  in- 
fluence.  considerably  the  decision  of  the  medical 
examiner.    Most     authorities,    for  instance,     are 


234    "Thx  Mbdical  Putst. 


NOTES   ON    CURRENT   TOPICS. 


August  31,  1904. 


agreed  that  if  the  stature  exceeds  five  feet  ten 
inches  there  is  an  increased  risk,  chiefly  from 
heart  affections.  More  than  usual  care  should, 
therefore,  be  taken  over  the  physical  examination 
of  the  vascular  sjrstem  in  a  very  tall  subject,  for 
it  is  well  known  that  such  people  do  not  bear  sudden 
strain  or  prolonged  physical  exertion  at  all  well. 
The  proportion  between  the  height  and  the  weight 
is  even  more  important  than  the  former  alone. 
It  may  be  advantageous  at  times  to  be  head  and 
shoulders  above  one's  fellows,  physically  speak- 
ing, but  a  giant's  stamina  is  not  commensurate 
with  his  stature ;  indeed,  the  contrary  is  more 
often   the   case,  

The  Hygiene  of  Slavery. 

Even  the  most  rigid  of  New  England  moralists 
has  had  to  admit  that  the  emancipation  of  the 
slave  has  not  been  an  entire  success.  It  is  true 
that  in  the  emancipation  a  great  principle  of 
right  triumphed,  but  principles  have  often  the 
drawback  of  being  injurious  in  their  appUcation 
in  some  of  their  details.  Hence  it  is  that  the 
negro  question  in  the  States  was  by  no  means 
settled  with  the  close  of  the  Civil  War.  It  is 
still  the  most  serious  social  question  in  America, 
as  the  constant  reports  of  alternate  outrages  and 
lynchings  show.  One  of  the  lesser  deleterious 
effects  of  the  aboUtion  of  slavery,  but  one  of  par- 
ticular interest  to  medical  men,  is  the  increased 
vulnerabihty  of  the  negro  race  to  certain  diseases. 
Of  these  the  most  important  is  consumption, 
which  has  increased  among  the  emancipated 
population  to  an  extraordinary  extent.  Under 
the  system  of  slavery  the  incidence  of  consump- 
tion on  the  black  and  white  populations  of  the 
South  was  practically  identical.  At  the  present 
time  to  quote  the  figures  from  Charleston,  while 
the  incidence  on  whites  has  diminished  by  about 
twenty  per  cent.,  that  on  blacks  has  increased  by 
230  per  cent.  As  regard  insanity,  the  tale  is 
similar.  Previous  to  emancipation  there  were, 
as  a  rule,  about  sixty  coloured  patients  in  the 
Eastern  Hospital  for  the  Insane,  Virginia,  where- 
as now  there  are  over  i  ,000.  The  cause  of  these 
changes  is  obvious  enough.  As  slaves  the 
negroes  had  to  Uve  regular,  methodical,  and,  on 
the  whole,  healthy  hves.  Their  houses  were 
comfortable,  their  food  good,  their  clothing 
sufficient.  If  sick,  they  had  prompt  medical 
attendance.  They  were,  in  fact,  valuable 
living  chattels,  and  as  such  their  owners  took 
care  that  their  lives  were  rendered  as  sound 
and  useful  as  possible.  Now-a-days,  however, 
they  must  shift  for  themselves.  They  are  in 
the  midst  of  a  civilisation  which  they  cannot 
understand,  for  which  they  are  quite  unfit. 
Overcrowded,  lazy,  dissipated,  drunken,  and 
ignorant  of  the  evils  resulting  from  such  habits 
they  are  rendered  an  ea^  prey  to  tubercle. 
Formerly  the  negro  had  no  need  to  think  for  the 
morrow — all  was  provided  for  faim.  Now  his 
mind  is  subjected  to  the  stress  of  competition 
in  the  most  advanced  civilisation  of  the  world, 
a  civilisation  alien  to  him,  and  yet  in  which,  if  he  is 


to  survive,  he  must  take  his  place.  It  is  no 
wonder  that  such  conditions  have  conduced  to 
the  fearful  increase  of  insanity  above  noted. 


The  "liive"  Bail  Peril. 
The  convenience  of  rapid  transit  nowadays  is 
not  without  its  drawbacks,  especis^  where  dcc- 
tiicity  is  concerned.  It  is,  no  doubt,  an  immense 
advantage  to  be  conveyed  swiftly  from  the  subuiiis 
to  the  city  and  vice  versd,  but  with  fresh  forces 
fresh  dangers  have  arisen.  Several  fatalities  have 
lately  occurred  owing  to  contact  with  the  so-called 
*'  live  "  rails  upon  railway  lines,  and  the  inquiry 
instituted  by  the  Board  of  Trade  has  shown 
that  the  danger  is  by  no  means  a  theoretical  one. 
It  has  been  stated  that  the  voltage  of  current 
upon  the  Metropolitan  ''  tube "  railway  is  not 
sufficiently  high  to  produce  a  fatal  result  through 
mere  contact.  Death  from  shock  ensues  only 
when  the  body  completes  the  circuit  between  the 
"  live  "  and  the  running  rail,  and  even  then  it 
would  be  necessary  for  the  current  to  pass  for  an 
appreciable  space  of  time.  The  fatal  cases  ex- 
amined by  Dr.  Oliver  and  reported  in  the  Lancet 
show  that  the  bums  inflicted  by  contact  with  the 
current-bearing  rail  are  deep  in  extent,  and  of  an 
unusually  necrotic  type.  The  question  of  pro- 
tection of  '*  live  "  rails  is  one  which  must  be  con- 
sidered seriously  by  the  railway  companies  and 
municipal  authorities,  and  though  it  is  impossible 
to  cover  in  the  rail  throughout  its  whole  length, 
yet  adequate  protection  should  be  secured  for  the 
pubUc  at  all  accessible  points.  It  is  satisfactory 
to  learn  that  guard  rails  are  now  being  affixed 
upon  the  Underground  Railway  wherever  a  "  hve  " 
rail,  which  is  placed  at  the  side  of  the  track,  is 
exposed  to  view.  Another  danger  exists  in 
the  case  of  the  electric  tramways  from  the  risk 
of  the  overhead  "  live  "  or  trolley  wire  breaking. 
When  such  an  event  occurs,  which  happily,  is  not 
frequent,  it  is  again  necessary  far  the  circuit  to 
be  completed  via  the  human  body  before  un- 
pleasant  consequences   ensue. 


PERSONAL. 


It  is  not  generally  known  among  the  medical  pro- 
fession that  the  speaker  of  the  House  of  Commons  is 
the  son  of  a  medical  man,  the  late  Mr.  James  Manby 
Gully,  M.D.,  of  Great  Malvern. 


The  British  Association  is  going  somewhat  far  afield 
for  its  next  meeting,  which  is  to  be  held  at  Capetown, 
under  the  Presidency  of  Professor  George  Darwin,  ©f 
Cambridge. 


The  new  rector  of  BerUn  University  for  the  coming 
year  is  a  member  of  the  medical  profession,  namely. 
Professor  Oscar  Hertwig,  Director  of  Medicine  and 
of  Philosophy,  and  Director  of  the  Anatomo-Biological  j 
Institute,  and  member  of  the  Academy  of  Science  of 
Berlin. 


August  31,  1904. 


CORRESPONDENCE. 


Ths  Mbdioll  Pixss.     235 


^  MivjOR  Ronald  Ross.  C.B.,  F.R.S.,  has  received  the 
distinction  of  being  elected  Foreign  Corresponding 
Member  of  the  Paris  Academy  of  Medicine. 

A  SIMILAR  recognition  of  professional  eminence  has 
been  conferred  by  the  Academy  upon  Dr.  Weir  Mitchell. 
of  Philadelphia. 

Professor  Tillaux,  President  of  the  Paris  Academy 
of  Medicine,  has  been  created  Grand  Ofiicier  of  the 
Legion  of  Honour,  by  the  President  of  the  French 
Republic,  who  is  himself  a  medical  man. 


The  appointment  of  Dr.  J.  E.  M.  Brown  to  be  a 
District  Surgeon  in  the  service  of  the  Federated  Malay 
States  has  been  confirmed. 


I>R.  C.  G.  Cassidy  succeeds  Dr.  A.  Bain,  who  has  been 
transferred  as  Medical  Officer  in  Charge  of  the  Empcm- 
yana  Leper  Asylum,  Cape  of  Good  Hope. 

Mr.  C.  M.  Tuke  has  been  elected  President  of  the 
West  London  Medico-Chirurgical  Society  for  1904-$. 


The  resignation  by  Dr.  Boyd  of  the  Medical 
ofiicership  of  South  Shields,  has  created  a  vacancy  for 
which  there  are  now  six  selected  candidates. 


^liss  McCaul  and  Miss  Elaine  St.  Aub>ii  who. 
under  the  personal  sanction  of  the  Queen,  went 
out  last  March  to  Japan  to  inspect  and  report 
upon  the  Japanese  military  nursing  both  in  the  field 
and  at  the  base  hospitals,  are  returning  to  England  in 
the  P.  and  O.  steamship  Sardinia,  which  is  due  at  Til- 
bury on  September  5. 

Special  Corredpoti&ence* 

[from   our  SFECrAL  CORRBSPONDENTS.] 


SCOTLAND. 
A  Government  Caution  as  to  Vaccination 
Certificates. — A  memorandum  as  to  the  granting 
of  certificates  of  successful  vaccination  has  been  issued 
by  the  Local  Government  Board,  in  which  it  is  stated 
that  the  Board  have  had  their  attention  drawn 
to  the  statements  made  in  the  reports  of  medical 
ofiicers  of  health  regarding  cases  of  small -pox  in 
children  who  presented  no  evidence  of  successful 
vaccination,  either  in  the  presence  of  local  scars  or  in 
modification  of  the  disease,  although  said  by  the  parents 
to  have  been  vaccinated.  Similar  cases  have  been 
observed  in  the  course  of  inspection  of  contacts. 
Further  inquiry  showed  that  in  many  sadi  cases  a 
certificate  of  successful  vaccination  had  been  lodged 
with  the  registrar.  The  Board  are  satisfied  that 
considerable  laxity  exists  in  the  granting  of  such 
certificates,  in  respect  that  they  are  not  always  founded 
on  personal  inspection  of  the  child  after  a  sufficient 
interval,  and  occasionally  have  even  been  signed 
at  the  time  of  the  operation,  when  its  result  was  un 
known,  and  when  subsequent  inspection  would  have 
disclosed  failure.  The  certificate  bears  that  the  opera 
tion  was  performed  by  the  person  who  signed  it,  and 
that  it  has  succeeded,  and  if  in  either  respect  the 
certificate  is  false  the  signatory  is  liable  to  a  criminal 
prosecution.  A  case  which  occurred  in  1872  is  quoted 
in  which  a  sentence  of  four  months'  imprisonment  was 
imposed  on  a  practitioner  who  granted  certificates  of 
successful  vaccination,  though  the  vaccination  had  not 
taken  efiect,  and  the  Board  desire  to  make  it  publicly 
known  that  if  in  future  any  case  of  this  nature  come*; 
to  their  knowledge,  it  will  be  their  duty  to  report  it  to 
the  Crown  with  a  view  to  proceedings  being  taken. 


BELFAST. 

Public  Sanatoria  for  Phthisis. — ^The  question  of 

consumptive  sanatoria   is   much   before   the   Belfast 

public  just  now.  being   discussed    in    the  Municipal 

Council,,  in  the  Board  of  Guardians,  and  in  the  local 


press.  The  Corporation  has  already  decided  to  pro- 
vide a  sanatorium,  and  sites  are  being  examined  for 
the  purpose  at  present.  The  Guardians  have  now 
decided  that  they  also  will  provide  a  sanatorium,  if 
the  Local  Government  Board  will  permit,  and  have 
asked  leave  to  purchase  a  house  and  grounds  loiown 
as  the  **  Abbey,"  at  Whitehouse,  some  four  mUes 
from  the  city,  on  the  north  side  of  the  Lough.  Two 
strong  objections  have  been  raised  to  their  proposed 
action :  First,  that  they  ought  to  combine  fcHTces  with 
the  Corporation  and  not  attempt  to  run  a  separate 
sanatorium  ;  and  second,  that  if  they  do  decide  on  a 
sanatorium  of  their  own,  the  proposed  site  is  unsuitable. 
As  regards  the  first  point,  there  can  be  no  doubt  that 
two  sanatoria  will  cost  more  than  one,  and  the  rate- 
payers must  find  the  difference.  The  Corporation 
propose  to  start  with  a  scheme  for  100  patients,  and 
are  willing  to  take  patients  from  the  workhouse  at  a 
fixed  rate  of  payment,  provided  they  are  considered 
curable.  The  Guardians  say  that  the  Corporation 
scheme  is  too  small  to  be  of  use,  as  they  themselves 
have  usually  200  to  300  consumptives  in  the  work- 
house infirmary.  Further,  they  say  that  they  must 
make  provision  for  all  cases,  curable  or  other- 
wise, and  difficulties  would  arise  in  selecting  those 
for  treatment  in'  the  Corporation  sanatorium.  As 
regards  the  question  of  site,  if  it  is  decided  to  provide 
a  workhouse  sanatorium,  the  "  Abbey,'  though  not  an 
ideal  site,  is  probably  as  good  as  could  be  found.  It 
is  true  that  it  is  on  a  cold  clay  soil,  not  well  drained 
and  near  the  muddy  shore  of  Belfast  Lough,  but  it 
is  160  feet  above  the  sea,  has  a  south  aspect,  some 
trees  to  shelter  it  on  the  north,  and  it  is  cheap. 

Thf.  Small-Pox  Outbreak. — The  genera!  outbreak 
of  small  pox  which  threatened  Ulster  a  fortnight  ago 
seems  to  be  passing  off  without  doing  much  damage, 
due  no  doubt  to  the  very  vigorous  means  which  were 
adopted  to  combat"  the  disease  in  every  town  in 
which  it  appeared.  After  Belfast,  the  worst  outbreak 
was  in  Armagh,  where  twenty-one  cases  occurred,  five 
being  severe  confluent  cases,  eleven  discrete,  and  five 
modified.  As  the  accommodation  was  insufficient,  a 
shed  divided  into  two  wards  each  to  contain  fifteen 
patients,  was  built  at  a  cost  of  /200.  No  fresh  cases 
have  appeared  in  Omagh.  Monaghan,  or  Enniskillen. 
Three  severe  cases  are  under  treatment  in  Castle- 
blayney  workhouse.  As  is  always  the  case,  the 
scare  is  having  some  excellent  results.  For  one  thing, 
the  inhabitants  of  the  districts  where  small-pox  has 
occurred  are  flocking  in  hundreds  to  be  vaccinated. 
Then  it  has  led  the  Guardians  in  many  of  the  country 
towns  to  set  their  hou<^s  in  order,  and  carefully 
consider  the  accommddation  available  if  cases  should 
occur  in  their  district,  for  whatever  shortcomings  the 
ratepayers  may  overlook,  they  will  certainly  not 
forgive  any  slackness  in  dealing  with  small-pox.  It  is 
extraordinary  how  strong  the  dread  of  this  disease 
remains,  in  spite  of  the  fact  that  generations  have 
passed  away  since  it  devastated  the  country. 


Cotredponbence* 

[We  do  not  hold  otinolvis  FM^oMlUt  for  the  opinions  o(  our 
Oorrespondento,] 


THE    DIMINISHING    BIRTH-RATE. 
To  the  Editor  of  The  Mbdical  Press  and  Circular. 

Sir, — ^^While  weighing  the  gage  thrown  down  by 
Dr.  Taylor  with  a  view  to  testing  the  justice  or  otherwise 
of  his  challenge,  up  rushes  LL.D.  with  lance  pointed 
and  vizor  down.  This  anonymous  champion  straight- 
way assails  me  fiercely,  not  as  a  neutral  critic,  but  as 
Dr.  Taylor's  sworn  foe.  Let  us  see  what  wounds  he 
has  inflicted. 

On  p.  33  of  your  issue  of  July  13th,  I  said,  "  In  1884 
the  total  birth-rate  (of  the  United  Kingdom)  stood 
at  31."  It  should  have  read  :  The  average  of  the  five- 
yearly  period,  1 884- 1 888,  stood  at  3 12.  To  refute 
my  figures  for  the  United  Kingdom  Dr.  Taylor 
quoted  the  returns  for  England  and  Wales  in 
1884.      That     error     is    rendered     none    the     less 


236    Thk  Mbdical  Press. 


CORRESPONDENCE. 


August  31.  19  04. 


grotesque  by  LL.D.'s  showing  that  my  figure  of 
31  for  the  total  birth-rate  of  1884  is  wrong. 
LL.D.  strikes  wide,  however,  when  he  says  that  my 
argument  "  founded  on  the  assumption  that  the  birth- 
rate in  1884  was  only  31,  therefore  falls  to  pieces." 
That  is  true  so  far  as  it  goes,  but  the  main  argument 
of  that  part  of  the  article  is  independent  of  the 
figures  31.  Accepting  LL.D.'s  correction,  I  see  no 
Reason  to  alter  my  very  mild  and  moderate  con- 
clusion as  stated  in  the  following  passage :  "  My 
figures,  I  am  aware,  may  not  be  absolutely 
accurate  but  I  think  it  may  be  safely  concluded 
that  the  fall  in  the  married  birth-rate  is  much  less 
than  that  shown  by  Dr.  Taylor.  In  a  word,  his 
figures  are  vitiated  at  the  outset  by  his  failure  to 
consider  the  facts  of  the  extra-marital  condition  of 
illegitimacy.  It  is  impossible,  therefore,  to  accept  his 
(Dr.  Taylor's)  fundamental  proposition  that  '  we  may 
take  the  birth-loss  in  the  United  Kingdom  as  due  to 
causes  operating  in  the  married  life  of  its  inhabitants.' " 
Let  LL.D.  justify  Dr.  Taylor's  logical  blunder  if  he 
can  ;  it  will  not  be  done  by  pointing  to  a  fortunately 
non-essential  blunder  that  has  crept  into  my  article. 

Dr.  Taylor  shows  an  equal  misconception  of  what  I 
say  when  he  wrote  on  August  loth,  that  I  "  build 
my  main  argument  on  the  1884  rate  being  31."  I  do 
nothing  of  the  kind.  I  assure  both  him  and  LI^D. 
that  the  single  one  of  my  various  arguments  concerned 
is  so  little  s^ffected  by  the  figures  that  I  am  wilUng  to 
cut  out  of  the  passage  in  my  article  (p.  32  Medical 
Press  and  Circular.),  from  "  his  figures,"  down  to 
"  condition  of  illegitimacy." 

My  abandonment  of  these  figures  disposes  of  LL.D.'s 
further  attack  on  my  estimate  of  what  would  happen 
had  there  been  no  decline  in  the  rate  of  illegitimacy.  I 
am  not  an  advocate  on  one  side  or  the  other,  and  am 
open  to  correction.  The  fallacy  is  self-evident  of 
J>T,  Taylor's  assumption  that  the  decline  in  the 
birth-rate  is  due  to  causes  afiecting  married  life, 
when  he  fails  to  consider  the  illegitimacy  included  in 
the  total  rates. 

Lastly,  the  social  and  economic  conditions  are  so 
absolutely  different  in  New  South  Wales  that  con- 
clusions founded  on  an  investigation  there  would 
have  little  application  to  the  United  Kingdom.  In 
New  South  Wales,  for  instance,  there  is  universal 
suffrage,  and  members  of  Parliament  are  paid  for 
their  services.  These  two  facts  alone  will  show  the 
vast  gulf  between  the  two  countries,  which  I  still 
maintain  may  be  described  by  the  homely  comparison, 
familiar  enough  in  my  own  Western  county,  of  the 
difference  between  chalk  and  cheese.  I  have  often 
noted  how  the  simple  directness  of  hobnailed  philosophy 
nettles  those  who  love  subtleties  and  sweeping  general- 
ities rather  than  rigid  logical  analysis. 

Why  does  not  LL.D.  come  into  the  light  of  day  and 
let  us  know  who  he  is  ?  Surely  he  is  not  afraid  of 
injury  to  some  great  reputation  and  authority  ?  To 
my  mind  no  man,  without  signing  his  name,  has  any 
right  to  pen  such  a  sentence  as  that  of  LL.D.'s  when 
he  says :  **  The  loose  way  in  which  Dr.  Walsh  handles 
figures  puts  him  almost  outside  the  pale  of  statistical 
controversy."  The  question  naturally  arises,  who 
put  LL.D.  inside  that  pale  ?  There  is  only  his  letter 
to  judge  by,  and  at  the  end  of  it  we  find  our  old,  old 
friend,  the  petiiio  principt'i.  In  accusing  me  of  favour- 
ing a  policy  of  *^smug  complacency,"  LL.D.  simply 
calls  names  where  he  should  furnish  formal  proof. 
This  question-begging  shows  that  whatever  his  years 
and  experience  he  does  not  always  observe  the  rules 
of  sound  argument.  If  he  can  produce  a  "  crushing 
refutation  "  to  my  "  fallacies  "  such  as  he  says  is  to 
be  found  in  the  Report  of  the  New  South  Wales  Com- 
mission, I  shall  be  the  first  to  welcome  his  exposure, 
provided  it  stands  the  tests  of  formal  critical  examina- 
tion. 

I  am,  Sir,  yours  truly, 

David  Walsh. 

Hanover  Street,  London,  W. 
August  26th,  1904. 


To  the  Editor  of  The  Medical  Press  and  Circulai. 

Sir, — ^WiU  you  allow  nie  to  answer  the  questions 
submitted  by  your  corresi)ondent  "  Qualified  Assis- 
tant ?  "  On  consideration,  it  must  be  obvious  to 
him  that  the  special  question  whether  '*  A  "  or  "  B  " 
did  right  to  marr>',  must  depend  on  many  reasons— 
on  their  age,  education,  chsuracters,  habits,  and  cir- 
cumstances, and  in  the  cases  before  us  I  have  alto- 
gether insufficient  data  on  which  to  form  an  opinion. 
But  whether  married  or  not,  I  do  hold  that  strict 
temperance  in  all  allowable  sensual  gratification,  and 
abstinence  from  that  which  is  inallowable,  is  right  and 
good,  not  only  for  the  individual,  but  for  his*  or  her 
future  progeny. 

Such  principles  carried  out  in  practice  will  not  result 
in  too  early  marriage  nor  in  the  production  of  the 
greatest  possible  number  of  children,  but  should 
result,  I  believe,  in  the  moral  growth  of  the  individual, 
and,  if  married  and  fertile,  in  vigorous,  healthy,  and 
sufficiently  numerous  offspring. 

Applying  such  principles  to  the  particular  cases 
cited,  I  hold  that  even  a  country  practitioner  and  a 
poor  curate  cannot  be  justified  in  using  artificial  meaa 
to  prevent  conception. 

Particular  cases  may  labour  under  unjust  disabilito 
which  demand  redress,  but  two  wrongs  will  not  makt 
a  right. 

The  common  labourerj  in  our  great  cities  (as  Ifr. 
Rowntree  has  shown),  is  too  often  not  paid  a  living 
wage,  sufficient  for  himself,  his  wife  and  a  family  of 
four  children,  but  is  underfed,  under-housed,  and 
underclothed.  This  is  sad  and  shameful,  but  (if  it 
were  possible)  it  would  be  a  poor  remedy  to  sterilise 
the  labourer  or  linMt  his  family  to  one.  The  injustice 
of  insufficiently  paid  labour  would  be  thereby  per- 
petuated. 

Similarly,  in  many  cases  the  stipends  of  the  clergy, 
and  especially  of  curates,  are  deplorably  and  dis- 
gracefully inadequate.  As  the  world  is  at  present 
constituted,  the  practical  philanthropist  must  hope 
that  all  these  cases  of  injustice  will  force  themselves 
more  and  more  on  the  notice  of  the  people  until  they 
refuse  to  grow  rich  or  comfortable  or  instructed  on 
the  enforced  charity  of  those  that  serve  them. 

It  is  no  true  remedy  for  the  clergy  to  sit  down  under 
their  grievances,  and  to  practise  and  encourage  an 
unnatural  sexual  life  which  must  be  more  or  less 
degrading  and  carries  with  it  no  real  element  of  cure. 

Such  a  course  will  onlv  perpetuate  injustice  and 
lower  the  general  ideal  of  religious  life  among  both 
clergy  and  laity. 

ExacUy  the  same  principles,  I  believe,  apply  to  the 
nation  as  to  the  cases  I  have  considered.  Let  us 
admit  that  England  is  too  small  for  the  genuine  natural 
increase  of  its  population.  It  is  the  coward  at  heart 
who,  because  of  this,  ¥dll  resort  to  methods  of  sexual 
congress  "  habitually  adjusted  to  a  certainty  of  im- 
perfection." Rather  should  he  busy  himself  in 
establishing  schools  of  emigration  in  which  his  children 
shall  be  fitted  for  pioneer  life— in  finding  new  markets 
for  his  goods,  and  in  bringing  reliable  knowledge  and 
assistance  to  the  very  doors  of  the  youthful  and  eaiter- 
prising.  It  may  well  be  doubted  whether^the  higher 
ideals  I  am  striving  to  preach  do  not  demand  some 
alteration  in  present  economic  conditions — a  change 
in  the  direction  of  greater  equaUtv  in  the  distribution 
of  wealth.  If  so,  let  us  attack  the  problem  bravely 
and  seriously.  To  fold  our  hands  and  avoid  present 
pain  at  the  cost  of  future  decadence,  is  a  miserable 
and  destructive  policy  for  the  nation  as  well  as  for 
the  family. 

I  am.  Sir,  yours  truly, 

John  W.  Taylor. 

22,  Newhall  Street.  Birmingham. 
August  25  th,  1904. 

MEDICAL   GEOLOGY. 
To  ike  Editor  of  Thb  Mbdical  Prbss  and  Circular. 
Sir, — Geology   is   a  wide   science.     To   some  the 
various  strata  of  our  earth's  cortex  is  of  interest,  and 


August  31,  1904. 


lite;rature. 


Thk  Medical  Press.    237 


their  relation  to  each  other,  and  the  forces  that  have 
disturbed  them.  The  chemist,  the  mineralogist,  and 
the  engineer  may  have  to  study  some  branch  of  geology ; 
md  there  is  no  doubt  but  that  some  kno^dedge  of 
Ideology  should  be  possessed  by  the  members  of  the 
nedical  profession.  When  we  are  analysing  the 
climatic  character  of  any  country  or  locality,  the 
irst  thing  to  look  to  is  the  nature  of  the  soil.  In 
England  the  differences  are  great.  We  may  find  two 
places  on  parts  of  our  coast  where  temperature,  rain- 
fall, sunshine,  and  other  external  influences  are  much 
the  same,  but  where  the  conditions  of  the  atmosphere 
iiffer  much.  Now  that  the  question  of  open-air 
treatment  of  lung  diseases  is  of  interest,  it  would  be 
well  to  be  careful  to  study  the  soil,  as  upon  that  so 
much  depends.  It  would  be  well  for  doctors  to  know 
the  difEerences  between  clay,  chalk,  greensand.  and 
Silurian,  geologically,  chemically,  ai}d  medically. 
Without  such  knowledge,  we  are  not  competent  to 
deaJ  properly  with  the  wide  question  of  climate. 
I  am.  Sir.  yours  truly, 

R.  L. 


SURGEON-MAJOR  FRENCH.  M.B.Ed., 
M.R.C.S.Eng.,  L.R.C.P. 
Major  George  Brooke  French,  of  the  Indian 
Medical  Service,  who  died  last  week  at  Tunbridge 
Wells,  was  a  graduate  of  the  University  of  Edinburgh. 
He  obtained  his  M.B.  in  1894,  and  was  prizeman  in  a 
number  of  subjects  and  took  first-class  honours  in 
many  others.  He  was  also  gold  medallist  in  medical 
iorisprudence  and  prizeman  in  surgery  in  the  Edin- 
burgh School  of  Medicine.  He  qualified  as  a  member 
of  the  Royal  College  of  Surgeons.  England,  in  188;, 
and  as  a  licentiate  of  the  Royal  College  of  Physicians. 
London,  the  following  year,  in  which  he  joined  the 
Indian  Medical  Service.  In  1891  he  took  part  in 
the  expedition  to  Manipur,  for  which  he  had  the  medal 
with  clasp  :  and  in  September,  1898,  became  a  Major. 

Xitetatute* 


PHYSICAL  DETERIORATION.(a) 
It  is  a  significant  fact  that  the  progress  of  civilisa- 
tion is  fraught  with  disadvantages  to  the  lower  strata 
of  society,  which,  it  is  to  be  feared,  more  than  com- 
pensate for  the  ethical  evolution  and  enhanced  comfort 
of  the  more  favourably  situated  members  of  the  com- 
munity.    In    spite  of    philanthropic    and    municipal 
efforts  overcrowding  proceeds  apace,  and  the  sanitary 
condition  of  our  slums  is  the    despair    of    sanitary 
experts.     Here  and  there  one  perceives  a  ray  of  light, 
authorising  the  hope  of  better  times  ahead,  such,  for 
instance,  as  the  spread  of  the  sanitary  gospel  of  fresh 
air,  the  importance  of  cleanliness  and  so  on.     But  we 
are  confronted  with  the  fact  that  a  large  proportion  of 
our  labouring  population  live  and  move  and  have  their 
being  under  conditions  which  render  fresh  air  and 
personal   cleanliness   physical  im|>ossibilitie8.      It   is 
estimated  that  3,250.000  persons  in  the  British  Isles 
live  in  overcrowded  dwellings,  that  is  to  say,  with  an 
average  of  three  persons  in  a  bedroom  ;  we  are  told 
that  in  York,  for  instance.  228  houses  have  between  them 
only  33  closets,  while  442  have  only  30  water-taps, 
the  tap  often  being  placed  in  the  wall  of  the  w.c.     How 
are  people  to  get  fresh  air  in  a  climate  like'ours  with  an 
average  air-space  of  only  200  cubic  feet  per  individual. 
These    Uunentable    conditions     are    notorious,    so 
notorious  that  it  is  unnecessary  to  allege  concrete 
examples,  since  every  city  furnishes  a  parallel.     The 
physical  deterioration  which  such  conditions  engender, 
as  set  forth  in  detail  on  a  bed-rock  of  personal  observa- 
tion by  the  author,  is  bu  t  what  one  must  expect .     More- 
over, the  effects  of  unhygienic  surroundings  are  en- 
hanced by  the  carelessness  and  ignorance  of  mothers 
in  respect  of  the  alimentation  and  general  care  o^ 

(a)  <•  Physical  Dettfloi«tion  :  ita  Oautes  and  tha  Cure."    By  A. 
watt  Smith.    Landon  :  John  Marray.    190i     Price  Oi; 


their  offspring,  resulting  in  a  lamentable  waste^of  infant 
life. 

But  the  remedy  I  Obviously  many  of  the  conditions 
are  the  consequence  of  a  social  system  which  presses 
hardly  on  the  wa^e-eaming  classes,  and  admit  of  but 
slow  and  uncertam  amelioration.  It  is  idle  to  pro- 
mulgate laws  and  enforce  measures  for  the  prevention 
of  overcrowding  when  every  rookery  razed  to  the  ground 
intensifies  the  overcrowding  in  the  neighbouring  area, 
when  rapacious  and  unscrupulous  landlords  are  allowed 
to  exact  rents  which,  in  amount,  are  inversely  to  the 
healthiness  of  the  tenements. 

Nevertheless,  the  author,  who  has  gone  very  tho- 
roughly into  the  subject,  is  enabled  to  make  various 
practical  suggestions  to  attenuate,  if  not  to  arrest, 
the  progress  of  physical  deterioration.  The  medical 
inspection  and  physical  culture  of  school  children, 
their  better  alimentation,  the  training  of  mothers,  and 
the  dissemination  of  a  knowledge  of  elementary  hy- 
giene— these  are  measures  which  would  certainly  tend 
to  prolong  life  and  to  raise  the  phjrsical  standard  of 
the  rising  generation.  Then,  too,  the  sUimentation  of 
the  adult  population  is  a  question  of  the  greatest  im- 
portance, both  from  ph3^iological  and  economical 
points  of  view.  If  we  can  enlarge  the  dietetic  horizon, 
if  we  can  impart  a  knowledge  of  how  to  choose  good 
food  and  how  to  cook  it.  we  shall  improve  the  physical 
condition  and  increase  the  comfort  of  the  labourer's 
existence,  and  pro  tanto  lessen  the  temptation  to  alco- 
holic indulgence.  We  are,  however,  inclined  to  agree 
with  the  author  that  no  great  progress  can  be  hoped  for 
unless  the  matter  be  taken  in  hand  from  the  earliest 
stage  of  child  life,  beginning  by  securing  an  adequate 
supply  of  clean  milk  for  hand-fed  infants.  In  towns, 
at  any  rate,  it  must  be  difiicuU  to  make  up  for  short- 
comings during  infancy. 

It  is  generally  assumed  that  the  tendency  of  the  rural 
population  to  aggregate  in  towns  is  the  result  of  a 
natural  law  which  we  are  powerless  to  circumvent. 
But  in  reality  it  is  nothing  of  the  kind.  Farm  la- 
bourers leave  the  land  because  they  are  inadequately 
paid,  and  because  of  the  wearisome  monotony  of  their 
lives.  They  have  to  live  in  tumbledown  cottages, 
when  they  are  fortunate  enouf^h  to  find  one  in  which  to 
lay  their  heads,  and  their  livmg  is  of  the  plainest.  In 
old  age  they  have  only  the  workhouse  to  look  forward 
to.  Were  there  a  system  which  would  enable  them 
to.live  in  humble  comfort,  with  a  cottage  and  a  garden 
of  their  own,  if  their  employers  only  took  the  trouble 
to  provide  some  sort  of  amusement  for  their  scanty 
hours  of  leisure,  no  such  wholesale  emigration  to  the 
towns  would  occur.  The  system  of  "  small  holdings  " 
is  the  one  great  inducement  that  can  be  offered  to  the 
farm  labourer  to  remain  in  the  country. 

Theauthor  has  discussed  these  points,  and  manyothers, 
in  a  magisterial  manner,  validating  the  statements 
by  copious  references  to  Blue  Books  and  official  reports. 
She  establishes  the  existence  of  a  wide-spread  evil 
which  threatens  to  sap  the  virility  of  the  race,  she 
studies  its  etiological  factors,  and  she  proposes  the 
appropriate  remedies.  Truly  the  task  is  a  heavy  one, 
but  it  is  not  beyond  the  power  of  man  to  compass  its 
ultimate  achievement.  The  author  has  no  panacea 
to  offer  us,  but  she  makes  it  clear  that  we  have  the 
remedy  in  our  own  hands.  It  is  a  matter  for  individual 
effort  in  the  main,  laws  being  inoperative  as  against 
ignorance  and  indifference.  We  would  appeal  to  all 
who  are  in  earnest  in  this  crusade  against  disease 
and  racial  decadence  to  read  this  eloquent  indictment 
and  to  co-operate  in  the  endeavour  to  inaugurate  a 
happier  future. 

SWAFFIELD    ON    LAPAROTOMY    WOUNDS,  (a) 

In  this  most  original  little  work  Dr.  Swaffield  has 

collected  the  detailed  methods  adopted  by  some  fifty 

of    the  leading  Continental  surgeons   in  closing  the 

(«}  "The  Cloaura  of  Laparotomy  Wooada  aa  Praetiaed  in  OennAOy 
and  Auatria;  Indudio^  Detailed  Mathoda  and  Viewa  Oommuaicated 
by  orar  Fifty  Leading  8aiv«>na.*'  Bditad  and  tranalated  by  W.  H. 
Swaffield,  F.B.O.S.,  H.D.  London:  J.  and  A.  COiurohill.  Pp.  72. 
1904 


238     Th»  Medic ai.  Pekm. 


LITERATURE. 


August  31,  1904, 


1 


incision  made  in  abdominal  coeliotomy.  The  different 
methods  enumerated  may  be  roughly  divided  into 
two  groups : — ^Those  in  which  a  simple  through-and- 
through  suture  is  adopted,  and  those  in  which  some 
method  of  suture  in  layers  is  adopted.  We  note  that 
eleven  alone  of  the  fiity  operators,  whose  views  are 
given,  are  in  favour  of  the  former  method,  and  that 
the  majority  of  these,  while  they  are  all  names  of 
great  weight,  still  represent  the  older,  rather  than  the 
younger,  school  of  surgeons.  This  coincides  very 
closely  with  our  own  views  on  the  subject,  and  we 
doubt  that  there  is  any  future  before  the  simpler 
method.  To  believe  that  a  through-and- through 
suture  can  be  made  to  bring  about  the  same  natural 
restitution  of  the  parts  that  can  be  obtained  by  suture 
in  layers  is  to  us  impossible.  It  may  be,  and  we  do  not 
doubt  it  in  this  case,  that  an  exceptional  operator  can 
obtain  excellent  results  by  the  through-and-through 
suture,  but  even  if  he  does  do  so,  it  is  beside  the  ques- 
tion. What  is  required  is  the  method  which  will  give 
the  best  results  in  the  hands  of  the  ordinary  surgeon, 
without  demanding  the  expenditure  of  an  undue 
amount  of  time.  We  are  sorry  that  Howard  Kelly's 
method  of  suturing  has  not  found  a  place  in  this  little 
brochure,  as  it  has  always  appeared  to  us  to  be  one  of  the 
best,  if  not  the  best  of  methods. 

"  THE  EDINBURGH  MEDICAL  JOURNAL  (a) 

The  present  volume  (No.  XV)  of  the  Edinburgh 
Medical  Journal  maintains  the  high  standard  of  ex- 
cellence attained  by  its  predecessors.  The  original 
contributions  are  'twenty-seven  in  number,  and  the 
majority  of  them  are  of  a  practical  character.  We 
need  do  no  more  than  quote  some  of  the  titles  to  show 
how  helpful  the  literature  of  the  volume  must  be 
to  men  in  active  practice.  "  Strangulated  Hernia."  "  The 
Cardiac  Muscle,"  "  The  Stools  of  Dysentery,"  "  The 
Treatment  of  Bronchiectasis,"  "  Cesarean  Section  for 
Contracted  Pelvis,"  "  Fibrinous  Bronchitis,"  and 
"  The  Neural  Factor  in  Heart  Disease."  Besides 
all  this  the  volume  contains  a  series  of  articles  on  "  Tlie 
Insanities  and  Criminal  Responsibility,"  by  Sir  John 
Batty  Tuke,  and  Mr.  C.  R.  A.  Howden,  Advocate, 
which  is  of  permanent  value,  and  giving,  as  it  does, 
the  ripe  experience  of  such  a  distinguished  alienist  as 
Sir  John  Batty  Tuke,  cannot  be  overlooked  by  those 
specially  concerned  with  the  study  of  mental  diseases 
and  social  reforms.  Under  the  heading  "  Recent 
Advances  in  Medical  Science,"  the  different  provinces 
of  medical  science  are  passed  under  review  in  each 
monthly  number :  Medicine,  surgery,  obstetrics, 
gynaecology,  therapeutics,  pathology,  diseases  of  the 
ear,  nose  and  throat,  and  public  health ;  this  last 
section  is  edited  by  Dr.  J.  Buchanan  Young,  and  is  one 
of  the  most  interesting  summaries  of  the  progress  of 
preventive  medicine  with  which  we  are  acquainted. 
We  have  occupied  an  unusual  amount  of  space  in  this 
notice,  but  we  feel  that  we  could  not  otherwise  have 
given  our  readers  a  true  picture  of  the  wealth  of  in- 
formation the  journal  contains.  Well-selected  matter 
of  a  practical  character,  conveniently  arranged  and 
excellently  designed  to  meet  the  requirements  of  the 
student  and  the  busy  practitioner.  The  printing, 
illustrations,  and  paper  are  all  good,  and  the  volume 
reflects  credit  on  all  concerned  in  its  publication. 

BLAND-SUTTON  ON  TUMOURS.  (6) 
In  the  third  edition  of  this  admirable  work  the 
author  has  made  some  important  alterations  and  ad- 
ditions. The  term  *'  epithelioma  "  has  been  abandoned 
and  replaced  by  the  phrase  "  squamous-celled  cancer." 
We  regard  this  change  as  a  good  one.  on  the  ground  that 
it  places  the  nomenclature  and  classification  of  these 
tumours  on  a  more  satisfactory  basis.  Another 
marked  step  in  advance  is  the  separation  of  ovarian 
fibroids  and  myelomata  from  the  sarcoma  group,  and 

(«)  ''The  BdiDbargh  Xedieal  jMumaL"  Edited  by  O.  A.  Oibwo. 
M.D.,  F.B.aP.Ed.,  and  Al«zk  ThompMMi,  W.D.,  F.S.a&Ed.  Naw 
Btries.    ToL  XV.    Bdinbnrirh  Mid  London :  Yomi«:  J.  Pentknd,  190i. 

(6)  "Tumoun,  Innocent  and  MaliffBant."  By  J.  Bland.Satton. 
F.B.O.S.  Thiid  edition,  with  312  illustraUoBS.  .S66pp.  CaaseU  and 
Co, Ltd.    IMS. 


their  recognition  as  separate  entities.  We  think 
it  probable  that  in  a  later  edition  the  author  viO 
deal  similarly  with  "  deciduoma  malignum,"  vfaich 
he  provisionally  places,  in  this  edition,  among  the 
sarcomata.  We  should  have  liked  to  see  a  fuller 
account  of  these  tumours,  with  some  illustrations; 
but  no  doubt  the  reason  of  the  brief  description  pvea 
is  to  be  found  in  the  uncertainty  which  the  author 
regards  as  still  prevailing  as  to  the  true  nature  of 
"  deciduoma."  As  a  matter  of  fact,  a  very  important 
contribution  to  the  subject  was  made  soon  after  this 
volume  was  published.  Mr.  Bland-Sutton  has  am- 
plified the  section  on  uterine  fibroids,  and  has  done 
excellent  service  to  the  sufferers  from  these  tumours 
by  demonstrating  the  modes  in  which  fibroids  imperil 
life.  In  the  second  edition  the  section  on  echino- 
coccus'colonies  was  omitted,  but,  yielding  to  representa- 
tions from  readers  who  regretted  the  omission,  the 
section  has  been  restored  with  additions,  which 
render  it  a  valuable  feature  of  the  book. 

It  is  not  necessary  to  enter  upon  a  detailed  criticism 
I  of  a  book  which  is  so  well  known,  and  which  may  be 
ranked  as  a  classic.  This  third  edition  is  a  wcrthy 
successor  to  the  previous  ones,  and  fully  maintains 
the  author's  high  reputation  as  an  authority  on  the 
subject.  •  To  any  of  our  readers  who  may  not  previously 
have  made  the  acquaintance  of  "  Tumours  "  we  cor 
dially  recommend  it  as  a  book  from  which  they  will 
derive  a  vast  amount  both  of  pleasure  and  of  profit. 


RIDDELL'S  MANUAL  OF  AMBULANCE.  («) 
In  revising*  this  well-known  ambulance  hand-book 
the  author  has  taken  the  opportunity  of  extending 
its  already  recognised  utihty  by  making  certain 
material  additions  to  it.  We  would  particularly  note 
the  excellent  new  series  of  full-page  illustrations  of 
stretcher  drill  which  are  extremely  well  reproduced. 
He  has  also  added  a  chapter  on  electrical  accidents, 
while  that  on  the  organisation  of  ambulance  classes 
has  been  considerably  amplified,  and,  we  think, 
improved.  The  chapter  on  anatomy  and  physiology 
contains  some  very  good  plates,  while  the  explanatory 
text  treats  the  subject  in  a  very  lucid  manner.  In 
deahng  with  ambulance  transport  and  stretcher  drill, 
the  author  gives  what  is  perhaps  one  of  the  best 
accounts  of  these  subjects  which  can  be  obtained. 
It  is  not  only  clear  and  to  the  point,  but  it  is  so  well 
illustrated  that  the  student  should  have  no  difficulty 
in  mastering  the  details  of  this  very  important  branch 
of  ambulance  work. 

It  is  a  pity  that  the  author  should  have  inserted  a 
chapter  on  the  after-treatment  of  ambulance  cases. 
Surely  the  principles  of  first  aid  do  not  come  into 
operation  once  that  aid  has  been  given.  There- 
fore we  think  '  more  harm  than  good  is  likely  to 
ensue  from  the  insertion  ot  temperature  charts  and 
figures  of  Leiter's  tubes.  In  a  subsequent  edition 
we  should  certainly  advise  the  withdrawal  of  this 
chapter  altogether.  Apart  from  this,  we  'can 
thoroughly  endorse  all  the  good  things  that  have 
been  said  regarding  previous  editions  of  this  work. 
This,  the  latest,  edition  will  be  found  not  only  an 
admirable  guide  for  students,  but  a  useful  work  of 
reference  for  teachers. 


GOWERS'S  MEDICAL  OPHTHALMOSCOPY.  (6) 
It  is  now  twenty-five  years  since  this  import- 
ant work  was  first  issued.  Since  then  the  science  of 
ophthalmoscopy  has  undergone  many  changes,  and 
improvements  in  the  instruments  used  in  its  study, 
together  with  advance  of  knowledge  of  the  mocbid 

(a)  «  A  ManoAlof  AmbuUnce."  By  J.  Scott  BiddelU  CM.,  KR. 
M.A.,  Senior  Surgeon  and  Lecturer  on  Clinical  Sunecy,  Aberdeen 
Royal  Inflrmary,  Ac.  Fifth  Edition.  Bevised  and  Eniarnd.  4f. 
London:  Ctaas.  Qriffln and  Co.,  Ltd.     Ifl04. 

(h)  ''AMaaaal  and  Atlas  of  Medical  OphthalmoMDiv.'  ^8 
Wm.  B.  Gowen.  M.D..  F.B.C.P.,  F.B8..  Bon.  VeWciw,  Boyal  Ool 
lege  of  Physioiant  of  Ireland.  Oongultlng  Phyeloian  toTTniTcnitr 
College  Hoepital.  Ac  Fourth  Edition.  Edited  by  the  A«lhor«iid 
MarcoeCtana,  M.B..  F.R.aS..  Sufgeon  to  the  Bmna  LoadonM. 
thalmic  Hon>ital,  Ophthalmio  Surgeon  to  the  NtlSoael  E<m& 
for  the  Paralyeed  and  Bplleptio.  lie.  net.^'  LoadM  :  J.  aedA. 
Cburchill.  1904 


August  31,  1904. 


MEDICAL  NEWS. 


The  MsmcAL  P&xst.  239 


conditions  observed,  have  made  it  incumbent  upon  the 
author  to  call  in  the  aid  of  an  ophthalmic  surgeon, 
so  as  to  bring  the  work  thoroughly  up  to  date.  He 
h.as  been  fortunate  in  obtaining  the  services  of  Mr. 
Marcus  Gunn,  "  whose  experience/*  as  the  author 
aptly  remarks,  '•  has  been  wide  in  range  and  wisely 
used." 

The  general  plan  of  the  work  is  so  well  known  that 
we  need  hardly  do  more  than  refer  to  it  here.  In  the 
first  portion  retinal  and  optic  nerve  changes  are  dealt 
with  ierioHm,  the  condition  of  optic  neuritis  being 
treated  of  in  a  particularly  exhaustive  and  complete 
manner.  The  second  portion,  however,  is  the  one 
which  is  most  useful  to  the  physician,  as  in  it  the 
ophthalmoscopic  clumges  occurring  in  special  diseases 
are  full^  gone  into.  In  speaking  of  tuberculous 
meningitis,  Gowers  points  out  that  tubercles  of  the 
choroid  are  less  frequently  found  than  in  general 
tuberculosis  without  meningitis.  He  gives  6' 5  as 
the  percentage  of  cases  of  locomotor  ataxy  associated 
with  optic  atrophy,  and  incidentally  mentions  that 
•"  tabes  must  be  ascrit>ed  to  the  action  on  the  nervous 
system  of  a  post-syphilitic  toxin." 

The  appendix  consists  of  a  series  of  valuable  auto- 
types which  have  been  somewhat  improved  in  this 
edition.'  They  are  certainly  beautiful  reproductions, 
and  illustrate  in  a  singularly  clear  way  the  various 
morbid  conditions  met  with  in  ophthalmoscopic 
examination.  While  they  can  never  replace  practical 
work,  these  plates  are  of  the  greatest  possible  service 
for  reference  by  those  who  have  diflftculty  in  making 
a  diagram  of  the  ophthalmoscopic  appearances  pre- 
sented on  the  examination  of  any  particular  case. 

There  is  no  work  in  any  language  to  compare  with 
the  one  under  review.  It  has  hitherto  been  regarded 
as  a  standard  work  of  reference  on  medical  ophthal- 
moscopy. This  new  edition  is  certain  to  increase  its 
popnlsurity  not  only  in  this  country,  but  also  abroad, 
and  ii  must  for  many  years  to  come  remain  the 
authori:ative  expression  of  all  that  is  best  in  British 
and  foreign  teaching  on  the  subject. 


Ttao  Plague. 

The  following  telegram  from  Sir  Cavendish  Boyle, 
Governor  of  Mauritius,  has  been  received  at  the 
Colonial  Ofiice : — ^For  week  ending  August  25th,  ten 
cases  of  plague,  five  fatal. 

Alien  Lunatics. 

A  RETURN  was  recently  presented  at  the  Lancashire 
Asylums  Board  meeting  at  Preston  showing  the  number 
and  nationality  of  alien  patients  in  the  asylums.  The 
total  numbers  were  88  males  and  46  females.  Of 
these  six  were  Americans,  two  Arabs,  two  Austrians, 
one  Belgian,  one  British  St.  Vincent,  one  Dane,  two 
Dutchmen,  five  Frenchmen,  28  Germans,  11  German 
Jews,  one  German  Pole,  one  Greek,  12  Italians,  five 
Norwegians,  one  North  American  negro,  seven  iPoles, 
one  Portuguese,  two  Roumanians,  seven  Russians,  four 
Russian  Jews,  one  Russian  Pole,  one  South  African, 
two  South  Americans,  two  Spaniards,  13  Swedes,  one 
Morocco  Jew,  and  14  whose  nationalties  were  unknown. 
Ront«ren  Rays  for  the  Russian  Army. 

It  is  stated  that  the  Russian  hospital  which  is  being 
sent  to  the  seat  of  War  by  the  citizens  of  Moscow  will 
have  a  first-rate  Rontgen  ray  outfit.  From  the 
report,  it  would  almost  seem  as  if  the  advantages  of 
that  method  of  diagnosis  had  not  yet  been  widely 
adopted  by  the  medical  profession  in  Moscow. 
Bequests  to  Msdical  Charities. 

Under  the  will  of  Mrs.  Jane  Bowron,  of  Hove,  who 
died  on  July  17th  last,  the  sum  of  ;(2,ooois  bequeathed 
to  the  Sussex  County  Hospital ;  £1, 500  to  Lady  Kinnaird 
Memorial  Hospital  for  Women,  at  Benares  ;  ;£  1,500  to 
the  Agra  Medical  Missionary  Training  Institute, 
affiliated  to  the  Medical  Missionary  Society,at  Moming- 
side  Park,  Edinburgh  ;  and  ^1,000  to  the  Brighton, 
Hove,  and  Preston  Medical  Dispensary. 


PASS  LISTS. 
University  of  London, 

At  the  general  intermediate  examination  in  medicine 
for  internal  students  held  in  July,  the  following  candi- 
dates were  successful : — 

Ella  Mabel  Barker,  Charles  Anthony  Basker» 
Harold  Garfield  Bennett,  Sylvia  Rose  'M.  Black- 
stone,  Mary  Alice  Blair,  Harry  Blakeway,  Gerald 
Tyler  Burke,  Thomas  W.  Higgins  Bume,  Angel 
Camacho,  Thomas  E.  Ashdown  Carr,  Henry 
Joseph  Gates,  Herbert  Stanley  Chate,  Bertram 
Walter  Cherrett,  Arthur  Beauchamp  Coomber,  Herbert 
Rees  Davies,  Kenelm  Hutchinson  Digby,  Reginald 
Lionel  Ernest  Downer,  Sheldon  Francis  Dudley, 
Robert  Cecil  Turle  Evans,  Mamiaduke  Fawkes,  Allan 
Bains  Feamley,  William  Stephen  Fenwick,  Janet 
Marcia  Fishe,"  Alexander  Fleming,  Sidney  Frank 
Fouracre,  Ernest  Wiliam  Giesen,  Sidney  Wilfred 
Griniwade,  Edith  Mary  Guest,  John  Hadwen,  Eric 
Henry  Rhys  Harries,  Henry  John  Henderson,  Tom 
Shadick  Higgins,  John  Ernest  Hodson,  Hendrik 
Houwink,  Douglas  Walter  Hume,  Mary  Sophia 
Jevons,  Elizabeth  Herdman  Lepper,  Clifford  Antony 
L.  Mayer,  Marian  Mayfield,  Minnie  Merrifield,  Ethel 
Mary  Morgan,  William  Poole  Henley  Munden.  Frederic 
Miller  Nield,  Henry  John  Nightingale,  Humphrey 
Nockolds,  Edgar  Lional  Robert  Norton,  Charles 
Aubrey  Pannett,  Walter  Patey,  Catherine  Payne, 
August  Frederick  Perl.  Arthur  John  Scott  Pinchin, 
Edward  John  Price,  Mona  Dew  Roberts,  Richard 
Cadwaladr  Roberts,  Henry  Charles  Samuels,  William 
Octavius  Sankey,  Marie  Simpson.  Eliza  Macdonald 
Smith,  Henry  Joste  Smith,  George  French  Stebbing, 
Alfred  K.  B.  R.  W.  Tavlor,  Douglas  Compton  Taylor, 
Alfred  Charles  Foster  turner,  James  Richard  Henry 
Turton,  Winifred  Emmeline  Watts.  Harry  Gordon 
Webb,  Leonard  Henry  Wootton,  and  Carl  Ernst  Zundel. 

At  the  intermediate  examination  in  medicine  for 
external  students  held  in  July,  the  following  can- 
didates were  successful : — 

Laurence  Ball,  Sydney  Herbert  Booth,  Ernest 
Frederick  Finch,  Robert  Applegarth  Hendry,  James 
Ernest  Middlemiss,  Edward  Selby  Phipson,  Harry 
Richardson  RawUngs.  Arthur  Toulmin,  Arthur  Henry 
Turner,  and  Joseph  W.  James  Willcox. 
Unlvsrslty  of  Oxford 

The  following  degrees  in  medicine  were  conferred 
during  the  summer  term  : — 

Doctors  of  MtfrfictW.— Thomas  E.  C.  Cx)le,  Edgar  W. 
Willett,  William  A.  P.  Waters,  Gustav  J.  Schorstem, 
and  Arthur  E.  Boycott  and  John  D.  Rolleston. 

Bachelors  of  MeMcine  and  Surgery.--W.  B.  BilHng- 
hurst,  A.  C.  Inman,  A.  F.  Hertz,  A.  E.  A.  Loosely. 
J.  H.  Thomas,  R.  D.  MacGregor,  and  P.  A.  Mansfield. 

Degree  days  are  announced  as  follows  for  the  coming 
term :— Thursday,  October  20th  ;  Thursday,  Novem- 
ber loth;  and  Saturday.  December  17  th.  Examina- 
tions for  scholarships  offered  in  natural  science  will  be 
held  on  December  6th.  at  Balliol  College,  Christ  Church, 
and  Trinity  College  ;  on  December  13th,  at  Lincoln  and 
Magdalen  Cx)lleges ;  on  January  17th.  1905,  at  Jesus 
College  ;  and  on^March  14th,  1905,  at  Keble  College. 
Soetoty  of  Apothecaries  of  London. 

At  the  examinations  held  in  August,  the  following 
candidates  passed  in  the  siibjects  indicated  : — 

Surgery. --K.  H.  Cooper  (Section  II.),  A.  W.  S. 
De  Vine  (Sections  I.  and  II.),  E.  F.  W.  Hoare  (Sections 
I.  and  II.),  A.  C.  Story  (Sections  I.  and  II.).  and  R.  H. 
Terry  (Section  L).  ^   ^   o 

Medicine.^G.  B.  Messenger  (Section  I.),  C.  S.  Scott 
(Section  II.),  I.  C.  Thorbum  (Sections  I.  and  II.),  A. 
B.  S.  Todd  (Section  IL),  and  S.  H.  R.  Welch  (Sections 
I-  and  IL).  ^     ^     ,^^ 

Forensic  Medictne,--^.  W.  S.  Boggs,  E.  F.  W. 
Hoare,  J.  E.  Jones,  I.  C.  Thorbum,  and  H.  M.  Waller. 

Midwifery.— V/.  G.  H.  Cable,  and  W.  R.  Elliott. 

The  diploma  of  the  Society  was  granted  to  the 
following  candidates  entitling  them  to  practise  medicine, 
surgery,  and  midwifery ;  :— R.  H.  Cooper,  A.  C.  Story, 
A.  B.  S.  Todd,  and  S.  H.  R.  Welch. 


240    The  Medical  Press.       iNOTICES  TO  CORRESPONDENTS. 


1 


August   31,  19041 


JlottUB  to 

€i>rrt«p0ttitttt0,  gHwrt  %aitxB,  itc 

IKS^  OoumFONDFKfs  requiting  a  reply  in  this  column  are  partioa 
larlj  requested  to  make  use  of  a  dUtimcHw  Signatwn  &r  InUitUt  an 
avoid  the  praotibe  of  signing  themselves  "Reader,"  "Subsoriber," 
**  Old  Subscriber,"  *o.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

OueiRAii  A&noLn  or  LamibB  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  publics, 
tion,  but  as  evidence  of  identity. 

CoNTKiBUTOBS  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
offloe  ;  if  reeidenc  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

BvBiRTS.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

yr,  D.  Camtab.— The  only  way  of  protecting  yourself  against 
such  an  unpleasant  contingency  in  future  is  to  refuse  to  give 
evidence  before  being  paid  your  fee.  It  is  open  to  you  to  refuse  this 
in  the  witness-box  be/ore  you  are  sworn. 

THE  PRESEBVATION  OF  RUBBER  0ATHETEB8. 
To  the  BdUor  o/Thb  Mboxcal  Pbkss  avd  Cihculab. 

Soi.'Gan  any  of  your  readers  tell  me  how  to  keep  red  rubber 
(flexible)  catheters  from  becoming  "  sticky/'  I  find  if  they  have 
been  in  constant  use  for  about  a  month  they  swell  and  lose  their  gloes 
I  have  tried  boiling,  etc.,  hut  all  to  no  use." 

Olasnevin,  August  Soth.  Yours  truly,  F.  Windeb. 

A  correspondent  writes  : 

Six,— Perhape  some  of  your  readers  can  give  me  some  advice  in  the 
following  case  :  An  officer,  age  46,  still  serving  in  mihtia.  of  good 
general  health,  applies  for  insurance.  He  has  served  througn  various 
arduouscampelgns  but  escaped  serious  illness  or  injury  except  on 
one  occasion.  He  was  then  shot  through  the  thigh  with  a  low 
velocity  bullet,  and  had  a  septic  wound  that  caused  extensive  damage 
to  the  leg.  He  lost  two  stones  in  wsJght,  and  which  he  has  not 
regained  after  ten  years  interval.  He  is  organically  sound,  so  fto  as 
one  can  tell,  except  that  the  specific  gravity  of  urine  is  1006,  bat  not 
excessive  in  quantity.  This  life  is  clearly  not  flrst-rate.  Is  it  insurable  ? 

Yours  faithfully,  C.  F. 
THE  DIMIiaSHING  BIBTHBATfi. 
Vide  Tm  Mxdical  Prkss  and  the  Bishop  of  Bipon. 
I  thank  the  foreei^t.  uommonaense. 

Which  on  mv  birth  have  smiled 
And  made  me  in  this  crowded  world 
An  only  healthy  child. 

The  Psalmist,  had  he  lived  to-day 

In  truth  would  not  be  able 
To  caU  him  blessed  who  has  swarms 

Of  children  round  his  table. 

My  bishop  and  my  doctor  both 

Quote  dismally  statistics. 
The  Politician,  on  his  side 

Quotes  overcrowded  districts 

My  mother  knows  were  she  to  aid 

A  still  decreasing  birth-rate 
A  fight  would  come  to  keep  paid  up 

The  gas  bQl  and  the  poor  rate. 

I  thank  (as  I  remarked  before), 

Although  I'm  rather  lonely 
That  commonsense  which  keens  me  still, 

My  parents  "  one  and  onlj.'^~  Onlooker. 

StIiVAHITH  writes  that  he  has  received  a  letter  from  a  consultant 
physician  under  the  following  circumstances.  A  patient  came  under 
his  care  with  secondary  syphilis.  I^  appears  that  this  patient  was 
sent  to  the  consultant  by  a  mutual  friend  who  paid  the  first  fee,  but 
was  not  prepared  to  pay  for  a  course  of  treatment.  The  patient 
then  came  luder  our  correspondent's  care.  A  few  days  later  a  note 
came  from  the  consultant  recommending  the  administrMion  of 
iodide  of  potassium,  together  with  mercurv,  on  aooount  of  the  high 
temperature,  and  saying  how  the  esse  had  come  under  his  notice. 
Our  correspondent  asks  What  he  should  do. 

[In  our  opinion,  as  the  consultant  has  gone  out  of  his  way  to  pre- 
vent any  misunderstanding  it  would  be  only  courteous  of  our 
oorrespondent  to  write  a  detailed  answer,  and  if  he  does  not  agree 
with  the  suggested  plan  of  treatment  to  state  briefly  his  views  on  the 
point.— BdTm.  p.  &  CI 

A  HOSPITAL  CUBIOBITY. 

WHur  pulling  down  the  old  Waterloo  Hospital  for  Children  tot  the 
new  building,  a  discovery  was  made  under  the  foundation  stone  of  a 
glass  tablet,  with  the  names  of  the  founders  and  date,  &c,  encrusted 
therein.  Also  a  small  copper  coin,  and  copy  of  the  Annual  Beport 
of  the  Hospital  for  the  year  1822,  contained  in  a  bottle,  and  all  in  an 
excellent  state  of  preservation.  Among  the  Patrons  and  Vioe 
Patrons  of  the  Institution  were  the  following  interesting  names  : — 
The  Duchesses  of  Kent,  Northumberland,  and  Princess  Augusta. 


the  Dukes  of  York.  Sussex,  Orsf ton,  Rutland,  Beaufort,  ftc ,  the  Bt 
Hon.  Bobt  Pfeei.  Sir  Humphry  Davy,  and  other  weU  known  Peop is; 


Bradford  Poor-Law  Union.— MedicalOfficer  of  Bana«ariiun.~BesldeBfc 
Medical  Officer.  Salary  £100  per  annum,  with  raUons,  apart- 
ments, and  washing.  Applications  to  Oeqrge  M.  Crowtber. 
Clerk  to  the  Guardians,  22  Mimor  Bow,  Bradford. 

Oardiir  Umon.— Assistant  Medieal  Officer,  fialaty  iSlSO  per  aaniua. 
with  rations,  apartments,  attendance,  and  washing.  AppUcatioos 
to  Arthur  J.  Harris,  Clerk.  Union  Offices,  Queen's  Chamben, 
Cardiff. 

The  Zaaaibar  Government.— Medical  Officer  for  the  Island  of  Ptaaha. 
Salary  £860  per  anmun.  tAppUoations  to  W.  8.  W.  N.^  car»  of 
Streets,  SO  Comhill,B.C.  : 

Down  District  Lunatic  Asylum,  Downpatrick.-^unior  Male  Assis- 
tant Medioal  Oflicer.    Salary    £100  per  annum,  ^""  ' — '^' 
apartments,    board,   washing,    fuel,  lijght,    anc      . 
Applications  to  the  Besident  Medical  Superintondent. 

Wandsworth  Union.- District  Medical  Officer.  Salary  i^OO  per 
annum.  Applications  to  F.  W.  Piper.  Clerk,  Union  Offices,  :it. 
John's  BiU,  Wandsworth. 

Great  Yarmouth  Hospital.— House  Surgeon.  Salary  £80  per  annua, 
with  board,  lodging,  and  washing.  Applications  to  BIchard  F. 
F.  Ferrier,  Hon.  Secretarv,  88  Hall  Plain,  Great  Yarmoutli. 

Hampstead  General  Hospital.— Besident  Medical  Officer.  Salsiy 
£120  per  annum,  with  rooms,  coals,  and  gas.  Api>lioationa  to 
George  Watts,  Secretarv. 

Bootle  General  Hospital,  Liverpool.— Junior  Besident.  Salary  £80 
per  annum,  with  board  and  laundry.  Applioationa  to  the 
Secretary,  Bootle  Hoapital,  Derby  Boad,  Bootle. 

Ballinasloe  District  Asylum.-Hecond  Assistant  Medical  Officer. 
Salary  £140  per  annum,  with  cash  allowance  of  £52  In  lieu  of 
rations,  ete.  Immediate  application  to  the  Resident  Medkal 
Sunerintendent,  James  St.  L.  Kirwan.  <See  Advt.) 

Open-adr  Sanatorium  for  Consumptivss,  Limpley  Stoke,  near  Bath. 
—Besident  Medical  Officer.  Salary  £200  per  annum.  Applications 
to  *'  Chairman,'*  N.A.P.C.  84  Park  Street,  BristoL 


JlptromtmeniB. 

GUEVS,    Arvold    J.,    M.B.C.S.Eng.,  L.B.CP.Lond.,    Hononiy 

Assistant  Medical  Officer  to  the  Royal  Albert  Edward  Infirmary, 

Wigan. 
Jacksok.  F.  W.,  L.R.C.P.Lond.,  M.B.C.S.,  Certifving  Sutireoo  under 

the  Factory  Act  for  the  Market  Rasen  District  of  the  coonlj- 

of  Lincoln. 


$ittlMi. 


BissHOPP.— On  August  26th,  at  Parham  House.  Tonbrldge  Wells,  the 

wife  of  Francis  R.  B.  fiisshapp,  M.A.,  M.D.Oantab.,  M.B.G.P. 

Lond.,  of  a  daughter. 
O'DwTSR.— On  August  17th,  at  Sunnyside,  Tipperary,  the  wife  of  Dr. 

Joseph  O'Dwyer,  of  a  son. 
Badpoed.— On  August  8rd,  at  Naircbi,  East  Africa  Protectorate,  the 

wife  of  William  J.  Radford,  F.B.O.S.,  of  a  son. 
Swain.— On  August  S6th,  at  4  Victoria  Square,  Clifton,  BitetoL  the 

wife     of  James    Swain,   M.S.,    H.D.Lond.,    F.R.a&.  of  a 

daughter. 


BnoMHALL— Dbari.— On  August  24th,  at  S.  Peter's  Church,  Moant- 
sorrel,  Loughborough,  Ernest  Bromhall,  M.B.C  S.Eng.,  L.E.C.P. 
Lend.,  Bawenstall.  to  Beatrice,  only  daughter  of  the  late  Bev. 
Thomas  Drake,  M.A.,  vicar  of  8.  Peter's,  Mountsorrel. 

Dahibl— Welsh.— On  August  2Srd,  at  Ari  Uamto',  Enniamore 
Gardens,  ».W.,  Augusta  Moore  Daniel,  son  of  the  late  Edwaid 
H.  Daniel  L.B  C.S.  (Ireland;,  and  of  Mrs.  Daniel,  Saxifleld, 
Scarborough,  to  Maigery  Katherine,  elder  daughter  of  Willism 
Welsh,  of  Bifrons,  Fleet,  Hants. 

EDiiuin>s— Floto.— On  August  27th,  at  the  Superintendent 
Registrar's  Office,  Westminster,  Percy  J.  Edmunds,  M3.,  B.8c, 
M.awC.S.,  of  5  Great  Marlborough  Street,  London,  W.,  to 
Clara  B.  JSklmunds,  third  daughter  of  the  late  William  Fiord,  of 
Weybridge. 

EWABT— Bbrhxt.— On  August  a4th,at  St.  Thomas's  Church  of  Eiw- 
land,  Edinburgh,  B.  W.  T.  Ewart,  M.B  ,  eUest  son  of  Uenk- 
Colonel  Ewart,  of  AUershaw,  Lanarkshire,  to  Catherine  Ann, 
youngest  daughter  of  8ir  Henry  H.  Bemey,  Bart.,  of  Bartoa 
Bendish,  Norfolk. 

GRiPFrrH— BoBBRTs.— On  August  28rd,  at  Llanystumdwy  Choicb, 
Carnarvonshire,  Idwal  Griffith,  Moria  f  Nevin,  younger 
son  of  Samuel  Griffith,  M.D.,  J. P.,  o  Portmadoc,  to 
Lilian  Gaynor,  elder  daughter  of  John  Boberts,  M.D.,  Tslarror, 
Criocieth. 


^jeatkB. 


C!.ARU.-On  August  14th,  at  Villa  Choisy,  Interlaken,  Switserland. 

Thomas  Claike,M.D.,  in  his  78th  year!  '     '"*""™' 

Whidborvr.— On    August  24th.    at  Warwick  House,  St  Davkl's. 

Exeter,  Catherine  8.  W.  Whidborne,  widow  of    Oeurse  Ferris 

Whidborne,  M.D.,  ag  d  8j. 


Wkt  ^Mial  ^tm  mA  ^tmht 


"SALUS   POPULI   SUPBEMA   LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    SEPTEMBER   7,    1904.     'No.    10. 


CDrfainal  Communications. 


PREVENTIVE  TREATMENT 

OF 

SCARLET  FEVER 

BY  ISOLATION  (AGCiREGATION)  HOSPITAI.S. 

By  HUBERT  E.  J.  BISS,  M.A.,  M.D.Cantab..  D.P.H.. 

BMtboume ; 

Late  AsatoteBt  M •dioal  Ofloer,  Metropolitan  Asylnmt  BoMd. 

PART  II. 

In  the  last  issue  of    The    Medical    Press    and 
Circular    I  spoke  of  the  difficulty  attending  the  dia- 
gnosis of  the  mild  varieties  of  scarlet  fever,  and  of  how 
this  fact  seemed  to  me  to  be  fatal  to  any  consistent 
system  for  extirpating,  or  even  largely  reducing^  the 
incidence  of  the  disease  by  isolation.     These  mild  cases 
occur  even  in  the  most  severe  epidemics,  but  with  the 
change  of  form  that  scarlet  fever  has  undergone  during 
the    last    tiventy-five  or  thirty  years,  they  are  much 
more    frequently  met  with  than  formerly.      Indeed, 
the  whole    character   of   scarlet    fever    to-day    is   so 
benign  that  it  is  a  matter  for  consideration  whether 
the  disease  is  of  sufficient  moment  to  the  community 
to  warrant  large  expenditure  of  money  to  combat  it. 
As  I  said   earlier  in  this  paper,  scarlet  fever  was  a 
dreaded,  and  justly[dreaded,  foe  during  the  middle  of  the 
nineteenth  century.     Its  reign  was  capricious,  auto- 
cratic,    and  arbitrary,  and  its  death-rate  appalling. 
Independent  of  any  human  efiort,  however,  it  gradually 
changed  its  form,  and  before  the  aggregation  hospitsJ 
had  been  established  as  a  recognised  institution,  it  had 
become,  like  the  scarlet  fever  of  Sydenham's  day,  a 
disease  in   name  only.     There  are,  of  course,  still  a 
proportion  of  severe  and  fatal  cases,   but  the  death- 
rate  is  now  so  low,  some  3  per  cent,  on  an  average, 
that  the  importance  of  scarlet  fever  as  an  epidemic 
disease  is  greatly  discounted.     Measles  and  whooping- 
cough  are  far  more  dangerous  and  fatal,  but  the  general 
opinion  is  that  isolation  is  not  worth  trying  as  a  means 
of  controlling  either  of  them ;  and  with  that  opinion 
most  people  who  are  acquainted  with  these  diseases, 
and  have  thought  over  the  subject,  will  be  disposed  to 
agree.     Supposing  it  be  admitted  that  by  the  aggrega- 
tion hospital  system  a  certain  proportion  of  attacks  of 
scarlet    fever  are  prevented,  the  question  has  to  be 
faced  as  to  whether  it  is  a  good  investment  of  the  money 
available  for  preventive  medicine,  to  spend  the  enor- 
mous sums  in  sparing  a  few  persons  the  trifling  discom- 
fort  entailed  by    the    disease   in   its  modern  form. 
For  it  must  be  remembered  that  by  keeping  up  the 
present  contributions  a  hundred  and  one  useful  sanitary 
measures  are  handicapped  or  rendered  impracticable. 
The  matter  from  this  point  of  view  has  a  commercial 
aspect  that  deserves  careful  attention.     If  the  invest- 
ment is  justifiable,  let  it  be  retained;  if  it  is  not  returning 
its  value  in  security  and  relief  to  the  population,  let  it  be 
exchanged  for  some  more  profitable  one.     This  scarlet 
fever  expenditure   is   no   small   matter.     In   London 
three-fifths  of  the  fever  patients  of  the  Metropolitan 


Asylums  Board  are  admitted  for  scarlet  fever,  and  one 
may  therefore  reckon  three-fifths  of  the  Board's  expendi- 
ture as  incurred  on  account  of  that  disease.  Taking 
the  year  1902  one  finds  that  three-fifths  of  the  fever 
hospital  expenses  amounted  to  no  less  than  ;£222,ooo^ 
and  three-fifths  of  thef  ever  ambulance  service  to  £2 1 ,000. 
Without  reckoning  the  proportionate  part  of  the  central 
office  expenses,  one  arrives  at  the  conclusion  that  scarlet 
fever  aggregation  costs  London  some  quarter  of  a 
million  pounds  annually — the  amount  produced  by 
a  penny-halfpenny  rate.  If  one  turns  to  capital  account 
and  takes  three-fifths  of  the  amount  sunk  in  fever  hospi- 
tal construction  and  equipment,  one  finds  :£i,333»oo^ 
incurred  under  this  head,  and  ;£36,ooo  for  capita) 
expenditure  on  ambulance  stations.  In  these  figures 
I  have  not  included  the  cost  of  Gore  Farm  Upper 
Hospital,  which  is  frequently  used  for  scarlet  fever, 
nor  the  amount  proposed  to  be  spent  on  the  new 
hospital  of  800  beds  at  Carshalton.  Here,  again,  one 
ought  to  add  three-fifths  of  the  capital  expenditure  on 
the  central  office,  but  leaving  these  items  and  interest 
on  borrowed  money  out  of  account,  the  bill  amounts, 
to  practically  one  and  a  half  million  pounds.  It  is 
difficult  to  escape  from  the  reflection  that  a  disease 
which  causes  only  some  five  or  six  hundred  deaths  a 
year  in  London — deaths  that  would  by  no  means  be 
averted  were  the  hospital  service  suspended  to- 
morrow— is  hardly  worth  so  much  expense.  Without 
advocating  unreservedly  the  use  of  these  hospitals  for  the 
treatment  of  tuberculosis,  I  cannot  but  think  that  far 
greater  relief  would  be  accorded  to  sufiering  humanity 
if  they  were  so  employed.  At  the  moment  three- 
quarters  at  least  of  their  accommodation  is  devoted  to 
sustenance  of  healthy,  able-bodied  persons  whose  only 
sin  against  their  fellows  lies  in  the  possession  of  a  little 
shaggy  skin  on  their  hands  and  feet.  If  they  were  all 
let  loose  to-morrow  there  would  probably  be  no  rise  in 
the  scarlet  fever  notifications;  the  experiment  has 
been  tried  elsewhere,  and  no  adverse  results  followed. 

When  speaking  of  the  records  of  epidemics  of  scarlet 
fever  in  the  past,  I  referred  to  the  constant  confusion 
of  that  disease  with  other  throat  affections,  especisOly 
diphtheria,  and  I  ventured  to  express  my  impression 
that  the  two  diseases  often  prevailed  side  by  side. 
Nowadays,  when  we  have  a  standard  of  reference  for  the 
diagnosis  of  that  which  we  call  diphtheria,  we  find 
that  the  old  clinical  distinctions  are  not  of  the  value 
that  they  were  once  thought  to  be.  If  "  diphtheria  " 
gains  in  distinctiveness  by  the  possession  of  its  own 
bacillus,  its  borders  are  broadened  to  include  a  number 
of  cases  that  have  only  that  bacillus  as  their  credential 
to  the  term.  Nor  is  this  all.  Many  a  case  that  for- 
merly gave  the  diagnostician  no  hesitation,  no  arrihfi 
pens^e  of  any  kind,  is  now  looked  upon  with  a  suspicion 
which  can  be  dispelled  only  by  the  bacteriologist.  A 
proportion  of  scarlet  fever  cases,  varying  according  to 
circumstances,  always  contain  Klebs-Loffler  bacilli,  in 
combination  with  other  organisms,  in  the  throat-exuda- 
tion. Now,  although  these  cases  may  present  clinically 
no  symptoms  of  diphtheria,  they  are  potent  to  infect 
with  the  diphtheria  organism,  not  only  their  neighbours 
in  a  ward  or  house,  but  even  themselves  at  a  later 
(convalescent)  stage  of  their  own  illness.  Consequently 
the  scarlet  fever  wards^of  a  hospital  are  seldom  long 


1 


242    The  Mbdical  PttBsg.        ORIGINAL  COMMUNICATIONS. 


Sept.  7,  1904. 


without  diphtheria  breaking  out  in  them,  and  it  is 
difficult  to  see  how  this  can  be  avoided.  Were  all  cases 
on  admission  subjected  to  bacteriological  examination, 
and  detained  in  wards  separate  from  the  other  scarlet 
fever  patients  during .  their  residence  in  hospital,  it 
might  be  that  post-scanatinal  diphtheria  would  become 
less  frequent.  But  the  administrative  difficulties  of 
arranging  for  such  isolation  are  great,  and  till  they 
are  overcome  it  must  be  anticipated  that  scarlet  fever 
patients  will  suffer  from  the  evils  of  indiscriminate 
aggregation,  and  diphtheria  be  a  common-place  inci- 
dent among  scarlet  fever  convalescents.  Aggregation 
of  human  beings  is  a  non-rational  device  and  eJways 
finds  its  reflection  in  disease  outbreaks  ;  this  is  true  of 
every  form  of  aggregation  that  has  ever  been  brought 
about — camps,  towns,  schools,  prisons,  and  what-not. 
Hospitals  have  shared  this  tendency  in  the  past,  and 
they  continue  to  exhibit  it  even  under  modem  regula- 
tion. Even  in  well-planned  buildings  in  which  every 
precaution  that  sanitary  science  can  suggest  is  adopted, 
the  mere  accumulation  of  human  beings  under  one 
roof  has  been  shown  to  be  essentially  vicious.  Thus, 
Dr.  Sykes  in  his  Milroy  Lectures  to  the  College  of 
Physicians  in  1 901,  speaking  of  the  Peabody  and  Model 
buildings  in  St.  Giles's,  pointed  out  that  whereas  in 
these  dwellings  (which  contain  a  good  class  of  tenant, 
well  supervii^)  the  general  and  infant  mortality  is 
much  below  that  of  London  generally,  nevertheless 
the  death-rate  from  certain  infectious  diseases  is  in 
excess — a  result  he  attributed  to  nothing  but  the  aggre- 
gation of  numbers  of  people  in  a  limited  space. 

Without  amounting  to  alarming  proportions  post- 
scarlatinal diphtheria  is  still  common  enough  to  give 
cause  for  serious  misgiving,  though,  happily,  its  mor- 
tality is  enormously  reduced  by  early  diagnosis  and 
serum  treatment  from  what  it  was  in  pre-anti toxin 
days.  If  one  takes  the  records  of  the  last  five-year 
period  (1898- 1902)  of  the  Metropolitan  Asylums  Board 
Hospitals,  one  finds  that  2,562  patients  admitted  for 
scarlet  fever  contracted  diphtheria  in  hospital,  and  of 
these  105  died.  Nor  was  this  result  accomplished  by  any 
particular  epidemic  :  it  was  due  to  the  day-in  and  day- 
out  sequence  of  little  groups  of  infections  in  different 
hospitsds  and  different  wards.  The  regularity  of  the 
appearance  of  diphtheria  may  to  a  certain  extent  be 
gauged  by  the  yearly  figures.     Thus : 


Year. 

No.  of  Cases. 

Deaths. 

Mortality  p.c. 

1898 

661 

24 

3-6 

X899 

692 

25 

3-6 

1900 

405 

12 

296 

1 901 

380 

23 

6-05 

1902 

424 

21 

4*95 

Here  it  will  be  seen  that  except  for  slight  fluctuations 
the  average  of  post-scarlatinal  diphtheria  was  well 
maintained  in  each  year,  and  it  seems  likely  to  continue 
to  be  so  under  prevailing  conditions.  Thinking  that 
diphtheria  infection  of  scarlet  fever  patients  was  per- 
haps the  result  of  receiving  patients  suffering  from  the 
two  diseases  into  the  same  hospitals,  the  managers  of 
the  Metropolitan  Asylums  Board  arranged  in  1901 
to  use  for  their  separate  treatment  two  neighbouring 
hospitals — the  Grove  and  the  Fountain — the  former 
being  reserved  for  diphtheria,  the  latter  for  scarlet  fever. 
One  year's  experience  sufficed  to  show  that  this  method 
was  not  of  any  avail  for  the  purpose,  and  the  old  arrange- 
ment was  consequently  reverted  to.  Not  only  is 
diphtheria  a  constant  occurrence  in  scarlet  fever  wards, 
but  scarlet  fever  is  equally  a  feature  of  diphtheria 
wards,  and  though  figures  under  this  head  are  not  avail- 
able for  citation,  I  should  give  it  as  my  general  im- 
pression that  post-diphtheritic  scarlet  fever  is  about  as 
common  as  post-scarlatinal  diphtheria.  It  may  safely 
be  said,  at  any  rate,  that  scarlet  fever  is  a  very  usual 
feature  of  diphtheria  wards.  But  scarlet  fever  in 
diphtheria  wards  and  diphtheria  in  scarlet  fever  wards 
are  not  the  only  banes  of  the  fever  medical  officer's 
life,  for  measles,  whooping-cough,  rotheln,  and  chicken- 
pox  are  daily  events,  and  frequently  two  or  more  of 
these  maladies  occur  synchronously.  The  number  of 
beds  available  for  hospital  purposes  is  practically  always 
gravely    curtailed    by    various    wards    being    placed 


hors  de  combat  from  outbreaks  of  one  or  other  of  these 
diseases,  and  it  is  idle  to  say  that  such  occurrences  are 
not  a  serious  blot  on  the  efficiency  of  the  institutiaas, 
not  to  mention  the  opprobrium  they  bring  on  the 
administration.  A  fever  hospital  has  been  wittily 
described  as  "  a  place  where  you  go  in  with  one  disease 
and  catch  all  the  others."  Like  most  epigramn:iatic 
sayings,  this  is  more  hen  trovato  than  exact,  but  it  con- 
tains a  germ  of  truth.  Under  present  circumstance, 
and  without  enormously  increasing  the  expenditure  on 
these  hospitals,  I  fail  to  see  how  things  are  to  be 
otherwise. 

Another  danger  of  the  fever  hospital — ^likewise  to  a 
great  extent  unavoidable — is  that  of  wrong  primary  dia- 
gnosis of  the  disease  from  which  the  patient  is  suffering. 
If  protection  is  to  be  afforded  by  the  hospital,  prompt 
and  early  removal  of  the  patient  is  essential  to  success. 
Medicine,  however,  does  not  lend  sufficient  aid  to  its 
followers  to  ensure  this  being  always  done,  and  one 
is  not  surprised  that  a  large  number  of  patients  are 
annually  sent  in  certified  to  be  suffering  from  scarlet 
fever  who,  in  fact,  are  not.       During  the  same  five-year 
period  (1898- 1902)  that  I  have  before  referred  to,  I 
find  that  into  the  Metropolitan  Asylums  Board  Hospi- 
tal, 3.1 18  persons  were  admitted  for  scarlet  fever  who 
were  the  subject  of  other  maladies.     The  proportioe 
they  bore  to  the  total  admissions  wa9    as   follows  :— 
1898,  47  per  cent. ;   1899,  3*9  per  cent. ;    1900,  5*8  per 
cent. ;    1901,  5'9  per  cent. ;    1902,  4*8  per  cent.     It  is 
one  thing  to  say  that  a  person  has  scarlet  fever,  but 
quite  another  tlung  to  say  that  he  certainly  has  not,  so 
that  in  practice  the  usual  course  is  to  retain  patients 
so  certified  till  the  diagnosis  can  be  confirmed  or  refoted. 
Thus  many  persons  are  detained  in  hospital  for  a  fort- 
night or  three  weeks,  and  as  isolation  acconmiodatioD  is 
not  always  available,  a  certain  number  of  them  dis- 
prove the  original  diagnosis  by  catching  scariet  fever 
while  under  observation.     For  a  reduction  of   these 
mistaken    primary    diagnoses    one    cannot    look.    If 
scarlet  fever  is  to  be  dealt  with  vigorously  under  aoy 
isolation   plan,   it   will   become   necessary    to  certif? 
and  remove  on  suspicion  a  vastly  larger  proportion  oif 
doubtful  cases  tlum  at  present.    Little  as  one  may 
like  the  prospect,  I  can  see  no  alternative  if  this  pre- 
ventive measure  is  to  be  thoroughly  tried  and  pus^ 
to  its  logical  conclusion. 

But  even  if  all  these  difficulties  and  disabilities  couli 
be  removed,  there  remains  one  further  circumstance 
which,  like  the  fly  in  the  'pothecary's  ointment,  is  like  to 
spoil  the  whole  of  the  roseate  scheme.     This  mild 
disease  has  proved  hitherto  as  little  susceptible  to  the 
wooings  of  the  clinician  as  to  the  big  guns  of  the 
municipal  sanitary  department.     It  is  neither  charmed 
by  the  one  nor  frightened  by  the  other.     Like  a  007 
girl,  scarlet  fever  grudgingly  reveals  its  secrets  to  those 
who  pay  it  attention,  and  only  those  whose  information 
is  derived  solely  from  text-books  can  think  they  have 
any  knowledge  of  the  vagaries  of  the  disease.     It  must 
have  been  supposed  by  those  responsible  for  inaugura- 
ting the  aggregation  hospital  that  scarlet  fever  was  an 
acute  infectious  disease  that  ran  a  fairly  definite  course, 
and  left  the  patient  at  the  end  of  a  fixed  period  free  to 
mingle  with  his  fellow-men  without  endangering  their 
health  by  his  proximity.    If  there  is  one  thing  that  the 
aggregation  hospital  has  done,  it  has  been  to  demon- 
strate its  own  ineptitude  as  a  safeguard  against  scarla- 
tinal infection.  Clinical  knowledge  of  scarlet  fever  has 
been  wrung  little  by  little  from  studying  the  disease 
at  close  quarters  under  hospital  conditions,  and.  though 
it  be  not  yet  generally  admitted,   there  can  now,  I 
think,  be  no  reasonable  doubt  that  the  lengthened 
infectivity  of  scarlet  fever  is  due  to  certain  local  lesions 
produced  by  the  disease  tending  to  run  a  subacute  or 
chronic  course  in  certain  constitutions.  The  chief  of  the 
lesions  are  inflammations  affecting  the  pharynx,  naso- 
pharynx, ear  and  nose.   The  class  of  case  in  which  these 
events  occur  must  surely  have  been  overlooked  by  the 
founders  of  the  hospital  system,  for  it  invalidates  and 
renders  nugatory  no  inconsiderable  proportion  of  the 
benefit  that  might  otherwise  accrue  to  the  commun- 
ity   from    the    preventive    influence   of   the  system. 


Sept.  7,  1904. 


OiQGINAL  COMMUNICATIONS. 


Turn  Medical  Puss.     245. 


Inflammatory  lesions  of  the  pharynx  in  scarlet  fever  are 
almost  invariably  characterised  by  a  persistence  that 
contrasts  markedly  with  the  course  of  like  lesions  in 
diphtheria.     A  few  days  after  even  a  severe  attack  of 
diphtheria  will  generally  find  a  patient's  throat- tissues 
psde.  not  swollen,  clean  and  white.     With  scarlet  fever, 
even  if  ulceration  does  not  occur,  nearly  always  one 
finds  the  throat  reddened  for  a  long  time,  the  tissues 
more  or   less  oedematous,    the   submaxillary    lymph 
glands  hard  and  knotty.     A  similar  intensity  marks 
inflammations  of  the  naso-pharynx  and  nasal  tissues 
when  these  are  affected,  and  the  otitis  media  of  the 
disease  is  usually  a  persistent  one.     Moreover,  for  a 
long   time  after  apparent   convalescence,    any   slight 
chiU  or  similar  adverse  circumstance  is  apt  to  convert 
these  subacute  conditions  into  active  ones,  and  recru- 
descence of  the  pharyngitis,  rhinitis,  or  otitis  media 
results.     Especially  in  children  with  hypertrophy  of 
the  adenoid  tissues  of  the  naso-pharynx  and  obstruc- 
tion to  the  free  passage  of  air  through  the  nose,  does 
this  happen.     These  inflammatory  lesions  of  the  upper 
air  passages  may  directly  follow  the  primary  attacks  of 
scarlet  fever,  or  they  may  remain  quiescent  for  a  long 
time.     Frequently  they  subside  j  not  infrequently  they 
persist.     The  subjects  of  these  manifestations  suffer  at 
intervals  from  tonsillitis  or  pharyngitis  ;  submaxillary 
lymph-adenitis,  leading  perhaps  to  abscess ;    chronic 
otitis  media,  with,  sometimes,  infection  of  the  cells  of  the 
temporal  bone,  lateral  sinus  or  brain  ;  chronic  rhinitis 
with  nasal  discharge.     The  more  serious  of  these  affec- 
tions   naturally    detain      the     patient    in    hospital 
till  death  or  cure  release  him,  but  a  quiescent  otitis 
media  or  rhinitis,  offering  as  they  both  do  no  external 
sign  of  their  presence,  allow  many  a  patient  to  be  sent 
home  in  a  potentially  infectious  state.     It  is  impossible 
to  attribute  blame  to  the  medical  officer.  So  common 
are  these  chronic  lesions  that  if  one  waited  till  all  sign  of 
inflammatory   trouble  had  disappeared   from   throat, 
nose,  and  ear,  a  good  half  of  the  patients  would  be 
detained  for  many  months.     Practically  this  is  im- 
possible, and  the  rule  is  to  send  home  those  cases  which 
do  not  exhibit,  after  a  period  of  weeks,  any  sign  of 
active  disease.     The  general  result  is  that  the  conditions 
gradually  disappear,  but  unfortunately  this  is  not  al- 
ways so.     Some  tangible  or  intangible  influence  resus- 
citates the  lurking  poison,  and  discharge  from  the  nose 
or  ear  appears  from  the  revived  inflammation ;  the  child 
is  then  at  least  as  infectious  as  he  was  on  the  day  he 
came  to  hospital.   Every  fever  hospital  has  i ts  "  return ' ' 
cases,  as  they  are  called,  no  matter  how  careful  its 
administration.     No  one  can  tell  which  of  a  hundred 
discharged  cases  will  prove  to  be  infectious  afterwards, 
but  one  knows  that  three,  four,  or  five  of  them  will  infect 
their  relations   or  plajrfellows,    sooner  or   later.     In 
fact,  as  a  medium  for  disseminating  scarlet  fever,  it  is 
difficult  to  conceive  of  anything  more  appropriate  than 
a  healthy  youngster,  who  has  no  worse  trouble  than  a 
running  nose,  attending  school,  gambolling  with  his 
mates,  and  daubing  their  toys  with  the  secretions  of 
his  infected  nasal  tnucous  membranes.     Mere  retention 
of  these  cases  with  chronic  lesions  of  the  upper  air 
p>assages  in  hospital  does  not  suffice  to  emasculate  the 
infection ;    one  patient  of  the  Metropolitan  Asylums 
Board  was  kept  for  eight  months  on  account  of  a  nasal 
disc£iarge,  but  returning  home,  apparently  cured,  he 
conveyed   scarlet   fever   to  his   brothers  and   sisters. 
Various  devices — ^none  very  promising,  perhaps — have 
been  resorted  to  to  obviate  the  slur  which  the  return 
case  is  supposed  to  cast  on  hospital  administration,  but 
so  far  none  have  achieved  even  a  modicum  of  success. 
The  liability  to  discharge  cases  that  prove  afterwards 
to  be  infectious  lies  in  the  facts  that  scarlet  fever  is  a 
disease  with  subacute  and  chronic  tendencies  ;  that  we 
have  but  poor  means  of  diagnosing  in  which  case  these 
tendencies  will  be  displayed;  and  that  the  hospital  system 
is  impotent  to  provide  means  to  control  them.     There 
is  one  minor  reform  that  might  accomplish  some  good : 
I  mean  abandonment  of  the  traditional  practice  of  giving 
children  a  hot  bath  immediately  before  sending  them  out 
of  the  hospital  gates.      Any  measure  better  calculated 
to  stir  into  activity  the  smouldering  inflammations  in 
the  upper  respiratory  passage  it  is  hard  to  imagine. 


But   this   really   is  a  side  issue;  the  whole  question  is^ 
far  deeper  and  broader  and  more  far-reaching.     The 
point  is  that  the  hospital  system  and  clinical  know- 
ledge and  methods  are  inadequate  to  cope  with  the 
demands  made  on  their  resources  by  scarlet  feverr  and 
that  while  return  cases  continue  in  fair  abundance  one 
cannot  regard  the  hospital — apart  from  every  other 
objection — as  fulfilling  a  function  of  much  service  to 
the  community.     When  we  add  to  this  disability  the 
positive  evils  resulting  from  aggregation,  the  lack  of  any^ 
diminution  in   the  mortality  and  prevalence  of   the* 
disease,  the  mistakes — ^unavoidable  mistakes,  if  isolation 
is  to  continue — in  certification,  and   the  inability  of 
medical  science  to  distinguish  mild  cases  of  scarlet 
fever,  and  to  sift  single  infections  from  complicated  ones, 
we  are  driven  to  the  conclusion  that  the  present  system^ 
is  but  ill-adapted  to  the  end  for  which  it  was  designed. 
With  these  grave  faults  and  shortcomings,  is  it  worth 
while  continuing   the   enormous  expenditure  on  our 
aggregation  hospitals  ?     Is  it  worth  while,  in  any  case, 
when  scarlet  fever  is  now  so  benign  in  its  incidence  that 
go  per   cent,  of  its  victims  are  but  little  more  than 
out  of  sorts  for  a  few  days  ?     These  questions  deserve, 
I  think,  serious  consideration,  and  if  they  are  kept 
at  the  level  of  scientific  reasoning  that  their  interest 
and  importance  entitle  them  to,  they  are  ripe  for  free 
discussion  among  sanitarians.     I  trust  they  may  be* 
preserved  from  the  hurly-burly  of  municipal  politics  with' 
which  they  have  no  primary  concern,  and  that  a  full 
and    authoritative    inquiry    under    medical    auspices^ 
may  be  instituted  to  resolve  them.  , 

IHE  EARLY  MANIFESTATIONS  OF 

INSULAR  SCLEROSIS, 

WITH  A  TABLE  SHOWING  THE  MODES  OF 
ONSET  IN  FIFTY  CASES,  TAKEN  FKOM 
NOTES  MADE  AT  THE  NATIONAL  HOSPITAL 
IN  QUEEN  SQUARE,  BY  THE  KIND  PERMIS- 
SION OF  THE   MEDICAL   STAFF. 

By    FREDERICK    S.    PALMER,    M.D..    M.R.C.P^ 

AvBittant  PhyilciMi  to  tbe  Wett  Snd  HocpKal  for  Dtoeawi  of  iho 

Nervous  System. 

I.v  the  seventh  of  Charcot's  classical  lectures  delivered 
at  La  Salp^trih-e  in  1868,  portraying  the  disease,  justly 
desifi^ated  disseminated  or  multilocular  sclcroAss,  he" 
maintained  that  "  nothing  is  simpler  than  to  diagnose 
the  affection  in  question  by  the  bedside  of  the  patient, 
at  least  when  it  has  reached  its  t3irpicaJ  period  of  perfect 
development." 

The  paragraph  read  according  to  its  literal  construe^ 
tion  is  probably  not  far  from  the  truth.  Tlie  clinical* 
tableau  so  accurately  sketched  by  the  distinguished* 
French  neurologist  remains  after  an  interval  of  thirty- 
six  years  a  faithful  representation  of  what  is  knowiTas^ 
the  classical  tyx>e.  Nor  would  it  be  ea.sy,  in  con  front  a-- 
tion  of  such  complete  evolution  of  the  symptomatology" 
as  he  described,  to  mistake  its  significance.  It  did' not; 
however,  escape  Charcot's  notice  that  the  disea.se  may 
be  encountered  under  a  variety  of  masks — in  all  sorts  of 
disguises — and  that  in  these  aberrant  or  imperfect  forms: 
the  recognition  of  the  primary  indicia  is  V>y  no  means^ 
a  simple  proceeding.  That  these  atypical  varieties 
undoubtedly  exist,  and  are  not  of  very  rare  occurrence, 
constituting  the  class  known  as  formes  fruste^,  is  now 
coirmonly  admitted.  Such  cases  not  infrequently 
run  a  protracted  course  of  years  from  start  to^  finish, 
presenting  few  of  the  salient  features  of  the  typical' 
disease  until  an  advanced  stage  has  been  reached  i  and^ 
sometimes  (though  more  rarely)  none  that  can  be  called' 
at>solutely  characteristic.  The  importance  of  recog*- 
nising  the  manifestations  of  these  irregular  types  ha»=. 
been  strongly  insisted  on  by  Dr.  Buzzard,  who,  from 
long  experience  and  careful  study  of  the  subject,  has  * 
made  it  in  a  peculiar  sense  his  own.  It  is  impossible  to* 
question  the  accuracy  of  his  assertion,  "  that  of  all 
organic  diseases  of  the  nervous  system,  disseminated 
sclerosis  is  that  which  is  commonly  mistaken  for 
hjrsteria." 

The  polymorphic  nature  of  the  malady,  its  variable 
periods  of  remission  or  intermission,  and  the  frequent 


244      '^HX   MSDICAL   PkBSS. 


ORIGINAL  COMMUNICATIONS. 


Sept.  7,  1904. 


association  of  emotional  symptoms  often  render  the 
differential  diagnosis  a  tasik  of  considerable  difficulty 
in  the  absence  of  pronounced  hysterical  stigmata. 
It  is  true  that  much  has  been  done  recently  to  unravel 
some  of  the  complicated  problems  which  these  at3rpical 
cases  present,  but  there  remains  still  a  large  field  for 
clinicad  investigation.  Presumably,  as  our  knowledge 
of  neuro-pathology  increases,  and,  it  may  be,  as  Dr. 
Ashley  Mackintosh  has  suggested,  by  the  adoption  of 
more  liberal  views  concerning  the  accepted  cardinal 
fdgns,  many  conditions  regarded  as  examples  of  psycho- 
neurosis  due  to  disturbance  of  the  highest  nervous 
centres  will  be  referred  to  the  initial  stages  of  insular 
sclerosis. 

In  reviewing?  the  multiformity  and  irregularity  of  the 
primary  manifestations,  it  is  indispensable  to  remember 
the  anatomical  lesions  which  constitute  the  malady  ; 
nor  is  it  less  important  to  bear  in  mind  the  fact,  insisted 
on  by  Dr.  J.  S.  Risien  Russell,  that  from  the  standpoint 
of  the  nervous  system  the  disease  is,  as  a  rule,  a  general 
one,  affecting  the  whole  of  the  cerebro-spinal  axis  from 
the  cerebral  cortex  to  the  filum  terminale,  involving 
the  ganglia,  cranial  and  spinal  nerves  with  their  roots, 
and  invading  their  peripheral  branches.  The  sclerotic 
islets  obey  no  fixed  law,  either  in  development  or  distri- 
bution ;  hence  departures  from  the  typical  form  are  not 
uncommon.  No  two  cases  can  be  said  to  resemble 
each  other  exactly  in  their  modes  of  onset  or  progress. 
As  all  parts  of  the  nervous  mechanism  are  open  to 
attack,  it  is  not  difficult  to  understand  the  first  blow 
of  the  disease  will  fall  upon  the  locality  which  the 
morbid  process  has  selected.  The  division  of  the 
malady  into  three  recognised  tj'pes,  distinguished  by 
Charcot  and  followed  by  nearly  all  the  other  writers 
on  the  subject,  is,  as  Marie  remarks  in  his  tenth  lecture, 
merely  an  artificial  arrangement  employed  for  the 
convenience  of  description,  and  the  terms  cephalic, 
spinal,  and  mixed  or  cerebro-spinal  apply  chiefly  to  the 
character  of  the  predominating  symptoms.  Anatomi- 
cally there  is  no  such  limitation  to  the  morbid  process. 
The  four  types  constructed  by  Marie,  based  on  the 
modes  of  onset  and  rate  of  progress,  need  not  detain  us ; 
many,  if  not  the  majority,  of  chronic  nervous  diseases 
could  be  similarly  subdivided.  Far  more  important 
than  any  distinction  of  types  seems  to  be  a  clear  under- 
standing that  in  insular  sclerosis  many  departures  are 
seen  from  the  classical  forms  described  by  Charcot,  and 
that  the  disease  has  remarkable  periods  of  remission. 

During  the  twelve  months  I  acted  as  clinical  clerk 
to  Dr.  Ferrier  at  the  National  Hospital,  and  had  the 
advantage  of  his  teaching,  several  examples  of  ir- 
regular type  came  under  my  notice.  At  his  sugges- 
tion, with  the  kind  permission  of  the  medical  staff, 
whose  invariable  courtesy  I  desire  gratefully  to  acknow- 
ledge, and  with  the  assistance  of  the  house  physicians, 
I  have  collected  notes  of  the  early  manifestations  in 
fifty  cases  recently  under  treatment  in  the  wards, 
arranged  in  the  form  of  a  table,  which  may  be  considered 
a  sequel  to  the  interesting  article  of  Dr.  Mackintosh 
in  the  "Review  of  Neurology  and  Psychiatry"  for 
February,  1903.  From  an  analysis  of  the  Table  the 
jfoUowing  results  are  obtained  : — 

Sex. — ^There  were  23  males  and  27  females,  which 
-agrees  with  the  view  of  Marie  and  others  that  in  this 
^disease  the  sexes  are  equally  affected. 

Age. — ^The  incidence  of  age  at  the  time  of  admission 
•to  the  hospital  is  given  in  the  decennial  periods  below — 
Between  10—20     20—30     30—40    40 — 50     50—60 

2  14  26  6  2    —50 

From  these  figures,  the  interval  between  the  com- 
mencement of  the  svmptoms  to  the  date  of  admission 
must  be  subtracted]  In  the  main  the  facts  are  in 
accordance  with  the  experience  of  all  neurological 
writers,  that  the  majority  of  the  cases  occur  in  early 
adult  life.  The  disease  is  rarely  seen  in  children  or 
after  fifty  years  of  age. 

CeniiHon.^Jn  the  50  cases,  27  were  married  and  23 
«figle.  ^^  ,. 

Occupation, — ^The  only  curcnmstance  worth  recordmg 
is  that  23  of  the  patients  (nearly  half)  were  engaged  in 
domestic  pursuits.    There  was  nothing  that  could  be 


traced  to  the  influence  of  toxic  agents  from  certain 
trade  occupations  insisted  on  by  Oppenheimu 

CaxAsation, — Although  no  definite  cause  could  be 
discovered  in  the  majority  of  the  cases,  it  is  interesting 
to  note  that  the  symptoms  commenced  either  during 
pregnancy  or  soon  after  delivery  in  6.  after  trauma  in 
5,  after  epidemic  influenza  in*  5,  after  diphtheria  i, 
after  sore  throat  (variety  not  known)  i.  and  in  one  case 
the  patient  referred  his  illness  to  a  severe  attack  of 
gonorrhoea,  which  he  said  preyed  on  his  mind  to  a  great 
extent.  Emotional  causes  were  suggested  in  four  of 
the  cases,  but  these  did  not  appear  to  be  very  definite. 
Sir  William  Gowers  has  called  attention  to  the  connec- 
tion between  disseminated  sclerosis  and  the  puerperium. 
beginning  during  pregnancy,  remaining  in  abeyance 
until  the  next,  and  then  becoming  progressive.  In  the 
other  cases  the  condition  could  not  be  traced  to  any 
antecedent  illness  or  other  known  cause  of  the  disease. 
Duraiion. — In  this  calculation  care  was  taken  to 
ascertain  as  nearly  as  possible  the  actual  time  when 
nervous  instability  first  appeared  in  a  definite  form. 
The  result,  taken  from  the  statements  of  the  patients,  b 
given  below. 

Under  i  year,  6  ;  between  i  and  2  years,  1 1  ;  2  and 
3  years,  3  ;  3  and  4  years,  7  ;  4  and  5  years,  9  ;  6  years 
3  ;  7  years,  3  ;  8  years,  4  ;  9  years,  i  ;  10  years,  i ; 
13  years,  i  ;    14  years,  1=50. 

The  longest  period  was  14  years,  and  the  shortest 
about  a  month.  The  cases  de.serving  of  comment  from 
their  long  duration  are  numbers  42,  5,  22,  and  31  re- 
corded in  the  Table. 

In  Case  42,  the  illness  commenced  with  tenderness 
of  the  plantar  surface  of  both  feet,  followed  by  difficulty 
in  walking.  At  first  the  motor  weakness  was  transient 
or  intermittent  in  character.  After  a  few  months  the 
disability  became  more  pronounced,  but  although  he 
had  experienced  several  periods  of  partial  remission, 
the  paresis  had  been  steadily  progressive. 

In  Case  5.  the  patient  first  noticed  difficulty  in  walking 
with  staggering  and  girdle  pain  round  the  waist 
during  her  first  pregnancy.  After  her  confinement, 
she  appeared  to  recover  the  power  of  walking  com- 
pletely, but  three  months  later  the  same  symptoms 
returned.  She  had  four  similar  attacks  subsequently 
with  partial  recovery  on  each  occasion.  For  the  last 
two  years  her  gait  has  been  so  unsteady  that  she  has 
never  ventured  out  alone. 

In  Case  22,  the  primary  symptom  observed  was  weak- 
ness of  the  right  leg  and  stumbling.  Her  right  foot 
seemed  to  strike  against  any  object  higher  than  the 
surface.  After  treatment  in  the  National  Hospital  she 
improved  a  good  deal,  but  always  noticed  some  degree 
of  weakness  in  the  same  foot.  She  was.  however, 
able  to  nurse  her  husband  through  a  long  illness,  and 
after  his  death  supported  herself  by  her  own  industry. 
Subsequently  her  right  arm  and  hand  became  affected. 
In  Case  31,  a  labourer  first  experienced  difficulty  in 
rising  from  his  chair  with  staggering  on  attempting  to 
walk.  The  symptoms  were  not  at  first  continuous,  hut 
lasted  several  months  at  a  time.  He  had  tried  several 
occupations,  but  had  to  give  them  all  up  one  after 
another  on  account  of  his  illness,  and  for  the  last  seven 
months  he  has  been  unable  to  walk  without  assistance. 
In  Dr.  Buzzard's  interesting  lecture  on  Insular 
Sclerosis,  delivered  at  the  National  Hospital  on  February' 
9th,  he  described  the  details  of  four  cases  under  his  care 
which  had  existed  with  varying  periods  of  remissions, 
two  for  1 3  years,  and  the  other  two  for  8  and  9  years 
respectively. 

Onset. — ^The  onset  was  sudden  in  12  of  the  cases,  and 
marked  by  a  gradual  invasion  in  38. 

The  number  of  the  former  is  relatively  high  com- 
pared with  Dr.  Mackintosh's  series,  24  against  12*5 
per  cent. 

In  the  arrangement  of  the  Table,  the  first  symptom 
mentioned  is  that  which  the  patients  gave,  as  the  earliest 
indication  of  their  nervous  disease.  Divided  into 
groups  according  to  the  usual  classification  the  result 
obtained  is — 


Sept.  7,  19^4 


ORIGINAL  COMMUNICATIONS.        Tm  Medical  Pmss.    245 


TABLE    REPRESENTING    THE    MODES    OF    ONSET    IN    FIFTY    CASES  OF  MULTIPLE    SCLEROSIS. 


^1 

il4'>M 
MsiS 

M26S 

f3oM 

I 

FJSM 

F«S 


1^ 


nil 


II 


II 


3 

•a 


H4IM 
M30S 
M37M 

F38M 
H28M 

F36M 

M37M 
F32M 

M37M 

M32S 

FaoS 
F45W 

F35S 


i4,F33U 
V  FS5M 


M46M 


F34S 


Cbthier 

Porter 

BIack«m*tb 

Hosier 

Domestic 

Vocalist 
Domestic 
Hawker 
Domestic 

Domestic 

Chemist 

Clerk 

Clerk 

Domestic 
Surveyor 

Domestic 

Labourer 
Domestic 

Omnibos 
writer 

Pianoforta 
worker 
Domestic 

Domeatic 

Domestic 

Domestic 
Domestic 

Labourer 

Charwoman 


P  36  S  ;Hoi]sekeeper 
F2?S 

M33M 

M30M 

F  28  S  JDomestio 


Packing-case 
maker 

Warehouse- 
man 

r^bourer 


F19S 

M28M 

M29M 


Dotr.estic 


Stableman 

French 
polisher 


3fi|F26S    Domestic 
F24S  jDomestic 

38I  M  34  M  Labourer 


a  yrs 
T4  mos. 

4*  y«- 
z8  mos. 
13  yis. 

3  yrs. 

5  yrs. 

6  yrs. 
6  yrs. 

5  y». 

18  mos. 

1  yr. 
5  y». 

8  yrs. 
a  yrs. 

5  yw. 

a  yrs. 

6  yrs. 

4  yrs. 

6  yrs. 

7  yrs. 
10  yrs. 

3  y». 

3iyn- 

4  yrs. 

5  yrs. 

a  yr«. 
3y». 
3  mos. 

5  mos. 

5  yrs. 

8  yrs. 

4  yrs. 

7  yrs. 
2  yrs. 

2  yrs. 

2  yrs. 

4  yrs. 


S 
S 
G 
G 


G 

S 
S 

G 
G 


G 
S 


G 
G 
G 


G 
G 


G 
G 

G 


G 
G 


S 
G 

G 

S 


Ipopl 

followed  by  stiflness 
of  legs 

Unsteadiness  of  gait, 
fatigue  in  walking 


Spastic 


Ezag.  ankle  clonus 


Extensor 


Predp.  mict. 


Keeling    and 
tottering 


Ezag.  ankle  cknus 
Ezag.  ankle  clonus 
Ezag.  ankle  ckxius 
Ezaggerated 


Extensor  Predp.    mict.,  in- 
oont.  constip. 


Vomiting  for  7  days  Ataxic 

folk)wed    by    dysar- 
thria 
Giddiness,    staggering,  Ataxic      and 

sacral    pain,    ambly-  staggering 

opia    (transient) 

.Mfficult^  in  walking,  Spastic     and 

staggenng,         girdle  dragging 

pain 
Headache,     giddiness.  Spastic     and  Ezag.  ankle  clonus 

transient    amblyopia  drag|;ing 
Diplopia  with  loss  of  Spastic     and  Ezaggerated 

power  in  R.  leg 
Difficulty  in  lifting  R. 

foot,   staggering  reeling 

L.    leg   gave   way   in  Spastic  Ezaggerated 

walking,   '^    epifepti-  slightly 

form  attacks  | 

Weakness  of  L.   armi  Unable        to  Ezag.  ankle  ckmus 

and  leg  during  preg-  stand  ~^ 


Extensor  {pr&dp. 
stip. 


mict.  con- 


Nystag.,  vol.  tremor, 
some  dysarthria. 

Int.  and  head  trem., 
blurred  speech,  pal- 
tor  of  opt.  discs. 

Vol.  tremor,  scanning 
speedi. 


staggering 
Ataxic      and  Exaggerated 


nancy 
Stillness^  and    fatigue  Spastic 

in  legs,  chiefly  left 
Dysarthria,    weakness 

of  legs,  giddiness 


Loss  of  power  in  legs.  Spastic 


and 


I  ottering 
Unable 
stand 


R. 

Exag.  ankle  clonus 
Exag.  ankle  ckmus 


ataxic 

Unabte 

stand 
Ataxic 

staggering 


Ataxic 


diplopia,  inoont.  of 
urine 

Weakness  of  the  legs, 
chiefly  of  the  left 

Draggtog  of  R.  leg, 
difficulty  and  delay 
in  mict. 

Weakness    of    L.    fegHemiplegic 
during       pregnancy, 
incont.  of  urine. 

Weakness  of  L.  leg 
after  a  fall 

Fatigue  in  R.  leg, 
staggering,  numb- 
ness of  L.  leg  and  In- 
cont. of  urine 

Draggling  of  R.  foot  in  Unable 
walidng  stand 

Staggering  gait,  fatigue  Unable        to 

in  walking  stand 

Numbness  and  tingling  Spastic     and 

of  L.  foot,  dragging      shufiling 

>-agging  of  R.  foot," 

stumbl 


and  Exag.  ankle  cknus 
R.  side 


Exag.  ankle  clonus  Extensor  Incont.    of   urine  Nystas.,    sk>wness    of 
L.  side  L.  side     and  fanes  speed). 

Spastic     and  Exag.  ankle  clonnsjExtensor  Predp.  mict.  and  Some  int.  tremor« 
dragging  jinoont.  cf  faeces 


Exag.  ankle    and 
knee  clonus ' 
Dragnng  and  Exag.  ankle  ck>nus 
shuSSing  " 


L.   le^   gave   way   inSy 
walking,  followed  by 


weakness  of  both  legs 
W^eaknesa   of   lews   in 

walking,  stumbUng 
StifiiDeas    of    R.    leg, 

sacral  pain 

Pain  in  sacral  region, 
foUowed  by  sta|^- 


genog. 
Namb 


Spastic     and 
reeling 


"iimlmess  in   L.   leg, 
difficulty  in  walking 

TrembUng  of  R.  hand, 
inability  to  write 
Numbness  of  both  feetJAtoxic* 
difT.  in  walking,  stag- 
gering 

Stumbling  of  R.  foot, 
trembling  and  weak- 
ness in  both  legs 

Difficulty    in    rising 
from  chair,  staggering 

Numbness  and  weak- 
ness in  both  legs 


Giddiness,  diplopia, 
numbness  of  three 
fingers  R.  hand 

Numbness,  followed  by 
weakness  of  both  legs 

Dysarthria,  diplopia, 
weakness  and  numb- 
ness of  R.  leg. 

Weakness  of  L.  leg 
with  dragging  of  foot 

R.  fadal  paralysis,  dys- 
arthria and  numb- 
ness of  R.  hsg 

Shaking  of  R.  hand, 
fatigue  in  walking, 
staggering 


to  Exag.   ankle  and 
knee  clonus 
and  Exaggerated 


lExag.  ankle  ck)nus 
R.  side 


Extensor 

Extensor 

Extensor 
Extensor 
Extensor 
Extensor 

Extensor 

Extensor 
Extensor 
Extensor 

Extensor 
Extensor 

Extensor 


Hesitating    mict., 

Precip.  mict. 

Normal 
Some  incont. 


voL   tremor, 
syllabic  speech. 

Nystag.    vol.    tremor. 


pallor 
R. 


of 


arm 


Inoont.    of 
and  fseoes 

Some    inoont. 
ucine 

Incont.    and 
ten.  of  urine. 


unne 
of 


Nystag., 
opt.  disc, 
Vol.    tremor 
and  leg. 

Nystae.,  skyw  scanning 
ed). 

scanning 
opt.  atrophy. 


Predp.  mict. 


Loss    of    control 
over  blad.  ft  rect. 

DifF.    in 
mict. 

Normal 

Difficulty  in  start- 
ing mict. 


^ystac., 
speed). 
Nystag., 
speech, 

Pallor  of  opt.   discs. 

Nystag.,  syll.   speech, 
L.  opt. 


atrophy. 
Nystag.,  vol.  tremor, 
syllabic  speedi. 
starting  Nystag.   on      upward 
movement. 


Inoont.  of  urine 


Nystag.,  voL  tremor, 
opt.  atrophy. 

Njrstag.  on  lateral  de- 
viation. 

Syllabic  speed). 


Normal 


Exag.  ankle  clonus 


itic     and 


>pastic 
dragging 


R.skle 
Exag.  ankle  claans 


Exag.  ankle  clonus 
Exaggerated 


Spastic,    can- 

not  walk 
Dragging, 

sli^Uf 

spastic. 
Shuffling,  can-  Ezag.  ankle  clonus 

not  walk 

Spastic  drag- 


Unable 
walk 


slightly 
to 


Ataxic 
reeling 

Spastic 
dragging 


Dragging     c 
L.  leg 

tic  and 

Ataxic      and 
spas 

to 


Spasi 
drai 


%htly 


Unabk) 

stand 
Ataxic,     ten. 

to  fall  to  R. 

side 
Spastic     and 

staggering 


Extensor  Predp.  mict. 
R.skle 

Extensor  Predp.  mict. 

Ez  tensor  Incont.  of  urine 

Eztensor  Nnnnal 

Extensor  Precip  mict. 


Extensor 
Extensor 


Exag.   anklft   and 
knee  clopus 
Knee-jerks  brisk 

Knee-jerks  brisk 


and 


Exag.   ankle 
knee  clonus 

Normal    jaw-jerk 

present 
Brisk  ankte  clonus 

L.  side 


Brisk 

Brisk  ankle  clonus 

on  R.  side 
Brisk  ankle  clonus 

on  R.  side 

Brisk  ankle  clonus 
Brisk  knee  ckn. 


Brisk  ankle  cbnus  Extensor 


Incont.    of    unne  Nystag.  vohtiooal  tre- 
mor. 
Inoont.    of   urine  Nystag.    (fine   oadlla- 
and  faeces  tions). 


Extensor 
R.side 

Extensor 

L.5ide 

Extensor 

Indefi- 
nite inc- 
to  ext, 
Extensor 


Extensor  Normal 
Extensor 


Extensor  Normal 
L.  side 


Extensor 


Extensor 
K.  side 


Njrstag.  on  lateral  de- 
viation, paUor  of  opt. 
discs. 

Nystag.  on  lateral  de- 
viation. 

Nystag.  pallor  of  L. 
optic  disc. 

SHflfat  nystagmoid 
movements  on  lateral 
deviation. 

VoL  tremor,  opt. 
atrophy. 


Inoont.  of  urine 

Normal 
Normal 
Normal 


Retention, 
stipation 


Delay     in     mict. 
constipation 


Predp.  mict. 

Predp.  mict. 
constipation 

Incont.  of  urine 


Extensor 


Extensor  Normal 
R.  side 


Diff.  in  starting 
mict.  and  con- 
stipation 


Nystag.  syllabic  speech, 
opt.  atrophy,  vol. 
tremor. 

Nystag.  in  all  direc- 
tions. 

Nystag.  vol.  tremor. 

Nystag.,  voL  tremor, 
l.  arm. 

N^rstag.  on  lateral  de- 
viation. 


vol.    tremor. 
c  speecb. 


Nystag., 

svl>aDi( 
Nystag.,  vol. 

K.  arm,  pallor  of  R. 

opt.  disc. 
Nystag.    (fine   osdila- 

tions). 

Nystag.   syll.   speedi. 

opt.  atrophy. 
Nystag.,  vol.    tremor, 

syllaDic  speech. 

Vol. 


Nystag.  on  upward 
and  uiteral  deviation. 

Nystag.  vol.  tremor, 
staccato  speech,  pal- 
lor of  opt.  disc. 


246    Tbs  Medical  Prkss. 


ORIGINAL  COMMUNICATIONS. 


Sept.  7,  1904. 


39 
40 
41 
43 

43 

44 
45 

46 
47 

48 
49 


ii 


M33M 

M30M 

M37S 

M33S 

F15S 

F45M 
F35S 
F31S 

F47S 

F38M 
F30S 

M25M 


stableman  . 

Butkr 

e 
driver 

labourer 

Mooe 

Domestic 
Doinefttc 
Domestic 
ftfilliner 

Domestic 

Hospital 
nurse 

Roadsweeper 


11 


4yrs. 

5yt». 

z8  mos. 

X4yrs. 

6  mos. 

Syrs. 
4|yts. 
7rn. 
z  mo. 

8  yts. 
4  yrs. 


I 


IS 


G 
G 
G 
G 

S 

G 
G 
G 
S 

G 
G 


Irembling  and  drap- 
ingi  of  L.  foot  in 
waUcimi 

Unsteadiness  of  gait, 
staggering 

Diff.  in  lifting  feet 
from  the  ground, 
duefly  left 

Tenderness  of  both 
feet,  increasing  diffi- 
culty in  walking 

Vomiting  lor  7  days, 
followed  by  weakness 
of  legs 

Weakness  of  legs  and 


3 


Ataxic      and 
spastic 

Staggering, 
dragging    of 
L.Toot 
Spastic 


brisk  ankle  clonus 


Brisk  ankle  clonus, 
R.  side 


;pasi 
batj 


itic    titu- 
ition 


Unaole 
sUnd 


and 


Scraping  of  L.  leg.  in 
walking,  staggering 

(Jnsteamncss  in  both 
hands,  dif!.  in  walking 

Numbness  of  left  side, 
difr.  in  walking,  di- 
plopia 

Numbness  of  R.  leg 
foltowing  abortion 

Loss  of  sensation  in 
R.  arm  and  numb- 
ness in  both  legs 

Fatigue  of  L.  leg,  ver- 
tigo, staggering 


Spastic 

ataxic 
Unable    to 

stand 
Reeling     and 

staggtfing 
Tottering 


Unable 
staod 

UnaDle 
stand 

Ataxic 


IS 


u 


Extensor 


.Extensor 


Brisk  ankle  ckmus  .Extensor 
L.  side 

Brisk  ankle  clonus  |Eztensor 

Brisk  ankle  clonus  Extenscr 

Brisk  ankle  cknus:  Extensor 
Brisk  ankle  cloous;Extensor 
Brisk  ankle  clonus  {Extensor 
Exaggerated 


tf) 


starting 
I  ooosti- 


Nystag.,  paDor  of  R. 
opt.  disc. 


Normal 


Precip.  mict. 


Dif!.    in    starting  Nystag. 
mict. 
Precip.  mict. 


Si 


Difl.    is 

mict.  a 

patiott 
I>iir.    in    starting  Nvstag.  paUor  of  oft. 

mict.    and    con-   discs. 

stipation 

Incont.  of  urine 


*f ystag.,   vol.    tremor. 


syllabic 

Scanning  speech,  vd. 
tremor,  opt.  atropliT. 

Nystag..  voL  treoBor. 


voL  trcmct,.! 


Extensor 
L..  side 


Exaggerated 
Exaggerated 

Normal 


Precip.  mict. 
Incont.  of  urine 

Precip.  mict. 


Extensor 
Extensor 


Extensor  Some    incont. 
urine 


*4ystag..    voL    trcaKX. 

syllabic  speech. 
Vystair..    voL  trewr,  I 

syllabic  speech. 
Nystag.,    VOL 


Nystag. 


Some    incont.    o4|Nystag..    X'ol.  troor  | 
staccato  gnceth. 

Nystag.,    vol.  'txwncT  1 
syllabic  speech,    op^  I 

atrj>j*y. 


lO 


A_with  cerebral  or  bulbar  symptoms  leading 
B— with  motor  and  sensory  (combined)  symptoms 

leading        ^ 

C— with  motor  symptoms  leading  ..  ..20 

D ^with  sensory  symptoms  leading  ..  ••       5 

50 

It  wiU  be  noticed  that  'onset  with  motor  weakness 
was  observed  in  more  than  half  the  number  of  the  cases, 
or  at  the  rate  of  52  per  cent. 

In  the  cerebral  and  bulbar  group  (A)  are  included— 

Onset  with  apoplectiform  attack     . . 

Vomiting         

Vertigo  

Diplopia  

Dysarthria  

Dysarthria  and  diplopia        

Headache  (occipital) 

Facial  paralysis         


In  the  sensory  group  (D)  — 
Onset    with    numbness    followed    by    weakness  of 

both  lower  limbs 

Numbness  of  one  leg  after  abortion . . 

Tenderness  of  both  feet,  followed  by  progressive 

paresis  of  legs 
Anaesthesia  of  right  arm  followed  by  numbness  of 

both  legs 
Pain  in  sacral  region,  followed  by  staggering  gait . . 


In  the  motor  and  sensory  group  (combined)  (B)— 

Onset  with  numbness  and  weakness  of  both  lower 

limbs  . .  •  •       ^  ",••,.    I." 

Numbness  and  weakness  of  one  lower  limb 
Weakness  of  both  legs  and  girdle  pain 
Weakness  of  both  legs  and  numbness  of  one  arm  . . 
Numbness  and  weakness  of  one  arm  and  leg 


In  the  motor  group  (C)— 

Onset  with  weakness  of  both  lower  limbs  . . 

Weakness  of  one  lower  limb 

Weakness  of  both  upper  limbs         . .  — 

Weakness  of  one  upper  limb 

Weakness  of  one  arm  and  leg  (hemiparesis) 


o 

2 
I 

26 


Remissions  of  the  symptoms  occurred  in  26  of  the 
cases,  or  at  the  rate  of  52  per  cent.  In  this  estimate 
every  admission  of  apparent  improvement  has  been 
taken  into  consideration.  The  intervals  and  degrees  of 
recovery  were  most  variable,  from  slight  amelioration 
to  almost  complete  intermission,  but  in  none  of  the 
cases  did  all  the  symptoms  entirelv  disappear.  5^me 
amount  of  motor  weakness  or  paraesthesia  remained. 
In  one  of  the  cases  there  were  four  remissions,  in  another 
three.  Two  remissions  were  described  in  eight,  and 
one  each  in  sixteen  of  the  cases. 

Gait. — At  the  time  of  admission  to  the  hospital  the 
various  forms  of  gait  noticed  were,  cerebello-spastic, 
21,  ataxic,  9;  spastic  and  ataxic,  4;  hemiplegic,  i; 
tottering,  shuffling,  and  draggmg,  4 ;  unable  to  stand 
or  walk,  1 1  =*  50. 

These  figures  agree  with  the  text-books,  that  al- 
though almost  every  variety  of  gait  is  said  to  occur, 
the  cerebello-spastic  is  the  one  most  frequently  en- 
countered. 

Tendon  Reflexes. — The  knee>jerks  were  brisk  or 
exaggerated  in  47  and  normal  in  three,  but  the  jaw- 
jerk  was  definitely  obtained  in  one  of  the  latter. 
Ankle-clonus  was  marked  in  22  on  both  sides,  in  12  on 
one  side,  and  knee-clonus  was  present  in  5  of  the  cases. 

Plantar  Reflexes. — Babinski's  phenomenon  was 
present  in  41  oi  the  cases  on  both  sides,  and  in  eight  od 
one  side  only.  In  the  other,  the  response  was  in- 
definite, but  inclining  to  the  extensor  type. 

Sphincters. — The  organic  reflexes  were  affected  in  40 
and  normal  in  10,  but  in  the  latter  mimber  one  of  the* 
patients  had  suffered  from  incontmence  of  urine  before 
admission,  and  had  recovered  control.  The  details 
given  were  as  follows :— Precipitate  micturition.  16 


Sept. 


7»  i«>04. 


ORIGINAL  COMMUNICATIONS. 


liesitating  mictrirition.  8 ;  incontinence  of  urine,  1 1  ; 
incontinence  of  urine  and  fseces,  4 ;  retention  of  urine 
•and  constipation,  i.  In  a  large  number  of  the  cases  the 
sphincter  affection  was  a  comparatively  early  feature  of 
the  disease. 

Accepted  Cardinal  Sis^ns, — The  inconstancy  of  the 
so-called  classical  symptoms  is  illustrated  by  the  figures 
given  below: — 

In  the  so  cases  now  recorded — 
Nystagmus,  volitional  tremor,  and  speech  defects 

were  observed  in    . .  . .     12 

Nystagmus  and  volitional  tremor  in  . .     10 

Nystagmus  and  speech  defects  in    . .  5 

Nystagmus,  or  nystagmoid  movements  alone,  in . .  14 
Volitional  tremor  and  speech  defects  in      . .  3 

Volitional  tremor  alone  in     . .  4 

Sx>eech  defects  alone  in  . .  1 

Pallor  of  optic  di9cs  alone  in  . .  . .       i 

50 
It  will  be  noticed  from  these  figures  that  nystagmus, 
or  nystagmoid  oscillations  (chiefly  on  lateral  deviation), 
were  present  in  41  of  the  cases,  or  at  the  rate  of  82  per 
cent.,  and  were  themostconstantof  the  so-called  classical 
signs.  The  rate  appears  high  compared  with  Charcot's 
estimate  of  50,  Uhtoff's  of  58.  and  Marie's  of  70  per 
cent.,  but  in  the  present  series  the  finer  movements  have 
been  included.  Volitional  tremor  and  speech  defects  were 
observed  in  21,  or  42  per  cent.  According  to  Sachs  all 
iorms  of  dysarthria  are  seen,  from  what  he  described  as 
"'  a  speech  tremor  not  unlike  that  observed  in  the  early 
stages  of  general  paralysis  "  to  the  ordinary  scanning, 
staccato,  or  syllabic  utterance.  I  have  therefore 
grouped  all  forms  of  abnormal  articulation  under  this 
head.  In  one  of  the  cases  pallor  of  the  temporal  halves 
of  the  optic  discs  was  the  only  classical  sign  present. 

Changes  in  the  fundus  oculi  were  noticed  in  1 3  cases, 
at  the  rate  of  26  per  cent. 
Optic  atn»phy  on  both  sides . .  . .       7 

Optic  atrophy  on  one  side i 

Pallor  Off  both  discs  (temporal  halves)  . .       4 

Pallor  of  one  disc  (temporal  half)  i 

13 

There  is  great  variation  in  the  figures  given  by  the 
different  writers  on  these  changes.  Those  quoted  by 
Ross  are  at  the  rate  of  30,  Buzzard  43,  Uhtoff  45,  and 
Mackiiitosh  47*5  per  cent. 

Uhtofi  found  complete  optic  atrophy  in  only  3  of  the 
iroo  cases  00  which  he  based  his  observations. 

Fades, — The  peculiar  facies  mentioned  by  Charcot — 
a  certain  vagueness  of  expression  or  stolid  indifference 
to  present  surroundings,  with  some  degree  of  mental 
«nfeeblement,  were  noticeable  in  17  of  the  cases. 

Sensory  Symptoms. — ^The  researches  of  Hoffman, 
£rb,  Freund,  F.  von  Gebhardt,  Oppenheim,  and  others 
liave  proved  beyond  all  dispute  that  disturbances  of 
conmion  sensibtUty  are  of  very  frequent  occurrence  in 
<ii88eminated  sclerosis.  Charcot  qualified  his  remark, 
that  tkey  do  not  form  a  part  of  the  clinical  picture,  by 
the  admission  "  that  formication  and  numbness  in  the 
«nieebled  limbs  of  a  transient  nature  were  sometimes 
complained  of."  With  the  exception  of  the  Babinski 
phenomenon  they  were  probably  the  most  constant  of 
all  the  symptoms  in  the  present  series  of  cases.  Thus, 
in  the  50  now  recorded  no  less  than  42  referred  to  some 
kind  of  sensory  disturbance  (chiefly  subjective  in 
character)  as  a  part  of  their  illness,  and  in  8  only  were 
the  sensations  perfectly  normal.  The  parassthesiae  com- 
prised headache,  pain  over  the  sacral  region,  girdle 
sensations,  cramp,  numbness,  tingling,  and  a  feeling  of 
'What  was  described  as  deadness  in  the  affected  mem- 
bers. Objective  symptoms  were  noticed  in  7— analgesia, 
hyperalgesia,  anaesthesia,  and  loss  of  muscle  sense. 
In  two  of  the  cases  trophic  Changes  were  observed — 
atrophy  of  Umited  groups  of  muscles.  In  100  cases  of 
insular  sclerosis  quoted  by  Hoffman,  he  found  parses- 
thesiae  in  66  and  objective  sensory  symptoms  in  28,  or 
together  at  the  rate  of  94  per  cent.,  which  correspond 
very  closely  with  my  figures.  These  observations  support 
Dr.  Mackintosh's  view  that  disturbances  of  sensation 
are  valuable  aids  to  diagnosis  in  insular  sclerosis. 


MsDiCAL  Prsss.     247 


Conclusions, — The  inferences  to  be  drawn  from  a 
study  of  the  preceding  notes  are,  I  venture  toethink— - 

1.  That  the  primary  indicia  of  multilocular  sclerosis 
are  exceedingly  variable  both  in  distribution  and 
degree. 

2.  The  onset  may  be  either  gradual  or  sudden  in 
character. 

3.  The  most  common  mode  of  onset  is  with  motor 
weakness  of  the  lower  limbs,  more  frequently  at  first 
umited  to  one  leg ;  but  that  onset  with  cerebral,  bulbar, 
or  sensory  symptoms  forms  a  considerable  proportion  of 
the  cases.  ; .. 

4-  Pregnancy  and  the  puerperal  state,  trauma,  and 
the  acute  infections  are  not  infrequent  antecedents. 

5.  Remissions  and  intermissions  of  the  symptoms  of 
variable  grades,  and  for  indefinite  periods,  occur  in  a 
large  number  of  the  cases. 

6.  Many  varieties  of  gait  are  observed  in  the  disease, 
but  the  most  common  is  the  cerebello-spastic  type. 

7-  The  Babinski  phenomenon  is  the  most  trust- 
worthy and  constant  of  all  the  symptoms. 

8.  The  tendon  reflexes  are,  as  a  rule,  exaggerated, 
but  in  a  certain  number  of  the  cases  may  be  normal. 

9.  The  organic  reflexes  are  usually  affected,  and  con- 
stitute an  early  feature  of  the  disease. 

10.  Sensory  symptoms  (chiefly  paraB9thesiae)  are 
commonly  complained  of,  either  early  or  "during  the 
progress  of  the  malady,  'Jand  are  of  considerable  dia- 
gnostic value.  -  *. 

11.  Emotional  symptoms,  the  peculiar  facies,  and 
some  degree  of  mental  enfeeblement  (loss  of  memory) 
are  not  infrequently  observed.    •• 

12.  Of  the  so-called  classical  signs,  nystagmus  or 
the  finer  nystagmoid  oscillations  are  the  most  frequent. 
Volitional  tremor  and  defects  of  articulation  are  less 
commonly  seen. 

13.  Optic  atrophy  and  pallor  of  the  optic  discs  are 
very  frequent  but  variable  symptoms. 

THE   DYSPEPTIC  ORIGIN 

OF  THE  MINOR  SYMPTOMS  OF 

BRIGHT'S  DISEASE. 

By  Dr.  N.  CHRYSSQVERGIS. 
Of  tha  Faealty  of  Medtoine  of  Beyroath. 

We  are  indebted  to  Professor  Dieulafoy  for  having 
grouped  under  the  common  head  of  "  the  minor 
complications  of  Bright's  disease  "  a  series  of  manifesta- 
tions not  in  themselves  of  any  great  importance  and 
variously  distributed  which,  he  says,  are  frequently 
observed  at  the  onset  and  in  the  course  of  Bright 's 
disease ;  so  much  so  indeed  that  from  his  point  of  view 
their  recognition  should  place  the  practitioner  on  his 
guard  and  lead  him  to  suspect  the  existence  of  chronic 
nephritis. 

Speaking  generally,  these  symptoms  are  attributed  to 
the  accumulation  in  the  blood  of  toxic  substances  as  the 
result  of  inadequate  renal  elimination.  "Almost  all 
the  minor  complications  of  Bright's  disease,"  says 
Dieulafoy — "the  cryaesthesia,the  electric  shocks,  the 
cramp  of  the  calf-muscles,  and  the  itching — appear  to 
me  to  be  the  consequence  of  a  stight  degree  of  uraemia. 
Graver  compHcations,  such  as  headache,  attacks  of  op- 
pression, gastric  disturbances,  and  fugitive  prostration, 
are  due  to  a  more  marked  degree  of  uraemic  intoxica- 
tion." This  opinion,  first  brought  forward  by  Professor 
Dieulafoy  upwards  of  ten  years  since,  does  not  seem  to 
have  attracted  much  adverse  criticism.  Moreover,  it  is 
indisputable  that  these  minor  symptoms  of  Bright's 
disease  are,  as  a  matter  of  fact,  observed  at  Che  onset 
and  in  the  course  of  chronic  nephritis,  and  I  agree  with 
I^ncereaux  and  Germain  S^  that  they  are  by  no  ineans 
solely  the  attributes  of  this  affection.  They  are  met 
with  in  subjects  whose  kidneys  were,  and  have  remained, 
intact,  that  is  to  say,  although  we  are  agreed  in  attribut- 
ing them  to  a  state  of  intoxication,  I  decline  to  attribute 
the  origin  of  this  intoxication  to  rennl  inadequacy. 
The  title  "  minor  dyspeptic  complications  "  seems  to 
describe  them  more  accurately,  indeed  their  patho- 
genesis is  essentially  due  to  excessive  production  of 


248    Thb  Mbmcal  Pmaw.        ORIGINAL  COMMUNICATIONS. 


toxins  in  the  digestive  tract  and  to  the  superabundance 
of  gaseous  formation  in  the  gastro-intestinal  canal. 

In  8upx)ort  of  this  hypothesis  it  must  be  premised 
that  the  symptoms  in  question  are  met  with  in  dyspeptic 
subjects  just  as  frequently,  if  not  more  so,  as  in  the  sub- 
jects of  nephritis.  The  best  plan  will,  no  doubt,  be  to 
scrutinise  them  seriatim,  at  any  rate  the  more  im- 
portant among  them. 

We  will  start  with  headache,  vertigo,  visual  troubles, 
noises  in  the  ears  and  lumbar  pain.  But  does  not  every 
dyspeptic  complain  of  these  symptoms,  not  now  and 
then,  at  distant  intervals,  but  daily,  in  fact,  almost 
constantly  ?  These  various  malaises  may  be  present 
in  various  affections  of  the  digestive  tract,  either  singly 
or  variously  associated,  without  it  being  open  to  us  to 
elicit  any  sign  that  would  justify  our  suspecting  the 
existence  of  a  renal  affection.  Even  more  significant 
is  the  fact  that  these  s3anptoms  get  worse  or  improve 
coincidently  with  modifications  of  the  digestive 
troubles.  Lastly,  with  regard  to  their  duration,  it  is 
true  that  in  most  instances  they  are  ephemeral,  the 
generally-received  view,  but  they  may,  under  certain 
circumstances,  last  for  several  hours  at  a  time,  even 
for  days,  and  recur  every  day  for  weeks  together,  so 
long  as  the  digestive  disturbances  continue  sufficiently 
pronounced. 

Melancholia  and  prostration,  which  are  also  grouped 
among  the  minor  symptoms  of  Bright' s  disease,  are  also 
very  frequent  in  dyspeptics,  in  whom — a  matter  of 
daily  experience — the  temper  is  usually  changed  and 
depression  is  the  rule. 

With  regard  to  the  itching,  it  is  far  from  uncommon  in 
these  subjects  and  it  is  often  easy  to  demonstrate  its 
non-dependence  on  renal  insufficiency  by  putting  the 
patient  (m  a  milk  diet,  that  almost  specific  treatment  of 
renal  manifestations.  Not  oxdy  is  the  itching  nOt  relieved 
thereby,  but  in  some  cases  the  very  treatment  causes 
it  to  supervene.  It  has  fallen  to  my  lot  to  meet  with  a 
certain  number  of  cases  of  this  kind  in  persons  suffering 
from  gastro-intestinal  atony,  an  affection  which  has  the 
disastrous  effect  of  depressing  the  motor  activity  of  the 
digestive*tract,  thus  promoting  stasis,  itself  the  proximal 
cause  of  auto-intoxication.  I  remember  one  case  in 
particular,  that  of  a  man,  set.  45,  dyspeptic  and 
neurasthenic,  who  complained  of  general  pruritus.  His 
medical  man,  having  erroneously  diagnosed  diabetes, 
he  had  been  put  on  strict  milk  diet  for  ten  days,  and 
under  its  influence  the  dyspeptic  troubles  and  itching 
had  got  worse.  The  urine,  examined  on  two  different 
occasions,  was  normal  save  for  an  excess  of  uric  acid. 
I  put  this  patient  on  a  tonic  and  eupeptic  regimen  and 
in  five  da3rs  the  itching  had  quite  subsided. 

With  regard  to  the  "electric  shocks"  which  are 
assumed  to  be  the  initial  signs  of  an  attack  of  uraemia, 
it  is  well  to  note  that  the  victims  of  this  symptom  have 
been  so  from  their  youth  upwards.  They  are  for  the 
most  part  congenital  neurasthenics,  and,  as  we  know, 
dyspepsia  and  neurasthenia  are  intimately  associated. 
The  symptom  in  question  is  due  to  spinal  hyperaes- 
thesia,  a  common  symptom  in  neurasthenics.  The 
slightest  contact,  even  certain  positions  of  the  body, 
suffices  to  determine  a  reflex  contraction  of  the  dorso- 
lumbar  muscles ;  moreover,  one  can  determine  these 
electric  shocks  in  all  neurasthenics  simply  by  rubbing 
the  spine. 

Epistaxis.  again,  is  a  symptom  not  infrequently 
met  with  in  dyspeptics,  especially  in  elderly  individuals 
in  whom  sclerosis  has  reduced  the  resistance  of  the 
walls  of  the  blood-vessels,  this  moreover,  being  asso- 
ciated with  heightened  intra-vascular  tension,  due  to 
the  unsatisfoctory  state  of  the  digestive  tract.  I 
remember  in  particular  three  dyspeptics  (two  of  whom 
were  also  emphysematous)  who  suffered  from  frequent 
epistaxis,  and  I  found  myself  unable  to  explain  this 
circumstance  on  any  other  ground  than  a  change  for  the 
worse  in  the  gastro-intestinal  troubles. 

These  remarks  in  respect  of  the  minor  troubles  apply 
equally  to  those  of  a  graver  kind,  and  the  latter  are 
vastly  more  significant — vtz.,  symptoms  involving  the 
respiratory     and     circulatory    functions  —  dyspnoea. 


Sept.  7,  1904- 


palpitations,  oedema,  polyuria,  and  poUakiuiia,  merely 
to  mention  the  principal  ones. 

Whenever  in  a  patient  whose  heart  and  lungs  are 
sound  we  witness  the  supervention  of  repeated  attacks 
of  dyspnoea,  we  naturally  think  first  of  all  of  renal 
inadequacy  (p>renephritic  dyspnoea),  especially  if  these 
respiratory  disturbances  are  associated  with  other 
minor  symptoms  of  Bright's  disease.  Now.  in  my 
opinion,  this  dyspnoea  is  attributable  to  two  different 
factors,  both,  however,  arising  from  a  common  cause — 
yi*.,  the  existence  of  digestive  disturbances.  We  have, 
in  the  first  place,  the  mechanical  disturbance  caused  by 
gaseous  distension  of  the  stomach  and  intestines,  in  the 
second  place  there  is  the  reflex  contraction  of  the  capil- 
laries to  which  Potain  called  attention  upwards  of 
twenty-five  years  since,  in  connection  with  acate 
affections  of  the  biliary  canals  and  especially  in  gall- 
stone jaundice.  To  these  two  principal  factors  most 
occasionally  be  added  spasm  of  the  bronchioles  and 
asthenia  of  the  inspiratory  muscles,  which  may  play  an 
adjuvant  rSle, 

I  need  not  insist  upon  the  various  forms  of  this  so- 
called  prenephritic  dyspnoea,  for  that  would  take  me  far 
from  my  subject.  Suffice  it  to  say  that  it  may  affect 
the  form  of  Cheyne  Stokes  respiration  or  occur  in  a 
paroxysmal  form  suggestive  of  an  attack  of  asthma, 
the  form  called  by  Max  Einhom  "  dyspeptic  asthma/' 
I  have  seen  the  latter  form  in  two  dyspeptics  whose 
urine  showed  nothing  abnormal. 

The  dyspeptic  troubles  do  not  fail  to  make  themselvefr 
felt  in  respect  of  the  cardiac  function.  Its  influence  is 
seen  clinically  by  cardiac  erethism,  characterised  by 
frequency  of  beat  and  increased  force  of  the  systolic 
contraction,  in  such  wise  that  the  first  sound  often  ac- 
quires a  vibratory  quality.  This  cardiac  erethism  is 
complained  of  by  the  patients,  who  state  that  they 
can  feel  the  beating  of  their  heart  and  even  suffer  from 
time  to  time  from  attacks  of  palpitation  w^ith  praecordial 
distress.  The  accentuation  of  the  closure  sound  of  the 
sigmoid  valves  is  also  almost  constantly  present  id 
dyspeptics,  especially  when  they  are  passing  through 
one  of  the  acute  crises  which  are,  after  all.  only  an  in- 
tensification of  the  habitual  condition.  It  indicates  an 
exaggeration  of  arterial  tension  caused  by  spasm  of 
the  peripheral  arterioles  or  the  vaso-constriction  of  the 
vascular  system  of  one  or  several  viscera  which  may. 
in  the  long  run.  determine  cardiac  hypertrophy. 
Auscultation  also  often  reveals  in  these  subjects  the 
bruit  de  galop,  a  sign  formerly  regarded  as  pathogno- 
monic of  the  prodromal  period  of  chronic  nephritis. 
Is  not  this  exactly  what  have  been  described  as  the 
cardiac  phenomena  of  the  prenephritic  period  ? 

This  cardiac  erethism  is  usually  associated  with  a 
similar  erethism  of  the  vascular  system  which  is  pro- 
ductive of  certain  phenomena  of  less  significance,  such 
as  deadness  of  the  fingers,  pallor  of  the  face.  &c. 

If  now  we  pass  on  to  the  consideration  of  a  symptom 
which  is  generally  regarded  as  a  sign  of  urinary  inade- 
quacy, viz,,  the  so-called  prenephritic  oedema,  it  is  im- 
possible not  to  be  struck  by  the  absolute  similarity^of 
this  oedema  and  that  seen  in  persons  suffering  from 
nervous  exhaustion,  who  also  suffer  from  dyspepsia  ;  in 
both  cases  the  oedema  is  usually  insignificant  in  degree 
and  fugitive  in  duration,  limited  to  the  eyelids,  the  face, 
to  the  malleoli,  occasionally  involving  an  entire  limh, 
orit  may  be  symmetrical.  Even  so,  the  cause  is  some 
vaso-motor  disturbance,   caused,  no  doubt,  by  toxic 

?henomena,  but  quite  independently  of  the  kidneys, 
hese  oedemata  are  characterised  by  vaso-dilatation  of 
the  affected  region,  following  more  or  less  marked  and 
durable  paralysis  of  the  lo^  vaso-motor  apparatus 
consequent  upon  asthenia  or  inadequacy  of  motor  inner- 
vation of  the  vessel  walls.  The  slowing  down  of  the 
circulation  thus  caused  promotes  serous  exudation  and' 
constitutes  the  principal  cause  of  this  prenephritic 
oedema,  which  may  be  aggravated  by  the  retention  of 
chlorides  when  this  takes  place. 

During  the  last  few  months  I  have  collected  notes  of 
three  cases  of  slight  oedema,  two  of  them  in  young 
females,  art.  36  and  26  respectively,  and  one  in  an"old 
man,  a>t.  70.     In  all  three  cases  the  analysis  of  the  urine 


Sept.  7,  1904. 


ORIGINAL  COMMUNICATIONS.         Th»  Mbdicai.  Pbbss.   249 


demonstrated  the  absolute  integrity  of  the  renal  func- 
tions, and  in  one  the  excretion  of  chlorides  was  not  in 
excess  of  the  average.  On  the  other  band,  it  was  easy 
to  satisfy  oneself  in  all  three  cases  as  to  the  existence 
of  dyspepsia  and  neurasthenia,  and,  as  a  matter  of  fact, 
the  oedema  disappeared  under  the  influence  of  a  merely 
antid3rspeptic  and  reconstituent  treatment. 

When  circulatory  troubles,  with  a  tendency  to 
congestion  of  the  kidneys,  predominate  in  certain  dys- 
peptic subjects,  as  the  result  of  fatigue  or  other  excess, 
they  are  manifested  by  more  or  less  copious  poljruria, 
which  lasts  just  as  long  as  the  acute  dyspeptic  crisis 
that  started  it.  This  view  is  confirmed  by  the  fact 
that  all  the  patients  who  are  able  to  take  careful  note 
of  themselves  declare  that  the  urinary  secretion,  inde- 
I>endently  of  any  other  cause,  is  never  as  copious  as  on 
days  when  the  dyspeptic  condition  is  worse  or  when 
gaseous  distension  attains  an  excessive  degree. 

As  to  the  pollakiuria,  according  to  Dieulafoy  it  is 
due  to  exaggerated  excitability  of  the  mucous  or  muscu- 
lar walls  of  the  bladder.  When,  he  says,  the  muscles 
of  the  body  of  the  bladder  alone  are  concerned  the 
pollakiuria,  early  or  late,  is  manifested  by  more  or  less 
pressing  and  frequent  desire  to  micturate  ;  whereas 
when  the  vesical  sphincter  is  affected  micturition  is  often 
followed  by  painful  spasm.  My  own  view  also  is  that 
the  pollakiuria  is  due  to  hyperaesthesia  of  the  vesical 
mucous  membrane,  this,  however,  being  caused  by 
active  congestion  thereof.  This  state  is  strictly  com- 
parable w-ith  the  cx>ndition  of  the  gastric  mucosa  met 
with  in  the  same  group  of  affections  which  is  manifested 
by  vomiting  occurring  after  the  ingestion  of  a  certain 
quantity  of  food  or  liquid.  In  tbe  same  way  the 
bladder,  of  which  the  congested  and  consequently 
h3rper aesthetic  mucosa  cannot  tolerate  any  accumulation 
of  urine,  whence  frequent  and  urgent  csills  to  micturi- 
tion. 

To  conclude  this  review  of  the  principal  so-called 
**  minor  signs  "  of  Bright 's  disease,  we  need  only  refer 
to  the  cryaesthesia.  The  excessive  sensitiveness  of 
neurasthenics  to  slight  variations  of  temperature  is 
well  known,  indeed,  even  the  contraction  of  the  flexor 
muscles  of  the  fingers  and  the  epileptiform  attacks — 
these  major  accidents  of  Bright's  disease — ^may  take 
origin  in  the  self-same  order  of  things.  Boucluurd  has 
vdtnessed  their  occurrence  in  the  subjects  of  gastro- 
ectaisis  and  he  does  not  hesitate  to  attribute  them  to 
the  absorption  of  toxic  substances  resulting  from 
irregular  fermentations  in  the  dilated  organ. 

It  is  evident,  therefore,  that  all  the  so-called  minor 
accidents  of  Bright's  disease  may  be,  and  often  are, 
met  with  in  dyspeptics.  And  let  us  not  jump  to  the 
conclusion  that  we  are  dealing  with  an  association  of 
nephritis  and  gastro-intestinal  trouble.  We  have  often 
— and  I  wish  to  insist  on  this  point — witnessed  these 
accidents  in  persons  who  not  only  never  afford  any  indi- 
cation of  renal  disease  but  who  never  did  so  throughout 
their  life's  history  and  whose  antecedents,  moreover, 
failed  to  suggest  any  plausible  cause  of  nephritis. 

I  will  go  even  farther,  for  I  do  not  hesitate  to  assert 
my  beUef  that  if  a  patient  who  has  previously  suffered 
from  these  accidents  ultimately  be^mes  the  subject 
of  genuine  Bright's  disease  it  would  be  rash  to  assume 
that  the  symptoms  in  question  x>ointed  to  the  existence 
of  actual  renal  disease  and  to  refer  the  onset  of  the 
latter  to  the  date  of  these  symptoms.  On  the  contrary, 
I  feel  convinced  that  the  etiological  factors  of  these 
*'  minor  signs  "  may.  in  the  long  run.  act  on  the  kidneys, 
so  that  these  accidents  prove  not  the  existence  of 
nephritis,  but  of  a  general  auto-intoxication,  which, 
later,  gave  rise  to  nephritis  as  an  epiphenomenon, 
so  to  speak.  What  remains  for  me  to  say  with  respect 
to  the  "  minor  accidents  of  Bright's  disease  "  will,  I 
think,  justify  the  views  I  have  expressed. 

I  have  pointed  out  that  two  principal  factors  give  rise 
to  these  symptoms,  one  toxic  (due  to  excessive  pro- 
duction of  toxins  within  the  organism,  and  especially 
in  the  digestive  tract),  the  other  mechanical  (excessive 
production  of  intestinal  gases).  These  we  will  discuss 
separately. 

It  is  more  particularly  in  the  digestive  tract  of  dys- 


peptics that  the  toxic  substances  are  elaborated, 
consequent  upon  irregular  fermentations.  But  to  tins 
source  of  auto-intoxication  we  must  add  another,  which 
reinforces  the  action  of  the  former — viz.,  the  dis- 
organisation of  metabolism.  This  has  for  result  the 
production  of  numerous  incompletely  oxidised  and 
therefore  toxic  principles ;  among  them  we  may  mention 
particularly  the  urinary  pigments,  regarded  by  Thudi- 
chum  as  extremely  poisonous. 

We  must  bear  in  mind,  too,  that  this  excessive  pro* 
duction  of  toxic  elements  is  further  aggravated  by  the 
functional  shortcomings  of  the  antitoxic  organs  (liver, 
thyroid  gland,  suprarenal  capsules,  Ac),  whence  in- 
complete destruction  of  these  very  elements  already  in 
excess.  The  kidney,  moreover,  is  to  some  extent  an 
antitoxic  organ,  so  that  from  this  point  of  view  it  may 
be  conceded  to  be  occasionally  in  a  state  of  meiopragia 
without  on  that  account  becoming  impermeable.  Far 
from  being  the  cause  of  the  auto-in toxica tion,  the  renal 
disturbance,  under  these  conditions,  is  purely  and 
simply  the  consequence.  But  if  this  double-barrelled 
toxaemia — excessive  production  and  inadequate  de- 
struction of  the  toxic  principles — is  allowed  to  persist, 
structural  changes  will  often  result,  either  in  the  kidney 
or  in  some  other  organ  which  happens  to  be  a  locus 
minoris  resisUntite,  In  this  way  the  patient  may 
ultimately  develop  genuine  renal  disease,  but  it  would 
none  the  less  be  an  error  to  regard  these  minor  sym- 
ptoms as  initial  manifestations  of  nephritis,  since  they 
only  supervene  later.  Consequently,  if  in  a  patient 
suffering  from  chronic  renal  disease  we  elicit  the  history, 
ten,  fifteen  or  twenty  years  pre\dously,  of  some  of 
these  signs,  we  shall  be  justified  in  referring  them  to  a 
previously  existing  dyspeptic  state  and  not  to  renaf 
inadequacy,  since  the  dyspeptic  factor,  by  the  gases 
and  toxins  to  which  it  gives  rise  in  excess,  has,  in  the 
long  run,  exerted  a  powerful  prejudicial  action  more 
jxjwerful  even  than  partial  urinary  insufficiency,  the 
outcome  of  hypothetical  renal  lesions,  in  the  production 
of  the  morbid  phenomena. 

Another  argument  which  militates  in  favour  of  the 
dyspeptic  origin  of  these  troubles  is  the  early  period  at 
which  they  make  their  appearance — i.e.,  in  young" 
persons  free  from  any  history  of  infective  influences 
capable  of  impairing  the  integrity  of  the  renal  apparatus- 
as  may,  indeed,  he  demonstrated  by  the  repeated 
analysis  of  the  urine,  which  is  shown  to  be  free  from  any 
abnormal  constituent. 

Lastly,  it  seems  to  me  that  the  statements  of  the 
patients  themselves  are  worthy  of  attention  when  they 
affirm  that  these  disturbances  are  more  marked  and 
severe  when  their  chronic  dyspepsia  is  from  any  cause 
intensified,  becoming  less  aggressive,  and  even  disap- 
pearing for  a  time,  when  the  digestive  function  is  dis. 
charged  more  satisfactorily.  How  often  have  I  not  been 
told  that  the  passage  of  considerable  quantities  of  flatus, 
freeing  the  digestive  canal,  has  been  immediately 
followed  by  relief  of  the  headache,  vertigo,  visual 
troubles  and  the  indescribable  malaise,  from  which 
they  had  been  suffering  for  several  hours  ? 

The  action  of  intestinal  flatus  is  double :  first  of  all  it 
is  toxic  when  absorbed  by  the  intestinal  mucosa,  and 
from  this  point  of  view  the  effects  are  common  with 
those  of  the  other  toxic  substances  of  digestive  origin. 
Then,  too,  they  exert  a  disastrous  mechanical  action,  the 
distension  of  the  gastro-intestinal  canal  inducing, 
through  the  reflexes,  a  series  of  disturbances  which 
react  on  the  circulation. 

In  view  of  these  two  factors — toxaemia  and  distension 
of  the  gastro-intestinal  tract — we  need  only  assume  a 
more  or  less  selective  action  on  the  vaso-motor  centres 
(an  action  which  may  be  promoted  by  a  "  vaso-motor 
diathesis  ")  to  explain  readily  enough  the  pathogenesis 
of  these  so-called  minor  troubles  of  Bright's  disease, 
since  they  are  attributable  en  dernier  ressort  to  circula- 
tory disturbances.  In  this  respect  we  are  in  agreement 
with  the  classic  writers,  the  point  which  I  have  under- 
taken to  discuss  being,  not  the  pathological  mechanism 
of  these  accidents,  out  the  primary  source  of  the 
intoxication  which  gives  rise  to  them. 


250     Thb  Mkdical  Pxxm. 


BRITISH  HEALTH  RESORTS. 


It  is  unnecessary  to  insist  at  length  on  the  practical 
importance  of  the  facts  which  we  have  brought  forward. 
It  cannot  but  passess  an  important  practical  bearing  on 
the  prognosis  and  treatment  for  us  to  know  whether  a 
patient  who,  for  instance,  presents  cryaesthesia,  polla- 
Jciuria  or  fugitive  oedema  is  really  a  nephritic  subject 
^r  is  merely  suflering  from  cluronic  dyspepsia.  From 
rthis  standpoint  my  opinion  is  clear  enough :  the  sym- 
•ptoms  in  question  do  not  justify  the  assumption  of 
mephritis  so  long  as  the  methodical  examination  of  the 
renal  functions  fails  to  reveal  any  evidence  of  actual 
disease,  such,  for  instance,  as  persistent  albuminuria, 
oliguria,  the  presence  of  casts  or  other  manifestation  of 
the  •kubud. 


Sept.  7.  1904. 


Clinical  VecorDs. 


THE    DAVID    -LEWIS    NORTHERN    HOSPITAL. 

LIVERPOOL. 

Double  Empyama  with  Pulmonary  Abscess. 

By  K.  W.  MONSARRAT,  CM.,  F.R.C.S.E.. 
Bargeon,  the  David  Lewia  Northern  HoepiUl.  Liverpool. 

Thb  patient  whose  Case  I  wish  to  shortly  relate  was 
a  dock  labourer,  jet.  26.  He  was  admitted  to  the 
Northern  Hospital  on  April  2nd.  1902,  under  the  care 
of  my  colleague.  Dr.  Bushby,  to  whom  I  am  indebted 
lor  the  notes  which  were  taken  before  he  was  transferred 
to  the  surgical  side. 

His  illness  commenced  with  headache,  malaise, 
shivering,  and  pain  in  the  left  side  of  the  chest,  and  on 
admission  he  had  the  usual  signs  of  left  basal  pneumonia. 
This  subsequently  affected  the  whole  of  the  left  lung. 
For  the  first  fortnight  after  admission  he  had  irregular 
pyrexia,  varying  between  103*8®  and  99"  ;  albumin 
jand  blood  were  present  in  the  urine.  On  April  i6th 
the  physical  signs  in  his  chest  were,  dulness  over  the 
left  back,  with  diminished  breath  sounds  and  impaired 
vocal  resonance ;  percussion  dulness  also  at  the  left 
apex,  with  a  few  soft  medium  rdles  ;  the  left  pleural 
'Cavity  was  explored  with  a  needle,  with  negative  result. 

At  the  end  of  this  fortnight  the  temperature  became 
regular,  in  that  it  rose  constantly  in  the  evening  to 
about  102®,  and  fell  in  the  morning  to  approximately 
oiormal. 

On  April  20th,  he  was  transferred  to  my  ward,  as  a 
second  exploration  at  the  left  base  had  revealed  pus. 
On  the  same  day  I  removed  2  in.  of  the  8th  rib  behind, 
.and  evacuated  about  20  oz.  of  inodorous  pus,  inserting 
.a  dradnage-tube  of  large  calibre. 

In  spjite  of  this,  his  general  condition  did  not  improve; 
•two  days  later  the  temperature  reached  104°  in  the 
afternoon  and  continued  to  rise  at  night.  The  local 
(Condition  at  the  left  base  improved,  however  ;  the  lung 
^advanced  and  the  discharge  decreased. 

On  May  20th  the  region  of  the  left  upper  lobe  was 
: investigated  with  an  exploring  needle  ;  the  phjrsical 
signs  here  had  remained  much  the  same — ^impaired 
•resonance,  diminished  vocal  fremitus,  and  indistinct 
.breath  sounds.  Pus  was  withdrawn  at  the  depth  of  an 
inch,  and  i^  in.  from  the  sternal  margin. 

The  next  day  I  removed  a  portion  of  the  second  rib  ; 
on  palpation  the  underlying  pleura  and  lung  felt  hard, 
dense,  and  indurated,  and  the  exploring  needle  again 
withdrew  pus.  On  incising  this  area  an  abscess  cavity 
was  opened,  lined  by  broken-down  lung  tissue,  and 
.containing^about  2  oz.  of  pus. 

As  il  was  not  satisfied  that  this  accounted  for  the 
.dulness(af  the  whole  of  the  upper  part  of  this  side  of  the 
•thorax,  I  passed  the  exploring  needle  in  a  direction 
upwards  towards  the  apex  and  at  once  came  upon  a 
•second  odilection  of  pus.  On  exploration  this  proved 
•to  be  an  apical  empyaema.  containing  about  15  oz. 
The  abscess  cavity  in  the  lung  was  packed  with  sterile 
•gauze  and  a  large  drainage-tube  was  passed  into  the 
•empyaema  cavity  from  the  front  wound. 

For  the  first  week  after  this  operation  he  still  had  a 
•considerable  rise  of  temperature  at  night,  attributable 
to  the  fact  that  the  upper  empyaema  cavity  did  not 
drain  satisfactorily.  The  man  was  kept  as  far  as 
^saibde  on  the  left  side,  almost  on  his  face,  but  he  was 


stupid  or  refractory,  and  turned  on  his  back  whenever 
he  thought  he  was  unnoticed.  After  the  ninth  day. 
however,  his  chart  became  satisfactory.  The  abscess 
cavity  in  the  lung  rapidly  contracted.  On  June  7th 
the  tube  at  the  base  was  discarded,  and  a  week  later 
that  in  the  anterior  wound  also.  When  discharged  00 
July  12  th  his  general  condition  was  excellent  and  the 
wounds  satisfactorily  healed. 

The  interest  of  the  case  lies  in  the  combination  of  con- 
ditions present.  When,  after  the  first  operation,  his 
condition  showed  no  considerable  improvement,  Dr. 
Bushby  formed  the  opinion  that  this  was  to  be  ascribed 
to  an  inflammatory  process  in  the  lung,  and  before  the 
second  operation  foretold  the  probable  presence  of  the 
abscess  which  was  found. 

With  regard  to  the  treatment,  I  followed  my  usual 
practice  in  removing  about  two  inches  of  rib,  in  retaining 
a  drainage-tube  of  large  calibre  from  beginning  to  end, 
with  no  particular  device  for  aspirating  the  cavity,  in 
refraining  from  irrigation  except  under  exceptioioal 
circumstances,  and  in  getting  the  patient  out  of  bed 
at  the  earliest  possible  moment,  which  in  the  average 
case  is  about  a  week  after  operation,  but  which  was 
here  delayed  by  the  complexity  of  the  conditions 
present. 


XritiBb  Dealtb  Vesorts* 


IX.— NEWQUAY  (CORNWALL). 

[by  our  special  medical  commissioner.] 

The  much  indented  coastline  of  the  Cornish  pen- 
insula furnishes  numerous  natural  features  desiraUe 
for  a  health  station  and  a  holiday  resort.  Within  a 
comparatively  small  area  great "  variety  exists,  bat 
much  discretion  is  needed  in  selecting  suitable  places  for 
given  cases.  The  south  coast  provides  many  sheltered 
and  picturesque  hamlets,  admirably  fitted  for  the  re- 
quirements of  the  chronic  invalid,  which  are  deservedly 
growing  in  popularity  as  winter  havens  for  the  agei 
delicate  children  and  the  subjects  of  respiratory  aflec- 
tions.  But  of  recent  years  the  bold  and  nigged  scenery 
of  the  northern  portion  of  the  peninsula  with  its  rolling 
seas,  rock-lined  coast,  and  bracingTclimatic  conditions, 
has  become  well  known  to  the  discerning  few  as  an 
almost  ideal  resort,  during  summer  days  at  least,  for 
the  convalescent,  and  particularly  for  the  overworked 
in  body  and  overwrought  in  mind. 

Newquay  is  the  best  known  of  the  North  Cornwall 
health  resorts.  It  is  delightfully  situated,  and  while 
open  to  invigorating  sea-breezes  nevertheless  along  the 
banks  of  the  river  Gannel  admirable  shelter  may  be 
obtained.  Already  the  place  is  rapidly  assuming  the 
proportions  of  a  small  town,  and  several  large,  roc^em. 
palatial  hotels  are  available  for  the  luxury-loving 
visitor,  while  apartments  of  every  description  abound. 

The  immediate  neighbourhood' is  rich  in  attractions 
and  provides  endless  opportunities  for  the  artist  and 
naturalist,  (a) 

Dr.  Arthur  Hardwick,  the  Medical  Officer  of  Health, 
has  kindly  furnished  us  with  copies  of  his  recent  reports, 
from  which  we  gather  the  following  data: — The  popula- 
tion is  estimated  at  3,300.  The  true  death-rate  is 
returned  at  6*06  per  1,000.  The  birth-rate  for  1903 
was  13*6  per  1,000. 

The  mean  temperature  for  last  year  was  51*3,  the 
mean  daily  range  being  only  77.  The  number  of  days 
of  bright  sunshine  is  given  as  286.  the  sunless  days  79. 

During  the  last  eleven  years. the  mean  humidity  has 
been  84,  the  mean  maximum  temperature  55*9, 
the  mean  minimum  temperature  47*2,  the  mean 
range  87,  and  the  mean  temperature  51*4.  The 
daily  average  of  bright  sunshine  is  recorded  as  4'8  hoars. 
The  mean  barometric  pressure  was  29*94  inches. 

We  have  carefully  studied  during  a  recent  x-isit  the 
right  of  Newquay  to  claim  distinction  as  a  desirable 


(a)  Oonsult  the  excellMt  manual,  'Newquay:  the  Vale  el  Xiui- 
heme  and  Ferranzabuloe,"  by  Fannie  Ooddard,  published  l9'"The 
Homeland  Association"  :  also  Messrs.  Ward.  Look  and  Oo.'s  oooTe- 
nlent  guide. 


Sept.  7,  1904. 


AUSTRIA. 


Thx  Mxdical  Prjbss.     25 1 


health  resort.  Nature  has  well  fitted  it  for  such  a  pur- 
pose and  although  art  has  done  much  to  secure  amuse- 
ments and  interests  for  the  vigorous,  pleasure-loving 
visitor  we  are  of  opinion  that  local  enterprise  might  do 
much  more  to  preserve  and  i.»rovide  those  characteristics 
and  requirements  peculiarly  desirable  for  many  lacking 
in  robust  health  and  absolutely  essential  for  the  ailing. 

In  the  immediate  neighbourhood  of  Newquay  there 
are  places  which  might  well  be  made  veritable  sanatoria 
for  those  with  phthisical  proclivities  or  actually  the 
•subjects  of  tuberculosis. 

We  are  strongly  of  opinion  that  Newquay  would 
prove  very  serviceable  for  those  conditions  so  commonly 
met  with  in  children  which  a  passing  pathology  termed 
strumous. 

Newquay  can  be  reached  by  the  L.S.  W.  Railway  or 
by  means  of  the  G.W.  Raflwa'y.  It  is  266  miles  from 
Waterloo  and  297  from  Paddington.  By  the  former 
route  Newquay  can  be  reached  in  about  SJ  hours,  the 
latter  portion  of  the  journey  being  by  coach  from 
Wadebridge,  a  distance  of  16  miles.  Through  carriages 
to  Newquay  are  run  by  the  G.W.R.  on  their  excellent 
"Comishraan  "  corridor  express  trains. 


fvancc. 


[from  our  owk  •corr^pondent.] 


P^aia,   September  4th,  1904. 
Cryogenine  and  Pyramidon. 
In  typhoid  fever,  cold  batlis  oonstitute  the  best  treat- 
ment, and  each  time  the  temperature  reaches  102°,  and 
•every  three  hours  night  and  day,  the  patient  is  placed 
in  a  bath  of  from  82**  to  7 1**. 

Nevertheless,  an  antithermic  agent  is  sometimes 
useful.  Sulphate  of  quinine  is  a  very  familar  remedy , 
more  as  a  general  tonic,  however,  than  an  antipyretic. 
Two  drugs  are  recommended  to  take  the  place  of 
•quinine — cryogenine  and  pyramidon ;  the  former  has 
been  put  on  the  therapeutic  market  by  Lumi^e  of 
Lyons,  and  has  been  faveurably  received  by  the  pro- 
fession. In  a  recent  pamphlet,  Dr.  Bou  ttevxUe  indi- 
•cated  the  advantages  of  the  drug :  complete  innocuity, 
producing  no  congestion  of  the  kidneys,  nor  diminish- 
ing   the  quantity  of  the  urine. 

On  the  other  hand,  its  antithermic  action  is  remarkable 
attaining  a  fall  of  nearly  two  degrees,  but  its  action 
lasts  only  a  few  hours.  The  first  day  he  gives  15  grs., 
the  second  12,  and  the  third  8,  after  which  daily  doses 
•of  8  or  4  grs.  according  to  the  eflfect  produced. 

In  Germany,  pyramidon  is  preferred.  Professor 
Valentin  prefers  to  substitute  the  treatment  by 
pyramidon  for  the  cold  baths. 

In  twenty- four  hours  he  ^obtains  almost  complete 
suppression   of    the   fever    and    delirium,  while   the 
frequency  of  the  pulse  diminishes.     The  dose  he  gives 
.is  very  small,  almost  honxsopathic — ^half  a  grain  every 
two  hours  night  and  day  ;   in  severe  cases  he  gives  one 
.grain,  while  in  children  he  does  not  exceed  one-fifth  of 
a  grain.    The   remedy    is     administered    during   the 
whole  course  of  the  malady-     These  fractional  doses 
;are  also  recommended  by  Dr-  Byk,  who  has  treated  in 
this  manner  several  cases,  with  invariable  success. 
Pain  in  the  Ear. 
Hydrochlorate   of  morphia,   grs.   vj ;    sulphate    of 
.atropine,   grs.  ij  ;    water,   ..^s.     Six  drops  in  the  ear 
:at  night. 

Bnstttiu 


[from  our  own  oorrbspondsnt.] 

YiBVVA,  September  4th,  1004. 
Psbudo-Haluucination. 
Psychologists  aveTead}'  to  tell  us  that  all  mankind 


are  living  in  a  state  of  deception  without  knowing  it. 
Heveroch  recently  brought  a  boy,  act.  14,  before  the 
Bohemian  meeting  in  Prague  who  knows  this,  and  is 
quite  conscious  of  the  deceit.  If  he  concentrates  his 
mind  on  some  object  not  immediately  before  him  or 
connected  with  the  outer  world,  he  can  see  swarms  of 
fairies  with  whom  he  can  converse  and  indulge  with 
them  in  their  pleasures  and  pastimes.  Pain  is  not 
mentioned.  He  is  perfectly  aware  of  the  duplicity 
and  sometimes  has  difficulty  to  shake  it  off.  In 
straining  or  making  an  effort  to  grasp  the  meaning 
of  any  mundane  truth  he  becomes  imperceptibly 
transformed  to  a  new  state,  or  what  psychologists 
call  his  "  real  state."  Is  this  an  instaromnium  for 
the  deluded  ?  Heveroch  further  informs  us  that 
this  is  the  son  of  an  alcoholic  parent,  and  fears  that 
this  boy  is  not  free  from  the  vice,  even  at  this  tender  age, 
which  entirely  destroys  the  charm  of  our  philosophy. 
Correcting  Position. 
Ostrcil  at  the  same  meeting  gave  a  description  of  a 
method  which  he  has  adopted  in  converting  a  face 
presentation  into  an  occipital  presentation.  Schatz 
and  Thorn  have  both  promulgated  a  method  of  their 
own  which  is  fundamentally  to  press  the  shoulders  of 
the  foetus  backwards  and  upwards,  inducing  the  head 
to  rotate  forwards  and  upwards.  Ostrcil  has  modified 
this,  and  contends  that  his  methods  are  better  than 
those  of  his  predecessors',  for  his  can  be  performed  by 
himself,  while  the  others  require  an  assistant.  The 
whole  can  be  done  without  any  untoward  circum- 
stances in  the  parturition. 

Peculiar  Type  of  Degeneration. 
Heveroch  exhibited  a  girl,  at.  11,  with  a  hereditary 
form  of  mental  degeneration.  The  girl  often  left  home 
and  wandered  about  distant  neighbourhoods  telling 
falsehoods  of  the  terror  she  had  of  returning  to  her 
parents.  Her  peregrinations  were  always  extended, 
and  her  deceit  proportionately  increased.  She  always 
locked  herself  in  her  own  room,  refused  to  go  to  school, 
and  at  the  beginning  of  her  aberrations  she  was 
attacked  with  cramp,  becoming  pale,  with  the  head 
turned  round  and  jerking  of  the  foot.  She  continued 
sullen  and  never  spoke,  but  gave  signs  of  great  hunger 
and  thirst.  These  symptoms  are  uncommon  in 
epileptics,  w^ho  seldom  consciously  cover  their  morbid 
misfortunes  by  falsehood.  Since  the  meeting,  it  is 
reported  that  the  girl  has  been  found  murdered. 
Subcutaneous  Injections  of  Gelatine. 
Moll  related  his  experiments  on  guinea-pigs  and 
dogs  with  intravenous  injections  of  gelatine.  He 
found  that  the  fibrin  of  the  blood  was  greatly  in- 
creased, while  the  agglutinating  power  of  the  red  blood 
corpuscles  prevented  extravasation.  Other  albuminoid 
substances  injected,  or  applied  subcutaneously,  in- 
creased the  fibrin,  which  also  favoured  coagulation. 
The  action  of  gelatine  declared  itself  within  twelve 
hours  and  not  beyond  twenty-four  hours  after  in- 
jection. It  is  calculated  that  the  blood  contains 
three  to  four  times  as  much  fibrin  after  this  period 
for  three  days  as  is  found  in  the  normal  condition. 
Taken  by  the  mouth  gelatine  has  no  such  effect.  It 
may  be  mentioned  also  that  sterilisation  does  not 
destroy  the  powers  of  haemostasis,  thus  pointing 
to  the  practical  application  of  gelatine  as  a  valuable 
method  of  treating  obstinate  haemorrhage,  although 
the  effects  cannot  be  expected  immediately.  In 
practice  it  may  be  valued  more  as  a  prophylactic  than 
an  immediate  haemostatic.  It  may  be  noted  that  the 
subcutaneous  injections  and  increase  of  fibrin  in  the 
blood  do  not  disturb  the  digestive  organs.  He 
exhibited  coagula  to  the  members,  which  substantiated 


252    Thb  Mkdxcal  Pkbss. 


OPERATING   THEATRES. 


Sept.  7,  1904. 


his  description  of  agglutination  and  thickening  of  the 
blood.  As  a  general  rule,  when  any  albuminous  body 
is  injected  subcutaneously,  leucocytosis  is  produced 
along  with  the  increase  of  fibrin. 

In  the  discussion  Imhofer  said  that  he  had  em- 
ployed gelatine  subcutaneously  with  the  best  results 
for  local  haemorrhage,  such  as  in  epistaxis.  He 
found  it  excellent  when  applied  locally  with  pledgets 
of  carbolised  lint  to  a  bleeding  surface.  Munzer 
thought  that  the  danger  of  injecting  gelatine  should 
not  be  under-rated.  Besides  the  weakening  effects 
that  usually  followed,  literature  was  not  without  its 
example  in  post-mortems,  where  the  exitus  lethalis 
followed  suddenly  after  the  injection  of  gelatine  for 
aneurysm.  Nonne,  of  Hamburg,  has  put  on  record 
a  good  example  as  a  warning,  where  a  young  man, 
full-blooded,  exhibited  a  slight  pulmonary  haemorrhage 
which  induced  the  attendant  to  inject  gelatine.  The 
man  died  suddenly,  and  in  the  lung  were  found  a 
few  emboli  which  had  been  the  cause  of  death.  If 
every  drug  and  method  of  treatment  has  failed,  gelatine 
may  be  resorted  to  as  a  last  resource. 


Ube  (Pperatino  Ubeatres. 

GREAT  NORTHERN  HOSPITAL. 
Operation  for  Distended  Gall  -  Bladder. — 
Mr.  Peyton  Be  ale  operated  on  a  woman,  aet.  about 
50,  whose  history  was  as  follows :  About  five  weeks 
before  admission  she  observed  her  abdomen  becomins: 
larger  with  a  sense  of  fulness  and  increased  weight. 
As  far  as  could  be  ascertained  she  had  had  no  other 
symptoms  except  a  slight  malaise  till  a  few  days  before 
admission,  when  she  was  seized  with  violent  pain  in  the 
right  iliac  region,  in  the  epigastrium  and  in  the  back  ; 
this  was  accompanied  by  a  rise  of  temperature  to  103®. 
On  admission  there  was  felt  in  the  abdomen  a  movable 
tumour,  occupying  the  right  iliac  region  in  the  position 
of  the  caecum  ;  the  tumour  was  about  the  size  of  a 
foetal  head,  apparently  globular  in  shape  and  very  hard  ; 
it  was  fairly  freely  movable  and  its  manipulation  gave 
rise  to  considerable  pain,  referred  chiefly  to  the  epi- 
gastrium and  the  dorsal  spine  ;  the  temperature  was 
now  normal,  but  the  patient  looked  and  seemed  ill.  The 
medical  man  who  sent  the  case  considered  it  to  be  a 
suppurative  appendicitis.  This,  however,  was  negatived 
by  the  mobility  of  the  tumour  and  its  globular  shape. 
As  it  was  impossible  to  make  any  definite  diagnosis, 
and  as  the  woman's  general  condition  was  becoming 
worse,  the  following  operation  was  performed:  An 
incision  of  about  three  inches  was  made  about  two 
inches  anterior  and  parallel  to  that  usually  employed 
in  performing  lumbar  colotomy.  On  opening  the 
peritoneum  a  large  globular  tumour,  very  hard  to  the 
touch,  was  felt  and  it  was  obviously  a  very  much 
enlarged  gall-bladder.  After  separating  a  few  adhef^ions 
it  was  without  difficulty  brought  out  through  the  wound, 
and  it  was  then  seen  to  be  a  sausage-shaped  swelling 
containing  fluid  at  very  great  tension.  It  was  then 
punctured  and  thick  treacly-looking  bile  escaped. 
The  gall-bladder  was  next  opened  freely  and  four 
large  gall-stones  were  evacuated,  together  with  about 
a  pint  of  the  inspissated  bile.  The  gall-bladder  was 
washed  out  with  hot,  sterilised  water,  the  interior 
being  carefully  examined  to  make  sure  that  there  was 
no  stone  in  the  duct.  The  lumbar  incision  was  then 
closed  with  the  exception  of  one  inch,  to  the  edges  of 
which  the  open  gall-bladder  were  stitched.  Mr.  Beale 
said  that  the  history  of  the  case  was  so  misleading 


that  any  diagnosis  before  operation  was  impoflsilde: 
the  tumour  seemed  to  be  globular  when  felt  through  tK^ 
abdominal  wall  because  there  were  adhesions  betwea 
it  and  the  liver,  stomach,  &c.,  around  its  upper  part; 
it  had  dragged  the  liver  down  to  such  an  extent  tint 
the  tumour  was  lying  on  the  caecum  ;  as  it  turned  ovt 
the  incision  was  in  the  most  favourable  position  that 
could  have  been  chosen,  though,  of  course,  it  was  much 
too  far  back  and  too  low  down  to  be  of  use  in  any 
ordinary  case  of  enlarged  gall-bladder.  As  it  was  it 
allowed  the  gall-bladder  to  drain  thoroughly  well,  aad 
Mr.  Beale  proposed  in  about  a  week's  time  to  sew  up 
the  opening  in  the  gall-bladder  and  drop  the  viscus 
back  into  the  abdominal  cavity.  He  had  come  across 
a  good  many  enlarged  gall-bladders  which  had  been 
mistaken  for  enlargement  of  the  kidney,  but  had  ntt 
before  seen  one  which  was  resting  on  the  caecum.  Ht 
said  that  he  had  made  the  incision  so  far  back  becavae 
he  was  in  the  habit  of  using  this  incision  for  reacfaia;^ 
appendix  abscesses,  and  at  the  time  of  operation  and 
from  the  previous  history  this  case  was  thought  no^ 
unlikely  to  be  of  such  a  nature. 

MIDDLESEX   HOSPITAL. 

Operation    for    Thyroid    Cyst. — ^Mr.     Ketaxxtk 
operated  on  a  man,  aet.  24.  who  had  been  admitted 
for  a  tumour  situated  in  the  right  lobe  of  the  thyToid 
gland,  which  had  been  present  for  some  years,  and 
which  latterly  had  somewhat  rapidly  increased  in  size,, 
but  had  given  rise  to  comparatively  few  S3rmpioDis. 
The  patient  was  a  thin,  anaemic  man.     Situated   lov 
down  in  the  right  lobe  of  his  thyroid  gland  was  a: 
tumour  rather  larger  than  a  pigeon's  egg,  which  wis. 
little  noticeable  when  the  patient  was  at  rest,   out 
when  he  performed  the  movements  of  deglutition,  it 
oecame  ver>'  evident,  rising  up,  as  it  were,  from  tlte- 
deep   parts   of   the   neck   behind   the   cUiviclb.     The 
growth  felt  firm  and  circumscribed,  but  its  situation 
rendered  it  difficult  to  say  whether  fl\ictuation  could 
be  obtained  in  it.     The  rest  of  the  gland'  appeared 
unaffected.     Except  that  he  was  somewhat  anaemic 
the  patient's  general  condition  was  good.     The  man 
having  been  anaesthetised,  a  vertical  incision,  aboot 
three  inches  in  length,  was  made  slightly  to  the  right 
of  the  middle  line,  reaching  downwards  almost  to  the 
upi)er  angle  of  the  sternum.      A  few  bleeding  vessels 
in  the  soft  parts  having  been  secured,  the  right  sterno- 
hyoid and  stemo-thyroid  muscles  were  separated  and 
held  aside  by  retractors,  and  the  lobe- of  the  thyroid 
containing    the    tumour   exposed.     A   slight    incision' 
having  been  made  in  this,  the  tumour  itself  came  into- 
view.   It  proved  to  be  a  somewhat  thin-walled  cyst,  and 
on  an  attempt  being  made  to  shell  it  o\it  from  the 
substance  of  the  gland,  the  wall  ruptured,   and  the 
contents,    which    consisted    of    about    two*  or    three 
drachms  of  fluid  glistening  with  cholesterin  crjrstals, 
escaped.     The  edges  of  the  opening  in  the  cyst  were^ 
then  taken  hold  of,  and  the  entire  cyst  wall  easily 
detached    and  removed.     The.  haemorrhage  from  the 
cavity  was  slight,  and  easily  controlled  by  plugging 
for  a  few  minutes  with  gauze.     A  small  drainage-tube 
wais  then  inserted  into  the  cavity  in  the  thyroid  gland, 
and  the  superficial  structures  and  skin  closed  round' 
this,  with  fine  silk  for  the  superficial'  structures,  and 
horsehair  for  the  skin.     A  dressing  of  cyanide  gauze- 
was   then  lightly   applied   by   means   of  a   bandaf^e- 
passed   round    the  neck   and.  under   the   arms..    Kr. 


Sept.  7,  1904. 


LEADING   ARTICLES. 


Ins  Mboical  Pkess.     253 


KeUock  said  that  unilocular  c>-st8  of  the  thyroid  were 
comparatively  rare  in  men.  Before  the  operation  it 
had  been  difficult  to  say  whether  the  tumour  was  a 
single  cyst  or  a  multilocular  cystic  adenoma.  It  was 
possible  that  it  was  of  the  nature  of  an  adenoma  with 
one  large  cyst,  but  the  thinness  of  the  wall  and  the 
character  of  the  contents,  the  latter  being  quite  fluid 
and  containing  many  cholesterin  crystals,  would 
suggest  that  it  had  some  other  origin.  He  further 
ix>inted  out  that  formerly  the  treatment  of  these  cysts 
consisted  in  either  simple  tapping  with  or  without 
the  injection  of  some  slightly  irritant  fluid,  or  by 
incision  and  drainage,  but  the  operation  he  had  just 
performed  showed  how  comparatively  easy  a  matter 
it  was  to  deal  with  such  things  in  a  more  radical 
manner.  The  drainage-tube  which  had  been  left 
leading  down  to  the  cavity  in  the  thyroid  was  for  the 
purpose  of  preventing  any  accumulation  of  blood, 
which  might  be  injurious  from  its  pressure,  and  this 
tube  would  be  removed,  he  hoped,  in  the  course  of 
thirty-six  or  forty-eight  hours.  It  was  important,  too, 
in  these  cases,  he  thought,  to  apply  a  very  light  dressing 
for  the  same  reason,  and  to  keep  the  patient's  head 
and  neck  quite  still,  lest  any  movement  might  set  up 
fresh  bleeding  from  the  damaged  surfaces  of  the  gland. 


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'  SALUS  POPULI  SUPRElf  A  LEX. 


WEDNESDAY.  SEPTEMBER  7,  1904. 


HOSPITAL  ISOLATION   AND   SCARLET 
FEVER. 

The  articles  on  scarlet  fever  and  its  treatment 
by  hospital  isolation,  contributed  to  our  columns 
by  Dr.  Killick  Millard  and  Dr.  Hubert  Biss,  de- 
serve careful  study.  It  would  not  be  wide  of 
the  mark  to  say  that  until  three  or  four  years  ago, 
when  Dr.  Dean  Marriott,  of  Nottingham,  and 
Dr.  KilUck  Millard  raised  the  question  of  the 
utility  of  fever  hospitals  as  controUing  factors 
in  the  spread  of  infectious  diseases,  no  serious 
doubt  on  the  subject  was  entertained  by  sani- 
tarians. Indeed,  it  was  a  prime  article  of  the 
hygienic  creed  that  isolation  hospitals,  as  they 
are   generally  called,   formed  the  chief  bulwark 


of    defence    against   infection.     The   opinions    of 
those  who  at  that  time  courageously  attacked 
this   behef  were  scouted  as  ridiculous,  and  with 
feathers  much  ruffled   at  the   audacity  of  their 
critics  medical  officers  of  health  endeavoured  to- 
treat   the   onslaughts   as   frivolous   and   beneath 
contempt.     But    the    spirit    of   the    reformer   is- 
stimulated  by  rebuffs,  and  by  dint  of  in-season 
and    out-of-season   efforts   to   win   adherents  to 
their  views,  Drs.  Marriott  and  Millard  gradually 
gained  the  ear  of  an  increasing  number  of  medical 
men.     The    general    attitude    of    the    profession 
towards  the  question  was  reflected  in  the  medical 
journals,   and,   one  by   one,   these  organs,   from 
showing    a    front  of    uncompromising    hostihty,. 
have  come  to 'lend  their  voice,  feebly  and  hesita- 
tingly it  is  true,  in  aid  of  the  demand  formulated 
by  Dr.  Millard  for  an    intra-professional  inquiry 
into  the  subject.     The  question  at  the  moment 
stands  in  this  position.     The  critics  of  the  isolation 
hospital  sjrstem,  or,   as  they  more  correctly  de- 
scribe it,  the  aggregation  hospital  system,   have- 
brought   forward    good   evidence   to   show,   first,, 
that  the  hospitals  have  not  been  a  striking  success- 
as     preventives  of    scarlet  fever  incidence,  and,, 
secondly,   that   the   hospitals   have   many   grave 
drawbacks.     Does  the  good  of  the  system  out- 
weigh   the    evil,   and,   if  so,  is   the  amount    of 
good  effected   commensurate  with   the   enormous 
sums    expended  ?     Since     a   widespread    feeling 
of  dissatisfaction  exists,  we  think  that  such  an  in- 
quiry as  that  suggested  ought  not  to  be  postponed.. 
For  it  must  be  remembered  that  this  agitation  is- 
not     a    hole-and-corner     affair.      Many    medical 
officers  of  health  have  individually  and   collec- 
tively expressed  their  approval  of  the  proposition  ; 
the  leading  journals  of  the  profession  have  now- 
given  it  their  support ;  and  lastly,  at  the  Congress, 
of  the  Royal  Institute  of  PubUc   Health  at  Folke- 
stone this  summer  a  motion  in  favour  of  inquiry 
was  passed   by  a   large  majority.     The  question,, 
then,  may  be  described  as  a  burning  one.     It  will 
be  noticed  that  Drs.  Millard  and  Biss,  and,  indeed,, 
most  of  those  who  have  taken  a  prominent  part 
in  the  matter,  have  confined  their  attention  to« 
the  isolation  of  scarlet  fever.     In  this  they  are- 
wise,  for  whatever  may  be  the  case  with  the  othes 
infectious  diseases,  it  is  in  the  instance  of  scarlet 
fever  that  the  anomahes  are  most  striking.     As- 
Dr.  Biss   showed  in  the  first  part  of  his  paper,, 
the  prevalent  type  of  scarlet  fever  to-day  is  an. 
exceedingly  mild  one,  and  it  may  well  be  ques«> 
tioned  whether  so  benign  a  disease  deserves  the- 
lavish     expenditure    of    money    now    bestowed^ 
upon   it.      Dr.    Biss'    present   contribution   is   a 
particularly  valuable  one,  not  only  for  its  erudi- 
tion and  insight,  but  for  the  temperate  and  scien- 
tific   manner   in   which   he   handles    a    questioni 
which,  as  he  justly  says,  should  not  be  regarded 
as    polemical.      The    considerations    he    adduces, 
from  the  past  history  and  present  condition  of 
scarlet  fever  in  this  country  are  exactly  those- 
which    should    possess  the  mind  of  anyone  who- 
wishes  to  do  justice  to  this  important  matter.  The 
evils,  he  maintains,  are  inseparable  from  aggregatr 


254     The  Medical  Prkss. 


LEADING  ARTICLES. 


Sept.  7.  ^9H- 


ing  such  people,  especially  when  the  bulk  of  those 
people  are  young  children,  and  deserve  serious  at- 
tention. The  records  of  post-scarlatinal  diphtheria, 
post-diphtheritic  scarlatina,  measles,  whooping- 
cough,  and  chicken-pox,  which  belong  to  all  fever 
Ihospitals,  however  well  managed,  have  to  be 
weighed  against  the  good  that  patients  may 
derive  from  their  sojourn  in  these  institutions, 
.and  one  cannot  look  to  any  marked  diminution 
under  this  head  till  the  present  ward  system  is 
replaced  by  the  much  more  expensive  cubicle 
arrangement  which  is  found  in  some  of  the 
Continental  hospitals.  After  all,  however,  the 
icrux  of  the  whole  question  is  whether  there  is,  or 
has  been,  as  the  result  of  the  wide  multiplication 
•of  fever  hospitals,  any  marked  diminution  or 
restriction  in  the  prevalence  of  scarlet  fever. 
This,  as  Dr.  Millard  observes,  is  a  point  that  must 
eventually  be  decided  by  statistics,  and  without  a 
combined  inquiry  it  is  difficult  to  see  how  far- 
reaching  and  authoritative  figures  are  to  be  ob- 
tained. The  belief  that  by  separating  patients 
suffering  from  scarlet  fever  from  their  healthy 
iellows  a  certain  number  of  attacks  must  be  pre- 
vented is  a  natural  one.  Dr.  Boyd  gives  in 
the  August  number  of  "  PubUc  Health  "  details  of 
a  careful  investigation  he  made  at  South  Shields, 
•which  tended  to  show  that  scarlet  fever  has  of  late 
years  prevailed  more  largely  in  the  better  class 
•districts  than  in  the  poorer  ones — a  result  he  is 
inchned  to  attribute  to  a  larger  number  of  cases  of 
the  disease  being  removed  to  hospital  from  the 
less  well-to-do  parts  of  the  town.  But  without 
general  inquiry  and  free  comparison  of  various 
towns  no  final  or  satisfactory  solution  of  the  prob- 
lem can  be  expected,  and  we  should  strongly 
urge  such  an  inquiry  ourselves.  Whatever  it 
may  bring  to  light,  we  think  that  opponents  of 
the  hospital  system  will  prove  to  be  right  in 
saying  that  the  success  of  that  system  has  been 
far  from  commensurate  with  the  predictions  of  its 
founders. 

EPILEPSY  OR  DRUNKENNESS? 
As  members  of  a  scientific  profession  medical 
men  are  closely  interested  in  the  question  of 
•criminal  law  administration.  At  any  hour  of  the 
•day  or  night  the  general  practitioner  is  apt  to  be 
-summoned  by  the  police  to  attend  a  sick  or  in- 
jured person,  a  service  for  which  he  is  paid  a 
miserably  inadequate  fee,  obtainable  only  through 
the  medium  of  circuitous  official  channels.  If 
the  General  Medical  Council  were  really  a  body 
■^Joncemed  with  the  interests  of  the  profession, 
this  small  but  irritating  matter  of  police  attendance 
fees  would  long  ago  have  been  settled  on  a  satis- 
factory basis.  The  duties  of  the  medical  man 
thus  summoned  are  often  of  a  most  difficult  and 
responsible  nature.  He  has  to  determine  be- 
tween the  various  forms  of  insensibility,  and  upon 
his  decision  may  rest  the  reputation  and  some- 
times the  life  of  a  fellow-citizen.  As  a  rule,  in  the 
•cases  where  disaster  follows  the  confusion  of 
various  other  forms  of  insensibility  with  that  due 
•to  alcohol  a  surgeon  has  not  been  called  by  the 


police.     On  the  whole,  the  official  police  surgeons 
are  a  highly- trained  and  experienced  body,  in 
whose    hands    the    risk    of    erroneous    diagnosis 
is    reduced  to  a  minimum.     The  chief  effect  of 
the  present  system  is   that  they  are  not  called 
often  enough,  because  the  police  trust  their  on 
judgment  and  do  not  realise  that  a  drunken  mas 
is  in  a  position  of  more  or  less  imminent  danger. 
The  majority  of  the  police  throughout  the  United 
Kingdom  are  untrained  even  in  the  elementary 
knowledge    of    ambulance    work,    whereby   they 
would  be  able  to  recognise  many  of  the  conditions 
of    sickness  that    are    commonly    mistaken   fa 
drunkenness.     With  a  little  training,  for  instance, 
any  constable  of  ordinary  intelligence  could  lean 
how    to    distinguish    epilepsy    from    alcoholism. 
A  modicum  of  such  elementary  knowledge  wouki 
have  recently  saved  a  London  magistrate  a  good 
deal  of  vexation.     An  unfortunate  epileptic,  who 
is  said  to  be  a  total  abstainer  and  of  irreproach. 
able  character,  was  brought  up  in  custody  by  thf 
police  on  a  charge  of  drunkenness.     The  father  d 
the  accused  states  that  he  was  prevented  goinj 
into  court  to  give  evidence  as  to  his  son's  liability 
to  epileptic  seizures.     However,   other   evidena 
was  forthcoming,  and  the  magistrate,  Mr.  How- 
den,  discharged  the  prisoner  with  the  unfortunate 
remark  that  he  would  give  him  the  benefit  of  tk 
doubt.     It  is  not  clear  why  a  man  who  has  been 
taken  into  custody  on  an  unfounded  charge,  and 
kept  for  the  night  in  a  police  cell,  should  be  dis- 
missed with  a  ''  whitewashing  "  of  that  dubious 
and    grudging    kind.     The    accused    was    either 
drunk  or  not  drunk,  he  was  either  an  epileptic 
or  not  an  epileptic,  he  was  either  innocent  or 
guilty   of    the   charge   of   drunkenness.     It  was 
perfectly  open  to  the  police  to  ascertain  the  factt 
as  to  the  epilepsy,  which  would  have  affwdd 
immediate  confirmation  or  otherwise  of  that  part 
of  the  defence.     Instead  of  so  doing,  the  police 
if  we  are  to  take  the  statement  of  the  father, 
excluded  such  evidence  from  court.     The  htdt 
appears  to  lie  in  the  ppUce  system,  which  regards 
it  as  a  stain  on  its  efficiency  if  a  charge  be  not 
substantiated  at  all  hazards.     A  great  deal  of  the 
possibility  of  minor  police  injustice  or   tyranny 
would  be  avoided  by  having  all  sick  and  insensible 
persons  in  custody  examined  by  a  medical  man. 
Another    safeguard    ¥rould    be  the  possibility  of 
immediate  appeal  firom   any  criminal    judgment, 
no  matter  how  trivial  the  case.     It  is  clearly  in- 
tolerable that  a  respectable  citizen  should  be  shut 
up  in  a  police  cell  because  the  police  have  had 
neither  the  desirable  knowledge  to  recognise  the 
fact  of  his  being  in  a  state  of  epileptic  seizure 
nor  the  sagacity  to  consult  a  surgeon  as  to  his 
condition.     Still  more  intolerable  is  it   that  he 
should  be  dismissed  next  morning  by  the  ma|[i^ 
trate  with  a  curt  remark  that  left  the  police  charge 
in    doubt.     The  blind  acceptance  of   police  tes- 
timony   without    any    attempt    to    bring   corro- 
bDratory     evidence     constitutes     a     raiioal    d^ 
feet  in  minor  criminal  proceedings.      The  histo^ 
of  epilepsy,  to   say  nothing  of  the  strictly  tem- 
perate    habits    of    accused,    would    have    been 


Sbpt.   7,   1904. 


NOTES    ON    CURRENT    TOPICS.       Thb  Mbdical  Press.    255 


^nfirmed  in  a  few  minutes  by  a  couple  of  friends  or 
•datives  in  the  witness-box.  The  matter  is  one  of 
miversal  importance.  At  any  moment  any 
atizen,  no  matter  what  his  standing  or  respec- 
tability, may  be  taken  ill  in  the  street  and  carried 
jff  to  a  police  cell.  In  many  cases  the  error  has 
mded  in  a  tragedy.  It  is  time  the  whole  matter 
^ere  investigated  by  an  authoritative  Royal 
Commission  so  that  the  margin  of  error  in  the  case 
[)f  persons  taken  into  police  custody  in  a  state  of 
unconsciousness  may  be  reduced  to  a  minimum. 
Meanwhile,  the  medical  profession,  which  is 
brought  into  direct  daily  contact  with  the  disas- 
trous defects  of  the  present  police  system,  may 
do  much  to  educate  the  pubUc  and  to  indicate 
the  way  of  reforming  a  force  which,  in  spite  of  its 
errois,  we  could  not  do  without. 


motes  on  Current  Zopice. 


Tsrplioid  Infection. 
We  are  always  inclined  to  become  somewhat 
stereotyped  in  our  beliefs  and  practices,  and  hence 
it  comes    that   having  learned,   quite  correctly, 
that  faecal   contamioation  of  drinking  water  is 
the   commonest    method    of    spreading    typhoid 
infection,  we  proceed  in  the  main   as  if  it  were 
the   only    possible   method.     Recent    experience 
has  proved^  however,  that  various  other  means 
of  infection  have  more  than  a  theoretic  interest, 
and  that  a  pure  water  supply  is  not  the  sum-total 
of  safety.     India  and  South  Africa  have  shown 
that   wind-blown   dust   is   under   some   circum- 
stances of  much  greater  importance  than  drainage 
as  a  factor  in  the  contamination  of  water,  while 
its  influence  affects  aU  foods  and  drinks  as  well, 
unless    proper   precautions    are    taken.     Various 
observers  have  shown,  too,  that  flies  may,  and 
do,    act    as    carriers    of    infection.     Much    more 
important,   however,    than   either   dust   or   flies 
are  the  deductions    that    follow    from    the    dis- 
covery of  typhoid  bacilli  in  the  urine.     It  is  now 
known  that  not   only   during   the  height  of  the 
disease,  but  often  for  weeks  after  convalescence, 
the  urine  of  typhoid  patients  contains  large  num- 
bers of  live  bacillL     There  can  be  but  little  doubt 
that  this  constitutes  a  serious  source  of  infection 
which,  up  to  the  present,  has  been  entirely  over- 
looked.    In  the  treatment  of  typhoid  fever  it  has 
long  been  the  custom  to  destroy  or  disinfect  the 
stools,  while  little  care  has  been  taken  to  deal 
specially  with  the  urine.     In  reality,  it  should 
be    handled    with    the    same    extreme     caution 
with  which  a  bacteriological  worker   treats   the 
virulent  cultures  in  his  laboratory.     It  should  be 
remembered,     too,     that    patients    having    left 
hospital  as  cured  may  still  be  passing  bacteria 
in  their  urine,  and  may  thu>  become  a  source  of 
danger    to    others.     Consequently,     equal    care 
should  be  taken  to  be  sure  that  the  urine  of  typhoid 
patients  is  free  from  bacteria  before  they  leave 
hospital  as  is  at  present  taken  to  make  sure  that 
diphtheria  patients   no   longer   have   diphtheria 
bacilH  in  their  mouths. 


Sir  Thomas  Browne, 
The  proposed  memorial  to  Sir  Thomas  Browne, 
to  which  members  of  the  medical  profession  are 
asked  to  subscribe,  has  drawn  a  strong  protest 
from  Dr.  Conolly  Norman,  of  Dublin,  who  in  a. 
contemporary  appears  in  the  character  of  advo- 
catus  diaboli,  "  Science  and  humanity,"  says 
Dr.  Norman,  **  are  the  watchwords  of  our  pro- 
fession. The  author  of  '  ReUgio  Medici '  was 
neither  scientific  nor  humane."  These  charges  he 
proceeds  to  prove,  we  think,  with  considerable 
success,  by  reference  to  Browne's  conduct  in  the 
trial  of  two  country  women  at  Bury  in  1664, 
on  a  charge  of  witchcraft.  The  principal  count 
against  them  was  that  by  their  machinations 
certain  children  had  been  afflicted  with  "fits."' 
Browne,  being  present  in  court,  and  asked  by  the 
judge  for  his  advice,  "  declared  that  he  was. 
clearly  of  opinion  that  the  fits  were  natural,  bu± 
heightened  by  the  devil,  co-operating  with  the 
malice  of  the  witches,  at  whose  instance  he  did 
the  villainies."  Influenced  by  this  expert  opinion,, 
the  jury  convicted,  and  the  women  were  executed. 
It  may  be  argued  that  behef  in  witchcraft  was 
universal  in  Browne's  time,  but  this  is  by  no 
means  true,  as  it  should  be  remembered  that  he 
was  contemporary  with  Hobbes,  Butler  and  Locke. 
And  one  of  the  many  points  on  which  he  prides  him- 
self is  that  he  is  neither  fanatic  nor  enthusiast.. 
Dr.  Norman  make?  out  a  good  case  on  the  two* 
charges  on  which  he  indicts  Sir  Thomas  Browne, 
and  many  lovers  of  literature  who  demand  thought 
as  well  as  style  in  a  writer  will  not  be  sorry  to- 
see  this  depreciation  of  one  whose  reputation  is 
greatest  among  those  who  have  never  opened  his 
works. 


Serum-therapy. 

One  of  the  most  interesting  discussions  which 
took  place  at  the  meeting  of  the  British  MedicaD. 
Association  a  few  weeks  ago  was  that  on  the  serum 
treatment  of  disease.  The  Executive  acted  wisely 
in  inducing  the  medical  and  pathological  sections, 
to  combine  for  the  purposes  of  discussion,  since- 
the  subject  is  at  present  not  merely  one  of  primary 
practical  importance,  but  ha^  also  theoretical  bear- 
ings oi  the  widest.  Discussed,  as  it  is  bound  to. 
be  in  such  a  gathering,  from  the  very  different 
standpoints  of  clinical  and  laboratory  experience 
one  might  have  expected  greater  differences  of 
opinion  than  actually  appeared.  In  fact,  such 
differences  as  did  appear  were  rather  superficial 
than  real,  and  on  the  whole  some  important  results, 
stand  out.  The  main  point  is  that  the  anti- 
bacterial sera,  of  which  anti -streptococci: 
serum  is  the  best  known,  may  definitely  be- 
regarded  as  valueless,  while  there  is  a  possibility 
of  their  being  actually  deleterious.  The  clinicar 
evidence  has  never  been  decisive,  while  on  theoretic 
grounds  the  arguments  against  them  are  so  strong 
that,  as  Dr.  Bullock  put  it,  "no  respectable 
laboratory  thinks  of  manufacturing  them  now."* 
As  regards  the  antitoxic  sera,  on  the  other  hand, 
such  as  the  anti-diphtheritic  and  anti-tetanic 
preparations,  they  are  now  outside  the  region  oi 


256    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


Sept.  7.  1904. 


•controversy  as  remedies  of  established  worth. 
In  regard  to  the  method  of  their  use,  it  is  well  to 
remember  Dr.  Martin's  advice,  based  on  ex- 
perimental grounds,  that  in  urgent  cases  the  serum 
should  be  administered  intravenously  rather  than 
subcutaneously,  as  a  speedier  result  can  thus  be 
obtained. 


Interrupted  Oiroulation  in  Treatment. 
As  long  ago  as  the  time  of  Ambroise  Par6, 
•damming  of  the  circulation  above  a  fracture  in  a 
Kmb   was  recommended   as  conducive   to  rapid 
healing.      The    treatment  never  seems  to   have 
been  widely  adopted,  though    many    writers    at 
various  times  mention  it  as  a  successful  measure 
in  local  lesions.    To  Dr.  Ewart,  of  St.  George's, 
is  due  the  credit  of  reviving  the  method,   and 
applying  it  with  success  in  cases  of  rheumatoid 
:arthritis.     He  empties  the  veins  of  blood  as  fa" 
as  possible  by  raising  the  limb  he  is  about  to 
treat,  and  by  firmly  stroking  it.     He  then  applies 
a  tourniquet  tightly  above  the  affected  joint  for  half 
a  minute  or  longer,  and  relaxes  it.    The  applica- 
tion of  the  tourniquet  is,  of  course,  accompanied 
by  blanching  of  the  part,  while  its  removal  is 
immediately   followed   by  a   sudden   hyperaemia. 
This    alternation    of     anaemia     and     hyperaemia 
is  repeated  rapidly  four  or  five  times.    The  treat- 
ment may  be  given  once  or  twice  a  day.     In  the 
«cases  treated  by  Dr.  Ewart  he  has  noticed  a  rapid 
decrease  of  swelling  and  diminution  of  stiffness, 
and  he  thinks  the  treatment  may  have  a  wide 
applicability. 

The  Fear  of  Death. 
A  WELL-KNOWN  writer — we  think  it  was  Mr. 
"George  Meredith — made   the  remark  some  time 
ago  that  our  profession,  in  common  with  the  clergy, 
was  injuring  the  English  race  by  increasing  their 
fear  of  death.     We  suppose  there  is  a  certain  truth 
in  the  charge  that  medical  science  increases  the 
dread   of   death,   since   it    makes   death  appear 
more  avoidable  than  formerly.     While  *'  man  is 
mortal "  is  as  universal  a  law  as  ever,  yet  each 
man's  mortality  at  a  particular  moment,  being 
known  ±0  be  governed  by  the  conjunction  of  certain 
natural  laws,  allows  a  possible  chance  of  escape. 
We  are  not  as  ready  to  fold  our  hands  and  say 
"  kismet "  as  formerly  in  the  presence  of  an  epi- 
demic ;    on  the  contrary,  we  are  inclined  to  ask 
who  is  responsible,  for,  as  someone  has  said,  for 
everv  epidemic  of  typhoid  fever  someone  should 
be  hanged.     If  death  here  and  now  has  thus  be- 
come 1  ss  a  matter  of  certainty  and  less  a  matter 
of   course  than  formerly,  its  very    unfamiliarity 
makes  it  more  feared.     Life,  too,  has  a  sacredness 
in  our  civilisation  which  is  comparatively  a  new 
thing,  and  is  bound  to  make  the  negation  of  life 
seem  a  greater  evil  than  in  old  times.     But,  is  it 
true  that  there  is  in  reality  more  dread  of  death 
than  formerly  ?    We  think  that  this  fear  of  death 
is  in  truth  a  very  exaggerated  thing.     In  health 
one  naturally  and  properly  wishes  to  remain  aUve, 
but  beyond   this  we    think  whatever  fear  may 
be  present  is  rather  of   suffering  than  of   death 


Those  who  have  sesa  many  people  die  of  disease 
are  inclined  to  the  view  that  dread  of  death  is 
comparatively  rare.  Death  is  natural,  and  the 
person  meets  it  as  naturally  and  impassivch- 
as  at  the  end  of  a  busy  day  he  meets  his  night's 
sleep.  Where  death  is  dreaded  it  is  rather  far 
the  sake  of  those  left  and  more  for  sonrow  at 
breaking  a  happy  career  than  for  amy  thing  in  the 
essence  of  death  itself. 


Hungry  School  Children. 

It  is  a  self-evident  fact  that  food  must  he 
furnished  before  any  mental  pabulum  can  he 
properly  assimilated.  The  revelations  of  recent 
evidence  before  the  English  Inter-Departmental 
Committee  on  Physical  Deterioration  certainly 
seem  to  show  that  failure  to  recognise  this  pdn- 
ciple,  either  from  wanton  neglect  or  abject  poverty, 
is  only  too  prevalent  among  the  poor  of  oar 
crowded  cities.  According  to  the  headmaster  of 
one  of  our  Board  schools,  12  to  15  per  cent,  of  the 
children  are  unable  to  give  their  minds  to  their 
lessons  on  account  of  actual  hunger,  which  con- 
dition was  proved  to  exist  in  several  cases  by  the 
eagerness  with  which  some  children  devoured 
stale  crusts  of  bread  given  to  them  as  a  test 
During  hard  winters  the  proportion  of  famished 
scholars  in  the  poorest  schools  is  stated  to  he 
even  higher.  In  some  instances  it  is  not  so  much 
the  want  of  food  as  its  quality  and  the  irregularity 
in  meal-times  that  chiefly  touch  the  physical 
welfare  of  the  children.  The  matter  was  moie 
than  once  fully  discussed  by  the  late  London 
School  Board,  who  appointed  a  Special  Committee 
in  1898  to  consider  the  question.  It  was  then 
resolved  that  in  case  of  culpable  neglect  of  a 
parent  to  provide  food  for  any  child  the  Board 
should  have  power  to  prosecute  for  cruelty,  but 
this  proposal  was  defeated  by  a  full  Board.  Private 
enterprise  and  philanthropy  have  done  much  to 
ameUorate  the  impoverished  conditions  of  school 
children,  and  on  this  account  educational  au- 
thorities have  been  unwilling  to  urge  that  the 
matter  should  become  an  item  of  public  expense. 
Dr.  Macnamara,  M.P.,  has  recently  drawn  atten- 
tion to  the  whole  subject  in  the  daily  press,  and 
he  is  of  the  opinion  that  the  support  of  the  great 
urban  educational  authorities  should  be  secured 
before  pressing  the  legislature. 


The  Demoralisation  of  the  Consumptive. 

The  view  that  certain  temperaments  are  pecu- 
liarly prone  to  particular  forms  of  disease  was 
firmly  held  by  physicians  of  the  old  school  It 
is  now  customary  to  assume  the  air  of  the  agnostic 
in  regard  to  much  in  medicine  which  cannot  be 
demonstrated  by  so-called  methods  of  precision. 
But  every  thoughtful  physician  knows  that  in  his 
own  and  his  patient's  physiological  upbuilding, 
and  in  the  initial  action  and  reaction  between 
them,  there  are  elements  altogether  beyond  the 
ways  of  the  mere  laboratory  investigator.  Some 
day,  perhaps,  we  may  unfold  something  of  the 
closely  draped  mystery  of  the  psychology  of 
the   pathological.     Meanwhile,    much   that  is  of 


S8Pr.  7,  I904- 


NOTES    ON    CURRENT    TOPICS.  Thk  Mboical  Pems.     257 


suggestive  value  has  accumulated  in  regard  to  the 
psychology  of  the  phthisical.  We  do  not  intend 
to  describe  the  various  traits  so  frequently  con- 
spicuous in  the  character  of  the  consumptive 
patient,  but  are  desirous  of  urging  on  all  who  are 
in  any  way  responsible  for  the  management  of 
these  cases  the  paramount  importance  of  recog- 
nising those  psychical  features  which,  if  rightly 
controlled,  make  for  mental  and  moral  develop- 
ment, and  if  neglected  lead  to  as  slow  but  sure 
deterioration  of  moral  character.  We  know,  as 
the  result  of  much  personal  investigation  of  so- 
called  sanatorium  life,  that  at  the  present  time 
in  connection  with  what  is  known  as  ''  open-air  " 
or  "  hygienic  *'  treatment  of  consumptives  there 
is  often  a  deplorable  ignorance  of  the  psychical 
requirements  of  the  healthy  life,  and  in  many 
institutions  the  procedure  adopted  is  such  as  tends 
to  develop  selfish,  morbid  introspection  and  moral 
decadence.  In  short,  there  is  danger  in  the 
eagerness  to  improve  physical  condition  of  alto- 
gether forgetting  the  culture  of  the  psychical 
side  of  the  patient,  and  so  there  is  in  process 
much  that  is  making  for  the  demoralisation  of 
the  consumptive. 


Five  Abdominal  Seotions  in  Four  Years. 

Our  American  brethren  have  never  been  re- 
proached with  want  of  courage  in  the  pursuit 
of  surgery,  and  they  have  certainly  educated  their 
patients  to  look  upon  "  the  knife  "  with  much  less 
horror  than  our  own  conservative  population 
usually  entertain  towards  it.  A  certain  Mrs.  B., 
a  patient  of  Dr.  Howard  Crutcher,  appears  to  have 
become  so  much  inured  to  abdominal  operations 
that  he  had  finally  to  dismiss  her  from  his  dumkle 
as  he  assured  her  that  it  was  against  his  principles 
to  do  half  a  dozen  laparotomies  on  the  same  patient. 
In  1894  Mrs.  B.  was  first  seen  and  operated  on  for 
rupture  of  a  large  pelvic  abscess.  Everthing  went 
well,  in  spite  of  a  gloomy  prognosis  that  Dr. 
Crutcher  felt  it  his  duty  to  give,  but  some  months 
alter  convalescence  a  ventral  hernia  developed.  A 
second  and  completely  satisfactory  operation  was 
performed  for  its  reliel  About  a  year  after  this. 
Dr.  Crutcher  was  called  to  see  her  for  the  third  time, 
and  found  that  she  had  appendicitis.  On  opening 
the  abdomen  he  discovered  a  gangrenous  appendix 
-with  two  perforations  ;  appendicectomy  was  done, 
and  the  patient  again  recovered.  In  1896  Mrs.  B. 
consulted  him  again,  this  time  for  a  growing  swell- 
ing in  the  pelvis.  After  a  period  of  observation. 
Dr.  Crutcher  decided  to  operate,  and  in  doing  so 
he  came  upon  an  ovarian  cyst,  which  was  duly 
removed.  After  an  uneventful  recovery  a  period  of 
two  years'  good  health  followed,  but  1898  found 
her  with  another  growth  in  the  pelvis.  Operation 
was  deferred,  as  Dr.  Crutcher  was  unwiUing  to 
interfere  if  he  could  avoid  doing  so,  but  the  growth 
increased  in  size,  and  laparotomy  was  performed 
•once  more.  Two  large  intra-ligacmentous  cysts 
filled  the  pelvis,  each  containing  forty  ounces  of 
fluid,  the  contents  of  the  left  cyst  being  almost 
hlack,  those  of  the  right  clear  and  limpid.  The 
<yst-walls  were  stitched  to  the  peritoneum,  and 


the  cavities  packed>ith  gauze.  They  both  closed 
in  a  short  time.  Mrs.  B.'s  final  appearance  in 
Dr.  Crutcher 's  consulting-room  was  occasioned  by 
another  ventral  hernia,  but,  as  we  have  already 
said,  he  declined  to  operate  again.  The  last  news 
that  come  to  hand  with  regard  to  her  was  that 
she  was  being  cured  by  the  faith-healers. 

The  Functions  of  the  Dental  Pulp. 

A  WIDER  kaowledge  of  the  extreme  delicacy  of 
construction  of  every  part  of  the  body  subserv- 
ing a  special  purpose  would  undoubtedly  tend  to 
prevent  its  abuse  or  neglect.  The  intricacy  of 
the  visual  mechanism  and  the  consequences  of 
overstrain  are  quickly  appreciated  by  the  public, 
but  when  it  comes  to  the  teeth  they  are  simply 
regarded  as  bits  of  bone,  able  to  stand  an  unhmited 
amount  of  wear  and  tear.  The  dental  pulp  itself, 
with  its  wonderful  fibrils,  is  at  least  as  delicately 
fashioned  as  the  retina,  though  it  may  not  be  such  a 
highly  specialised  tissue.  The  vital  action  of  this 
vascular  and  sensitive  substance  is  by  no  means 
sufficiently  recognised.  Dr.  R.  R.  Andrews,  in  a 
paper  read  before  the  fifty-fifth  Annual  Session  of 
the  American  Medical  Association,  in  the  Section 
of  Stomatology,  laid  particular  stress  upon  the  truly 
vital  functions  of  the  dental  pulp,  the  chief  of  which 
is  the  protective  influence  exerted  upon  the  dentin?. 
By  virtue  of  its  odontoblasts,  the  cells  nearest  the 
surface,  any  weak  place  in  the  dentine  is  speedily 
repaired,  and.  indeed,  attempts  at  calcification  may 
be  seen  under  the  microscope  throughout  the  whole 
of  the  superficial  layer.  Its  great  vascularity  and 
the  thinness  of  the  walls  of  the  blood-vessels  suggest 
that  the  leucocytes  play  an  important  part  in  the 
absorption  and  destruction  of  deleterious  sub- 
stances.  When  the  tooth  is  allowed  to  decay  the 
vital  action  of  its  pulp  is  then  overwhelmed,  and 
it  is  a  well-known  clinical  fact  that  the  tubercle 
bacillus  may  find  an  entrance  into  the  body  through 
the  channel  of  a  carious  tooth.  The  restoration  of 
function  of  the  dental  pulp,  in  other  words,  con- 
servative dentistry  in  the  highest  sense,  is  the  whole 
aim  and  object  of  odontological  science.  Con- 
servare  quam  exfrahere. 

The  Pate  of  Biliary  Oaloub. 
One  of  the  most  fascinating  chapters  in  medi- 
cine is  that  which  deals  with  the  formation 
and  destiny  of  the  various  calculi  that  are  met 
with  in  the  different  organs,  glands  and  ducts  of 
the  body.  Their  origin  is  frequently  shrouded 
in  obscurity,  and  the  complications  to  which 
they  may  give  rise  are  both  numerous  and  some- 
times puzzling.  Thus,  no  less  than  twenty-three 
possible  complications  of  gall-stones  have  been 
described,  many  of  which  are  absolutely  fatal 
unless  the  condition  be  promptly  recognised  and 
an  immediate  operation  performed.  The  relative 
merits  of  medical  and  surgical  treatment  in  cases 
of  cholelithiasis  has  long  proved  a  favourite 
theme  for  discussion  at  the  learned  societies,  and 
there  can  be  no  doubt  that  the  former  method 
is  of  great  value  as  a  prophylactic.  If  the  forma- 
tion' of  calculi  can  be  prevented  altogether,  so 
much  the  better,  but  when  once  they  are  present 


258     Tbx  Medical  Pkxsc. 


NOTES  ON  CURRENT  TOPICS. 


Sept.  7.  i<xx|. 


the  individual  is  not  free  from  danger  until  they 
have  either  been  removed  by  operation  or  passed 
per  vias  naturales.  The  most  common  complica- 
tion of  gall-stones  is  their  impaction  within  the 
bile  or  cystic  ducts,  perforation  of  which  not  in- 
frequently occurs.  The  fate  of  a  moderately  large 
biUary  calculus  is  interesting  to  trace.  Intestinal 
obstruction,  ulceration,  or  perforation  may  occur 
as  the  result  of  a  fistulous  communication  between 
the  gall-bladder  and  bile-duct  and  the  duodenum. 
The  virulence  and  activity  of  the  bacillus  coli  is 
apt  to  be  much  increased  under  such  circumstances, 
so  that  septic  changes  involving  the  mucous 
membrane  of  the  passages  traversed  by  the  stone 
may  arise.  One  of  the  most  remarkable  complica- 
tions is  the  elimination  of  the  calculus  directly 
through  the  skin  of  the  abdomen,  which  cannot  be 
regarded  as  a  common  event.  M.  Princeteau  (a) 
has  recorded  the  case  of  a  woman,  aet.  59,  in  which  a 
good-sized  gall-stone  was.  ejected  spontaneously 
through  the  right  hypochoncLrium,  a  minute  sinus 
having  previously  existed  at  the  spot. 


Shakespeare's  Grave. 

It  would  be  difficult  to  match  the  so-called 
Shakespeare-Bacon  controversy  in  any  age  of  which 
we  have  record.  If  ever  an  example  were  needed 
to  illustrate  the  hold  that  ingenious  sophist  ies 
can  obtain  over  thoughtful,  well-educated  minds, 
the  wrangle  over  the  personality  of  the  author 
of  Shakespeare's  works  would  surely  furnish  one  of 
the  most  remarkable.  When  people  seriously  set 
themselves  to  work  on  iconoclasm,  and  are  prepared 
to  admit  evidence  of  any  kind,  astonishing  results 
can  be  obtained.  A  well-known  playwright  of  his 
day,  whose  personality  and  productions  were  as 
well  known  to  his  contemporaries  as  those  of  Mr. 
Pinero  and  Mr.  H.  A.  Jones  to  us  to-day,  has  been 
conclusively  shown  by  different  parties — (a)  to 
have  been  somebody  else ;  (b)  to  have  been  two 
people  ;  and  (c)  not  to  have  existed  at  all  (as  an 
author).  Those  who  are  old-fashioned  enough  to 
enjoy  the  greatest  dramatic  masterpieces  of  any 
time,  and  credulous  enough  to  attribute  their 
authorship  to  the  man  who  wrote  them,  stand 
aghast  at  the  latest  proposals  of  the  fanatics, 
for  they  are  little  else,  who  wish  to  open  the  poet's 
tomb  in  search  of  confirmation  for  their  fads. 
What  good  could  possibly  result  from  such  a  pro- 
cedure it  is  impossible  to  conceive.  Knowledge 
of  personal  appearance  of  Shakespeare  is  derived 
principally  from  the  famous  "  Droeshout  "  paint- 
ings and  the  bust  in  Stratford  church  ;  each  is  in- 
artistic, and  probably  fanciful.  They  differ  greatly 
the  one  from  the  other  ;  indeed,  their  chief  points 
of  resemblance  are  the  fulness  of  the  hair  over  the 
ears  and  the  baldness  of  the  crown  of  the  head. 
All  the  other  portraits  are  of  doubtful  authenticity, 
and  even  more  widely  divergent.  After  a  lapse  of 
three  hundred  years  one  could  not  hope  to  discover 
from  a  grave  seventeen  feet  deep  any  remains 
that  could  possibly  lead  to  identification.  The 
cause  of  science  or  of  justice  may  occasionally  de- 

(a)  La  Medicine  Moderne,  August  10th,  1904 


mand  the  exhumation  of  a  body,  but  it  is  sheer 
stupidity  to  expect  than  any  useful  informatioa 
could  be  derived  from  desecrating  Shakespeare's^ 
grave.  We  would  be  inclined  to  associate  ourselves^ 
with  the  primitive  curse  contained  in  the  doggerd 
inscription  over  the  dramatist's  tomb  on  those^ 
who  wish  to  disturb  his  bones. 


The  Sense  of  Cfonell. 

In  civilised  man  the  sense  of  smell  is  a  faculty 
undoubtedly  much  less  developed  than  among  his 
primitive  ancestors  ;    indeed,  there  is  anatomical 
evidence  that  the  olfactory  lobe  is  but  a  remnant 
of  what  it  has  been  in  lower  animal  forms.     To* 
those  addicted  to  travel  on  the  Continent  this  state 
of  things  may  be  advantageous,  but  there  is  no- 
doubt  that  in  medicine  the  sense  is  often  one  of 
great     \alue.        Typhus    has     a      characteristic 
odour,  which  to  those  accustomed  to  deal  with  the 
disease  is  of  itself  sufficient  to  establish  a  cia mio- 
sis, and  to  some,  indeed,  even  typhoid  is  recog- 
nisable on  Uke  grounds.     Persons  suffering  from 
tuberculosis  of  the  limgs  are  perceived  by  their 
attendants  to  have  a  stale,  sour  odour  about  their 
bodies,  probably  from  decomposition    of   sweat, 
and    most    doctors   and   nurses   are    acquainted 
with  the  acid  smell  of  patients  with  acute  rheumar^ 
tism.     These  are  only  some  diseases  among  many 
in  which  the  nose  is  a  useful  aid  to  diagnosis,  and 
in  chemical  tests  and  pathological  observation  the 
olfactory  sense  is  often  of  no  Uttle  help.     The  seas^ 
of  smell  can  be  cultivated,  and  to  medical  men 
may  be  conmiended  the  olfactory  exercise  which 
serves  the 'Japanese  not   only  with   a    means  of 
educating  a  n^lected  faculty,  but  with  a  pleasant 
pastime.     '*  Incense    snuffing,"    as    it    is    called, 
is  a  ceremonial  that  has  been  in  vogue  for  four  ccdt- 
turies  in  the  land  of  the  chrysanthemum,  and 
the  rules  of  the  game  have  been  elaborated  in 
weighty  treatises.     The  principle  on  which  it  is 
founded  is  that  of  competition*    The  host  of  the- 
kiki'ko  party  brings  in  a  tray  covered  with  different 
kinds  of  incense,  to  each  of  which  names  or  num- 
bers are  given.     These  varieties  of  incense  are  then 
burned  alone  and  in  combination,  and  the  guest 
who  identifies  the  largest  number  by  their  smeU  is 
awarded  a  prize.     An  interesting  point  is  that 
between  the  smeUs  the  competitors  are  provided 
with   vinegar    to   sniff,    in    order    to    bring    the 
Schneiderian  membrane  into  working  order  again. 
By  such  an  education  the  olfactory  acuity  of  the 
Japanese  is  said  to  increase  wonderfully.     Perhaps- 
the  General  Medical  Council  may  see  its  way  t& 
add  a  course  of  sniffing  tO'  the  list  of  obligatory 
studies  in  the  medical  students'  curriculum. 


The  Diafirnostic  Value  of  the  Strawbeny 
TonfiTue. 

The  anxiety  with  which  the  tongue  is  regarded 
by  the  physician  in  a  suspected  case  of  scarlet  fever 
is  in  itself  a  sufficient  indication  of  its  diagnostic 
importance.  As  we  all  know,  a  thick  white  fur 
speedily  develops  upon  the  surface  of  the  tongue 
through  which  some  of  the  fungiform  papillae  may 
generally  be  seen  protruding^     In  three  or  four  days 


Sept.  7,  1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Mkdical  Prks?.    259 


this  coating  disappears,  leaving  a  raw  surface 
studded  with  injected  and  enlarged  papilbe.  The 
appearance  of  a  ripe  strawberry  is  by  this  time 
fairly  well  imitated.  Dr.  Foord  Caiger  states  that 
a  renewal  of  the  normal  epithelium  occurs  early 
in  the  course  of  the  second  week  of  the  disease, 
when  the  tongue  assumes  its  usual  aspect.  In  com- 
mon with  most  physical  signs,  however,  a  too 
absolute  reliance  cannot  be  placed  upon  the 
**  strawberry  tongue,"  for,  according  to  Dr.  J.  F. 
Schamberg,  (a)  this  sign  is  not  present  in  every  case 
of  scarlet  fever,  indeed,  in  mild  cases  the  tongue 
may  appear  quite  normal.  Redness  of  the  tip  and 
edges,  the  reocudnder  being  coated  with  fur,  is  by 
no  means  characteristic  of  scarlatina  alone,  for  a 
somewhat  similar  appearance  may  be  observed 
in  typhoid  fever.  Again,  mere  enlargement  of  the 
papllse  occurs  in  some  varieties  of  superficial 
glossitis,  in  which  the  resemblance  in  question  is 
only  a  distant  one.  The  healthy  tongue  may  also 
exhibit  considerable  variation  from  time  to  time 
in  the  size  of  its  papilke,  according  to  the  degree 
of  congestion  and  activity  of  the  mucous  membrane 
of  this  portion  of  the  alimentary  canal.  In  ery- 
thema scarlatiniforme,  a  disease  which,  perhaps, 
simulates  scarlet  fever  more  closely  than  any- 
thing else,  the  **  strawberry  tongue "  has  been 
seen  in  its  most  typical  form.  The  appearance  of 
the  tongue  must  therefore  be  taken  in  conjunc- 
tion with  other  physical  signs,  such  as  the  sore 
throat,  the  rash  itself,  and  the  constitutional 
symptoms,  as  an  aid  to  diagnosis. 

The  Boyal  Oommiasion  on   Extra-Asylum 
Lunacy. 

A  MurcH-NEEDED  Royal  Commission  has  been  at 
length  appointed  to  inquire  into  the  existing 
methods  of  dealing  with  idiots  and  epileptics,  and 
the  imbecile,  feeble-minded,  or  defective  persons 
oot  certified  under  the  Lunacy  Laws,  and  to  report 
3s  to  the  amendments  in  law  or  other  measures 
-which  should  be  adopted  in  respect  of  their  care, 
training,  and  control.  The  following  have  been 
appointed  by  His  Majesty  the  King  as  members  of 
the  Commission  : — The  Marquis  of  Bath  (Chair- 
man), Mr.  William  Patrick  Byrne;  C.B.,  Dr. 
Frederick  Needham,  Mr.  Henry  David  Greene,  K.C., 
M.P.,  Mr.  Charles  E.  H.  Chadwyck-Healey,  K.C., 
Rev.  Harold  Nelson  Burden,  Mr.  Charles  Stewart 
Loch,  Mr.  Charles  Hobhouse,  M.P.,  Mr.Willoughby 
H.  Dickinson,  and  Mrs.  Pinsent.  While  recog- 
nising the  difl&culties  that  inevitably  surround  the 
selection  of  suitable  members  for  a  Royal  Com- 
mission of  Inquiry,  we  cannot  help  regretting  that 
ttie  medical  profession  is  so  inadequately  repre- 
sented. Dr.  Needham  is,  of  course,  a  tower  of 
strength  in  himself,  but  in  a  matter  of  the  kind  to 
be  investigated  he  should  have  been  strengthened 
by  two  or  three  of  the  most  experienced  asylum 
authorities  obtainable  in  the  United  Kingdom.  The 
proportion  of  lawyers  to  medical  men  on  this  Com- 
mission repeats  the  traditional  legislative  attitude 
with  regard  to  mental  disease — namely,  law  first 
and   medical  science  afterwards — magno  iniervoUlo. 

(s)  Jmkm.Am0r.  Mid,  Anoc.,  August  Oth.  1004. 


Bmokinfir  Without  Harm. 
From  Germany  comes  good  news — ^it  is  possible 
to  smoke  without  risk,  if  proper  precautions  are 
taken.  Bamberger,  who  writes  on  the  subject, 
divides  consumers  of  tobacco  into  two  classes — 
the  dry  smokers  and  the  wet  smokers.  The  for- 
mer consist  of  those  who  puflE  their  cigars  through 
mouthpieces,  and  thus  keep  the  ends  dry.  It 
includes  also  those  who  prefer  the  domestic  pipe 
to  the  allurements  of  more  costly  methods 
of  destroying  tobacco.  Wet  smokers  are  those 
who  chew  their  cigar  ends  or  keep  them  constantly 
moist  with  saliva.  These  careless  individuals 
have  the  mouth  constantly  filled  with  saliva 
in  which  the  tobacco  extracts  are  dissolved,  and 
now  that  the  spitting  habit  is  forbidden  they  are 
forced  to  swallow  quantities  of  this  noisome 
juice.  Consequently  they  suffer  far  more  from 
the  evil  effects  of  tobacco  than  their  "  dry  " 
brethren,  and  if  in  addition  the  "  wet "  smoker 
is  addicted  to  alcohol  his  condition  is  a  parlous  one 
indeed.  Bamberger  would  have  medical  men 
warn  their  patients  to  take  to  dry  methods  of 
smoking,  and  he  suggests  that  in  the  stem  of  the 
cigar-holder  a  piece  of  cotton  saturated  with 
perchloride  of  iron  should  be  placed,  as  thereby 
many  harmful  products  of  tobacco-smoke  are 
rendered  innocuous.  It  is,  however,  one  thing 
for  the  physician  to  advise  and  another  for  the 
patient  to  follow  the  advice.  To  pick,  one's 
cigar-holder  with  wool  would  make  smoking 
such  hard  labour  that  most  men  would  prefer 
to  forego  the  pleasure,  whilst  we  fear  that  the 
admirable  qualities  of  perchloride  of  iron  do  not 
include  that  of  enhancing  the  flavour  of  the  finest 
Havannas.  A  mouthful  of  "  juice  "  from  a  pipe 
or  cigar-holder  is  sufficiently  distasteful  without 
adding  thereto  the  astringent  properties  of 
"steel  drops."  After  all,  our  German  friend 
comes  late  into  the  field,  for  the  plan  of  filtering 
cigar  smoke  through  a  pledget  of  cotton-wool  is 
as  old  as  the  hills.  If  the  wool  be  lightly  packed  it 
may  be  not  intolerable  to  the  inveterate  cigar- 
smoker — poor  man  ! — ^who  has  been  constrained 
to  cut  down  his  daily  allowance — ^may  we  say  a 
second  time  ? — poor  man  ! 


Poplar  Workhouse  Scandal. 

Poplar  Workhouse  has  long  earned  an  unenvi" 
able  reputation  on  account  of  the  maladministration 
of  its  lunacy  wards.  Time  after  time  in  the  columns 
of  The  Medical  Press  and  Circular  have  we 
called  attention  to  the  revelations  of  incompetency 
and  inadequacy  made  at  inquests.  Again  and 
again  have  we  called  for  a  Local  Government 
Board  inquiry  into  the  administration  of  Poplar 
Workhouse  Infirmary,  especially  as  to  the  quality 
of  the  sick  nursing  and  of  the  attendance  and 
management  of  the  lunatic  ward.  The  latest 
inquest  at  Poplar  Workhouse  shows  a  laxity  of 
administration  that  would  not  be  tolerated  by 
public  opinion  anywhere  outside  great,  overgrown, 
callous  London.  From  the  evidence  given  before 
the  Cx)roner  on  September  3rd,  it  seems  that  a  para- 
lysed man  of  thirty-seven  was  set  to  clean  windows. 
He    fell   from   some   steps,    became    unconscious. 


26o     Thb  Msdical  Prbs$. 


PERSONAL. 


Sept.  7,  1904. 


and  was  forthwith  taken  to  the  padded  room  and 
given  a  dose  of  salts  by  an  attendant.  Death  was 
certified  to  be  due  to  rupture  of  a  blood-vessel  in 
the  brain.  This  picture  is  surely  painful  enough  to 
attract  the  attention  of  the  Local  Government 
Board.  First  a  partially  disabled  inmate  is  put 
to  dangerous  and  absolutely  unsuitable  work. 
He  receives  a  fatal  head  injury,  and  while  un- 
conscious is  carried  not  to  a  ward  but  to  a  padded 
room,  and  salts  are  administered  to  him  by  an 
attendant.  We  should  like  to  know  by  whose 
orders  he  was  (i)  set  to  window  cleaning  ;  (2)  taken 
to  a  padded  room  ;  (3)  dosed  with  salts.  What 
have  the  Inspectors  of  that  Board  to  say  about 
the  padded  room  and  the  single  attendant  in  the 
lunatic  ward  ?  These  facts  have  been  brought  to 
their  notice  by  former  inquests.  In  the  public 
interest  an  accurate  list  of  inquests  held  in  Poplar 
Workhouse  and  resulting  in  censure  by  juries  would 
be  of  advantage.  Meanwhile,  a  searching  I-ocal 
Government  Board  inquiry  is,  in  our  opinion, 
imperative. 


PERSONAL. 
The     King    has     presented     his   Marienbad   phy- 
sician. Dr.  Ott,  with  a  coloured  portrait  of  himself 
in  the  uniform  of  an  Austrian  General. 


Sir  Rennell  Rodd's  probable  succession  to  the 
Embassy  at  Rome  has  recalled  his  mission  to  King 
Menelik  of  Abyssinia  in  the  Diamond  Jubilee  year. 
The  average  height  of  the  members  of  that  mission  was 
well  over  six  feet,  and  that  of  Dr.  Pinchin,  the  medical 
officer,  was  no  less  than  six  feet  seven  inches,  while 
two  others  reached  six  feet  four  inches. 


Dr.  Heger  was  President  of  the  International 
Congress  of  Physiologists  held  at  Brussels  last  week, 
in  the  absence  of  Sir  Michael  Foster,  M.P. 


Dr.  G.  B.  Mason  has  been  gazetted  Surgeon- 
Lieutenant  of  the  Mounted  Infantry  Company  of 
the.  Antigua   Defence   Force. 


It  is  officially  announced  that  Dr.  S.  J.  Steward 
has  been  appointed  a  supernumerary  Government 
Medical  Officer  of  Trinidad,  West  Indies. 


Dr.  J.  A.  PicKELS,  Medical  Officer  of  Lagos, 
arrived  in  England  on  leave  of  absence. 


has 


Capt.  A.  E.  Hamerton,  R.A.M.C.,  and  Capt.  C. 
Hudson,  I.M.S.,  are  mentioned  in  dispatches  from 
Somaliland  as  having  done  particularly  valuable  work 


Dinner  will  be  held  on  the  same  evening  at  the  Hotel 
M^tropole. 

Sir.  Thomas  Stevenson  will  open  the  >Mnter 
Session  of  Guy's  Hospital  Medical  School  on  Monday, 
October  3rd.  A  House  Dinner  will  be  held  the  same 
evening  in  the  College  Dining  Hall  at  7.30  p.m. 

The  Winter  Session  at  King's  College,  London,  wiD 
begin  on  Tuesday,  October  4th,  with  an  introductory 
address  at  3.30  p.m.  by  Dr.  Thomas  Buzzard.  lit 
the  evening  the  Old  Students'  Dinner  will  be  held  at 
the  Hotel  Cecil  at  7  p.m.,  Dr.  Urban  Pritchard  in  the 
chair. 


Dr.  Percy  Kidd  will  take  the  chair  at  the  annual 
dinner  of  the  London  Hospital  Medical  School,  in 
the  College  Librjuy,  on  October  3rd,  at  6.30  for  7  p.m* 
the  Winter  Session  opening  the  same  day. 


At  St.  Mary's  Hospital  Medical  School  the  Winter 
Session  will  begin  on  Monday,  October  3rd,  with  aa 
introductory  address  by  Dr.  A.  E.  Wright.  The 
annual  dinner  will  be  held  at  the  Whitehall  Rooms 
Hotel  Metropole,  on  the  same  evening,  Mr.  A.  Q. 
Silcock  in  the  chair. 


The  annual  dinner  of  past  and  present  students 
of  the  Middlesex  Hospital  will  take  place  on  October 
3rd,  at  7  o'clock,  at  the  Trocadero  Restaurant,  Dr. 
Sidney  Coupland  in  the  chair.  The  Winter  Session 
will  open  on  the  same  date. 

The  Winter  Session  of  the  Medical  Faculty  of  Uni- 
versity College,  London,  will  commence  on  Monday, 
October  3rd,  with  an  introductory  lecture  by  Pro- 
fessor J.  Norman  Collie,  Ph.D.,  F.R.S.  The  Old 
Students'  Dinner  will  be  held  the  same  evening,  at  the 
Hotel  Cecil,  when  the  chair  will  be  taken  by  Mr.  John 
Tweedy,  President  of  the  Ro3ral  College  of   Surgeons. 

Westminster  Hospital  Medical  School  will  open 
on  Monday,  October  3rd.  The  annual  dinner  will 
take  place  on  the  same  evening  at  the  Trocadero 
Restaurant,  when  the  chair  will  be  taken  by  Dr.  W. 
Rivers  Pollock. 


The  Principal  Medical  Officer  has  also  brought  to 
notice  the  merits  of  Capt.  S.  de  C.  O'Grady,  R.A.M.C., 
Capt.  F.  L.  Blenkinsop,  I.M.S.,  and  Major  F.  W.  Gee, 
I.M.S.,  who  are  accordingly  mentioned  in  the  Somaliland 
dispatches. 


Arthur  Thomson,  M.A.Oxon.,  M.B.Edin.,  Professor 
of  Human  Anatomy  and  Regius  Professor  of  Medicine, 
has  been  elected  a  member  of  the  General  Medical" 
Council  for  a  period  of  five  years. 

Sir  Isambard  Owen  has  been  appointed  a  Gbvemor 
of  the  Welsh  University  of  Aberystwyth. 

It  is  announced  that  Dr.  Jameson  will  return  shortly 
to  the  Cape,  athough  he  has  not  regained  his  nsnal 
state  of  health. 


Among  non-commissioned  officers  appears  the  name 
of  Corporal  D.  Watt,  R.A.M.C. 


On  the  2nd  instant,  Miss  Blanche  Julia  Cripps,  elder 
daughter  of  the  well-known  surgeon,  Mr.  William 
Harrison  Cripps,  F.R.C.S.,  of  2,  Stratford  Place, 
London,  W.,  and  Abbotsford,  N.B.,  was  married  to 
Mr.  T.  Jefferson  Faulder,  house  surgeon  at  St.  Bar- 
tholomew's Hospital. 


The  Winter  Session  of  Charing  Cross  Hospital  Medical 
School  will  commence  on  Monday,  October  3rd,  by  the 
delivery  of  the  fifth  Biennial  Huxley  Lecture  by  Sir 
William  MacEwen,   F.R.S.,"  and    the     01d_Students 


Dr.  Frederick  Needham,  Commissioner  in  Lunacy, 
and  ex-President  of  the  Medico-Psychological  Associa- 
tion, has  been  appointed  a  member  of  the  Royah 
Commission  of  Inquiry  into  existing  methods  of  treat- 
ing persons  of  defective  mind  not  certified  under  the- 
Lunacy  Laws. 

Dr.  Ott  has  been  authorised  to  make  the  following 
statement  to  Renter's  representative  regarding  his 
Majesty's  cure: — "The  King  has  obtained  this  year 
excellent  results  from  his  visit  and  cure  in  Marienbad. 
While  his  Majesty  had  come  in  very  good  health,  the 
cure  has  had  very  beneficial  effects,  and  the  King 
leaves  Marienbad  in  the  most  perfect  health  in  every 
respect,  and  declares  that  he  never  felt  better  in 
his  life.  The  waters,  the  baths,  the  exercise,  and 
the  diet  have  agreed  wonderfully  well  with  his  Majesty, 
and  his  sleep  is  as  sound  as  possible.  The  King  has  lost 
just  the  proper  amount  of  weight,  a  fact  which  is 
clearly  evident  in' his  light  and  easy  step.  His  Majesty 
will  undergo  a  slight  after-cure  for  ten  days  or  a  fcfft- 
night,  consisting  merely  in  taking    a  snudl  quantity 


Sept.  7,  1004. 


CORRESPONDENCE. 


The  Medical  Pkxss. 


261 


of  Marienbad  salts.  His  Majesty  has  expressed  his 
entire  satisfaction  with  the  results  of  his  cure  at 
Marienbad." 


Special  aorreBpondence* 

[from  our  special  correspondents.] 


SCOTLAND. 
State     Registration     of    Nurses.  —  Miss    Isla 
Stewart.    Matron    of    St.    Bartholomew's    Hospital, 
delivered  an   address  on      this   topic  in   Edinburgh 
last   week.     She    said    that    the    prevailing   state    of 
afEaiiswas  unfair  to  the  public,  and  also  to  the  trained 
nurses   who  had   to  compete  with   the   half- trained. 
Two    Bills  for     the    registration  of    nurses  were    at 
present    before  Parliament— one  by  the  State  solely 
for  the  registration  of  nurses,  and  the  other  by  the 
Royal  British  Nursing  Association.     Both  Bills  pro- 
vide for  a  Central  Council,  whose  importance  could  not 
be  over  estimated.     In  the  former  Bill  the  Council 
would  be  composed  chiefly  of  nurses  elected  by  and 
responsible  to  the  body  of  nurses  whom  they  repre- 
sented.    The    institution    of      public    examinations, 
and   the  granting  of  certificates  to  successful  candi- 
dates    would     ensure     a      minimum     standard     of 
technical   efficiency.     Power   was   also   given    to   the 
Covmcil  to  remove  the  names  of  nurses  who  prove 
unworthy  from    the   Register.     This  is  the  first  time 
that  the  subject  of  registration  of  nurses  has  been 
broaght  prominently  before  the  notice  of  the  public 
in  Scotland,  and  it  cannot  be  said  that  hitherto  the 
profession  have  displayed  any  great  interest  in  the 
matter.     The    meetmg    was    not    largely    attended, 
and  few  of  the  general  public  or  medical  profession 
were  present — to  some  extent,  no  doubt,   owing  to 
the  comparative  emptiness  of  the  city  at  the  holiday 
season. 


BELFAST. 

The  District  Lunatic  Asylum. — ^The  annual  re- 
port of  this  institution,  just  issued  by  the  medical 
superintendent.  Dr.  W.  Graham,  contains  a  numoer 
of  matters  of  interest.  The  average  daily  numoer  of 
patients  under  treatment  was  1,021,  and  the  admissions 
during  the  year  were  254,  a  reduction  of  13  as  com- 
pared with  the  previous  year.  The  cost  of  pro- 
visions was  ^8  OS.  9d.  per  head,  and  the  total  cost 
£23  9s.  lod.  per  head.  After  deducting  receipts  from 
pay  patients,  profits  from  the  farm,  and  Government 
grants,  the  cost  to  the  city  is  £1$  149.  sd.  per  head. 
Of  the  254  cases  admitted,  hereditary  influence  is 
assigned  as  the  probable  cause  in  29,  but,  as  Dr.  Graham 
points  out,  these  figures  are  not  worth  much  when 
we  consider  the  well-known  reluctance  of  families 
to  admit  such  a  cause.  As  one  of  the  contributory 
causes  to  the  recent  increase  in  the  number  of  cases. 
Dr.  Graham  133^8  some  stress  on  changes  in  the  dietary 
of  the  people.  As  he  says,  the  labourer  and  artisan 
used  to  make  porridge,  milk,  and  potatoes,  with  an 
occasional  piece  of  fish,  their  staple  food.  Now  they 
use  quantities  of  Indian  tea  (which  they  often  boil), 
and  stout,  and  all  sorts  of  cheap  tinned  foods. 

The  most  remarkable  point  is  the  increase  of  general 
paral3^is  of  the  insane — 18  males  and  one  female  hav- 
ing  Deen  admitted  during  the  year.  In  the  four  years 
1894-97  there  were  nine  cases  admitted,  and  in  the 
same  number  of  years  1900-03  there  were  57  admissions 
suffering  from  this  disease.  Taking  this  as  his  text.  Dr. 
Graham  gives  a  very  vigorous  little  sermon  on  the 
necessity  which  he  thinks  exists  for  better  teaching  in 
matters  of  morals  and  hygiene. 

The  Small-pox  Outbreak. — A  few  fresh  cases 
continue  to  crop  up  each  week  in  various  parts  of 
Ulster,  though  as  a  whole  the  outbreak  is  certainly 
dying  out.  One  case  was  discovered  in  Belfast  last 
week,  and  removed  to  the  hospital  at  Purdysbum.  A 
bad  case  was  admitted  to  the  fever  hospital  at  Irvines- 
town,  CO.  Fermanagh,  and  died  in  a  few  days.  Prac- 
tically all  the  inhabitants  have  been  re- vaccinated. 
One   case   was   admitted    to   Clones   fever    hospital 


last  week,  and  there,  too,  re-vaccination  is  generals 
There  are  five  cases  in  Cavan  fever  hospital 

Chair  op  Pathology  in  Queen's  College,  Bel- 
past. — A  petition  has  oeen  drawn  up  and  circulated' 
for  signature   among   the   members  of   the   hospital 
staffs  in  Belfast,  in  favour  of  the  candidature  of  Dr. 
Thomas    Houston    for   this  chair.      This  petition  is- 
addressed  to  the  President   of   Queen's  College,  and' 
as  it  has  been  signed  by  practically  every  hospital 
man  in  the  city,  it  can  hardly  fail  to  carry  weight. 
As   has  been  pointed  out,   the  Chair  of  Pathology 
differs  from  all  other  chairs  in  this,  that  it  is  a  matter- 
of  direct  moment   to   the  members  of  the  medical 
profession  in  the  district    as  to  who  its  occupant  is, 
for  they  must  come  into  almost  daily  relation  with 
him    in    making    pathological    examinations.       Dr. 
Houston  is  a  man  so  thoroughly  qualified  to  fill    the- 
vacant  chair,  and  such  a  favourite  with  the  profession 
generally  that  the  feeling  in  his  favour  is  very  strong. 
For  the  purely  scientific  chairs  much  may  be  said  for 
appointing    the  best-qualified   man  without    respect 
to  local  feeling,  but  in  a  chair  whose  occupant  is  in 
such  intimate  relations  with  the  local  men  in  practical 
work  it  is  felt  that  a  well-qualified  local  candidate 
deserves   special   consideration. 

Correspondence* 

[We  do  not  hold  onnelves  responsible  for  the  opinions  of  our- 
OorrespondentSL } 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular- 

Sir, — ^Dr.  Taylor  answers,  in  your  last  issue,  not 
my  letter  of  August  loth,  but  mj'  case  as  pressed 
on  his  consideration  by  "  Qualified  Assistant."  What 
answer  has  he  given  to  my  query  whether,  I,  a  strug- 
gling country  practitioner,  l^ing  married,  ought  to- 
bring  into  the  world  an  unlimited  family  ?  In  the  most 
pleasant  but  'evasive  way  Dr.  Taylor  intimates  he 
has  not  sufficient  grounds  to  say  li  I  was  justified 
in  getting  married.  That  is  not  the  point.  Rightly 
or  wrongly,  I  am  married  (to  a  charming  gentlewoman, 
by  the  way).  Ought  I  to  follow  Dr.  Taylor's  pro- 
position and  thereby  court  inevitable  starvation  in 
our  small  home  ?  His  general  law  applies  to  all  married 
folk,  and  must,  if  true,  be  of  universal  application^ 
Therefore,  I  ask  Dr.  Taylor  once  more  if,  with  the 
income  of  a  well-to-do  artisan,  but  with  the  necessary 
outward  show  of  a  well-to-do  member  of  the  middle 
classes,  I  am  morally  constrained  to  produce  an- 
unlimited  progeny  ?  Finally,  is  continence — the 
highest  form  of  restriction — ^to  be  banned  as  well 
as  methods  or  artificial  prevention  ?  A  writer  who* 
lays  down  the  law  in  so  decisive  a  way  as  Dr.  Taylor 
can  surely  explain  details  of  application. 
I  am.  Sir,  yours  truly. 

A  Country  Practitioner. 

Bucks,  September  ist.  1904. 


To  the  Editor  of  The  Medical  Press  and  Circular.- 
SiR, — I  must  express  my  cordial  thanks  to  Dr.  Taylor 
for  his  courteous  reply  to  my  letter ;  I  am  much  in- 
debted to  him  for  so  kindly  dealing  with  the  specific 
points  I  raised.  But  I  cannot  say  that  to  my  mind 
the  difficulty  is  solved.  In  the  first  place  I  think  it 
is  a  pity  Dr.  Taylor  avoided  a  direct  reply  to  the  ques- 
tion whether  our  friends  the  country  doctor  and  the- 
poor  curate  did  right  to  marry.  No  doubt  there  were- 
many  factors  to  be  considered  in  their  cases,  but  I 
hoped  the  issue  would  be  narrowed  down  to  the  single 
point  whether  a  professional  man  with  an  income  of 
say,  ;£i  50  or  ;£20o  a  year  profit,  little  reasonable  prospect 
of  increase,  and  no  expectations  should  consider  himself 
debarred  from  the  comfort  that  a  good  wiffe  would  bring^ 
to  his  home,  because  he  absolutely  couTd  not  afford  an 
unlimited  family.  Our  country  x^actitioner  is.  let  us 
assume,  a  well-educated  man,  pursuing  a  life  of  hard- 
ship and  self-sacrifice  for  the  benefit  of  his  fellow  crea- 
tures. His  home  is  his  only  pleasure.  Is  he  to  have  what 
every  labourer  in  the  country  looks  to  have — a  help- 


262    Trk  Medical  Press. 


CORRESPONDENCE. 


5^ypT.  7,  1904. 


meet  and  stay,  or  to  be  dependent  on  the  caprices  of  some 
elderly  village  body  who  will  come  in  and  "  do  for  " 
him  ?  And  our  poor  curate,  without  the  least  dis- 
paragement to  him,  I  can  only  say  that  perhaps  the 
greatest  benefit  of  the  Reformation  lay  in  abolishing 
celibacy  for  the  clergy.  Dr.  Taylor  will  appreciate  what 
I  mean. 

"  Two  wrongs  will  not  make  a  right.'*  Paraphrased 
this  means — ^Because  society  forbids  you  to  be  natural, 
you  are  wrong  in  being  unnatural.  It  is  a  choice  of 
unnaturalnesses.  The  sexual  instinct  is  natural ; 
you  must  either  abstain,  which  is  unnatural,  or  take 
artificial  precautions,  which  is  unnatural.  You  are 
dn  a  dilemma.  The  only  way  out  is  to  marry  and  abstain, 
which  is  probably  the  most  unnatural,  as  well  as  the 
most  impracticable. 

To  young  men  like  myself  who  look  forward  to  an 
-opening  in  the  near  future,  bachelorhood  is  regarded 
merely  as  a  temporary  penalty  that  one  pays  for  having 
been  bom  in  a  certain  social  stratum,  but  one  cannot  oe 
blind  to  the  fact  that  some  day  the  question  of  providing 
for  more  children  than  one  can  afford  may  present  itself 
in  concrete  form.  I  cannot  hope  that  Dr.  Taylor's 
^ipractical  philanthropist  will  have  put  the  world  into 
joint  by  that  time,  and  I  fear  it  will  be  but  cold  com- 
fort I  should  derive  from  contemplating  how  much 
longer  it  would  be  before  the  hardness  of  my  lot  forced 
an  alteration  in  the  economic  conditions  of  the  country. 
AH  of  us  have  not  a  Horace's  capacity  for  suiting  cir- 
cumstances to  ourselves,  and  are  compelled  to  suit 
•ourselves  to  circumstances. 

I  am,  Sir,  yours  truly. 

Qualified  Assistant. 

Glasgow,  September  3rd,  1904. 

THE  LUNACY  QUESTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Some  years  ago  there  was  a  discussion  at  one 
•of  the  London  Medical  Societies  which  was  rather 
amusing.  I  remember  hearing  the  late  Sir  Wm. 
Gull  assert  that  it  was  easier  to  calculate  the  distance 
between  the  sun  and  our  earth  than  explain  the  phe- 
nomena of  insanity ;  in  fact,  that  it  was  a  great 
deal  more  difficult  to  understand  the  aberrations 
'Of  the  brain  than  those  which  astronomy  has  to  con- 
sider. Very  few  at  first  agreed  with  Sir  William 
and  the  specialists  in  insanity  did  certainly  not  agree 
•with  him. 

Sir  William,  however,  had  far  the  best  of  them 
in  the  discussion,  and  most  of  those  who  heard 
Slim  came  away  with  the  impression  that  he  was 
right  in  his  views,  and  that  insanity  is  an  incompre- 
hensible matter,  and  cannot  be  dealt  with  in  the 
same  way  as  most  maladies  of  the  human  system. 

To  try  and  define  insanity  is  like  trying  to  define 
most  negatives,  and  it  would  be  well  to  define  sanity 
first    before  dealing  with  the  negative. 

It  would  be  well  if  a  law  were  passed  that  prac- 
titioners should  be  required  to  report  to  some  central 
authority  all  cases  that  they  attend  or  advise  upon, 
if  in  any  such  cases  the  mind  of  the  patient  is  so 
disturbed  or  deranged  as  to  require  special  care  to 
be  observed  by  those  in  charge  of  the  case,  lest 
any  injury  might  be  caused  by  the  patient  to  himself 
-or  others  in  any  way.  or  the  patient  might  suffer 
from  improper  influence  personally  or  in  any  other 
way.  that  is,  in  respect  to  disposal  of  property,  &c..  &c. 

I  hope  that  The  Medical  Press  and  Circular 
^will  assist  the  Commission  appointed  to  deal  with 
this  subject, 

I   am,   Sir,   yours   truly. 

Robert  J.    Lee. 

West  Kensington,  Sept  5th,  1904. 


THE    POSITION    OF    MEDICAL    OFFICERS    OF 

HEALTH. 
Tb  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  Times  has  recently  published  an  able  and 
•comprehensive  account  of  the  Report  of  the  Com- 
h)  it  tee  on  Physical  Deterioration,  and  a  leading  article 
upon  it.     In  this  article  the  difficulty  of  the  position  of 


medical  officers  of  health  is,  among  other  things,  dis- 
cussed. The  article  points  out  that  the  provision  of 
the  Act  of  1872,  by  which  the  post  of  medical  officer  of 
health  is  created,  has  been  virtuallv  neutralised  in  manv 
places  by  the  fact  that  the  officer  is  the  servant  of  a 
body  of  men,  many  of  whom  obtain  seats  upon  local 
authorities  with  the  purpose  of  placing  difficulties  in 
the  way  of  active  sanitary  administration.  Enforce- 
ment of  sanitary  laws  is  not  compulsory,  and  the  Local 
Government  Board  has  no  power  to  coerce  the  Autho 
rity.  The  medical  officer  may  remonstrate  in  private 
when  flagrant  neglect  of  duty  is  displayed,  but  it  is  as 
much  as  his  place  is  worth  to  make  any  public  protest 
or  to  set  himself  in  open  antagonism  to  his  employers. 
He  knows  very  well  that  when  the  Authority  is  domi- 
nated by  men  of  a  certain  type  it  is  because  there  exists 
no  public  opinion  to  which  an  appeal  can  be  effectually 
made,  and  that  such  an  appeal  would  surely  lead  sooner 
or  later  to  loss  of  his  position.  In  most  cases  the 
officer,  recognising  that  there  is  no  remedy,  is  forced  to 
restrict  himself  within  a  very  limited  sphere  of  activity, 
much  as  he  may  regret  and  deplore  it.  In  many 
municipalities,  especially  in  the  smaller  towns  when 
tradesmen  and  owners  of  slum  property  dominate  tttt 
Authoritv,  the  model  bye-laws  of  the  Local  Government 
Board,  although  adopted  in  their  entirety,  arc  enforced 
only  in  so  far  as  they  do  not  interfere  with  the  interests 
of  landlords ;  the  sanitary  inspector's  department  is 
undermanned  and  unprovided  with  disinfecting  or 
even  drain-testing  apparatus  ;  slum  dwellings,  display- 
ing all  the  worst  forms  of  insanitary  conditions  and 
over-crowding,  abound,  whilst  in  many  places  no 
provision  is  made  for  isolation  of  any  form  of  infec- 
tious disease,  and  the  Food  Adulteration  Acts  are 
simply  ignored.  As  the  Times  points  out,  it  is  in 
boroughs  where  local  administration  presents  this 
character  that  the  inspectors  of  the  Local  Government 
Board  are  so  often  engaged  in  investigating  the  causes 
of  outbreaks  of  disease,  and  where,  after  tracing  this  or 
that  epidemic  to  its  origin  they  as  constantly  report 
that  the  whole  inquiry  was  but  a  repetition  of  one 
conducted  in  the  same  place  a  few  years  previously, 
and  that  the  overcrowding,  or  the  water  contamination, 
or  the  slum  dwellings,  to  which  the  attention  of  the 
locality  was  directed  on  the  former  occasion,  have 
remained  unaltered,  if  not  aggravated  by  increase  of 
population.  Towards  remedy  of  these  abuses  the 
Committee  on  Deterioration  recommend  that  the  post 
of  medical  officer  of  health  should  be  made  permanent, 
so  that  the  officer  should  not  be  liable  to  dismissal  by 
the  Authority  when  striving  to  carry  out  his  duly 
conscientiously.  The  Time?  seems  to  think  that  such 
a  reform  would  put  an  end  to  the  evils  it  exposes.  It 
avows  that  modem  sanitary  legislation  "  has  been 
practically  inoperative  in  the  very  places  in  which  it 
was  most  required,  and  has  left  large  sections  of  the 
population  to  live  and  grow  under  every  conceivable 
moral  and  physical  disadvantage,  while  the  ratepayers 
themselves  are  absolutely  without  any  remedy  against 
their  '  representatives.'  "  No  doubt  some  good  would 
be  done  by  giving  the  medical  officer  of  health  security 
in  his  position  :  but  as  the  Authority  would  still  fix 
the  amount  of  his  remuneration  and  control  its  increase 
when  deserved,  it  is  easy  to  see  how  uncomfortable 
the  position  of  an  uncompliant  man  might  be  made, 
and  how  far  from  independent  he  must  remain.  What 
is  most  remarkable  is  the  Times'  suggestion  that  the 
ratepayers  have  no  remedy.  Their  remedy,  and  the 
only  complete  remedy  for  the  abuses  which  exist  more 
or  less  throughout  the  country,  is  to  turn  out  inferior 
members  of  local  authorities  and  replace  them  by  men 
really'  imbued  with  public  spirit  and  not  capable  of 
sacrificing  the  welfare  of  their  poorer  fellow-citizens  in 
pursuit  of  selfish,  mean,  and  sordid  ends.  This  remedy 
is  in  the  hands  of  the  ratepayers.  It  is  their  fault  and 
their  shame  that  it  is  not  applied.  The  great  bulk  of 
the  public  know  little  and  seem  to  care  less  about  local 
government ;  men  of  intellect  and  position  refuse  to 
take  any  part  in  it ;  they  will  not  offer  themselves  as 
candidates  for  local  boards,  nor  take  active  steps  in 
putting  fit  men  on.     Even  in  I^ndon  not  more  than 


Sept.  7,  1904. 


LITERATURE. 


Tbb  Medical  Pkess.     263 


4.0  per  cent,  of  the  burgesses  could  be  induced  to  vote 
at  tlie  last  County  Council  election,  and  there  prevails 
an  equal  lack  of  local  patriotism  in  this  regard  through- 
out the  country.  Democratic  institutions  cannot  be 
administered  to  full  advantage  unless  all  intelligent 
citizens  take  a  due  interest  in  their  working.  The 
existing  apathy  forms  a  danger  to  the  nation.  Rather 
tlian  allow  the  present  state  of  things  to  continue,  it 
^would  almost  be  better  to  revert  to  bureaucracy  and 
pnt  the  whole  of  the  sanitary  administration  of  the 
nation  into  the  hands  of  the  Local  Government  Board. 
The  proposed  change  in  the  status  of  the  medical 
officer  of  health  would  be  a  move  in  that  direction  ; 
t>ut  by  diminishing  the  responsibility  of  the  local 
authorities,  and  encouraging  the  indifference  of  re- 
sponsible citiiens  whose  duty  it  is  to  guard  the  interests 
of  the  community  to  which  they  belong,  it  would,  it 
seems  to  me,  do  even  more  harm  than  good  to  the 
cause  of  real  reform  and  advancement. 

I  am,  Sir,  yours  truly. 

An  Active  Sanitarian. 


INSPECTOR-GENERAL  OF  FLEETS  DUGALD 
MacEWAN.  M.D.,  R.N. 

We  regret  to  announce  the  death  of  Inspector- 
General  Dugald  MacEwan,  M.D.,  R.N..  at  his  residence 
in  Bedford,  at  the  age  of  seventy-eight  years.  Dr. 
MacEwan  was  a  native  of  Lochgilphead,  Argyllshire*, 
and  he  entered  the  Royal  Navy  as  Surgeon  in  1847, 
became  Staff  Surgeon  in  April,  1856,  Fleet  Surgeon  in 
1875,  Deputy  Inspsctor-General  of  Hospitals  and  Fleets 
in  January,  1882,  and  Inspector-General  in  January, 
1 887.  He  served  in  China,  the  East  Indies,  and  Burma, 
in  the  Balitic  throughout  the  Russian  War,  and  was 
present  at  the  bombardment  of  Sweaborg  and  Hango, 
in  South  America.  His  decorations  included  the  Bur- 
mese and  (Russian)  Baltic  medal,  and  the  Jubilee  and 
Coronation  medals.  He  was  awarded  the  "  Sir  Gilbert 
Blano  "  medal, and  was  Honorary  Physician  to  the  King 
and  to  the  late  Queen  Victoria.  At  the  time  of  his 
retirement  in  1887  ^®  ^^^  ^^^  seventeen  years  been  in 
attendance  when  her  Majesty  was  travelling  on  board 
the  Royal  yacht,  Victoria  and  Albert.  He  is  survived 
by  his  widow,  four  sons,  and  three  daughters. 

SURGEON-MAJOR  JOHN  CAMPBELL,  C.B.,  M.D., 
R.A.M.C. 
Surgeon-Major  John  Campbell,  C.B.,  M.D.,  late 
Indian  Army,  who  died  on  Friday  last  at  Looe,  Corn- 
wall, was  bom  in  1 8 17.  .He  was  the  youngest  son  of  the 
late  Captain  Thomas  Campbell,  R.N.,  and  served  in 
the  Afghan  War  of  1 841,  in  Scinde  in  1843.  and  in  the 
Indian  Mutiny  in  1857.  He  was  decorated  for  the 
services  which  he  rendered  during-  the  siege  of  Lucknow. 

Xitetatnte. 


TAYLOR  ON  APPIJED  ANATOMY.  (1) 
Mr.  Taylor's  book  is  undoubtedly  one  of  the  most 
interesting  works  dealing  with  anatomy  published 
^rithin  recent  years.  The  plan  of  the  book,  which  the 
author  rightly  describes  in  the  preface  as  "  surgery 
from  the  anatomical  standpoint."  is  excellent.  The 
arrangement  of  the  materiaJ  and  the  manner  in  which 
it  is  presented  enables  the  reader  to  find  in  the  shortest 
possible  time  the  information  which  he  seeks.  The 
various  regions  of  the  body  are  each  first  dealt  with  in  a 
short  anatomical  description — the  more  minute  details 
being  given  in  smaller  type — and  then  the  bearing  of  a 
knowledge  of  the  anatomical  facts  upon  the  pathology 
of  the  part,  and  upon  the  diagnosis  and  treatment 
of  its  morbid  conditions,  is  graphically  explained. 

This  method  of  presenting  anatomical  facts  and 
details  is  undoubtedly  one  which  will  excite  and  hold 
the  interest  of  the  reader. 


The  importance  of  an  accurate  knowledge  of  anatomy 
in  surgical  work  can  hardly  be  over-estimated,  and' 
since  it  is  not  merely  a  kno\yledge  of  isolated  applied" 
facts  which  is  essential,  we  feel  that  the  author  has 
done  well  in  introducing  into  his  descriptions  an* 
accuracy  and  an  amount  of  anatomical  detail  often 
found  lacking  in  works  on  applied  anatomy.  In 
the  progress  of  medicine,  surgery  and  pathology 
anatomical  and  embryological  observations  and  dis- 
coveries, at  first  merely  of  scientific  interest,  are  ever 
proving  themselves  of  the  greatest  importance  in 
elucidating  and  explaining  morbid  conditions,  or  in 
enabling  physicians  and  surgeons  to  arrive  at  correct 
diagnoses  and  devise  new  forms  of  treatment.  It 
is  indeed  quite  useless  to  attempt  sharply  to  separate 
the  points  which  are  of  practical  from  those  of  pure 
theoretical  importance  in  anatomy.  The  subject  is, 
however,  so  vast  that  all  parts  cannot  be  treated 
equally,  and  selection  is,  therefore,  necessary.  We 
believe  that  in  making  his  selection  Mr.  Taylor  has  been 
most  successful,  and  that  he  has  produced  a  work 
which  will  be  not  only  of  the  greatest  use  to  surgeons, 
but  will  also  prove  itself  a  stimulus  to  students  of 
anatomy  by  indicating  to  them  the  manner  in  which 
a  knowledge  of  this  subject  is  of  the  highest  importance- 
in  explaining  and  elucidating  the  subjects  studied  in 
the  later  years  of  the  medical  curriculum. 

In  a  short  notice  it  would  be  quite  impossible  to  calF 
attention  to  the  many  excellent  points  presented 
by  the  work,  but  we  must  not  fail  to  mention  the- 
many  beautiful  illustrations  drawn  from  specially 
prepared  dissections.  These  are  the  work  of  Mr.  J. 
Murray,  and  are  a  special  feature  of  the  book — indeed, 
many  of  them  are  among  the  most  beautiful  ana- 
tomical pictures  that  we  know. 

Perhaps  the  most  interesting  of  these  figures  are 
those  illustrating  the  relationships  of  the  parts  con- 
nected with  the  organ  of  hearing  to  the  .base  of  the 
skull,  those  exhibiting  the  firm  connections  and 
relations  of  the  stomach,  and  those  dealing  with  the 
surgery  of  the  rectum. 

The  general  impression  left  by  a  .survey  of  Mr. 
Taylor's  book  is  that  it  is  the  right  kind  of  work  to 
place  in  the  hands  of  the  best  type  of  medical  student 
in  his  final  years. 

BISHOP   ON   ESSENTIALS   OF   PpLVIC 
DIAGNOSIS,  (a) 

Thb  design  of  this  book  is  to  assist  those  who  have 
little  practical  acquaintance  with  pelvic  diagnosis, 
but  whose  general  training  is  such  as  enables  them  to» 
pick  out  the  salient  symptoms  of  a  particular  case. 
Elaborate  tables,  evidently  very  carefully  considered, 
have  been  constructed  with  the  object  of  conducting  the 
inquirer  along  settled  routes  to  a  definite  opinion  as  to- 
the  true  nature  of  the  disease  which  lies  at  the  root  of 
these  overt  symptoms  and  signs. 

In  a  fair  preface  there  is,  what  seems  to  us,  a  just 
appreciation  both  of  the  difficulties,  dangers,  and 
objections  to  the  making  of  such  a  t)Ook.  We  quite 
agree  that  as  to  the  value  of  such  each  one  must  judge 
for  himself.  But  it  is  undeniable  that  such  a  book 
as  this  presupposes  the  existence  of  very  grave  gaps 
in  clinical  education— of  lacunae  which,  if  often  found, 
could  hardly  be  filled  in  or  bridged  by  the  most  elabor- 
ately compiled  tables.  Indeed,  while  we  admire  the 
completeness  of  these  "  aids  to  diagnosis,"  we  question- 
whether  their  very  accuracy  and  completeness  would 
not  prove  the  most  effectual  bar  to  their  usefulness. 
Assuredlv,  the  average  text-book  would  better  serve  the 
wants  of  the  average  man.  The  main  objection  would 
seem  to  lie  in  the  very  difficulty  of  utilising  the  methods. 
Those  who  most  require  assistance  are  exactly  those 
least  fitted  to  avail  themselves  of  so  complex  a  scheme. 
We  incline  to  believe  that  this  book  will  be  most  liked 
where  least  needed. 


(a)  "A  Trestiae  on  Appll^  Analomy.*'  By  Edward  H.  Taylor, 
XDDub  F.R.C.S  I.,  8nrg«on  to  Sir  P.  Dun's  Hospital.  Dublin  ; 
Examiner  in  Applied  Anatomy,  Trinity  College,  Dublin.  Pp.  xxvil 
and 788.  With  J78 flmires  and  placet,  many  in  colours.  London*. 
Charles  Oriflin  and  Go.    1904. 


(a)  "TheBssentialflof  Pelvic  Dlairnoeis,  with  Illustrative  Cases."- 
ByE.8Unmore  Bishop.  F.R.O.8..  Hon.  Suipon,  Ancoats  Hospital, 
Manchester.  Ac.;  and  an  Appendix  on  Examination  of  the  Blood,  Ac. 
Bv  C.  H.  Melland.  M.D.Lond.:  Hon.^Physician,  Anooats  Hospital.. 
Bristol;  John  Wright  and  Co.  London:  Simpkin,  Marshall,, 
and  Co.,  Ltd. 


264    The  Medical  Press.        LITERARY  NOTES  AND  GOSSIP. 


Sept.  7,  1904. 


I 


Perhaps  the  foregoing  general  observations  do  scant 
justice  to  the  plan  of  the  work.  Properly  to  under- 
stand this  the  Introductory  Chapters  should  be  read. 
These  are  followed  by  a  few  chapters  on  general  methods 
•of  examination,  these  by  a  particularly  interesting  dis- 
•cussion  of  pain  as  a  diagnostic  factor  in  pelvic  disease. 

The  Appendix  (Examination  of  Blood)  seems  a  some- 
what ne^less  addition  to  the  work. 


GALABIN    ON    DISEASES    OF    WOMEN.(aJ 

The  sixth  edition  of  this  well-known  manual,  which 
we  have  often  favourably  noticed  in  its  earlier  editions, 
hardly  calls  for  detailed  criticism. 

Most  of  the  new  material  concerns  operative  tech- 
nique, and  a  notable  addition  and  improvement  is  to  be 
iound  in  Chapter  14,  which  is  devoted  to  Diseases  of  the 
Urethra  and  Bladder.  Such  a  chapter  is  indeed  in- 
•evitably  needed  in  any  modern  work  upon  gynaecology. 

There  are  many  new  illustrations,  though  we  cannot 
specially  commend  the  illustrations  as  a  whole.  The 
micro-photographs,  also  a  new  feature,  and  twenty-five 
an  number,  might  in  the  greater  number  of  cases  have 
been  omitted.  Take,  for  example.  Fig.  82,  which 
purports  to  show  in  section  the  mucous  membrane  of  a 
uterus  removed  by  hysterectomy  on  the  first  day  of 
menstruation.  But  there  is  here  no  emphasis  of  the 
(Characteristic  details — only  just  enough  for  a  specialist 
to  rely  upon.  Why  not  append  a  description  to  each 
micro-photograph  which  would  draw  attention  to  note- 
'worthy  points ;  and  why  not  also  give — as  is  done  in 
some  cases — the  magnification,  or  still  better  a  state- 
ment of  the  glasses^-eye-pieces  and  objectives — used. 
The  popularity  of  the  bcK)k  has  been  proved  and  is 
deserved.  It  is  essentially  practical  in  its  scope ; 
and  its  teaching  is  clear  and  unambiguous. 


CRILE  ON  BLOOD  PRESSURE  IN  SURGERY,  {b) 
It  is  a  cctfisiderable  time  since  we  have  read  a  work 
•of  such  interest  and  of  so  great  practical  importance 
as  is  the  volume  before  us,  containing  the  account  of 
the  researches  made  by  Dr.  Crile  into  causes  of  altered 
blood  pressure  and  the  deductions  which  he  has  been 
able  to  draw  from  these  researches.  We  may  say  at 
'once  that  the  work  he  has  done  appears  to  us  to  be 
'Of  the  very  greatest  value,  and  to  have  well  deserved 
the  Cartwright  Prize  which  it  obtained. 

The  first  .260  pages  of  the  book  are  occupied  by  the 
statistics  of  251  experiments  made  on  animals.  There 
is,  of  course,  in  this  part,  a  large  amount  of  repetition, 
bat  as  the  experiments  were  most  costly  in  tmie  and 
trouble,  it  was  considered  well  to  have  a  full  account 
of  them  placed  on  record.  The  last  150  pages  are 
occupied  with  the  summary  of  experimental  data,  and 
are  of  the  greatest  interest ;  but  even  if  the  busy 
surgeon  has  not  the  time  necessary  for  their  close 
study  he  will  find  an  admirable  rhumi  of  Dr.  Crile's 
•conclusions  in  the  last  ten  pages.  Dr.  Crile  recognises 
that  there  are  two  different  causes  of  death  daring 
surgical  procedures — shock  and  collapse.  Shock  is  an 
exhaustion  of  the  vaso-motor  centres,  in  which  neither 
the  heart-muscle,  the  cardiac  centres,  nor  the  respira- 
tion are  other  than  secondarily  affected.  Collapse  is 
due  to  a  suspension  of  the  function  of  the  cardiac  or 
of  the  vaso-motor  mechanism,  or  to  haemorrhage.  In 
the  former,  the  exhaustion  of  the  centres  renders 
■stimulants  and  strychnine  of  little  value  ;  indeed,  the 
latter  is,  in  the  writer's  opinion,  dangerous.  Saline 
infusion  is  also  of  slight  or  no  use.  On  the  other  hand, 
adrenalin  acts  on  the  heart  and  the  blood-vessels,  and 
raises  the  blood  pressure  in  every  degree  of  shock,  even 
when  the  medulla  has  been  cocainised  and  in  the  de- 
capitated animal.  It  is,  however,  rapidly  oxidised  by 
the  tissues  and  blood,  and  its  effects  are  fleeting.  It 
consequently  must  be  given  continuously,   but  also 

(«)  "DiseaMsof  Women."  By  A.  L.  GaUbin,  M.D.,  F.B.C.P., 
late  Fellow  of  Trinity  OoUeffe,  Gaxnbridjre :  Consulting^  Obstetric 
Pbysician.  Guy*s  Hospital.  Ac.  Sixth  Edition,  mueh  enlarged. 
London :  J.  and  A.  Churchill,  1903. 

(6)  **  Blood  Pressure  in  Surgery .  an  Experimental  and  Clinical  Re- 
•search."  By  George  W.  Crile,  A.M.,  M.D.,  Professor  of  Clinical  Surgery, 
Western  Reserve  Medical  College.  London  and  Philadelphia  :  J.  6. 
lippincott  and  Co.    8vo.  pp.  422.    1903. 


with  caution,  as  it  possesses  a  power  of  maxtafiy 
stimulating  the  cardio-inhibitory  mechanism.  la 
collapse,  cardiac  stimulants  and  strychnine  are  both 
of  value  as  the  vaso-motor  centres  are  not  exhausted. 
Saline  infusion  was  also  found  to  be  of  value.  In 
shock,  a  contrivance  called  the  pneumatic  rubber 
suit,  made  with  the  object  of  providing  an  artifidal 
peripheral  resistance  and  so  raising  the  blood  pressure, 
acted  successfully.  By  the  combined  use  of  artificial 
respiration,  the  infusion  of  adrenalin,  and  the  appfi. 
cation  of  the  rubber  suit,  a  patient  who,  from  fatal 
injury  to  the  brain,  had  been  conventionally  dead  for 
nine  minutes,  was  partially  resuscitated  for  thirty-two 
minutes,  during  which  time  a  strong  heart  beat  was 
noted,  and  he  was  able  to  move  his  he^.  We  strongly 
recommend  the  perusal  of  this  work  to  our  readers. 

PHYSIOLOGY  OF  DIGESTION  AND  DIETETICS,  a 
This  privately  published  but  most  interestini 
volume  consists  of  a  series  of  reprints  of  essays  whidi, 
during  the  last  nine  years.  Dr.  Robertson  has  con- 
tributed to  various  journals.  They  deal  principally 
with  the  digestion  and  value  of  saccharine  foods  is 
health  and  disease,  and  should  prove  of  interest  u 
the  physiologist  and  of  service  to  cUnicians. 

Xiterary  notes  and  ®o00fp* 

The  forthcoming  publishing  season  promises  to  be 
unusually  prolific  in    new  medical   books    and    new 
editions  ;  it  is  currently  reported  that  one  London  house 
alone  has  as  many  as  'thirty  in  the  press. 
*    «    « 

A  "  Hospital  Penny  Fund,"  has  been  inaui^rated 
by  the  Editor  of  our  interesting  weekly  contemporary 
Public  Opinion,  In  his  forcible  appeal  for  funds  he 
remarks  that  the  Hospital  Sunday  and  Saturday  Funds 
are  but  annual  afitairs,  and  the  man  in  the  street — too 
often,  alas  I — thinks  he  has  done  his  duty  if  he  increases 
his  offering  to  the  collection  on  that  Sunday,  or,  per- 
chance, puts  a  piece  of  silver  in  the  box  of  the  Saturday 
Fund  collector.  Correct  statistics  of  those  who  do  and 
do  not  give  are,  of  course,  difficult  of  attainment,  out 
the  Editor  avers  that  there  are  30,000,000  in  Great 
Britain  who  never  give  one  penny.  If  each  of  these  gave 
Out  a  penny,  over  ;fi  30.00^  would  be  realised.  The 
scheme  is  not  to  oe  confined  to  London  alone  ;  but 
will  appeal  to  the  provinces,  to  Scotland,  Ireland,  and 
Wales,  and  incentives  to  collection  wiU  oe  offered  in  the 
shape  of  prizes.  This  philanthropic  effort  has  our 
heartiest  wishes  for  success. 

«    «     * 

Dr.  H.  C.  L.  Morris  has  written  a  serviceable  little 
book  on  "  Bognor  as  a  Health  Resort" 

'^Dr.  R.  Hbnslowe  Wellington,  Secretary  of  the 
Medico-Legal  Society  has  just  published  a  valuable 
monograph  on  "  The  Verdict  of  Suicide  whilst  Tem- 
porarily Insane." 

*     «     * 

V  WE~understand  that  Dr.  Norman  Moore  is  writing 
a"^history  of  St.  Bartholomew's  Hospital,  which  will 
shortly  be  issued  by  Messrs.  Arthur  Pearson  &  Co.  Mr. 
Howard  Penton  has  drawn  some  original  illustrations 
forjthe  book,  which  will  also  include  reproductions  of 
the  ancient  seals  and  monuments  of  the  Hospital  with 
many  historical  reminiscences.  The  procewis  of  the 
sale  of  the  work  will  be  devoted  to  the  rebuilding  fund, 
and  the  list  of  subscribers  to  the  first  edition,  limited  to 
two  thousand  copies,  will  be  printed  as  an  appendix. 
Applications  for  copies  should  be  addressed  to  the 
Honorary  Secretary  of  the  Rebuilding  Fund,  St. 
Bartholomew's  Hospital,  London. 
«     *     « 

We  have  received  from  Messrs.  Mabie,  Todd  and 
Bard  publishers,  and  manufacurers  of  the 
famous    "  Swan "    Fountain    Pens,     a     well-printed 

{a)  "CoQtribiitioas  to  the  Physiolorv  of  Digestion  and  Pieteetics" 
By  W.  G.  Aitchison  Robertson.  M.D.,  D.S.O.,  F.R.C.P.E.,  F.R.&B. 
Eatnburgfa,  190.^. 


Sbpt.  7.    1904' 


MEDICAL  NEWS. 


Th«  Mkdical  Puss.    265 


booklet  of  fifteen  photographic  views  of  the  great 
International  Exhibition  now  being  held  at  St. 
Louis,  whicli  convey  a  striking  impression  of  the 
immensity  and  beauty  of  the  various  structures. 
Messrs.  Mabie,  Todd,  and  Bard  intimate  that  they  will 
gladly  send  a  copy  of  the  book  free  to  all  readers 
mentioning  this  paper,  who  apply  by  post-card  to  them 
at  93.  Cheapside,  London,  E.C.,  95,  Regent  Street, 
London,  W.  ;  or  3,  Exchange  Street,  Manchester. 
*     *     * 

Wb   learn   from  the  editor  in  chief  of  the  Index 

Medicus  (second  series),  that  a  circular  letter  has  been 

extensively  distributed  signed  by  the  Directeur  g^n^ral 

de  rinstitut   de  Bibliographie  m6dicale  de  Paris,  93, 

Boulevard  Saint  Ciermain,  in  which  it  is  stated  that  the 

Index  Medicus  ceased  to  appear  after  the  issue  of  the 

number  for   January,   1904,  and  that  its  publication 

would    probably   not    be    resumed    this    year.     This 

statement      is    incorrect,    had    the    writer    inquired 

of  the  Secretary  of  the  Carnegie  Institution,  or  of  the 

Editor    of    the    Index    Medicus,   he  would  have  been 

saved  making  an  unfounded  and  misleading  assertion. 

Its  origin  is  doubtless  to  be  found  in  the  fact  that  owing 

to  "  strikes  "  in  the  printing  offices  of  Boston,  in  which 

dty  the  journal  is  printed,  the  January  number  was 

delayed. 

iPePtcal  Hewg^ 

Postal  Workers*  Sanatorium  Scheme. 
A  RECENT  conference  of  representatives  of  the  different 
branches  of  the  postal  service  was  held  in  one  of  the 
committee-rooms  at  the  General  Post  Office,  London,  to 
consider  a  proposal  for  providing  sanatorium  accom- 
modation for  postal  employes  by  affiliation  with  the 
National  Committee  for  the'Establishment  of  Sanatoria 
for  Workers  SufiFering  from  Tuberculosis.     The  chair 
was  taken  by  Mr.  J.  Fitzgerald  (treasurer  of  the  Fawcett 
Association).     Mr.  C.  H.  Garland,  in  an  explanatory 
statement,  said  it  was  proposed  to  elect  a  provisional 
committee    to   carry   out    the   necessary   preliminary 
arrangements  in  connection  with  the  movement  for 
securing   a   sufficient  amount  of  accommodation   in 
sanatoria  for  all  the  cases  of  consumption  which  were 
likely  to  occur  among  postal  servants.     The  original 
idea  was    to  establish  a  sanatorium  for  themselves 
exclusively.     "When,  however,  the  project  was  launched 
for  providing  sanatorium  accommcxlation  for  the  whole 
of  the  workers  of  this  country,  it  was  thought  desirable 
to  associate  themselves  with  it.     The  National  Com- 
mittee >yas  formed  under  the  auspices  of  the  Hospital 
Saturday  Fund,  and  its  scheme  would  have  the  support 
of  the  working  classes  generally.    By  allying  themselves 
with  those  identified  with   the  wider  movement  they 
would  have  placed  at  their  disposal  a  large  amount  of 
expert    opinion    and    advice.     The    proposal  of  the 
National  Committee   was    to  erect  a  sanatorium  by 
public  subscriptions,  and  the  beds  were  to  be  endowed 
byfriendly  societies,  trade  unions,  and  other  organisa- 
tions.    The  object  of  the  postal  movement  was  to 
create  a  fund  in  order  to  reserve  for  the  use  of  postaJ 
employes  in  that  sanatorium  a  certain  number  of  beds. 
The    Postmaster-General   had    practically   given   his 
consent  to  their  scheme,  which  included  a  voluntary 
payment  by  members  of  the  postal  staffs  of  2s.  per 
aminm.     lie  was  told  by  the  chief  medical  officer  of 
the  Post  Office  that  a  subscription  of  2s.  a  year  would 
produce  a  sufficient  sum  to  provide  all  the  accommo- 
dation required  for  Post  Office  cases,  and  would  pro- 
bably leave  a  surplus  to  pay  the  travelling   expenses 
of  those  coming  from  a  distance.     There  was  no  inten- 
tion on  their  part  to  appeal  for  subscriptions  outside  the 
postal  staffs.     There  would  be  a  public  appeal  made  by 
the  National  Committee  for  funds  with  which  to  build 
the  sanatorium.     The  beds  would  be  under  the  control 
"Of  the  organisations  which  endowed  them.     He  could 
not  say  definitely  where   the  sanatorium  would  be 
erected,  but  negotiations  were  going  on  for  the  acquisi- 
tion of  a  site  about  seventeen  miles  from  Hastings. 
The  more  hopeful  members  of  the  National  Committee 
considered  that  building  operations  would  be  started 
«arly  next  year,  while  others  thought  that  they  would 


not  be  started  till  the  middle  of  the  year.  The  subscrip- 
tion of  2S.  a  year  by  postal  workers  would  entitle  them 
to  accommodation  at  the  sanatorium  free  of  all  charge, 
and  in  addition  their  sick  pay  would  be  continued  for  six 
months.  After  further  discussion,  a  provisioual  com- 
mittee was  elected  to  carry  out  the  necessary  prelimi- 
nary arrangements. 

St,  Thomas's  Hospital  House  Appointments. 

The  following  have  been  appointed  House  Officers 
fromfyesterday  (Tuesday),  Sept.  eth.-^Eesident  House 
Physicians :  B.  Higham,  M.R.C.S.,  I..R.C.P. ;  W. 
Haward,  M.B.,  B.S.Dur.,  M.R.C.S.,  L.R.C.P.  :  H.  C. 
Lecky,  M.A..  M.B.,  B.Ch.Oxon.  (extn.) ;  C.  H.  Latham. 
M.R.C.S.,  L.R.C.P.  (extn.).  House  Physicians  to 
Oui-P-Uients  :  A.  G.  Gibson.  B.A.,  M.B.,  B.Ch.Oxon., 
B.ScLond.  ;  K.  Takaki,  M.R.C.S.,  L.R.C.P.  Resident 
House  Surgeons  :  H.  S.  Bennett,  M.R.C.S.,  L.R.C.P.  ; 
N.  C.  Carver,  B.A.,  B.C.Cantab.,  M.R.C.S.,  L.R.C.P. ; 
A.  C.  Birt,  M.R.C.S..  L.R.C.P. ;  G.  T.  Birks,  M.A., 
M.B.,  B.C.Cantab.  House  Surgeons  to  Out-Patients  : 
H.  A.  Kisch.  M.R.C.S.,  L.R.C.P. ;  G.  R.  Footner, 
B.A.Cantab.,  M.R.C.S.,  L.R.C.P. ;  R.  E.  G.  Gray. 
M.A.Cantab..  M.R.C.S.,  L.R.C.P.;  J.  C.  F.  D.  Vaughan. 
M.R.C.S.,  L.R.C.P. ;  Obstetric  House  Physicians . 
Senior,  J.  P.  Hedley,  M.A.,  M.B.,  B.C.Cantab.,  M.R.C.S. 
L.R.C.P. ;  Junior,  H.  I.  Pinches,  M.A.,  M.B.,  B.Cantab., 
M.R.C.S.,  L.R.C.P.  Ophthalmic  House  Surgeons  :  Senior, 
H.  S.  Stannus,  M.B.,Lond.,  M.R.C.S..  L.R.C.P.  Throat 
Department :  T.  B.  Henderson,  M.A.,  M.B.,  B.Ch.Oxon. 
R.  E.  MTiitting,  B.A.,  B.C.Cantab.  Skin  Dep  ifiment  : 
W.  L.  Harnett,  M.A.,  M.B.,  B.CCantab.,  M.R.C.S.. 
L.R.C.P. ;  F.  M.  BuUey,  B.A.Cantab.,  M.R.C.S.. 
L.R.C.P.  Ear  Department :  T.  Guthrie,  M.A.,  M.B., 
B.C.Cantab.,   M.R.C.S.,  L.R.C.P. 

Idiots  and  ImbeoUes.— A  Royal  Commission. 

The  King  has  been  pleased  to  appoint  a  Royal 
Commission  to  consider  the  existmg  methods  of 
dealing  with  idiots  and  epileptics  and  with  imbecile, 
feeble-minded  or  defective  persons  not  certified  under 
the  Lunacy  Laws,  and  to  report  as  to  the  amendments 
in  the  law  or  other  measures  which  should  be  adopted 
in  respect  of  their  care,  training  and  control.  The 
members  of  the  commission  are  as  follows  :  The  Marquis 
of  Bath  (chairman) ;  Mr.  William  Patrick  Byrne,  C.B.  ; 
Mr.  Charles  Hobhouse,  M.P.;  Dr.  Frederick  Need- 
ham ;  Mr.  Henry  David  Greene,  K.C.,  M.P.  Mr. 
Charles  E.  H.  Chadwyck-Hjealey.  K.C..;  Rev.  Harold 
Nelson  Burden ;  Mr.  Willoughby  H.  Dickinson ; 
Mr.  Charles  Stewart  Loch ;  and  Mrs.  Pinsent.  Dr. 
Needham  is  a  Commissioner  in  Lunacy  and  an  ex- 
president  of  the  Medico-Psychological  Association^ 
■Intemailimal  Congi^ess  of  Physiologists. 

The  International  Congress  of  Physiologists  met  on 
August  31st  at  the  Solvay  Institute  in  Brussels  'and  will 
continue  in  a  series  of  similar  meetings  to  be  held  at 
Turin,  Cambridge,  Berne,  and  Basle.  The  President,. 
Dr.  Heger,  in  his  opening  address,  expressed  regret  for 
the  absence  through  reasons  of  health  of  the  Honorary 
President,  Sir  Michael  Foster,  M.P.  The  proceedings 
of  the  congress  are  private. 

Killed  by  Swallowing  a  Wasp. 

A  COACHMAN  named  Fisher,  who  worked  for  Mr. 
Compton  Rickett,  M.P.  for  Scarborough,  has  just 
died  at  his  employer's  country  seat  at  East  Hoathly. 
near  Lewes,  as  the  result  of  a  wasp  sting.  He  swallowed 
the  insect  with  some  beer,  and  his  throat  was  so  badly 
stung  that  he  was  suffocated. 

Sanitary  Institute* 

The  thirty-eighth  course  of  lectures  and  demonstra- 
tions for  sanitary  officers  which  will  commence  at  the 
Sanitary  Institute,  Parke's  Museum,  London,  on 
Monday,  September  12th,  wiU  .embrace  lectures  on 
Municipal  Hygiene  and  on  Meat  and  Food  Inspection, 
including  the  taking  of  samples  of  water,  food,  and 
drugs  for  analysis,with  practical  demonstrations  of  meat 
inspection. 

Uveppool  Mortality. 

The  death-rate  in  Liverpool,  which  for  some  weeks 
has  been  very  high,  reaching  39*2  per  thousand  per 
annum  a  fortnight  ago,  fell  during  the  past  week  to  29 
per  thousand.  The  decrease  is  due  to  ^the  cooler 
weather,  and  the  consequent  fall  in  diarrhoea  mortality. 


366    Tn»  Medical  Press.      NOTICES  TO  CORRESPONDENTS. 


IBacanttw. 


Dowo  District  LuMtic'Aeylum,  Downpatrick.— Junior  Male  Aaris- 
tant  Hedioal  Officer.  Balary  £100  per  annum,  with  (omithed 
apartments,  board,  wasliinf,  fuel,  light,  and  attendance. 
Applications  to  the  Resident  Medical  Suj^ntendent. 


SotittB  to 

Jl^^  GoKRispoiiDBiin  requiring  a  reply  in  this  oolumn  are  partiou 
larly  requested  to  make  use  of  a  dUUnetive  Signatwre  wr  IniiM,  an 
avoid  the  practice  of  signing  themselves  "Header/'  "Subscriber," 
**  Old  Subscriber,"  ftc  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

OueiKAL  Abtiolis  or  Lbttkbs  intended  for  publication  should  b^ 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publioa- 
tion,  but  as  evidence  of  identity. 

CoimuBDTOBS  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

Bhpukts.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced,  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  Tliis  should  be  done 
when  returning  proofs. 

LIFE  INSURANCE  QUEST. 
F.R.C.P.  writes  in  answer  to  query  as  to  the  proposal  for  life 
insurance  from  "  C.  F.'*  in  our  last  week's  issue  :— "  This  life  may 
be  insurable  at  hazardous  rates  in  some  offices.  In  that  case  it 
would  be  well  for  the  medical  examiner  to  state  the  case  most  dearly 
to  the  office,  and  to  suggest  a  limitation  of  period  covered  by  insur- 
ance. The  non-recovery.ot  applicant's  weight,  together  with  the  low 
specific  gravity  of  the  urine,  render  the  life  undesirable  from  the 
insursace  point  of  view.  If  the  low  specific  gravitv  is  permanent 
the  case  shouki,  in  my  opinion,  be  rejected  on  lany  terms— this  I 
suggest  as  a  general  view  on  data  so  far  as  available.— 

Dr.  B.  N.  P.— Antipyrine  is  credited  with  powerful  anti- 
galactogogue  properties  and  is  sometimes  employed  to  arrest  the 
lacteal  secretion.  Under  these  chrcumstances  it  is  by  no  means 
improbable  that  the  administration  of  large  doses  of  this  antipyretic 
in  cases  of  mikl  puerperal  infection  may  explain  the  sudden  oeste- 
tion  of  the  secretion  in  your  patient.  At  the  same  time  it  has  to  be 
borne  in  mind  that  the  secretion  often  ceases  spontaneously, 
especially  when  there  has  been  fever.  In  any  case  the  administra- 
tion of  drugs  of  this  class  in  puerperal  infections  is  of  much  less 
therapeutical  importance  than  measures  aimed  at  removing  the 
source  of  the  infection. 

THE  PRESERVATION  OF  RUBBER    CATHETERS. 
To  the  Bditor  o/Thb  Mxdcial  Passs  and  Oieculab. 

Sir,— In  reply  ito  the  letter  of  your  correspondent  with  re- 
ference to  the  '*  preservation  of  Rubber  Catheters,"  we  do  not 
find  that  a  good  quality  Bed  Rubber  Catheter  becomes  <*  stic^  " 
and  swells  after  so  short  a  use  unless  same  has  been  treated  with 
grease  or  oil  in  the  place  of  glycerine.  If  this  is  the  case  the  evil 
msybe  remedied  by  washing  in  wtfm  water  and  soda  immediately 
after  use.  Yours  faithfully. 

London,  E.O.,  Sept.  2, 1904.  S.  Maw,  Soh  ft  Sohb. 

Ma.^.  E.  Atkzhbov.— The  report  reached  ua  as  we  were  at  press. 
We  hope  to  utilise  it  in  an  early  number. 

Mb.  B.  Babbt.— We  have  seen  it  stated  that  such  is  the  case  but 
we  have  had  no  direct  or  official  intimitation  of  the  fact. 

8.  R.  v.— The  Transactions  of  a  Medical  Congress  are,  so  to  speak, 
public  propertv,  and  it  is  openito  anyone  to  make  use  of  them  for  liter- 
ary purposes  though  it  is  customary  and  desirable  in  so  doing  to  give 
the  source  of  the  information  in  order  that  readers  may,  if  so 
disposed,  verify  their  references. 

DB.  Ross.— No,  it  would  be  decidedly  improper  for  your  corre- 
spondent  to  consent  to  attend  a  patient  whose  acquaintanoe  he  had 
made  as  deputy  for  a  sick  confrere,  at  any  rate  in  respect  of  the 
particular  illness. 

THE  FREEDOM  OF  THE  SOCIETY  OF  APOTHECARIES 
OF  LONDON. 
Bt  an  announcement  in  another  column  it  wilt  be  seen  that  the 
governing  body  propose  to  admit  ten  members  of  the  medkal  pro- 
fession already  holdinsr  the  L.8.A.  Diploma,  to  the  freedom  of  the 
Society  whic  h  we  understand  includes  slso  the  Ireedom  of  the  dty 
of  London.  Full  particulars  may  be  obtained  on  application  to  Mr 
A.  Mowbrsy  Upton,  Clerk  to  the  Society,  Apothecaries  Hall'. 
London. 

Dr.  Hblfibld (Malta);— The  English  Authorities  do  not  recognise 
French  degrees  in  our  colonies,  although  facilities  are  offered  for 
passing  the  Final  Examinations  to  those  possessing  the  degrees  of 
a  known  university  in  France. 

Mb.  Watbok.— The  latest  information  Is  being  collected  concerninir 
the  various  Educational  Institutions  and  will  be  published  hi  reeunu 
in  our  next  number,  Including  the  query  put  by  you. 

Dk.  J.  B.  Habbubv.— Communicatioa  to  handle  hereby  aoknow- 
lodged-  \ 


Sept.  7,  1904^ 


^rith^S;;:^"^"^  ^^^^^^  Offl<^r.      salary  £130  per  «.,„. 
OiJm,  ^»n^«.  Clerk.  Union  6fflces,  Quel's  SSSSj 

^***b5rnSl8Wn2S®^''o'?  ^^"^  Sanatorium  for  ConsumpUveiatE-u 
menteTSd'^wihiSS^*^  F«r  annum,  with  ritiaS.iS^ 

3-1^^^^^  near^Wo^jgham^^ 

ADDlWHotH  f*^  *""um,  with  rooms,  commons,  and  wuW 
R?Si?hlSSf *^''*'^^****'y-«S.BayIis.  ^^  Moor,^^ 

^®*?2?H '^  Hospital—Casualty  Officer.    Salary  iSlSO  n«r  «. 

B  th^SSrr'''^""^^^  CSomersSS:, 

^anSSJr^i^Th^  Hospital-House    S^eon.      Salary  £80  «r 

^'^Tr*'*i!iJium°^'!^ /^^■^?'^J^--»«*d«»<^  Sui^n.  Salary  m 
TowSSS"^^'^  -^^^  ^^^^ 

L^vei^cSS.      *^*^^''^  ^^  Guardians,  15  High  ftS  sSST 

tofcff  H^noJ?J^  **'*«'•  *«*»»»?»  "^  ^-"Wngv^pliouS 
to  the  Honorary  Secretary,  OencnJ  Hospital,  OhelteiSam: 

^''i^^i^^^Si^^?^^^^^^^  ««-«» ^«^^ 

^■ns w'^k?,'BJf;?'PoS^'^'*"-' "^^  ^^' ^'  ^^*  '^•'- 


""'^x"  ot2ri?.^2:;\,'S.f jfr^s:  ^^^^  ''"'*'•  ^"^•-**'^ 


Fauldeb— CRipP8.-0n  September  2nd,  at  the  Marylebone  Pariib 
cnurch,  London,  Thomas  Jefferson  Faulder,  son  of  the  late  B  B. 
!>Sl**®i5»  £L''^*»"!;S^'  Carlude,  to  BUnche  Julie,  elder  daughter 
W„  and  Abbottsford,  Melrose,  ^.B. 

GABBiBH-JuDOE.-On  ScDtomber  8rd.  at  St.  Giles's  Church. 
Oaniberwell,  Harold  John  Garrlsh,  eldest  son  of  J.  T.  Qarrish.  of 
Grove  Une.  Denmark  HiU,  to  Ethel  Maud,  daughter  of  E.  W. 
W.  Judge  of  OamberweU. 

Gould  ^PAPB.--On  September  8rd,  at  St.  Thomas's  Telford  Aveone. 
Stratham  Hill,  Valentine  B.  J.Gould,  of  Llanelly.son  of  J.R^ 
OouW,  M  D.,  of  Bolton,  to  Maude  Mary,  only  daughter  of  Geo. 
Pape,  of  Thornton  Avenue,  Streatham  HilL 

I^AKiTO— RioHABD.— On  August  a4th.  Robert  Croske  Leaning,  M.E, 
B.S.,  second  son  of  the  late  Harry  Leaning,  Esq.,  of  Chanotry 
^}?u^^^^  ^  ^^l  Gladys,  youngest  daughter  of  the  late" 
William  Richards,  E8q.,ofTlalycoed.  Monmouthshire. 

Wilson— O&Arrov.— On  Sept.  lit.  Geoffrey  Remington  Wilson.  M.X'. 
M.B.Cantab.,  eldest  son  of  Mr.  Thomas  Wilson,  of  Uarpenden 
Herts,  te  Eileen  Margaret  Georgina  Grattan,  youngert 
daughter  of  Dr.  M.  H.  Grattan,  of  Ongar.  ^ 


^rath0* 


Bbhvstt.— On  September  2nd,  at  Amersham,  Bucks,  Ellen  Selfc- 
Bennett,  of  S  Marlborough  Place,  N.W.,  youngest  daugliter 
-of  the  late  Rev.  Henry  Page,  and  wklow  ef  the  late  Sir  J.  Risdoa 
Bennett,  M.D.,  F  R.C.P.Lond.,  LL  D.,F.R.S. 

BuBTON.— On  September  2nd,  at  Sonthsea,  Annie  Margaret,  wi()ow 
of  the  late  Rev.  Richard  Burton,  of  Alverntoke,  and  daughter  of 
the  late  W.  H.  Allchin,  surgeon,  of  East  Mailing,  Kent,  aged  70. 

Cock.— On  August  80th,  at  147  Queen's  Road)  Peckham,  Herbert. 
Edgecombe,  M.R.C.&,  L.R.C.P.,  aged  82,  eldest  son  of  Dr.  and 
Mrs.  Cock. 

CoLLixoB.— On  August  81st.  at  Spaxton  Recterv*  near  Bridgwater,  iit 
her  84th  year,  Oeorgaina,  widow  of  the  late  Adohriius  Colling*, 
M.D.,  of  Guernsey,  and  daughter  of  the  late  Honourable  J« 
Nurse,  of  Ashbury,  Barbados,  West  Indies. 

CaoBSMAH.—On  September  1st,  at  White's  Hill,  HambrooK,  Bristol, 
Edward  Grossman,  M.D.,  in  his  72nd  year. 

Woods.— On  August  80th.  atlnglewood.  The  Avenue,  Boshey.  Herta, 
Emily  Rosamond  Woods,  daughter  of  the  late  Otptain  Johi» 
Knipe,  formerly  6th  Dragoon  Guards,  of  Spring  Hili;  Borrii  in 
Ossory,  Queen's  County.  Ireland,  andvridow  of  the  late  W.B. 
Woods, M.D.,  MA.,  T.C.D.,  et  Oxon,  R.N>,.inher SSndyeac. 


MU  ^dm\  ^tm  mH  (i)ttmhv. 


'^SALirS   POPULI   SUPREMA    LEX-' 


Vol.  CXXIX, 


WEDNESDAY,    SEPTEMBER    14,    1904-        No.    iik 


EDUCATIONAL    NUMBER,     1904—1905, 


INTRODUCTORY  REMARKS. 
The  choice  of  a  future  career- is  clearly  one  of  the 
most  momentous  problems  with  which  a  young  man 
can  be  faced.  Its  decision  must  be  necessarily  guided 
by  many  influences,  some  of  them  ojDvious  enough, 
while  others  can  be  appreciated  and  explained  only 
by  wisdom  acquired  at  the  shrine  of  experience. 
The  first  great  thing  to  be  considered  is  whether  the 
youth  has  any  special  aptitude  or  what  is  usually 
described  as  a  *' Uking "  for  any  one  particular 
calling  in  life.  Without  such  incUnation  it  is  to  the  last 
degree  unwise  fot  any  person  deliberately  to  embrace 
the  study  of  the  heaUng  art.  Of  all  the  learned  pro- 
fessions that  of  medicine  demands  the  most  affectionate 
and  whole-hearted  aUegiance  from  her  chUdren. 
At  the  same  time  it  is  unhappily  true  that  the  ranks  of 
medical  practitioners  contain  many  who  have  drifted 
into  their  occupation  and  who  lack  the  enthusiasm  that 
alone  can  lift  them  out  of  the  rut  of  incompetency. 
Much  the  same,  however,  may  be  said  of  all  intellectual 
pursuits. 

As  regards  the  material  rewards  of  the  profession  ol 
medicine  the  aspirant  should  recognise  from  the  outset 
that  the  labourers  are  many  and  the  harvest  small. 
Any  man  who  wishes  to  amass  a  fortune  before  he  has 
attained  middle  age  had  better  make  up  his  mind  to 
follow  some  business  occupation.     As  a  medical  prac- 
titioner he  will,   in  most  instances  be  able  to  make 
enough  to  live  upon  within  a  short  time  of  starting 
practice.     Where  there  is  much  competition,  however, 
he  will  find  it  hard  to  get  much  beyond  that  sum,  and 
as  a  rule  his  increased  income  is  swallowed  up  by  greater 
proportionate  expenses.     A  large  general  practice  can 
be  built  up  only  by  years  of  hard  and  conscientious 
work,  at  the  end  of  which  the  practitioner  wiU  probably 
have  amassed  a  moderate  fortune.     In  all  cases  he  will 
find  it  desirable  to  be  provided  with  a  sufficient  sum 
of  money  either  to  buy  a  practice  or  to  furnish  a  house 
and  tide  over  the  first  years  of  waiting.     Should  he 
wish  to  enter  the  Public  Health  Service  he  will  have  to 
devote  several  years  to  acquiring  a  special  knowledge  of 
the  duties  to  be  performed  in  the  office  of  a  medical 
officer  of  health.     Or  he  may  prefer  to  enter  the  Army. 
Navy,  or  Indian  Medical  Services,  which  carry  pay 
from  the  time  of  appointment  and  confer  a  pension 
upon  retirement ;  latterly  something  has  been  done  to 
render  these  Services  more  popular,  but  much  remains 
to  be  done  in  that  direction.     Then  there  are  lunacy. 
Poor-law,  and  Local  Government  Board  appointments, 
some  of  them  well-paid  and  highly  responsible  posts. 
Lastly,  the  medical  student  may  have  made  up  his 
mind  to  tread  the  honourable  but  thorny  paths  of  the 


consulting  surgeon  or  physician,  or  of  the  specialist.- 
In  that  case  he  must  be  provided  with  means  to  support 
him  through  ten  years  or  more  that  will  be  required  to 
enable  him  to  make  a  livelihood.  Many  medical  men 
whose  names  have  become  household  words  have  had 
to  endure  many  years  of  penury  and  self-deniaL 
Indeed,  no  profession,  not  even  excepting  that  of  the 
barrister,  could  furnish  more  instances  of  hard  living 
and  high  thinking  than  that  met  with  in  the  ranks  of 
consultant  surgeons  and  physicians.  On  the  other' 
hand,  the  prizes  to  be  gained  in  the  higher  branches  of 
the  profession  are  considerable,  when  tested  by  suclr 
acquisitions  as  social  position,  titles,  honours,  influencer 
and  substantial  income.  At  the  same  time  it  must 
be  borne  in  mind  that  not  a  few  men  of  unblemished 
reputation  and  of  great  intellectual  and  professional 
acquirements  live  and  die  without  having  gained  the 
favours  of  fortune.  To  succeed  in  these  directions 
requires  the  possession  of  moderate  means,  average 
intellectual  endowments,  good  education,  a  hospital 
appointment,  a  good  address,  and  an  iron  resolution.. 

The  rewards  of  medicine,  then,  are  not  to  be  measured^ 
by  their  bank  value.  Any  medical  man  who  conscien- 
tiously follows  the  practice  of  his  profession,  who' 
is  sympathetic  to  the  suffering,  who  scorns  delight* 
and  lives  laborious  days,  and  who  makes  "  duty  "  and* 
"responsibility"  his  watchwords,  will  most  certainly 
rejoice  in  the  esteem  and  consideration  of  his  fellow* 
I  citizens.  The  key  to  nine- tenths  of  the  situation  is? 
admirably  given  in  the  aphorism  which  sajrs  that 
"  Medicine  is  a  wholly  admirable  profession,  but  ibr  thet* 
most  part  not  a  good  business.** 

There  is  in  the  study  and  practice  of  medicine  ample- 
scope  for  talents  of  the  most  varied  kind.       If,  unfor- 
tunately, a  tendency  manifests  itself  in  the  daily  prac- 
tice of  the  healing  art  to  fall  into   a  routine,   to   treat 
disease  by  rule  of  thumb,  that  is  the  fault,  or  the  defect,, 
of  the  individual  practitioner.      The    calling  is  one  in^ 
which    the  individual   practitioner  is  called  upon   to  • 
exercise  independence  of  judgment,  seeking  in  his  own  1 
sphere  to  winnow  the  wheat  from  the  chaff  in  the  hVige 
collection  of  principles,  dogmas,  and  views  bequeathed! 
to  us  by  our  predecessors  in  the  profession.     We  would ! 
impress  upon  every  intending  student  that  it  Kes  with- 
him  to  utilise  the  experience  which  will  be  his  to  assist 
in  throwing  light  into  dark  comers — ^not  so  much  by 
the  publication  of  an  occasional  case  of  exceptional' 
interest,  but  by  endeavouring  to  deduce  some  general' 
law,  some  vital  principle,  from  the  morbid  phenomena' 
which  come  under  his  notice.     He  should  never  forget* 
that  he  is  always  a  student — ^no  longer  a  listener  at 
compulsory  lectures  but  perforce  an  observer,  more' 


268    The  Medical  Press. 


ENGLAND— EDUCATION. 


Sept.  14,  1904. 


or  less  thorough,  more  or  less  conscientious,  of  the 
working  of  Nature's  laws,  some  of  which  we  see  as 
through  a  glass  darkly,  but  of  others  we  know  little  or 
nothing.  Some  epoch-marking  discoveries  have  come 
from  the  ranks  of  the  general  practitioner,  and  assuredly 
it  is  never  the  material  that  is  wanting. 
The  Choice  of  a  School. 
The  question  of  the  choice  of  a  medical  school  is  often 
determined,  so  to  speak,  by  accidents  of  time,  place, 
and  tradition.  Many  students  nowadays  go  to  one  of 
the  excellent  provincial  schools  in  their  neighbourhood. 
Many  others  again,  are  attracted  to  the  Universities, 
North  or  South  of  the  Tweed,  or  across  the  Irish  Channel, 
which  grant  the  degree  of  M.D.  without  exacting  an 
abnormally  high  standard  of  examination.  Men  who 
are  receiving  their  general  education  at  one  of  the 
universities  will  naturally  enter  the  medical  school 
attached  to  their  Alma  Mader,  at  any  rate  for  a  portion 
of  the  five  years'  medical  curriculum.  In  some  few 
instances  the  possession  [of  a  University  qualification 
is  made  a  sine  qud  non  in  the  holding  of  some  coveted 
hospital  or  other  professional  appointment.  There 
may  be  some  sort  of  excuse  for  this  species  of  organised 
"  protection,"  which  the  labouring  classes  would  call 
"  trades-unionism,"  in  the  case  of  the  professorships 
and  examinerships  in  some  of  the  ancient  Universities. 
When  a  similar  exclusion,  however,  is  applied  by  medical 
charities  the  situation  becomes  intolerable.  The  fact 
remains,  however,  that  in  the  majority  of  English 
hospitals  and  infirmaries  none  but  London  graduates 
and  diplomates  need  apply.  A  newly  formed  associa- 
tion of  Scotch  Diplomates — many  of  whom  are  English- 
men and  Irishmen — are  calling  attention  to  the  un- 
fairness of  the  conditions  that  exclude  them  from 
holding  honorary  appointments  on  the  medical  staffs  of 
many  English  charities.  These  facts  may  possibly 
furnish  useful  hints  to  the  intending  student,  who  has 
to  make  the  best  of  present  conditions. 

The  Choice  of  Qualifications. 
No  sooner  has  the  study  of  medicine  been  entered 
upon  than  the  student  is  called  upon  to  define  his  aims ; 
in  other  words,  he  has  to  decide  through  what  portal 
he  will  enter  the  profession.  The  point  is  one  of  un- 
questionable importance,  because  there  is  no  going 
back  on  the  choice  later  in  the  student-career.  The 
reorganisation  of  the  University  of  London  has  ren- 
dered it  possible  for  the  average  student  to  obtain  a 
degree  in  medicine  on  terms  less  prohibitive  than  was 
formerly  the  case,  but  the  fact  remains  that  although 
the  purely  medical  standard  is  attainable  by  any  fairly 
diligent  student,  the  matriculation  examination  and 
that  in  science  nevertheless  constitute  serious  stumbling 
blocks.  The  average  student  will  probably  find  it  more 
convenient  to  take  the  diplomas  of  the  English  Conjoint 
Board,  and,  should  he  deem  a  degree  worth  the  extra 
trouble,  he  can  put  in  attendance  at  one  or  other  of  the 
provincial  Universities  with  the  view  of  subsequently 
passing  the  examinations  for  the  doctorate.  Or  he 
may  choose  to  take  a  qualification  or  degree  in  the 
Scotch  or  the  Irish  schools,  where  education  is  sound, 
practical,  and  well-equipped,  and  the  traditions  of  the 
teachers  unrivalled.  *  (m 

The  Course  of  Study. 
It  is  unnecessary  to  discuss  the  details  of  the  medical 
curriculum.  We  would,  however,  impress  upon  the 
student  the  importance  of  entering  upon  his  work 
eamestiy,  with  firm  determination  to  familiarise  him- 
self with  the  subjects —anatomy,  physiology,  and 
materia  medica — ^which  constitute  the  threefold  basis 
of  practical  medicine.  And  in  respect  of  anatomy, 
the  only  valuable  knowledge  is  that  gained  by  actual 


dissection  of  the  dead  body.    Verbal  descriptions  and 
plates  are  only  aids  to  knowledge,  not  knowledge  itsdl 
Dissection   gives   information   at    first    hand — actual 
knowledge,   not  mere  statements — and   the   pcactiee 
of  dissection  is,  in  fact»  a  first  coarse  in  surgery.     We 
would  warn  the  student  against  that  form  of  intellectual 
laziness  which  consists  in  abandoning  the  dissecting- 
room  in  favour  of  the  library.    The  latter  course  may 
enable  the  student  to  pass  examinations,  but  it  win 
never  confer  that  intimate  familiarity  with  the  things 
themselves  which  is  indispensable  to  success  in  practice. 
Nor  should  he    despise  that  somewhat    arid   subject. 
materia  medica.      A  knowledge  of  the  physical  pro- 
perties of  drugs  and  of  their  physiological  action  is  all- 
important,  to  the  hospital  ph3r8ician  as  to  the  general 
practitioner.     Treatment  is  the  ultimate  object  of  aB 
medicine,  and  the  medicinal  treatment  of  disease  is  stSL 
an  integral  part  of  the  practice  of  medicine. 
The  Clinical  Work. 
It  is  in  the  wards  and  in  the  out-patient  department, 
after  all,  that  the  student  acquires  most  of  his  informa- 
tion concerning  the  course  and  treatment  of  disease. 
There  he  watches   the  daily  progress  of  morbid  pro- 
cesses, and  learns  the  means  employed  to  afford  reliefer 
to  bring  about  recovery.     It  will  be  his  privilege  to 
unravel  the  tangled  threads  of  each  patient's  life-history, 
and  by  the  careful  examination  of  data  to  arrive  at  a 
reasoned  conclusion  known  as  the  diagnosis.     In  this 
way  he  will  gradually  learn  to  recognise   the  main 
principles  which   underlie   the   practice   of   medicine. 
Each  patient  who  comes  under  his  observation  will,  if 
properly  studied,  yield  his  quota  of  practical  know- 
ledge, and  the  value  of  the  opportunity  depends  upon 
th:?  ability  and  willingness  of  the  student  to  avail  him- 
self thereof.     The  object  and  aim  of  clinical  training 
is  to  cultivate  the  student's  powers  of  direct  observa- 
tion and  to  train  him  to  make  correct  deductions,  and 
the  habit  of  careful  observation  is  one  which  should 
become  second  nature.     The  instruction  received  in 
the  wards  is  incomplete  unless  supplemented  by  the 
lessons  to  be  learned  in  the  post-mortem  room.     There 
the  student  can  follow  the  morbid  process  to  its  omi- 
clusion.  The  post-mortem  room  is  the  natural  comple- 
ment of  the  ward,  and  it  is  often  only  in    this    room 
that  the  clinical  problem  is  unravelled  and  the  student 
enabled  to  observe  the  organic  lesions  which  determined 
the   sjnnptoms   he   has   been  studying.     Incidentally 
the  student  should  learn  as  much  as  he  can  of  the 
method  of  carrying  out  these  examinations,  for  it  faDs 
to  the  lot  of  most  practitioners  to  have  to  make  such 
examinations,  and  errors  of  observation  or  appreciation 
may  be  fraught  with  the  gravest  consequences  to  pos- 
sibly innocent  persons. 

The  Higher  Qualifications. 
There  remains  the  question  of  the  higher  qualifica- 
tions, e.g.,  the  Fellowships  of  the  Royal  Colleges,  which 
are  indispensable  to  those  who  contemplate  a  hospital 
career,  either  as  physician  or  surgeon.  The  Fellowship 
of  the  London  Royal  College  of  Physicians  is  not  ob- 
tained by  examination,  but  by  selection  from  among 
the  members,  but  it  is  nevertheless  demanded  as  a 
necessary  qualification  in  the  holding  of  many  hospital 
appointments.  Candidates  for  the  membership  arc 
required  to  pass  a  searching  examination  and  to  satisfy 
certain  other  requirements  before  they  can  be  admitted 
thereto,  and  subsequent  elevation  to  the  Fellowship 
is  largely  a  matter  of  personal  influence,  though  merit 
per  se  is  not  a  bar  to  selection.  The  Fellowship  of  the 
Royal  College  of  Surgeons,  on  the  other  hand,  is  a  purely 
professional  distinction,  and  is  open  to  anyone  who  can 
pass  the  examinations.     It  is  advisable  to  pass  the 


Sbpt,  I4,  1904, 


ENGLAND— EDUCATION. 


The  Medical  Pkess.   269 


:&rst  examination  for  the  Fellowship  as  soon  as  possible 

-after  passing  the  first  membership,  in  order  not  to  have 

to    go   over  the  ground  later  a  second  time.      The 

P'eUowships  of  the  Scotch  and  Irish  Colleges  of  Surgeons 

-are  conferred  after  examination,  but  are  not  recognised 

«by  the  majority  of  large  English  medical  charities. 

Choice  of  a  Career. 

For  five  long  years  at  a  minimum  the  student's 

ajnbitions  do  not  soar  beyond  the  boards  of  examiners. 

To  obtain  the  right  to  practise  is,  for  the  time  being, 

the  object  of  his  existence.     When  he  has  entered  the 

portals  of  the  profession  he  is  confronted  with  the 

•question  of  deciding  in  what  particular  path  he  shall 

<iirect  his  energies.     Many  neo-practitioners,  not  un- 

ivisdy,  spend  a  year  or  two  in  resident  appointments  at 

their  own  hospitals  or  at  some  provincial  hospital  or 

infirmary.    Others  acquire  a  knowledge  of  the  practice, 

as  distinguished  from  the  theory,  of  medicine  by  serving 

as  assistant  or  locum  tenens.     Others,  again,  either  join 

their  parents  in  practice  or  purchase  partnerships. 

Then,    too,    there   are    the   Services — Indian,    Army, 

Navy,  and  Colonial — to  choose  from.     The  Poor-law 

Infirmaries  provide  each  year  a  certain  number  of 

appointments,  and  these  are  the  first  rungs  of  the  ladder 

-which  leads  to  the  superintendency  of  these  institutions. 

These  posts  are  fairly  remunerated,and  afford  reasonable 

■security  of  tenure,  but  they  entail  much  hard  work, 

together  with  heavy  responsibilities. 

Public  Health  Service. 
Every  student  who  can  afford  the  time  is  strongly 
advised  to  qualify  in  State  Medicine,  since  this  diploma 
renders  its  holder  eligible  for  appointment  as  medical 
officer  of  health,  and,  moreover,  the  knowledge  thus 
gained  is  invaluable  in  every  department  of  practice. 
A  diploma  in  State  Medicine  entails  a  special  course 
of  preparation  and  training  subsequent  to  qualification, 
the  conditions  of  which  will  be  found  under  the  appro- 
priate heading.  Although  the  tenure  of  office  is  not  as 
yet  on  a  satisfactory  basis,  there  are  many  appointments 
of  the  kind  which  afford  a  free  field  for  intelligent  ac- 
tivity. 

Post-Graduate  Instruction. 
Medicine  has,  of  late  years,  become  a  field  of  vastly 
wider  extent  and  when  he  enters  upon  his  professional 
work  the  conscientious  practitioner  is  apt  to  experience 
a  painful  sense  of  his  shortcomings  in  many  branches 
of  medical  practice.  The  knowledge  which  has  been 
rendered  available  of  recent  years  has  obviously  placed 
a  peculiar  responsibility  upon  the  physician  fresh  from 
his  studies.  The  desire  so  generally  felt  by  men  in 
practice  to  extend  and  complete  their  knowledge  of 
special  subjects  has  led  to  the  organisation  of  post- 
graduate institutions  on  a  large  scale,  of  which  advantage 
is  freely  taken  by  those  who  are  fortunate  enough  to 
reside  within  accessible  distance  thereof.  We  would 
strongly  urge  senior  students  and  young  practitioners 
to  avail  themselves  of  every  opportunity  to  acquire  a 
working  knowledge  of  the  various  special  branches — 
eye,  ear,  throat,  gynaecology,  and  so  on.  This  leads 
us  to  the  question  of 

Specialism  in  Medicine. 
Hitherto  the  student  has  been  taught  that  "  the 
greatest  mistake  of  all  is  to  start  in  a  specialty  without 
being  thoroughly  grounded  in  general  practice." 
Admitting  that  it  behoves  everyone,  no  matter  what 
particular  department  of  practice  he  may  decide  to 
adopt,  to  have  acquired  a  thorough  grounding  in  the 
general  principles  of  medicine,  it  is  impracticable  for 
him  to  devote  much  time  to  a  general  practice.  On  the 
contrary,  there  is  much  to  be  jaid  in  favour  of  the  view 
that  it  is  best  for  the  young  practitioner  to  make  his 


choice  at  the  earliest  possible  moment  of  the  line  of  work 
which  he  designs  to  follow.  As  soon  as  he  has  qualified, 
therefore,  or  as  soon  after  as  may  be,  the  intending 
specialist  should  endeavour  to  obtain  a  junior  post  in 
one  or  other  of  the  special  hospitals,  where  he  can  gradu- 
ally work  his  way  up. 

Medical  Practice  in  Foreign  Countries. 
Practitioners  qualified  in  Great  Britain  who  desire  to 
practise  their  profession  abroad  are  still  confronted 
with  many  difficulties.  True,  a  step  in  the  direction  of 
reciprocity  has  been  taken  in  the  case  of  Italy,  but  else- 
where in  Europe  considerable  difficulty  will  be  experi- 
enced in  obtaining  permission  to  practise  ;  indeed,  with 
the  one  exception  of  Italy,  it  is  usually  necessary  to  go 
through  the  whole  curriculum  and  pass  the  examina- 
tions in  their  entirety. 

LONDON    SOHOOIjS. 

The  Schools  of  Medicine  in  the  Metropolis  are 
the  following,  tbe  scholarships,  prizes,  students' 
appointments,  fees,  &c.>  being  set  forth  in  connec- 
tion with  each  place  named.  The  names  of  the 
hospital  staff,  lectures,  residential  terms,  and 
detailed  information  will  be  found,  as  a  rule,  in 
our  adY«trtisement  columns. 

St.  Bartholomew's  Hospital. — ^This  hospital  has 
750  beds,  and  for  many  years  past  the  school  attached 
has  had  a  larger  number  of  entries  than  any  other 
medical  school  in  London.  New  laboratories  have 
been  specially  equipped  for  the  study  of  pathology, 
bacteriology,  chemistry,  and  chemical  pathology. 
Collegiate  residence  is  here  permissible,  subject  to  the 
ordinary  rules.  The  recreation  ground  for  the  use  of 
students  is  at  Winchmore  Hill. 

Appointments. — ^Ten  house  physicians  and  ten  house 
surgeons  are  appointed  annually.  During  the  first  six 
months  of  ofl&ce  they  act  as  "  junior  "  house  physicians 
and  house  surgeons,  and  receive  a  salary  oi  £2$  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  receive  a 
salary  of  £So  a  year.  A  resident  midwifery  assistant 
and  an  ophthaUnic  house  surgeon  are  appointed  every 
six  months,  and  are  provided  with  rooms  and  receive  a 
salary  of  £So  a  year.  Two  assistant  anaesthetists  are 
appointed  annually,  and  receive  salaries  of  ^£120  and 
;£ioo  a  year  respectively^  An  extern  midwifery  assis- 
tant is  appointed  every  three  months,  and  receives  a 
salary  of  £So  a  year.  Chief  assistants  and  clinical 
assistants  are  appointed  in  each  of  the  special  depart- 
ments. In-patient  dressers,  in-patient  clinical  clerks, 
clerks,  and  dressers  to  the  assistant  physicians,  and  to 
the  physicians  and  surgeons  in  charge  of  special  depart- 
ments are  appointed  every  three  months  without  fee4 

Scholarships,  6-c. — There  are  four  open  scholarships 
in  science,  £7$,  £75>  £^SO,  £so»  tenable  for  one  year, 
and  a  JeafEreson  exhibition,  value  £20 ;  at  the  end  of 
first  year  four  junior  scholarships  of  £$0,  ;f20,  ;£2S,  /is, 
respectively  ;  Treasurers'  prize  for  practical  anatomy ; 
Foster  prize  in  practical  anatomy  ;  senior  scholarships, 
value  £so,  for  anatomy,  physiology,  and  chemistry ; 
Wix  prize,  Hichens  prize,  Lawrence  scholarship  and 
gold  medal,  value  40  guineas,  for  medicine,  surgery,  and 
midwifery ;  two  Brackenbury  scholarships,  of  £$g,  in 
medicine  and  surgery  ;  Bentley  prize,  for  reports  of 
surgical  cases ;  the  Kirkes  gold  medal  for  clinical 
medicine,  with  scholarship  of  £$0.  Shuter  scholarship 
of  £so ;  Skynner  prize  ol  £1$  i  Sir  G.  Burrows*  prize 
of  2 10,  and  Matthews  Duncan  medal  and  pfize,  value 
about  j£20. 

Fees, — By  payment  of  an  annual  composition  fee,  a 
student  is  entitled  to  attend  all  the  courses  of  instruction, 
and  to  hold  the  various  clinical  appointments.  For 
students  commencing  their  medical  studies  : — Entrance 
fee,  30  guineas  ;  annual  fee,  30  guineas,  for  five  years^ 
A  student  on  qualification  at  the  end  of  the  five  years 
is  not  liable  for  any  further  fees,  and  receives  a  per- 
petual ticket.     Should  he  fail  to  qualify  in  this  time. 


270    The  Medical  Press. 


ENGLAND— EDUCATION. 


Sbpt^  14.  1904^ 


the  fee  for  further  instruction  is  10  guineas  for  each  six 
months.  Fees  for  University  students  : — Entrance  fee, 
20  guineas ;  30  guineas  annually  for  two  years,  and 
10  guineas  for  each  six  months  if  not  qualified.  Fees 
for  preliminary  scientific  students  : — 20  guineas  ;  for 
laboratory  instruction  for  D.P.H.,  15  guineas. 

The  Warden,  Mr.  W.  D.  Harmer,  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  and  anatomical  museums, 
an  anatomical  theatre,  enlarged  dissecting-room,  and 
chemical  theatre.  The  hospital  and  convalescent  home 
contain  300  beds  available  for  clinical  study. 

Clinical  instruction  is  given  in  medicine,  surgery,  and 
obstetrics,  and  in  the  spnecial  department,  diseases  of 
the  skin,  diseases  of  children,  mental  disorders,  the 
throat,  the  eye,  nose  and  ear,  and  in  the  orthopaedic, 
Rontgen,  and  electrical  departments. 

Scholarships,  Medals,  6-c. — ^The  Livingstone  scholar- 
ship (100  guineas),  the  Huxley  scholarship  (55  guineas), 
and  six  other  entrance  scholarships,  total  value  ;£55o, 
are  awarded  annually.  Two  scholarships  of  the  value 
of  72  guineas  each  are  reserved  for  students  of  Oxford, 
Cambridge,  or  London  Universities.  All  are  awarded 
annually.  Two  Universities  scholarships,  value  72 
guineas  each,  are  open  to  students  from  the  University 
of  Oxford  who  have  passed  the  ist  M.B.,  to  students  of 
the  University  of  Cambridge  who  have  passed  the  2nd 
M.B.,  and  to  students  of  the  University  of  London  who 
have  passed  the  intermediate  examination  in  medicine. 
Candidates  must  give  notice  to  the  librarian  of  their 
intention  to  compete  on  or  before  September  24th,  1904. 
The  Golding  prize  of  ;f  10  is  open  to  students  at  the  end 
of  their  first  winter  session.  The  Huxley  medal,  with 
prize  of  jfio,  is  open  to  students  at  the  end  of  their 
second  winter  session.  The  Pereira  prize  of  £$  is  open 
to  all  general  students.  The  Llewelljm  prize  of  £2$ 
is  awarded  annually  at  the  end  of  the  curriculum^  The 
Governors'  Clinical  Gold  Medal  is  also  open  to  students 
at  the  end  of  their  curriculum,  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  ;f  100  a  year ;  medical 
and  surgical  registrars  to  the  hospitsd  receive  ^^40  a  year 
each,  with  luncheon  in  the  hospital ;  obstetric  registrar, 
six  house  physicians,  six  house  surgeons,  and  two  resi- 
dent obstetrical  officers  are  appointed  each  year ; 
clinical  clerks  and  dressers  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,  115 
guineas  in  one  sum,  or  126  guineas  in  five  instalments. 

The  composition  fee  for  sons  of  registered  medical 
practitioners  is  105  guineas,  and  the  fee,  by  instalments, 
115  guineas.  For  dental  students,  55  guineas  in  one 
sum,  or  61  guineas  payable  in  two  instalments  of  31 
and  30  guineas  respectively. 

St.  George's  Hospital. — This  hospital  is  centrally 
situated  in  the  West  End,  facing  Hyde  Park.  It  con- 
tains 356  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  ;  four  general  assistants,  four 
assistants  in  the  special  departments.  Candidates  for 
the  above  offices  are  selected  quarterly  by  competi- 
tion from  among  the  perpetual  pupils,  sixteen  pupils 
being  in  office  at  any  one  time.  Obstetric  assistant 
with  a  yearly  salary  at  the  rate  of  £$0  and  board  and 
residence  in  the  hospital ;  curator  of  the  museum  with 
a  salary  of  ;f 200 ;  assistant  curator  with  a  salary  of 
£100  ;  two  medical  registrars,  with  salaries  of  ;£20O  per 
annum  ;  a  surgical  registrar  with  a  salary  of  i^200  per 
annum  ;  an  administrator  of  anaesthetics  with  a  salary 
of  £so  and  two  with  salaries  of  £$0  per  annum  ;  a  sur-  ^ 
gery  officer  with  a  salary  of  ;£ioo  a  year  ;  two  or  more  1 
demonstrators  of  anatomy  with  a  salary  of  £$0  each  ; 


and  assistant  demonstrators.     All  offices  axe  open  to 
candidates  without  additional  fee. 

Exhibitions,  6^. — ^The  Brown  exhibitions«.one  of  £100 
per  annum,  tenable  for  two  years,  and  open  to  perpetual 
pupils  possessing  a  registrable  diploma  ;  and  one  of  £40 
per  annum,  tenable  for  three  years  and  open  to  students 
of  two  years'  standing  or  upwards,  who  at  the  time  of 
competition  have  not  been  qualified  to  practise 
medicine  and  surgery  for  more  than  three  years.  The 
Brackenbury  prizes  of  the  value  of  ;f  40  each,  one  each  in 
medicine  and  surgery.  The  Webb  prize  in  bacterio- 
logy, value  £^0.  The  Clarke  good  conduct  ami  clinical 
work  prize  in  surgery,  the  Thompson  medaT,  the  Brodie 
clinical  prize  in  surgery,  the  Johnson  prize  in  anatomy, 
the  Pollock  clinical  prize  in  physiology,  the  Treasurer's 
prize  for  clinical  reports,  and  four  general  proficiency 
prizes  of  ten  guineas  each. 

Scholarships. — One  in  Arts,  of  ;£ioo.  One  in  Science, 
of  ;£ioo.  Examination,  September  20th.  One  of  £y> 
in  anatomy  and  physiology,  open  to  students  who  have 
passed  a  recognised  examination  in  anatomy  and 
physiology. 

Fdtf5.--Composition  fee  for  perpetual  pupils,.  ;f  150  or 
£160,  in  the  following  instalments  :  First  year  £^0, 
second  year  £so,  third  year  ^^40,  fourth  yesLr£2o.  The 
fee  for  general  subjects  in  dental  surgery  is  £$$,  payable 
in  two  instalments  :  first  year  £^0,  second  year  £2^. 
Only  perpetual  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  602  beds 
in  constant  occupation.  There  are  special  wards  for 
ophthalmic  and  obstetric  cases,  eight  beds  in  the 
latter  being  appropriated  for  difficult  cases  of 
labour.  Some  beds  have  also  been  set  apart 
for  diseases  of  the  ear  and  throat,  and  an  "iso- 
lation" ward  for  cases  of  infectious  disases  arisiiu; 
in  the  hospital  has  been  constructed.  An  obstetnc 
registrar  and  tutor  and  an  ophthalmic  registrar  and 
tutor  are  appointed  to  augment  the  teaching  in  the 
special  departments,  in  addition  to  those  attached  to 
the  general  surgical  and  medical  wards.  Attached  to 
the  hospital  is  a  large  residential  college  with  TOons 
for  about  sixty  men,  whilst  for  students  who  prefer  to 
live  in  the  suburbs,  no  other  hospital  is  so  conveniently 
placed,  the  railway  accommodation  being  good  and 
close  at  hand.  There  is  a  complete  School  of 
Dental  Surgery  at  this  Institution,  which  is  recognised 
by  the  Royal  College  of  Surgeons  of  England ;  the  facili- 
ties thus  afforded  of  completing  the  whole  coune  of 
dental  study  within  the  walls  of  one  hospital  win  be 
appreciated  by  those  intending  to  practise  dentistry. 

Appointments. — Eight  house  surgeons,  eight  house 
physicians,  eight  assistant  house  phy^icians^  twenty- 
four  assistant  house  surgeons,,  eight  obstetric  residents^ 
two  ophthalmic  house  surgeons,,  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  ;{ioo  and  £$0  in 
classics,  mathematics,  and  modem  languages.  Open 
scholarships  of  ;£i5o  and  ;f6o  in  chemistry,  physics,  and 
biology,  and  an  open  scholarship  of  £$0  for  University 
students  in  two  of  the  following  subjects  : — Anatomy, 
physiology,  organic  chemistry,  zoology,  physics.  The 
following  are  the  scholarships,  prizes,  and  medals  open 
to  students  of  the  hospital : — ^The  Arthur  Durham 
prizes  for  dissection,  £1$  and  £$  ;  Junior  prizes  for 
general  proficiency,  ;i2o,  £1$,,  ;Jio ;  Hilton  prize  for 
dissection,  £$  ;  Michael  Harris  prize  for  anatomy,.  ;f  10 ; 
Sands  Cox  scholarship  for  physiology,  £1$  ;  Woold- 
ridge  prize  for  physiology,  ;£io  ;  Beaney  prize  in  patho- 
logy»  ]f  34  ;  Golding-Bird  prize  in  bacteriology,  gold 
medal  and  £20 ;  Treasurer's  gold  medal  in  clinical 
medicine  ;  Treasurer's  gold  medal  in  clinical  surgery ; 
Beaney  studentship  in  materia  medica  (tenable  for  3 
years),  annually  £31  los.  ;  Gull  studentship  in  patho- 
logy (tenable  for  3  or  5  years),  annually  ;£i5o. 

New  School  Buildings. — ^A  considerable  addition  to 
the  school  buildings  was  made  in  1897,  comprising  a 


Sbpt.  14^  1904. 


ENGLAND— EDUCATION, 


Thb  Medical  Press.    271 


-series  of  class-rooms,  laboratories,  and  a  lecture  theatre 
for  the  teaching  of  physiology.  In  1903  the  magnificent 
"Wills  Library  was  opened,  and  a  new  museum  for  patho- 
logical specimens  and  additional  lecture  and  class  rooms 
axe  in  course  of  erection. 

JFees. — ^A  new  system  for  payment  of  composition 
lees  has  been  recently  instituted  at  this  school.  Par- 
ticulars may  be  obtained  on  application  to  the  Dean, 
Ouy's  Hospital,  London  Bridge,  S.E. 

King's  College  Hospital. — ^This  hospital  is  cen- 
ftrally  situsited,  being  contiguous  to  the  Royal  College 
of  Surgeons,  Lincoln's  Inn  Fields.  The  College  adjoins 
Somerset  House  and  is  close  to  the  hospital,  in  which 
there  are  220  beds  available  for  clinical  teaching  ;  oph- 
thalmic, ear,  throat,  skin,  and  dental  departments  are 
attached  to  the  hospital.  Some  wards  are  specially 
devoted  to  children's  diseases.  The  wards  have  been 
recently  refloored  and  the  electric  light  installed 
throughout. 

Scholarships. — ^£800  are  awarded  annually  in  scholar- 
ships and  prizes.  At  entrance,  a  science  exhibition  of 
£100  value  is  open  to  all  candidates  under  the  age  of 
nineteen ;  two  scholarships  of  the  value  of  ^fioo  each 
(subjects  literary)  are  open  to  students  commencing 
their  curriculum.  A  scholarship,  value  ;£  50,  is  open  to 
students  of  a  British  University  who  come  up  to  London 
to  complete  their  curriculum  ;  two  junior  scholarships 
of  ;£2o  each  for  first  year  students,  one  of  £30  for  second 
year  students,  one  of  £$0  for  third  year  students  in 
residence,  and  one  of  ^£40  for  fourth  vear  students.  In 
addition,  students  may  compete  for  the  Daniell  scholar- 
ship, value  /40  ;  the  Wameford  prizes,  value  ;£40  ;  the 
Rabbeth  scholarship,  value  ^£20  ;  the  Carter,  Todd, 
J  elf.  Tanner,  Leathes  prizes,  and  all  class  and  clinical 
prizes. 

Appointments, — ^Medical  and  surgical  Sambrooke  re- 
^gistrarships,  tenable  for  two  years,  each  £$0  per  annum. 
^Resident  hospital  appointments,  viz,,  senior  and  junior 
lK>use  physicians,  assistant  house  physician,  ph3rsician 
.accoucheur's  assistant  and  assistant  house  accoucheur, 
and  three  house  surgeons  with  free  board  and  residence 
at  the  hospital ;  and  senior  and  junior  clinical  assistants 
on  special  departments. 

University  of  London. — Special  courses  of  lectures  and 
practical  instruction  in  the  chemical,  physical,  physio- 
logical, and  other  laboratories  have  been  arranged  for 
students  preparing  for  preliminary  scientific  inter- 
mediate science  and  other  examinations  of  the  Univer- 
sity of  London. 

F.R,C,S.  Examinations, — Special  classes  are  arranged 
ior  the  final  F.R.C.S.  examinations.  Further  parti- 
•culars  can  be  obtained  from  the  Dean. 

London  Hospital. — ^This  hospital  is  the  largest  in 
England,  containing,  as  it  does,  820  beds.  It  has,  more 
over, ^ards  and  a  teaching  stafi  for  almost  every  special 
department  in  the  domain  of  medicine ;  the  scholar- 
ships and  prizes  are  many  and  valuable,  and  both  school 
axLd  stafi  are  deservedly  popular  with  students. 

Appointments. — ^The  "  House  "  appointments,  which 
are  numerous,  are  made  without  fee  of  any  kind,  and  all 
resident  officers  are  provided  with  free  board  and  rooms, 
and  in  some  instances  with  salary  also. 

The  additional  buildings  for  the  department  of  public 
health,  for  the  biological,  chemical,  and  physical 
laboratories,  materia  medica  museum,  &c.,  and  the  new 
bacteriological  department  with  general  laboratory, 
research  laboratories,  class  rooms  for  D.P.H.  work, 
sterilising  room,  animal  room,  &c,,  are  now  open. 

Fees. — Perpetual  fee  for  lectures,  demonstrations^ 
and  hospital  practice,  payable  in  three  instalments  of 
45,  45,  and  40  guineas  at  the  commencement  of  the 
first,  second,  and  third  years  respectively,  130  guineas  ; 
or,  if  in  one  payment,  120  guineas.  Fee  for  students 
entering  in  their  third  year  (their  first  and 
second  years  having  been  spent  at  a  recognised 
medical  school  elsewhere),  60  guineas.  This  fee 
is  payable  by  students  entering  who  have  passed 
the  first  M.B.  Oxford ;  the  second  M.B.  Cam- 
bridge ;  or  the  Intermediate  M.B.  London.  Dental 
students  (general  hospital  practice  and  lectures),  40 
guineas.    General  fee  for  dental  practice,  10  guineas. 


Note. — ^A  reduction  of  15  guineas  will  be  allowed  to 
the  sons  of  medical  men  from  the  perpetual  fee  if  paid 
in  full,  or  5  guineas  from  each  instalment. 

Special  entries  can  be  made  either  for  single  courses 
of  lectures  or  for  hospital  practice. 

Accommodation  is  obtainable  at  a  very  reasonable 
rate  close  by,  or  in  the  suburbs  a  few  minutes'  distant 
by  train.  Fuller  particulars  can  be  obtained  of  the 
Warden,  Mr.  Munro  Scott. 

St.  Mary's  Hospital. — ^This  hospital  is  situated  at 
Paddington,  near  the  terminus  of  the  Great  Western 
Railway,  and  at  present  contains  281  beds.  Fresh 
laboratories,  fitted  with  electric  light  and  all  modem 
improvements,  for  the  study  of  pathology  and  bac- 
teriology, have  recently  been  added,  and  also  a  new 
physiological  lecture-room.  A  special  department  of 
pathological  chemistry  has  been  instituted.  The  new 
wing,  the  ground-floor  of  which,  comprising  the  new 
out-patient  department,  was  opened  m  1898,  is  now 
approaching  completion  ;  this  will  raise  the  number 
of  beds  to  350,  and  will  include  additional  operating 
theatres,  a  new  clinical  laboratory,  a  clinical  theatre, 
and  an  X-ray  department. 

Appointments. — ^AU  clinical  appointments  in  the 
hospital  are  free  to  students  of  the  Medical  School,  and 
the  resident  medical  officers  are  chosen  by  competitive 
examination.  Six  house  physicians,  six  house  sur- 
geons, four  obstetric  officers,  and  two  resident  anaesthe- 
tists are  appointed  in  each  year,  and  receive  board  and 
residence  m  the  Hospital. 

Scholarships,  S^. — One  scholarship  in  natural  science, 
of  the  value  of  ;£i45,  open  to  any  gentleman  who  has 
not  completed  a  winter  session  of  study  at  a  medical 
school.  One  scholarship  in  natural  science,  of  the 
value  oi  £7^  15s.,  and  two  oi  £$2  los.,  under  the  same 
conditions,  Two  scholarships,  each  of  60  guineas, 
open  to  students  from  any  British  University.  The 
scholarships  will  be  awarded  by  examination  on 
September  20th  and  21st. 

Fees. — ^Fee  for  attendance  on  the  full  five  years'  curri- 
culum of  hospital  practice  and  aU  lectures,  demonstra- 
tions, and  special  tutorial  classes,  ;(Si40,  paid  in  one 
sum  on  entering  the  school ;   or  in  instalments,  £i4S* 

Students  who  have  completed  their  examinations  in 
anatomy  and  physiology  at  the  Universities  of  Oxford, 
Cambridge,  or  other  University,  are  admitted  as  per- 
petual pupils  on  payment  of  a  fee  of  60  guineas  in  one 
sum,  or  65  guineas  in  two  annual  instalments.  Uni- 
versity students,  prior  to  completing  the  anatomy  and 
physiology  examinations,  pay  an  annual  fee  of  25 
guineas.  After  completing  the  anatomy  and  physio- 
logy examinations,  the  inclusive  fee  may  be  paid. 

Preliminary  Scientific  Course. — Special  clasises,  under 
recognised  teachers  of  the  university  are  held  through- 
out the  year. 

Middlesex  Hospital. — ^This  hospital,  which  is  con- 
veniently situated  in  the  centre  both  of  business  and 
residential  London,  contains  340  beds.  There  are 
special  departments  for  cancer,  and  for  ophthalmic, 
throat,  aural,  skin,  dental,  children's  diseases,  and 
electrical  treatment  (X-ray  and  Finsen  light). 
Wards  are  also  devoted  to  cases  of  uterine  disease. 
The  new  school  buildings  are  now  in  regular  use.  Resi- 
dence for  students  is  obtainable  in  the  residential 
college,  which  has  its  frontage  on  the  hospital  garden. 

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  depart- 
ments are  also  appointed  in  addition  to  the  foregoing. 

Scholarships,  <S^. — ^Two  entrance  scholarships  of  the 
value  of  3^1 00  and  ;£6o  respectively.  One  entrance 
scholarship  of  the  value  of  ]£6o,  open  to  Oxford  and 
Cambridge  students  only.  (Subjects — Anatomy  and 
physiology,  including  histology).  *'  Emden  "  Cancer 
Research  Scholarship,  ;£ioo.  "  Richard  Hollins," 
Research  Scholarship,  ;£i05.  Two  Broderip  scholar- 
ships of  £60  and  ;f40  respectively,  for  medicine 
and  surgery  ;  John  Murray  medal  and  scholarship, 
awarded  every  third  year  ;  the  Governor's  prize  of  £2\ 


272    The  MtDiCAL  Pkkss. 


ENGLAND— EDUCATION. 


Sept.  X4<  1904- 


for  students  in  their  final  vear.  Hetley  clinical  prize, 
value  £2$,  awarded  annually  for  proficiency  in  practical 
clinical  medicine,  rargery,  and  obstetrics ;  the  Lyeli 
Gold  Medal  in  surgery  and  surgical  anatomy ;  the 
Leopold  Hudson  prize,  value  11  guineas,  in  surgical 
pathology,  including  bacteriology ;  Freeman  scholar- 
ship, ;f  30,  in  obstetrics  and  gynaecology  ;  exhibitions 
of  10  guineas  and  5  guineas  for  anatomy  and  physiology 
to  second  and  first  gear's  students  respectively,  as  well 
as  class  prizes  in  all  subjects. 

Fees.'-GeneiaX  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  year  respectively.  For  those  who  have  completed 
their  anatomical  and  physiolog^ical  studies  the  fee  is  70 
guineas  on  entrance,  or  in  two  instalments  of  40  and  35 
guineas.  The  composition  fee  for  London  University 
students  is  145  gumeas.  For  those  who  have  passed 
the  preliminary  science  examination  120  guineas.  The 
fee  for  the  curriculum  for  dental  students  is  54  guineas 
on  entrance,  or  two  instalments  of  40  guineas  and  20 
guineas. 

St.  Thomas's  Hospital. —  This  hospital,  with 
medical  school  attached,  is  situated  on  the  southern 
Embankment  of  the  Thames,  facing  the  Houses  of 
Parliament,  and  contains  602  beds,  of  which  about 
540  are  in  constant  use.  The  school  buildings, 
which  are  separated  from  the  hospital  by  a  quadrangle, 
comprise  numerous  theatres,  laboratories,  and  class 
rooms,  which  are  well  adapted  for  the  modem  teaching 
of  large  bodies  of  students  in  all  subjects  of  the  medical 
curriculum.  There  is  a  large  library  and  reading-room, 
and  a  very  complete  museum  and  gymnasium. 

Appointments  are  open  to  ail  students.  A  resident 
assistant  physician  and  a  resident  assistant  surgeon  are 
appomted  annually  at  a  salary  of  /loo  with  board  and 
loaging ;  two  resident  casualty  omcers  at  a  salary  of 
;^ioo  per  annum.  Two  hospital  registrars,  at  an  annual 
salary  of  ;£ioo  each,  are  appointed  yearly.  The  tenure 
of  these  offices  may  be  renewed  for  a  term  not  exceeding 
two  years.     An  obstetric  tutor  and  registrar  is  ap- 

gointed  each  year  at  an  annual  salary  of  ;£5o.  Four 
ouse  phjrsicians,  two  house  physicians  to  out-patients, 
four  house  surgeons,  four  house  surgeons  to  out- 
patients, two  obstetric  house  physicians,  two  ophthal- 
mic house  surgeons,  and  eight  clmical  assistants  in  the 
special  departments  are  appointed  every  three  months. 

Scholarships,  Prizes,  S^. — ^Three  entrance  scholar- 
ships are  offered  for  competition  in  September,  viz.,  one 
of  ;fi50  and  one  of  ;£6o  in  chemistry,  physics,  and 
biology  at  the  commencement  of  the  second  year  ;  one 
of  £so  open  to  University  students  who  have  passed 
in  anatomy  and  physiology,  for  a  medical  degree  in 
any  of  the  Universities  of  the  United  Kingdom,  and 
have  not  entered  as  students  in  any  London  Medical 
school.  Numerous  scholarships,  prizes,  and  medals 
are  open  to  competition  throughout  the  whole  career 
of  a  student,  including  a  Fellowship  of  ;£ioo  given  by 
the  Salters'  Company  for  research  in  pharmacology. 

Special  courses  of  instruction  for  the  Preliminary 
Scientific  and  Intermed.,  M.B.Lond.,  for  the  Oxford 
and  Cambridge  examinations,  and  for  the  Primary  and 
Final  F.R.C.S.  are  held  throughout  the  year. 

A  register  of  approved  lodgings  is  kept  by  the 
medical  secretary,  who  has  a  list  of  local  meidical  prac- 
titioners and  others  who  receive  students  into  their 
houses.  The  prospectus  of  the  school  may  be  obtained 
on  application  to  Mr.  Rendle,  the  medical  secretary. 

University  College.  London,  and  Hospital. — 
This  hospital  is  situated  in  Gower  Street,  not  far 
from  Euston  Railway  terminus.  The  college  in  which 
the  classes  are  held  faces  the  hospital,  on  the  opposite 
side  of  the  street.  The  number  of  beds  available  for 
teaching  purposes  is  191. 

Appointments, — ^Eight  house  physicians,  six  house 
surgeons,  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  thdr 
board  and  lodging  free. 

The  offices  of  out-patient  physicians'  and  surgeons' 
assistants,  clinical  clerks,  surgeons'  dressers,  and  oph' 
thalmic  surgeons'  assistants  are  filled  by  pupils  who  zn 
also  students  of  the  college,  without  additional  fee. 

Scholarships,  &-c,  —  Entrance  scholarships  (ex- 
amination begins  on  September  20th.  at  10  o'clock) :  One 
of  the  value  of  ;£i  20,  and  two  of  60  guineas  for  proficiency 
in  science,  the  subjects  being  those  of  the  Preliminary 
Scientific  Examination  of  the  University  of  London, 
and  two  of  80  guineas  each,  the  subjects  being  anatomy 
and  physiology  ;  the  Atkinson-Morley  surgical  scholar- 
ship of  /4S  a  year,  tenable  for  three  years  ;  Atchison's 
scholarship,  value  £^s,  tenable  for  two  years  ;  Sharpey 
physiological  scholarship,  value  about  ^£105  a  year; 
Filliter  exhibition  for  proficiency  in  pathological 
anatomy,  value  £y> ;  Erichsen  prize,  operating 
case,  value  /lo  los..  awarded  for  practical 
surgery,  Dr.  Fellow's  clinical  medals,  the  Listen 
gold  medal,  Alexander  Bruce  gold  medal,  Cloff 
memorial  prize.  Tuke  medals  for  pathology,  class 
medals.  &c.,  gold  and  silver  medals  or  other  prizes,  a» 
well  as  certificates  of  honour,  are  awarded  after  com- 
petitive examinations  in  particular  branches  of  study. 
The  Tuffnell  scholarship  of  ;£8o  for  chemistry,  twcy 
years  ;  and  the  Clothworkers'  exhibitions  in  chemistry 
and  physics  of  £zo  each,  can  also  be  held  in  the  medical 
faculty. 

Composition  Fees. — The  following  have  been  grouped 
to  meet  the  requirements  of  the  various  examining 
boards: 

A. — For  the  Courses  required  by  the  University  of 
London,  i.  For  the  Preliminary  Scientific  course: 
25  guineas,  entitling  to  one  attendance.  2.  For  the 
Intermediate  Course  :  60  guineas,  if  paid  in  one  sum ; 
62  guineas  if  paid  in  two  instalments.  3.  For  the  Final 
M.B.,  B.S.  Course:  80  guineas,  if  paid  in  one  sum; 
82  guineas,  if  paid  in  two  instalments.  This  course  of 
instruction  is  also  suitable  for  the  corresponding  Exam- 
inations at  the  Universities  of  Oxford,  Cambridge,  and 
Durham. 

B. — For  the  Medical  education  required  by  the 
Examining  Board  in  England  and  the  Society  of 
Apothecaries :  4.  For  the  Course  required  for  the  First 
Examination  :  ^30  guineas  entitling  to  one  attendance. 
5.  For  the  Second  :  50  guineas,  if  paid  in  one  sum  ;  51 
guineas,  if  paid  in  two  instalments.  6.  For  the  Course 
required  for  the  Third  Examination  :  80  guineas,  if 
paid  in  one  sum  ;  82  guineas,  if  paid  in  two  instalments. 

The  composition  fee  in  each  case  entitles  to  attend- 
ance on  Lectures  and  Hospital  Practice  during  three 
years. 

C. — For  Dental  Students.  Composition  fee  for  the 
Courses  required  for  the  L.D.S.,  65  guineas  ;  or  excla- 
sive  of  Chemistry,  Practical  Chemistry.  Physics,  and 
Materia  Medica,  50  guineas. 

*  Students  may  repeat  attendance  at  the  Courses  in 
Chemistry  and  Physics  for  £'^  3s.  (inclusive)  and  in 
Elementary  Biology  for  £2  2s. 

Westminster  Hospital. — ^This  hospital  is  con- 
veniently 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  depart- 
ments. New  school  buildings  have  been  erected  close 
by  which  afford  accommodation  for  1 50  students.  The 
class  rooms,  dissecting  rooms,  and  lecture  theatre  are 
excellent  samples  of  modern  erections,  affording  ample- 
scope  for  study. 

Appointments, — ^Medical  and  surgical  registrars,  each 
£^0  per  annum  ;  two  house  physicians,  two  house  sur- 
geons, two  assistant  house  surgeons,  and  resident 
obstetric  assistant.  These  officers,  except  the  two  first 
named,  are  all  boarded  free  of  expense.  Fourth  year's 
students  are  appointed  to  be  clinical  assistants  in  the 
various  departments. 

Scholarships,  S^c, — (a)  Winter  Session — ^The  Guthrie 
scholarship  £60,  entrance  scholarship  £40,  entraoce 
scholarship  £30,  dental  scholarship  ;£2o ;  subjects, 
Latin,  mathematics,  experimental  physics,  chemistry, 
and  either  Greek,   French,   or  German.     University 


Smtt,  14,  1904. 


ENGLAND— EDUCATION. 


The  Medical  Press.    273 


soliolarships,  ^£40  and  £30 ;  subjects,  anatomy  and  phy- 
siology.    Natural  science  scholarship,  £60,  same  as  for 
Prel.   Sd.  of  University  of  London.     Natural  science 
scliolaTship,  ;£40,  chemistry  and  physics.     Free  presen- 
ta.tioii,  open  to  pnpils  of  Epsom  Medical  College.     (6) 
Suxxuner  Session. — Natural  science  scholarship,  £60, 
same  as  "winter.    Natural  science  scholarship,  £40,  same 
as  above.    Arts  scholarship,  £60,  arts  scho&rship,  £40, 
University  scholarships,  ;£40  and  £30,  subjects  same  as 
in  winter  session,     (c)  Prizes. — ^Treasurers*,  10  guineas, 
for  first  year's  men  ;  Chadwick,  20  guineas  for  students 
of  any  year  not  exceeding  fifth.     To  be  competed  for  by 
nnquallfied   men.     Bird   medal   and   prize,    ^14,    for 
students  who  have  completed  fourth  winter  session. 
Stnrges  prize  in  clinical  medicine,  £S,  clinical  surgery 
prize,    £$,  to  be  competed  for  by  unqualified  men. 
And  class  prizes  in  the  various  subjects. 

Fees. — In  one  payment  of  no  guineas,  or  two  pay- 
ments of  60  guineas  each,  payable  on  entrance  and  at 
the  commencement  of  second  year  respectively,  or  by 
six  payments  distributed  over  six  sessions  of  25  guineas 
and  20  guineas  alternately.    Fees  for  shorter  periods  or 
for  single  courses  may  be  learned  on  application  to  the 
Dean.     Fees  for  dental  students,  payable  in  one  sum  on 
entrance,  50  guineas,  or  in  two  instalments  of  £27  los. 
London  School  op  Medicine  for  Women  (Royal 
Free  Hospital). — This  school,  which  is  situated  in 
Hunter  Street,  Brunswick  Square,  opens  at  the  same 
time  as,  and  the  periods  of  study,  lectures,  &c.,  are 
similar  to  those  at,  the  ordinary  medical  schools.     A 
dissecting-room,    physiological,    chemical,    biological, 
physical,  and  pharmaceutical  laboratories  and  library 
are  provided  at  the  school,  and  clinical  lectures  are 
regularly  delivered  at  the  Royal  Free  Hospital  close  by, 
which  institution  is  appropriated  to  the  students  at  the 
School  as  a  field  of  practical  study  ;  all  clerkships  and 
dresserships  are  open  to  the  students  of  the  School. 
Resident  and  other  posts  are  open  to  the  students  after 
qualification.     Numerous  scholarships  and  prizes  are 
awarded,   particulars  of  which  can   be  obtained  on 
application. 

Fees. — The  fee  for  the  Intermediate  and  Final  M.B. 
Lend.  Course  is  £9$  i^  V^^  ^^  one  sum,or  £100  if  paid  in 
three  instalments.  The  fee  for  the  Course  ioT  the 
Conjoint  Colleges  of  Scotland,  &c.,  including  Elemen- 
tary Science,  is  ;£io5  if  paid  in  one  sum,  or  ;£i  10  if  paid 
in  three  instalments.  The  fee  for  hospital  practice  and 
clinical  teaching  is  ;£40,  or  £4$  if  paid  in  instalments. 

Special  classes  for  the  Preliminary  Scientific  exami- 
nation of  the  University  of  London,  For  the  whole 
course,  £2$^ 

EXTBA-ACADBMICAL  INSTITUTIONS 
IN  LONDON. 

*"  National  Dental  Hospital. — This  institution  is 
centrally  situated  (Great  Portland  Street,  W.),  and 
excellent  teaching  facilities  and  hospital  practice  are 
here  obtainable,  special  demonstrations  being  given 
by  members  of  the  staff.  There  are  also  a  mechanical 
laboratory,  bacteriological  laboratory,  museum,  stu- 
dents' common  room,  a  metallurgical  laboratory,  extrac- 
tion and  stopping  rooms,  lecture  hall,  regulations  room, 
&c.,  all  lighted  by  electricity,  and  warmed  and  venti- 
lated after  the  most  approved  requirements ;  in  fact, 
this  institution  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  examination.  The  prizes  include  two  entrance 
exhibitions,  value  ;£40  and  ^£20,  and  the  Rymer  prize  of 
£^  5s.,  the  examinations  for  which  are  held  in  May 
and  October,  The  fee  for  two  years'  hospital  practice 
required  by  the  curriculum,  including  lectures,  is  ;J40. 
(See  advt.) 

London  School  of  Dental  Surgery. — The  teach- 
ing and  hospital  practice  at  this  institution,  like 
that  at  the  foregoing,  are  recognised  by  the  Royal 
College  of  Surgeons  for  the  dental  diploma.  It  is 
situated  in  Leicester  Square,  is  open  daily,  and 
under  the  supervision  of  a  special  stafi  and  house 
surgeons.     The  Hospital  having  been  rebuilt  recently. 


the  accommodation  is  equal  to  all  requirements* 
There  is  the  Saunders  scholarship  and  Entrance 
scholarship,  value  ;£20  each,  the  Woodhouse  Prizer 
of  ;^io,  and  other  prizes  awarded  yearly,  the  Storef 
Bennett  Research  scholarship,  value  £$0,  awarded 
triennially,  and  the  five  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,  £$6  6s.  The  fee  for  three  years' 
tuition  in  mechanical  dentistry  and  the  two  years' 
hospital  practice  as  required  by  the  curriculum  is 
£i^S  if  paid  in  one  instalment,  or  75  guineas,  50  guineas, 
and  50  guineas  if  paid  in  three  instalments.  For 
tuition  in  mechanical  dentistry  the  fee  is  50  guineas 
per  annum. 

London  School  of  Tropical  Medicine. — This 
Institution  is  the  outcome  of  a  suggestion  by  the 
Right  Hon.  Joseph  Chamberlain,  H.M.  late  Secretary  of 
State  for  the  Colonies,  and  is  situated  at  the  Royal 
Victoria  Docks,  in  connection  with  the  Seamen's 
Hospital,  than  which  no  more  suitable  spot  could  be 
found,  as  ships  arrive  there  in  great  numbers  from  the 
Tropics,  affording  immediate  opportunity  for  the 
study  of  tropical  diseases.  The  school  buildings  are 
placed  within  the  hospital  grounds,  and  systematic 
courses  of  instruction  are  obtainable  from  duly  author- 
ised teachers  throughout  the  year.  Students  also 
have  the  privilege  of  attending  the  medical  and  surgicaf 
practice  at  the  "  Dreadnought  "  Hospital,  Greenwich, 
Information  as  to  fees,  &c.,  can  be  obtained  of  the  Deaitf 
or  the  Secretary. 

Medical  studentB  ar«  admitted  to  the  practice 
of  the  following  Metropolitan  hospitals,  to  which 
no  medical  school  is  attached.  Detailed  par- 
ticnlars  will  be  supplied  on  application  to  the 
various  secretaries. 

West  London  Hospital,  Hammersmith, — This  con> 
tains  154  beds,  and  has  an  extensive  out-patient 
department.  Dresserships  and  clinical  clerkships  may 
be  obtained.  Two  house  surgeons  and  two  house; 
physicians  are  selected  every  six  months.  Special 
departments  have  recently  been  opened  for  diseases  of 
the  throat,  ear,  skin,  and  deformities.  Electrical  and 
X-ray  departments  have  also  been  added.  The  practice 
of  this  hospital  is  reserved  exclusively  for  medical  men, 
junior  students  not  being  admitted. 

Great  Northern  Central  Hospital,  Holloway 
Road,  N. — This  institution  has  been  recently  enlarged, 
contains  159  beds,  and  is  now  recognised  for  study 
during  the  fifth  year  by  the  Conjoint  Board.  The 
practice  of  the  hospital  is  open  to  practitioners  and 
senior  students,  and  clinical  and  pathological  assistants- 
are  appointed  in  the  wards  and  out-patient  depart- 
ments, as  in  the  larger  general  hospitals. 

Bethlem  Royal  Hospital. — Two  resident  house 
physicians  who  have  recently  obtained  their  diplomas 
to  practise  medicine  and  surgery  are  elected  every  six 
months,  and  are  provided  with  apartments,  complete 
board,  attendance,  washing,  and  an  honorarium  of 
25  guineas  per  quarter.  The  students  of  certain 
specified  London  medical  schools  receive  clinical 
instruction  in  the  wards  of  the  hospital,  and  qualified 
practitioners  may  attend  for  a  period  of  three  months  on 
payment  of  a  fee.  Post- graduate  lectures  are  also 
given. 

National  Hospital  for  Epilepsy  and  other 
Diseases  of  the  Nervous  System,  Queen's  Square, 
W.C,  contains  200  beds.  It  has  on  its  stafi  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  giveo 
each  year.  «■• 

Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Brompton. — The  largest  institution  for  the 
treatment  of  affections  of  the  chest  in  the  United 
Kingdom,  there  being  318  beds  in  the  two  buildings* 
There  are  four  house  physicians,  who  reside  in  the 


^74    I'RS  >Iedical  Press. 


ENGLAND— EDUCATION. 


Sept.  14.  1904- 


liospital.  each  ior'a,  period  of  six  months.  Lectures  and 
•demonstrations  are  given  bv  members  of  the  medical 
rStaflE  on  Wednesda3rs  and  Fridays  at  four  o'clock,  save 
'during  the  vacations.  Terms,  £2  2s.  for  three  months  ; 
^5  5s.  perpetual.  This  hospital  is  recognised  by  the 
'Conjoint  Board,  the  University  of  London,  and  the 
Apothecaries'  Society. 

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 
imembers  of  an  exceptionally  experienced  staff.  Fee 
for  three  months'  attendance  on  hospital  practice, 
2  guineas  ;  six  months,  3  guineas. 

Royal  Hospital  for  Diseases  of  the  Chest,  City 
Hoad. — (80  beds.) — ^This  hospital  has  been  enlarged  by 
the  :addition  of  a  very  complete  out-patients*  depart- 
imenl;,  and  also  by  the  erection  of  a  new  wing,  which 
provides  accommodation  for  80  in-patients. 
Throat  and  Ear  Hospitals. 

{Metropolitan  Ear,  Nose,  and  Throat  Hospital. 
— The  hospital  was  founded  in  1838,  and  is  situated  in 
Grafton  Street,  Tottenham  Court  Road.  The  out- 
patient department  is  open  daily  at  2.30  p.m.  to  prac- 
titioners and  students  for  acquiring  clinical  instruction 
and  technical  knowledge.  Operations  are  performed 
on  in-patients  on  Tuesdays,  Wednesdays,  and  Thurs- 
days at  9  a.m.  Fee  for  one  month's  attendance  at  the 
hospital  one  guinea,  and  for  three  months  two  guineas. 
During  the  forthcoming  session  demonstrations  will  be 
given  by  members  of  the  staflf  on  the  pathology  and 
treatment  of  diseases  of  the  ear  and  respiratory  pas- 
sages. Short  practical  classes  will  also  be  held  in 
•clinical  pathology  and  surgical  anatomy.  Weekly 
.clinical  lectures  are  given  by  the  staff  on  the  special 
.disease  treated  at  the  hospital,  the  date,  time,  and 
•subject  of  these  lectures  are  previously  announced  in 
the  medical  journals.  Further  particulars  may  be 
'Obtained  upon  application  to  the  Hon.  Secretary  to 
<the  Medical  Board,  at  the  hospital. 

Central  London  Throat  and  Ear  Hospital, 
Gray's  Inn  Road,  contains  seventeen  beds,  with  an 
extensive  out-patient  department  recently  enlarged. 
Clinical  demonstrations  and  instruction  to  qualified 
practitioners  and  senior  students  daily  duiing  the  hours 
.of  the  surgeons'  visits.  Twelve  clinical  assistants,  who 
must  be  duly  qualified,  are  elected  to  assist  the  surgeons. 
Operation  days — ^Tuesdays  and  Fridays,  2  p.m.  Fees  for 
±he  three  months'  attendance,  £$  3s.  ;  six  months', 
£S  Ss.  Full  details  of  this  institution  and  post-gradu- 
.ate  work  will  be  found  on  reference  to  our  advertising 
<x>lumns  or  on  application  to  the  Dean. 

Hospital  for  Diseases  of  the  Throat.  Golden 
Square,  W. — This  hospital  has  been  recently  rebuilt 
and  contains  50  beds.  Clinical  instruction  is  given 
daily  in  the  Out-patient  Department  on  diseases  of  the 
nose,  throat,  and  ear.  There  are  nine  clinics  weekly, 
and  an  annual  out-patient  attendance  of  nearly  50,000. 
Major  and  minor  operations  daily  (Mondays  excepted) 
in  different  theatres.  Four  senior  and  forty- two  junior 
<clinical  assistants  are  appointed  from  among  *  the 
students  to  assist  the  surgeons.  Students  are  admitted 
•to  the  practice  of  the  hospital  at  the  following  fees  : — 
Three  months,  £$  5s.  ;  six  months,  £y  7s.  ;  perpetual 
attendance,  ;^io  los.  Further  details  can  be  had  by 
.applying  to  the  Dean. 

Women  and  Children. 

The  Hospital  for  Women,  Soho  Square. — The 
liospital  contains  61  beds.  In  connection  with  this 
institution  there  is  now  an  organised  school  of  gynaeco- 
logy 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  depart- 
ments are  appointed  every  three  months.  Fee  for  the 
three  months'  course,  and  certificate,  £S  8s. 

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 
jstaff  in  this  department  have  gained  for  them  a 
European  reputation.     There  are  47  beds. 


Hospital  for  Sick  Children  in  Great  Onncnd 
Street,  Bloomsbury,  W.c.,  and  Cromwell  House.  Higji. 
gate. — Fee  for  three  months'  attendance,  £2  2s.: 
perpetual,  £3  3s.  There  are  now  200  beds,  besides  52 
additional  at  the  convalescent  branch,  and  it  » 
probably  the  largest  institution  of  the  kind  in  the 
world.  The  practice  of  the  hospital  is  open  to  pupils 
of  the  different  hospitals  and  medical  schools  oi 
London  and  medical  practitioners  on  conditions  to  be 
ascertained  from  the  Secretary. 

Eye  Hospitals. 

Royal  London  Ophthalmic  Hospital,  formerly  in 
Moorfields,  and  recently  rebuilt  in  the  City  Road,  is  the 
largest  hospital  devoted  to  this  specialty  in  Great 
Britain,  and  contains  138  beds.  Students  and  practi- 
tioners are  admitted  to  the  practice  daily  at  9  o'clock. 
Operations,  10  o'clock  and  after.  Fee  for  six  months, 
£3  3s.  ;  perpetual,  £$  5s.  Further  particulars  of  the 
Secretary. 

Royal  Westminster  Ophthalmic  Hospftal,  ad- 
joins Charing  Cross  Hospital  in  King  William  Street 
It  has  about  34  beds  and  a  very  large  out-patient  clim- 
que.  The  lectures  and  demonstrations  are  arranged 
with  special  reference  to  the  requirements  of  practi- 
tioners and  senior  students.  Fee,  six  months,  £$  3s. ; 
perpetual,  £$  ss. 

Royal  Eye  Hospital,  St.  George's  Circus,  South- 
wark. — ^There  are  40  beds  and  two  cots.  Fees,  £2  2s. 
for  three  months,  £3  3s.  for  six  months,  and  £s  $&. 
perpetual.  Courses  are  held  on  ophthalmoscopy, 
refraction,  and  diseases  of  the  eye  ;  fee,  £1  is.  for  each 
course,  but  perpetual  students  may  attend  each  course 
once  without  extra  fee.  Pathology  class,  £1  is.  extra 
to  cover  cost  of  materials. 

Skin  Hospitals. 

St.  John's  Hospital  for  Diseases  of  the  Skin.— 
Out-patient  department,  Leicester  Square  ;  In-patient 
department,  Uxbridge  Road,  W.  This  hospital  has  a 
well-equipped  in-patient  department,  with  50  beds. 
It  has  a  School  of  Dermatology  at  49  Leicester  Square, 
which  is  conducted  by  the  medical  staff  of  the  hospital 
A  spacious  laboratory  is  also  provided.  During  the 
past  year  the  free  course  of  Chesterfield  Lectures  given 
by  Dr.  Morgan  Dockrell  has  proved  a  great  success, 
being  well  attended  by  the  profession.  The  next 
course  (free)  will  commence  in  October  next,  and  the 
dates  and  times  will  be  duly  announced  in  our  columns. 
The  Out-patient  Department  is  to  be  rebuilt  imme- 
diately.   (See  advt.) 

One  of  the  oldest  institutions  of  the  kind  is  the 
Western  Skin  Hospital  (Welbeck  Street,  W.),  which 
was  started  as  long  ago  as  185 1.  The  practice  of  the 
hospital  is  open  to  students  and  practitioners.  Stu- 
dents of  this  specialty  iiave  also  the  ''  London  Skin 
Hospital,"  in  Fitzroy  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 
t)f  the  Metropolis,  with  10  beds  and  an  out-patient 
department  of  S,6oo,  so  that  the  students'  needs  in 
this  direction  are  well  catered  for. 

London  Temperance  Hospital. — ^The  hospital  con- 
tains no  beds,  and  is  conducted  as  its  name  implies 
on  non-alcoholic  principles  by  an  excellent  staff.  The 
medical  and  surgical  practice  is  open  to  students  and 
practitioners.  Appointments  (vacancies  for  which  are 
advertised  in  the  medical  journals) :  Surgical  and 
medical  registrars,  resident  medical  officer,  and  one 
assistant  resident  medical  ofl&cer. 

Metropolitan  Hospital,  King:sland. — ^This  was 
until  recently  known  as  the  Metropolitan  Free  Hospital, 
is  situated  in  the  north-eastern  district  of  the  Metro- 
poUs,  and  contains  160  beds.  It  is  a  general  hospital, 
with  various  special  departments  for  the  treatment  of 
diseases  of  the  eye,  throat,  ear,  &c, 

Tottenham  Hospital,  N, — ^This  hospital  contains 
medical  and  surgical  wards  and  a  ward  for  children, 
having  in  all  73  beds.  There  are  special  departments 
for  gynaecological  cases,  diseases  of  the  eye,  ear,  throat 
and  nose,  and  skin  diseases.  It  has  now  been  author- 
ised by  the  University  of  London  to  give  certificates  of 
post-graduate  study  for  the  M.D.  and  M.S.  degrees. 


Sept.  14.  1904. 


ENGLAND— EDUCATION. 


Tbb  Msdxcal  Press.   275 


jflBTEOPOIilTAN    POST-GRADUATE 
INSTITUTION. 

Medical  Graduates*  College  and  Polyclinic— 
This  institution  afiords  to  medical  men  special  facilities 
for  acquiring  technical  skill,  and  advancing  their 
medical  and  scientific  knowledge.  The  building,  which 
is  large  and  commodious,  is  situated  in  Chenies  Street, 
Gower  Street,  and  contains  lecture  and  consulting 
rooms,  pathological  and  clinical  laboratories,  Rontgen 
ray  room,  an  ophthalmoscope  room,  a  library  and 
museum,  and  reading  and  smoking  rooms.  Cliniques, 
at  which  patients  are  shown,  are  given  every  day  of  the 
week  except  Saturday,  at  4  p.m.  Lectures  on  Medicine, 
Surgery,  and  other  allied  subjects  are  deliveired  on 
Mondays.  Tuesdays,  Wednesdays,  and  Thursdays  at 
5.15  p.m.  Four  sessions  of  practical  classes,  each  lasting 
six  weeks,  and  a  vacation  session  of  three  weeks'  dura- 
tion, are  held  during  the  year,  the  subjects  taught  com- 
prising ophthalmology,  otology,  clinical  microscopy, 
orinary  analysis,  gynaecology,  laryngology,  applied 
anatomy,  nervous  diseases,  and  practical  X-ray  work. 
There  are,  in  addition,  extra-mural  classes  in  operative 
surgery,  bacteriology,  and  public  health. 

A  complimentary  ticket  for  three  days,  admitting  to 
diniques  and  lectures,  is  issued  to  any  medical  practi- 
tioner on  personal  application  at  the  college.  The 
annual  subscription  for  medical  practitioners  of  either 
sex.  holding  qualifications  granted  in  any  of  H.M.'s 
dominions — wherever  resident — is  One  Guinea.  Ful' 
information  may  be  obtained  from  the  medical  super- 
intendent, Mr.  Hayward  Pinch,  F.R.C.S. 

West  London  Post-Graduate  College. — ^The 
West  London  Hospital,  Hammersmith,  contains  154 
beds;  the  Post-Graduate  course  was  started  in  1895. 
Instruction  is  given  in  the  out-patient  department  daily 
at  2.15  p.m.,  by  assistant  physicians  and  assistant 
surgeons,  and  post-graduates  can  accompany  members 
of  the  staff  on  their  daily  visits  to  the  wards. 

Fees.— The  fee  for  the  hospital  practice,  including  all 
the  ordinary  demonstrations  and  lectures,  is  £1  is.  for 
one  week ;  £2  2s.  for  one  month  ;  £4.  4s.  for  three 
months  ;  £6  6s.  for  six  months  ;  £9  9s.  for  one  year  ; 
and  ;i2i  for  a  life  ticket ;  all  fees  to  be  paid  in  advance. 

A  course  of  attendance  on  either  the  medical  or  surgi- 
cal practice  alone  may  be  taken  out  for  the  fee  of  £$  3s. 
for  three  months.  The  fee  for  three  months'  attend- 
ance in  any  one  special  department,  other  than 
mwUcine  or  surgery,  is  £2  2s. 

North-East  London  Post-Graduate  College. — 
At  the  Tottenham  Hospital,  N.,  which  is  recognised  by 
the  University  of  London  for  purposes  of  post-graduate 
study  for  the  M.D.  and  M.S.  degrees,  facilities  are 
afforded  to  medical  practitioners  for  taking  part  in  the 
work  of  an  active  general  hospital,  and  for  attending 
demonstrations  of  various  branches  of  medicine, 
surgery,  and  gynaecology,  with  opportunities  for 
clinical  instruction  in  diseases  of  the  eye.  ear,  throat, 
nose,  diseases  of  the  skin,  and  dentistry.  Clinical 
lectures  and  demonstrations  are  given  twice  weekly, 
and  include,  in  addition  to  the  above,  instruction  in 
ievers,  tropical  medicine,  psychological  medicine,  state 
medicine,  electro-diagnosis,  and  the  administration  of 
aacsthetics.  Operations  are  performed  every  after- 
noon of  the  week,  except  Saturday.  The  fee  for  one 
month's  hospital  practice  is  2  guineas;  for  three 
months',  3  guineas,  and  for  a  perpetual  ticket,  5  guineas. 
Post-graduates  who  have  attended  a  three  months' 
course  in  any  department  are  eligible  for  appointment 
as  clinical  assistants  in  those  departments.  Additional 
information  can  be  obtained  from  the  Dean  at  the 
Post-Graduate  College,  Tottenham. 
PBOVINOCAIj  MEDICA.IJ  SCHOOLS. 
Bristol  University  College. — ^Faculty  of  Medi- 
cine.—-The  lectures  and  instruction  given  in  the 
Faculty  of  Arts  and  Science  of  University  College, 
Bristol,  are  adapted  to  the  various  preliminary  examina- 
tions, and  students  can  complete  in  Bristol  the  entire 
<»uTse  of  study  required  for  the  medical  and  surgical 
degrees  of  the  University  of  London  and  the  Royal 
College  of  Surgeons  of  England,  and  of  the  Apothe- 


caries' Society  of  London,  and  for  the  examination  .of 
the  Army  and  Navy  Boards.  Students  of  the  college 
are  admitted  to  the  cUnical  practice  of  those  very 
important  and  well-equipped  institutions,  the  Bristol 
Royal  Infirmary  and  the  Bristol  General  Hospital. 
The  infirmary  and  the  hospital  comprise  between  them 
a  total  of  470  beds,  and  both  have  very  extensive  out- 
patient departments,  and  special  departments  for  the 
diseases  of  women  and  children,  and  of  the  eye,  ear,  and 
throat,  besides  large  outdoor  maternity  departments 
and  dental  departments. '  Students  of  the  college  also 
have  the  privilege  of  attending  the  practice  of  the 
Bristol  Royal  Hospital  for  Sick  Children  and  Women 
containing  104  beds,  and  that  of  the  Bristol  Eye 
Hospital,  with  40  beds.  The  total  number  of  beds 
available  for  ctinicai  instruction  is  therefore  614.  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.  Also  obstetric  clerks 
and  ophthalmic  dressers.  Clinical  lectures  are  given 
regularly  at  both  institutions. 

Scholarships,  Prizes,  S'C. — Prizes  and  certificates  of 
honour  are  given  in  University  College  in  all  the 
subjects  of  the  curriculum.  There  are  two  entrance 
scholarships,  value  £$0  and  £$0  respectively,  two 
Martyrs'  memorial  scholarships  (pathology  and  morbid 
anatomy)  of  ;fio  each,  the  Tibbit's  memorial  prize,  . 
value  £9,  for  .proficiency  in  practical  surgery,  Henry 
Marshal  prize,  ;£i2;  Clairke  Scholarship,  ;£i  5 ;  Sanders 
Scholarship,  i^22  los. ;  one  gold  and  silver  medal 
awarded  by  the  committee,  and  various  prizes  for 
clinical  work  in  surgery  and  medicine. 

Fees, — School  fees  for  attendance  on  all  courses  of 
lectures,  except  comparative  anatomy,  70  guineas,  or 
55  guineas.  Dental  composition  fee,  60  guineas. 
Clinical  fees — Surgical  practice,  one  year,  12  guineas; 
perpetual,  20  guineas.  Medical  practice,  20  guineas  ; 
perpetual  medicine  and  surgery,  35  guineas ;  clerk  or 
dresser,  5  guineas  ;  obstetric  clerk,  3  guineas. 

Prospectus  and  further  information  on  application  to 
the  Dean,  Professor  E.  Markham  Skerritt. 

School  of  Medicine,  The  University,  Leeds. 
— This  school  was  originally  founded  seventy  years 
since  as  the  Leeds  Medical  School.  The  build- 
ing, erected  on  a  site  contiguous  to  the  infirmary, 
and  opened  six  years  ago,  contains  one  of  the  finest 
dissecting  rooms  in  the  Kingdom,  extensive  laboratories 
for  physiology  and  pathology,  with  the  most  recent 
improvements  in  fittings  and  apparatus,  ample  lecture- 
room  accommodation,  a  large  Ubrary,  and  separate 
museums  for  pathology  and  anatomy.  Professors  and 
lecturers  are  attached,  and  the  cUnical  teaching  is 
given  by  the  physicians  and  surgeons  attached  to  the 
infirmary.  Ophthalmic  demonstrations  and  demon- 
strations of  slun  diseases  are  given  in  the  infirmary  by 
surgeons  in  each  department,  where  also  are  obtainable 
various  cUnical  clerkships,  dresserships,  and  other  ap- 
pointments ;  and  an  extern  maternity  charity  is  attached, 
at  which  the  necessary  attendance  at  labours  can  be 
taken  ;  besides  the  infirmary  there  is  a  large  dispenssiry, 
a  large  hospital  for  infectious  diseases,  and  a  hospital 
for  women  and  children,  all  of  which  are  open  to 
students  of  the  schooU 

Scholarships,  Prizes,  6'C. — (i)  A  Gilchrist  scholarship 
of  £so  a  year  for  three  years  is  awarded  annually.  (2) 
A  University  scholarship  of  £2$  (awarded  annually). 
(3)  An  entrance  scholarship  of  64  guineas.  There  are 
also  a  Hard  wick  prize  in  clinical  medicine,  a  M'Gill 
prize  in  clinical  surgery,  each  of  the  value  of  ;£io,  and 
Thorpe  prizes  of  ;f  10  and  £$  in  forensic  medicine  and 
hygiene,  and  a  Scattergopd  prize  in  midwifery,  besides 
silver  and  gold  medals  and  other  class  prizes.  The 
composition  fee  for  attendance  upon  all  the  required 
courses  of  school  lectures  is  64  guineas  for  University 
students  who  have  attended  the  prehminary  scientific 
courses,  and  the  same  for  non-University  students, 
exclusive  of  chemistry  and  biology. 

F 


276    The  MEDicAt  Pi*ss. 


ENGLAND— EDUCATION. 


Sept.  14,  1904. 


At  the  General  Infirmary,  containing  447  beds,  the 
perpetual  fee  for  medical  and  surgical  practice  and 
clinical  lectures  is  £42  in  one  sum,  or  two  instalments 
of  ;f22  each.  These  fees  are  not  included  in  the  com- 
position fees  for  lectures,  and  are  payable  separately. 

A  scholarship  of  £42  to  cover  the  cost  of  medical  and 
surgical  practice  is  offered  annually  by  the  Infirmary. 

Manchester.  —  The  Manchester  University 
School  of  Medicine. — The  medical  school  build- 
ings, which  include  large  laboratories,  dissecting- 
rooms,  hbrary  and  reading-rooms,  are  on  the  most 
modem  principles,  and  students  wishing  to  engage  in 
anatomical,  physiological,  or  pathological  research  will 
find  excellent  opportunity  for  study  in  the  complete 
and  well-furnished  laboratories.  Hospital  practice  is 
taken  out  at  the  Royal  Infirmary,  which  contains  300 
beds.  The  Cheadle  Lunatic  Asylum,  St.  Mary's 
Hospital,  the  Southern  Hospital,  and  other  special 
hospitals  also  afford  teaching  facilities  of  great  import- 
ance. 

Appointments. — ^The  following  appointments  are 
made  in  connection  with  the  Manchester  Royal  Infir- 
mary : — Surgical  registrar,  at  ;£8o  per  annum ;  a 
pathological  registrar,  at  ;£ioo  per  annum  ;  a  medical 
registrar,  at  £70  per  annum ;  two  assistant  medical 
officers,  each  at  £$0  per  annum ;  a  director  of  the  Clinical 
Laboratory  at  £7$  per  annum  ;  an  assistant  director  of 
the  Clinical  Laboratory  at  £$0  per  annum  ;  a  resident 
medical  officer  at  the  Convalescent  Hospital,  Cheadle, 
one  year,  ;£iSo  per  annum;  resident  medical  officer, 
one  year,  £iSO;  and  an  assistant  at  ;f8o  per  annum  ; 
resident  surgical  officer,  one  year,  £iSO  per  annum; 
two  chloroformists,  annually,  at  ^50 ;  two  house 
surgeons  and  one  house  physician  are  appointed  every 
three  months  for  a  term  of  six  months ;  a  resident 
assistant  at  the  Convalescent  Hospital,  Cheadle, 
appointed  every  six  months,  and  other  appointments. 

Scholarships. — Dalton  entrance  scholarships,  ;f40  per 
annum  for  two  years  ;  Cartwright  entrance  scholarship, 
£3S  per  annum  for  three  years ;  Hulme  entrance  scholar- 
ships, three  of  ^f3S  per  annum  for  three  years ;  Rogers 
entrance  scholarship,  ;£4o  per  annum  for  two  years  ; 
Seaton  entrance  scholarship,  ^40  per  annum  for  two 
years  ;  James  Gaskill  entrance  scholarship,  ;f4o  per 
annum  for  two  years  ;  Kay  Shuttleworth  (Sir  J  as. 
Philips)  scholarship,  £$0  per  annum  for  three  years  ; 
Theodore's  modem  languages  exhibition,  £1$  ;  Hono- 
rary Research  Fellowships ;  Entrance  scholarships  in 
Medicine,  ;iioo  (towards  College  and  Infirmary  fees) ; 
Manchester  Grammar  School  scholarships,  three  of  £2  5 
per  annum  for  three  years  ;  Turner  scholarship  of 
3^20  to  students  who  have  completed  four  years  of 
study  in  the  University ;  Piatt  physiological  scholar- 
ships, two  of  the  value  of  £$0  each,  tenable  for  two 
years,  open  to  students  between  the  ages  of 
18  and  25;  Piatt  biological  scholarship,  £$0 ; 
one  Professor  Tom  Jones  exhibition  in  anatomy  oi  £2$  ; 
one  Professor  Tom  Jones  memorial  surgical  scholarship 
of  ;£ioo,  awarded  triennially ;  two  Piatt  exhibitions, 
£1$  each,  for  first  and  second  year's  students  in  physio- 
logy ;  Sidney  Renshaw  physiological  exhibition,  £1$  i 
Dumville  surgical  prize,  £1$,  at  the  end  of  the  winter 
session  ;  two  Dauntsey  medical  entrance  scholarships, 
value  £z$,  tenable  for  one  year;  John  Henry  Agnew 
scholarship  in  diseases  of  children,  value  about  £10, 
awarded  annually  ;  a  Gilchrist  scholarship  of  £$0  per 
annum  tenable  for  three  years,  awarded  to  the  candi- 
date standing  highest  in  the  first  division  of  the 
Matriculation  examination  of  the  University ;  the 
Bradley  memorial  scholarship,  ;f20,  in  clinical  sur- 
gery is  offered  annually  in  the  summer  session  to  candi- 
dates who  must  be  fourth  year  students  ;  one  medical 
and  one  surgical  clinical  prize  are  also  offered  annually. 

Fees. — Composition  fee,  £70,  in  two  sums  of  £^s 
each.  Hospital  practice  :  composition  fee,  ^^42,  or  two 
instalments  of  ^£22  each. 

Dental  Fees. — ^Composition  fee,  ^^50,  payable  in  two 
sums  of  £2$  each.     Hospital  practice,  ;£2i. 

University  of  Durham  College  of  Medicine, 
Newcastle-on-Tyne, — ^A  very^commodious  and  ornate 


new  building  has  been  erected  here  at  a  cost  of  abott 
;i3i,ooo.  The  Royal  Infirmary,  at  which  climcal  in- 
struction is  obtained,  contains  280  beds.  PathologiQl 
demonstrations  are  given  as  opportunity  offers.  Prac- 
tical midwifery  can  be  studied  at  the  Newcastle  Lyin^ 
in  Hospital.  Opportunities  for  practical  study  arc  also 
afforded  by  the  Dispensary,  City  Infectious  Diseases 
Hospital,  Eye  Infirmary,  and  at  the  Northumberland 
County  Lunatic  Asylum. 

Appointments. — ^Assistant  demonstrators  of  anatomr 
receiving  each  an  honorarium  ;  prosectors  for  the  pro- 
fessor of  anatomy ;  assistant  demonstrators  of  physio- 
logy and  pathology ;  assistants  to  the  dental  surgeon. 
cUnical  clerks,  and  dressers  are  appointed  at  regular 
intervals.  One  year's  attendance  at  the  College  is 
required  on  the  part  of  candidates  for  the  degrees  in 
medicine  of  the  University  of  Durham. 

Scholarships,  S'C. — University  scholarships,  vahe 
;£ioo,  for  proficiency  in  arts,  awarded  annually  at  the 
beginning  of  winter  session  to  full  students  in  their  fiia 
year  only.  The  Dickinson  memorial  scholarship  (value, 
the  interest  of  ;{40o  with  a  gold  medal)  for  inedidnc. 
surgery,  midwifery,  and  pathology,  open  to  full  students 
who  have  passed  the  primary  examination  of  a  Ucensinf 
body.  The  TuUoch  scholarship,  interest  of  £400 
annually,  for  anatomy,  physiology,  and  chemistiv. 
The  Charlton  memorial  scholarship,  interest  of  £70!> 
annually,  open  to  full  students  entered  for  the  class  of 
medicine,  at  end  of  the  fourth  or  fifth  winter.  TheGibb 
scholarship,  interest  of  ^500  annually,  for  pathology,  at 
end  of  summer  session.  Goyder  memorial  scholarship 
in  cUnical  medicine  and  clinical  surgery,  proceeds  of 
£$2$  annually.  The  Luke  Armstrong  inemorial  schol- 
arship, interest  on  £680.  The  Stephen  Scott  scholar- 
ship in  surgery,  interest  on  £1 ,000.  The  Heath  scholar- 
ship in  surgery  (the  next  award  will  be  in  1906) ;  the 
interest  on  ;£4,ooo  is  awarded  every  second  year.  The 
Gibson  prize  in  midwifery  and  diseases  of  women  and 
children  ;  the  interest  on  ;f22S  is  awarded  yearly.  At 
the  end  of  the  session  a  prize  of  books  is  awarded  in  each 
of  the  regular  classes. 

Fees. — (a)  A  composition  ticket  for  lectures  at  the 
college  may  be  obtained— 1.  By  payment  of  72  guineas 
on  entrance.  2.  By  payment  of  46  guineas  at  the  com- 
mencement of  the  first  sessional  year  and  36  guineas  at 
the  commencement  of  the  second  sessional  year.  3.  By 
three  annual  instalments  of  36,  31,  and  20  guineas,  re- 
spectively, at  the  commencement  of  the  sessional  year. 
(b)  Fees  for  attendance  on  hospital  practice  :  For  three 
months*  medical  apd  hospital  practice,  five  guineas; 
for  six  months,  eight  guineas  ;  or  by  three  instalments 
at  the  commencement  of  the  sessional  year,  viz.,  fint 
year,  12  guineas  ;  second  year,  10  guineas  ;  third  year, 
six  guineas  ;  or  by  two  instalments,  viz.,  first  year.  14 
guineas  ;   second  year,  1 2  guineas. 

Sheffield  University  College  Medical  Depart- 
ment.— ^The  medical  department  contains  a  medical 
library,  good  class-rooms,  an  excellent  anatomical  de- 
partment, and  every  provision  for  medical  education 
under  the  most  modem  principles.  The  Favell  labora- 
tory of  physiology  consists  of  a  lecture  and  demonstra- 
tion theatre,  students*  laboratory,  preparing  room  and 
galvanometer  room,  all  of  which  are  equipped  with  the 
most  modem  apparatus.  The  pathology  department 
is  in  a  separate  temporary  building.  It  contains  a 
pathological  museum  and  laboratory,  and  a  bacteriolo- 
gical laboratory,  which  has  been  completely  equipped 
through  the  generosity  of  "  A  Sheffield  Citizen."  The 
course  of  lectures  and  instruction  is  adapted  to  meet  the 
requirements  of  the  various  examining  bodies.  Fulf 
courses  of  instruction  required  for  the  D.P.H.  are 
given.  The  dental  department  is  recognised  by  the 
examining  bodies.  Students  at  this  college  obtain 
medical  and  surgical  practice  at  the  Royal  Infinnary, 
containing  247  beds,  and  also  at  the  Sheffield  Royal 
Hospital,  containing  160  beds.  The  fees  for  atten- 
dance, £6  6s.  each  for  medical  and  surgical  practice 
during  the  winter  session,  and  for  three  months  £$  3s. 
each.  Perpetual  fee  for  medical  and  surgical  hospital 
practice  in  a  single  payment  of  £4$,  or  in  two  payments 
viz.,  ^26  on  entrance,  and  £22  within  twelve  months 


Sept.  14.  1904. 


ENGLAND— EDUCATION. 


The  Medical  Press.    277 


fterwards.  Students  are  also  admitted  to  the  practice 
f  the  Jessop  Hospital  for  Diseases  of  Women  (80  beds), 
)  the  City  Fever  Hospitals,  and  to  the  South  Yorkshire 
unatic  Asylum  at  Wadsley.  The  winter  session  will 
>mmence  on  October  3rd.  The  building  of  the  new 
>Uege  for  departments  of  Arts,  Science,  and  Medicine, 
in  active  progress  and  will  be  ready  for  occupation  in 
ctober,  1905.  The  site  adjoins  Weston  Park  and  is 
ithin  easy  distance  of  the  hospitals. 
Scholarships,  <S<:. — An  entrance  scholarship  of  the 
alup  of  ;£iio  is  annually  awarded  to  the  best  candidate 
f  of  sufficient  merit)  in  mathematics,  elementary 
hysics,  inorganic  chemistry,  Latin,  English. 
Composition  fee,  60  guineas,  or  in  two  instalments  of 
5  guineas  and  30  guineas,  for  lectures  and  practical 
lasses  required  by  the  Examining  Board  in  England. 
The  Kaye  scholarship,  for  second  year's  students, 
atives  of  Sheffield,  is  awarded  annually,  under  certain 
egnlations.  Prizes  for  clinical  medicine  and  cUnical 
nrgery:  prizes  in  books  and  certificates  awarded 
mnaally. 

University  College,  Cardiff,  School  of  Medi- 
cine.— ^This  college,  which  is  one  of  the  colleges  of  the 
University  of  W^es,  has  since  its  foundation,  in  1883, 
prepared  students  for  the  Preliminary  Scientific  exami- 
nation of  the  University  of  London,  and  for  the  corre- 
sponding examinations  of  other  licensing  bodies.  In 
1893  Chairs  of  Anatomy  and  Physiology  and  a  Lecture- 
smp  in  Materia  Medica  and  Pharmacy  were  established, 
[naking  it  possible  for  students  of  medicine  to  spend 
three  out  of  the  five  years  of  prescribed  study  at  Cardiff. 
.Arrangements  with  the  managing  committee  of  the 
Cardifl  Infirmary  give  students  of  the  College  the  privi- 
lege of  attending  this  large  and  well-ordered  hospital, 
which  is  situated  within  five  minutes'  walk  of  Univer- 
sity College.  Many  students,  especially  from  Wales 
and  Monmouthshire,  avail  themselves  of  the  opportuni- 
ties thus  afforded  to  pursue  the  earlier  part  of  the 
medical  curriculum  near  home.  All  classes  are  open 
alike  to  both  men  and  women  students  over  sixteen 
years  of  age.  Tne  courses  of  instruction  given  at 
Cardiff  are  recognised  as  qualifying  for  the  examinations 
of  the  Universities,  Royal  colleges,  and  other  licensing 
bodies  of  Great  Britain  and  Ireland.  Having  spent 
two  or  three  years  in  study  at  Cardiff,  and  having 
passed  the  examinations  in  tnese  years,  a  student  may 
proceed  to  London  or  elsewhere  and  complete  his  quah- 
lying  course  for  a  University  degree  or  for  a  college 
diploma. 

Students  preparing  for  the  first  and  second  examina- 
tions of  the  Conjoint  Board  for  England,  or  for  the 
corresponding  examinations  of  the  Conjoint  Board  for 
Scotland,  or  for  those  of  the  Society  of  Apothecaries, 
may  compound  for  their  classes  by  paying  a  single 
composition  fee  of  ;f4i  los.,  or  by  paying  ;^20  and 
£24  I  OS.  at  the  beginning  of  their  first  and  second  years 
respectively.  Those  preparing  for  the  preliminary 
scientific  and  intermediate  examination  in  medicine  of 
the  University  of  London  may  compound  for  their 
three  years*  instruction  at  Cardiff  by  paying  a  single 
composition  fee  of  £$7  los..  or  by  paying  ^13  13s.,  £28, 
and  £21  at  the  beginning  of  their  first,  second  and  third 
years  respectively. 

In  1899  ^  department  of  Public  Health  was  estab- 
lished, and  lecturers  in  bacteriology  and  in  public  health 
and  hygiene  were  appointed.  Medical  men  preparing 
for  a  diploma  in  Public  Health  and  Hygiene  can  attend 
complete  courses  of  lectures  and  laboratory  instruction 
in  this  department.  These  courses  are  recognised  by 
the  University  of  Cambridge,  by  the  Royal  Colleges  of 
Physicians  and  Surgeons,  and  by  Victoria  University. 

A  course  of  lectures  to  midwives,  adapted  to  the 
requirements  of  the  Central  Midwives'  Board,  under  the 
Midwives'  Act,  will  be  commenced  early  in  October, 
1904.  The  lectures  will  be  suitable  both  for  pupil- 
midwives  and  practising-midwives,  as  well  as  for  nurses 
^ho  desire  to  enter  for  the  examination  for  certification 
nnder  the  Act. 

Scholarships,  <S^. — ^The  attention  of  students  about 
to  matriculate  is  drawn  to  the  numerous  entrance 
scholarships  for  exhibitions  which  are  offered  at  the 
college  for  competition  in  September,  most  of  which 


may  be  held  by  medical  students.  Full  particulars  of 
the  examination  for  these  may  be  obtained  from  the 
Registrar. 

Liverpool  Royal  Southern  Hospital. — The  clini- 
cal school  of  this  hospital  is  situated  within  convenient 
distance  of  the  Liverpool  University,  and  affords  every 
facility  for  clinical  and  pathological  study.  The  hospi- 
tal contains  200  beds,  and  in  addition  to  the  general 
medical  and  surgical  cases  attention  is  devoted  to  the 
diseases  of  women  and  children.  There  is  a  special 
ward  for  tropical  diseases  in  connection  with  the  Uni- 
versity laboratories. 

The  medical  and  surgical  staff  visit  the  wards. dailv, 
and  the  ward  instruction  is  supplemented  by  weekly 
clinical  lectures.  Additions  have  been  made  to  the 
teaching  staff  so  that  students  may  now  obtain  in- 
struction in  diseases  of  the  eye,  ear  and  throat.  De- 
monstrations in  the  use  of  the  X-ray  apparatus  are 
given  at  intervals.  There  is  an  excellent  pathological 
department,  with  laboratory  attached,  where  demon- 
strations are  arranged  for  and  regular  instruction  is 
given  in  practical  pathology.  The  practice  of  St^ 
George's  Hospital  for  Diseases  of  the  Skin  is  free  to 
students,  and  thus  ample  opportunity  is  afforded  for 
acquiring  a  knowledge  of  dermatology.  In  addition  to 
the  clinical  clerkships  which  are  allotted  to  the  students 
the  resident  posts  of  ambulance  ofiicers  are  given  to  the 
students  whom  the  board  may  think  most  suited  to  hold 
them  every  three  months.  The  Alexander  Fellowship 
in  Pathology  of  ;^  100  a  year  is  open  to  students  of  this 
school ;  three  prizes  of  £s  each  are  also  awarded  to  the 
gentlemen  who  present  the  best  taken  series  of  medical 
and  surgical  cases.  Fees  :  Perpetual,  ^£26  5s.  ;  one 
year,  ;f  10  los. ;  six  months,  £y  7s. ;  three  months, 
£4AS- 

There  are  rooms  for  a  limited  number  of  resident 
students  :  terms  (exclusive  of  fee  for  hospital  practice). 
£1$  15s.  per  quarter.  The  practice  of  the  hospital  is 
recognised  by  all  examining  bodies. 

Liverpool  School  of  Tropical  Medicine. — ^This 
school,  which  has  for  its  object  research  into  Tropical 
Diseases  and  Improvement  in  Tropical  Sanitation,  was 
founded  in  Liverpool  in  1899  by  Sir  Alfred  Jones, 
K.C.M.G.,  who  is  the  chairman  of  the  school.  The 
research  work  of  the  school  is  carried  on  at  the  Johnston 
Laboratories,  in  Liverpool  University.  The  clinical 
work  is  carried  on  at  the  Royal  Southern  Hospital. 
A  special  feature  of  the  work  of  the  Liverpool  School  of 
Tropical  Medicine  has  been  the  despatch  of  a  large 
number  of  important  medical  expeditions  to  various 
places  in  the  tropics,  especially  West  Africa.  Although 
the  School  has  only  been  in  existence  for  a  short  time  it 
has  already  sent  over  a  dozen  of  these  expeditions. 
In  addition,  the  School  has  issued  a  number  of  valuable 
publications  and  monographs  on  subjects  connected 
with  tropical  diseases,  which  can  be  obtained  from 
Messrs.  Williams  and  Norgate.  The  Duke  of  North- 
umberland, K.G.,  and  Mr.  William  Adamson  are 
Vice-Chairmen  of  the  School,  and  the  following  is  the 
Staff : — ^The  Sir  Alfred  Jones  Professor  of  Tropical 
Medicine,  Major  Ronald  Ross,  C.B..  F.R.S.,  F.R.C.S.  ; 
Walter  Myers  Lecturer,  Dr.  J.  W.  W.  Stephens,  M.D.  ; 
Walter  Myers  Fellow,  Dr.  J.  E.  Dutton  ;  Assistant 
Lecturers,  Dr.  A.  S.  Grunbaum.  Dr.  Fielding  Ould, 
Dr.  Balfour  Stewart,  Dr.  H.  R  Christy,  A.  H.  Milne, 
M.A.  (Cantab.),  Hon.  Secretary. 

The  foUowinir  are  the  principal  provincial  hos- 
pitals haidng  the  greatest  Dumber  of  bedik  to 
which  students  are  admitted  where  clinical  in- 
stmction  can  be  obtained,  but  to  which  there  is 
no  medical  school  attached  :— 

Bath  Royal  United  Hospital. — ^This  is  a  well- 
appointed  hospital  in  the  West  of  England,  with  130 
beds,  at  which  students  can  obtain  clinical  instruction* 
The  hospital  is  recognised  by  the  Colleges,  and  is 
licensed  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  230 
beds.  Non-resident  pupils  are  received — and  abun- 
dance of  cUnical  material  is  obtainable.     One  year's 


278     The  Medical  Press. 


ENGLAND— EDUCATION. 


attendance  is  recognised  by  the  Examining  Boards. 
Fee,  perpetual,  £10  los. 

Brighton  Sussex  County  Hospital  contains  190 
beds.  It  is  recognised  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. 

Liverpool  Northern  Hospital  contains  155  beds. 
Clinical  instruction  is  given  by  the  staff  during  the 
summer  and  winter  sessions.  CUnical  clerkships  and 
dresserships  are  open  to  all  students  without  additional 
fees.  Fees  for  hospital  attendance  :  Perpetual,  £2^  5s.; 
one  year,  i\o  los. ;  six  months,  £7  ys, ;  three  months, 
^4  4s. ;  practical  pharmacy,  £2  2S. 

Norfolk  and  Norwich  Hospital. — ^This  hospital  is 
recognised  by  the  Colleges,  and  contains  220  beds. 
Fees,  ;fio  los.  for  six  months,  £1$  15s.  for  twelve 
months'  medical  and  surgical  practice.  Pupils,  resi- 
dent and  non-resident,  are  admitted. 

Northampton  General  Infirmary. — ^The  number 
of  beds  is  163.  Out-pupils  are  received,  and  have 
every  opportunity  of  acquiring  a  practical  knowledge  of 
their  profession.  Instruction  is  also  given  in  anatomy 
and  materia  medica  and  practical  pharmacy.  Non- 
resident pupils  are  taken  at  a  fee  of  ^10  los. 

HOYAL  Berkshire  Hospital. — ^The  town  of  Read- 
ing, at  which  this  hospital  is  situated,  has  a  very  large 
working-class  population,  and  excellent  opportunities 
for  clinical  instruction  in  the  wards  and  extensive  out- 
patient department  are  afforded  here.  It  contains  a 
splendid  Ubrary,  in  which  the  Reading  Pathological 
Society  holds  its  meetings. 

The  Royal  Hospital,  Portsmouth. — ^The  hospital 
is  a  preparatory  school  of  medicine  and  surgery,  and 
the  attendance  of  pupils  is  recognised  by  the  Examining 
Boards.  The  number  of  beds  is  1 50.  The  fees  being 
the  same  as  at  all  similar  institutions. 

Royal  Devon  and  Exeter  Hospital,  Exeter. — 
The  hospital  contains  218  beds  (including  special 
children's  wards),  and  has  a  good  Ubrary.  museum, 
dissecting  room,  and  post-mortem  room.  Attendance 
on  the  practice  of  this  hospital  qualities  for  all  the 
Examining  Boards.  Arrangements  can  be  made  by 
which  students  can  attend  midwifery  on  application  to 
the  House  Surgeon. 

Wolverhampton  General  Hospital. — ^The  hospi- 
tal contains  230  beds,  attendance  at  this  hospital  being 
recognised  by  all  the  Examining  Boards.  Pupils  are 
trained  in  cUnical  work  by  the  medical  and  surgical 
staff.  Fees ;  Six  months,  £6  6s. ;  twelve  months, 
^12  I2S. ;  perpetual,  ;£2i. 

^  THE  ENGLISH  UNIVERSITIES. 

The  English  Universities  are  eight  in  number,  viz., 
Oxford,  Cambridge,  London,  the  Victoria,  Durham, 
Liverpool,  Leeds  and  Birmingham.  The  choice 
of  a  University  is  usually  determined  by  social,  geo- 
graphical, and  financial  considerations.  Evidently 
students  whose  parents  are  able  and  willing  to  incur 
the  necessary  expense  would  do  well  to  select  one  or 
other  of  the  ancient  Universities,  since  their  degrees 
confer  upon  their  holders  a  status  not  accorded  by  the 
pubKc  to  the  degrees  of  more  modem  educational  insti- 
tutions. To  those  less  favoured  by  fortune,  but  blessed 
with  energy  and  a  fair  share  of  intelligence,  the  London 
University  offers  ample  scope,  and  its  degrees  are  recog- 
nised as  the  outward  and  visible  sign  of  high  profes- 
sional attainments.  A  capable  and  industrious  student, 
however,  may  equally  well  lay  the  foundations  of 
success  in  one  of  the  newer  provincial  universities. 
OXFORD. 

There  are  two  degrees  in  medicine,  B.M.  and  D.M., 
and  two  degrees  in  surgery,  B.Ch.  and  MXh^  The 
B.M.  and  B.Ch.  degrees  are  granted  to  those  members 
of  the  University  who  have  passed  the  second  (B.M.) 
examination.  Graduates  in  Arts.  B.A.,  are  alone 
eligible  for  these  degrees.  In  order  to  obtain  the 
degrees  of  B.M.  and  B.Ch..  the  following  examinations 
must    be    passed   : — i.    Preliminary   :      Subjects : — 


Sept.  14.  1904. 

Physics,  chemistry,  zoology,  and  botany.  2.  fto- 
fessional  (a)  First  .examination  (held  twice  a  yeu). 
Subjects  : — Organic  chemistry,  unless  the  candidate  has 
obtained  a  first  or  second  class  in  chemistry  in  the 
Natural  Science  School ;  Human  physiology,  anless  be 
has  obtained  a  first  or  second  class  in  animal  phjrsiology 
in  the  Natural  Science  School;  Human  anatoicy; 
Materia  medica  with  pharmacy,  (b)  Second  examina- 
tion  :  Subjects  : — ^Medicine,  surgery,  midwifery,  patho- 
logy, forensic  medicine  with  hygiene.  The  approxi- 
mate dates  of  the  examinations  are  as  follows : — 
Preliminaries : — Physics,  and  chemistry,  December 
and  June  ;  Zoology  and  botany.  Decemb^  and  Blarch : 
Professional  (First  and  Second  B.M.),  June  and 
December. 

The  degree  of  D.M.  is  granted  to  Bachelors  of  Medi- 
cine of  the  University  who  have  entered  on  their 
thirty-ninth  term  on  their  presenting  a  dissertatkc 
approved  of  by  the  appointed  professors  and  examines. 

The  degree  of  M.Ch.  is  granted  to  Bachelors  of  Sur- 
gery of  the  University  who  have  entered  their  twenty- 
seventh  term,  who  are  members  of  the  surgical  staff  d 
a  recognised  hospital,  or  have  acted  as  dresser  or  house 
surgeon  in  such  a  hospital  for  six  months,  and  who 
have  passed  an  examination  in  surgery,  surreal  ana- 
tomy, and  surreal  operations.  This  examination  is 
held  annually,  m  June. 

The  First  examination  for  the  degrees  of  B.M.  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  offered  and  passed  together. 

In  the  Second  Examination  candidates  are  allowed 
to  present  themselves  in  Pathology,  and  also  in  Forensic 
Medicine  at  separate  Examinations  at  any  time  after  tbe 
First  Examination  has  been  passed  ;  but  no  candidate 
is  permitted  to  enter  for  the  Examinations  in  Medicine. 
Surgery,  and  Midwifery  until  he  has  attained  the  twenty 
fourth  term  from  his  matriculation — i.e.,  six  years. ' 

Diploma  in  Public  Health, — An  examination  is  held 
yearly  in  Michaelmas  Term.  The  first  part  comprises 
the  application  of  Chemistry  and  Physics  to  General 
Hygiene.  The  second  part  comprises  the  following 
subjects : — General  Pathology,  with  special  relation 
to  Infectious  Diseases  ;  the  Laws  relating  to  Public 
Health ;  Sanitary  Engineering ;  Vital  Statistics 
Both  parts  may  be  taken  together  at  the  same  Examina- 
tion, or  they  may  be  taken  at  separate  Examinations: 
but  no  one  is  deemed  to  have  satisfied  the  Examiners  in 
Part  II.  unless  he  has  satisfied  the  Examiners  in  the 
subjects  of  Part  I.  A  diploma  is  issued  to  every 
candidate  who  has  passed  in  both  parts  of  the  Examina- 
tion, but  no  Diploma  or  Certificate  is  given  under  any 
other  circumstances.  Candidates  must  have  theiir 
names  on  the  "Medical  Register  "  and  must  have  satisfied 
an  the  Rules  of  the  General  Medical  Council  of  the 
United  Kingdom  relating  to  the  admission  of  Candi- 
dates for  Diplomas  in  Public  Health  which  are  in  force 
at  the  time. 

More  detailed  information  may  be  obtained  from  the 
"  Examination  Statutes  "  with  the  "  Regulations  "  for 
the  current  year,  published  annually  in  June  at  the 
Clarendon  Press  Depot,  price  is. 
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  yeais)  in 
the  University,  and  have  passed  the  "  previous  "  exami- 
nation in  classics  and  mathematics.  There  are  three 
examinations  :  The  first  in  ( i )  chemistry  and  physics, 
and  (2)  biology ;  the  second  in  human  anatomy  and 
physiology;  and  the  third  in  (i)  pharmacology  and 
general  pathology,  (2)  in  surgery,  midwifery,  asd 
medicine.  The  first  and  the  third  examinations  are 
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  subjects  for  the  examination  for  the 
degree  in  surgery  are  included  in  the  third  examinatioa 


Sept. 


14.  1904. 


ENGLAND— EDUCATION. 


for  the  M.B.  degree*  candidates  are  admitted  to  the 
degree  of  Bachelor  of  Surgery  on  passing  the  third  ex- 
amination for  Bachelor  of  Medicine. 

The  M.D.  degree  may  be  taken  three  years  after  the 
M.B.  An  Act  has  to  be  kept,  including  the  presen- 
tation of  an  original  thesis,  with  oral  examinations 
and  an  essay  to  be  written  extempore.  There  is  also 
the  degree  of  Blaster  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  has  a  special  examination  or 
submits  original  contributions  of  merit  to  the  science 
or  axt  of  surgery.  The  yearly  expenditure  of  a  student 
'Who  keeps  his  term  by  a  residence  in  a  college  is  from 
£iSO  to  ;^20O  a  year.  This,  however,  may  include' all 
payments  to  the  University  and  the  College — all  fees  as 
ixrell  as  clothes,  pocket  money,  travelling  expenses,  &c. 
Kon-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  public 
health  without  the  necessity  of  residence,  the  examina- 
tion being  in  so  much  of  State  Medicine  as  is  comprised 
in  the  functions  of  officers  of  health,  and  subject  to  the 
latest  requirements  of  the  General  Medical  Council. 
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  King- 
dom, 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 
testimonial  testifying  to  his  competent  knowledge  of 
the  subjects  comprised  in  the  duties  of  a  medical  officer 
of  health. 

There  is  also  a  special  examination  in  Tropical  Medi- 
cine and  Hygiene,  held  annually  in  August.  It  is 
open  to  qualified  practitioners  under  certain  conditions 
as  to  previous  study  and  experience.  Successful 
candidates  receive  a  University  Diploma. 

An  abstract  of  all  Regulations  may  be  obtained  upon 
sending  a  stamped  directed  envelope  to  the  Assistant 
Registrary,  Cambridge.  Full  information  is  contained 
in  the  University  Calendar. 

UNIVERSITY  OF  LONDON. 
The  Medical  Faculty  grants  the  degrees  of  Bachelor 
of  Medicine  and  Surgery,  Doctor  of  Medicine  and 
Master  in  Surgery.  Under  the  new  regulations  the 
students  are  divided  into  "  Internal  "  and  "  External." 
An  internal  student  is  one  who  has  matriculated  at  the 
University  and  is  studying  in  a  school  approved  by  that 
body,  or  under  the  teachers  of  the  University.  An 
external  student  is  one  who  has  adopted  an  alternative 
course  of  study.  The  regulations  differ  somewhat  in 
their  application  to  the  two  groups  of  students.  We 
only  propose  to  deal  with  them  astheyafiect  internal 
students,  since  the  special  information  required  by  the 
others  had  best  be  obtained  direct  from  the  Registrar. 
Under  no  circumstances  will  a  student  be  admitted  to 
the  final  examination  for  a  degree  until  at  least  three 
years  has  elapsed  since  matriculation  or  other  examina- 
tion entitling  to  registration  as  a  medical  student.* 

The  Matriculation  Examination  will  take  place  three 
times  in  each  year — ^in  January,  June  (or  July),  and 
September.  Application  for  admission  to  it  must  be 
made  on  a  special  form  about  six  weeks  beforehand, 
and  the  candidate  must  have  completed  his  i6th  year  at 
the  date  of  the  examination.  Candidates  must  show  a 
competent  knowledge  of  five  subjects,  among  which 
must  be  English  and  elementary  mathematics.  The 
other  three  (one  of  them  a  language)  may  be  selected 
from  the  following : — ^Latin,  Greek,  French,  German, 
Arabic,*  Sanscrit,*  Spanish,*  Portuguesfe,*  Italian,* 
Hebrew,*  Ancient  History,  Modem  History,  Logic, 
Physical  and  General  Geography,  Geometrical  and 
Mechanical  Drawing,  Mathematics  (more  advanced 
than  in  the  compulsory  examination).  Elementary 
Mechanics,  Elementary  Chemistry,  Elementary  Biology 

*  May  obtain  registration  as  InterBar~cNF£xterDal  students  on  pre- 
sentation  of  docomentary  evidence  as  to  their  condition  and  a  payment 


The  Medical  Press.    279 


(Botany),  Elementary  Biology  (Zoology).*  Elementary 
Physics,  Heat,  Light,  and  Sound,  Electricity,  and 
Magnetism.  Candidates  who  desire  to  be  examined  in 
the  subjects  against  which  an  asterisk  is  affixed  must 
give  at  least  two  months'  notice. 

The  Preliminary  Scientific  Examination  will  take 
place  twice  in  each  year,  in  January  and  July.  It  will 
consist  of  papers  in  chemistry,  biology,  and  physics, 
and  there  will  be  a  practical  examination  in  each 
subject.  Examiners  will  also  be  at  liberty  to  test 
candidates  viva  voce,  A  student  may  present  himself 
for  examination  in  each  of  the  three  subjects,  separately 
or  in  all  at  the  same  time.  Part  I.  of  this  examination 
includes  papers  in  inorganic  chemistry,  physics,  and 
biology,  with  practical  examinations ;  Part  IT.  is  an 
examination  in  organic  chemistry. 

The  Intermediate  Examination  in  Medicine  will  take 
place  twice  a  year,  January  and  July.  Candidates 
must  have  passed  the  Preliminary  Scientific  Examina- 
tion at  least  two  years  previously.  The  subjects  of 
examination  are  Anatomy,  Physiology  and  Histology, 
and  Pharmacology,  including  Materia  Medica.  Can- 
didates who  have  failed  in  one  subject  only  at  this 
examination  may  oifer  themselves  for  re-examina- 
tion in  that  subject,  if  permitted  to  do  so  by  the 
examiners.  Three  scholarships,  one  of  the  value  of 
l40  in  Anatomy,  another  of  the  same  amount  in 
Physiology,  and  one  of  ^^30  in  Pharmacology  may  be 
awarded  by  the  examiners  to  any  candidate  who  has 
passed  the  whole  of  the  examination  at  one  time. 

The  Final  M.B. ,  B.S.,  Examination  will  take  place 
twice  a  year,  in  October  and  May.  No  candidate  will 
be  admitted  to  this  examination  unless  he  has  com- 
pleted the  course  of  study  prescribed  in  the  schedule  or 
in  less  than  two  academic  years  from  the  date  of  passing 
the  Intermediate  Examination  in  anutomy  and 
physiology. 

The  subjects  of  the  examination  are  Medicine  (includ- 
ing Therapeutics  and  Mental  Diseases),  Pathology, 
Forensic  Medicine  and  Hygiene,  Surgery,  and  Mid- 
wifery and  Diseases  of  Women.  The  subjects  may  be 
divided  into  two  groups,  one  of  which  shall  comprise 
Medicine,  Pathology,  Forensic  Medicine  and  Hygiene  : 
and  the  other  Surgery,  Midwifery  and  Diseases  of 
Women.  Either  group  may  be  taken  first  at  the  option 
of  the  candidate,  or  the  groups  may  be  taken  together. 

Only  candidates  who  show  a  competent  knowledge  of 
all  the  subjects  comprising  a  group  will  be  passed.  The 
examiners  will  be  empowered  to  recommend  the  award 
of  a  University  Medal  to  the  candidate  who  has  most 
distinguished  himself  in  the  whole  examination. 

Doctor  of  Medicine, — ^The  examination  for  the  degree 
of  Doctor  of  Medicine  will  be  held  twice  in  each  year,  in 
December  and  July.  Every  candidate  must  have 
passed  the  examination  for  the  M.B.,  B.S.,  of  this 
University.  Candidates  may  present  themselves  for 
examination  in  one  of  the  following  branches  :  ( i ) 
Medicine,  (2)  Pathology,  (3)  Mental  Diseases,  (4) 
Midwifery  and  Diseases  of  Women,  (5)  State  Medicine  ; 
and  if  they  wish,  may  pass  also  in  another  branch  at  a 
subsequent  examination.  Candidates  for  Branches 
I  to  4  who  have  taken  honours  at  the  M.B.,  B.S., 
examination  in  the  subject  in  which  they  present  them- 
selves for  the  M.D.  degree,  or  who,  subsequently  to 
taking  the  M.B.,  B.S.,  have  conducted  a  piece  of 
original  work  approved  for  the  purpose  by  the  Univer- 
sity, or  have  had  special  experience  approved  by  the 
University,  may  present  themselves  for  the  M.D. 
examination  one  year  after  taking   their  Bachelor's 

of  £2 :  Graduates  of  such  British,  Colonial,  and  foreign  Universities 
as  are  approved  by  the  Senate  lor  that  purpose,  and  those  who  have 
passed  all  the  examinations  required  for  a  degree  in  those  Universities, 
also  women  who  have  obtained  Tripos  certificates  granted  bv  the 
University  of  Cambridge,  and  women  who  have  obtained  certificates 
showing  that,  nnder  the  conditions  prescribed  by  the  Delegacy  lor 
Local  Examinations  at  Oxiord,  they  have  passed  the  Second  PubHc 
Examination  ol  that  University  or  have  obtained  honours  in  the  Oxiord 
Uuversity  Examination  for  Women  in  Modem  Languages,  and  students 
who  hold  the  Scotch  School  Leavinc  Certificate,  having  passed  on  one 
and  the  same  occasion,  in  the  Hi^^er  or  Honours  Grade  in  all  the 
subjects  required  by  the  regulations  for  the  Matriculation  Examination, 
and  those  who  hold  the  Zengniss  der  Reife  from  a  Gymnasium  or  Real- 
gymnasium  within  the  Gennan  or  Austrian  Empire,  or  the  Maturitftts- 
Zeugmss  of  a  Swiss  Gymnasium  or  Obeirealschule,  or  the  EidRcnossische 
Maturiats-Zeugniss  of  Switzerland. 


28o     The  Medical  Press. 


ENGLAND— EDUCATION. 


Sept.  ij.  19W. 


degree.  Other  candidates  must  show  that  they  have 
taken  the  degree  of  M.B.,  B.S.,  not  less  than  two  years 
previously  ;  and  as  regards  candidates  in  Branches 
I  to  4.  that  subsequently  to  taking  that  degree  they 
have  held  for  at  least  six  months  a  resident  or  non- 
resident medical  hospital  appointment,  or  that  they 
have  been  in  qualified  practice,  for  not  less  than  five 
years,  while  candidates  in  Branches  2  and  3  must  show 
that  they  have  held  in  the  one  case  a  pathological  and 
in  the  other  an  asylum  appointment.  In  each  branch 
there  will  be  (i)  two  papers  on  the  special  subject  of  the 
branch  ;  (2)  a  clinical  examination  ;  (3)  an  essay  to  be 
written  on  one  of  two  given  subjects  connected  with  the 
branch.  In  Branch  i  there  will  also  be  a  paper  on 
pathology,  and  in  Branches  2,  3.  and  4  a  paper  in 
medicine,  while  in  Branch  2  a  laboratory  examination 
will  be  substituted  for  the  Clinical  Examination  held  in 
the  other  branches. 

Candidates  in  Branch  5  (State  Medicine)  must  show 
that  they  have  taken  the  degrees  M.B.,  B.S.  not  less 
than  two  years  previously,  and  that  subsequently  to 
taking  those  degrees  they  have  had  (i)  six  months' 
practical  instruction  in  an  approved  laboratory  ;  (2)  six 
months'  practical  instruction  from  a  medical  officer  of 
health,  of  which  three  must  not  coincide  with  the  labora- 
tory work,  and  three  months'  practice  at  a  hospital  for 
infectious  diseases.  The  interval  between  passing  the 
M.B.,  B.S.  and  proceeding  to  the  M.D.  State  Medicine 
may  be  reduced  to  one  year,  subject  to  conditions 
corresponding  to  those  affecting  Branches  i.  2.  3,  and  4. 

Master  of  Surgery. — ^The  examination  for  the  degree 
of  Master  in  Surgery  will  take  place  twice  in  each  year, 
commencing  on  the  same  dates  as  the  foregoing,  and 
the  general  regulations  already  quoted  with  regard  to 
the  M.D.  will  practically  apply  to  it,  surgery  being 
substituted  for  medicine.  The  examination  will  consist 
of  (i)  two  papers  on  surgery  (one  of  which  may  be  a 
case  for  commentary) ;  (2)  an  essay  to  be  written  on  one 
of  two  subjects  which  may  be  selected  from  any  branch 
of  surgery  ;  (3)  two  papers  on  surgical  pathology  and 
surgical  anatomy ;  (4)  a  clinical  examination ;  (5) 
operations  on  the  dead  body  ;  (6)  a  viva  voce  at  the 
discretion  of  the  examiners.  Competent  knowledge  in 
every  subject  of  the  examination  must  be  shown  in 
order  to  pass. 

For  the  M.S.  degree  and  all  branches  of  the  M.D.  a 
candidate  is  at  liberty  to  forward  a  thesis  or  copies  of 
published  works  embodying  the  result  of  independent 
research  in  the  subject  in  which  he  presents  himself  for 
a  degree  and  also  anv  printed  contributions  to  the 
advancement  of  professional  knowledge  published 
either  separately  or  conjointly.  If  the  examiners  con- 
sider such  thesis  or  works  of  sufficient  merit  they  are 
empowered  to  exempt  a  candidate  partly  or  entirely 
from  examination  in  the  subject  to  which  such  work 
refers.  They  also  have  power  to  award  a  University 
Medal  to  the  candidate  who  at  the  examination  in  any 
branch  passes  with  most  distinction. 

Fees. — For  the  Matriculation  :  £2  and  £1  on  re- 
examination in  any  one  subject,  and  £2  for  more  than 
one.  Preliminary  Scientific  Examination  :  £$  for  each 
entry  to  the  whole  examination,  and  £2  for  each 
subject  when  less  than  the  whole  examination  is  taken 
at  one  time.  Intermediate  Examination  :  ;f  10  for  each 
entry  to  the  whole  examination,  and  £$  for  examination 
in  one  subject.  M.B.,  B.S.  Examination  :  ;£io  for  each 
entry  to  the  whole  examination,  and  £$  for  examina- 
tion or  re-examination  in  either  group.  M.D.  and 
M.S.  Examinations  ;  ;f  20  for  each  entry. 

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 
Medicine,  Bachelor  in  Hygiene,  and  Doctor  in  Hygiene, 
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  phaxmacology.     For  the  third  ;    Pathology,  medi- 


cal jurisprudence,  public  health,  and  ^emc&tanr 
bacteriology ;  and  for  the  fourth  :  Medicine,  ciiokal 
medicine  and  psychological  medicine,  sargery  and 
clinical  surgery,  midwifery,  and  diseases  of  women  and 
children. 

It  is  required  that  one  of  the  five  years  of  piofessioiial 
education  shall  be  spent  in  attendance  at  the  UnivenitT 
College  of  Medicine  and  the  Ro3ral  Infirmary.  Kev- 
castle-upon-Tyne.  First  and  second  year  students 
(dating  from  registration)  are  not  required  to  complT 
with  the  regulation  regarding  attendance  on  hospital 
practice. 

Candidates  who  have  passed  the  First  and  Seoo&d 
Examinations  of  the  University  wiU  be  exempt  from 
the  First  and  Second  Examination  of  the  Conjoint 
Board. 

For  the  degree  of  Bachelor  in  Surgery  (B.S.)  every 
candidate  must  have  passed  the  examination  for  tl4 
degree  of  Bachelor  of  Medicine  of  the  University  of 
Durham,  and  must  have  attended  one  course  of 
lectures  on  operative  surgery,  and  one  course  at 
regional  anatomy.  Candidates  will  be  required  to 
perform  operations  on  the  dead  body,  and  to  give  pnxrf 
of  practicsd  knowledge  of  the  use  of  surgical  instmmeots 
and  appliances. 

For  the  degree  of  Master  in  Surgery  (M.S.)  candi- 
dates must  not  be  less  than  twenty-four  years  of  a§e. 
and  must  satisfy  the  University  as  to  their  knowledge  d 
Greek.  In  case  they  shall  not  have  passed  in  this  sub- 
ject at  the  Preliminary  Examinations  in  Arts  for  the 
M.B.  degree,  they  must  present  themselves  at  Durtiaic 
for  examination  in  it  at  one  of  the  ordinary  examina- 
tions held  for  this  purpose  before  they  can  proceed  to 
the  higher  degree  of  M.S.  They  must  also  have  ob- 
tained the  degree  of  Bachelor  in  Surgery  of  the  Univer- 
sity 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 
miUtary  service,  or  in  medical  or  surgical  practice^ 

For  the  degree  of  Doctor  in  Medicine  (^^.D.)  candi- 
dates must  be  of  not  less  than  twenty-four  years  of  age. 
and  must  satisfy  the  University  as  to  their  knowled^ 
of  Greek.  In  case  they  shall  not  have  passed  in  this 
subject  at  the  Preliminary  Examinations  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  have  obtained 
the  degree  of  Bachelor  of  Medicine  of  the  University  d 
Durham,  and  must  have  been  engaged  for  at  least  two 
years,  subsequently  to  the  date  of  acquirement  of  thr 
degree  of  Bachelor  of  Medicine,  in  attendance  on  the 
practice  of  a  recognised  hospital  or  in  the  naval  or 
military  services,  or  in  medical  or  surgical  practice. 

Each  candidate  must  prepare  an  essay,  which  must 
be  typewritten,  based  on  original  research  or  observa- 
tion, on  some  medical  subject  selected  by  himself,  and 
approved  by  the  Professor  of  Medicine,  and  must  pass 
an  examination  thereon,  and  must  be  prepared  to 
answer  questions  on  the  other  subjects  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  PubUc  Health  see  Calendar  1904-5. 

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.  In  the  case 
of  the  M.D.  (Essay)  Examination,  candidates  must  send 
in  their  essays  six  weeks  before  the  date  of  the  examina- 
tion. 

Residence  can  be  had  in  a  separate  hostel  for  female 
students  at  moderate  inclusive  fees  for  board,  &c., 
particulars  of  which  and  any  other  college  information 
will  be  given,  on  application  to  Prof.  Howden,  Secretar)', 
University  of  Durham  College  of  Medicine,  Newcastle- 
on-Tyne. 

VICTORIA  UNIVERSITY  OF  MANCHESTER. 

Candidates  for  degrees  in  medicine  and  surgery  must 
attend  classes  in  the  University  during  at  least  two 
years. 

The  degrees  in  the  Faculty  of  Medicine  are  Bachelor 


Sept.  14,  1904. 


ENGLAND— EDUCATION. 


The  Medical  Press.    281 


of  Medicine  (M.B.),  Bachelor  of  Surger>  {Ch.B.), 
I>octor  of  Medicine  (M.D.)>  and  Master  of  Surgery 
<Cli.M.).  AU  candidates  for  degrees  in  medicine  and 
surgery  are  required  to  pass  the  Matriculation  Examina- 
tion, 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  Matriculation  Examination  are — 
I.  Latin;  2,  mathematics;  3,  mechanics;  4,  EngUsb 
a.nd  history;  5,  one  of  the  following : — (a)  French; 
(6)  German;  {c)  Greek;  {d)  Italian;  {e)  Spanish; 
(/)  any  other  modem  language,  permission  to  present 
-which  has  been  obtained  from  the  Joint  Matriculation 
Board.  Notice  of  intention  to  present  either  Italian 
or  Spanish  must  be  given  to  the  Secretary,  Joint 
Matriculation  Board,  Manchester,  before  March  ist  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  examina- 
tion are,  i,  Chemistry;  2,  Elementary  biology;  3, 
Physics. 

Candidates  must  have  ait  tended,  during  at  least  one 
year,  courses  of  both  lectures  and  laboratory  work  in 
■each  of  the  above-named  subjects. 

Second. — i.  Anatomy  ;  2,  Physiology  (including  phy- 
siological chemistry  and  histology) ;  3,  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 
sessions,  in  materia  medica  and  pharmacy  for  one 
summer  session.  Candidates  may  present  themselves 
separately  in  (a)  anatomy  and  physiology,  (6)  materia 
medica  and  pharmacy. 

Final. — ^The  examination  is  divided  into  two  parts, 
"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  less  than 
two  years  after  passing  Second  M.B.,  or  before  the  fifth 
year  of  medical  study  in  accordance  with  the  University 
regulations.  The  subjects  of  examination  are  as  fol- 
lows :  I,  Pharmacology  and  therapeutics ;  2,  General 
pathology  and  morbid  anatomy  ;  3,  Forensic  medicine 
and  toxicology  and  public  health ;  4,  Obstetrics  and 
•diseases  of  women  ;  5,  Surgery,  systematic,  clinical,  and 
practical ;  6,  Medicine,  systematic  and  clinical,  includ- 
ing mental  diseases  and  diseases  of  children.  Candi- 
•dates  may  select  as  a  first  part  of  the  examination  two 
or  three  of  the  subjects  i,  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  re- 
lating to  the  M.D.  and  Ch.M.  degrees  can  be  obtained 
on  appUcation  to  the  Registrar. 

Fees. — Matriculation  examination,  £2  ;  for  any  sub- 
sequent examination,  £1.  First  Examination,  £s  ;  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  ;^io  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  Matriculation  Examination  is  held  in  June,  in 
July  (for  schools),  and  about  the  end  of  September. 
The  first  M.B.  and  Ch.B.  is  held  in  June  ;  also  about  the 
•end  of  September.  The  Second  and  Final  Examina- 
tions are  held  in  March  and  July,  the  examination  for 
Ch.M.  in  July  only. 

UNIVERSITY  OF  BIRMINGHAM. 
The   University  of   Birmingham   grants  degrees   of 
M.B.,  Ch.B.,  M.D.,  Ch.M.,  and  also  a  B.Sc.  in  the  sub- 
ject of  Public  Health.     As  a  rule,  in  order  to  obtain 


any  of  these  degrees  it  is  necessary  that  a  student  shall 
have  passed  at  least  the  first  four  years  of  his  curriculum 
in  attendance  upon  the  classes  of  the  University,  but 
the  Senate  has  power  of  recognising  attendance  at 
another  University  as  part  of  the  attendance  qualifying 
for  these  degrees. 

Degrees  of  Bachelor  of  Medicine  and  Bachelor  of 
Surgery. — The  student  must  have  passed  either  the 
Matriculation  Examination  of  the  University  or  one  of 
the  following  examinations,  which  will  be  accepted  in 
Ueu  thereof  for  the  present : — {a)  The  previous  examina- 
tion of  the  University  of  Cambridge  ;  {b)  Responsions 
of  the  University  of  Oxford  ;  (c)  The  matriculation 
examination  of  any  other  University  in  the  United 
Kingdom  ;  {d)  The  leaving  certificate  (higher)  of  the 
Oxford  and  Cambridge  Boards ;  {e)  The  Oxford  or 
Cambridge  junior  local  examination  (first  or  second 
class  honours) ;  (/)  The  Oxford  or  Cambridge  senior 
local  examination  (honours) ;  (g)  The  College  of  Pre- 
ceptors examination  for  first-class  certificate. 

Matriculation  Examinations  are  held  in  June  and 
September  each  year. 

Degrees  of  Doctor  of  Medicine  and  Master  of  Surgery. — 
At  the  end  of  one  year  from  the  date  of  having  passed 
the  Final  M.B.,  Ch.B.  Examination,  the  candidate  will 
be  eligible  to  present  himself  for  the  higher  degrees  of 
either  Doctor  of  Medicine  or  Master  of  Surgery  or  both, 
the  regulations  for  which  may  be  had  upon  application 
to  the  Registrar.  The  University  also  grants  a  Degree 
and  a  Diploma  in  Public  Health,  and  provides  adequate 
instructions  for  the  same. 

Dental  Department. — ^The  University  grants  the 
Degrees  of  Bachelor  and  Master  of  Dental  Surgery 
(B.D.S.  and  M.D.S.)  The  whole  of  the  instruction  for 
which  may  be  taken  out  in  the  University. 

The  General  and  Queen's  Hospitals. — ^The  prac- 
tices of  these  hospitals  are  amalgamated  for  the  purpose 
of  chnical  instruction  under  the  direction  of  the 
Birmingham  Chnical  Board,  by  whom  all  schedules  will 
be  signed  and  all  examinations  conducted.  The  hos- 
pitals have  a  total  of  upwards  of  400  beds.  6,000  in- 
patients and  80,000  out-patients  are  treated  annually, 
and  many  valuable  posts  are  open  to  students  at  both. 

Further  information  can  be  obtained  from  Professor 
Windle,  Dean,  Medical  Faculty. 

UNIVERSITY  OF  LIVERPOOL. 

Students  may  enter  for  the  degrees  of  the  University 
of  Liverpool,  or  may  study  for  the  degrees  and  qualifi- 
cations of  the  other  licensing  bodies. 

Hospitals. — Students  may  take  out  their  clinical 
work  at  the  Liverpool  Royal  Infirmary,  or  at  the  United 
Hospitals  Clinical  School,  which  has  been  formed 
by  the  David  Lewis  Northern  Hospital,  the  Royal 
Southern  Hospital,  and  the  Stanley  Hospital.  Par- 
ticulars as  to  fees,  appointments,  &c.,  may  be  obtained 
from  the  Secretaries  of  these  schools.  The  practice 
of  the  Lying-in,  Eye  and  Ear,  Women's,  Children's. 
Dental,  and  Skin  Hospitals  is  also  open  to  students  of 
the  Faculty  of  Medicine. 

Fellowships  and  Scholarships. — Fellowships,  Scholar- 
ships, and  Prizes  of  over  ;£700  are  awarded  annually. 
A  Holt  Fellowship  in  Pathology  and  Surgery,  of  the 
value  of  / 1 00  for  one  year,  is  awarded  annually  by  the 
Medical  Faculty  to  a  senior  student  possessing  a 
medical  qualification.  The  successful  candidate  is 
required  to  devote  a  year  to  tutorial  work  and  investi- 
gation in  the  Pathological  department.  A  Holt 
Fellowship  in  Physiology,  awarded  under  similar  con- 
ditions, also  of  the  value  of  ;£ioo  for  one  year.  A 
Robert  Gee  Fellowship  in  Anatomy,  awarded  under 
similar  conditions,  of  the  value  of  ;f  100  for  one  year. 
An  Alexander  Fellowship  for  Research  in  Pathology 
of  the  annual  value  of  ;{ioo,  renewable.  A  Johnson 
Colonial  Fellowship  in  Pathology  and  Bacteriology 
(;£ioo  a  year,  renewable).  A  John  W.  Garrett 
International  Fellowship  in  Physiology  and  Pathology 
(;£ioo  a  year,  renewable).  An  Ethel  Boyce  Fellow- 
ship in  Gynaecological  Pathology  (;f  100  a  year,  renew- 
able). A  Stopford  Taylor  Fellowship  (j^'ioo  a  year, 
renewable)  in  Derma tological  Pathology.  A  ThelwaU 
Thomas  Fellowship  (;i  100  a  year,  renewable)  in  Surgical 


282     The  Medical  Press. 


ENGLAND— EDUCATION. 


SspT.  I4«  1904. 


Pathblogy.  Two  Lyon  Jones  scholarships,  of  the  value 
of  i2\  each  for  two  years,  are  awarded  annually — a 
Junior  Scholarship,  open  at  the  end  of  the  first  year  of 
study  to  Liverpool  University  students  in  the  subjects 
of  the  first  M.B.  Examinations,  and  a  Senior  Scholar- 
ship, open  to  all  students  in  the  school  at  the  end  of  the 
second  or  third  year  of  study,  in  the  subjects  of  Ana- 
tomy, Physiology,  and  Therapeutics.  The  Derby 
Exhibition  of  i\^  for  one  year  is  awarded  in  Oinical 
Medicine  and  Surgery  in  alternate  years.  Students 
may  compete  in  their  fourth  and  fifth  years.  In  1904 
the  subject  will  be  Clinical  Medicine.  The  Torr 
Gold  Medal  in  Anatomy,  the  George  Holt  Medal  in 
Physiology,  the  Kanthack  Medal  in  Pathology,  the 
Robert  Gee  Book  Prize,  of  the  value  of  ;f  5,  for  Children's 
Diseases,  and  numerous  class  prizes  are  awarded 
annually. 

Entrance  Scholarships. — Four  Robert  Gee  Entrance 
Scholarships,  of  the  value  each  of  £2$  for  one  year,  are 
offered  annually  for  competition.  The  holder  is 
required  to  take  out  the  Science  Course  for  the  Univer- 
sity Degree  in  Medicine. 

Communications  should  be  addressed  to  the  Dean, 
Professor  Benjamin  Moore,  M.A.,  D.Sc,  the  University, 
Liverpool. 

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,  oil  passing  which  the 
candidate  receives  the  diploma  of  Licentiate  of  the 
Royal  College  of  Physicians  (L.R.C.P.),  and  Member  of 
the  Royal  College  of  Surgeons  (M.R.C.S.).  The  Society 
of  Apothecaries  grants  a  complete  diploma  in  medicinei 
surgery,  and  midwifery. 

Conjoint  Examining  Board  in  England. 

Candidates  for  the  above  licences  are  required  to 
complete  five  years  of  professional  study  at  recognised 
medical  schools  and  hospitals,  after  passing  the  pre- 
liminary examination,  of  which  six  months  may  be 
spent  at  an  institution  recognised  by  the  Board  for 
instruction  in  chemistry,  or  one  year  may  be  passed  at 
an  institution  recognised  by  the  Board  for  instruction 
in  chemistry  and  biology,  to  comply  with  the  following 
regulations  and  to  pass  the  examinations  hereinafter 
set  forth. 

Professional  Examinations.  — There  are  three  examina- 
tions, each  being  partly  written,  partly  oral,  and 
partly  practical.  These  examinations  wiU  be  held  in 
the  months  of  January,  April,  July,  and  October, 
unless  otherwise  appointed,  fourteen  clear  days'  notice 
before  the  day  on  which  the  examination  commences 
being  required,  the  candidate  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  is  allowed  to  take  this 
examination  in  three  parts  at  different  times.  Rejec- 
tion entails  a  delay  of  not  less  than  three  months 
from  the  date  of  rejection,  and  the  candidate  will  be 
re-examined  in  the  subject  or  subjects  in  which  he  has 
been  rejected.  If  referred  in  chemistry  or  biology,  he 
must  produce  evidence  of  further  instruction  at  a  recog- 
nised institution.  Practical  pharmacy  may  be  passed 
at  any  time  during  the  curriculum.  Any  candidate  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  University 
in  the  United  Kingdom,  India,  or  in  a  British  Colony, 
will  be  exempt  from  examination  in  those  subjects  in 
which  he  has  passed. 

The  fees  for  admission  to  the  first  examination  are  as 
follows  : — For  the  whole  examination,  ;f  10  los.  ;  for 
re-examination  after  rejection  in  Part  I.,  £$  3s.  ;  and 
for  re-examination  in  each  of  the  other  parts,  £2  2s. 

The  subjects  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  second  examination  at  the 


expu^tion  of  two  winter  sessions  and  one 
session  (or  fifteen  months  during  the  ordinary  sessioBs) 
from  the  date  of  registration  as  medical  students,  and 
after  the  lapse  of  not  less  than  nine  months  firom  tb* 
date  of  passing  Parts  I.  and  III.  of  the  first  examinatiaiL 

A  candidate  referred  at  the  second  examination  viQ 
be  required,  before  being  admitted  to  re-exaininatioii. 
to  produce  a  certificate  that  he  has  pursued,  to  tbe 
satisfaction  of  his  teachers,  in  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,  examinatioiis 
are  :  ;£io  los.  for  the  whole  examination,  and  £6  6s.  for 
re-examination  after  rejection. 

The  subjects  of  the  third  and  final  examinations  aie: 
— Part  I.  Medicine,  including  medical  anatomy, 
pathology,  practical  pharmacy,  therapeutics,  forensic 
medicine  and  public  health.  Candidates  who  have 
passed  in  practical  pharmacy  at  the  first  examinatioi 
will  not  be  re-examined  in  that  subject  at  the  third 
examination.  Part  II.  Surgery,  including  pathology, 
surgical  anatomy,  and  the  use  of  surgical  appliance. 
Part  III.  Midwifery  and  gynaecology.  Candidates 
may  take  this  examination  in  three  parts  separately,  or 
they  may  present  themselves  for  the  whole  examinatiog 
at  one  time. 

Fees  for  admission  to  the  third  or  final  examinatkm 
are  as  follows : — For  the  whole  examination.  £1$  15s. 
Part  I. — For  re-examination  in  medicine,  including 
medical  anatomy,  pathology,  therapeutics,  forensic 
medicine,  and  public  health,  £s  5s.  ;  for  re-examination 
in  practical  pharmacy  (if  taken  at  this  examination). 
£2  2s.  Part  II. — ^For  re-examination  in  surgery,  includ- 
ing pathology,  surgical  anatomy,  and  the  use  of  surgical 
appliances,  £$  5s.  Part  III. — For-  re-examination  ia 
midwifery  and  gynaecology,  £$  3s. 

A  candidate  referred  on  the  third  or  final  examina- 
tion will  not  be  admitted  to  re-examination  until  after 
the  lapse  of  a  period  of  not  le^s  than  three  months  froa 
the  date  of  rejection,  and  will  be  required,  before  beiag 
admitted  to  re-examiaation,.  to  produce  a  certificate,  m 
regard  to  medicine  and  surgery,  of  having  attended  tbe 
medical  and  surgical  practice,  or  the  medical  or  surgical 
practice,  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, 
subsequently  to  the  date  of  his  reference,  not  less  than 
three  months'  instruction  in  that  subject  by  a  recog- 
nised teacher. 

Regulations  for  Colonial,  Indian,,  and  Foreign 
Candidates,  and  University  Candidates. 

Persons  holding  a  Colonial,.  Indian,  or  a  forei^ 
qualification  entitling  them  to  practise  medicine  in  tbe 
country  of  origin,  and  conferred  after  a  course  of  studj 
and  examinations  equivalent  to  those  required  by  the 
Royal  Colleges,  are  admissible  to  the  second  and  third 
(final)  examinations  forthwith. 

Members  of  a  University  in  the  United  Kingdom  are, 
under  certain  conditions,  eligible  for  admission  to  the 
third  (final)  examination  two  years  after  passing  at 
their  University  in  the  subjects  included  in  the  first 
and  second  examinations  of  the  Board. 

Royal  College   of   Physicians   of  London. 

Licentiates. — Candidates  are  now  subject  to  the  regn- 
lations  of  the  Conjoint  Examining  Board  in  England. 

The  following  by-laws,  amended  in  conformity  with 
the  revised  regulations  of  the  Conjoint  Examining 
Board,  were  re-enacted  as  follows  : — 

"  Every  candidate  for  the  College  licence  (unless 
specially  exempted)  shall  be  required  to  produce  satis- 
factory evidence  of  having  passed  before  the  commence 
ment  of  professional  study  a  preliminary  examination 
on  subjects  of  general  education  recognised  b>  the 
College. 

'*  Every  candidate  shall  be  required  to  produce  satis- 
factory evidence  of  having  completed  five  years  of  pro- 
fessional study,  after  passing  a  recognised  preliminary 
examination  before  admission  to  the  final  examinatioo. 

"  A  candidate  shall  not  be  admitted  to  the  secood 
examination  until  the  completion  of  two  winter  sessions 
and  one  summer  session  (or  1 5  months  during  the  ordir 


Sept.  14,  1904. 


IRELAND— EDUCATION. 


The  Medical  Press.    283 


nary  sessions)  at  a  recognised  medical  school,  nor  until 
the  expiration  of  one  winter  and  one  summer  session 
after  passing  Parts  I.  and  III.  of  the  first  examination. 

"  A  candidate  shall  not  be  admitted  to  the  third  (or 
final)  examination  till  the  expiration  of  five  winter  and 
five  summer  sessions  from  the  date  of  passing  the  pre- 
liminary examinations  and  of  four  winter  and  four  sum- 
mer sessions  after  passing  Parts  I.  and  III.  of  the  first 
examination,  and  of  two  winter  and  two  summer 
sessions  after  passing  the  second  examination." 

Members. — ^The  membership  of  the  College  is  granted 
after  examination  to  persons  above  the  age  of  25  years 
Mrho  do  not  engage  in  trade,  do  not  dispense  medicine, 
and  do  not  practise  in  partnership.  This  diploma  is 
only  granted  to  persons  sdready  registered,  or  who  have 
passed  the  final  examination  for  the  licence. 

Medical  graduates  of  a  recognised  University  are 
admitted  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  October,  is  partly  written  and  partly 
oral.  It  IS  directed  to  medicine,  and  is  conducted  by 
the  president  and  censors.  Candidates  under  40,  unless 
they  have  obtained  a  degree  in  arts  in  a  British  Univer- 
sity, 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  applica- 
tion to  the  Registrar.  The  fee  for  the  membership  is 
j£42,  but  if  the  candidate  is  a  licentiate  £1$  5s.  is 
deducted.  In  either  case  £6  6s.  has  to  be  paid  before 
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  Sur- 
geons 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  and  physiology,  which  may  be  passisd 
after  the  third  winter  session  ;  the  second  chiefly 
directed  to  surgery,  which  may  be  pass^  after  six 
years  of  professional  study.  The  second  examination 
may  be  passed  before  attaining  the  age  of  25,  but  the 
diploma  is  not  granted  until  that  age  is  reached.  Can- 
didates for  this  part  of  the  examination  must  have 
passed  the  final  examination  of  the  Conjoint  Board  in 
Hngland,  and  have  been  admitted  members  of  the 
College  before  they  can  be  admitted  thereto,  except  in 
the  case  of  graduates  in  medicine  and  surgery  of  recog- 
nised Universities  of  not  less  than  four  years'  standing. 
Fees. — ^First  examination,  £$  55.  ;  second  examina- 
tion, j£i2  I2S.  The  total  fee  payable  on  admission  to 
the  Fellowship  v&  £zi  los.,  except  for  members,  when 
the  fee  is  ;£2i.  (The  examination  fees  to  the  extent  of 
£17  17s.  count  as  part  of  the  total  fee.)  Further  infor- 
mation can  be  obtained  on  appUcation  to  the  Secretary 
of  the  Royal  College  of  Surgeons,  Lincoln's  Inn  Fields, 
London,  W.C. 

There  are  two  examinations — primary  and  final. 
The  primary  examination  is  held  quarterly  on  the  first 
Wednesday,  and  on  the  Monday  and  Tuesday  in  the 
same  week,  in  the  months  of  January,  April,  July,  and 
October.  The  final  examination  is  held  monthly. 
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  soUds  and  fluids ;  Heat,  Light,  and  Electricity. 
Practical  chemistry.  Materia  medica,  and  Pharmacy. 
A  synopsis  indicating  the  lunge  of  the  subjects  may  be 
obtainai  on  application.  Part  II. — ^Anatomy  and 
Physiology  and  Histology.  The  examination  is  held  in 
January,  April,  July,  and  October. 

The  final  examination  is  held  monthly,  and  is  divided 
into  Sections  i  and  2. 

Section  i  consists  of  three  parts. 
Part  I.  includes  :   Principles  and  Practice  of  Surgery, 
Surgical  Pathology,  and  Surgical  Anatomy,  Operative 
Ib^nipulations,  Instruments  and  Apphances. 

Part  II.  includes  :  (a)  The  Principles  and  Practice  of 


Medicine,  including  Therapeutics,Pharmacology,Patho- 
logy,  and  Morbid  Histology.  (6)  Forensic  Medicine, 
Hygiene.  Theory  and  Practice  of  Vaccination ;  and 
Mental  Diseases. 

Candidates  passing  either  (a)  or  (h)  will  not  be  re- 
examined therein. 

Part  III.  includes :  Midwifery,  Gynaecology,  and 
Diseases  of  New-bom  Children,  Obstetric  Instruments 
and  Appliances.  Candidates  may  enter  for  Parts  I., 
XL,  and  III.  together  or  separately. 

Section  i  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. 

Section  2. — This  section  consists  of  two  parts. 

Part  I. — Clinical  Surgery. 

Part  II. — Clinical  Medicine  and  Medical  Anatomy. 
Section  2  cannot  be  passed  before  the  expiration  of  the 
fifth  year. 

Fees. — ^Primary  examination,  £10  los. ;  final  exami- 
nation, £\o  los.  ;   total  fee,  ;f2i. 

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, 
Apothecaries'  Hall,  E.C. 

This  licence  is  a  registrable  diploma  in  Medicine, 
Surgery,  and  Midwifery,  and  qualifies  the  holder  to 
compete  for  medical  appointments  in  the  Army,  Navy, 
and  Indian  Services,  also  for  Poor-law,  Civil,  and 
Colonial  appointments. 

The  Gillson  scholarship  in  Pathology  of  the  annual 
value  of  £go,  tenable  for  one  year,  is  open  to  Licentiates 
of  the  Society  and  to  candidates  for  the  diploma  who 
obtain  it  witnin  six  months  of  election  to  the  scholar- 
ship. An  examination  in  the  art  of  prescribing 
is  held  annually,  in  January,  at  which  the  following 
prizes  are  awarded  : — ^A  gold  medal  of  the  value  of  £6  ; 
a  silver  medal,  and  a  prize  of  books  to  the  two  best 
candidates. 


Ireknb. 


THE  IRISH  MBDIOAIj  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  contrary,  the  hospitals  and 
schools  are  entirely  separate  (except  that  Sir  Patrick 
Dun's  Hospital  is  ofl&cially  connected  with  Trinity  Col- 
lege), and  a  student  of  any  hospital  is  free  to  enter  for 
the  whole  or  any  part  of  his  course  at  any  school  or  hos- 
pital he  pleases.  As  might  be  expected,  relipion.  social 
rank,  and  locality  of  residence  have  their  influence  in 
causing  certain  classes  of  students  to  resort  to  schools 
and  hospitals  suitable  to  theiir  condition.  But  scholas- 
tic or  collegiate  regulations  impose  no  restrictions  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  free  to  do  as  he  pleases^ 

BOARD  AND  RESIDENCE. 

There  is  in  Dublin  no  organisation  for  domestic 
accommodation  of  medical  students,  save  for  those  who 
are  passing  through  Trinity  College,  in  whose  case 
rooms  and  "  commons  "  (i.e.,  dinner)  are  provided  at 
fixed  rates.  Those  who  can  afiord  to  pay  £6  6s.  or 
£y  7s.  per  month  for  their  lodging  and  maintenance 
may  find  accommodation  in  the  family  of  some  medical 
man  who  receives  boarders,  in  which  case  they  become 
members  of  the  family  for  the  time  being.  The 
majority  of  Dublin  students,  however,  take  a  lodging  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. 

COST  OF  MEDICAL  EDUCATION  IN  IRELAND^ 

The  cost  of  obtaining  a  medical  qualification  depends 
to  some  extent  on  the  qualification  sought.     In  this 


284    The  Medical  Press. 


IRELAND— EDUCATION. 


Skft.  14.  1904. 


connection  the  following  tables  may  be  of  use  to  the 
prospective  student : — 

COST    OF    MEDICAL    EDUCATION. 

School  of  Physic,  Dub.  Univ.  . .  £1 19  14s. 

Royal  College  of  Surgeons  School  2^  24  19s. 

Catholic  University  School       ..  if  124  19s. 

Queen's  College  . .  . .  About  £1 10 

COST  OF   DIPLOMAS   OR   DEGREES. 

Dublin  University  ;       . .  . .     £27  (to  this  must  be 

added   iZ^   4s..  the 
cost  of  obtaining  an 
Arts  degree). 
Royal  University  ..  ..     £1$. 

Conjoint  Royal  Colleges  . .     £^2. 

Apothecaries'  Hall         . .  . .     2^2  is. 

Thus,  the  absolute  payment  will  amount  to  some- 
where between  ;£i25  and  ;£229  i8s.,  according  as  the 
teaching  of  the  Queen's  Colleges  and  the  degrees  of  the 
Royal  University,  or  the  teaching  and  degrees  of  Dublin 
University,  are  taken.  For  the  Conjoint  Colleges  the 
entire  cost  is  £166  19s.,  taking  the  minimum  mode  of 
payment.  So  that,  assuming  that  extras  or  voluntary 
costs  are  incurred  the  total  will  vary,  say,  from  £170  to 
'  ;i200.  "  Grinding  "  usually  costs  £$  ss.  for  each  of  the 
four  examinations,  but  if  a  student  needs  private 
instruction  in  special  subjects  he  must  pay  extra  for  it. 

This  sum,  or  something  like  it,  may  be  expended  by 
the  student  or  his  parent  in  paying  for  lectures,  &c.,  and 
examination  fees  as  they  fall  due,  and  there  is  no  diffi- 
culty in  obtaining  the  needful  information  for  his 
g^iidance  if  he  likes  to  pay  for  his  course  in  this  fashion. 
If,  on  the  other  hand,  he  prefers  to  pay  a  large  sum 
down,  he  can  "  apprentice  "  himself  to  a  teacher  who 
will  undertake  all  monetary  responsibility  for  his  educa- 
tion, and  who  may  be  able  to  give  him  some  special 
advantage  as  his  own  pupil  at  hospital.  This  so-called 
''  apprenticeship,"  is  very  generally  a  simple  contract 
for  the  payment  of  fees,  and  involves  but  Uttle  special 
teaching.  All  the  Dublin  schools  require  fees  to  be  paid 
in  advance. 

DATE  OF  ENTRY. 

The  entry  of  names  and  commencement  of  study  in 
Ireland  is  supposed  to  date  from  the  ist  of  October  in 
each  year,  but  the  session  really  dates  from  the  ist  of 
November,  and  the  entry  of  names  may  be  delayed  by 
the  dilatory  to  the  2Sth  of  the  same  month.  It  should, 
however,  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 
delivered,  and  if  he  loses  a  fortnight  at  the  beginning 
he  must  make  up  for  it  afterwards  by  constant  attend- 
ance. 

The  student  begins  work  by  attending  a  recognised 
medical  school  each  morning  at  ten  o'clock,  and  occupy- 
ing his  day,  to  five  p.m.,  between  lectures  and  dissec- 
tions. His  vacations  are  a  fortnight  at  Christmas  and 
a  week  at  Easter,  and  he  finally  returns  home  at  the 
end  of  June. 

PRELIMINARY  EXAMINATIONS. 

The  first  act  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.  He  must 
register  at  the  earliest  possible  moment,  or  he  may  lose 
credit  for  his  work. 

The  only  preliminary  examination  held  specially  for 
medical  students  is  that  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  subjects  of  examination  as  prescribed  by  the 


General  Medical  Council  are  as  follows  : — i.  English 
language,  including  a  specified  author,  dictation,  gram- 
mar, and  composition  ;   also  parsing  and  analysis  iron 
the    book    specified.     2.  Latin,    including    gramnur, 
translation  from  specified  authors,  and  translation  ol 
easy  passages  not  taken  from  such  authors-    3.  Efe- 
ments    of    mathematics,    comprising    (a)    arithmetic 
including  vulgar  and  decimal  fractions  ;     (h)  algebra, 
including    simple    equations ;     (c)    geometry,    Eudid. 
Books  I.,  II.,  and  III.,  with  easy  deductions.     4.  One 
of   the   following   optional  subjects  : — (a)    Gredt,  (6) 
French,  {c)  German. 

QUALIFICATION   IN   IRBLAND. 

The  Medical  Licensing  Bodies  of  Ireland  are  four  in 
number,  and,  as  a  rule,  students  gravitate  into  one  or 
other  of  five  classes  : — a.  Those  who  enter  Trinity  Col- 
lege, and  take  a  full  graduation  in  Arts  in  addition  to 
their  professional  degrees.  6.  Those  who  take  the 
hcence  of  the  conjoint  Royal  Colleges  of  Physidans 
and  Surgeons,  c.  Those  who  take  the  licence  of  the 
Apothecaries'  Hall.  d.  Those  who  take  their  qualifica- 
tions at  the  Royal  University  of  Ireland,  where  gradua- 
tion in  Arts  is  not  necessary,  e.  Those  -who  pursae 
their  studies  in  Ireland,  but  who  migrate  to  London. 
Edinburgh,  or  Glasgow  for  their  Ucences.  Almost  all 
these  last-named  emigrants  come  from  the  Queen's 
Colleges,  and  the  greater  number  of  them  from  Belfast, 
while  the  Dublin  students  qualify,  as  a  rule,  in  I>nbliiL 

We  do  not  attempt  to  give  details  as  to  the  requisite 
courses  of  instruction  for  degrees  or  diplomata,  sis  onr 
epitome  must  necessarily  be  insufficient  for  the  infor- 
mation of  the  student,  and  we  can  occupy  our  availabk 
space  with  information  more  useful  to  him.  The 
official  information  upon  which  students  may  depend 
can  be  obtained  by  sending  a  note  to  the  Registrars  of 
the  Licensing  Bodies  or  Schools. 

The  Irish  Licensing  Bodies  are  as  follows  : — 
THE  UNIVERSITY  OF  DUBLIN. 

The  University  of  Dublin  grants  the  degrees  of  M.B.. 
B.Ch.,  and  B.A.O.  to  students  who  have  obtained  their 
Arts  degree,  and  who  have  been  for  at  least  five  aca- 
demic years  on  the  books  of  the  Medical  School,  and  the 
higher  degrees  of  M.D.,  M.Ch..  and  M.A.O.  to  those  who 
have  held,  or  have  been  qualified  to  hold,  for  at  least 
three  years,  the  grade  of  M.B.  and  B.Ch.  It  does  not 
grant  degrees  to  any  but  full  graduates  in  Arts,  conse- 
quently its  degrees  hold  the  highest  rank  of  social  and 
educational  qualifications,  and  are  sought  for  by  those 
who  look  forward  to  occupying  the  best  positions  in  the 
profession. 

The  expense  of  obtaining  the  degrees  of  M.B.,  B.Ch.. 
and  B.A.O.  is  approximately  as  follows  : — Lectures. 
£64.  IIS.  6d.  ;  Hospitals,  ^£55  13s. ;  Degree  Fees,  127.— 
Total,  ;£i47  4S.  6d. 

The  expense  of  the  B.A.,  amounting  altogether  to 
;£83  AS.,  should  be  added,  making  the  total  cost 
£2y>  8s.  6d. 

In  addition  to  its  ordinary  qualifications  the  Uni\'er- 
sity  grants  the  following  higher  degrees  : — 

Doctor  of  Medicine. — ^To  obtain  this  the  candidate 
must  have  obtained  the  degree  of  M.B.,  or  have  been 
qualified  to  have  obtained  it  for  three  years.  He  must 
then  read  a  thesis  before  the  Regius  Professor  of  Medi- 
cine.    Total  fee  for  this  degree,  ;^i3. 

Master  of  Surgery, — The  candidate  must  be  a  Bachelor 
in  Surgery  of  tluree  years'  standing,  and  must  then  pass 
an  examination  in  clinical  surgery,  operative  surger>'. 
surgical  pathology,  surgery,  and  surgical  anatomy  (on 
the  dead  subject ).     Fee  for  degree,  ;f  1 1 , 

Master  in  Obstetric  Science. — ^The  candidate  must  have 
passed  the  M.B.  and  B.Ch.  examinations,  and  have  com- 
pleted, in  addition  to  the  courses  for  M.B.,  B.Ch..  a 
course  of  obstetric  medicine  and  surgery.  He  is  then 
required  to  pass  an  examination  in  the  following  sub- 
jects : — Practice  of  midwifery,  gynaecology,  anatomy  of 
female  pelvis  and  elementary  embryology,  and  cUnical 
gynaecology.     Fee  for  this  degree,  £^. 

Diplomatc  in  Medicine,  Surgery,  and  Midwifery. — 
Candidates  for  the  diplomas  in  Medicine,  Surgery,  or 
Obstetric  Science  must  be  matriculated  in  Medicine,  and 
must  have  completed  two  years  in  Arts  and  five  years  in 


Sbpt.  14.  1904. 


IRELAND— EDUCATION. 


The  Medical  Press.    285 


Medical  studies.  The  course  and  examination  is  the 
-saxce  as  for  the  degrees,  except  that  the  lectures  and 
-examinations  in  botany  and  zoology  need  not  have  been 
taken  out  or  passed,  and  that  the  candidate  need  not 
bave  obtained  an  Arts  degree.  Fee  for  the  diplomas  in 
medicine,  surgery,  and  midwifery,  i%\,  A  diplomate, 
•on  completing  his  course  in  Arts  and  proceeding  to  the 
degree  of  B.A.,  may  become  a  Bachelor  by  attending 
the  lectures  on  botany  and  zoology,  passing  the  previous 
medical  examination  in  those  subjects,  and  paying 
the  de&;ree  fees. 

Diploma  in  Public  Health. — ^The  candidate  must 
^be  an  M.D.  of  Dublin,  Oxford,  or  Cambridge,  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  (v.  also 
page  286.). 

THE  ROYAL  UNIVERSITY  OF  IRELAND. 

The  Royal  University  of  Ireland  is  purely  an  examin- 
ing body.  Its  degrees  are  granted  on  one  year's  acts. 
d,e.,  the  matriculation  examination  of  this  University 
<none  other  will  suffice)  and  a  "  first  University  exami- 
nation "  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 


M.B.,  B.Ch.,  B.A.O.,  and  the  higher  degrees  of  M.D., 
M.Ch.,  and  M.A.O.  It  also  confers  a  diploma  in  sani- 
tary science  and  a  diploma  in  mental  diseases. 

All  degrees  are  open  to  persons  of  either  sex. 

The  University  examinations  are  held  in  the  spring, 
beginning  about  May  ist,  and  in  the  autumn,  beginning 
about  October  ist. 

All  candidates  for  any  degree  must  pass  the  matricu- 
lation examination  and  the  first  University  examina- 
tion. 

The  course  for  the  degree  of  M.B.,  B.Ch.,  B.A.O.. 
extends  over  five  years. 

Students  will  be  admitted  to  the  first  University 
examination  after  one  year  from  matriculation.     Fee. 

^^• 

The  medical  course  consists  of  three  previous  examina- 
tions, one  at  the  end  of  each  year,  and  one  degree 
examination  at  the  end  of  the  fifth  year.  Fee  for  each 
previous  exapiination,  £1  ;  for  the  degree  examination, 
£2  ;   for  the  diploma.  ;f  10. 

In  addition,  the  following  degrees  are  granted  : — 
Diploma  in  Sanitary  Science. — Conferred  only  on  gra- 
•duates  in  medicine  of  the  University  of  at  least  twelve 
months'  standing.  Fee,  £2,  Subjects. — Climatology, 
chemistry,  geology,  physics,  vital  statistics,  hygiene, 
sanitary  law. 

The  M.D.  Degree. — Conferred  only  on  graduates  in 
medicine  of  the  University  of  three  years'  standing. 
They  must  at  the  same  time  produce  a  certificate  of 
having  been,  for  at  least  two  academical  years,  engaged 
in  hospital  or  private,  medical,  surgical,  or  obstetrical 
practice,  or  in  the  military  or  naval  medical  service. 
Fee,  £$.  The  examination  comprises  medical  dis- 
eases and  the  theory  and  practice  of  medicine,  including 
pathology.  Every  candidate  will  be  examined  at  the 
bedside,  and  required  to  diagnose  at  least  three  medical 
cases,  and  prescribe  treatment,  and  to  write  detailed 
reports  on  at  least  two  cases  to  be  selected  by  the 
examiners  and  to  discuss  the  questions  arising  there- 
from. 

The  M.Ch,  Degree. — Conferred  only  on  graduates  in 
medicine  of  the  University  of  three  years'  standing,  and 
who  can  produce  a  similar  certificate  of  practice  to 
that  required  for  the  M.D.  degree.     Fee,  £$. 

The  examination  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,  and  who  can  produce  a  similar  certificate  of  j 
practice   to   that   required   for   the   M.D.    and   M.Ch. 
degrees.     Fee,  £$.  ' 


The  examination  comprises  midwifery  and  diseases  of 
women  and  children. 

Prizes,  6^. — ^First  examination  in  Medicine.  Two 
first-class  exhibitions  of  £20  each,  and  two"  second  of 
;£io  each. 

Second  Examination  in  Medicine. — ^Two  first-class  of 
£2S*  and  two  second-class  of  £i$»  and  the  Dr  Henry 
Hutchinson,  Stewart  Medical  Scholarships,  value  ;£io. 

The  Henry  Hutchinson,  Stewart  Medical  Scholarships 
in  psychological  medicine,  diseases  of  the  nervous 
system,  and  anatomy,  physiology  and  pathology  of 
brain,  cord,  and  nerves.  Competition  among  medical 
graduates  of  not  more  than  two  years'  standing. 
Fee  £2. 

Third  Examination  in  Medicine. — ^Two  first-class 
exhibitions  of  £^0  each,  and  two  second  of  ;£20  each. 

Medical  Degrees  Examination. — ^Two  first-class  exhi- 
bitions of  £^0  each,  and  two  second  of  £2$  each.    One 
travelling  medical  scholarship  of  ;£ioo.     One  medical 
studentship  of  ^£200  per  annum,  tenable  for  two  years. 
ROYAL   COLLEGES   OF    PHYSICIANS   AND 

SURGEONS. 
The  examinations  held  conjointly  by  the  two 
Colleges  are  the  inlet  of  most  Irish  students  to  the  pro- 
fession, 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  are  conducted  by 
examiners  chosen  by  each  of  the  colleges  for  the  subjects 
appropriate  to  them.  The  curriculum  has  recently 
been  revised,  and  made  of  a  more  practical  nature.  In 
common  with  the  English  Colleges,  the  subjects  of  the 
First  Professional  examination  may  be  studied  either 
at  a  medical  school  or  at  an  institution  other  than  a 
medical  school  recognised  by  the  Colleges,  after  due 
inspection,  for  instruction  in  these  subjects.  We  recom- 
mend students  to  apply  for  the  official  programme  to 
the  Secretary  of  the  Committee  of  Ibfegmgement,  Royal 
College  of  Physicians,  or  to  the  Registrar  of  either 
College.  In  the  case  of  the  Preliminary  Examination 
seven  clear  days'  notice  must  be  given  to  the  Secretary ; 
fourteen  days'  notice  are  required  from  candidates 
for  the  Professional  examination. 

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  ;£i34  19s..  making 
altogether  £166  19s.,  exclusive  of  re-examination  fees, 
which  have  to  be  paid  in  case  the  candidate  fails  to 
pass  his  examination. 

The  conjoint  Colleges  also  confer  a  diploma  in 
PubUc  Health,  of  which  information  will  be  found  on 
page  286. 

ROYAL  COLLEGE  OF  PHYSICIANS. 
This  College  issues  a  Ucence  in  Medicine  and  a 
licence  in  Midwifery  to  registered  medical  practitioners. 
The  subjects  of  examination  for  the  former  qualifica- 
tion are : — Practice  of  medicine,  clinical  medicine, 
pathology,  medical  jurisprudence,  midwifery,  hygiene 
and  therapeutics. 

The  candidate  for  the  licence  in  Midwifery  must  pro- 
duce certificates  of  having  attended  a  course  of  lectures 
on  midwifery,  and  of  having  attended  practical  mid- 
wifery and  diseases  of  women  for  six  months,  at  a  lying- 
in  hospital  or  maternity  recognised  by  the  College  ;  or, 
where  such  hospital  attendance  cannot  have  been 
obtained  during  any  period  of  the  candidate's  course  of 
study,  of  having  been  engaged  in  practical  midwifery 
under  the  supervision  of  a  registered  practitioner  hold- 
ing a  public  medical  appointment,  the  certificate  in 
either  case  to  state  that  at  least  twenty  labour  cases 
have  been  actually  attended.  A  registered  medical 
practitioner  of  five  years'  standing  is  exempted  from  the 
examination  by  printed  questions. 

Fees. — Fee  for  the  licence  to  practise  medicine, 
£1$  15s.  Fee  for  examination  for  the  Ucence  to  prac- 
tise midwifery,  £1  3s. 

Membership. — The  Examinations  for  Membership  are 
held  in  January,  April,  July,  and  October. 

ROYAL    COLLEGE    OF    SURGEONS. 
This  College  grants  a  licence  in  Surgery  to  registered 
medical  practitioners.     Candidates  who  hold  registrable 
surgical  diplomas,  including  the  licence  of  the  Apothe- 


286    Thb  Medical  Press. 


IRELAND— EDUCATION. 


Sept.  14.  igo^. 


caries'  Society  of  London,  granted  since  October,  1886, 
are  admitted  to  examination  without  further  evidence 
.  of  study,  but  candidates  who  hold  medical  qualifications 
only,  including  the  L.S.A.  granted  before  October,  1886, 
will  be  requir^  to  produce  certificates  of  two  courses  of 
lectures  in  anatomy  and  dissections,  one  course  of  prac- 
tical histology,  one  course  of  lectures  in  surgery,  and 
one  course  of  operative  surgery. 

Candidates  are  examined  in  surgery,  clinical  and 
operative ;  surgical  appliances ;  and  ophthalmic 
surgery.  The  fee  is  £26  5s.  The  fee  for  a  special 
examination  is  ;£3 1  los. 

A  diploma  in  Midwifery  is  also  granted  after  exami- 
nation to  registered  medical  practitioners.  Candidates 
must  produce  evidence  of  (a)  attendance  on  a  course  of 
lectures  on  midwifery  and  diseases  of  women  and 
children  in  a  recognised  school ;  (b)  attendance  on  six 
months'  practice  at  a  recognised  lying-in  hos{>ital  or 
recognised  dispensary  for  lying-in  women  and  children  ; 
and  {c)  of  having  conducted  at  least  thirty  labour  cases. 
The  fee  for  the  examination  is  ;£i  5  1 55. 

Fellowship, — Candidates  for  the  Fellowship  of  the 
College  must  enter  their  names  with  the  Registrar  at 
least  a  month  before  the  date  of  examination,  in  order 
that  the  Council  may  decide  whether  to  approve  of  the 
application.  Examinations  are  held  the  third  Mondays 
in  February,  May,  and  November.  If  the  application 
is  approved,  the  candidate  will  be  admitted  to  the  next 
sessional  examination  or  to  a  special  examination 
{except  during  the  months  of  August  and  September) 
if  granted  by  the  Council.  Candidates  are  divided  into 
two  grades : — 

Grade  i. — ^Licentiates  or  graduates  in  surgery  of  less 
than  ten  years'  standing. 

Grade  2. — ^Licentiates  or  graduates  in  surgery  of  more 
than  ten  years'  standing. 

Candidates  in  Grade  i  must  pass  two  examinations — 
Primary  (in  anatomy  and  physiology)  and  Final  (in 
surgery).  Candidates  in  Grade  2  need  pass  but  one 
examination  in  surgery,  surgical  anatomy,  and  surgical 
pathology. 

F«tf5.— -Grade  i. — For  Licentiates  of  College ;  Pri- 
mary examination,  £1$  15s. ;  Final  examination, 
;fio  I  OS.  Licentiates  in  Surgery  of  other  licensing 
bodies  :  Primary  examination,  £26  5s. ;  Final  exami- 
nation, £1$  15s.  Students  of  the  College:  Primary 
examination,  £$  5s. ;  Final  examination,  ;£2i.  Students 
of  other  Ucensing  bodies :  Primary  examination, 
;£io  I  OS. ;  Final  examination,  £$i  los. 

Grade    2. — Licentiates    of    the    College,    £26    5s. ; 
Licentiates  in  Surgery  of  other  Ucensing  bodies,  ^^42. 
APOTHECARIES'  HALL  OF  IRELAND  (L.A.H.). 

This  body  is  authorised  to  grant  a  complete  qualifica- 
tion in  medicine,  surgery,  and  midwifery,  recognised 
and  registrable  under  the  Medical  Act  of  1 886,*  and 
entitUng  the  holder  to  occupy  medical  appointments  in 
all  the  pubUc  services.  It  also  confers  the  legal  right 
to  dispense  medicines.  The  examinations  are  held 
on  the  third  Monday  in  January,  April,  July,  and 
October,  and  the  requirements  in  respect  of  studies 
are  approximately  the  same  as  those  of  the  Conjoint 
Examinations  of  the  Royal  Colleges  of  Physicians  and 
Surgeons  in  Ireland.  The  examination  fees  payable  for 
the  qualifications  of  L.A.H.  are  as  follows  :-r-First  pro- 
fessional, £s  5s.  ;  second,  £$  5s, ;  third,  £$  5s.;  Final 
examination,  £6  6s. 

The  fees  for  re-examination  are  £1  is.  for  each  sub- 
ject, excepting  in  the  subjects  of  chemistry,  medicine, 
surgery,  and  ophthalmology,  the  fees  for  which  are 

£2   2S. 

The  fee  for  final  alone  is  ;£is  15s.,  when  the  other 
examinations  have  been  taken  elsewhere.  Candidates 
may  be  admitted  to  a  special  examination  under  special 
circumstances,  at  an  extra  fee  of  ten  guineas. 

Each  candidate  must  produce  evidence  of  having 
before  entering  on  medical  studies  passed  a  preliminary 
examination  in  general  education  recognised  by  the 
General  Medical  Council,  and  of  having  been  registered 
by  that  Council  as  a  student  in  medicine.  Certificates 
of  medical  study  will  not  be  recognised  if  the  com- 
mencement of  the  course  to  which  the  certificate  refers 


dates  more  than  fifteen  days  prior  to  such  registratioiL 
This  registration  is  not  undertaken  by  the  HaU.  bot  the 
student  must  apply  to  the  Registrar  of  the  General 
Medical  Council  that  he  may  be  so  entered.  The  detaik 
of  the  course  of  education  required  and  syllabus  of  the 
examinations  will  be  supplied  an  application  to  tbe 
Registrar  at  40  Mary  Street,  DubUn. 

Candidates  already  on  the  "  Register  "  wiU  receive  the 
diploma  of  the  HaJl  on  passing  an  examination  ii 
pharmacy  and  paying  a  fee  of  ten  guineas.  If  medicine 
or  surgery  should  be  required  two  guineas  extra  will  be 
charged.  The  candidate  will  be  exempt  from  each  of 
the  above  subjects,  which  are  covered  by  his  previous 
qualification  or  qualifications. 

LICENCE  IN  DENTAL  SURGERY. 

There  is  probably  no  specialty  in  surgay  which 
gives  as  great  a  number  of  its  practitioners  a  living  and 
the  prospect  of  an  income  as  dentistry.  A  young  man 
who  has  got  his  diploma  and  knows  something  of  his 
business,  and  is  willing  to  attend  to  it.  seldom  fails  to 
get  a  substantial  foothold  in  Ireland  in  a  few  yean. 
The  University  of  Dublin  grants  both  a  Degree  and  a 
Licence  in  dental  surgery.  To  obtain  the  former, 
candidates  must  have  taken  a  degree  in  arts  ;  the 
licence  is  obtainable  by  all  duly  qualified  persons  who 
have  passed  the  Public  Entrance  Examination  o{ 
Trinity  College,  Dublin.  The  Royal  College  of  Sur- 
geons in  Ireland  grants  a  Licence  in  Dentistry. 

Course  of  Study  for  the  Licence  in  Dentistry. — Candi- 
dates are  required  to  pass  three  examinations,  vii.  :— 
Prehminary  (in  General  Education),  Primary  Dental, 
and  Final  Dental. 

All  information  concerning  this  licence  may  be 
obtained  from  the  Registrar  of  the  College.  The 
Primary  Dental  Examinations  commence  on  the 
second  Monday  in  the  months  of  February,  May,  and 
November.  The  subjects  of  examinations  include 
physics,  chemistry  (including  metallurgy),  anatomy, 
physiology  and  histology,  and  surgery.  The  fees  for 
the  primary  Dental  Examination  amount  to  ;(io  los; 
and  for  re-examination,  if  rejected,  £$  5s.  The  Final 
Dental  Examinations  commence  on  the  Thursdays 
immediately  following  the  Primary  Dental  Examina- 
tions. Candidates  are  examined  in  dental  surgery, 
theoretical  (including  dental  pathology),  clinical,  and 
operative ;  and  in  dental  mechanics,  theoretical, 
clinical,  and  practical  (including  the  metallurgy  of  the 
workshop).  Candidates  must  pass  in  all  the  subjects 
at  the  same  time. 

The  fees  for  the  Final  Dental  Examination  in  the 
case  of  candidates  holding  L.R.C.S.I.,  or  students  who 
have  passed  Primary  Dental  or  Third  Professional 
Examination  of  the  College,  ;f  10  los. ;  re-examination. 
£S  ss.  The  fees  for  Final  Examination  of  all  other 
candidates,  £26  5s.,  and  for  re-examination,  ;fio  los. 
The  extra  fee  for  Special  Examination,  £$  ss,  A  re- 
jected candidate  will  not  be  again  admitted  to  examina- 
tion until  after  a  period  of  three  months. 

THE  DIPLOMA  IN  PUBLIC  HEALTH. 

This  diploma  is  granted  by  Dublin  University,  the 
Royal  University,  and  the  conjoint  Royal  Colleges. 
Every  candidate  must  be  a  registered  medical  practi- 
tioner. The  examination  is  in  : — ( i )  Chemistry  (includ- 
ing chemical  physics).  (2)  Engineering  and  architec- 
ture. (3)  Sanitary  law  and  vital  statistics.  (4^ 
Hygiene.  (5)  Bacteriology.  (6)  Meteorology.  The 
General  Medical  Council  recommend  that  all  candidates 
shall  have  studied  in  a  special  bacteriological  laboza- 
tory,  also  for  six  months  as  pupil  of  a  working  medical 
officer  of  health,  described,  for  Ireland,  as  "  the  medical 
officer  of  health  of  a  county  or  of  one  or  more  sanitary 
districts  having  a  population  of  not  less  than  30,000; 
or  a  medical  officer  of  health  who  is  a  teacher  in  Public 
Health  of  a  recognised  medical  school." 

In  addition  to  taking  the  prescribed  course  a  candi- 
date for  the  D.P.H.  of  the  University  of  Dublin  must  be 
a  Doctor  in  Medicine  or  a  graduate  in  Medicine,  Sur- 
gery, and  Midwifery  of  DubUn,  Oxford,  or  Cambridge, 
and  his  name  must  have  been  on  the  "  Medical  Register" 
I  for  at  least  twelve  months  before  the  examination.  The 


Sept.  14,  1904. 


IRELAND— EDUCATION. 


The  Medical  Press.    287 


Royal  University  only  confers  its  diploma  on  its  own 
graduates. 

THE  DIPLOMA  IN  PSYCHOLOGICAL  MEDICINE. 
The  Royal  University  of  Ireland  grants  a  diploma  for 
proficiency  in  the  treatment  of  mental  diseases  under 
the  following  conditions  : — 

The  diploma  is  conferred  only  on  graduates  in  medi- 
cine of  the  University.  Candidates  must  give  notice, 
in  writing,  to  the  secretaries  of  their  intention  to  present 
themselves,  and  must  pay  the  prescribed  fee  of  £z  at 
least  one  month  previous  to  the  examination.  Can- 
didates who  satisfy  the  examiners  will  be  required  to 
pay  a  further  fee  of  f;^  before  the  diploma  is  conferred. 
The  subjects  for  this  examination  are  those  required  by 
the  Hutchinson  Stewart  Scholarship  for  proficiency  in 
the  treatment  of  mental  diseases. 

THE  IRISH  MEDICAL  SCHOOLS. 
The  Irish  Medical  Schools  are  as  follows : — 
The  School  of  Physic  of  Dublin  University— 
This  school  is  formed  by  an  amalgamation  of  the  School 
of  Trinity  College  and  of  the  College  of  Physicians. 
Every  student  of  the  school  must  be  matriculated  by 
the  Senior  Lecturer,  for  which  a  fee  of  5  s.  is  payable, 
but  he  need  not  attend  any  of  the  Arts  course  unless  he 
desires  to  obtain  a  University  licence  or  degree  in  medi- 
cine, surg^y,  and  midwifery.     No  student  is  permitted 
to  matriculate  unless  he  has  passed  the  entrance  exami- 
nations of  the  University,  of  the  Royal  University,  of 
the  College  of  Surgeons,  or  some  other  examination 
recognised  by  the  General  Medical  Council. 

Two  medical  scholarships  are  given  annually  at  the 
School  of  Physic,  value  £10  per  annum,  tenable  for  two 
years,  the  examinations  for  which  are  held  each  year  in 
June ;  one  scholarship  is  given  in  anatomy  and  in- 
stitutes of  medicine ;  the  other  in  zoology,  chemistry, 
botany,  and  experimental  physics^ 

A  prize  of  ;£ioo  is  awarded  by  the  Board  to  the 
successful  candidate  at  a  special  examination  in  alter- 
nate years  in  medicine  or  in  surgery,  provided  that  the 
merit  be  deemed  sufficient.  The  successful  candidate 
is  required  to  spend  three  months  in  the  study  of  medi- 
cine or  surgery,  as  the  case  may  be,  in  Berlin,  Paris,  or 
Vienna.  Before  he  can  obtain  the  first  instalment  of 
it^o  he  must  satisfy  the  Senior  Lecturer  that  he  possesses 
sufficient  knowledge  of  a  Continental  language  to  derive 
full  benefit  from  the  prize.  The  examination  is  held  in 
June,  and  is  open  to  students  who  have  passed  the 
Final  Examination  in  Medicine  or  in  Surgery,  as  the 
case  may  be,  within  two  years  of  the  examination. 

In  order  to  obtain  the  second  sum  of  £^0  the  prize- 
man must  have  furnished  to  the  Regius  Professor  his 
formal  report  on  the  hospitals  attended  by  him  within 
two  years  from  the  time  of  obtaining  the  prize. 

Class  prizes  are  given  at  the  end  of  the  session  of 
between  ^5  and  j£io  in  value. 

The  John  Mallet  Purser  Medal,  founded  by  Prof. 
Purser's  past  pupils,  is  awarded  annually  to  the  student 
who,  at  the  ordmary  June  "  Half  M.B."  Examination 
in  Anatomy  and  Institutes  of  Medicine,  shall  obtain 
highest  marks  in  Physiology  and  Histology,  provided 
that  he  passes  the  examination  in  full. 

FitZ'Patrick  Scholarship. — ^This  scholarship  consists  of 
the  interest  on  ^J  1,000.  It  will  be  awarded  annuaUy 
to  the  student  who  obtains  the  highest  aggregate  marks 
at  the  five  sections  of  the  Final  Examinations,  provided 
that  he  has  completed  his  medical  course  in  the  pre- 
scribed period  of  five  years. 

The  Royai,  College  of  Surgeons  in  Ireland. 
Schools  of  Surgery. — ^These  schools  are  attached  by 
Charter  to  the  Royal  College  of  Surgeons,  and  have 
existed  as  a  department  of  the  College  for  nearly  a 
century.  They  are  carried  on  within  the  College 
buildings,  and  are  specially  subject  to  the  supervision 
and  control  of  the  Council,  who  are  empowered  to 
appoint  and  remove  the  professors,  and  to  regulate  the 
methods  of  teaching  pursued.  The  Duildings  have 
been  reconstructed,  the  capacity  of  the  dissecting  room 
nearly  trebled,  and  special  pathological,  bacteriological, 
public  health,  chemical,  and  pharmaceutical  labora- 
toies  fitted  with  the  most  approved  appliances,  in 
order  that  students  may  have  the  advantage  of  the 


most  modem  methods  of  instruction.  A  refreshment 
room  is  now  open,  where  students  can  have  luncheon. 
There  are  special  rooms  set  apart  for  lady  students. 
The  entire  building  is  heated  by  hot- water  pipes,  and 
lighted  throughout  by  the  electric  light. 

All  the  lectures  and  courses  of  practical  instruction 
may  be  attended  by  medical  students  who  are  otherwise 
unconnected  with  the  College. 

The  diplomas  of  the  College  are  open  to  students  of 
either  sex.  Separate  rooms  have  been  provided,  and 
careful  provision  made  for  the  instruction  and  comfort 
of  women  students. 

Prizes. — The  Barker  Prize,  ;£2i  ;  the  Carmichael 
Scholarship,  ^^15;  the  Mayne  Scholarship,  £1$.  The 
Gold  and  Silver  Medals  in  Surgery  and  the  Stoney 
Memorial  Gold  Medal  in  Anatomy. 

Class  Prizes  of  £2  and  £1,  accompanied  by  medals  if 
sufficient  merit  is  shown,  will  also  be  given  in  each 
subject.  Prospectus  and  Student's  Guide  can  be  ob- 
tained on  written  application  to  the  Registrar,  Ro3ral 
College  of  Surgeons,  Dublin. 

The  Catholic  University  School  is  situated  in 
Cecilia  Street,  Dame  Street.  It  prepares  students  for 
all  medical  examinations,  particularly  those  of  the 
Irish  Colleges  of  Physicians  and  Surgeons,  and  the 
Royal  University  of  Ireland.  The  school  has  recently 
been  rebuilt  and  refitted,  -its  working  space  having 
thereby  been  nearly  doubled,  and  several  new  labora- 
tories, including  those  for  the  study  of  bacteriology  and 
public  health,  have  been  added.  The  institution  has 
also  been  recently  chartered,  under  the  Educational 
Endowment  (Ireland)  Act,  and  it  is  now  controlled  by  a 
Board  of  Governors.  The  total  fees  for  school  and  hos- 
pital courses  is  ;£i6o,  payable  as  the  courses  are  taken 
out. 

The  following  Exhibitions  are  awarded  annually  : — 
Two  first  year's,  value  ;£i  2  los.  each  ;  two  second  year's, 
value  jf  10  each  :  one  third  year's  Royal  Exhibition  of 
;£i2  los.  ;  one  final  Conjoint  Colleges'  Exhibition  of 
■^12  los.  ;  two  large  gold  medals,  besides  several  other 
class  medals. 

A  Guide  for  Medical  Students,  which  gives  all  the 
information  required  by  parents,  and  by  students  who 
desire  to  join  the  medical  profession,  may  be  obtained 
free  on  application  to  the  Registrar. 
THE  QUEEN'S  COLLEGES— BELFAST,  CORK, 
AND  GALWAY. 
These  three  important  academic  institutions  were  the 
special  schools  of  the  Queen's  University.  They  have 
ceased  to  have  any  direct  relation  to  a  central  examina- 
ing  body,  but  educate  students  for  all  colleges  and 
degrees,  and  are  maintaiaed,  as  hitherto,  by  a  handsome 
Government  grant.  The  same  curriculum  as  that  for- 
merly adopted  is  continued,  and  the  various  exiiibitions 
and  scholarships  are  still  available.  Each  college  has 
the  disposal  of  about  ;£  1,500  per  annum  in  scholarships 
and  prizes.  TThe  curriculum  is  generally  well  adapted 
for  preparation  for  the  Royal  University  examination. 
The  colleges  are  well  adapted  for  high-class  technical 
education,  having  lecture  rooms  provided  with  every 
appliance  necessary  in  the  modem  training  of  a  medical 
student.  The  colleges  are  completely  equipped  with 
students'  reading  rooms  and  lending  libraries  and 
refreshment  rooms,  and  with  all  adjuncts  to  collegiate 
Ufe,  such  as  literary  societies  and  athletic  organisations. 
The  expense  of  living  in  the  collegiate  towns  is  quite 
moderate.  The  course  of  lectures  in  the  winter  session 
must  be  diligently  attended,  no  student  obtaining  a 
certificate  who  has  not  put  in  three-fourths  of  a  course. 
The  scholarship  examinations  are  held  in  October. 
QUEEN'S  COLLEGE.  BELFAST. 
The  total  cost  of  the  medical  curriculum  of  the  Royal 
University  of  Ireland,  including  examination  fees  and 
perpetual  fee  for  the  Royal  Hospital,  but  not  including 
fees  for  the  special  hospitals,  is  about  £gS'  If  the  Con- 
joint Examination  of  the  Royal  Colleges  is  taken  the 
expense  is  almost  the  same. 

Clinical  instruction  is  given  at  the  Royal  Victoria 
Hospital.  The  Maternity  Hospital,  the  Ulster  Hospital 
for  Women  and  Children,  the  Hospital  for  Sick  Children, 
the  Ophthalmic  Hospital,  the  Ulster  Eye,   Ear,  and 


288    The  Medical  Pkess. 


IRELAND— EDUCATION. 


1 


Sept.  14.  IW- 


Throat  Hospital,  and  the  District  Lunatic  Asylum  are 
also  open -to  students. 

Prizes, — ( i )  Ten  medical  scholarships  each  year,  value 
^20  each ;  (2)  t-wo  Dunville  studentships  (one  each 
alternate  year),  value  ;ii50  each;  (3)  one  Andrews 
studentship  each  alternate  year,  value  £14/^',  (4)  nume- 
rous sessional  prizes. 

During  the  summer  session  special  classes  are  formed 
in  bacteriology  and  clinical  pathology,  and  during  the 
winter  facilities  are  afforded  to  medical  men  to  work  at 
these  subjects  in  the  pathological  laboratories.  From 
time  to  time  lectures  and  demonstrations  are  given  in 
the  anatomical  department  on  the  Advanced  ^atomy 
of  the  Nervous  System,  or  some  other  department  of 
applied  anatomy. 

A  pamphlet  containing  full  information  can  be  had 
on  appUcation  to  the  Registrar,  Queen's  College, 
Belfast. 

QUEEN'S  COLLEGE.  CORK. 

The  arrangements  in  the  Faculty  of  Medicine  are 
made  chiefly  with  reference  to  the  requirements  of  the 
Royal  Universitv  of  Lreland,  but  students  proceeding 
for  the  examinations  of  the  Conjoint  Boards  of  England. 
Scotland,  or  Ireland,  the  Society  of  Apothecaries  of 
London,  or  the  Apothecaries  Hall  of  Ireland,  can 
arrange  the  course  of  lectures  which  they  attend,  and 
the  order  in  which  they  attend  them,  to  meet  the  re- 
quirements of  those  bodies.  Certificates  of  attendance 
in  the  college  are  also  accepted  by  the  University  of 
Cambridge.  The  total  fees  for  the  college  lectures  and 
Hospital  attendances  required  by  the  Royal  University 
of  Ireland  is  about  £85. 

Clinical  instruction  is  given  at  the  North  and  South 
Infirmaries.  Students  can  also  attend  the  Mercy  Hos- 
pital, the  Cork  Union  Hospital,  the  County  and  City  of 
Cork  Lying-in  Hospital,  the  Maternity,  the  Hospital  for 
Diseases  of  Women  and  Children,  tlie  Fever  Hospital, 
the  Ophthalmic  and  Aural  Hospital,  and  the  Eglinton 
Lunatic  Asylum.  The  winter  session  commences  on 
October  27  th,  and  ends  at  the  end  of  April.  The 
courses  of  the  summer  session  are  delivered  in  the 
months  of  April.  May.  and  June. 

Scholarships  and  Prizes. — Eight  medical  scholarships, 
two  in  each  of  the  first  four  years,  of  the  value  of  £2$ 
each,  and  in  the  fifth  year  the  Blaney  Scholarship  of  the 
value  of  about  £$2,  and  a  Senior  Exhibition,  value  £30. 
Three  Exhibitions,  one  in  practical  medicine,  one  in 
practical  surgery,  and  one  in  practical  midwifery,  each 
of  the  value  of  £1$-  Book  prizes  at  the  sessional 
examinations. 

Further  information  can  be  obtained  in  the  College 
Regulations,  or  on  application  to  the  Registrar,  Queen's 
College,  Cork. 

QUEEN'S  COLLEGE,  GALWAY. 

Clinical  teaching  is  carried  on  in  the  Galway  Hospital, 
established  as  a  Public  General  Hospital  (in  the  place  of 
the  County  Galway  Infirmary)  by  Act  of  Parliament 
(1892).  The  Galway  Fever  Hospital  is  also  open  to 
students.  The  medical  lectures  are  recognised  by  the 
Royal  University  of  Ireland  and  the  various  Licensing 
Bodies  in  the  United  Kingdom. 

Prizes. — ^There  are  eight  Junior  Scholarships  in  Medi- 
cine of  the  annual  value  of  £2$  each.  Two  are  tenable 
by  matriculated  students  of  the  first,  second,  third,  and 
fourth  years.  The  Council  has  power  to  award  exhibi- 
tions for  distinguished  answering.  Sessional  prizes  are 
offered  in  each  subject.  A  Senior  Scholarship  in  Ana- 
tomy, value  ;£40,  the  holder  of  which  is  usually  appointed 
Demonstrator,  is  offered  annually  for  competition, 
tenable  for  one  year  by  a  student  who  shall  have 
attended  the  Medical  School  of  the  College  for  at  least 
two  sessions,  and  shall  have  obtained  a  Degree  in  Arts 
or  Medicine,  or  a  Diploma  in  Medicine,  from  a  Licensing 
Body.  Scholarship  examinations  are  held  at  the  com- 
mencement, and  those  for  Sessional  Prizes  at  the  close, 
of  each  session. 
THE  PHARMACEUTICAL  SOCIETY  OF  IRELAND. 

The  Pharmaceutical  Society  of  Ireland  issue  two 
qualifications  and  a  certificate^  The  qualification  of 
Registered  Druggist ;  the  qualification  of  Phar- 
maceutical Chemist ;  and  the  certificate  of  competency 
as  Assistant  to  a  Pharmaceutical  Chemist. 


Registered  Druggist. — ^This  qualification  entitles  the 
holder  to  keep  open  shop  for  the  selling,  retailing 
and  mixing  of  poisons.     In  order  to  obtain  it.  a  penoB 
must  now  have  served  an  apprenticeship  or  assistant- 
ship  of  four  years  to  an  apothecary,  pharmaceatical 
chemist,  or  to  a  person  who  was,  or  would  have  bees 
entitled  to  become,  a  registered  chemist  and  druggist 
or  a  registered  druggist,  and  be  21  years  of  age.    He 
shall  be  examined  with  respect  to  his   knowledge  of 
English  orthography  and  composition,  arithmetic,  and 
the  weights  and  measures  of  the  British  Pharmacopoeia, 
the  appearance  and  properties  of  the  various  drugs  and 
chemicals  in  general  use.  and  as  to  the  provisions  of  the 
Poisons  Act.     The  fee  is  four  guineas. 

Examinations  in  Dublin  (also  in  Belfast  and  Cork 
or  other  place  if  12  candidates  offer)  on  the  second 
Tuesday  of  January,  April.  July,  and  October. 

Pharmaceutical  Chemist. — ^The  qualification  of  a 
pharmaceutical  chemist  in  Ireland  confers  greater 
privileges  than  is  the  case  in  England. 

The  subjects  of  examination  are  divided  between 
the  "  Preliminary  "  and  the  "  Licence." 

The  Preliminary  examination  is  held  on  the  first 
Thursday  and  following  day  of  January,  April.  July, 
and  October. 

The  fee  is  £2  2s.  for  the  first  attempt,  and  tos.  6d. 
for  each  subsequent  examination.  Further  particulars 
with  reference  to  the  subjects  for  examination  may 
be  obtained  from  the  Registrar.  The  British  Society's 
examination  is  accepted  in  lieu  of  this,  as  well  as  those 
recognised  by  the  General  Medical  Council  as  a  pre- 
liminary to  medical  studies. 

Pharmaceutical  Licence  Examination. — ^This  examina- 
tion confers  the  title  of  Pharmaceutical  Chemist  and 
the  right  to  compound  medical  prescriptions.  Candi- 
dates must  be  21  years  of  age,  and  must  have  passed 
the  Preliminary  at  least  a  year  previously.  They 
must,  unless  having  passed  the  Preliminary  previous 
to  1884,  produce  certificates  of  having  served  four  years 
as  assistant  or  apprentice  to  an  apothecary  or  pharma- 
ceutical chemist  or  four  years  to  a  druggist,  two  years 
to  an  apothecary  or  pharmaceutical  chemist,  also  a 
certificate  of  having  attended  a  course  of  practicar 
chemistry  of  not  less  than  three  months'  duration, 
and  of  having  actually  worked  at  the  bench  for  100  hour? 
during  the  said  course  at  a  recognised  school ;  and  also 
a  course  of  botany  and  materia  medica.  The  fee 
for  examination  is  five  guineas,  and  for  re-examination 
a  guinea  and  a  half.  Examinations  are  held  in  Dublin 
on  the  second  Wednesday  and  following  day  of 
January,  April,  July,  and  Octot>er. 

Assistant  to  a  Pharmaceutical  Chemist. — The  exami- 
nation for  the  certificate  of  competency  as  an  assistant 
may  be  described,  in  brief,  as  the  same  as  that  for  the 
Licence,  minus  the  examination  in  chemistry  and 
botany,  with  the  fee  reduced  to  one  guinea  (half  a 
guinea  on  the  second  and  subsequent  attempts).  The 
Preliminary  examination  must  be  passed  as  for  the 
Licence,  and  the  usual  14  days'  notice  must  be  given. 
Candidates  must  have  been  engaged  in  practical 
pharmacy  for  four  years. 

Examinations  are  held  on  the  second  Mondays  of 
February,  May,  August,  and  November,  or  on  such 
days  as  the  Council  may  direct. 

DEPARTMENT  OF  AGRICULTURE  AND  TECH- 
NICAL INSTRUCTION  FOR  IRELAND. 
Royal  College  of  Science  for  Ireland. 
Session  1904-1905. 

This  College,  situate  in  Stephens  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  agriculture, 
chemical  manufactures,  engineering,  physics,  and 
natural  science.  A  diploma  of  Associate  of  the  College 
is  granted  at  the  end  of  the  three  years'  course.  Non- 
associate  students  may  join  for  any  course  required. 
There  are  several  entrance  scholarships,  (a)  in  agricnl- 
ture,  (^)  in  science  and  technology,  tenable  for  three 
years,  of  the  value  of  .^50  each  yearly,  -with  free 
tuition.  There  are  four  Royal  scholarships  of  the 
value  of  £so  each  yearly,  with  free  education,  tenable 


Sept.  14,  1904. 


IRELAND— EDUCATION. 


Tmt  Medical  Press.    289 


lor  two  years.  Two  are  competed  for  by  the  associate 
students  at  the  end  of  each  session.  The  chemical, 
pliysical,  zoological  and  botanical,  geological  and 
mineralogical  Uboratories  and  drawing  schools  are 
open  dally  for  practical  instmction.  The  Session 
commences  on  Tuesday,  October  4th. 

The  courses  of  chemistry,  physics,  botany,  geology, 
a.iid  mineralogy  and  zoology  are  recognised  by  the 
Royal  University  of  Ireland,  and  certificates  of  attend- 
ance are  granted  to  medical  and  other  students  attend- 
ing these  courses,  as  also  the  courses  of  the  chemical, 
physical,  zoological,  botanical,  and  geological  labora- 
tories. 

THE  DUBLIN  HOSPITALS. 
The  clinical  hospitals  in  Dublin  are  ten  in  number, 
exclusive  of  three  lying-in  hospitals.  There  are  also 
Vwo  children's  hospitals,  an  orthopaedic  hospital,  a  fever 
hospital,  an  ophthalmic  hospital  with  two  centres,  a 
dental  hospital,  and  other  special  institutions.  Some 
of  the  clinical  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,  andTto  change  his  place  of  instruction  from  year 
to  year  as  he  may  see  fit. 

The  Irish  Licensing  Bodies  require  attendance  on 
hospitals  for  twenty-sevep  months,  i.e.,  three  winter 
sessions  of  six  months  and  three  summers  of  three 
months,  with  the  five  years  of  study.  The  fee  at  all 
general  hospitals  is  £8  8s.  in  winter,  and  for  the  summer 
£6  6s.,  or  ;£i2  12s.  for  the  entire  session  of  nine  months  if 
taken  together. 

GENERAL  HOSPITALS. 
Richmond,  Whitworth,  and  Hardwicke  Hos- 
piTAi-s. — ^The  accommodation  at  these  hospitals  is  as 
follows  : — Hardwicke  Hospital,  120  beds  ;  Whitworth 
Hospital,  82  beds;  Richmond  Hospital,  no  beds — 
total,  312  beds.  These  hospitals  are  visited  each  morn- 
ing at  nine  o'clock  by  the  physicians  and  surgeons,  and, 
in  addition  to  the  usual  bedside  instruction,  clinical 
lectures  are  delivered  on  the  most  important  cases. 
Instruction  is  also  given  on  various  special  branches  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  sub- 
jects is  given.  Six  resident  clinical  clerks  are  ap- 
pointed each  quarter,  and  provided  with  furnished 
apartments,  fuel,  &c.  The  appointments  are  open  not 
only  to  advanced  students,  as  formerly,  but  also  to 
those  who  are  qualified  in  medicine  and  surgery.  A 
house  surgeon  for  the  Richmond  Hospital  and  a  house 
physician  for  the  Whitworth  and  Hardwicke  Hospitals 
are  elected  annually,  and  receive  a  salary.  The  Rich- 
mond Lunatic  Asylum,  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  build- 
ing for  the  isolated  treatment  of  fevers,  containing  40 
beds,  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  appoin  ted  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.  Mr.  Conway  Dwyer.  F.R.C.S., 
9  Rutland  Square,  Dublin. 

The  Adelaide  Medical  and  Surgical  Hospitals 
occupy  a  central  position  within  a  few  minutes' 
walk  of  the  College  of  Surgeons  and  Trinity  College. 
From  October  ist,  the  physicians  and  surgeons  visit 
the  wards  and  give  instruction  at  the  bedside  at 
the  advertised  hours.  There  is  a  lar^je  detached 
fever  hospital,  and  also  wards  for  infants  and  children. 


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  individu- 
ally instructed  in  the  use  of  the  stethoscope,  ophthal- 
moscope, laryngoscope,  and  microscope ;  also  special 
instruction  is  given  on  practical  pathology  and  X-ray 
photography.  Three  resident  pupils  are  selected  half- 
yearly  and  two  house  surgeons  annually.  Prize  exami- 
nations, including  examinations  for  the  Hudson  Scholar- 
ship, £30  and  a  gold  medal,  and  a  senior  prize  of  ;£io 
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  Mr. 
Heuston,  F.R.C.S.I.,  15  Stephens  Green  North. 

The  Royal  City  of  Dublin  Hospital.— This  hos- 
pital has  recently  been  enlarged  and  improved  to 
a  very  consideraole  extent.  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  children,  and  of  women,  and  practical  in- 
struction is  given  on  diseases  peculiar  to  women  ;  there 
is  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.  A  new  operation  theatre,  sterilising  room,  and 
anesthetic  room  have  been  constructed  in  accordance 
with  the  most  modem  surgical  requirements.  A 
Rontgen-ray  and  light  treatment  of  lupus  department 
has  recently  been  added.  A  resident  medical  officer 
is  elected  annually,  and  resident  medical  and  surgical 
pupils  are  appointed  from  among  the  past  and  present 
students  of  the  hospital.  Operations  are  performed 
on  Tuesdays,  Thursdays,  and  Saturdays,  at  10  a.m. 
Full  particulars  can  be  had  on  application  to  Mr. 
G.  Jameson  Johnston,  M.B.,  F.R.C.S.I.,  Hon.  Sec.  Med. 
Board. 

Sir  Patrick  Dun's  Hospital  is  situated  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.  Formerly  all  University  students  were  com- 
pelled 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  free  to  all  students.  There  is  a  special 
wing  devoted  to  fever  cases,  and  regular  clinical  instruc- 
tion is  given  by  the  members  of  the  medical  staff 
throughout  the  winter  and  summer  sessions.  Special 
classes  for  students  commencing  their  hospital  studies 
will  be  held  in  these  departments  during  the  months  of 
October,  November,  and  December.  They  will  em- 
brace the  elements  of  medicine  and  surgery,  including 
note-taking.  Opportunities  are  also  afforded  to 
students  for  examining  cases  of  throat,  ear,  and  eye 
diseases,  as  well  as  for  performing  minor  surgical 
operations  and  bandaging.  In  the  X-ray  Department 
opportunities  are  given  the  members  ot  the  hospital 
class  of  seeing  the  various  applications  of  the  X-rays 
to  the  diagnosis  and  treatment  of  injury  and  disease. 

Mater  Misericordia  Hospital. — ^This  hospital, 
containing  335  beds,  is  open  at  all  hours  for  the  recep- 
1  tion  of  accidents  and  urgent  cases.  Fifty  beds  are 
j  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  afiord^  for  the  study  of  the  diseases 
of  women  in  the  wards  under  the  care  of  the  obstetric 
physician,  and  at  the  dispensary,  held  on  Tuesdays  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  dispensary.  A 
special  course  of  instruction  in  pathology  and  bacterio- 
logy, as  applied  to  medicine,  will  be  given.  Connected 
with  the  hospital  are  extensive  dispensaries,  which 
afiford  valuable  opportunities  for  the  study  of  general, 
medical  and  surgical  diseases,  accidents,  &c.     Leonard 


290  .  The  Medical  P&ess. 


IRELAND— EDUCATION. 


Sept.  14*  1904. 


Prizes  :  One  gold  and  one  silver  medal  will  be  offered 
for  competition  annually  in  the  subject  of  medicine,  and 
one  gold  and  one  silver  medal  in  the  subject  of  surgery. 
Junior  Leonard  Prizes  :  Two  prizes,  of  the  value  of  £s 
and  two  prizes  of  the  value  of  £2  will  be  offered  for  com- 
petition m  medicine  and  surgery  respectively. 

Mercer's  Hospital. — ^This  hospital,  founded  in 
1707,  is  situated  in  the  centre  of  DubUii,  in  the  imme- 
diate vicinity  of  the  Schools  of  Surgery  of  the  Royal 
College  of  Surgeons,  the  Catholic  University  School  of 
Medicine,  and  Trinity  College.  It  contains  120 
beds  for  medical  and  surgical  cases,  and  arrange- 
ments have  been  made  with  the  medical  oflBicers 
of  Cork  Street  Fever  Hospital  whereby  all  students 
of  this  hospital  are  entitled  to  attend  the  clinical 
instruction  of  that  institution  and  become  eligiole 
for  the  posts  of  resident  pupil,  &c.  There  is  a  Su-ge 
out-patient  department,  and  a  special  department 
for  diseases  peculiar  to  women.  There  are  also  special 
-wards  for  the  treatment  and  study  of  children's  diseases. 
During  the  past  few  years  the  hospital  has  undergone 
extensive  alterations  m  order  to  brmg  it  up  to  modem 
requirements.  A  house  surgeon  is  appointed  annually. 
Five  resident  pupils  are  appointed,  each  for  six  months, 
and  clinical  clerks  and  dressers  are  appointed  monthly 
from  among  the  most  deserving  members  of  the  class. 
The  certificates  of  this  hospital  are  recognised  by  all 
the  licensing  bodies.  For  further  particulars  apply  to 
Mr.  R.  Charles  B.  Maunsell,  M.B.,  F.R.C.S.,  32  Lower 
Baggot  Street.  Dublin. 

St.  Vincent's  Hospital  was  estabUshed  in  1834,  it 
has  160  beds,  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  medicine  and  surgery,  and  are 
illustrated  by  cases  in  the  hospitals.  The  resident 
officers  consist  of  a  house  surgeon,  a  house  physician, 
and  four  resident  pupils.  Three  clinical  lectures  are 
delivered  daily  in  the  wards,  illustrated  by  selected 
cases,  and  beginning  at  9  a.m.  Two  gold  medals 
and  other  valuable  prizes  and  certificates  of  merit 
are  awarded  at  the  end  of  each  session.  A  prospectus 
can  be  had  from  Dr.  Tobin,  Stephens  Green. 

Dr.  Steevens'  Hospital,  situated  at  Kingsbridge, 
is  one  of  the  oldest  and  largest  of  the  clinical  hospitals 
in  Dublin,  and  contains  over  200  beds.  Recently,  a 
very  fine  Nurses'  Home  has  been  added  to  the  in- 
stitution, with  accommodation  for  over  seventy  nurses. 
And  a  new  and  thoroughly  equipped  dispensary  and 
out-patient  department  has  been  completed  and  opened 
to  patients.  There  is  accommodation  for  twelve 
resident  pupils — ^four  medical,  six  surgical,  and  two  in 
the  special  departments,  each  of  whom  is  supplied  with 
a  separate  room.  All  information  with  regard  to  these 
appointments  can  be  had  from  the  Resident  Medical 
Officer  at  the  hospital.  Licensing  bodies  recognise  six 
months'  residence  as  equivalent  to  a  year's  ordinary 
attendance  at  hospital.  The  manufactories  and  rail- 
way works  in  the  neighbourhood  supply  this  hospital 
with  large  numbers  of  accidents  and  other  cases,  while 
the  special  ward  for  venereal  diseases  affords  excep- 
tional opportunities  for  the  study  of  this  important 
subject. 

Jervis  Street  Hospital  is  the  oldest  established 
in  Dublin.  The  new  hospital  was  completed  in 
1896,  since  which  time  it  has  been  open  for  the  re- 
•ception  of  patients.  In  addition  to  large  medical 
and  surgical  dispensaries,  the  out-patient  depart- 
ment includes  special  departments  for  the  treat- 
ment of  diseases  of  the  skin,  eye,  ear,  and  throat, 
and  diseases  pecuUar  to  women.  Two  resident 
surgeons  are  appointed  annually.  Clinical  clerks  and 
surgeons'  dressers  are  selected  from  among  the  most 
attentive  of  the  advanced  students  without  the  payment 
of  any  additional  fee.  Twelve  interns  are  appointed 
annually,  and  are  provided  with  apartments.  &c.,  free 
of  expense.  Special  certificates  are  given  to  resident 
pupils  and  dressers  who  have  performed  their  respective 
duties  to  the  satisfaction  of  the  physicians  and  surgeons. 
Oold  and  silver  medals  are  given  after  examinations 
held  at  the  close  of  the  summer  session. 


Students  of  the  hospital  will  get  special  iostmctioB 
in  the  diseases  of  children  and  orthopaedic  surgery  at 
the  Children's  Hospital,  Temple  Street.  This  will 
meet  the  requirements  of  the  R.U.I. 

SPECIAL  HOSPITALS. 
The  special  hospitals  of  Dublin  are  the  Rotunda,  thft 
Coombe,  and  the  National  Lying-in-Hospitals,  Cofk 
Street  Fever  Hospital,  the  Royal  Victoria  Eye  and  Ear 
Hospital  (amalgamation  of  St.  Mark's  dphthalmic 
Hospital  and  the  National  Eye  and  Ear  Hospital),  the 
Dental  Hospital,  the  Throat  Hospital,  the  Orthopxdic 
Hospital,  the  Children's  Hospitals  in  Harcourt  Street, 
and  in  Temple  Street,  and  the  City  Hospital  for 
Diseases  of  the  Skin. 

The  Rotunda  Hospital. — ^This  institution  is  the 
largest,  the  longest  established,  and  the  most  famous 
gynaecological  as  well  as  maternity  hospital  in  the 
British  Empire.  The  work  performed  by  it  is  about 
three  times  greater  than  that  of  any  other  hospital 
of  its  kind  in  Ireland.  More  than  2,000  patients  per 
annum  are  admitted  to  the  maternity  wards,  over 
2,700  per  annum  are  attended  in  the  extern  maternity 
department.  The  patients  attending  in  the  out- 
patient department  number  over  14,000  per  annum. 
Daily  clinical  lectures,  operations,  and  practical  in- 
struction in  midwifery,  gynaecology,  and  cystoscopy 
are  delivered  between  the  hours  of  10  and  i  a.m..  and 
a  special  afternoon  class  in  gynaecology  is  held  by  the 
senior  assistant.  The  new  pathological  laboratory, 
under  the  direction  of  Dr.  Neville,  hs^  become  an  im- 
portant feature  of  the  hospital.  The  hospital  affords 
exceptional  advantages  to  qualified  men  who  desire 
to  take  out  post-graduate  courses  in  practical  work. 
Students  can  enter  at  any  time  for  periods  of  one  month 
or  longer.  Certificates  of  attendance  are  accepted  by 
all  the  licensing  bodies,  and  the  hospital  certificate  is 
acknowledged  by  the  Local  Government  Board  as  a 
full  legal  midwifery  qualification.  The  L.M.  certificate 
is  obtained  by  attendance  at  the  hospital  for  six 
months,  with  the  subsequent  passing  of  an  examina- 
tion. A  special  certificate  in  gynaecology  is  given  to 
students  whose  work  meets  with  the  Master's  approval. 
Paid  clinical  assistants  are  selected  (from  among 
those  who  have  obtained  the  hospital  certificate)  by 
competitive  examination  for  periods  of  six  months. 
The  residents'  quarters  have  recently  undergone  com- 
plete renovation,  and  afiiord  comfortable  accommo- 
dation. 

CooMBE  Lying-in  Hospital. — ^This  hospital,  which 
has  been  rebuilt  and  considerably  enlarged,  and  contains 
70  beds,  was  founded  in  1826  by  BIrs.  Boyle,  and  "was 
incorporated  by  Royal  Charter  m  1867  ;   it  is  situated 
in  the  centre  of  a  district  densely,  populated  by  the 
poorest    of    the    community,    and    thus    affords    the 
amplest  opportunities  for  practice.      It  receives  about 
800  labour  cases  within  its  walls,  while  those  attended 
as  extern  amount   to  more  than   2,000  in   number. 
Moreover,  the  gytiaecological  hospital  for  the  reception 
of  cases  of  the  diseases  peculiar  to  women  gives  ad- 
mission to  nearly  300  patients  annually.     A  new  wing 
for  gynaecological  cases  has  been  added.     The  fee  for 
attendance  is  £S  8s.  for  six  months  as  extern,  and 
;£i8  1 8s.  as  intern  pupil.     During  that  period,  the  pupil 
attends  on  given  days  and  nights  in  each  week,  and 
takes  charge  in  his  turn  of  any  case   that   may  be 
admitted  to  the  labour  wards,  or  may  call  forhisassis- 
ance  outside.     A  clinical  clerkship  is  obtainable  half- 
yearly  by  all  pupils  who  have  obtained  their  midwifery 
diploma  from  the  hospital,  and  special  certificates  are 
given.     Lectures  are  delivered  in  the  hospital,  and 
clinical  instruction  is  given  daily  at  the  bedside.  Nurses 
who  take  out  the  usual  hospital  course  of  six  months 
receive  special  instruction  in  midwifery-,  and  can  obtain 
their  diplomas  at  the  termination  of  the  course,  on 
passing  the  examination. 

♦  National  Maternity  Hospital. — ^This  institution, 
under  the  mastership  of  Dr.  Barry  and  Dr.  A.  Home, 
is  situated  in  Holies  Street. 

Sir  Patrick  Dun's  Maternity. — This  is  a  branch  of 
Sir  P.  Dun's  Hospital,  and  is  under  the  management  of 
the  King's  Professor  of  Blidwifery  in  Dublin  University. 


Sbft.  14,  1904. 


IRELAND— EDUCATION. 


The  Medical  Press.    29T 


The  department  is  at  present  in  process  of  being  re- 
orfcanised; 

Cork  Street  Fever  Hospital  is  the  only  special 
fever  hospital  in  Dublin.  It  is  supported  mainly  by  an 
'anxiiial  Government  grant,  and  capitation  grants  for 
patients.  Regular  clinical  instruction  is  given  during 
the  "Winter  and  summer  session  to  those  who  desire  a 
special  course  in  fevers.  There  are  also  courses  for 
the  Diploma  in  Public  Health.  All  particulars  may 
i^e  obtained  on  application  to  the  Medical  Superin- 
tendent. 

The  National  Children's  Hospital  for  the  treat- 
ment of  all  non-infectious  diseases  peculiar  to  children, 
yrith  which  the  Pitt  Street  Children's  Hospital,  founded 
in  1 82 1,  was  amalgamated,  is  capable  of  containing  50 
heds  for  the  reception  of  cases  of  deformity  and  all 
other  forms  of  surgical  disease.  There  is  a  large 
S^neral  dispensary  for  extern  patients  held  daily  from 
10  to  II.  Operations  are  performed  on  Saturday  at 
12  o'clock.  Practitioners  and  students  can  attend  on 
application  to  Sir  Lambert  H.  Ormsby,  F.R.C.S.I. 

Xhk  Children's  Hospital,  Dublin  (under  the  care 
of  the  Sisters  of  Charity). — ^This  institution  is  one  of  the 
most  progressive  and  up-to-date  children's  hospital  in 
the  Kingdom,  besides  being  the  largest  in  Ireland. 
There  are  100  beds  available  for  patients  ;  about  i.ooo 
cases  are  admitted  to  the  wards  annually  ;  and  about 
7,000  or  8,000  seen  in  the  dispensary.  During  the  last 
year  a  new  operating  theatre  has  been  opened.  It  is 
^tted  and  furnished  in  the  best  possible  fashion  for 
present-day  surgery.  Special  attention  is  given  to 
orthopaedic  surgery,  and  the  number  of  deformities 
from  all  parts  of  Ireland  treated  and  cured  in  the 
hospital  is  rapidly  increasing.  A  special  masseuse 
lias  been  appointed  to  the  hospital  to  aid  in  this  depart- 
ment. A  convalescent  home  for  the  institution  has 
recently  been  acquired  at  Rahomy ;  twenty  beds  are 
available.  While  situated  in  the  country,  it  is  within 
very  easy  reach  of  the  sea,  and  during  the  summer  the 
children  are  brought  daily  to  the  sea-side. 

The  hospital  is  recognised  for  clinical  instruction  in 
the  diseases  of  children  b}r  the  R.U.I,  and  licensing 
bodies,  which  require  a  certificate  of  instruction  in  this 
imXMDrtant  branch  of  medical  education.  A  nursing 
home  is  in  connection  with  the  institution,  and  trained 
nurses  are  always  available  for  private  cases.  Senior 
students  or  others  requiring  a  post-graduate  course  at 
the  hospital  should  apply  for  full  particulars  to  H.  C. 
Mooney,  hon.  sec.,  or  to  any  member  of  the  staff. 

The  Incorporated  Orthop-«dic  Hospital,  Ire- 
land.— ^This  hospital  was  founded  in  1876.  and  contains 
T'O  beds.  It  is  available  for  every  class  of  deformity 
available  for  treatment.  Particulars  may  be  obtained 
from  Captain  Borthistle,  Registrar,  at  the  hospital,  or 
from  R.  L.  Swan,  F.R.CS.I.,  32  Stephen's  Green. 

The  Royal  Victoria  Eye  and  Ear  Hospital, 
Adelaide  Road,  Dublin. — ^This  hospital,  which  was 
opened  in  March,  1904,  is  an  amalgamation  of  St. 
Mark's  Ophthalmic  Hospital  and  the  National  Eye 
and  Ear  Infirmary.  The  hospital  contains  80  beds. 
Clinical  instruction  in  diseases  of  the  eye,  including  the 
-use  of  the  ophthalmoscope  and  operations,  is  given 
daily  from  10  till  i.  Instruction  in  aural  surgery  is  also 
given.  Special  classes  for  practical  instruction  in  the 
-use  of  the  ophthalmoscope,  &c.,  and  for  the  demon- 
stration of  cases,  are  formed  from  time  to  time 

The  Incorporated  Dental  Hospital,  Lincoln 
Place. — ^This  handsome  hospital,  recently  erected, 
is  the  only  special  Dental  Hospital  in  Dublin.  It  is 
•officered  by  a  very  strong  stafi  of  the  leading  dental 
surgeons  of  Dublin,  and  has  a  large  clientele  and  exten- 
sive practice  among  the  Dublin  poor.  The  fees  are 
^151 5s.  for  the  first  year's  study,  and  ;£i2  12s.  for  second, 
-and  proportionately  smaller  fees  for  shorter  periods. 

The  City  Hospital  for  Diseases  of  the  Skin  and 
-Cancer,  Great  Brunswick  Street. — ^The  first  and  only 
one  of  its  kind  in  the  city  was  the  first  in  Ireland  to 
instal  the  Finsen  treatment.  Senior  students  are 
admitted  free  to  the  practice  of  this  hospital,  which  has 
a  large  daily  out-patient  attendance.  Classes  of  in- 
-struction  wiU  be  given  at  regular  intervals  during  the 


winter  and  summer  sessions  in  the  use  of  the  Finsen 
light.  X-rays,  high  frequency  currents  and  radium,  with 
demonstrations  on  (i)  the  production  and  use  of  the 
Rontgen  rays,  (2)  electric  currents,  direct  and  alter- 
nating, with  description  of  resistances  and  rectifiers  ; 
(3)  accumulators,  their  construction,  use,  and  methods 
in  charging;  (4)  vacuum  tube,  choice  of  tube  for 
particular  kinds  of  work.  Fluorescent  screen,  and 
how  to  localize  foreign  bodies. 

BELFAST     HOSPITALS. 

♦  Hospital  for  Sick  Children,  Queen  Street. — This 
institution,  erected  by  voluntary  donations,  and  sup- 
ported by  voluntary  contributions,  was  opened  for  the 
reception  of  patients  on  April  24th,  1 879.  The  hospital 
consists  of  a  medical  ward  with  twenty-eight  beds,  and 
one  of  a  similar  size  for  surgical  cases.  It  is  strictly 
non-sectarian  in  its  principles,  and  is  open  to  all  de- 
nominations. Children  from  birth  to  the  age  of  1 2  years, 
and  not  suffering  from  contagious  disease,  are  ad- 
missible as  in-patients.  A  very  large  extern  is  con- 
ducted in  the  out-patient  department  between  the 
hours  of  9  and  10  a.m.,  where  children  from  birth  to 
14  years  are  attended  to.  The  convalescent  home, 
which  is  situated  at  Newtownbreda,  contains  thirteen 
cots,  and  its  situation  and  equipment  render  it  an 
admirable  adjunct  to  the  after-treatment  of  the  cases 
admitted  to  the  hospital.  During  the  winter  session 
systematic  courses  of  lectures  and  demonstrations  in 
the  medical  and  surgical  diseases  of  infancy  and  child- 
hood are  delivered  in  the  wards  on  Wednesday  and 
Friday  of  each  week  at  9  a.m. 

♦»fATER  Infirmorum  HOSPITAL. — ^Established  1883. 
160  beds. 

The  Belfast  Maternity  Hospital  (Incorporated). 
— ^Established  1794.  16  beds. — ^The  practice  of  the 
Maternity  Hospital,  the  certificate  of  which  is  recog- 
nised by  the  Royal  University,  &c.,  &c.,  is  open  to 
students.  The  fee  for  the  session  is  £2  2S.  Resident 
nurses  are  also  received  for  training  for  a  period  of  six 
months,  and  a  diploma  given  which  is  recognised  by 
public  bodies.  Conditions  for  such  on  application  to 
the  Matron.  During  the  year  1903,  326  patients  were 
treated  in  the  hospital,  and  304  patients  at  their  own 
homes.  Besides  this,  458  patients  were  dealt  with  in 
the  extern  gynaecological  department.  Clinical 
lectures  and  bedside  demonstrations  are  given  by 
members  of  the  staff  during  both  the  winter  and  summer 
sessions.  Students  wishing  to  attend  should  apply 
to  Dr.  H.  D.  Osborne,  32  Lonsdale  Terrace,  Belfast, 
Hon.  Secretary  to  Medical  Staff,  on  or  before  November 
1st  and  May  ist. 

Ophthalmic  Institution  and  Eye  and  Ear 
Hospital,  Great  Victoria  Street,  Belfast.- 
EstabUshed  1844.  New  hospital  erected,  1867.  New 
extern  department  and  operation  theatre  added,  1902, 
This  hospital  is  situated  on  the  main  road  between 
Queen's  College  and  the  Royal  Victoria  Hospital.  It 
contains  about  30  beds  for  intern  patients,  and  a  large 
extern  department.  The  latter  is  open  on  Monday, 
Wednesday,  and  Friday  at  noon  for  eye  cases,  and  on 
Monday  and  Thursday  at  noon  for  ear  and  throat  cases< 
Special  courses  of  instruction  are  given  during  the 
winter  and  summer  sessions,  but  students  can  enter  at 
any  time,  and  can  always  obtain  plenty  of  practice  in 
ophthalmoscopic  work.  Full  particulars  may  be 
had  Irom  Dr.  Cecil  Shaw,  18  College  Square  East, 
Belfast. 

Royal  Victoria  Hospital. — Established  1791  ; 
incorporated  by  Royal  Charter,  1875  and  1898.  New 
hospital  opened,  September  17,  1903.  300  beds ; 
Convalescent  hospital,  24  beds  ;  Children's  Hospital, 
33  beds ;  Consumptive  Hospital,   10  beds. 

Ulster  Eye,  Ear,  and  Throat  Hospital. — 
FstabUshed  1871,  New  hospital  opened  1874,  30 
beds. 

♦Ulster  Hospital  for  Children  and  Women, 
Mountpottinger,  Belfast,  is  the  only  hospital  in  the 
large  part  of  the  city  situated  on  the  County  Down 
side  of  the  river.  It  is  placed  in  a  working-class 
district,  and  has  a  great  field  for  its  charitable  opera- 
tions.    There  are  in  the  hospital  about   twenty-two 


292    The  Mbdical  Pmss. 


IRELAND— EDUCATION. 


Sbft,  14.  1904. 


beds  for  children  and  eight  for  women«  There  is  an 
extern  department  for  children  open  every  week-day, 
except  Saturday,  from  9  till  10,  and  for  -women  at 
11.30,  and  a  special  department  for«diseases  of  the  eye, 
ear,  and  throat  on  Tuesdays  and  FHdays  from  9  till  io« 
During  the  summer  and  wmter  sessions,  clinical  instruc- 
tion is  given  to  students  daily,  operations  being  chiefly 
performed  on  Wednesday  and  Saturday.  There  is  a 
resident  midwife  for  extern  work,  and  every  facility  is 
aflorded  students  for  attending  their  cases  in  the 
district. 

CORK  HOSPITALS. 
Victoria  Hospital  for  Women  and  Children. — 
Established  1874.     70  beds. 

♦  County  and  City  of  Cork  Lying-in  Hospital, — 
Established  1798.     17  beds. 

♦  Eye,  Ear,  and  Throat  Hospital,  Western  Road. — 
Incorporated  1898.     35  beds. 

♦Fever   Hospital   and   House  of  Recovery. — 
Established  1 80 1 4     no  beds. 
♦Maternity.^ — Established  1872. 
♦Mercy  Hospital, — Established  1857.     80  beds. 

♦  North  Charitable  Infirmary. — Established  1774. 
1 10  beds. 

Cork  South  Infirmary  and  County  Hospital. — 
Founded  1773.  The  hospital  contains  100  beds, 
available  for  clinical  instruction,  40  medical  and  60 
surgical.  There  are  also  special  wards  devoted  to  the 
treatment  of  diseases  peculiar  to  women  and  children, 
and  a  large  medical  and  surgical  extern  department. 

Clinical  instruction  is  given  daily  during  the  session 
from  9.30  to  11.30,  in  both  the  medical  and  surgical 
wards,  and  clinical  lectures  are  regularly  deUvered. 

The  operation  and  sterilising  rooms  are  thoroughly 
up  to  date.  The  X-ray  department  is  fully  equipped 
with  the  newest  apparatus  necessary  for  such  work. 
Students  are  regularly  instructed  in  the  methods  of 
using  tlie  rays  by  practical  demonstration  on  the  cases 
requiring  their  use. 

The  hospital  has  been  largely  availed  of  by  students 
of  the  Cork  School  of  Medicine. 

GALWAY  HOSPITALS. 

♦  County  Hospital. — EstabUshed  1786.     60  beds. 

*  No  Muwer  to  our  requeet  tor  information  received  from  these 
hospitals. 

IRISH  PUBLIC  SERVICES. 
The  Poor-law  Medical  Service. 
Since  the  early  part  of  1899,  ^  "^taX  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  allocation  of  duties  of  medical  officers 
was  transferred  from  the  old  Boards  of  Guardians,  com- 
posed in  due  proportion  of  members  elected  by  the 
local  voters  and  members  who  acted  ex-officio  in  virtue  of 
property  qualiiications,  to  new  boards  composed  wholly 
of  the  elected  representatives.  This  change  has  placed 
the  sole  control  of  the  service  in  the  hands  of  the  elected 
Guardians,  who  have,  we  regret  to  say,  sought  to  place 
considerations  of  economy  before  everything.  The 
Irish  Medical  Association,  whose  work  it  is  to  safe- 
guard the  interests  and  improve  the  condition  of 
the  Poor-law  medical  officer,  considers  it  an  im- 
perative duty  to  point  out  to  young  practitioners 
the  following  facts: — (i)  That  the  Poor-law  Medical 
Service  is  one  in  which  there  is  no  promotion.  (2) 
That  it  is  a  service  where  few  facilities  exist  for  original 
research,  and  still  less  for  further  medical  culture, 
especially  in  the  rural  districts.  (3)  That,  while 
medical  education  has  become  wider  in  its  require- 
ments, and  more  costly  and  difficult  to  procure, 
the  same  or  a  less  rate  of  payment  given  to  less 
educated  men  forty  years  ago  is  still  offered,  and  this, 
too,  at  a  time  when  the  rural  prosperity  of  the  country 
is  less,  and  consequently  lucrative  private  practice  more 
difficult  to  obtain. 

We  need  go  no  further  than  to  say  that  the  Irish 
Poor-law  Medical  Service  is  a  service  to  avoid.  To  all 
who  contemplate  entering  it  we  emphatically  say. 
Don't.  So  important  is  it  that  young  medical  men 
should  recognise  what  Ufe  in   the  Poor-law  Medical 


Service  means  at  present  that  we  quote  a  short  extoa 
from  a  letter  written  by  a  member  of  it : — "  Wc  have 
no  pay  practically;  no  holidays.  We  are  always oa 
duty.  We  have  no  pension.  We  have  no  promotioiL 
Consequently,  every  day  spent  in  snch  a  service  is  one 
day  worse,  which,  I  think,  makes  it  fairly  rank  at  fim 
very  worst  service  of  any  kind  in  the  world,  for  aiy 
other  service  leads  a  man  to  promotion  or  pensioB, 
In  addition,  the  fact  of  a  man  being  in  this  service 
lowers  his  social  status.  Everything  points  to  it 
being  a  service  to  be  shunned." 

Reforms  must  come  finally,  but  they  will  only  come, 
as  they  have  come  in  other  services,  in  conseqnenoe  d 
the  dearth  of  candidates.  The  various  branches  of  the 
Irish  Medical  Association  through  the  country  have 
found  it  necessary  to  adopt  the  following  resolution  :— 
"  That  henceforth  no  medical  man  shall  apply  for  or 
accept  any  dispensary  appointment  at  a  smaller 
remuneration  than  ;{2oo  per  annum,  or  workhouse 
appointment  under  2^20  per  annum,  unless  both  be 
held  conjointly,  when  the  minimum  salary  shall  be 
;£300  per  annum."  Already  the  effect  of  this  is  beiag 
felt,  and  many  dispensary  districts  are  vacant.  We 
desire  to  point  out  to  the  young  qualified  man  the 
importance  of,  in  all  cases,  supporting  the  interests  ci 
the  profession  as  a  whole  on  tlus  important  question. 

There  are  159  workhouses  and  about  813  dispensary 
medical  officers,  besides  apothecaries.  The  number  d 
vacancies  that  occur  annually  averages  100.  The 
salary  in  this  service  used  to  average  about  ;£ii4.  hut  is 
rapidly  coming  down,  and  when  it  is  taken  into  con- 
sideration that  in  the  vast  majority  of  rural  districts  it 
is  necessary  to  keep  one  or  more  horses,  the  average 
area  being  from  forty  to  sixty  square  miles,  it  is  plaia 
that  there  will  not  be  a  large  margin  left  from  the  puHit 
emoluments. 

The  medical  officer  is  also  ipso  facto  the  registrar  of 
births,  marriages,  and  deaths,  and  medical  officer  d 
health  for  the  district,  under  the  PubUc  Health  Act. 
passed  in  1873  and  amended  in  1878.  The  former  ofl5ce, 
in  country  districts,  yields  between  £$  and  ;f  10  a  year. 
and  the  emoluments  of  the  latter  appointment  in  very 
few  cases  reach  ;f  20,  averaging  about  £1 2.  The  medial 
officer  is  also  vaccinator  for  the  locality,  and  is  required 
to  vaccinate  everyone  who  wishes  to  come.  For  each 
patient  a  fee  of  2s.  is  paid,  along  with  his  salary,  by  the 
guardians,  and  the  sum  total  of  those  fees  varies,  accord- 
ing to  the  populousness  of  the  district,  from  £^  to  lioc^, 
an  average  for  the  provinces  being  about  £10. 

Qualifications. — The  qualifications  required  by  the 
Local  Government  Board  are  a  hcence  in  surgery,  ia 
medicine,  and  in  midwifery ;  but  registration  in  the 
"  Medical  Register,"  if  effected  since  the  passing  of  the 
Medical  Act,  in  1886,  fulfils  all  requirements.  The 
candidate  must  also  be  23  years  of  age. 

The  appointment  to  both  workhouse  and  dispensary 
lies  with  the  guardians,  who  elect  by  vote.  As  politics 
and  rehgious  feehng  run  high  in  Ireland,  these  elements 
enter  largely  into  the  election  of  Poor-law  medical 
officers.  Family  interests  also  possess  great  weight. 
In  some  districts  an  attempt  has  been  made  to  insist 
upon  the  candidate  being  a  member  of  the  United 
Irish  League.  We  need  not — ^we  trust — ^point  out  to 
any  member  of  the  medical  profession  that  to  endeavour 
to  obtain  a  post  on  such  a  quahfication  as  that  of  the 
membership  of  any  political  organisation  is  to  commit 
an  act  which  is  unworthy  of  his  profession. 

Duties, — ^The  duty  of  the  dispensary  doctor  is  two- 
fold. He  is  to  attend  his  dispensary  on  a  given  day  or 
days  in  the  week.  Frequently  there  arc  two  dispen- 
saries in  the  district,  separated  from  each  other  by 
several  miles,  and  he  will  have,  perhaps,  to  attend  tw 
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  reUeving  officer,  and  to  continue  his  attendance 
as  often  as  may  be  necessary  to  the  termination  of  the 
case.  Moreover,  he  has  a  great  many  registry  books 
to  keep  and  a  multitude  of  returns  to  make,  and  in 
many  districts  he  has  to  make  up  all  the  medicines  fos 
the  poor. 


Sept.  14,  1904. 


SCOTLAND— EDUCATION. 


The  Medical  Peess.       295 


The  pressure  of  these  duties  is  in  a  great  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  in  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  differ  from  the  guardians,  his  position  may  become 
impossible.  He  may  be  peremptorily  summoned  in 
any  weather,  at  any  hour,  and  to  any  distance,  to  a 
case  which  he  may  probably  find  to  be  altogether 
trivial,  or  to  a  person  whom  he  may  know  to  be  per- 
fectly well  able  to  pay. 

Workhouse  Hospitals. — ^The  number  of  unions  in 
Ireland  in  1 59,  to  each  of  which  is  attached  a  medical 
officer,  who  is  appointed  and  controlled  by  the  board  of 
guardians  in  the  same  manner  as  the  dispensary  surgeon. 
The  salary  is  usually  better  than  that  of  the  dispensary 
doctor,  and  the  duties  of  a  more  easy  and  satisfactory 
description,  inasmuch  as  they  are  confined  to  daily 
attendance  at  the  workhouse  hospitals,  and  no  night 
visits  out  of  doors  or  long  journeys  across  the  country 
are  involved. 

The  Irish  Lunacy  Service. 

This  service,  at  present,  affords  a  comfortable  liveli- 
hood for  22  Resident  Medical  Superintendents  and  32 
Assistants.  The  Superintendents  receive  salaries  and 
allon(<rances  ranging,  according  to  the  number  of  inmates 
of  the  asylum,  from  ;£5oo  to  ;i  1,000  a  year,  and  the 
Assistants  receive  salaries  and  emoluments  averaging 
about  ;f200  a  year.  There  are  also  Visiting  Physicians 
receiving  about  ;fi20  a  year,  but  this  class  of  officer 
is  being  allowed  to  die  out,  and  no  new  appointments 
will  be  made.  The  Superintendents  and  Assistants 
must  devote  their  whole  time  to  their  duties. 

Heretofore  the  appointments  of  Medical  Superin- 
tendents have  been  in  the  patronage  of  the  Lord 
Lieutenant,  but,  under  the  new  Local  Government 
Act,  they  are  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 
which  the  management  of  the  the  asylum  is  entrusted. 
In  addition  to  these  officers,  there  are,  in  certain  larger 
asylums.  Clinical  Residents,  who  receive  about  £$0 
a  year  and  full  allowances.  These  appointments  afiord 
excellent  introduction  to  the  higher  places  in  the  service. 
Other  Appointments. 

There  are,  in  addition  to  those  which  we  have  men- 
tioned, centain  appointments  open  to  medical  practi- 
tioners in  special  localities.     They  are  : — 

(i)  Attendance  on  the  Royal  Irish  Constabulary. 
(2)  Attendance  on  the  Coastguards.  (3)  Factory 
Surgeoncies.  (4)  Attendance  upon  the  depot  soldiers 
who  are  not  otherwise  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  jposition  rests  with  the 
Inspector-General  of  the  Royal  Irish  Constabular^r,  who 
usually  acts  upon  the  advice  of  tne  local  District 
Inspectors  as  to  the  convenience  of  the  men,  and,  of 
course,  the  emoluments  depend  on  the  number  of 
Constabulary  stations  and  the  number  of  men  in  each. 

The  Coastguard  Service. — ^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  5s.  to  2s.  6d.  per  visit.  The  appoint- 
ments rest  with  the  Admiralty,  but  are  usually  secured 
for  the  local  Poor-law  Medical  Officer.  In  this  case, 
also,  emoluments  depend  on  the  number  of  stations  and 
men. 

Factory  surgeoncies  are  in  the  gift  of  the  Chief 
Inspector  of  Factories  in  Whitehall.  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  upon  the 
size  of  the  factory,  the  position  being,  in  Dublin  or 
Belfast,  or  in  other  large  manufacturing  centres,  a 
lucrative  one,  but  in  other  places  scarcely  worth  taking. 
The  attendance  on  the  military  depdts  is  not  worth 
mentioning. 

The  names  of  the  Professors,  Lecturers,  and  Hospital 
Staffs  of  the  foregoing  Schools  and  Hospitals  are  not 
included  in  this  place,  being  found  in  the  advertisement 
of  each  Institution,  as  indicated  belott. 


Boyal  College  of  PhyBicians  54 

SehooU. 

Univewity  of  Dublin  ...  59  . 

Royal  CoUefre  of  Surgeons  ...  55 

Queen's  College,  Cork  ...  62 

Queen's  College,  GkJway      ...  53 

CathoUo  Univenity 69 

General  HospitaU: 

Royal  City  of  Dublin 61 

Sir  Patrick  Dun's       52 


St.  Vincent's     6* 

Richmond,    Whitworth  and 

Haxdwioke 52^ 

Mesfh     55 

Adelaide e(y 

Jervis  Street 60 

Special  H(Mitais  : 
City  Hospital  for  Disease)  of 

the  Skin       52 

Rotunda,  Lying-in     55 

Royal  Victoria  Eye  and  Ear  62 

National  Children's    G» 

Incorporated  Dental  ...        .^  54 


NoTWiTHSTANDiNc;  the  increased  competition  which 
the  recent  vigorous  growth  of  the  great  English  pro- 
vincial medical  schools,  added  to  the  unsurpassed 
attractions  of  the  historic  Metropolitan  hospitals,  with 
their  stafEs  of  renowned  teachers,  ensures,  the  Scottish 
medical  schools  seem  fully  to  retain  their  popularity,, 
not  only,  as  is  natural,  among  Scotsmen  and  their 
colonial  descendants,  but  among  medical  students  from. 
England.  Wales,  and  Ireland,  and,  indeed,  all  parts  of 
our  Empire.  In  fact,  if  appearances  be  any  guide,  it 
would  seem  that  the  number  of  Oriental  students- 
attending  classes  in  Edinburgh  is  increasing  year  by 
year.  And  undoubtedly  the  competition  of  other 
centres  has  had  the  advantage  of  making  Scottish 
teachers  bestir  themselves,  with  the  result  that  the- 
efficiency  of  the  medical  schools  is  now  much  greater- 
than  a  decade  ago.  The  Carnegie  bequest,  which, 
practically  ensures  free  university  education  to  all' 
Scotsmen  who  are  willing  to  take  advantage  of  it,  has 
considerably  increased  the  number  of  undergraduates, 
but  it  is  thought  that  the  increase  from  this  cause  has 
now  attained  its  maximum.  The  benefit  of  the  second 
half  of  the  bequest,  i.e.,  the  improved  equipment  of 
the  teaching  schools  and  the  encouragement  of  post- 
graduate research,  are  naturally  slower  in  manifesting 
themselves,  but  will  prove  permanent  factors  m  pro- 
moting the  well-being  of  the  Universities  and  Scottish 
education  generally.  Of  the  four  universities,  Edin- 
burgh, of  course,  occupies  the  premier  position  as  a 
medical  school,  but  at  Glasgow,  Aberdeen,  and  St^. 
Andrews,  an  almost  equally  good,  indeed  '"  individual 
details,  better — training  can  be  obtained.  Two  ordi 
nary  qualifications  to  practise  are  granted  in  Scotland — 
the  M.B.,  Ch.B.  of  the  Universities,  and  the  triple 
qualification  of  the  Colleges  of  Physicians  and  Surgeon? 
of  Edinburgh  and  the  Faculty  of  Physicians  and 
Surgeons  of  Glasgow.  The  standard  of  examination  for 
the  University  degree  is  naturally  a  good  deal 
higher  than  that  for  the  triple  qualification,  and  the 
curriculum  wider.  Nevertheless,  the  standard  for  the 
latter  is  being  steadily  raised,  though,  on  account  of 
the  large  number  of  examiners  in  most  subjects  it  is 
probably  slightly  less  uniform  than  that  of  the  univer- 
sities, where  the  examinations  are  conducted  by  the 
professors  with  one  or  more  extra-mural  assessors  in 
each  subject.  Two  features  of  the  Scottish  system 
deserve  mention — ^first,  as  regards  the  co-ordination  ot 
various  separate  teaching  bodies  in  each  centre  ;  second ».. 
as  regards  the  conditions  under  which  the  students  live.^ 


294    The  Medical  Pkess. 


SCOTLAND— EDUCATION. 


Sept.  14,  1904. 


.Around  each  university  there  has  grown  up  an  extra- 
mural medical  school*  in  which  the  teachers  are  hospital 
physicians,  surgeons,  and  specialists  unconnected  with 
"fthe  university,  but  whose  classes  qualify  for  graduation. 
Thus  the  student  has  usually  ample  choice,  and  can, 
within  certain  limits,  attend  the  teacher  from  whom 
he  thinks  he  will  derive  most  benefit,  while  the  extra- 
mural   lecturers,    being    unendowed    and    constantly 
^recruited  by  fresh  blood,  have  a  permanent  incentive 
to  keep  their  courses  up  to  the  mark,  since  any  slack- 
ness is  at  once  followed  by  a  diminution  in  the  number 
'Of  students'  fees.     In  hospital  work  it  is  the  same,  the 
student  having  the  option  of  attending  a  clinical  pro- 
fessor and  an  ordinary  physician  or  surgeon.     A  very 
important  part  of  the  student's  clinical  work,  too,  is 
done  at  institutions  and  under  teachers  quite  uncon- 
nected with  the  universities ;    this  is  his  dispensary 
practice,  which  may  be  taken  at  one  of  several  dis- 
pensaries situated  in  the  poorer  districts  of  the  towns. 
Until  recently,  practical  training  in  obstetrics  was  one 
'of  the  least  satisfactory  parts  of  the  teaching  in  Edin- 
burgh, and  many  students  were  in  the  habit  of  going 
to  Glasgow  to  take  their  maternity  work  there,  where 
the    department    is    excellently    organised    and     the 
material  ample.     Recently,  however,  steps  have  been 
taken  which  should  render  this  unnecessary,  and  ought 
to  give  Edinburgh  students  quite  sufficient  opportunity 
•of  acquiring  as  good  a  practical  acquaintance  with  this 
most  important  subject  as  they  have,  and  previously 
had,  of  obtaining  a  theoretical  knowledee  of  it.     From 
what  has  been  said  it  will  be  seen   that  university 
'  undergraduates    and    triple    qualification    men     rub 
■  shoulders  at  every  turn — ^in  the  wards,  dispensary,  and 
lecture-room.     University  students  have  the  privilege 
■K>f  studying  under  both  intra-  and  extra-mural  teachers, 
while  men  going  up  for  the  triple  qualification  are 
limited  to  the  latter.     It  is  not  uncommon,  therefore, 
for  a  man  to  come  up  intending  to  take  the  licence, 
and  to  change  his  mind  and  go  in  for  a  degree,  or  vice 
ifATsd.  and  this  can  usually  be  done  without  much 
-added  expense  or  taKing  out  many  fresh  classes,  pro- 
-vided  the  change  is  not  made  too  late  in  the  curriculum. 
For  the  rest,  the  student  lives  as  he  likes  and  where 
lie  likes;    the  authorities  only  demand  that  he  shall 
attend  classes  with  due  regularity  and  diligence,  and 
-exhibit  sufficient  proficiency  to  pass  his  examinations. 
Most  men  live  in  lodgings,  a  few  board  with  private 
families,  and  some  live  in  the  various  halls  of  residence 
-which  have  been  established.     In  these  last,  too,  the 
student  ^s  his  own  master,  the  halls  being  managed 
solely  by  a  committee  of  the  residents  for  the  time 
l)eing.     It  is  impossible  to  make  any  very  definite 
-statement  as  to  the  relative  cost  of  a  medical  education 
in  the  different  schools,  as  compared  with  London  and 
Dublin,  as  so  much  depends  on  the  extra  classes  taken 
out,  the  mode  of  living,  and  so  on.     The  minimum 
inclusive  fees  for  the  Licence  are  ;fi20,  for  the  M.B. 
degree  about  ;ii46 ;   but  almost  every  student  finds  it 
practically  necessary  to  attend  additional  classes.     On 
the  whole,  the  cost  of  living  is  highest  in  Edinburgh, 
lowest  in  Aberdeen ;   in  the  former,  while  the  rent  of 
lodgings  is  lower  than  in  London,  maintenance,  in- 
cluding clothing  and  provijsions,   is  some\vhat  more 
expensive.     Incidental  expenses,  amusements,  &c.,  are, 
however,   considerably  less  in   the  Northern  capital. 
In  Aberdeen,  money  goes  much  further  than  in  the 
south,  and  the  student  ought  to  keep  himself  on  about 
two-thirds  of  the  funds  required  in  Edinburgh. 

THE    CARNEGIE    TRUST. 
Through  the  munificence  of  Mr.  Andrew  Carnegie, 
JLJL.D.,  payment  is  now  made  -•  of  the  whole  or  part  of 


the  ordinary  class  fees  exigible  by  the  Universities  from 
students  of  Scottish  birth  or  extraction,  and  of  siztees 
years  of  age  or  upwards,  or  scholars  who  have  given  t«o 
years'  attendance,  after  the  age  of  fourteen  years,  at 
State-aided  schools  in  Scotland,  or  at  such  other  schools 
and  institutions  in  Scotland  as  are  under  the  in^ectkm 
of  the  Scottish  Education  Department." 

The  Trust  provides  for  the  pajrment  of  the  class  ftn 
of  the  above  students  proceeding  to  graduation  in  medi- 
cine or  science.  Application  for  payment  of  class  fees 
under  the  conditions  of  the  Trust  should  be  made  to  tbe 
Secretary.  Mr.  W.  S.  McCormick,  Merchante'  HaH 
Hanover  Street,  Edinburgh. 

Scholarships,  Fellowships,  and  Grants  in  aid  of 
original  research  are  now  awarded  annually  by  the 
Trust.  For  particulars,  conditions,  &c.,  apply  to  the 
Secretary. 

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  (ChJl). 
The  first  two  must  be  taken  together,  the  last  two  may 
be  taken  separately. 

No  one  is  admitted  to  the  degrees  of  Bachelor  oi 
Medicine  and  Bachelor  of  Surgery  who  has  not  beea 
engaged  in  medical  and  surgical  study  for  five  yean, 
after  passing  a  preUminary  examination  in  general 
knowledge  in  accordance  with  the  medical  ordinances. 
A  degree  in  Arts  or  science  of  a  British  or  other  recog- 
nised University  is  held  to  supersede  such  preliminary 
examination.  The  subjects  mcluded  in  this  general 
examination  are  Enghsh  grammar  and  compost  tion. 
EngUsh  history  and  geography,  Latin,  arithmetic  and 
the  elements  of  mathematics,  and  Greek*  or  French, 
or  German. 

The  annus  medicus  of  each  year  is  held  to  be  consti* 
tuted  by  at  least  two  courses  of  not  less  than  one 
hundred  lectures  each,  or  by  one  of  such  courses,  and  tvo 
courses  of  not  less  than  fifty  lectures  each,  exclusive  of 
the  clinical  courses,  in  which  lectures  are  given  twice  a 
week  during  prescribe  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 
University  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  during  courses  of  not 
less  than  2^  months  each  ;  public  health,  not  less  thaii 
thirty  lectures ;  practical  anatomy,  during  two  courses  of 
not  less  than  five  months  each ;  chemistry,  anatomy, 
physiology,  pathology,  surgery  ;  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  or  college  affiliated  to  a  Univer- 
sity entitled  to  grant  the  degree  of  M.D.  He  most 
attend  a  course  of  twenty-five  lectures  on  practical 
pharmacy  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  estabhsh- 
ment  recognised  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  dinical  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  stafi  of  physicians  and  surgeons,  and  he  must 
have  acted  as  clerk  in  the  medical  and  dresser  in  the 
surgical  wards  of  such  a  hospital,  and  the  practice  of  a 
dispensary,  or  of  a  physician  and  surgeon.  He  must 
also  have  had  approved  opportunities  of  studying  (i) 
operative  surgery,  (2)  mental  diseases  at  a  recognised 
asylum,  (3)  at  a  recognised  hospital,  post-mortems, 
fevers,  and  diseases  of  the  eye,  and  (4)  one  of  the  follow- 
ing :  Diseases  of  children,  of  the  ear,  nose  and  throat,  or 
of  the  skin,  (5)  vaccination. 

He  must  personally  attend  at  least  twelve  cases  of 
labour    under    the    superintendence    of    a    registo^ 


Sbpt.  14,  1904. 


SCOTLAND— EDUCATION. 


The-  Medical  Press.    295 


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  on  or  before  the  date 
for  lodging  certificates  for  the  final  examination  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,  and  that  he 
will  not  be,  on  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  sdiedule  for  the  Final  examination,  and 
must  be  signed  before  the  schedule  is  given  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 
viva  voce : — 

1.  On  zoology,  botany,  physics,  and  chemistry. 

2.  On  anatomy,  physiology,  and  materia  medica 
and  therapeutics. 

3.  On  pathology. 

4.  On  medicine,  surgery,  midwifery,  forensic  medi- 
cine, and  public  health. 

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  examina- 
tion in  the  subjects  comprised  in  the  first  division,  viz., 
botany,  zoology,  physics,  and  chemistry,  may  be 
admitted  to  examination  in  all  or  any  two  of  these  sub- 
jects at  any  examination  held  after  they  have  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. 

Candidates  who  have  passed  the  first  and  second 
divisions  may  be  examined  in  the  third  division  at  the 
end  of  the  fourth  winter  session,- 

Candidates  who  have  passed  their  examinations  in 
the  subjects  comprised  in  the  first,  second,  and  third 
divisions  may  be  admitted  to  examination  in  the  fourth 
or  final  division,  when  they  have  completed  the  fifth 
year  of  study^ 

The  degree  of  Doctor  of  Medicine  may  be  conferred  on 
any  candidate  who  has  obtained  the  degrees  of  Bachelor 
of  Medicine  and  Bachelor  of  Surgery,  and  who  is  of  the 
age  of  twenty-four  years,  and  who  produces  a  certificate 
of  having  been  engaged,  subsequently  to  his  having 
received  the  degrees  of  M.B.  and  Ch.B.,  for  at  least  one 
year  in  attendance  on  a  hosfMtal,  or  in  scientific  work 
bearing  directly  on  his  profession,  or  in  the  military  or 
naval  medical  services,  or  for  two  years  in  practice 
other  than  purely  surgical.  The  candidate  shall  submit 
to  the  Faculty  of  Medicine  a  thesis  certified  by  him  to 
have  been  composed  by  himself,  and  which  shall  be 
approved  by  the  Faculty,  on  any  branch  of  knowledge 
comprised  in  the  professional  examinations  for  the 
degrees  of  Bachelor  of  Medicine  and  Bachelor  in 
Surgery,  which  he  may  have  made  a  subject  of  study 
after  having  received  those  degrees.  The  candidate 
will  also  be  examined  in  clinical  medicine  and  must 
show  practical  acquaintance  with  advanced  methods  of 
diagnosis  ;  he  may  take,  at  option,  gynaecology,  mental 
diseases,  or  diseases  of  children  for  one  of  his  three 
cases.  The  degree  of  M.D.  is  conferred  on  holders  of 
the  degrees  of  M.B.,  CM.  (old  regulations),  on  the 
submission  of  a  thesis  approved  by  the  Medical  Faculty, 
provided  that  the  candidate  shall  have  passed  the 
medical  preliminary  examination  in  the  subjects  of 
Greek  and  logic  or  moral  philosophy.  Should  the  can- 
didate elect  to  do  so,  he  may,  however,  take  the  M.D. 
degree  under  the  new  regulations,  i,e.,  substituting  an 
examination  in  clinical  medicine  for  that  in  Greek  and 
logic.     This  course  is  usually  pursued  by  those  who  did 


not  pass  in  these  subjects  with  the  rest  of  their  pre- 
liminary examinations. 

The  regulations  for  the  degree  of  Ch.M.  ate  very- 
similar,  the  candidate  being  examined  in  surgical' 
anatomy,  operations  on  the  dead  body,  clinical  surgery, 
and  some  ot  the  special  branches. 

Candidates  settled  abroad,  who  cannot  appear- 
personally  to  receive  the  degree,  may,  after  satisfying* 
the  Senatus  to  that  effect,  have  the  degree  conferred  on* 
them  in  absentia. 

Fees  : — The  fee  to  be  paid  for  the  degrees  of  Bachelor- 
I  of  Medicine  and  Bachelor  of  Surgery  is  twenty-two- 
guineas,  and  the  proportion  of  this  sum  to  be  paid  by  a 
I  candidate  at  each  division  of  the  examination  is  regis- 
I  tered  from  time  to  time  in  the  University  Court.  The- 
I  fee  for  the  degree  of  Doctor  of  Medicine  or  of  Master  of' 
I  Surgery  is  ten  guineas  (old  repilations,  £s  5s.)- 

The  total  expenses  of  the  curriculum,  including. 
'  examination  and  matriculation  fee,  is  £146. 
I  Bursaries  and  scholarships  open  for  Session  1904- 
1905:  Among  the  bursaries  and  scholarships  open*, 
during  the  ensuing  year  are : — Freeland  Barbour- 
Fellowship  of  ;fioo-  in  Anatomy,  and  Physiology,  and' 
Pathology.  Allan  Fellowship  of  £48  15  s.  in  Clinical 
Medicine  and  Surgery.  Heriot  bursaries,  appUcations- 
to  Treasurer,  20  York  Place,  before  September  15  th. 
Mackay  Smith  scholarship  in  Chemistry,  value  £2^. 
Two  Mackie  bursaries  for  students  in  second  and  third* 
years,  whose  pecuniary  circumstances  need  assistance. 
Applications  to  Dean  by  October  rst,  Four  Buchanan- 
bursaries.  Two  Sibbald  bursaries  of  £^0,  and  a 
medical  scholarship  of  ;£4o  a  year  for  three  years, 
particulars  from  Messrs.  Mackenzie.  Innes,  and 
Logan,  W.S.,  23  Queen  Street,  Edinburgh,  before 
September  15th.  Two  Thomson  bursarie*  of  £2$  for- 
four  years,  one  conferred  at  each  preliminary  examina- 
tion in  October  and  March..  Five  Grierson  bursaries 
(natives  of  Crawford  and  Leadhillis  have  a  preference). 
Names  must  be  sent  in  before  October  ist.  Two  John 
Aitken  Carlyle  bursaries  of  £28  for  one  year  for  pro- 
ficiency in  class  examinations  in  anatomy  and  chemistry 
or  physiology.  Four  Mackenzie  bursaries  of  /20,  in- 
practical  anatomy.  Renton  bursary  of  £20  >for 
one  year,  for  students  attending  classes  of  natural 
physiology,  mathematics,  chemistry,  or  political 
economy,  who  also  can  show  they  are  in  need  of  pecu- 
niary aid.  Two  Crichton  bursaries  of  £$0,  for  four 
years,  one  competed  for  at  each  preliminary  examina- 
tion. Buchanan  scholarship  of  ;£40  los.,  for  profi- 
ciency in  midwifery  and  gynaecology,  as  shown  by  class 
work  and  in  the  final  examination.  Other  scholarships- 
are  : — The  James  Scott,.  ;£42  ids.  annually,  in  mid- 
wifery ;  the  Ettles,.  £31  5s.  annually  to  the  most 
distinguished  graduate ;  two  Hope  prizes,. ;f  30  annually 
in  chemistry ;  two  Crichton,  ;£roo  annually,  for" 
research  iijt  anatomy  and  physiology.  One  Vans 
Dunlop  scholarship  in  preliminary  subjects,  value  £100. 
Mouat  scholarship  in  practice  of  physic,  about  £$$. 
Houldsworth  scholarship  in  Pharmacology,  £40.  For 
details  of  these,  as  well  as  a  number  of  other  prizes, 
bursaries,  &c.,  the  University  Calendar  must  be  con- 
sulted. 

Graduation  in  Science  :  The  University  of  Edinburgh 
also  possesses  a  Faculty  of  Science  which  may  confer 
two  degrees.  Bachelor  of  Science  (B.Sc.)  and  Doctor  of 
Science  (D.Sc).  These  degrees  are  given  in  pure 
science  and  in  applied  science.  Candidates  for  the 
degree  of  B.Sc.  in  pure  science  must  attend  at  least 
seven  courses  of  instruction  in  the  subjects  selected  by^ 
them  during  the  course  of  not  less  than  three  academical 
years.  Three  of  these  courses  must  be  on  subjects- 
prescribed  for  the  first  science  examination,  and  four  on 
those  for  the  final  examination.  Four  of  these  courses- 
must  be  taken  in  the  University  of  Edinburgh.  The 
subjects  for  the  first  science  examination  are : — i. 
Mathematics  or  biology  (first  professional  in  medicine^ 
not  accepted  as  equivalent  to  latter) ;  2,  Natural 
philosophy  ;  3,  Chemistry.  For  the  second  examination 
they  may  be  selected  from  among  the  following : 
Mathematics,  physics,  astronomy,  chemistry,  anatomy, 
physiology,  geology,,  zoology,,  and  botany.     Graduates 


296    The  Medical  Press. 


SCOTLAND— EDUCATION. 


Sept.  14,  1904. 


as  B.Sc.  may,  after  five  years,  proceed  to  the  degree  of 
D.Sc,  undex^ing  an  examination  in  the  subjects 
chosen,  and  presenting  a  thesis  founded  on  original 
-work. 

Graduation  in  Public  Health :  Similar  degrees  are 
conferred  in  Public  Health.  Candidates  must  be 
graduates  in  medicine  of  a  University  recognised  by  the 
University  Court,  and  must  matriculate  for  the  year 
in  which  they  proceed  for  examination.  Before 
proceeding  to  the  first  examinatiqn  they  must  produce 
evidence  that  (x)  they  have  worl^ed  at  least  twenty 
hours  a  week  during  a  period  of  not  less  than  eight 
months,  after  taking  their  medical  degree,  in  a  recog- 
nised Public  Health  laboratory.  Five  of  these  months 
must  be  spent  consecutively  in  the  Public  Health 
Laboratory  of  the  University  of  Edinburgh,  and  (2) 
have  attended  a  course  of  lectures  on  phjrsics  in  addition 
to  that  qualifying  for  graduation  in  medicine,  and  one, 
of  at  least  three  months'  duration,  on  geology*  such  as 
the  Senatus  may  approve  of. 

Candidates  for  the  second  examination  of  B.Sc.  in 
Public  Health  are  not  admitted  until  at  least  eighteen 
months  have  elapsed  after  having  passed  M.B.,  Ch.B., 
or  sooner  than  six  months  after  the  first  examination. 
They  must  have  attended  two  separate  course^  of 
Public  Health,  of  at  least  forty  lectures  each,  one  deal- 
ing with  medicine,  the  other  with  engineering,  each  in 
its  relation  to  public  health,  in  such  manner  as  the 
Senatus  shall  determine.  They  must  also  have  studied 
practical  sanitary  work  under  a  Medical  Officer  of 
Health  for  six  months,  have  had  three  months'  clinical 
instruction  in  a  recognised  fever  hospital,  and  three 
months'  instruction  in  mensuration  and  drawing. 

Full  details  of  the  subjects  included  in  the  different 
courses  are  given  in  the  official  programme  of  the 
Faculty  of  Science,  which  may  be  obtained  from  the 
University  (price  2d.). 

Tn  a  similar  manner  to  that  described  under  degrees 
in  pure  science,  a  B.Sc.  may  after  five  vears  proceed  to 
take  the  degree  of  D.Sc.  in' Public  Health. 

Fees  for  Science  Degrees  :  B.Sc,  first  examination, 
iZ  3s-  \  B.Sc,  second  examination,  £1  3s.  ;  D.Sc, 
£10  los. ;  total,  /16  i6s. 

Ufliversify  Hall,  Ediaburfb — In  an  educational 
number  it  is  worth  while  to  call  attention  to  the 
advantages  now  offered  to  students  coming  to  Edin- 
burgh to  study,  in  the  shape  of  social  residences  akin  to, 
though  very  much  less  pretentious  than,  the  English 
University  colleges.  During  the  past  six  years  several 
buildings  have  been  acquired  in  Edinburgh  for  this 
purpose,  in  which  students  can  Uve  in  a  self-governing 
community.  In  each  house  there  are  private  studies 
with  or  without  bedrooms,  and  common  sitting  and 
dining  rooms.  The  charges  vary  from  7s.  6d.  to  22s.  6d. 
per  week.  The  residents  elect  a  treasurer  from  among 
their  number  who  acts  as  intermediary  between  them 
and  the  housekeeper  or  servants.  It  is  a  satisfactory 
indication  of  the  comfort  of  the  Hall  that  several 
graduates  now  live  in  it  and  are  willing  to  help  or  coach 
the  undergraduates  for  moderate  fees.  To  gain 
admission  two  references  must  be  produced  from  past 
or  present  residents.  These  are  considered  and  voted 
on  at  a  house  meeting.  In  all  disputed  points  Professor 
Geddes  is  the  referee,  while  Dr.  Ricardo  Stephens  is  the 
rent  treasurer,  who  will  supply  any  further  information 
required.  The  Hall  is  an  admirable  place  for  parents  to 
send  their  sons  to.  Any  unruly  member  may  be 
expelled  by  a  meeting  of  the  residents  similar  to  that 
held  for  elective  purposes 

Medical  School  for  Women. — The  medical  teach- 
ing of  women  in  Edinburgh  is  carried  on  by  the 
Scottish  Association  for  the  Medical  Education  of 
Women  (the  Secretary,  Minto  House,  Chambers  Street). 
The  classes  are  conducted  by  the  lecturers  of  the  Medical 
School  of  the  Royal  Colleges,  and  qualify  both  for  the 
Edinburgh  University  degree  and  for  the  Licence  of  the 
Triple  Bioard.  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..  Women  students  are 
eligible  for  the  benefits  of  the  Carnegie  Bequest, 


UNIVERSITY  OF  GLASGOW. 
The  University  of  Glasgow  is  both  a  teaching  and  u 
examining  body,  but  admits  to  examination  only  tboR 
candidates  whose  course  conforms  to  its  own  refahr 
tions.    Within  certain  Umits  provision  is  made  ioi 
accepting    instruction    given   by   recognised   medical 
schools  and  teachers ;   but  eight  of  the  sabjecU  other 
than  clinical  must  be  taken  in  this  or  some  otbo 
recognised  University  entitled  to  confer  the  degree  d 
M.D.,  and  at  least  two  years  of  the  course  must  be  taioen 
in  Glasgow  University.     Undfcr  the  new  regolatioiB, 
laid  down  in  Ordinance  No    14,  Glasgow  Na  i,  ol  the 
Commissioners  under  the  Universities  (Scotland)  Act, 
1S89,  four  degrees,  open  both  to  men  and  to  women,  aic 
conferred— M.B.  and  Ch.B.  (always  conjointly).  MLD. 
and  Ch.M.     A  preliminary  examination  must  be  passed 
in  (i)  EngUsh,  (2)  Latin,  (3)  Elementary  mathematics, 
and  (4)  Greek.  French,  or  (German,  with  possible  optira 
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  regulation  recently  enacted,  it  is  no 
longer  compulsory  to  pass  in  all  the  ionr  preliminazy 
subjects  at  once,  and  they  may  now  be  passed  at  tvo 
stages.     For  M.B.  and  Ch.B.  a  curriculum  of  five  yeaa 
is  required.     A  syllabus  with  full  details  of  the  cnrri. 
culum  and  of  the  preliminary  examination  may  he 
had,  post  free,  on  application  to  the  assistant  clerk. 
Matriculation  Office. 

The  fees  for  M.B.  and  Ch.B.  are  £23  2s. ;  for  M.P. 
£10  los.,  and  for  Ch.M.  £10  los.  For  hospital  attend- 
ance there  is  an  initial  fee  oi  £10  ids.,  with  a  further 
fee  of  £i  3s..  for  each  winter  session,  and  £2  2S.  for 
each  summer  session  of  clinical  instruction.  There  are 
three  very  extensive  general  hospitals  in  the  city, 
which  afford  exceptional  opportunities  for  clinical 
work,  while  the  Royal  and  other  asylums,  the  City 
Fever  Hospitals,  the  Maternity  Hospital,  the  Sick 
Children's  Hospital,  the  Eye  Infirmary.  &c.,  give 
facilities  for  the  study  of  special  branches. 

The  degrees  of  B.Sc.  and  D.Sc.  in  Public  Health  are 
also  now  conferred.  Of  late  the  University  has  made 
considerable  efforts  to  extend  its  laboratory  accom- 
modation and  equipment,  to  augment  its  teaching  stafl. 
and  to  encourage  post-graduate  and  research  work. 
Within  the  last  few  years  there  have  been  provided 
new  laboratories  in  the  departments  of  pathology, 
anatomy  (costing  ;£i  3,000),  chemistry,  and  surgery 
(costing  ;f9,900) ;  while  new  laboratories,  to  cost,  with 
equipment,  upwards  of  ;^6o,ooo,  are  now  in  course  of 
erection  for  the  departments  of  physiology,  materia 
medica,  and  medical  jurisprudence  and  public  health. 
Bursaries  and  prizes  to  the  annual  amount  of  about 
£900  are  appropriated  to  medical  students,  including  an 
Arthur  bursary  for  women,  £2$  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  £ifioo 
may  be  held  by  medical  students  who  have  gone 
through  the  Arts  course- 

Qoeeo  Margaret  College  for  Women.  —  Founded 
in  1883  (by  the  Glasgow  Association  for  the  Higher 
Education  of  Women,  which  was  formed  in  1877  ^t^ 
the  object  of  bringing  University  instruction,  or  »ts 
equivalent,  within  the  reach  of  women).  Queen  Margaret 
College  in  1890  added  to  its  faculty  of  Arts  a  School 
of  Medicine  for  Women-  This  was  organised  entirely 
on  University  lines,  and  with  the  view  of  preparing 
for  University  degrees;  and  when,  in  1892,  in  con- 
sequence 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.  and  Ch.B.  is  given  by  University  pro- 
fessors and  lecturers,  with  excellent  facilities  for 
hospital  and  dispensary  work  in  the  Royal  Infirmary 
and  other  hospitals.  A  Hall  of  Residence  for  the 
students  was  founded  six  years  ago.  Fees  for  the  classes 


Sbpt.  14,  1904. 


SCOTLAND-EDUCATION. 


The  Medical  P«kss.    2Q7 


a>t  Qneen  Margaret  College  may  be  paid  by  the  Carnegie 
Trustees. 

UNIVERSITY  OF  ABERDEEN. 
The  University  of  Aberdeen  possesses  under  its 
charters  the  amplest  privileges  claimed  or  enjoyed  by 
axLv  academical  institution.  It  confers  degrees  in  the 
five  faculties  of  Arts,  Science,  Divinity,  Law,  and 
Medicine.  It  also  grants  diplomas  in  Public  Health, 
Agriculture,  and  in  Education.  It  is,  moreover,  a 
teaching  bcdy  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 
accommodation  for  which  has  recently  undergone  con- 
siderable extension.  The  degrees  of  M.B.  and  Ch.B. 
are  c^onferred  together ;  they  cannot  be  obtained 
separately.  The  curriculum  of  study  is  nearly  the  same 
as  in  the  University  of  Edinburgh  ;  the  regulations  in 
the  preceding  columns  will  therefore  applv  here.  Two 
years  must  be  passed  at  Aberdeen.  With  regard  to 
fees,  each  candidate  for  the  degrees  of  M.B.  and  Ch.B. 
mast  pay  a  fee  of  £$  5s.  in  respect  of  each  of  the  first 
tiiree  professional  examinations,  and  £7  7s.  for  the  final 
examination.  Total  cost,  exclusive  of  the  fees  for 
degrees,  is  about  ;£i30.  Besides  the  Royal  Infirmary, 
students  have  the  opportunity  of  attending  several 
other  local  institutions  where  special  courses  of  in- 
struction are  given.  Perpetual  fee  for  hospital  practice 
is  only  £6,  The  professional  examinations  are  held 
twice  in  each  year,  namely,  in  March  and  July,  directly 
after  the  close  of  the  winter  and  summer  sessions. 

Bursaries. — Bursaries,  Scholarships,  and  Fellow- 
ships to  the  number  of  fifty,  and  of  the  annual  value  of 
over  j£i,i83,  may  be  held  by  students  of  medicine*  (See 
*'  University  Calendar.") 

The  Degree  of  M.D. — The  degree  of  Doctor  of 
Medicine  may  be  conferred  on  any  candidate  who  has 
obtained  the  degrees  of  M.B.  and  CM.  (Old  Regula- 
tions), 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  examination  in  clinical  medicine  in  addition 
to  presenting  a  thesis.  Similar  regulations  apply  to  a 
degree  of  Ch.M.  (Master  ol  Surgery). 

A  Diploma  in  Pubhc  Health  is  conferred  after  exami 
nation  on  graduates  in  medicine  in  any  University  in 
the  United  Kingdom.     Regulations  may  be  seen  in  the 
"  Calendar,"  or  obtained  on  application  to  the  Secretary 
the  Medical  Faculty4 

Aberdeen  Royal  iflfimary. — This  is  a  well-equip- 
ped institution,  containing  250  beds,  and  afiords 
excellent  opportunities  for  clinical  study  to  students  at 
the  Aberdeen  University*  The  city,  moreover,  offers 
inducement  in  the  way  of  cheaper  hving  and  compara- 
tive quiet  to  that  obtained  in  Edinburgh  and  Glasgow, 
and  will  doubtless  be  preferred  by  some  on  this  account. 
ST.  ANDREWS  UNIVERSITY, 
United  College  Si.  Andrews  and  University 

College,  Dundee. 
This  University  (session  opens  October  7  th)  grants 
the  degrees  of  M.B.,  Ch.B.,  M.D.,  and  Ch.M.  The 
degrees  of  the  University  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  in  any  foreign, 
Indian,  or  Colonial  University  recognised  for  the 
purpose  by  the  University  Court,  or  in  such  medical 
schools  or  under  such  teachers  as  may  be  recognised  for 
the  purpose  by  the  University  Court.  The  preliminary 
examination  and  the  professional  examinations  are  of 
the  same  character  as  in  the  other  Scottish  Universities. 
A  Diploma  in  Public  Health  is  also  granted  by  the 
University  of  St.  Andrews  to  graduates  in  medicine  of 
any  University  in  the  United  Kingdom.  Twelve 
months  must  elapse  between  the  date  of  graduating  in 


medicine  and  entering  for  the  examinations  for  the 
diploma.  The  course  of  study  required  consists  of  ( i )  a 
six  months'  course  of  practical  chemistry,  bacteriology, 
and  the  pathology  of  diseases  transmissible  from 
animals  to  man  in  a  laboratory  of  the  University  of 
St.  Andrews ;  (2)  six  months'  work  with  a  medical 
officer  of  health ;  (3)  three  months'  clinical  instruction  in 
infectious  diseases.  Subjects  for  first  examination  : — 
Chemistry,  physics,  bacteriology,  and  meteorology^ 
Second  examination : — Sanitation,  sanitary  law,  vital 
statistics,  medicine  in  relation  to  public  health. 

University  College,  Dundee,  was  affiliated  and  made 
to  form  part  of  the  University  of  St.  Andrews  on 
January  15  th,  1897,  and  the  whole  medical  curriculum 
may  be  taken  in  the  College.  The  United  College, 
St.  Andrews,  offers  classes  for  the  first  two  years  of 
professional  study. 

Bursaries  and  Scholarships^ 

Uflitetf  College,  St.  Asdrews.  —  Malcolm  bursary 
£25  a  year,  tenable  for  five  years).  Fourteen  Taylour 
Thomson  bursaries,  ^30  to  ;f20,  five  tenable  for  one 
year,  nine  for  two,  open  to  women  only  proceeding  to 
graduate  in  medicine. 

University  College,  thndee.  —  Eleven  entrance 
bursaries  of  £1$,  open  to  women  for  arts,  science,  or 
medicine,  tenable  for  one  year.  Four  ;£20  and  three 
£1$  second  year  bursaries  for  men  or  women  in  arts, 
science,  or  medicine,  tenable  for  one  year.  Four;£2o 
and  two  /15  third  year  bursaries  for  men  or  women  in 
arts,  science,  or  medicine,  tenable  for  one  year.  Two 
Educational  Trust  bursaries  of  £2$,  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 
;£x,ooo  (men  only). 

Preliminary  Examinations. — The  dates  of  the  next 
two  examinations  are  September  23rd,  1904,  and  March 
24th,  1905.  Schedules  (obtainable  from  the  Secretary 
of  the  University)  to  be  returned  filled  up,  and  fees  paid 
by  September  10 th,  1904,  or  March  8th,  1905. 

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  xo  guineas  in  each  case. 
For  the  Diploma  of  Pubhc  Health  examinations  the 
fee  is  £s  5s.  for  each  of  the  two  examinations. 

Class  Fees. — ^The  fee  payable  in  each  of  the  following 
classes  is  4  guineas,  t;i>.:--themistry,  Physics,  Zoology, 
Botany,  Physiology,  Anatomy,  Materia  Medica, 
Pathology,  Forensic  Medicine,  and  Public  Health, 
Medicine,  Surgery,  and  Midwifery.  The  fee  for  the 
practical  classes  in  these  subjects  is  3  guineas  each.  In 
Clinical  Surgery,  Clinical  Medicine,  Ophthalmology, 
Diseases  of  the  Throat,  Nose,  and  Ear,  and  Mental 
Diseases,  the  class  fees  are  2  guineas  each.  The  fee  for 
Public  Health  Chemistry  required  for  the  D.P.H.,  is 
£y  ys.  A  special  class  in  Bacteriology  is  also  held  for 
the  D.P.H.  for  which  the  fee  is  3  guineas. 

Dofldee  Royal  Asylnni. — The  appointments  include 
a  qualified  resident  assistant  and  two  resident  clinical 
clerks.     CUnical  instruction  is  given. 

Further  information  will  be  found  in  the  Calendar  of 
the  University,  pubUshed  by  Messrs.  Blackwood  and 
Sons,  Edinburgh,  or  can  be  had  of  the  Dean  of  the 
Medical  Faculty,  Professor  Weymouth  Reid,  F.R.S. 

Dofldee  Royal  Iflflroiary.  —  The  Infirmary  con- 
tains 300  beds,  with  a  special  ward  for  the  treatment  of 
children.  Three  resident  quahfied  assistants  are 
appointed  annually.  Chnical  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  Scotch  Universities,  the  University  of  London, 
the  University  of  Cambridge,  the  Royal  University  of 
Ireland,  and  by  the  Royal  Colleges  of  England  and 
Scotland.  Hospital  Ticket  for  the  Infirmary,  £2  2s. 
each  session,  or  £^  3s.  a  year.  Further  information  on 
appUcation  to  the  Medical  Superintendent, 
THE  COLLEGES. 

The  Royal  College  of  Physicians  of  Edinburgh,  the 


298    The  Medical  Press. 


SCOTLAND— EDUCATION. 


Sept>  14.  IQ04. 


Royal  College  of  Surgeons  of  Edinburgbi,  and  the 
Faculty  of  Physicians  and  Surgeons  of  Glasgow  have 
made  arrangements  by  which,  after  a  series  of  examina- 
tions, the  student  may  obtain  the  diploma  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 
Licentiate  of  the  Faculty  of  Physicians  and  Surgeons 
of  Glasgow.  The  diplomas  are  also  recognised  by  the 
Army,  Navy,  and  other  pubUc  bodies. 

The  three  co-operating  bodies  grant  their  single 
qualifications  only  to  candidates  who  are  already  regis- 
tered as  possessing  another  and  opposite  qualification 
in  medicine  and  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,  Glas- 
gow.— 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 
severally  attended.  Anatomy,  one  course,  six  months. 
Practical  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,  nine  months.  Principles  and  practice  of 
surgery,  one  course,  six  months.  CUnical  surgery,  nine 
months.  Midwifery  and  diseases  of  women  and 
children,  one  course,  three  months.  Medical  juris- 
prudence, one  course,  three  months.  Pathological 
anatomy,  one  course,  three  months.  The  candidates 
must  also  produce  the  following  certificates  : — (a)  Of 
having  attended  not  less  than  six  cases  of  labour  under 
the  superintendence  of  the  practitioner  whb  signs  the 
certificates,  who  must  be  a  registered  medical  practi- 
tioner, (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  Super- 
intendent of  a  laboratory  of  a  public  hospital  or  dis- 
pensary, 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  stafifs  of 
physicians  and  of  surgeons,  (d)  Of  having  attended, 
for  six  months,  the  practice  of  a  pubhc  dispensary 
specially  recognised  by  any  of  the  co-operating  bodies  ; 
of  having  been  engaged  for  six  months  as  visit-assistant 
to  a  registered  medical  practitioner,  {e)  Of  having 
been  instructed  in  vaccination. 

First  Examination,  Fee  £5. — The  first  examination 
shall  embrace  chemistry,  comprising  the  following 
particulars  :— Chemical  phjrsics,  heat,  light,  and  elec- 
tricity ;  the  principal  non-metaUic  and  metallic  ele- 
ments, and  their  more  common  combinations,  also  the 
leading  alcohols,  organic  acids,  ethers,  carbohydrates, 
and  alkaloids ;    the  candidates  will  also  be  examined 

?ractically  in  testing  ;  physics  and  elementary  biology, 
he  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' 
practical  anatomy. 

Second  Examination,  Fee  £$, — The  second  examina- 
tion shall  embrace  anatomy  and  physiology,  and  shall 
not  take  place  before  the  termination  of  the  summer 
session  of  the  second  year  of  study.  Candidates  must 
produce  to  the  Inspector  certificates  of  attendance  on 
the  prescribed  courses  of  anatomy,  practical  anatomy, 
and  physiology. 


Third  Examination,  Fee  £$, — Comprises  the  sftbjtcte 
of  pathology,  materia  medica,  and  pharmacology  and 
advanced .  anatomy. 

Final  Examination,  Fee  £1$, — The  Final  examfnatioa 
shall  embrace  the  principles  and  practice  of  mcdidse 
(including  therapeutics  and  medical  anatomy,  clinical 
medicine) ;  the  principles  and  practice  of  surgery  (m- 
eluding  surgical  anatomy  and  surgical  pathology); 
cUnical  surgery ;  midwifery  and  gynaecology,  medScal 
jurisprudence  and  hygiene ;  and  shall  not  take  place 
before  the  termination  of  the  full  period  of  study. 

Subjects  of  PreUminary  Education  :  ( i)  English  lan- 
guage, including  grammar  and  composition  ;  {2)  Latin, 
including  grammar,  translation  from  specific  authocs, 
and  translation  of  easy  passage  not  taken  fom  sodi 
authors;  (3)  elements  of  mathematics,  comprising  («^ 
arithmetic,  including  vulgar  and  decimal  fractioDs; 
(6)  algebra,  including  simple  equations;  (c)  geometiy. 
including  the  first  two  books  of  Euclid  ;  (4)  elemental^ 
mechanics  of  solids  and  fluids,  comprising  the  demean 
of  statics,  dynamics,  and  hydrostatics  ;  (5)  one  of  the 
following  optional  subjects  : — («)  Greek ;  (b)  Frenck; 
(c)  German  ;  {d)  ItaUan ;  (e)  any  other  modem  ian- 
gu^e  ;  (/)  logic ;  ^g)  botany  ;:  (A)  zoology  ;  (i)  elemes- 
tary  chemistry. 

Qualification  in  Public  Health :  The*  College  of 
Physicians,  in  association  with  the  Royal  Collie  of 
Surgeons  of  Edinburgh  and  the  Faculty  of  Physicians 
and  Surgeons  of  Glasgow,  confers  a  certificate  of  com- 
petency in  public  health.  The  examinations  are  he^ 
in  April  and  October.     Fee,  ;iio  ros. 

For  the  special  regulations  of  the  Royal  College  of 
Surgeons;  of  Edinburgh,  intending  candidates  should 
apply  to  Mr.  James  Robertson,  48  George  Square. 
Edinburgh ;  and  for  those  of  the  Royal  College  d 
Physicians,  to  Dr.  R.  W.  PhiUp,  45  Charlotte  Square 
Edinburgh. 

The  Fellowship  of  the  Royal  College  of  Physicians  d 
Edinburgh  is  conferred  only  by  election,  and'  the  candi- 
date must  have  been  a  member  of  the  college  for  at 
least  three  years  previously,  and  have  attained  the  agt 
of  twenty-seven  years. 

The  Membership  is  conferred  only  on  a  licentiate  of  a 
college  of  physicians  or  graduate  in  medicine  of  a 
British  or  Irish  University,  provided  he  shall  have  at- 
tained the  age  of  twenty-four  years  and  shall  have  pasiei 
an  examination  (i)  On  the  principles  and  practice  of 
medicine,  including  therapeutics  ;  {2)  on  one  of  the 
following  subjects  to  be  selected  by  the  candidate,  in 
which  a  high  standard  of  proficiency  is  expected :— {a) 
one  or  more  departments  of  medicine  specially  pro- 
fessed ;  {b)  psychological  medicine  ;  {c)  pathology ; 
(<2)^edical  jurisprudence  ;  {e)  public  health  ;  (/)  mid- 
wifery ;  (g)  gynaecology.  The  examination  is  of  a 
searching  character  extending  over  three  days,  the  firet 
of  which  is  devoted  to  the  examination  of  patients,  vicu 
voce  and  practical  examination  on  methods  of  diagnosis 
— e.g.,  microscopy  of  blood,  clinical  bacteriology,  quan- 
titative analysis,  &c.,  and  written  commentary  on  a 
case  examined.  The  second  day  is  taken  up  by  written 
papers,  and  the  third  by  practical  examination  en 
special  subject  and  orals. 

The  fee  lor  membership  is  35  guineas,  for  fellowship 
38  guineas,  with  a  stamp  duty  of  £2$ — ;f  loi  13s.  in  all. 

The  Ucence,  or  single  qualification  in  medicine,  is  con- 
ferred on  candidates  who  already  possess  a  recognised 
qualification  in  surgery.  The  examinations  for  this 
Ucence  are  held  on  the  first  Wednesday  of  each  month, 
save  those  of  September  and  October,  in  medicine, 
materia  medica,  midwifery,  and  medical  jurisprudence. 
The  fee  is  £1$  15s.,  and  intending  candidates  should 
communicate  with  the  Secretary  of  the  College  at  least 
eight  days  before  the  date  of  examination. 

The  Fellowship  of  the  Royal  College  of  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 


Skpt.  14,  1904, 


SCOTLAND--EDUCATIGN. 


T^  Mbpical  Prbss.    gQ^    1 


'Sritain,  and  who  are  twsnty-five  y^arq  ol  age.  The 
subjects  for  ^ixamination  for  those  who  are  ahready 
Licentiates  of  the  College  are  on  th%  principles  and 
(practice  of  surg«y,  clinical  and  operative  surgery,  and 
^me  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 ; 
^«uid  in  such  supplementary  subjects  as  have  not,  m  an 
•adequate  manner,  been  included  in  the  examination  for 
tlie  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 ;  '(&)  advanced  anatomy  and  physio- 
logy :  (c)  surgical  pathology  and  morbid  anatomy ; 
*id)  midwifery  and  gynaecological  medicine  and  sur- 
gery ;  {e)  medical  junsprodence  and  hygiene ;  (/) 
"practice  of  medicine  and  therapeutics.  The  examina- 
tions are  written,  oral,  and  practical.  Three  weeks* 
-notice  must  be  given  to  Mr.  James  Robertson,  from 
whom  full  particulars  as  to  certificates  required  may  be 
obtained.  The  fee  is  £^0  for  thpse.who  hold  the  di- 
ploma of  Licentiate  of  the  College,  and  £4$  to  others  (no 
stamp  duty  is  payable  on  the  diploma).  Registered 
practitioners,  aged  not  less  than  40,  who  have  been  in 
l>ractice  for  not  less  than  ten  years,  and  who  have  highly 
Klistinguished  themselves  by  original  investigations, 
may  under  special  circumstances  be  elected  without 
-examination.  Women  are  not  admitted  to  the  Fellow- 
ship. 

LiCBNCE. — ^The  examination  embraces  the  principles 
-and  practice  of  surgery  (including  operative  surgery  and 
-surgic:al  pathology),  cUnical  surgery,  and  8urg[ical 
^anatomy,  and  shall  not  take  place  before  the  termina- 
-tion  of  the  full  period  of  study.     Fee,  £1$  15s. 

Wood  Bursary. — The  examination  for  the  Wood 
l>orsary,  of  £60  per  annum,  tenable  for  three  years, 
wiU  take  place  on  October  21st  and  23nd,  at  the 
•college.  The  subjects  will  be  found  in  our  advertising 
•columns. 

Dental  Diploma. — Every  candidate  for  the  dental 
diploma  must  have  attended  the  general  lectures  and 
•courses  of  instruction  required  at  a  University  or  an 
•established  medical  or  dented  school  recogmsed  by  the 
"College  as  qualifying  for  the  diploma  in  surgery.  The 
*fee  is  ;£io  los. 

e^inbnrgh  Royal  lafirmtry.— Clinical  instruction 
-is  afforded  at  this  institution,  which  contains  780  beds 
^n  the  building,  and  10  beds  in  a  convalescent  home 
-under  the  supervision  of  professors  of  the  Univeraty 
:siind  the  ordinary  physicians  and  surgeons  of  the  Infir- 
mary. Special  instruction  is  given  on  diseases  of 
-women,  physical  diagnosis,  diseases  of  the  eye,  ear, 
-throat  and  teeth,  and  anaesthetics.  Separate  wards  are 
•<levoted  to  venereal  diseases,  diseases  of  women,  diseases 
of  the  eye.  also  to  cases  of  incidental  delirium  or  insanity, 
-smd  three  wards  are  specially  set  apart  for  cUnical  in- 
•strnction  to  women  students.  Post-mortem  examina- 
-tions  are  conducted  in  the  anatomical  theatre  by  the 
-pathologists.  The  perpetual  fee,  on  one  payment,  ;£i2 ; 
*the  annual  fee,  £6  6s. ;  half-yearly,  £4  45. ;  quarterly, 
£2  23. ;  monthly.  £1  is.  Separate  tickets  amounting  to 
/12  I2S.  entitle  the  student  to  a  perpetual  ticket.  No 
4ees  are  payable  for  any  surgical  or  medical  appoint- 
-ment. 

The  appointments  are  as  follows  :— 

1 4  Resident  physicians  and  surgeons  are  appointed 
4tnd  live  in  the  house  free  of  charge.  There  is  no 
salary.     The  appointment  is  for  six  months. 

2.  Non-resident  physicians  and  surgeons  (in  the 
Ispecial  subjects  and  for  out-patient  work)  are  appointed 
■or  six  months.     These  appointments  may  be  renewed. 

3.  Clerks  and  dressers  are  appointed  by  the  surgeons 
and  physicians.  These  are  open  to  all  students  and 
junior  physicians  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.    EDINBURGH. 

The  government  of  this  school,  established  in  1505,  is 
now  vested  in  a  board  which  is  equally  representative 
of  the  two  Royal  Colleges  and  the  Lecturers,  the  school 
being  styled  "  The  School  of  Medicine  of  the  Royal 
Colleges,  Edinburgh."  The  present  number  of  lec- 
turers is  about  sixty,  of  whom  the  greater  number 
deliver  qualifying  courses  of  instruction  of  the  same 
duration  and  scope  as  those  delivered  within  the 
University,  while  a  large  number  of  non-qualifying 
courses  on  special  subjects  of  interest  to  medical  science, 
but  which  are  not  required  for  graduation,  are  delivered 
both  in  the  winter  and  summer  sessions.  Ttie  students 
who  attend  the  classes  of  the  School  of  Medicine  are 
largely  students  proceeding  to  the  University  degree,  as 
well  as  those  who  are  intending  to  take  other  qualifica- 
tions, such  as  the  triple  qualification  of  the  Royal 
College  of  Physicians  of  Edinburgh,  the  Royal  College 
of  Surgeons  of  Edinburgh,  and  the  Faculty  of  Phj^i- 
cians  and  Surgeons  of  Glasgow  ;  that  of  the  Royal 
College  of  Physicians  of  London,  and  the  Royal  College 
of  Surgeons  of  England,  and  the  degrees  of  the  different 
Universities.  The  number  of  students  attending  the 
school  averages  1,300  annually. 

The  minimum  cost  of  the  education  in  the  School  of 
Medicine  for  the  triple  qualification  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  ^x>ut  £1 20.  which  is  payable  by  yearly 
instalments  during  the  period  of  study. 

The  Winter  Session  opens  October  ist. 

GLASGOW  EXTRA-MURAL  SCHOOL. 

St.  Mnngv's  College  aid  Olasgew  Royal  Inflr- 
nary. — ^This  college  was  incorporated  m  1889  under  its 
new  title,  being  formerly  known  as  the  Glasgow  Royal 
Infirmary  School  of  Medicine.  The  Medical  Faculty 
occupies  buildings  erected  for  the  purpose  of  the 
medical  school  in  the  grounds  of  the  hospital,  and  the 
laboratories,  museums,  and  lecture  rooms  are  of  the 
most  approved  description.  The  college  has  been 
recently  equipped  with  a  complete  electric  light  in- 
stallation, and  a  powerful  electric  educational  lantern. 
Attendance  on  the  classes  in  St«  Mungo's  College 
qualifies  for  the  medical  degrees  of  the  Universities 
and  the  medical  and  surgicaJ  colleges  in  accordance, 
with  their  regulations. 

The  Royal  Infirmary,  which  id  at  the  service  of  the 
College  for  teaching  purposes,  is  one  of  the  largest 
general  hospitals  in  the  kingdom.  It  has  over  600  beds 
available  for  clinical  instruction,  including  an  ophthal- 
mic department,  and  it  has  special  wards  for  diseases 
peculiar  to  women,  for  venereal  diseases,  erysipelas, 
bums,  and  diseases  of  the  throat.  At  the  dispensary 
special  advice  and  treatment  are  given  in  diseases  of  the 
eye,  ear,  teeth,  and  sldn^  in  addition  to  the  large  and 
varied  number  of  ordinary  medical  and  surgical  cases — 
about  78.000  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  U)und  than  in  the  Glasgow  Royal  Infirmary. 

Appointments. — All  appointments  are  open.  There 
are  five  physicians'  and  eight  surgeons*  assistants, 
who  obtain  free  board  and  residence  in  the  hospital 
and  act  in  the  capacity  of  house  physicians  and 
house  surgeons.  There  is  also  a  house  surgeon  for 
the  ophthalmic  department.  These  appointments 
are  made  for  six  months,  and  are  open  to  gentle- 
men who  have  a  legal  qualification  in  medicine  and 
surgery.  Clerks  and  dressers  are  appointed  by  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. 


300     Tbb  MSDICAL  PftSSS. 


NOTES   ON   CURRENT   TOPICS. 


.SKPX.-14,  1904^ 


Fees, — ^The  fees  for  Lectares,  including  Hospital 
attendance  necessary  for  cantdidates  for  the  Diplomas 
of  the  ]£nglish,  Scotch,  and  Irish  Colleges  of  Physicians 
and  Surgeons,  amount  to  £67,   . 

Afldersoa's  College  MedlciU  ScbMl,  Ql«g*v_ 
New  and  excellently  equipped  buildings  were  opened 
in  October,  1887,  in  Dumbarton  Road,  immediately  to 
the  west  of  the  entrance  to  the  Western  Infirmaryi  and 
within  four  minutes'  walk  of  the  University.  Extensive 
laboratory  accommodation  is  provided  for  practical 
anatomy,  practical  chemistry,  practical  botany,  practi- 
cal zoology,  practical  physiology,  practical  pharmacy, 
operative  surgery.  There  are  also  provided  a  Ubrary 
and  reading  room,  and  students'  recreation  room. 
The  buildings  are  constructed  upon  the  most  approved 
modern  principles.  The  dissecting  room  is  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  dissec- 
tions by  the  professor  and  demonstrators,  by  whom 
daily  examinations  and  demonstrations  on  the  parts 
'dissected  are  conducted.  The  supply  of  subjects  is 
ample,  and  students  are  consequently  provided  with 
parts  as  soon  as  they  may  be  ready  for  them.  Tne 
dissecting  room  is  provided  with  a  complete  series  of 
dissecting  specimens  mounted  in  plaster  of  Paris 
illustrating  the  anatomy  of  the  human  body.  There  is 
also  a  large  Bone  Room,  furnished  with  complete  sets  of 
painted  and  unpainted  bones. 

The  Carnegie  Trust  pays  the  fees  of  students  at 
Anderson's  College  on  conditions  regarding  which 
particulars  may  be  obtained  from  W.  S.  McCormick, 
Esq.,  LL.D.,  Carnegie  Trust  Offices,  Edinburgh. 

Class  Fees, — ^For  each  course  of  lectures  (anatomy, 
ophthalmic  medicine  and  surgery,  aural  surgery,  dis- 
eases of  throat  and  nose,  and  mental  diseases  excepted), 
first  session,  £2  2S.  ;  second  session  (in  Anderson's 
College),  /I  IS. ;  afterwards  free.  For  the  following 
practical  "classes,  viz. :  Chemistry,  botany,  zoology, 
physiology,  pharmacy,  first  session.  £2  2S.  ;  second 
session.  £2  2s.  Operative  surgery,  £2  as. ;  laboratory 
fee,  IDS.  6d.  Public  health  laboratory,  ^11  us. ;  with 
lecture,  £12  12s. 

Anaiomy  Clas^  Fees. — ^Winter :  First  session  (in- 
cluding practical  anatomy),  £4.  4s. ;  second  session 
(including  practical  anatomy),  £4  4s. ;  third  session, 
£2  2S.  To  those  who  have  had  the  necessary  courses  of 
practical  anatomy,  the  fee  will  be  ;£i  is«  Summer : 
Lectures  and  practical  anatomy,  £2  12s.  6d^ 

Wetteri  Miraitry.  —  Fees:  Hospital  attendance. 
*;^io  los.  (permanent) ;  clinical  instruction,  wmter 
^3  .^s.,  summer  £2  2S.,  pathology,  £4  4s.  (systematic), 
practical  pathology,  £s  38. ;    vaccination,  £1  is. 

Royal  laflrmary. — ^Feea :  Hospital  practice  and 
clinical  instruction,  first  year,  ^10  los. ;  second  year, 
3J10  los. ;  afterwards  free.  Six  months,  £6  6s. ;  three 
months,  £4  4s. ;  pathology,  both  courses,  £4  4s. ; 
vaccination  fee  jfi  is^ 

Dental  Cirricslm. — Students  studying  with  a 
view  to  the  dental  diploma  can  obtain  instruction  in 
the  following  subjects :  Physics,  chemistry,  anatomy, 
physiology,  surgery,  practice  of  medicine,  and  materia 
medica.  The  speoai  dental  courses  may  be  obtained 
in  the  Dental  School,  5  I  St.  Vincent  Street,  Glasgow. 

POST-GRADUATE  COURSES  IN  SCOTLAND. 

In  Edinburgh  a  number  of  post-graduate  courses  con- 
tinue more  or  less  throughout  the  year. 

In  Glasgow,  special  courses  in  ear  diseases  are  held  in 
November  and  May  at  Anderson's  College,  and  Post- 
graduate courses  in  pathology  and  bacteriology  at  the 
University  in  autumn^ 

[End  of  thb  Educational  Numbbr.] 


Dotep  on.Cturrent  XLopicB. 

Hie  "t^alue  of  Bxaminatiozia 
EvfeRY  cloud  ha.s  its  silver  lining,  and  it  may 
somewhat  soften*  the  student's  isievitable  avcfskm 
to  examinations  to  know  that  Sir  Thomas  6ax1o«r 
considers  them  invaluable  training  for  after  life. 
In  a  speech  delivered  at  the  distribution  of  prizes 
at  St.  Thomas's  Hospital  in  tfae  summer,  he 
pointed  ont  that  the  practitioner's  life  Was  made 
up  to  a  gre^t  extent  of  examinations,  principaHr 
vivd  vcce  ones.  Patients,  and  esx>ecially  patients* 
friends,  fill  up  half  the  doctor's  visit  by  questioning 
and  cross-questioning,  and  ready  replies  which  caa 
be  substantiated  by  facts  and  IQustrated  by  ex- 
amples constitute  the  prjactitioner's  greatest  asset 
The  art  of  the  student  under  exaniination  ronsisis 
in  persuading  the  exanuner  that  he  knows  whatke 
is  talking  about,  even  if  his  real  information  is 
comparatively  slender.  The  general  practitioner 
who  can  do  the  same  to  his  patients  is  marked  out 
for  success,  and  generally  achieves  it.  The 
vivd  voce  examination  provides  excellent  training 
in  the  art  of  smartly  answering  questions  that 
come  somewhat  unexpectedly,  and  Sir  Thomas 
Barlow  thinks  that  they  also  help  to  banish  one 
of  the  greatest  hindrances  to  the  young  doctor, 
namely,  self-conscinusiless.  It  is  a  comfort  to 
think  that  the  gentlemen  on  the  other  side  of  the 
table  who  smile  superciliously  on  the  stanunerin« 
candidate  arc  really  his  dearest  friends,  and  that 
the  incredulity  that  sometimes  characterises  thdr 
glance  at  the  victim,  far  from  being  intended  to- 
pain  .himi  is  merely  a  method  of  encourageinent  in 
disguise. 


A  HANDSOME  presentation  was  last  week  made  to 
Dr.  Arthur  Pugh,  assistant  to  Dr.  O'Kelly,  on  the 
occasion  of  his  leaving  Chipping  Norton. 

The  Carlisle  Board  of  Guardians  have  decided  to 
retain  a  bed  for  a  year  in  the  new  sanatorium  for  con- 
sumptives at  Threlkeld,  at  an  annual  cost  of  ^78,  for 
the  use  of  Carlisle  Union  cases. 


Medioal  Thinking  and  Medical  Thou^t. 

There  is  a  great  tendency  in  this  busy  age  tol 
reduce  aU  the  processes  of  life  to  a  severity  of ' 
form   of   the   Gradgrind   order.      Everything    i$ 
stripped  of  its  trappings,  and  the  essential  alone  is  I 
preserved.     Newspapers  give  their  news  in  bri«f  j 
paragraphs  ;  the  shorthand  writer  is  replacing  the- 
confidential  secretary  ;  drugs  are  compressed  into 
"  tabloid  "  form.     The  same  inl3uence  is  apparent 
in  what  is  usually  termed  the  practical  side  d 
medical  education.    The  student  must  be  taugbt 
this,  that,  or  the  other,  because  he  may  need  it ;. 
such  and  such  a  subject  must  be  dropped  out  d 
his  curriculum  as  it  has  ceased  to  be  useful.    A 
certain  amount  of  well-considered  change  is  inevit- 
able if  useful  progress  is  to  be  made,  but  there  is  a 
great  danger  in  the  cx)aching  and  cramming  that 
students  have  to  undergo  to  meet  the  demands  of 
the  modem  examiner  that  he  will    seldom  come- 
into  touch  with  medical  thought— at  any  rate,  in 
its  best  and   highest  exercise.     It  Ls  no  disparage^ 
ment  to  the  up-to-date  physician  to  say  that  he  !ias 
not  the  time  to  devote  to  thinking   that  his  old- 
fashioned  predecessor  enjoyed,  and  that  what  hfr 
gains  in  scientific  method  is,  to  a  certain  extent, 
acquired"  at    the  expense  of  scientific  thought. 
The  work-a-day  man  has  to  have  another  mm  to 
do  his  thinking  for  him,  and  to  furnish  him  with  the 
results.     At  least,  so  one  is  often  led  to  suppose,. 


SftM.  14.  i$04. 


CORRESPONDENCE. 


The  Medical  Feess.   3^^ 


when  institutixig  comparison  between  this  age  and 
former  ones.  There  can  be  no  donbt,  however, 
that  much,  if  not  all,  of  the  real  pleasure  of  medical 
work  is  sacri^ced  by  tl)pse  who  fail  to  enter  into 
the  spirit  of  medicine  when  they  assume  its  practice. 
The  student  who  coshes  his  life's  work  to  be  an 
intellectual  pleasiu-e  under  all  conditions  should 
take  the  earhest  opportunity  of  placing  himself 
on  familiar  terms  with  what  we  may  call  the  mind 
of  medicine.  He  cannot  accomplish  this  better 
than  by  the  study  of  the  works  of  some  of  the  old 
masters  in  medicine,  who  are  still  models  on  which 
all  sound  practice  may  be  fashioned.  Every 
student  should  buy  such  a  book  as  "  Graves's 
Clinical  Lectures,"  or  Sir  Thomas  Watson's  "  Prin- 
ciples and  Practice  of  Phjrsic,"  the  first  day  he 
caters  the  hospital,  and  read  it  through  once  a 
year.  By  the  time  he  is  qualified  he  will  have  no 
difficulty  in  judging  which  is  the  best  book  on  his 
shelves,  and  which  gave  him  the  greatest  insight 
into  medical  thought. 


The  Voice  of  Authority  in  Medioal  Studies. 

To  a  young  man  fresh  from  school  the  greatest 
danger  of  the  early  years  of  medical  study  lies  in 
his  disposition  to  take  the  word  of  his  teachers  for 
law.    TThe    tradition  of   aU   scholastic   establish- 
ments is  to  magnify  the  pedagogue  and  to  keep  the 
pupil  under,  so  that  the  latter  comes  to  regard  the 
opinion  of  his  instructor  as  the  last  word  to  be 
said  on  each  i>articular  subject.     So,  too,  with  his 
books.     The  authors  of   the  commentaries  and 
treatises  on  which  he  is  nurtured  are  mystic  ab- 
stractions who  knew  all  about  the  matters  of  which 
they  write.     If  the  student  is  ever  to  become  a 
scientific  man  in  the  true  sense  of  the  word,  he 
must,  from  the  start,  cultivate  a  respectful  dis- 
respect for  everybody's  word  about  the  phenomena 
be  observes,  and  never  accept  any  statement  that 
he  is  not  able  either  to  verify  himself,  or  to  find 
cogent  evidence  in  favour  of.     Every  fact  in  che- 
mistry,   anatomy,    physiology,    and   medicine   is 
capable  of  verification  by  obsen^ation  or  experi- 
ment, and   in  so  far  as  in  him  Ues  the  student 
should  not  let  one  pass  without  endeavouring  to 
satisfy  himself  that  it  rests  oa  a  solid  foundation. 
Dogmatism  has  no  place  in  medical  study.     The 
student  may  have  a  high  regard  for  the  opinion  of 
his  teacher,  but  he  should  never  be  satisfied  till 
he  has   followed    aU    the   steps    through   which 
that  teacher's  mind  passed  before  arriving  at  the 
final  conclusion.     A  schoolmaster  may  be  very  im- 
pressive in  enunciating  a  law  in   mathematics, 
knowing   that  his   position   is   unassailable— the 
law  is  an  old  one  that  has  been  demonstrated  over 
and  over  again  ;  but  the  scientific  teacher  is  at  the 
mercy  of  his  pupils  if  he  is  "  cock-sure  "  about  any- 
thing without  having  proved  it  for  himself.     The 
darkest   period    of  medicine  was   from  the   day 
of  Galen    to    the  day  of   Harvey ;    the   period 
when  all  medical  knowledge  was  centred  in  the 
works  of  the  great  writers,  and  every  case  was 
treated  by  the  application  of  the  methods  recom- 
mended  in    those    works.      No    name,    however 
great  and  justly  honoured,   should  be   allowed 
to  be  a  guarantee   for    a  single    fact  that  the 
medical  man  can  find  out  for  himself  ;   authority 
has  a  very  back  seat  in  the  domain  of  medicine. 
The  student's  training  is  not  derived  from  reading 
books,  but  from  finding  out  if  what  his  books  say 
is  true. 


Correepondence* 

[We  do  not  hold  ooiMfaret  rMpoiniUo  for  the  optnlont  of  oar 
OomopondMitek] 


THE  DIMINISHING  BIRTH-RATE. 

To  the  Editor  of  The  Medical  Press  and  Cikculak* 

Sir, — I  only  have  to  refer  "  A  Country  Practitioner  " 
to  my  original  address  for  the  following,  which  contain^ 
a  sufiicient  answer  to  all  his  questions : — 

"  My  own  opinion  is  that  while  occasional  abstinence 
(or  continence)  in  married  life  is  perfectly  allowable- 
and  may  have,  as  I  have  suggested,  a  high  moral 
hereditary  value,  no  artificial  prevention  is  advisable 
save  that  which  is  produced  by  operation,  when  de- 
formity or  grave  disease  imperatively  demands  it." — 
Page  23  of  published  address. 

I  have  no  reason  to  alter  or  qualify  this  in  any  way.. 
I  am.  Sir,  yours  truly, 

John  W.  Taylor.. 

22  Newhall  Street,  Birmingham, 

To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — It  seems  to  me  that  the  national  importance 
of  this  question  more  than  justifies  the  prominence  you 
have  lately  accorded  to  it  in  your  coiumns.  This- 
intricate  problem  cannot  be  solved  off-hand  by  the 
ipse  dixit  of  any  individual,  no  matter  how  distinguished 
he  may  be  in  other  branches  of  scientific  work.  Nor 
will  the  matter  be  advanced  by  the  triumphant  detection 
on  one  side  or  the  other  of  minor  errors  in  the  argu- 
ments of  the  protagonists  of  the  discussion.  The 
question  was  most  ably  raised  by  Dr.  Taylor,  and  his 
views  have  been  clearly  if  somewhat  forcibly  criticised 
in-  the  article  subsequently  contributed  by  Dr.  David 
Walsh  to  your  columns.  There  can  obviously  be  only 
one  solution.  Dr.  Taylor  is  either  right  or  wrong  in  his- 
views  that  the  fall  in  the  birth-rate  is  due  mainly  t<> 
preventive  practices  among  married  folk,  and  that 
such  practices  are  productive  of  the  greatest  moral 
and  physical  harm.  If  he  is  right  he  should  be  able 
to  meet  all  criticisms  that  are  brought  forward  in  ai. 
clear  and  logical  way.  He  has  laid  down  the  law  in- 
tones of  such  strong  conviction  that  he  owes  it  to  his 
reputation  to  sustain  his  propositions  with  ample  and' 
adequate  proof.  Meanwhile.  I  trust  the  matter  will' 
be  thoroughly  threshed  out  in  The  Medical  Press  and 
Circular,  the  only  medical  journal  which  has  had  the 
courage  to  bring  this  most  important  social  problem, 
to  the  front. 

I  am.  Sir,  yours  truly. 

Duns  Scotus. 


To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  original  paper  of  Dr.  Taylor  was  widely- 
quoted  and  commented  on  in  all  our  church  journals,, 
and  I  certainly  gathered  from  their  perusal  that  he  said* 
the  diminishing  birth-rate  was  due  to  certain  restrictions- 
practised  among  married  people.  These  practices- 
he  condemned  utterly  and  said  that  they  wrought 
incalculable  harm  both  upon  parents  and  children  that 
were  bom  in  spite  of  them.  His  main  text  was  that 
married  folk  ought  to  have  as  many  children  as  possible, 
and  that  claim  he  advanced  without  any  reference  to» 
the  means  or  social  position  of  the  parents  or  to  the 
upbringing  and  the  future  of  their  offspring.  I  then' 
wrote  stating  my  position  as  a  poor  curate's  wife, 
who  has  had  to  keep  house  and  bring  up  three  children* 
on  an  annual  income  of  ;£250.  I  asked  Dr.  Taylor  if 
he  thought  I  ought  to  have  brought  an  unrestricted 
number  of  children  into  the  world  "  oa  the  strength* 
of  social  and  intellectual  qualificatioDS  that  fail  to  fur- 
nish the  decencies  of  life  reasonably  demanded  by  mjr 
husband's  station  in  society."  I  am  much  disappointed' 
at  Dr.  Taylor's  reply,  which  is  to  the  effect  that  he  has 
not  enough  data  to  say  whether  I  ought  to  have- 
married  or  not.  That  is  not  the  point.  I  am  married,, 
rightly  or  wrongly,  and  I  want  to  know  how  his  rules- 
apply  to  my  case. 

I  am,  Sir,  yours  truly, 

A  Poor  Curate's  Wtfi?, 


-302    Th£  Medical  Psxss. 


NOTICES  TO  CORRESPONJDENTS. 


Sbpt.  14,  1904. 


^^MkfB  to 

09*  CtoUUHronOMfB  rwiukbiflr  *  r^J  ^  ^^^  oolumn  are  purtioa- 
darly  rtquflflwl  to  uukks  nee  of  *  dMCwXiw  Sf^noturvor/iiaiat.  and 
.AToid  thepnotioeofai«ning  tkemMlvM  "Reader,"  " Subaoriber," 
-**  Old  Subnriber."  ko,  Muoh  oonfoaioo  wUl  be  spared  by  attention 
to  tbisrule. 

OftieiMAL  Articlm  or  Lbttbrs  Intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  addieas  of  the  writer,  not  neoessarily  for  publioa- 
^tion,  but  as  evidence  of  identity. 

OownivrtOMM  are  kindly  requested  to  send  their  conununicaUons, 
f  resident  in  England  or  the  Colonies,  w  the  Bditor  at  the  London 
oOoe ;  if  resident  in  Ireland,  to  the  Dublin  offlce,  in  order  to  save  time 
>ln  re-forwarding  from  oiBce  to  oiBoe.  When  sending  subscriptions 
the  same  rule  applies  as  to  offloe ;  these  should  be  sddressed  to  the 
Publisher. 

NOTICE  TO  BOSFZTAL  AND  COLLEGE  DEAN8. 
Tin  Editor  desires  to  thank  those  gentlemen  attached  to  the  various 
Bchools  and  Bcspltsls  for  supplying  him  with  the  infotmation  from 
which  the  foregoing  pages  have  been  compoeed. 

NOTICE  TO  OUR  READERS. 

As  this  number  is  mainly  devoted  to  information  necessary  for 

>  students  Intending  to  join  one  or  other  of  the  various  medical  colleges, 

.  and  for  tboie'  w^,  having  passed  their  curriculum,  are  about  to  enter 

the  ranks  of  the  profession,  much  of, the  ofdinary  matter  which 

.  usually  fHts  cur  columns  is  necessarily  deferred  till  next  week. 

GRATUITOUS  00PIB8. 
A   VBBT  large   number  of  oopiea  of  this  issue  are  being  sent 
gratuitously  to  all  the  educational  esiabllshments,  hospitals,  reading- 
rooms,  olnbs,  and  large  hotels  in  t)ie  United  Kingdom,  and' to  a  Utfge 
tnumberln.Amerioa,  India,  the  Colonies,  and  on  the  Continent:  should 
■tany  of  our  readers  desire  to  present  a  copy  to  a  patient  or  friend  who 
contemplates  sending  his  son  to  a  medical  school,  our  publisher  will 
be  happy  to  supply'  him  with  a  dnplioate  free  of  cost  on  receipt  of 
address. 

Lbttxas  from  our  Paris,  Berlin  and  Vienna  correspondents,  and 
several  communications  from  others,  are  unavoidably  held  over  this 
week  on  account  of  the  space  devoted  to^educational  matters. 

EPSOM  COLLEGE-ELECTION  TO  FEMALE  SCHOLARSHIP. 
Av  election  to  a  Fema'e  Scholarship  at  this  College  Mil  shortlv 
take  place,  notice  of  which  will  be -found  in  another  oohimn  of  thie 
iflSUCb  Candidates  must  be  between  the  ages  of  7  and  It,  and  must  be 
necessitous  orphan  daughters  of  dn]v  qualmed  medical  men  who  have 
been  for  not  less  than  five  years  in  independent  practice  in  England 
or  Wales.  Form  of  application  can  be  obtained  at  the  offlce  of  the 
-College,  87  Hoho  Square,  W. 

Dr.  T.  J.  8.— Ton  need  not  have  any  hesitation  in  using  antl- 
phlogisttne  under  the  circumstances  you  mention.  We  believe  it 
is  an  excellent  preparation  and  should  be  glad  to  hear  of  the  result 
in  this  particular  case.  ^ 

POISONING  BY  oleander:  OB  BOSE.BAY. 
This  beautiful   ilowering  shrub  which    is  such  a    prominent 
-  feature  in  the  gardens  of  southern  Europe  possesses  well.mavked 
toxic  properties  and  these  are  often  turned  to  account  by  soldiers 

•  desirous  of  obtainhig  a  furiough.  A  handful  of  leaves  are  infused 
in  boiling  ^ater  and  the  solution  swallowed  In  a  esse  recently 
obeerved  by  Dr.  Bonnette,  in  south  Oran,  the  symptoms  commenced 
with  nausea,  vertigo,  prostration  and  a  fall  of  temperature  to  97 '5<'  F.; 
the  extremities  became  cold,  with  dilatation  of  the  pupils,  loss  of 
pupillary  reflex  and  anasthesia  of  the  cornea.  The  heart  became 
irregular  and  the  pulse  slow  and  thready  with  gasping  breathing, 
constipation,  and  mental  confusion   merging  into    ooma.     These 

-s^ptoma  lasted  throughout  one  day  and  recovery  set  in  with  green 
duurrfaoea  and  a  copious  excretion  of  dark  urine.  The  heart  remained 
slow  for  some  time  after. 

▲  LEGAL  TIEW  OF  MEDICAL  PRACTICE. 

The  following  anecdote  was  overtieaxd  recently  at  the  Medico*Legal 
Society's  Roome. 

The  following  is  told  of  the  late  Lord  Morris,  when  examining  a 
veterinary  surgeon  at  Coleraine. 

**  Now  teU  me  this.    The  12  grains— wouldn't  they  teetotally  kill 

•  the  devil  himself  if  he  swallowed  them  ?  " 

The  witness  was  annoyed  and  pompously  replied  : 
'*  I  don't  know,  my  lord.    I  never  had  him  for  a  patient." 
From  the  bench  cjiroe  the  answer  : 

"  That's  true,  no,  dochter,  sure  and  ye  never  had.  More's  the  pity. 
The  old  bhoy's  still  alive." 

THE  DIMINISHING  BIRTHRATE.: 
A  GORBXsroNDBXT  ssks  if  the  Birth-rate  is  diminishing  tliroughout 
the  United  Kingdom,  or  only  in  certain  localities.  We  have  looked 
into  the  latest  returns  of  the  Registrar  General  to  hand  which 
include  the  eighty  largest  towns  of  England,  Ireland  and  Scotland, 
add  find  the  increase  is  pretty  general  but  more  marked  in  the 
largest  cities.  In  Greater  London  with  its  vast  suburban  popula- 
tion the  births  during  the  last  week  were  651  below  those  of  the 

-corresponding  period  for  the  last  ten  years.     As  «9  -offset  ^to  this, 

Jthe  deaths  were  152  below  the  average. 


jaieetinoe  of  the  |>odelieft,  ^Cectitra,  4et. 


.Wbdvudat.  SxTTBion  14th. 
Mioicu.  GEADQATks'  CoLLSos  ARD  PoMcuvic  (Si  Chcnla  ttnsL. 
W.C).-4p.m.     Mr.  H.  L.  Barnard.    Clinique.     tSoigieaL) 
TauBAOAT,  SsntMBHa  J  5th. 
Mbdical  Graduates*  Collbos  aA>  Poltclixic  (22  Ghenles  ftmt,  I 
W.GO.'-Ap.nu  Mr.  Hutchinson :  CKnlqoe.    (SaqgicaL) 
FaiDAT,  Sbptbmbsr  letb. 
MxmcA!i  Gbadvatbs'  Collbob  avb  Poltclihic  (21  (Themes  BiRn 
W.C.).~4  p.m.    Mr.  L.  Faton :  Clinique.    (Byo.) 


Birkenhead  Borough  Hospital.— Junior  Beeklent  House  8ai|e»e 

Salary  £80  per  annum.  Applications  to  the  Honorary  Secretsiy. 
Birmingham  General  Dispensary.— Resident  Burgeon.  Salary  £1% 

per  annum,  with  ftimished  rooms,  fire,  lighte,  and 

Applications  to  Ernest  W.  Forrest.  Secretary. 
French  Hospital  and  IHspensary,  ITS  SKafteshory  Avenne,  W.a- 

Resklent  Medical   Officer.    Halary.«a()  per  annum  with  M 

board.    Applications  to  the  Secre  aiy. 
Halifax  Union  Poor-law  HospltaI.-Beslilent  Medloal  OfBoer.   M« 

£120  per  annum,  with  apartments,  rations,  and  waahing.  Affi. 

cations  to  Arthur  T.  Longbotham,  4  Oailton  Street,  Balilax. 
Hereford  County  and  City  Asyham.— Assistant  M«Mlieal   OfBoo. 

Halary  £160  per  annum,  with  furnished  apartment,  board,  aal 

laundry.    Apf»Uuations  to  the  Medksal  ouperintantait. 
Horton    Infirmary,    Banbury,— House    Suiyeoo.     Salary  £S0  per 

annum,  with  board  and  residence  in  the  Infirmary*  AppiicatMsi 

to  the  Honorary  Secretary,  21  Marlborough  Kmd,  Banbuzr. 
North   Cambridge  Hospital,  Wisbech— BesUient  Medloal  Oilis. 

SaUry  £103  per  annum,  with  furnished  rooms,  attendanoe,  eak, 

gas,  and  washing.    Applications  to  William  F.  Braj,  Secrstsir. 
Royal    Berkshire     Hospital.  —  House     Physician.       Salaty   m 

per  annum,  with  board,  lodging,  and  wasfaing.    ApplteatioM  tc 

the  Secretary. 
St.  Mary's  Huspital.  Paddlogton,  W.— Medical  Offloer  in  chaise  d 

"  X  '  Ray  Department.    Salary  £150  per  annum.     AppUoaCioni 

to  Thomas  Ryan,  Secretary. 


Jl|^oitttmtni0. 

Baxp>'tlde    Dahibll,     G.     W.,    MB.C.S.Eng ,      L.R.C.PJiOoi, 

AnsBsthetlst  to  the  Edinburgh  Dental  Hospital. 
BuLLBiD.  ARThub,  L.R.C.P..  L.R  CS.Edln.,  L  F.P.8.aiasg..  Madbl 

Ofllcer    for  the  Hearts  of  Oak  Friendly  Society  at  Midsoaa 

Norton  (Somerset). 
Gbaham,  Joiiv,B.So.,  M.E,Ch.B.Qlasg.,  Resident  Aaaiatant  in  tk 

Victoria  Infirmary,  Glasgow. 
HooLB,  JoiiK,  M.lft.0.8.Eng.,  L.8.A..  Medical  Oflleer  of  Heattk  to 

the  Ashbourne  Rural  District. 
Lbwis,  a.  WoLSBLBT,  M.D.,  F.R.C  S.,  Medical  Superintendent  of  tbi 

Kent  County  Lunatic  Asylum,  Barming  Heath,  near  Maids^BBe. 
McLarbh,  Gbobok  H.,  M.R.C.8wEng.»  House  SutgMMi  to  the  Rbnisf- 

ham  and  HUland  Eye  Hospital.     . 
Napibr,  a.  Habpbr,  M'.B.,  Ch.B.G1aag.,  Resident  AasisUBt  im  tkr 

Victoria  Infirmary,  Glasgow. 
Pollock,  Ahdrbw  M.,  M.B.,  Ch.B.Glasg.,  Resident  Asatstant  in  tfce 

Victo  ia  luflmiary.  Glasgow. 
SiiARPB,  Edward  B..  If  .B.,  Ch  B.Edio.,  Junior  Assistant  House  Bar- 

geon  to  the  Stockport  Infirmary. 
Staxvus,  H.  S.,  M.B.Lond.,  M.E.C.S  Eng.,  L.]LC.P.Lond.,  Ssniai 

Ophthalmic  House  Surgeon  to  St.  Thomaa'a  Hospital. 
Thomson,  J.  White.  M.B..  Ch.B.GUsg.,  a  Resident  Asaiatant  in  tte 

Victoria  Infirmary,  Glasgow. 


HUMBT— Bans.— On  September  10th,  at  Niool  Boad  PresbyteriiB 
Church,  Barlssden,  Daniel  Morgan  Humby.  L.D  8.,  M  &€£., 
L.R  C.P.,  to  Edith  Muriel,  eldest  daughter  of  A.T.  BetU,  Biq., 
of  Harlesden. 

KBKVBDT-BABiireTOH.— On  September  7th,  at  St.  Paul's  Church, 
Glenegeary,  WUliam  PUyer  Kennedy,  M.D.,  Gay  Street,  BOh, 
aecottd  son  of  A.  D.  Kennedy,  Esq.,  Glen-na-geragh  Hall.  Kisf- 
stoven,  to  Alice  Frances  L'Estrange  (Allie).  youngest  danfhter 
of  tbe lato  WiUUm  W.  Babington,  Esq.,  B.A..  of  Cork,  and  Hn. 
fiabington,  of  Dunluce,  Glenegeaiy,  co*  Dublin. 

KiRBT— TuRLB.«-On  September  8th,  at  St.  John's  Church,  Whctstso^ 
N.,  Laurence,  second  son  of  the  late  Frederick  Baker  Khby,aBd 
of  Mrs.  Kirby,  of  Torrington  Park,  North  Finohley,  to  BllBabech 
Maxgant,  third  daughter  of  James  Torle,  M.D.,  of  North 
Finchley. 


^wths. 


Carvbr.— On  September  7th,  at  Torquay,  Edmund  (Tarver,  M.D.1 

late  of  Cambridge,  aged  80. 
Chalmrbs.— On  September  Ilth,  at  Leighton,  Southborough,  EUes. 

widow  of  the  late  David  Chalmers,  M.D.,  of  Everton,  livecposl 

aged  78. 
DiGKivsoir.— On  September  6th,  at  Trebrea  Lodge.  Tintagel,  WittiMi 

Lee  Dickinson.  F.B.C.P.,'ekler  son  of  W.ttowahip  DiddaMo, 

F.R.C.P.,  of  Trebrea  Lodge,  and  10  Stanhope  Place,  London, 

aged  40. 
DfTDOBOB.— OnSepUmber  8th,  at  22  Oariton  Hill,  N.W.,  Bobert 

Ellis  Dudgeon,  M.D..  in  his  85th  year. 
BlOBDAB.— On    September  9tb,   at    Res^yiUp, .  Irdand.  Oertmleb 

dearly -loved  ^ifeof  Lt.-Colonel  J.  Giordan,  B.A.M.C.,  RI.P- 


W)h  ^dm\  ^tm  wd  ^tmlm. 


"SALU8   POPUU   STTPREMA   LEX' 


Vol.  CXXIX. 


WEDNESDAY,    SEPTEMBER   21,    1904.       No.   12. 


®ci0iiial  Commanicationd* 

HOSPITAL    ISOLATION   OF 
SCARLET   FEVER: 

THE  DESIRABILITY  OF  AN  INQUIRY 
INTO  ITS  EFFECT. 
By  MEREDITH  YOUNG,  M.D.,  D.P.H., 
Medkal  Offloer  of  HmIOi,  County  Boroogh  of  Htockport. 
The  hospital  isolation  of  scarlet  fever  has 
"been  practised  for  so  long,  and  has  become  such 
a.  routine  preventive  medicine  prescription,  that 
it  seems  almost  heresy  to  entertain  the  slightest 
don'bt  as  to  its  efiective  value.  At  the  same  time 
"tlie  1)enefits  of  the  procedure  have  been  most 
seriously  questioned  by  a  number  of  men  of  standing 
in  the  Public  Health  Service,  and  the  arguments 
ancl  statistics  adduced  by  them  in  support  of 
tlieir  contention,  though  vigorously  assailed,  still 
stand  in  the  main  uncontroverted.  To  the  per- 
fectly open  mind  the  supporters  of  hospital  iso-s 
.lation  have,  up  to  the  present,  done  little  more 
tlian  effect  what  the  eulogistic  Russian  war- 
correspondent  would  term  "  a  masterly  retreat." 
Iliere  are  doubtless  many  who,  like  the  writer, 
iwould  gladly  welcome  a  verdict  in  favour  of  the 
isolation  hospital,  provided  that  it  was  the  genuine 
outcome  of  an  exhaustive  and  independent  in- 
quiry. But  the  present  position  is  that  of  Ma- 
homed's cof&n — ^half-way  between  heaven  and 
earth — and  it  is  a  most  disconcerting  and  dis- 
appointing one. 

In  my  own  town  of  Stockport,  with  a  popu- 
lation of  100,000,  a  sum  of  about  ;£20,ooo  has  been 
spent  during  the  past  sixteen  years  on  the  isolation 
of  scarlet  and  typhoid  fevers  alone,  and  the  former 
disease  has  monopolised  quite  three-quarters  of 
the  available  hospital  accommodation ;  roughly 
sp>eaking,  therefore,  the  hospital  treatment  of 
scarlet  fever,  the  utility  of  which  both  to  the 
community  and  to  the  individual  is  so  seriously 
questioned,  costs  this  town  on  an  average  ;£  1,000 
per  annum,  and  appears  Ukely  to  cost  more. 

Thousands  upon  thousands  of  pounds  of  public 
money  continue  to  be  expended  upon  this  doubt- 
fully useful  measure.  And  there  can  be  no  ques- 
tion but  that  local  authorities  are  frequently 
so  handicapped  financially  by  this  expenditure 
on  hospital  isolation  that  other  public  measures 
of  indubitable  benefit  are  passed  by. 

The  wholesale  and  indiscriminate  removal  to 
hospital  of  scarlet  fever  cases  is  a  measure  not 
-without  other  drawbacks  than  those  mentioned 
by  Dr.  Millard  and  his  followers.  For  example, 
it  tends  to  weaken  the  sense  of  individual  respon- 
sibilityand  leads  to  the  relaxation  of  those  proper 


precautionary  measures  which  should  be  taken 
by  every  householder  on  the  outbreak  of  infectious 
disease  in  his  family  ;  and  particularly  is  this  the 
case  when  everything  is  done  for  the  affected 
household  free  of  expense.  The  wretched  and 
far-reaching  apathy  which  such  a  measure  in- 
culcates could  not  be  .better  illustrated  than  by 
the  words  of  a  mother  who  had  three  children 
ill  of  measles,  and  who  remarked  to  the  writer 
that  "  she  wished  it  had  been  scarlet  fever, 
because  they  took  them  to  the  hospital  for  that 
and  there  was  no  bother  with  them  then." 

Dr.  Millard,  as  is  well  known,  has  made  a  careful 
and  thorough  inquiry,  and  has  published  an  abun* 
dance  of  statistics  to  show  that  hospital  isolation 
has  failed  to  materially  reduce  the  prevalence  or 
fatality  of  scarlet  fever.  Dr.  James  Niven, 
who  has  probably  conducted  a  more  elaborate 
inquiry  into  the  question  than  anyone  else,  is 
forced  to  the  conclusion  that  whilst  hospital 
isolation  of  scarlet  fever  has  reduced  its  pre^ 
valence  in  Manchester,  '*  the  reduction  was  not 
so  great  as  could  be  desired."  (Annual  Report, 
1 90 1.)  Numerous  other  practised  observers  have 
recorded  varying  opinions  and  collected  valuable 
statistics.  Evidence  on  all  the  main  points  and 
many  of  the  side  issues  is  thus  already  to  hand, 
and  much  more  would  be  abundantly  forthcoming 
if  some  authoritative  and  independent  body  would 
undertake  to  formulate  the  most  useful  lines  of 
investigation,  and  subsequently  collate  and  ana- 
lyse the  material.  Scarlet  fever  has  been  isolated 
more  than  any  other  disease  for  about  twenty 
years,  and  therefore  there  should  be  a  mass  of 
useful  and  interesting  evidence  available  at  com* 
paratively  short  notice. 

Clinical,  pathological,  and  bacteriological  in« 
vestigation  is  still  required  to  make  the  story 
complete  ;  and  if  the  investigation  be  conducted 
on  proper  lines  discoveries  of  the  utmost  importance 
might  be  the  result.  The  etiology  of  scarlet 
fever  is  still  obscure  ;  its  causd  causans  yet  re* 
mains  hidden  ;  its  variations  in  type  and  epi- 
demicity  are  explicable  only  by  the  flimsiest  conjec- 
ture ;  the  prevention  of  return  cas^,  the  transmis- 
sion of  otorrhoea  and  rhinorrhcea,  the  causation  of 
post-scarlatinal  nephritis,  the  persistence  of  infec- 
tivity  and  a  host  of  other  matters  require  elu- 
cidation. We  have  abundance  of  evidence  as 
to  the  occurrence  of  complications  in  hospital- 
treated  cases,  but  to  what  extent  have  we  similar 
evidence  in  respect  of  the  home-treated  cases  ? 
What  evidence,  again,  have  we  at  present  of  the 
occurrence  of  "  return "  cases  outside  the  pa- 
tient's own  household  ?  To  these  and  many 
other   associated  problems   there   can   surely  be 


^04    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Sept.  2t.  191^. 


found  an  answer  if  a  proper  stimulus  to  research 
be  only  given. 

The  main,  if  not  the  sole,  objection  to  an  inquiry 
into  this  matter  is  that  it  may  "  shake  public 
Confidence."  But  has  not  the  confidence  of  the 
hiedical  profession  and  of  thinMng  laymen  already 
l^een  shaken  ?  And  is  not  the  best  manner  to 
^restore  that  confidence  to  court  the  fullest  in- 
vestigation and  to  search  out  the  truth,  what- 
ever it  may  be,  rather  than  to  plunge  our  heads 
ostrich-wise  into  a  mass  of  unconvincing  sta- 
tistics and  empty  platitudes  ? 

The  matter  is  one  of  considerable  urgency, 
for  many  local  authorities  are  now  hesitating  as 
to  the  adoption  of  isolation  hospital  schemes,  in 
the  hope  that  those  of  the  profession  on  whom 
they  rely  for  advice  in  such  matters  will  adequately 
defend  their  theories  or  forswear  them. 

Would  it  not  be  wisdom  also  to  somewhat 
extend  the  scope  of  any  inquiry  which  may  be 
held,  and  to  ascertain  whether  there  are  any 
disadvantages  attendant  on  the  hospital  isolation 
of  diphtheria  and  enteric  fever  ? 

Dr.  E.  D.  Marriott  has  suggested  {Lancet,  vol.  i, 
1902,  p.  1078)  that  in  the  Boer  War  hospital  *'  aggre- 
gation "  played  some  part  in  the  disastrous 
diffusion  of  enteric  fever.  If  there  be  any  truth  in 
this,  would  it  not  be  well  to  learn  it  at  once  ? 

It  is  by  no  means  an  easy  matter  to  say  by 
whom  the  inquiry  could  best  be  conducted,  if 
it  be  undertaken  at  all.  The  body  to  which  pro- 
bably most  of  those  interested  looked  for  a  lead 
(the  Incorporated  Society  of  Medical  Officers  of 
Health)  has  on  more  than  one  occasion  given 
evidence  of  its  desire  to  avoid  responsibility — 
to  put  the  thing  at  its  mildest.  Moreover,  this 
body  is  composed  of  experts,  and  an  inqmry  by 
experts  into  their  own  principles  and  practices 
would  savour  of  the  Gilbertian.  If  one  were 
given  a  choice,  one  would  unhesitatingly  pro- 
nounce in  favour  of  a  Royal  Commission  or  a 
Select  Committee,  for  in  this  way  one  would  cer- 
tainly secure  what  is  required — that  is,  men 
accustomed  to  weigh  evidence  calmly,  to  find  a 
common-sense  way  through  mazy  arguments, 
and  to  sift  statistics,  whilst  it  would  be  possible 
to  secure  on  such  a  body  the  very  necessary 
services  of  one  or  more  experienced  general 
me  ical  practitioners.  Moreover,  the  verdict  of  a 
Royal  Commission  would  undoubtedly  carry 
weight  with  both  professional  men  and  laymen. 

In  conclusion,  if  some  body  is  appointed  to 
investigate  this  vital  question,  is  it  impudent 
or  impertinent  to  draw  their  attention  to  four 
most  excellent  rules  drawn  up  for  the  guidance  of 
statisticians  by  Quetelet  ? 

"  I.  Never  have  preconceived  ideas  as  to 
what  your  figures  are  to  prove. 

"2.  Never  reject  a  number  that  seems  contrary 
to  what  you  might  expect,  merely  because  it  departs 
a  good  deal  from  the  apparent  average. 

"  3.  Be  careful  to  weigh  and  record  all  the 
possible  causes  of  an  event,  and  do  not  attribute 
to  one  what  is  really  the  result  of  the  combination 
of  several. 

"  4.  Never  compare  data  which  have  nothing 
in  common." 


I 

L 


The  examination  of  the  rats  found  on  board  the 
steamer  at  Hamburg  from  West  Africa,  which  were 
beUeved  to  have  died  of  plague,  shows  that  this  sus- 
picion was  without  foundation.  The  discharge  of  the 
cargo  has,  therefore,  been  continued. — Renter. 


FAMILY    CARE    OF     THE 

INSANE,   {a) 

(A  Visit  Paid  to  Gardelegsn  in  November,  1903. ^ 
By  Dr.  C.  WICKEL. 
Priodpal  Vedical  OAcer  at  the  Prorinbi*!  Aaylum  of  VLtmif^ftm, 
TRANSLATED,    WITH    THE    AUTHOR*S    PERMISSION, 

By  CONOLLY  NORMAN,  F.R.C.P.I.  {b) 

At  the  first  International  Congress  for  the  Relief  of 
the  Insane,  with  a  special  view  to  their  Nursing  Care 
in  Families,  held  at  Antwerp  on  September  ist,  1902, 
Alt,  in  his  paper,  stated  that  his  chief  reason  for  estab- 
lishing family  care  in  Gardelegen  was  to  demonstrate 
that  even  at  home  in  Germany  this  mode  of  treatmeot 
can  be  naturalised  without  a  preliminary  education  of 
the  population  extending  over  many  years,  and,  further, 
to  show  that  suitable  patients  would  be  happier  living 
in  a  family  than  even  in  an  institution  like  Uchtspringe, 
where  fre^om  of  treatment  is  carried  to  the  highest 
conceivable  point. 

At  the  present  time,  after  famUy  care  has  existed 
for  five  and  a  half  years  at  Gardelegen,  it  can  be  said 
that  the  experiments  made  there,  and  the  results 
obtained  thereby,  furnish  a  most  full  and  complete 
proof  of  the  justice  of  Alt's  anticipations. 

On  an  excursion  which  I  took  for  the  purpose  of 
acquiring  informatioa  in  the  autumn  of  1903.  it  was 
my  privilege  to  become  lamiiiar,  from  my  own  obser- 
vations, with  family  care  as  carried  out  in  Gardelegea, 
and  I  am  happy  to  be  able  to  report  thereon  ia  this 
place. 

In  the  autumn  of  1898,  the  first  patients,  namely,  fonr 
women,  were  transported  from  Uchtspringe  to  suitable 
families  in  Gardelegen.  In  April,  1901,  eleven  female 
patients  were  sent.  From  that  date  forward,  the 
number  of  cases  in  family  care  has  increased  rapidly 
and  almost  unintermptedly,  reaching  the  figufe  ot 
119  (chiefly  female  patieirts)  in  January,  1*904. 

The  patients  at  Gardelegen  are  to  be  regarded  as 
belonging  to  the  institution  of  Uchtspringe.  More 
than  two  patients  are  not  committed  to  the  care  of  any 
family  at  the  same  time.  The  number  of  families  who 
act  as  hosts  is  constantly  increasing.  Only  an  ex- 
ceedingly small  number  of  such  families  have  proved 
themselves  unsuitable  for  the  care  and  watching  of 
patients.  The  return  of  patients  to  the  institution' 
necessarily  takes  place  in  some  cases  in  which  severe 
bodily  illnesses  or  mental  exacerbations  occur. 

In  the  year  1903,  a  head  nurse  was  stationed  at 
Gardelegen.  The  medical  care  of  the  settlement  was 
at  first  managed  solely  from  Uchtspringe.  In  the 
summer  of  1905,  a  special  physician  was  appointed  who 
resides  in  Gardelegen,  and  takes  charge  of  the  patients 
in  family  care  uwler  the  director  (medical  supwin- 
tendent)  of  Uchtspringe,  Dr.  Alt,  Dr.  H.  Stamm,  who 
had  faniUiarised  hknself  at  Gottingen,  as  physician  to 
the  asylum  there,,  with  the  institution  of  family  care, 
received  this  post. 

Gardelegen,  like  the  asylum  at  Uchtspringe,  is 
situated  on  the  Stendal-Hanover  Railway,  fourteen 
kilometres  (between  eight  and  nine  miles)  distant  from 
Uchtspringe,  or  about  twenty  minutes*  journey  by 
train.  It  is  a  pretty,  cheerful,  little  country  village, 
the  chief  town  of  its  district,  having  about  8,000  in- 
habitants. It  has  nice  clean  streets  and  solid  well- 
built  houses.  On  the  whole,  it  gives  a  certain  impres- 
sion of  prosperity. 

Round  the  town  and  corresponding  to  the  old  forti- 
fications and  earthworks,  run  pleasure  grounds  and 
promenades.  A  handsome  avenue  leads  out  of  the  old 
town  towards  the  new  along  which  he  a  few  villas,  but 
chiefly  strongly  built,  decent,  one-storey  houses.  A 
well-kept  garden  is  attached  to  most  of  these  houses. 
In  this  lo(^ty  almost  every  house  contains  a  patient. 


(a)  As  this  paper  refers  to  one  of  the  more  recent  Oerman  inttlta- 
tlons  for  family  care,  whioh  has  attracted  a  good  deal  of  attention 
abro<id,  I  think  this  rendering  of  it  may  bave  some  interest  to  the 
readers  of  Tiu  Meoioal  Pans  and  Oibcular  —O.N. 

(6)  From  Bresler'a  PwifchiatriKh-Seurotoffiache  WiKMauckrift, 
June,  1904. 


Sept.  21,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Paess.    305. 


Gardelegen  has  no  general  water  supply.  The  water 
omes  from  public  pump  wells.  It  is  unobjectionable, 
rbe  general  sanitary  condition  of  the  town  is  very  good, 
nfectious  diseases  seldom  visit  it,  and  typhoid  espe- 
ially  has  not  appeared  for  a  succession  of  years. 

The  number  of  houses  open  to  receive  patients  is 
'ery  considerable.  Hereby  is  clearly  seen  how  great 
n  interest  the  population  already  take  in  the  family 
are  of  the  insane.  I  myself  had  several  opportunities 
if  confirming  this  by  my  own  observation.  A  villager 
ame  to  the  house  of  the  doctor  while  I  was  there  and 
legged  to  be  given  a  patient.  He  declared  he  would 
ake  all  possible  trouble,  and  that  he  had  already  pre- 
lared  a  room  in  accordance  with  regulations  and  under 
he  advice  of  other  hosts.  Owing  to  the  precautions 
irhich  are  adopted  in  the  choice  of  applicants  and  to 
he  great  number  of  applications  that  had  been  already 
nade,  it  was  necessary  at  first  to  advise  him  to  wait, 
bdeed,  before  a  family  receives  a  guest,  the  most  ex- 
haustive inquiries  are  prosecuted  as  to  the  calling  and 
the  character  of  the  family,  as  to  their  employment, 
and  particularly  as  to  the  ccmditions  of  their  dwelling 
with  special  reference  to  hygiene.  How  completely 
this  is  done  the  paper  of  questions  provided  for  this 
purpose,  and  which  is  appended  hereto,  will  serve  to 
ffldicate.  In  the  dwelling  of  a  family  of  hosts  who  had 
received  patients  for  some  time  and  were  known  as 
specially  good  at  the  work,  people  who  even  assisted 
the  others  with  their  advice,  the  wife  of  another  host 
was  waiting  for  the  doctor  and  begged  urgently  that 
he  might  give  her  a  patient  once  more.  On  the  day 
before,  in  fact,  her  patient,  who  was  a  case  of  periodic 
mania,  had  been  brought  back  to  Uchtspringe  on 
account  of  a  return  of  excitement.  The  woman  was 
now  afraid  that  perhaps  she  would  be  blamed  for  the 
re-appearance  of  excitement,  and  that  in  consequence 
no  other  patient  could  be  entrusted  to  her  again. 
She  repeatedly  represented  that  she  would  thus  be 
disgraced  "  before  the  others."  In  company  with  the 
doctor,  I  visited  the  very  great  majority  of  the  quarters 
.There  patients  are  maintained.  Throughout,  the 
dwellings  were  clean  and  well  kept.  The  rooms  set 
apart  for  the  patients  were  faultless  in  their  condition, 
roomy,  clean,  open  to  light  and  air,  cheerful  and  pro- 
vided with  clean  bedding.  In  case  a  room  was  not  in 
absolute  order,  the  family  were  always  eager  to  excuse 
themselves  and  explain  the  reasons.  Frequently  more 
furniture  was  found  in  the  patient's  room  than  the 
regulations  required.  We  saw  some  rooms  which 
obviously  were  specially  constructed  or  renovated  for 
the  reception  of  patients.  These  rooms  were  exhibited 
by  the  families  with  a  certain  pride. 

When  we  visited  a  lodging,  some  member  of  the 
iamily  immediately  appeared  holding  a  book  which 
contains  the  rules  about  family  care,  which  is  also  used 
for  the  memoranda  of  the  doctor  and  of  the  head  nurse 
as  to  the  time  of  the  visit,  the  medical  prescriptions, 
the  notes  about  clothing,  renovation,  improvement,  &c. 
It  also  contains  special  columns  to  indicate  the  occur- 
rence of  the  menses,  the  body-weight,  and  occasional 
convulsive  seizures.  Almost  in  every  case  the  master 
or  the  mistress  of  the  house  was  present.  In  Garde- 
legen, indeed,  there  is  a  great  deal  of  home  industry, 
particularly  the  preparation  of  mother-of-pearl.  There- 
fore the  inhabitants  are  not  often  absent  from  home. 
The  hosts  seemed  good-natured,  accommodating,  and 
intelligent.  Almost  all  of  them  reported  without  sug- 
gestion on  the  condition  of  their  patient  as  to  bodily 
state,  occupation,  and  occasional  alterations  in  mind. 
A  master  tailor  communicated  his  observations  about 
his  patient,  a  child,  set.  8.  in  a  very  clear  way  such  as 
wocdd  have  been  creditable  to  any  trained  attendant. 
The  matter  in  question  related  to  attacks  of  petit  mal, 
appearing  for  the  first  time  in  an  idiot  boy. 

The  patients  themselves  came  forward  or  were 
brought  in  from  their  work.  They  were,  without  exeep- 
tion,  well  cared  for,  clean  in  person  and  clothing,  under 
and  upper.  Their  condition  of  nutrition  was  very  good. 
They  aU  looked  contented.  Many  of  them  seemed  very 
happy.  From  the  behaviour  of  the  members  of  the 
famUy  and  from  the  attitude  of  the  patients,  it  could 


be  concluded  that  their  relation  with  each  other  was 
a  friendly  one.  This  was  very  noticeable  when  the 
patients  were  still  children.  In  such  cases,  indeed,  it 
frequently  seemed  that  relations  similar  to  those* 
between  parents  and  child  existed. 

In  most  cases  the  patients  were  employed  in  the 
kitchen  peeling  potatoes,  washing,  and  the  like,  or  they 
were  helping  the  woman  of  the  house  in  sewing.  This, 
of  course,  was  in  accordance  with  the  preponderance  oft 
female  patients.  Some  of  them  accompanied  the 
woman  of  the  house  on  her  journeys  to  the  yard  in  care 
of  fowl,  &c.  Others  who  were  incapable  of  occupation- 
sat  in  the  common  room  with  the  members  of  the- 
family.  Some  young  patients  were  met  on  the  street,, 
watching  the  children  of  their  hosts  at  play  or  taking* 
part  in  their  games.  I  asked  a  number  of  patients  in 
the  usual  way  whether  they  would  not  rather  go  back 
to  Uchtspringe.  and  whether  Uchtspringe  was  not  a 
prettier  and  better  place.  In  no  case  did  I  receive  an 
affirmative  answer.  They  all  preferred  remaining,  witht 
the  family  of  their  hosts. 

I  will  never  forget  with  what  jojrful  alacrity  one 
worthy  old  lady,  one  of  the  eldest  of  the  Gardelegem 
hosts,  described  the  steps  in  the  mental  development 
of  her  patient  whom  she  produced  for  inspection.  Iir 
well-chosen  language,  she  reported  that  the  patient,, 
when  delivered  over  to  her  care  some  years  before,  could 
neither  speak  nor  be  induced  to  occupy  herself,  and! 
even  had  sometimes  to  be  watched  closely  with  regard 
to  cleanliness.  Gradually  the  patient  became  more 
lively,  began  to  occupy  herself  under  constant  instruc- 
tion and  verbal  direction,  learned,  in  the  course  of  time, 
to  sew  and  to  dam.  and  is  now  a  useful  helper  to  her 
hostess  in  the  house  and  at  her  work.  The  patient 
speaks  little,  but  intelligibly.  This  was  a  case  of 
idiocy,  who  is  now  aet.  19.  Granted  that  in  this  patient 
perhaps  a  certain  further  development  of  the  mentall 
faculties  might  have  taken  place  even  in  an  institution,, 
yet  there  can  be  no  doubt  that  we  must  assign  a  great 
part  of  the  striking  and  far-reaching  result  t6  the  more 
genial  influences  of  the  family  and  to  the  exertions  of 
the  hostess  and  her  belongings.  According  to  the 
statement  of  the  doctor,  similar  instances  of  the 
favourable  influences  exercised  upon  the  mental  con- 
dition of  the  patients  in  family  care  at  Gardelegen  have 
been  repeatedly  observed. 

In  a  trusty  and  experienced  family,  a  press  for 
bandages  and  other  dressings  is  kept.  Any  minor 
surgical  dressing,  &c..  which  is  required  is  carried  en> 
,  there.  Instruments  and  other  surgical  necessaries  for 
special  cases  are  kept  in  the  doctor's  residence.  Pro- 
vision is  made  for  bathing.  A  host's  family  has  erectedi 
a  little  building  in  the  yard  attached  to  their  holding., 
where  there  is  a  water  supply  and  a  tank  with  arrange- 
ments for  warming  water  and  two  enamellM  baths.. 
In  an  ante-room  to  the  bathroom  a  weighing  machine 
is  placed.  Every  four  weeks  'at  furthest  each  patient 
comes  here  in  company  with  some  member  of  the  family 
and  has  a  bath  and  is  weighed.  The  host  who  builtt 
the  bath-house  and  has  to  look  after  the  machinery- 
receives  30pfennige  (a  little  under  3d.)  for  eich  bathing,, 
which  is  paid  by  the  asylum.  The  baths  and  the- 
weighing  machine  are  also  asylum  property. 

Eight  of  the  guests  belonged  to  the  better  classes, 
three  ladies  to  the  first  and  five  to  the  second.  Every 
two  paying  patients  of  the  second  class  have  a  large 
and  well-furnished  parlour  and  a  bedroom  in  common.. 
Every  lady  of  the  first  class  has  a  sitting-room  and  a. 
bedroom  to  herself.  In  a  family  whose  house  is  situated' 
in  the  street  leading  to  the  new  town,  two  of  these  Ikdies- 
live,  old  cases  of  chronic  paranoia.  They  possess  a 
prettily  furnished  bedroom  and  a  large  comfortable 
living  room  between  them.  The  head  nurse  is  pro- 
vided with  lodging  in  one  of  the  better  ffeimilies.  She- 
takes  her  meals  together  with  a  lady  of  the  first  class. 

Nearer  the  middle  of  the  town,  in  the  vicinity  of  the 
church  square,  a  woman  who  was  formerly  an  inspector 
of  schools,  and  who  lived  alone,  had  a  very  good  and 
nicely  furnished  dwelling  of  considerable  size.  Two- 
ladies  live  with  her  who  are  also  old-standing  cases 
of  chronic    paranoia.     The  hostess   dbvotes    herselfi 

a 


3o6    The  Medical  Piess. 


ORIGINAL    COMMUNICATIONS. 


Sept.  21,  1904. 


entirely  to  her  two  patients.  She  cooks  for  them,  looks 
after  their  apartments,  and  goes  for  walks  with  them. 
In  a  shopkeeper's  family  a  young  imbecile  lady  was 
taken  care  of.  She  had  two  handsomely  furnished  and 
spacious  apartments.  She  appeared  quite  contented, 
and  announced  that  she  was  going  in  the  evening  with 
her  host's  family  to  the  circus.  The  doctor  told  me 
that  this  patient  could  not  get  on  at  all  at  home,  and 
was  very  troublesome  in  the  institution,  but  had  done 
remarkably  well  up  to  the  present  in  family  care. 

It  has  never  been  observed  that  a  patient  was  over- 
worked, or  made  game  of,  or  worried  by  the  inhabitants 
of  the  town.  Absolutely  no  untoward  event  worthy 
of  mention  has  occurred  up  to  the  present  in  connection 
with  family  care  in  Gardelegen. 

When  patients  of  the  third  class  (public  patients)  are 
admitted  to  the  institution  at  Uchtspringe,  their  re- 
lations are  required  to  signify  beforehand  that  they 
agree  to  the  transfer  of  the  patient  to  family  care,  if 
such  a  course  should  be  considered  desirable  having 
respect  to  the  nature  of  the  case.  With  regard  to 
patients  of  the  first  and  second  class,  relatives  are  asked 
in  each  particular  case  whether  they  consent  to  the 
patient  being  placed  in  family  care.  Since  a  special 
physician  has  been  on  the  spot,  this  consent  has  always 
been  gladly  given.  Furthermore,  individual  relatives 
of  patients  of  the  third  class  who  at  first  had  doubts 
about  the  placing  of  their  people  in  family  care  became 
perfectly  content  with  this  method  after  they  knew 
that  there  was  a  doctor  in  residence,  and  at  their  visits 
they  expressed  their  complete  satisfaction.  In  con- 
nection with  this  I  may  be  allowed  to  make  a  brief 
observation  upon  some  points  which  make  it  apparent 
how  valuable  the  presence  is  of  a  medical  man  devoting 
himself  entirely  to  family  care  and  living  on  the  spot. 
The  doctor  learns  to  know  more  thoroughly  not  only 
his  patient  but  also  the  family  of  the  host  by  the  in- 
timate and  almost  daily  intercourse  that  he  has  with 
them,  and  he  is  thus  in  a  better  position  to  utilise  the 
peculiar  qualities  of  the  people  for  family  care.  He  is 
able  to  commit  to  them  particular  patients  according 
to  the  foresight  and  cleverness  shown  in  particular 
cases,  and  he  can  thus  individualise  better  in  the  loca- 
tion of  his  patients ;  but,  above  all,  the  constant 
interest  of  the  doctor  in  the  patient  calls  forth  from 
the  host  and  his  family  a  correspondingly  heightened 
interest.  By  commendation  of  particularly  excellent 
guardians,  by  reference  to  the  example  of  others,  and 
by  the  eventual  removal  of  a  patient  who  is  hard  to. 
manage  to  a  more  able  guardian,  and  the  substitution 
of  one  that  is  easier  to  manage,  emulation  is  kept  alive 
among  the  hosts.  Without  doubt,  a  rivalry  of  this 
kind,  a  certain  competition,  an  effort  to  do  their  best, 
at  present  exists  among  the  families  of  the  hosts  in 
Gardelegen.  and  this  is  a  very  desirable  thing  in  the 
interests  of  the  patients.  Very  notable  in  this  con- 
nection is  the  expression  already  referred  to  of  the 
woman  who  feared  she  would  be  disgraced  **  before  the 
others." 

Alt  has  already  shown  in  the  most  striking  way  how 
much  always  depends  upon  the  cleverness  and  activity 
of  the  physician  in  the  introduction  and  successful 
development  of  family  care.  It  is  scarcely  necessary 
to  particularly  mention  here  that  the  choice  of  the 
patients  who  are  to  be  committed  to  family  care  needs 
the  most  skilful  consideration. 

With  reference  to  the  forms  of  mental  trouble  in  the 
persons  committed  to  family  care  in  Gardelegen,  con- 
genital and  acquired  conditions  of  weak-mindedness 
come  first,  and  also  old,  quiet  paranoiacs,  forms  of 
disease  which  are  already  recognised  as  being  eminently 
suitable  for  family  care,  (a)  The  following  table  gives 
details : — 


.  (a)  The  nnin^^r  of  penont  in  family  oar«  in  Oftidelegen  has  riMH 
f^om  1 19 to  142  Saeioff  that  'here  ar^  In  addtUon  92  patients  in  the 
Htendaota'  vlllagre  at  Uchtspringe  and  in  the  nt'iffhbourinc  villaireii, 
and  tliat  there  are  besldee  in  Jerichow  and  its  vroinit.T  140  patients 
located  in  lamilies.  it  is  to  be  obseryed  that  at  the  time  of  tte  writing 
of  this  paper  the  number  of  penons  In  tkmWy  care  in  the  province  of 
Baxony  has  already  attaiaed  to  S60. 


Forms  of  Disease. 

Grown-up 
Patients  of 

GhildRatf 

Male      Female 
Sex.    ,     Sex. 

Male     riea^ 
«ex.       8«. 

Paranoia 

Imbecility,  Milder  Forms 

of  Idiocy     , 
Epilepsy'..'*!     .. 
Periodic  Insanity 

2 

II 

I 

27 

3 
I 

2      ^     20 

~   i  - 

Total 

14 

82 

3      » 

It  is  in  contemplation  to  erect,  in  the  course  of  tim^ 
a  little  central  hospital  in  Gardelegen  for  the  receptim 
of  patients  who  are  temporarily  excited,  or  who  snfiq 
from  severe  bodily  illness.  In  the  central  hospital  ai 
examination  room  and  a  room  for  drugs  and  surgic^ 
necessaries  and  bathing  accommodation  will  be 
vided  as  well  as  a  residence  for  a  head  attendant 
Family  care  would  thus  be  carried  out  aronnd  a  si 
infirmary  as  at  Jerichow,  according  to  the  plan  desigm 
by  Alt,  and  called  by  him  the  German  system  of  fasd 
care. 

A  visit  to  the  iamily  care  settlement  at  Gardelegci 
presents  a  highly  cheerful  picture  of  earnest,  active 
successful  progress.  We  here  behold  a  practical  q 
periment  in  family  care  on  a  large  scale  which  has  be^ 
crowned  with  success,  such  an  experiment  as  is  v^ 
designed  to  be  an  example,  and  to  serve  as  an  exampi 
May  it  contribute  to  excite  further  that  interest  i 
family  care  of  the  insane  which,  up  to  the  present.  I 
been  constantly  increasing  in  Germany,  and  may 
tend  to  smooth  the  way  for  the  freest  and  most  natnq 
of  all  methods  of  relief  for  the  unsound  of  mind. 

The  communications  which  the  Medical  Supem 
tendent.  Dr.  Alt,  made  to  me  with  reference  to 
tenance  cost  may  be  of  interest.  "  The  cost  of  clothioi 
including  boots  and  shoes,  and  including  the  renevi 
of  articles  worn  out  during  the  year,  amounts  to  ;' 
pfennige  per  head  daily.  The  amount  spent  on  rf 
pairing  shoes  in  the  last  year  ran  to  0*3  pf.  The  ' 
of  the  physician  stationed  at  Gardelegen,  and  of  t] 
head  nurse  set  apart  for  looking  after  the  patient 
amount  respectively  to  10*6  and  4*4  pf.  The  latt 
charges  will,  of  course,  diminish  proportionately 
the  increase  and  extension  of  the  system.  The  cost 
medicines  has  heretofore  been  at  the  lowest,  amonntia 
to  about  0'25  pf.  Tobacco  is  not  given  by  the  institt 
tion  to  patients  in  family  care,  who  very  often 
tobacco  and  cigars  from  their  hosts  as  an  encooragi 
ment  to  work,  or  reward  for  work  accomplished.  Th 
total  cost  of  a  patient  at  Gardelegen  by  the  day^ 
amounts  to  a  certified  expenditure  of  from  80  to 
102*65  pf-  The  latter  figure,  is,  therefore,  about  17-3$ 
pf.  lower  than  the  maintenance  in  the  asylum  for  a 
grown-up  patient  (a  third-class  patient  at  Uchtspringe 
costing  I  mark  20  pf.  per  diem),  and  very  much  cheaper 
than  the  total  cost  of  a  patient  in  the  asylum.  Accofd- 
ing  to  last  year's  balance  sheet,  the  total  cost  of  a 
patient  in  the  institution  amounted  to  172*19  pf.  pv 
diem. 

"  The  family  care  of  patients  of  the  better  classes,  on 
the  other  hand,  offers  unmistakable  advantages  com- 
pared with  asylum  care,  inasmuch  as.  for  the  paying; 
patients  at  present  in  Gardelegen — three  ladies  of  the 
first  class  and  five  of  the  second — 7' 7$  marks  daily  leas 
is  paid  out  than  is  received." 

Without  further  argument,  these  details  show  cleaiiy 
that  to  the  many  other  advantages  which  it  brings  with 
it  we  must,  in  deciding  upon  the  question  of  the  familj 
treatment  of  the  insane,  add  a  considerable  pecuniax)* 
profit  which  can  by  no  means  be  put  in  the  last  place. 

In  conclusion,  I  must  here  again  express  my  wannest 
thanks  to  the  medical  superintendent.  Dr.  Alt,  for  all 
the  kind  help  he  has  given  me,  and  also  to  Dr.  Stantm. 
vibo  showed  me  round. 

Appendix. 

List  of  Questions  to  be  considered  in  allocating 
patients  to  family  care  : — 


Sept.  21,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    307 


I .  Full  name  of  host  ?     Address  ?     Age  ?     Religion  ? 
^farried  or  Widowed  ?  (age  of  wife  or  housekeeper). 

2.  Total  number  of  members  of  household  ?  (a)  children? 
TiYunber,  age,  sex,  employment ;   (6)  lodgers,  servants  ? 

3.  Kmployment  or  trade  of  the  host  ?  Is  there  con- 
•stantly  a  member  of  the  family  at  home  ?  4.  Do  the 
lAxnily  live  in  orderly  comfortable  conditions?  Do 
tlxeir  means  of  subsistence  come  from  their  own  in- 
dustry ?  5.  What  is  the  general  impression  which  the 
family  makes  ?  6.  How  does  it  stand  with  regard  to 
orderliness  and  cleanliness  (of  dwelling,  clothing)  ? 
7*  Does  any  suspicion  exist  of  drink  or  tuberculosis  ? 
Have  any  cases  of  mental  disease  appeared  among  the 
family  ?  8.  Why  do  the  family  wish  to  take  charge 
of  patients  ?  How  many  do  they  want,  and  of  which 
sex  ?  Do  they  express  any  other  special  wishes  re- 
garding them  ?  9.  How  is  the  holding  situated  ? 
<enclosed  by  other  holdings  or  by  dwellings  in  the 
neighbouring  streets).  10.  Of  what  does  the  holding 
consist  ?  (offices,  byres,  arable).  11.  How  is  the  arable 
situated  ?  the  garden  ?  12.  Do  the  family  own  cattle  ? 
(horses,  goats,  pigs,  fowl).  13.  Water  supply  ?  Where 
is  the  well  situated  ?  Is  the  water  gGK)d  and  well 
flavoured  ?  Where  is  the  cesspool  ?  14.  Privy  ? 
15.  House?  (brickwork,  timber,  cellar,  roof,  architec- 
tural condition).  16.  Dwelling  of  the  family  ?  (No.  of 
rooms,  ground  plan,  kitchen,  &c.).  17.  Where  does  the 
family  spend  the  day  ?  Living  room,  eating  room 
(size,  air,  light,  heating,  aspect,  floor,  furniture).  Are 
there  beds  in  the  living  room  ?  18.  Sleeping  rooms  of 
patients  ?  (a)  Air  space  (area  of  floor,  height  of  room) ; 
{6)  No.  and  size  of  windows,  aspect,  light ;  do  the 
ivindows  look  out  on  the  street  or  ysird  ?  have  they 
movable  sashes  ?  {c)  How  do  the  doors  lead  ?  {d)  Walls? 
(how  covered,  hangings,  dryness) ;  {e)  articles  of  fur- 
iiiture  ?  (/)  Floor  (covered  ?  cellar  underneath  ?) 
(g)  Ceiling  ?  {h)  Heating  ?  (t)  Bed  ?  19.  Are  there  any 
other  dwellings  under  the  same  roof  ?  If  so,  who 
occupies  them  ?  Occupier's  trade,  number  of  children, 
sex,  age ;  servants,  lodgers,  other  members  of  family  ; 
moral  character.  20.  Report,  if  such  be  forthcoming, 
from  someone  who  can  vouch  for — (a)  general  respec- 
tability (character,  repute,  mode  of  bringing  up 
4:hildren) ;   {b)  domestic  circumstances  of  the  family. 


parte  Clinical  Xectute9« 

THE 

MEDICAL  TREATMENT 

OF 

CANCER  OF  THE  STOMACH. 

By  Professor  ALBERT  ROBIN,  M.D., 

Member  of  the  Aoedemy  of  Medidne ;  Prof  eator  Agr^  at  the  Faculty 
of  Medicine  of  Paris  ;  Phyaiolan  to  the  Paria  Hospitala. 

I  DRKW  your  attention  just  now  to  a  man,  aet.  65, 
in  the  Serres  ward,  pointing  out  to  you  that  his 
extreme  emaciation  and  the  straw-yellow  hue 
of  the  skin  were  suggestive  of  the  existence  of  a 
neoplasm.  As  a  matter  of  fact,  he  is  suffering 
from  cancer  of  the  pylorus.  For  a  year  past  he 
has  suffered  from  loss  of  appetite  and  progressive 
enfeeblement ;  he  complains  of  pain  in  the  region 
of  the  stomach  associated  with  vomiting  of  glairy 
material  mixed  with  food.  I  will  take  advantage 
of  this  case  to  discuss  the  symptomatology  of 
gastric  cancer,  and  more  particularly  its  treat- 
ment. 

The  onset  of  carcinoma  is,  as  a  rule,  insidious 
and  gradual.  The  principal  symptom  is  loss  of 
appetite,  with  repulsion  for  particular  articles  of 
food,  such  as  meat  and  wine.  Nevertheless, 
one  occasionaUy  meets  with  cases  in  which  the 
appetite  is  increased  instead  of  diminished. 
Vomiting  is  one  of  the  most  constant  symptoms 
of  gastric  carcinoma,  and  is  due  to  the  situation  of 
the  growth  at  the  orifices,  to  disturbances  of  the 


chemistry  of  digestion  and  the  irritation  caused 
by  the  presence  of  the  growth  itself.  The  most 
characteristic  sickness  is  that  which  occurs  on 
rising  on  an  empty  stomach,  or  during  the  day, 
preceded  or  accompanied  by  extreme  nausea. 
The  vomit  consists  of  glairy  mucus,  which  is 
brought  up  without  effort,  as  it  were  by  mere  re- 
gurgitation, the  so-called  "  cancer  brash."  In 
some  cases  the  vomiting  is  purely  alimentary, 
the  food  being  returned  some  hours  after  meals, 
with  great  relief  to  the  patient,  whose  stomach  is 
thus  emptied  of  its  contents.  These  may  be  re- 
turned unaltered,  but  usually  there  is  fermentation, 
and  the  vomit  has  an  acrid  or  putrid  odour. 
Under  the  microscope  we  see  sarcinae,  numerous 
micro-organisms  and,  according  to  Boas,  onie  long 
bacillus  in  particular,  to  which  some  authorities 
accord  a  special  diagnostic  value.  There  is  an 
absence  of  hydrochloric  acid,  and  there  is  only  ^  a 
minute  quantity  of  peptone,  while,  on  the  other 
hand,  fermentation  acids  are  present  in  abun- 
dance. Acid  fermentation  is  much  more  common 
in  gastric  carcinoma  than  gaseous  fermentation. 
Lastly,  we  get  the  so-called  "  coffee  -  ground  " 
vomit  due  to  the  presence  of  altered  blood  that  has 
oozed  from  eroded  vessels.  This  may  be  accom- 
panied by  melaena  or  not,  and  melaena,  on  the  other 
hand,  may  exist  without  coffee  -  ground  vomit. 
Copious  hsematemesis  is  exceptional  in  gastric 
carcinoma,  and  its  occurrence  points  rather  to 
gastric  ulcer.  Another  cardinal  symptom  is  pain. 
This  is  very  common,  but  it  is  far  from  being  as 
acute  as  in  ulcer.  Cancer  patients  do  not  suffer 
much  from  acute  attacks  of  pain  ;  they  complain 
of  a  feeling  of  weight  with  occasional  sharp  pangs 
over  the  growth,  which  is  tender  to  the  touch. 
They  are  rarely  free  from  this  distressing  sensa- 
tion, even  between  meals  ;  it  is  not  at  once  in- 
creased by  the  ingestion  of  food,  but  gradually  in- 
creases in  intensity  as  digestion  proceeds,  with 
some  pjrrosis. 

Severe  pain  on  palpation  of  the  tumour  in- 
dicates the  existence  of  partial  perigastric  peri- 
tonitis. Really  severe  pain,  however,  is  rare  and 
occurs  only  when  the  fibres  of  the  pneumogastric 
are  involved  by  the  growth.  Intestinal  troubles 
are  common,  constipation  being  the  rule,  diarrhoea 
supervening  only  in  the  terminal  stage. 

The  exact  situation  of  the  neoplasm  may  often 
be  determined  by  palpation.  In  the  case  before 
us  there  is  a  prominent,  diffuse  hard  tumour  on 
the  anterior  surface.  The  stomach  is  not  dis- 
tended, and  this  shows  that  the  pylorus  is  intact. 
To  complete  our  investigation  we  must  have  an 
analysis  of  the  stomach  contents.  Some  years 
ago  the  absence  of  free  hydrochloric  acid  was 
regarded  as  pathognomonic  of  cancer  of  the 
stomach,  but  this  is  not  the  case,  since  it  may  be 
wanting  in  many  other  affections,  as,  for  instance, 
chronic  gastritis,  hjrposthenic  dyspepsia,  &c. 
Moreover,  in  some  cases  of  gastric  carcinoma 
the  acid  is  not  only  present,  but  is  present  in  ex- 
cess, and  I  have  noted  this  in  eleven  out  of  250 
cases  of  the  kind.  Nevertheless,  the  point  is 
one  to  be  observed,  because  the  absence  of  acid 
may  confirm  a  suspicion  based  on  other  incon- 
clusive facts.  When  present  in  excess  the  pro- 
bability is  that  the  cancer  has  supervened  on  an 
ulceration  of  long  standing.  Lactic  acid  is 
usually  present,  and  in  Germany  its  formation 
was  at  one  time  declared  to  be  a  distinctive  sign. 
This,  however,  it  is  not,  for  it  is  absent  in  a  quarter 


308    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Sept.  2t,  1904. 


of  these  cases,  and,  on  the  other  hand,  is  met  with 
in  simple  dyspepsia. 

Leucocytosis  seemed  Ukely  at  one  time  to 
afiord  us  valuable  information  in  this  connection, 
but  experience  has  not  confirmed  this  conclusion, 
in  short,  our  diagnosis  must  be  based  on  the 
clinical  examination  of  the  patient,  not.  only  of 
the  stomach,  but  also  of  the  other  organs,  in  which 
there  may  be  metastasis,  or  which  may  be  secon- 
darily involved  by  the  gastric  affection.  The 
liver  in  particular  must  be  carefully  explored  as 
well  as  the  omentum,  the  peritoneum  and  the  um- 
bilicus. Look  out  also  for  enlarged  glands  above 
the  left  clavicle,  which,  if  present,  possess  grave 
significance,  in  that  they  contraindicate  sur- 
gical intervention.  In  the  case  before  us  there 
are  no  enlarged  glands.  Lastly,  examine  the 
lower  limbs  to  see  if  there  be  oedema  or  possibly 
phlegmasia  alba  dolens  of  the  veins  of  the  calf.  The 
examination  of  the  urine  affords  no  assistance. 

Among  other  compUcations  the  most  frequent, 
after  those  already  mentioned,  are  affections  of 
the  broncho-pulmonary  apparatus.  Then,  too, 
there  may  be  a  rise  of  temperature,  brief,  irregular 
or  intermittent,  attacks  of  fever,  due  to  the  ab- 
sorption of  the  toxic  products  of  gastric  fermenta- 
tion. Sometimes  the  temperature  remains  above 
normal,  a  form  of  septicaemia.  We  can  do 
nothing  to  control  the  two  last,  but  the  first 
variety  yields  to  the  administration  of  antiseptics. 
Lastly,  we  may  get  various  symptoms  of  intoxica- 
tion— coma,  tetany,  polyneuritis,  and  so  on — but 
these  are  altogether  exceptional. 

In  view  of  the  advances  that  have  been  accom- 
plished in  the  surgery  of  the  stomach,  one  is  apt 
to  suppose  that  the  rSle  of  the  physician  herein 
has  disappeared.  Nothing  of  the  kind.  We  may 
concede  that  medical  treatment  holds  out  no  pros- 
pect of  recovery,  that  it  can  at  most  attenuate  the 
more  distressing  symptoms  and  mitigate  the 
causes  of  the  pain.  Moreover,  we  meet  with 
cases  which  are  inoperable  by  reason  of  the  ex- 
treme enfeeblement  of  the  patient,  and  who,  by 
appropriate  medical  means,  may  so  far  regain 
strength  as  to  become  able  to  withstand  an 
operation. 

I  need  hardly  tell  you  that  the  curative  treat- 
ment of  cancer  has  yet  to  be  dicovered.  Still  it 
is  useful  that  you  should  be  told  of  the  various 
remedies  that  have  been  tried  because  even  if 
they  do  not  cure,  they  are  sometimes  very  useful 
palliatives  and  adjuvants.  Condurango,  for  in- 
stance, used  to  be  highly  thought  of,  though  in 
reality  it  is  really  a  tonic  bitter.  It  is  still  given 
as  a  tincture  or  fluid  extract.  Iodide  of  sodium, 
methylene  blue,  and  bichromate  of  potash,  in 
doses  of  from  a  fifth  to  one  grain,  conium,  tincture 
of  thuja,  &c.,  &c.,  have  all  been  tried,  but  I  have 
never  obtained  any  results  worth  speaking  of.  I 
have  not  experimented  with  various  anti-cancer 
sera,  but  those  who  have  done  so  do  not  appear  to 
have  much  to  say  in  their  favour. 

Some  years  ago  Fiessiager  and  Jaboulay 
claimed  to  have  obtained  great  benefit  from 
muriate  of  quinine  in  the  treatment  of  cancer  in 
general.  The  treatment  is  appUcable  to  the  treat- , 
ment  of  cancer  of  the  stomach,  and  in  my  hands 
it  has  certainly  appeared  to  delay  the  progress  of 
the  disease  and  to  mitigate  some  of  the  symptoms. 
Later  on  I  wiVL  compare  the  results  of  this  treat- 
ment with  those  of  surgical  intervention. 

Muriate  of  quinine  is  administered  by  the  mouth. 


by  the  rectum,  or  hypodermically.  The  avera^ 
dose  is  16  grains  a  day.  It  is  best  given  by  the 
mouth,  but  sooner  or  later  the  stomach  becomes 
intolerant.  Per  rectum  it  ultimately  excites 
tenesmus,  and  subcutaneously  it  is  painful 
Consequently,  my  plan  has  been  to  alternate  the 
three  modes.  For  eight  days  I  give  twice  daily 
in  the  epigastric  region  an  injection  of,  at  first 
l\  Ix,  then  !T\  cxx  of  a  solution  of  Tyvi  of  the  salt 
in  3xij  of  sterilised  distilled  water.  During  the 
next  eight  days  I  give  8  grains  of  the  salt  in 
cachet  form,  either  fasting  or.  a  short  time  before 
food  or  milk,  and  a  like  quantity  in  suppository. 
just  before  bed- time.  Then  I  return  to  the  in- 
jections, and  so  on.  If  tolerance  supervenes  to- 
wards one  method  of  administration  we  make  up 
the  dose  by  the  mode  that  is  still  tolerated.  In 
some  patients  we  can  give  as  much  as  20  or  even 
30  grains  daUy,  but  this  is  exceptional. 

Muriate  of  quinine  seems  to  me  to  be  one  of  the 
best  palliatives,  and  under  its  influence  I  have  often 
witnessed  a  remarkable  improvement.  I  rein- 
force the  action  of  this  salt  by  associating  it  with 
two  other  products  which  appear  to  me  to  exert 
a  favourable  influence  in  retarding  the  evolution 
of  the  disease,  viz.,  arrhenal  and  bromide  of  gold. 
Arrhenal  in  5  per  cent,  solution  is  given  in  londrop 
doses  twice  daily  for  five  days.  Then  for  another 
five  days  I  give  a  tablespoonful  of  a  solution  con- 
taining one  grain  of  bromide  of  gold  in  10  ounces 
of  water.  Such  is  the  fundamental  treatment  of 
carcinoma,  a  plan  which,  it  is  true,  gives  very 
modest  results,  but  which  will  nevertheless  bear 
comparison  with  those  of  surgical  intervention  as 
usually  practised. 

The  next  important  point  to  consider  is  that  of 
aUmentation.  There  is  a  tendency  when  gastric 
cancer  is  diagnosed  forthwith  to  place  the  patient 
on  milk  diet.  This  is  often  a  mistake.  There 
are  cases  in  which  milk  diet  is  appropriate  and 
others  in  .which  it  is  not.  We  may  put  on  the^ 
strict  milk  diet  patients  with  gastric  intolerance 
or  pyloric  obstruction,  those  who  have  an  insur- 
mountable distaste  for  food,  and  lastly,  those  who 
suffer  from  haematemesis.  The  quantity  must 
be  adapted  to  the  capacity  of  the  particular 
patient,  and  every  means  must  be  employed  to 
ensure  its  being  tolerated. 

In  deciding  the  question  of  what  food  to  give; 
you  must  be  guided  by  the  state  of  the  intestines. 
If  the  intestinal  functions  are  more  or  less  dis- 
turbed they  will  be  unable  to  make  up  fbr  the 
inadequacy  of  gastric  digestion,  consequently  we 
must  discard  meat,  which  excites  repulsion,  and 
insist  on  a  vegetable  diet,,  selecting  substances 
rich  in  nitrogen  in  order  to  maintain  as  far  as 
possible  the  intake  of  nitrogeneous  matter.     lU 
on  the  other  hand,  the  intestinal  functions  are  in 
fairly  good   order  we    may  order   a  mixed  diet 
adapted  to  the  state  of  the  stomach.     Under  these 
conditions,  by  getting    the  patient  ta  eat  he  can 
be  kept  going  for  a  tolerably  long  time.     To  get 
him  to  eat,  however,  we  must  give  him  an  appetite, 
and  it  is  here  that  we  must  have  recourse  to 
bitters.     Among    the    so-called    **  ap^ratifs "    or 
appetite-givers  is   the  persulphate   of  soda.     It 
must  be  given  in  weak  solution,  and  stopped  as 
soon  as  the  appetite  begins  to  return  ;  in  any  case, 
discontinue  it  in  eight  days  (persulphate  of  soda^ 
gr.  XXX,  distilled  water,  fl.  oz.,  x.     A  tablespoonful 
half  an  hour  before  lunch  and  dinner).    Mcta- 
vanate  of  soda  is  another  good  appctite^rcstorer. 


Sbpt.    21.    1904. 


BRITISH  HEALTH  RESORTS. 


The  Medical  Press.   309 


(Metavanate  of  soda,  gr.  \  ;  distilled  water,  one 
^int  ;  dose  one  tablespoonful.)  Failing  success, 
you  can  try  a  combination  of  the  tinctures  of 
gentian  and  quassia  with  jaborandi  and  nux 
vomica.  When  you  have  induced  the  patient 
to  eat  you  must  assist  the  digestion,  since  we 
oannot  trust  to  his  unaided  powers.  You  will, 
tlierefore,  prescribe  hydrochloric  acid  and  digestive 
ferments — pepsine  and  malt  during  the  meal  and  a 
Iceratinised  piU  of  pancreatine  after  the  meal. 

Fermentation  must  be  controUed  by  the  ad- 
xninistration  of  fluoride  of  ammonium  (fluoride 
of  ammonium,  gr.  v  ;  distilled  water,  fl.  oz.,  xij. 
A.  tablespoonful  with  lunch  aad  dinner).  When 
tlie  fermentation  causes  pain  and  vomiting  give  a 
teaspoonful  of  the  following  mixture  immediately 
alter  eating  and  another  as  soon  as  the  pain  begins  : 
Subnitrate  of  bismuth,  i  drachm ;  carboUc  acid, 
1 5  drops ;  chloroform  water,  4  fl.  ounces.  If 
the  pain  be  very  severe  you  may  order  occasionally 
a^  teaspoonful  of  the  following  :  Cocaine  muriate, 
I  grain ;  codeine,  i  grain ;  Hme  water,  5  fl. 
ounces  ;  chloroform  water,  i^  ounce.  In  presence 
of  intense  pain  apply  a  blister  to  the  epigastrium, 
and  powder  the  raw  surfaces  with  powdered 
opium.  If  the  pain  be  caused  by  acid  fermentation 
giving  rise  to  pyrosis,  prescribe  the  following 
povrder  :  Precipitated  chalk  and  hydrated  mag- 
nesia, aa  I  drachm  ;  soda  bicarb.,  i^  drachm. 
Mix  and  divide  into  twelve  powders,  one  to  be 
taken  as  required. 

Then  for  the  vomiting,  when  persistent,  put  the 
patient  on  a  strict  milk  diet,  and  before  each  drink 
of  milk  give  him  4  or  5  drops  of  the  following  solu- 
tion :  Picrotoxine,  i  grain ;  rectified  spirit,  q.s.  to 
dissolve ;  hydrochlorate  of  morphine,  i  grain ; 
neutral  sulphate  of  atropine,  gr.  i ;  ergotin 
Bonjean,  r\  16 ;  cherry  laurel  water,  VS^  180. 
If  nothing  whatever  can  be  tolerated,  abandon 
the  milk  and  nourish  the  patient  by  rectal  enemata. 
This  course  is  also  advisable  when  there  is  hae- 
matemesis.  Among  other  tonics  I  may  mention 
-subcutaneous  injections  of  glyceroph:)sphate  of 
soda  in  5 -grain  doses  daily  for  a  month. 

Our  patient  is  obviously  in  a  very  bad  way. 
Nevertheless,  since  his  admission  a  week  ago  he 
lias  gained  some  25  ounces  in  weight.  Of  course, 
he  cannot  recover,  but  do  you  suppose  that 
surgical  intervention  would  give  a  better  result  ? 
According  to  recent  statistics  pylorectomy  or 
gastrectomy  gives  an  operative  mortaUty  of 
about  26  per  cent.  The  immediate  results  of  the 
operation  are  indisputably  admirable  in  such 
patients  as  survive  the  operation,  the  digestive 
functions  improve,  the  pain  subsides  and  they 
gain  in  weight.  Unfortunately,  the  improvement 
is  not  of  long  duration,  and  if  the  lymphatics  are 
involved,  which  is  the  rule,  the  growth  recurs  in 
other  organs,  and  death  supervenes  from  re- 
currence, cachexia  or  metastasis.  Most  of  such 
patients  under  my  own  observation  have  suc- 
cumbed to  broncho-pulmonary  compHcations. 
The  average  period  of  survival  is  one  year,  and 
by  purely  medical  treatment  the  average  period 
is  eight  months.  Under  these  circumstances  I 
really  hardly  care  to  expose  the  patient  to  an 
operation  that  kills  three  patients  out  of  ten,  on 
the  off-chance  of  obtaining  a  prolongation  of  life 
ior  three  months.  You  will  bear  in  mind  that 
the  surgical  is  the  best  treatment  when  cancer  can 
l>e  diagnosed  with  certainty.  In  one  case,  under 
Doyen,  the  patient  survived  three  years  and  a  half. 


and  in  that  instance  we  were  unable  to  agree  upon 
the  diagnosis  quite  at  the  onset.  The  tumour 
was  removed  in  its  entirety  and  Ufe  was  prolonged 
beyond  anything  that  medical  treatment  proper 
could  offer.     Such  cases,  however,  are  exceptional. 

Our  patient  is  too  feeble  to  bear  such  an  opera- 
tion. One  might  perform  gastro-enterostomy, 
but  the  operative  risks  are  just  as  great  and  the 
operation  would  only  reUeve  the  pyloric  stenosis. 
When  successful  this  operation  sometimes  pro- 
cures an  improvement  in  the  symptoms  and  an 
increase  in  weight,  but  the  strength  does  not 
return,  and  the  characteristic  yellow  colour  of  the 
skin  persists.  That  is  not  surprising,  since  the 
operation  has  not  removed  the  cancer,  and  has  for 
object  merely  to  prevent  gastric  stasis.  The 
disease  runs  its  course,  and  the  patient  is  carried 
off  by  one  or  other  of  the  compUcations.  Such 
patients  do  not  Uve  longer  than  those  who  refuse 
operation. 

To  sum  up,  there  is  no  curative  treatment  of 
carcinoma,  but  there  is  a  palliative  medical  treat- 
ment which  enables  us  to  prolong  life  for  consider- 
able periods.  In  any  event,  if  we  do  not  markedly 
prolong  Ufe,  we  are  in  a  position,  with  the  means 
at  our  disposal,  to  assuage  the  i>atient's  sufferings 
and  to  imbue  him  with  a  certain  hopefulness.  It 
is  only  in  the  painful  cases,  where  the  means  I 
have  described  fail  to  afford  any  relief,  that  we  are 
justified  in  having  recourse  to  gastro-enterostomy, 
which,  in  my  opinion,  will  always  be  in  the  nature 
of  an  exceptional  operation. 


;|Briti6b  Dealtb  1{esott0* 

X.— FALMOUTH. 


[by  our  special  medical  commissioner.] 


^  Among  Cornish  health  stations  Falmouth  very 
rightly  occupies  a  foremost  place.  This  picturesque 
old  port,  sheltered  on  the  west  side  of  its  extensive 
and  much  indented  harbour,  has  won  the  enthusiastic 
advocacy  of  such  distinguished  physicians  as  Sir 
Joseph  Fayrer  and  Sir  Edward  Sieveking ;  and  medical 
men  in  all  parts  of  the  country  have  testified  to  the 
benefits  of  this  highly  favoured  resort  on  the  Cornish 
Riviera. 

The  situation,  conveniences,  and  climatic  conditions 
are  such  as  peculiarly  fit  the  place  for  a  winter  resi- 
dence. The  abundant  and  semi-tropical  vegetatfon 
affords  clear  evidence  of  the  mildness  and  equability 
of  the  climate.  Falmouth  in  the  summer  months  is  for 
many  persons  undoubtedly  enervating ;  and  even  in  late 
spring  we  have  found  it  distinctly  relaxing.  But  for  the 
aged  and  the  infirm,  the  delicate  and  the  convales- 
cent, and  particularly  for  the  subjects  of  chronic 
respiratory  affections  Falmouth  can  supply  much  that 
is  of  the  greatest  benefit.  For  those  enfeebled  by 
years  or  the  attacks  of  disease  this  sheltered,  old- 
fashioned  marine  residence  provides  protection  from 
the  stress  of  winter  weather  and  allows  of  the  main- 
tenance of  a  fairly  free  open-air  life  throughout  the 
year. 

Falmouth  possesses  an  important  Meteorological 
Observatory,  and  its  records  extend  from  the  year 
1867.  These  returns  clearly  indicate  the  prevalence  of 
climatic  conditions  particularly  desirable  for  the 
physically  feeble.  Much  sunshine  is  enjoyed,  the 
temperature  is  equable,  and  the  mean  of  the  maximum 
and  minimum  temperatures  is  about  50° ;  the  mean 
range  being  between  9°  and  10°.  The  air  possesses 
peculiarly  balmy  qualities,  and  there  is  good  protection 
from  winds.  Shsurp  frosts  are  almost  unknown,  and 
such  fogs  as  occur  are  generally  free  from  irritant  pro- 
perties. 


3^0    Tmk  Medical  Press. 


GERMANY. 


Sept  21.  1904. 


Endless  interest  circles  about  the  spacious  bay. 
the  well-protected  harbour,  and  the  winding  river  Fad- 
The  immediate  district  is  rich  in  places  of  historic 
and  natural  interest.  The  town  and  vicinity 
offer  much  that  is  pleasing  to  artist  and  antiquary. 
Persons  of  all  tastes  will  find  in  Falmouth  congenial 
material  for  study. 

The  hotels,  viewed  from  the  standpoint  of  health- 
seeker  and  invsdid.  leave  much  to  be  desired,  but  good 
apartments  are  always  available. 

We  have  carefully  studied  the  health  resources  of 
this  resort,  and  consider  it  particularly  adapted  for 
the  special  requirements  of  those  who,  from  the  wear 
and  tear  of  years  or  the  encroachments  of  disease, 
require  a  peaceful,  regulated,  equable  and  protected 
life.  For  chronic  invalids  it  can  offer  many  attractions. 
It  is,  however,  perhaps  most  useful  as  a  winter  resi- 
dence for  chronic  bronchitis,  sufferers  from  laryngeal 
affections  and  those  who  are  the  subjects  of  chronic 
tuberculous  and  other  slowly  progressive  forms  of 
pulmonary  disease.  Patients  with  chronic  renal  disease 
should  do  well  in  Falmouth  ;  and  some  forms  of  nervous 
derangement  may  be  expected  -  to  gain  benefit  from 
residence  in  this  quiet  town. 

It  is  not  for  us  here  to  describe  the  many  attractive 
features  which  the  enterprise  of  man  has  added  to  the 
benefits  so  richly  provided  by  Nature  ;(a)  it  suffices  to 
say  that  much  has  been  accomplished  to  meet  the 
requirements  of  the  health-seeking  visitor. 

Falmouth  is  306^  miles  distant  from  London.  The 
Great  Western  Railway  run  excellent  trains  in  a  little 
over  seven  and  a  half  hours,  {b) 


fvmcc. 


[from  our  own  correspondent.] 


Paris,  Septemb«r  18th,  1904. 
Treatment  of  Acute  Rheumatism. 

The  classical  treatment  of  acute  rheumatism  has 
been  for  years  salicylate  of  soda.  It  acts  on  this  affec- 
tion as  a  specific,  like  mercury  on  syphilis  and  quinine 
on  intermittent  fever. 

In  1876,  Strieker  proclaimed  the  efi&cacy  of  salicylic 
acid,  already  tried  by  Buss,  of  St.  Gall.  But  it  was 
Germain  L^e  who,  a  year  later,  in  a  memorable  communi- 
cation to  the  Acad6mie  de  M^decine,  indicated  the 
rules  of  the  treatment  of  rheumatism  by  salicylate  of 
soda. 

Not  only  should  the  treatment  be  prescribed  at  the 
outset,  but  if  the  fever  be  high,  large  doses  should  be 
given — two  drachms  daily.  For  children,  a  drachm 
should  not  be  exceeded.  Salicylate  of  soda  irritating 
the  stomach,  it  is  best  given  in  Vichy  water  or  in  a 
mixture,  as — 

Salicylate  of  soda,  5iij* 

Rum,  5j. 

Syrup  of  orange  water,  Sa^j. 

From  two  to  eight  tablespoonsful  a  day. 

The  treatment  should  not  be  suspended  with  the 
cessation  of  the  pain ;  to  insure  durable  effects  it 
should  be  continued  in  decreasing  doses  for  fifteen  da3rs. 

Salicylate  of  soda  is  toxic  for  some  patients.  The 
intolerance  is  shown  by  nausea,  vomiting,  vertigo,  and 
sometimes  by  heart  troubles,  which  may  terminate  in 
syncope. 

The  drug  also  provokes  congestion  of  the  kidneys ; 
by  accumulating  in  the  economy  it  gives  rise  to  grave 


(«)See  "Old  Falmouth.**  By  8.  E.  Gay.  (London:  Headley 
Bros.)  The €k>rporation of  Falmouth  issue  a  uiefnl  guide,  (Lv- 
dun  :  The  Healtii  Beeorte  Aaiooiation.)  Meaani.  Ward,  Lock  and 
Oo.  have  publiahed  a  uiefnl  ffuide  which  contain*  much  data  regard- 
ing meteorological  conditiona.  A  useful  table  respecting  the 
olimatie  state  of  Falmouth  appears  in  "  The  Climates  and  Baths  of 
Great  Britain.    (London  :  MacmOlMi  and  Co.)    Vol.  I.,  p.  66. 

(6)  See  *•  The  Cornish  Riviera.**  PnUished  by  O.W.  BaUway, 
Paddington,  W. 


toxic  accidents  when  the  function  of  the  renal  organs 
is  compromised.  Thus,  when  a  patient  sufien  froo 
chronic  nephritis,  salicylate  of  soda  should  not  be 
prescribed.  The  same  may  be  said  of  those  sofferiaf 
from  arterio-sclerosis,  from  heart  disease,  and  in 
pregnant  women  by  reason  of  its  abortive  propertici 

In  all  these  cases,  other  drugs  may  be  prescribed 
with  more  or  less  benefit. 

It  is  thus  that  anHpyrin,  recommended  by  Hasios 
Bemheim,  can  be  substituted.  It  is  prescribed  is 
daily  doses  of  forty-five  to  sixty  grains.  It  relieves  the 
pain  and  lowers  the  temperature,  bat  it  has  not  the 
specific  action  of  salicylate  of  soda. 

Salol  and  salophen  have  been  given  by  many,  while 
aspirin  seems  to  be  very  efficacious  and  well  tolerated; 
but,  according  to  Dr.  Gerest,  pyramidon  is  equal  in  its 
effects  to  salicylate  of  soda.     He  administers  it  in  doses    | 
of  five  grains  every  six  hours  or  every  four   boon.    ' 
ac(!ording  to  the  intensity  of  the  affection,  and  continnes    I 
it  eight  days  after  the  fever  has  3rielded. 

Generally,  he  says,  from  the  day  following  the 
administration  of  the  pyramidon,  a  great  improvement 
in  the  local  and  general  symptoms  takes  place ;  the 
temperature  falls  almost  completely,  and  gradually 
the  phjrsical  signs  disappear. 

No  accident  of  any  kind  was  ever  observed  daring 
the  treatment ;  the  only  inconvenience  is  the  produc- 
tion of  sweating,  but  few  patients  complain  of  it,  and 
in  any  case  it  diminishes  rapidly,  although  the  drug  is 
continued.  However,  it  would  be  well  to  abstain  from 
giving  it  to  consumptive  and  diabetic  patients  ;  in  the 
former  on  account  of  the  sweating,  and  in  the  latter 
because  it  increases  the  quantity  of  sugar  eliminated 
by  the  urine. 

Bleeding  Hemorrhoids. 

The  following  will  be  found  thoroughly  trustworthy  in 
this  troublesome  complaint : — 
Cocaine,  gr.  ^. 

Solution  of  adrenalin  (i  in  1,000).  o.m. 
Antipyrin,  grs.  v. 
Cocoa  butter,  q.s. 

For  one  suppository. 

(Germans* 

[from  our  own  correspondent.J 

Bcuior,  September  IMi,  IMA 
In  the  Korr,  Bl.  f.  Schweitz,  Aertze,  Bd.  14, 1904,  is  an 
article  on 

Primary  Peritonitis  in  Infancy, 
by  Dr.E.  D6beli.  He  records  a  case  observed  by  himseV 
of  primary  purulent  peritonitis,  and  remarks  that  he 
has  been  unable  to  find  more  than  five  other  cases 
recorded  in  literature.  His  own  case  was  that  of  a 
boy,  II  weeks  old.  It  had  been  suckled  by  the 
mother  from  its  birth  to  within  four  d^ys  of  the  com- 
mencing illness.  The  child  was  led  five  times  in  the 
twenty-four  hours,  and  vomited  after  every  meal.  It 
had  three  to  four  normal  sto(^  daily.  The  child  had 
been  very  restless  for  some  days  before  being  taken  to 
the  polyclinic. 

On  December  26th  the  state  was  as  follows : — Slightly 
furred  tongue,  temperature  37°  C,  weight  5  kgnn. 
The  child  was  put  to  the  breast  and  drank  40gnn.  on 
the  following  day.  The  general  condition  had  got 
worse — temperature  39°  C,  weight  4*900  kgrm.  For 
the  next  few  days  the  secretion  of  milk  returned  to 
the  breast,  so  that  the  quantity  sufficed  for  the  infant 
Constant  vomiting  at  first  of  milk,  then  of  bile  matter. 
January  ist. — ^The  child  had  not  taken  the  breast  from 
the  day  before.     The  last  st€>€>l  was  on  December  3is> 


Sept.  21,  1904. 


AUSTRIA. 


The  Medical  Pkbss.    3IX 


The  kidney  excretion  ceased,  and  the  child  cried  con- 
stantly. Face  pinched,  somnolence,  continued  vomit- 
ing of  bile  matter,  but  nothing  faecal.  Extreme 
meteorism,  dulness  in  the  dependent  parts.  The  child 
cried  aloud  when  its  abdomen  was  touched.  The 
vomiting  not  so  severe  after  washing  out  of  the  stomach. 
There  was  a  suspicion  that  an  abscess  had  burst  into 
the  peritoneum,  but  the  desperate  condition  of  the 
child  would  not  permit  of  any  surgical  interference. 
The  child  died  at  six  in  the  evening. 

The  autopsy  showed  purulent  peritonitis.  On 
opening  the  abdomen  a  large  quantity  of  thin,  odour 
less  pus  mixed  with  lymph  flakes  escaped.  The  whole 
peritooeum,  especially  that  over  the  visceral  parts,  was 
mach  injected,  and  showed  numerous  fibrinous  de- 
posits. The  mesenteric  glands  were  swollen.  There 
was  scarcely  any  other  pathological  sign ;  there  was 
no  perforation,  the  vermiform  and  its  neighbourhood 
and  also  that  of  the  umbilicus,  were  normal.  The 
spleen  was  not  enlarged,  the  liver  and  kidneys  were 
healthy.  The  case  was  diagnosed  as  one  of  diffuse 
purulent  streptomycotic  peritonitis. 

In  a  case  described  by  Netter,  in  a  child,  a  day  old, 
there  was  also  meningitis.  The  excitors  were  pneumo- 
cocci.  Also  in  a  case  of  Perrin's,  there  were  pneumo- 
cocci  in  the  pus. 

In  the  cases  adduced  the  infection  most  probably 
took  place  from  the  intestines.  The  danger  of  the 
passage  of  bacteria  from  the  intestine  into  the  blood 
was  greatest  in  the  first  days  of  life.  The  so-called 
paerperal  infection  of  children  was  most  frequent 
during  puerperal  epidemics.  Of  course,  any  peritonitis 
starting  from  the  umbilicus  would  easily  be  recognised. 

In  the  Arch.  /.  Experim.  Path,  und  Pharmak.  is  a 
paper  by  Breuer  and  v.  Seiller  on 
The  Influence  of  Castration  on  the  Blood  of 
THE  Female. 

The  authors  have  endeavoured  by  way  of  experi- 
ment to  determine  the  question  of  the  influence  of  the 
ovaries  in  connection  with  chlorosis.  As  the  thyroid 
and  suprarenal  capsules  have  undoubtedly  an  influence 
on  tissue  change,  so  the  ovaries  have  been  thought  to 
have  an  influence  in  certain  anomalies  of  constitution. 
Independent  of  their  function  of  evolution,  they  have 
been  credited  with  another  function,  that  of  an  internal 
secretion  that  is  capable  of  influencing  tissue  changes. 

Experiments  were  made  on  young  female  animals  by 
depriving  them  of  their  ovaries,  and  the  experiments 
showed  that  the  loss  caused  a  decided  change  in  the 
quantity  of  the  blood  in  the  form  of  diminished  blood 
corpuscles  and  lessened  quantity  of  haemoglobin. 

The  diminution  in  the  blood  was  only  a  passing  one, 
and  after  a  time  the  function  of  the  ovaries  appeared 
to  be  taken  up  by  other  organs.  Whether  the  poorness 
of  the  blood  in  blood  corpuscles  was  due  to  over- 
destruction  or  diminished  regeneration  could  not  be 
determined. 


BuBtria* 


[from  our  own  correspondent.] 

ynwA,  September  18th,  19M. 

Anomalous     Form    of     Jackson's    Epilepsy. 

At  the  Bohemian  meeting  in  Prague,  Vitek  showed 
a  man.  xt.  17,  who,  eleven  years  ago,  suffered  from 
meningitis,  which  was  followed  by  hydrocephalus.  The 
iirst  attack  of  Jackson's  epilepsy  occurred  at  the  onset 
of  the  meningitis  and  repeated  itself  at  intervals 
afterwards,  always  becoming  shorter.  The  contrac- 
tions commenced  in  the  right  lower  extremity,  gra- 
dually rising  to  the  right  upper  extremity  and  right  side 


of  the  face,  while  the  eye  was  twisted    towards  the 
left. 

The  most  int^esting  point  in  this  case  was  the  in- 
vasion of  insensibility,  unconacioasness,  biting  of  the 
tongue,  involuntary  passing  of  water  as  well  as  other 
genuine  symptoms  of  epilepsy.  It  might  be  mentioned 
that  after  this  meningitis  amaurosis  with  atrophy  of 
the  papilla  set  in. 

His  interpretation  of  the  course  of  the  disease  was 
that  the  meningitis  in  the  first  attack  was  the  result  of 
an  inflammatory  encq>halic  process  of  the  central 
convolution,  whereby  an  adhesion  of  the  meninges  and 
grey  cortex  of  the  brain  became  united.  Finally, 
hydrocephalus  formed  in  the  subarachnoid  space,  tear- 
ing up  the  adhesions  and  increasing  the  number  and 
severity  of  the  attacks. 

Gouty  Paralysis. 

Thomayer  gave  a  very  instructive  fhumi  of  the 
paralysis  of  gout,  which,  he  afiirmed,  assumed  very 
mysterious  manifestations,  occurring  in  the  hands  of 
the  neuro-pathologist  as  epilepsy,  hallucinations, 
aphasia,  and  paraplegia,  which  disappear  as  soon  at 
the  gouty  symptoms  appear.  These  phenomena  are 
met  with  everywhere,  and  need  not  be  described, 
although  it  might  be  pointed  out  that  there  are  four 
varieties  of  this  gouty  condition  requiring  close  obser- 
vation. 

The  first  and  common  form  is  where  the  paralysis 
recedes  as  soon  as  the  gouty  symptoms  develop ;  the 
second  has  the  paralysis  concurrent  with  the  gouty 
symptoms  and  disappears  with  them  ;  the  third  has 
the  paralysis  long  after  the  gouty  symptoms  have  dis- 
appeared ;  while  the  fourth  has  the  most  peculiar 
anomaly  of  all  by  having  paraljrsis  of  one  extremity  at 
the  same  time  that  the  patient  is  suffering  excruciating 
pain  in  the  opposite  extremity. 

All  these  forms  of  paraljrsis  must  be  recognised  as 
temporary  neuritis  without  disintegration  of  the  nerve 
fibre,  having  their  origin  in  a  toxic  agent  acting  on  the 
periphery  of  the  nervous  system.  It  should  be  borne 
in  mind  that  this  toxic  substance  is  not  to  be  found 
in  the  urine  no  matter  how  careful  an  analysis  has 
been  performed.  The  speaker  assured  his  hearers  that 
he  had  repeatedly  injected  the  urine  of  these  patients 
into  frogs  and  failed  to  elicit  any  symptom  of  the  poison.. 
Sack's  Amaurotic  Idiocy. 

Heveroch  presented  two  sisters,  aet.  respectively 
2\  and  i  years,  with  a  family  tendency  to  idiocy.  The- 
children,  he  related,  were  quite  normal  and  healthy  at 
birth,  and  continued  so  for  six  months.  About  .this 
time  convulsions  appeared,  which  were  followed  by 
squinting  and  inability  to  steady  the  eyes  or  recognise 
anyone,  although  the  development  still  went  on.  The 
muscles  were  soft  and  paretic,  but  not  atrophied. 
Neither  of  the  children  could  sit  up  after  this  time ; 
neither  could  creep  or  walk,  but  lay  helpless  performing 
purposeless  movements.  Spasms  occurred  either 
voluntary  or  from  external  stimuli.  Neither  of  them 
had  evidently  any  sense  of  hearing  or  smell,  although 
taste  seemed  to  be  present.  No  trace  of  intelligence 
was  to  be  observed.  The  parents  were  perfectly 
healthy,  but  the  history  of  the  father's  side  was  not 
satisfactory,  where  there  was  a  history  of  alcoholism, 
epilepsy,  hydrocephalus,  and  arthritis  deformans  to  be 
found. 

Both  of  these  children  differ  from  Sach's  type  of 
the  disease  in  (i)  being  the  offspring  of  Catholic 
children  and  not  Mosaic ;  (2)  the  absence  of  the 
characteristic  macula  lutea  hypercausis  and  sense  of 
smell ;  and,  lastly,  one  of  the  children  had  passed  its 
second  year  without  any  promise  of  improving. 


3^2    The  Medical  Press. 


THE    OPERATING    THEATRES. 


Sept.  21,  1954. 


-    EvoLUTio  Precox. 

A  large  number  of  these  precocious  children  are 
described  as  mensthiatio  precox,  but  Jaroslav  drew 
special  attehtioa  to  a  child,  set.. 6^,  which  he  showed 
to  the  members  as  a  remarkable  case  of  premature 
•development.  At  its  birth  it  was  much  larger  in 
site  than  its  other  two  elder  sisters,  and  also  grew 
rapidly  after  it  was  bom.  In  its  fourth  month  the 
breasts  became  swollen,  with  a  sanguineous  discharge 
from  the  vagina ;  at  the  sixth  month  this  was  re- 
pieated.  and  has  recurred  regularly  since  every  four 
weeks,  continuing  to  discharge  for  three  or  four  days  at 
the  period.  The  only  exception  occurred  two  years 
ago,  after  an  attack  of  scarlet  fever,  when  the  menses 
were  suppressed  for  six  months.  At  the  age  of  one 
and  a  half  the  hair  was  a  considerable  length  on  the 
pubes  and  in  the  arm-pits.  The  child  now  weighs 
25*5  kilos,  or  4  stone  3  lbs.,  and  measures  in  height 
127  centimetres,  or  4  feet  2  inches,  and  has  all  the 
appearance  of  a  girl  of  13  or  14  years  of  age.  The 
breasts  measure  14  centimetres  in  diameter,  half 
spherical  mammilla,  well  formed  and  dark  coloured 
around,  well  nourished  and  the  hymen  in  situ.  The 
labia  majora  are  pigmented  and  full ;  and  per  rectum 
a  large  uterus  can  be  detected  with  a  very  large  irre- 
gular spherical  left  ovary.  The  pelvis  is  wide  ;  and 
the  skiagraph  gives  a  picture  of  a  perfectly  developed 
female  of  18  years.  The  epiphyses  of  the  ossia  femoris 
are  quite  hardened,  and  the  pelvic  bones  perfectly 
ossified  and  bound  together.  The  pelvis  measures : 
Distantia  bi-spinalis,  24*5  centimetres ;  bi-cristalis, 
25  centimetres ;  bi-trochanterica,  24*5 ;  and  the 
conjugata  externa,  1 5  centimetres.  dPi* 

Jaroslav  said  the  causes  for  these  precocities  were 
recorded  as  many,  but  few  had  the  record  of  this  case 
to  show.  Among  the  etiological  factors  were  rhachitis, 
tuberculosis,  l>acterium  coli,  stimulating  diet,  heredity, 
and,  finally,  primary  hyperplasia  of  the  ovary. 
Dilatation    of   Colon. 

Braun  showed  a  specimen  of  a  dilated  colon,  which 
he  had  taken  from  a  patient  on  whom  he  had  operated 
for  a  distended  sigmoid  flexure  which  had  hitherto 
defied  every  therapeutic  device  of  injections,  punctur- 
ing and  stimulating.  He  concluded  that  operation 
and  resection  gave  the  best  results  in  all  such  cases. 

Wredel  did  not  think  that  every  case  required  such 
operative  treatment,  as  he  had  recently  treated  three 
5uch  cases  of  dilatation,  although  one  had  to  be  resected. 

Madelung  said  he  preferred  laparotomy  as  a  radical 
cure. 

Intussusception  and  Operation. 

Israel  described  a  case  of  intussusception  which  he 
had  endeavoured  to  treat  with  water  and  air  injections, 
but  the  invaginated  bowel  could  not  be  kept  from 
repeating  the  dislocation,  which  necessitated  operation 
on  the  fifth  day,  after  which  the  patient  made  a  perfect 
recovery.  Since  then  he  had  operated  on  two  others 
by  an  extraperitoneal  method,  and  left  an  anus 
preternaturalis,  both  of  which  seemed  to  be  doing 
wen. 


Ube  9perattna  JLbcatvcB. 


ST.  BARTHOLOMEW'S  HOSPITAL. 
Operation  for  Perforated  Gastric  Ulcer  in 
A  Male. — ^Mr.  McAdam  Eccles  operated  on  a  man. 
jet.  2S,  who  for  two  years  had  had  continued  indigestion 
with  gradual  loss  of  appetite.  The  patient  was 
seized  with  an  exacerbation  of  pain  soon  after  his 
mid-day    meal   on    the    day    before    admission.     He 


vomited,  but  the  ejected  matters  contained  no  bkxML 
He  immediately  became  somewhat  collapsed,  and 
had  very. great  difficulty  in  reaching  the  hospital  froci 
his  home,  a  quarter  of  a  mile  away.  On  admisuon, 
his  pulse  was  64,  his  temperature  normal,  but  his 
respirations  were  somewhat  quickened.  The  abdomiial 
walls  were  held  rigid  everywhere,  but  especially  so 
in  the  epigastrium.  Pain  over  this  region  was  very 
severe  and  radiated  to  the  back  of  the  left  shoulder. 
The  liver  dulness  was  present,  and  there  was  no  sign 
of  free  fluid  in  the  abdomen.  There  was  some  un- 
certainty as  to  the  diagnosis,  but  within  a  few  boon 
from  admission  his  temperature  had  risen  toioi'6Mii$ 
pulse  to  94.  and  his  respirations  to  28.  Further,  his 
liver  dulness  had  given  place  to  a  resonance,  and  then 
was  marked  rigidity  over  the  upper  half  of  the  ab- 
domen. Mr.  McAdam  Eccles  decided  to  exptore 
An  incision  was  made  four  inches  long  in  the  middk 
line  above  the  umbilicus.  The  extra-peritoneal  tissve 
was  oedematous.  Gas  escaped  when  the  peritonena 
was  opened.  The  anterior  wall  of  the  stomach,  which 
was  not  adherent  to  the  parietes.  was  bathed  with 
gastric  contents.  A  small  perforation,  the  size  of  the 
uncut  end  of  a  cedar  pencil,  was  found  close  to  the 
pylorus,  but  definitely  to  its  left.  The  stomach  wall  in 
its  neighbourhood  was  much  thickened,  and  the 
surrounding  peritoneum  injected,  and  covered  with 
a  flake  of  lymph.  Owing  to  the  induration  of  the 
stomach  wall  about  the  site  of  the  perforation,  that 
was  much  difficulty  in  closing  it  because  of  the  silk 
Lembert  sutures  tending  to  cut  out.  After  some  time, 
however,  a  satisfactory  plication  was  accomplished, 
and  an  omental  graft  stitched  over  it.  A  thorough 
cleansing  of  all  the  surrounding  area  was  carried  out  br 
sponging.  No  flushing  was  used.  The  wonnd  was 
closed  in  the  upper  portion,  but  the  lower  was  packed 
with  sterile  gauze.  Mr.  Eccles  remarked  that  there 
were  several  points  of  considerable  interest  in  the 
case.  In  the  first  place  there  was  the  fact  that  the 
patient  was  a  male,  for  gastric  ulceration  in  men  is 
distinctly  uncommon,  and  a  perforated  gastric  uhxr 
extremely  rare.  Duodenal  ulceration  and  perforation, 
he  pointed  out,  were  not  so  unusual  in  males.  Again 
the  extreme  pain  with  intense  rigidity  of  the  upper 
part  of  the  abdominal  wall  was  a  feature  of  great 
importance  in  the  diagnosis,  and  this  practically 
decided  him  in  performing  an  exploration.  The 
fact  that  the  abdomen  was  opened  and  the  aperture 
in  the  stomach  wall  found  and  sutured  within  six 
hours  of  perforation  was  greatly,  he  said,  in  favour 
of  recovery.  In  the  majority  of  perforations  of  the 
gastric  and  duodenal  walls  he  believed  it  be  be  safer 
to  simply  plicate  with  Lembert's  sutures,  placed  well 
beyond  the  site  of  perforation  as  well  as  over  it,  rather 
than  to  excise  the  ulcer  and  restore  the  continuity  of 
the  wall.  The  omental  grafting  also  helped  to  secure 
good  union.  He  considered  that  unless  there  was 
extensive  extravasation  of  gastric  contents,  it  was 
better  to  merely  wipe  out  the  escaped  material  and  to 
avoid  free  flushing,  which  had  a  tendency  to  distribute 
rather  than  evacuate  the  irritating  matters.  It  was 
not  well,  he  thought,  in  these  cases  to  completely 
close  the  abdominal  wall  for  fear  of  possible  leakage, 
and,  therefore,  a  gauze  drain  should  be  left  for  the 
first  few  days,  and  its  presence  for  that  period  would 
but  slightly  retard  heaUng  of  the  wound  and  convaks- 
cence. 

The  patient  made  an  uninterrupted  recovery. 


SkfT,   21,    IQO4. 


LEADING   ARTICLES. 


CANCER  HOSPITAL. 

OPEKAtlON     FOR  OBSTRUCTION  OF   THE   PYLORUS.— 

^Pyloroplasty  followed  by  Further  Constriction. 

Gastro-enterostomy.— Mr.    Bowreman    Jessett 

operated  on  a  woman,  aet.  46,  for  obstruction  of  the 
pylonis.     The  patient  came  to  the  hospital  first  in 
January,    1903;     she   then   complained   of   constant 
vomiting,  which  had  lasted  more  or  less  for  two  years  ; 
slxe  could  retaia  nothing.      She  had  lost  four  stones 
in    vreight,    at  this  time  weighing  seven  stones.      The 
stomach    was    greatly  dilated  and  a  somewhat  hard 
mass  could  be  tWlt  to  the  right  of  the  umbilicus.     The 
-succussion  note  was  very  distinct.     The  general  aspect 
sbowed  pinched  features,  with  an  anxious  look,  and 
^he  woman  wjts  very  emaciated.     There  was  little  or 
no    pain.    She    never    had    had    haematemesis.     Mr. 
Jessett  opened  the  abdomen  in  the  middle  line  between 
the  ensilorm  cartilage  and  the  umbilicus,  withdrew  the 
-stomach  and  examined  the  pylorus,  which  was  found 
to  be  thickefued.     He  next  made  an  opening  in  the 
stomach   about    two   inches   from    the   pylorus   and 
passed  in  a  finger.     He  could  find  no  growth,  but  an 
old  ulcer  partly  cicatrised  was  seen  at  the  back  of  the 
pylonis.     He  could  barely  get  the  tip  of   the   little 
finger  into  the  pyloric  orifice.     He  decided  to  perform 
pyloroplasty.     The  patient  made  an  excellent  recovery 
^nd  remained  well  for  some  nine  months,  when  the 
old  symptoms  began  to  return.     Her  weight  was  then 
eleven  stones ;  since  then  she  gradually  lost  two  stones. 
:She  came  to  the  hospital  again  fifteen   months  after 
the  first  operation.      Her  weight  was  then  nine  stones, 
2ind  she  had  been  sufiering  from    constant  pain.     She 
had  vomited  up  about  half  a  pint  of  dark  fluid   three 
months  previously.     Mr,  Jessett  advised  her  to  come 
into  the  hospital  to  have  gastro-jejunostomy  performed. 
This  was  done  a  month  after.     An  incision  was  made 
dn  the  right  linea  alba,  and  a  loop  of  jejunum  with- 
•drawn  through  the  opening  with  the  stomach  ;  these 
were   united    first    by  a  circular  continuous  suture 
'extending  round  the  posterior  parts,  and  through  the 
:serous  and  muscular  coats.     A  free  opening  was  then 
-made  into  the  bowel  and  the  stomach,  and  the  cut 
•edges  united  by  continuous  suture  passing  through 
^11  the  coats  of  both  viscera.     The  suture    which  had 
-^united  the  serous  surfaces  was  then  continued  round 
the    whole    opening.     A    few    stitches    were    passed 
through  the  serous  and  muscular  coats  of  the  proximal 
-end  of  the  jejunum,  fixing  the  gut  to  the  stomach  wall 
to    prevent    kinking.     The    abdominal    wound    was 
united  in  three  layers,  and  the  patient  returned   to 
bed.     Mr.  Jessett  said  that  this  case  illustrated  very 
well  what  many  surgeons  had  reported — namely,  that 
strictures  of  the  pylorus  operated  on  by  pyloroplasty  are 
very  apt   to  become  constricted  again.     It  was  in- 
teresting,  he  thought,   to  see  how  the  patient    had 
improved    in    general   health    and    weight    for    nine 
months     after  the  first  operation  ;   then  the  pyloric 
-orifice  again  became  c»nstricted,  and  the  old  symptoms 
recurred,  so  that  he  would  advise   in   all  such  cases 
that  a     gastro-jejunostomy  should  be  performed  in 
the  first  instance. 

Six   months  after  the  last  opera tiofl  the  patient  is 
well. 


The  Medical  Press.    313 


VMi  TBAmuHioir  Ahu>ad. 

TTbe  AeMcal  preB0  an&  Citcuut. 

Pabiiihad  eTorjr  Wadnewlay  morninCt  Pdoe  6d.     Pott  free,  6|d. 
JjyVBBTISBIDDfTl. 
On   iMnotnoir  :-Whole  Pi««,   £6    Oi.     OdL  ;     Half  Page, 
£i  10s.  Od. ;  Quarter  Page,  £1  6fcOd.;  One-eia;h(ih, Its. 6d. 

OonifclMmble  Reduotkna  from  the  foregoliif  aoale  are  made  whea 
aaoideriafivwifor  aeerieaot  inaarttona.  X^#me  on  appUoa- 
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advance  (he  ooat  is  only  21s.  per  annum,  poet  flee.  An  edition 
is  printed  on  thin  plate  paper  for  foreign  and  Colonial  sub- 
scribers at  Sis.  per  annum,  poet  free,  if  paid  in  adranoe,  or 
291. 6d.  credit  rate. 

Ube  AeMcal  ptcss  an&  Cftcnlat* 


The  influence  of  a  fine  September  has  already  made 
litself  felt  in  the  mortality  returns  in  a  marked  manner, 
iboth  in  town  .and  in  country. 


SALUS  POPULI  SUPREMA  LEX.' 


WEDNESDAY.  SEPTEMBER  21,  1904. 


HOSPITAL    ISOLATION     AND     SCARLET 

FEVER. 
This  week  we  publish  further  contributions  on 
the  supposed  value  of  isolation  hospitals  as  pre- 
ventives of  scarlet  fever,  and  we  commend  the  argu- 
ments used  to  the  judgment  of  our  readers.  They 
confirm  the  conclusions  reached  by  the  writers 
in  the  last  two  numbers  of  The  Medical  Press  and 
Circular,  namely,  that  the  whole  subject  of  the 
utility  of  these  hospitals  is  ripe  for  full  and  free  in- 
vestigation by  an  authoritative  body.  We  hope 
to  publish  further  communications  on  the  same 
question,  as  we  feel  that  the  matter  is  one  on 
which  every  particle  of  information  available  should 
be  forthcoming.  All  over  the  country  large  sums 
of  money  are  being  spent  by  municipalities  on  the 
construction  and  maintenance  of  these  institutions ; 
indeed,  the  hospital  is  one  of  the  largest  items  of 
the  sanitary  budget,  and  it  behoves  medical  men 
who  are  intimately  connected  with  the  scheme  to 
see  that  the  money  is  used  to  the  best  advantage. 
At  present  it  may  be  gravely  doubted,  in  view  of 
the  evidence  brought  forward,  whether  the  com- 
munity is  wise  to  burden  itself  with  the  mainten- 
ance for  a  period  of  many  weeks  of  thousands  of 
cases  of  scarlet  fever.  Unless  it  can  be  shown 
that  the  procedure  affords  a  marked  degree  of 
protection  from  the  incidence  of  the  disease — 
an  assumption  that  is,  to  say  the  least,  doubtful — 
it  is  difl&cult  to  contend  that  its  benefit  is  at  all 
commensurate  with  its  cost.  It  must  be  clearly 
borne  in  mind  that  the  aim  of  isolation  hospitals 
is  only  incidentally  philanthropic,  and  that  they 
were  not  primarily  instituted  to  afford  relief  to 
sufferers  from  infectious  diseases.  Had  they 
been  erected  for  that  purpose,  their  founders 
would  never  have  left  severe  cases  of  measles 
and  whoopng-cough— diseases  far  more  prevalent 
and  fatal  than  scarlet  fever  is  at  present — to  be 
nursed  and  tended  in  back  kitchens  and  garrets, 


3^4    Tub  Medical  Prsss. 


LEADING  ARTICLES. 


Sept.  21,  1904, 


while  xnikL. cases  ol  scarlet  fever  receive  every  atten- 
tion in  hospital.  The  aim  of  the  hospitals  was 
to  abolish  scarlet  fever  from  our  midst,  or  at  least 
to  reduce  it  materially,  and  by  their  ability  to 
accompUsh  this  end  they  must  stand  or  fall.  Cer- 
tainly, in  the  opinion  of  some  of  our  contributors, 
they  have  been  but  qualified  successes.  Then, 
too,  as  to  certain  positive  evils  of  these  hospitals. 
There  need  be  no  hesitation  in  saying  that  the  evils 
of  segregation  have  shown  themselves  to  a  greater 
or  less  extent  in  all  the  large  fever  hospitals,  in 
spite  of  elaborate  care  in  construction  and  skilful 
administration.  On  the  other  hand,  information 
is  forthcoming  from  many  of  the  smaller  institu- 
tions to  show  that  such  evils  are  practically  un- 
known in  them,  and  that  cross-infection  of  patients 
is  of  the  greatest  rarity.  The  suggestion  naturally 
occurs  that  whilst  the  small  hospitals  have  been 
useful  and  advantageous,  the  larger  ones  have  not 
been  so,  and  here  again  we  see  a  fruitful  Une  for  in- 
vestigation. No  sort  of  conclusion  can  be  enter- 
tained nuless  founded  on  the  most  complete  infor- 
mation and  on  the  widest  data  available.  It  has 
been  contended  that  every  medical  officer  of  health 
should  make  his  own  inquiries,  and,  having  satis- 
fied himself  that  his  hospital  is  doing  good  in  his 
district,  should  rest  content  in  that  assurance. 
Surely  this  is  a  selfish  view  to  take  of  the  matter. 
Some  towns  and  districts  admit  partial  failure 
and  positive  evils,  and  it  is  for  those  districts  that 
are  free  from  them  to  allow  the  knowledge  of  their 
advantages  to  become  of  general  utihty.  The  kind 
of  information  that  is  needed  is  so  broad  and  so 
varied  that  no  inquiry  would  be  hkely  to  be  suc- 
cessful that  was  not  undertaken,  not  only  by  ac- 
knowledged experts,  but  by  men  of  authority 
whose  disinterestedness  and  integrity  were  above 
suspicion.  Such  an  inquiry  should  embrace 
questions  of  construction,  site,  and  disposition  of 
hospitals  ;  their  principles  of  administration  and 
their  arrangements  for  dealing  with  doubtful  and 
compUcated  cases.  Besides  these  points,  the  ex- 
perience of  this  country  with  regard  to  scarlet 
fever  should  be  compared  with  that  of  those  coun- 
tries that  do  not  isolate  scarlet  fever,  and  dif- 
ferent towns,  and  different  parts  of  the  same  town, 
should  be  compared  as  to  the  incidence  of  the  disease 
in  them.  It  might  prove  that  whereas  it  hardly 
paid  the  community  to  segregate  all  their  scarlet 
fever  cases,  yet  it  might  be  well  to  continue  with 
the  isolation  of  those  that  occurred  in  dairies, 
pubUc  institutions,  and  closely-crowded  quarters 
of  towns.  And,  again,  it  might  be  held  that, 
having  a  diminished  number  of  cases  to  deal  with, 
there  should  be  arrangements  at  all  large  hospitals 
for  separating  patients  from  one  another  in  cu- 
bicles, at  any  rate  in  the  case  of  young  children. 
Without  associating  ourselves  entirely  with  the 
views  expressed  by  all  our  contributors,  we  hold 
strongly  that  they  have  made  out  a  good  primd 
facte  case  for  investigation,  and  we  should  be  glad 
to  hear  that  a  strong  representative  committee 
had  been  formed  for  the  purpose.  A  Royal  Com- 
mission has  been  hinted  at,  but  the  question  has 


hardly  reached  the  point  of  public  interest  at  which 
a  Government  can  no  longer  hold  back,  and  ve 
think  in  the  meantime  the  work  could  be  done 
better  in  many  ways  by  medical  men. 


MEDICINE  AND  PATHOIX)GY. 

It  has  been  a  necessary  result  of  the  growth  of 
the  sciences  which  are  auxiliary  to  the  practice  of 
medicine  that  their   pursuit   has  fallen  into  the 
hands  of  others    than    the  practitioners  of  the 
art.     Only  a  few  years  ago  the  physician  regarded 
it  as  his  own  duty  to  examine,  let  us  say,  sputum 
for  suspected  tubercle    bacilh,  whereas  nowadays 
he  rarely  performs  such  examination.     Similazly, 
the  surgeon  who  required  the  help  of  microcotogy 
in  the  diagnosis  of  a  tumour  formerly  cut  his  sectknt 
and  himself  examined  it;  but  to-day  a  sorgeon 
would  be  considered  rash  thus  to  rely  on  his  own 
opinion.     In  all  such  cases  it  is  now  the  practice 
to  refer  the  suspected  material  to  an  expert  in 
pathology,  whose  report  is  to  be  reg^ded  as  one 
of   the  principal  factors  in  diagnosis.     Following 
on  this  sphtting-up  of  duties  that  formerly  fell  to 
one  person,  there  is  naturally  a  certain  narrowing 
of  outlook.  The  physician  is  more  purely  a  clinician 
than  formerly,  and  the  surgeon  tends  to  become 
more  of  an  operator.     Each  is  content,    to  some 
extent,  to  leave  pathology  to  the  expert  patholo- 
gist.    At  the  same  time,  the  latter  subject  has 
grown  to  such  dimensions  that  the  pathologist  can 
rarely  be  intimate  with  the  clinical  side  of  disease. 
The  consequence  of    this   separation    of    spheres 
of  work  is  often,  unfortunately,  a  certain  lack  of 
appreciation  in  each  of  the  work  done  by  the  other. 
The    pathologist   is    too    apt    to    form  his  con- 
clusions without  taking  clinical  considerations  into 
account,   and  indeed  the   physician    or    surgeon 
often  demands  his  opinion  without   giving  him 
any  help  from    the  clinical  side.     Nothing  can  be 
more     absurd    than    to     expect     a     pathologist 
from     pathological     evidence    alone     to    decide, 
for  instance,  the  exact  nature  of  a  tumour.     The 
clinical  history,    however,    taken   in   conjunction 
with  the  microscopic  appearance,  may  be  abso- 
lutely diagnostic  as  between,  say,  a  sarcoma  and 
an  inflammatory  swelling,  or  between  a  malignant 
and  an  innocent  growth.     It  is  only  by  combining, 
as  far  as  possible,  the  visions  from  the  two  points 
of  view  that  good  results  will  be  reached.    The 
physician  or  surgeon,  therefore,  should  never  send 
material  to  a  laboratory  without  giving  at  the 
same  time  a  concise  clinical  history  of  the  case. 
We  have  heard,  indeed,  of  a  pathologist  receiving 
a  drop  of  blood  on  a  scrap  of  paper,  and  beings 
asked  to  decide  whether  the  cow  whence  it  came 
was   tuberculous ;  and   it   is   na4:   uncommon  to 
receive     material      in    some     strong     antiseptic 
with  a  request  for  a  full  bacterioscopic   exami- 
nation.    "  Science    is    One,"  said    Socrates,  and^ 
in  so  far  as  the  student  of  any  branch  fails  to 
realise  the  connection  of    that  branch  with  the 
tree  of  knowledge,,  in.  so  far  does  he  fail  as  a  man 
of  science. 


SbPT.    21,    1904- 


NOTES   ON    CURRENT    TOPICS. 


The  Medical  Press.    3^5 


THE  LONDON  HOSPITAL    AND  HOSPITAL 
ABUSE. 
Th£  abuse  of  hospitals  is  one  of  the  standing 
grievances  of  the  general  practitioner.    That  this 
discontent  rests  on  a  solid  foundation  can  hardly  be 
doubted  by  any  candid  onlooker  acquainted  with 
the  facts  of  the  case.       The  enormous  attendance 
of  out-  and  in-patients  furnishes  in  itself  sufficient 
internal  evidence  of  the  indiscriminate  relief  ob- 
tained at  the  great  general  hospitals  throughout  the 
kingdom.     In  spite  of  generations  of  complaint  on 
the  part  of  the  medical  profession  the  evil  is  grow- 
ing by  leaps  and  bounds,  and  has  of  late  years  been 
increased  by  the  adoption  of  the  pay  system  by 
various  great  general  hospitals.     Needless  to  say, 
the  S3rsteni  of  part  pajnnent  is  likely  to  multiply 
abuse  by  offering  a  salve  to  the  conscience  of  well- 
to  do  folk  who  might  otherwise  possibly  entertain 
some  lingering  scruples  as  to  the  moral  justifica- 
tion of  their  acceptance  of  alms  intended  for  the 
sick  poor.     It  is  of  some  interest  to  ask  why  so 
little  has  been  done  to  meet  the  demands  of  the 
general  practitioner  as  regards  the  loss  he  sustains 
through  the  laxity  of  the  hospital  authorities  in 
excluding    well-to-do   persons   from   the   benefits 
of  which  they  are  the  stewards.      The  causes  are 
complex.     First  of  all  the  medical  charities  and  the 
medical  profession  do  not  work  together.  The  hos- 
pitals are  engaged  in  an  internecine  conflict  and  in 
efEorts  at  self-aggrandisement.     Many  private  and 
non-medical  interests   are  wrapped  up  in  these 
institutions,  together    representing   an    enormous 
annual  expenditure  of  money.     It  is  not  too  much 
to   say  that  the  aim — ^natural  if  not  excusable 
—of  ^such  persons  is  to  swell  the  funds  of  the 
individual  hospitals  and  secure  the  maximum  num- 
ber of  patients,  regardless  of  the  medical  practi- 
tioners outside.     It  is  a  serious  matter  that  this 
attitude  is  positively  supported  by  the  honorary 
medical    staffs,  who  are   induced  to    give   their 
gratuitous  services  to  many  in-  and  out-patients 
perfectly  well    able    to    pay  the    moderate  fees 
of  the  general  practitioner.       Much  more  might 
be  written  upon  the  subject,  but  the  tale  is  some- 
what trite,  and  its  chief  points  have  been  familiar 
to  generations  of  medical  men.     The  great  self- 
evident  want  is  that  of  organisation  in  all  ranks  of 
the  profession  for  the  purpose  of  common  support 
and  defence.     The    East  End  (London)  Medical 
Association  —  a   strong    local    combination — has 
shown  what  can  be  done  by  firm  and  united  act  on. 
For  many  years  the  administration  of  charity  at 
the  London  Hospital  has  been  called  in  question. 
The  answer  of  the  authorities  has  always  been  to 
ask  for  proof  of  abuse  and  to  deny  the  existence  of 
the  same  in  general   terms.     The  Society  men- 
tioned has  furnished  a  number  of  cases  of  abuse  of 
the  London  Plospital  by  well-to-do  persons.     The 
authorities  of  the  hospital  have  acknowledged  the 
existence  of  such  abuse  and  have  appointed  an 
almoner  to  sift  cases.     The  further  suggestion,, 
however,  that  medical  men  should  come  to  the 
hos^tal  to  identify  patients  appears  to  be  about 
as  ridiculous  and  unpractical  as  it  would  be  possible 


to  expect  even  from  a  hospital  committee.  It  is 
hkely  that  from  the  circumstances  of  the  case 
abuse  at  the  I^ondon  Hospital,  situated  as  it  is 
in  the  midst  of  a  poor  population,  is  less  than  at 
most  of  the  great  general  hospitals  of  the  Metro- 
polis. Now  that  the  ice  has  been  broken  and  the 
first  step  towards  justice  and  conciliation  taken 
by  the  hospital  authorities,  it  is  to  be  hoped  that 
in  combination  with  the  East  End  Medical  Associa- 
tion they  will  readjust  the  relations  of  the  London 
Hospital  with  neighbouring  practitioners.  It  is  to  be 
hoped,  also,  that  the  Association  will  be  enabled  ta 
banish  a  system  of  patients*  payments  recently  adop- 
ted at  that  hospital — a  fact  which,  in  our  opinion,, 
constitutes  a  serious  blot  upon  a  great  charity. 
Since  the  pubUcation  of  the  London  Hospital 
disclosures  certain  interviews,  apparently  au- 
thentic, have  appeared  in  the  daily  newspapers,. 
They  purport  to  come  from  stewards  and  secre- 
taries of  other  great  London  hospitals.  For 
the  most  part  they  deny  the  existence  of  hospital 
abuse  ;  one  of  those  interviewed  contrives  to  give 
a  good  advertisement  of  the  pay  wards  in  his  own 
hospital ;  aU  ignore  the  general  practitioner  iib 
contemptuous  fashion.  That  is  the  kind  of  at- 
titude to  which  medical  reformers  have  become 
accustomed.  It  is  only  by  extending  organised 
attack  all  along  the  line  that  the  general  prac- 
titioner can  ever  hope  to  come  into  possession  of  his 
birthright,  of  which  he  is  at  present  more  or  less- 
deprived  by  hospital  competition.  The  East  End 
Medical  Association  should  be  the  model  and 
example  of  local  societies  throughout  the  United 
Kingdom. 


ViotCB  on  Cnrrent  UopiC0« 


Hanfl,  the  ThinkiDfir  Stallion. 
The  art  of  training  the  lower  animals  to  per- 
form tricks  has  long  been  popular  with  mankind, 
and  though  these  feats  are  primarily  intended  to 
astonish  and  amuse,  they  have  in  many  cases  a 
scientific  interest  for  the  anthropologist  and  even  the- 
psychologist.   As  a  rule  dancing  dogs  and  curvetting 
cats  merely  bespeak  a  certain  amount  of  sympathetic- 
perseverance  on  the  part  of  the  trainer,  reinforced^ 
one  fears,  by  the  lash,  and  a  certain  Htheness  of 
the  muscular  system  of  the  animal.     The  per- 
formances of  the  anthropoid  apes  stand  on  a  dif- 
ferent platform.    Sally,  the  chimpanzee,  was  taught 
to  count  up  to  five,  an  accomplishment  entirely 
lacking  among     the    inhabitants  of    Damarland 
when   Mr.  Francis    Galton  visited  them.     Similar 
proofs    of    inteUigence    in     animals     are     men- 
tioned from   time  to    time,  and    the]  upholders 
of  instinct  as  opposed  to  reason  do  not  stand  oa. 
anything  Uke  so  secure  a  foundation  as  they  did 
five-and-twenty   years   ago.     The   most   remark- 
able of  animals,  however,  seems  to  be  Hans,  the- 
thinking  horse,  as  he  is  called,  who  has  been  as- 
tonishing  Teutonic  audiences    for    the    last  few 
months.    The  horse  is  by  no  means  one  of   the- 
most  inteUigent  of  animals,  and  his  usual  tricks  do* 
not  assume  a  higher  form  than  that  of  waltzing  on> 


3x6    The  Medical  Pees9. 


NOTES  ON  CURRENT  TOPICS. 


Sept.  21.  1904. 


his  hind  legs  or  caracolling  at  the  bidding  of  his 
masters.  There  have,  however,  been  one  or  two 
''  calculating  horses  **  who  were  able  to  tap  out 
numbers  with  the  fore-leg,  but  they  have  generally- 
been  noticed  to  keep  a  pretty  sharp  eye  on  the 
movements  of  the  trainer,  who  probably  possessed 
some  means  of  indicating  to  them  the  requisite 
number  of  taps.  But  the  performances  of  Hans 
have  been  so  extraordinary  that  he  has  been  sub- 
mitted to  an  examination  before  a  commission 
•of  thirteen  experts,  including  Dr.  Nagel,  Professor 
of  Physiology  in  BerUn,  and  Professor  Stumpf, 
Director  of  the  Psychological  Institute.  This  com- 
mission has  unanimously  decided  that  Hans  solves 
problems  and  answers  questions  as  the  result  of 
a  mental  process  analogous  to  that  of  the  human 
brain,  and  that  he  is  not  influenced  in  any  way 
by  the  acts  or  suggestions  of  his  owner.  If  this 
really  be  true  it  is  to  be  hoped  that  a  full,  signed 
-account  of  the  examination  will  be  issued,  for  Hans 
will  certainly  deserve  to  rank  with  one  of  the  seven 
wonders  of  the  world.  It  is  well  to  bear  in  mind 
the  circumstantial  reports  showing  that  Hans 
acts  under  the  influence  of  a  wire-puUing  atten- 
dant, and  that  the  whole  thing  is  a  trick  of  the 
**•  spiritualist  "  order. 


consolidation  was  discovered,  and  the  day  aftei- 
wards  the  typical  morbilliform  rasti  made  its 
appearance. 


The  Sequenoe  of  Disease  Phenomena. 

The  apparent  want  of  regularity  often  notice- 
able in  the  processes  of  Nature  is  sometimes 
diflftcult  to  reconcile  with  the  existence  of  definite 
laws.  The  principle  of  conformity  to  type  is, 
however,  so  frequently  departed  from  that  the 
•existence  of  biological  *'  sports  "  is  iuUy  recognised. 
The  manifestations  of  disease  itself,  though  gener- 
-ally  following  the  classical  descriptions  set  forth  in 
text-books,  yet  at  other  times  differ  so  widely  from 
the  standard  that  a  difl&culty  is  felt  in  placing 
them  under  any  known  pathological  group. 
Many  a  time  the  practitioner  is  confronted  with  an 
affection  of  which  he  may  truly  say,  "  I  have  never 
seen  this  described  in  the  books  I  "  The  modes 
•of  onset  and  the  clinical  appearances  of  disease 
vary  not  less  than  the  countenances  of  the  patients. 
It  is  doubtful  whether  two  cases  of  typhoid  fever, 
for  instance,  are  precisely  identical  in  every  par- 
ticular, as  regards  either  onset  or  course.  Abortive 
forms,  to  which  the  terms  "  ambulatory "  and 
"larval"  are  sometimes  applied,  are  comparatively 
common.  Certain  affections  adhere  more  or  less 
strictly  to  a  definite  order  in  the  appearance  of 
their  symptoms,  as,  for  example,  acute  lobar  pneu- 
monia. Others,  especially  those  of  a  functional 
•character  like  hysteria,  are  a  law  unto  themselves. 
A  correct  diagnosis  is,  no  doubt,  greatly  facilitated 
when  the  disease  conforms  to  a  well-known  type, 
but  the  sequence  of  morbid  phenomena  is  often 
much  disturbed,  particularly  in  children.  Dr. 
Adolph  Rupp(a)  has  reported  a  most  instructive 
case  of  measles  in  a  young  child,  in  which  all  the 
ordinary  symptoms  and  signs  of  that  complaint 
were  reversed,  the  illness  commencing  with  diar- 
rhoea and  bronchitis.     The  next  day  penumonic 


The  Garden  Oity. 

Perhaps  the  most  practical  piece  of  philanthropr 
of  late  years  has  been  Mr.  Booth's  Garden  Qtj 
scheme,  for  it  supplies  what  most  philanthropic 
undertakings  unfortunately  lack — a  sound  com- 
mercial bas  s.  The  idea  of  a  garden  city,  an  open- 
air  town,  where  every  prospect  pleases  and  Bian  is 
made  as  little  vile  as  possible,  was  a  bold  oiMt 
and  was  regarded  as  Utopian  when  it  was  fint 
mooted.  But  the  Garden  City  Company  ban 
to-day  reached  a  point  at  which  the  success  of  their 
first  city  is  assured,  and  the  future  holds  ma&v 
possible  extensions  of  their  scheme.  The  sitaatiai 
of  this  first  city  is  an  admirable  one,  standing  three 
hundred  feet  above  the  sea  level  near  Hitchin,  and 
already  the  plan  of  the  town  is  being  mapped  oat 
and  the  sites  are  being  taken  up.  Beauty  and 
hygiene  are  the  two  factors  that  govern  all  the 
designs,  and  for  the  first  time  in  history  it  seems 
as  if  beauty  and  hygiene  are  going  to  pay  a  divi- 
dend. Manufacturers  are  being  attracted  in  num- 
bers by  the  cheapness  of  land  to  transfer  their 
work)  there,  and  already  sufficient  have  been  ac- 
tually arranged  for  to  give  employment  to  twehr 
hundred  families.  The  Garden  City  is  thus  as. 
sured  of  some  five  thousand  inhabitants,  a  sixth 
of  the  number  that  the  Company  have  fixed  as  the 
Umit  of  the  population.  A  beautiful  stretch  oi 
country  is  being  converted  into  a  public  parL 
whilst  besides  the  model  cottages  that  are  bdnj 
erected,  a  number  of  wealthy  people  are  arrangingj 
for  country  houses  on  the  outskirts  of  the  town.  The 
extraordinary  feature  of  the  project  is  the  cheap- 
ness of  everything,  for  land  is  to  be  o  stained  at  a 
ground-rent  oi£io  per  acre,  and  rates  are  to  be  fixed 
at  1 5  per  cent.  No  wonder  that  the  Londoner's 
mouth  is  being  made  to  water  at  the  prospect. 
We  hope  that  the  Garden  City  will  achieve  the  suc- 
cess it  so  warmly  deserves,  but  it  is  not  likely  to 
solve  all  the  hygienic  problems  that  beset  it  unless 
its  plans  and  designs  are  submitted  to  careful 
medical  supervision. 


,(a;  Amer^  Joum.  of  Ob§tetriei,  Au«:ust,  1904. 


Incubation  Period  of  Typhoid  Fever. 

An  experiment  of  great  interest  and  importance 
was  performed  on  a  human  being  in  Paris.  Fortu- 
nately the  anti-vivisectors  cannot  blame  the  doctors 
this  time,  for  the  se  it  of  the  experiment  was  the 
corpus  vile  of  the  experimenter.  A  nurse,  wishing 
to  put  an  end  to  herself,  swallowed  two  tablespoon- 
f uls  of  broth-culture  of  Eberth's  bacillus,  but,  to  her 
chagrin,  no  untoward  effects  followed  at  the  time. 
On  the  third  day,  however,  she  was  unweU  with 
headache,  though  she  had  no  fever,  and  by  the  sixth 
day  she  was  obliged  to  take  to  bed  with  feelings  of 
malaise  and  weakness  in  the  lower  limbs.  The 
temperature  the  next  evening  was  38*6°  C,  and 
the  following  day  she  had  epistaxis,  several  rose- 
spots,  and  pyrexia  to  the  extent  of  40*2°  C.  On  the 
tenth  day  Widal's  reaction  was  present.  The  attack 


Sept.  14,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    317 


ran  the  ordinary  course  of  typhoid  fever  of  great 
severity,  as  may  be  gathered  from  the  fact  that 
not  less  than  176  baths  were  given.  Now,  although 
<ieliberate  experiments  on  human  beings  are  so 


of  comparison  and  contrast  with  the  statistics* 
of  insanity  in  these  countries.  Just  as  at  home, 
the  asylum  population  is  increasing  year  by  year, 
and  the  figure  reached  last  year  in  Bengal — 1,348 — 


monstrous  as  be  quite  out  of  the  question  in  any  ,  is    the    highest    yet    recorded.     Colonel    Browne 


community,  there  is  no  gainsapng  the  fact  that 
ivlien  they  happen  to  be  performed  as  in  this 
case  they  afford  information  of  the  highest  utiUty. 
This  incident  to  the  Paris  nurse  shows  not  only 
that  Eberth's  bacillus  is  the  specific  causative 
organism  of  typhoid  fever,  if  any  further  confirma- 
tion were  needed,  but  it  throws  fresh  and  un- 
expected light  on  the  incubation  period  of  the 
disease.  Mr.  Duflocq  Voisin,  who  reports  the  case, 
attributes  the  shortness  of  this  period — only  two 
days — to  the  large  number  of  bacilli  ingested, 
but  be  that  the  case  or  not,  we  must  now  be  pre- 
pared to  admit  that  the  minimum  incubation  time 
of  typhoid  fever  may  be  very  short  indeed.  We 
know  that  the  bacilU  in  some  cases  take  as  long  as 
three  weeks  to  produce  their  effects,  and  that  the 
usual  period  is  about  ten  days  or  a  fortnight,  but 
it  is  now  established  beyond  doubt  that  it  is  possible 
for  them  to  set  up  typhoid  fever  in  forty-eight  hours. 


Post-Diphtheritio  Adiposity. 

I>iPHTHERiA  is  a  disease  that  has  many  far-reach- 
ing results,  and  it  is  well  known  that  convalescents 
from    acute   diseases  often  rapidly  make  up  the 
loss  of  tissue  they  have  sustained  during  their  ill- 
ness.    But  we  venture  to  think  that  Miss  Eliza- 
beth Daltrey,  aet.  9,  of  Bethnal  Green,  enjoys  a 
unique  distinction  in  being  in  possession  of  10  stone 
3  pounds  of  body-weight  as  the  result  of  an  attack 
of    diphtheria.     Apparently   a   normal   child    till 
overtaken  with  the  disease,  no  sooner  had  it  run 
its  course  than  she  began  to  put  on  flesh,  or  rather 
fat,  at  an  alarming  rate.  Her  waist  now  measures  42 
inches,  her  chest  46  inches,  and  her  arm  16}  inches 
— ^not  a  mean  record  for  a  child  4  feet  6}  inches  high. 
The  clue  to  her  abnormal  development  seems  to  lie 
in  her  appetite,  which  is  reported  to  be  prodigious. 
She  consumes  as  a  rule  twenty-four  slices  of  bread 
and  butter,  besides  beef,  potatoes,  and  other  neces- 
sities of  Ufe,  every  day.     Of  course  this  wretched 
little  monstrosity  is  being  exhibited  by  music  hall 
proprietors  to  excite  the  wonder  and  admiration  of 
their  clients  ;  it  is  too  much  to  expect  parents  and 
impresarios  to  refrain  from  filling   their  pockets 
at  the  expense  of  public  decorum.     Instead  of  this 
child  being  placed  under  medical  care  and  supervi- 
sion she  is  being  paraded  nightly  to  excite  the  gapes 
of  East  End  audiences — a  state  of  things  we  should 

have  thought  that  would  hardly  have  been  per- 1  __  .    .  ...  _  t_.-.- 

^  /  r        jjj^  cause  of  the  condition  is  obscure,   but  it  is 


does  not  regard  this  increase  as  signifying  an 
increase  in  the  actual  number  of  lunatics  in  the- 
province,  but  rather  as  due  to  the  more  frequent 
resort  to  asylum  treatment.  If  this  view  is  correct, 
and  it  is  borne  out  by  the  Census  figures  of  1901, 
which  show  a  decrease  in  the  total  number  of 
lunatics,  then  the  increase  in  the  asylum  popu- 
lation is  rather  a  matter  for  congratulation  than 
otherwise.  The  principal  cause  of  mortality 
was  tuberculosis,  and  the  death-rate  was  100  per 
thousand — the  highest  in  Indian  asylums,  the 
lowest  being  y6  per  thousand  in  the  Punjab.  At 
Decca,  where  tuberculosis  was  most  rife,  there- 
was  considerable  overcrowding,  only  fifty  super- 
ficial feet  of  space  being  available  for  each  patient. 
As  in  most  asylums,  mania  is  the  most  common 
type  of  insanity  met  with,  but  during  the  year 
no  case  of  general  paralysis  of  the  insane  was 
noted.  It  is  by  no  means  common  in  any  Oriental 
race — a  fact  worth  remembering  in  relation  to- 
the  discussion  as   to  its  dependence  on  syphilis 

Diaeases  of  Country  Women. 
An  interesting  investigation  has  recently  been 
conducted  by  an  organisation  in  Canada  known 
as  the  National  Council  of  Women.  Circulars  were 
distributed  to  a  large  number  of  farmers'  wives 
and  daughters  throughout  Ontario  containing 
queries  as  to  the  state  of  health  prevailing  in  that 
class.  A  poll  has  thus  been  taken  of  the  com- 
moner diseases,  and  the  two  diseases  which  are 
said  to  have  pre-eminence  are  rheumatism  and 
"  catarrh."  The  term  rheumatism  is  probably 
used  in  a  very  wide  sense,  including  all  the 
chronic  affections  to  which  the  name  is  given, 
most  of  which  are  due  to  the  exposure  to- 
cold  and  wet  to  which  these  women  are  tiable. 
In  addition,  the  site  of  the  farmer's  house  is  often 
unsuitable,  being  damp  and  undrained.  Asso- 
ciated with  rheumatism  mention  is  made  of 
purpura,  erythema  .nodosum  and  urticaria.  , 
''  Catarrh  "  in  Canada  is  applied  in  a  somewhat 
narrower  and  more  specific  sense  than  in  this, 
country.  It  means  usually  a  chronic  pharyngitis, 
beginning  very  gradually,  but  of  ten  going  on  to  an 
extensive  thickening  of  the  mucous  membrane 
of  the  pharynx,  spreading  to  the  larynx,  the  nares, 
and  not  infrequently  the  Eustachian  tubes.  A 
common  enough  result  is  a  troublesome  deafness. 


mitted  by  the  magistrate  who  has  to  sanction  her 
performance.  Children  of  the  proportions  of 
Khzabeth  Daltrey  are  the  subjects  of  disease,  and 
only  a  morbid  pleasure  can  be  derived  from  watch- 
ing their  clumsy  antics. 


Insanity  in  India. 

In  the  Annual  Report  of  the  Lunatic  Asylums 
of  Bengal  recently  issued.  Colonel  Browne  gives 
us  many  particulars  which  are  of  interest  by  way 


generally  said  to  be  the  constant  breathing  of  im- 
pure air  in  ill-ventilated  rooms.  This  theory  is 
supported  by  the  fact  that  it  is  much  rarer  among 
the  men  than  among  the  women  on  the  farms,  as 
the  former  spend  much  of  their  time  out  of  doors. 
rXmong  the  diseases  which  appear  with  lesser  fre- 
quency are  dyspepsia  and  anaemia,  while  one- 
suflferer  returns  her  trouble  as  "  that  tired  feeling." 
It  is  a  pleasure  to  find  consumption  is^  not  pro- 
minently mentioned. 


3i8    The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


SbPT.   21.  1904. 


The  SuoklinfiT  of  Infants. 

There  is  no  doubt  that  the  practice  of  rearing 
children  by  hand  is  in  many  cases  a  result  of  the 


is  curious  how  often  points  such  as  tfa^e  aieovv. 
looked  even  by  careful  surgeons,  unless  their  atten. 
tion  is  specially    drawn  to  them.     Dr.   Howard 


same  distaste  for  parental  responsibiUty  of  which  |  ColHns,  of  New  York,  who  has  given  a  good  deal  o{ 
we  have  heard  so  much  in  regard  to  the  artificial 
prevention  of  conception.     In  the  higher  ranks  of 
society  it  has  always  been  unusual  for  the  mother  to 

suckle  the  child,  but  there  is  grave  reason  to  believe  

that  a  simUar  reluctance  is  spreading  throughout ;  pairs 'QTd7^sin7"forceps7^a^^^ 

all  ranks.    A  good  deal  of  discussion  on  the  subject  ,  renders  this  easv 

has  taken  place  in  France  recently,  and  the  well-  j  '        ^_^__ 


care  to  the  subject,  (a)  is  convinced  that  gteve 
should  always  be  worn  dry,  using  sterilised  standi 
or  lycopodium  as  a  lubricant.  In  drawing  on  the 
gloves  nothing  should  be  used  except  a  couple  of 

a  little  practice 


kno^'n  charity  of  the  "  Gouttes  de  Lait  "  has  beeii 
accused  of  encouraging  the  habit.  Our  readers 
will  remember  that  this  charity  was  estabhshed  a 
few  years  ago  to  supply  working  women  with  suit- 
able artificial  milk  for  their  children.  It  is  now 
maintained  that  the  comparative  excellence  of  the 
supply  encourages  nursing  women  to  wean  their 
babies  and  feed  them  otherwise  than  from  the  breast. 
The  consequence  is  that  where  a  branch  of  the 
'^  Gouttes  de  Lait  "  has  been  established  nursing 
is  less  and  less  practised  by  mothers.  It  is  doubt- 
less true,  however,  as  is  pointed  out  on  the  other 
side,  that  the  conditions  of  modern  life  tend  to 
make  it  more  impossible  for  working  women  to 
give  as  much  of  their  time  to  their  infants  as  for- 
merly. The  post  ofl&ce,  the  telephone,  the  type- 
writing machine,  not  to  speak  of  the  factory, 
keep  women  tied  to  long  hours  of  labour  which 
render  the  nursing  of  an  infant  either  an  im- 
possibility or  such  a  drag  as  to  prove  a  serious  busi- 
ness embarrassment.  In  such  cases,  and  in  others 
where  healthy  mother's  mUk  is  unavailable,  there 
is  no  doubt  that  the  "Gouttes  de  Lait"  is  doing 
excellent  work.  At  the  same  time  the  greatest 
care  is  necessary  in  its  administration,  and  it  is 
always  to  be  remembered  that  the  substitution  of 
a'tificial  for  natural  feeding  is  never  to  be  made 
vdthout  the  gravest  consideration. 


Rubber  Gloves. 

It  has  become  so  much  the  fashion  to  wear  gloves 
while  operating  that  there  are  doubtless  many 
who  merely  follow  the  fashion  without  paying 
much  attention  to  its  underlying  basis  of  reason. 
In  doing  so  they  are  very  Uable  to  render  their 
trouble  futile  by  overlooking  some  simple  precau- 
tions. The  principal,  though  not  the  only  reason 
for  wearing  gloves  is  that  they,  unUke  the  hands, 
can  be  rendered  absolutely  sterile.  Nevertheless 
one  often  sees  a  surgeon,  when  preparing  for  an 
operation,  wash  his  hands  with  a  certain  amount  of 
care,  probably  less  than  he  would  take  if  he  were  not 
about  to  wear  gloves,  and  then  proceed  to  put  on 
the  sterilised  gloves,  using  his  hands  freely  in  doing 
so.  If  his  hands  were  sterilised. by  the  washing, 
why  proceed  to  wear  gloves  ?  If  they  were  not 
steriUsed,  then  the  gloves  have  been  thoroughly 
exposed  to  infection  in  the  process  of  drawing  them 
on.  Or,  again,  if  the  gloves  are  floated  in  water 
or  antiseptic  solution,  then  a  certain  amount  of 
fluid  is  bound  to  be  left  in  the  fingers.  The  skin 
soaks  in  this  for  a  Uttle,  infects  it,  and  a  change  of 
level  discharges   the  fluid  into   the   wound.     It 


The  Position  of  GynsBcolosry  at  the  Meetinn 
of  the  BMA. 

Our  readers  may  remember  that  we  drew  at- 
tention  to,  and  strongly  criticised,  the  a^^ang^ 
ments  at  the  recent  meetings  of  the  British 
Medical  Association,  by  which  papers  dealing 
with  obstetrical  and  gynaecological  subjects  were 
brought  before  sections  other  than  that  devoted 
to  the  consideration  of  such  subjects.  We  an 
glad  to  learn  that  the  Council  of  the  Associatioi 
has  adopted  views  similar  to  those  which  we  ex- 
pressed, and  that  it  has  decided  that,  in  future, 
the  allocation  of  papers  to  their  respective 
Sections  shall  be  subject  to  its  directions.  TOs 
decision  means  that  gentlemen  who  desire  to 
display  their  knowledge  of  special  subjects  most 
do  so  before  the  Sections  devoted  to  those  subjects, 
and  not  heiore  some  other  Section  which  thev 
may  personally  favour.  To  discuss  the  subject 
of  hysterectomy  before  the  Surgical  Sectioa 
of  the  meeting  when  a  Gynaecological  SectioB 
was  in  existence  was  about  as  suitable  an  ar- 
rangement as  it  would  have  been  to  have  discussed 
the  treatment  of  middle  ear  disease  before  the 
Medical  Section.  We  can  quite  understand  the 
desire  of  a  general  surgeon  to  gather  every 
branch  of  special  surgery  into  the  Surgical  Section, 
but  we  cannot  understand  the  Association  per- 
mitting such  a  course,  unless  it  at  the  same  time 
decided  to  aboUsh  the  Special  Sections. 


The  Ohildren's  Tooth-Broah. 

The  need  of  S3^tematic  attention  to  the  teeth, 
especially  during  childhood,  is  not  hy  any  means 
universally  recognised.  So  it  would  appear,  at 
least,  from  the  deUberations  of  a  certain  rural  board 
of  guardians.  The  suggestion  of  one  of  their  num- 
ber that  the  children  in  their  cottage  home  should 
be  suppUed  with  tooth-brushes  was  not  only  thrown 
out  by  the  majority,  but  the  proposal  was  actually 
ridiculed  by  a  select  few,  among  whom  was  the 
Mayor  of  a  well-known  watering-place,  who  con- 
sidered that  such  luxuries  would  lead  to  greater 
degeneration  of  the  race  than  that  al  eady  exist- 
ing. Hard  crusts  are  all  very  well  in  their  place, 
but  what  if  the  teeth  are  too  decayed  to  bite  them  ? 
The  toast,  made  by  others,  that  they  themselv^ 
had  never  used  such  an  essential  article  of  toilet, 
nor  their  fathers  before  them,  and  yet  had  attained 
to  a  good  old  age,  is  unworthy  of  an  assemblage  of 
ci  Oised  folk.  We  wonder  what  the  medical 
member  of  the  board  (if  there  were  one)  said  at  the 

(a)  M^dicaiNem,  N.Y.,AaguttS0th,lM8. 


Sept.  21,  1904- 


NOTES    ON   CURRENT    TOPICS. 


The  Medical  Piess.    319 


^scussion.  Could  those  who  look  at  the  tooth- 
brush with  contempt  simply  because  they  them- 
selves happen  to  be  blessed  with  a  naturally  perfect 
set  of  grinders  pay  a  visit  to  the  Dental  Hospital 
and  see  for  themselves  the  deplorable  state  of  many 
people's  teeth  as  a  result  of  neglect,  they  would 
doubtless  reconsider  their  decision.  One  need  not 
go  so  far.  Take  the  teeth,  for  example,  of  any 
number  of  school-children,  presumably  healthy, 
and  the  large  proportion  of  those  with  imperfect 
dentition  in  which  caries  chiefly  predominates 
will  surprise  those  who  have  not  previously  paid 
any  attention  to  the  subject.  The  statistics  of  the 
medical  officers  to  the  School  Board  bear  out 
this  fact  over  and  over  again.  Bad  teeth  and 
the  accompanying  oral  sepsis  contribute 
much  to  the  physical  degeneratibn.  As  a 
5et-off,  however,  to  such  short-sighted  poUcy, 
it  is  gratifying  to  note  that  another  board  of 
guardians  has  recently  appointed  a  qualified  dentist 
to  look  after  the  teeth  of  the  children  in  their 
homes. 


Pregnancy  in  Uterus  Bicomis. 

Various  good  authorities  have  stated  that  preg- 
nancy does  not  occur  in  a  bicomate  uterus,  but 
the  dictum  is  shown  by  recent  records  to  belong 
to   the   class   of   generalisations   condemned   by 
Bacon :       "  Inductio     per     enumerationem     sim- 
plicem  ubi  non  experitur  instantia  contradict  ria.** 
Contradictory  instances  have,  however,  been  found, 
and  so  the  supposed  law  fails,  but  at  the  same 
time  the  recorded  instances  are  so  rare  that  they 
deserve  notice  when    they  occur.      One   of   the 
best    authenticated     is    a    case    recently    pub- 
lished  by    Dr.     Green    of    Boston,  (a)    During 
labour    the    uterus     was    seen     to    be    divided 
into  two  distinct  parts  by  a  median  sulcus,  which 
became   deepest  at   the  fundus,  and  was  accen- 
tuated by  each  contraction.     On  the^  right  side 
the  foetus  was  made  out,  while  on  the  left  a 
placental  bruit   was  heard.    After  the  birth  of 
the  child,  a  mass  of  the  size  of  a  normal  uterus 
in  the  third    stage    remained    toward    the    left, 
while  a  smaller  one  was  felt  to  the  right.     Ex- 
ploration  of    the    uterus    after    the   puerperium 
bore  out  the  diagnosis.    The  sound  only  passed 
a  short  distance  in  the  middle  line,  but  slipped 
to  one  side  or  other.    The  comu    on  the  right 
side  was  five  inches  in  depth,  that  on  the'leTt 
half  an  inch  more. 


the  fever  pitch  of  pre-scientific  days.    The  refusal 
to  recognise  the  necessity  of  subordinating  the 
lower  animals  to  the  ultimate  good  of  man  in  the 
experimental  laboratory  has  led  to  the  strange, 
sad,  erratic,  and  contradictory  cult  of  the  anti- 
vivisectionist.     Fanatics  of  that  order  eat  boiled 
lobsters,  blanched  veal,  driven  grouse,  grilled  cod 
and   salmon ;    decorate   their  hats   with   egret's 
feathers    and    stuffed    humming-birds    or    gulls ; 
flog  their  horses  and  put  them  in  bearing  reins  ; 
shoot  trapped  pigeons,  hunt  tame  deer,  and  com- 
mit many  acts  of  wanton  cruelty  that  would  make 
the   average   thinking  medical  man  shudder   to 
contemplate.    Yet  they,  sooner  or  later,  become 
the  patients  of  the  men  they  so  bitterly  denounce. 
A  fortnight  ago  an  amusing  instance  of  misplaced 
indignation  was  divulged  at  an  East  London  in- 
quest.   Some  maternity  students  from  the  London 
Hospital  were  accused  of  behaving  with  great 
cruelty  to  a  baby.     It  appears  that  they  were 
really  trying  to  animate  a  gasping  new-bom  babe 
by  the  Schulz  system  of  respiration,  which  involves 
swinging  the  child  about  in  the  air.    The  jury 
found  that  death  was  due  to  insufficient  expansion 
of  the  limgs,  and  the  students  accordingly  re- 
turned   to    their    scientific    labours,  to   use   the 
language  of  the  police-court  reporters,  "  without 
a  stain  upon  their  characters." 


The  Brutality  of  Kindness. 

To  the  outsider  many  of  the  professional  acts 
•of  the  medical  man  must  savour  of  downright  hard- 
hearted brutality.  But  it  is  kindness  in  reality 
akin  to  that  of  the  parent  who  refuses  to  spoil 
the  child  by  sparing  the  rod.  The  keen  knife 
and  the  manipulations  of  the  surgeon  save  many  a 
limb  and  many  a  life.  Were  it  not  for  the  iron 
nerve  of  the  trained  men  of  medicine,  both  physi- 
cians and  surgeons,  the  mortality  of  poor,  maimed 
and  suffering  humanity  would  rise  straightway  to 


Reversed  Peristalsis  of  Intestines. 

The  question  of  reversed  peristalsis  in  the  ali- 
mentary canal  is  both  interesting  and  also  of  con- 
siderable practical  importance.  Partial  peristalsis  is 
seen  in  the  curious  power  of  regurgitation  of  food 
from  the  stomach  to  the  mouth  possessed  by  some 
persons,  a  faculty  more  or  less  closely  analogous 
with  the  herbivorous  habit  of  "  chewing  the  cud." 
Peristalsis  is  also  concerned  commonly  in  biUous 
vomiting.     Another    familiar    example    is    faecal 
vomiting  in  the  later  stages  of  intestinal  obstruc- 
tion.    Reversed  peristaltic  action  of  the     whole 
alimentary  canal,  however,  is  extremely  rare.     A 
most  interesting  instance  recently  occurred  in  a 
patient  at  the  Westminster  Hospital  under  the 
care  of  Dr.  William  Murrell  for  ulcerative  colitis. 
The  malady  was  cured  by  the  injection  into  the 
bowel  of  argyrol,  a  chemical  combination  of  syn- 
thetic vitellin  containing  30  per  cent,  of  silver. 
When  about  five  pints  of  solution  had  been  injected, 
the  patient  being  in  the  knee  and  elbow  position, 
fluid  was  seen  pouring  from  his  mouth.     The  same 
sort  of  thing  happened  at  subsequent  injections, 
and  it  was  proved  by  chemical  tests  of  the  vomited 
fluid  that  the  unaltered  silver  had  passed  through 
the  whole  length  of  the  canal  from  the  rectum  to 
mouth.     For  some  reason  or  other  the  ileo>caeca1 
valve  had  failed  to  exert  its  usual  action  against 
backward  pressure  from  the  colon  side.    The  case 
is  of  value,  as  it  is  an  accurate  and  scientific 
record  of  a  rare  clinical  occurrence. 


(a)  Botton  Med.  and  Surg,  /otrm.,  June  Oh,  10U4. 


An  Extraordinary  Motion  for  Malprazis. 

A  R£.\f ARKABLE  actiou  for  damages  is  pending  in 
the  French  Courts,  the  defendant  being  a  well- 
known  surgeon.  Dr.  J.  B.  Fort.     We  gather  that 


320    The  Medical  Press. 


PERSONAL. 


Sept.  31.  1904. 


Dr.  Fort  undertakes  to  bring  about  dilatation  of 
pyloric  obstruction  by  electrolysis,  apparently  on 
the  lines  folio vved  some  years  since  in  the  treat- 
ment of  urethral  stricture.  He  makes  use  of  an 
insulated  electrode,  with  a  flexible  gum-elastic 
end  as  a  guide.  This  he  introduces  through  the 
oesophagus,  and  in  so  doing,  in  this  particular 
instance,  the  "  guide  "  broke  off.  As  there  was  no 
reason  to  anticipate  any  trouble  from  the  passage 
of  this  pliable  foreign  body  through  the  intestines 
matters  were  allowed  to  take  their  course,  but  a 
few  days  later  the  patient  was  seized  with  violent 
abdominal  pain  and  promptly  succumbed.  Nothing 
more  was  heard  of  the  matter  for  some  months, 
when  a  discharged  assistant  of  Dr.  Fort's  wrote  to 
the  widow  informing  her  that  her  deceased  hus- 
band had  been  the  victim  of  a  surgical  mishap, 
whereupon  the  widow  instituted  proceedings  to 
recover  damages.  The  body  was  exhumed,  and 
was  carefully  examined  by  several  experts  in  the 
presence  of  the  defendant.  The  terminal  portion 
of  the  sound  was  discovered  in  the  intestine,  not 
apparently  having  caused  any  local  injury.  If 
this  version  be  correct  it  is  difficult  to  see  what 
ground  for  action  there  can  be,  and  it  seems 
highly  probable  that  the  proceedings  will  end  in  a 
non-suit. 


publish  his  work  shortly  to  the  world.  It  is  tan- 
talising to  be  told  so  much  and  yet  have  to  wait 
some  months  before  being  admitted  to  the  whole 
secret,  but  one  may  safely  trust  the  discoverer  of 
argon  and  helium  not  to  buoy  his  admirers 
up  with  false  hopes.  The  science  of  chexnistry 
has  moved  with  rapid  steps  of  late  years,  and  the 
wonders  of  radium  seem  likely  to  lead  to  concep- 
tions of  the  origin  of  matter  that  would  have  been 
regarded  as  rank  heresy  ten  years  ago. 


PERSONAL. 


No  PubUc  Mortuary. 

It  is  a  lamentable  fact  that  many  districts,  some 
of  them  densely  populated,  both  in  town  and 
country,  are  unprovided  with  a  public  mortuary. 
The  way  out  of  the  difficulty  has  been  hitherto 
met  in  the  time-hono  ired  way  by  taking  off  the  body 
of  anyone  found  dead  to  the  nearest  public-house. 
But  even  the  "  trade  "  may  revolt  and  turn  away 
from  its  doors  the  passive  harbinger  of  "  crowner 
quests."  Such  was  the  case  at  Maidenhead  the 
other  day  when  a  body  was  found  in  the  river. 
After  being  refused  by  several  publicans,  the  body 
was  deposited  on  an  island  for  several  hours 
among  the  rushes,  but  room  for  it  was  eventually 
found  in  an  unoccupied  public-house  belonging  to 
the  Corporation.  Can  it  be  believed  that  Maiden- 
head, the  wealthy,  the  populous,  the  picturesque 
river  resort,  is  without  a  pubUc  mortuary  ?  Such, 
however,  is  the  fact.  It  would  be  as  well  to  insert 
a  clause  in  the  next  Public  Health  Act  making 
it  compulsory  on  all  local  sanitary  authorities 
to  provide  adequate  mortuary  accommodation 
in  their  districts. 


H.R.H.  THE  Duchess  of  Albany  will  open  the  new- 
operating  theatre  at  the  National  Hospital  for  the 
Paralysed  and  Epileptic,  Queen  Square,  London,  on 
October  8  th. 


Dr.  W.  a.  Burt  has  been  elected  President  of  the 
Ontario  Medical  Association  for  the  coming  year. 


Mrs.  Barrow  has  endowed  a  bed  in  the  Liverpool 
Royal  Infirmary  at  a  cost  of  ;f  1,000,  in  memory  of  her 
late  husband,  Mr.  William  James  Barrow. 

Dr.  Schweninger,  who  was  at  Friedrichsruh  in 
attendance  on  the  late  Prince  Herbert  Bismarck,  was 
for  many  years  the  physician  of  the  Iron  CfaanceUor. 


Professor  Kocher,  of  Berne,  will  preside  over  the 
first  congress  of  the  Societe  Internationale  de  Chirurgie 
to  be  held  in  Brussels  in  September,  1905. 


The  Orifirin  of  Elements 

Sir  William  Ramsey  is  not  the  man  to  boast  or 
speak  prematurely,  and  an  announcement  he  made 
at  a  dinner  given  to  him  by  the  Society  of  Chemists 
in  New  York  cannot  but  stir  the  curiosity  and 
interest  of  the  whole  scientific  world.  Sir  WilUam 
stated  that  he  believed  chemistry  to  be  on  the  eve 
of  discovering  the  origin  of  elements — a  conclusion 
he  had  come  to  as  the  result  of  his  own  researches 
and  experiments.  He  has  recently  discovered  a 
new  substance  of  such  properties  as  to  place  the 
whole  question  in  a  new  light,  and  he  hopes  to 


On  behalf  of  the  David  Lewis  Trust.  Mr.  B.  W.  Lc\7 
formally  handed  over  to  the  Lord  Mayor  of  Manchester^ 
as  representative  trustee,  the  title-deeds  of  the  Saak- 
bridge  Colony  for  Epileptics. 

Surgeon-Major  T.  E.  F.  McGeagh  has  resigned  his 
commission  in  the  Honourable  Artillery  Company  of 
London,  and  retires  into  the  Veteran  Company,  with 
permission  to  wear  the  uniform  of  the  corps. 

Sir  William  McGregor,  who  recently  kissed  hands 
at  Balmoral  on  his  appointment  as  Governor  of  onr 
oldest  colony,  Newfoundland,  just  thirty  years  ago 
took  his  M.D.  degree  at  the  neighbouring  L-niversity  of 
Aberdeen. 


The  appointment  of  Dr.  Herbert  M.  Ellis,  Inspector- 
General  of  Hospitals  and  Fleets,  to  the  position  of 
Director-General  of  the  Medical  Department  of  the 
Navy,  in  the  place  of  Sir  Henry  F.  Norbury,  whose 
term  of  office  has  expired,  is  now  officially  announced. 

Dr.  Lorrain  Smith.  fcMmerly  Professor  of  Pathology 
in  Queen's  College,  Belfast,  who  has  been  appointed 
Professor  of  Pathology  and  Pathological  Anatomy  in 
succession  to  Professor  Delepine,  in  the  University  of 
Manchester,  will  open  the  Medical  Session  at  the 
latter  on  Monday,  October  8th.  by  delivering  an 
inaugural  address. 


Sister  Margaret  Brown,  the  English  hospital 
nurse  nursing  the  Queen  of  Italy,  was  specially  selected 
for  the  post  by  the  Matron  of  Queen  Charlotte's  Hos- 
pital, where  she  was  for  some  time  a  sister.  Needless  to 
say,  in  addition  to  her  high  professional  qualifications, 
she  possesses  tact  and  all  the  other  qualities  which  are 
essential  in  a  good  nurse. 


Professor  Morisani,  the  Queen'^s  accoucheur,  is  a 
well-known  person  in  Italy,  for  one  reason,  on  ac- 
count of  his  exceedingly  dwarf -like  stature.  The 
Professor,  who  lives  at  Naples,  has  a  son  in  the  same 
profession  as  himself,  and  almost  of  the  same  stje. 


SbFT.  21.   1904. 


CORRESPONDENCE. 


The  Medical  Press.    3^1 


Special  aorre0pon&ence* 

[prom  our  special  corrbspondent.] 

SCOTLAND. 
Edinburgh  University  and  Degrees  in  Veteri- 
nary Medicine. — ^It  is  a  matter  of  public  knowledge 
that  for  some  considerable  period  negotiations  have 
beeo  going  on  between  the  Town  Council,  as  trustees  of 
the  Royal  (Dick)  Veterinary  College,  and  the  Univer- 
sity authorities  in  reference  to  the  question  of  the 
granting  of  degrees  in  veterinary  science.  The  posi- 
tion of  matters  now.  as  explained  in  an  evidently 
authoritative  article  in  the  Scotsman,  seems  to  be  some- 
what as  follows  : — ^The  Dick  College,  founded  in  1823, 
is  apparently  the  only  endowed  institution  of  this 
nature  in  the  country.  It  was  affiliated  to  the  Royal 
College  of  Veterinary  Surgeons  of  London  on  their  in- 
corporation in  1844,  and,  since  the  death  of  its  founder 
in  1866,  has  been  under  the  guardianship  of  the  Town 
Council  of  Edinburgh,  by  whom  it  was  remodelled  in 
1S86,  so  that  now  the  whole  tuition  required  is  given 
a  one  compact,  centralised  building.  The  curriculum, 
ionneriy  a  two  years'  one,  now  extends  over  four 
winter  sessions  of  thirty  weeks,  leaving  the  summer 
jree  for  practical  work  in  the  country.  Each  group  of 
subjects  has  to  be  "  passed  '*  in  before  further  attend- 
ances qualify  for  subsequent  examination — a  provision 
which  many  of  us  would  have  the  medical  curriculum 
imitate.  Students  failing  for  more  than  a  year  without 
Teasonable  cause  are  permanently  disqualified.  Not 
Tcry  long  ago  the  prospect  of  a  largely  increased  endow- 
ment of  veterinary  science  appeared.  Mr.  McAllum, 
a  veterinary  surgeon  in  Edinburgh,  offered  ;£  15,000  to 
endow  a  chair  of  pathology  and  bacteriology ;  Miss 
Dick,  the  sister  of  the  founder,  has  bequeathed  about 
^23,000,  part  of  which  is  for  a  chair  of  comparative 
anatomy ;  and  further  mone3rs  are  expected  to  fall  in. 
Farther,  the  New  Veterinary  College,  which  hived  off 
torn  the  Dick,  has  been  absorbed  into  the  new  school 
at  Liverpool,  and  no  longer  needs  to  be  considered  in 
«ny  amsdgamation  scheme.  The  projected  scheme  of 
1hc  Town  Council  and  University  contemplates  a  new 
Conjoint  Administrative  Board,  and  the  removal  of 
the  college  from  the  guardianship  of  the  Council,  a 
lody  obviously  unfitted  to  manage  such  an  institution. 
The  University  has  issued  a  draft  ordinance  somewhat 
•on  the  lines  of  graduation  in  medicine,  with  Bachelor's 
and  Doctor's  degree  in  veterinary  science.  The  pre- 
liminary examination  is  to  be  the  same  as  for  medicine, 
(/.,  a  higher  standard  than  the  existing  one,  and  the 
Doarae  covers  the  subjects  required  by  the  College  of 
leterinary  Surgeons  plus  heredity  and  the  general 
principles  of  breeding.  Before  graduation,  the  can- 
tfdate  must  be  registered  as  a  veterinary  surgeon. 
<One  of  the  special  difficulties  is  that  veterinary  regis- 
tration is  under  a  one-portal  system,  and  two  sets  of 
examination  fees  will  require  to  be  paid,  and  two 
oaminations  passed  unless  some  arrangement  can  be 
i  to  whereby  the  College  examinations  are,  in  the 
of  University  candidates,  accessible  to  university 
oaminers. 
Maternity  Work  in  Edinburgh. — ^The  Milne 
inrray  Lodge,  which  is  now  open  for  the  reception  of 
ndents,  wUl  greatly  enhance  the  possibilities  of 
tting  a  sound  practical  training  in  obstetrics  in 
"  iburgh.  The  Lodge  is  close  to  the  Maternity 
pital,  and  is  in  telephonic  communication  with  it. 
'velve  students  are  accommodated  at  one  time,  and 
the  usual  period  of  residence  is  a  month,  each  during 
Jthat  time  easily  overtakes  his  six  cases.  As  a  matter 
'  fact,  we  believe  that,  besides  these  extern  cases,  the 
in  during  the  past  month  had  the  opportunity  of 
Keiag  nearly  forty  confinements,  most  of  them  abnor- 
B^.  a  great  advance  on  anything  practicable  hitherto. 


aorte0pon&ence« 


[We  do  not  hoM  oanelres  retponsibl*  for  the  opinions  of  our 
CorrespoDdenta.] 


John  Dale  Tucker,  stated  to  be  an  M.D.  of  Penn- 
lylvania,  U.S.,  was  fined  £10  and  £$  costs  on  each  of 
^  informations  before  the  Liverpool  magistrates  on 
Saturday  for  affixing  the  name  of  Dr.  John  Gould  to 
^0  death  certificates. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — ^The  discussion  on  this  important  subject  has 
been  up  to  the  present  somewhat  disappointing.  As  a 
layman,  after  carefully  following  up  the  original  articles 
and  the  subsequent  letters,  it  seems  to  me  that  Dr. 
Walsh  pointed  out  a  serious  flaw  in  Dr.  Taylor's  paper 
in  the  omission  of  illegitimacy  figures  from  the  total 
birth-rate.  Then  "  LL.D."  exposed  an  error  in  Dr. 
Walsh's  figures,  in  answer  to  which  the  latter  says  the 
mistake  does  not  affect  his  main  arguments.  Several 
concrete  examples  have  been  brought  forward  by 
correspondents  asking  Dr.  Taylor  whether  his  universal 
law  of  unrestricted  families  applies  to  their  particular 
cases.  The  answer  they  have  obtained  can  hardly  be 
called  satisfactory,  and  it  certainly  seems  to  me 
that  Dr.  Walsh's  main  criticisms  have  yet  to 
be  answered.  The  matter  stands  here  for  the 
moment.  I  sincerely  trust  more  light  will  be  forth- 
coming from  the  medical  profession  before  it  is  allowed 
to  drop.  Why  should  good,  struggling,  sensible, 
kindly  citizens  be  asked  to  bring  up  children  with 
no  prospects  better  than  those  of  the  streets  and  the 
workhouse  ?  What  is  the  value  of  abstract  and  ill- 
supported  ethical  theories  to  them  ? 

I  am.  Sir,  yours  truly, 

L.  W.  Hudson. 
Heme  HiU,  S.E. 


THE  LUNACY  QUESTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — I  have  no  desire  to  discu!^  this  question  beyond 
Dr.  Robert  Lee's  point  as  to  our  incapacity  in  defining 
insanity.  The  apparent  difficulty  in  arriving  at  an 
acceptable  definition  consists  in  the  fact  that  such 
diverse  views  are  held  as  to  what  constitutes  insanity, 
and  so  long  as  this  exists  it  is  obvious  no  unanimity 
or  concurrence  of  opinion  can  exist.  For  example,  a 
case  was  recorded  a  few  days  ago  at  an  inquest  on  the 
body  of  a  drowned  sailor.  It  transpired  that  a  delusion, 
common  among  sailors,  had  existed  in  the  mind  of 
deceased,  that  learning  the  art  of  swimming  created 
an  unfavourable  omen  as  to  fatality  in  drowning — a 
delusion  not  altogether  harmless.  Now,  theoretically, 
one  person  might  regard  this  as  evidence  of  insanity, 
and  another  the  reverse.  Certainly,  neither  could 
define  it  as  legally  insane.  Further  as  medical  men. 
we  are  only  called  upon  to  certify  insanity  for  legal 
purposes,  and  with  this  idea  I  ventured  to  define  it  in 
your  columns  recently  "  as  a  morbid  condition  of  mind 
requiring  supervision."  Dr.  Lee  will  observe  that  I  do 
not  commit  myself  by  saying  even  legal  supervision, 
which  would  necessarily  at  once  subject  a  person  to 
the  hands  of  the  law,  whereas  on  the  other  hand,  if  we 
suppose,  say,  the  validity  of  a  will  on  Hie  ground  of 
imbecility  or  otherwise  were  questioned  in  a  Uiw  court, 
the  issue,  as  far  as  I  conceive,  would  be  determined  on 
the  definition  in  question  one  way  or  the  other.  Dr. 
Lee,  who  also  observes  that  we  are  not  required  to 
define  insanity  as  applied  to  any  given  individual  in  a 
lunacy  certificate,  which  I  so  far  agree  is  impracticable, 
because  we  do  not  understand  mind  sufficiently  as  he 
rightly  suggests.  We  are  only  asked  to  describe  the 
case  in  the  lunacy  form,  and  not  to  define  insanity 
therein.  Granted  the  apparent  difficulty  in  agreeing 
to  a  definition  as  to  what  constitutes  insanity,  surely 
all  specialists  are  in  accord  on  one  point,  and  that  is  in 
regard  to  the  insane  requiring  the  interposition  of  the 
law,  and  it  is  upon  this  idea  I  submit  they  must  found 
their  definition. 

I  am.  Sir,  yours  truly, 

Clement  H,  Sei^. 
Brighton,  September  8tU,  1904. 


322    The  Medical  Pkess. 


LITERATURE. 


Sept.  21,  1904^ 


MR.  ISAAC  HARTHAN,  M.R.C.S.ENG. 
Wb  regret  to  announce  the  death  of  Mr.  Isaac 
Harthan.  surgeon,  ivhodied  at  his  residence.Blythewood, 
Parkfield  Road,  Didsbury,  on  the  5th  inst.  He  retired 
from  practice  some  years  ago.  Formerly  for  a  long 
period  he  followed  his  profession  in  Hulme.  and  lived 
in  City  Road.  Mr.  Harthan  became  a  member  of  the 
Royal  College  of  Surgeons  in  1856  after  studying  at 
Liverpool. 

HENRY  ARTHUR  BENHAM,  M.D..  OF  BRISTOL. 
We  regret  to  announce  the  death  of  Dr.  Harry 
Arthur  Benham,  the  medical  superintendent  of 
the  asylum  at  Stapleton,  at  that  institution  on  the 
14th  inst.  He  had  been  in  indifferent  health  for  some 
months  past  and.  therefore,  although  his  death  was 
sudden,  it  was  not  entirely  unexpected.  The  cause  is 
stated  to  be  heart  failure.  The  deceased  succeeded 
Dr.  George  Thompson  on  that  gentleman's  retirement 
in  1890  from  the  asylum,  and  with  which  he  had  been 
connected  as  assistant  medical  officer  for  some  eight 
or  ten  years,  and  he  had  therefore  put  in  over  twenty 
years'  service  there.  He  was  in  his  fiftieth  year.  A 
strong  Conservative,  he  took  a  keen  interest  in  politics, 
but  was  precluded  from  taking  any  active  part  in  them 
owing  to  his  position.  He  was  an  enthusiastic  Free- 
mason, and  had  held  several  prominent  offices  in  the 
Order.  He  took  his  M.D.  at  Aberdeen  in  1883.  He 
was  a  lecturer  on  mental  diseases  at  the  University 
College,  Bristol,  and  a  member  of  the  Council  of  the 
Medico-Psychological  Association  of  Great  Britain  and 
Ireland.  From  time  to  time  he  made  valuable  con- 
tributions to  the  medical  papers  on  his  special  subject. 
His  father  came  of  an  old  Bristol  family.  His  only 
brother  was  also  a  medical  man,  but  he  died  some  years 
ago  while  abroad.  He  will  be  mourned  by  a  large 
circle  of  friends,  and  especially  amongst  his  professional 
and  Freemasonry  brethren. 

CHARLES  WILLIAM  IZOD,  M.D. 
The  death  took  place  last  Friday,  at  Whitehall  Court, 
Westminster,  of  Dr.  Charles  William  Izod,  who  for 
many  years  was  medical  adviser  to  the  members  of 
the  French  Royal  Family  during  their  residence  at 
Claremont  Palace.  Esher,  and  latterly  to  the  Duchess 
of  Albany.  He  was  also  present  at  the  death  of  Queen 
Amelie  and  the  Duchesse  de  Nemours.  Dr.  Izod,  who 
practised  for  fifty  years  in  Esher,  was,  on  the  occasion 
of  his  jubilee,  presented  with  a  testimonial  by  the 
Duchess  of  Albany.  His  qualifications  were  M.R.C.S. 
Eng.,  taken  in  1846;  L.S.A..  1847;  and  L.M.Dub. 


EDMUND  CARVER,  M.D. 
Dr.  Edmund  Carver,  formerly  demonstrator  o^ 
anatomy  at  Cambridge  University  Medical  School, 
but  who  had  retired  from  practice,  died  on  Wednesday 
at  Torquay  at  the  age  of  eighty.  Dr.  Carver  was  ad- 
mitted a  Member  of  the  Royal  College  of  Surgeons, 
England,  in  1848,  and  a  Licentiate  of  the  Society  of 
Apothecaries  the  following  year,  having  professionally 
studied  at  University  College  Hospital  Medical  School. 
In  1854  he  was  elected  a  Fellow  (by  examination)  of 
the  Royal  College  of  Surgeons,  in  1858  graduated  B.A. 
from  St.  John's  College,  Cambridge,  in  1859  took  the 
M.B.  degree,  and  in  1866  proceeded  M.A.,  but  only 
took  his  M.D.  in  189 1.  Besides  being  Demonstrator  of 
Anatomy  at  Cambridge,  he  was  Surgeon  and  afterwards 
Consulting  Surgeon  to  Addenbrooke's  Hospital,  was  a 
Fellow  of  the  Oimbridge  Philosophical  Society,  at  one 
time  a  President  of  the  Cambridge  Medical  Society,  and 
was  a  retired  Surgeon-Major  of  the  Cambridge  Univer- 
sity Rifle  Volunteers.  Dr.  Carver  had  also  been  House 
Surgeon  to  University  College  Hospital,  Gower  Street, 
Resident  Clinical  Assistant  at  the  Consumption  Hospital, 
Brompton,  and  Surgeon  to  the  Huntingdon  County 
Hospital  and  the  Hunts  Rifle  Regiment  Militia. 


FLEET-SURGEON  JOSEPH  WOOD,  R.N..  M.D: 
The  death  took  place  at  Glengall,  Hurstpietpoint,  o» 
the  sth  inst.,  of  Fleet-Surgeon  Joseph  Wood.  R.S. 
(retired),  at  the  age  of  62.  Mr.  Wood,  who  took  th^ 
degree  of  M.D.  of  Edinburgh  in  1864  and  L.R.C.S.EdiB. 
and  L.M.  in  1866,  joined  the  service  in  1869,  becaise 
staff-surgeon  in  1880.  and  fleet-surgeon  ten  years  later, 
retiring  in  1893.  He  was  surgeon  of  the  Htnuilt^ 
during  the  war  against  the  Zulus  from  1877  to  1879 
and  was  awarded  the  Zulu  medal. 


SURGEON-GENERAL  JAMES  JAMESON,  C.K 
Surgeon-General  James  Jameson,  C.B.,  died  qb 
Tuesday  last  at  his  residence,  Newlands,  Eltian. 
The  son  of  Mr.  William  Jameson,  of  Ladeside,  Kilbinie, 
N.B.,  he  was  bom  in  1837,  ^^^  ^^^  therefore  67  yem 
of  age.  He  became  an  M.D.  of  Glasgow  Unxveiatr 
in  1865,  and,  having  entered  the  Army  Medical  Serrict 
as  Assistant  Surgeon  in  November,  1857,  he  becaor 
Surgeon  in  March  and  Surgeon-Major  in  April.  187}. 
Surgeon-Colonel  in  1888,  and  Surgeon  Major-Getienl  m 
1893.  ^^  May,  1896,  he  was  promoted  to  be  Director- 
General  of  the  Army  Medical  Service,  which  appoint- 
ment he  held  till  190-1.  Surgeon-General  Jamoofr 
was  made  a  C.B.  in  1897,  ^^^  honorary  surigeon  tothe- 
King,  and  a  Knight  of  Grace  of  the  Order  of  St  Jofai 
of  Jerusalem.  During  the  Franco-German  war  of 
1870-71  he  served  with  the  English  ambulance.  Bt 
married,  in  1864,  a  daughter  of  the  Rev.  Robert  David. 
Cartwright,  of  Kingston,  Canada. 


COLONEL  JOHN  HENRY  BEATH,  M.D..  CR 
'  The  death  was  recently  announced  at  Stiriiof 
of  Lieutenant-Colonel  John  Henry  Beath,  M.D., 
C.B..  in  his  seventieth  year.  He  was  a  son  of 
the  late  Dr.  Andrew  Beath.  of  Stirling,  and  was  edo- 
cated  at  the  High  School  of  that  town.  Laur 
he  graduated  M.D.  of  Edinburgh  University.  He 
received  in  1857  an  appointment  on  the  Medical  Suf 
and  served  on  it  during  the  Indian  Mutiny,  hm^ 
present  at  the  siege  and  capture  of  Lucknow.  In  1859 
he  joined  the  3rd  Foot  (The  Buffs),  and  was  with 
regiment  in  the  China  war  of  r86o:  Colonel  Beath' 
foreign  service  extended  over  fourteen  years,  his 
campaign  being  the  Egyptian  expedition  in  iS8:J 
when  he  was  mentioned  in  one  of  the  despatches  of  Sir 
Garnet  Wolseley  in  the  following  terms  : — "  Surgeon- 
Major  J.  H.  Beath,  M.D.,  has  been  brought  to  mr 
notice  for  some  special  favour,  and  I  am  glad  to  havi- 
this  opportunity  of  recommending  so  zealous  and  hard- 
working an  officer."  Queen  Victoria  accordingly  coo- 
f erred  upon  Dr.  Beath  the  Order  of  the  Bath,  and  gavt 
him  permission  to  accept  and  wear*  the  insignia  of  tfar 
Order  of  the  Medjidieh,  which  the  Khedive  had  codp 
f erred  upon  him.  For  ten  years  he  held  the  garrisM 
appointment  in  his  native  town-  of  Stirling,  from  whick 
appointment,  owing  to  failing  health,  h«  retired  onlf 
two  years  ago. 


Xitetatnte* 


PRYOR  ON  GYNECOLOGY,    (a) 
After  reading  the  title-page  of  this  work  expecta- 
tions  were  raised  which  were  subsequently  destined  to» 
be  agreeably  disappointed.     We  looked  forward  with 
no  undue  degree  of  pleasure  to*  reading  one  of  the  latest 
additions  to  gynaecological  text-books — ^innumerable as 
these  seem  to  be  in  America.     Yet,  Dr.  Pryor's  repnta- 
tion  as  a  distinctly  original  worker  in  the  field  of  open- 
tive  gynaecology  is  by  no  means  confined  to  his  own 
land,  and  we  were  somewhat  surprised  that  he  should 
have  added  another  to  the  student's  already  crowded  1 
choice  in  the  matter  of  text-books. 


(«)   *'  OyiUBoology  " :  a  Text-Book  for  Students,  and  «  Oidd«  for 
Praotttiooeis.     By  W.    B.  Fryor,  M.J>..   Prol««aor  ofOTUNoiW. 

(New  York  Polytechnic  Medical  ^hooin  Ac,    jLondon  and  90^ 
York :  D.  Appleton  and  Co.,  1903. 


Sept.  21,  1904. 


LITERATURE. 


Tbe  Medical  Pkess.    323 


But  the  title  is  the  only  part  of  this  suggestive  work 
^which  we  could  ¥riUingly  dispense  with.  It  is  some- 
"What  of  a  misdirection,  for  Dr.  Pryor  has  given  us  a 
valuable  addition  to  gynaecological  literature  which  is. 
however,  from  the  student's  or  examination  point  of 
view  a  very  poor  text-book.  But  the  book  has  a  more 
abiding  interest  than  any  mere  examination  guide ; 
it  is  a  personal  document  which  deals,  if  briefly,  always 
suggestively,  with  some  of  the  chief  problems  of  modem 
or  surgical  gynaecology. 

This  point  of  view  being  kept  in  mind,  we  can  under- 
stand the  omission,  noted  in  the  preface,  of  such  subjects 
as  bacteriology  and  pathological  histology — subjects 
"Which,  however,  we  could  nowise  accept  as  properly 
excluded  from  the  pages  of  a  work  intended  primarily 
as  a  student's  text-book,  or  even  for  the  guidance  of 
the  average  practitioner.  In  our  mind  it  is  certainly 
debatable  whether  the  gist  of  Dr.  Pryor's  message, 
which  is  essentially  one  to  specialists — might  not  have 
been  better  conveyed  in  the  form  of  a  book  of  essays  on 
technique  in  modem  gynaecological  work.  In  any  case 
it  is  true  to  say  that  this  book — or  much  of  it — will 
prove  useful  and  interesting  exactly  in  proportion 
to  the  previous  personal  knowledge  and  experience  of 
the  reader.  We  are  convinced  that  the  proper  reader  will 
turn  again  and  again  to  its  pages,  not  necessarily  for 
agreement,  but  for  views  which  are  founded  on  a  large 
and  well-studied  experience,  and  which  are  always 
clearly  and  suggestively  stated.  It  is  only  needful  to 
add  that  the  illustrations  and  general  get-up  of  the 
book  are  admirable. 


tion  may  not  agree  to  recognise  a  single  and  universaL' 
basis  of  matter — ^whether  under  the  name  of  heHum- 
or  hudofp  or  moisture — the  fact  is  unquestionable  that 
the  general  trend  of  recent  pl^ysical  and  chemical = 
discovery  has  been  to  make  scientists  suspect,  if  not 
actually  believe,  its  essential  unity. 

Of  course,  the  great  practical  interest  which  the  new 
science  of  radio-activity  possesses  for  medical  men  is 
its  promise  in  the  broad  domain  of  therapeutics— -es- 
pecially in  the  section  devoted  to  the  treatment  of  the 
hitherto  hopelessly  intractable  forms  of  carcinoma, 
sarcoma,  and  tuberculous  disease.  In  this  connection, 
and  on  this  account,  we  heartily  welcome  Mr.  Soddy's 
work,  as  an  excellent  introduction  to  the  study  of  the 
subject.  And  as  no  science  is  really  foreign  to  medicine 
— ^not  even  the  so-called  science  of  metaphysics— 
we  strongly  recommend  this  volume  to  the  attention  of 
our  readers.  The  intense  interest  attached  to  scientific 
research  and  discovery  is— or  sorely  should  be— the 
silvery  margin  of  the  too  frequently  clouded  aspect  of  a 
medical  career;  and,  although  the  consciousness  of 
the  possession  of  knowledge  hourly  approximating  to 
that  of  the  angels  may  offer  but  cold  consolation  to  a 
dispensary  doctor  during  his  hill-side  pilgrimage  of 
twelve  or  fifteen  miles  in  a  bUnding  and  petrifying 
blizzard,  it  will  surely  give  him  in  his  house  of  rest  that 
soothing  conscientiousness  of  the  high-minded  perform- 
ance of  the  noblest  duties  allotted  to  humanity — those - 
in  which  man  approaches  most  closely  to  the  thoughts 
and  actions  of  the  "  Divine  Exemplar  "  Himself. 


SODDY  ON  RADIO-ACTIVITY,  (a) 
As  the  author  observes  in  his  preface :  ''  The 
discovery  of  this  new  property  of  self-radiance,  or 
•  radio-activity,*  has  proved  to  be  the  beginning  of  a 
new  science,  in  the  development  of  which  physics  and 
chemistry  have  worked  together  in  harmony."  The 
pioneer  in  the  chemical  development  of  the  subject  ^ 
was,  as  is,  of  course,  well  known  to  all  readers.  Madame  ' 
Curie,  and  our  author  places  prominently  before  us 
the  less  universally  familiar  fact  that  "  On  the  physical 
side,  the  brilUant  and  elaborate  researches  of  Prof. 
Rutherford,  at  first  mainly  with  thorium — an  element 
which,  like  uranium,  is  so  feebly  active  that  it  had  been 
studied  for  a  century  before  its  radio-activity  was  dis- 
covered— paved  the  way  for  a  complete  and  general 
theory  of  the  cause  and  nature  of  the  new  property." 
The  fundamental  basis  of  this  theory  is  that  the  radio- 
active elements  are  in  a  process  of  evolution  (or  devolu- 
tion) towards  Ughter  and  more  statile  forms  ;  that  they 
are  proceeding  in  this  direction  by  a  line  df  continuous 
and  explosive  disintegration  of  the  constituent  atoms  ; 
and  that  the  fragments  thus  set  free  are  spontaneously 
ejected  in  directly  eccentric  courses,  and  thus  constitute 
the  characteristic  "  radiations."  The  recent  discovery 
of  the  continuous  production  of  elementary  helium 
from  radium  is,  of  course,  a  direct  experimental  con- 
firmation of  this  theory. 

The  study  of  the  subject  of  radio-activity  has  opened 
up  new  and  unexpected  views  of  the  constitution  of 
matter.  It  has  "  burst  up  "  physically  and  meta- 
phorically the  previously  indivisible  "  atom."  As  we 
ourselves  could  never  picture  to  our  unscientific  fancy 
such  an  entity  as  a  finally  indivisible  atom,  we  cannot 
pretend  to  lament  its  scientific  extinction.  And,  as 
the  Daltonic  atom  was  but  a  chemical  adaptation  of 
the  ideas  of  Democritus  on  the  constitution  of  matter, 
so  the  discoveries  of  M.  Becquerel  and  Madame  Curie 
carry  us  back  in  imagination  to  the  conceptions  of 
Thaly,  when  the  first  of  Greece's  famous  roll  of  wise 
men  taught  his  disciples  that  all  forms  of  matter  were 
ultimately  reducible  to  a  single  element.  Although 
the  physico-chemical "  Volapuk  "  of  the  present  genera 


KIRKBY'S  PRACTICAL  PRESCRIBING,  (a) 

Practical  pharmacy  is  in  danger  of  becoming  a 
lost  art.  Most  modern  medical  practitioners  would 
seem  to  have  but  little  genius  for  dispensing,  and  with 
the  present  vogue  for  factory-made  medicines  medical 
students  have  but  little  inducement  to  devote  much 
time  or  attention  to  the  practical  work  of  the  phar- 
macist. But  it  is  most  necessary  that  everyone  who 
embarks  on  the  practice  of  physic  should  at  least  be 
able  to  avail  himself  of  the  adequate  resources  of  his 
national  Pharmacopceia.  Unfortunately,  there  are 
good  grounds  for  the  oft-repeated  complaint  that 
present  day  medical  students  receive  an  education 
which  is  defective  in  so  far  as  it  relates  to  the  writing 
and  compounding  of  prescriptions. 

The  admu-able  little  work  which  Mr.  Kirkby  has 
prepared  is  conveniently  suited  for  the  needs  of  the 
average  student.  It  is  based  on  a  course  of  practical 
prescribing  and  dispensing  elaborated  by  the  author 
for  members  of  the  Manchester  Medical  School. 

In  design,  execution  and  general  suggestiveness,  it 
merits  high  praise  ;  and  it  may  be  expected  to  become 
popular,  not  only  in  the  Victoria  University,  but  in 
other  centres  of  medical  study. 

The  work  is  divided  into  convenient  sections  dealing 
with  various  methods,  preparations,  and  forms  of  ad- 
ministration. In  the  section  deaUng  with  the  forms 
of  administration  and  incompatibles,  all  the  prepara- 
tions of  the  British  Pharmacopoeia  and  of  the  For- 
mulary of  the  British  Pharmaceutical  Conference  are 
mentioned,  together  with  their  doses. 

A  highly  commendable  feature  of  the  work  is  the 
presentation  of  dispensing  exercises  which  should  be 
of  much  service  to  teachers  as  well  as  of  assistance 
to  students. 

The  forms  of  administration,  solubilities  and  incom-  - 
patibles  of  the  chief  official  and  extra-official  drugs  are 
given   in  convenient   alphabetical   arrangement,   and 
should   prove  invaluable   for  the   purposes   of   rapid 
reference. 

There  is  also  a  useful  collection  of  the  words  and 
phrases  used  in  prescription  writing,  but  the  author 
has  wisely  reversed  the  customary  arrangement,  since, 


(«)  "  Radio-Activity  :  an  Btementary  Treatise  from  th«  Standpoint 
of  the  Disintegratioa  Theory."  By  Fredk.  Soddy,  M.A.,  Lecturer  on 
Physical  Chemistry  and  Radio-Activlty  m  the  University  of  Glasgotr. 
With  Forty  llhistrations.  England  :  The  Eleetririan  Printing  and  Pub- 
hshioglCo.ALtd. 


(a)  "  Pntctical  Preacribin|r  and  Diftpensing  for  Medical  Students." 
By  William  Kirkby,  sometime  Lecturer  in  Phsrmacoffnosy  in  the 
Queen's  College,  Manchester.  Pp.  109.  Manchester :  Shenratt  and 
Hughes.    1904. 


324    The  Medical  Pkess. 


LABORATORY  NOTES. 


Sept.  21,  1904. 


:as  he  points  out,  the  prescribe!  usually  wishes  to 
know  the  Latin  equivalent  of  the  English,  and  not 
vice  versd,  as  is  the  case  with  the  dispenser. 

The  work  appears  to  be  peculiarly  free  from  blemishes 
and  particulaorly  put  in  practical  detail.  It  is  mani- 
festly the  work  of  one  who  is  a  skilled  chemist,  and  an 
expert  pharmacist,  and  who  knows  not  only  the 
requirements  of  the  modem  student  but  the  best  way 
in  which  his  needs  may  be  met. 

We  commend  the  work  to  both  teachers  and  students. 


DAWSON  TURNER'S  MEDICAL  ELECTRICITY,  (a) 

The  rapid  appearance  of  a  fourth  edition  of  this 
•excellent  book  is  in  itself  sufficient  evidence  of  its 
■excellence  and  popularity.  As  might  be  expected  by 
those  who  have  followed  the  trend  of  modem  electro- 
therapeutics a.  good  deal  of  attention  has  been  paid  to 
the  use  of  sinusoidal  and  high-frequency  currents. 
It  is  to  the  latter  part  of  the  book  that  many  interested 
in  electrical  matters  will  at  once  turn.  Under  the 
heading  '*  Therapeutic  AppUcations "  is  a  short  but 
good  summary  of  what  has  hitherto  been  done  by  the 
use  of  the  high  frequency  currents.  The  wide  diver- 
"gence  of  the  morbid  conditions  that  are  thereby  relieved 
or  cured,  and  the  general  nature  of  the  description, 
register  the  undeveloped  stage  of  this  modem  method. 
Dr.  Turner  quotes  the  words  of  a  contemporary  author 
who  says : — "  There  can  be  no  doubt  that  in  high- 
Irequency  currents  we  have  a  method  of  treatment  of 
distinct  value.  Their  power  of  service  is  marked  in 
functional  nervous  disturbances  and  in  localised 
vascular  dilatations,  but  their  influence  over  diseases  of 
the  skin  suggest  also  that  they  are  capable  of  pro- 
foundly modifying  general  metabolism,  and  that  they 
will  in  time  be  found  to  have  a  wide  range  of  application 
in  the  treatment  of  diseased  conditions."  The  re- 
markable result  otained  in  the  treatment  of  piles  and  of 
dilated  stomach  might,  in  our  opinion,  have  been  with 
-advantage  somewhat  emphasised  in  Dr.  Turner's 
account.  The  whole  of  the  book  has  been  revised  in 
the  present  edition  and  thirty  fresh  illustrations  have 
Ibeen  added.  We  echo  cordisdly  the  author's  hope  that 
the  tide  of  unqualified  electrical  practice  will  ere  long  be 
stemmed,  and  that  the  day  of  the  instrument-maker, 
the  nurse,  and  the  amateur  empiric  will  soon  come  to 
an  end.  Certainly  the  writing  of  good  books,  such  as 
that  of  the  author's,  will  help  us  on  the  road  to  better 
things. 


GIBBONS  ON  REFRACTION.  (6) 
The  author  in  his  preface  states  that  he  has  attempted 
to  supply  students  of  ophthalmology  with  the  practical 
information  needed  upon  the  various  subjects  treated. 
The  deductions  from  the  various  formuls  used  in 
optics  have  been  simplified  and  inserted.  Whilst 
falling  in  with  the  accepted  custom  of  omitting  the 
more  p-irely  mathematical  treatment  of  the  subjects, 
lie  considers  that  the  student  should  be  familiar  with 
the  physics  involved  for  the  proper  understanding 
^f  the  subject,  and  consequently  much  of  the  book  is 
occupied  by  the  explanation  of  the  physical  pheno- 
mena met  with.  The  author  "feels  that  the  new 
material  and  diagrams  the  work  contains  justifies  its 
publication,  so  offers  no  apology  for  adding  one  more 
to  the  numerous  books  upon  the  same  subject." 

The  title  of  this  most  readable  and  excellent  dis- 
sertation on  the  Refraction  of  the  Eye,  is  rather  mis- 
leading, for  it  does  not  deal  with  any  of  the  conditions 
usually  classed  as  "  diseases  of  the  eye,"  and  any  one 
who  purchases  it  expecting  to  find  a  description  of 
the  diseases  of  the  eye,  will  find  his  mistake.     It  is  a 

(«)  ''lUnml  of  Medical  Electricity."  By  Dairaon  Turner.  6.  A.. 
M.D..  F.B.C.P.1Sd.  Medical  Offloer  in  Ohar^e  of  Electrical  Depart- 
ment in  the  Boyal  Inflrma  y,  Edinburgh,  Ac.  Fourth  Edition. 
London  :  fiailltere  Tindall  and  Oox.    1904.    Price  lOs.  6d  net. 

(6)  **The  Eye.  its  Refraction,  and  Difleasee.  The  Refraction  and 
Fnnctioaal  Testing  of  the  Bye.  Ck>mplete  in  itself,  in  twenty-eight 
chapters,  with  numerous  explanatory  Onts  and  Diagrams  "  By 
Edwazd  S.  Gibbons,  M.D.  Pp.  472.  Mew  York ;  The  MaoMlllM 
Compai\y.    IflOi. 


treatise  on  the  perfection  and  accommodation  0!  the 
eye.  and  the  methods  of  functional  testing,  &c.,  but 
in  no  sense  a  treatise  on  ophthalmology,  ''  complete 
in  itself,"  as  the  title  says.  With  this  warning  ve 
can  recommend  this  most  carefully  prepared 
volume  to  the  notice  of  all  those  who  require  a  wdl 
printed,  profusely  illustrated,  and  intelligently  written 
treatise  on  the  subjects  dealt  with. 


ORTHMANN  ON  GYNECOLOGICAL 
PATHOLOGY,  (a) 
We  congratulate  Dr.  Roberts  on  the  manner  in 
which  he  has  translated  this  valuable  little  work  into 
English.  Gynaecological  pathology  is  a  subject  which 
has  for  some  unaccountable  reason  been  somewhat 
overlooked  in  this  country.  The  works  on  general 
pathology  pass  over  the  special  pathology  of  the  female 
genital  organs  with  a  cursory  notice,  and  gynaecological 
hand-books  and  text-books  are  more  occupied  with 
the  therapeutical  and  surgical  aspect  of  gynaecolog\- 
than  with  its  pathology.  For  this  reason,  the  want  ii 
a  reliable  work  dealing  with  the  subject  is  distinctly 
felt,  and  this  English  edition  of  Orthmann's 
work  will,  we  are  sure,  be  appreciated.  The  book 
consists  of  two  parts,  the  first  dealing  with  the  most 
important  and  modern  methods  of  technique,  the 
second  with  diagnosis  and  pathology.  So  far  as  it 
goes,  it  is  good,  but  it  is  perhaps  just  a  little  short. 
It  is  illustrated  by  some  seventy  or  more  micro-photo- 
graphs which  are  admirably  reproduced. 


new  Bppltanced. 


IMPROVED  HAGEDORN'S  NEEDIE  HOLDER, 


Mr.  Cecil  H.  Leaf.  M.B.Can- 
tab.,  F.R.C.S.Eng.,  sends  us  the 
following  description  of  an  im- 
proved needle  holder  : — 

One  draw^back,  he  remarks, 
which  may  be  urged  against 
Hagedom's  Needle  Holder  is 
that  a  somewhat  uncomfortable 
movement  of  the  little  finger 
is  necessary  to  unlock  it  I 
have  therefore  requested  Messrs. 
Arnold  and  Sons,  of  West 
Smithfield,  to  construct  a 
Hagedom  with  a  Macphail's 
catch.  This  renders  the  un- 
locking a  comfortable  process. 
The  holder  as  thus  modified 
is  shown  in  the  accompan]ring 
illustration. 


Xaboratorg  notes. 


We  have  received  from' Messrs.' Burroughs,' Wellcome 
samples  of  various  preparations  of  obvious  value  to 
the  medical  profession.  We  may  especially  mention 
"  Soloid  "  of  Ferric  Chloride,  gr.  10  (0*648  gm.).  The 
advantages  of  this  preparation  are  that  it  avoids  the 
need  of  carrying  about  a  solution  of  ferric  chloride. 
Each  product  represents  the  amount  of  ferric  chloride 
contained  in  40  minims  of  solution  of  ferric  chloride, 

(a)  *•  Orthmann's  Handbook  of  Oynnoolosioal  Pathology  lor  Fno- 
tltionera  and  Stadents."  TransUtod  by  C.  Hubert  Roberts,  M.DI, 
F.R.C.S.,  M.a.aP.  Physician  to  tjkie  Samaritan  Hoepifeal,  LoadM. 


Sept.  21,  1904. 


MEDICAL  NEWS. 


The  Medical  Press.    325, 


B.  P.,  and  one,  dissolved  in  a  sufficient  quantity  of 
water  to  produce  40  minims,  forms  a  solution  equival- 
lent  to  the  official  strength.  By  varying  the  quantity 
of  water,  this  strength  may  be  increased  or  diminished 
according  to  circumstances. 

Another  convenient  preparation  is  the  "  Tabloid  " 
Ferric  Chloride,  in.  10  (0*592  c.c).  This  will  be 
found  a  convenient  means  of  administering  ferric 
chloride,  especially  to  patients  requiring  a  regular 
course  of  treatment. 

'  For  the  preparation  of  antiseptic  solutions  *'  Soloid  " 
Mercuric  Potassium  Iodide,  gr.  4*37  (0*283  gm.),  will 
be  found  most  convenient.  One  dissolved  in  ten 
ounces  of  water  forms  a  solution  of  i  in  1,000  (fre- 
quently known  as  mercury  biniodide  solution).  The 
colour  of  "  Soloid "  Mercuric  Potassium  Iodide  is 
due  to  a  harmless  ingredient  added  as  a  safeguard 
against  errors. 

The  list  of  "  Soloid "  preparations  includes : — 
•'Soloid'*  Mercuric  Potassium  Iodide,  gr.  1*75 
(0*113  gm.),  issued  in  tubes  of  twenty-five,  and  bottles 
oi  100 ;  "Soloid"  Mercuric  Potassium  Iodide,  gr. 
4-37  (0*283  gm.),  issued  in  bottles  of  twenty-five  and 
roo';  and  "  Soloid "  Mercuric  Potassium  Iodide, 
gr.*8*75r(o*567^gm.),  issued  in  bottles  of  twenty-five 
and  loa 


iDedfcal  news* 


Vaeeination  Frauds. 

AT  the  Old  Bailey  last  week,  Hugh  Stanley  Revell, 
35,  surgeon,  who  had  pleaded  guilty  to  having,  whilst 
medical  officer  under  the  Guardians  of  the  Wandsworth 
and  Clapham  Union,  falsified  certificates  of  vaccination 
and  thereby  defrauded  the  guardians  of  considerable 
sums  of  money,  was  brought  up  for  sentence.  The 
Recorder  sentenced  him  to  seven  weeks'  imprisonment, 
which  entitled  him,  as  he  had  been  in  custody  for  three 
months,  to  be  at  once  discharged. 

Valut  of  an  Eyo. 

At  the  Congress  of  Ophthalmologists,  which  was 
opened  at  Lucerne  last  week,  there  was  a  discussion  of 
the  question  as  to  what  value  should  be  placed  upon 
an  eye,  injured  or  lost,  with  a  view  to  fixing  an  in- 
demnity. A  number  of  papers  on  the  subject,  including 
one  by  Dr.  Wurdemann  (Milwaukee),  were  read.  A 
resolution,  proposed  by  Dr.  Fuchs  (Vienna),  was 
adopted  declaring  that  the  congress  had  no  power  to 
draw  up  a  definite  table  of  damages  applicable  in  all 
countries,  as  the  laws  on  the  subject  were  everywhere 
different.  With  regard  to  the  question  of  the  deter- 
mination of  the  power  of  vision,  the  congress  decided  to 
elect  national  committees  for  the  purpose  of  collecting 
material  to  be  submitted  to  the  next  congress. 

Th9  lospection  of  City  Restaurants. 

The  Public  Health  Department  of  the  London  City 
Corporation  has  issued  its  first  certificate  of  cleanliness 
under  a  new  scheme  for  the  attainment  of  cleanliness  in 
the  kitchens  of  restaurants  and  above-ground  bake- 
houses within  the  City  area.  Dr.  CoUingridge.  the 
medical  officer  of  health  for  the  City,  states  in  a  report 
that  repeated  representations  have  been  made  by 
owners  and  occupiers,  who,  having  been  called  upon 
to  carry  out  repairs  and  improvements,  felt  strongly 
that,  as  some  recompense  for  the  outlay,  they  should 
be  in  a  position  to  exhibit  a  certificate  that  their 
premises  were  in  a  satisfactory  sanitary  condition. 
A  standard  of  requirements  has  been  drawn  up,  and 
further  certificates  will  be  issued  after  the  Court  of 
Common  Council  reassembles  on  September  22nd. 
With  regard  to  restaurant  kitchens,  one  of  the  sugges- 
tions is  that  each  kitchen  should  have  a  minimum 
height  of  8  ft.,  a  minimum  cubic  capacity  of  1.500  ft., 
except  in  special  circumst.-^nces,  and  not  less  than  400 
cubic  feet  per  head  for  each  person  employed  therein. 


Th9  Medioal  Profession. 

The  Winter  Session,  1904-05  will  commence  om 
October  ist.  The  entrance  examination  for  the  Con- 
joint Diplomas,  medicine,  surger>',  and  midwifery  oV 
the  Royal  College  of  Physicians  and  Surgeons,  Dublin, 
will  be  held  on  Monday,  September  26th.  Entrance- 
form  and  Medical  Student's  Guide  can  be  had  at  the- 
Royal  College  of  Surgeons,  Stephen's  Green,  Dublin. 

Food  Adulteration  In  London. 
The  Local  Government  Board,  in  view  of  the  factf 
that  from  1894  to  1903,  inclusive,  only  143  samples  of 
food — mainly  milk — out  of  a  total  of  5,792  samples 
analysed    by    Dr.    A.    Wynter    Blyth,    Marylebone's 
public  analyst,   were  reported   to  be  adulterated,   or- 
2.4  per  cent,  against  a  percentage  of  11.7  throughout 
the  Metropolis,  asked  how  this  disparity  was  accounted" 
for.     The  Board  also  pointed  out  that,  although  Dr. 
Blyth  stated  before  a  departmental  committee  that  he 
met  with  many  samples  of  milk  treated  with  borax  or- 
boracic  acid,  yet  there  was  no  reference  in  his  reports . 
during  the  past  five  years  to  the  presence  of  preser- 
vatives in  the  milk  and  butter  examined  by  him.     Dr. 
Blyth,  who  is  supported  in  his  answer  by  the  Maryle-- 
bone  Borough  Council,  has  replied  that  the  reason  of 
Marylebone's  comparative  freedom  from  adulteration  > 
is   that   a   systematic  sampling  of  oifenders   on   the- 
"  black   list "    has   driven   them   further  afield.     He 
adds :    "A  few  years  ago  Marylebone  took  more  sam- 
ples in  proportion  to  its  population  than  any  other 
London  borough,  and  it  is  reaping  the  advantage  of" 
its  activity."     Concerning   the  preservation   of  milk 
by  means  of  borax,  he  says  that,  unless  a  standard  is 
fixed,  seeing  the  wide  difference  of  professional  opinion ' 
on  the  matter,  he  is    unable  to   certify  as  adulterated 
a  boraxed  milk  or  cream,  save  the  quantity  is  exces- 
sive.*' 

f  Bays  in  Blood  Diseases. 
Dr.   Bozzoli,   director  of  clinical  medicine  at   the- 
Turin    University,    has    informed    the    Academy    of 
Medicine  that  experiments  he  has  made  have  shown 
that   the   X-rays  have  remarkable   efficacy   in   some- 
serious  diseases  of  the  blood.     He  says  that   he   has 
cured  by  this  means  a  supposedly  incurable  case  of 
leucaemia. — Electricity, 

Disinfection  of  Books. 
The  authorities  of  the  various  public  libraries  in  the 
city  of  Berlin  have  for  some  time  past  occupied  them- 
selves with   the  question   of  disinfecting   the  books. 
To  this  end  a  number  of  books  which  had  been  in  use  - 
in  the  libraries  for  more  than  two  years  were  examined' 
by  medical  experts,  who  declared  that  they  contained 
tubercle  bacilli,  also  dangerous  germs,  which  were  con- 
veyed  to  the  books  by  persons  suffering  from  con- 
sumption turning  the  leaves  over  with  their  saliva- 
covered  fingers. 


^  At  the'meeting  of  the  Committee  of  Management  of 
the  Clare  County  Infirmary,  held  on  Monday,  the  5  th 
inst.,  the  committee,  through  their  chairman,  con-- 
gratulated  Dr.  Paris,  surgeon  to  the  infirmary,  on  his 
restoration  to  health,  and  said:  "The  governors  were 
very  pleased  with  the  manner  in  which  he  always 
discharged  his  duty." 

At  the  meeting  of  the  Rathkeale  Board  of  Guar- 
dians, held  on  Wednesday,  the  7th  instant,  a  letter- 
was  read  from  the  I.  L.  G.  Board  refusing  to  sanction- 
the  payment  of  an  operation  fee  to  Dr.  Thomas  Hayes. 
They  based  their  refusal  on  the  ground  that  Dr.  Hayes . 
was  the  medical  officer  of  the  workhouse,  although  he 
was  on  his  holidays  on  the  occasion.  The  facts  of  the 
case  are :  Dr.  Hayes,  though  on  his  holidays,  was 
still  at  home,  when  he  was  requisitioned  by  his  medical' 
substitute  to  perform  an  urgent  operation  on  an 
accident  case.  He  immediately  complied  with  the 
call  and  is  now  refused  his  legitimate  fee.  Suppose  he- 
had  gone  one  hundred  miles  from  home  and  been 
similarly  requisitioned,  would  he  not  be  entitled  tO' 
charge    ?     Does  distance  make  the  difference  ?  " 


326    The  Medical  Press.         NOTICES  TO  CORRESPONDENTS. 


Sbft.  21.  1904. 


£UAkts  to 


(JH^  OoBMHroHSSMfB  requiring  a  reply  in  this  column  are  partion- 
larly  requested  to  make  use  of  a  dittlmetiv  Signatun  or/nUioi,  and 
:aToid  the  praotloe  of  signing  themselves  **  Reader,"  "  Subscriher," 
*  Old  Subscriber,'  ko.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

A  POPULAR  FAIXACY. 

A.  coHMOX  popular  error  is  that  a  doctor  is  comrelled  to  go  to  a 
esse  whenever  he  is  sent  for-  as  though  he  were  a  public  ofScial  sub- 
sidised out  of  the  public  funds.  Indeed,  this  wwa  the  idea  of  a  jury- 
man at  the  inquest  upon  a  recent  Manchester  case,  to  which  the 
doctor  had  declined  to  go. 

•*  What  are  you  paid  for,  I  should  like  to  know?"  he  indignantly 
asked  the  doctor. 

*'  0o  you  pay  me  ?*'  the  latter  inquired. 

"  Aren't  you  paid  out  of  the  rates?"  then  asked  the  sapient 
juryman. 

M.R.C.P.— The  reduction  in  space  given  to  your  Institution  in  ou 
Students'  Number  was  unad voidable. 

Fifth  Year.-  The  next  examination  of  the  Medico-Psychological 
Society  will  be  held  on  Novenlber  7th.  You  will  find  the  necessary 
particulars  on  reference  to  our  advertising  columns. 


^Reetittfis  of  the  §0delitB,  %tsimtB,  &c, 

Wbdhesdat,  Sxptkjibxb  21st. 
HvDiCAL  GRADUATkS'  CoLLxoB  AKD  PoLYcuvic  (23  Ohenics  Street, 
W.C.).-4p.m.     Mr.  J.  Clarke.    Clinique.    iSurgical.) 
Thursday,  SxPTxiiBSB  S2nd. 
Mbdical  Oraduatxs'  Collbqb  ABO  PoLTCLimc  (22  Chenies  Street, 
W.G.).— 4  p.m.  Mr.  Hutchinson  :  Olinique.    (SurgicaL) 
Fbidat,  Sbptbhbkr  2ard. 
Medica!i  Gbaduatbs'  Colleob  AKD  PoLTCLiBic  (28  Chenies  Street 
r^.C.).— 4  p-m.     Dr.  D.  Grant :  Clinique.    (Ear.) 


Birkenhead  Borough  Hospital. -^un*o'  Resident  House  Suigeon. 
Salary  £80  per  annum.  Applicatl  ns  to  the  Honorary  Secretary. 

Horton  Inflrmsry.  Banburj.- House  Burgeoi .  Salary  £80  per 
annum,  with  board  and  residence  in  the  Infirmary.  Applications 
to  the  Honorary  SecreUry,  21  Marlborough  Koad,  Banbury. 

I  Halifax  Union  Poor-law  Hospital.— Resident  Medical  Offlcer.  Salary 
£120  per  annum,  with  apartmenU,  rations,  and  washing.  Appli- 
cations to  Arthur  T.  Longbotham,  4  Carlton  Street,  Halifax. 

Liverpool  City  Infectious  Diseases  Hospitals.— Ass' sUnt  Resident 
Medieiil  OlScer.  Salary  £120  per  annum,  with  board,  washing, 
and  lodging  at  the  hospital.  Applications  to  the  Chai*man  of 
the  Port  Sanitary  and  Hospitals  0>mmittee,  c.o.  Town  Clerk, 
Municipal  Offlces,  Liverpool. 

West  Riding  of  the  County  of  York— Stories  Hall  Asylum  Kirkbur- 
ton,  near  Hudderafleld.— Assistant  Medical  Offlcer.  Salary  i^l40 
per  annum,  with  furnished  rooms,  board,  attendance,  and  wash- 
mg.    Applications  to  the  Medical  Superintendent 

Manchester  (k>rporatioD— Monsall  Fever  HosplUl.— Fourth  Medical 
Assistant.— Salary  £100  per  annum,  with  board,  lodging,  and 
washing.  Applications  to  the  Chairman  of  the  Sanitary  wom- 
mittee.  Public  Health  Office,  Town  Hall,  Manchester. 

Ancoata  Hospital,  Manchester.— Resident  House  Physician.  Salary 
£80  per  annum,  with  board,  residence.  Ac.  Applications  to 
Saml.  Baron,  Secretary.  .    .     „ 

Kiaderminster  Infirmary  and  Children's  Hospital.— House  Surgeon. 
Salary  £U0  per  annum,  with  rooms  in  the  Infirmary  and  atten. 
dance.  Applioat  ions  shoo  d  be  addressed  to  the  Secretary  on  or 
before  September  28rd.    Canvassing  not  allowed. 

•Croydon  Union.— Resident  AisisUnt  Medic«l  Superintendent  and 
Dispenser  at  the  Infirmary,  Mayday  Road,  Croydon.  Salary 
j^lSO  per  annum,  with  furnished  apartments,  rations  as  per  scale, 
and  washing.  Applications  to  Harry  list  Clerk  to  the 
Ounidians,  Union  Offices,  Mayday  Rosd,  Thornton  Heath. 

NewcastJe-upon-Tyne  City  HospiUl  for  Infectious  Diseases.— Resfclent 
Medical  Offlcer.  Salary  £100  per  annum,  with  board,  lodgioir, 
±c.  Applications  to  the  Medical  Offlcer  of  Health,  Town  Hall, 
Newcastle-upon-Tyne. 

National  Maternity  Hospital,  Dublin.— Intern  Assistant  Master. 
Salary  £60  per  annum.  Immediate  application  to  Secretary, 
Holies  Street.    (See  advt.) 


S^oxttimtniB. 

Hatkb,  Louis  B.,  M.D.,  B.C.Cantab.,  Honorary  Medical  Offlcer  to 
Out-patients  at  the  Harrogate  Infirmary. 

•HmiT,  A.  W.  D.  L.R.C.P.Lond.,M  B.C.8.Eng  ,  Surgeon  to  the  Loyal 
Crown  Lodge  of  Oddfellows  at  Chasf ord  ( Devon). 

KiBiOB,  Martib  a..  M.a.C.S.Eng..  L.RC.P.Lond.,  Public  Vaccina- 
tor for  the  No  2  District  by  the  Devonpoi  t  Board  of  Guardians. 

Lbtick,  G.  K.,  M.B.Lond.,  Medical  Officer  of  Health  to  the  Havant 
UrUn  District  Council. 

MosTTB,  Stdbbt  G.,  M.B.Oxon.,  Medical  Officer  of  Health  of  South 
Shields. 


Btab,  Richard  P.,  F.R.C.8.Irel.,  Public  Vscdnator  to  the  Fbsk  Do. 
trict  by  the  Devnnport  Board  of  Guardians. 

Satbr,  Thomas.  M.R.C.S.Eng.,  L.R.C.P.Loiid.  Medksal  Oflker  wi 
Public  Vaccinator  for  the  KirkliDgton  D'strict  of  the  Bedbk 
Union  and  for  the  Pickhill  District  of  the  Thirsk  Union.  ' 


^irth«. 


BLOJfPiBLD.— On  Sept.  12th.  at  Horsefair,  Pontefract,  Yorks,  the  wilt 

of  George  Wills  Blomfield,  M.D.,  of  a  son. 
EccLBS  —On  September  18th,  at  124  Harley  Street,  Loodoo,  the 

wife  of  W.  McAdam  EcL-les.  M.S.,  F.R.C.S.,  o(  a  son. 
Lawlbss.— On  Saturday.  September  lOth,  the  wife  of  Oeorgc  &. 

Lawless,  F.R.C  S.I.,  Medical  Superintendent,  Armsgfa  Dtstrici 

Asylum,  of  a  daughter. 
WBBarrsB.- On  Aug.  V8th,  at  Toorak,  Melbourne,  Aostra'ia,  the  wile 

of  Dr.  Percy  8.  Webster,  of  a  son. 
WiiBLAN.— On  September  12th.  at  26  Synnott  Place,  Dab^tkc 

wife  of  James  A.  Whelsn,  L.R.C.S.L,  of  a  son. 


Ck>AD— YuiLL.— On  September  17th,  at  St.  Mary  Abbott's  Chnck 
Kensington,  London.  Stanley  Allan  Oad.  M  R.C.3.,  L.RX  f^ 
7Elflrin  Avenue.  TiOndon.  W.,  third  son  of  Thomas  Coad,  kc 
of  the  Horse  Guards.  Whitehall,  to  Sarah  youngest  danghUr 
of  the  late  John  Yuill  HU  side,  Partick  Hill  Olasirow. 

TUBXBB— Hamilton.— On  September  14t.h,  at  the  P^sh  rboith, 
Tavistock,  Devon.  William  Turner.  M.S.  (London*,  F.v.C.8.,  rf 
58  Qneen  Anne  Street,  Cavendish  Squara,  London,  to  lily,  ml4 
daughter  of  John  Kerr  Hamilton,  of  St.  Ramon's,  Tavisto^ 


^eathB. 


BsBiiAM.— On   September    14  th,  Harry    Arthur    Beobam,  M.D. 

Medical  Superintendent  of  the  Bristol  City  and  County  A^-hai, 

aged  49 
BiDDLB.— On  September    18th.  at    Charlton  Lodge    Kingstoa-oa- 

Thames,  Frances  Elisa  Lydia.  the  beloved  wife  of  Daniai  BUdk, 

M.R.C.8.Enir.,  and  L.S.A.Lond. 
Hardav — On     September  16th.  at  West  Haddon,    Ruby  Oeetfr 

Harday,  M.R.C.R..  in  his  85th  year. 
HUTCHIKSOB.— On  September  15th  at  his  rpsidence.  Ford,  Braaknae 

Park,    Bournemouth,    Samuel  John    Hutchinson,    M.RCJ. 

L.D.8.  Lond.,  of  64  Brook  Street,  Grosven  «r  Square,  Loadia 

aged  68. 
Jambson  —On    September  ISth,  at  Newlands,  Eltham,  Soifccs 

General    James  Jameson,  O.B.,  &c.,  late  Director-GeDeial  Are; 

Medical  Service,  aged  67. 


OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— St.  Bartholomew's  (1.80  p.m.).  University 

(2  p.m.).  Royal  Free  (2  p.m.),  Mkldlesex  (1.80  p.m.),  Cbuiii 
Cross  (8  p.m.X  St.  Thomas's  (2  p.m.),  London  (2  p.in.X  Kisfl 
College  C2  p.m.),  St.  George's  (Ophthalmic,  l_p.m.),  St.  MMrj\ 
(2  pm.).  National  Orthopsadic  (10  a.m.),  St.  Peta>^s  (2  pja^ 
Samaritan  (0.80  a.m.  and  2.80  p.m.),  Gt  Ormood  Street  (Ml 
a.m.),  Gt.  Northern  Central  (2  SO  p.m.),  Westminster  (2  p.Di 
Metropolitan  (2.80  p.m.),  London  Throat  (9.30  a.m.),  Ouocr 
(2  p.m.).  Throat.  Golden  Square  (9.80  a.m.),  Guy's  (1.90  p.m.). 

THURSDAY.-«t.  Bartholomew's  (1.80  p.m.),  Sfc.  Tbomaa's  (SJI 

&m.).  University  College  (2  p.m).  Charing  Croes  (8  p  m.\  tL 
rarge's  (1  p.m.),  London  i2p.m.).  King  s  College  «2p  m.).  Middli- 
sex  0*90  p.m.),  St.  Mary's  (2.80  p.m.),  Soho  Square  (2  pa.), 
North- West  London  (2  p.m.).  Chelsea  (3  p.m.)  Great  Nonkm 
Central  (Gynacological,  2.80  p.m.),  MetropoUtan  (SJN>  pa.). 
London  Throat  (9.80  a.m.).  St.  Mark's  (2  p.m.),  Samaritaa  iJ» 
a.m.  and  2.80  p.m.).  Throat,  Golden  Square  (9.30  a.m.),  <te7^ 
(L80  p.m.). 

FRIDAY.— London  (2  p.m.),  St  Bartholomew's  (1.30  p.m.).  8t 
Thomas's  (8.80  p.m.),  Guy's  (1.80  ^m  ),  Middleeex  (L80  pjs.). 
Charing  Cross  (8  p.m.).  St.  George  s  (1  p.m.).  King  s  OoDr^  (! 
p.m.),  St.  Mary's  (2  p.m.).  Ophthalmic  (10  a.m.),  Oanoer  (2  djl] 
Chelsea  (2  p.m.),  (}reat  Northern  Ontral  (2  80  p  m ),  Weit 
London  (z  80  p.m.),  London  Throat  (9  80  a.m.),  Ramaritan  (9JD 
a.m.  and  2.80  p.m.).  Throat,  Golden  Square  (9.30  a.m ),  Qtj 
Orthopoxlic  (2.80  pim.),  Soho  Square  (2  p.m.). 

SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  MkUlesez  (1 » 
p.m.),  St.  Thomas's  (2  p.m.).  University  College  (9.16  aai.), 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  ^t.  Mary's  (10  jmd.) 
Throat.  Ctolden  Square  (9  80  a.m.1,  Guy  s  (I  80p  m.). 

MONDAY.- London  (2  p.m.).  St  Bartholomews  (1.30  pm.),  St 
>.m.),  ""    "  •     "*  "    —    —      ■    -- 


St.  George's  (2  p.m.),  S^  Marv's  (ISS 
p.m.),  Middlesex  (1.80  p.m.).  Westminster  (2  p.m.),  (Nielses |! 
p.m.),  Samaritan  (Gymooological,  by  Physksians,  S  pjn.),  Soho 
Square  (2  p.m.).  Royal  Orthopodic  (2  p.m.).  City  Orthop«fio(4 
p.m.).  Great  Northern  Centre  (2  80  p.m ),  West  London  (UD 
p.m.j,  liondon  Thropt  (9.80  a.m.),  Roj^al  Free (2  p.m.),Gny^U0 

TUEDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.30  pja.),  St. 
miomas's  (8.80  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.80  pjs.), 
Westminster  (2  p.m.).  West  London  (2.80  p.m.),  Univcnitr 
College  (2  p.m.),  St  George's  (I  p.m.  ,St  M«ry's(t  pim.),8L 
Marrs  (JLSO  p.m.).  Cancer  (2  p.m.)  Metropolitan  (LaOpsLl. 
London  Throat  (9.80  a»m.).  Royal  Ear  (8  p.m.),  SamariUa  (99 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9J0  a.m.),  Soho 


Square  (2  p.m.) 


Mh  ^dm\  ^tm  and  (t)ivmht 


"SALUB  FOPUU   SUPJU5KA   LEX." 


•Vol.  CXXIX.  WEDNESDAY,    SEPTEMBER   28,    I904«       Wo-   I3« 


9ciainal  Co  mmunications. 
THE   HOSPITAL  ISOLATION 

OF 

SCARLET   FEVER. 

By  A.  MEARNS  FRASER,  M.D.,  CM.,  D.P.H. 
Camb.,  &c.. 

Medical  Officer  of  Health  for  Portamouth. 

No  branch  of  sanitation  is  receiving  more  atten- 
tion at  the  present  time  than  that  which  com- 
prises the  prevention  of  infectious  diseases  by 
aggregation  of  the  cases  in  a  so-called  isolation 
hospital.  It  is  therefore  interesting  to  remember 
that  the  establishment  of  isolation  hospitals  all 
over  the  kingdom  was  not  the  result  of  the  careful 
observation  of  the  successful  working  of  a  hos- 
pital in  the  prevention  of  the  disease  ;  the  now 
•almost  universal  adoption  of  isolation  hospitals  is 
based  on  the  idea  that  it  must  inevitably  be  bene- 
ficial to  remove  every  case  of  infectious  disease  from 
the  house  in  which  it  exists  to  a  place  where  it  can 
be  kept  by  itself  away  from  all  other  members  of 
the  community.  Now,  this  is  a  common-sense  view 
that  appealed  to  all,  and  one  is  quite  prepared  for 
the  feverish  anxiety  of  some  medical  officers  of 
health  to  have  every  infectious  case  in  their  district 
removed  at  once  to  the  hospital,  and  one  can  quite 
:appreciatb  the  action  of  most  medical  officers  of 
health  in  regarding  the  isolation  hospital  as  their 
principal  weapon  for  fighting  infectious  disease. 
It  was,  and  is  now,  though  possibly  to  a  less  extent, 
usual,  if  infectious  disease  had  not  been  very  preva- 
lent in  a  district,  to  attribute  this  to  the  provision 
of  an  isolation  hospital,  and  in  annual  reports  on 
:such  districts  congratulations  were  offered  to  the 
.-sanitary  authority  on  their  foresight  in  providing 
:such  isolation  hospital  accommodation  ;  on  the 
other  hand,  if  infectious  disease  had  been  more 
prevalent  than  usual  one  often  noticed  regrets 
•expressed  that  the  isolation  hospital  accommoda- 
tion had  proved  insufficient  to  cope  with  the  out- 
break ;  the  disease  in  question  had  spread,  and 
: sanitary  authorities  were  urged  to  make  further 
provision  in  the  future. 

During  the  last  year  or  two,  however,  in  the 
minds  of  a  number,  of  medical  officers  of  health 
there  has  arisen  considerable  doubt  as  to  whether 
the  benefit  of  isolation  hospitals  is  really  so  great 
as  has  generally  been  supposed  ;  some,  indeed, 
having  got  past  the  stage  of  doubt,  insist  that 
rat  any  rate  as  regards  the  prevention  of  scarlet 
fever  isolation  hospitals  are  of  little  use.  The 
-reasons  that  have  brought  about  this  change  of 
thought  are  not  far  to  seek. 

The  isolation  of  scarlet  fever  cases  in  hospitals 


has  been  practised  in  many  large  towns  for  about 
twenty  years :  this  is  a  long  enough  period  for  the 
S5rstem  to  be  effectually  tried,  and  in  those  places 
at  which  it  has  been  most  persistently  carried  out 
there  should  surely  be  some  diminution  in  the 
scarlet  fever  prevalence.  This,  however,  is  not  the 
case :  towns  isolating  a  large  percentage  of  their 
scarlet  fever  cases  can  show  no  appreciable  im- 
provement in  this  respect  over  other  towns  which 
have  isolated  few  or  none  ;  curiously  enough,  too, 
some  towns  which  have  isolated  very  few  of  their 
cases  show  a  greater  diminution  than  those  which 
have  practised  extensive  isolation.  The  case  of 
Birmingham  has  been  quoted  ;  this  city,  which  is 
second  only  to  Huddersfield  in  the  extent  of  isola- 
tion practised  (84  per  cent,  of  the  cases  of  scarlet 
fever  being  isolated  during  the  ten  years  1890- 
1899),  actually  had  an  attack-rate  in  1902  of  9 
per  1,000  population,  an  attack-rate  larger  than 
in  any  previous  year  since  1890  and  higher  than 
in  any  other  large  town  in  the  kingdom  in  that 
year.  Indeed,  a  return  of  the  scarlet  fever 
"attack-rates"  existing  in  the  various  towns 
compared  with  the  amount  of  hospital  isolation 
practised  affords  very  instructive  reading,  and  any- 
one interested  in  the  question  cannot  do  better 
than  obtain  a  copy  of  Dr.  KiUick  Millard's  paper 
on  the  subject,  (a) 

To  what,  then,  can  this  non-success  of  the  isola- 
tion hospital  in  the  control  of  scarlet  fever  be 
attributed,  and  what  are  the  reasons  which  have 
withheld  the  results  so  confidently  anticipated  by 
sanitarians  at  the  inceptioniof  the  isolation  hospital  ? 
I  believe  they  may  be  found  in  the  fact  that  the 
originators  of  the  system  overlooked  some  of  the 
difficulties  in  the  way  of  securing  complete  hospital 
isolation.  Under  the  Infectious  Diseases  (Notifica- 
tion) Act  it  was  doubtless  anticipated  that  in  the 
first  place  every  case  of  scarlet  fever  occurring  in 
a  district  would  be  promptly  notified  to  the  medical 
officer  of  health,  and,  if  incapable  of  being  isolated 
at  home,  would  be  promptly  removed  to  the 
isolation  hospital ;  and,  secondly,  it  was  beUeved 
that  once  admitted  to  hospitalit  would  remain  there 
till  free  from  all  infection,  so  that  on  its  discharge 
there  need  be  no  fear  of  its  again  spreading  the 
disease. 

In  practice,  however,  this  ideal  has  never  been 
attained.  In  the  first  place  it  is  well  known  that  in 
every  town  a  number  of  cases  of  scarlet  fever  occur 
which  are  of  so  slight  a  character  that  no  medical 
man  is  called  in  and  they  are  only  discovered,  if  at 
all,  through  investigating  the  source  of  other  and 
possibly  more  severe  cases  which  have  arisen  from 

(a)  "  The  Inflaence  of  Hoapltal  Isolation  in  Scarlet  Ferer."    By  C. 
Kulick  Millard,  ILD.,  D.Bc.    London :  Kebman,  Ltd. 


328    The  Msdical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Sept.  28,  1904. 


those  originally  unrecognised.  To  these  must  be 
added  cases  which  arie  concealed,  either  because 
the  parents  are  afraid  of  their  children  being  com- 
pelled to  go  to  hospital,  or  because  it  is  feared  that 
the  knowledge  of  .the  existence  of  a  case  of  scarlet  ^ 
fever  in  the  house  may  interfere  with  the  work  of 
the  wage-earners  of  the  household.  Here,  then,  is 
one  reason  for  the  want  of  success  of  the  isolation 
hospital ;  there  is,  however,  an  even  more  important 
factor. 

I  have  said  that  the  object  of  the  isolation 
hospital  is  to  retain  the  case  of  scarlet  fever  until 
it  can  safely  be  returned  to  the  community  without 
fear  of  a^ain  spreading  the  disease.  It  must  be 
obvious  that  tins  is  a  fundamental  principle  of  the 
system,  the  complete  attainment  of  which  is  an 
absolute  essential  for  the  success  of  the  isolation 
hospital,  yet  again,  in  actual  practice  this  ideal 
has  never  been  attained.  I  beUeve  there  is  no 
hospital  superintend^t  in  the  kingdom  who  would 
be  prepared  to  gua,rantee  that  any  particular 
individual,  on  his  or  her  discharge  from  the  hospital, 
was  actually  free  from  infection,  and  incapable  of 
again  spreading  the  disease  on  mixing  with  other 
susceptible  members  of  the  community.  Indeed, 
"  return  "  cases  are  so  common  that  paper  after 
paper  has  been  written,  and  innumerable  discussions 
have  taken  place  to  find  out  how  it  wis  that  scar.'et 
fever  should  still  be  spread  by  patients  who,  to  all 
appearances,  were  discharged  from  hospitals 
perfectly  free  from  infection.  Further,  it  is  now 
the  practice  in  most  towns  to  issue  printed  notices 
that  the  patient  should  on  his  discharge  from 
hospital  be  kept  away  from  school  and  other 
children  for  periods  varying  from  a  week  to  a 
month.  In  spite  of  these  precautions,  however, 
return  cases  persist  with  a  disheartening  regularity. 

The  above  are,  I  beUeve,  the  two  chief  explana- 
tions why  isolation  hospitals  do  not,  and,  moreover, 
are  not  hkely,  so  far  as  we  can  see,  to  control  the 
prevalence  of  scarlet  fever  in  a  town.  And  if  it 
cannot  be  shown  that  isolation  hospitals  control 
the  disease,  there  at  once  disappears  the  chief 
rattan  d'itre  for  their  existence. 

I  must  mention,  however,  another  argument 
that  is  often  urged  in  favour  of  hospitals — namely, 
the  actual  benefit  to  the  patient  from  the  superior 
nursing  he  will  in  most  cases  obtain  in  hospital, 
compared  with  that  provided  at  home.  Here, 
again,  the  experience  of  past  years  has  not  sup- 
ported this  contention,  for  the  number  of  cases  of 
adenitis,  rhinorrhoea,  and  otorrhoea  that  occur 
periodically  in  every  scarlet  fever  ward,  to  say 
nothing  of  others  which,  admitted  with  scarlet 
fever,  contract  in  addition  such  diseases  as  measles, 
whooping-cough,  diphtheria,  and  chicken-pox,  are 
so  numerous  as,  in  the  opinion  of  many,  to  counter- 
act any  extra  advantage  that  may  be  derived  from 
trained  hospital  nursing. 

There  is  yet  another  side  of  the  question  that 
must  be  considered,  and  one  that  I  have  in  the 
past  laid  considerable  stress  upon,  namely,  the 
financial  aspect. 

I  believe  that  in  the  departments  of  most  medical 
officers  of  health  one  of  the  principal,  if  not  actu- 
ally the  largest  item  of  expenditure  is  the  isolation 
hospital.  Now  scarlet  fever,  although,  as  known 
at  present,  an  exceptionally  mild  disease,  yet  is  so 
prevalent  that  75  per  cent.,  and  often  more,  of  the 
accommodation  at  isolation  hospitals  in  large 
towns  is  nominally  taken  up  by  this  disease  alone. 
Millions  have  been  spent  on  the  erection  of  isolation 
hospitals  and  hundreds  of  thousands  are  annually 


spent  on  their  maintenance.  Now  as  by  far  tbe 
larger  part  of  the  cost  of  the  erection  and  main* 
tenance  of  hospitals  is  undoubtedly  incurred  througji 
an  attempt  to  control  scarlet  fever,  the  reflectioa 
must  occur  whether  sufficient  justificatioa  exisis 
for  the  expenditure  of  such  large  sums  of  money  on 
a  disease  that,  with  the  exception  only  of  chicken- 
pox,  causes  a  slighter  mortality  than  any  of  the 
common  infectious  diseases.  If  the  hospitals 
were  really  cqntrolling  the  disease,  and  if  year 
after  year,  as  isolation  methods  improved,  a 
corresponding  diminution  in  its  prevalence  were 
noticeable,  then  possibly  some  excuse  for  the 
expenditure  might,  in  spite  of  the  mildness  of  the 
disease,  be  found.  But  as  the  facts  exist  at  present, 
with  the  annual  expenditure  on  isolation  hospitak 
growing  larger  and  larger,  and  at  the  same  time- 
scarlet  fever,  if  not  becoming  more  prevalent,  at 
least  not  showing  any  diminution,  then  it  does 
indeed  seem  that  the  time  has  arrived  when  aa 
official  inquiry  as  to  the  advisability  of  modifjinj 
or  improving  the  present  system  stiould  he 
instituted. 

If  it  should  be  found  that,  owing  to  our  inability 
to   define   the   length   of   the   infecti^^ty    of   the 
disease,   not  much    improvement  in    the  present 
methodcan  be  hoped  for,  then  let  the  money  devoted 
to  scarlet  fever  be  spent  in  other  directions,  such 
as  the  betterment  of  the  houses  of  the  working 
classes.     Money    spent    in    this    latter   direction 
cannot  fail  to  give  some  definite  beneficial  return, 
and  it  is  to  my  mind  a  question  whether,  if  the 
same  money  which  has  been  expended  in  the  past 
on  the  isolation  of  scarlet  fever  had  been  devoted 
to    clearing    away    slum     property,     we     should 
have  had  far  better  results  to  show,  not  only  in  the 
improved  dwellings   of   the  working  classes,  bnt 
also  indirectly    in   that  diminution  of  infections 
disease  which  alwajrs  results  from  the  improvement 
of  the  homes  of  the  poor.     One  word  in  conclusion . 
in  the  above  remarks  and  in  previous  writings  on , 
the  subject  of  isolation  hospitals,  I  have  hmited 
m)rself  entirely  to  their  connection  with  scarlet  fever^ 
and  nothing  that  I  have  said  appUes  to  enteric 
fever,  small-pox,  or  diphtheria.     Moreover,  I  am 
not  advocating  the  total  abolition  of  the  hospital 
isolation   of   scarlet   fever ;    under    existing  legal 
enactments   it  is   difficult   to   see    how    sanitary 
authorities   can   avoid  providing  accommodation 
for  a  certain  small  percentage  of  the  cases  that 
occur  ;  inasmuch  as  a  dairyman,  or  a  tailor  and  a 
few  others   are  legally  prevented  from  pursuinj^ 
their   usual  employment  whilst   scarlet   fever  is 
present  in  their  houses,  it  is  only  right  that  provision 
should  be  made  for  removing  and  treating  these 
cases  elsewhere.     What  I  do  cont^end,   however, 
is  that  it  is  quite  time  a  thorough  investigation  was 
held  to  ascertain  if  the  wholesale  isolation  of  the 
mild  cases  of  scarlet  fever  that  is  practised  at 
present  is  worth  the  large  sums  of  money  expended 
upon  it,  and  incidentally  to  have  an  authoritative 
opinion  as  to  whether  there  are  not  good  reasons 
for  supposing  that  the  money  now  spent  on  the 
hospital  isolation  of  scarlet  fever  cannot  be  more 
profitably  employed  in  other  directions. 

In  an  inquiry  of  this  nature  the  evidence  to  be 
sifted  will  be  considerable,  and  it  is  essential  that  it 
should  be  conducted  by  men  of  weight  and 
standing.  Personally,  I  should  like  to  see  it  the 
subject  of  a  Royal  Commission;  moreover,  as 
suggested  by  Dr.  Millard,  laymen  might  with 
advantage  be  on  such  a  board  of  inquiry;  the 
question  is  largely  one  of  finance,  and  it  would  be  of 


Sept.  28,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    329 


great  value  to  have  the  opinion  of  men  of  experience 
in  local  government  administration,  men  who, 
leaving  the  purely  medical  aspect  to  their  medical 
confrkresy  would  be  able  to  pronounce  a  judgment 
as  to  whether  the  results  obtained  from  the  hospital 
isolation  of  scarlet  fever  as  at  present  practised 
afforded  an  adequate  return  to  sanitary  authorities 
for  the  expenditure  involved. 


SCIATICA,   (a) 

By  J.  E.  HARBURN,  L.R.C.P.,  L.R.C.S.Ed., 
BuztoD. 

The  subject  which  I  desire  to  briefly  draw  your 
attention  to  is  one  of  considerable  interest  on  account 
of  the  intractable  nature  of  the  complaint,  and  also 
by  reason  of  the  difl&culty  which  is  often  experi- 
enced in  affording  relief.  This  is  evidenced  by 
the  numerous  remedies  which  have  at  various  times 
been  suggested  for  its  treatment. 

Judging  from  the  large  and  increasing  number 
of  cases  which  are  sent  to  health  resorts  year  by 
year  for  special  treatment,  it  would  seem  that 
sciatica  in  many  instances  tends  to  assume  a 
chronic  course,  and  exerts  a  most  debilitating 
and  depressing  effect  on  the  health  of  those  who 
suffer  trom  it.  During  the  past  seven  years  over 
400  cases  have  been  treated  in  the  practice  which 
is  conducted  by  my  colleague.  Dr.  Armstrong,  and 
myself  at  Buxton  ;  and  it  is  from  consideration  of 
tbe  notes  of  these  cases  that  I  have  drawn  the 
observations  which  I  venture  to  bring  before  you 
to-day. 

The  term  "  sciatica  **  is  somewhat  loosely  used 
to  describe  all  painful  conditions  of  the  sciatic 
nerve  or  its  branches,  but  experience  shows  that 
the  following  classification  is  desirable  : — 

(a)  Sciatic  neuralgia. 

(6)  Sciatic  perineuritis. 

(c)  Sciatic  neuritis. 

(a)  Sciatic  neuralgia  is  frequently  of  a  very  tem- 
forary  character  and  may  be  simply  functional, 
probably  showing  no  change  whatever  in  the  sheath 
of  the  nerve.  When  the  general  health  of  the 
j>atient  is  low,  however,  it  is  often  of  considerable 
duration.  The  pain  may  be  intermittent,  and 
there  is  usually  tenderness  at  two  or  three  points 
of  the  nerve.  It  often  occurs  in  patients  who  have 
neuralgia  in  other  parts. 

(6)  Sciatic  perineuritis  sometimes  precedes 
or  follows  neuritis,  and  in  these  cases  we  have  to 
deal  with  the  symptoms  of  sciatic  neuralgia  and 
sciatic  neuritis.  There  is  generally  tenderness 
along  the  whole  of  the  upper  third  of  the  nerve, 
and  the  surface  temperature  of  the  hmb  may  be 
reduced.     The  patellar  reflex  may  be  intensified. 

(c)  Sciatic  neuritis  is  infinitely  the  most  serious 
and  intractable  form  of  the  disease,  and  a 
large  proportion  of  the  most  refractory  cases  come 
under  this  heading.  There  is  great  tenderness  not 
only  of  the  nerve  itself,  but  over  the  surrounding 
parts.  The  temperature  of  the  hmb  is  always 
reduced  ;  there  is  tingling  and  numbness  and 
muscular  atrophy  in  the  later  stages.  The  pa- 
tellar reflex  is  sometimes  lost,  and  cases  of  this 
variety  have  been  mistaken  for  locomotor  ataxia. 

Accurate  differentiation  is  of  the  utmost  im- 
portance both  as  regards  prognosis  and  treatment, 
for  while  cases  of  the  first  group  can,  as  a  rule,  be 
speedily  cured,  those  in  the  second  are  more 
troublesome,  and  in  the  third  the  most  refractory 

(a)  Read  before  the  Manchester  Clinical  Society,  May,  1904. 


of  all.  As  I  hope  to  show  later,  the  treatment  in^ 
dicated  varies  greatly.  Methods  which  are  of 
service  in  Class  A  are  absolutely  harmful  in 
Classes  B  and  C. 

The  causes  of  sciatica  are  in  some  cases  dif&cult 
to  trace.  In  the  great  majority  of  cases,  however^, 
there  is  a  gouty  or  rheumatic  taint  present,  and  in 
a  striking  number  of  instances  the  patients  had 
been  subjected  to  great  worry  and  over-pressure^ 
which  had  lowered  the  nerve  tone,  probably  induc- 
ing defective  metabohsm  and  tardy  excretion  oi 
body  waste.  A  large  number  of  these  cases  oc- 
curred in  over-worked  business  and  professional  men.. 

The  exciting  causes  of  sciatica  are  cold,  damp,, 
and  traumatism.  Possible  pressure  within  the 
pelvis  from  constipation,  uterine  displacements  ^ 
tumours  and  aneurysms  must  not  be  lost  sight  of. 
Neuritis  is  often  caused  by  the  action  of  such  poisons- 
as  lead,  arsenic,  and  alcohol,  and  it  should  be  re- 
membered  that  the  subjects  of  glycosuria  and  dia- 
betes are  very  hable  to  this  affection  of  the  nerve 
In  not  a  few  cases  sciatic  neuritis  occurs  as  a  sequel 
to  influenza. 

Treatment :  Acute  Sciatica. — ^Whatever  variety 
of  the  disease  is  present,  in  the  acute  stage  rest  is- 
absolutely  essential.  In  many  instances  a  well- 
padded  splint  extending  from  the  spine  to  the  foot 
is  of  great  service. .  Dry  heat  applied  by  means  of 
the  Tallerman  apparatus,  or  of  its  offshoots,  the 
Greville  or  Dowsing  methods,  or  if  these  are  not 
available,  by  the  application  of  indiarubber  hot- 
water  bottles,  will  be  found  most  effective.  With  re- 
gard to  drugs,  no  combination  has,  in  our  experi- 
ence, been  so  effective  as  the  following  : — Aspirin, 
6  grains ;  phenacetin,  5  grains ;  salicylate  of  quinine, 
2  grains  ;   and  codeiae,  J  to  i  grain. 

The  bowels  should  be  well  cleared  with  small 
doses  of  calomel  followed  by  salines.  In  those 
cases  in  which  the  pain  is  not  reUeved  an  occasional 
injection  of  morphia  with  atropine  may  be  neces- 
sary, but  this  is  a  remedy  which  should  be  used 
with  great  caution  and  not  too  frequently  repeated, 
as  it  tends  to  interfere  with  the  excretion  of  body 
waste,  and  may  also  lead  to  the  establishment  of 
the  morphia  habit. 

Subacute  Sciatica, — It  is  in  this  stage  of  the 
trouble  that  the  various  spas  become  of  service. 
In  Buxton  we  have  found  nothing  so  successful  as 
the  half  combined  bath.  The  patient  sits  in  a 
vapour  bath  which  comes  up  to  the  waist  line  only  ; 
this,  while  not  so  exhausting  as  thefuU  vapour  bath,, 
allows  a  higher  temperature  to  be  borne  by  the 
affected  parts.  Thus  a  tem{>erature  up  to  115°  F. 
can  be  tolerated  with  advantage  for  ffom  ten  to* 
fifteen  minutes.  At  the  end  of  this  time  the 
patient  sits  in  a  bath  of  the  Buxton  thermal  water, 
heated  to  a  temperature  of  95°  for  eight  minutes,, 
and  during  the  last  three  minutes  a  hot  under- 
current douche  at  102®  to  no*  is  appUed  to  the- 
affected  limb. 

In  this  stage  also  electricity  in  various  forms- 
is  used  with  excellent  results.  The  sinuridal 
electric  water  bath  (200  alternations  per  second), 
or  the  high  frequency  currents  of  D' Arson val,  are 
the  most  useful,  as  they  have  a  distinctly  anaes- 
thetic effect  upon  the  nerve,  whilst  improving 
its  nutrition.  Acupuncture  has  often  been  found 
beneficial  at  this  stage,  as  has  also  the  appUcation 
of  menthol  plaster  or  a  blister  over  the  head  of  the- 
affected  nerve,  or  the  use  of  the  thermo-cautery. 
The  administration  of  fairly  large  doses  (10  to  15 
grains)  of  iodide  of  potassium  three  times  a  day 


330    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Sept.  28.  1904, 


for  three  or  four  days  is  sometimes  beneficial, 
and  in  some  instances  the  combination  of  this  with 
arsenic  has  been  of  great  service. 

Chronic  Sciatica. — ^In  the  treatment  of  the  chro- 
nic forms  of  sciatica  it  is  essential  that  distinction 
should,  as  far  as  possible,  be  made  between  true 
neuritis  and  other  forms  of  this  complaint.  Where 
neuritis  is  not  present  the  Aix  massage  bath  with 
the  douche  applied  to  the  painful  part  is  of  great 
valu^,  as  are  also  dry  and  electric  massage,  followed 
by  gentle  stretching  of  the  nerve  in*  cases  where 
adhesions  are  ptfeserit.  The '  Buxton  swimming 
bath  at  the  natural  temperature  of  82°  F.  is  one 
of  the  most  valuable  remedies  at  our  disposal. 

In  true  neuritis,  however,  massage  is,  as  a  rule, 
most  harmful,  and  nerve-stretching  is  quite  contra- 
indicated.  The  warm  immersion  bath  with  hot 
under- water  douche  or  the  natural  swimming  bath 
will  greatly  help  these  patients  ;  and  electricity 
in  the  forqi  of  the  constant  current  ascending  and 
descending  over  the  affected  nerve,  or  the  constant 
current  bath,  is  of  much  service. 

The  affected  limb  should  be  kept  warm  by  the 
wearing  of  double  socks  and  pants.  Dr.  Far- 
quhar,  of  Marlborough,  speaks  very  highly  of  the 
injection  of  one- third  grain  of  pilocarpin  nitrate 
on  alternate  days  for  two  or  three  weeks,  except  in 
cases  where  there  is  organic  mischief.  In  some 
very  obstinate  cases  of  sciatica  the  injection  of 
osmic  acid  has  been  used  with  success,  but  it  is 
a  drastic  and  uncertain  remedy. 

If  the  pain  is  perpetuated  by  adhesions  which 
gentle  nerve-stretching  does  not  break  down, 
forcible  stretching  under  anaesthesia  may  be  re- 
sorted to. 

In  some  cases  where  all  else  has  failed  the  nerve 
has  been  cut  down  on  and  forcibly  stretched,  and  in 
two  cases  it  was  found  that  the  sheath  and  nerve 
were  so  intimately  connected  that  the  former 
had  to  be  dissected  off.  Dr.  Crawford  Renton, 
of  Glasgow,  has  pubhshed  a  series  of  remarkable 
cases  in  which  this  condition  was  found. 


PROLONGED  LACTEAL  SECRE- 
TION AS  A  CAUSE  OF 
CONSTITUTIONAL  DEBILITY(tf) 

By  Dr.  L.  CHEINISSE, 

Sz-lQteme  of  the  Montpellier  Hospitals,  Laareat  of  the  Faculty  of 
Medicine. 

The  mammary  gland  of  the  female  is  intimately 
associated,  physiologically,  with  the  genital  function, 
and  closely  resembles  that  gland  in  the  male,  from 
which,  indeed,  it  only  begins  to  differ  at  the  onset  of 
puberty.  Essentially  an  intermittent  function,  the 
mechanism  of  lacteal  secretion  is  usually  set  up  by 
reflex  stimulation  such  as  the  presence  of  a  foetus  in 
the  uterus  or  suction  applied  to  the  nipples  by  the 
infant.  These  conditions,  however,  by  no  means 
comprise  the  whole  of  the  natural  history  of  the  mam- 
mary gland,  for  there  are  many  other  exciting  causes 
capable,  of  starting  or  maintaining  the  secretion. 
Though  rather  rare  than  otherwise,  instances  of  the 
kind  are  frequent  enough  for  them  to  have  been  re- 
cognised and  classified.  Some  twenty  years  ago.  Dr. 
R.  Duval  went  into  the  subject  thoroughly  and  de- 
-scribed  five  categories  of  non-puerperal  lacteal  secre- 
tion :  (i)  Cases  in  ..which  the  secretion  is  prompted  by 
the  menstrual  function  ;  (2)  cases  in  which  the  stimulus 
comes  from  a  tumour  of  the  breast ;  (3)  cases  in  which 
there  is  secretion .  of  milk  in  connection  with  some 
titero-ovarian  affection  ;   (4)  cases  in  which  it  is  set  up 


(«)  See  hmS$maineM€di€QU,  July  18th,  1004. 


by  mechanical  or  psychical  stimulation  unassociatftl 
with  any  structural  changes  in  organs ;  and  (5)  m- 
stances  of  persistent  lacteal  secretion  after  the  meno- 
pause. 

I  recently  had  under  observation  a  patient  who  ei- 
hibited  a  further  anomaly  of  the  lacteal  functioo.  one 
which  possesses  something  more  than  a  pathological 
interest,  since  it  may  determine  consequences  ven- 
detrimental  to  the  health  and  comfort  of  the  victiin. 
The  patient  was  a  young  primipara,  who,  in  coose- 
quence  of  the  inadequacy  of  her  secretion  of  m\\\ 
was  constrained  to  supplement  the  supply  by  a  pro- 
portion of  cow's  milk.  Five  months  later  she  was 
obliged  to  absent  herself  for  some  weeks,  and  the  chid 
had  therefore  to  be  weaned  at  short  notice.  Two  daw 
later  the  breasts  had  become  swollen  and  painful,  aixi 
relief  was  obtained  by  emptying  .them  by  aspirats^ 
the  milk.  She  continued  this  practice  for  a  fortnii^ 
several  times  daily  to  begin  with,  and  subsequendr. 
as  the  quantity  of  milk  diminished,  less  frequentlv 
The  gland,  however,  went  on  secreting,  though  not  in 
any  large  amount,  but  milk  flowed  away  when  cm 
sUght  pressure  was  applied  to  the  breast,  and  dori^ 
the  night  enough  escaped  to  wet  the  front  of  the  nigk- 
dress.  The  secretion  increased  in  amount  on  tk 
slightest  fatigue,  even  after  moderate  walking.  Tk 
inconvenience  did  not  go  beyond  this,  so  the  lady  die 
not  consider  it  necessary  to  seek  advice  on  the  subject,  i 

She  was  Uving  at  this  time  under  very  healthy  cob 
ditions.  but  she  noticed  that  she  was  losing  weigh 
and  had  become  subject  to  attacks  of  palpi tatioL 
The  family  physician,  to  whom  she  applied  witboi 
mentioning  anything  about  the  persistence  of  th 
secretion,  recommended  a  change  of  air  and  the 
ordinary  remedies  for  anaemia.  This  treatment  faikd 
to  do  her  any  good,  and  as  she  continued  to  lose  fles> 
and  strength  she  ultimately  consulted  me.  I.  toe. 
was  struck  by  the  manifest  anaemia,  and.  for  a  time.  I 
was  unable  to  discover  any  plausible  explanation  of  its 
occurrence.  The  heart  and  lungs  appeared  to  fcr 
normal,  and  the  abdominal  organs  revealed  no  evideaa 
of  disease.  Menstruation,  which  had  recurred  sooe 
after  the  infant  had  been  weaned,  had  since  been  norma! 
in  date  and  amount. 

This  was  as  far  as  I  had  got  with  my  investigal 
when  one  day.  while  auscultating  the  heart,  I  noti 
that  the  pressure  of  the  stethoscope  brought 
drops  of  milk  from  the  left  nipple.  On  squeezing 
mamma  more  milk  came  away,  and  on  repeating 
experience  on  the  other  side  the  same  effect  was  pro- 
duced. Naturally,  my  first  thought  was  that  the  ladr 
was  again  pregnant,  but  apart  from  the  fact  that  sk 
had  menstruated  regularly  I  was  unable  to  discovorj 
any  other  sign  to  confirm  my  assumption.  Moreover: 
on  questioning  her,  I  found  that,  as  a  matter  of  ^t 
the  secretion  had  never  ceased  since  her  child  vas» 
weaned,  that  is  to  say,  twenty-six  months  previoosiy. 
She  said  she  did  not  attribute  any  importance  to  the: 
presence  of  milk  in  the  breast,  and  from  motives  d 
modesty  had  abstained  from  mentioning  the  matter. 
It  at  once  occurred  to  me  that  there  might  be  a  dose 
relationship  between  the  persistence  of  this  secretiai 
and  the  disturbances  of  nutrition  which  the  patiect 
presented,  and  which  had  resisted  the  usual  stomachic 
treatment.  Before  making  up  my  mind  I  thoaght  it 
desirable  to  ascertain  the  exact  nature  of  the  secretioQ. 
Under  the  microscope  I  found  colostrum  corposdes. 
true  milk  globules,  and  a  few  epithelial  cells  uMier-< 
going  disintegration.  These  figured  elements  were 
isolated  and  disassociated — a  curcumstance  which, 
according  to  Palazzi,  justifies  the  presumption  that 
the  secretion  is  not  the  outcome  of  a  fresh  pregnanqr. 
but  is  due  to  persistence  of  the  function  long  after  the 
period  of  lactation. 

With  these  data  before  me  and  with  the  object  rf 
arresting  the  lacteal  secretion.  I  prescribed  tcn-gxain 
doses  of  antipyrine  three  times  daily,  in  cachet  k 
the  course  of  a  few  days  the  patient  ifound  that  miU 
could  no  longer  be  squeezed  out  of  the  breasts.  It  dmv 
be  simple  coincidence,  but  the  fact  remains  that  bm 
this  date  the  patient  gradually  improved  in  health 


Sept.  28,  1904. 


ORIGINAL    COMMUNICATIONS. 


Thx  Medical  Psxss.    331 


and  soon  ceased  to  experience  any  symptoms,  although 
no  other  treatment  was  resorted  to  ;  in  fact,  within  a 
iew  weeks  she  had  quite  recovered  her  normal  standard 
of  health. 

This  case  is  interesting  not  only  as  an  example  of 
remarkable  persistence  of  the  lacteal  secretion,  but 
also,  and  more  particularly,  on  account  of  the  influence 
which  this  abnormality  exerted  on  the  general  health. 
Exceptional  as  the  occurrence  may  appear  at  first 
•sight,  it  is  in  reality  by  no  means  unique.  Putting 
aside  for  the  moment  the  question  of  the  impairment 
of  health  caused  by  this  anomalous  secretion.  I  should 
like  to  discuss  the  persistence  itself.  Under  ordinary 
circumstances  the  hypertrophy  and  secretory  activity 
of  the  gland  are  limited  to  the  period  of  lactation,  and 
when  this  has  come  to  an  end,  though  the  cells  continue 
to  secrete  for  the  first  few  days  after  the  weaning  of 
the  child,  the  alveolae  then  begin  slowly  to  retract. 
Large  numbers  of  fat  cells  are  detached  from  the 
membrane  and  Undergo  transformation  into  a  residue 
which  is  ultimately  in  great  part  absorbed.  The  gland 
recedes  and  remains  quiescent  until  another  pregnancy 
sommons  it  from  the  reserve  and  starts  it  again  on 
active  service.  That  is  the  general  law,  and  although 
it  admits  of  certain  exceptions,  these  departures  from 
the  normal  have  not,  so  far,  received  sufficient  atten- 
tion. I  note,  indeed,  that  in  three  recent  works  on  the 
lacteal  function  the  only  aberration  mentioned  is  that 
in  some  countries,  Hungary  for  instance,  women  of  the 
labouring  classes  continue  to  suckle  their  infants  till 
the  age  of  three  years,  and  even  more.  Observations 
of  this  kind  have  obviously  nothing  in  common  with 
the  subject  under  consideration,  which  concerns  the 
persistence  of  the  lacteal  function  long  after  the 
period  of  lactation  or  even  in  the  absence  of  lactation, 
an  instance  of  which  is  recorded  by  TceitUne  in  a 
woman  in  whom  the  secretion  of  milk  was  maintained 
for  five  years,  although  she  had  never  given  her  infant 
the  breast.  This  case,  however,  is  not  on  all  fours 
with  my  own,  in  that  the  patient  was  the  subject  of 
chronic  metritis. 

But,  leaving  on  one  side  cases  in  which  the  milk 
secretion  is  under  the  empire  of  some  affection  of  the 
uterus  or  ovaries,  we  must  admit  that  there  are  cases 
in  which  weaning  the  child  does  not  put  a  stop  to  the 
secretion.  Dr.  Opitz,  protesting  against  the  distinc- 
tion usually  inculcated  between  colostrum  and  milk, 
according  as  the  fluid  does  or  does  not  contain  colos- 
trum corpuscles,  says :  "  We  meet  with  cases  in  which 
there  is  a  copious  secretion  of  milk  a  year  or  more  after 
the  normal  period  of  lactation  has  terminated — a  secre- 
tion which  contains  colostrum  corpuscles,  but  is  micro- 
«:opicaIly  indistinguishable  from  milk."  Palazzi,  on 
the  other  hand,  refers  to  three  women  with  persistent 
secretion  of  nulk,  who  had  weaned  their  infants  re- 
spectively seven,  seventeen,  and  thirty- two  months 
previously. 

Not  only  may  the  secretion  of  milk  continue  for  long 
periods  of  time,  but  it  may  be  very  abundant,  amount- 
ing, it  may  be,  to  genuine  galactorrhoea.  Instances  of 
this  kind  are  on  record  in  medical  literature,  and  in  the 
Transactions  of  medical  societies,  which,  although  not 
referred  to  in  works  specially  devoted  to  anomalies  of 
lactation,  are  nevertheless  worthy  of  attention. 

Moir  reports  the  case  of  a  woman  in  whom,  although 
she  had  never  brought  up  any  of  her  children  at  the 
breast,  the  secretion  invariably  persisted  until  the 
third  month  of  the  next  pregnancy.  After  the  birth 
of  her  second  child,  the  function  remained  active  for 
eighteen  months,  after  the  third  for  two  years,  after 
the  fourth  for  twenty-five  months,  and  after  the  fifth 
for  twenty-four  months,  when  she  had  a  miscarriage, 
since  which  she  has  not  again  been  pregnant.  Knee- 
land  publishes  notes  of  a  case  im  which  a  woman,  xt.  35, 
who  had  given  birth  to  a  child  five  years  previously, 
still  continued  to  secrete  milk,  though  she  gave  up 
suckling  the  child  at  the  end  of  two  years.  Dr. 
Gibbons  brought  before  the  Obstetrical  Society  of 
London  a  case  in  which  both  breasts  secreted  freely 
for  some  weeks  after  delivery,  when  the  milk  dis- 
appeared from  the  right  breast,  soon  after  which  she 


weaned  the  child  ;  but  the  left  breast  continued  to 
secrete  over  half  a  pint  of  milk  daily  for  eleven  months, 
when  it  suddenly  ceased  on  the  re- appearance  of  men- 
struation. 

.  It  is  generally  recognised  that  when  lactation  is 
prolonged  beyond  a  year  or  eighteen  months  it  entails 
more  or  less  serious  drawbacks  for  the  mother.  Marion 
Sims,  for  example,  mentions  cases  of  menorrhagia 
caused  by  "  superlactation,"  and  Sinclair  has  shown 
that  the  sudden  termination  of  unduly  prolonged  lac- 
tation may  determine  hyperaemia  of  the  utero-ovari£^n 
apparatus,  and  by  promoting  too  pronounced  involu- 
tion of  these  organs  may  determine  complete  or  partial 
prolapse  of  the  uterus.  Apart  from  these  complica- 
tions, we  should  take  cognisance  of  the  constitutional 
disturbances  (exhaustion),  and  even  psychical  troubles 
that  have  been  observed  after  prolonged  lactation. 

We  now  have  to  ask  ourselves  whether  simple  per- 
sistence of  secretion  after  the  cessation  of  lactation  is 
capable  of  bringing  about  the  same  troubles.  Now  it  is 
evident  that  when  the  secretion  of  milk  is  so  copious 
as  to  merit  the  designation  of  galactorrhoea,  this 
glandular  activity  entails  the  same  consequences  as 
puerperal  galactorrhoea,  which,  like  any  other  patho- 
logical secretion,  may  modify  the  tenor  of  organic 
exchanges  and  cause  very  pronounced  denutrition. 
Dr.  Nussbaum  states  that  he  has  met  with  several  cases 
in  which  the  mammary  glands  have  persisted  in  secret- 
ing milk  for  one  or  two  years  after  weaning,  and  in  such 
quantity  as  to  be  described  as  galactorrhoea.  This 
was  followed  by  impoverishment  of  the  blood,  marked 
prostration,  and  loss  of  control  over  the  emotions, 
symptoms  which  he  attributes  to  this  persistent  and 
considerable  loss  of  nutrient  fluid.  In  one  case  the 
patient,  a  woman,  aet.  37,  had  suckled  her  infant  until 
nine  months  of  age,  and  eighteen  months  later  she  still 
presented  bilateral  galactorrhoea  with  consequent 
exhaustion.  A  second  case  was  that  of  a  woman, 
aet.  36,  who  had  had  two  pregnancies.  The  child  had 
been  weaned  at  nine  months,  but  the  secretion  of  milk 
did  not  cease,  and  she  consulted  Dr.  Nussbaum  a  year 
later,  when  she  presented  symptoms  suggestive  of  ulcer 
of  the  stomach.  In  both  these  cases  the  administra- 
tion of  laxatives  and  antipyrine,  together  with  com- 
pression of  the  breasts,  had  for  eff«;t  first  to  reduce, 
and  ultimately  to  determine,  the  flow.  It  should  be 
mentioned  that  in  both  cases  there  were  uterine  com- 
plications, catarrhal  endometritis  in  one  and  retro- 
flexion of  the  uterus  with  catarrh  in  the  second,  so  it 
may  be  that  they  belong  in  reality  to  the  group  of  cases 
of  persistent  laic  teal  secretion  dependent  upon  irri- 
tation of  the  utero-ovarian  apparatus.  However  that 
may  be,  the  history  shows  the  grave  consequences  that 
may  be  brought  about  by  prolonged  and  excessive 
functional  activity  of  the  mammae. 

Commenting  on  these  two  cases.  Dr.  Nussbaum  re- 
mairks  that  he  had  only  been  enabled  to  discover  one 
instance  of  persistent  lacteal  secretion  (Tceitline), 
which  he  had  looked  upon  as  unique.  As  a  matter  of 
fact,  a  number  of  cases  Of  the  kind  have  been  published, 
and  attention  had  previously  been  called  to  the  disas- 
trous consequences  of  this  abnormal  occurrence.  In 
a  work  published  in  1859,  Claude  Bernard  mentions 
that  instances  were  met  with  of  women  continuing  to 
secrete  milk  over  long  periods  of  time  with  consequent 
prostration,  and  he  suggests  that  diminished  activity 
on  the  part  of  the  sympathetic  nervous  system  might 
account  for  the  abnormal  function  by  stimulating 
excessive  circulation.  That  assumption,  he  argued, 
was  borne  out  by  the  action  of  electricity,  which  caused 
contraction  of  the  blood-vessels  by  direct  stimulation 
of  the  gland  itself  or  of  the  sympathetic  nervous 
system. 

These  quotations,  however,  refer  only  to  exhaustion 
caused  by  an  exaggeration  of  the  function,  not  only  in 
respect  of  duration  but  also  in  respect  of  quantity. 
In  my  case  the  interesting  feature  is  the  evidence  that 
prolonged  activity  of  the  secretory  apparatus  may 
determine  exhaustion  even  apart  from  galactorrhoea. 
Nor  do  I  suppose  for  a  moment  that  the  case  is  excep- 
tional.    In  all  probability  the  occurrence  is  far  more 


33^    The  Medical  Press. 


FRANCE. 


SgPT.  28.  1904. 


frequent  than  one  might  be  tempted  to  suppose,  and 
if  it  escapes  our  observation  it  is  simply  because  the 
patient  does  not  call  the  doctor's  attention  to  the 
abnormal  secretion  either  from  motives  of  mistaken 
modesty  or  merdy  because  she  does  not  attach  any 
importance  to  the  fact.  In  any  event,  I  have  satisfied 
myself  that  the  observation  is  by  no  means  an  isolated 
phenomenon.  Dr.  Beltz,  for  instance,  brought  before 
the  Medical  Society  of  Rheims  the  case  of  a  woman 
who,  after  her  first  labour,  weaned  the  infant  on  the 
eighth  day,  yet  the  secretion  persisted  for  four  years 
without  obvious  galactorrhoea.  since  the  milk  did  not 
flow  away  of  itself.  During  the  menstrual  periods,  far 
from  diminishing,  the  flow  increased.  This  patient,  he 
states,  presented  no  very  definite  symptoms,  but  she 
complained  of  pains  in  the  stomach  and  the  back,  de- 
bility and  general  lassitude.  He  concludes  by  in- 
sisting on  the  necessity  of  arresting  the  flow,  which,  he 
opined,  was  the  probable  source  of  the  constitutional 
impairment. 

The  first  lesson  to  be  drawn  from  these  facts  is  that 
we  must  not  ridicule  the  popular  idea  of  the  necessity 
of  "  getting  rid  of  the  milk  "  when  the  child  is  weaned. 
However  absurd  may  seem  the  stories  that  are  told  of 
the  milk  having  "  gone  to  the  leg,"  or  what  not,  there 
may  be  a  substratum  of  truth  in  the  popular  belief. 
On  the  other  hand,  the  idea  that  denutrition  can 
possibly  be  brought  about  by  persistence  of  the  lacteal 
secretion  is  worth  bearing  in  mind,  and  it  should  occur 
to  us  whenever  we  have  to  do  with  a  patient  who  is 
suffering  from  anaemia  and  emaciation  without  obvious 
cause,  especially  as  moderate  persistence  of  the  secretion 
may  very  well  be  overlooked  by  the  patient  when  she 
applies  for  advice.  Unless  the  real  cause  of  the  con- 
stitutional impairment  be  discovered,  we  may  run 
through  the  whole  therapeutical  arsenal  without 
effecting  an  improvement. 


half-pay,  although  a  family  may  depend  on  their 
earnings,  having  no  doubt  in  view  the  offer  of  a  sunt 
in  full  settlement  of  their  claim  against  their 
employer. 


SritiBb  Dealtb  IResorts* 


[by  our  special  medical  commissiombr.] 


Clinical  IRecorDs* 


NOTE  ON  A  CASE  OF  SIMULATED  UNI- 
LATERAL AMAUROSIS,  FOLLOWING  AN 
INJURY  RECEIVED  UNDER  THE 
WORKMAN'S    COMPENSATION  ACT. 

By  THEODORE  A.  W.  OGG,  L.R.C.S.Edin., 
L.R.C.P.Edin.,  &c.' 


The  following  case  occurred  in  a  workman  who 
received  a  slight  injury  to  the  right  side  of  his  head 
during  his  employment.  The  injury  was  of  the 
nature  of  a  bruise  and  the  workman  complained  of 
complete  loss  of  sight  in  the  right  eye  with  partial 
blindness  in  the  left  as  the  result  of  and  following 
the  injury,  and  as  a  consequence,  inabihty  to  follow 
his  employment. 

He  was  wearing  at  this  time  a  pair  of  spectacles 
belonging  to  someone  else  of  his  household.  On 
examination  the  eyes  presented  nothing  abnormal, 
and  he  was  then  tested  with  various  coloured 
glasses,  through  which  he  was  able  quite  accurately 
to  distinguish  the  colour  of  a  candle  flame,  seen,  he 
said,  with  the  left  eye. 

An  opaque  disc  was  then  introduced  (unknown 
to  him)  opposite  the  left  eye  and  he  was  then  asked 
the  colour  he  saw,  when  he  again  gave  the  correct 
colour,  stating  repeatedly  when  asked  that  he  saw 
the  flame  with  his  left  eye,  which,  of  course,  was 
impossible. 

He  visited  me  on  the  afternoon  of  the  following 
day  and  said  that  his  sight  was  so  considerably 
improved  as  to  be  now  sdmost  quite  well  and  he 
would  again  resume  work.  I  have  recorded  this 
case  as  one  of  many  that  are  liable  to  occur  under 
the  Workman's  Compensation  Act,  where  I  have 
found  workmen  quite  content  to  remain   idle  on 


XI.— LYNTON  AND  LYNMOUTH. 

These  twin  villages  of  North  Devon  have  long  be» 
beloved  by  artists  and  quiet  holiday-makers,  but  their 
advantages  as  desirable  health  stations  have  been 
much  overlooked.  The  peculiar  situation,  the  sbd- 
tered  glens,  the  wooded  hills,  the  free  exposure  to  sini 
and  sea,  afford  conditions  which  may  well  prove  in- 
valuable in  the  hygienic  management  and  therapeatic 
treatment  of  many  delicate  persons  and  not  a  fev 
actual  invalids. 

Lynton,  which  forms  the  key  to  Exmoor,  is  situated 
on  the  cliff  side  428  feet  above  the  sea,  while  Lynnumtk 
nestles  around  the  East  and  West  Lynn  after  their 
course  through  rocky  and  well-wooded  gorges.  Tie 
natural  conditions  are  peculiarly  suited  to  the  reqiun- 
ments  of  the  health  seeker. 

Science  and  art  have  also  done  much  to  furnish  tbe- 
necessities  for  hygienic  comfort.  The  w^ater  supply  is 
excellent,  the  drainage  good,  hotel  and  Icxlging-houar 
accommodation  is  plentiful,  and  sport  in  plenty 
available  for  those  in  a  condition,  to  participate. 

The  thoughtful  student  and  the  overworked  puMc 
man  will  find  the  neighbourhood  peculiarly  rich  ia 
interesting  features,  which  afford  instruction  for  mind 
while  at  the  same  time  securing  recreation  for  body,  (ti 

After  a  careful  personal  investigation  of  Lynton  aa^ 
Lynmouth,  we  are  of  opinion  that  it  may  be  recom- 
mended as  a  particularly  desirable  resting  station  im 
busy  workers,  who,  through  excessive  indulgence  in 
work  and  worry,  feel  the  fret  and  fray,  the  stress  and 
strain  of  business  and  profession,  and  develop  cos- 
ditions  which  are  conveniently  summarised  as  neuni- 
thenia. 

The  district  offers  splendid  opportunities  for  gra- 
duated hill  climbing.  Pulmonary  diseases  and  affec 
tions  benefited  by  open-air  methods  should  do  wel 
during  summer  months  at  Lynton. 

Persons  having  heart  and  other  vascular  diseast 
would  be  well  advised  to  select  a  less  hilhr 
station. 

Lynton  can  be  reached  from  Waterloo  (L.S.W.R) 
in  about  six  and  a  half  hours,  the  latter  twenty  miles 
of  the  journey  being  by  light  railway  from  Barns  taple.(i) 

The  vigorous  will  enjoy  the  picturesque  method  d 
approach  by  a  coach  drive  of  about  eighteen  miles 
from  Minehead  <G.W.R.  route). 

Visitors  may  also  reach  Lynton  from  Paddingtoo 
(G.W.R.)  vid  Taunton  and  Barnstaple. 

At  some  seasons  of  the  year,  steamers  from  Bristol 
stop  at  L3mmouth,  but  as  there  is  no  pier  the  landing 
is  difficult,  and  in  rough  weather  quite  unsuited  to  the 
invalid. 


france^ 


[from  our  own  correspondent.] 


im. 


Pakib,  September  2Sth, 
CORYZA. 

Acute  coryza,  popularly  called  "  cold  in  the  head," 
is,  as  everyone  knows,  a  very  troublesome  affectioo 
in  adults,  while  in  infants  it  frequently  compromises 
their  existence. 

Several  remedies,  both  internal  and  external,  have 
been  tried  with  varying  success. 


(a)  See  new  volume  (No.  87)  of  **  The  HomelaAd  HMdbooto 
"Lynton,  Lynmouth,  and  the  Lomn  Doone  Ooontiy.' 


The  Homeland  AMOciation. 

(b)  Poneult  MeMra.  Ward,  Look  and  Co.'e  **  Pictorial  and  OMcrip- 
tive  Ooide  to  Lynton,  Lynmouth,  and  North-Sast  Devon." 


■Sbpt.  28.  1904. 


GERMANY. 


Thb  Medical  Press.    333 


As  internal  treatment,  M.  Ruault  recommended 
'benzoateof  soda  (one  drachm  for  children  and  twice 
that  amount  for  adnlts,  in  divided  doses  during  the 
<lay ).  This  drug  arvested  the  progress  of  the  coryza  or 
-abridged  its  duration.  Other  agents,  such  as  tincture 
oi  belladonna,  aoonite,  or  opium,  were  advised  by 
different  authors,  but  their  action  was  uncertain. 

The  local  means  should  be  preferred.  At  the  first 
sneeze,  inhalation  of  the  vapour  of  eau  de  Cologne,  so 
•as  to  prodnoe  a  sensation  of  heat  in  the  pituitary  mem- 
brane, is  very  beneficial.  A  few  drops  of  the  following 
:solution,  on  blotting  paper  and  inhaled,  also  act  well : — 

"Bf'        Phenic  acid,   5  ; 
Anmionia  liq..  5  ; 
Frooi  spirit,  i ; 
Water,  i. 

Some  rhinologists  refuse  to  prescribe  injections  of 
the  nares  in  the  acute  stage  of  coryza.  contenting 
themselves  with  spraying  the  parts  with  a  warm  solu- 
tion of  cocaine  at  i-ioo,  or  adrenalin  1-1,000.  M. 
*Ooartade,  however,  irrigates  with  a  saline  or  boric  acid 
solution  -at  a  very  high  temperature  (118°),  which  he 
xepeats  moraiDg  and  evening,  using  a  pint  at  a  time. 
According  to  him,  one  or  two  days  suffice  to  effect  a 
•cure  if  the  treatment  is  begun  at  the  very  outset  of  the 
attack,  the  first  or  second  day.  If  later,  the  chances 
<rf  success  are  diminished  ;  nevertheless  the  gravity 
and  duration  of  the  malady  are  always  attenuated. 
M.  Courtade  prescribes  at  the  same  time,  internally, 
-salicylate  of  soda.  This  treatment  would  prevent  the 
•ex tension  of  the  inflammation  to  the  pharynx  and  the 
bronchi  as  so  frequently  happens  in  certain  pati^ts. 

In  infants,  irrigations  are  impossible  ;  they  can  be 
-replaced  by  insufflations  of  air  with  an  elastic  ball, 
^'hich  expel  the  secretions ;  instillations  of  a  few 
drops  of  a  solution  of  menthol  and  olive  oil  (1-150) 
-re-establish  the  permeability  of  the  nasal  fossae. 

A  Novel  Method  of  Suturing  Wounds. 

A  practitioner  is  caHed  to  a  case  in  a  hurry  without 
^ny  indication  of  its  nature ;  arriving  at  the  house  he 
finds  himself  in  presence  of  a  wound  that  requires  to 
be  sutured.  He  searches  in  his  pocket  for  his  emer- 
gency case,  and  finds  he  has  left  it  at  home.  He  has 
come  perhaps  a  long  way  and  does  not  want  to  waste 
time  by  retumdng  to  his  house  ;  he  is  annoyed.  Going 
through  his  pockets  again,  he  can  only  discover  his 
little  subcutaneous  syringe.  That  is  quite  sufficient 
for  the  purpose,  as  Dr.  Gerest,  of  St.  Etienne,  points 
•out,  and  he  will  proceed  to  suture  the  wound  in  the 
following  manner : — 

Opening  the  inside  lid  of  the  little  case,  a  bundle  of 
•silver  wires  for  keeping  the  needle  patent  is  found.  He 
takes  one  of  these  wires  and  inserts  it  into  the  needle, 
t&king  care  that  it  does  not  project  beyond  the  point. 
He  then  passes  the  needle  through  both  edges  of  the 
wound;  pushing  the  wire  a  little  beyond  the  point  he 
holds  it  while  he  withdraws  the  needle.  It  is  thus  by 
this  simple  method  that  the  suture  is  through  and 
iready  to  be  twisted.  The  same  operation  is  done  as 
many  times  as  sutures  are  needed,  and  then  the  edges 
.are  drawn  together. 

The  advantage  ctf  this  simple  method  over  the  ordi- 
jiary  operation  is  that  it  is  much  less  painful.  There 
is  no  dragging  on  the  needle  loaded  with  a  double 
•thread  which  is  so  much  dreaded  by  the  patient. 

Naturally,  the  above  method  can  only  be  applied 
to  simple  cutaneous  wounds,  but  do  they  not  form  the 
majority  >Qf  minor  accidents  ? 


[from  our  own  corrbspondsnt.] 

Bbuk,  Beptembar  26tii,  lOM. 
A  Modern  View  of    the   Etiology.J  Prophylaxis, 

Treatment    and    Prognosis    of    Pulmonary 
Phthisis. 

This  subject  is  discussed  by  Dr.  Famowski  in  a 
recent  number  of  the  Prager  Med,  Wochenschi  The 
author  believes  that  pulmonary  tuberculosis  arises 
from  inactivity  and  that,  therefore,  it  can  be  removed 
by  work.  He  recognises  the  lymphogenous  origin 
of  the  disease,  the  commencement  of  which  lies  in  the 
earliest  youth.  One  finds  the  lymph  glands  swollen 
and  pleuritic  rubbings  are  often  heard.  The  low 
power  of  movement  of  the  apices  explain  why  these 
parts  are  the  first  to  be  attacked.  The  prophylaxis 
consists  in  the  most  careful  attention  to  the  nose, 
mouth  and  fauces,  whilst  the  breathing  should  be 
exclusively  nasal.  All  tuberculous  subjects  with 
bronchial  symptoms  should  be  kept  away  from  children ; 
mothers  who  are  diseased  should  be  forbidden  to 
suckle  and  nurse  their  children,  and  such  should  be 
warned  against  allowing  conception  to  take  place. 
Two  symptoms  are  mentioned  as  specially  characteristic 
of  the  early  stage :  a  peculiar,  tormenting,  burning 
pain  t>etween  the  shoulder-blades,  especially  when  the 
body  is  bent  forwards,  and  a  disagreeable  sweat 
odour,  often  noticed  when  the  clothes  are  being 
taken  off.  The  most  important  therapeutic  agent 
is  respiratory  gymnastics.  As,  however,  the  author 
does  not  trust  to  the  exercises  being  carried  out  pro- 
perly, he  orders  inhalations  to  be  made  several  times 
a  day  of  vapour  with  a  medicinal  addition.  These 
should  act  as  regards  the  lung  exercise  as  object  lessons 
from  an  educational  point  of  view,  and  also  as  ex- 
pectorants. Patients  with  hsemorrhagic  expectora- 
tion or  pronounced  haemoptysis  should  not,  of  course, 
practise  these  exercises.  In  suitable  neighbourhoods 
the  terrain  treatment  is  carried  out,  nasal  respiration 
being  indispensable.  For  inhalation,  the  prescription 
following  is  made  use  of : — 

Or.        Guaiacoli  purissimi. 
lodipin. 
Liquor,  sod.  sulpbiti  ana  5  grm. ;  ft.  emulsio. 

S.   I  to  1 5  drops  to  be  inhaled  thrice  daily. 

The  commencing  dose  was  one  drop,  the  length 
of  time  and  the  increase  of  dose  being  decided  by  the 
condition  of  patient.  The  chief  aim  is  the  lung 
exercise,  the  action  of  the  drug  only  secondafy.  Deep 
nasal  inspiration  alone  had  an  anticatarrhal  influence. 
With  the  idea  of  preventing  a  fresh  invasion  of  tubercle 
bacilli,  the  author  orders  nasal  douching  and  very 
thorough  cleansing  of  the  teeth  with  subsequent 
washing  out  of  the  mouth  and  gargling.  Anaemia, 
one  of  the  most  frequent  complications  of  tuber- 
culosis and  nervousness,  he  treats  with  the  same 
cure.  Disturbances  of  the  digestive  tract  must  also 
be  treated  ;  loss  of  appetite  is  frequently  overcome 
by  solveol,  guaiacol,  or  creosotal.  The  patient's 
prospects  are  improved  by  careful  attention  to  all  the 
details  given.  He  does  not  look  upon  pulmonary 
tuberculosis  as  cured  when  bacilli  are  no  longer  to 
be  found  in  the  sputum,  but  when  normal  breath 
sounds  are  heard  again  in  the  chest,  when  pleuritic 
rubs  and  bronchitic  symptoms  have  disappeared,  and 
the  lungs  have  regained  their  normal  elasticity.  He 
looks  upon  people  in  the  first  and  second  stage  of  the 
disease  as  fit  for  work,  and  allows  them  to  work  during 
the  time  of  treatment.  He  only  allows  them  to 
announce  themselves  ill  from  time  to  time  for  purposes 


334    The  Medical  Pkess. 


AUSTRIA. 


Sept.  28.  190^ 


of  rest  and  recruiting  from  work,  by  which  the  treatment 
is  assisted.  He  looks  upon  people's  curative  establish- 
ments as  without  any  object,  their  value  lying  only 
in  their  being  places  of  refuge  for  the  incurable,  and 
as  diminishing  the  chances  of  infection  of  others. 
He  also  considers  treatment  in  high  altitudes  as  un- 
necessary, as  bronchitis  may  be  prevented  by  nasal 
breathing  and  protection  from  cold.  Finally,  he 
lays  the  greatest  stress  on  the  utmost  dexterity  and 
expertness  with  the  stethoscope,  whereby  the  ear 
becomes  familiar  with  all  the  sounds  of  the  borderland 
between  the  diseased  and  the  normal.  He  would 
rather  trust  the  ear  than  the  microscope. 


Bndtrta* 


[from  our  own  correspondent.] 

yiniTA,  September  26th,  1904. 
False  Legs  of  Iron. 

At  the  Naturforscher  meeting,  Hovorka  showed  a 
prothesis  which,  he  said,  had  all  the  advantages  of 
lightness  and  cheapness  that  the  present  age  of  eco- 
nomy could  desire,  more  particularly  in  warfare,  where 
so  many  limbs  were  mutilated.  It  was  in  its  simplicity 
a  very  light  steel  tube  finished  with  gauze,  which  acted 
as  the  upholstery  for  the  fitting.  He  thought  the 
amputating  surgeon  should  work  with  the  instrument- 
makers  in  these  protheses,  when  an  operation  was 
performed,  as  they  assisted  him  to  secure  by 
mechanics  the  greatest  utility  of  the  limb,  which 
added  greatly  to  the  advantage  of  the  patient's 
usefulness  in  after  life.  There  is  one  small  matter 
in  the  treatment  which  should  not  be  omitted. 
The  stump  usually  atrophies  and  contracts  for  some 
time  after  the  operation.  To  hasten  this  action  mas- 
sage should  be  practised  zealously  to  hasten  and  harden 
it  for  the  prothesis. 

Incarcerated  Hernia. 

Haberer  related  the  history  of  a  few  cases  of  bowel 
torsion  and  incarceration  which  he  had  operated  on. 
The  first  was  a  hernia  associated  with  purulent  peri- 
tonitis, which  died.  The  second  was  torn  in  replacing 
the  bowel  and  caused  profuse  bleeding.  The  wound 
was  sewn  up,  the  whole  cavity  washed  out,  and  the 
bowel  returned  with  a  successful  issue. 

Plucker  related  a  case  of  hernia  which  he  treated  that 
occurred  in  the  seventh  intercostal  space  after  a  stab 
with  a  sharp  instrument  which  had  evidently  pierced 
the  diaphragm,  allowing  the  peritoneum  and  bowel  to 
escape  into  the  chest.  Resection  of  the  eighth  rib 
was  performed  and  the  whole  of  the  prolapsed 
bowel  replaced  after  relieving  the  perforation  of  the 
diaphragm,  which  had  strangulated  the  hernia. 

After  closing  the  wound  with  a  few  stitches,  a  tampon 
was  placed  over  the  rupture  to  hold  all  in  place,  but. 
unhappily,  empyema  set  in  and  complicated  the  case, 
which  finally  healed  up  and  made  an  excellent  recovery. 

Hippel  thought  that  these  were  very  uncertain  cases 
to  deal  with,  as  the  protrusion  of  the  peritoneum  and 
part  of  the  bowel  was  no  guarantee  that  other  parts 
of  the  internal  organism  were  not  injured,  though  the 
protruding  parts  were  perfectly  free  and  healthy. 

Plucker  said  that  a  distinction  ought  to  be  made 
between  wounding  the  diaphragm  from  the  abdomen 
and  wounding  it  from  the  thorax.  In  the  former  case, 
laparotomy  would  be  the  correct  method.  Again,  if 
the  instrument  were  long  and  pointed,  even  when  pene- 
trating from  the  chest,  laparotomy  should  be  the  opera- 
tion to  follow,  but  the  judgment  of  the  surgeon  must  be 
the  guide. 

Braun  then  related  a  few  cases  of  occlusion  of  the 
colon  from  displacement  and  torsion. 


Rhen  said  that  he  had  only  seen  one  of  colon  ooda- 
sion  from  torsion  and  one  from  displacement  oC  the 
caecum,  in  the  case  of  a  girl  going  to  school,  aad  falling 
on  the  ice.  Tlje  great  effort  to  prevent  the  fall  dis- 
placed the  bowel,  and  quite  closed  the  Inmen.  Both 
cases  recovered  after  the  operation. 

Hoffmann  at  this  juncture  related  a  peculiar  case  of 
laparotomy,  which  he  performed  for  partial  peritonitis, 
with  a  supposed  purulent  abscess  according  to  diagnosis. 
On  opening  the  abdomen  the  stomach  was  distended 
with  five  or  six  litres  of  brown  fluid,  resembling  that 
previously  vomited.  The  pylorus  was  quite  free  and 
would  permit  two  fingers  to  pass.  During  the  opera- 
tion the  patient  collapsed.  In  the  post-mortem  the 
pancreas  was  found  necrosed,  while  all  the  other  orgaos 
were  healthy. 

How  this  acute  dilatation  of  the  stomach  occuned 
was  somewhat  puzzling.  Hoffmann  could  see  nothing 
to  account  for  it  but  the  sudden  loss  of  atony  with  a 
greater  amount  of  distention  than  usual. 

Wohlgemuth  related  another  case  of  abdominal 
complexity,  where  he  operated  for  appendicitis  or 
cryptorchism.  Both  diagnoses  were  correctly  made. 
Laparotomy  revealed  a  compromise.  CryptorchisiD 
was  present  with  genuine  ulceration  in  the  appendix. 
Surgery  in  Jackson's  Epilepsy. 

Berge  recorded  two  cases  of  Jackson's  epilepsy  od 
which  he  operated,  the  first  being  six  years  after  the 
accident  to  the  head.  There  was  a  slight  impressioD 
of  the  wound  still  existing  on  the  left  parietal  bcme  on 
the  left  side,  which  he  raised  and  found  a  few  sharp  spik^ 
undeftieath,  penetrating  the  grey  substance,  and  along 
with  this  a  cyst.  After  removal  the  fits  disappeared, 
but  the  paralysis  of  the  right  hand  and  right  leg  still 
persisted.  The  second  case  was  that  of  a  young  giil, 
aet.  13,  with  a  cyst  on  the  floor  of  the  right  lateral 
ventricle.  He  finally  covered  the  wound  with  a  Konig 
flap,  which  healed  perfectly.  In  a  fourth  case  he  could 
not  obtain  the  same  successful  result.  The  epilepsy 
disappeared  all  right,  but  the  paralysis  still  continued 
after  the  probable  extirpation  of  the  centre,  which  lies 
about  i^  centimentre  below  the  surface.  After  dis- 
cussing the  theory  of  Jackson's  disease,  he  reviewed 
the  treatment  adopted  by  Jonnescus  by  extirpating 
the  cervical  sympathetic  gland  on  both  sides  of  the  neck 
with  the  object  of  reducing  the  blood  pressure  in  tbe 
brain. 

To  Prevent  Urinary  Infection.. 

Goldberg  gave  the  results  of  his  experiments  witb 
strepto-  and  staphylococci,  as  welT  as  with  celi  bacilli. 
This  form  of  treatment  wais  suecesslal  in  99  per  craiit.  wf 
the  cases  where  stone  was  located  in  the  bladder,  whife> 
eleven  were  improved.  In  the  case  of  strictvre. 
92  per  cent,  were  successful  and  eight  faiEed  ;  in  7S 
prostate  cases  75  were  not  infected  ;  in  28  retentisa 
cases  only  three  failed ;  and  from  56  infected  cases  25 
were  perfectly  healed  by  the  application,  and  31 
improved. 

The  Surgery  of  Chronic  Nephritis. 

Stern  related  the  case  of  an  eight-day  anuria  in 
which  he  had  operated  for  calculi  in  the  kidneys,  but  an 
reaching  the  organ  he  found  it  to  be  a  case  of  chronic 
nephritis  on  both  sides.  Two  hours  after  the  operation 
a  large  quantity  of  urine  was  passed,  but  subsequently 
the  patient  died.  The  post-mortem  confirmed  the 
diagnosis  of  chronic  nephritis  on  both  sides. 

In  another  case  he  tried  Edebold^s  method  of  decap- 
sulating,  but  without  success.  In  one  o£  nephralgia  he 
adopted  Isreal's  method  of  splitting  the  enormoosly 
distended  capsule^  which  gave  immediate  reUef.  Hw- 
same  good j  resultjollowcd  the  operation  in  a  case  of 


Sept.  28,  1904. 


OPERATING   THEATRES. 


Tbx  Mxdicai.  PsESsr  335 


haematuria  without  any  stone  as  a  cause.  He  is  pre- 
pared to  substantiate  Isreal  in  his  opinion  of  doing 
good  by  surgery  in  these  cases. 

Rehn  advocated  great  care  and  caution  in  the  selec- 
tion of  cases  for  nephrotomy.  He  had  performed  the 
operation  in  several  cases  of  renal  haematuria,  but 
lost  every  one  of  them.  He  believed  the  operation  only 
aggravated  haemorrhage,  as  the  patients  always  got 
worse  after. 


TTbe  ^perattttd  UbcattcB. 


GUY'S  HOSPITAL. 
Operation  for  Cancer  of  the  Stomach. — Mr. 
Arbuthnot  Lane  operated  on  a  woman,  aet.  64, 
who  had  a  tumour  in  her  epigastrium,  and  suffered 
from  constant  vomiting  when  any  food  was  taken,  the 
stomach  being  able  only  to  retain  temporarily  a  very 
small  quantity  of  fluid.  Manual  examination  sug- 
gested an  old-standing  growth  of  the  stomach,  ap- 
•parently  about  its  centre,  and  involving  a  considerable 
area  of  the  organ.  A  vertical  incision  was  made,  and 
the  stomach  exposed.  An  extensive  growth  occupied 
in  an  annular  fashion  the  middle  third  of  the  viscus. 
As  far  as  could  be  made  out,  no  gas  could  be  driven 
from  the  small  portion  of  the  remainder  of  the  cardiac 
end,  whi<:h  was  free  into  the  portion  of  the  stomach 
beyond  the  growth.  Indeed,  the  patient  had  been 
kept  alive  with  nutrient  enemata  for  a  considerable 
time.  The  upper  part  of  the  jejunum  was  divided 
and  the  distad  section  connected  with  the  cardiac 
portion  of  the  stomach.  The  proximal  part  of  the 
jejunum  was  then  put  into  the  distal  portion  of  the 
same  gut  at  a  convenient  distance  from  its  communi- 
cation with  the  stomach.  Considerable  difficulty 
was  experienced  in  effecting  the  connection  with  the 
stomach  because  of  the  smallness  of  the  area  of  the 
cardiac  end  unaffected  by  growth,  and  because  of  its 
fixation.  Mr.  Lane  pointed  out  that  the  period  in  the 
course  of  the  disease  in  which  the  operation  was  per- 
formed rendered  any  attempt  at  partial  or  complete 
excision  of  the  stomach  impossible,  as  the  growth 
was  so  extensive,  and  besides  there  was  much  glandular 
infiltration  ;  still  the  procedure  adopted,  he  thought, 
would  render  the  remainder  of  the  patient's  life  less 
miserable  than  it  had  been  previous  to  operation. 
Mr.  Lane  considered  that  this  method  was  certainly 
accompauiied  by  much  less  risk  and  discomfort  to  the 
patient  than  the  older  manner  of  operating,  while  at 
the  same  time  it  was  performed  with  great  ease. 
By  means  of  this  operation,  he  said,  any  regurgitation 
of  food  from  the  small  intestine  into  the  stomach  is 
avoided,  and  the  risk  of  kinking  is  nil.  He  also  pre- 
ferred to  establish  the  junctions  without  any  mechani 
cal  aid  whatever. 

Operation  for  the  Effects  of  Chronic  Con- 
stipation.— The  same  surgeon  operated  on  a  woman, 
act.  35,  whose  recent  life  had  been  a  burden  to  her 
from  the  pain  and  discomfort-  she  experienced  in 
consequence  of  chronic  constipation.  Besides  the 
appearance  of  premature  senility,  which,  Mr.  Lane 
pointed  out,  was  always  a  consequence  of  the  auto- 
intoxication present  in  these  ^oses,  she  had  the  usual 
local  pain  below  the  last  rib  on  the  right  side,  the 
tenderness  and  fulness  in  the  right  iliac  fossa,  frequently 
accompanied  by  a  fulness  in  the  pelvic  region,  with 
pain  and  discomfort  in  the  vicinity  of  the  sacrum, 
and  in  addition  all  the  other  symptoms  found  in  this 


condition.  An  opening  was  made  in  the  left  groin 
through  which  the  transverse  colon  immediately 
prolapsed.  Mr.  Lane  drew  attention  to  the  fact  that 
in  these  cases  the  transverse  colon  forms  a  U  with  its 
convexity  downwards,  frequently  reaching  into  the 
pelvis.  The  whole  of  the  true  pelvis  was  occupied 
by  thie  distended  caecum,  the  end  of  the  ileum  entering 
it  to  the  left  of  the  rectum  ;  the  sigmoid  flexure  was 
so  shortened  up  and  bound  down  by  the  adhesions 
which  had  formed  about  it  that  it  would  have  been 
unwise,  Mr.  Lane  said,  to  attepipt  to  utilise  it ;  for- 
tunately, as  is  usually  the  case,  the  rjsctum  was  much 
dilated  and  elongated,  and  its  walls  were  considerably 
hj^pertrophied.  The  ileum  was  cut  through  about 
six  inches  from  its  termination,  between  a  couple  of 
encircling  Ugatures ;  the  ligatured  stumps  of  bowel 
were  then  inverted  by  purse-string  sutures,  which 
passed  through  the  peritoneum  and  muscle  at  a  suitable 
distance  from  the  ligature ;  the  proximal  end  of  the 
ileum  was  then  connected  laterally  with  the  rectum, 
an  aperture  of  communication  of  considerable  size 
being  effected.  Mr.  Lane  said  that  the^  risks  of  th 
operation  are  much  reduced  by  prepurgation  and 
previous  frequent  irrigation  of  the  colon  by  some 
suitable  antiseptic  lotion.  Mr.  Lane  remarked  that 
the  results  of  these  operations  for  the  condition  con- 
sequent on  a  habitual  overloading  of  the  cesspool  have 
proved  at  least  as  satisfactory  as  he  had  anticipated. 
The  risk  associated  with  the  operation  he  considered 
to  be  very  small,  whilst  the  benefit  the  patients 
derived  both  in  comfort  and  in  the  condition  of  their 
nutrition  is  remarkable.  The  subsequent  progress  of 
the  case  was  most  satisfactory. 

Operation  for  Badly  United  Fracture. — ^The 
same  surgeon  operated  on  a  man,  aet.  40,  for  complete 
physical  disability  which  was  consequent  upon  a 
spiral  fracture  of  the  right  tibia  and  fibula,  the  dis- 
ability being  caused  by  a  considerable  overlapping 
of  the  bones,  which  were  connected  together  by  a 
quantity  of  callus,  which  occupied  the  interval  between 
them.  Owing  to  the  alteration  in  the  axes  of  the 
fragments  to  one  another,  the  patient  was  unable  to 
walk  securely.  An  incision  was  made  over  the  tibial 
junction,  and  the  seat  of  the  fracture  freely  exposed. 
The  axes  of  the  fragments  were  accurately  defined, 
and  sections  were  made  through  each  at  an  angle  of 
45°  in  such  a  manner  that  the  tibial  surfaces  could  be 
brought  accurately  together  after  the  bone  inter 
vening  between  the  two  sections  had  been  removed. 
The  surfaces  were  brought  into  accurate  apposition, 
and  were  retained  immovably  by  a  couple  of  stout 
silver  wires,  which  passed  through  the  extremities  of 
both  fragments.  By  means  of  this  operation,  Mr. 
Lane  said,  the  axes  of  the  fragments  were  rendered 
identical. 


St.  Vinoent'fl  Hospital,  Dublin. 

We  have  been  asked,  to  state  that  the  Inaugural 
Address  which  wais  announced  to  be  delivered  at  the 
opening  of  the  winter  session  of  the  above  hospitad. 
on  Tuesday,  October  4th,  has  been  unavoidably 
postponed  until  Tuesday.  October  nth. 
'    Aptftbeearies'  Hall  of  Ireland. 

The  quarterly  examinations  will  take  place  on.  the 
following  dates  in  October: — ^The  first  professional 
will  commence  on  Monday,  October  17  th.  1904.  The 
second  professional,  on  Thursday.  October  20th ; 
the  third  professional,  on  Monday.  October  24th.  All 
entries  must  be  lodged  at  least  fourteen  days  previously 
with  the  Registrar,  40  Mary  Street. 


33^    The  Msdical  Press 


LEADING   ARTICLJES. 


Sept.  zS,  1904. 


TTbe  AeMcai  press  and  Circular. 

PuUiihad  vnry  WednoMtoj  mornliiff,  Prioe  6d.     Poet  tree,  Hd. 


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ie2  lOt.  Od. ;  <)ii»rter  Paffe,  £1  6e.  Od. ;  One^ghth,  12e.  6d. 
Coneklenble  Beduotioni  from  Ihe  f orefoingr  soale  are  mede  wliee 

•a  order  ie  given  for  a  leriet  of  iiuertions.     Terms  on  applioa- 

tioD  to  the  PuUiaher. 
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6d,  per  line  beyond. 

SVBlO&TPTIOini. 

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S8s.  6d.  credit  rate. 


Ubc  flDcOical  press  an&  Circular. 


SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY,  SEPTEMBER  28,  1904. 


ORAL  INFECTION. 
One  of  the  recent  developments  of  Listerian 
principles  is  to  be  found  in  the  increased  attention 
paid  not  only  by  dentists  but  also  by  general 
surgeons  to  infective  conditions  of  the  mouth. 
It  is,  of  course,  obvious  that  the  mouth  can  never 
be  made,  even  if  it  were  desirable  to  make  it,  abso- 
lutely aseptic.  The  buccal  cavity  is  possessed  of 
its  normal  flora  just  as  the  skin  and  intestines  are  ; 
no  amount  of  care  and  no  expenditure  of  antiseptics 
can  ever  render  any  of  them  sterile.  In  the  case  of 
the  mouth  several  pathogenic  organisms  are  so 
commonly  present  that  in  judging  their  significance 
one  has  to  reckon  rather  with  their  numbers  and 
^'irulence  than  with  their  actual  presence.  It  is 
precisely  on  account  of  these  bacteria  finding  a 
normal  habitat  in  the  mouth  that  minor  conditions 
of  disease  and  injury  of  the  buccal  tissues  consti- 
tute a  menace  disproportionate  to  their  actual 
extent.  The  interest  that  is  now  being  taken  in 
the  subject  is  evidenced  by  the  fact  that  oral  infec- 
tion formed  a  subject  of  debate  this  summer  at  both 
the  British  Medical  Association  meeting  and  at  the 
annual  session  of  the  American  Medical  Association, 
and  that  large  numbers  of  surgeons  put  in  an  appear- 
ance in  the  respective  dental  sections  of  those 
meetings  to  take  part  in  the  discussions.  Diseases 
of  the  teeth  and  contiguous  structures  are  apt  to  be 
regarded  by  medical  men  as  belonging  too  exclu- 
fiively  to  the  province  of  the  dentist,  but  it  should 
not  be  overlooked  that  although  much  of  the  treat- 
ment may  have  to  be  carried  out  by  the  latter,  the 
responsibility  of  making  the  primary  diagnosis 
usually  falls  on  the  general  practitioner.  For  he  it 
is  whom  the  patient  first  consults,  and  his  will  be 
the  delicate  task  of  deciding  whether  the  condition 
of  the  mouth  is  secondary  to  some  disease  of  the 
whole  system,  or  whether  the  buccal  affection  is  the 


primary  cause  of  the  constitutional  symptoms. 
The  blood  supply  of  the  gums  and  dental  pulp  is  a 
terminal  one,  situated  at  some  distance  from  the 
centre  of  the  circulation,  so  that  it  is  not  snrpzising 
that  in  states  of  impaired  or  perverted  natritum 
these  structures  are  some  of  the  first  to  safier. 
With  their  resistance  thus  lowered,  the  teeth  and 
gums  become  a  ready  prey  to  the  pyogenic  organ- 
isms of  the  mouth,  and  the  interesting  conditioii 
now  known  as  pyorrhoea  alveolaiis  is  a  not  infre- 
quent sequela.  The  differentiation  of  this  afiectioo 
from  an  ordinary  alveolar  abscess  is  most  im- 
portant, as  not  merely  is  the  dental  procedure 
required  for  its  cure  totally  difiFerent,  but  the 
general  ill-health  at  the  root  of  the  trouble  calk 
for  special  treatment  according  to  its  nature. 
Moreover,  if  the  practitioner  is  on  his  guard  be 
vnh  perhaps  be  able  to  avert  the  onset  of  pyorrhoea 
alveolaris  if  he  includes  in  his  directions  to  the 
patient  instructions  as  to  the  proper  cleansing  and 
rubbing  of  the  teeth.  When  pyorrhoea  alveolaris 
has  already  set  in,  the  sufferer  should  be  placed  as 
soon  as  possible  in  the  hands  of  a  scientific  dentist 
so  that  all  tartar  and  concretions  about  the  teeth 
may  be  removed,  and  the  whole  visible  surface 
polished  and  thoroughly  cleansed.  By  this  means, 
combined  with  continued  local  lavage  and  general 
constitutional  treatment,  the  patient  will  be  placed 
in  the  best  circumstances  for  bringing  about  a  cure 
of  this  troublesome  disease.  Although  it  is 
pyorrhoea  alveolaris  following  some  general  affec- 
tion that  comes  most  frequently  to  medical  notice, 
there  are  still  other  general  affections  which  result 
from  pyorrhoea  alveolaris  of  purely  local  origin. 
These  affections  generally  assume  the  form  that  it 
is  fashionable  at  the  present  day  to  call  auto-intoxi- 
cation, and  pyorrhoea  alveolaris  set  up  by  neglect 
of  the  teeth  or  by  accidental  circumstances  may 
gravely  undermine  the  vitality  of  the  whole  system 
by  continually  pouring  into  the  mouth  morbid 
discharges  of  a  purulent  character.  The  persistent 
absorption  of  the  bacterial  toxins  contained  in  such 
discharges  cannot  but  be  baneful,  and  it  is  more 
than  probable  that  local  derangements  of  the 
throat  and  stomach  are  also  caused  by  this  action. 
Dr.  Rhein,  whose  paper  introduced  the  discussion 
in  the  Section  of  Stomatology  at  the  Session  of  the 
American  Medical  Association  this  year,  made  a 
very  suggestive  point  in  connection  with  the  evil 
of  oral  infection.  He  animadverted  on  the  strange 
anomaly  that  the  strictest  asepticism  is  secured  in 
all  surgical  appliances  during  an  operation,  and 
that  every  part  of  the  patient  in  the  neighbourhood 
of  the  wound  is  rigorously  treated  with  disinfectants, 
whilst  the  mouth  is  entirely  overlooked  as  a  possible 
source  of  infection.  Not  only  ought  it  to  be  im- 
possible for  secretions  of  the  surgeon's  and  his 
assistants'  mouths  to  contaminate  the  wound— an 
event  guarded  against  in  some  hospitals  by  the 
wearing  of  respirators — but  in  operations  on  the 
aUmentary  tract  the  patient's  own  mouth  ought  to 
be  considered  as  a  potential  source  of  danger,  and 
brought  into  a  condition  of  the  greatest  possiUe 
cleanliness.     Almost    precisely    similar    remarks 


SbPT.    28,    1904. 


LEADING   ARTICLES. 


The  Medical  Press.    337 


-were  made  by  Mr.  Godlee  at  the  British  Medical 
Association  meeting,  whilst  he  further  pointed  out 
the  improvements  in  the  results  of  operations  on 
the  mouth,  due  to  the  greater  care  expended  on 
£ec\mng  oral  cleanliness.  The  dangers  of  infection 
from  unhealthy  conditions  of  the  mouth  cannot 
be  too  seriously  pondered  over,  and  watched  for, 
by  medical  men. 


usually  be  counted  on  as  willing  to  adopt  and 
comply  with  any  reasonable  directions  based  upon 
established  scientific  facts.  We  may  congratu- 
late ourselves  that  the  "medical  advisers**  to 
the  Local  Government  Board  are  at  least  free 
from  the  all  too  prevalent  phobia  regarding  the 
dangers  of  tuberculosis. 


THE    SEIZURE    OF   TUBERCULOUS    MEAT. 
The  development  of  a  systematic  study  of  the 
comparative    pathology     of     tuberculosis    shows 
that  we  have  stiU  much  to  learn  regarding  the  nature 
of  that  disease.     It  is  also  becoming  clear  that  the 
dogmatic   assertions  of  many  alarmists  are  not  in 
accordance  with  scientific  fact  or  homely  common 
sense.      We  are  glad,  therefore,  to  receive  rational 
direction  even  from  such  a  conservative  body  as 
the  Local  Government  Board.    The  Board  has  con- 
sidered the  Report  of  the  Select  Committee  of  the 
House  of  Commons  on  the  Tuberculosis  (Animals) 
Compensation  BiU  of  this  year,  wherein  reference 
is  m.ade  to  the  variety  of  practice  existing  with 
regard  to  the  amount  of  tuberculous  deposit  in  a 
carcase    held   to  justify  its  total  condemnation. 
They  have  also  considered  the  complaints  made 
by  butchers  as  to  the  injury  caused  by  their  prose- 
cution in  open  court  for  having  tuberculous  meat 
upon  their  premises.     An  official  circular  has  now 
been  sent  out  to  the  Councils  of  Metropohtan  and 
other  Boroughs  and  of  Urban  and  Rural  districts. 
Speaking  generally,  it  is  most  desirable  that  there 
should  be  as  far  as  possible  uniformity'  in  the  prac- 
tice   of     meat    inspection.     The    principles    laid 
down  by  the  Royal  Commission  on  Tuberculosis  in 
1898  furnish  rational  and  trustworthy  directions. 
The  entire  carcase  and  all  the  organs  might  be 
.seized  when  there  is  miliary  tuberculosis  of  both 
lungs,  when  tuberculous  lesions  are  present  in  the 
pleura  and  peritoneum,   when  tuberculous  lesions 
are  present  in   the   muscular  system,   or  in  the 
lymphatic  glands,  embedded  in  or  between  the 
muscles,  and  when  tuberculous  lesions  exist  in  any 
part  of  an  emaciated  carcase.     If  otherwise  healthy 
the  carcase  shall  not  be  condemned,  but  every  part 
of  it  containing  tuberculous  lesions  shall  be  seized 
when  the  lesions  are  confined  to  the  lungs  and  the 
thoracic  lymphatic  glands,  when  the  lesions  are 
confined   to   the   liver   or  pharyngeal  lymphatic 
glands  or  any  combination  of  the  foregoing,  but  are 
collectively  small  in  extent.     We  are  pleased  to 
find  that  the  Board  are  of  opinion  that  at  the  present 
time  there  is  no  need  for  any  further  increase  in 
stringency,  but  they  very  rightly  insist  on  the  im- 
portance of  action  in  strict  accordance  with  the 
principles  which  have  been  laid  down.     It  is  also 
a  judicious   instruction   that   if   a   butcher  who 
is  in  possession  of  tuberculous  meat  has  notified 
the  fact  to  the  proper  authority  as  soon  as  he  could 
be  reasonably  expected  to  be  aware  of  it,  the  case 
should  not  be  taken  into  court.    We  are  certainly 
not  a  logical  people,  and  as  a  nation  our  scientific 
instincts   are   not   notable,    but   in   dealing  with 
morbid    conditions    generalUy,    Englishmen    may 


INFANTILE  DIARRHOEA. 
The  important  subject  of  the  relation  of  infan- 
tile diarrhoea  to  public  health  has  received  concise 
and  practical  treatment  at  the  hands  of  Sir  Charles 
Cameron,  the  Medical  Officer  of  Health  of  Dublin, 
in  a  recent  report  to  his  Public  Health  Committee. 
The  disease  is  one  which  is  increasing  year  by 
year  in  our  large  cities,  and  under  modern  condi- 
tions is  Ukely  to  go  on  increasing,  unless  strong 
measures  are  taken  to  prevent  its  spread.  In 
America  it  has  proved  during  the  last  half  decade 
such  a  veritable  scourge  that  its  prophylaxis  and 
treatment  are  regarded  as  one  of  the  most  serious 
problems  that  confront  the  sanitarian.  In  these 
countries,  partly  owing  to  difference  of  climate, 
and  partly  to  different  customs  of  nursing,  it  has 
not  yet  become  so  widespread,  and  consequently 
has  not  received  the  attention  it  deserves.  The 
rates  of  mortaUty  quoted  by  Sir  Charles  Cameron, 
however,  show  that  it  can  no  longer  be  neglected, 
and  that  it  is  tending  to  become  the  cause  of  a 
large  proportion  of  deaths  occurring  in  young  chil- 
dren. In  Dublin  the  death-rate  from  this  cause  is 
comparatively  low,  in  no  week  rising  above  5-5  per 
1 ,000  living,  though  when  we  remember  that  infan- 
tile diarrhoea  is  a  preventable  disease,  this  stillrepre- 
sents  an  appalling  waste  of  life.  In  other  cities — 
Liverpool,  York,  Hull,  Salford,  Walsall— it  is  much 
higher,  reaching  the  highest  point  of  16  per  1,000 
in  East  Ham.  Without  going  into  the  question  of 
the  bacterial  causes  at  work,  a  subject  which  is 
being  throughly  investigated  in  the  States,  there 
is  no  doubt  that  practically  speaking,  unsuitable 
food  is  responsible  for  infantile  diarrhoea.  Among 
the  cases  whose  history  Sir  Charles  Cameron  was 
able  to  investigate,  out  of  seventy-four  infants 
under  one  year  old  who  died  from  this  cause,  only 
eleven  were  at  the  breast.  Of  twenty-five  children 
over  one  year  old,  nineteen  took  ill  after  the 
nursing  by  their  mothers  had  ceased.  As  nursing 
at  the  breast  is  the  rule  in  Dublin,  and  feeding  by 
the  bottle  the  exception,  it  will  be  seen  that  the 
incidence  of  diarrhoea  on  those  who  are  bottle-fed 
is  enormously  greater  than  on  breast-fed  children. 
The  higher  rates  we  have  mentioned  as  occurring 
in  some  of  the  larger  English  cities  are  probably 
due  to  the  greater  frequency  of  bottle-feeding 
in  them  than  in  Dublin.  The  bottles  are  rarely 
kept  clean,  and  when  rubber  tubes  are  attached, 
they  are  usually  simply  culture-fields  of  bacteria. 
When  not  in  use,  the  bottle  is  commonly  laid  on 
the  window-sill  and  exposed  to  street-dust,  but  not 
infrequently  its  resting-place  is  the  even  more 
insanitary  coal-hole,  dirty  cupboard,  or  hob. 
In  many  cases  the  milk  with  which  infants  have 
been  fed  has   been  kept  from  the  previous  day. 


338    Thb  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Sept,  28,  1904. 


and  of  course  in  impure  surroundings.     In  addi- 1  21 '.2,  and  25*1  ;  Wigan,  31*6,  25*7,  29*9,  and  31-6; 


tion  to  milk  it  is  extraordinary  what  things 
mothers  give  their  young  children  as  food.  Sir 
Charles  Cameron's  list  for  infants  under  a  year  old 
includes  cabbage,  potatoes,  fruit,  meat,  fish,  bread, 
rusks,  and  various  artificial  foods,  while  he  notes 
the  not  uncommon  habit  of  administering  porter 
as  a  sedative.  It  is  to  be  remembered  that  this 
system  of  dirty  and  bad  feeding  is  in  nearly  every 
case  the  result  of  sheer  ignorance,  and  but  rarely, 
due  to  a  criminal  carelessness.  The  mother  does 
not  intend  to  injure  the  child — she  merely  feeds  it, 
as  perhaps  she  herself  was  fed,  and  as  her  neigh- 
bours feed  theirs.  She,  indeed,  finds  it  hard  to 
believe  that  the  child's  illness  is  due  to  any  pre- 
ventable cause,  and  she  is  astonished  and  insulted 
at  the  suggestion  that  the  food  is  bad  or  the  bottle 
dirty.  It  is  here  that  much  good  can  be  done  by 
education.  Instruction  in  elementary  hygiene 
should  be  given  in  the  primary  schools,  for  the 
Board-school  pupil  of  to-day  is  the  parent  of  a  few 
years  hence.  And  indeed,  instruction  has  very 
often  a  wonderful  way  of  filtering  through  the 
children  to  the  elders  at  home.  The  employment 
of  inteUigent  female  visitors  to  the  houses  of  the 
poor  can  also  do  much  good,  but  they  must  have 
tact,  or  their  advice  will  be  worse  than  futile. 
Perhaps  one  of  the  most  pregnant  suggestions 
ever  made  with  regard  to  the  etiology  of  summer 
diarrhoea  was  that  of  Dr.  F.  J.  Waldo  in  his 
Milroy  Lecture  some  years  ago.  He  surmised 
that  the  peculiar  incidence  of  the  malady  in 
towns  might  be  explained  by  food  contamination 
by  dust  charged  with  the  bowel  organisms 
of  lower  ammals,  especially  the  horse.  There 
is,  perhaps,  no  disease  whose  prevention  is 
more  completely  in  our  hands  than  infantile  diar- 
rhoea, and  the  responsibility  is  with  our  sanitary 
authorities  to  make  it,  as  a  cause  of  death,  a  vanish- 
ing quantity. 


TlotCB  on  Cnrrent  XCopfcs. 

The  Weekly  National  Bill  of  Health. 
The  weekly  returns  of  births  and  deaths  in 
London  and  seventy-five  other  great  towns  cf 
England  and  Wales  are  fountains  of  perennial 
interest.  The  total  deaths  registered  for  the 
week  ending  September  17th  corresponded  to 
an  annual  rate  of  I7'0  per  1,000  of  their  aggre- 
gate population.  A  rate  of  17-0  represents  -  a 
good  average,  although  far  above  the  standard 
ideal  aimed  at  by  zealous  sanitarians.  In  the 
preceding  three  weeks  the  rates  had  been  20-5, 
1 8' 2,  and  17*5  The  highest  annual  death-rate 
per  1,000  living,  as  measured  by  last  week's 
mortality,  were  from  all  causes,  25-1  in  Hull,  25*5  in 
Sunderland,  26-1  in  Hanley,  27-8  in  Salford, 
and  31*6  in  Wigan.  The  fallacy  of  taking  a  single 
week,  however,  is  shown  by  taking  a  town  like 
Liverpool,  where  the  mortality  for  the  four  last 
weeks  has  been  29-4,  27-2,  247,  22-3  ;  and  in 
Bootle,  with  30-4,  287,  23-6,  177.  Sunderland, 
on  the  other  hand,  has  been  19*3,  197,  18-3,  25*5. 
Hull  has  been  fairly  consistent  with  26*5,  26*3, 


while  Salford  has  returned  33* 5,  266,  237,  27-8. 
Preston,  which  formerly  had  a  bad  record,  showed 
19*5,  22*2,  21*3,  and  19.0.  One  death  was  reported 
from  small-pox  in  the  provinces  and  one  in  Glas- 
gow. A  large  number  of  deaths  were  due  to 
diarrhoea.  In  London  the  mean  average  of 
patients  in  the  infectious  hospitals  during  the  past 
thirteen  weeks  was  :  small-pox,  38  ;  scarlet  fever, 
1,753  ;  diphtheria,  771  ;  and  enteric  fever,  93. 


Pharmacy  Law  in  the  TransvaaL 

The  Transvaal  Pharmacy  Ordinance,  which  last 
month  became  law,  by  the  assent  of  Lord  Milner^ 
contains  several  points  which  are  distinctly 
in  advance  of  the  position  of  pharmacy  law  in 
these  countries.  In  reference  to  the  much-vexed 
question  of  company  proprietorship  of  druggists* 
shops  it  is  provided  that  the  managing  director  of 
the  company  shall  be  in  all  cases  himself  a  regis- 
tered "  chemist  and  druggist,"  and  that  the  name 
of  the  assistant  managing  the  ^tiop*  or  branch 
shall  be  posted  in  a  prominent  place  in  the  shop. 
Even  more  stringent  is  the  regulation  that  for  an 
offence  committed  by  a  company  every  director 
shall  be  responsible,  just  as  if  the  offence  were 
committed  by  him  as  an  individual.  This,  we 
understand,  is  a  reform  for  which  the  Pharma- 
ceutical Society  at  home  is  striving.  As  regards 
the  sale  of  poisons  strict  rules  are  to  be 
enforced.  A  penalty  of  a  fine  up  to  seventy-five 
pounds,  or  six  months'  imprisonment,  is  named 
for  the  offence  of  keeping  or  selling  poisons  without 
labelling  them  "  poison,"  while  lesser  fines  or 
terms  of  imprisonment  are  named  for  other 
offences.  We  think  the  power  to  send  to  prison  in 
these  cases  is  a  very  useful  one,  and  we  should  be 
glad  to  see  clauses  embodying  it  added,  not  merely 
to  our  own  pharmacy  laws,  but  to  the  licensing 
laws  in  general. 


Lesions  in  MovaMe  KidneyB. 

Abnormal  mobility  of  any  organ  of  the  body 
does  not  in  itself  constitute  a  disease,  though  it  is 
quite  common  to  find  that  such  increased  freedom 
of  movement  or,  it  may  be,  actual  displacement 
induces  reflexly  a  train  of  symptoms  which  may  be 
productive  of  life-long  suffering.  In  the  case  of 
the  pelvic  viscera  this  is  especially  noticeable.  The 
liability  of  an  unduly  mobile  or  misplaced  organ 
to  disease  has  many  times  been  discussed,  but 
clinical  evidence  would  seem  to  prove  that  it  is  not 
more  likely  to  undergo  structural  change  than  one 
which  is  normally  in  position,  unless  adhesions 
are  contracted  between  itself  and  the  neighbouring 
tissues.  With  regard  to  the  kidneys,  it  is  fre^ 
quently  observed  that  alterations  in  their  position 
are  found  in  neurotic  subjects,  though  the  reason 
for  this  is  not  quite  obvious.  The  association  of  a 
movable  or  floating  kidney  with  gall-stones  is 
well  known,  and  displacement  or  ptosis  of  other 
organs  may  be  present  at  the  same  time.  Kinking 
of  the  ureter  occurs  sometimes,  but  with  less  fre- 
quency than  might  be  supposed.  Intermittent 
hydronephrosis  should,   therefore,  be  a  common 


Sbft.  28,  1904. 


NOTES    ON    CURRENT    TOPICS.         Thb  Medical  Press.    339 


occurrence  in  cases  of  considerable  mobility,  and 
this  would  eventually  lead  to  degenerative  changes 
in  the  kidney  itself.  In  a  series  of  cases  in  which 
the  operation  of  nephropexy  was  performed 
at  the  Chelsea  Hospital  for  Women,  Mr.  Frank 
E.  Taylor  (a)  has  found  that  unsuspected  lesions 
were  discovered  in  no  less  than  x  o  per  cent.  Three 
cases  are  reported,  in  two  of  which  the  misplaced 
organ  contained  a  calculus,  while  the  third  proved 
to  be  one  of  renal  tuberculosis.  Two  other  cases 
are  also  described  in  which  the  organ  was  hydro- 
nephrotic  as  well  as  movable.  The  inference  to  be 
drawn  from  these  observations  is  that  the  kidney 
should  be  carefully  examined  at  the  time  of  opera.- 
tion,  special  attention  being  paid  to  any  doubtful- 
looking  spots. 


A  Medical  Journalist. 
The  brilUant  journalistic  feat  of  Dr.  G.  E.  Morrison 
in  securing  for  the  Times  the  full  text  of  the  new 
treaty  with  Tibet,  about  which  so  much  mystery 
liung,  brings  into  prominence  again  the  name  of 
one  of  the  members  of  the  medical  profession  who 
have  found  fame  in  other  fields  than  that  for  which 
they  were  designed.  Bom  under  the  prosaic  roof 
of  Geelong  College  near  Melbourne,  the  spirit  of 
adventure  early  seized  Morrison,  and  he  first 
distinguished  himself  by  voyaging  in  a  canoe  the 
whole  length  of  the  River  Murray,  which  is  to 
Australia  what  the  Mississippi  is  to  America.  Not 
content  with  this,  he  next  walked  across  the 
Australian  continent  from  north  to  south,  writing 
an  account  of  his  wanderings  for  the  Melbourne 
Age.  The  same  paper  sent  him  on  a  voyage  in  a 
trading  schooner  among  the  Pacific  Islands,  and 
subsequently  to  New  Guinea  as  leader  of  an 
exploring  expedition.  There  his  career  nearly 
came  to  an  end  for  he  was  badly  wounded  by  a 
native  spear  ;  in  fact,  part  of  the  weapon  remained 
in  his  body  for  many  months  and  was  only  finally 
extracted  at  Edinburgh,  whither  he  had  gone  to 
study  medicine.  After  graduation.  Dr.  Morrison 
starfed  off  on  his  travels,  once  more  finding  his  way 
to  the  Rio  Tinto  mines  in  Spain,  where  he  ofiiciated 
as  medical  officer,  and  to  Ballarat,  where  he  was 
appointed  the  superintendent  of  the  district 
hospital.  It  was,  however,  at  Pekin  as  Special 
Correspondent  to  the  Times  that  he  found  his 
meHetf  and  few  will  forget  his  well-informed  and 
prescient  telegrams  on  the  events  preceding  the 
Boxer  rising.  Lord  Curzon,  then  Under-Secretary 
for  Foreign  Affairs,  had  finally  to  confess  that  the 
Times  was  better  informed  than  the  Government. 
Medicine  seldom  leads  its  followers  to  fame  as 
journalists,  but  so  long  as  it  possesses  in  its  ranks 
men  of  the  type  of  Dr.  Morrison,  it  will  have  no 
cause  to  be  ashamed  of  its  performances  in  this 
respect. 

Moral  Imbecility. 

The  condition  to  which  the  term  moral  imbecility 
has  been  appUed  should  be  understood  and  recog- 
nised by  all  teachers  and  trainers  of  the  young, 
for  thus  only  can  its  unfortunate  subjects  be  pre- 


(•)  Annaii  t/ Surgery,  Avgtnt,  1001 


vented  from  disgracing  themselves  and  doing 
injury  to  others.  Medical  treatment  is  not  likely 
to  be  of  any  use,  but  an  early  diagnosis  may  be  the 
means  of  enabling  the  guardians  of  a  child  to  deal 
firmly  and  wisely  with  him.  A  shocking  case  of  a 
moral  imbecile  occurred  recently  in  America.  The- 
subject  was  a  sick  nurse,  aged  forty-five,  and  when 
she  was  finally  brought  to  book  it  was  found  that 
she  had  fatally  poisoned  some  twenty  people, 
besides  having  attempted  arson  on  several  occa- 
sions. Her  favourite  plan  was  to  administer  the 
lethal  drug  in  Hunyidi  J;lnos  water,  but  sometimes 
she  did  so  by  enema — always,  however,  so  com- 
bining the  poison  with  other  drugs  that  its  char- 
acteristic effects  were  masked.  She  was  not  the 
subject  of  any  delusions  or  fancied  injury,  but 
appeared  to  be  actuated  by  a  sheer  reckless  love  of 
destruction.  It  came  out  that  her  father  had  been 
eccentric  in  his  habits,  whilst  one  of  her  sisters  was 
a  chronic  dement  and  another  a  prostitute. 
She  herself  had  been  a  troublesome  child,  given 
to  l)dng  and  deceit,  and  though  entered  at  two* 
training  schools  as  a  nurse  she  had  been  dismissed 
from  both.  Her  lying  propensities  had  been 
recognised  at  these  institutions,  and  she  was 
regarded  as  untrustworthy  in  character  and 
pecuUar  in  manner.  Under  the  circumstances 
it  is  little  less  than  astonishing  that  she  should 
have  found  employment  as  a  private  nurse,  but 
such  was  the  case,  and  the  disastrous  result  already 
mentioned  followed.  At  her  trial  a  commission  of 
three  medical  men  was  appointed  to  inquire  into- 
the  state  of  her  mind,  and  they  had  no  difficulty 
in  finding  that  she  was  not  responsible  for  her 
actions.  She  was  removed  to  a  State  hospital  for 
care  and  restraint,  and  within  a  year  developed 
delusions  of  poisoning  and  hallucinations  of  hearing, 
accompanied  by  marked  impairment  of  initiative. 
That  a  woman  of  this  kind  should  have  been  allowed 
to  continue  for  years  in  the  enjoyment  of  public 
confidence  in  a  civilised  country  is  barely  credible, 
and  we  think  her  career  forms  an  argument  for  the- 
State  regulation  of  nurses,  both  in  this  country  and 
America,  although  under  any  S3rstem  the  difficulty 
of  detecting  the  early  stages  of  mental  disease  and 
irresponsibihty  would  obviously  remain. 


Beohterew*8  Reflex. 
A  NEW  reflex  promising  some  aid  in  the  diagnosis- 
of  lesions  of  the  spinal  cord  is  described  by  Bech- 
terew,  (a)  and  its  presence  and  significance  are 
corroborated  by  the  fact  that  they  have  been 
independently  discovered  and  described  by  another 
physician,  Mendel.  This  reflex  is  somewhat  analo- 
gous to  Babinski's,  and  can  sometimes  be  obtained 
when  the  latter  is  uncertain  or  altogether  absent. 
Bechterew's  sign  is  elicited  by  striking  lightly  over 
the  dorsum  of  the  foot  at  the  base  of  the  toes, 
when  immediate  flexion  of  the  digits  follows  in 
certain  pathological  conditions.  If  the  sign  is  well 
marked,  there  may  be  also  abduction  of  the  toes, 
but  the  essential  feature  is  the  flexion.  It  does^ 
not  occur  in  perfectly  healthy  persons,  but  only 
when  an  organic  lesion  of  the  pyramidal  tracts  oft 


(«)  Obo$renUPtychiattii,Jmie  1904. 


34Q    Th»  Medical  Peess. 


NOTES   ON   CURRENT   TOPICS. 


Sept.  28,  1904. 


the  cord  is  present,  so  that  its  significance  is  much 
the  same  as  that  of  Babinski's  sign.  In  some 
»cases  a  similar  reflex  can  be  eUcited,  according 
to  Bechterew,  in  the  hand,  percussion  over  the 
•carpo-metacarpal  joints  producing  flexion  of  the 
fingers.  While  the  difficulty  of  diagnosing  organic 
from  functional  diseases  of  the  nervous  system 
•continues  to  be  so  great,  one  is  thankful  for  every 
little  aid  in  cUnical  work,  and  if  the  new  reflex 
is  as  trustworthy  and  helpful  as  that  of  Babinski 
"has  proved  itself,  it  may  be  cordially  invited  to 
take  its  place  in  the  category  of  physical  signs. 


Antiseptio  Value  of  Iodoform. 
There  are  few  things   so    touching  in  recent 
practice  as  the  love  of  the  surgeon  for  iodoform. 
Far  from  being  repelled  by  its  odour  he  seems  to 
positively  revel  in  it,   and   as   to  reports  from 
bacteriologists  saying  that  it  is  neither  aseptic  in 
itself  nor  antiseptic  when  applied  to  wounds,  he 
continues  to  regard  such  assertions  as  calumnies 
upon  an  old  and  valued  friend.      Enterprising 
firms  bring  out  all  sorts  of  elegant  substitutes,  but 
the  surgeon  passes  them  by  unheedingly,  and  even 
occasional  cases  of    iodoform  poisoning  do  not 
deter  him  from  scattering  it  freely  on  the  next 
•wound  he  encounters.     After  all,  it  seems,  he  is 
right.     A  reassuring  paper  on  the  subject  has  been 
published  by  Heile  (a)  as  the  result  of  some  careful 
work  he  has  done  in  the  University  Laboratory 
at    Breslau.     He    found    that    iodoform    under 
favourable  conditions  is  broken  up  in  the  tissues, 
and  that  a  body  called  d*  iodacetyUden-^a  power- 
-ful  antiseptic — ^is  given  off.  But  for  this  action  to  be 
•brought  about  the  tissues  must  be  allowed  to  act 
'on  the  iodoform  in  the  absence  of  air,  when  if  the 
medium  be  alkaline  the  formation  of  di-iodacetyl- 
iden  goes  on  for  a  long  time.     Under  such  condi- 
tions an  antiseptic  value  far  higher  than  that  of 
•corrosive  subhmate  is  attained  by  this  new  body, 
and  thus  it  would  seem  that  for  once,  at  any  rate, 
the  clinical  instinct  of  the  surgeon  has  triumphed 
•over   the   theories  of  bacteriologists.     But  it   is 
important  to  notice  that  the  formation  of  di-iod- 
acetyliden  takes  place  only  anaerobically,and  there- 
fore the  sprinkling  of  open  wounds  with  iodoform 
would  not  seem  to  be  of  much  service.     On  the 
other  hand  Heile's  researches,  which  we  hope  may 
l>e  extended,  supply  a  rational  basis  for  the  use  of 
the  iodoform  gauze  plug  and  drain  to  deep  wounds, 
and  it  is  satisfactory  to  know  that  this  practice 
of  the  many  eminent  men  who  prefer  iodoform 
gauze  to  any  new  product  of  the  laboratory  is 
apparently  well  founded. 


Hie  Cell  and  Immunity. 
Ever  since  the  disappearance  of  the  old 
"*  exhaustion  theory "  of  immunity,  due  in  the 
first  instance  to  Pasteur,  two  rival  theories  have 
contested  the  fiekl,  and  it  is  only  in  these  days  that 
a  final  agreement  between  them  seems  possible. 
On  the  one  hand. there  were  those  who  held  with 
Metchnikoff  that  the  important  factor  in  immunity 

(a)  Arehiv ^..KUnUdie  Chirurffit,  Vol.  Ixzi.,  p.  787. 


was  the  leucocyte,  and  that  its  so-called  phago- 
cytic function  explained  the  facts  sufficiently.  0& 
tixe  other  hand,  Buchner  and,  in  general,  the 
German  school  held  to  a  "  humoral  theory," 
believing  that  the  protective  bodies  existed,  not  in 
the  cells,  but  in  the  fluids  of  the  body.  Opposite 
and  apparently  irreconcilable  as  these  two  views 
were,  Buchner  made  the  first  step  tovrards  uniting 
them  by  his  expression  of  opinion  in  1894,  that  the 
protective  bodies— or  alexins,  as  he  termed  them— 
although  found  in  the  fluids,  were  a  secretion  of  the 
leucocytes.  He  regarded  phagocytosis  as  of 
secondary  importance.  It,  however,  has  been 
stoutly  and  consistently  defended  by  JVCetchnikoff, 
and  although  at  one  time  most  inquirers  other 
than  those  immediately  influenced  by  him  had 
ceased  to  attach  much  importance  to  it,  it  seems  by 
the  latest  observations  to  have  undergone  a  certain 
reinstatement.  This  has  taken  place  as  a  result 
of  the  discovery  by  Wright  and  others  of  bodies 
called  **  opsonines,"  whose  presence  in  the 
serum  is  necessary  to  enable  leucocytes  to  exercise 
phagocytic  powers.  It  is  only,  then,  by  a  constant 
interaction  of  serum  and  cell  that  immunity  is 
possible.  On  the  one  hand,  the  antitoxic  and 
antibacterial  bodies  are  in  all  probability  secreted 
by  the  leucocytes  and  certain  of  the  body-cells, 
while  on  the  other,  the  phagocytic  activity  of  the 
cell  is  only  exercised  in  the  presence  of  certain 
bodies  supplied  by  the  serum. 


Private  Hospitals- 

One  of  the  most  noticeable  changes  in  medical 
practice  in  our  generation  is  the  sudden  and  great 
growth  of  private  hospitals.    There  is  no  doubt 
that  in  many  forms  of  disease  more  suitable  treat- 
ment and  greater  care  can  be  given  to  a  patient 
in  a  private  hospital  than  is  possible  in  his  own 
home.     In    surgical    cases,    for    instance,    where 
operations  are  to  be  performed,  they  can  be  done 
with  greater  safety  to  the  patient  and  much  greater 
convenience  to  the  surgeon  in  a  room  specially 
designed   and  kept  for   the  purpose    than  in  a 
hastily    fitted  bedroom  in  a  private  house.    On 
the  point  of  economy,    too,    the  private  hospital 
presents    obvious    advantages    ovqr    the    home. 
Instead  of  a  patient  requiring,  as  at  home,  the 
entire  services  of  one  or  two  nurses,  a  number  of 
patients  can  be  efficiently  attended  by  one  nurse. 
The  cooking  of  food,  too,  and  the  preparation  of 
invahd    necessaries  of  every  sort,  is  done  as  a 
matter  of  routine  by  those  who  are   accustomed 
to  it,  while  in  a  private  house  a  sick  person  can 
often  only  receive  due  attention  at  the  expense  of 
the  comfort  of  the  entire  household.     Considering 
the  many  advantages  on  the  side  of  the  private 
hospital  system  we  cannot  wonder  at  its  genera] 
adoption,  and  we  may  expect  a  still  further  exten- 
son  in  the  future.     With  this  increase,   however, 
there  will  be  considerable  need  of  caution  as  to  the 
management  of  many  of  the  nursing  homes  which 
are  likely  to  spring  up.     The  custom  which  obtains 
in  some  homes  at  present  of  providing  untrained 
women  as  nurses  is  strongly   to  be  deprecated. 


Sbpt.  28,  i904« 


NOTES    ON    CURRENT   TOPICS. 


The  Medical  Press.    341 


There  can  be  no  objection  to  employing  for  some 
period  of  their  probation  pupils  of  a  recognised 
training  school  in  order  to  habituate  them  to  the 
nature  of  private  practice,  but  there  is  every 
objection  to  the  permanent  employment  in  these 
homes  of  women  who  have  not  gone  through  a 
regular  course  of  training.  Medical  men  should 
be  very  careful  as  to  the  qualifications  of  the 
nurses  employed  in  the  private  hospitals  they 
patronise. 

Soap  Tincture  for  the  Hands. 
It  is  probably  true  that  success  in  sterilising 
the  hands  depends  rather  on  the  care  shown  by 
the  individual  surgeon  than  on  the  method  em- 
ployed. Nevertheless,  as  every  surgeon  wishes 
to  make  use  of  the  method  which  is  at  once  most 
efficacious  and  least  troublesome,  it  is  worth  while 
drawing  attention  to  the  rationale  of  the  action  of 
alcohoUc  soap,  which  has  been  found  successful  by 
many.  With  the  object  of  discovering  the  most 
serviceable  antiseptic,  Iverck'has  performed  a 
series  of  experiments  on  moulds,  and  he  believes 
that  the  best  effects  can  be  gained  by  a  combination 
of  watery  and  alcohohc  germicidal  solutions.  He 
finds  that  spores,  and  probably  bacteria,  may  be 
divided  into  two  classes.  The  one  kind  is  coated 
with  a  film  of  air,  and  is  thereby  protected  against 
any  watery  poison,  while  the  other,  being  coated 
with  a  mucous  or  gelatin  capsule,  is  impervious  to 
alcohol,  but  easily  reached  by  water.  The  first 
part  of  the  process  of  cleansing  should,  then, 
consist  in  the  application  of  an  alcohoUc  solution 
oi  soap,  which  effectively  removes  the  air  and 
emulsifies  the  fats  of  the  skin,  leaving  the  germs 
exposed.  Rinsing  in  watery  solution  will  then 
wash  away  or  destroy  the  germs  which  have 
escaped. 

The  Artificial  Production  of  Leuksemia. 

An  important  investigation  bearing  on  the 
etiology  of  leukaemia  was  brought  before  the  recent 
meeting  of  the  British  Medical  Association  by  Dr. 
Moorhead,  of  Dublin.  His  report  was  only  a  pre- 
liminary one,  and,  consequently,  tentative  conclu- 
sions are  alone  permissible,  but  it  is  not  too  much 
to  say  that  he  has  succeeded  in  producing  in  rabbits 
a  condition  bearing  many  resemblances  to  leukae- 
mia. Having  obtained  a  supply  of  lymph  glands 
fresh  from  a  fatal  case  of  lymphatic  leukaemia, 
several  extracts,  alcohohc,  glycerine,  and  saline, 
were  made.  Of  these  one  only,  the  saUne  extract, 
had  any  power.  On  infection  into  rabbits  a 
marked  fall  of  blood  pressure  took  place,  while 
continuous  injection  produced  distinct  changes  in 
the  blood-forming  tissues.  Controls  with  extracts 
of  normal  lymph-glands,  and  of  thymus  glands, 
were  constantly  negative.  The  principal  changes 
produced  by  the  leukaemia  extract,  which  were 
remarkably  similar  in  the  three  animals  treated, 
were  hyperplasia  of  the  lymph-glands  and  spleen, 
leucocytosis,  and  softening  and  other  changes  in 
the  bone  marrow.  The  probability  is  that  Dr. 
Moorhead  has  succeeded  in  obtaining  a  soluble 
toxin  of  leukaemia,  and  it  is  to  be  hoped  that 


further  experiment  on  the  same  Unes  may  succeed 
in  elucidating  the  causation  of  one  of  the  least 
understood  of  our  common  diseases. 


The  Management  of  Diphtheria  Suspects. 
In   spite  of  the  great  strides  which  sanitary^ 
science  has  made  during  the  last  couple  of  decades,, 
the  acute  exanthemata  do  not  seem  much  nearer 
extermination    than    formerly.     Their    virulence 
certainly  seems  to  have  undergone  some  modi- 
fication, and  that  is  the  only  noteworthy  change 
in    their   life-history.     It   is    a   matter   for   con- 
gratulation  that  the   medical   profession   are   at. 
last  awakening   to   the  futility  of   many  of   the 
methods   which   have   received   the   sanction    of 
authority  and  tradition  for  deahng  with  the  acute- 
specific    fevers.     The  valuable    papers    by  Drs. 
Biss,  Millard,  and  others    recently  published  in 
our     columns  have    aroused   an   interest   in  the 
question  which   is    the    inevitable    precursor    of 
a     thorough     and    systematic     inquiry.      There- 
is     one      disease  —  diphtheria  —  so      insidious- 
in  its  onset    that  its  presence   may  be  wholly 
unsuspected.     ^Vhen    this    affection    is    epidemic 
there  is  always  a  considerable  difficulty  in  deter- 
mining   the    true    clinical  diagnosis  in  doubtful 
cases,  and,  in  fact,  the  universal  practice  is  to* 
let  the  bacteriologist  decide  the  question.     Even 
when  the   report  is  in  the  negative,   cases  fre- 
quently occur  in  which  the  after-progress  shows 
that  the  disease  must  have  been  one  of    true 
diphtheria.     According  to  the  annual  report  of 
the    medical  officer  of   health  for  Bristol,   1,134 
cases  were  notified  as  diphtheria  (including  mem- 
branous croup)  during   1903.     Dr.  D.  S.  Davies 
pointei  out  the  great  significance  of  the  presence 
of  the  Hoffman  bacillus  in  the  nose  and  mouth 
of  children  who  have  been  in  direct  association 
with   cases   of   clinical   diphtheria,   and   he   con- 
siders that  such  scholars  act  as  "  carrier  "  cases. 
For   such   "suspects**  the   plan   of  opening  an 
out-patient   hospital,  where  the   necessary   local 
treatment   has   been    applied   by   skilled   nurses 
under   medical   supervision,  has   been   found   to- 
work  well.     In  this  manner  we  learn  that  a  more 
serious   local    outbreak   was    happily   prevented.. 


"BreathinfiT  out  Slaufirhter." 
If  it  be  true  that  "  many  a  true  word  is  uttered 
in  jest,*'  it  is  equally  certain  that  many  of  the 
quaintly-turned  phrases  and  poetical  ideas  of 
the  ancients  contained  such  germs  of  truth  as 
to  place  them  on  the  level  of  prophecies.  The 
expression,  "  breathing  out  slaughter,"  stripped 
of  its  poetic  imagery  and  read  in  the  light  of 
modem  bacteriology,  becomes  transformed  into 
a  bald  statement  of  scientific  fact.  In  other 
words,  we  are  beginning  to  learn  that  the  act 
of  respiration  is  not  quite  so  innocent  as  was- 
formerly  supposed,  and  that  the  air  around  us. 
may  be  contajninated  to  a  considerable  degree 
by  the  organisms  exhaled  in  the  breath  o!  everj'^ 
individual.  Many  of  these  bacteria  are  normal 
inhabitants  of  the  mouth,  and  are  non-patho- 
genic, but  others  may  be  the  germs  of  specific 


342     The  Medical  Press. 


PERSONAL. 


Sept.  28,  1904. 


<<iisease.  With  regard  to  the  tubercle  bacillus, 
the  latest  researches  appear  to  show  that  the 
number  of  bacilli  ejected  in  this  manner  in  ordi- 
nary quiet  respiration  is  so  smaU  that  it  may  be  dis- 
regarded, whereas  the  act  of  coughing  is  accom- 
panied with  danger  to  all  around.  The  report 
recently  issued  by  the  Local  Government  Board 
•devotes  considerable  space  to  the  investigations 
undertaken  by  Dr.  Mervyn  Gordon  into  the 
•contamination  of  air  by  various  respiratory  acts, 
such  as  coughing,  singing  and  speaking.  It  has 
thus  been  ascertained  that  bacilli  and  strepto- 
cocci are  capable  of  being  wafted  to  as  great  a 
distance  as  forty  feet  in  front  of  a  speaker,  and 
the  experiments  of  Nenninger  are  quoted  to 
the  effect  that  the  B.  prodigiosus  may  penetrate 
.as  far  as  the  smaller  bronchi  of  animals  made  to 
inhale  the  spray  of  an  emulsion  of  this  organism. 
This  new  phase  of  air-borne  infection  is  worthy 
-of  consideration  by  those  who  have  the  interest 
•of  preventive  medicine  at  heart. 


seven  teachers  of  provincial  medical  schools  (fists 
on  the  table),  fifty  M.D.'s  from  various  parts  of 
France,  and  probably  about  thirty  or  forty  in- 
temes,  also  that  the  party  will  be  accompanied 
by  twelve  ladies.  A  number  of  hospitals  and 
laboratories  will  be  visited,  as  well  as  various 
workhouse  infirmaries  and  Metropolitan  Asylums 
Board  hospitals.  The  entertainments  include 
a  luncheon  provided  by  the  Lancet,  and  a  dinner 
held  on  October  12  at  the  Hotel  Cecil. 


The  Incorporated  Medical  Practitioners' 
ABSociation  and  the  Midwives  Act. 

The  Council  of  the  above  body  has  at  a  recent 
meeting  passed  the  following  resolution  regarding 
the  action  xA  the  Central  Midwives'  Board  in 
deciding  to  appoint  unqualified  women  as 
examiners  for  the  certificate  of  the  Board  : — "That 
we,  the  Coimcil  of  the  Incorporated  Medical  Prac- 
titioners* Association,  at  this  our  first  meeting  since 
the  vacation,  desire  to  place  on  record  our  protest 
against  the  action  of  the  Central  Midwives*  Board 
in  deciding  to  appoint  as  examiners  for  the  certifi- 
cate of  the  Board  non-medical  women,  thereby 
raising  to  tbe  level  of  the  duly  registered  medicsil 
practitioner,  who  has  undergone  an  expensive 
•course  of  study  and  a  searching  examination,  women 
ivho  are  not  required  to  show  proof  that  they  possess 
any  knowledge  of  the  different  subjects  which  a 
medical  practitioner  has  to  study  in  order  to  obtain 
a  diploma."  We  thoroughly  sympathise  with  this 
resolution  and  trust  that  other  medical  bodies 
in  England  and  Wales  will  come  forward  and  make 
a  similar  protest.  The  actions  of  the  Central 
Mlidwives'  Board  since  it  commenced  its  existence 
have  been  in  many  instances  apparently  dictated 
by  a  spirit  of  opposition  to  the  medical  profession, 
and  we  regret  to  say  that  certain  of  the  medical 
members  of  the  Board  have  not  made  the  firm 
stand  against  such  actions  that  might  have  been 
reasonably  expected. 


The  forthcoming  visit  of  French  physicians  and 
surgeons  to  London  will  take  place  from  October 
loth  to  1 2th.  It  expresses  in  a  particular  form 
the  general  spirit  of  the  entente  cordiale  between 
British  and  French  citizens,  and  is  therefore  de- 
serving of  -every  encouragement  at  the  hands  of 
"SO  loyal  a  body  of  citizens  as  the  members  of  the 
medical  profession.  It  is  announced  that  the 
chairman  of  the  Paris  committee  has  written, 
stating  that  his  party  would  probably  include 
about  fifteen  professors  of  the  Faculty  de  Paris, 
Hiirty  physicians  and  surgeons  of  Paris  hospitals, 


PERSONAL. 
Inspector-General  Duncan  Hilston,  M.D.,  C.B-, 
has  been  appointed  Honorary  Physician  to  the  King, 
in  place  of  Inspector-General  D.  McEwan,  deceased 
Dr.  Hilston,  who  joined  the  service  in  May,  i860,  and 
retired  in  1897,  has  seen  active  service  in  New  Zealand 
when  he  was  mentioned  in  despatches. 

The  address  at  the  opening  of  the  Medical  Faculty 
of  the  University  of  Birmingham  will  be  delivered 
by  Dr.  P.  H.  Pye-Smith  on  October  ?rd. 


Dr.  J.  N.  McDouGALL,  of  Coldingham.  Berwick- 
shire, was  recently  presented  with  a  brougham  bj 
friends  and  patients. 

The  opening  address  of  the  West  London  Post- 
Graduate  College  will  be  delivered  on  Thux^day. 
October  13th,  by  the  Bishop  of  Oxford. 

Mr.  C.  M.  Tuke  is  the  President  for  1904-05  of  the 
West  London  Medico-Chirurgical  Society. 

Dr.  Graham  Buck  has  been  appointed  acting 
Resident  Magistrate  in  charge  of  the  Broome  District, 
West  Australia,  and  Chairman  of  the  Broome  Quarter 
Sessions. 


Any  medical  man  resident  in  London  who  wishes 
to  attend  the  dinner  at  the  Hotel  Cecil,  to  be  given  to 
the  French  physicians  and  surgeons  on  October  12th. 
should  communicate  with  one  of  the  Honorary  Secre- 
taries, Dr.Dawson  Williams  or  Dr.  W.  Jobson  Home. 


Dr.  Leith  Napier,  of  Adelaide,  formerly  one  of  the 
staff  of  the  Chelsea  Hospital  for  Women,  has  brought 
an  action  against  the  Government  to  recover  ;£6,5O0 
damages  for  fracture  of  the  base  of  the  skull  sustained 
from  a  fall  from  a  horse  whilst  serving  on  a  contingent 
about  to  be  dispatched  to  South  Africa. 

On  the  occasion  of  their  golden  wedding.  Dr.  and 
Mrs.  Latimer  Parke,  of  Tideswell,  Derbyshire,  were 
last  week  presented  with  a  handsome  testimonial  by 
residents  of  the  Peak  district,  where  Dr.  Parke  has 
been  in  practice  for  fifty-four  years. 


The  exhibition  of  the  Institution  of  Hygiene  in 
London  will  be  opened  by  Sir  Joseph  Fayrer,  K.C.S.I., 
on  Friday  next. 


H.  M.  THE  King  has  been  graciously  pleased  to 
confer  the  Volunteer  Officers'  Decoration  upon  the 
undermentioned  officers  of  the  Volunteer  Force,  who 
have  been  duly  recommended  for  the  same  under  the 
terms  of  the  Royal  Warrant,  dated  July  28th,  1892  :— 
Surgeon-Major  A.  Lugard,  3rd  Middlesex  R.G.A. ; 
Brigade-Surgeon  Lieut.-Colonel  W.  D.  Waterhouse. 
4th  V.B.  Royal  Fusiliers ;  Surgeon-Major  £.  Haydon. 
M.D.,Hay  Tor  V.B.  Devonshire  Regiment;  Surgeon- 
Lieut. -Colonel  F.  K.  Pigott,  ist  V.B.  the  King's 
Shropshire  Light  Infantry ;  Surgeon-Major  J.  G. 
Saville  (retired),  V.B.  Manchester  Regiment ;  Surgeon- 
Major  W.  L.  Stewart,  M.D.,  ist  Banff  R.G.A.  ;  Surgeon- 
Major  R.  Kerk.  M.D.,  8  th  V.B.  Royal  Scots  ;  Brigade- 
Surgeon  Lieut.-Colonel  F.  H.  Appleby.  5th  Notts 
V.B.  the  Sherwood  Foresters. 


Sept.  28.  1904- 


CORRESPONDENCE. 


The  Medical  Press.    343 


Spectal  (£otre0pon&ence* 

[from  our  own   correspondents.] 

SCOTLAND. 
New  Hospitals  in  Glasgow.— The  hospital  equip- 
ment of  Glasgow  has  received  an  iinP^tao^?,^^i*'?^ 
bv  the  opening  of  the  new  buildings  at  Hobhill.  i>ulce 
Street,  arid  Oakbank,  which  have  been  in  course  of 
erection  for  nearly  four  years.     The  buildings  have 
been  constructed  bv  the  Parish  Council  at  a  cost  of 
nearly  half  a  mUlion.  with  the  object  of  treating  the 
sick  and  infirm  poor  separately  from  other  paupers. 
The  Hobhill  Hospital  has  grounds  to  the  extent  ot 
fifty-four   acres,   and   is   designed   for   the  accommo- 
dation of  1.600  patients— the  infirm  poor,  and  children. 
The    blocks    containing    the    fourteen    medical    and 
surgical  wards  are  built  in  two  storeys  each  ;  the  wards 
accommodate  twenty-six  patients  in  the  main  ward, 
and  have  side  rooms  for  one  or  two  beds  m  addition. 
There  are  also  four  two-storey  blocks  for  the  aged  and 
infirm,    isolation   blocks  containing   four   bed   wards, 
and  a  children's  section  consisting  of  thirteen  two- 
storey  blocks,  a  school,  and  a  building  to  accommodate 
100  chUdren  likely  to  be  in  residence  only  a  short  time. 
Ample  administrative  buildings  have  also  been  pro- 
vided.    The  Eastern  District  Hospital  m  Duke  Street 
has  accommodation  for  200  patients,  while  provision 
has  also  been  made  for  the  treatment  of  about  fifty 
mental  cases.     There  are  besides  wards  for  medical, 
surgical,   skin,  and  obstetric  cases,  isolation  and  ob- 
servation   wards,    an    operatmg    theatre,    mortuary, 
post-mortem  room,  and  pathological  laboratory.    One 
special  feature  has  been  introduced— the  radiation  of 
wards  from  a  common  centre  with  the  object,  rendered 
necessary   by  the  restricted  space  at   the  architects 
disposal,    of    economismg    the    ground    occupied    by 
corridors  and  staircases.     The  Western  District  Hos- 
pital comprises  eight  blocks,  affording  accommodation 
for    200  patients,  and  including  administrative  block 
and  surgical,  medical,  maternity,  and  skin  pavihons. 
Throughout  the  buUdings  there  has  been  no  attempt 
at  ornament  or  decoration  and  the  fumishmg  is  of  the 
plainest  and  simplest  description.     The  poUcy  of  the 
Council  has  been,  and  wisely,  to  obtain  the  largest 
amount  of  accommodation  at  the  smaUest  cost,  along 
with  all  the  most  modem  improvements  and  apphances 
lor  the  benefit  of  the  patients.     The  buUdmgs  were 
formally  opened  by  Mr.  George  Dolt,  chairman  of  the 
CouncU,   on  September  15  th,  and  after   the  ceremony 
the  party  proceeded  to  Woodilee  Asylum,  another  of 
the    Councirs    undertakings,    to    inaugurate    a    new 
nurses*  home,  which  has  been  necessitated  by  the  in- 
creased number  of  nurses  resulting  from    the    intro- 
duction of  female  nursing  into  the  male  wards,  and 
the  handing  over  of  the  complete  management  of  the 
sanatoria  to  women  nurses. 

BELFAST. 
Small- POX  in  Ulster.— The  outbreak  of  smaU-pox 
seems  to  be  about  at  an  end  in  Ulster.  Durmg  the  past 
week  no  new  case  has  occurred  except  one  in  Monaghan, 
and  as  that  was  in  a  suspected  family  who  had  been 
under  observation,  and  was  at  once  isolated,  it  is  not 
likely  to  be  foUowed  by  others.  The  local  authorities 
are  now  engaged  in  paying  the  bills  incurred  during 
the  outbreak,  not  the  least  of  which  are  those  for 
vaccmation,  and  from  the  remarks  made  at  various 
pubUc  boards  it  is  clear  that  if  the  payment  of  vacci- 
nation fees  was  not  provided  for  by  Act  of  Parhament 
the  medical  profession  would  fare  badly. 

The  Use  of  Salicylic  Acid.— An  interesting  case 
came  before  the  Recorder  of  Belfast  last  week,  m  which 
the  question  at  issue  was  the  harmlessness  or  otherwise 
of  the  addition  of  salicylic  acid  to  ginger  wine,  to  the 
extent  of  7*2  grains  per  pint.  There  was  a  great 
array  of  medical  evidence,  but,  unfortunately,  it  was 
of  that  contradictory  character  which  gives  some 
excuse  for  the  layman  to  scofi^.  The  city  analyst  said 
that  he  believed  saUcylic  acid  to  be  a  dangerous  drug, 
which  should  «only  be  used  under  medical  advice.     Dr. 


Henry  O'Neill  said  that  the  ordinary  dose  was  5  to  20 
grains,  and  above  this  was  dangerous.  He  gave  a* 
vivid  picture  of  the  state  of  collapse  that  might  follow 
too  large  a  dose.  It  was  specially  dangerous  to  persons 
sufiering  from  diseases  of  the  heart,  liver,  or  kidneys, 
and  in  such  its  continued  use  might  be  followed  by 
death.  Dr.  S.  B.  Coates  agreed  with  Dr.  O'Neill, 
and  said  he  would  not  allow  the  smallest  quantity  of 
the  drug  to  be  used  as  a  preservative  in  food.  Dr. 
Torrens  also  corroborated  this  view,  but  went  even 
further,  for  he  stated  that  he  had  once  been  nearly 
killed  by  salicylic  acid  when  he  had  rheumatic  fever, 
and  had  never  prescribed  it  since.  Sir  William 
Whitla  said  that  though  the  B.  P.  dose  was  5  to  20 
grains,  more  was  often  given,  frequently  even  as  much 
as  120  grains  a  day.  This  would  represent  the 
amount  contained  in  two  gallons  of  the  ginger  wine, 
and  the  sugar  in  the  same  quantity,  nearly  half  a  stone, 
would,  in  his  opinion,  do  more  harm  than  the  sali- 
cylic acid.  The  amount  contained  in  the  wine  he 
considered  absolutely  harmless.  All  the  bad  effects 
described  by  the  other  witnesses  were  due  to  impurities 
in  the  drug,  which  used  to  be  found  almost  constantly, 
but  were  absent  now  that  better  methods  of  prepara- 
tion were  employed.  Dr.  A.  Montgomery  was  also 
examined,  and  expressed  liis  agreement  with  Sir 
William  Whitla.  In  summing  up  the  Recorder  said 
that  if  the  drug  was  not  necessary  it  should  not  be 
introduced  into  the  wine,  and  if  it  were  harmful  it 
should  not  be  introduced.  As  ginger  wine  had  been 
used  long  before  salicylic  acid  had  come  into  use,  and 
there  was  no  evidence  that  it  was  better  now  than  then, 
he  was  bound  to  conclude  that  it  was  not  necessary, 
and  therefore  should  not  be  introduced.  It  appears 
from  this  decision  that  the  Recorder  avoided  giving 
any  opinion  on  the  question  of  the  harmfulness  or 
otherwise  of  the  drug.  We  are  not  aware  of  any 
medical  man  who  has  a  special  weakness  for  gmger  wine, 
but  if  any  of  us  had,  we  should  probably  prefer  it 
without  the  salicylic  acid,  so  see  no  reason  to  regret 
the  decision. 

Corredpondence* 

[We  do  not  hold  ounelvei  reaponaible  for  the  opinions  of  <mr 
Oorrespondenta.  ] 

THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — ^Viewing  this  subject  mainly  from  the  same 
standpoint  as  Mr.  L.  W.  Hudson,  I  agree  with  him 
that  the  discussion  has  been  somewhat  disappointing. 
It  is  especially  disappointing  to  find  Dr.  Drysdale  ap- 
parently retiring  after  contributing  a  letter  full  of 
controversial  points  and  containing  at  least  one 
dogmatic  statement  of  the  most  questionable  character. 
Dr.  Drysdade  has  done  more  than  any  living  English- 
man to  bring  into  practice  the  theoretical  views  he 
holds.  Since  the  days  of  Mr.  Bradlaugh  and  Mrs. 
Besant,  whose  colleague  he  was  in  the  propaganda 
to  which  they  devoted  much  of  their  lives.  Dr.  Drysdale 
has,  if  I  mistake  not.  assumed  the  position  of  pro- 
tagonist in  this  particular  cult.  Judging  from  his 
utterances  he  is  probably  proud  to  feel  that  thousands 
of  married  couples  are  acting  upon  the  advice  which 
he  has  persistently  urged  upon  them.  In  some  cases 
it  is  possible  parents  may  be  fully  justified  in  limiting 
the  number  of  their  offspring ;  the  danger  lies  in  the 
creation  of  an  overmastering  sentiment  of  egoism 
throughout  the  nation,  which  may  lead  to  what  is 
practically  race-suicide.  It  is  in  the  influence  upon 
a  nation  as  a  whole  that  I  am  most  interested.  Of 
this  influence,  when  Dr.  Drysdale' s  ideas  are  carried 
to  their  logical  conclusion,  we  have  a  plain  object- 
lesson  in  France.  In  view  of  this  lesson.  Dr.  Drysdale 
has  the  hardihood  to  express  the  opinion  that  "  Econo- 
mically it  is  out  of  the  question  for  the  people  of  any 
European  State  like  ours  to  think  of  having  large 
families  with  impunity."  Is  he  not  bound  to  establish 
the  truth  of  this  statement  by  an  examination  of  the 


344    The  Medical  Press. 


LITERATURE. 


Sept.  28.  1904. 


'  economical  position  of  France  in  relation  to  the  popu- 
lation question  ?  France,  with  the  most  fertile  soil — 
a  soil  capable  of  supporting  many  more  millions  than 
at  present  subsist  upon  it — the  most  magnificent 
climate,  and  the  most  intelligent  populace  of  Europe, 
has  not  enough  men  for  her  home  requirements. 
Her  numbers  are  only  kept  partly  up  by  immigration 
of  Italians,  Swiss,  and  Germans.  She  cannot  spare, 
and  virtually  does  not  send,  any  emigrants  to  occupy 
and  develop  the  vast  possessions  mis-named  colonies — 
even  to  beautiful  Algeria  close  to  her  shores — which 
she  has  acquired  mostly  within  late  years,  so  that 
these  form  in  great  part  a  useless  burden,  expense, 
and  source  of  weakness  to  the  State.  France  is 
already  one-third  less  in  population  than  Germany, 
and  the  disparity  is  rapidly  increasing,  so  that  re- 
sumption of  her  once  dominant  position  in  Europe 
seems  for  ever  hopeless.  It  is  not  prudence  alone 
which  guides  the  modem  French  parent,  but  rather 
the  narrowest  form  of  anti-social  egoism — the  egoism 
which  sacrifices  everything  in  pursuit  of  ease  and 
pleasure,  and  regards  toil  and  self-abnegation  as  the 
sources  merely  of  pain  and  unhappiness.  These 
ideas  are  inculcated  into  the  children — ^who  among  the 
well-to-do  and  wealthy  are  almost  invariably  guarded 
from  the  stress  and  fight  in  life,  without  which  fine 
character  can  rarely  be  evolved.  France  is  a  dying 
nation  through  shrinkage  of  population,  and  she 
presents  besides  glaring  signs  of  moral  decay.  These 
evils  are  only  to  be  cured  by  abandonment  of  the 
vices  of  civilisation  and  a  return  to  those  more  primi- 
tive, natural,  and  simpler  customs  which  Dr.  Drysdaleis 
doing  his  best  to  banish  from  his  own  land. 
I  am.  Sir,  yours  truly, 

A  Student  of  Sociology. 
September  22nd,  1904. 


THE    LUNACY    QUESTION. 
To  the  Editor  of  The  Medical  Press  and  Circular.  I 

Sir, — Some  years  ago  I  was  dining  with  the  late 
Dr.  Forbes  Winslow  in  Manchester  Square,  when  more 
than  forty  guests  were  present,  and  naturally  the 
subject  of  insanity  was  discussed  after  dinner.  The 
discussion  assumed  a  very  amusing  character.  Three 
pretty  well-known  men  seemed  to  have  put  their 
heads  together  in  a  sportive  mood— namely.  Dr.  Rad- 
cliffe.  Dr.  Clark,  of  the  Lancet,  and  Mr.  Ernest  Hart. 
They  were  sittng  nearly  opposite  to  our  hospitdible 
host,  and  they  seemed  to  be  intent  on  provoking  him 
by  questions  for  the  entertainment  of  the  table.  It 
ended  in  their  doing  this  to  such  an  extent  as  to  make 
Dr.  Winslow  declare  that  in  his  opinion  nearly  all 
the  world  was  insane.  Of  course,  if  that  is  really 
the  view  of  any  specialist  in  insanity,  and  if  it  is  a 
correct  view,  we  must  find  it  rather  difficult  to  know 
when  to  certify  and  how  to  deal  with  this  subject 
in  a  moral  and  legal  spirit.  Professionally,  however, 
I  think  we  shall  agree  that  when  we  have  to  do  with 
a  patient  whose  mind  is  diseased  and  who,  in  our 
opinion,  is  not  capable  of  taking  care  of  himself  and 
may  be  dangerous  to  others,  we  ought,  morally  and 
professionally,  to  be  careful  and  in  no  way  be  parties 
to  any  transactions  which  will  not  bear  the  just  and 
proper  criticism  of  an  independent  and  capable  law^-er, 
or  of  a  jury  of  good  men. 

I  am,  Sir,  yours  truly, 

Robert  Lee. 

September  22nd,  1904. 


Xfterature* 


PATENT  FOODS  AND  PATENT  MEDICINES,  {a) 
This  little  book  is  composed   of  reprints  of  two 


fc)  "  Pfttent  Foods  and  Patent  Medidoes.'*  Two  I/ectarcfl  bjr 
Robert  Hatohison,  M.  D.  F.R.C.P.  London :  John  Bale,  Sons,  and 
Danielason,  Ltd.  1904.    Pp.45.    I8.net. 


lectures  given  by  Dr.  Hutchison,  that  on  Patent  Foods. 
being  delivered  before  the  South- West  London  Medica] 
Society,  the  second  being  addressed  to  the  students 
of  the  London  Hospital.  In  the  discourse  on  "  Patent 
Foods,''  the  author  ingeniously  defines  a  patent  food 
as  "  a  substance  which  is  manufactured  by  artificial 
means  from  natural  food  products,  and  which  is 
intended  to  be  used  as  a  substitute  for  ordinary  natural 
foods,  and  ....  such  foods  are  usually  sold  by 
pharmacists  instead  of  being  procurable  from  the 
ordinary  dealers  in  common  food."  Dr.  Hutchison 
then  deals  with  the  scientific  considerations  which 
might  justify  the  manufacture  of  patent  foods.  Briefly, 
these  are  :  where  the  patient  has  no  relish  for  ordinary 
food,  where  difficulty  in  chewing  or  swallowing  is 
experienced,  when  there  is  a  necessity  for  predigested 
foods,  where  the  physician  desires  to  increase  the 
amount  of  any  particular  ingredient  in  the  diet, 
&G.  Almost  every  artificial  food  in  the  market  fails 
to  meet  the  requirement  of  being  reasonable  in  price, 
in  comparison  to  the  amount  of  nourishment  obtained. 

Dr.  Hutchison  says,  **  the  majority  of  artificial 
foods  do  not  correspond  to  any  one  of  those  qualifica- 
tions I  have  set  out."  He  goes  on  to  show  where  they 
fail,  and  explains  how  even  those  that  may  be  valuable 
because  they  contain  certain  desired  constituents 
are  very  much  more  expensive  and  are  no  more 
satisfactory  than  certain  ordinary  foods  or  preparations 
that  are  not  proprietary.  For  example,  honey  is 
much  cheaper  than  extracts  of  malt,  and  contains 
wholly  digested  sugar,  while  that  of  the  latter  pre- 
paration is  only  partially  digested.  He  also  shows 
how  seldom  there  is  any  necessity  for  predigested 
foods.  Cod-liver  oil  emulsion,  petroleum  emulsioD 
and  pancreatic  emulsion  are  shown  to  be  practically 
unnecessary ;  the  place  for  beef  extracts  is  shown  to- 
be  in  the  kitchen,  and  not  in  the  sick  room.  Peptone 
preparations,  beef  juices,  and  many  other  foods  are 
examined,  and  finally  four  pages  are  devoted  to- 
showing  the  composition  of  infants'  foods. 

The  second  lecture,  one  delivered  to  the  students  at 
the  London  Hospital,  ought  to  be    read  extensively 
both  by  the  medical  profession  and  the  general  public. 
Its  phraseology  is  such  that  the  latter  class  can  appre- 
ciate it  as  well  as  the  medical  man.     Comparatively 
few  people  do  not  have  recourse  to  patent  medicines 
in  one  form  or  another,  and  we  are  immensely  in- 
debted to  Dr.  Hutchison  for  calling  attention  to  this 
important    subject.     People    who    have    never    had 
occasion  to  analyse  even  qualitatively  a  mixture  of 
three   or  four   drugs   (not  necessarily    official    in    the 
British    Pharmacopoeia)    can    have    no    idea    of    the 
immense  amount  of  labour  which  the  three  pages  of 
analyses  of  proprietary  medicines  given  on  pp.  36-3^ 
must  have  entailed,  and  although  Dr.  Hutchison  may 
have   missed    one    or    two   unimportant    ingredients, 
the  results  are  ample  to  show  how  little  justification 
manufacturers    of    these    "  quack "     remedies    ha\'e 
for  their  glowing  advertisements.     Many  are  palpable 
frauds,  others  are  mixtures  of  drugs  that  are  commonly 
prescribed,  and  some  are  ordinary  household  remedies- 
hidden  by  colouring  matters,  «S:c.     With  characteristic 
generosity    Dr.   Hutchison   admits    that   the   makers, 
sometimes    recognise    that    drugs    which  have  fallen 
into  disuse  among  medical  men  are  still  very  valuable, 
but    these  are  the   exceptions.     Obesity  preparations 
and  drink  cures  are  considered,  as  well  as  liver  pills 
and  cough  mixtures,  and  some  very  sensible  obser- 
vations are  made  on  the  ethics  of  patent  medicines, 
and  finally  Dr.  Hutchison  shows  how  quackery  may 
be  fought.     He  very  justly  remarks  that  the  crusade 
against    quackery    ought    to    be    undertaken    by   an 
official  body,  and  not  be  left  to  the  initiative  of  private 
individuals.     We  congratulate  Dr.  Hutchison  on  the 
able  way  in  which   he   has  striven  to  bring  home  to 
the  medical  profession  the  fact  that  they  can  all  help 
in  lessening  the  power  of  the  patent  medicine  proprietor 
over  the  general  public,  and  we  hope  that  these  papers 
will  receive    the    moral  and  practical  support  of  the 
profession. 


Sept.  28,  1904. 


LITERATURE. 


Ti^B  Medical  Press.    345 


CLINICAL  HANDBOOK  OF  URINE  ANALYSIS,  (a) 

As  the  author  remarks  in  his  preface,  this  is  an 
attempt  "  to  place  before  the  clinical  student  and 
medical  practitioner  the  essentisds  of  clinical  urine 
analjrsis  in  a  brief,  simple,  and  convenient  form. 

"  The  methods  described  are,  as  a  rule,  those  which 
have  been  most  fully  studied,  and  which  are  at  present 
considered  the  most  suitable  for  clinical  requirements." 

The  opening  chapter  is  entitled  "  Collection  for 
Analysis,"  where  valuable  hints  are  given  as  to  the 
best  means  and  conditions  of  taking  samples  for  the 
difFerent  examinations  and  the  author  gives  the  student 
the  benefit  of  his  experience  in  the  preservation  of 
urine  during  the  time  that  elapses  between  micturition 
and  analysis.  Then  follows  a  "  Scheme  of  Urine 
Analjrsis,"  and  the  remainder  of  the  book  is  divided 
into  two  parts  :  Qualitative  Examination  and  Quanti- 
tative Miethods.  In  the  chapters  on  "  Physical 
Examination,"  the  author  discusses  the  causes  and 
significance  of  variations  in  quantity,  colour,  odour, 
reaction,  specific  gravity,  transparency  and  the  deposit 
in  a  most  able  and  satisfactory  manner.  A  considera- 
tion of  the  deposit  occupies  pp.  24-49,  t>ut  we  should 
have  liked  to  see  the  use  of  such  a  stain  as  Jenner's 
blood  stain  recommended  as  being  of  considerable 
assistance  to  the  beginner  in  facilitating  the  detection 
of  leucocytes,  epithelial  cells,  and  other  objects  likely 
to  be  present  in  the  organised  deposit.  Such  a  stain  is,  of 
course,  superfluous  after  the  operator  has  had  much 
experience  in  the  microscopical  examination  of  the 
sediment. 

Four  pages  are  devoted  to  the  detection  of  the 
gonococcus  and  the  bacillus  tuberculosis,  but  it  would 
have  been  well  to  add  that  the  gonococcus  does  not 
grow  readily  on  gelatine,  and  for  the  information  of  the 
operator  a  list  of  the  other  organisms  found  in  the 
urethra  and  vagina  of  healthy  persons,  which  resemble 
the  gonococcus,  should  be  given  to  impress  on  the 
student  the  great  care  necessary  before  it  is  advisable 
to  give  an  opinion  regarding  the  presence  of  the  gono- 
coccus. Still,  the  author  lays  stress  on  th  e  necessy 
of  using  Gram's  method  of  staining,  and  the  presence 
of  the  orjganism  wiihin  the  pus  cells,  and  after  a  little 
practice  it  would  be  impossible  for  anyone  to  go  wrong 
if  he  follows  the  instructions  given.  In  the  figure  of 
gonococci  (Fig.  2,  Plate  III.)  the  organisms  are  repre- 
sented as  if  they  were  stained  by  Gram  and  the  pre- 
paration counter-stained  with  eosin.  Probably  the 
figure  is  taken  from  a  preparation  stained  with  some 
blood  stain,  but  in  order  to  avoid  possible  errors  due 
to  the  seeming  contradiction  of  letterpress  and  figure, 
the  colouring  of  this  plate  should  be  altered  in  the 
next  edition.  In  the  footnote  on  p.  35,  the  strength  of 
solution  of  caustic  potash  used  in  the  preparation  of 
L6ffler*s  alkaline  methylene  blue  is  given  as  10  per  cent. 
This  is  obviously  a  misprint  for  o'oi  per  cent.  Both  in 
the  case  of  the  gonococcus  and  the  tubercle  bacillus,  it  is 
always  advisable — indeed,  most  people  consider  it  a 
necessity — to  *'  fix  "  the  film  preparation  by  passing 
it  three  tidies  through  the  flame.  The  "  Qualitative 
Chemical  Examination  "  is  well  written,  and  we  heartily 
endorse  Dr.  Bedford's  recommendation  that  in  testing 
for  albumin,  the  heat,  nitric  acid,  and  picric  acid  tests 
should  all  be  employed.  There  can  be  no  doubt  that 
traces  of  albumin  are  frequently  missed  because  of 
the  slovenly  way  in  which  students  and  others  test 
for  it. 

Part  II  deals  with  quantitative  methods,  and  here 
the  author  has  to  describe  volumetric  methods  in 
preference  to  gravimetric,  owing  to  the  latter  requiring 
an  accurate  chemical  balance.  He,  however,  makes 
a  very  wise  choice  of  the  numerous  volumetric  methods 
that  are  in  use,  but  we  might  point  out  that  in  the 
estimation  of  glucose  by  Pavy's  method  it  is  advisable 
to  dilute  the  urine  with  dilute  ammonia,  as  this  greatly 
lessens  the  risk  of  the  precipitation  of  cuprous  oxide. 
Three  pages  are  devoted  to  calculi,  and  there  is  a 


^(a)"A  Clipical  Handbook  of  Urine  Analysia."  By  Oharles  H. 
Bedford,  D.Sc.,  ILD.Edin.  With  iUnstrations,  10  plates,  and  three 
App*ndiot8.  Seoond  Edition.  Pp.  172^  Edinbursfa:  Bell  and 
Bndfate.    1904. 


chapter  on  "  Cryoscopy  "  and  "  Drug  Tests  of  ReiiaF 
Excretory  Power."  The  book  closes  with  three 
Appendices  and  ten  plates  ;  the  latter  are  unusually^ 
well  produced,  the  exception  being  that  of  gonococci^ 
in  pus  cells,  mentioned  above,  and  the  plate  of  tubercle- 
bacillus,  which  would  not  be  of  much  use  to  a  practi- 
tioner who  was  unacquainted  with  the  organism. 

MILK :    ITS  PRODUCTIONS  AND  USES,  (a) 

Dr.  WiLLOtiGHBY  is  well    known  in   the  scientific 
world  and  as  the  contributor  of  the  article  on  milk  for- 
the  "Encyclopaedia    Medica,"  and  his  experience    is 
such  as  to  commend  the    book  now  under  considera- 
tion  to   the  notice  of    all    interested   in  milk.     We- 
consider  that  he  is  somewhat  erring  on  the  side  of 
modesty   in   considering    that   his   work   will   chiefly 
interest  medical  officers  and  "  gentlemen  in  the  country 
who  engage  in  dairy  work,"  for  it  contains  matter 
which,  though  not  strictly  analytical,  will  be  of  value- 
to  analysts,  and  though  not  professing  to  be  a  farmer's 
manual,  it  will  appeal  to  that  class  owing  to  the  useful' 
information  that  it  cpntainis  on    the  breeds  of    cows 
and  their  relative  values  from  a  milk  production  point 
of  view. 

Finally,  there  is  another  class  of  men  to  whom  this 
book  will  be  exceedingly  welcome — namely,  sanitary 
inspectors.  These  men  have  not  merely  to  assist  in 
the  carrying  out  of  the  Foods  and  Drugs  Acts,  by 
taking  samples  for  analysis,  but  have  to  assist  the 
medical  officers  in  tracing  the  cause  of  outbreaks  of 
disease  communicated  by  milk,  and  in  addition  to* 
see  to  the  carrying  out  of  the  provisions  of  the  Acts 
dealing  with  dairies,   cow-sheds  and  milk-shops. 

There  has  been  up  to  the  present  no  book  of  con- 
venient size  and  reasonable  price  which  contains  so 
much  information  in  a  concise  form.  There  are 
analytical  treatises  which  go  more  fully  into  the  matter 
of  the  composition  and  testing  of  milk  in  the  laboratory, 
but  these  works  do  not  contain  the  all-round  infor- 
mation which  is  given  here. 

The  book  is  divided  into  fifteen  sections,  beginning 
with  the  breeds  of  cattle,  choice  of  cows,  their  housing,, 
their  food  and  diseases.  After  this  the  legal  aspect 
of  disease  is  dealt  with,  the  Acts  dealiuR  with  it,  the 
elimination  of  tuberculosis,  and  the  control  of  cow- 
sheds and  dairies. 

Next  the  composition  of  milk  and  milk  products  is 
considered,  the  relation  of  milk  and  disease ;  after - 
which  comes  a  section  on  the  construction  of  the- 
dairy,  and  the  appliances  used  therein — ^refrigerators, 
separators,  chums  and  the  like. 

Section  thirteen  deals  with  milk  analysis,  and  in- 
our  opinion  this  might  with  advantage  have  been 
extended.  The  description  of  taking  the  specific 
gravity  by  means  of  a  Sprengel  tube  is,  however,  a 
waste  of  space,  as  a  float  or  a  Westphal  balance  is 
always  employed  in  practice. 

Again,  in  estimating  the  total  solids  no  one  would 
operate  on  so  small  a  quantity  as  a  gramme,  nor  are- 
methods  depending  on  the  use  of  asbestos  employed  in 
this  country. 

The  methods  for  the  estimation  of  fat  in  milk  are- 
well  and  accurately  described. 

On  page  232  the  author  says,  "  Salt,  cane-sugar,  and 
dextrin  are  occasionally  added  to  restore  the  specific 
gravity  lowered  by  watering."  Has  the  author  ever 
personally  come  across  such  instances  ?  The  amount  . 
of  salt  required  to  restore  the  gravity  lowered  by 
watering  would  surely  be  so  great  as  to  be  tasted. 

The  subject  of  preservatives,  which  is  now  one  of 
extreme  importance  is  dismissed  in  two  and  a  half 
pages,  and  we  find  no  mention  whatever  of  the  use  of 
boro-fluorides.  We  are  glad  to  find  on  page  243  the- 
author  frankly  states  that  preservatives  should  not  be 
permitted  in  mUk  intended  for  the  use  of  infants,  nor 
(by  inference)  should  they  be  permitted  .in  mUk  at 
all. 


(«)  "Milk:  itfl  Productions  and  Utea.  With  Chapters  on  Dairy 
Farming,  the  Diseases  of  Tattle,  and  on  the  Hygiene  and  Control  of 
Supplies'*  Bv  Edward  F.  WiUoughby,  M.D.Lond.,  D.P.H.Lond. 
and  Camb.  Fp.  269.  with  55  illustrations.  Price,  Oi.  net.  London  :- 
Charles  GriflBn  and  Co.,  Ltd. 


34^    Thb  Medical  Puss. 


UTERATURE. 


SggT.  aS.  iy>4. 


The  last  sectioa  contains  an  account  of  the  bac- 
teriology of  milk,  together  with  the  methods  of  8»aining 
the  organisms  most  lilceiy  to  be  found. 

We  congratulate  the  author  on  the  successful  way 
in  which  he  has  completed  his  task  of  making  a  read- 
able book,  free  from  padding,  but  yet  containing  so 
much  useful  information  that  we  predict  that  a  second 
edition  will  speedily  be  required. 


INTERNATIONAL  CLINICS,  (a) 

The  first  two  volumes  of  the  Fourteenth  Series  of 
"**  International  Clinics  "  are,  as  regards  the  subject- 
matter  which  they  contain,  somewhat  disappointing. 
That  this  must  necessarily  be  the  case  will  be  apparent 
when  it  is  stated  that  almost  every  communication, 
•especially  in  Volume  I.,  appears  to  have  been  written, 
not  because  the  author  has  something  new  and  im- 
portant to  state,  or  because  he  is  capable  of  setting 
forth  the  ordinary  clinical  facts  of  medicine  in  a 
specially  attractive  form,  but  because  it  is  wanted  as 
so  much  copy  to  help  in  the  making  of  a  book.  It 
would  be  invidious  to  single  out  any  individual  com- 
munications for  condemnation,  and  without  doubt 
dt  must  be  at  times  difficult  for  the  editor  to  make  a 
selection  that  will  please  everybody,  but  there  need  be 
no  hesitation  in  saying  that  the  papers  worth  reading 
in  the  two  volumes  could  easily  be  contained  in 
-one. 

,  Among  the  best  papers  in  Volume  I.  are  "  The 
'Chloride  Reduction  Treatment  of  Parenchymatous 
Nephritis,"  by  Monsieurs  Widal  and  Gaval,  and 
"  The  Practical  Application  of  Cryoscopy  to  Medicine," 
l}y  Dr.  Catteli.  The  former  of  these  is  carefully  and 
thoughtfully  written,  and  will  well  repay  perusal, 
^hile  the  latter  is  an  admirable  summary  of  the  subject 
with  which  it  deals.  The  review  of  the  progress  of 
medical  science  during  1903  contained  in  this  volume 
ds  also  excellent. 

The  first  section  in  Volume  II.  deals  with  the  diseases 
of  warm  climates,  and  most  of  the  papers  in  it  are 
fairly  good,  the  best  perhaps  being  those  on  Haemo- 
globinuria  and  liver  abcess.  The  remaining  papers  in 
this  volume  with  the  exception  of  that  on  Osteomalacia 
are  sketchy  and  commonplace. 

We  would  like  to  ask  the  author  of  the  paper  on 
the  "  Treatment  of  Ovarian  Lesions,"  for  his  evidence 
•of  the  statement  (p.  156,  Vol.  I.)  that  "  the  normal 
mature  Graafian  follicle  is  from  0*5  cm.  to  20  cm. 
^n  diameter,  and  there  are  in  normal  ovaries  usually 
eighteen  or  twenty  of  these  more  or  less  fully  developed 
follicles."  Again,  on  page  62,  Vol..  II,  we  presume 
that  it  is  30  grains  and  not  30  grams  (sic)  of  quinine 
Sulphate  that  are  recommend^  to  be  taken  within 
'four  hours. 

In  contrast  to  the  text,  the  illustrations  in  both 
volumes  are  of  great  value,  and  are  splendidly  executed. 
They  largely  compensate  for  the  other  defects  that 
nave  been  noted.  The  books  are  nicely  bound  and 
•printed,  and  are  provided  with  a  good  index. 

REPORT   OF   THE   ARMY   MEDICAL    DEPART- 
MENT FOR  THE  YEAR  1902. 
This  Report  possesses  more  than  usual  interest  in 
being   the  first   since   the  cessation   of  hostilities  in 

'South  Africa.  In  view  of  the  public  attention  which 
has, been  drawn  to  physical  deterioration,  those  parts 

'of  the  Report  which  deal  with  the  recruiting  of  the 
Army  are  of  special  interest.  We  learn  that  307*9 
per  1,000  recruits  were  rejected  on  inspection,  a  figure 
which,  compared  with  the  previous  year,  shows  an 

-increase  of  2677.  On  loolung  into  the  causes  for 
rejection,  we  find  that  the  majority,  namely,  4.9^. 
were  due  to  under  chest  measurement.  Loss  or  decay 
of  teeth  follows  next  with  4,316,  while  defective  vision 
is  responsible  for  3,437  rejections.  All  these  numbers 
are  from  a  total  of  87,609  inspected. 
We  cannot  help  drawing  attention  to  the  Reports  on 


surgical  operations  given  in  each  of  the  commaiMk.  ag 
the  classification  adopted  might  certainly  be  trnprovcd. 
On  page  B4.  we  find  among  the  principal  mupai 
operations  *'  one  for  primary  syphilis  aiid  one  foe 
gonorrhoea." — this  leaves  much  to  the  iwia|rim^ 
as  to  the  exact  operation  whidi  was  perlormed. 

On  page  13  it  is  stated  that  there  were  1 50  adausaions 
for  non- venereal  ulcer  (the  cause  of  which  is  not  stated) 
for  the  United  Kingdom,  and  on  page  233.  100  ad- 
missions for  India,  while  throughout  the  IUi!ont  several 
other  cases  are  given.  From  this  and  £com  other 
parts  of  the  Report  one  would  think  that  non-veneceal 
ulcer  of  the  penis  was  a  common  lesion. 

In  the  Report  on  South  Africa  we  notice  that  t 
very  frequent  cause  of  iavaliding  was  "caries  ol 
teeth,"  and  that  this  disease  alone  provided  152 
invalids,  giving  a  ratio  of  335  per  1,000.  We  are  ^ 
to  know  that  steps  have  at  Ust  been  taken  to  look 
after  the  teeth  in  the  Army,  and  surely  it  would  havt 
been  more  economical  to  have  had  these  men  pro- 
perly treated  in  South  Africa. 

With  regard  to  the  sanitary  conditions  in  Sootk 
Africa  some  very  interesting  extracts  are  given  froa 
a  Report  by  Lieut. -Colonel  Macpherson,  CM.G.. 
R.A.M.C.  on  the  sanitary  conditions  likely  to  afiect 
the  health  of  troops  in  cantonments  and  encamp- 
ments in  South  Africa.  This  Report  which,  has  beai 
circulated  as  an  official  publication,  very  deariv 
brings  to  notice  the  backward  state  of  civil  sanitation 
and  of  sanitary  administration  in  both  large  and 
small  towns  in  South  Africa,  an  unsatisfactory  state 
of  matters  which  is  probably  due.  not  .so  much  to 
want  of  will  on  the  part  of  the  local  authorities,  as 
to  want  of  money. 

The  Indian  Report  shows  that  there  has  been  aa 
increase  in  the  number  of  cases  of  enteric  fever  in 
India,  and  this  increase  is  attributed  to  the  arrival 
of  large  drafts  and  reliefs  from  active  service  in  Sooth 
Africa.  There  seems  to  be  a  special  predisposition  on 
the  part  of  the  young  soldier  to  acquire  enteric  durii^ 
his  first  year  in  India,  and  the  very  considerable 
increase  in  the  number  of  men  of  the  most  susceptible 
age  will,  to  some  extent,  account  for  an  increase  in  the 
actual  number  of  admissions.  There  were  two  fatal 
cases  of  hydrophobia,  and  we  are  glad  to  learn  that 
during  the  year  the  Pasteur  Institute  at  Kasauli, 
under  the  charge  of  Major  D.  Semple,  M.D.,  R.A.M.C. 
has  continued  its  good  work;  120  patients  connected 
with  the  British  troops  in  India  were  treated  in  the 
Institute ;  of  these,  sixty  were  bitten  by  animals 
proved  to  have  had  rabies ;  eighteen  by  animali 
certified  by  a  veterinary  surgeon  to  have  had  rabies; 
and  forty-two  by  animals  suspected  of  rabies ;  not  a 
single  one  of  these  cases  developed  hydrophobia. 

It  is  unfortunate  that  these  valuable  Reports  should 
be  practically  out  of  date  by  the  time  that  they  are 
published,  but  we  suppose  that  it  is  impossible  to 
avoid  their  being  so. 


OPPENHEIM'S  NERVOUS  DISEASES,  (a) 
Prof.  Oppenhetm's  work  is  so  well  known  and  so 
highly  valued  by  all  neurologists,  both  on  the  Continent 
and  at  home  in  its  original  form,  that  we  feel  sure  this 
second  edition  of  the  English  translation  will  find  many 
to  welcome  it.  The  new  matter  added  to  the  third 
German  edition  has  been  translated  and  inserted  into 
this,  and  the  editor  has  also  added  the  results  of  re- 
search and  investigation  in  the  field  of  neurology  since 
the  revision  of  the  German  original.  Though  described 
on  the  title-page  as  a  text-book  for  students  and 
practitioners  the  work  before  us  differs  considerably 
from  what  we  expect  to  find  in  the  ordinary  text-book, 
and  in  these  differences  lie  no  inconsiderable  part  of 
its  charm.     The  individuality  of  the  author  is  stamped 


(«) «' International  Clinicf:  A  Qoarterly  of  lUustratad  Clinical 
leoturea."  Fourteenth  Series.  Kdited  by  A.  O.  J.  KeUy,  AM., 
M.D.,  PbUadelphia.  U.S.A.    XiOndon :  J.  B.  Lippincott  Co.    1904. 


(a)  **  Diseaaes  of  the  Nerroas  System :  A  Text-book  for  £  _ 
and  Practitioners  of  Medioiae."  By  H.  Oppentaeim,  M.D.,  Vn- 
fessor  at  the  UnlTexuity  of  Berlin.  Translated  and  edited  by 
Edward  E.  Mayer.  A.M.,  M.D.  Beoond  American  edition,  rerited 
and  enlarged,  ^ith  348  Ulnstrations.  London:  J.  B.  Lippifloott 
Co.    1904.    Price91s.net. 


Sbpt.  28.  1904- 


LITERATURE. 


The  Medical  Pkess.    347 


^n  every  page,  and  one  can  well  believe  his  remark 
that  all  he  has  written  "  is  corroborated  by  personal 
observation  and  knowledge." 

Our  author  divides  his  work  into  two  parts — a  general 
and  a  special.  In  the  first  he  treats  of  the  methods 
.of  examination,  general  sjrmptomatology  and  objective 
examination;  while  in  the  second  he  treats  of  the 
diseases  of  the  cord,  the  peripheral  nerves,  the  brain, 
the  neuroses,  the  sympathetic  nervous  system,  and 
toxic  conditions.  In  deJEding  with  the  general  examina- 
tion. Professor  Oppenheim  mentions  only  such  methods 
as  are  likely  to  be  of  use  clinically.  Instruments  like 
aesthesiometers  and  algesimetera  and  the  "  exact 
measures"  used  by  physiologists  are  impracticable  at 
the  bedside.  The  electrical  examination  is  very  well 
and  fully  described,  and  Erb's  figures  illustrating  the 
motor  points  are  given,  but  the  use  of  such  figures  is 
greatly  lessened  by  the  absence  of  all  anatomical 
description  of  their  position. 

A  most  interesting  feature  of  the  work  is  the  ana- 
tomical and  physiological  description  of  the  nervous 
system  which  is  prefixed  to  the  sections  dealing  with 
ie  diseases  of  the  spinal  cord,  peripheral  nerves,  and 
the  brain.  The  most  recent  anatomical  investigations 
of  these  structures  are  described  and  discussed  with 
such  clearness  and  fulness  that  these  sections  might  be 
used  almost  as  a  text-book  on  the  physiological  anatomy 
of  the  nervous  system.  This  wealth  of  anatomical  and 
physiological  detail  is  perhaps  the  cause  of,  as  it 
certainly  brings  more  into  prominence,  the  absence^f 
information  on  the  psychological  aspect  of  the  nervous 
system.  Professor  Oppenheim  does  deal  shortly 
with  hypnotism,  and  admits  it  as  a  valuable  thera- 
peutic agent  in  certain  cases  ;  but  we  miss  any  suggestion 
as  to  the  rationale  of  its  action  or  even  any  criticism 
of  the  explanations  that  have  b^en  given  of  it  by  others. 
Surely,  however,  it  is  now  impossible  adequately  to 
discuss  the  nature  of  the  neuroses  or  their  pathology 
in  the  absence  of  psychological  investigation.  The 
study  of  psychology  has.  however,  been  so  long  neg- 
lected by  the  ordinary  medical  man  that  its  absence 
from  the  work  before  us  will,  we  believe,  be  looked  upon 
as  an  advantage  rather  than  an  omission  by  the 
majority  of  its  readers.  That  these  readers  will  be 
numerous  we  are  fully  convinced,  and  we  look  forward 
to  seeing  the  book  become  one  of  the  standard  text- 
books on  neurology  among  students. 


We  understand  that  this  book  has  met  with  great 
success  in  America,  and  we  have  no  doubt  that  physi- 
cians is  this  country  will  appreciate  it  quite  as  much. 
It  gives  a  very  clear  outline  of  the  subject  with  which 
it  deals,  and  the  form  of  question  and  answer  serves  to 
impress  the  various  facts  upon  the  mind  of  the  reader. 
In  another  edition  an  index  might  with  advantage  be 
added. 


HOLT'S  CARE  AND  FEEDING  OF  CHILDREN,  (a) 
This  is  the  third  edition  of  a  catechism  of  infant 
management  originally  published  in  America.  It  is 
now  presented  to  us  in  a  somewhat  enlarged  and  im- 
proved form,  with  the  addition  of  an  introduction  from 
the  pen  of  Dr.  Eric  Pritchard.  The  book  is  intended 
lor  the  use  of  mothers  and  nurses,  but  in  our  opinion 
It  is  better  suited  for  students  of  infantile  disease 
and  for  general  practitioners.  We  have  scarcely 
advanced  so  far  in  this  country  as  to  entrust  the  care 
of  infants  to  nursery  maids  or  even  to  parents  entirely. 
It  is  a  good  thing  for  medical  practitioners  that  the 
public  are  not  too  skilled  in  such  matters,  otherwise 
some  of  us  might  have  little  enough  to  do.  We  fear 
that  a  book  such  as  this,  if  put  into  the  hands  of  the 
Kwty,  would  to  a  large  extent  supplant  the  family 
physician.  As  we  have  said  already,  it  is  more  suitable 
tor  students  and  practitioners.  The  best  part  of  the 
wok  is  undoubtedly  that  dealing  with  the  feeding  of 
"i^nts  and  young  children.  There  is,  perhaps,  no 
subject  so  little  understood  by  the  general  practitioner 
as  that  of  infant  feeding.  Too  often  artificial  foods 
are  ordered  regardless  of  the  fact  that  their  usual 
effect  is  to  produce  rickets.  Holt  has  little  or  nothing 
to  say  regarding  such  foods.  In  fact,  he  practically 
condemns  their  use  when  he  savs  (p.  46)  that  they  are 
attended  with  great  risk." 


ILn  T?**S^^f"*  Peedtngof  C3hlldreii."  By  L  Bmmetl  Holt. 
■^LUD.,Pn>reuorof  DlMaMSof  OhUdren  in  the  CoUege  of 
jgwMMii  and  SarnonB  (ColambU  Univertity).  Ao.    With  an  in- 

S2^**Su.**?  J5t1?   Pritchard.  M.A.,   M J)  .  Oxon., 

52^,  JJlM  AUtioa,  revised  and  enlarged,    pp.  149! 
Bii  London:  Sidney  Appletoa.    1904. 


M.R.O.P. 
Price  3b. 


HAAB'S  ATLAS  OF  EXTERNAL  DISEASES  OF 
THE  EYE.  {a) 

This  number  of  the  Medical  Hand- Atlas  Series  is  a 
worthy  companion  to  Professor  Haab's  "  Atlas  and 
Epitome  of  Ophthalmoscopy  and  Ophthalmoscopic 
Diagnosis."  The  fact  that  it  has  reached  already  a 
second  edition  proves  that  it  is  widely  accepted  amongst 
students  and  general  practitioners. 

Starting  with  an  excellent  chapter  on  the  *'  Examina- 
tion of  the  Eye  in  Disease  "  (including  a  subdivision  on 
the  "  Detection  of  Malingerers  ")  the  reader  is  pre- 
sented with  pictures,  in  print  and  colours,  of  the  most 
important  external  diseases  of  the  eye,  beginning  with 
lachrymal  diseases  and  ending  with  those  affecting  the 
orbit.  The  forty-eight  chromo-lithographic  plates 
serve  admirably  to  place  before  the  reader  the  actual 
appearance  of  the  various  diseases.  Each  illustration 
represents  a  case,  the  history  of  which  is  given  in 
small  type  on  the  top  of  the  opposite  preceding  page — 
a  method  worthy  of  commendation,  as  it  enables  one 
to  read  the  description  of  the  case  most  readily,  while 
occasionally  referring  to  the  illustration  for  elucidation 
of  the  text. 

Professor  Haab's  teaching  is  broad-minded,  and  is 
what  one  would  expect  from  a  man  of  so  great  clinical 
experience,  while  his  editor,  Dr.  de  Schweinitz,  does 
not  hesitate  to  add  comments  which  in  several  in- 
stances present  views  at  variance  with  those  of  Dr. 
Haab. 

This  form  of  ophthalmic  text-book  has  much  to 
recommend  it  from  a  student's  point  of  view,  if  the 
illustrations  be  well  done,  as  they  are  in  Dr.  Haab's 
books.  For  it  is  often  a  matter  of  great  difficulty  to 
explain  to  a  student  by  black  and  white  illustrations 
many  of  the  diseases  of  the  eye,  while  these  difficulties 
are  easily  removed  by  a  well-executed  coloured  illus- 
tration. 

We  can  cordially  recommend  this  book  to  students 
and  general  practitioners. 


THE  CASE  AGAINST  ANTI- VIVISECTION,  (h) 
In  the  short  and  incisive  preface  prefixed  to  this 
little  volume,  the  author  tells  us  that,  "  The  writer  of 
this  pamphlet  hopes  against'  hope  that  it  will  not  give 
grave  offence  where  no  offence  is  intended.  Unhappily  for 
him,  it  is  bound  to  be  aggressive.  But  there  is  one 
thing  to  be  said  for  it,  that  it  keeps  close  to  its  subject, 
which  is  the  methods,  literature  and  arguments  of 
the  an ti- vivisection  societies.  It  is  concerned*  with 
them  and  with  nothing  else ;  it  puts  the  case  against 
these  societies,  and  there  stops."  In  discharging  the 
reviewer's  task,  it  is,  of  course,  to  us  a  very  patent 
fact,  as  well  as  to  every  one  of  our  readers,  that  an 
elaborate  attempt  to  analyse  the  garbled  statements 
and  limping  logic  of  the  anti-vivisectionists  can  be 
nothing  but  a  pure  waste  of  time  and  space.  Every 
medical  man,  who  is  in  touch  with  the  progress  and 
present  status  of  professional  knowledge,  knows  the 
principal  results  obtained  by  the  Vivisectionists ;  he 
also  knows  the  principal  statements  and  arguments 


(a)  •«  Atlas  of  the  External  DiBeasee  of  the  Sye,  ino  lading  a  Brief 
Treatlae  on  the  Pathology  and  Treatment.* '  By  Prof.  Dr.  0.  Haab, 
of  Zorich.  Aathcrlsed  Translation  from  the  German.  Second 
edition,  revised.  Edited  by  G.  E.  de  Schweinitz,  A.M.,  M.D.. 
Professor  of  Ophthalmolog>  in  %\  e  University  of  Pennsylvania,  dc. 
96  colour ed  lithographic  illnstrakiox s  in  48  plates,  pp.  262.  Phila- 
delphia, New  York,  London :  W.  B.  Sannden  and  Co.  1908.  Price 
Is.  net. 

(d)  oThe  Case  Against  nti-VivisecUon."  By  Stephen  Paget. 
8^1  PP-  104.  Price,  limp  cloth,  Is.  6d.  net.  London:  The 
Scientific  Press.  Ltd.    1904. 


34^     The  Medical  Press. 


LITERATURE. 


Sept.  28,  190V 


put  forward  by  the  Anti-Vivisectionsts.  Accordingly 
had  it  not  been  for  the  continuous  endeavours  of  the 
latter  section  of  the  public  to  influence  our  legislators, 
and  prejudice  the  general  public  against  the  most 
important  methods  for  the  advancement  of  physio- 
logical and  pathological  science,  there  would  be  hardly 
any  object  in  our  noticing  Mr.  Paget's  excellent 
pamphlet.  The  contents  of  this  are  divided  into 
four  chapters  :  I.,  An  ti- Vivisect  ion  Societies  ;  II., 
Literature ;  III.,  Arguments ;  IV.,  "  Our  Cause  in 
Parliament."  The  two  latter  are,  of  course,  specially 
deserving  of  attention  at  present.  The  reader  who 
wants  to  reason  his  wavering  friends  out  of  the  fallacies 
and  mis-statements  of  the  Anti-Vivisectionists,  should 
fill  his  quiver  with  the  weapons  provided  in  the  chapter 
of  "  Arguments  "  ;  and  he  who  is  anxious  to  diminish 
their  future  power  of  legislative  mischief  should  make 
himself  thoroughly  acquainted  with  the  last  chapter. 
We  cordially  congratulate  Mr.  Paget  on  the  brilliant 
contribution  to  the  "  advancement  of  science,"  which 
we  have  just  read. 


VENTRE,  (a) 
This  volume  is  so  beautifully  printed  and  illustrated 
that  it  must  secure  a  certain  proportion  of  attention 
by  these  features  alone.  But  it  has  many  other 
claims.  The  writer  is  evidently  an  enthusiast  in 
the  speciality,  and  has  thought  it  out  in  all  its  depart- 
ments with  laborious  care  and  thoroughness.  The 
work  of  such  an  author  is  always  deserving  of  careful 
scrutiny ;  it  can  never  fail  to  illustrate  its  subject  by 
some  new  light,  even  if  that  light  be,  in  some  instances, 
merely  the  reflection  of  the  beam,  which  led  the  author 
himself  astray.  Dr.  Bourcart  claims  for  the  present 
work  that  it  is  destined  to  place  before  the  reader,  in  a 
scientific  point  of  view,  a  really  new  method  of  treatment 
"  caver tant  que  proc6de  exclusif  et  se  suffisant  h 
lui-meme,  le  massage  localise  k  I'abodmen  est  de  date 
r^cente."  The  author  is,  very  evidently,  a  past 
master  of  his  subject,  and  is  prepared  to  defend  his 
positions  with  skill  and  vigour.  Nevertheless,  it  is 
well  to  point  out  that  such  exclusive  statements  are 
peculiarly  open  to  critical  aspersion.  When  the  late 
Sir  Henry  M.  Stanley  crossed  the  "  Dark  Continent  " 
for  the  purpose  of  inflicting  "  relief "  upon  Emin 
Pasha,  he  was  accompanied  by  a  troop  of  Zanzibaris, 
mostly  as  primitive  members  of  the  human  family  as 
could  be  found  anjnvhere.  We  have  the  testimony  of 
the  brave  and  chivalrous  Irish  surgeon,  Thomas 
Heath  Parke,  who  was  the  medical  officer  of  that 
expedition,  to  the  fact  that  when  one  of  those  dark- 
complexioned  natives  became  afflicted  with  abdominal 
twinges,  his  favourite  procedure  was — when)  collateral 
circumstances  proved  non-conflicting — to  place  himself 
on  the  ground,  in  the  supine  posture  and  horizontal 
plane,  and  there  and  then  have  his  abdomen  "  walked 
on  "  by  one  of  his  (barefooted)  compatriots.  And 
very  effective  was  this  pre-scicntific  mode  of  applying 
localised  abdominal  massage  reported  to  be  I  And 
wc  may  be  pretty  sure  that  directly  after  the  eviction 
of  our  common  ancestor  from  the  Garden  of  Eden  and 
the  beginning  of  his  liability  to  the  ills  of  the  flesh,  he 
practised  massage  when  his  great  toe  abruptly  collided 
with  an  unexpected  fragment  of  rock,  or  his  shin  with 
a  fallen  tree.  And  when  the  abdominal  surface 
received  the  impact  of  a  foreign  body  with  a  very 
unusual  amount  of  vis  viva,  we  feel  pretty  certain 
that  the  good  offices  of  Eve  were  requisitioned  for  the 
purpose  of  diminishing  by  pressure  and  friction  the 
personal  inconveniences  to  which  her  curiosity  and 
disobedience  had  rendered  her  fallen  spouse  liable. 
That  massage  is  the  most  primitive  weapon  in  the 
surgical  armamentarium  we  have  no  doubt  whatever. 
But  it  is  only  of  recent  years  that  its  application  has 
been  reduced  to  approximate  scientific  order.  Our 
author  tells  us  in  his  preface  that,  "  C'est  par  le  develop- 
pement  scientiftque   du   massage    ^ynecologique   que   le 

(a)  "lie  Ventre:  Elado  Anatomiqae  et  Olioiqae  de  la  CftTite 
Abdominale  aa  point  deToe  da  MMsage.  I.  Le  Rein.*'  Par  de 
Dr.  M.  Boaroart.  Onvrage  illuetre  de  1B4  fignree.  OeoeYe:  H. 
Kandig,  flditear.    Paris :  F.  Alo»n,  Bditenr.     1904. 


massage  scientifique  du  venire  s*est  cree,"  and  hepromiMly 
add  that  "  c'est  par  les  travaux  des  premieis  piooiiia» 
de  langue  fran9aise  qui  se  sont  rendas  k  Stockbob 
( Jentzer  et  moi  d'abord  ;pui8  Stapfer  et  d'antresaicoR] 
que  I'elan  a  kt6  donn6."     The  sketch  of  the  surface 
anatomy  of  the  abdomen  is  a  good  one,  and  copkmdr 
illustrated— after  the  Paris  "  Salon  "  style  ;  the  account 
of  the  internal  anatomy  is  also  good,  and  very  ckaAr 
put — as    French    word    painting    usually    is.       li 
directions  for  renal  massage  are  excellent,  and  tlie 
accompanjring  illustrations  are  worthy  of  all  praise. 


THE  NATURE  OF  MAN.  (a) 

Dr.  Mitchell,  in  presenting  this  work  to  £n|;laii 
readers  clauns  that  Metchnikofi  "  has  gained  the  right 
to  a  hearing  by  forty  years  of  patient  devotion  and 
brilliant  research.  In  the  volume  now  given  to  t^ 
public  he  has  addressed  himself  to  the  gravest  a^ 
most  serious  problems  of  humanity,  to  life  and  sa 
and  death  and  the  fear  of  death."  And  the  someirtd 
startling  statement  is  made  that  "  now  for  the  fat 
time  in  the  history  of  thought,  the  exact  methods  tf 
science  have  been  brought  to  the  statement  of  tixt 
problems." 

The  work  is  certainly  a  remarkable  one.  and  br 
without  danger  in  its  fascination,  but  neverthdes 
u^h  in  suggestiveness  and  stimulating  to  seriw 
tnought.  Metchnikofi  has  well  won  a  high  repatatka 
as  a  biologist,  but  pathologists  know  that  he  has  abi 
some  of  the  elements  which  go  to  make  a  great  i& 
mancer.  The  contents  of  the  present  volume  ue 
perhaps  best  considered  as  the  products  of  the  recRa- 
tive  hours  of  an  ageing  naturalist  desirous  of  contb- 
buting  something  to  the  conceptions  of  hunum  existen 
before  the  curtain  is  rung  down  cxi  the  individBil 
observing  life. 

The  author  has  turned  aside  from  the  day's  pumit 
to  wander  into  regions  which  the  lamp  erf  science  mH 
probably  never  enlighten.  He  attempts  to  dabble  a 
the  deep  waters  of  faith  and  tries  to  sound  the  dcptb 
of  religious  belief  with  the  short  line  plummet  aUov&i 
by  science.  The  result  is  oftentimes  disappointini. 
and  Metchnikofi  in  these  pages  has  done  himself  grav! 
injustice  by  departing  from  the  position  of  a  reverent 
agnostic  and  assuming  a  dogmatism  which  is  lacloB^ 
in  scientific  spirit  and  indecorous  to  certain  of  ^ 
dearest  beliefs  and  desires  of  the  keenest  thinkers. 

We  fear  the  enigmas  of  life  and  death  are  not  to  be 
revealed  by  such  brilliant  but  misleading  presentatioB 
as  are  contained  in  these  pages. 

The  volume  is  divided  into  three  sections,  and  de«l 
respectively  with  the  disharmonies  in  the  nature  of 
man ;  attempts  to  diminish  the  ills  arising  from  th^ 
disharmonies  of  the  human  constitution  (religious  and 
philosophical  systems) ;  and  what  science  is  able  todff 
to  alleviate  these  disharmonies. 

We  cannot  attempt  to  survey  the  many  features  rf 
this  striking  work,  for  every  chapter  afiords  materii! 
for  careful  consideration,  and  is  capable  of  initiatmn 
endless  discussion.  The  many  references  will  provf 
invaluable  to  students  and  no  one  can  read  these  pages 
without  being  impressed  by  the  importance  of  the 
subjects  raised.  It  is,  however,  a  work  which  needs 
to  be  read  with  wise  discernment,  sind  is  hardly  a 
volume  to  be  placed  thoughtlessly  in  the  hands  of  on* 
trained  laymen.  The  insistence  on  the  view  that  dis- 
harmonies in  the  human  constitution  aie  the  chief 
sources  of  our  sorrows  may  serve  to  solve  some  of  the 
problems  of  human  existence,  but  we  fear  the  doctrines 
set  forth  in  this  book,  ingenious  and  peculiarly  fasci- 
nating as  many  of  them  are,  will  hardly  Ughten  the 
burden  which  many  have  to  carry,  or  serve  as  directing 
light  along  life's  dark  pathway. 

(a)  '*  The  Nature  of  Man :  Sluaies  in  Optimiatio  PhiloMphT.' 

By  Elle  Metohnikofl,  Professor  at  the  Paatear  Instiiate.  1k» 

Bnglish  iranslation  edited  by  P.  Chalmers  Mitchell,  MX,  DJc. 

(Oxon.),8eoretar7  of  the  Zoologleal  Society  of  London.  P»A 

{aOFigs.    London :  William  Heinemann.    1903.    Price  19k  M-ic^ 


Sept.  28,   1904. 


LITERARY  NOTES  AND  GOSSIP. 


The  Medical  Press.    349 


Xttctars  notes  an&  Oossip* 

"Lemco  Dishes  for  all  Seasons,"  issued  by  the 
l^eibig's  Extract  of  Meat  Co.,  is  not  only  a  useful  and 
urtistic  advertisement  of  the  manifold  advantages  of 
the  preparation  they  are  pleased  to  call  by  the  fanci- 
ful and  euphonious  name  of  "  Lemco,"  but  is  an 
ngeniously  arranged  and  thoroughly  serviceable 
»okery  book  which  we  commend  to  the  consideration 
>f  nurses  and  those  who  may  be  called  upon  to  prepare 
appetising  dishes  for  the  sick  and  delicate. 

The  forthcoming  number  of  the  BriHsh  Journal  of 
Inebriety,  the  official  publication  of  the  Society  for 
the  Study  of  Inebriety,"  will  contain  an  important 
atrtide  on  "The  Criminal  Responsbility  of  the 
Alcoholic,"  by  Dr.  W.  C.  Sullivan,  and  also  a  criticism 
by  Dr.  Harry  Campbell  on  certain  recently  promul- 
gated views  on  the  pathology  of  chronic  alcoholism. 

*  •     • 

The  August  number  of  the  Journal  of  the  American 
Medical  Association  contains  a  special  article  on  the 
Ustory  of  the  United  States  Public  Health  and  Marine 
Hospital   Service.     A  well-merited   tribute   of  praise 
4s  given    to    Surgeon-General  Wyman,   who    by    his 
admirable  foresight  and  diplomacy  saved  the  country 
in  1892  from  the  threatened  cholera  invasion.     The 
same  officer  has  been  mainly  responsible  for  the   ex- 
pansion and  centralisation  of  public  health  work  in 
America,  and  was  also  one  of  the  first  to  suggest  a 
•plan  for  international  sanitation  of  sea-ports.     Among 
-the  "  original  articles  "  is  one  on  "  Static  Foot  Error," 
by  W.    P.    Blodjett,    M.D.     The  incidence   of   these 
troubles  is   tabulated  according  to  sex,  age,  time  of 
year,    occupation   and   etiology.     Pain   in   the   ankle 
•region  is  said  to  be  the  most  common  symptom,  and 
it  is  pointed  out  that  while  relief  is  usually  obtained  by 
the  use  of  suitable  spring  supports,  it  is  only  in  very 
-few  cases  tHat  such  supports  can  ever  afterwards  be 
dispensed    ^^vith.     In    a    paper    entitled    "  Practical 
Notes   on   Ointments:    their    Use   and   Abuse."    Dr. 
Duncan  Bulkley  points  out  the  principal  indications 
lor  the  use  of  ointments,  and  also  gives  some  practical 
hints  on   thie  way  to  compound   them.     Dr.   V.   A. 
Latham  reports  on  a  case  of  "  Neoplasm  of  the  Pulp," 
which  he  regards  as  a  carcinoma.     He  considers  his 
case  important  with  reference  to  the  site  of  origin  of 
tontnie  and  gum  cancers. 

♦  ♦     • 

The  July*  *Bulletih"  of  the  Johns  Hopkins  Hospital, 
Baltimore'    contains   (i)   "  The   Sensory    Distribution 
of  the  Fifth  Cranial  Nerve,"  by  Harvey  Cushing,  M.D. 
In^this  most  valuable  article  Dr   Cushing  gives  us 
the  results  which  he  has  obtained  by  a  careful  examina- 
tion of   the  area  of  anaesthesia  left  in  patients  by 
destruction  or  avulsion  of  the  sensory  root  of  the  fifth 
nerve.     In  all  twenty-six  cases  were  examined,  and 
the  examination  was  made  in  most  of  them  shortly 
after  the  operation.    The  area  of  anaesthesia  mapped 
out  corresponds  closely  with  that  figured  by  Frohse, 
as  the  results  of  his  anatomical  studies.      Posteriorly 
it  includes  a  portion  of  the  helix  of  the  auricle,  and 
also  the  anterior  wall  of  the  external  auditory  meatus. 
This  is  what  would  be  expected  from  a  study  of  the 
development  of  these  parts,  inasmuch  as  these  portions 
of  the  ear  are  developed  from  the    mandibular  arch. 
Cushing  also  points  out  the  important  fact  that  the 
skin  areas  supplied  by  the  different  branches  of  the 
fifth  nerve  do  not  overlap.     {2)  "  Stephen  Hales,  the 
Physiologist,"  by  Percy  M.  Dawson,  M.D.     This  is  an 
interesting  historical  sketch  dealing  chiefly  with  the 
physiological  experiments  of  Hales.     ( 3 )  * '  The  Chemical 
Or^rin    of   Leucocytes,"    by    E.    SchnoU,    M.D.     The 
object  of  this  elaborate    research  was  to  answer  the 
-question   "  Is   the    adult    human    body    capable    of 
synthesising  nucleins  from  nuclein  free  food,  or  is  it 
dependent  for  its  nucleins  upon  those  ingested  in  the 
food  ? "     To    answer    this    Schnoll   investigated    the 
blood  in  leukaemic   cases.     While  feeding  these  cases 
on  (a)  ordinary  diet,  (6)  purin-free,  albumin  rich  diet 
ic)  mixed  purin-albumin  rich  diet,  {d)  purin  rich  and 


albumin  rich  diet,  he  found  that  the  number  of  leuco- 
cytes increased  in  the  blood  with  increase  of  al- 
buminous diet,  irrespective,  apparently,  of  the  nuclein 
contents.  His  observati<His  are  too  few,  as  yet,  for  a 
definite  conclusion,  but  so  far  he  is  led  to  believe  that 
nucleins  can  be  manufactured  in  the  adult  body. 
(4)  "  Mental  Phenomena  and  Visceral  Disease,"  by 
Carey  B.  Gamble,  jun.,  M.D.  In  the  proceedings  of 
the  Hospital  Medical  Society  Dr.  Painter  read  an 
interesting  communication  on  the  "  Pathology  of 
Rheumatoid  Diseases."  and  a  case  of  tuberculosis  of 
the  parotid  gland  was  exhibited  by  Professor  Osier. 

*  *     * 

Our  youthful  contemporary,  the  South  African 
Medical  Record,  a  monthly  journal  devoted  to  the 
interests  of  the  medical  profession  in  South  Africa, 
has  for  the  most  interesting  paper  in  the  August 
number  one  by  Dr.  P.  D.  Strachan,  entitled  "  The 
Question  of  the  Presence  in  South  Africa  of  Undulant 
or  Malta  Fever."  In  it  he  points  out  that  a  number 
of  cases  of  fever  are  met  with  in  South  Africa  which, 
although  usually  called  typhoid  fever,  bear  a  most 
close  resemblance  clinically  to  Malta  fever.  That  they 
are  not  malarial  in  origin  is  proved  by  the  examination 
of  the  blood,  and  by  the  inefficiency  of  quinine  in 
treatment.  Up  to  this  Dr.  Strachan  has  been  unable 
to  make  use  of  bacteriological  methods  of  diagnosis, 
but  he  hopes  to  do  so  shortly,  and  will  make  known 
his  results.  The  question  of  medical  advertising  is 
dealt  with  in  a  strongly  worded  editorial.  Advertise- 
ments of  medical  men.  both  direct  and  indirect,  had 
become  so  common  that  recently  the  Cape  Medical 
Council  was  compelled  to  endeavour  to  put  a  check 
to  it  by  dealing  severely  with  all  cases  that  came  under 
its  notice.  This  has  led  in  some  cases  to  hardship, 
and,  in  consequence,  there  has  been  some  outcry 
against  its  decrees.  We  are  glad,  however,  to  see 
that  the  Council  is  determined  to  uphold  the  position 
that  it  has  taken  up,  and  will  in  future  enforce  fuUy 
its  decrees.  As  an  example  of  a  common  (indirect  ?) 
method  of  advertisement,  and  one  of  a  peculiarly 
objectionable  type,  we  may  quote  the  following,  which 
appeared  in  the  Cape  Times  of  April  19th :  *'  I  hereby 
tender  my  sincere  thanks  to  Dr.  Wood,  Dr.  Pringle, 
and  Dr.  Drew,  also  to  the*  Sister  of  the  Brickersteth 
Ward,  New  Somerset  Hospital,  for  the  kindness  and 

attendance  to  me  during   my  stay  at  the  hospital.'* 

*  *     * 

The  69th  Annual  Report  of  the  British  Medical 
Benevolent  Fund,  for  the  year  1903  has  just  been  issued 
and  should  be  studied  by  all  who  are  in  any  way 
able,  either  by  sympathy  or  financial  support,  to  assist 
in  the  relief  of  distressed  qualified  members  of  the 
profession,  their  widows  and  orphans.  This  excellent 
work  deserves  the  highest  praise  and  most  unqualified 
approval  and  practical  encouragement. 

NEW  BOOKS  AND  NEW  EDITIONS. 
The  following  have  been  received  since  the  publication 
of  our  last  list : — 
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Asthma  in  Relation  to  the  Nose.    By  Alexander  Francis,  M.B., 
B.CCantab.    Pp.  136.    Price  «•  net. 
Baiixiere,  Tindall  and  Cox  (London). 
Adenoids.    By  Wyatt  Wingrave,  M.D.    (Medical  Monograph  Series, 

1^0.  9.)    Illustrated.    Pp.  xs8.    Price  as.  6d.  net. 
A  Manual  of  Practical  Medical  Electricity.    By  Dawson  Turner, 
B.A.,  M.D.,  &c.    Fourth  Edition,  revised  and  enlarged.    lUus- 


trated.    Pp.  435-    Pri<»  xo«-  W.  net. 

Lseases  of  the  Stomach  and  their  Surgical  Treatment.    By  / 

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OBITUARY. 


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Arthur  C.  Fifield  (London). 
The  Ballad  of  Jndas  Iscariot.    By  Robert  Buchanan.    Pp.   ax. 

Selections  from  Tennyson's  "  In  Memoriam."    Pp.^Q*    PriOP^ad* 
Culture.    By  Ralph  WaWo  Emerson.    Pp.  38.  J*nce  3d. 
WaWen  ;  My  Life  in  the  Woods.    By  H.  D.  Thoreau.    Pp.  X58. 

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Tolstoy  as  a  Schoolmaster.    By  Ernest  Crosby.    Pp.  94.    Price  6d. 
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H    K   Lewis  (London). 
'Enlarffement  of  the  ProsUte .  its  Treatment  and  Radical  C^ore.    By 
C  Mansell  Monllin,  M  J).Oxon.,  F.R.C.S.    Third  Edition.    Pp.  204. 
Price  6s.  ,     ,     , 

J.  B.  LiFPiNCOTT  Co.  (Ixmdon). 
International  Clinics.    Vol.  II.  ^     . 

A.  O.  LKelly,  A.M..  M.D.Philadelphia,  U.SA. 
LoMCMANS,  Grbbw  ANtt  Co  (Lottdon).       -  ^    _       ^       „  . 
Elementary  Practical  Physiology.    By  John  Thornton,  M.A 
trated.    Pp.324.    Price  3s.  6d. 
Macjcillam  a»d  Co.,  Ltd.  (Lrjndon).  ,^  ,     ^  _  .a       ^ 

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^°HandbS)^''of^S?Sk)gy.    By  W.  D.  Halliburton,  MOD.,  F.R.S. 

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Rebmak,  Limited  (London).  ,.^,jxw^         •*.^u- 

An  Atlas  of  Human  Anatomy.    By  Carl  Toldt,  M.D.,  assisted  by 
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YouiiG  J.  Pehtlai»i»  (Edinburgh).  ,,        .     ^... 

The  Nervous  Affections  of  the  Heart.    By  George  Alexander  Gibson, 
M.D..  D.Sc.,  &c.    inustrated.    Pp.  99.] 

®bttuari?. 


Fourteenth  Series,  X904< 


Edited  by 


Ilhis- 


PROFESSOR  NIELS  FINSEN,  OF  COPENHAGEN. 
The  death  of  Professbr  Finsen,  at  Copenhagen,  on 
the  24th  instant,  has  excited  world-wide  regret. 
Although  he  had  attained  the  age  of  43  only,  his  name 
had  nevertheless  become  familiar  in  all  civilised 
countries  by  reason  of  his  famous  discovery  of  the 
'•  light  cure  '*  for  lupus.  For  years  past  his  health 
had  been  precarious,  so  much  so,  indeed,  that  he  had 
been  unable  to  take  an  active  part  in  the  development 
of  his  original  discovery.  The  great  merit  of  his 
work  was  that  which  must  always  remain  attached 
to  the  man  who  takes  the  first  step  on  a  new  pathway 
of  human  knowledge  and  achievement.  Finsen's 
name  will  be  ever  associated  with  the  ultra-violet 
treatment  of  lupus  and  of  other  skin  diseases.  The 
ultra-violet  rays  occur  naturally  in  sunlight,  and  may 
be  obtained  artificially  by  an  electric  arc  light.  Both 
methods  were  used  by  Finsen  in  his  apparatus,  and 
were  shown  by  him  to  have  a  special  action  on  the 
skin  of  man  as  well  as  a  bactericidal  eflfect  on  micro- 
organisms. In  applying  these  rays  he  showed  that 
they  possess  far  greater  power  of  penetration  in  blood- 
less tissues  than  in  those  filled  with  blood.  In  the 
original  apparatus  the  light  from  a  powerful  arc  lamp 
was  led  through  a  tube  so  arranged  as  to  concentrate 
the  violet  and  ultra-violet  rays  and  to  remove  the 
heat  rays.  To  effect  this,  water  was  kept  running 
between  quartz  lenses.  One  of  the  latter  pressed  on  a 
lupus  for  an  hour  or  more  daily  for  many  months  was 
found  to  cure  the  disease  in  almost  all  cases.  The 
apparatus  was  costly  and  the  course  tedious,  and 
Finsen's  method  has  undergone  numerous  modifications 
in  the  direction  of  quickness,  cheapness,  and  ease  and 
convenience  of  application.  It  may  be  questioned 
whether,  on  the  whole,  ordinary  surgical  measures  are 
not  preferable  in  the  treatment  of  lupu$.  Finsen, 
however,  opened  up  to  the  medical  world  a  fresh 
field  of  therapeutics,  whose  fruits  may  be  some  day 
both  multitudinous  and  fair.     In  our  own  country  the 


Sbpt.  28.  1904. 


Finsen  light  cure  of  lupus  has  been  known  diiefly  a 
connection  with  the  London  Hospital.  It  was  intuj. 
duced  there  by  Queen  Alexandra,  who  fnmi^ied  Us 
necessary  installation  entirely  at  her  own  expeuc^ 
Her  Majesty,  accompanied  by  her  sister,  the  Dovago 
Empress  of  Russia,  had  become  acquainted  with  tk 
wonders  of  the  new  treatment  at  a  visit  to  Vwokan 
Finsen's  Medicinske  Lysinstitut  in  Copenha^ea.  ii 
April.  1899.  Immediately  on  her  return  home  Q^ 
Alexandra  communicated  with  the  London  Hospital 
Shortly  afterwards  Dr. — now- Sir — Stephen  Mackemie 
visited  Copenhagen  to  stiidy  Finsen's  methods,  aad 
later  a  matron  and  a  nurse  from  the  London  Hospitai 
followed  for  the  same  purpose.  Not  content  viHi 
providing  the  means  alone,  we  understand  that  her 
Majesty  sent  the  first  patient  in  the  person  of  a  pogr 
girl  from  Great  Footers,  near  Egham.  The  Queen  kas 
followed  the  subsequent  progress  of  the  Finsen  tnu- 
ment  at  the  London  Hospital  with  the  greatest  interai 
and  has  paid  frequent  visits  of  inspection  to  flat 
institution.  The  example  of  Dr.  Finsen,  who  coi- 
trived  to  compass  so  much  good  work  in  a  life  so  bd 
and  brief,  may  well  be  held  up  as  a  pattern  to  al 
members  of  his  humane  and  self-sacrjficing  professioL 

DR.  CROKER,  BELFAST. 
The  death  occurred  last  week,  on  the  22nd  insi. 
of  Dr.  George  Croker,  one  of  the  oldest  practiticnenia 
Belfast.  If  he  had  Uved  six  weeks  longer,  he  would  have 
have  entered  on  his  90th  year,  having  been  bom  a 
October  31st,  181 5,  in  Beaufield  House,  Co.  Wzcklov. 
He  was  for  some  years  family  physician  to  the  Maiqis 
of  Downshire,  and  then  surgeon  to  the  Royal  SoatI 
Down  Rifles  at  Hillsbro'.  When  the  headquarters  of 
the  regiment  was  removed  to  Downpatrick,  he  retoid 
from  that  post,  and  was  appointed  to  a  dispensary  a 
the  east  side  of  Belfast,  where  he  continued  to  practix 
till  failing  health  obliged  him  to  resign  six  years  i^ 
To  the  present  generation  of  medical  men  in  Belial 
Dr.  Croker  was  known  as  a  most  genial  and  kindly  old 
genltleman,  of  the  highest  principles  and  old-worid 
courtesy.  His  ruling  passion  was  a  love  for  aninak 
of  all  sorts.  . 


DONALD  FLUDYER  BOULTON,  M.R.C.S.  EngJ 
L.S.A. 

It  is  with  regret  that  we  have  to  record  the  dead 
of  Dr.  Donald  Fludyer  Boulton,  at  his  residence 
Newmarket  Street,  Usk,  on  the  nth  instant.  Th«j 
deceased  gentleman,  who  was  62  years  of  age.  had  a  | 
paralytic  stroke  three  weeks  ago.  Dr.  Boulton  sue-  | 
ceeded  his  father  as  surgeon  at  H.M.  Prison,  L'sk 
about  thirty  years  ago,  was  club  doctor  to  two  or  three 
Friendly  Societies  in  the  town,  and  had  an  extensive 
practice.  Dr.  Boulton  was  a  most  enthusiastic  sporU- 
man,  and  was  a  keen  follower  of  the  Llangibby  Hounds, 
and  was  often  with  the  otter  hounds.  In  his  younger 
days  he  was  a  gentleman  jockey,  and  rode  winners  at 
the  local  races.  He  was  very  popular  and  highly 
respected  in  the  district  generally.  He  was  educated 
at  St.  Bartholomew's,  and  took  the  qualifications  of 
membership  of  the  R.C.S.  and  the  L.S.A. 


THOMAS    CHAPLIN.    M.D.St.    And.,  Ac,- 
Dr.  Thomas  Chaplin,  formerly  of   Jerusalem  and 
afterwards     of  St.  Leonards,   died  last  week  at  his 
residence,  St.   Leonards,   in  his   seventy-fourth  year. 
Professionally   educated   at   Guy's   Hospital,  he  was 
admitted  a  member  of  the  Royal  College  of  Surgeons. 
England,  and  a  licentiate  of  the  Society  of  Apotbe 
caries  in  1853,  and  took  the  M.D.  Degree  at  St.  Andrews 
in    1858.     He   was   formerly   resident    in   Jerusalem 
where  he  was  physician  to  the  English  Mission  HosjMtal 
for  Jews,  honorary  physician  to  the  German  Hospital 
and  Leper  Asylum,   and   President  of   the  Jemsalein 
Medical  Society.     Dr.   Chaplin,  who  was  a  honorary 
Associate  of  the  Order  of  St.  John  of  Jerusalem,  wasa 
member  of  the  Council  of  the  Victoria  Institute  and 
of  the  Executive  Committee  of  the  Palestine  Exjjtora- 
tion  Fund.     He  had  written,  amongst  other  subjects, 


SSPT.   28,    X9O4. 


MEDICAL  NEWS. 


The  Medical  Press.    351 


on  the  **  Fevers  of  Jenisalem,"  and  for  the  Victoria 
Institute  on  "  Some  Diseases  Mentioned  in  the  Bible." 


AeMcal  flews. 


The  MIdwivM  Aet 

Wk  are  requested  to  publish  the  following  resolution 
adopted  by  the  Council  of  the  Incorporated  Medical 
Practitioners'  Association  : — "  That  we,  the  Council 
of  the  Incorporated  Medical  Practitioners'  Association, 
at  this  our  first  meeting  since  the  vacation,  desire  to 
place  on  record  our  protest  against  the  action  of  the 
Central  Midwives  Board  in  deciding  to  appoint  as 
examiners  for  the  certificate  of  the  Board  non-medical 
women,  thereby  raising,  to  the  level  of  the  duly 
registered  medical  practitioner  who  has  undergone  an 
expensive  course  of  study  and  a  searching  examination, 
women  who  are  not  required  to  show  proof  that  they 
possess  any  knowledge  of  the  different  subjects  which 
a  medical  practitioner  has  to  study  in  order  to  obtain 
a  diploma." 

Ankylostomiasis. 
A  COMMITTEE  representing  the  South  and  West 
Yorkshire  coalowners  and  the  Yorkshire  Miners' 
Association,  is  engaged  in  devising  measures  to  prevent 
the  introduction  of  ankylostomiasis  into  the  pits  in 
Yorkshire.  Among  other  steps  it  is  intended  to  give 
lantern-illustrated  lectures  at  the  various  mining 
centres,  in  order  to  secure  the  intelligent  co-operation 
of  the  men.  The  two  lecturers  appointed  are  Dr. 
Porter  of  Sheffield  and  Dr.  Vaughan  Bateson  of  Brad- 
ford, the  task  of  illustration  being  entrusted  to  Mr. 
Scott,  the  Secretary  of  the  Committee. 

CarboUe  Acid  Polsoninir. 
Mr.  Walter  Schroeder.  Deputy-Coroner  for  the 
Central  District  of  London,  stated,  at  an  inquest  at 
Hampstead  recently,  that  since  the  Order  in  Council 
declaring  that  liquid  preparations  of  carbolic  acid  and 
its  homologues,  containing  more  than  3  per  cent,  of 
those  substances,  are  to  be  deemed  poisons,  the  number 
of  deaths,  accidental  or  suicidal,  from  this  cause  has 
very  greatly  decreased.  It  will  be  remembered  that 
it  was  largely  owing  to  the  exertions  of  the  British 
Medical  Association  that  the  Order  in  Council  was 
issued. 

Sir  William  HacGreffOP. 

A  dinner  was  given  on  September  i6th  by  Sir 
Alfred  Jones,  President  of  the  Liverpool  Chamber  of 
Commerce,  in  honour  of  Sir  William  MacGregor, 
K.C.M.G.,  C.B.,  late  Governor  of  Lagos,  who  has  been 
appointed  to  the  Governorship  of  Newfoundland. 
A  sum  of  nearly  ;f  1,000  was  subscribed  by  those  present 
to  be  handed  over  to  the  Liverpool  School  of  Medicine 
in  the  name  of  Sir  William  MacGregor  in  recognition 
of  his  services  to  sanitation  in  West  Africa.  Sir 
William  MacGregor  is  a  Doctor  of  Medicine  of  the 
University  of  Aberdeen. 

A  Chemleal  and  Phapmaceuttoal  COngpess. 
A  CONGRESS  of  Chemistry  and  Pharmacy  organised 
under  the  auspices  of  the  Pharmaceutical  Association 
of  Li6ge  and  the  Chemical  Society  of  Belgium,  will  be 
held  in  connection  with  the  International  Exposition 
to  be  held  at  Li6ge  in  July,  1905.  In  addition  to 
technical  matters,  (questions  relating  to  legislation 
and  professional  ethics  will  be  discussed.  Communi- 
cations should  be  addressed  to  one  of  the  Secretaries, 
M.  J.  Raymond,  16.  Place  des  Carmes,  Li^ge,  or  M.  J. 
Wauters,  83,  Rue  Souveraine,  Brussels. 

Woflt  London  Hwtteo-Chlrapirlcal  Soetoty. 

The  following  are  the  officers  and  members  of 
Council  for  1904-5  :— President :  Mr.  C.  M.  Tuke.* 
Vice-Presidents  :  Mr.  C.  B.  Keetley,  Mr.  W.  P.  Barrett, 
Dr.  G.  H.  D,  Robinson,  Mr.  J.  R.  Lunn,  Dr.  E.  Fumiss 
Potter,  Dr.  E.  Bromet,*  Dr.  G.  P.  Shuter,*  Mr.  H. 
Webb.*  Council:  Mr.  R.  Pollock.  Dr.  A.  M.  Ross 
Sinclair,  Mr.  G.  A.  Garry  Simpson,  Dr.  Percy  Dunn, 
Mr.  McAdam  Eccles,  Mr.  E.  P.  Paton,  Dr.  A.  Saunders, 
Dr.  A.  J.  Rice  Oxley.  Dr.  J.  A.  Mansell  Moullin.*  D. 


A.  Morison,*  Dr.  A.  E.  Russell,*  Dr.  C.  Buttar.*» 
Treasurer  :  Mr..  T.  Gun  ton  Alderton.  Secretaries  i 
Dr.  Andrew  Elliot,  Dr.  W.  H.  Walter.*  Librarian  : 
Mr*  H.  W.  Chambers.  Editor  of  Journal :  Dr.  Leonard 
Dobson.  Editorial  Secretary :  Mr.  J.  G.  Pardoe. 
(Those  marked  with  an  asterisk  did  not  hold  similar 
office  last  year.) 

The  evening  meeting  will  be  held  at  the  West  London? 
Hospital  on  Friday,  October  7  th,  at  8.30  p.m.  The- 
President,  Mr.  C.  M.  Tuke,  will  deliver  an  address  on* 
"  Progress  in  Psychology." 

B«4uoiU  to  Vodioal  CliariUot. 

By  the  will  of  Mr.  Thomas  Whiffin,  of  Putney,  who* 
died  on  March  27  th,  the  following  bequests  are  directed 
to  be  paid,  free  of  legacy  duty  : — ^^500  each  to  St. 
George's  Hospital,  St.  Thomas's  Hospital,  Guy's- 
Hospital,  Charing  Cross  Hospital,  the  Metropolitan 
Free  Hospital,  Kingsland  Road,  King's  College- 
Hospital,  the  Middlesex  Hospital,  and  the  Victoria 
Hospital  for  Children,  Queen's  Road,  Chelsea ;  £2  so- 
each  to  the  Brompton  Hospital  for  Consumption, 
the  National  Hospital  for  Paralysis  and  Epilepsy, 
Queen's  Square,  Bloomsbury,  the  Hospital  for  Women, 
Soho  Square,  the  Samaritan  Free  Hospital.  Maryle- 
bone  Road,  the  City  Orthopaedic  Hospital,  Hatton 
Garden,  the  Central  London  Ophthalmic  Hospital,, 
the  Royal  Hospital  for  Incurables,  Putney,  the  Asylum 
for  Idiots,  Earlswood ;  the  Royal  Blind  Pension 
Society,  and  the  Royal  Association  in  Aid  of  the 
Deaf  and  Dumb,  Oxford  Street. 

The  Brltiflb  OyDnoolofieal  Society. 
The  annual  dinner  of  this  Society  will  be  held  ont 
Thursday,  November  24th,  at  the  Monico,  Piccadilly 
Circus,  at  7.30  p.m. 

The  Royal  Academy  of  Medicine  in  Iroland.; 

The  annual  general  meeting  of  the  Royal  Academy 
of  Medicine  in  Ireland  will  be  held  on  Friday.  October 
14th,  at  4.30  p.m.,  at  the  Royal  College  of  Physicians, 
Kildare  Street,  when  the  report  will  be  submitted  and 
the  election  of  officers  will  take  place. 


OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— St.  Bartholomew's  (1.80  p.in.),  University  College 
(2  p.m.),  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m«),  Oharing: 
Gross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.).  King'* 
Ck>llege  (i  p.m.).  St.  Geonre's  (Ophthalmic,  1  p.m.),  St.  Mary's 
(2  p  m.).  National  Orthopiedic  (10  a.m.),  St.  Peter's  (2  p.m.), 
Samariton  (9.80  a.m.  and  2.80  p.m.),  Gt.  Ormond  Street  (9.80 
a.m.),  Gt  Northern  Central  (2  80  p.m.),  Westminster  (2  p.m.;. 
Metropolitan  (2.80  p.m.),  London  Throat  (9.30  a.m.).  Cancer 
(2  p.m.).  Throat.  Gol'^en  Square  (9.80  a.m.),  Guy's  (1.80  p.m.). 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  St.  Thomas's  (8.80 
p.m.).  University  College  (2  p.m).  Cnarin|^  Cross  (8  p  m.^,  St. 


George's  (1  p.m.),  London  i2p.m.).  Kings  College  (2  p.m.), 
sex  O'SO  p.m.),  St.  Mary's  (2.80  p.m.).  Soho  Square  (2  p.m.), 
North-West  London  (2  p.m.),  Chelsea  (2  p.m.)  Great  Northern 
Central  (Gynaacological,  2.80  p.m.),  Metropolitan  (2.80  pm.), 
London  Throat  (9.90  a.m.),  St.  Mark's  (2  p.m.),  Samaritan  (9.80 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Guy's 
(1.80  p.m.). 

FRIDAY.— London  (2  p.m.),  St  Bartholomew's  (1.80  p.m.),  St. 
Thomas's  (8.80  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.80  p.m.). 
Charing  Cross  (8  p.m.).  St.  George  s  (1  p.m.),  King  s  GoUf^  (2 
p.m.),  St.  Mary's  (2  p.m.),  Ophthahnic  (10  a.m.).  Cancer  (2  pjn.) 
Chelsea  (2  p.m.).  Great  Northern  C!entral  (2 80  p.m),  West 
London  (2  8()  p.m.),  London  Throat  (9.80  a.m.),  SamarlUn  (9.80 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  City 
Orthopasdic  (2.80  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (1  80 
p.m.).  St  Thomas's  (2  p.m.).  University  CoUege  (9.15  a.m.). 
Charing  Cross  (2  p.m.),  St  George's  (1  p  m.),  Ht  Mary's  (10  p.m.> 
Throat  Golden  Square  (9  80  a.m.),  Guy's  (1.80pm.). 

MONDAY.- London  (2  p.m.),  St  Bartholomews  (1.80  p.m.),  St 
Thomas's  (8.80  p.m.).  St.  George's  (2  p.m.),  St  Manr's  (2.86 
p.m.),  Middlesex  (1.80  p.m.).  ^(^tminster  (2  p.m.),  Chelsea  (2* 
p.m.),  Samaritan  (Gyn»cological,  hy  Physicians, 2  p.m.),  Soho^ 
Square  (2  p.m.).  Royal  Orthopndio  (2  p.m.).  City  Orthopadic  (4 
p.m.).  Great  Northern  Centre  (2  80  p.m.),  West  London  (2.80 
p.m.),  Ix>ndon  Thiof  t  (9.80  a.m.),  Royal  Free  (2  p.m.),  Guy's(l.8i> 

TUBBDAY.— London  (2  p.m.),  St  Bartholomew's  (1.80  pjn.),  St 
Thomas's  (8.80  p.m.),  Guy's  (1.80p.m.).lMkldl€sex  (1.80  p.m.),. 
Westminster  (2  p.m.).  West  London  (2.80  p.m.),  University 
College  (2  p.m.),  St  George's  (I  p,m.).  St  Marys  (I  P^O.  St. 
Marrs  (i.80  p.m.).  Cancer  (2  p.m.)  Metropolitan  (1.80  P-m.), 
London  Throat  (9.80  a.m.).  Royal  Bar  (8  p.m.),  Samaritan  (9.80 
a.m.  mnd  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Siho 
Square  (2  p.m.) 


352    The  Medical  Press. 


NOTICES  TO  CORRESPONDENTS. 


Sbpt.  28.  1904. 


€0rrtBp0tib£tttB,  ^Itott  ^tetters,  Jcc 


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avoid  the  practice  of  eigning  thenwelTea  "Beader."  •' Subeorlber," 
t*  Old  Subeoriber,"  ftc  Much  oonfudon  will  be  spared  by  attention 
•to  this  rule. 

OEieiHAL  Artiolm  or  Littus  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- 
rtion,  but  as  evidence  of  identity. 

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the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

RiPEims.^Beprints  of  articles  appearing  in  this  Journal  can  be  had 
«t  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
•printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

A  WARNING. 

Our  London  readers  should  note  that  Just  at  present  the  police 
are  making  active  inquiries  as  to  the  whereabouts  of  a  sallow  young 
man  with  a  scar  on  his  forehead,  who  is  stealing  things  from  con- 
sul ting  and  waiting  rooms.  His  plan  is  to  call  outside  consulting  hours 
«nd  ask  to  be  allowed  to  write  a  note  for  the  medical  man  on  his 
return. 

Dr.  T.  rLewisham).~Speaking  generally,  one  year's  hospital  train- 
ing is  absolutely  inadequate  to  turn  out  a  properly  equipped 
nurse.  Tiiree  years  at  least  is  necessary,  and  a  still  further  experience 
-of  ho»-pital  life  is  requisite  if  she  aspires  to  taking  any  of  the  posts 
including  supervision  in  the  larger  institutions  for  the  sick.  It  is 
just  possible  here  and  there  that  an  individual  case  may  demand 
exceptional  treatment,  as,  for  instance,  when  a  nurse  received  her 
toaining  in  the  days  when  a  three  years'  course  was  not  considered 
essential.  It  would  be  impossible,  however,  to  ^ve  an  opinion  on 
sny  such  instance  without  a  full  acquaintance  with  the  facts  of  the 
case. 

The  Dimivishiko  Birth-eats— It  is  a  fact  that  the  Society  of 
Medical  Officers  of  Health  were  unable  to  come  to  a  decision  as  to 
whether  or  not  the  declining  birth-rate  ot  the  United  Kingdom  was 
•due  to  '*  preventive  "  practice  amongst  msrried  persons. 

F.B.C.S.  (Birmingham)  writes  us  asking  if  any  of  our  readers  have 
.known  cases  where  gall-stones  have  been  vomited.  He  has  recently 
iiad  under  his  care  a  patient  who  nearly  died  from  exhaustion,  &o. 
There  was  localised  peritonitis  and  symptoms  pointing  to  impacted 
gall-stone.  She  refused  operation,  but  recovered  ultimately  after 
vomiting  a  large  gall-stone.  (For  similar  case  see  Jonathan  Hutchin- 
«on's  *' Smaller  Atlas  of  Olinioal  Illustrations,"  Plate  lvii.~ED. 
Jf  .P.  ft  C.) 

BBX8TOLIBN8IS.— Diabetes  insipidus  has  been  met  with  occasionally 
in  Raynaud's  disease,  and  glycosuria  more  frequently,  and  in 
«oine  instances  the  sugar  appeared  to  be  secondary  to  gimgrene. 
Raynaud  recorded  an  interesting  case  in  the  Nouvmu  Dictionnaire, 
1872,  in  which  he  gave  the  probable  sequence  of  events  as  several 
.years  of  recurring  local  asphyxia,  then  diabetes,  which  brought  on 
.gangrene  and  tuberculosis.  One  of  the  best  comprehensive  accounts 
of  Bciynaud's  disease  with  which  we  are  acquainted  is  to  be  found 
in  Monro's  bock,  published  in  1880  by  Maclehose  and  Sons,  of 
•Glasgow. 


(Itteetings  of  the  §oncl«0,  JUttwcte,  <Stc, 

WSDNBBDAT,  SEPTEMBER    28th. 

Medical  Graduates*  Oollboe  akd  PoltclihicXSS  Chenies  Street, 
•W.C  ).  -  4  p.m.     Mr.  T.  P.  Legge  :    CUnique.    (Surgical.) 

Thxtrsdat,  Sereiiebb  29th. 

Medical  Graduates'  College  ahd  Poltclivic  (22  Ohenies  Street, 
"W.C.).— 4  p.m.  Mr.  Hutchinson  :  Clinique.    (Surgical.) 

Friday,  Beptbmbkr  30th. 

Medica!*  Graduates'  Collbob  and  Poltolieic  (22  Chenies  Street, 
W.C.).— 4  p.m.     Mr.  B.  Jjake :  Clinique.    (Ear.) 


I^eicester  Inflnnaiy.— Assistant    House   Suisreon.    Salary  £80  per 


annum,  with  board,  apartments  and  wMtaine.    Arndkattoa  u 

the  Sec  retary,  the  Infirmary.  Liecester. 
West  Biding  of  the  County  of  York— Storthes  Hall  Asylum  Knkbv. 

ton,  near  Huddersiiekl.>-Assi8tant  Medical  Officer.    Salary  £l« 

per  annum,  with  furnished  rooms,  board,  attendance,  aad  «ub- 

ing.    Applications  to  the  Medical  SuperintendenL 
French  Hospital  and  DispensAry,  172  Shaftesbury  Avenue,  WX.- 

Bcsident  Medical   01&oer.<    Salary  £»)   per  annum  with  HH 

board.    Applications  to  tbeSecre  arj'. 
Ancoats  Hospital,  Manchester.— Besident  House  Fhysftciaii.   Sskir 

£80  per  annum,  iK-ith  board,  residence,  Ac.    ApplicatioM  ts 

Saml.  Baron,  Secretan*. 
The  Manchester  Northern  (late  Clinical)  Hospital  for  Wanaen  sad 

Children— House  Surgeon.    Salary  £80  per  annum,  with  apst- 

ments  and  board.  Ap^ications  to  Mr.  Hubert  Teague,  Secrecan, 

38  Barton  Arcade,  Manchester. 
Central  London  Throat  and  Ear  Hospital,  Orgy's  Inn  Bead.— flseoM 

Assistant  Anesthetist.   Honorary  yearly  appointment.  Apniiea- 

tlons  to  be  made  before  September  28th  to  Bichard  Keodav. 

Secretary. 
Boyal  Halifax  Infirmary.— Third  House  Surgeon.     Salary  £80  p9 

annum,  with  residence,  board,  and  washing.     Applieation»  to 

Gates  Williams,  Secretary,  Boyal  Halifax  Infirmary.  Halifax. 
Northampton  General  Hospital.— Bouse  Surgeon.     Salary  £100  pfr 

annum,  with    furnished  apartments,   board,  attendance,  and 

washing.     Appliuations    to   C.  ij.    Biabee,    Secretary-Soper- 

intendent. 
Newcastle-upon-Tyne  City  Hospital  for  Infectious  Diseases.— Bcshfee 

Medical  Officer.     Salary  £100  per  annum,  with  board,  lodm. 

Ac.    Applications  to  the  Medical  Officer  of  Health,  Town  HsH. 

Ne  woastle-u  pon-Ty  ne. 
The  Earlswood  Asylum.  Bedhill  (The  National  Training  Home  fertki 

Feebleminded )  —Junior  Assistant  Medical  Officer.    Sidary  £m 

per  annum,  with  board,  loaging.  washing,  Ac,  AppUcations  to 

the  Secretary,  36  King  William  Street,  London  Bridge,  S.C. 
Parish  of  Kensington. -Second  AssisUnt  Besident  Medical  Officer. 

Salary  £80  per  annum,  with  apartmentu,  'board,  and  washi^ 

Applications  to  W.  U.Stephens,  Clerk  to  the  Guardians,  "^ 

Bead,  Kensington,  W. 


Fbltoe,  Walters.,    L.B.C.P.I.,  LB.CS.L,  Medical  Ofllcer  sal 

Public   Vaccinator   for  the  Newlv'n  East  District   by  the  St. 

Columb  (Cornwall)  Board  of  Guardians. 
JoHirsoN,  W.  Crosby.  M.B.,  Ch.B.Vict.,  Honorary  Physician  to  Uk 

Pendleton  Branch  Dispensary  of  Salford  Boyal  Huspital. 
Bodger,  T.  B.,  M.a,  B.S.Glasg.,  Certifying  Surgeon  under  the  Fk^ 

tory  Act  for  the  danquhar  District  of  the  County  of  Dumfries. 
BiMPSOH,     Thomas      Youro,     H.B.C.8^    L.B.C.P.Lond..     Josiv 

House  Surgeon  at  the  Boyal  Albert  Hospital,  Devonport 
Style.  F.  W.,  M.B.C.S.,  L.B.C.P.Lond.,  Medical  OfBoer  for  the  Bveit 

(Devon)  and  District  Postal  Staff. 


girths. 


Chavce.— On  September  aoth,  at  OOMerrion  Square,  W.,  the  wife  s! 
Arthur  Chance,  of  a  son. 


BouREB— BoBBRTB.— On  September  21st,  at  Holy  Trinity,  8!t^ 
bourne,  Kent,  Henry  James  Frederick  Bourne,  L.B.C&, 
L.B.G.P.,  of  Bridge  House,  Hailing,  Kent,  eldest  aurviviBg  Ms 
of  the  late  Henry  Bourne,  of  Antigua,  W  J.,  and  BedhllL  Sana. 
to  Lilian  Theodora,  youngest  daughter  of  the  late  Ber.  w. 
Boberts,  formerly  vicar  of  Hailing,  Kent. 

Oarr— Morris.— On  September  21st,  at  Shanghai  Cathedral,  SjdDer 
H.  Oarr,  M.D..  son  of  the  late  T.  W.  Garr,  of  Newtown  Hov^ 
Carlisle,  Cumberland,  to  S.  Emmie  Morris,  Ovoca,  EUot  Hil. 
Lewidiam,  London. 

Daltov— Brieblby  Shbrxdav.— On  September  20th,  at  the  CUhe- 
dral.  Mullingar,  by  the  Bev.  B.  A.  O'BeUly,  S.J.,  Cloofom 
Wood  (uncle  to  the  bride),  assisted  by  Bev.  W.  Egan.  PJ*.. 
Mount  Nugent;  Bev.  L.  J.  Condon,  O.S.A.,and  Bev.  Mieteel 
M'Swtney.  Cork,  Bichaxd  Dalton,  Esq.,  H.D.,  son  of  Garret 
Dalton,  Esq.,  68  Grand  Parade,  Cork,  to  Rosamond,  younseit 
daughter  of  Bichard  Brinsley  Sheridan,  Esq.,  J.P.,  Lake  View, 
Mount  Nugent,  co.  Cavan.    N'o  cards. 

Stock— Vae  Beek.— On  September  20th,  at  St.  Peter's  Cathedral 
Pietermaritsbuig,  Natal,  Philip  Graham  Stock,  Captain 
B.A.M.C..  Assistant  Medical  OfRcer  of  Health,  Johann^b«g, 
youngest  son  of  Granger  Stock,  Clifton,  Bristol,  to  Ellen  BUa- 
beth  (Nellie),  eklest  daughter  of  Carl  Tan  Beek,  Esq.,  Johannes- 
burg. 


JBtXtttB. 


Abhtoh.— September  19th,  at  Marlborough  Lawn,  Oheltenhan, 
Brigade  Surgeon  William  Ashton,  eldest  son  of  the  late 
William  Ashton,  Esq..  of  Doneraile,  co.  Cork, aged  00. 

Clarke.— On  September  20th,  at  2S  Lower  Book  Gardens,  Brightos. 
Margaret  Beatrice,  widow  of  Vans  Christian  darke.  M.D.,EN., 
aged  82. 

Foster.— On  September  21st,  Mary  Bound,  the  wife  of  Joseph 
Foster,  M.D.,  of  10  St.  George's  Bead,  Eooieston  Sqove, 
aged  61  years. 


^ht  ^dm\  ^tm  mA  ^itmhv. 


••SALUS    POPULI    SUPREMA    LEX." 


Vol.  CXXIX. 


WEDNESDAY,    OCTOBER    5,    1904. 


No.    14. 


0rtdtaal  Communications. 
THE  ISOLATION  HOSPITAL. 

By  G-  D.  MARRIOTT,  L.R.C.P.,  L.F.P.S.Glasg., 
Medical  Officer  of  Health,  Borough  of  Nottingham. 

The  isolation  hospital  is  a  preventive  insti- 
tution or  nothing.  If  it  fails  to  prevent  it  fails 
altogether.  To  imagine  that  it  could  remain 
as  a  nursing-home  is  to  misapprehend  the  aim 
and  object  of  such  undertakings,  and  to  lose 
sight  of  the  financial  considerations  which  are 
involved.  The  main  purpose  which  they  were 
intended  to  serve  and  the  chief  use  to  which 
they  have  been  put  was  the  aggregation  of  cases 
of  scarlet  fever.  Attention  has  at  last  been  com- 
pelled to  the  fact  that  the  system  cannot  be 
justified  in  the  face  of  notification  returns,  and 
we  are  now  being  asked  to  believe  that  such  places 
are  at  least  necessary  for  the  better  nursing  of 
enteric  and  other  cases.  In  other  words,  the 
isolation  hospital,  having  failed  as  a  means  of 
prevention,  is  to  survive  as  a  pauperising  insti- 
tution— a  state  of  things  which  would  be  as  im- 
possible as  it  would  be  absurd. 

It  has  been  said  that  the  wholesale  condem- 
nation of  the  isolation  hospital  was  at  least  a 
tactical  blunder,  that  it  would  have  been  wiser 
to  advocate  the  limitation  of  the  scope  of  the 
proposed  inquiry  to  scarlet  fever  isolation.  Bui 
would  it  be  possible  to  so  limit  it  ?  I  doubt  it. 
It  would  be  difficult,  for  instance,  for  a  Royal 
or  other  Commission  to  exclude  from  its  delibe- 
rations discussions  dealing  with  the  "  isolation  " 
of  diphtheria  and  those  borderland  variants  to 
which  Dr.  Biss  has  so  ably  called  attention. 
Should  it  be  proved,  as  we  believe  it  will  be,  that 
"  isolation  "  in  both  cases  has  been  a  gruesome 
mistake,  there  will  bejsuch  an  outcry  in  this  country 
as  will  enforce  a  further  inquiry  into  the  conse- 
quences, both  to  the  individual  and  the  com- 
munity, of  the  aggregation  system  generally. 
In  my  judgment  such  an  inquiry,  carried  out 
from  an  authority  from  which,  as  Dr.  Millard 
rightly  suggests,  all  partisans  should  be  excluded, 
could  only  end  in  one  way  —  namely,  in  the 
complete  abolition  of  a  system  which  never  had 
a  ray  of  sanction  either  of  science,  experience, 
or  common  sense. 

Let  it  be  granted,  for  the  sake  of  argument, 
that  the  result  of  the  inquiry  is  a  general  con- 
demnation, so  far  as  the  "  isolation  "  of  scarlet 
fever  and  diphtheria  are  concerned  ;  what  work, 
then,  remains  for  the  isolation  hospital  to  do  ? 

Thanks  to  sanitary  betterment — and  not  to 
the    aggregative    system — ^we    have    got    rid    of  I 


relapsing  fever.     If  typhus  has  not  yet  entirely 
disappeared,  it  is  because  of  the  neglect  of  the 
most   elementary   precautions   against    a   disease 
I  the  materies  morbi  of  which  is  not  able  to  cross 
an    open   space.     Enteric   cases   are   successfully 
nursed  in  the  common  wards  of  general  hospitals. 
Measles    and    whooping-cough,     it     is    generally 
conceded,    will   never   be   made    the   subjects   of 
experimental  "  isolation,"  as   has  been   the  case 
I  with  scarlet  fever.     This   leaves   us   only   small- 
j  pox  to  deal  with.     I  wish  here  to  be  as  guarded 
'  as  I   always  have  been  in  my  criticism  of  the 
small-pox     hospital  —  an     institution     which     is 
I  generaJly  dissociated,  as  far  as  possible,  from  the 
!  ordinary    isolation    hospital.     That     the     aggre- 
I  gation  of  small-pox  cases  is  bad  for  the  aggregated 
,  I  never  had  any  doubt.     In  the  case  of  a  disease 
the   striking-distance   of   which   is   so   great,   re- 
moval in  presence  of  the  usual  crowd  must  be  re- 
garded with  suspicion,  and  is  a  fact  which  few  would 
attempt   to  deny.     Nor  can  the  constant  presence 
of  the  small-pox  cab  in  the  crowded  thorough- 
fares of  a  city  be  looked  upon  with  any  degree 
of  satisfaction.     True  it  is  also  that  the  removal 
of  the  first  case  does  not  always — it  would  be 
correct,  probably,  to  say  does  not  often — prevent 
the   spread   of   the   disease   either   in    the   home 
or  in  the  locality.     The  safeguard  here,  as  we  all 
know,  is  vaccination.     In  vaccination  we  have  a 
means   of   prevention   which    transcends   in   im- 
j  portance  every  system  of  "  isolation  '*  that  has 
ever  been  devised,  and  without  which  no  system 
I  could  succeed  at  all.     It  is  surely,   then,   more 
I  reasonable,  and  more  scientific,  to  insist  on  the  pass- 
I  ing   of   a  Re- vaccination   Bill   than   to   advocate 
the  covering  of  the  earth  with  small-pox  hospitals. 
I  In  this  connection  it  will  not  have  escaped  the 
I  notice  of  the  profession  that  the  medical  officer 
I  of  health  of  this  city  has  been  recently  success- 
I  fully  treating  small-pox  cases  in  what  was  prac- 
I  tically  the  open  air— cases  which  he  despaired  of 
I  getting  well  if  left  in  the  wards  of  the  small-pox 
hospital.     Dr.  Bobbyer's  reading  of  these  happen- 
ings may  not  chime  with  mine  ;  probably  it  does 
not,  but  the  fact  is  generally  interesting,  and  to 
me  significant. 

Since  the  passing  of  the  Public  Health  Bill 
almost  the  sole  conception  of  disease-preven- 
tion has  been  the  erection  and  crowding  of 
so-called  up-  to  -  date  and  well  -  equipped  "  iso- 
lation "  hospitals.  Monies  that  ought  to  have 
been  devoted  to  works  of  sanitation,  which  is 
to  say  disease-prevention,  have  been  squandered 
on  experimentation.  In  spite  of  the  generally 
recognised  impossibility  of  obtaining  any  data 
on  which  such  a  claim  could  be  based,  medical 


354    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Oct.  s,  1904. 


politicians,  such  as  Sir  Walter  Foster,  have  been 
declaring  that,  but  for  such  institutions  the  popu- 
lation of  these  islands  would  have  been  long 
ere  this  decimated  and  our  civiUsation  destroyed  ; 
and  lamenting  that  the  whole  municipal  debt 
of  three  hundred  millions  had  not  been  incurred 
in  the  establishment  of  isolation  hospitals. 
While  leading  politicians  who  are  members  of 
our  profession  talk  like  this,  can  it  be  wondered 
at  that  others  in  less  exalted  positions  have  per- 
suaded themselves  that  they  can  settle  these 
important  questions  with  a  wave  of  the  hand, 
or  that  an  enUghtened,  though  not  converted, 
section  of  the  medical  press  should  give  such 
grudging  assent  to  what  it  is  no  longer  able  to 
ignore  ? 

Now  one  word  of  warning.  It  is  probable 
that  the  value  of  the  "  isolation  "  hospi- 
tal is  now  about  to  be  appraised.  Let  us  hasten 
slowly  !  It  is  inconceivable  that  any  greater 
mistake  could  be  made  than  to  hurry  the  thing 
forward.  The  question  is  ripe  for  discussion 
among  ourselves — it  is  not  yet  ripe  for  an  inquiry 
by  Royal  Commission.  Truth  is  truth  to  the 
end  of  the  reckoning,  and  there  is  nothing  to  fear 
from  free  discussion,  but  much  to  fear  from  undue 
haste. 


PARAFFIN   IN  PLASTIC 
SURGERY,  (a) 

By  STEPHEN    PAGET,    F.R.C.S., 
Surgeon,  West  London  Hospital,  &c. 

The  author  stated  he  had  injected  paraiSin  in 
about  seventy  cases  of  depressed  nose  and  ten  of 
prolapse  of  the  rectum  or  vagina.  |For  the  nose 
cases,  he  used  a  parafiin  melting  at  1 14=^  or  i  i5^F., 
prepared  by  Rogers,  327  Oxford  Street,  London, 
and  a  syringe  made  by  Droll,  of  Frankfort,  recom- 
mended by  Dr.  Stein,  of  Wiesbaden.  In  these 
nose  cases  it  was  of  the  utmost  importance  not  to 
attempt  too  much,  but  to  be  content  with  the  least 
improvement  that  would  content  the  patient. 
Those  cases  were  most  favourable  where  the  skin 
was  loose,  free,  soft,  and  healthy,  and  the  tip  of  the 
nose  was  well-formed  and  in  the  middle  line. 
Those  cases  were  less  favourable  where  the  skin 
was  rigid  or  shrunk.  And  those  were  wholly  un- 
favourable where  the  skin  was  scarred,  adherent, 
pinned-down  to  the  deeper  structures,  and  wasted. 
Everything  depended  on  the  state  of  the  skin ;  if 
that  was  favourable,  it  did  not  matter  if  the  septum 
were  perforated.  He  had  not  had  any  case  of 
embolism  or  sloughing,  and  he  beUeved  that  these 
dangers  might  always  be  avoided ;  the  more  common 
danger  was  that  of  attempting  too  much.  The 
least  excess  of  paraffin  impaired  the  result  of  the  | 
injection,  and  the  surgeon  ought  to  attempt  nothing  ' 
more  than  just  to  make  the  patient  unnoticeable.  ! 
He  advised  that  a  general  anaesthetic  should  be  1 
given  ;  that  gentle  pressure  should  be  continued 
for  ten  or  fifteen  minutes  after  the  injection,  till  the 
paraffin  was  perfectly  rigid,  and  that  a  cold  wet 
compress  should  be  laid  over  the  upper  part  of  the 
face  for  a  day  or  two.  No  sort  of  nasaJ  splint 
was  of  any  use. 

Of  the  cases  of  prolapse  of  the  rectum  or  vagina, 
treated  by  injection  of  paraffin  under  the  mucous 
membrane,  two  had  relapsed,  and  in  one  the  injec- 
tion had  been  followed  after    some  months  by  a 


stricture  of  the  rectum  ;  but  the  majority  of  the 
cases  had  been  successful,  and  the  injection  would 
avail  even  in  cases  where  numerous  operations  had 
failed.  In  these  cases  of  prolapse,  the  purpose  of 
the  injection  was  to  strengthen  and  thicken  and 
approximate  the  walls  of  the  cavity,  and  thereby 
to  hold  up  the  slack  redundant  mucous  membrane, 
and  prevent  its  eversion.  A  paraffin  melting  at 
104°  or  105^  was  hard  enough.  It  must  be  injected 
immediately  under  the  mucous  membrane,  into 
the  loose  submucous  tissue,  and  no  deeper.  In 
prolapse  of  the  rectum,  two  or  more  nodules  or 
hummocks  of  paraffin  should  be  raised,  in  the  lower 
two  inches  of  the  rectum,  just  under  the  mucous 
membrane ;  these  being  apposed  would  tend  to 
prevent  prolapse  and  leakage,  but  could  not  hinder 
the  natural  action  of  the  bowels,  and  a  good  result 
might  be  obtained,  even  though  the  sphincters 
were  destoyed  or  useless.  In  prolapse  of  the  vagina 
a  patient  might  be  enabled  to  do  without  a  pessary, 
or,  at  least,  might  be  kept  from  prolapse  by  paraffin 
plus  a  pessary,  though  the  pessary  alone  had  been 
useless.  But,  of  course,  a  cystocele  or  a  very  bad 
prolapse  of  the  vagina  was  not  easily  cured, 
especially  if  the  patient  had  to  work  hard  for  her 
living. 


auBtriaii  aunical  Xectares. 


{a)  Abstract  of  Paper  read  at  the  Oxford  meeting  of  the  British 
Mtdlcal  AsBOciation. 


ON  COLOUR  HEARING, 

By  Professor  HEINRICH  CHALUPECKY,  M.D.. 

Docent-Chair  of  Medicine,  University  of  Prague. 
[from  our  VIENNA  CORRESPONDENT.] 

In  reviewing  our  knowledge  on  this  speculati\'e 
phenomenon  of  the  doubling  of  human  sensa- 
t  ons,  the  lecturer  said  that  it  would  be  instruc- 
tive to  examine  more  minutely  the  different 
theories  advanced  on  the  subject.  The  first  of 
these  views  is  given  by  Nuel  under  the  title  of 
"  Central  Irradiation,"  wherein  he  contends  that 
the  explanation  of  the  double  sense  of  sound  and 
colour,  or  sound-producing  colour,  is  due  to  the 
proximity  of  the  hearing  and  seeing  centres  with 
a  disposition  to  hypersensibihty.  This  sensitive 
state  permits  of  a  stimulus  acting  on  one  to  pass  over 
to  the  neighbouring  centre,  and  act  on  the  second 
centre  with  a  positive  result  in  either  colour  or 
sound. 

Steinbrugge's  view  of  the  phenomenon  is  that 
the  nerves  conveying  sound  and  sight  lie  in  close 
communion  with  one  another,  so  that  the  stimulus, 
passing  along  the  communication,  is  transmitted 
equally  to  each  centre  with  the  double  result — i,e., 
one  peripheral  stimulus  produces  both  hearing  and 
seeing. 

Thorp  thinks  the  confusion  of  colour  and  hearing 
is  intra-cerebral  where  fine  fibres  connect  the 
acoustic  with  the  optic  nerve. 

Now  the  objection  to  these  three  theories  is 
that  the  principle  does  not  apply  to  all  cases.  To  the 
first  it  is  objected  to  on  the  ground  that  the  cortex 
is  in  connection  with  all  the  other  centres  ;  how, 
therefore,  disposition  can  affect  two  centres  is 
difficult  to  comprehend.  This  same  objection 
applies  to  the  second  theory.  Pedrono  raises  a 
similar  objection  to  the  third.  These  aberrant 
fibres  referred  to  are  common  in  the  brain  between 
organs  of  sense  where  no  such  anomaly  exists. 

Urbantschitsch  has  recently  applied  himself  ex- 
perimentally to  discover  the  real  connection,  and 
finally  concludes  that  the  phenomenon  is  a  reflex 


Oct.   5,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    355 


miction.     He  found  that  by  applying  equal  stimuli  ! 

— i.e.,  strong  light  and  loud  sounds — similar  results  ' 

•could  be  produced.     Again,  if  strong  light  were  ap-  i 

plied  to  the  eyes  for  some  time  the  auditory  nerve  | 

"became  tired  and  dull,  and  vice  versd.     Another  of 

the  experiments  conducted  was  v  ith  a  grey  surface 

slightly  undulating,  on  which  the  patient  looked, 

and  near  to  this  surface  was  a  tuning-fork.     On 

continuing  the  gaze   after  the    tuning-fork    was 

sounded   the   patient   could   see   red   and  yellow 

lines  on  the  grey  surface,  and  finally  all  the  rays 

of  the  spectrum  appeared  to  him.     This  interesting 

experiment  does  not  prove  the  double  sensation, 

but  when  we  find  the  retina  exhausted  by  the  effect 

of  sound,  we  must  conclude  that  the  stmulus  has 

a  very  close  connection  with  the  auditory  apparatus. 

Here  again  we  must  distinguish  between  retinal 

exhaustion  and  retinal  disturbance.     By  intense 

gazing  at  any  object  the  blood-vessels  of  the  retina 

can  be  so  altered  that  chromatopsia  is  induced — (.«., 

colours,  rings,  &c. — simply  by  the  muscles  of  the 

eye   checking  the   free  circulation   of   the  blood 

through  the  finer  structure  of  the  eye-ball. 

It  may  be  noted  here  that  these  are  the  more 
recent    opinions     on     the    subject,      which    are 
not  a  great  deal  in  advance  of  the  older  ones. 
In     1848     Comaz    observed   that    an    increased 
colour  sensation  was  the  anti-analogue  of  colour- 
blindness.    At  a  later  period  Marce   adopted   a 
scale  of  hyperchromatopsia  which  more  recently 
has  been  developed  by  Albertoni  in  connection 
with  a  modulated  scale  of  sounds  which  had  been 
acknowledged  as  defective  in  the  earlier  experiment, 
as  it  is  frequently  observed  that  the  patient  who 
could  not  distinguish  colours  very  well  was  as  bad 
at  recognising  or  distinguishing  notes  in  a  scale  of 
sounds.     This  led  to  the  estabhshment  of  a  scien- 
tific scale  of  corresponding  sounds  that  were  de- 
fective in  the  colour-blind  patient.     It  was  found 
by  observation  that  red-bUnd  patients  could  not 
distinguish   the   G   tone,    while  green-blind  were 
unable  to  differentiate  the  D  sound,  which  were 
fixed  at  Hauth's  scale,  and  subsequently  extended 
to  G,  E,  C,  and  followed  in  the  spectrum  to  C,  D. 
Preyer  deduced  another  on  this  same  basis  by  hght 
and  vibrations.     He  found  that  the  tone  C  pro- 
duced a  brown  colour,  and  the  tone  D  a  red  colour. 
In  the  same  way  he  found  E  to  be  orange,  F  yellow, 
G  green,  A  blue  and  B  violet.     With  the  assistance 
of  the  ItaUan  School  of  Harmony,  he  endeavoured 
to  elaborate  this  scale  still  further  by  combining 
colours,  such  as  red-green  and  violet,  and  in  har- 
mony with  D,  G,  B.     At  a  later  period,  Castel 
combined  these  two  systems,  which  now  form  one 
under  his  name.     Notwithstanding  all  this  scien- 
tific parade,  we  are  still  without  the  real  cause  of 
colour-blindness,  unless  we  infer  from  these  ob- 
servations of  sound  and  light  that  both  organs  of 
sense  were  defective.     Beyond  this  deduction,  no 
theory  of  the  production  can  be  formulated  to 
account  for  the  phenomena,  and  we  are  thus  forced 
to  look  in  some  other  direction  for  a  better  explana- 
tion. 

The  theory  of  evolution  is  found  to  be  more  satis- 
factory to  the  speculative  mind.  In  the  lower 
animals  one  nerve  centre  has  all  the  functional 
activity  of  the  differentiated  brain  of  the  higher 
animals.  Thus  it  is  argued,  where  a  double  sen- 
sation exists  the  brain  is  not  fully  developed,  or 
has  not  reached  the  normal  standard  of  evolution. 
It  is  well  known  in  practice  that  these  malforma- 
tions are  hereditary,  and  that  double  sensations  of 
hearing  and  seeing  are  atavic  in  character.     This 


argument  would  be  perfectly  easy  and  lucid  if 
Hilbert  would  not  disturb  the  calm  repose  with  an 
awkward  question  :  How  is  it  that  this  acoustic- 
photoism  often  occurs  in  the  short  interval  of 
waking  and  sleeping  ?  Does  the  stimulus  excite 
two  senses — hearing  and  seeing — after  conscious- 
ness is  lost  ?  He  is  incUned  to  interpret  this 
phenomena  in  a  different  manner,  and  thinks  the 
sensitive  condition  of  sound-producing  colour 
mostly  belongs  to  the  young,  to  disappear  as 
years  roll  on  ;  hence  senile  decay  is  what  we  have 
been  prone  to  call  the  normal  state  of  the  brain, 
which,  according  to  this  reasoning,  is  only  senile 
involution  of  the  organism. 

After  reviewing  such  diverse  opinions,  one  is 
driven  to  the  concliision  that  the  double  sensation 
is  only  an  exalted  condition  of  the  entire  cortex  of 
the  brain,  or,  in  other  words,  due  to  cortical  hyper- 
aesthesia,  and  the  best  explanation  after  all  our 
efforts  may  be  found  in  the  chnical  experiment  of 
Cololian  and  Rodiet,  who  produced  cortical  hyper* 
aesthesia  with  alcohol,  whose  acute  stage  pro- 
duces many  hallucinations.  With  these  patients 
it  is  no  uncommon  thing  to  produce  in  any  two  of 
the  special  senses  the  opposite  effect.  By  percus- 
sing the  surface  of  the  body  the  alcoholic  can  often 
hear  someone  talking,  or  see  different  colours. 
Reasoning  in  this  way,  one  is  inclined  to  ask  himself 
if  this  double  sensation  of  Hght-producing  sound  is 
another  form  of  hallucination,  when  all  the  senses 
can  be  taken  in  detail.  It  seems  that  hallucina- 
tions are  the  product  of  irritated  nerve  centres, 
which  may  be  simply  from  irritating  the  centre 
itself,  such  as  with  the  toxic  alcohol,  or  the  stimulus 
produce  a  s  milar  result ;  hence  we  may  have  either 
central  or  peripheral  stimuh  producing  the  same 
result.  Absinthe  and  haschisch  are  still  more 
excitant  or  epileptic  in  their  action  than  alcohol, 
the  latter  being  an  Arabian  extract  of  cannabis  in- 
dica,  and  a  stimulant  which  Gautier  tells  us  that 
he  drank  himself  to  produce  colour  tones,  which  he 
describes  as  ced,  green,  blue,  and  yellow,  which 
he  could  perceive  in  distinct  waves  with  different 
soimds.  In  another  part  of  his  work  he  tells  us 
that  the  playing  of  a  piano  made  such  a  noise 
that  certain  of  the  notes  felt  to  him  as  arrows 
piercing  his  heart,  while  the  other  tones  were  blue, 
red,  &c.  Baudelaire,  the  poet,  had  the  misfor- 
tune of  indulging  in  haschisch,  and  taste  and  smell 
are  associated  with  colour  and  tones,  which  he 
makes  free  use  of  in  his  poetry. 

There  are  other  well-known  toxins,  such  as  san- 
tonin, which  at  first  produce  xanthopsia,  followed 
by  a-  violet  colour-blindness,  burning  of  the  skin, 
and  finally  a  dull  insensible  feeling — i.e.,  first 
hyperaesthesia  followed  by  anaesthesia. 

With  these  facts  before  us  we  have  only  to  ima- 
gine a  cortical  hyperaesthesia  of  a  congenital  nature, 
and  we  obtain  all  the  factors  necessary  to  produce 
sound-photopsia  or  aberration  of  the  other  senses. 
Our  famous  painters,  poets,  musicians  and  me- 
chanics belong  to  this  class  of  cerebral  deviations. 
This  sound -stimulus  producing  colour  is  well 
marked  in  the  poet  Binet,  whose  verse  is  crowded 
with*coloured  spectra  which  he  tells  us  were  pro- 
duced by  the  strains  of  music.  We  may  there- 
fore conclude  that  all  these  elaborate  theories  of 
proximity  of  centres  on  nerve  fibre  connections  with 
central  gangUa,  and  nerve  heredity,  or  atavism 
are  speculations  of  a  very  abstruse  nature  and  not 
at  all  borne  out  by  pathology  or  physiology. 
Sound-hearing  may  be  defined  as  a  physiological 
deviation   of  the  cortex  which,  if  weakened,  over- 


356    The  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


Oct.  5.  1904. 


worked  or  stimulated  into  a  condition  of  hyper- 
aesthesia,  feeble  stimuli  are  sufficient  to  produce 
abnormal  physiological  results. 

THE  EVOLUTION 

OF   THE 

SANATORIUM     TREATMENT 
OF  CONSUMPTION,  (a) 

By  T.  N.  KELYNACK,  M.D.,  M.R.C.P., 

Physician  to  the  llotmt  Vemon  Hospital  for  Consumption  and 
Diseases  of  the  Chest,  Hampstead  and  North wo()d. 

Gentlemen,— The  so-called  "  open-air  "  treat- 
ment of  consumption  has  been  subjected  to  what 
a  vulgar  public  is  accustomed  to  approve  as  the 
gentle  art  of  "  booming."  At  first  discounten- 
anced and  ridiculed,  it  has  rapidly  grown  in  favour 
both  with  the  profession  and  the  pubUc.  But 
an  injudicious  optimism  on  the  part  of  the  laity, 
and  an  ill-judged  and  unqualified  advocacy  of 
some  members  of  the  medical  profession,  have  not 
unnaturally  tended  to  turn  the  tide  of  unlimited 
hopefulness,  and  with  the  ebb  of  an  irrational 
'enthusiasm  there  is  a  real  danger  that  the  true 
place  of  the  sanatorium  in  the  arrest  and  allevia- 
tion of  pulmonary  tuberculosis  may  not  be  properly 
apprehended  and  much  of  the  principles  and  no 
little  of  the  practice  of  regulated  hygienic  treat- 
ment of  consumption  be  discountenanced  and 
neglected. 

It  cannot  be  denied  that  much  disappointment 
has  resulted  in  many  quarters  in  consequence  of  the 
failure  of  the  open-air  treatment  to  fulfil  all  the 
miracles  of  healing  which  unscientific  enthusiasts 
claimed  for  it.  The  new  treatment,  as  it  is  still 
sometimes  designated,  has  been  advertised  and 
exploited  as  though  it  possessed  specific  therapeutic 
properties.  And  in  the  upspringing  of  institutions 
professing  to  pro\4de  rational  hygienic  treatment  of 
consumption  it  must  be  admitted  that  establish- 
ments have  come  into  being  the  conduct  of  which 
has  not  gone  to  encourage  faith  or  develop  practice 
in  a  systematic  and  scientific  management  of  the 
disease. 

Undoubtedly  in  the  rational  application  of 
hygienic  methods  we  have  the  most  effective  means 
known  to  medical  art  of  combating  pulmonary 
tuberculosis,  and  it  will  be  lamentable  if.  through 
lack  of  judgment,  insufficiency  of  knowledge,  or 
selfishness,  the  pendulum  of  public  and  professional 
opinion  be  allowed  to  swing  back  from  its  position 
of  illogical  and  unscientific  hopefulness  to  a  posi- 
tion of  equally  illogical  and  unscientific  hopeless 
despair,  when  by  a  clear  statement  of  the  true 
position  as  evidenced  by  pathological  research  and 
clinical  experience  an  attitude  of  mind  can  be 
reached  which  is  willing  to  prove  all  things  and 
hold  fast  to  that  which  is  clearly  demonstrated 
to  be  good. 

Having  studied  the  development  of  the  sana- 
torium movement  in  this  country  and  visited  most 
of  these  institutions  in  Great  Britain  and  Ireland 
devoted  to  the  management  of  consumptive  cases, 
I  venture,  in  the  short  time  allotted  to  me,  to 
endeavour  to  place  before  you  the  main  features  in 
the  evolution  of  the  modern  sanatorium  for  the 
treatment  of  consumption,  to  indicate  somewhat 
of  the  nature  of  the  present  practice  followed,  and 
to  forecast  something  in  regard  to  the  future. 

(o)  A  Lecture  delirered  at  the  Post-Oraduates'  OoUege  and  Poly- 
clinic, Lordon.  on  TuMday.  July  6th,  1904, 


The    Growth    of    Hygienic    Treatment. 

Every  healthy  man  is  slow  to  realise  the  advan- 
tages which  accrue  from  a  regulation  of  his  life  in 
accordance  with  hygienic  principles.  The  need 
for  public  sanitation  he  readily  admits,  but  the 
practice  of  personal  hygiene  he  willingly  neglects. 
It  is  easily  understood,  therefore,  how  difficult  it 
has  been  to  make  the  average  mind  realise  that 
hygienic  methods  were  all-important  in  the 
management  of  the  morbid,  and  especially  in  such 
a  disease  as  pulmonary  tuberculosis. 

There  seems  to  be  a  general  idea  that  our  views 
and  practice  in  regard  to  the  hygienic  treatment  of 
consumption  were  made  in  Germany  ;  but,  whilst 
we  willingly  bear  witness  to  the  directing  and 
inspiring  influence  of  Brehmer,  Dettweiler,Walther, 
and  others,  it  is  but  right  that  we  should  accord 
due  honour  to  English  and  American  pioneers. 

[Quotations  were  here  given  from  the  writings 
of  such  pioneers  as  George  Bodington,  Henry 
MacCormac,  Parrish,  and  Benjamin  Ward 
Richardson.] 

The   Sanatorium   of  To-Day. 

Interesting  and  instructive  as  it  is  to  consider 
the  development  of  what  we  may  term  the  sana- 
torium idea,  it  is  more  important  to  investigate 
the  principles  which  underUe  the  institutional 
treatment  in  the  present  and  study  the  methods 
employed  in  the  various  establishments  which  now 
stud  the  country. 

Sanatoria  now  exist  for  all  sorts  and  conditions 
of  sufferers.  The  wealthy  may  enjoy  many 
of  the  luxuries  of  hotel  or  club  life,  while  the 
pauper  can  at  least  be  supplied  with  the  inex- 
pensive necessities  of  fresh  air  and  exercise.  And 
it  is  well  that  provision  should  be  made  for  patients 
drawn  from  every  rank  of  life,  for  consumption  is 
no  respecter  of  position.  But  it  is  most  necessary-, 
if  the  method  is  not  to  fall  into  disrepute,  that 
the  essential  principles  of  the  hygienic  treatment 
be  insisted  on,  and  the  method  of  their  application 
directed  by  medical  authority. 

At  present  there  exists  the  widest  diversity. 
Some  sanatoria  are  conducted  in  accordance  with  a 
slavish  imitation  of  the  so-called  "  Nordrach 
system,"  and  procedures  are  insisted  on  ill-suited 
to  the  character  and  constitution  of  most  British 
patients. 

In    certain   institutions    there    is    the    greatest 
laxity,  patients  being  left  to  order,  in  great  measure, 
their  own  manner  of  life,  and  receiving  but  Uttle 
better  attention  than  residents  in  a  convalescent 
home.     Several    so-called    sanatoria    exist    where 
there  is  no  resident  medical  officer,  and  in  not  a 
few    the   chief   work   devolves   upon    a   recently 
quaUfied    junior     and    necessarily    more    or    less 
inexperienced     resident.      A    number     of     lady 
medicals  are  taking  up  sanatorium  management. 
A  considerable  number  of  those  responsible  for  the 
medical    conduct    of   sanatoria   have    themselves 
been  the  subjects  of  phthisis,  and  not  a  few  have 
come  under  the  influence  of  the  masterful  personal- 
ity of  Walther  at  Nordrach.     With  some  of  these 
there  would  sometimes  seem  to  be  a  tendency  to 
elaborateness  of   details  and  all- pervasive  super- 
vision which  is  liable  to  rob  the  patient  of  all 
originality  and  initiative,  and  undoubtedly  some- 
times go  far  to  develop  neurotic  characteristics. 
Wide  differences  also  exist  in  regard  to  nursing 
in  sanatoria.     Those  who  follow  the  Continental 
methods  of  procedure  discountenance  the  presence 
of    the    trained   nurse,  and   some   even   disallow 


Oct.  5.  1904. 


ORIGINAL    COMMUNICATIONS. 


Thk  Mbdical  Pxbss.    357 


attendants  to  wear  anything  resembling  a  nurse's 
garb.     It  is  undoubtedly  well  that  patients  should 
be  prevented  from  falling  into  habits  of  selfishness 
and  encouraged  to  do  for  themselves  such  matters 
as  will  not  interfere  with  their  restoration  to  health, 
and  those  patients  belonging  to  the  working  classes 
should  be  expected  to  assist  in  actual  work  as  far  as 
their  condition  will  allow.     But  we  believe  that  a 
well-trained  nurse  is  most  desirable,  not  only  for 
the  carrying  out  of  rational  therapeutic  measures, 
but  also  for  the  maintenance  of  what  we  may  term 
the   educational   atmosphere  of  sanatorium  life. 
Much  discussion  has  taken  place  regarding  the 
structural  form  and  situation  of  sanatoria.     These 
establishments     present     remarkable     contrasts. 
Some  are  almost  palatial  in   their  design,  lavish 
in  their  equipment,  extravagant  in  their  upkeep, 
and   such  as    can  only    be    brought  within    the 
means  of  the  wealthy.     Others  are  simple  in  con- 
struction, bare  and  comfortless  in   their  fittings, 
inexpensive   in   their   conduct,  and   intended   for 
the    comparatively    poor.     Many    are    admirably 
placed  in  sunny  and  protected  regions,  while  not 
a  few  aire  situated  on  exposed,  damp,  windswept 
sites.     But  the  remarkable  fact  comes  out  clearly 
that  while  some  cases  do  well  under  the  simplest, 
and  it  may  be  seemingly  most  unfavourable,  con- 
ditions, others,  even  when  placed  in  what  theoreti- 
cally should  be  the  most  advantageous  Ufe,  do  ill. 

Principles     of     Sanatorium     Treatment. 

But  however  widely  sanatoria  may  differ  in 
the  details  of  procedure,  it  is  most  desirable  that 
the  general  principles  guiding  action  should  be 
similar. 

In  selecting  a  suitable  case  for  sanatorium  treat- 
ment it  is  well  to  remember  that  hygienic  manage- 
ment seeks  to  secure  : 

I.  The  removal  of  the  patient  from  fresh  invasion 
by  the  tubercle  bacillus,  and  separation,  as  far  as 
possible,  from  all  influences  aiding  its  introduc- 
tion. 

II.  The  estabhshment  in  the  patient  of  pro- 
cesses of  repair  and  the  development  of  the  highest 
powers  of  resistance. 

To  this  end  the  instruments  employed  are  : 

1 .  Continuous  exposure  to  fresh  air. 

2.  Free  access  to  sunhght. 

3.  Regulated  rest. 

4.  Controlled  exercise. 

5.  Abundant  feeding. 

6.  Obedience  to  hygienic  requirements. 

7.  Strict  medical  supervision,  v  ^'"^        ' 
I  cannot  stay  now  to-  explain  the  manner  of 

action  of  these  various  factors,  but  they  should  be 
employed  with  a  clear  apprehension  of  their 
physiological  influence  and  therapeutic  value. 
Unfortunately,  at  the  present  time  too  much  in 
sanatorium  treatment  is  lacking  in  scientific  pre- 
cision and  savours  too  much  of  mere  empiricism. 

And  such  a  state  of  affairs  is  likely  to  persist 
so  long  as  discordant  views  prevail  regarding  the 
pathology  of  pulmonary  tuberculosis  and  widely 
divergent  views  are  promulgated  regarding  its 
origin,  spread,  arrest,  and  prevention. 

It  is  much  to  be  regretted  that  so  little  is  being 
done  in  the  sanatoria  of  this  country  to  encourage 
systematic  scientific  research. 

It  is  well  that  we  should  remember  that  much 
connected  with  the  so-called  hygienic  management 
of  consumption  is  at  present  in  Httle  more  than  the 
experimental  stage. 


Selection   of  Cases  for  Sanatorium 
Treatment. 
There  is  need  for  the  greatest  care  and  the  most 
judicious  discrimination  in  selecting  cases  for  sana- 
torium treatment. 

Too  often  resort  to  open-air  treatment  is 
advised  as  though  it  possessed  the  virtue  of  a 
definite  specific.  In  many  instances  patients  are 
sent  by  their  medical  advisers  to  sanatoria  as  a  last 
resort.  B/  a  reckless  advocacy  of  institutional 
treatment  much  harm  is  being  done  to  many  an 
individual,  and  public  sympathy  and  support  are  in 
danger  of  being  discouraged  and  even  aUenated. 

All  cases  of  consumption  should  no  doubt  be 
treated  in  accordance  with  strict  hygienic  principles^ 
and  generally  speaking  the  best  hygienic  manage- 
ment can  only  be  provided  in  properly  constructed 
and  well-conducted  sanatoria.  But  at  the  present 
time  with  the  limited  accommodation  available 
for  the  indigent  and  those  of  limited  means  it  is 
most  desirable  that  there  should  be  a  wise  selection 
of  cases.  This  is  abundantly  clear  when  we 
remember  that  in  England  and  Wales  alone  con- 
siderably more  than  40,000  deaths  are  registered 
every  year  from  phthisis,  and  that  between  the  ages 
of  fifteen  and  twenty-five  one-fourth  of  the  total 
deaths  are  due  to  this  disease. 

But  prognosis  in  pulmonary  tuberculosis  is 
beset  with  difficulties.  Many  of  the  old  precepts 
have  ceased  to  have  directing  value.  The  pessi- 
mism of  past  days  has  given  place  amongst  not  a 
few  to  an  optimism  which  unfortunately  is  often- 
times groundless.  It  is  sometimes  claimed  that 
phthisis  is  the  most  curable  of  chronic  infective 
diseases,  and  while  pathological  evidence  and 
clinical  experience  go  far  to  afford  basis  for  such  an 
opinion,  yet  I  am  convinced  that  we  should  always 
do  best  to  regard  phthisis  in  all  its  forms  as  a 
most  grave  malady.  Many  cases  certainly  do 
arrive  at  a  complete  arrest  of  the  pathological 
process,  but  among  the  poor  and  working  classes 
quiescence  is  often  only  temporary,  and  relapse, 
re-infection  or  a  re-awakening  of  the  slumbering 
ill  only  too  commonly  occurs. 

Hygienic  treatment  may  accompUsh  much.  Ix 
undoubtedly  affords  the  most  scientific  and  the 
most  successful  means  for  a  rational  combat  with 
consumption.  But  the  powers  of  the  open-air 
treatment  are  Umited,  and  it  is  detrimental  both 
for  the  individual  and  the  charitable  public  to 
make  claims  which  experience  cannot  support. 

We  must  view  the  prognosis  of  phthisis  in  the 
light  of  present-day  knowledge  and  submit 
every  case  to  individual  study  before  advising 
resort  to  what  may  be  an  expensive  and  ultimately 
useless  institutional  control. 

[The  various  points  guiding  prognosis  in  cases  of 
phthisis  were  then  discussed  and  indications  given 
for  judicious  selection  of  cases  for  sanatorium  treat- 
ment.] 

The  Future  of  the  Hygienic  Treatment  of' 
Consumption 


As  I  have  already  indicated,  the  so-called  hygienic 
treatment  of  consumption  undoubtedly  afford  the* 
most  trustworthy  and  successful  means  for  dealing 
with  tuberculous  cases.  It  is,  of  course,  possible 
that  medical  science  may  discover  some  method 
whereby  a  special  serum  or  other  body  may  pro- 
vide prophylactic  powers  or  act  as  a  definite 
antitoxin,  and  so  necessitate  a  modification  in  our 
institutional  treatment. 


358     The  Medical  Press. 


CLINICAL    RECORDS. 


Oct.  5.  1904. 


Meanwhile  much,  may  be  done  to  extend  and 
amplify  the  appUcation  of  such  hygienic  measures 
as  clinical  experience  has  shown  are  rich  not  only 
in  preventive  force  but  also  effectual,  to  a  great 
extent,  as  curative  and  alleviative  agents. 

From  what  I  have  said  regarding  the  necessity 
for  a  careful  selection  of  cases,  it  is  clear  that 
much  remains  to  be  accompUshed  in  the  way 
of  a  more  precise  differentiation  in  the  grouping  of 
patients. 

It  is  most  undesirable  that  so-called  incipient 
cases  should  be  allowed,  as  is  now  so  often  the  case, 
to  associate  with  persons  in  an  advanced  stage. 

Institutions  located  in  or  near  our  large  centres 
of  population  should  be  used  mainly  for  advanced 
cases  and  for  the  purpose  of  observation  of  those  in 
which  prognosis  is  doubtful. 

Cases  in  which  arrest  is  at  all  possible  should  at 
once  be  given  the  opportunities  of  a  country 
sanatorium,  which,  particularly  in  the  case  of  the 
poor,  should  not  be  dif&cult  of  access  from  centres 
of  work. 

There  is  great  need  at  the  present  time  for  suitable 
homes  for  those  helpless  and  hopeless  cases  occur- 
ring among  the  poor  and  labouring  classes,  for 
whom  there  is  now  practically  no  refuge  save  the 
much-dreaded  workhouse. 

Undoubtedly  the  action  of  most  general  hospitals, 
special  hospitals  for  consumption  and  sanatoria,  in 
refusing  admission  to  all  manifestly  hopeless  cases 
necessitates  the  retention  of  large  numbers  of 
dying  phthisical  patients  in  homes  devoid  of  all 
hygienic  requirements  and  such  as  faciUtate 
infection  of  relatives  and  friends,  many  of  whom 
are  often  pecuUarly  predisposed  to  contract  the 
disease. 

Efficient  sanatorium  treatment,  it  must  be 
remembered,  can  never  be  inexpensive.  Means 
must,  however,  be  found  for  deaUng  with  the 
immense  number  of  those  who,  self-supporting 
whilst  in  health,  when  smitten  by  disease  are  com- 
pelled to  join  the  ranks  of  the  dependent.  At  the 
present  time  there  is  abundant  sanatorium  accom- 
modation for  the  well-to-do.  Much  is  also  being 
done  to  meet  the  requirements  of  the  poor,  but  for 
sufferers  belonging  to  the  struggling  professional 
and  business  classes  adequate  opportunities  for 
hygienic  treatment  are  few  and  far  between. 

Much  will  also  have  to  be  done  in  providing  for 
satisfactory  "after  care."  Only  too  frequently 
a  patient  who  has  done  well  during  residence  in  a 
sanatorium  speedily  relapses  because,  in  the 
absence  of  systematiscd  means  to  secure  suitable 
work  and  a  hygienic  dwelling,  he  or  she  is  com- 
pelled to  return  to  the  old  occupation  and  the 
former  insanitary  mode  of  Ufe  ;  and  thus  time, 
skill,  and  money  are  expended  in  vain  and  a 
desirable  form  of  treatment  is  brought  into  dis- 
repute. 

I  am  afraid  that  in  this  country  there  is  at  the 
present  time  but  little  chance  of  national  friendly 
societies  and  labour  organisations  rendering  much 
assistance  in  the  estabUshment  and  maintenance 
of  sanatoria  for  the  working  classes,  after  the 
manner  adopted  in  Germany.  Much  may  be  said 
in  favour  of  the  suggestion  to  hand  over  London 
consumptives  to  the  care  of  the  Metropohtan 
Asylums  Board. 

I  am  also  of  opinion  that  some  of  the  many 
convalescent  homes  which  abound  in  this  country 
might  well  be  devoted  to  the  further  up-building  of 


*hose  who  have  passed  through  our  public  sanatoria, 
where,  it  must  be  remembered,  the  patient  can 
usually  only  be  retained  for  a  comparatively  short 
period,long  enough,  it  is  true,  to  teach  the  necessity 
for  and  the  best  means  of  maintaining  the  hygienic 
life,  but  oftentimes  quite  inadequate  to  procure 
anything  approaching  a  complete  arrest  of  the 
tuberculous  process. 

I  do  not  propose  to  discuss  the  advantages  and 
disadvantages  of  compulsory  notification  in  rela- 
tion to  any  pubHc  system  of  sanatoria.  A  volun- 
tary notification  is  in  force  in  many  important 
centres,  and  it  is  clear  that  reliable  information 
regarding  the  presence  of  tuberculous  subjects  and 
the  conditions  under  which  they  have  fallen  ill 
and  the  arrangements  for  their  relief  and  treatment 
would  be  of  the  greatest  service  if  wisely  used  not 
only  for  the  safety  of  the  State  but  the  benefit  of  the 
individual  sufferers.  It  is  very  necessary,  however, 
to  bear  in  mind  constantly  that  among  many  per- 
sons in  all  ranks  of  life  there  exists  an  unreason- 
able, and  I  think  I  may  safely  add  an  unwarranted, 
fear  of  any  association  with  the  phthisical,  and  as  is 
well  known  already  in  America  this  phthisio- 
phobia  has  much  increased  the  difiiculties  in 
founding  and  maintaining  sanatoria  and  otherwise 
adequately  dealing  with  the  consumptive. 

Gentlemen,  it  is  well,  if  we  would,  retain  the 
confidence  of  the  pubUc  and  maintain  the  dignity 
of  our  profession,  that  we  should  readily  admit 
that  we  are  still  far  from  a  clear  understanding 
of  the  nature  of  the  disease  we  term  pulmonary 
tuberculosis. 

Treatment  still  lingers  for  reliable  direction  from 
pathology. 

We  have  in  great  measure  shaken  free  from 
the  trammels  of  many  erroneous  views,  but  we  are 
still  to  a  large  extent  groping  in  doubt  and  un- 
certainty. 

Sanatorium  treatment  has  accomplished  much, 
and  I  believe  is  destined  to  have  far  reaching 
influence,  not  only  in  bringing  benefit  to  the  indi- 
vidual sufferer,  but  in  making  clear  to  the  public 
the  advantages  of  the  hygienic  life. 

But  we  must  be  wilUng  to  admit  that  much 
connected  with  the  so-called  hygienic  treatment  of 
consumption  is  still  in  the  experimental  stage. 

Let  us  therefore  continue  to  maintain  the  truly 
scientific  attitude  ;  and  while  extending  a  critical 
sympathy  let  us,  with  the  true  insight  of  the 
rational  therapeutist  and  the  far-seeing  wisdom 
of  the  sanitarian,  remember  that  the  modem 
sanatorium  for  the  consumptive  is  still  in  process 
of  being. 


Clinical  IRecor&s* 


HEMIANiESTHESIA        AND  CONSCIOUS 

TROUBLES  OF  SENSIBILITY   IN  SLIGHT 
AND  OLD  HEMIPLEGIA. 

By  G.  A.  SCHERB, 

Assistant-ProfesBor  to  the  Medical  School :  Oonsaltin^  Phytficiao  to 
the  Muotaphu  Hospital,  Algiers. 

Professor  O.  Marie,  my  distinguished  master, 
once  asked  whether,  in  the  case  of  a  hemiplegic, 
a  well-marked  organic  hemianaesthesi  i  could  last 
for  years. 

In  1898,  MM.  Degerine  and  Long  reported  to 
the  Society  of  Biology  of  Paris  that,  as  the  result 
of  numerous  microscopic  researches  in  seriated 
sections,  clear  cases  of  sensory  troubles,  persisting 


Oct.  5,  1904 


CLINICAL    RECORDS. 


The  Medical  Press.    359 


until  death,  occur  among  hemiplegics.Ct*)  The  con- 
dition may  exist  many  years  after  the  initial 
**  stroke,"  even  though  the  motor  troubles  have 
considerably  diminished.  They  have  pointed  out 
th.at  a  slight  lesion  accompanied  with  trifling  motor 
troubles  involving  the  external  part  of  the  thalamus 
■was  likely  to  bring  about  an  obstinate  hemianaes- 
thesia  by  destroying  that  grey  substance  which 
constitutes  a  relay  or  a  stage  between  the  ascending 
peduncular  ways  and  the  thalamo-cortical  fibres. 
One  understands,  under  these  circumstances,  the 
possible  existence  of  a  more  intense  and  lasting 
hemianaesthesia  than  the  concomitant  hemiplegia, 
by  reason  of  the  sensitive  ducts  being  here  still, 
as  in  the  calotte*s  region,  more  or  less  distinct 
from  the  motor  paths. 

MM.  De  erine  and  Egger  (1903)  have,  besides, 
recently  reported  a  case  absolutely  confirmatory 
of  those  views,  which  were  rather  novel  and 
opposed  to  the  classic  teaching  of  Charcot,  who 
always  said  that  the  lower  part  of  the  internal 
capsule  contains,  still  isolated,  the  sensitive 
bundle.  This  is  what  induces  me  to  state  the 
particulars  of  the  following  case,  carefully  recorded 
by  M.  De  Mouzon,  an  outdoor  student  attached 
to  my  wards  of  the  Mustapha  Hospital : — 

D.,  aet.  49,  farm  labourer,  native  of  La  Lozfere, 
a    short  but  thick-set   and   vigorous   highlander, 
had  a  fall,  eight  yea  rs  ago,  from  a  height  of  about 
two  metres  into  a  vat.     Owing  to  his  having  been 
unconscious,  he  could  not  give  any  information 
as  to  the  cause  of  his  faU,  nor  could  he  say  what 
part  of  his  body  was  hurt.     This  j)oint  is  of  im- 
portance, both  from  the  diagnostic  and  the  forensic 
point  of  view.     Now,  suppose  that  man  believed 
himself  hurt  and  crippled  in  the  course  of  his  w  :rk, 
there  would  be  great  reservations  to  be  made, 
for  one  should  put  oneself  the   question  whether 
there  had  not  been  a  previous  ictus  which    had 
determined   the   fall.     He  did  not  know  why  or 
how  he  fell,  and,  as  he  came  to  about  half  an  hour 
afterwards — ^that  is,  when  his  mates  took  him  out 
of  the  vat — he  had  no  sore  on  the  head  nor  any  in- 
dication whatever  of  a  trauma  of  the  skull.     How- 
ever,  he  kept  his  bed   for   twenty   days,  for  he 
could  not  move  the  right  side  of  his  body.     His 
speech  was  not  at  all  affected,  and  his  face  only 
bore  slight  traces  of  motor  troubles,  which  have 
persisted    up    to  now.       At    the    end    of    those 
twenty  days  he  could  make  a  few  steps,  and  he 
walks  to-day  almost  normally,  and  he  must  be 
attentively  observed  to  perceive  that  in  walking 
he  drags  his  right  leg  sUghtly.     Thus  he  shows 
Babinski's  sign  on  the  right  side  by  pricking  the 
right  sole,  with  exaltation  of  the  patellar  reflex  and 
of  the  wrist.     If  he  tries  to  whistle,  there  is  a 
deviation  of  the  left  side  of  his  month,  and  he 
whistles  badly ;   if  he  puffs  up  his  cheeks  by  ob- 
turating his  Ups,  the  right  labial  commissura  ap- 
pears incompetent  directly.     No  muscular  atrophy 
exists,  and  Mr.  Bordet,  a  friend  of  mine,  who  has 
submitted  him  to  an  electro-diagnosis  of  the  shoul- 
der muscles,  where  the  motor  deficiency  is  most 
marked,    has    found    normal    electric    reactions. 
However,  the  patient  does  not  cease  to  complain 
that  his  motions  on  the  right  are  impeded.     No 
noticeable   weakening   of   the   muscular   strength 
was  evident  on  the  right  side,  but  that  strength 
is  somewhat  transient ;  it  exhausts  itself  quickly  ; 
he  is  unequal  to  any  continuous  effort.     More- 
over, he  cannot  raise  his  right  arm  above  his  head 

(a)   '•  Traite  de  Medecine  "  de  Brouardel  et  Gilbert.    T.  viiL 


—on  account  of  the  peri- arthritis,  no  doubt — and  he 
suffers  from  his  right  shoulder  if  he  ventures 
to  raise  his  right  arm  above  the  horizontal  line. 
Obviously  hypertrophied  is  the  right  hand,  and 
that  uniformly.  That  constitutes  the  trophic 
troubles  which  are  the  first  indications  of  that 
hypertrophied  hand  that  one  sometimes  meets 
with  in  the  case  of  hemiplegia.  No  deviation  at 
all  of  the  vertebral  column.  The  pupils  are  even 
and  the  eyesight  is  not  impaired,  no  shortening  of 
the  visual  field  has  taken  place,  while  olfaction, 
hearing  and  taste  have  remained  normal.  And 
there  is  not  any  hjrsterical  stigma. 

From  the  first  day  my  attention  has  been  drawn 
by  the  sensitive  deficiency.  I  have  had  this  case 
under  obser  ation  for  a  ^  ear  and  it  has  not  varied- 
Besides,the  patient  himself  is  aware  of  it  all ;  the  first 
remark  he  made  when  he  began  using  his  right  hand 
was  that  he  did  not  feel  the  heat  of  the  bowl  of  his 
pipe .  The  sensitive  troubles  have  in  the  study  there- 
of been  seried  ;  upon  the  whole — and  that  is  also 
the  rule  in  organic  anaesthesia  proceeding  from 
a  cerebral  lesion — they  are  prominent  chiefly  at 
the  extremities  of  the  Umbs. 

Brush  Examination. — Right  sided  hemianaes- 
thesia.  In  the  upper  Hmb,  the  troubles  pre- 
dominate at  the  hand  and  by  degrees  diminish 
at  the  elbow  and  arm,  only  to  increase  again  at 
the  level  of  the  shoulder.  The  foot  is  almost 
entirely  anaesthetic,  the  leg  and  the  thigh  are 
rather  less.  The  trunk  and  the  face  are  hyper- 
aesthetic  on  the  right,  and  the  mucous  sensibility 
of  the  mouth  on  the  same  side  is  impaired. 

Pressure  Sensation. — ^Considerable  difference  ex- 
ists between  the  faculty  of  the  left  side  and  that  of 

I  the  right. 

Sensibility  to  Pricking, — Same  observations  as 
in  examination  of  tactile  feelings. 

I  Thermasthesia. — Considerable  reduction  in  the 
extremities,  with  delay  or  slowness  in  perception. 

I  With  regard  to  cold,  however,  there  is  no   lack  of 

I  sensitiveness  in  this  direction.  Experiments  have 
been  made  with  ice  and  a  hammer  heated  in  boil- 
ing water.  It  is  to  be  noted  that  the  right  shoulder 
region  shows  a  dull  sensibility  to  temperatures 
which  the  hand  fails  to  perceive. 

Perception  of  Passive  Segmentary  Attitudes, — ^The 
attitudes  imparted  to  various  segments  of  the  right 
upper  limb  are  not  altogether  lost.  Now,  as  for 
flexion,  supination,  abduction,  pronation,  Ac. 
Let  the  right  arm  of  the  patient  be  placed  in  a 
certain  position  ;  he  cannot  place  his  left  arm  in  a 
similar  position  if  he  shuts  his  eyes.  In  trying  to 
do  so,  slowness  and  groping  uncertainty  prevail. 
In  the  lower  hmbs  motions  are  well  performed. 
Stereognostic  Sense, — Almost  absolute  disappear- 
ance in  the  right  hand.  Moveover,  if,  without  the 
control  of  his  eyesight  you  give  an  ordinary  glass 
to  the  patient  to  weigh,  he  directly  values  the 
weight  thereof  at  2  kilogrammes.  Most  gross 
mistakes  of  weight  o:  this  kind  are  made  about 
very  common  things.  He  does  not  know  them 
by  feeling  them,  and  he  is  incapable  of  valuing 
their  weight. 

Conclusions. — It  is  evident  that  there  are  to  be 
found  all  the  attributes  of  organic  hemianaesthesia 
through  lesion  of  the  encephalon.  These  troubles 
are  fixed  and  conscious,  dating  from  about  eight 
years  back,  without  any  change  ;  they  are  not, 
however,  accompanied  by  hemianopsia,  and  motor 
disturbances  are  very  shght  indeed.  Still,  it  is  on 
the  right  shoulder  that  they  predominate  on  ac- 
count  of   some    ankylosing    arthritis ;    the  most 


360    The  Medical  Press. 


BRITISH  HEALTH  RESORTS. 


Oct.  s.  1904. 


profound  troubles  of  sensibility  lie  in  the  perimeter 
of  the  scapulary  region,  on  account,  undoubtedly, 
of  the  fact  that  it  is  there  the  sensory  re- 
education could  less  easily  be  made,  owing  to  the 
fact  of  restricted  motions.  Nevertheless,  it  must 
be  insisted  upon  that  the  shoulder  troubles  do  not 
in  the  least  affect  any  metameric  disposition. 

Thus  it  is  exceedingly  probable  that  in  the  case 
of  D.  the  matter  is  one  of  a  very  sUght  lesion  of 
the  thalamus  in  its  external  and  posterior  part, 
as  the  motor  deficiency  is,  indeed,  so  little  de- 
veloped. That  lesion,  if  extended  backward, 
would  have  resulted  in  hemianopsia  ;  if,  on  the 
contrary,  forward  laterally,  these  motor  troubles 
would  have  been  more  serious. 

A  solely  lenticular  or  capsular  limited  lesion 
-would  not  have  been  accompanied  by  sensory 
troubles  so  deep  and  persistent.  This  case  is  one 
to  study  carefully  from  a  clinical  point  of 
view.  It  comes  absolutely  within  the  range  of 
these  sensory  definitive  posthemiplegic  troubles 
of  which  MM.  Dejerine  and  Long  try  to  fix  the 
anatomical  substratum. 


Ube  ®nt^pattent  Departments. 

Dermatologtcal  Cases  under  the  care  of  Dr.  P.  S.  Abraham, 
[reported  by  dr.  g.  n.  meachen.] 

Case  I. — Extra-Genital  Chancre  from  a  Bite. — A 
single  man,  act.  29,  a  stall-holder,  came  with  an  obsti- 
nate sore  upon  the  back  of  his  right  hand.  The  history 
was  that  he  was  engaged  in  a  fracas  with  his  brother  on 
the  night  of  May  30th.  This  latter  individual  was  in 
a  state  of  intoxication,  and  was  known  to  be  sufiering 
from  syphilis.  In  the  course  of  a  struggle,  the  patient 
was  bitten  by  his  antagonist  upon  the  back  of  the  right 
hand.  He  did  not  take  much  notice  of  the  occurrence 
at  the  time,  but  the  spot  remained  somewhat  inflamed 
for  some  time  afterwards.  At  the  expiration  of  a 
month  he  observed  a  distinct  sore  place  over  his  knuckle 
and  some  painful  lumps  appeared  under  his  arm. 
When  seen,  on  August  26th,  1904,  there  was  an  oval, 
ulcerated  sore,  1}  inch  in  its  longest  diameter, 
situated  upon  the  dorsum  of  the  right  metacarpo- 
phalangeal joint.  The  edges  were  raised  and  infil- 
trated, and  the  surface  was  raw  and  discharging  ichorous 
matter.  About  one  inch  behind  it  was  another  sore, 
one-quarter  the  size,  and  of  a  punched-out  appearance. 
The  axillary  glands  were  enlarged.  A  typical  secondary 
eruption  of  the  scaly,  maculo-papular  type  was  present 
upon  the  body  and  limbs,  which  the  patient  stated  had 
appeared  soon  after  the  sore.  Seven  weeks  ago  the 
throat  was  troublesome,  and  the  original  sore  began  to 
spread  and  to  ulcerate.  On  examination,  the  fauces 
did  not  present  any  abnormal  appearance.  He  had 
not  had  any  medical  treatment. 

The  history  of  accidental  inoculation  in  this  case  was 
perfectly  clear,  but  even  if  this  had  not  been  so.  the 
raised  and  infiltrated  character  of  the  lesions  upon  the 
hand  with  their  serous  exudation  would  have  been 
quite  sufficient  to  form  a  diagnosis,  without  asking  any 
further  questions  or  examining  any  other  part  of  the 
body.  The  multiplicity  of  primary  chancres  was  not 
so  uncommon  as  was  generally  supposed,  particularly 
when  the  lesions  were  extra-genital. 

The  patient  was  at  once  put  upon  vigorous  anti- 
S3rphilitic  treatment. 

Case  II. — Extensive  Tinea  Circinaia. — A  married 
man,  aet.  41,  presented  himself  for  treatment  with  an 
eruption  extending  almost  completely  round  his  neck, 
which  he  had  noticed  for  the  last  three  months.  He 
believed  he  contracted  it  at  a  barber's  shop.  On 
examination,  a  collar-like  rash  could  be  seen  of  a  dark 
red  colour  and  with  a  raised  margin  forming  a  ring 
practically  all  round  the  neck.  The  borders  were 
slightly  scaly,  and  here  and  there  the  more  central 
parts  appeared  to  be  clearing  up.  The  nuchal  and 
occipital  rej!:ions  were  the  most  aflfected,  but  the  disease 


had  not  encroached  upon  the  scalp.  Patches  of  a 
similar  nature  were  also  seen  in  the  left  ante-cubital 
space  and  upon  the  extensor  surface  of  the  right  elbov. 
There  was  no  inflammatory  reaction  nor  pustulation 
of  the  surface.  A  scraping  from  the  border  of  the 
patches  upon  the  neck  examined  in  liquor  potasss 
revealed  an  abundance  of  mycelium. 

The  comparative  rarity  of  tinea  circinata  spreading 
in  a  collar  fashion  round  the  neck  was  commented  upon. 
Extensive  areas  of  ringworm  of  the  body  were,  how- 
ever, frequently  seen  in  the  groins  and  thighs,  some- 
times mounting  upwards  upon  the  abdomen.  The  so- 
called  "  eczema  marginatum."  applied  to  these  erup- 
tions was  not  a  bad  clinical  term,  though  they  had 
nothing  whatever  to  do  with  true  eczema.  They  were 
frequently  mistaken  for  seborrhoeic  dermatitis.  It 
was  important  in  all  cases  to  take  a  surface-scraping, 
for  in  this  way  only  was  a  correct  diagnosis  possible. 

This  man  was  given  an  ointment  containing  half  a 
drachm  each  of  carbolic  and  salicylic  acids  to  the  ounce 
of  vaseline. 


JSrftfBb  Dealtb  IReeorts. 


[by  our  special  medical  commissioner.] 


XIII.— CHAGFORD. 

Dartmoor  has  long  fascinated  the  favoured  few 
and  closely  held  the  allegiance  of  artist  and  antiquary, 
sportsman  and  naturalist,  (a) 

Its  topographical  features  and  climatic  conditions 
well  fit  it  as  a  desirable  upland  health  station.  With 
the  coming  of  rational  ideas  regarding  the  prophy- 
lactic and  curative  value  of  the  hygienic  treatment  of 
the  human  subject,  the  advantages  of  this  tableland 
region  of  Devon  should  become  well  known.  (6) 

The  rampart  is  high  and  the  average  temperature 
low.  Penetrating  mists  are  very  prevalent,  but  appear 
to  exercise  a  soothing  influence  on  many  cases  subject 
to  certain  laryngeal  and  respiratory  affections.  Severe 
frosts  are  experienced  in  winter,  and  the  bracing 
character  of  the  air  is  highly  beneficial  for  many  cases 
able  to  undergo  active  exercise  in  the  open.  Much 
cloud  prevails  at  all  times  of  the  year,  and  lessens 
radiation  from  the  ground. 

Among  the  many  centres  bordering  on  Dartmoor 
which  might  well  be  developed  into  sanatoria.  Chagford 
merits  a  foremost  place.  It  lies  at  an  altitude  of  650 
feet  above  sea  level,  well  sheltered  amid  the  hills  on 
the  north-eastern  slopes  of  Dartmoor.  The  scenery  is 
varied,  and  highland,  lowland  and  woodland  are  all 
close  at  hand.  The  pedestrian  has  almost  numberless 
walks  of  peculiar  attractiveness,  the  invalid  can  quietly 
enjoy  the  benefits  of  salubrious  air  and  bracing  breezes, 
the  feeble,  contemplative,  or  invaUd  can  find  peaceful 
sport  on  the  banks  of  the  Teign,  while  the  antiquarian 
and  naturalist  will  find  ample  material  for  fascinating 
study.  In  short,  the  district  is  rich  in  natural  health- 
giving  features,  and  mind-stimulating  characteristics, 
so  that  both  physical  and  psychological  influences  can 
be  combined  in  the  treatment  of  disease. 

We  have  resided  at  Chagford  during  summer  days 
and  thoroughly  investigated  the  neighbourhood,  and 
consider  it  an  almost  ideal  country  station  for  the 
overworked  and  brain-fagged.  It  should  prove  a 
perfect  holiday  resort  for  those  who  find  in  inland 
uplands  restorative  properties.  For  certain  phthisical 
cases  it  offers  admirable  opportunities  for  open-air 
treatment.  An  excellent  private  sanatorium  above 
the  village  of  Chagford  is  already  doing  much  good 
work,  as  we  have  been  able  to  ascertain  from  personal 
inspection. 

The  district  is  not  well  suited  to  heart  cases,  and  some 
patients  will  find  the  air  too  bracing,  and  during 
winter  months  the  exposure  too  severe. 


(a)  See  such  a  classic  work  as  **  A  PerambulatioD  of  the  ABti«nc 
and  Royal  Forest  of  Dartmoor."  By  the  late  Samael  Rowe, HA. 
Third  Edition.  1902.  Oonsalt  also  "  A  Hundred  Tears  on  Dart- 
moor."   Bv  William  Grossing.    Fifth  Bdition.    1909. 

{b)  See  *'  Dartmoor  and  its  Surroundingfs."  By  Beatrix  F.  CreK- 
well.    Third  Edition.    1903.    London:  The  Homeland  Associatioa. 


Oct.  5,  1904. 


FRANCE. 


The  Medical  Press.    361 


During  spring  and  summer  adolescents  and  delicate 
children  should  be  greatly  benefited  by  residence  in 
this  district. 

There  are  several  good  hotels  and  comfortable 
lodging  houses  at  Cha^ord,  and  excellent  apartments 
may  be  obtained,  (a) 

Chagford  is  about  193  miles  distant  from  Waterloo, 
and  may  be  reached  by  a  drive  of  about  an  hour  and 
a  half  from  Okehampton  (L.  and  S.W.R.). 

It  can  also  be  approached  from  Yeoford  junction. 

Perhaps  the  most  convenient  access  is  by  Exeter, 
Newton  Abbot,  thence  by  rail  to  Moreton  Hamp- 
stead  (G.W.Ry.),  and  coach  to  Chagford. 

Recently  services  of  motor  cars  have  been  opened 
from  Exeter  (L.S.W.Ry.)  and  Moreton  Hampstead 
(G.W.Ry.)  to  Chagford. 


Special  HrtfcIcB. 

THE  CHEMISTRY  OF  FINE   WINES. 

Brewing  has  become  a  fine  art  in  which  the  latest 
scientific  discoveries  are  brought  to  bear,  either  to 
cheapen  the  cost  of  production  or  to  ensure  more 
perfect  preservation.  This  appUes  with  equal  force 
to  the  "  brewing  "  of  wine,  for  we  hardly  know  what 
other  term  to  apply  in  respect  of  a  beverage  which 
undergoes  so  many  and  such  complicated  manipula- 
tions before  l>eing  delivered  to  the  public.  We  know 
that  the  Bordeaux  wine  merchants  receive  huge 
quantities  of  crude  undrinkable  wines  from  the  South 
of  France,  Italy,  Algeria,  possibly  even  from  Cali- 
fornia and  Australia,  and  that  from  these  unpromising 
juices  they  somehow  prepare  a  wine  which  is  charac- 
teristically "  claret."  The  great  difficulty  with  which 
they  have  to  contend  is  that  of  controlling  the  fer- 
mentative process,  in  other  words,  of  "  fixing  "  the 
finished  product.  They  overcome  this  difficulty  by 
adding  gypsum,  which,  in  contact  with  the  tartar 
{tSLrtrate  of  potassium),  becomes  transformed  into 
sulphate  of  potash,  the  lime  being  thrown  down  as  a 
tartrate.  The  presence  of  an  excessive  proportion  of 
the  potash  salt  is  injurious  to  health,  and  a  limit  has 
been  fixed  by  law,  in  France,  though  in  practice  it  is 
by  no  means  uniformly  enforced.  White  wines 
undergo  another  treatment,  like  alum  in  bread,  for 
the  purpose  of  making  them  appear  whiter  than  they 
are.  The  agent  employed  is  sulphurous  acid,  obtained 
by  burning  sulphur  in  the  barrel  before  introducing 
the  wine.  Any  excess  of  acid  gives  a  certain  pun- 
gency to  the  wine  which,  if  not  necessarily  harmful 
to  the  flavour  is  reputed  to  be  iajurious  to  health. 
Some  time  since  the  Paris  Council  of  Hygiene  for- 
mulated a  recommendation  to  the  effect  that  wines 
containing  more  than  twenty  centigrammes  of  sul- 
phurous acid,  or  two  grammes  of  sulphate  of  potash, 
per  litre  must  be  regarded  as  unfit  for  consumption. 
Acting  on  this  opinion  the  United  States  Government 
proposes  to  prohibit  the  importation  of  all  wines 
falling  within  the  scope  of  this  resolution,  and  it  so 
happens  that  certain  high  class  wines  of  Barsac  and 
Sauterne  proved  on  analysis  to  contain  nearly 
tliirty-eight  centigrammes  of  acid  and  close  upon  three 
grammes  of  the  potash  salt  per  litre.  The  news  natur- 
ally excited  considerable  emotion  in  the  French  wine 
trade,  and  influence  is  being  brought  to  bear  on  the 
home  authorities  to  declare  inappUcable  the  standard 
laid  down  by  the  Paris  Council  of  Hygiene,  and  to  make 
the  necessary  diplomatic  protests  to  foreign  govern- 
ments. 

The  case  for  the  wine  manufacturers  does  not 
strike  one  as  strong.  In  the  first  instance  they  advance 
the  highly  technical  and  elusive  argument  that  the 
authority  of  the  Paris  Council  does  not  extend  to 
places  outside  the  city  walls,  consequently,  that  its 
dictum  carries  no  weight  in  Bordeaux.  This  argu- 
ment is  hardly  ad  rem,  because,  if  the  standard  be  a 
reasonable  one,  it  must  occur  to  everyone  that  if  it 
is  not  generally  appUed  it  ought  to  be,  and,  moreover, 


on  the  face  of  it,  the  resolution  errs  if  anything  on  the 
side  of  indulgence.  Another  argument,  more  plausible 
than  the  one  just  mentioned,  is  that  it  is  absurd  to 
apply  to  fine  wines  regulations  which  were  intended  to 
regulate  only  the  sale  of  the  ordinary  qualities  of  wine 
in  general  use.  They  point  out  that  while  an  excess 
of  chemical  substances  in  the  latter  may  be  pre- 
judicial to  health,  in  consequence  of  the  much  larger 
quantity  consumed,  it  has  practically  no  importance 
in  the  high-priced  wines  which,  they  assume,  are  always 
taken  in  strict  moderation.  There  is  obviously  a 
certain  amount  of  truth  in  the  argument,  though  too 
much  stress  must  not  l>e,  laid  on  the  assumption  of 
moderation,  and  the  stomachs  of  the  well-to-do  merit 
fully  as  much  consideration  as  those  of  the  poorer 
classes. 

In  view  of  the  immense  political  influence  at  the 
disposal  of  the  wine  trade  in  France  the  question 
appears  to  be  one  which  ought  to  be  decided  by  the 
sanitary  authorities  of  the  wine-importiing  countries 
and  not  by  the  producers.  So  far  as  we  are  aware, 
there  is  no  legislation  bearing  on  this  point,  though  in 
practice  the  presence  of  foreign  substances  injurious 
to  health  in  wines  would,  no  doubt,  bring  them  within 
the  scope  of  the  laws  prohibiting  adulteration. 

We  do  not  pretend  to  settle  the  question  of  what  is 
the  proper  limit  in  this  respect,  but  we  would  suggest 
that  if  an  excess  be  prohibited  in  Paris  and  in  the 
United  States,  the  propriety  of  enacting  similar 
restrictions  is  likewise  worthy  of  consideration  at 
home.     Avis  ^  qui  de  droit, 

france. 


[from  our  own  correspondent.] 


(a)  See  Ward  and  Baddeley's  ''South  Devon";  also  Dar- 
linfiTton's  "  Exeter,  Torquay,  and  Dartmoor." 


PARU,  October  Ist,  1904. 
Stovaine — A  New  Local  Anesthetic 

Stovaine  is  a  new  local  anaesthetic  derived  from 
tertiary  amylic  alcohol,  discovered  by  Foumeau.  It 
crystallises  in  little  brilliant  flakes,  much  resembling 
cocaine  ;  it  is  extremely  soluble  in  water.  The  physio- 
logical properties  of  stovaine  have  been  studied  by 
Billon  and  Lannoy,  while  Dr.  Ponchet  read  an  im- 
portant paper  on  it  at  the  meeting  of  the  Academie 
de  M6decine,  from  which  it  appears  that  stovaine  is 
much  less  toxic  than  cocaine ;  it  is  a  vaso-dilator, 
it  possesses  an  antithermic  action,  and  has  evident 
antiseptic  properties.  Its  therapeutic  applications 
have  been  studied  by  Prof.  Reclus,  Lapersonne,  Chaput, 
Huchard,  and  by  Mr.  Sauvet,  dentist. 

According  to  Mr.  Chaput,  the  analgesic  action  of 
stovaine  is  identical  to  that  of  cocaine.  It  is  less 
toxic  than  cocaine,  and  has  a  vaso-dilator  action  which, 
producing  congestion  of  the  bulb,  suppresses  syncope 
and  allows  patients  to  be  operated  on  seated,  and  to  rise 
immediately  after  the  operation.  Injected  into  the 
lumbar  region,  it  permits  all  kinds  of  laparotomies  to 
be  made  with  ease. 

Prof.  Reclus  said  that  he  injected  more  stovaine 
than  he  dared  do  cocaine,  and  he  was  able  to 
perform  operations  under  its  influence  which  he  could 
not  have  done  with  cocaine.  It  was  thus  that  he  was 
able  on  the  same  patient,  and  at  one  sitting,  to  remove 
four  voluminous  varicose  veins,  two  from  each  leg, 
without  the  slightest  pain  to  the  patient. 

The  domain  of  stovaine,  like  that  of  cocaine,  appears 
to  him  to  be  circumscribed  tumours,  cutaneous  or 
subcutaneous  lupus,  lipoma,  fibroma,  cancroides, 
extirpation  of  the  phalanges  of  the  toes  or  fingers, 
ingrowing  naUs,  whitlow,  (artificial  anus,  umbilical 
hernia,  hydrocele.^varicocele,  castrations,  laparotomy 
for  non-adherent  ovarian  cyst,  empyema  (with  resection 
of  the  ribs).  In  his  hospital  practice,  two-thirds  of  the 
operations  were  done  with  stovaine. 

Mr.  Lapersonne  considered  that  stovaine  was  called 


362    The  Medical  Peess. 


AUSTRIA. 


Oct.  s.  1904. 


to  render  excellent  services  in  ocular  surgery.  By  in- 
stilling stovaine  into  the  eye,  all  operations  on  the  cornea 
and  even  that  for  cataract  could  be  done.  Injected 
into  the  conjunctiva,  it  was  superior  to  cocaine ;  the 
insensibility  was  complete  in  less  than  a  minute,  and 
gave  sufficient  time  for  the  operation. 

Dr.  Sauvet,  dentist,  said  he  had  employed  stovaine 
instead  of  cocaine  for  the  last  two  months,  and  ob- 
tained excellent  results.  He  employed  a  solution  of 
075  per  cent,  for  the  extraction  of  teeth,  and  never 
had  an  accident. 

Prof.  Huchard  insisted  on  the  total  absence  of  the 
slightest  toxic  symptoms.  He  injected  one-fifth, 
one-fourth  and  a  half  a  grain  for  costal  neuralgia,  and 
none  of  the  patients  complained  of  headache,  nausea 
or  vertigo.  At  first  he  recommended  the  patients  to 
keep  lying  half  an  hour,  but  afterwards  he  allow^ed 
them  to  rise  immediately  after  the  injection. 


Getmani?. 


[from  our  own  correspondent.] 


BxRLiv,  October  2nd,  1904. 

At  the  Society  for  innere  Mediziu,  Hr.  Meyer  spoke 
on 

Streptococcus  Curative  Serum 
from  clinical  and  experimental  observations.  The 
serums  hitherto  made  use  of  had  not  been  so  successful 
as  the  diphtheria  serums,  as  systematic  clinical  obser- 
vations had  been  wanting.  So  much  so  had  this  been 
the  case  that  prominent  experts  had  declined  to  make 
use  of  them. 

Two  years  ago  he  had  commenced  the  attempt  to 
immunise  the  larger  animals,  being  guided  in  his 
experiments  by  two  principles — (i)  that  the  passage 
through  animals  had  altered  the  streptococci,  and  (2) 
that  the  unity  of  streptococci  had  not  been  proved. 
He  had,  therefore,  in  his  animal  experiments  used 
streptococci  taken  direct  from  the  human  subject  only, 
and  his  preliminary  treatment  had  been  carried  out  by 
two  forms  alone,  vig..  that  found  in  suppuration  and 
that  met  with  in  sepsis.  In  distinguishing  the  strains 
he  had  followed  v.  Behring's  lead.  These  strains 
killed  mice  in  doses  of  from  o'ooi  to  0*003  within 
twenty-four  hours.  He  was  of  opinion  that  only  a 
serum  that  is  derived  from  strains  that  are  pathogenic 
both  for  men  and  animals  can  be  curative  for  the 
human  subjects,  and,  therefore,  can  be  made  thera- 
peutic use  of.  Animal  passage,  however,  takes  patho- 
genic'property  for  the  human  subject  along  with  it. 

He  had  treated  the  following  diseases  in  the  human 
subject  with  his  serum  : — Simple  angina,  scarlatinal 
angina,  erysipelas,  articular  rheumatism  and  sepsis. 
For  a  favourable  result  to  be  obtained  only  application 
of  the  serum  was  essential.  According  to  his  view,  the 
serum  destroyed  the  streptococci,  and  by  this  their 
toxins  become  free,  so  that  with  late  use  of  the  serum 
when  the  streptococci  are  present  in  large  numbers, 
instead  of  a  curative  effect  actual  damage  to  the 
organism  may  follow. 

Generally  speaking,  after  one  or  two  injections,  a 
rapid  fall  of  temperature  and  pulse  takes  place.  This 
is  frequently  critical,  sometimes  not.  Even  in  severe 
sepsis,  a  favourable  turn  often  seems  to  take  place. 
He  would  not  recommend  the  use  of  the  serum  in  mild 
cases,  as  such  do  all  right  with  the  usual  means.  But  in 
cases  that  were  evidently  serious  from  an  early  stage 
he  would  recommend  a  trial  with  his  serum,  which  at 
present  was  only  prepared  for  experimental  purposes  in 
hospitals. 


At  a  subsequent  meeting,  Hr.  v.  Openchowski  gave 
a  communication  on 
The  Action  of  [Digitalis  in  Regard  to  Sclerosis 

OF  THE  Right  Coronary  Arteries. 
Years  ago  he  showed  that  digitalis  acted  on  the  left 
side  of  the  heart  only,  and  that  the  right  heart  was  cat 
off  from  this  action  by  narrowing  of  the  right  coronary 
arteries.  This  difference  in  action  was  of  value  as  rt- 
garded  the  mechanism  of  the  circulation.  Many 
clinicians  and  pharmacologists  had  adopted  his  views. 
This  dissociation  was  also  of  clinical  importance. 
If  the  right  heart  acted  more  powerfully  than  the  left, 
and  set  up  dyspncea,  spitting  of  blood,  oedema  of  tht 
lungs,  dilatation  of  the  left  ventricle,  diminution  in  sizt 
of  the  right,  a  frequent  small  pulse  (130),  enlargement 
of  the  liver,  and  diminution  in  the  quantity  of  urine, 
it  was  possible  that  more  digitalis  went  to  the  right 
heart  than  to  the  left.  This  was  rendered  possible  by 
dilatation  of  the  right  coronary  arteries,  though 
sclerosis  and  loss  of  power  of  contraction.  The  speaker 
had  diagnosed  three  cases  of  sclerosis  of  the  right 
coronary  arteries,  in  which  the  left  were  only  slightly 
attacked.  In  the  last  case  the  right  coronary  artery 
was  doubled  in  size  and  completely  sclerosed,  whilst 
the  left  was  narrow  and  elastic. 

He  then  showed  some  cardiograms  in  which  the 
right  heart  and  jugular  vein  indicated  heavy  work, 
whilst  the  left  curve  was  only  slightly  raised. 

Herr  Block  showed  a  case  of 
Brachycardia. 
A  woman,  aet.  48,  of  healthy  parentage,  and  who  on 
the  whole  had  been  healthy.  Eighteen  years  ago  she 
had  ulcers  on  the  vagina  that  were  treated  locally. 
Ten  years  ago  the  radical  operation  for  cancer  of  the 
portio  was  performed,  and  at  that  time  nothing  ab> 
normal  was  found  about  the  heart.  Four  years  ago, 
the  patient  was  brought  to  the  speaker  for  an  opinion 
concerning  violent  attacks  of  pain  in  the  stomach 
with  diarrhoea.  Examination  showed  symptoms  of 
commencing  tabes,  but  still  there  was  no  cardiac  mis- 
chief. He  had  seen  this  patient  off  and  on  since  that 
date.  For  three  months  she  had  suffered  from  peculiar 
attacks,  which  had  become  more  frequent  lately,  up 
to  ten  or  twelve  in  the  day.  The  patient  becomes 
suddenly  giddy  and  unconscious  and  pale,  the  head  is 
stretched  backwards  with,  at  the  same  time,  a  re- 
markable slowing  of  the  pulse  down  to  36,  32.  and  28. 
These  attacks  pass  off  in  a  short  time.  There  is  widening 
of  the  heart  towards  both  sides,  the  beat  at  the  apex 
heaving,  the  first  sound  dull,  with  a  minimum  capillary 
pulse.  The  symptoms  of  tabes  had  distinctly  pro- 
gressed. The  cause  of  the  brachycardia.  considering 
the  gastric  crisis,  was  supposed  to  be  an  affection  <tf 
the  vagus,  or  it  might  be  intra-cardiac.  He  had  made 
an  injection,  but  without  result.  The  cause  was  there- 
fore in  the  cardiac  muscle,  and  all  symptoms  were 
dependent  on  a  common  cause,  viz.,  syphilis. 


Hnstrfa* 


[from  our  own  corrbspondbnt.J 

ViMNA,  October  2nd.  1«M. 
Meteorism  and  Liver  Changes. 
At  the  Naturforscher  meeting  Oppenheimer  brought 
before  the  members  the  importance  of  liver  changes  m 
the  diagnosis  of  disease,  particularly  p>eritonitis.  From 
his  experience  in  laparotomy  sections,  and  also  with 
animals,he  is  persuaded  that  liver  dulness  is  an  importaDt 
factor  in  bonum.  or  in  malum  sensum,  when  temperature 
and  pulse  are  not  in  harmony.  The  history  of  the  case  goes 
far  to  explain  many  morbid  conditions  when  making 
differential  diagnosis,  but  there  often  arise  cases  with 


Oct.  5.  1904. 


HUNGARY. 


The  Medical  Psess.    3^3 


sudden  deaths  which  we  have  difficulty  in  ex- 
plaining. The  same  causes  may  be  in  operation  that 
often  occur  in  phthisical  patients  where  enteroptosis  or 
SL  falling  of  any  of  the  internal  organs,  such  as  the 
liver,  &c.,  may  cause  undue  pressure  and  serious  con- 
sequences. He  related  experiments  on  animals  with 
the  object  in  view  of  illustrating  this  accident  by  in- 
flating the  bowel  and  applying  pressure  to  the  chest, 
"Which  rapidly  produced  cardiac  stasis  and  sudden 
death. 

_Oppenheimer  thinks  that  many  of  the  accidents 
arising  after  the  operation  of  anus  pretematuralis  are 
due  to  the  high  pressure  in  the  bowel,  which  is  not 
relieved  after  the  operation. 

Invagination  of  the  Bowel. 

Braun  recorded  sixteen  cases  of  invagination  of  the 
bowel  on  which  he  had  operated,  eight  of  these  being 
acute  and  seven  chronic.  In  his  opening  remarks  he 
said  he  could  offer  no  explanation  for  the  great  number 
of  these  cases  that  occurred  in  other  countries,  especially 
in  England,  where  acute  invagination  seems  to  be  much 
more  frequent  than  on  the  Continent. 

The  general  opinion  entertained  by  clinicians  at  the 
present  time  of  the  cause  leading  to  this  accident  is 
spasm  of  a  limited  portion  of  the  bowel  and  not,  as  was 
formerly  believed,  a  paralysis  of  the  bowel.  Probably 
the  diagnosis  of  this  disease  was  not  so  accurately  made 
as  in  other  countries,  which  may  account  for  the  greater 
frequency  to  be  found  there.  The  symptoms  generally 
met  with  in  acute  cases  in  children  are  sudden  illness  in 
a  healthy  child  with  tenesmus,  vomiting,  haemorrhage. 
slimy  mucus  in  the  stools,  with  collapse  and  a  distinct 
tumour  at  the  site  of  the  invagination  to  be  found  over 
the  abdomen. 

The  chronic  form  is  more  difficult  of  diagnosis, which 
was  demonstrated  from  preparations. 

The  treatment  to  be  relied  upon  is  operation  as  soon 
as  the  dislocation  is  observed.  Removing  it  by  mani- 
pulation or  mechanical  means,  as  reported  in  some 
hospitals,  is  not  to  be  relied  upon.  Partial  relief  is  no 
doubt  frequent,  but  sooner  or  later  the  operation  must 
be  undertaken.  Injecting  air,  water,  and  other  fluids 
into  the  bowel  have  often  been  practised  and  may  give 
temporary  relief,  but  the  bowel  soon  returns  to  its 
former  malposition.  It  therefore  remains  to  relieve  by 
operation  if  possible  what  has  not  as  yet  been  success- 
fully done  by  resection.  He  considers  the  cause  of  this 
failure  is  due  to  the  position  of  the  buttocks  after 
operation.  Whatever  may  be  the  cause,  he  is  in  favour 
of  an  anus  pretematuralis,  which  should  be  performed  as 
early  as  possible  in  acute  cases.  It  is  often  easy  in  these 
early  opportunities  to  disinvaginate  the  bowel  and 
relieve  the  sufferer  without  further  delay  or  trouble. 
In  the  chronic  form  of  invagination  entero-anastomosis 
is  considered  the  most  successful  operation. 

It  may  be  mentioned  here  that  Eiselsberg  has  re- 
ported several  successful  cases  by  resection,  but  we 
conclude  that  they  must  have  been  in  the  very  early 
stage. 

In  the  discussion  that  followed,  Kradel  accentuated 
the  difference  of  the  frequency  of  this  disease  in  England 
and  Germany,  for  example.  He  had  personally 
operated  on  eight  cases  of  invagination  without  a  single 
success.  In  three  cases  on  which  he  did  not  operate, 
partial  relief  was  obtained  and  the  patient  recovered. 
All  of  them  were  under  one  year,  except  one,  and  the 
youngest  was  eleven  weeks  old  at  the  time  of  invagina- 
tion. At  the  post-mortem  the  disinvagination  was 
complete  except  in  one  case,  which  died  of  perforation 
and  peritonitis.  Whether  operation  is  undertaken 
or     not,     the     time    necessary    is    exhausted.       In 


the  case  of  reposition  by  injections  of  air  or  water, 
enormous  pressure  must  be  applied  which  cannot  be 
long  endured.  If  the  operation  be  undertaken  and 
disinvagination  performed,  it  is  difficult  to  prevent  a 
return.  Statistics  seem  to  forbid  heroic  treatment. 
If  the  case  be  diagnosed  early  and  operated  on  within 
a  few  hours  there  is  hope  for  success  ;  but  if  the  in- 
tussusception has  existed  for  any  time  the  case  is  hope- 
less. Bartelsmann  recommended  injections  and  re- 
corded four  cases  in  which  he  was  perfectly  successful. 
The  operation  was  not  continued  beyond  an  hour. 
Naunyn  considered  the  diagnosis  a  very  severe  task  in 
adults,  but  thought  surgical  operation  the  best.  Braun 
concurred  in  this  opinion  of  the  diagnosis,  which  could 
easily  be  mistaken  for  any  turning  of  the  bowel  or 
other  enlargement. 

Jachk  related  the  history  of  two  cases  of  disinvagina- 
tion, which  he  accomplished  with  perfect  success  by 
injections.  The  ages  were  four  and  five  months  re- 
spectively, and  the  operations  were  undertaken  nine- 
teen and  eleven  and  a  half  hours  after  the  diagnosis 
was  confirmed. 

Pauli  recorded  the  history  of  five  cases  which  he  had 
treated  successfully. 

Berge  related  a  case  which  he  operated  on,  and  as 
soon  as  he  had  relieved  the  strangulated  bowel  the 
child  died. 

Wilmas  discussed  the  production  of  invagination  and 
described  a  few  experiments  he  conducted  on  animals 
to  prove  that  the  cause  was  due  to  irritation  of  the 
longitudinal  fibres  of  the  canal,  which  causes  it  to  fold 
in  parts. 

Kuhn  reported  96  cases  which  he  had  observed.  He 
thought  the  distribution  of  invagination  of  the  bowel 
was  very  erratic.  In  Norway  and  Sweden  this  accident 
was  very  rare,  while  in  Malmo  and  Copenhagen  it  was 
very  common.  Fifty  to  60  per  cent,  of  his  cases  were 
restored  by  manual  treatment,  such  as  massage  and 
injections. 

Braun  and  Madelung  were  surprised  at  these  results, 
and  instantly  asked  if  50  or  60  per  cent,  actually  re- 
covered without  operative  surgery,  to  which  he  replied 
in  the  affirmative.  Was  he  sure  he  had  diagnosed  the 
cases  aright  as  invagination  ?  This  he  also  affirmed 
was  the  case. 


Dunoats* 


[from  our  own  correspondent.] 


BvDAFwr,  October  let,  IMM. 
At    the   recent   meeting   of   the   Royal   Hungarian 
Medical  Society,   Dr.  Caspar  related  his  conclusions 
drawn  from  125  cases  of  typhoid  fever,  in  which  the 
Widal  test  has  been  used. 

1 .  The  serum  reaction  may  be  obtained  towards  the 
end  of  the  first  week  of  typhoid  fever,  but  is  more  usual 
later  in  the  disease. 

2.  It  may  be  present  without  a  relapse  at  the  end 
of  the  fourth  month. 

3.  It  may  be  absent  one  day  and  present  the  next. 

4.  Of  125  cases  of  typhoid  fever  the  reaction 
was  absent  in  only  one  case.  In  two  cases  it  failed, 
but  there  was  in  each  only  one  test,  in  one  case  on  the 
twelfth,  and  in  the  other  on  the  eighty-second  day. 

5.  In  nineteen  cases  of  other  diseases  clearly  un- 
complicated by  typhoid  there  was  no  reaction. 

6.  In  a  number  of  difficult  and  perplexing  cases 
the  serum  test  was  of  distinct  service  in  establishing 
or  correcting  the  diagnosis. 

7.  This  test  will  probably  prove  itself  a  useful  aid 
to  clinical  diagnosis,  and  especially  in  hospital  practice. 


364    The  Medical  Press.  THE    OPERATING    THEATRES. 


Oct.  5.  1904. 


Professor  Herozel  gave  a  rhum^  of  the  technique 
of  pneumotomy.  He  avoids  exploratory  puncture, 
which  he  considers  liable  to  infect  the  pleural  cavity, 
and,  in  case  the  parietal  andjvisceral  pleura  have  not 
become  adherent,  liable  to  infect  healthy  lung  tissue 
when  the  needle  is  withdrawn,  and  hable  to  cause 
severe  haemorrhage  from  puncture  of  large  vessels. 
He  does  not  practise  it  unless  it  is  to  be  followed  by 
pneumotomy,  in  which  case  the  needle  is  used  as  a 
guide  to  the  cavity  to  be  opened. 

The  resection  of  the  ribs  should  be  free.  He  claims 
that  the  more  extensively  the  lung  is  exposed,  the 
easier  does  the  examination  in  manipulation  of  the 
lung  become,  and  the  more  rapidly  will  the  cavity  close 
and  heal.  One  or  two  ribs  are  removed  in  the  usual 
manner.  Should  three  to  four  ribs  be  resected,  a 
flap  incision  of  the  superjacent  soft  parts  is  the  most 
satisfactory  method. 

After  the  resection,  if  the  pleural  surfaces  are 
adherent,  the  operation  becomes  easier  and  safer. 
The  retraction  of  the  intercostal  space  on  deep  inspira- 
tion and  the  slight  descent  of  the  lower  lung  border 
noted  before  the  operation,  the  speaker  thinks,  would 
indicate  this.  Sometimes  after  the  resection  of  the 
ribs,  the  lung  can  be  seen  to  slide  up  and  down  during 
respiration,  as  the  intestine  is  seen  through  the  un- 
opened peritoneum.  When  adherent,  the  parietal 
pleura  appears  greyish-yellow,  spotted  with  fat, 
thickened  and  dense  to  the  touch.  Finally,  a  fine 
needle  pushed  into  the  lung  is  adherent,  and  conse- 
quently fixed  to  the  chest  wall.  A  free  lung  would 
cause  it  to  oscillate. 

The  attempts  to  produce  this  adhesion  of  the  pleural 
surfaces  by  ignipuncture,  electrolysis,  cauterisation, 
chloride  of  zinc,  and  other  methods  have  now  been 
abandoned  in  favour  of  immediate  union  by  suture. 
This,  it  is  claimed,  can  be  easily  done  by  experienced 
operators,  especially  when  the  surface  of  the  lung  is 
exposed,  and  if  it  is  forced  into  the  wound  by  in- 
spiration or  coughing.  The  lung  once  fastened  to  the 
edges  of  the  wound,  its  collapse  or  pneumothorax  is 
avoided.  The  operation  can  now  also  be  quickly 
finished. 

As  regards  the  pneumotomy  in  indurated,  infil- 
trated, anaemic  tissues,  when  the  blood  circulation 
is  impeded,  the  lung  can  be  satisfactorily  opened  with 
the  scalpel,  but  since  eventually  the  operator  meets 
soft,  healthy  tissue,  and  is  dealing  with  foul  gan- 
grenous tissue,  in  order  to  limit  infection,  the  use  of 
the  Paquelin  cautery  is  to  be  preferred. 

The  speaker  considers  that  an  anaesthetic  is  hardly 
necessary.  He  would  not  use  ether.  In  an  operation 
alluded  to  chloroform  was  used. 

In  regard  to  the  results  of  operative  treatment, 
Herozel  claims  to  show  that  in  ninety-one  cases  there 
was  recovery  in  60  or  61  per  cent. 


Ube  (Spetattna  Ubeatrea* 


GUY'S  HOSPITAL. 
Two  Cases  of  Renal  Surgery. — Mr.  Clement 
Lucas  operated  on  a  little  boy,  act.  6,  for  pyo-nephrosis 
of  the  left  kidney.  The  patient  was  passing  a  large 
quantity  of  pus  in  his  urine,  and  had  a  temperature  of 
102°.  The  left  kidney  could  be  distinctly  felt  enlarged 
and  fluctuating  by  bi-manual  examination  in  the  loin 
and  the  front  of  the  abdomen.  The  trouble  began  by 
pain  in  paissing  water  four  years  ago.  At  that  time  he 
was  admitted  into  the  hospital,  and  a  stone  removed 
from  the  bladder  by  supra-pubic  lithotomy.     The  boy 


w^  re-admitted  two  years    later  for  a  perinephhtic 
abscess  situated  in  the  right  loin.     This  was  opened  and 
drained,  but  its  immediate  cause  was  not  at  the  timf 
ascertained.     The  abscess  healed  after  a  time,  and  tht 
patient  was  discharged  in  improved  health.   Since  then, 
according  to  the  mother,  he  has  t>een  wasting,  and  of 
late  it  had  been  noticed  that  his  urine  was  very  thick 
and  had  an  unpleasant  odour.     Mr.  Lucas  diagnosed  a 
distended  pyo-nephrotic  kidney  on  the  left  side,  and 
cut    down    upon    the    left    loin.     After    dividing  the 
muscles  and  separating  the  perinephritic  fat,    an  en- 
larged kidney  came  into  view  through  which  a  number 
of  pale  cystic  abscess  pouches  were  visible.     A  small 
stone  could  be  felt  in  the  pelvis  of   the  kidney.    The 
pelvis  was  opened  opposite  this,  and  the  stone  removed 
with  forceps.     A  quantity  of  exceedingly  foetid  pus 
then  escaped,  but   the  various  abscess  cavities  failed 
to  drain  until  Mr.  Lucas,  pushing  his  finger  in  various 
directions,  opened  their  narrow  orifices  into  the  genenl 
nephritic  pelvic  cavity.     The  interior  of  the  kidney  and 
its  various  cavities  were  next  washed  out  by  repeated 
flushings  with  warm  boric  lotion  until  what  returned 
was  free  from  foetor.     A  large  drainage-tube  was  fixed 
in  the  interior  of  the  kidney  so  as  to  provide  for  con- 
tinuous drainage  till  the  organ  had  shrunk.     Mr.  Lucas 
said  that  in  this  case  both  kidneys  appeared  to  have 
undergone  suppuration  as  a  result  of  ascending  pyeUtis 
consequent   upon   stone   in   the   bladder.     The  right 
kidney  discharged  in  all  probability  through  the  pen- 
nephritic  abscess    which    occurred  a  year  previously. 
The  urgent  condition  for  which  the  boy  was  admitted 
recently  was  due,  Mr.  Lucas  considered,  to  the  acnte 
suppuration  with  distension  going  on  in  the  left  kidney, 
where  a  small  phosphatic  stone  was  discovered  giving 
rise  to  obstruction,  whilst  acute  bacterial  infection  was 
destroying   the   renal   structure.     The    object   of  the 
operation,  he  pointed  out,  was  to  get  free  drainage  ot 
all  abscess  cavities  within  the  organ  by  making  them 
readily  communicate  with  the  distended   pelvis.    As 
the  right  kidney  appeared  to  have  recovered  after  dis- 
charging itself  a  year  before,  he  hoped  that  by  draining 
and  disinfecting  the  left  kidney  and  removing  from  it 
the  obstructing   stone,    it   might   recover    sufficiently 
to  remain  a  useful  organ.     With  a  suppurating  kidney, 
alkaline  urine,  and  phosphatic  stones,   there  was.  be 
thought,  always  a  question  whether  one  may  not  be 
dealing  with  a   tuberculous  condition    to    which  the 
stone  is  secondary. 

As  a  result  of  the  operation  the  boy's  temperature  im- 
mediately fell  to  normal  and  his  general  conditioo 
improved. 

The  second  case  was  that  of  a  man,  aet.  27,  who  first 

I  came  under  Mr.   Lucas*  care  a  year  previously.    The 

I  patient  had  suffered  from  pain  in  the  right  lumbar 

I  region  for  fifteen  years,  but  only  on  one  occasion  had 

I  had  anything  approaching  a  renal  colic.     For  years  he 

I  said  there  had  been  deposits  in  the  urine,  sometimes 

blood  and  pus  in  quantity.     Rontgen  rajrs  failed  to 

demonstrate  a  stone,  and  Mr.  Lucas  at  that  time  said 

he  was  inclined  to  regard  the  case  as  one  of  tuberculous 

kidney.     He  explored  the  kidney  through  the  loin  and 

found  large  branching  phosphatic  calculi  surrounded  by 

pouches  of  pus  of  a  very  foetid  character.     The  calculi 

were  removed,  the  cavities  washed  out,  and  the  kidney 

I  drained  for  a  time,  after  which  the  wound  was  allowed 

I  to  heal,  and  the  patient  left  the  hospital  greatly  relieved. 

I  In  the  spring  of  the  present  year,  he  began  to  be  re- 

'  minded  again  of  his  kidney  by  a  recurrence  of  pain  m 


Oct.   5,  1904. 


LEADING   ARTICLES. 


The  Medical  Piess.    365 


the  right  loin.  Soon  after,  the  deposit  of  pus,  which, 
tliough  greatly  diminished,  had  never  entirely  dis- 
appeared, began  to  increase  in  quantity.  The  patient 
'was  re-admitted  a  week  before  the  present  operation, 
vrhen  the  kidney  could  be  distinctly  felt  to  be  con- 
siderably enlarged,  and  Mr.  Lucas  concluded  that 
suppuration  was  still  going  on  within  it.  As  the  man 
never  had  any  pain  in  the  other  kidney,  and  as  he 
passed  a  fairly  good  amount  of  urea  by  the  normal 
passage  at  the  time  the  kidney  was  drained  a  year 
i>efore,  and  considering  the  extensive  damage  to  renal 
-structure  discovered  at  the  first  operation,  Mr.  Lucas 
axlvised  the  patient  to  submit  to  excision  of  the  kidney 
if  at  the  time  of  the  second  operation  the  organ  was 
found  to  l>e  practically  useless.  At  the  operation  an 
incision  was  made  just  above  the  level  of  the  old  scar 
in  a  transverse  direction,  and  this  was  enlarged  by  a 
vertical  incision  corresponding  to  the  anterior  border 
of  the  quadratus  lumborum.  The  capsule  of  the 
kidney  was  found  to  be  closely  adherent  to  the  peri- 
nephritic  fat  and  other  structures,  so  that  it 
"would  have  been  impossible  to  remove  the  kidney  with 
its  capsule.  Mr.  Lucas,  therefore,  first  emptied  the 
organ  by  puncturing  it  with  a  large  cannula,  then  tore 
open  the  capsule,  and  stripped  the  kidney  out  from 
^within  the  capsule  till  he  reached  the  point  where  the 
fleshy  substance  became  continuous  with  the  pelvis 
and  the  main  vessels.  At  this  point  the  pedicle  of  the 
kidney  was  transfixed  and  ligatured,  the  substance  of 
the  organ  being  all  cut  awa3^  Very  little  haemorrhage 
took  place  during  the  operation.  A  large  packing  of 
cy^uiide  gauze  was  used  for  drainage.  Mr.  Lucas  said 
that  the  pathological  examination  of  the  kidney 
showed  that  the  organ  was  tuberculous,  although  re- 
peated examinations  of  the  urine  had  failed  to  find 
any  bacillus.  The  fact  that  the  tubercle  bacillus  was 
at  work  in  the  kidney  ^accounted,  he  thought,  for  the 
disease  not  clearing  up  after  the  complete  extraction 
of  the  phosphatic  stones  fifteen  months  before.  Thus 
the  second  operation,  which  comprised  the  removal  of 
the  kidney,  brought  the  diagnosis  back  to  that  originally 
made  before  the  extraction  of  the  phosphatic  stones, 
and  it  would  seem  that  the  formation  of  these  stones 
-was  probably  second  ary  to  the  tuberculous  process 
causing  alkalinity  of  the  urine  and  precipitation  of  the 
phosphatic  salts  therefrom. 

Since    the    operation    the   patient    has     progressed 
favourably  and  his  temperature  has  remained  normal. 

Case  of  BuboDtc  Placat  in  the  Tyne. 

Bubonic  plague  was  last  week  reported  to  have 
"broken  out  on  board  the  London  steamer.  "Bishops- 
gate.*'  which  arrived  in  the  Tyne  from  Hamburg,  and 
^was  placed  under  strict  observation.  While  the  vessel 
-was  at  Hamburg,  discharging  a  cargo  from  Rosario,  rats 
-which  had  died  from  plague  were  found  on  board. 
At  J  arrow  it  was  necessary  to  remove  to  the  floating 
hospital  for  infectious  diseases  the  boatswain,  a 
Oerman,  who  only  joined  the  vessel  at  Hamburg 
before  she  left  for  the  Tyne,  and  a  bacteriological 
examination  made  by  Dr.  Harker  showed  that  the 
patient  was  suffering  from  bubonic  plague.  The 
"  Bishopsgate"  has  been  carefully  disinfected  and 
allowed  to  leave  the  Tyne,  the  remainder  of  the  crew 
being  found  all  well. 

Harvelan  Society  of  London. 
The  opening  meeting  of  the  seventy-fourth  session 
of  the  Harveian  Society  of  London  will  be  held  at 
.8.30  p.m.,  on  Thursday,  October  13th,  at  the  Stafford 
Rooms.  Titchborne  Street.  Edgware  Road.  Mr.  C.  B. 
Keetley  will  deliver  the  Harveian  Lecture  for  the  year, 
the  subject  being  "  Plastic  Surgery." 


RianriEBD  foe  TkAHsaiuaiOH  Abroad. 

Xin[>e  Acbical  presB  anb  Circnlar. 

PubUahed  every  WedneedAy  mornlnff,  Prioe  6d.     Pott  tree,  Hd. 

IDVBBTIBSMEinni. 

Om    ImiotTioir :— Whole  Page,   £6    Os.     (ML  ;     H*lf  Pa«e 

£2  10b.  Od.  ;  Quarter  Page,  £1  6a.  Od. ;  One-eighth,  12a.  ed. 
Ckuridenble  Beduotiona  Irom  the  foregoing  acde  are  made  whoa 

an  order  is  given  tor  a  seriei  of  inaerUona.     Terma  on  appUoa- 

tion  to  the  Publiaher. 
Small  announoementa  of  Practloea,  Aaaistancies,  Vaoanciea,  Book  a, 

*o.-Seven  Unea  or  under  (70  worda),  4a.  ed.  per  inaertion  ; 

6d.  per  line  beyond. 

SVBiOBIFTIONB. 
Subeoriptions  may  oommence  m  any  period  of  the  year.  If  pi^d  n 
advance  the  ooat  ia  only  21a.  per  annum,  poat  free.  An  edition 
ia  printed  on  thin  plate  paper  for  foreign  and  CUonial  aob- 
Bcribera  at  21a.  per  annum,  poet  free,  if  paid  in  advance,  or 
2Sb.  ed.  credit  rate. 


Ube  AcMcal  pre00  anb  Cfrcniar. 


SALUS   POPULI   SUPREMA  LEX. 


WEDNESDAY.  OCTOBER  5.  1904. 


MR.  CORONER  TROUTBECK  ON  YOUNG 
SURGEONS. 
The  position  taken  up  by  the  London  Coroner, 
Mr.  Troutbeck,  with  regard  to  medical  practitioners 
and  their  evidence  generally  may  be  characterised 
as  unfortunate.  Sooner  or  later  it  seems  more 
than  probable  that  his  ill-advised  tactics  will  lead 
to  disastrous  consequences,  so  far  as  the  relations 
of  the  Coroner's  Court,  the  public,  and  the  medical 
profession  are  concerned.  The  leading  principle 
which  has  guided  Mr.  Troutbeck,  and  upon  which 
he  has  dilated  in  season  or  out  of  season,  is  the 
incompetency  of  the  general  practitioner.  If  any 
person  dies  of  cerebral  haemorrhage,  or  of  advanced 
heart  disease,  or  from  any  other  ordinary  morbid 
condition,  the  medical  practitioner  who  is  certified 
as  competent  to  attend  to  the  health  of  our  fellow- 
citizens  during  hfe  is  nevertheless  incompetent, 
according  to  this  sapient  Coroner,  to  ascertain  and 
certify  the  cause  of  their  deaths.  To  tell  us  how 
they  die  demands  the  services  of  an  expert  **  patho- 
logist "  (save  the  mark  !},  whose  expertness  is  ap- 
parently to  be  decided  by  a  standard  fixed  J^ 
Mr.  Troutbeck.  The  gentleman  singled  out  by  the 
Coroner  for  that  distinction  deserves  nothing  but 
sympathy.  He  has  been  placed  in  a  false  position, 
whilst  his  services  are  utilised  to  deprive  certain 
of  his  professional  brethren  of  a  considerable 
amount  of  legitimate  medical  practice.  It  was 
originally  announced  that  Mr.  Troutbeck's 
**  expert  "  was  to  be  called  in  at  a  special  fee  in 
difficult  and  obscure  cases  only.  With  that 
arrangement  there  would  not  have  been  much 
room  for  difference,  eis  it  is  obvious  the  Coroner 
should  have  some  latitude  in  his  power  of  sum- 
moning highly-skilled  aid  under  special  circum- 
stances. As  a  matter  of  fact,  the  simplest  and  most 
ordinary  cases  are  placed  daily  in  Dr.  Freyberger's 
hands  by  Mr.  Troutbeck.     We  have  no  hesitation 


366     The  Medical  Press 


LEADING   ARTICLES. 


Oct.  5.  ly^. 


in  asserting  that  in  a  large  proportion  of  these  cases 
equally  good  or  better  evidence  could  be  fur- 
nished by  local  medical  men,  who  in  many  instances 
have  attended  the  deceased  during  life.  There  is 
little  need,  however,  to  discuss  either  the  facts  or 
the  merits  of  the  dispute  that  has  arisen  between 
Mr.  Troutbeck  and  the  medical  profession.  The 
whole  matter  has  been  investigated  by  a  sub-com- 
mittee of  the  British  Medical  Association,  which 
has  collected,  sifted  and  arranged  facts,  evidence 
and  conclusions  with  masterly  precision.  A 
correspondence  with  Mr.  Troutbeck  has  simply 
evoked  contemptuous  defiance  and  evasion  of 
issues,  together  with  a  flat  denial  of  what  appear 
to  be  incontrovertible  statements.  Nor  has  a 
further  appeal  of  the  committee  to  the  Lord  Chan- 
cellor, under  whose  jurisdiction  the  Coroners  fall, 
produced  anymore  satisfactory  result.  The  next 
steps  of  the  British  Medical  Association  committee 
will  be  awaited  with  interest.  If  Mr.  Trout- 
beck is  unwise  enough  to  declare  war  to  the  knife 
with  the  medical  profession,  he  will  most  certainly 
raise  issues  of  a  far  wider  significance  than  those 
that  appear  on  the  surface.  The  machinery  of 
the  Coroner's  Court  is  antiquated,  and  its  pro- 
cedure often  sUpshod  and  unsatisfactory  to  a 
degree.  It  is  a  question  whether  the  whole  system 
could  not  advantageously  be  replaced  by  a  simpler 
court  of  official  inquiry  framed  somewhat  on  the 
hnes  of  those  of  the  Procurator  Fiscalship  of  Scot- 
land. Meanwhile,  nothing  but  harm  can  result 
from  the  unceasing  flouts  and  jeers  which  Mr  .Trout- 
beck sees  fit  to  fling  at  the  heads  of  all  medical 
men  except  that  of  his  pathologist,  who  is  now 
openly  announced  as  pathologist  to  the  London 
County  Council.  The  inner  history  of  that  ap- 
pointment has  not  yet  come  to  light,  but  it  seems 
not  unhkely  that  the  pohcy  of  distrust  of  the 
general  practitioner  may  one  day  be  traced  to  one 
or  more  influential  members  of  that  body.  If  the 
Association  committee  want  to  get  at  the  root  of 
the  matter,  we  should  advise  them  to  ascertain 
the  attitude  of  medical  members  of  the  London 
County  Council  with  regard  to  Coroners  and 
to  the  appointment  of  Dr.  Freyberger.  The  latest 
feat  of  Mr.  Troutbeck  has  been  to  launch  a  particu- 
larly offensive  attack  against  house  surgeons 
generally.  One  of  his  jurymen  not  unnaturally 
asked  why  the  evidence  of  a  house  surgeon  had 
not  been  taken,  whereupon  the  Coroner  explained 
that  the  testimony  of  such  persons  was  of  little 
value.  The  dispute  between  the  profession  and 
Mr.  Troutbeck  has  now  been  going  on  for  a  long 
time.  Remonstrances  and  arguments  have  been 
of  no  avail,  as  that  gentleman  now  clearly  shows 
by  fastening  a  gratuitous  insult  upon  the  large 
class  of  resident  medical  officers,  many  of  whom 
are  highly  qualified  and  brilliant  men.  The  time 
is  come  for  legislative  interference  in  the  relations 
of  the  Coroner's  Court  and  the  medical  profession. 
The  situation^has'grown  intolerable.  In  the  long 
run  it  may  be  that  the  thanks  of  medical  men,  as 
well  as  of  the  general  pubhc,will  be  due  to  Mr. 
Coroner  Troutbeck  for  the  persistent  way  in  which 


he  has  forced  the  flaws  and  the  potential  poum 
of  maladministration  of  the  Coroners  Acts  upon 
the  public  attention. 


CHRONIC  CASES  IN  HOSPITAL  WARDS. 

The  question  of  the  suitability  of  individual 
cases  for  admission  as  in-patients  to  hosphak 
requires  the  exercise  of  a  good  deal  of  judgment 
about  the  exercise  of  which  evidently  exists  some 
misconception  in  the  minds  of  those  who  an 
responsible.  The  two  chief  factors  which  inflaeooe 
the  decision  are,  first,  the  urgency  of  the  case; 
and,  secondly,  the  in-patient  capacity  of  the 
hospital.  Every  resident  medical  officer  knows, 
or  should  know,  that  he  is  perfectly  justified  b 
temporarily  exceeding  the  bed- accommodation 
at  his  disposal  in  times  of  emergency.  Over- 
crowding of  hospital  wards  is,  of  course,  an  ed 
to  be  rightly  avoided,  but  few  medical  superin- 
tendents will  be  found  who  would  seriously  object 
to  go  beyond  the  theoretical  limit  if,  for  exampk. 
a  bad  accident  or  a  case  demanding  speedy  opera- 
tion required  admission.  Preference  must  always 
be  given  to  acute  cases,  and  the  smaller  the  hospil 
the  more  necessary  it  is  that  this  rule  should  ba 
enforced.  We  have  known  of  instances  whew 
serious  accidents  have  been  sent  away  from 
hospitals  on  the  ground  that  there  was  no  accons 
modation,  whereas,  if  the  truth  were  known,  tb(t 
beds  were  largely  taken  up  by  chronic  cases* 
awaiting  their  discharge  or  the  application  of  % 
long-delayed  plaster  splint.  Mere  slackness  on 
the  part  of  house-officers  is  neither  the  only  nor  tl» 
chief  cause  of  the  filling  of  beds  by  unsuitable  casc& 
In  some  districts  the  subscriber's  letter  system  hs 
such  power  that  a  patient,  armed  with  this  doa- 
ment  and  suffering,  it  may  be,  from  some  trim 
Complaint,  which  could  quite  well  be  treated  in  thi 
out-door  department,  is  instantly  admitted  into 
one  of  the  few  vacant  beds  of  which  he  or  she  take! 
triumphant  possession,  while  the  unfortunate 
individual,  stricken  by  mortal  sickness,  but  un 
provided  with  such  a  passport,  is  wholly  unable  to 
find  shelter.  This  is  by  no  means  an  imaginanr 
occurrence.  In  other  cases,  patients  are  admitted 
with  hngering  diseases,  such  as  chronic  phthisis, 
or  incurable  nervous  affections,  who  would  bt 
better  off  in  their  own  homes  or  in  the  Poor-law 
infirmaries,  for  it  is  obviously  unfair  to  keep  a 
single  bed  occupied  for  months  in  succession  by  a 
patient  for  whom  Uttle  good  can  be  done,  when  in 
the  same  space  of  time  five  or  six  acutely  suffering 
ones  might  have  been  permanently  cured  by 
operation  or  otherwise.  The  whole  question  is  of 
immense  practical  importance,  both  to  the  general 
pubUc  and  also  to  the  governing  bodies  of  tia 
hospitals  themselves.  Where  there  is  a  medical 
school  attached  to  a  hospital  the  "  chronic  case," 
considered  in  the  abstract,  has  a  definte  part  to 
play  in  chnical  instruction,  for  it  often  happens  that 
bedside  teaching  is  impossible  upon  acute  cases, 
either  from  the  severity  of  the  symptoms  or  because 
the  patient  is  frequently  admitted  at  night 
Chronic  cases,   on  account  of  the  stationar)*  w 


Oct.  5.  ^904> 


NOTES    ON    CURRENT    TOPICS.         The  Medical  Press.    367 


slowly  changing  character  of  their  physical  signs, 
are  particularly  suitable  for  cUnical  examination 
by  students,  and  a  good  teacher  can  always  find 
some  fresh  point  upon  which  to  dilate  when  the 
regular  ward  visit  takes  place.  But  in  hospitals 
without  a  medical  school,  where  the  number  of 
beds  is  more  or  less  limited,  an. intelligent  selection 
of  cases  for  in-patient  treatment  must  be  made, 
due  consideration  being  paid  both  to  the  relative 
severity  of  the  symptoms  and  also  to  the  claims  of 
the  outside  supporters  of  the  institution.  All 
suffering,  chronic  or  acute,  must  be  relieved,  and 
how  this  can  best  be  done  with  the  greatest  pos- 
sible benefit  to  all  is  one  of  the  problems  which  we 
are  glad  to  think  is,  on  the  whole,  being  daily 
solved  in  our  hospitals  and  infirmaries. 


notes  on  Cntrent  UopicB. 

Dearth  of  Medical  Men  in  Russia. 

The  evils  of  a  great  war  reach  far  beyond  the 
battlefields  on  which  the  trial  of  strength  is  made. 
The  penalties  of  suffering  and  death  may  be  paid 
by  innocent  sufferers  many  thousands  of  miles 
away  from  the  scene  of  action.  Too  often  the  bread- 
winners— fathers,  sons,  husbands  and  brothers — 
are  called  to  fight  the  battles  of  their  country, 
which  does  not  always  provide  adequately  for 
friends  and  relatives  in  case  of  death  or  disable- 
ment. Another  way  in  which  those  left  at  home 
may  indirectly  suffer  is  in  the  dearth  of  medical 
men,  of  wham  the  flower  is  called  away  to  every 
campaign.  In  the  South  African  War  even  our 
own  overcrowded  medical  profession  was  depleted 
to  such  an  extent  that  the  pinch  was  everywhere 
felt  in  the  lack  of  stop  gaps  and  of  resident 
assistants  and  medical  officers.  At  the  present 
moment  in  Russia,  where  a  war  is  being  waged  on 
a  scale  far  surpassing  our  own  South  African  cam- 
paign, the  want  of  medical  men  in  country  districts 
is  making  itself  most  keenly  felt.  Thus  a  London 
newspaper  reports  that  there  is  no  one  to  fill  up  the 
gaps  caused  by  medical  men  who  have  gone  to  the 
war.  The  usual  possible  candidates  have  them- 
selves gone  to  Manchuria  with  the  many  field- 
hospitals  that  have  been  equipped  by  the  Red  Cross 
Society,  the  town  councils,  and  other  public  bodies, 
and,  in  many  instances,  by  private  enterprise. 
The  wicked  waste  and  wantonness  of  war  was  never 
more  cruelly  shown  than  in  these  districts  of  rural 
Russia  drained  of  their  medical  men.  Under  any 
circumstances  it  seems  that  the  inhabitants  of 
that  country  are  destined  for  years  to  come  to  pay 
a  toll  of  daily  sacrifice  for  its  attempts  at  foreign 
annexation. 


Baoteriolofiry  of  Pertussis. 

Considering  the  easy  field  for  study  offered  by 
whooping-cough  it  is  a  matter  of  some  surprise  that 
we  are  still  without  any  decided  knowledge  as  to 
the  causative  organism.  It  is  a  common  disease 
in  most  countries,  so  that  there  is  no  lack  of  clinical 
material  on  which  to  work.  Moreover,  for  genera- 
tions it  has  been  recognised  as  infectious,  and  no 
observation  has  thrown  any  doubt  on  this  belief. 


It  has  been  established  that  the  sputum  may 
act  as  a  vehicle  of  infection,  although  not  perhaps 
the  only  one.  In  addition  to  these  facts,  all 
tending  to  bring  the  disease  into  the  region  of  easy 
investigation,  it  is  known  that  one  attack  confers  • 
immunity,  a  second  attack  in  the  same  subject 
being  extremely  rare.  In  spite  of  all  this,  there  is 
as  yet  no  general  agreement  as  to  the  nature  and 
history  of  the  organism  at  work.  It  is  true  the 
investigations  have  not  been  wanting,  but  the 
results,  where  there  are  any,  are  greatly  at  variance 
with  each  other.  One  of  the  most  elaborate 
inquiries  was  that  conducted  some  years  ago  by 
Czaplewski,  who  found  in  every  case  of  a  Series  of 
forty-nine  a  small  bacillus  resembling  that  de- 
scribed in  connection  with  influenza.  This 
bacillus  he  regarded  as  the  cause  of  pertussis, 
although  he  was  unable  to  obtain  any  experimental 
proof.  More  recently  Manicatide  has  described 
a  very  similar  bacillus  which  he  found  in  sixty-seven 
out  of  eighty- two  cases  examined.  It  differs,  how- 
ever, from  Czaplewski's  bacillus  in  certain  staining 
and  cultural  reactions.  It,  however,  gives  the 
agglutination  reaction  with  serum  from  patients 
affected  with  whooping-cough,  and  an  antiserum 
produced  by  inoculating  sheep  and  horses  is  stated 
to  have  been  of  service  in  the  treatment  of  the 
disease.  It  is  possible  that  further  inquiry  may 
establish  the  identity  of  Czaplewski's  and  Mani- 
catide's  organisms,  but  at  present  the  whole  ques- 
tion is  in  a  very  unsettled  condition. 

Suprarenin  in  Sursrical  Operations. 
The  great  therapeutical  use  that  was  anticipated 
from  animal  extracts  when  they  were  introduced 
into  practice  some  years  ago  has  hardly  been 
justified  in  the  majority  of  instances,  but  in  the 
case  of  supra-renal  gland  extract  a  powerful  and 
valuable  drug  has  been  placed  at  our  disposal. 
In  fact,  its  full  uses  are  probably  not  thoroughly 
grasped  yet.  A  series  of  experiments  by  MuUer  (a) 
seems  to  show  that,  in  surgery,  it  may  lend 
invaluable  aid  in  the  performance  of  quite  exten- 
sive operations  by  allowing  them  to  be  performed 
practically  without  loss  of  blood.  MuUer  found 
that  by  previously  injecting  the  parts  to  be  cut 
with  suprarenin  solution,  not  only  was  the  opera- 
tion rendered  far  easier  of  performance  for  the 
surgeon,  but  also  the  amount  of  shock  was 
diminished  by  averting  the  loss  of  blood.  He 
experimented  on  animals,  removing  portions  of 
the  liver  and  the  kidney,  and  performing  excision 
of  glands,  rib-resection,  and  lar5mgectomy.  No 
blood  was  lost  if  a  sufficiently  strong  injection  was 
given,  and  no  toxic  symptoms  were  noted.  Supra- 
renin hydrochloride  in  salt  solution  was  used  in 
strengths  varying  from  1-1,000  to  1-10,000,  and 
was  freely  injected  into  the  site  of  the  projected 
operation.  Its  vaso-constrictor  effect  was  well 
marked  in  half  a  minute  in  the  case  of  strong  solu- 
tions, and  in  one  or  two  minutes  when,  the  weaker 
ones  were  employed,  Miiller  thinking  that  in 
man  the  most  that  it  is  advisable  to  give  is  10 


(a)  Miuneh,  nud.  fVoeh.,  Nos.  6  and  6, 1904. 


368    The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Oct.  5.  1904. 


cubic  centimetres  of  a  i  per  cent,  solution,  but  as 
this  is  sufl&cient  to  render  all  operations  bloodless, 
no  more  could  ever  be  wanted.  We  wonder  if  the 
.  surgery  of  the  future  is  to  be  as  free  from  blood  as 
it  is  now  free  from  pain,  and  if  suprarenin  is  to  be 
the  agent.  If  so,  the  act  will  have  lost  its  greatest 
present  drawback,  and  no  greater  boon  since  the 
introduction  of  antiseptics  will  have  been  conferred 
on  both  operators  and  their  patients. 

Speech,  Silence,  and  Bacteria. 
The  world  has  been  recently  set  agape  by  the 
pubUshed  investigations  of  the  Local  Government 
Board  into  the  subject  of  the  sputtering  forth  of 
bacteria  in  the  act  of  speaking.  It  was  shown  that 
in  ordinary  quiet  speech  bacteria  were  emitted  only 
rarely.  In  all  abnormal  respiratory  acts, 
however,  such  as  speaking  loudly,  laughing,  cough- 
ing, sneezing,  and  so  on,  these  micro-organisms, 
with  all  their  powers  for  good  or  for  evil,  were 
distributed  right  and  left  in  wholesale  fashion. 
In  some  instances,  indeed,  we  are  told  they  were 
traced  to  a  distance  of  forty  feet.  It  is  just  as 
well  to  remind  our  readers  that  the  whole  subject 
was  dealt  with  some  time  ago  by  Dr.  Mend^s  de 
L6on,  of  Amsterdam,  who  showed  experimentally 
that  many  micro-organisms  were  e-ipelled  from 
the  mouth  in  particles  of  saliva  expelled  by  the  act 
of  speaking.  He  drew  the  attention  of  the  British 
Gynaecological  Society  to  the  danger  of  the  con- 
tamination of  open  abdominal  wounds  in  this  way 
by  the  operator  speaking  to  bjrstanders.  The 
practical  outcome  of  his  work  was  a  mask  devised 
to  prevent  the  particular  risk  in  question.  The 
article  was  published  at  the  time  in  The  Medical 
Press  and  Circular  (January  27th,  1904). 
An  editorial  comment  on  Dr.  De  Leon's  researches 
appeared  at  the  time  under  the  heading  of  "  Silent 
Surgeons."  Our  remarks  had  a  wide  circulation 
at  the  time  among  the  lay  newspapers.  It  is  to 
be  hoped  they  will  give  equal  publicity  to  the  fact 
that  the  honour  of  the  original  discovery  is  due  to 
a  distinguished  surgeon  of  Amsterdam. 

Pepper  as  a  Dressingr  for  Wounds. 
It  is  never  wise  to  dismiss  popular  notions  as 
nonsense  without  careful  critical  examination. 
There  is  no  smoke  without  fire,and  it  often  happens 
that  man  finds  out  the  right  thing  by  rule  of  thumb 
generations,  or  it  may  be  centuries,  before  the 
light  of  exact  science  is  available.  Take  the  in- 
stance of  pepper  as  a  dressing  for  wounds  in  the 
rough  and  ready  veterinary  surgery  of  the  farm 
and  the  stable  and  streets.  The  carman  who 
borrows  a  pepper-pot  from  the  nearest  public- 
house  and  liberally  bestrews  with  pepper  the  cut  on 
his  horse's  knee  wots  nothing  and  cares  less  that 
the  essential  oil  of  pepper  is  a  strong  aromatic  and 
stimulant  antiseptic.  He  knows,  however,  that 
the  wound  wiUheal  quickly  under  that  treatment, 
and  that  is  enough  for  him.  There  is  not  the  least 
ground  for  supposing  that  pepper  is  a  painful 
dressing  for  a  wound,  indeed,  anyone  who  cares 
to  try  it  on  a  cut  finger  will  find  it  infinitely  less 


painful  than  a  score  of  other  things  used  for  the  same 
purpose.  But,  forsooth,  because  it  is  a  strong 
stimulant  to  the  'tongue  certain  wiseacres  ait 
apt  to  imagine  that  it  must  be  equally  powerful 
when  appUed  to  cut  tissues,  forgetting,  or  not 
knovvdng,  the  differing  response  to  stimulation  of 
nerves  of  special  and  of  ordinary  sense.  Acting 
on  this  nonsensical  view,  some  magistrates  actuafly 
sent  to  prison  for  several  weeks  an  unfortunate 
man  who  peppered  a  horse's  wounds.  The 
so-called  cruelty  was  a  rough  kind  of  antiseptic 
surgery.  The  sentence  in  question  was  barbarous, 
inane,  ridiculous,  and  absolutely  unworthy  of  the 
spirit  of  the  present  scientific  age,  which  clearly 
has  not  yet  permeated  the  magisterial  bench  of  the 
kingdom. 


Toxins  and  the  Eye. 

As  might  be  expected,  the  conjunctival  surface, 
like  the  rest  of  the  surface  of  the  body,  has  a  rich 
bacterial  flora.  Among  the  commoner  bacteria 
present  are  the  staphylococcus  aureus  and  the 
micrococcus  lanceolatus.  While  these  or  other 
bacteria  are  present  in  small  numbers,  or  on  the 
surface  of  the  eye,  no  inflammation  results,  so  that 
it  is  evident  that  they  do  not  cause  inflammation 
simply  by  acting  as  foreign  bodies.  Inflammation 
can  be  caused  by  certain  bacteria  alone,  and  that 
only  after  a  certain  period  of  exposure  to  them  has 
taken  place.  It  is  probable,  then,  that  the  action 
of  bacteria  on  the  eye  is  due  to  the  production  by 
them  of  certain  toxins,  and  this  occurs  only  whet 
the  organisms  are  in,  and  not  merely  on,  the 
conjunctiva.  Experiments  with  the  toxins  of  the 
bacteria  which  are  known  to  affect  the  eye  bearont 
this  conclusion.  Randolph  of  Johns  Hopkiis 
Hospital,  who  has  devoted  much  time  to  the  sub- 
ject, was  unable  to  produce  any  injury  by  the  men 
instillation  of  bacterial  toxins  into  the  conjunctival 
sac,  even  with  several  hours'  contact.  On  the  other 
hand,  the  same  toxins  when  injected  into  the 
tissues  of  the  eye  produced  marked  changes, 
varying  in  kind  and  degree  with  the  bacterial 
source  of  the  toxin  employed.  An  interesting 
practical  point  is  that  the  presence  of  even  virulent 
bacteria  on  the  conjunctiva  is  probably  harmless, 
so  long  as  the  covering  membrane  remains  intact. 


Alcoholism  and  Insanity. 

There  is  no  class  of  disease  of  whose  causation 
we  are  more  ignorant,  and  in  which  the  public  take 
more  interest,  than  those  of  the  mind.  And,  indeed, 
there  is  no  more  difficult  task  than  for  an  alienist 
to  pick  out  from  an  imperfectly-known  and  often 
deliberately  misleading  personal  history,  taken  in 
conjunction  with  a  still  less  known  original  con- 
stitution, some  one  factor  or  habit  and  label  it 
alone  as  the  cause.  It  is  the  entire  group  of  •ant^ 
cedent  conditions  which  i>  in  truth  the  cause  of 
anything,  as  Mill  long  ago  insisted,  and  in  the 
case  of  disease,  and  especially  of  disease  of  the 
mind,  is  this  particularly  to  be  remembered.  In 
the  selection  of  one  of  these  conditions  and  the 
setting  it  up  as  the  cause,  there  is,  when  the  group 
of  conditions  is  large,  ill-defined,  and  imperfectly 


Oct.  5.   1904. 


known,  a  great  latitude  given  for  individual  bias. 
In  the  classification  of  the  causes  of  insanity,  for  in- 
stance, no  two  observers  would  be  hkely  to  return 
the  same  table  for  any  hundred  patients.  This 
being  so,  we  are  not  surprised  that  Dr.  Clouston's 
opinions  recently  put  forward  as  to  the  prominence 
of  alcoholism  as  a  cause  of  insanity  have  not 
received  quite  the  respect  which  is  due  to  any 
observation  by  that  distinguished  alienist.  His 
judgment  that  in  42-3  per  cent,  of  the  male  patients 
in  the  Royal  Edinburgh  Asylum  last  year  drink 
was  the  cause  of  their  condition  is  in  marked  con- 
trast to  the  figures  of  other  observers.  Thus  the 
average  throughout  the  English  asylums  is  returned 
as  16  per  cent.,  though  on  the  other  hand  Dr. 
Conolly  Norman,  of  the  Richmond  Asylum  in 
DubUn ,  approaches  Dr.  Clouston's  views.  It  is  very 
noticeable  and  strongly  in  support  of  their  opinion 
that  in  the  special  form  of  insanity  known  as 
"  alcoholic,"  about  whose  diagnosis  there  is  no 
mistake,  there  has  been  a  decided  increase  in  recent 
years.  At  the  same  time  it  is  not  necessary  to 
assume  that  drinking  habits  are  actually  on  the 
increase.  It  would  explain  the  facts,  if  in  truth 
they  are  facts,  equally  well  to  hold  that  there  is  a 
diminished  resistance  on  the  part  of  the  organism 
to  alcoholic  poisoning.  We  are  inclined,  indeed, 
to  think  that  in  many  cases  the  alcoholism  is 
primarily  a  symptom  of  the  mental  weakness 
which  it  in  turn  increases. 

Australian  Surgery  Thirty  Years  Agro. 

The  present  generation  of  medical  men  find  it 
next  to  impossible  to  draw  a  picture  of  the  condi- 
tions which  obtained  in  surgical  work  in  the  early 
seventies.  We  have  grown  up  so  completely  in  the 
age  of  anaesthesia  and  asepsis  that  we  find  it  hard 
to  reahse  that  there  was  a  time  when  these  were 
not,  and  we  are  always  interested  to  hear  the  pre- 
revolution  reminiscences  of  our  seniors.  Dr. 
Mehdlle  Jay,  of  Adelaide,  gives  us  in  a  recent 
address  (a)  an  interesting  sketch  of  what  surgical 
work  was  like  in  the  Southern  Hemisphere  when 
he  began  his  professional  life  more  than  thirty 
years  ago.  Though  anaesthesia  was,  of  course,  at 
that  time  the  common  practice,  yet  it  was  regarded 
as  by  no  means  a  necessary  adjunct  to  opera- 
tions. Dr.  Jay  saw  one  unfortunate  patient 
who,  within  a  few  days,  suffered  amputa- 
tion of  a  leg  and  enucleation  of  an  eye  without 
any  attempt  to  numb  his  sensibility.  In  the  early 
seventies  chloroform  was  the  favourite  anaesthetic 
used  in  Austraha,  but  in  1875,  following  on  the 
occurrence  of  some  deaths  under  chloroform,  an 
exhaustive  inquiry  was  made  by  Dr.  Thomas  on 
the  relative  advantages  of  ether  and  chloroform. 
As  a  result  it  was  made  obligatory  by  the  governing 
body  of  the  Adelaide  Hospital  that  ether  should  be 
the  anaesthetic  used  when  possible.  After  thirty 
years'  experience.  Dr.  Jay  finds  the  decision  amply 
justified,  and  he  has  never  seen  a  serious  result 
attributable  to  ether  anaesthesia.  In  the  operating 
theatre  it  was  unusual  for  the  surgeon  to  wash  his 
hands  before  operating,  though  he  usually  did  so 
(a)  AiutrdUnftan  Med.  Gautte,  July  20tb,  1904. 


NOTES    ON    CURRENT    TOPICS.  The  MnmcAL  Press.    369 


afterwards.  It  was  the  custom  for  him  to  wear 
a  frock  coat  throughout,  and  the  more  numerous 
the  blood-stains  thereon,  the  prouder  he  was 
Ligatures  were  always  left  long  and  hanging  from 
the  wound,  and  great  pains  were  taken  in  learning 
the  exact  amount  of  force  which  should  be  em- 
ployed in  removing  them  later  without  bringing  on 
secondary  haemorrhage.  It  was  the  duty  of  the 
house  surgeon  each  day  to  puU  on  the  Ugatures 
until  one  by  one  they  came  away.  In  the  treat- 
ment of  dislocations  use  was  made  of  a  com- 
plicated and  powerful  system  of  pulleys,  and  in 
1873  the  thumb  of  a  young  man  was  aU  but  torn 
from  his  hand  by  this  apparatus.  It  is  hardly 
matter  for  wonder  that  cases  of  pyaemia,  septicae- 
mia, erysipelas,and  hospital  gangrene  were  common 
m  the  surgical  wards. 

The  Effect  of  Smokinfir  Upon  the  Throat. 
ONE  Of  the  evils  resulting  from  the  excessive 
or,  in  some  cases,  even  the  moderate  use  of  tobacco 
is  Its  pecuhar  effect  upon  the  pharyngeal  mucous 
membrane.  The  exact  nature  of  the  pathological 
processes  which  may  foUow  too  great  indulgence 
m  smoking  is  not  always  easy  to  determine  since 
these  are  by  no  means  constant.  Then  different 
laryngologists  or  throat  speciaUsts  would,  in  all 
probabiUty,  give  as  many  different  theories  as  to 
the  manner  in  which  the  fragrant  weed  may  prove 
injurious  to  the  pharynx  and  upper  air  passages. 
Definite  teaching  upon  this  point  is  most  desirable, 
for  the  subject  appeals  with  force  to  singers, 
speakers,  and  many  others  whose  vocal  organs 
are  being  constantly  exercised.  The  so-called 
"  clergyman's  sore  throat  "  is  always  supposed  to 
be  aggravated  by  smoking,  but  no  one  will  assert 
that  this  is  a  common  or  a  chief  cause  of  chronic 
pharyngitis,  which  occurs  in  those  of  nervous 
temperament  too  frequently  to  be  merely  acci- 
dental. A  recent  analysis  of  tobacco  smoke  from 
cigarettes  shows  that  there  are  410  c.c.  of  carbon 
monoxide  per  100  grammes,  and  it  is  the  opinion  of 
experts  that  it  is  this  gas  and  not  nicotine  which 
does  the  greatest  amount  of  harm.  This  was  the 
view  taken  by  Dr.  S.  W.  Langmaid,  of  Boston,  at  a 
discussion  upon  the  subject  before  the  annual 
meeting  of  the  American  Laiyngological  Society, 
who  stated  that  the  quantity  of  nicotine  carried 
to  the  throat  was  really  very  small  as  compared 
with  the  amount  of  carbon  monoxide  which  was 
absorbed  into  the  system  and  then  produces  vaso- 
motor disturbances  in  the  pharynx.  Singers  with 
voices  of  low  register  appear  to  be  less  affected  by 
smoking  than  those  whose  voice  is  of  a  higher  pitch. 

Temperance  Lectures  in  Schools. 

The  sympathetic  hearing  given  by  Lord  London- 
derry the  other  day  to  the  deputation  of  the  medical 
profession  that  waited  on  him  to  urge  the  import- 
ance of  teaching  hygienic  and  cognate  subjects  in 
elementary  schools  has  not  yet  borne  practical 
fruit.  One  of  the  points  most  strongly  insisted  on 
by  the  speakers  of  the  deputation  was  the  good 
Ukely  to  accrue  to  the  rising  generation  by  clearly 
setting  before  them  at  an  early  stage  of  their  career 


370    The  Medical  Press. 


NOTES    ON    CURRENT    TOPICS. 


Oct.  5.  1904. 


the  moral  and  physical  dangers  of  alcohol.  It  seems 
that  in  the  Cheshire  schools  such  instruction  has 
been  given  for  some  years,  and  the  County  Educa- 
tion Committee  when  it  was  formed  passed  a  reso- 
lution that  these  lectures  should  be  continued. 
Unfortunately,  teaching  in  such  subjects  is  not 
included  in  the  school  curriculum  mapped  out  by 
the  seers  of  Whitehall,  and  the  Government 
Inspector  has  been  obUged  to  point  out  to  the 
Committee  that  the  Board  of  Education  have 
consistently  refused  to  recognise  lectures  on  alcohol 
and  temperance  as  fit  subjects  for  inclusion  in  the 
school  time-table.  Dr.  Hodgson,  however,  seems 
to  have  been  equal  to  the  occasion,  for  he  proposed 
that  the  lectures  should  be  given  as  object-lessons 
in  elementary  science,  and  moved  the  Committee 
to  take  on  their  own  shoulders  the  responsibility 
of  the  lectures,  so  that  the  local  managers  might 
not  be  exposed  to  continual  wrangles  with  the 
inspectors.  The  County  Committee  adopted  the 
motion  by  a  large  majority,  and  as  they  are  the 
authority  for  secular  education  the  matter  seems 
to  be  well  within  their  province.  Undoubtedly  the 
study  of  inebriety  and  alcoholism  is  a  "  science," 
though,  perhaps,  one  that  is  hardly  contemplated 
by  the  syllabus  of  the  Education  Board,  and  as 
such  may  be  taught ;  but  we  wonder  where  the 
object-lessons  are  to  come  from.  Will  the  local 
pubUc- houses  be  laid  under  contribution  ?  Or 
will  the  teacher  merely  simulate  the  symptoms  of 
intoxication  ?  We  hope,  at  all  events,  the  Cheshire 
Committee  will  win  their  fight,  and  these  useful 
lectures  be  continued. 


City  Orthopaddic  Hospital. 

The  position  that  the  City  Orthopaedic  Hospital 
finds  itself  placed  in  is  an  embarrassing  and 
anomalous  one.  The  MetropoUtan  Hospital  Sunday 
Fund  have  refused  it  their  annual  grant  because 
the  Governors  of  the  institution  continue  to  oppose 
the  amalgamation  of  their  hospital  with  others  that 
call  for  a  similar  class  of  case  ;  there  has  been  no 
reflection  on  the  management  or  treatment  of 
patients  ;  the  question  is  purely  one  of  policy. 
On  the  other  hand,  a  good  deal  of  sympathy,  im- 
phed  and  expressed,  has  been  shown  by  people 
who  have  taken  interest  in  the  hospital  in  the 
past,  and  by  new  friends  whom  they  have  won  over 
to  the  cause.  A  scheme  for  placing  the  City 
Orthopaedic  on  a  footing  that  will  render  it  inde- 
pendent of  the  Hospital  Sunday  Fund  is  now  on 
foot,  and  there  seems  some  prospect  of  success 
being  attained.  Without  expressing  an  opinion  on 
the  merits  of  this  particular  question,  one  may 
point  to  this  incident  as  an  example  of  the  necessity 
of  some  central  body,  such  as  the  King  Edward  VII. 
Hospital  Fund  for  London,  definitely  taking  on  its 
shoulders  the  onerous,  invidious,  but  necessary  task 
of  deciding  by  public  inquiry  all  questions  of 
hospital  policy  and  administration.  As  we  have 
before  pointed  out,  the  King's  Fund  is  in  an 
immensely  strong  financial  position  with  its  income 
of  ;f  100,000,  and  it  can  command  the  services  of  the 
best  talent,  lay  and  medical,  for  work  of  this  kind. 
It  is  neither  fair  to  individual  hospitals  nor  to  the 


public  that  these  questions  should  be  made  foot- 
balls of  in  the  columns  of  the  daily  Press.  They 
are  capable  of  definite  solution  if  taken  in  hand 
by  an  authoritative  body,  and  the  committee  of  the 
King's  Fund  is  obviously  the  right  body  for  the 
purpose.  Only  all  its  proceedings  should  be  carried 
out  in  the  full  light  of  publicity.  We  propose  to 
allude  in  an  early  issue  to  the  action  of  the  Fund 
with  regard  to  the  sale  of  the  site  of  the  Royal 
Orthopaedic  Hospital  under  the  chaimianship  of 
Mr.  Harry  H.  Marks,  and  its  amalgamation  with 
the  National  Orthopaedic  Hospital. 


Radium  BayB  in  Diphtheria. 

It  is,  of  course,  only  right  that  any  substance 
that  shows  promise  of  being  of  service  in  the  treat- 
ment of  disease  should  be  fully  investigated 
therapeutically,  but  it  must  be  confessed  that 
experience  gained  in  the  appUcability  and  utilit\'  of 
radium  has  not  fulfilled  all  the  hopes  that  were 
entertained  when  the  metal  was  first  discovered. 
There  may  still  be  disease  conditions  in  which 
radium  rays  will  prove  themselves  superior  to 
those  of  Rontgen  and  Finsen,  but  it  would  seem 
from  some  careful  researches  carried  out  by  Pro- 
fessor Prescott  at  the  Massachusetts  Institute  of 
Technology  that  radium  has  httle,  if  any,  germici- 
dal power.  Experiments  were  made  on  the  destruc- 
tive effects  of  radium  rays  on  micro-organisms  in 
such  widely  differing  resistances  as  Bacillus  coli, 
Bacillus  diphtheria,  and  Saccharomyces  cerevisia. 
all  of  which  were  exposed  for  varying  periods  up  to 
ninety  minutes.  None  of  these  bacteria  seemed  to 
be  much  affected  by  the  emanations,  and  Professor 
Prescott  thinks  that  on  whatever  grounds  radium 
rays  may  be  useful  in  disease,  it  is  not  on  that  of  the 
bactericidal  properties.  Other  observers  haw 
claimed  that  two  days'  exposure  will  killBaciliui 
typhosus  and  anthrax  spores,  but  such  a  lengthened 
period  of  apphcation  is  hardly  possible  in  the 
treatment  of  patients,  especially  as  the  rays  have 
shown  that  they  can  set  up  inflammatory  or 
destructive  changes  in  the  tissues.  Professor 
Prescott  asserts  that  radium  is  certainly  not 
adapted  to  the  treatment  of  diphtheria,  and  thatit 
should  not  be  allowed  to  take  the  place  of  anti- 
toxin. The  fringe  of  the  possibilities  of  radium 
is  yet  only  reached,  but  one  is  glad  of  definite 
evidence,  even  when  negative,  as  to  its  ascertained 
potentialities  and  hmitations. 

The  Journal  "  Pubhc  Opinion  "  and  the 
Hospitals. 

The  rejuvenation  of  an  old-standing  London 
journal — Public  Opinion,  to  wit — has  resulted  in  a 
number  of  the  more  or  less  familiar  advertisement 
schemes  that  characterise  modern  journalism- 
As  a  medical  journal  we  are  concerned  only  with  one 
of  them — namely,  a  plan  to  benefit  the  hospital 
by  prize  competitions.  Prizes  to  the  extent  of 
several  thousand  pounds, divided  into  sums  varying 
from  ;£200  downwards,  are  offered  to  those  who 
collect  and  send  in  the  largest  sums  to  the  office  of 
the  weekly  journal  above  mentioned.  There  is 
not  the    slightest  attempt  to  disguise  or  conceal 


Oct.  5,   1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    37^ 


the  fact  that  25  per  cent,  of  the  money  thus  con- 
tributed will  be  appropriated  for  prizes^and  the 
necessary  outlay.  As  pointed  out  by  the  editor  of 
Truth,  who  has  taken  the  matter  vigorously  in 
hiand,  the  commercial  nature  of  this  journahstic 
venture  is  self-evident.  The  nature  of  the  scheme, 
at  any  rate,  is  openly  declared ;  and  there  can  be 
little  doubt  that  many  medical  charities  spend  at 
least  25  per  cent,  of  income  in  the  machinery  of 
oollection.  It  would  be  interesting  to  learn  what 
is  the  precise  proportion  of  income  spent  upon 
collection  and  upon  administration  by  the  London 
Hospital  Saturday  and  Sunday  Funds  and,  above 
all,  by  the  Charity  Organisation  Society.  We 
cannot,  however,  approve  of  the  enterprise  of 
JF*ubltc  Opinion  in  the  present  instance.  Unfor- 
tunately, there  are  many  axes  in  the  hands  of 
servants,  tradesmen,  landlords,  and  philanthropists 
that  are  daily  ground  at  the  expense  of  our  medical 
charities. 


The  Supply  of  Drugrs  to  Irish  Unions. 
The  question  of  the  supply  of  drugs  to  Irish 
Unions  is  again  assuming  importance.  It  will  be 
remembered  that  some  years  ago  rather  startling 
facts  were  elicited  as  to  the  methods  in  vogue  for 
obtaining  contracts.  The  method  of  tendering 
suggested  by  Dr.  Stafford,  a  member  of  the  Local 
Government  Board,  was  then  adopted,  with 
eminently  satisfa^.tory  results  for  a  time.  It 
now^  transpires,  however,  that  many  of  the  leading 
firms  of  wholesale  chemists  in  Ireland  have  ceased 
to  tender  because  it  is  impossible  for  them  to  com- 
pete with  the  prices  quoted  by  others.  In  many 
cases,  rebates  are  offered  on  the  official  price  list 
as  much  as  37  and  40  per  cent.,  with  the 
of  result  that  many  articles  are  suppUed  below 
their  cost  price.  It  is  suggested  that  the  Local 
Oovernment  Board  intend  to  hold  an  inquiry  into 
the  causes  which  have  caused  leading  Irish  firms 
to  cease  tendering  ;  but  inasmuch  as  it  is  admitted 
that  the  Unions  are  receiving  good  drugs  at  a  lower 
price  than  they  ever  did  before,  we  doubt  that  the 
Board  will  consider  itself  called  upon  to  interfere. 


Bedding:  and  Disease 
The  fitness  of  the  bedding  upon  which  we  he 
3,nd  with  which  we  cover  ourselves  at  night  has 
an  important  bearing,  not  only  upon  the  character 
of  the  sleep  but  also  upon  the  general  health,  and 
it    fs   accordingly   not    less   worthy    of    attention 
than    other    matters   concerned    in   the    hygiene 
of    the    bed-chamber.     The    cause    of    the   unre- 
freshed  feeling  which  many  people  experience  on 
rising  in  the  morning  is  not  always  due  to  deficient 
ventilation.     The   necessity  for  pure   air  in   the 
sleeping-  apartment    is  gradually  becoming  more 
recognised  by  the  public,  but  the  voice  of  the  health 
lecturer  has  not  hitherto  been  specially  upUfted 
with  regard  to  the  quahty  and  quantity  of  the 
bedding  itself.     To  heap  up  blankets,  coverlets, 
and  rugs  does  not  confer,  in  reality,  any  greater 
-warmth  than  two  or  three  light  coverings  of  suit- 
able texture,  as,  for  instance,  a  sheet,  blanket  and 
eider-down  quilt,  while  it  is  frequently  productive 


of  the  heavy,  unrefreshing  sleep  of  which  so  many 
complain.  The  old-fashioned,  but  extremely  un- 
healthy habit  of  sleeping  in  the  same  -garment 
next  the  skin  which  has  been  worn  during  the  day 
is  still  rife  among  those  who  have,  or  think  they 
have,  a  tendency  to  rheumatism,  and  any  sugges- 
tion as  to  discontinuing  this  unpleasant  custom  is 
apt  to  be  resented.  The  same  curious  conserva- 
tism is  shown  with  regard  to  the  feather-bed, 
which  is  a  crafty  device  contrived  to  absorb  a 
maximum  of  the  organic  matter  thrown  o3  by 
sleep.nj.  I-ying  upon  hard  beds  has  cured 
many  complaints  of  a  congestive  character,  and 
the  modern  spring-mattress  is  capable  of  being 
purified  with  greater  ease  and  at  less  expense 
than  its  older  rival.  The  wool  flock  contained 
within  the  mattress  is  undoubtedly  a  possible 
source  of  danger  to  health,  as  has  been  recently 
I>ointed  out  by  a  sanitary  inspector  in  Glasgow, 
who  stated  that  analyses  of  this  material  in  many 
cases  compared  unfavourably  with  ordinary"-  sewage! 
Efficient  sterihsation  by  heat  should,  however,  suffice 
to  render  the  wool  flock  perfectly  innocuous  as  a 
material  for  bedding  which,  on  account  of  its  cheap- 
ness, is  almost  universaUy  used. 

Progeries  and  Senilism. 
It  is  not  long  since  our  knowledge  respecting  the 
conditions  which  lead  to  that  variety  of  physical 
immaturity  known  as  infantiUsm  was  considerably 
enriched  by  the  able  and  lucid  description  of  a  series 
of  cases  by  Mr.  Hastings  Gii^ord.  The  same  ob- 
server, in  a  valuable  communication  to  the 
Practitioner,  has  described  a  peculiar  condition  of 
retarded  development  combined  with  premature 
old  age,  to  which  he  gives  the  very  appropriate  name 
of  "  progeries  "  (Or  progeros),  prematurely  old). 
Three  cases  are  narrated  which  died  at  the  ages  of 
seventeen,  eighteen,  and  forty-three,  respectively. 
The  patients  were  all  Uke  children  in  stature,  but 
of  a  peculiar  wizened  appearance,  and  possessed 
a  wrinkled,  atrophic  skin.  In  intellectual  power 
they  were  somewhat  precocious,  but  otherwise  the 
physical  functions  were  normally  performed. 
Mr.  Gifford  defines  the  condition  as  one  of  "  in- 
fantilism upon  which  has  descended  the  blight  of 
premature  old  age,"  and  in  this  connection  it  is 
interesting  to  observe  that  at  the  post-mortem 
upon  the  first  case  atheromatous  changes  were 
found  with  commencing  calcareous  degeneration 
in  the  coronary  arteries  and  upon  the  valves  of 
the  left  side  of  the  heart.  Premature  senility 
alone  is  of  frequent  occurrence,  but  when  it  is  found 
in  conjunction  with  infantihsm  the  result  is  patho- 
logically most  incongruous. 


Lieutenant-Colonel  E.  M.  Wilson,  C.B., 
C.M.S.,  D.S.O.,  recently  retired,  since  his  appoint- 
ment as  surgeon  in  1881  has  seen  active  service  in 
the  following  campaigns  :  Soudan,  1884-85  (medal 
with  clasp  and  Khedive's  bronze  star)  ;  Soudan 
Frontier  Field  Force,  1885-86  ;  expedition  up  the 
Gambia,  1891-92  ;  Ashanti  expedition,  1895-96  ; 
Nile  expedition,  1 898  (mentioned  in  despatches  ; 
appointed     D.S.O.     and    medals).      Before    this 


372     The  Medical  Press. 


CORRESPONDENCE. 


Oct.  $.  1904. 


record  he  served  in  187905  civil  surgeon  in  the  Zulu 
War  (medal  and  clasp). 


PERSONAL. 


His  Majesty  the  King  has  graciously  approved 
the  appointment  of  Lieutenant-Colonel  Richard 
Philip  Smart.  Chief  Government  Medical  Officer  and 
Superintendent  of  Public  Health  of  the  Island  of 
Malta,  to  be  a  member  of  the  Executive  Council  and 
an  official  member  of  the  Council  of  the  Government 
of  that  island. 


Their  Royal  Highnesses  Prince  and  Princess  Henry 
of  Prussia  have  shown  their  sympathy  with  the  work 
of  the  London  Royal  Waterloo  Hospital  for  Children 
and  Women  by  a  letter  of  sympathy  and  an  annual 
subscription  of  five  guineas. 

Fleet-Surgeon  J.  C.  Dow.  M.B.,  has  retired  from 
active  service  with  the  honorary  rank  of  Deputy- 
Inspector-General . 

Dr.  J.  B.  Hogg.  Inspector  of  Asylums  in  Queensland, 
in  his  annual  report  recently  presented  to  the  Houses 
of  Parliament,  points  out  that  the  proportion  of  insane 
to  the  general  population  is  steadily  increasing  in  all 
the  Australian  States,  and  in  a  ratio  greater  than  that 
of  the  United  Kingdom. 

The  Harveian  Lecture  will  be  delivered  on  Thursday 
evening,  October  13th,  by  Mr.  C.  B.  Keetley,  on 
"  Plastic  Surgery." 

Mr.  C.  M.  Tuke  will  deliver  the  Presidential  Address 
of  the  23rd  Session  of  the  West  London  Medico- 
Chirurgical  Society  on  Friday  evening,  October  7th, 
upon  the  subject  "  Progress  in  Psychology." 

Sir  James  Reckitt,  of  Hull,  has  generously  offered 
to  double  the  amount  of  the  Hospital  Sunday  Fund 
collected  in  that  town,  after  the  first  thousand  pounds 
have  been  reached. 

Dr.  E.  Symes  Thompson  will  deliver  a  course  of 
four  lectures  on  "  Evolution  in  the  Vegetable  Kingdom" 
on  October  4th  and  the  three  following  days,  at 
Gresham  College,  London,  at  6  p.m.  each  day. 

On  October  20th,  Lord  and  Lady  Rothschild  will 
open  the  administrative  buildings  of  the  Epileptic 
Colony  at  Chalfont  of  the  National  Society  for  the 
Employment  of  Epileptics. 


Dr.  Chambers  will  entertain  members  of  the  South- 
EsLstem  Division  of  the  Medico-Psychological  Asso- 
ciation at  luncheon,  at  the  Priory,  Roehampton, 
London,  S.W.,  on  Thursday,  October  6th. 


Dr.  R.  Murray  Leslie  is  the  new  President  of  the 
North-East  London  Clinical  Society,  of  which  the 
present  winter  session  will  be  inaugurated  by  an  address 
on  October  6th  by  Sir  R.  Douglas  Powell  on  "  Anti- 
septic Principles  in  Medicine." 

LiEUT.-CoLONEL  P.  M.  Ellis,  uow  commanding  the 
9th  Company  of  the  Royal  Army  Medical  Corps  at 
Colchester,  has  been  appointed  Principal  Medical 
Officer  of  the  7th  Division,  3rd  Army  Corps,  at  the 
Curragh. 


Dr.  Henry  Ashby,  of  Manchester,  will  deliver  the 
Wightman  Lecture  of  the  Society  for  the  Study  of 
Diseases  in  Children  in  May,  1905. 


It  is  officially  announced  that  the  Emperor  of 
Germany  has  acceded  to  the  request  of  Professor  Dr. 
Robert  Koch  to  be  relieved  of  his  post  of  Director  of 
the  Institute  for  Infectious  Diseases,  with  a  retiring 
pension.  Notwithstanding  his  resignation,  it  is  under- 
stood that  Dr.  Koch  will  remain  in  the  service  of  the 


State  for  purposes  of  research  work,  and  in  the  course 
of  the  coming  winter  he  will  proceed  to  German  East 
Africa  to  carry  out  certain  bacteriological  studies  there. 

Dr.  William  Martin,  for  over  forty  years  physiciaD 
to  Jervis  Street  Hospital,  Dublin,  has,  we  understand, 
tendered  his  resignation. 


Dr.  Brien  O'Brien  has  been  appointed  medical 
officer  to  the  Irish  Constabulary  of  the  Belfast 
District,  in  succession  to  Dr.  W.  B.  McQuitty. 

Special  (iorreBpoit&ence* 

[from   our   own    correspondent.] 


BELFAST. 

Ulster  Medical  Society. — A  spscial  meeting  of 
this  Society  was  held  last  week  to  elect  a  President  for 
the  ensuing  two  years  in  place  of  Professor  Lorraia 
Smith,  who  was  elected  at  the  annual  meeting  in  June, 
but  who  has  resigned  his  post  on  leaving  Belfast  for 
Manchester.  Dr.  William  Calwall  was  unanimously 
elected  to  the  post,  and  as  he  has  been  for  a  number  of 
years  one  of  the  most  active  members  of  the  Society, 
frequently  reading  papers  and  showing  cases,  there  is 
no  doubt  that  the  Society  will  flourish  under  his  rule. 
The  winter  session  will  open  in  November,  and  it  is 
expected  that  the  bust  of  Sir  William  WTiitla  will  be 
unveiled  at  an  early  date  in  the  session.  ' 

The  Small-Pox  Outbreak. — After  an  interval  of 
several  weeks,  in  which  it  seemed  to  have  been  stamped 
out,  small-pox  has  appeared  at  two  different  parts  of 
the  city  last  week,  a  man  and  a  child  being  affected. 
Both  were,  of  course,  removed  at  once  to  the  hospital  at 
Purdysburn,  where  the  man  has  died.  The  families 
in  both  cases  have  been  isolated  at  the  intercepting 
hospital  at  Twin  Island.  One  or  two  cases  have 
occurred  in  the  country  towns  of  Ulster  during  the 
week,  but  active  measures  are  being  taken  everywhere 
the  disease  appears,  and  there  is  every  reason  to  hope 
that  it  will  soon  be  entirely  stamped  out. 


Cotreepon&encc. 


[We  do  not  hold  ourselves  responsiUle  for  the  opinions  of  our 
Correspondent&J 


WHAT    IS    "  INSANITY  "  ? 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  interesting  table  talk  which  Dr.  Robert 
Lee  describes  as  having  taken  place  at  the  house  of 
the  late  Dr.  Forbes  Winslow,  and  at  which  the  deceased 
gentleman  is  represented  as  having  expressed  the 
opinion  "  that  nearly  all  the  world  was  insane," 
appears  to  me  to  afford  admirable  corroboration  of  my 
contention  as  to  the  necessity  of  a  legal  or  practical 
definition  of  insanity. 

A  short  period  ago  I  ventured  to  define  insanity  in 
its  comprehensive  or  theoretical  sense  as  '*  a  greater  or 
less  deviation  from  reason,"  which  definition  would,  of 
course,  embrace  superstitious  and  imaginary  ideas 
treated  as  realities  but  unsupported  by  generally 
accepted  evidence.  Now  I  apprehend  Dr.  Forb^ 
Winslow  gave  vent  to  the  opinion  just  recited  as 
applied  to  those  such  as  my  definition  would  include. 
If  my  conjecture  be  correct,  I  venture  to  say  there  are- 
numbers  of  observers  of  the  human  mind  who  would 
agree  with  the  deceased  gentleman.  Wliy,  therefore, 
should  Dr.  Lee  regard  the  late  gentleman's  opinion  as 
"  very  amusing  "  ?  Further,  if  it  be  necessary  i» 
order  to  convey  a  meaning  of  insanity  in  its  compre- 
hensive aspect  to  formulate  a  definition — I  do  not  assert 
it  is — but  assuming  the  necessity  for  argument's  sake. 
how  much  more  necessary  must  it  be  to  define  insanit}*' 
in  its  legal  or  more  contracted  sense. 

I  am,  Sir,  yours  truly, 

Clement  H.  Sers- 

Brighton,  September  29th,  1904. 


Oct.  5,  1904. 


OBITUARY. 


The  Medical  Press.    373 


THE    "MEDICAL    REGISTER." 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  the  interests  of  the  profession,  may 
I  ask  you  to  be  good  enough  to  draw  attention  in  an 
early  issue  to  the  importance  to  practitioners  of 
keeping  their  addresses  correct  in  the  "  Medical 
Register  "  ? 

The  chief  points  to  which  I  should  like  to  call 
attention  are: — (i)  The  Register  should  not  be  con- 
fused with  the  Medical  Directory,  as  is  so  often  done; 
changes  should  be  notified  to  this  office  by  practitioners 
themselves,  and  a  post-card  should  be  received  in 
acknowledgment. 

(2)  This  year  circulars  of  inquiry  have  been  sent  to 
all  practitioners  whose  names  begin  with  letters  from 
H  to  O  inclusive,  and  who  originally  registered  at  the 
office  of  the  Branch  Council  for  England  ;  any  person 
whose  name  falls  within  those  letters  who  has  not 
received  a  circular  should  communicate  with  this 
office  at  once. 

(3)  Anyone  who  is  doubtful  whether  his  address  is 
correct  should  inquire  at  the  office  without  delay. 

In  past  years  you  have  kindly  done  your  best  to 
assist  me  in  my  efforts  to  save  practitioners  from  the 
grave  inconvenience  of  finding  that  their  names  do  not 
appear  upon  the  Register  because  of  the  impossi- 
bility of  getting  into  communication  with  them,  and 
I  hope  therefore  that  you  will  be  good  enough  to 
continue  to  give  me  the  benefit  of  your  valuable 
assistance  in  the  matter. 

I  am,  Sir,  yours  truly, 

H.   E.  Allen,   Registrar. 
General  Council  of  Medical  Education  and  Regis- 
tration, 299  Oxford  Street,  London,  W. 
September  26th,  1904. 

MR.  CORONER  TROUTBECK  AND  HOUSE 
SURGEONS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Is  it  not  time  that  public  opinion  was  educated 
as  to  the  relationship  of  the  coroner  to  the  pubUc  ? 
As  an  administrative  servant,  his  duties  are  clearly 
defined,  and,  just  as  in  the  case  of  one  of  his  Majesty's 
judges,  should  he  persistently  evade,  exceed,  or  fall 
short  of  his  statutory  powers  and  instructions,  he  be- 
comes amenable  to  the  higher  authorities.  The  West- 
minster coroner,  Mr.  Troutbeck,  has,  in  the  opinion  of 
many  persons,  exceeded  his  powers  by  employing  Dr. 
Freyberger.  He  has  persistently  flouted  the  general 
practitioner,  whom  he  has  replaced  by  a  so-called 
"  expert  "  pathologist.  At  a  recent  inquest  he  ex- 
plained to  the  jury  he  had  called  Dr.  Freyberger  to 
give  post-mortem  evidence  in  place  of  the  house-surgeon 
of  a  hospital  because  he  mistrusted  the  evidence  of  a 
young  house  surgeon,  "  perhaps  "  only  just  qualified. 
Does  Mr.  Troutbeck — self-reliant  man  that  he  is — not 
know  that  post-mortems  in  hospitals  are  conducted 
by  skilled  pathologists,  about  whose  scientific  standing 
and  experience  there  can  be  no  question  whatever  ? 
I  am.  Sir,  yours  truly, 

A  Westminster  Victim. 
September  27th,   1904. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  have  followed  the  discussion  of  this  momen- 
tous question  from  the  initiatory  stage  of  Professor 
Taylor's  address' in  your  columns  to  the  present  with 
much  interest,  and  in  reading  Dr.  Woods  Hutchinson's 
article  in  the  last  number  of  the  Contemporary  Review, 
it  occurred  to  me  that  one  or  two  passages  therein 
might  appropriately  be  transferred  to  your  columns 
as  embodying  certain  facts  for  the  elucidation  of 
points  raised  by  some  of  your  correspondents.  In  the 
article  referred  to,  entitled  "  Animal  Marriage,"  the 
writer  points  out  that  every  form  of  conjugal  union 
which  the  ingenuity  of  man  has  been  able  to  devise 
can  be  found  to  exist  in  full  perfection  among  the  so- 
called  lower  animals.  "  From  promiscuity,  through 
union  simply  for  the  mating  season,  to  polygamy, 
polyandry,    and   finally   monogamy   and   monoandrj-, 


every  possible  phase  and  form  of  the  institution  can 
be  studied  outside  of  the  human  species.  The  same 
results  appear  to  have  been  reached  by  experiment 
here  as  in  our  own  species — namely,  that  in  proportion 
as  the  species  rise  in  the  scale  of  aggressiveness  and 
intelUgence,  promiscuity  or  mere  mating-season  union 
tends  to  disappear,  and  either  a  lasting  form  of  poly- 
gamy, or  more  frequently  a  fairly  well  settled  form 
of  monogamy,  in  many  cases  even  lasting  for  life,  is 
reached.  The  progress  of  the  forms  of  combination  of 
the  sexes  might  be  expressed  in  the  statement  that 
the  accumulations  of  racial  experience  tend  to  show 
that  hy  the  production  of  a  smaller  number  of  offspring 
and  the  expenditure  upon  these  of  a  greater  amount  of 
parental  care,  better  results  can  be  obtained  in  efficiency 
and  capacity  for  survival. 

"We  have  Uving  examples  of  every  possible  stage  of 
the  solution  of  this  problem,  from  the  production  of 
eggs  by  hundreds  of  thousands,  as  in  the  insects  and 
the  fishes,  with  absolutely  no  parental  care  and  a  loss 
from  enemies  of  95  per  cent.,  through  the  intermediate 
types  of  mammails,  with  their  broods  of  from  six  to  a 
dozen  members,  and  with  an  infant  mortality  of  pro- 
bably not  more  than  50  per  cent.,  up  to  the  highest 
mammals,  including  man,  with  but  a  single  offspring 
at  a  birth  and  an  infant  mortality  of  20  per  cent. 
And  we  believe  that  almost  every  individual  instance 
will  be  found  to  be  explainable  by  conformity  to  this 
law,  in  so  far  as  circumstances  permit  ;  each  progressive 
organism  giving  the  greater  amount  of  care  and  pro- 
tection to  the  young,  and  thus  causing  the  race  to 
grow  and  progress  ;  while  each  retrogressive  or  de- 
generate organism  gives  a  smaller  amount  of  parental 
care  than  is  necessary  to  maintain  the  race  at  its  level." 

Thus,  according  to  Dr.  Hutchinson,  we  have  the 
voice  of  Nature  proclaiming  the  fewer  the  better,  not 
only  for  the  individual,  but  for  the  community  at 
large.  But  here  comes  in  the  eternal  if  to  spoil  the 
Malthusian  chimera — the  power  of  which  is  exempli- 
fied in  everyday  experience — that  the  members  of 
large  families  are  generally  better  citizens,  more 
energetic  and  resourceful  than  the  pampered  ones 
and  twos  of  limited  liability. 

I  am,  Sir,  yours  truly, 

One  Personally  Interested. 


(Sbituats* 


GEORGE  CROKER,  M.D.Glasg.,  F.R.C.S.I 
We  regret  to  announce  the  death  of  Dr.  George 
Croker,  at  his  residence,  Mount  Pottinger,  Belfast, 
on  September  22nd.  Dr.  Croker  was  bom  in  Wicklow, 
and  studied  at  Glasgow,  where  he  graduated  M.D.  in 
1 840  and  four  years  later  became  a  Fellow  of  the  Royal 
College  of  Surgeons  in  Ireland.  For  a  time  he  practised 
in  the  south  of  Ireland,  but  afterwards  he  became 
resident  physician  to  the  present  Marquis  of  Down- 
shire's  grandfather.  Later,  he  took  up  residence  in 
Bally hackamore,  and  acted  as  dispensary  medical 
officer  of  No.  1 1  Castlereagh  district.  He  leaves  two 
sons  and  two  daughters  ;  one  of  his  other  sons.  Dr. 
E.  Croker,  died  when  house  physician  of  the  Royal 
Victoria  Hospital  some  years  ago.  Dr.  Croker,  who 
attained  the  age  of  90  years,  was  greatly  respected 
and  had  at  one  time  a  large  practice. 

ARCHIBALD  HAMILTON.  M.D. 
The  death  has  taken  place  suddenly  at  Windermere 
of  Dr.  Archibald  Hamilton,  one  of  the  oldest  doctors  in 
Westmoreland.  He  took  his  degree  at  Edinburgh 
University  in  1861  and  came  to  Windermere  as  an 
assistant  to  the  late  Dr.  Cowes.  Dr.  Hamilton  was 
a  Conservative,  and  at  one  time  president  of  the 
Windermere  Conservative  Association.  His  bright 
and  humorous  speeches  are  well  remembered.  He 
was  a  county  magistrate  and  a  member  of  the  District 
Council.  It  was  largely  owing  to  his  efforts  that  the 
purchase  of  the  Queen's  Park  Recreation  Grounds  was 
effected.  He  was  also  one  of  the  organisers  of  the 
Windermere  Art  Exhibition  held  last  year. 


374     The  Medical  Press. 


LABORATORY  NOTES. 


Oct.  5,  1904- 


MR.  W.  J,  LE  TALL,  M.R.C.S.Enc.  L.S.A. 
We  regret  to  announce  the  death  of  Mr.  William 
James  Le  Tall,  who  died  recently  at  his  residence, 
Hackenthorpe,  after  several  weeks'  illness.  Deceased 
was  the  son  of  the  late  Dr.  Benjamin  Le  TaJl,  of  Newton 
Croft,  for  many  years  surgeon  at  Woodhouse.  De- 
ceased was  medical  practitioner  for  Woodhouse,  but 
some  years  ago  he  retired,  and  lived  at  Hackenthorpe. 
He  was  64  years  of  age,  and  had  been  connected  with 
the  Woodhouse  branch  of  the  Society  of  Friends 
practically  all  his  life.  He  held  the  qualifications  of 
M.R.C.S.,  L.S.A.,  which  he  took  in  the  year  1862. 


WILLIAM  WHAMOND.  M.D.Glasg.,  L.F.P.S. 
Glasg. 
Dr.  William  Whamond,  one  of  the  oldest  medical 
practitioners  in  Jarrow,  has  succumbed  at  his  residence 
Balgownie,  after  a  short  illness.  He  qualified  in 
1862,  and  went  to  Jarrow  forty  years  ago,  and  soon 
established  a  lucrative  practice.  In  addition,  he  was 
the  official  inspector  of  boys  at  the  large  works  on 
Tyneside,  and  attended  personally  to  this  branch  of 
his  labours  to  the  last.  The  doctor  was  a  Justice  of 
the  Peace  for  the  borough,  but  seldom  sat  on  the  bench. 
Dr.  Whamond  was  twice  married,  and  leaves  a  widow 
and  two  young  children. 


BRIGADE-SURGEON  EDWIN  WILSON,  M.R.C.S.E. 
Brigade-Surgeon  Edwin  Wilson  died  suddenly  on 
the  27th  ult.,  at  Bray,  aged  78.  He  became  an  M.R.C.S. 
Eng.  in  185 1.  received  his  commission  as  assistant 
surgeon  in  May,  1855,  rising  to  the  rank  of  surgeon 
in  1868,  and  surgeon-major  in  1873,  ^^^  retired  in  1884 
with  the  honorary  rank  of  brigade-surgeon.  He  served 
in  the  71st  Highlanders  with  the  Central  India  Field 
Force  under  Sir  Hugh  Rose  in  1858,  and  was  present 
at  the  battles  of  Koonch  and  Golowlee,  the  capture  of 
Calpee,  the  action  of  Morar.  and  the  recapture  of 
Gwalior.  He  was  also  in,  medical  charge  of  the  flying 
column  which  was  sent  in  pursuit  of  Burgore  Sing. 
For  these  services  he  received  the  medal  with  clasp. 


Xftetature. 


CLINICAL  DIAGNOSTIC  BACTERIOLCXJY.  (c) 
This  book,  it  is  stated  in  the  preface,  is  intended  for 
the  many  practitioners  who  have  not  had  an  oppor- 
tunity of  studying  in  a  laboratory  or  who  have  not  the 
necessary  equipment  for  bacteriological  work.  For 
such  persons,  however,  the  seventy-six  pages  devoted 
to  an  examination  of  the  acid-fast  bacilli  can  have  little 
practical  value  ;  and  in  the  strictly  clinical  part  of  the 
work  the  methods  recommended  are  in  many  cases  of 
so  delicate  and  elaborate  a  character  as  to  necessitate 
a  previous  knowledge  of  bacteriological  technique,  and 
the  apparatus  of  a  well-equipped  laboratory.  The 
absence  of  exact  directions  as  to  the  best  methods  of 
procuring  specimens  and  packing  and  dispatching  these 
by  post  is  to  be  regretted.  On  the  other  hand,  Dr. 
Coles'  book  will  be  found  of  the  greatest  service  to 
those  working  in  a  well-appointed  laboratory,  especially 
to  senior  students  and  resident  medical  officers  of 
hospitals,  who  have  to  do  the  daily  bacteriological 
•examination  of  morbid  materials  from  the  wards  or 
post-mortem  room.  With  few  exceptions  we  have 
found  the  directions  given  to  be  trustworthy,  and 
special  attention  has  evidently  been  paid  to  methods 
of  staining,  although  we  doubt  if  there  is  anything  to 
be  gained  in  a  work  of  this  nature  in  multiplying  these. 
For  instance,  six  methods  of  staining  the  pneumococcus 
capsule  are  given,  and  six  of  staining  the  diphtheria 
bacillus.  We  differ  from  Dr.  Coles  when  he  states  that 
in  examining  urine  there  is  little  advantage  to  be  gained 
by  obtaining  the  specimen  by  means  of  a  catheter, 
and  in  urine  and  other  body  fluids  we  believe  that  far 
better  results  can  be  obtained  by  a  high  speed  centri- 
fuge than  by  any  form  of  sedimentation  glass.  A 
valuable  feature  of  the  book  is  the  list  of  authorities 

(a)  '*  Clinical  Diagnostic  Bacteriology,  in<^adiDg  8erum  Diafnosi^ 
and  Cyto-diagno8i«."  By  Alfred  C.  Ooles,  M.D.,  D.Sc,  F.R.».Ed. 
Pp.  330.    London  :  J.  and  A.  Churchill. 


given,  and  here  the  latest  and  most  valuable  work  of  the 
best  British  and  foreign  observers  has  been  included. 
With  regard  to  the  tests  by  which  it  is  proposed  to 
distinguish  between  tubercle  bacilli  and  other  acid-fast 
varieties,  these  will  no  doubt  be  subjected  to  close 
examination  in  the  immediate  future,  and  if  found 
trustworthy  will  be  generally  adopted.  In  our  ow-n 
experience  we  have  met  with  two  cases  in  which  a 
mistaken  diagnosis  was  made  owing  to  the  smegma 
bacillus  being  taken  for  the  tubercle  bacillus,  and  such 
cases  are  not  uncommon.  The  investigation  of  this 
matter  must,  however,  for  the  present  rest  in  the  hands 
of  bacteriological  experts.  The  chapter  on  c>'to- 
diagnosis  should  be  read  by  all,  for  this  aid  to  diagnosis, 
based  on  the  examination  of  the  nature  and  variety 
of  the  cellular  elements  found  in  an  exudation,  has  not 
been'as  fully  employed  in  the  past  as  it  should  have 
been. 


Xaborators  Tlotea. 

"TABLOID"  LITHIUM  CITRATE  AND  URO- 
TROPINE,  EFFERVESCENT. 
Medical  men  who  wish  to  administer  lithium  citrate 
in  conjunction  with  urotropine  will  find  "  Tabloid " 
Lithium  Citrate  and  Urotropine,  Effervescent,  an 
excellent  preparation  for  the  purpK>se.  It  is  mano- 
factured  by  Messrs.  Burroughs  Wellcome,  and  each 
tabloid  contains : — 

Lithium  citrate,  gr.  5  (0*324  gm.). 
Urotropine,  gr.  3  (0*194  gni.). 
Effervescent  basis,  q.s. 
In  most  cases  it  is  clearly  desirable  to  administer  a 
combination  of  this  nature  in  a  good  draught  of  water, 
in  such  ca.se  the  effervescent  properties  of  this  product 
will  be  found  advantageous.     The  combined  action  of 
these  drugs  is  likely  to  render  the  particular  tabloid  of 
special  value  in   the  case  of  gouty  patients  suffering 
from    urinary  complications. 

KEPLER'S  MALT  EXTRACT,  WITH  H.CMO- 
GLOBIN. 

We  have  examined  a  sample  of  this  well-known 
preparation  of  malt  extract,  received  from  the  manu- 
facturers. Burroughs  Wellcome  and  Co.,  and  have 
proved  the  presence  of  haemoglobin.  It  is  claimed 
that  by  the  administration  of  haemoglobin  the  iron 
contained  therein  is  presented  in  a  readily  assimilable 
form,  and  with  this  statement  most  medical  men  are 
agreed. 

The  malt  extract  is  a  good  one  and  contains  some- 
what less  moisture  than  we  have  found  in  similar 
specimens.  The  sample  submitted  to  us  is  remarkably 
free  from  any  caramelised  taste,  and  its  flavour  is 
excellent.  These  points  are  of  consequence  as  they 
render  it  convenient  of  administration  to  children  and 
to  invalids. 


SERRAVALLO'S  IRON  AND  CHINCHONA  TONIC 
This  tonic  forms  an  admirable  means  of  adminis- 
tering iron  and  the  cinchona  alkaloids  in  a  palatable 
form.  Unlike  so  many  preparations  which  claim  to 
contain  an  appreciable  amount  of  iron,  we  find  on 
analysis  that  this  preparation  really  does  contain  a 
quantity  likely  to  be  of  value  in  cases  of  anaemia, 
debility,  chlorosis,  &c.  At  the  same  time  the  alkaloids 
from  the  bark  successfully  mask  the  taste  of  the  iron 
and  add  to  the  value  of  the  preparation.  The  basis  of 
the  preparation  is  a  wine  of  good  quality,  and  we  have 
pleasure  in  bringing  this  preparation  before  the  notice 
of  our  readers.  The  London  depot  is  at  45,  Holbom 
Viaduct. 


MILO  FOOD. 
This  food  is  prepared  by  Henri  Nestle.  Vevey. 
Switzerland  (of  condensed  milk  fame),  with  a  basis  of 
dessicated  milk,  as  is  shown  by  its  containing  on  our 
analysis  7*8  p)er  cent,  of  milk- fat  and  a  proportionate 
amount  of  milk-sugar.     The  remaining  parts  of  the 


Oct.  5,  1904. 


MEDICAL  NEWS. 


The  Medical  Press.    375 


food  consist  of  cane  sugar  and  starch,  a  portion  of  which 
has  been  partly  converted  by  the  action  of  diastase. 
While  some  authorities  insist  that  no  starch  whatever 
shall  form  part  of  the  food  of  children  under  nine 
months  of  age,  the  proportion  here  given  cannot  be 
objected  to,  and  its  presence  together  with  the  maltose 
and  dextrine  will  serve  to  break  up  any  curd  that 
\vould  otherwise  be  formed  by  milk  that  would  in  all 
probability  be  given  with  the  food  to  young  children. 
The  mineral  matter,  I'j  per  cent.,  is  of  the  proper 
nature,  consisting  mainly  of  the  phosphates  of  calcium 
and  potassium  to  furnish  the  salts  required  for  the 
building  up  of  the  framework  of  growing  children.  The 
nitrogenous,  or  flesh-forming  properties  are  present  in 
due  proportion  (i2'i  per  cent.),  and  the  food,  when 
mixed  with  milk  and  water,  yields  a  uniform  liquid  of 
a  slightly  sw^eet  taste  and  agreeable  flavour,  such  as 
would  readily  be  taken  by  children.  The  pamphlet 
issued  by  the  manufacturers  contains  an  adequate  and 
accurate  description  of  the  composition  of  the  food 
and  is  deserving  of  the  attention  of  medical  men. 


AeMcal  Tlew0« 


THE  WELSH  RAILWAY  ACCIDENT.— A  MEDICAL 
HERO. 

The  terrible  railway  accident  in  Wales  on  Monday 
last,  when  four  persons  were  killed  and  many  injured, 
will  be  ever  memorable  in  the  medical  world  for  the 
heroic  conduct  of  a  medical  man.  This  gentleman, 
according  to  the  description  of  one  of  the  passengers, 
took  the  direction  of  affairs  into  his  own  hands  and 
gave  orders  for  the  smashing  of  doors  and  the  cutting 
of  holes  in  the  roofs  of  the  broken  carriages,  in  order 
to  reach  the  injured.  His  purely  medical  aid  was  no 
less  prompt  and  valuable.  He  is  described  as  having 
"  worked  magnificently,"  and  as  having  even  torn  up 
his  coat  to  make  bandages.  Before  going  to  press  we 
have  been  unable  to  identify  with  certainty  this 
gentleman,  of  whom  the  medical  profession  may  well 
be  proud,  but  presumably  he  was  Dr.  W.  Philip  Jones, 
of  Wostenholme  Road,  Sheffield,  who  was  among  the 
slightly  injured. 

Death  of  a  If ed leal  Han  from  Chloroform. 

An  inquest  was  held  in  Liverpool  last  week  concern- 
ing the  death  of  Edward  Lloyd  Roberts,  who  was  in 
practice  as  a  doctor  at  Chester  with  his  father.  On 
Wednesday  evening  he  engaged  a  room  in  a  temperance 
hotel  in  Liverpool.  The  next  morning  an  assistant  in 
the  hotel  knocked  at  his  door  several  times,  and,  failing 
to  get  any  answer,called  in  the  police,  who  forced  open 
the  door  and  found  him  lying  on  the  bed,  fully  dressed. 
He  had  a  handkerchief  in  his  left  hand  near  his  mouth, 
and  was  dead.  In  his  pockets  were  several  bottles 
which  had  contained  either  chloroform  or  laudanum. 
Richard  Mills,  a  brother-in-law,  said  that  Dr.  Roberts 
was  a  teetotaler,  quite  steady  in  his  habits,  and  he  had 
been  in  fairly  good  health.  He  had  been  addicted  to 
the  habit  of  taking  chloroform  for  the  last  twenty  years. 
He  had  told  witness  that  while  under  the  influence  of 
chloroform  he  had  beautiful  dreams  and  that  he  took 
it  very  strong.  He  had  tried,  but  unsuccessfully,  to 
break  off  the  habit.  The  chemists  in  Chester  would 
not  supply  him  with  the  drug,  but  he  obtained  it  at 
shops  where  there  were  new  assistants  or  in  other 
towns.  In  Dr.  Corlett's  opinion  death  was  due  to 
chloroform  poisoning  by  inhalation,  and  Detective- 
Inspector  Robertson  said  that  he  had  seen  Dr.  Roberts 
on  Tuesday,  and  at  that  time  he  was  quite  satisfied'that 
he  had  no  intention  of  committing  suicide.  The  jury 
returned  a  verdict  of  death  from  misadventure,  and 
expressed  deep  sympathy  with  the  family. 

St.  Bartholomew's  Hospital. 

The  following  are  the  results  of  the  recent  examina- 
tions : — Senior  Entrance  Scholarships  in  Science  (value 
£2$  each),  E.  P.  Cumberbatch  and  G.  Graham.  Junior 
Entrance  Scholarship  in  Science  (value  ;ii5o),  T.  S. 
Lukis.     Preliminary  Scientific  Exhibition   (value   £30), 


G.    Rigby   Lynn.     Jeaffreson   Exhibition   (value   /20), 
K.  C.  Bomford.  * 

London  Hospital  Medical  Collage.— Entrance  Seholarshlps. 
Science,  "  Price "  Scholarship  {£120),  Mr.  A.  H. 
Penistan  ;  Science  Second  (3^60)  Scholarship,  Mr.  C. 
Ilderton  Wright ;  Science,  Third  (£3$)  Scholarship,  Mr. 
Ronald  Candy;  Science,  Hon.  Certificate,  Mr.  E.  B. 
Morley.  "  Price  "  Scholarship  in  Anatomy  and  Physio- 
logy (;^6o),  Mr.  R.  B.  Lloyd,  Emmanuel  CoUege.  Cam- 
bridge. Epsom  Scholarship  (;£i20),  Mr.  J.  P.  Little. 
Middlesex  Hospital  Medical  School. 

The  following  scholarships  have  been  recently 
gained  : — First  Entrance  Scholarship  (^Jioo).  Mr.  A.  O. 
EngUsh.  Second  Entrance  Scholarship  (;£6o),  Mr.  P. 
S.  B.  Langton.  University  Scholarship  {£60).  Mr 
E.  L.  Kennaway.  B.A.  Oxon.  Freer  Lucas  Scholar- 
ship (jji26),  Mr.  E.  A.  Saunders. 

University  of  Durham— Faculty  of  Medicine. 

The  following  candidates  have  satisfied  the  exa- 
miners : — 

M.B.  (  final). — Honours — Second  Class. — Neville 
Avory  Eddlestone,    and  Richard  Woodward  Swayne. 

Pass  List. — ^Vincent  Edgar  Badcock.  Frederick 
William  Cheese,  M.R.C.S.,  L.R.C.P.,  John  Bowman 
Cooke,  George  Denholm,  Sampson  George  Victor 
Harris,  Florence  Barrie  Lambert,  Arthur  Cecil  Hays 
McCuUagh,  Frederick  Charles  Pybus,  George  Robert 
Philipson,  Norman  Spedding,  Thomas  Leathard 
Wormald. 

Second  Examination. — Anatomy,  Physiology,  and 
Materia  Medica.  Honours — First  Class. — Herbert  Max 
Le  Vinson. 

Honours — Second  Class. — Edward  Percival  Hearne 
Joynt,  Charles  Gordon  Kemp,  Roland  Wilfred  Pearson, 
M.R.C.S.,  L.R.C.P. 

Pass  List. — Orrock  Arnott,  Harold  Henry  Blake, 
Frederick  William  Cheese,  M.R.C.S..  L.R.C.P.,  William 
HaroldhEdgar,  George  Reginald  Ellis,  John  Everidge, 
John  Ernest  Hanna,  Herbert  Fletcher  Joynt,  Stanlev 
Dunn  Metcalfe,  William  RoUin,  James  Wilkie  Smith, 
Leslie  Henry  Walker,  George  Walker,  Lionel  Langford 
Westrope. 

First  Examination. — Elementary  Anatomy  and 
Biology,  Chemistry  and  Physics. — Honours — First  Class. 
— Charles  Frederick  Morris  Saint. 

Honours — Second  Class. — Henry  Glendinning  Davi- 
son. 

Pass    List. — Norman    St.    Clair    Bruce    Cummins. 
Percy    Hall,    Isaiah    Hodgkinson,    Herbert    Richard 
McAleenan,  Satyen  Mozumder,  Jack  Dixon  TurnbuU. 
Odontoloflrical  Boeiety  of  Great  Britain. 

We  are  asked  to  announce  that  the  above  Society 
is  prepared  to  receive  applications  for  grants  in  aid 
of  the  furtherance  of  scientific  research  in  connection 
with  dentistry.  For  particulars  and  forms  of  appli- 
cation apply  to  the  hon.  secretary,  Scientific  Research 
Committee,  Odontological  Society,  20  Hanover  Square, 
W. 

King's  College  and  Kind's  CoHeffe  Hospital  (University  of 
London.) 

The  following  scholarships  have  been  awarded  in 
the  Faculty  of  Medicine : — Medical  entrance,  £$0, 
E.  B.  Clayton  and  A.  F.  Comyn,  equal  ;  Sambrooke. 
;iioo,  B.  Hughes  ;  Two  Warneford,  ;^ioo  each,  T.  H. 
Whittington  and  G.  Matthews ;  Epsom  Scholarship 
(fee  tuition),  H.  A.  Milner. 

The  Medico-Lesral  Society. 

The  third  annual  general  meeting  of  this  Society 
will  be  held  at  22  Albemarle  Street,  New  Bond 
Street,  London,  W.,  on  Tuesday  next,  October  nth, 
at  8. 1 5  p.m.,  when' the  reports  of  the  treasurer  and  the 
secretaries  will  be  presented,  the  officers  for  the  coming 
session  elected,  and  the  following  resolutions  moved  : — 
(a)  By  Dr.  W.  Wynn  Westcott,  "  That  this  Society 
shall  be  called  the  '  Medico-Legal  Society  of  Great 
Britain  and  Ireland.'  "  {b)  By  Dr.F.  J.  Smith,  "  That 
the  annual  subscription  shall  be  one  guinea,  and  that 
a  composition  life  subscription  be  fixed."  {c)  By  Mr. 
R.  Henslowe  Wellington,  "  That  the  rule  re  the 
Presidency  be  rescinded,  so  that  the  office  may  be 
held  for  three  consecutive  years." 


376    The  Medical  Press.         NOTICES  TO  CORRESPONDENTS. 


Oct.  5,  1904. 


JUrtiaB  to 


m^r  OOBRXflFONDEMfs  requiiinsT  a  reply  in  this  oolumn  are  particu- 
larly requested  to  make  use  of  a  distinctive  Siffnatwn  or  Initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subecriber,'* 
••  Old  Subscriber,"  &c.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Oeiginal  Articlss  or  LarrsBS  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. 

CoRTRiBUTORS  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Ck>lonies,  to  the  Editor  at  the  London 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwa«iing  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  th© 
Publisher. 

Bkpbikts.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

"TiiBOAT Case"  (Bedford):— A  correspondent  from  Bedford  has 
sent:  us  what  evidently  is  a  clinical  record  of  an  anomalous  case  of 
diphtheria.  Unfortunately  a  portion  of  the  MS.  has  been  lost  in 
the  post,  and  the  onlv  clue  to  its  origin  is  the  postmark  on  the 
envelope.  We  should  be  glad  to  have  a  further  copy  with  the  name 
and  address  of  the  sender. 

THE  POOR  MAN'S  CHILD. 

A  DISTRICT  nurse  was  sent  to  see  a  po  jr  young  patient,  and  wishing 
to  examine  the  child  and  thinking  a  wash  desirable,  she  asked 
the  mother  if  she  had  a  bath.  "  Lor,  yuss,  nuss,"  was  the  answer  : 
*'  we've  'ad  a  bath  in  the  'ouse  these  seven  years;  but,  thank  Gord, 
we've  never  'ad  to  use  it !  '*  Further  inquiries  elicited  that  the 
bath  was  regarded  as  medicinal,  and  only  to  be  taken  under  doctor's 
orders  !—*'  Our  Hospitals  and  Chanties  laustrated  '  (Kegan  Paul). 

J.  W.  B.  (Beading).— It  is  against  our  rule  to  discuss  medical 
subjects  with  lay  correspondents.  The  Finsen  treatment  undoubtedly 
cures  some  cases  of  lupus,  but  for  others  it  ooropares  unfavour- 
ably with  ordinary  surgical  measures.  A  full  answer  to  ^'our  ques- 
tions could  be  obtained  by  means  of  an  ordinary  consultation. 

THE  DOCTOR  ORDERED  A  TONIC. 

Maoistrati  to  Paddy:— "I  see  you  were  arrested  for  stealing  a 
grate  " 

Paddy—'*  Sure,  an'  it  was  the  dochtor's  fault,  he  towld  me  to  take 
iron,  and  didn't  I  follow  his  advice  and  take  a  stove,  bad  luck  10 
him ! "  ,,,.., 

Edinbhsis.— The  propositions  that  uric  acid  met  with  in  man  is  con- 
veyed to  his  tissues  mamly  by  means  of  flesh,  eaten  as  food,  cannot 
be  taken  as  established.  The  facts  of  avian  physiology  will  have 
first  to  be  clearly  explained,  to  say  nothing  of  many  phenomena 
concerning  natund  and  morbid  uric  acid  formation  in  man.  At  the 
same  time  the  arguments  both  pro  and  con  are  worthy  of  most  care- 
ful consideration. 

PREVENTION  OF   CRUELTY  TO  CHILDREN. 

The  Act  of  1804 having  been  found  duriig  the  ten  years  working 
to   be  defective  and  difficult  of  application,  an  amended  Act  was 


the  iniquitous „^     ,. 

gains  a  money  premium  on  the  death  of  the  child.  The  bona  fides 
of  transactions  of  this  nature  will  need  such  convincing  proofs  in 
future  that  it  will  be  morally  impossible  for  the  guilty  to  profit  by 
this  form  of  so  called  cruelty— imprisonment  being  the  more  likely 
alternative. 

Wbst  Town  (Berks.).— The  number  is  out  of  j  print— you  will 
find  the  reference  in  any  medical  library. 

D.  P.  H.— The  fallacy  of  a  low  general  death-rate  which  disguises 
a  high  infantile  mortality  is  obvious.  We  are  obliged  for  drawing  our 
attention  to  the  point  and  accept  with  pleasure  your  offer  of  a  paper 
on  infantile  mortality  generally. 

4Reeting0  of  the  §aaelie0,  ^ecturce,  &c. 

Wbdhbsdat,  October   6th. 

OosrBTRicAL  Socibtt  op  Lovdon  (20  Hanover  Square,  W.).— 8  p.m. 
Specimens  will  be  shown  by  Dr.  Lockyer,  Dr.  Handfleld-Jones.  and 
others.  Paper:— Dr.  J.  M.M.  Kerr:  Certain  Details  regarding  the 
Operation  of  Caasarean  Section  in  Cases  of  Contracted  Pelvis,  based 
upon  a  Series  of  30  Cases. 

Medical  Graduatm'  Collbob  and  Poltclikic  (2!  Cheniee  Street, 
W.C.).-4p.m.    Mr.  P.  J.  Freycr  :    Cllnique.    vSurgical.) 

Thursday,  OcTCBRR  6th. 
HinicAL  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  Hutchinson  :  Clinique.    (Surgical.) 

Friday,  October  ISth. 
Harvbiah  Society  OF  London  (Stafford  Rooms,  Titchbome  Street, 
Edgware  Road.  W.).— 8  SO  p.m.   Harveian  Lecture    Mr.  C.  B.  Keetley 
on  "  Plastic  Surgery.'* 


City  Hospital  for  Infectious  Diseases,  Newcastle-upon-Tyne.— Resdes*' 

Medical  Officer.     Salary  £100  per  annum,  with  board,  lodna^, 

dto.    Applications  to  the  Medical  Officer  of  Health,  Town  HiQ, 

Newcastle-upon-Tyne. 
Wolverhampton      and     Staffordshire    General     Hospital.— Boom 

Physician.    Salary  £IOi>  per  annum,  with  board,  lodging,  ud 

washing.  Applications  to  Edmund  Forster,  House  Governor  aad 

Secretary. 
Royal  Victoria  Hospital,  Dover.— House  Surgeon.    Salarr  £100  pe^ 

annum,  with  board,  lodging,  and  washing.    Applicattons  to  the 

Hon.  Secretary,  Arthur  B.  Elwin,  Eso.,  2  Castle  Street,  Dover. 
Royal  HospitAl  for  Diseases  of  the  Chest,  City  Road,  E.C.— ReaideBt 

Medical  Officer.    Salarv  £120  per  annum,  with  furnished  aptfi. 

ments,  board,  and  washing.  Applications  to  the  Secretary. 
Brecon  and  Radnor  Lunatic  Asylum,  Talgar>h,  Breconshire.— Medical 

Superintendent.    Salary  £450  per  annum,  with  fully  fumiabed 

house,  coal,  light,  washing,  and  garden  produce.  Appticatioos to 

J.  H.  Evans. 
Northampton  General  Hospital. — House  Surgeon.     Salary  £100  per 

annum,  with    furnished  apartments,    buard,  attendance,  ud 

washing.     Applications    to   C.  d.    Risbee,    Secretary-Super. 

intendent. 
County  Asylum,  Mickleover,  Derby.— Senior     Assistant    Medical 

Officer.    Salary  £160  per  annum,  with  furnished  apartmenu. 

board,  washing,  and  attendance.     Applioations  to  the  Medical 

Superintendent. 
Leicester   Infirmary.— Assistant    House    Surgeon.    SalAi7  £80  pa 

annum,  with  board,  apartmenti  and  washing.     Applicatiom  to 

the  Secretary. 
Essex  County  Asylum,  Brentwood.— Assistant  Medical  Officer.  Salm 

£150  per  annum,  with  board,  and  residence.  Applications  to  Hit 

Medical  Superintendent. 


Jlppointtnenis. 


Anderson,  C.  A.,    Junior  House  Physician  to  St.  Bartholometi'i 

Hospital. 
Birkbtt,  H.  J.  D.,  Junior  House  Surgeon  to  St.   Bartholomewt 

Hospital. 
BowsK,  u.  W.,  Surgeon  to  the  Royal  Ear  Hospital,  Soho,  W. 
Boyle,  H.  E.  O.,  L.R.C.P.Lond..    M.R.C.S.Eng.,  Assistant  Chloro- 

formist  to  St.  Bartholomew's  Hospital. 
Brbwerton,  E.  W.,  F.R.C.8.EDg.,  Clinical  Assistant  to  the  Depart- 
ment for  Diseases  of  the  Eye,  St.  Bartholomew's  Hospital. 
Burfield,  J.,  Junior  House  Surgeon  to  St.  Bartholmew's   Hospital. 
BURRODOHBs,  H.N.,  Senior  House  Surgeon  to  3t.  Bartholome«i 

Hospiul. 
Cocke,  1£.  Sturgeon,  M  B.C.S.,  L.R.C.P.Lorid.,  Assistant  Surges 

to  the  Royal  Ear  Hospital,  Soho,  W.     • 
Coleman,  F.,  M.R.C.S.,  L.D.S.,  Clinical  Assistant  to  the  Denial 

Department,  St.  Bartholomew's  Hospital. 
Colt,  G.  H.,  Junior  House  Surgeon  to  St.  Bartholomew's   Hospital 
Cripps,  L^  Junior  House  Surgeon  to  St.  Bartholomew's  Hospital 
Gask,  G.  £.,  F.B.C.S.Eng.,  Clinical  Assistant  to  the  Department  (rf 

Orthopeedics,  St.  Bartholomew's,  Uospiul. 
Gould,  H.  A.,  Resident  Midwifery  Assiscant  at  St.  Bartholomer's 

Hospital. 
Hadpield,  C.  F.,    Junior  House  Physician  to  St.    Bartholomew's 

Hospital 
Haooard,  T.  B.  a.,  M.R.C.S.Eng.,  L.R.C.P.Lond..  Senior  House  Sur 

geon  to  St.  Bartholomew's  Hospital. 
Hepwobth,  F.   a.,  M.R.C.S.£ng.,  L.R.O.P.Lond.,   Junior    House 

Physician  to  St.  Bartholomew's  Hospital. 
HooABTU,  A.  H.,  M.R.C.S.Eng.,  L.R.C.P.,  Assistant  Extern  Mid- 
wifery Assistant  at  St.  Bartholomew's  Hospital. 
HoRDBR.  T.  J.,  M.D.,  B.ScLond.,  M.R.C  P.,  Clinical  Assistuit  to 

the  Department  for  the  Diseases  of  the  Skin,  St.  Barcholomew  s 

Hospital. 
Macfadyen,   N.,  M.R.CS.Eng^  L.R.C.P.Lond.,  Assistant  Extern 

Midwifery  Assistant  at  St.  Bartholomew's  Hospital. 
MuRisoN.  A.  LooAN,   M.a.0.8.,  L.R.C.P.Lond.,  Surgeon  to  the 

Rojal  Ear  Hospital,  Soho.  W. 
Neligan,   a.    B.,    MR.C.S.Eng.,    L.R.aP.Lond.,  Senior    Hoo* 

Physician  to  St.  Bartholomew's  HospilaL 


^irtha. 


Coleman.— On     September  28th,  the  wife  of  J.    6.  B.  Colentto, 

M.R.C.S..  L.R.C.P.,  Sutton  Bridge,  of  a  daughter. 
Going.- On  September  28th,  at.Erinagh,  Littlehampton,  tke  wife 

oc  B.  JH.  Going,  F.R.C.S.Eng.,  of  a  daughter. 
Pinches.— On  October    Ist^    at  20     Margaret    Street,    Cavendish 

Square.  London,  the  wife  of  Major  W.  H.  Pinches,  R.A.H.C., 

of  a  daughter. 


4KatriagcB. 


Cutler— Phillips.— On  Sejtember  SSth,  at  St.  Albjns  Abbej, 
Horace  Cutler,  M.A.,  M.B..  B.C.,  of  Broughton,  Hamp^ 
shire,  fourth  son  of  Samuel  Cutler,  of  West  Bank,  Lenishaa 
H  ill.  to  Edith  Maud,  second  daughter  of  Arthur  F.  Phillips,  of 
Torringtou  House,  St.  Albans. 

Riddell— Wilson.- On  September  29th,  at  St^  James's  Parisfc 
Church.  Dover,  by  the  Bev.  A.  Howell  Smith,  Sector  Robot 
George  BiddeU,  M.B.,  F.R.C  S.E.,  D.P.H.,  Botherham  to 
Annie,  daughter  of  the  late  James  Wilson,  Esq.  ' 


Wraths. 


BuRMAN.— On  October  2nd  at  43  Nightingale  Road,  Clapton,  Williaa 
Kimin,  eldest  son  of  the  late  William  Burman,  aurgeou,  in  hi* 
75th  year. 


i 


Wnt  ^dial  ^xm  mA  diitmht 


"SALUS   POPULZ   SUPBEMA   LUX.' 


Vol.  CXXIX. 


WEDNESDAY,    OCTOBER    12.    1904. 


No.    15. 


^tiOfnal  Commnnfcations* 

HOSPITAL    ISOLATION   AND 

SCARLET  FEVER: 
THE   STATISTICAL  ASPECT. 

By  C.  KILLICK  MILLARD,  M.D.,  D.Sc, 

M.OA,  IieiCMtar. 
Late  Medical  SoperinUndeiit,  Citjr  HoeplUl.  Btnnins'luuii. 

In  my  previous  article  I  stated  that  the  all- 
important  question  whether  fever  hospitals  really 
were  doing  good  could  only  be  finally  decided  by 
appealing  to  statistics,  and  I  mentioned  two 
principal  methods  of  applying  statistics  to  this 
question.  The  first  was  to  compare  the  pre- 
valence of  the  disease  before  and  after  the  estab- 
lishment of  a  hospital.  The  second  was  to  com- 
pare towns  possessing  fever  hospitals,  and  treating 
a  large  proportion  of  their  cases  in  hospital,  with 
towns  not  possessing  these  institutions,  and  in 
which,  therefore,  all  cases  of  scarlet  fever  had  to  be 
treated  at  home. 

There  are,  however,  other  methods  which  may 
be,  and  have  been,  tried.  Thus,  the  prevalence  of 
the  disease  can  be  ascertained  for  the  different 
wards  and  subdistricts  of  a  town,  and  these  can 
then  be  compared  with  one  another  with  reference 
to  the  proportion  of  cases  removed  to  hospital. 
This  method  has  recently  been  applied  by  Dr.  Boyd 
to  South  Shields,  and  the  result  published  in 
IHiblic  Health  for  August.  From  this  it  appears 
that,  speaking  generally,  those  wards  in  South 
Shields  in  which  the  proportion  of  cases  removed 
to  hospital  is  high  show  a  somewhat  smaller  amount 
of  scarlet  fever  than  do  those  where  the  proportion 
removed  is  lower.  On  the  face  of  it  this  certainly 
appears  to  be  an  argument  in  favour  of  hospit^ 
isolation.  As  i^  so  often  the  case  with  statistics, 
however,  there  is  an  important  consideration  which 
may  entirely  nuUify  the  apparent  significance  of 
such  a  comparison  as  this.  In  South  Shields,  like 
other  towns,  there  is  a  single  sanitary  organisation 
and  a  single  system  of  hospital  isolation,  and  the 
same  standard  is  adopted  in  deciding  which  cases 
shall  or  shall  not  be  removed  to  hospital. 

The  reason  why  some  districts  of  a  town  show 
a  larger  proportion  of  removals  than  others  is 
solely  because  the  social  condition  of  the  inhabitants 
varies.  In  some  districts  a  large  proportion  of 
the  inhabitants  will  belong  to  the  lowest  stratum 
of  society,  living  in  small  tenements  in  *'  slummy  " 
surroundings.  In  such  circumstances,  a  very  large 
proportion  of  cases  will  usually  go  to  hospital. 
Other  districts  will  contain  a  large  proportion  of 
the  more  prosperous  classes  living  in  newer  and 


larger  houses,  and  with  tetter  sanitary  surround- 
ings. In  these  districts  a  considerable  number  of 
parents  will  prefer  to  keep  their  children  at  home. 
Therefore,  before  we  can  proceed  to  deduce  any- 
thing from  the  fact  that  the  poorer  districts  of  a 
town,  isolating  most,  have  the  least  scarlet  fever, 
we  must  be  sure  that  the  difference  in  social  con- 
dition is  not  itself  the  explanation.  Now,  although 
it  is  often  assumed  that  scarlet  fever  (like  typhus 
fever)  naturally  tends  to  prevail  most  in  the 
"  slummy  "  or  poorer  parts  of  the  town,  it  is  prob- 
able that  the  idea,  so  common  with  the  pubhc,  that 
scarlet  fever  is  associated  with  insanitary  surround- 
ings is  only  one  of  the  many  misconceptions  in 
regard  to  this  disease  which  need  to  be  removed 
before  we  can  view  it  in  its  true  perspective.  The 
origin  of  the  belief  can  readily  be  traced  to  the 
association  of  ideas  in  connection  with  the  term 
'*  fever."  Personally,  I  am  inclined  to  think  that 
scarlet  fever  is  naturally  less  prevalent  in  the  more 
*'  slummy  "  parts  of  a  town,  and  I  may  say  that 
Dr.  Boyd,  in  the  paper  referred  to  above,  also 
lends  support  to  this  view.  It  is  important  that 
this  point  should,  if  possible,  be  settled,  and  the 
experience  of  towns  where  there  is  no  hospital 
isolation  to  confuse  the  issue  ought  to  enable  this 
to  be  done. 

Another  method  of  using  statistics  to  determine 
the  value  of  hospital  isolation,  and  one  which 
has  several  times  been  adopted,  is  to  make  a  com- 
parison in  a  given  town  between  the  secondary 
cases  which  occur  in  houses  where  the  primary 
case  is  left  at  home  with  those  which  occur  where 
the  primary  case  is  removed  to  hospital.  We 
should  certainly  expect  that  in  the  latter  class 
there  would  be  a  smaller  proportion  of  secondary 
cases,  and  this  has  generally  appeared  to  be  the 
case.  A  priori,  indeed,  this  seemed  such  a  very 
probable  result  that  until  quite  recently  it  was 
scarcely  challenged,  and  it  was  looked  upon  as  a 
strong  statistical  proof  of  the  value  of  hospital 
isolation.  But  Dr.  Niven,  of  Manchester,  who 
has  devoted  special  attention  to  this  subject,  has 
recently  pointed  out  in  his  Annual  Report  for 
1903  that  there  is  a  very  important  precaution  to 
be  taken,  and  without  it  the  results  of  this  method 
are  likely  to  be  most  misleading.  The  precaution 
is  this  :  It  frequently  happens  that  cases  of  scarlet 
fever  occur  so  slight  in  chaacter  that  they  are  not 
at  first  recognised  as  scarlet  fever,  and  they  are  there- 
fore allowed  to  remain  at  home  and  no  attempt  at 
isolation  is  made.  Such  cases  may  give  rise 
to  several  other  cases  in  a  family,  and  their  real 
nature  is  then  discovered.  These  overlooked  cases 
give  rise  to  a  very  high  proportion  of  secondary 
cases,  and  unless  they  are  carefuUy  picked  out  and 


378    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Oct.  12.  1904. 


excluded  from  the  group  of  home-treated  cases 
they  will  unfairly  "  weight "  that  group.  Dr.  Niven, 
moreover,  is  careful  to  take  into  consideration 
*'  return  cases/'  a  certain  proportion  of  which  al- 
ways occuf  after  the  return  home  of  the  hospital- 
treated  patients. 

The  following  figures  are  a  summary  of  an  im- 
portant table  given  on  page  97  of  the  Manchester 
Health  Report  for  1903  : — 

Scarlet  Fever  in  Manchester,  1901-1903. 

An  Abstract  of  Dr,  Niven* s  table,  on  page  97  of  his 

Annual  Report  for  1903. 


I  Number    of 

c^BCB.     I  years  Left 
at  Home 


Removed  to 
hospital    . 

Treated  at 
home  .     . 

"  O  V  e  r- 
looked" 
cases    .     . 


Number  of 

Secondary 

plug  Be* 

tain 

Cases. 


j,68i 
573 

214 


5,040 
560 

431 


3,468     I    6,031 


Pereentag^e  cal> 

culated   upon 

number  of 

Susceptible 

Persons 

under  15. 


738 
90 

288 


1,116 


14-6 
160 

66-8 


38-1 


Although  Dr.  Niven  is  an  advocate  of  hospital 
isolation,  he  is  constrained  to  admit  (page  102) 
that  as  regards  his  own  figures  hospital  isolation 
shows  httle  material  saving  so  far  as  the  other 
inmates  of  infected  houses  are  concerned. 

There  is  another  method  which  has  been  very 
frequently  employed,  but  which  is  also  hable  to  be 
misleading,  and  this  is  to  compare  the  relative 
fatality  among  home-treated  and  hospital-treated 
patients.  On  the  face  of  it,  this  seems  a  reasonable 
enough  method,  and  so  long  as  it  was  believed  that 
hospitals  were  accomplishing  a  great  amount  of 
good,  no  surprise  was  felt  when  it  was  found,  as 
usually  proved  to  be  the  case  in  most  towns,  that 
the  fatality  among  the  hospital-treated  patients 
came  out  distinctly  lower  than  among  those 
treated  at  home.  In  some  annual  reports  calcula- 
tions were  even  made,  using  the  relative  fataUty 
among  hospital  and  home-treated  patients  as  a 
basis,  to  show  the  actual  number  of  Uves  which  were 
supposed  to  have  been  saved  through  the  superior 
treatment  received  in  hospital.  But,  unfor- 
tunately for  these  calculations,  the  difference 
in  some  towns  between  the  hospital-treated  and 
home-treated  patients  came  out  so  impossibly 
great  that  even  the  most  sanguine  could  scarcely 
accept  them.  Thus,  in  Warrington,  for  the  ten 
years  1890-99,  the  home fatahty  was  19*2  percent., 
against  a  hospital  fatality  of  72  ;  whilst  in  Hud- 
dersfield,  during  the  same  period,  the  figures  were 
1 6*9  against  3*2.  In  the  latter  town,  indeed,  in  the 
year  1899,  ^^e  figures  were :  hospital  cases,  1-5 
per  cent.  ;  home  cases,  28*5  per  cent.  !  It  is 
clearly  quite  impossible  to  accept  these  figures 
seriously.  Among  the  towns  without  isolation 
hospitals,  in  which,  therefore,  all  cases  were  home- 
treated,  no  such  abnormal  fataUties  are  an5rwhere 
to  be  found.  Indeed,  the  fatahty  of  scarlet  fever 
in  the  non-isolating  towns  is,  speaking  generally, 
in  no  degree  higher  than  in  the  isolating  towns. 
The  explanation  of  the  apparently  terrible  fatality 
in  the  home-treated  patients  in  Warrington  and 
Huddersfield  is  simply  this  :  in  these  towns  the 
home-treated  group  is  a  small  one,  most  of  the 
cases  going  to  hospital.  A  few  cases,  however, 
are  too  ill  to  be  removed,  and  are  left  at  home  to 


die,  and  these  unduly  "  weight  "  the  home  groap. 
In  other  words,  a  certain  amount  of  selection  must 
inevitably  take  place  of  the  cases  that  go  to 
hospital  and  of  tho^  that  remain  at  home,  and 
this  completely  invalidates  a  comparison  between 
them.  Now,  the  same  causes  which  have  operated 
in  Warrington  and  Huddersfield  may  be  presumed 
to  have  operated,  though  to  a  less  extent,  in  other 
towns,  and  unless  we  can  positively  exclude  them, 
which  is  scarcely  possible,  it  must  obviously 
be  most  unsafe  to  trust  to  any  comparison  of  the 
kind. 

Moreover,  there  are  some  towns,  e.g,^  London 
and  Birmingham,  where  the  fatality  of  the  hos- 
pital patients  is  actually  higher  than  that  of  thcst 
treated  at  home.  This  also  is  explainable  by  the 
selection  of  cases  which  takes  place,  hospital 
patients  being  drawn  from  a  different  social  class. 
There  are  few,  I  think,  who  would  care  to  contend 
that  the  higher  fatality  of  the  hospital  patients 
in  London  is  any  evidence  of  inferior  treatment; 
but  if  the  comparison  is  not  admitted  in  the  case 
of  London,  or  wherever  it  teUs  against  hospital 
treatment,  ought  we  in  fairness  to  make  use  of  it 
just  when  it  happens  to  tell  in  favour  of  sucb 
treatment  ? 

Before  leaving  the  subject,  I  would  take  exception 
to  the  contention  sometimes  put  forward  that 
those  who  have  criticised  the  hospital  isolation  of 
scarlet  fever  have  not  yet  conclusively  proved 
that  it  is  doing  no  good.  Surely,  the  burden  of 
proof  in  such  a  case  as  this  should  be  with  those 
who  advocate  hospital  isolation  rather  than  with 
those  who  criticise  the  measure.  On  the  one 
hand  we  have  men  who,  in  spite  of  much  admitted 
evidence  of  a  most  discouraging  nature,  still  con- 
tinue to  advocate  the  building  of  further  hospitals 
on  the  old  lines,  just  as  if  they  were  accomplishing 
all  that  was  originally  expected  of  them.  On  the 
other  hand  are.  those  who  merely  advocate  that 
the  whole  question  should  be  thoroughly  investi- 
gated before  further  increasing  the  already  large 
capital  expenditure  on  hospitals. 

Then,  again,  it  has  frequently  been  urged  that 
those  who  have  criticised  hospital  isolation  have 
nothing  better  to  offer  in  its  place.  Surely,  this  is 
not  a  vaUd  objection.  A  precisely  similar  "ob- 
jection "  could  have  been  urged  against  those 
who  first  criticised  blood-letting  or  any  other  no«* 
obsolete  but  once  much-vaunted  measure  !  If  a 
thing  is  doing  no  good,  or,  at  least,  yielding  no 
results  commensurate  with  the  cost  entailed,  no 
substitute  for  it  is  required. 

I  think  I  have  said  sufficient  to  show  that  the 
question  of  the  utiUty  of  fever  hospitals  is  a 
highly  complex  one,  and  that  many  of  the  argu- 
ments put  forward  in  support  of  it  require  careful 
examination  before  they  can  be  accepted  as  con- 
clusive. The  same,  no  doubt,  apphes  to  some,  at 
least,  of  the  arguments  used  against  it.  The  pre- 
sent state  of  affairs  is  eminently  unsatisfactory. 
If  it  were  a  subject  of  dry  scientific  interest,  only 
it  would  not  so  much  matter,  but  unfortunately, 
the  questions  at  issue  are  involving  a  large  and  in- 
creasing expenditure  of  pubhc  money  which  is  vw}' 
badly  needed  for  many  other  pubUc  health  pnr- 
X)oses.  As  the  late  Sir  John  Simon  wrote,  nearly 
forty-five  years  ago,  in  one  of  his  classic  reports 
to  the  Privy  Council,  when  attacking  the  evils  of 
overcrowding  in  general  hospitals  :  "  The  doings 
of  hospitals  and  the  relative  successfulness  of  such 
doings  are  of  great  pubhc  imjwrtance ;   and  all 


Oct.  12,  1904. 


questions  concerning  them  ought  to  admit  of  being 
answered  quite  unambiguously  to  the  public." 

INFLUENCE    OF     NUCLEIN 

IN  THE  TREATMENT   OF 

BRIGHTS  DISEASE  OF 

THE   KIDNEYS 

AT    A     HIGH     ALTITUDE. 

By  A.  S.  ASHMEAD,  M.D. 

In  a  case  of  chronic  Bright 's  disease  treated  by 
me  in  the  Pocono  Mountains,  the  camp  for  the 
treatment  of  consumption.  Pike  County,  Pa., 
at  an  elevation  of  2,000  feet,  I  record  the  following 
results  : — The  urine  at  once  became  very  red, 
and  continued  so  for  two  weeks.  This  was  pro- 
bably due  to  increase  of  uro>haematin,  by  the  in- 
fluence of  the  particular  remedy  used  and  the 
peculiarity  of  ozonised  air  of  the  region  and  its 
influence  on  the  liver  and  blood. 

An  increase  of  drinking  water  or  other  liquid  is 
necessary  at  this  height,  more  than  is  required  at 
lower  elevations,  where  the  air  is  less  dry  ;  and,  in 
consequence,   there  is  increased  urination. 

Meat  as  an  article  of  diet  is  not  craved  here, 
but  starches,  especially  potatoes,  are  consumed 
with  the  greatest  avidity.  Even  a  moderate 
supply  of  meat,  say,  once  a  week,  proves  to  be  too 
much  for  the  system.  Old  residents  are  not  quick 
of  bodily  movement — they  walk  slowly,  work 
leisurely,  and  seem  to  act  in  everything  they  do 
in  a  lazy  manner.  This  is  not  because  they  are 
really  lazy  ;  the  pecuUarity  is  not  temperamental 
by  any  means,  but  it  is  because  the  air  here  does 
not  permit  of  alacrity. 

One  soon  adapts  one's  self  to  this  variation  of  life's 
conditions,  and  lazy  actions  soon  take  full  posses- 
sion of  even  the  alert  New  Yorker.  This  laziness 
is  most  natural ;  one's  muscles  soon  tire  out  ; 
sleep  is  the  order  of  the  day,  rather  than  merely 
of  the  night,  and  especially  does  the  feeling  of 
drowsiness  overcome  one  for  two  hours  after  rising. 
The  ozonised  air,  the  dry  mountain  breeze  blow- 
ing all  the  time  gently  stimulates  the  circulation 
of  blood  in  the  brain's  arterioles,  while  at  the  same 
time  there  is  increased  fulness  of  the  veins. 

Insomnia  could  not  exist  here.  Nutrition  is  influ- 
enced naturally  and  quickly  by  the  sole  influence 
of  the  air,  and  independently  of  the  food  taken 
in.  Tissues  are  thus  to  a  great  extent  nourished  by 
air  rather  than  by  food,  and  oxygen  is  required 
instead  of  meat. 

Haematin,  the  colouring  matter  of  the  red  blood 
cells,  is  formed  in  greater  proportion  than  neces- 
sary, and  an  increased  supply  of  drink  is  demanded 
to  wash  from  the  blood  the  over-supply.  Thus 
matters  are  equalised. 

Nuclein,  in  lo-drop  doses,  in  diseases  of  the 
kidneys  seems  to  help  the  establishment  of  this 
equihbrium.  It  is  the  only  remedy,  in  my  opinion, 
that  will  do  this.  Haematin  by  itself  in  Bright's 
disease  is  perhaps  curative,  but  the  effect  of  the 
altitude  and  ozonised  air  in  producing  it  in  greater 
quantity  does  not  seem  to  me  to  last  sufficiently 
long  to  effect  much  result,  for  in  two  weeks  the 
urine  has  become  of  natural  colour. 

Even  advanced  cases  of  this  disease  will  And 
immediate  relief  by  the  conjoined  treatment  of 
nuclein  and  altitudinal  air.  The  diuretic  effect 
of  life  at  an  altitude  and  by  breathing  the  per- 
centage of  ozone  that  exists  here  is  not  due  alto- 


ORIGINAL    COMMUNICATIONS.        The  Medical  Pmm.    37Q 


gether  to  the  nuclein.  The  haematin  itself  has  an 
influence  on  the  albumen,  even  when  formed  in 
normal  amount,  and  an  increased  elimination  of 
poisonous  urea  results.  The  chief  plastic  element 
of  human  blood  is  albumen.  (Edematous  effu- 
sions in  Bright's  disease  follow  elimination  of 
albumen.  Any  oxidising  agent,  astrontia  salt, 
sulphuric  or  nitric  acid,  will  produce  precipitation 
of  albumen,  and  ozonised  air  will  do  the  same 
thing. 

Cfurbonic  acid,  as  we  all  know,  acts  as  a  natural 
stimulant  to  the  heart  or  arterial  system,  but 
ozonised  air,  its  absolute  opponent,  has  the  con- 
trary effect,  for  the  veins,  as  well  as  arteries, 
are  filled  to  overflowing  by  highly-coloured  blood. 
Nuclein,  therefore,  is  a  necessary  element  to  add  to 
the  natural  treatment  for  its  desired  effect  on 
leucocytes.  Better  equalisation  of  the  component 
parts  of  all  secretions  is  the  result  of  the  com- 
bined treatment  of  altitudinal  air  and  nuclein. 

The  hver  is  the  great  assimilating  organ  of  the 
human  economy.  Albuminose,  which  is  carried 
through  it  in  its  passage,  is  brought  into  contact 
with  the  hepatic  cells  and  converted  into  albumen. 
Albuminose  is  never  found  in  the  hepatic  vein, 
the  exit  from  the  liver,  therefore  this  substance  is 
(or  should  be)  all  converted  into  albumen. 

In  a  climate  like  this,  where  so  little  albuminous 
material  is  required,  where  one  craves  none  at  all 
almost,  a  disease  like  Bright's  disease  which  pro- 
duces, independently  of  the  food,  more  albumen 
than  the  blood  takes  up  must  necessarily  cure 
itself  if  only  helped  by  a  drug  which  will  equalise 
the  composition  of  the  blood.  The  poison  of 
Bright's  disease  is  urea,  to  be  sure,  a  50  per  cent, 
nitrogenised  material  which  is  retained  in  the  blood 
instead  of  being  washed  out  naturally  ;  500  grains 
a  day  should  be  eliminated,  or  thereabouts.  If 
too  much  of  it  is  retained  in  the  blood,  we  have  con- 
vulsions or  coma. 

This  substance  comes  naturally  from  the  disin- 
tegration of  the  tissues  and  following  much  exer- 
cise ;  the  broken-down  muscular  tissues  form  a 
great  quantity  of  it.  Thus  in  Japan  a  jinriksha 
man,  aiter  a  long  run  with  his  passenger,  will  show 
in  his  urine  a  superabundance  of  this  excrementi- 
tious  substance.  In  this  altitudinal  climate  the 
cold  air  blowing  constantly  produces  an  indis- 
position to  take  much  physical  exercise ;  the 
muscles  are  always  lazy,  so  that  there  is  induced 
the  condition  directly  antagonistic  to  the  forma- 
tion of  urea  in  the  blood,  and  the  disabled  kidney 
is  not  required  to  excrete  an  excess  of  the  ma- 
terial. It  is  given  time  to  resuscitate  itself. 
There  is  a  quick  betterment,  not  only  by  reconstitu- 
tion  of  the  albumen-forming  process  of  the  eco- 
nomy by  ozone  (red  corpuscular  element)  and 
nuclein  (white  corpuscular  element),  but  there 
is  no  increased  burden  to  be  borne  by  it,  put  upon 
it  to  eUminate  the  excess  of  urea,  and  the  dangers 
of  uraemia  are  thus  averted,  while  the  albuminuria 
disappears,  and  the  amount  of  urine  increases  and 
washes  clean  and  heals  the  diseased  organ. 


Typhoid  In  Vow  York. 

The  Health  Department  of  New  York  fears  that  a 
serious  epidemic  of  typhoid  fever  is  developing  in  the 
city.  During  the  past  three  weeks  441  cases  have  been 
reported  to  the  city  authorities,  of  which  seventy-four 
have  resulted  fatally.  The  Health  Department 
believes  there  will  be  an  increase  in  the  number  of 
cases  during  October  and  November,  and  has  issued 
a  public  warning  against  the  consumption  of  oysters 
and  of  unboiled  milk  and  water. 

D 


38o    The  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


Oct.  12.  1904. 


THE  DRINKING  HABITS 

OF 

UNCIVILISED    AND    SEMI- 
CIVILISED  RACES,  (a) 

By  CHAS.  FORBES  HARFORD,  M.A.Cantab.,M.D., 
Principal  of  Lirlogitone  College. 

The  protection  of  the  weaker  races  of  the  world 
from  demoralisation  by  the  liquor  traffic  has  for  many 
years  past  occupied  the  attention  of  a  special  committee, 
the  Native  Races  and  the  Liquor  Traffic  United  Com- 
mittee. In  the  course  of  these  investigations,  which 
have  been  chiefly  directed  towards  the  obtaining  of 
legislative  reform,  son^e  valuable  facts  have  been 
recorded  concerning  the  drinking  habits  of  these  races 
which  are  of  the  greatest  importance.  Naturally, 
these  habits  differ  in  each  country,  often  in  each 
district,  so  that  instances  can  only  be  quoted  as  examples 
from  the  most  important  centres,  though  there  are 
certain  points  of  general  resemblance  to  which  attention 
may  be  directed.  Perhaps  the  most  convenient 
method  of  considering  this  subject  will  be  to  classify  the 
different  kinds  of  drinks  which  are  commonly  used, 
noting,  where  possible,  the  way  in  which  they  are  used, 
and  the  effects  which  they  produce.  They  are  as 
follows: — (i)  N on- Alcoholic  Beverages. -^V/sLter,  milk, 
palm  wine  and  cocoanut  milk  when  fresh,  tea  and 
coffee,  drinks  made  with  various  kinds  of  meal  and 
water.  (2)  Native  Fermented  Drinks, — ^Various  forms 
of  com  beer  of  varying  alcoholic  strength,  palm  wine, 
cocoanut  milk  and  the  like  which  have  been  allowed 
to  ferment.  (3)  Distilled  Liquors. — Native  spirits 
(especially  such  as  are  prepared  in  India),  Cape  brandy, 
potato  spirit,  prepared  especially  in  Germany  for 
consumption  in  West  Africa.  These  classes  of  liquor 
may  be  taken  as  samples  of  the  drinks  used  by  the 
native  races,  especially  of  India  and  Africa,  the  wines, 
beers,  and  the  better  forms  of  spirits  manufactured  in 
England  and  other  European  countries  being  almost 
left  out  of  account  as  they  are  in  the  main  too  costly 
for  wide  use.  (1)  Non-alcoholic  Beverages. — Chiefly 
used  by  the  races  concerned  with  their  meals,  but  as 
we  are  dealing  mainly  with  the  liquors  which  produce 
intoxication  little  need  be  said  about  them.  (2)  Native 
Fermented  Drinks. — Palm  wine  and  similar  products 
do  not  usually  contain  a  large  percentage  of  alcohol, 
but  when  large  quantities  are  taken  intoxication  may 
be  produced.  Sir  William  Macgregor  estimates  the 
strongest  form  of  pahn  wine  to  contain  less  than  3  per 
cent,  of  alcohol.  There  are  many  varieties  of  com 
beer.  Mr.  Joseph  Orpen,  of  Rhodesia,  has  given 
some  valuable  information  about  different  kinds  of 
what  are  known  as  Kaflr  beer ;  one  form,  "  leting," 
he  describes  as  an  acid  refreshing  drink  of  little  or  no 
intoxicating  quality.  "  Joala,"  on  the  Other  hand, 
which  is  more  properiy  known  as  Kaflr  beer,  is  generally 
made  with  the  object  of  producing  drink  of  the  greatest 
intoxicating  strength  attainable  by  native  manu- 
facture. It  is  us^  purposely  to  produce  its  toxic 
effects,  and  is  drunk  in  large  quantities  till  the  stomach 
is  quite  distended.  It  has  a  stupefying  effect,  and, 
in  addition,  produces  violent  headaches  and  indigestion, 
even  when  not  mixed  with  spirits,  which  is  often  done. 
Probably  drugs  such  as  bhang  are  frequently  added  to 
these  native  drinks  for  purposes  of  intoxication,  and 
this  accounts  for  much  of  the  evil  produced  by  them. 
(3)  Distilled  Liquors.— Mi.  H.  H.  Mann,  M.Sc,  has 
furnished  some,  valuable  particulars  as  to  native 
spirits  manufactured  in  India.  Some  of  those  pre- 
pared in  Assam,  for  instance,  are  particularly  injurious, 
containing  large  quantities  of  fusel  oil  and  other 
specially  poisonous  ingredients,  in  some  cases  about 
twenty  times  as  much  as  would  be  found  in  a  properly 
knatured  Scotch  whisky.  This  he  attributes  to 
want  of  supervision  by  the  Government  and  the  fact 
that  the  spirit  is  not  allowed  to  mature.     As  regards  the 

la)  Pftper  read  at  the  meeting  of  the  i!3ocietar  for  the  Study  of 
Bebriety,  OctoUr  11th,  1S04. 


results  of  the  drinking  of  such  spirits,  the  case  of 
Assam  may  again  be  quoted.  So  serious  has  \ht 
situation  become  in  that  province  that  the  Assasi 
branch  of  the  Indian  Tea  Association,  represented  by 
their  chairman.  Mr.  Buckingham,  C.I.E.,  have  recently 
petitioned  the  Government  to  amend  the  law  rdating 
to  the  sale  of  liquor  in  that  part  on  account  of  the 
serious  effect  produced  on  their  native  labourers,  a 
striking  evidence  of  the  gravity  of  the  evils  complained 
of,  and  the  Government  are  taking  steps  to  remedy  some 
of  the  abuses.  Similar  complaints  have  been  frequently 
made  by  employers  of  labour  in  South  Africa,  and 
have  resulted  in  the  stringent  laws  prohibiting  the 
sale  of  liquor  to  natives  which  have  existed  for  some 
time  in  the  territory  administered  by  the  British 
South  Africa  Company,  a  policy  which  was  strongly 
approved  of  by  Mr.  Rhodes,  which  was  secured  ii 
Bechuanaland  by  the  splendid  persistence  of  Khanu. 
and  which  has  been  introduced  in  a  rigorous  manner 
into  the  Transvaal  and  Orange  River  Colony  by  Lord 
Milner.  This  latter,  whilst  prohibiting  the  use  of 
spirits  and  the  stronger  forms  of  Kafir  beer,  permits, 
under  certain  conditions,  the  supply  of  the  milder  farms 
containing  not  more  than  3  per  cent,  of  alcohol.  Ths 
beneficial  legislation  has  not  been  extended  to  Cape 
Colony,  where  a  pernicious  form  of  brandy  is  made 
from  grapes  known  as  "  Cape  smoke."  Samples  of 
this  are  said  to  have  been  found  to  contain  copper 
sulphate,  and  it  appears  to  be  particularly  intended 
for  native  consumption,  it  might  also  be  said  for  thdr 
degradation,  and  this  produces  untold  harm.  Un- 
fortunately the  strong  views  entertained  by  practical 
men  in  South  Africa  has  not  extended  to  West  Africa, 
where  immense  quantities  of  potato  spirit,  maoa- 
factured  in  Germany  for  the  purpose,  form  the  largest 
part  of  the  trade  of  Great  Britain,  as  well  as  of  France 
and  Germany,  with  the  West  African  natives.  Ths 
spirit  is  frequently  shipped  in  a  concentrated  form 
containing  about  80  per  cent,  of  alcohol,  and  some 
samples  of  this  were  found  to  contain  as  much  as 
4  per  cent,  of  fusel  oil.  Trade  gin  and  mm.  as  they 
are  called,  can  have  but  one  use,  viz.,  the  intoxicatioo 
of  the  native.  No  respectable  European  will  e?er 
touch  them,  and  they  have  been  known  to  have  been 
used  for  mixing  with  paint  instead  of  turpentine.  They 
are  used  principally  on  the  occasion  of  funerals  and  at 
festivals.  It  is  contended  that  there  is  not  so  mud 
drunkenness  in  West  Africa  as  in  England.  There  is 
an  element  of  truth  in  this,  and  we  can  only  hope  that 
it  may  never  become  so.  But  the  facts  of  the  case  are 
probably  as  follows:— (1)  The  West  Africans  are 
naturally  a  sober  people  and  they  do  not  want  the 
drink,  but  are  too  weak  to  resist  it  if  taste  for  drink 
has  been  deliberately  encouraged  by  the  traders  of  a 
so-called  Christian  country,  and  maintained  for  the 
sake  of  profit,  whilst  the  local  Governments  do  little 
to  stop  it  on  account  of  the  revenue.  (2)  Drunkenness 
is  not  so  easily  noticed  among  the  Africans,  as  they 
drink  at  home  and  not  at  pubUc  bars,  so  they  are  able 
to  sleep  off  the  effects  before  coming  before  the  public: 
On  the  occasion  of  festivals,  however,  drunkenness  is 
sometimes  very  widespread.  Thus  it  will  be  seen 
that  most  of  the  weaker  races  are  not  naturally  drunken, 
and  the  responsibility  lies  with  professedly  Christian 
nations.-  In  the  case  of  these  races,  especially  in 
Central  Africa,  the  outlook  is  most  hopeful,  as  it  is 
in  dealing  with  children  at  home,  in  that  prevention 
may  be  adopted,  which  in  this,  as  in  so  many  other 
cases,  is  infinitely  better  than  cure.  This  should  be 
our  aim. 


Bequests  to  Medical  Charttlet. 
Under  the  will  of  John  Earley  Cook,  of  Cobham. 
Surrey,  who  died  in  February  last,  the  London  Hospital 
receives  a  legacy  of  ;£2,ooo  ;  St.  Bartholomew's  Hospital. 
£i,SOO;  the  Metropolitan  Convalescent  Institution, 
;£i,ooo;  Earlswood  Asylum,  £s<^  I  and  3(200  to  the 
Margate  Infirmary  and  to  the  Seafbrd  Convakscjent 
Home. 


Oct.  12,  1904. 


ORIGINAL    COMMUNICATIONS. 


Tna  Medical  Paasa.   381 


THE  HEADACHE  OF  ANAEMIA 

AND  ITS 

TREATMENT. 

By   DAVID   WALSH,   M.D.Edin.. 
Senior  Fhytioian  to  the  Western  Skin  Hoipital,  London. 

Hbadachb  is  ol  necessity  a  common  occurrence, 
for  it  is  a  prominent  symptom  of  nearly  all  the  acute 
specific  and  of  many  cbronic  ailments.  Sooner  or  later 
its  far-reaching  importance  as  a  symptom  is  brought 
liome  to  every  physician,  for  there  is  no  class  of  malady 
in  which  the  teachings  of  the  class-room  and  of  the 
text-books  need  to  he  more  carefully  controlled  by 
actual  bedside  experience.  In  some  cases  it  is' what, 
for  want  of  a  better  term,  we  call  *'  functional,"  whilst 
in  others  it  points  to  grave  organic  disease.  We  have 
always  to  be  on  the  alert  for  the  obscurer  and  more 
serious  forms,  for  they  constitute  an  ever-present  pit- 
fall of  practice. 

Headache  is  due  to  some  disturbance  of  the  nutrition 
of  the  brain,  brought  about  b^y  circumstances  that  differ 
widely  in  different  cases.  Speaking  generally,  it  con- 
notes either  alteration  in  the  condition  of  the  blood 
or  interference  with  its  circulation  in  the  higher 
centres.  It  varies  not  only  in  its  severity  and  intensity, 
but  in  its  situation  and  in  the  duration  of  the  paroxysms. 
It  may  be  sudden,  sharp  and  excruciating,  or  it  may 
be  dull,  aching  and  persistent.  It  may  be  so  intense 
as  to  unfit  the  patient  for  work,  or  it  may  be  so  mild  as 
to  be  felt  only  after  exertion.  Nervous  headache,  the 
result  of  anxmia,  not  infrequently  affects  the  sufferer 
at  intervals  throughout  a  long  life.  It  is  the  accom- 
paniment and  curse  of  high  intellectual  endowment, 
and  is  most  marked  when  the  functional  activity  of  the 
brain,  whether  in  perception,  emotion,  or  intellect, 
outstrips  the  vigour  of  the  rest  of  the  body. 

Headache  is  often  associated  with  other  symptoms, 
such  as  dizziness  or  vertigo,  a  general  sense  of  pressure 
or  discomfort  in  the  head,  a  disturbance  of  cerebral 
function  with  insomnia  and  with  attacks  of  nausea  or 
vomiting.  It  is  not  the  purpose  of  this  article  to  con- 
sider exhaustively  the  entire  subject  of  headaches,  but 
merely  to  discuss  that  form  associated  with  anaemia, 
especially  in  reference  to  the  S3anptomatology  and 
treatment  of  the  same. 

Reflex  headaches  need  not  be  more  than  mentioned 
here,  as  in  the  individual  case  a  correct  diagnosis  in- 
dicates the  proper  line  of  treatment.  An  example  of 
purely  reflex  headache  is  that  due  to  eye-strain.  Many 
so-called  reflex  headaches  in  reality  arise  from  other 
causes.  In  ulcer  of  the  stomach  and  in  constipation, 
for  instance,  headache  is  probably  due  most  often  in 
the  one  case  to  the  accompanying  anaemia,  and  in  the 
other  to  toxic  absorption  from  the  bowel. 

Headache  is  a  common  symptom  of  djrspepsia  and 
is  usually  of  a  dull,  aching  character,  involving  both 
frontal  and  vertical  regions.  Depression  and  irrita- 
bility are  often  quite  out  of  proportion  to  the  amount 
of  gastritis  and  may  end  in  neurasthenia.  There  is 
often  constipation  idtemating  with  diarrhoea,  a  con- 
dition toxaemic  in  character  and  allied  to  copraemia. 
It  often  happens  that  even  when  the  bowels  have  been 
relieved  and  the  gastric  irritability  lessened  the  head- 
ache still  keeps  the  patient  awake  at  night.  Such  cases 
are  not  uncommon  in  middle-aged  men  of  great  mental 
activity,  whose  nervous  system  has  been  run  down  by 
anxiety  and  mental  strain.  It  is  found  in  these  in- 
dividuals that  the  haemoglobin  is  subnormal  and  that 
the  red  cells  are  not  only  diminished  in  number  but 
are  small,  irregular  in  shape,  deficient  in  colour,  and 
immature.  The  judicious  administration  of  iron  in  a 
non-astringent  and  readily  assimilable  form  usually 
effects  a  cure.  With  the  restoration  of  the  blood  cells 
and  the  haemoglobin  value  to  the  normal,  the  headache 
speedily  ceases,  the  appetite  improves,  the  irritability 
of  temper  is  lessened,  and  there  is  an  increase  of  energy 
and  capacity  for  work. 

That  impoverishment  of  blood  is  an  important 
element  in  many  cases  of  migraine  or  sick  headache, 
and   that  treatment  directed  to  improving  the  con- 


dition of  the  blood  is  the   proper  step,   are  points 
illustrated  by  the  following  cases  : — 

Case  I. — M.  B.,  a  woman,  aet.  30,  had  suffered  from 
migraine  for  over  ten  years,  the  attacks  coinciding 
with  the  occurrence  of  the  menstrual  periods.  She 
had  had  much  treatment,  including  arsenic,  gelsemin, 
butyl-chloral  hydrate,  and  various  courses  of  Bland's 
pill,  but  without  benefit  apparently.  She  was  not 
anaemic  in  appearance,  but  on  examination  the  red 
blood  corpuscles  were  found  to  number  only  3.600,000 
per  c.mm.,  the  haemoglobin  estimate  being  46  per  cent. 
She  was  given  iron-vitellin,  and  in  ten  days  her  red 
cells  rose  to  4,700,000,  and  the  haemoglobin  to  66  per 
cent.  There  has  been  no  recurrence  of  the  migraine, 
and  the  patient  is  now  apparently  perfectly  well  and 
has  had  no  attack  for  three  months.  Many  cases  of 
migraine  or  sick  headache  are  associated  with  anaemia. 
The  attacks  are  of  a  paroxysmal  or  intermittent  charac- 
ter, the  seizures  usually  incapacitating  the  patient  for 
three  or  four  days  at  a  time. 

Case  II. — A  governess,  aet.  about  26,  suffered  from 
periodical  attacks  of  migraine  or  sick  headache,  induced 
by  excessive  brain-work,  over-anxiety,  and  long  hours, 
combined  with  deficiency  of  bodily  exercise,  short 
restless  nights  and  disturbed  sleep.  The  seizures  were 
paroxysmal  or  intermittent  in  character,  and  occurred 
usually  every  three  or  four  weeks,  incapacitating  the 
patient  one  to  three  days  at  a  time.  The  headache  was 
severe  and  was  accompanied  by  loss  of  appetite,  nausea 
and  vomiting.  The  patient  suffered  from  dysmenor- 
rhoea,  and  the  attacks  usually  preceded  thie  onset  of 
the  menstrual  period.  It  was  noticed  that  the  sus- 
ceptibility to  the  migrainous  attacks  was  aggravated 
by  anything  tending  to  lower  the  gener^  standard  of 
health,  such  as  dyspepsia  or  constipation.  The  patient 
had  had  much  treatment  extending  over  a  long  period 
of  years,  the  remedies  prescribed,with  little  or  no  benefit, 
including  arsenic,  phosphorus,  Blaud's  pill,  gelsemin, 
butyl-cmoral  hydrate,  phenacetin,  &c.  The  patient 
presented  no  very  obvious  signs  of  anaemia,  but  a  blood 
examination  showed  that  the  red  cells  were  only 
2,500,000  per  c.mm.\  the  haemoglobin  being  ^6  pear 
cent.  It  was  found  impossible  to  improve  her  hygienic 
condition  or  obtain  for  her  a  cessation  of  work.  She 
was  given  iron-vitellin  three  times  a  day  for  three 
weeks,  and  at  the  expiration  of  that  time  the  red  cells 
had  increased  to  4,600,000  and  the  haemoglobin  to 
61  per  cent.  Her  general  condition  was  markedly  im- 
proved, her  appetite  was  increased,  the  periods  were 
less  profuse,  and  for  three  months  the  attacks  of  mi- 
graine have  been  so  sUght  as  not  to  incapacitate  the 
patient  for  a  single  day. 

The  commonest  form  of  headache  met  with  in  prac- 
tice is  that  in  which  the  subjective  and  objective  sym- 
ptoms of  anaemia  are  striking  and  easily  recognisable. 
In  these  cases  the  headache  is  usually  vertical  as  re- 
gards situation,  although  it  may  now  and  then  be 
frontal.  It  is  due  to  the  fact  that  the  brain  is  supplied 
with  blood  which  is  deficient  in  quantity  and  poor  in 
quality.  Patients  suffering  from  it  are  often  drowsy  in 
the  upright  position  but  wakeful  in  bed  because  the 
blood  fails  to  distend  the  cerebral  arteries  during  the 
day  but  flows  into  them  at  ni^ht.  In  some  cases  not 
only  is  the  blood  poor  in  quahty,  but  it  also  contains 
abnormal  and  toxic  constituents.  The  result  is  a  con- 
dition of  arterial  spasm  which  may  give  rise  to  sudden 
loss  of  consciousness.  It  is  the  converse  of  the  ple- 
thoric headache  met  with  in  elderly  men  who  are  free 
livers  with  regard  to  food  and  alcohol,  and  who  from 
want  of  sufficient  exercise  suffer  from  constipation  and 
deficient  urinary  secretion.  The  subjects  of  chlorotic 
headache  are  usually  young  women,  although  the  con- 
dition is  by  no  means  uncommon  in  middle-aged  spin- 
sters. That  iron  is  the  most  efficient  remedy  in  these 
cases  is  illustrated  by  the  following  notes  selected  from 
a  series  of  similar  cases  which  have  been  treated  in 
exactly  the  same  manner. 

Case  III. — A  married  woman,  aet.  24,  suckled  her 
first  child  for  six  months,  and  for  two  months  subse- 
quently suffered  from  paroxysmal  headache,  the  pain 
being  situated  over  the  brows  and  in  the  eye-balls. 


382    The  Medical  Psess. 


ORIGINAL    COMMUNICATIONS. 


Oct.  12,  1904. 


which,  she  said,  seemed  too  large  for  the  head  and  as  if 
they  would  be  forced  out  of  the  skull.  There  was 
tachycardia,  but  there  was  no  actual  prominence  of 
the  eye-balls  and  the  thyroid  was  not  enlarged.  The 
patient  presented  the  ordinaury  signs  of  anaemia  with 
palpitation  and  shortness  of  breath  on  exertion.  The 
red  blood  corpuscles  numbered  2,560,000  per  c.mm., 
and  the  haemoglobin  value  was  34  per  cent.  The 
patient  was  given  iron-vitellin  three  times  a  day,  and 
four  days  later  the  red  cells  were  2,750,000,  the  haemo- 
globin value  being  38  per  cent.  A  week  later  the  red 
cells  had  risen  to  3,400,000,  and  the  haemoglobin  value 
was  42  per  cent.  At  the  expiration  of  twenty-one  days 
from  the  commencement  of  treatment  the  red  cells 
were  4,200,000,  and  the  haemoglobin  value  was  82  per 
cent.  The  headache  rapidly  improved  and  at  the  ex- 
piration of  the  three  weeks'  course  of  treatment  had 
entirely  disappeared.  The  typical  consulting-room 
case  of  the  character  just  recorded  is  that  of  a  young 
woman  of  white  or  greenish  tint,  who  complains  of 
weakness,  constipation,  and  amenorrhoea.  An  exami- 
nation of  the  blood  reveals  a  marked  diminution  of  the 
red  corpuscles  together  with  a  deficiency  of  haemoglobin, 
perhaps  to  the  extent  of  50  per  cent,  or  more. 

The  two  following  cases  illustrate  headache  due  to 
anaemia  arising  from  different  causes  : — 

Case  IV. — ^A  married  woman,  aet.  36,  the  mother  of 
four  children,  after  enjoying  many  years  of  uninter- 
rupted good  health,  suffered  from  a  profuse  vaginal  dis- 
chairge  followed  by  chronic  arthritis,  possibly gonorrhoeal 
in  origin.  Under  the  influence  of  salicylate  of  sodium 
the  joint  trouble  subsided,  but  wats  replaced  by  brachial 
neuralgia  and  frontal  headache,  worse  at  night  amd  of 
so  severe  a  character  as  to  interfere  with  rest.  Iodides 
in  large  doses  were  tried  in  vain,  and  other  remedies, 
such  as  aconitine  and  gelsemin,  afforded  but  temporary 
relief.  The  patient  was  distinctly  anaemic,  the  toneue 
was  large  and  flabby,  and  there  was  little  or  no  appetite. 
A  month  spent  at  a  bracing  seaside  resort,  adthough  it 
improved  the  patient's  general  condition,  failed  to 
relieve  the  neuralgic  pains  in  the  atrm  and  aggravated 
the  cephalalgia.  Iron-vitellin  in  half-ounce  doses  was 
then  ordered,  at  first  without  apparent  benefit,  but 
after  six  weeks'  treatment  the  symptoms  gradually 
subsided,  and  the  patient  made  an  excellent  recovery, 
the  leucorrhoea  giving  no  further  trouble. 

Case  V. — ^A  man,  aet.  48,  who  had  had  many  attacks 
of  malarial  fever  in  India,  and  for  many  years  had  in- 
dulged freely  in  alcohol,  sought  advice  for  persistent 
headache  of  a  throbbing  chauracter.  He  showed  signs  of 
advanced  arterial  degeneration  and  was  evidently  suffer- 
ing from  granular  contracted  kidney.  The  urine  had  a 
specific  gravity  of  1007,  contained  a  fair  amount  of 
albumin  with  a  few  coarse  granulau:  casts.  The  patient 
was  dieted,  his  nitrogenous  food  being  reduced  to  the 
minimum,  and  he  was  given  directions  with  respect  to 
the  general  cau*e  of  his  health  and  systematic  exercise. 
His  condition  improved,  but  the  headache  wais  persis- 
tent and  was  a  source  of  considerable  discomfort. 
The  patient  was  then  placed  on  iron-vitellin,  and  at  the 
expiration  of  a  week  there  was  a  distinct  lessening  of 
pain.  After  a  month  the  headache  ceaised,  there  being 
concurrently  an  improvement  in  the  condition  of  the 
urine,  although  a  trace  of  albumin  remained. 

So  far  as  the  treatment  of  amaemia  is  concerned, 
apart  from  meaisures  such  ais  pure  air,  liberal  diet,  food 
surroundings,  and  regulation  of  the  bodily  functions, 
haematinics  are  the  only  remedies  that  need  be  discussed. 
They  are  not  medicines,  but  foods.  There  au^e  many 
reputed  haematinics,  but  iron  is  the  only  member  of  the 
group  which  is  practicadly  efficacious.  Phosphate  of 
lime,  arsenic  and  manganese  are  of  little  or  no  avail  in 
this  connection,  and  aure  not  true  haematinics.  Under 
the  influence  of  iron  in  anaemia  the  cheeks  grow  rosy, 
the  lips  and  mucous  membranes  aire  restored  to  their 
normal  chatracter,  the  eye  brightens,  the  tongue  cleans, 
the  digestive  organs  are  invigorated,  there  is  an  increase 
in  body  weight,  a  development  of  muscle  and  improved 
nerve  action.  The  modem  tendency  is  to  discredit 
arsenic  and  mangainese  more  and  more  in  the  treatment 
of  anaemia.  Physicians  agree  that  success  depends  to 
no  small  extent  upon  the  particular  preparation  of  iron 


that  is  used.  That  fact  hats  been  abundantly  proved 
by  experience  with  the  old-established  and  aassiaX 
remedies  for  anaemia,  namely,  the  tinctura  ferri  ner- 
chloridi,  the  sulphate  of  iron,  Blaud's  pill,  and  thealocs 
and  iron  pill  of  the  British  Pharmau^opoeia.  These 
aistringent  preparations  of  iron  aire  placed  at  an  imme- 
diate disadvantage  by  the  fact  of  the  close  association 
of  constipation  with  anaemia.  Cleao'ly,  it  is  undesirable 
to  administer  drugs  that  have  an  astringent  or  con- 
stipating effect,  even  though  such  am  effect  may  be  to 
some  extent  reduced  by  combining  the  astringent  iron 
with  a  laucative,  sis  in  the  familar  mistura  ferri  aperieiis 
of  hospital  practice.  But  whatever  the  anoertainty 
that  surrounds  the  chemical  changes  undergone  in  the 
paissage  of  inorganic  iron  from  the  intestine  to  the  blood, 
there  can,  on  the  other  hand,  be  no  question  as  to  the 
ill  effects  produced  by  aistringency  upon  the  digestive, 
the  absorptive,  and  the  expulsive  functions  of  the 
gastro-intestinal  canal. 

Taking  the  chief  prepairations  of  inorganic  iron  one 
by  one,  we  find  that  Blaud's  pill  often  increases  con- 
stipation and  heaidache.  The  tinctura  ferri  perchloridi 
does  the  same,  and  in  many  caises  irritates  the  delicate 
mucous  membrane  of  the  stomach,  probably  by  coagu- 
lating the  albumen  of  the  gastric  contents  and  of  the 
mucous  lining  cells,  besides  constricting  the  capillaries 
of  the  stomach  wall.  It  hats  always  seemed  to  me  that 
not  a  few  ulcers  of  the  stomach  in  anaemic  women  may 
have  been  caused  by  the  prolonged  action  of  astringent 
iron  remedies  to  which  they  have  been  subjected. 
Otherwise,  why  should  a  patient  stctually  devekii> 
gastric  ulcer  during  a  long -continued  course  of  iron? 
Instances  of  that  kind  are  familiar  enough  in  hospital 
practice.  If  aistringent  iron  upsets  a  healthy  stomach, 
ais  it  often  does,  it  is  likely  to  act  fax  more  injurioosiy 
upon  a  weak,  anaemic  organ.  The  objection  of  astrin- 
gency  applies  also  to  the  sulphate  of  iron,  -whether  given 
in  the  form  of  mixture  or  of  pill.  In  Blaud's  pill,  the 
iron  is  comparatively  non-aistringent,  but  its  adminis- 
tration is  often  most  disappointing,  amd  it  certainly 
increases  constipation  and  headache  in  some  cases. 
The  old-fashioned  adoes  and  iron  pill  is  undoubtedly 
effective  in  many  caises  of  amenorrhoea.  As  a  tem- 
porary remedy,  it  is  often  of  value,  especially  in  fuU 
doses  of  ten  or  fifteen  grains  daily.  I  have  known  a 
patient,  however,  keep  on  with  these  pills  for  nearly 
two  yeaurs,  to  the  great  detriment  of  her  health.  Lastly, 
a  good  deal  of  harm  may  result  from  setting  up  a  chrome 
congestion  of  the  female  pelvic  organs. 

(>ganic  iron  approaches  more  or  less  closely  the  fonn 
in  which  iron  is  absorbed  from  ordinary  food.  Frois 
that  point  of  view  the  administration  of  egg-adbumen  a 
of  spinach,  or  of  other  iron-containing  foodstuff, 
would  alone  suffice  to  cure  anaemia.  Experience, 
however,  hais  long  shown  that  for  some  obscure  reason 
it  is  necessary  to  give  iron  prepaurations  in  doses  far 
exceeding  the  capacity  of  intestinal  absorption. 

The  difficulty  so  fau:  has  been  to  obtain  a  true  organic 
salt  of  iron,  but  the  problem  appears  to  have  been  solved 
in  the  production  of  iron-vitelUn,  a  tasteless  and  non- 
astringent  prepairation,  which  increaises  the  appetite 
and  possesses  well-marked  haematinic  properties.  It 
improves  in  a  remairkable  degree  the  condition  of  the 
bl(X)d,  increases  the  red  cells  at  the  rate  of  100.000  a 
day  or  more  and  the  haematinic  vadue  from  i^  to  3  per 
cent.,  a  result  far  in  excess  of  that  resulting  from  the 
aulministration  of  any  form  of  inorgamic  iron.  Its  chief 
clinical  advantaige,  however,  is  that  it  hais.a  genera! 
stimulating  influence  upon  the  processes  of  nutrition, 
thereby  exerting  a  tonic  and  reconstructive  action 
which  I  have  never  observed  from  the  use  of  any  other 
form  of  iron. 

In  conclusion,  the  point  I  desire  to  emphasise  is 
this  :  Anaemia  is  the  causative  condition  of  many  of 
the  most  frequently  encountered  caises  of  headache, 
although  in  many  instances  the  impoverishment  of  the 
blood  may  not  be  apparent  from  the  generad  appearance 
of  the  patient.  Blood  examination,  however,  aad  a 
careful  analysis  of  the;  symptoms,  will  reveal  marked 
deficiency  in  the  percentage  of  the  haemoglobin  or  red 
blood  corpuscles,  and  one  or  more  subjective  symptoms 
of  anaemia.     So  frequently  is  this  the  case  that  it  is 


Oct.  12,  1904 


SPECIAL    ARTICLES. 


Tbs  Medical  Psess.    3^3 


vrell  to  examine  each  patient  with  headache  from  that 
standpoint  and  to  begin  the  administration  of  iron, 
preferably  in  the  form  of  iron-vitellin,  along  with 
tlie  preliminary  hygienic  and  dietetic  measures.  This 
has  been  my  practice  for  some  time  past  and  I  have 
had  every  reason  to  he  satisfied  with  its  results. 


Special  Hrticlee* 

LUNACY  IN  IRELAND. 
The  Annual  Report  of  the  Richmond  District 
Asylum,  Dublin,  which  has  recently  appeared,  is  in 
every  respect  an  interesting  document,  and  in  view 
of  the  serious  increase  of  lunacy  in  Ireland  is  one 
that  deserves  careful  study  by  all  interested  in  the 
future  of  the  country.  If  it  were  only  on  account 
of  the  personality  of  the  Medical  Superintendent, 
"Who,  no  matter  what  his  subject,  always  attracts 
and  retains  the  attention  of  his  readers,  the  Report 
"would  be  of  value.  In  the  present  instance,  how- 
ever, the  facts  themselves  are  of  primary  import- 
ance, though  they  gain  much  as  food  for  study  by 
Dr.  Conolly  Norman's  setting  and  by  the  addition 
of  his  opinions  based  on  them.  The  increase  of 
lunacy  in  Ireland,  which  is  causing  grave  and  well- 
founded  alarm  at  the  present  day,  is  unfortu  nately 
shown  by  the  steady  increase  in  the  number  of 
patients  in  the  Richmond  Asylum  and  its  branch  at 
Portrane.  During  last  year  there  was  an  increase 
of  one  hundred  and  thirty-nine  cases.  At  the 
same  time  it  is  pleasing  to  find  that  the  number  of 
admissions  during  1903  does  not  show  any 
advance  on  that  during  1902 — the  figures  being 
respectively  658  and  662.  The  number  for 
1902  was,  however,  higher  by  142  than  the 
highest  figure  ever  reached  previously.  As  in 
recent  years,  the  cases  admitted  were  mostly 
of  a  very  unfavourable  nature  as  regards  prospect 
of  recovery,  many  of  the  patients  being  in  broken 
health  physically,  and  afflicted  with  incurable 
t3rpes  of  mental  disease.  Suicidal  tendencies 
-were  more  marked  than  usual,  and  some'interesting 
cases  occurred  in  which  persons  with  suicidsd 
impulses  presented  themselves  for  admission  as 
voluntary  patients.  Under  such  circumstances  we 
congratulate  Dr.  Norman  and  his  stafE  on  the  fact 
that  no  case  of  suicide  occurred  during  the  year. 
A  freer  mode  of  treating  the  depressed  is  practised 
in  the  Richmond  Asylum  than  is  thought  per- 
niissible  in  most  other  institutions,  and  it  speaks 
well  for  the  intelligence  and  tact  of  the  subordinate 
staff  that  it  is  so  successful.  We  are  pleased,  too,  to 
note  that  it  has  not  been  necessary  to  resort  to 
restraint  on  any  occasion  during  the  year.  Dr. 
Norman  holds  very  similar  views  to  Dr.  Clouston 
on  the  importance  of  alcoholism  as  a  cause  of 
insanity.  Of  394  cases  for  which  one  probable 
cause  of  the  condition  is  assigned,  in  127  it  is 
drink.  On  the  other  hand,  sexual  intemperance, 
which  is  given  a  preponderant  place  in  many  causal 
tables,  is  not  here  assigned  as  the  cause  of  a  single 
admission.  Hereditary  influences  are  made 
accountable  in  82  cases,  but  we  fancy  a  much  higher 
figure  would  have  resulted  if  an  accurate  family 
history  were  in  every  case  available,  and  if  other 
stigmata  were  taken  into  account  beside  actual 
previous  insanity  in  the  family.  The  mortahty 
in  the  asylum  during  the  year  is  not  unduly  high — 
7-9  per  cent,  on  the  average  number  of  patients, 


but  some  of  the  causes  seem  capable  of  diminution. 
Phthisis,  especially,  is  responsible  for  a  greater 
proportion  of  the  deaths  than  seems  necessary  if 
modem  preventive  and  therapeutic  measures  are 
practised,  though  it  must  be  remembered  that  it  is 
a  disease  which  in  an  insane  person  is  very  likely  to 
advance  far  before  suspicion  is  roused.  Dj^entery 
also  still  claims  its  share  of  deaths,  and  typhoid 
fever,  though  almost  unrepresented  in  the  mortality 
list,  is  present  in  the  female  house  every  year.  It 
is  interesting  to  note  the  variety  and  number  of  the 
industrial  occupations  in  which  it  has  been  found 
possible  to  engage  the  great  majority  of  the 
patients.  All  the  clothes  worn  in  the  asylum 
have  not  only  been  made  on  the  premises,  but  the 
stuff  itself  has  there  been  woven.  One  can  hardly 
think  of  any  occupation  from  chimney-sweeping 
to  *'  drawn-thread  work,"  from  blacksmith's 
work  to  embroidery,  at  which  some  of  the  patients 
are  not  employed.  The  importance  of  this  steady 
industrial  spirit  is,  from  the  point  of  view  o! 
economy,  great,  but  far  greater  when  one  regards 
it  as  a  rational,  satisfying,  and  successful  method 
of  treatment. 


THE  CENTRAL  MIDWIVES'  BOARD. 
That  curious  body — the  Central  Midwves'  Board 
as  at  present  constituted — ^met  again  after  an  interval 
of  quietude  on  the  29th  ult.  There  were  in  attendance 
a  Chairman  (Mr.  E.  P.  Young),  two  ladies  (Miss  Wilson 
and  Miss  Oldham),  and  a  medical  man  (Dr.  Sinclair). 
The  meeting  commenced  with  a  discussion  on  a  letter 
from  a  medical  practitioner.  This  gentleman  wrote 
to  complain  of  the  conduct  of  a  registered  midwife, 
to  whom  he  bad  written  that  it  had  cpme  to  his 
knowledge  that  she  was  interfering  with  his  treatment 
of  a  child  under  his  care,  and  that  if  she  continued  to 
do  so  he  would  take  legal  action.  The  midwife  had 
replied.  "  You  may  take  legal  proceedings  whenever 
you  hke.  It  is  much  like  your  '  impotence  '  to  write 
to  me,  so  please  mind  your  own  business.'*  This 
poor  woman,  who  is  perhaps  only  imbued  a  Uttle  too 
strongly  with  the  spirit  of  the  Board  which  governs 
her,  is  to  have  her  conduct  inquired  into  by  the  local 
authorities  before  the  C.M.B.  will  interfere.  We  are 
sure  than  an  excuse  will  be  found  for  her ;  after  all, 
imitation  is  the  sincerest  flattery.  The  next  business 
was  the  reading  of  a  letter  from  the  London  Obstetrical 
Society,  informing  the  Board  that  the  certificate  of 
the  Society  had  been  removed  from  a  certain  midwife. 
The  C.M.B.  decided  that  evidence  should  be  demanded 
in  support  of  the  charges  against  the  midwife.  The 
Board  was  next  asked  to  become  an  architect  and  to 
give  its  valuable  opinion  regarding  the  suitability 
of  lying-in  wards  at  Brentford.  This  it  decided  to 
be  by  the  vote  of  two  ladies  to  one  medical  man. 
The  Board  then  discussed  the  question  of  the  com- 
pensation of  midwives  who  were  suspended  to  prevent 
them  from  infecting  their  patients.  It  was  suggested 
that  the  Board  should  promote  legislation  to  such  an 
end,  and  it  was  decided  that  a  note  should  be  made  of 
the  necessity  for  so  doing,  again  by  the  vote  of  two 
ladies  to  one  medical  man.  Dr.  Sinclair  next  asked 
that  the  statement  of  accounts  should  be  sent  to  the 
members  of  the  Board  a  week  before  the  meeting, 
in  order  that  members  might  have  an  opportunity  of 
becoming  acquainted  with  them.  At  this,  the  ladies 
became  nervous,  and  thought  that  at  the  discussion 
of  such  an  important  question  the  presence  of  Mr. 
Heywood  Johnstone  was  essential,  and  must  be  awaited. 
After  an  apparently  lengthy  discussion,  it  was,  how- 
ever, ruled  by  the  Chairman  that  the  suggestion  made 
by  Dr.  Sinclair  was  unnecessary,  and  that  the  present 
system  of  springing  the  accounts  on  the  meeting  was 
sufficient.  Accordingly,  Mr.  Johnstone's  presence 
was  dispensed  with,  and  the  Bocird  adjourned  until 
October  nth. 


1 


384    Ths  Medical  Psess. 


SPECIAL   ARTICLES. 


Oct.  12,  1904. 


THE  EXAMINATION  OF  WATERS,  (a) 

Books  on  this  subject  are,  perhaps  owing  to  the 
limited  demand,  not  very  numerous,  and.  with 
lew  exceptions,  those  that  are  in  use  are  out  of  date, 
owing  to  the  rapid  advance  of  knowledge  in  this 
direction ;  consequently,  a  book  written  by  Dr.  Thresh, 
who  has  acquired  a  reputation  in  the  subject  of  water 
supply  in  its  manifold  bearings,  is  sure  of  a  welcome. 
It  is  nothing  new  to  medical  officers  of  health,  and  to 
anal3rsts,  to  be  told  that  an  examination  of  the 
source  of  supply  of  a  water  often  affords  more  im- 
portant information  than  could  be  obtained  from 
analytical  or  bacteriological  examinations,  as  these 
only  show  the  condition  of  the  water  at  the  time  the 
sample  was  taken,  while  an  examination  of  the  imme- 
diate neighbourhood  of  the  source  of  supply  may.  and 
usually  does,  show  the  chances  of  possible  pollution. 
In  his  preface  the  author  says :  "  In  numerous  instances 
I  have  had  to  investigate  supplies  which  have  been  the 
cause  of  outbreaks  of  disease,  and  in  many  others  to 
investigate  the  cause  of  some  chauige  rendering  the 
water  objectionable  in  character.  In  nearly  all  such 
cases  I  have  found  that  the  examination  of  the  source 
of  the  water  afforded  information  without  which  the 
chemical,  bacteriological,  or  microscopical  examination 
of  the  water  could  not  have  been  correctly  inter- 
preted." We  think  that  this  must  be  a  slight  exag- 
geration,- coming  as  it  does  from  one  who  has  had  much 
experience  in  the  analysis  of  water,  while  the  many 
and  varied  instances  given  in  the  book  of  the  value  of 
analysis  seem  to  contradict  this.  On  the  contrary. 
Dr.  Thresh  seems  to  have  shown  more  conclusively 
than  we  have  seen  elsewhere  that  the  chemical, 
bacteriological,  and  microscopical  examination  of  a 
water  is  usually  sufficient  to  condemn  it  or  even  to 
pass  it,  when  the  few  details  asked  for  by  the  analyst 
as  to  the  depth  and  nature  of  the  well  are  answered, 
though,  as  we  have  previously  remarked,  possibilities 
of  pollution  are  sometimes  revealed  by  an  examina- 
tion of  the  source  of  supply.  Our  experience  is 
similar  to  Dr.  Thresh's  in  the  discovery  of  sources  of 
pollution  by  microscopical  examination,  which  had 
been  overlooked  at  a  careful  inspection.  All  persons 
acquainted  with  the  subject  will  also  agree  that  "  much 
more  skill  and  care  (in  the. analysis  of  water)  are 
requisite  to  obtain  concordant  and  accurate  results 
than  is  generally  imagined." 

"  The  chief  object  of  the  work,  however,  is  to  show 
how  to  examine  sources  of  supply,  and  how  to  use 
the  information  thus  acquired,  in  the  interpretation 
of  results  obtained  from  the  examination  of  the  waters 
yielded  by  these  sources,  and  to  demonstrate  that  it  is 
more  important  to  consider  the  quality  than  the 
quantity  of  the  organic  and  inorganic  constituents 
found  in  waters  from  whatever  source  derived."  The 
condemnation  of  standards  is  the  view  adopted  by  all 
who  have  had  any  experience  in  the  analysis  of  water. 
Dr.  Thresh  remarks,  "  Standards  may  be  useful  to  the 
beginner  and  the  inexperienced,"  the  logica  sequence 
being  that  only  those  falling  in  this  category — ^we 
have  all  been  included  in  it  at  some  time  or  other — 
patronise  standards. 

His  book  is  divided  into  three  parts ;— ( i ) 
The  Examination  of  the  Sources  from  which 
the  Water  is  Derived ;  (2)  Various  Methods  of 
Examining  Water  and  the  Interpretation  of  the 
Results;  (3)  Analytical  Processes  and  Methods  of 
Examination.  In  reading  the  first  of  these  parts, 
in  which  the  author  is  at  his  best,  one  cannot  help 
admiring  the  excellent  way  in  which  the  subject  is 
handled.  It  is  well  written,  illustrated  with  numerous 
and  aptly  chosen  instances  of  the  cases  in  point,  and 
forms  interesting  as  well  as  instructive  reading.  The 
examination  of  shallow  and  deep  wells,  springs,  surface 
water  supplies,  rivers  and  streams,  service  reservoirs, 
water  mains,  Ac,  is  well  described ;  and  though  much 


(a)  "  The  BzamiDAtioD  of  Water  and  Water  Sappliee.**  By  John 
C.  Thmh.  D.8o.LoQd.,  M.D.Vkt.,  D.P.H.Camb.  Pp.  400,  awlxvi 
19  platee,  11  ttloetimlioiie  in  text  and  99  Ubiee.  14a.  n«t.  London : 
J.  andA.CharehiU.    1901. 


of  the  information  is  not  new  to  those  acquainted  with 
the  subject,  yet  it  is  necessarily  included  to  ensure  a 
better  appreciation  of  the  many  details  that  win  be 
new  to  not  a  few  readers. 

In  the  second  part  Dr.  Thresh  is  touching  a  delicate 
subject  and  adding  fresh  fuel  to  the  controversy  which. 
for  the  sake  of  the  professions  interested,  we  are  glad 
to  see  going  on.  There  is  probably  no  one  so  withont 
bias  that  he  looks  on  the  question  of  the  rdati^c 
values  of  bacteriological  and  chemical  analyses  with 
an  impartial  eye.  Some  lean  one  way,  some  the 
other.  The  more  bigoted  do  more  than  lean — they 
boldly  declare  that  there  can  be  no  possible  advantage 
in  performing  a  bacteriological  or  chemical  analysis, 
as  the  case  may  be ;  in  fact,  to  do  so  is  likely,  if  not 
certain,  to  be  misleading.  In  most  cases  this  is  due 
to  lack  of  experience  of  the  processes  they  so  freely 
condemn.  We  have  here  a  book  written  by  one  who, 
from  his  experience  in  both  chemical  and  bacteriological 
methods,  ought  not  to  be  biassed,  but  Dr.  Thresh  is 
human — his  book  reveals  it — and  although  he  nearly 
takes  the  vid  media  (proverbially  the  safest),  he  has  a 
slight,  but  still  an  apparent,  leaning  towards  the 
bacteriological  side  of  the  controversy.  Neverthdess, 
he  is  very  fair.  "  There  is  now  a  general  opinion 
that  a  bacteriological  examination  is  more  important 
than  a  chemical  analysis.  This  is  undoubtedly  true  m 
some  cases,  but  not  in  all.  .  .  .  When  we  find  that 
waters  used  for  long  periods  by  large  conmiunities 
are  condemned  by  bacteriologists  as  being  dangerously 
polluted,  and  that  the  results  obtained  from  the  same 
water  by  different  bacteriologists  differ  to  an  extent 
which  is  impossible  in  a  chemical  analysis,  our  faith 
in  bacteriological  examination  is  somewhat  shaken." 
And  again:  "It  is  obvious,  therefore,  that  chemical 
and  bacteriological  examinations  have  their  special 
uses,  and  that  one  can  rarely  replace  the  other," 
but  (p.  133)  "  bacteriology  can  tell  us  but  little,  if 
anything,  of  such  past  pollution." 

Dr.  Thresh  lays  much  stress  on  the  colour  of  a 
water.  "  The  medical  officer  of  health  or  sanitary 
inspector  making  inspections  of  districts  supplied 
with  water  from  shallow  wells  or  similar  sources  of 
supply  may  be  guided  in  their  selections  of  samples 
for  analysis  by  viewing  some  of  the  water  in  a  deep 
tumbler  placed  on  a  sheet  of  white  paper.  Those  in 
which  a  yellow  tint  is  observed  are  the  most  likely  to 
be  impure."  Though  this  in  many  cases,  perhaps  in 
most,  may  be  true,  it  is  misleading,  inasmuch  as  it 
seems  to  suggest  that  absence  of  yellow  colouring 
(in  such  a  short  vessel  as  a  glass)  would  render  it 
very  probable  that  the  water  was  pure.  We  should 
hesitate  very  much  to  say  that  this  very  slender 
piece  of  evidence  was  sufficient  to  justify  neglecting 
to  have  the  sample  examined.  Surely,  if  the  expense 
of  having  all  the  samples  fully  analysed  was  prohibitive, 
it  would  be  better  for  the  M.  O.  H.  to  do  as  he  is  else- 
where urged— examine  the  source,  and  if  that  did  not 
afford  sufficient  grounds  for  rejecting  the  water. 
partial  analysis  might  be  contracted  for.  or  even  the 
cheap  process  described  in  "  A  Simple  Method  of 
Water  Analysis  "  would  be  better  than  trusting  to  the 
colour. 

A  readable  chapter  is  the  "  Interpretation  of  Results 
of  Chemical  Examination,"  in  which  several  matters  are 
mentioned  which  will  be  news  to  many,  such  as  the 
assurance  that  there  is  no  vestigeof  proof  in  the  hack- 
neyed instance  of  the  increased  prevalence  of  rickets 
in  Glasgow  being  due  to  the  use  of  the  proverbially 
soft  Loch  Katrine  water.  Dr.  Thresh  has  ceased  to 
determine  the  hardness  of  water  to  less  than  half  a 
degree,  since,  as  he  says,  the  same  examiner  some- 
times gets  slightly  different  results  on  the  same  water, 
even  when  using  the  same  solutions.  While  scorning 
standards,  as  we  all  do.  Dr.  Thresh  wisely  gives  figures 
suggesting  what  amount  of  the  different  constituents 
of  water  would  indicate  or  suggest  sewage  poUutioa. 
but  he  seems  to  allow  rather  more  latitude  than  most 
analysts. 

We  regret  we  cannot  support  Dr.  Thresh  in  his 
statement    that    "  practically    all    the    infonnatioa 


Oct.   12,  1904. 


FRANCE. 


Tex  Mbdical  Psess.    385 


necessary  may  be  obtained  by  an  analysis  made  as 
described  by  me  in  a  pamphlet  entitled,  '  A  Simple 
Method  of  Water  Analysis.' "  If,  even  after  a  careful 
SLnd  complete  chemical  and  bacteriological  analysis, 
it  is  sometimes  difficult,  even  impossible,  to  offer  a 
definite  opinion  on  a  water,  and  if  one  is  still  more 
often  unable  to  say  anything  definite  about  a  partial 
chemical  examination,  is  it  not  possible,  nay  probable, 
that  results  obtained  in  the  manner  described  in  the 
pamphlet  referred  to  will  in  most  cases  be  misleading, 
a.nd  tend  to  do  anything  but  raise  the  opinion  of  lay 
persons  as  regards  the  value  of  water  anal3rsis  ? 

A  welcome  section  is  that  on  the  bacteriological 
analysis  of  water ;  we  know  that  the  author  has  gone 
to  considerable  trouble  to  sift  the  apparently  con- 
flicting mass  of  literature  on  the  subject,  and  favoured 
as  he  is  with  great  opportunities  for  comparing  the 
results  of  his  laboratory  work  with  the  knowledge 
obtained  from  inspection  of  the  sources  of  waters, 
he  should  be  in  a  position  to  indicate  to  those  not  so 
favoured  what  are  the  best  and  most  trustworthy 
methods.  We  have  performed  the  bacteriological 
analysis  described  in  the  book,  and  we  confess  ourselves 
indebted  to  Dr.  Thresh  for  the  schemes  he  suggests  for 
the  search  for  B.  coli  communis.  The  subject  is, 
however,  capable  of  being  greatly  developed,  as  it  is 
yet  in  its  infancy,  but  we  thmk  that  the  author  has  to 
a  great  extent  justified  his  claim  as  to  the  merits  of 
bacteriology  applied  to  the  examination  of  waters. 
There  are  nineteen  plates  dealing  with  the  micro- 
scopical examination  of  water,  and  a  feature  of  these 
is  that  they  are  mostly  drawn  from  actual  sediments 
met  with  in  the  the  course  of  the  author's  practice,  and 
the  reader  is  informed  of  the  source  of  the  deposits 
and  sometimes  of  the  conclusions  the  author  has 
been  enabled  to  draw  from  them.  The  book  is 
closed  by  formulae  for  solutions  and  culture 
media,  and  by  notes  on  "  Detection  of  Radium 
in  Water,"  "  Helium  in  Spring  Waters,"  "  The 
Temperature  of  Water,"  "  The  New  Turbidi- 
meter," "  Copper  in  Water,"  "  Uncertainty  of  Deep 
Well  Borings,"  "  Value  of  Systematic  Examination 
of  Public  Supplies,"  and  "  The  Question  of  Standards." 
'We  have  little  but  praise  for  this  volume,  which  will 
doubtless  receive  the  wide  appreciation  it  deserves. 


Sritisb  Dealtb  Vesorts* 


[by  our   special   medical   commissioner.] 


XIV.— BUXTON. 

Buxton  lies  in  and  on  the  sides  of  a  hill-surrounded 
-valley  in  the  north-west  comer  of  Derbyshire  in  the 
High  Peak  district.  It  claims  to  be  the  highest  town 
in  England,  and  is  1,000  feet  above  sea-level.  The 
subsoil  is  of  limestone  and  millstone  grit.  The  average 
mean  temperature  is  about  47°  F. ;  the  rainfall  about 
5 1  inches ;  and  the  mean  relative  humidity  is  about 
S:^  per  cent.  The  air  is  peculiarly  bracing,  and  even 
in  summer  the  place  is  never  unpleasantly  hot.  The 
water  supply  is  excellent*  and  is  derived  from  the 
^rit -stone  formation.  The  sanitary*  arrangements  are 
good.  Exceptionally  attractive  provision  is  made  for 
the  amusement  and  recreation  of  visitors.  Buxton 
with  Bath  shares  the  distinction  of  being  one  of  our 
chief  thermal  spring  stations.  The  waters  have  a 
uniform  temperature  of  82°  F.  They  contain  nitrogen 
iras  in  solution,  much  C|  (carbonate  of  calcium),  and 
numerous  other  salts  in  small  quantities,  (a) 

Various  forms  of  baths  can  be  enjoyed  at  Buxton, 
and  much  benefit  is  experienced  by  many  patients 
from  drinking  the  waters,  which  are  particularly 
suitable  for  cases  of  gout,  rheumatism  and  rheumatoid 
arthritis.  Almost  all  so-called  "  rheumatic "  con- 
ditions are  benefited  by  a  course  of  the  waters  and 
suitable  baths,  particularly  lumbago,  sciatica,  neuritis 
and    neuralgia,    forms  of  synovitis,   cystitis,   chronic 

(eg  See  "  Buxton  :  ita  Walen,  Baths,  and  Aooeasory  Method!  of 
Treatment.**  B/  I>n.  W.  Anutrongr  ftnd  J.  E.  Harbom.  Brlitol  : 
Wright  and  Co.    1903. 


cases  of  glycosuria  and  some  varieties  of  eczema  and 
psoriasis. 

Some  chronic  dyspeptics  and  hepatic  cases  are 
relieved.  Not  a  few  sufferers  from  chronic  constipation, 
obesity  and  lithiasis  improve  much  at  Buxton. 

For  the  after  treatment  of  sprains,  dislocations  and 
fractures,  and  as  a  recruiting  station  after  malaria, 
plumbism,  and  certain  acute  disorders,  Buxton  presents 
many  advantages.  Many  nervous  cases  do  well,  and 
the  place  is  well  suited  to  the  needs  of  certain  neur- 
asthenics. 

Buxton  is  not  suited  for  cases  marked  by  much 
debility.  The  waters  and  baths  are  contra-indicated 
in  pyrexial  cases,  advanced  lung  and  heart  affections, 
when  there  is  extensive  renal  disease  or  a  tendency 
to  plethora  and  cerebral  hyperemia,  (a) 

Buxton  offers  facilities  for  all  classes.  The  well-to- 
do  may  find  every  comfort  in  the  admirable  hotels 
and  hydropathic  establishments,  while  the  poor  may 
enjoy  the  benefits  of  the  place  at  the  Devonshire 
Mineral  Water  Hospital,  which  affords  accommodation 
for  300  patients.  Buxton  also  has  the  advantage  of 
being  surrounded  by  country  peculiarly  attractive 
and  well  fitted  for  the  requirements  of  the  health 
seeker. 

Efforts  are  now  being  made  to  develop  Buxton  as  a 
winter  resort.  It  is  163  miles  from  London,  but  can 
be  easily  reached  by  through  carriages  in  a  little 
over  four  hours  (Midland  Railway). 

Stance* 

[prom  our  own  corrbspondbnt.] 


Pabxs,  October  8lh,  1904. 
Hyperemia  in  the  Treatment  of  Articular 
Disease. 

Some  years  ago  Dumreicher  published  a  case  of 
pseudarthrosis  cured  by  venous  hyperaemia.  and  a 
short  time  afterwards  Hef erich,  at  the  Surgical  Congress, 
highly  recommended  this  method  in  the  same  cir- 
cumstances. Habbs  towards  1885  had  in  the  same 
way  obtained  remarkable  results  in  cases  of  fracture 
where  union  was  retarded.  But  it  was  in  1892  that 
Bier  made  his  first  communication  on  the  treatment 
of  surgical  tuberculosis  by  venous  hyperaemia.  Rely- 
ing on  the  cases  of  Rokitansky  as  regards  the  immunity 
from  tuberculosis  of  hyperaemiated  tissues,  he  pro- 
duced artificial  hyperaemia  in  the  limbs  of  individuals 
suffering  from  local  tuberculous  disease.  He  provoked 
the  venous  congestion  by  winding  an  elastic  bandage 
around  the  central  portion  of  the  diseased  limb,  and 
left  it  in  place  several  days,  and  even  several  weeks. 
A  notable  improvement  was  observed  in  the  majority 
of  cases. 

Since  then.  Bier  has  published  several  papers  on 
the  subject  modifying  his  method,  which  is  now  as 
follows : — Above  the  seat  of  the  disease  an  elastic 
bandage  or  simply  a  flannel  is  applied.  The  com- 
pression must  be  sufficient  to  close  the  veins  without 
affecting  the  arterial  circulation.  In  order  not  to 
injure  the  subjacent  tissues,  it  is  sometimes  necessary 
to  use  a  large  bandage  or  to  interpose  a  slight  layer  of 
cotton  wool.  At  each  new  application  it  is  prudent 
to  change  the  place  of  the  bandage  a  little  in  order 
to  avoid  possible  muscular  atrophy.  If  the  bandage 
is  properly  applied  the  periphery  of  the  part  swells, 
becomes  of  a  bluish  colour,  and  oedema  appears ;  if 
this  colour  is  not  observed,  the  compression  is  too 
strong  and  must  be  eased. 

The  duration  of  the  compression  varies  with  the 
nature  of  the  affection  treated.  If,  for  instance,  it  is 
a  case  of  tuberculous  diseasa  of  the  joint,  the  bandage 


(a)  Ooniult  article  by  the  Ute  Dr.  W.  H.  Ord  and  Dr.  A.  E. 
Oarrod  :  *<  The  Climates  and  Bathe  of  Great  Biitoln."  Vol.  i ,  p. 
638.  London:  KaomUUn.  18B5. 


386    The  Medical  Press. 


GERMANY. 


Oct.  12,  1904. 


will  be  left  on  for  four  or  five  hours  morning  and 
evening.  This  treatment  will  be  continued  eight 
days,  after  which  the  bandage  need  only  be  applied 
for  an  hour  daily.  The  patient  should  in  no  wise  suffer 
from  its  application.  The  effects  of  hyperaemi^, 
according  to  Bier,  are  as  follows : — It  relieves  the 
pain,  increases  the  bactericidal  action  of  the  tissues 
and  stimulates  nutrition. 

Tuberculosis  of  the  limbs  and  joints  were  the 
affections  chosen  by  Bier  for  his  experiments.  Habbs 
tried  passive  hyperemia  on  about  200  cases  of  tuber- 
culous disease  of  the  extremities.  The  results  were 
in  general  very  good,  especially  in  cases  that  had  not 
yet  suppurated  externally.  A  large  number  of  chronic 
inflammations  of  the  knee,  the  hands,  and  feet,  which 
were  doubtless  produced  by  the  bacilli  of  Koch,  were 
so  favourably  influenced  by  the  treatment  that  no 
trace  of  the  disease  could  be  discovered  on  its  con- 
clusion. Articular  disease  in  children  where  the  bones 
had  not  yet  been  affected  derived  unhoped-for  results 
from  the  bandage.  Where  the  joint  had  suppurated, 
producing  fistula,  the  treatment  was  much  less  success- 
ful. Arthritis  due  to  gonococci.  a  very  painful 
affection,  leaving  behind  stiffness  or  a  considerable 
deformity,  improved  rapidly  by  this  artificial  venous 
congestion.  The  pain  quickly  disappeared,  and  the 
after-deformity  was  much  less  than  that  observed  by 
other  treatments,  while  the  function  of  the  joint  was 
hardly  ever  affected.  Blecher  tried  the  method  for 
stiff  joints  after  prolonged  immobility,  and  obtained 
complete  re- establishment  of  the  articular  function. 

Bier  also  recommends  his  method  in  the  treatment 
of  gout,  acute  articular  rheumatism,  chronic  rheu- 
matism, chronic  oedema,  sprains,  subacute  periostitis, 
chronic  arthritis.  Hyperaemia  eases  pain  in  all 
these  affections,  and  has  a  marked  action  on  the 
absorption  of  exudations. 

Your  readers  will  find  the  following  prescript ipn 
of  use : — 

Painful  Affections  of  the  Stomach. 

Stovaine  (the  new  local  anaesthetic  referred 
to  in  my  last),  grs.  x  ; 

Syrup,  .^v. 

A  teaspoonful  in  a  little  water  after  meals. 
Vomiting. 

Stovaine,  grs.  vj  ; 

Sulph.  of  atropine,  gr.  J ; 

Hydroch.  of  morphia,  grs.  ij  ; 

Spirits  of  chloroform,  5iij  q« 

5  drops  every  2  hours  until  relieved. 

Getmanp* 

[from  our  own  correspondent.] 


Bkeux,  October   8th,  1004. 

At  the  Medical  Society,  Hr.  Bumm  discussed  the 
Serum  Treatment  of  Puerperal  Fever. 

He  said  that  as  far  as  private  practice  was  concerned, 
puerperal  sepsis  had  not  become  much  less  frequent 
than  formerly.  This  was  partly  due  to  the  diffi- 
culties of  effective  disinfection  of  houses,  inadequate 
assistance,  and  the  circumstance  that  midwives  were 
drawn  from  the  menial  classes,  and  partly  also  due 
to  the  patients  themselves,  who  went  about  too  long 
when  suffering  from  slight  haemorrhages  (miscarriages), 
and  only  called  in  the  medical  attendant  when  the 
uterine  contents  had  already  become  foul.  It  was 
unjust  always  to  put  the  blame  on  the  attending  mid- 
wife or  nurse.  We  had  still  to  fight  puerperal  fever. 
What  had  been  recommended  and  done  as  regards 
washing  out  and  even  extirpation  of  the  uterus  had  as 
yet  proved  ineffective.     It  was  therefore  our  duty  to 


try  a  remedy  that  professed  to  strike  at  the  root  of  the 
evil. 

What  prevented  a  united  opinion  being  formed  as 
to  treatment  by  Marmorek's  serum  was  the  many- 
sidedness  of  the  disease  called  puerperal  fever.  In 
cases  of  pain  in  general  sepsis  the  prognosis  was  not 
difficult,  and  not  more  so  in  cases  of  purely  local 
infection.  Between  these,  however,  lay  the  great 
number  of  cases  that  once  or  twice  showed  a  high  tem- 
perature with  rigors,  and  which  to  our  surprise  recovered 
spontaneously.  If  serum  had  been  used  in  such  a  case 
one  was  not  justified  in  at  once  putting  down  the  result 
to  it.  The  speaker  had  principally  used  Aaronson's 
serum  from  Schering's  factory.  Careful  grouping  was 
required  in  estimating  results. 

His  grouping  was  as  follows  : — 

1.  Septic  puerperal  peritonitis.  Five  cases  treated 
with  high  doses  of  serum  without  any  effect  on  tem- 
perature, bacterial  character  of  the  blood,  or  clinical 
course.     All  died. 

2.  Four  cases  of  post-operative  peritonitis  in  which 
there  was  mixed  infection.     All  died. 

3.  Three  cases  of  septicaemia.  In  two  the  blood  was 
swarming  with  streptococci ;  these  died.  In  the  last 
case  the  temperature  fell  three  times  after  injection  of 
serum,  thrombo-phlebitis  of  a  leg  took  place,  which 
terminated  in  recovery. 

4.  Three  cases  of  septic  endocarditis.  All  died.  Id 
one  case  an  intravenous  injection  gave  the  impres- 
sion of  causing  a  bad  result. 

5.  Four  cases  of  pure  pyaemia.  All  died.  Here  also 
there  was  mischief  after  an  intravenous  injection. 

6.  Peri-  and  parametritic  exudations.  These  were 
not  treated  by  serum,  as  their  onset  showed  that  the 
rational  way  to  recovery  was  already  opened. 

7.  Streptococcic  endometritis.  Fifty-three  cases. 
Twenty-one  of  these  were  mild  cases  with  favourable 
prognosis,  and  were  not  further  considered  ;  32  were 
serious  cases  with  thick  purulent  deposits  on  the  wound 
surface  of  the  uterus  and  high  fever.  In  17  cases  the 
blood  was  examined  and  in  12  streptococci  were  found: 
5  died.  In 21  cases  the  effect  of  the  serum  injection 
could  always  be  seen  on  the  temperature  charts. 
This  caused  the  subjective  impression  that  the  serum  was 
really  effective,  and  this  impression  was  strengthened 
by  objective  observation.  The  streptococci  lay  in  lon^ 
chains  between  the  pus  cells  in  the  lochial  secretion  of 
such  cases,  then  short  chains  and  many  individual 
cocci  or  cocci  in  groups  within  the  pus  corpuscles.  This 
phagocytosis  was  especially  distinct  after  serum  injec- 
tion. This  lent  confirmation  to  the  view  that  the  senin 
supported  or  aided  the  curative  powers  of  the  organism. 
He  had  only  seen  harm  result  after  intravenous  injec- 
tion ;  abscesses  could  be  avoided  by  taking  care  that  the 
serum  was  clear.  It  was  useful  in  large  doses  only. 
It  should  be  used  also  in  cases  in  which  from  the  nature 
of  the  circumstances  sepsis  was  anticipated. 

Prof.  Olshausen  denied  that  puerperal  infection  was 
as  frequent  as  formerly  ;  statistics  were  more  carefully 
made  up.  It  was  extraordinarily  difficult  to  decide 
on  the  value  of  any  remedy,  as  the  several  cases  with 
rigors  occurring  daily  for  weeks  sometimes  got  bette 
He  had  never  seen  any  success  from  Aaronson's  serum  . 
but  he  would  continue  trying. 

In  reply  to  a  question  by  Hr.  Hausemann.  Hr. 
Bumm  said  that  after  injection  phagocytosis  appeared 
when  it  had  been  absent  before  the  injection,  and  that  it 
also  appeared  in  the  cases  that  went  on  to  recovery. 

Hr.  Falk  attributed  the  transient  improvement  seen 
in  two  cases  to  the  injection  itself,  and  thought  ttat 
almost  as  much  could  be  done  by  saline  injection. 


Oct.  12.  1904. 


HUNGARY. 


The  Medical  Fxess.    387 


Hr.  Freund  was  of  opinion  that  the  serum  treatment 
must  be  continued,  notwithstanding  the  fact  that  he 
had  not  with  certainty  seen  any  good  from  it.  The 
speaker  had  done  good  in  differentiating  the  various 
anatomical  features  of  puerperal  infection.  How 
^uld  it  be  recognised  that  the  infection  had  not  yet 
proceeded  from  the  endometrium  ? 

Hr.  Bumm  made  his  conclusion  from  inspection  of 
the  genitals,  from  negative  examination  of  the  blood, 
as  well  as  from  the  absence  of  the  usual  signs  of 
general  sepsis.. 


[from  our  own  correspondent.] 


YiBViiA,  October 9th,  1904. 
Gun-Shot  Wound  and  Operation. 
At  the  Prague  meeting  Lieblein  recorded  the  history 
of  a  man,  set.  21,  who  was  brought  to  his  clinic  in  a 
collapsed  condition,  having  received  two  shots  in  the 
breast  from  a  revolver.  The  radial  pulse  on  both 
sides  was  feeble,  but  Lieblein  observed  that  the  left 
was  weaker  than  the  right,  and  from  this  concluded 
that  the  subclavian  artery  on  the  left  side  was 
damaged,  which  diagnosis  was  confirmed  the  following 
day  by  a  large  aneurysm  appearing  in  the  infra- 
clavicular fossa.  After  this  the  patient  seemed  to 
improve,  and  nothing  was  done  for  forty  hours, 
but  a  relapse  having  set  in  and  the  symptoms  becoming 
ominous,  operative  interference  was  demanded.  In 
consideration  of  the  size  and  importance  of  the  vessel 
he  cut  down  and  ligatured  the  subclavian  in  the 
super-scapular  fossa.  The  wound  was  closed  with 
tampons,  and  within  an  hour  and  a  half  after  operation 
the  patient  was  in  a  serious  and  exhausted  condition, 
but  afterwards  recovered.  Lieblein  recommends  this 
method  of  tying  above  the  site  of  injury,  as  less  damage 
is  done  and  more  security  obtained. 

Meteorism  in  the  C«cal  Region. 

Bayer  discussed  the  present  teaching  in  text-books 
of  the  diagnosis  in  the  cases  of  closure  of  the  large 
intestine.  He  gave  it  as  his  opinion  that  the  meteoric 
distension  of  the  caecum  was  strong  proof  for  localising 
the  site  of  closure.  The  caecal  region  was  relatively 
weaker,  but  at  the  same  time  the  wall  of  this  part  of 
the  bowel  had  a  double  strain  put  upon  it  by  the  anti- 
peristaltic action  of  the  large  intestine,  and  at  the 
same  time  a  peristaltic  action  that  met  in  this  region. 
These  two  opposing  forces  produced  inflation,  con- 
gestion of  the  surrounding  parts,  and  by  the  continued 
over-distension  tore  the  serous  part  of  the  bowel, 
which  soon  led  to  gangrene  and  finally  death.  The 
nearer  this  obstruction  was  to  the  caecum  the  more 
rapidly  did  the  gangrene  appear.  Caecal  meteorism, 
therefore,  was  a  reliable  symptom  of  an  obstruction  in 
the  large  intestine. 

Chiari  agreed  with  Bayer  in  this  diagnostic  symbol, 
but  thought  that  the  caecal  wall  was  much  weaker 
and  had  a  sharp  angular  bend  at  this  part  of  the  bowel, 
which  might,  in  general,  be  accepted  as  a  common 
symptom.  There  were  cases,  however,  that  departed 
from  this  rule,  where  meteorism  damaged  other  parts 
of  the  bowel  besides  the  caecum.  He  recently  con- 
ducted a  post-mortem  where  the  meteorism  was 
confined  not  to  the  caecum  but  to  the  large  intestine, 
where  the  distension  of  gas  had  torn  the  bowel  in 
several  places  in  the  ascending  colon.  It  might  be  added 
that  the  case  was  that  of  a  lunatic,  and  that  he  had  been 
throwing  his  hands  about  in  such  a  manner  as  to 
strike  the  abdomen,  and  probably  caused  the  rupture 
of  the  distended  bowel  at  these  places. 


Hemangioma    and    Noma. 

Springer  exhibited  a  few  cases  which  he  had  operated 
on  with  varying  success.  The  first  was  a  case  of 
haemangioma  which  had  come  in  from  the  country. 
After  the  operation,  in  consequence  of  the  bandaging 
a  circular  part  of  the  head  became  necrosed  through 
pressure,  not  only  affecting  the  skin,  but  the  muscles, 
periosteum  and  bones  of  the  head,  more  particularly 
the  frontal  bones.  The  child  had  certainly  been  in  a 
low  condition,  and  the  severe  cachexia  was  probably 
the  origin  of  the  necrosis.  The  wound  now  is  pretty 
well  healed  with  an  epithelial  colouring,  but  the  whole 
is  not  what  was  expected,  notwithstanding  grafting. 
The  next  case  was  a  two-year-old  boy,  on  which  he  had 
operated  for  noma  that  occurred  on  the  upper  lip, 
after  an  attack  of  measles.  The  morbid  growth 
extended  to  the  upper  jaw,  which  he  resected  with  the 
soft  tissues  and  alveolar  process.  The  operation  had 
the  effect  of  checking  the  further  progress  of  the  disease. 
He  therefore  commenced  cosmetic  operations  by 
forming  a  new  upper  lip  by  taking  flaps  out  of  the 
under  lip  according  to  Brun's  method.  He  exhibited 
another  case  of  noma,  in  an  adult,  where  the  whole 
cheek  was  removed  and  a  part  of  the  maxillary  bone 
resected.  The  meloplastic  operation  of  Gussen- 
bauer  has  now  quite  restored  the  cosmetic  and  func- 
tional condition  of  the  affected  part. 

In  the  discussion  that  followed,  the  etiology  of 
noma  was  examined  from  different  points  of  view. 
Petruschky  had  found  diphtheria  bacilli  in  two  cases 
of  noma,  which  were  injected  into  other  cases  and 
produced  diphtheria,  while  the  serum  was  used  in  the 
original  cases  with  perfect  success,  the  noma  dis- 
appearing. 

Ganghofner  said  that  we  were  receiving  daily  proof 
that  noma  was  not  the  effect  of  an  individual  bacillus, 
but  seemed  to  have  different  causes  for  its  origin,  if 
not  different  bacilli,  as  the  course  of  noma  was 
different  in  its  malignity  according  to  time  and  place. 
Within  fifteen  years  he  had  seen  twenty  cases  of  noma 
similar  to  those  described  by  Bayer  on  whom  he  had 
operated,  with  eighteen  deaths.  He  was  pleased, 
however,  to  see  that  the  treatment  by  escharotics.  &c., 
was  now  being  abandoned  for  the  operative  method. 

Springer  had  examined  several  cases  of  noma 
bacteriologically,  and  found  in  some  staphylooocci, 
in  others  streptococci,  where  inoculation  failed. 
Removing  the  gangrenous  parts  around  the  growth 
was  of  no  avail.  The  centre,  though  healthy,  must 
be  removed  with  a  wide  margin,  as  in  all  malignant 
tumours,  even  if  the  bone  were  affected. 


Dnngan?* 


[from  our  own  correspondent.] 


BuDAPMT.  October  8th,  1W4. 
At  the  latest  meeting  of  the  Interhospital  Medical 
Association,  Dr.  Etvel  exhibited  several  patients 
with  sciatic  dislocation  of  the  hip,  treated  with  the 
method  first  described  by  T.  Elgart.  The  reducing  of 
posterior  dislocations  of  the  hip  is  done  as  follows  : — 
The  narcotised  patient  is  placed  on  the  floor,  his  dis- 
located limb  held  over  the  knee  of  the  surgeon,  with 
the  patient's  knee  at  right  angles,  and  the  pelvis 
steadied  by  an  assistant.  By  seizing  the  leg  at  the 
ankle  and  pressing  downward  the  head  of  the  femur 
will  move  upward,  the  surgeon's  knee  acting  as  fulcrum. 
Inward  rotation  of  the  femur  is  also  practised  by 
pushing  the  leg  outward.  With  the  free  hand,  the 
prominent  head  of  the  femur  is  seized  and  pressed 


388    The  Mbdical  Press. 


OPERATING  THEATRES. 


Oct.  12,  igo4. 


outward,  so  as  to  assist  its  gliding  over  the  cartilaginous 
ring. 

Salzwedel's  method  of  treating  local  inflammatory 
processes  with  an  alcohol  compress  has  been  modified 
by  Beskoren  in  order  to  avoid  the  smarting  caused 
by  the  application.  He  said  that  to  this  aim  he  adds 
to  the  alcohol  an  equal  amount  of  a  i  per  cent, 
solution  of  aluminium  acetate,  which  raises  the  tem- 
perature of  the  fluid  several  degrees  and  makes  it 
more  soothing.  The  moistened  gauze  is  applied 
directly  over  the  inflamed  area,  and  a  piece  of  rubber 
tissue  with  more  gauze  over  this.  A  perforated 
impermeable  bandage  is  then  wound  around  the 
parts. 

He  related  also  a  severe  case  of  typhoid  haemorrhage 
occurring  in  his  private  practice,  which  was  virtually 
saved  by  the  prompt  use  of  adrenalin.  Thirty  drops 
of  the  commercial  solution  were  given  every  three 
hours  in  physiological  salt  solution.  No  ill-effects 
wese  observed.  Although  it  is  improper  to  judge  from 
one  case,  the  patient  had  been  bleeding  steadily  with 
all  the  other  drugs. 

Toxic  symptoms  following  the  use  of  aspirin  have 
been  already  experienced  and  spoken  of;  however, 
the  case  of  Frank  had  a  peculiar  interest,  which  rendered 
it  worthy  of  emphasising.  Namely,  he  noticed  some 
very  strange  sypmtoms  after  the  ingestion  of  one  grain 
of  aspirin.  In  fifteen  minutes  the  upper  lips  began  to 
swell,  deglutition  became  painful,  while  pulse  and 
respiration  were  very  much  increased.  The  swelling 
soon  extended  over  the  entire  head,  and  was  not 
relieved  by  cold  applications.  Somewhat  later,  an 
extremely  troublesome  urticaria  made  its  appearance 
over  the  entire  body.  The  following  day  all  the  sym- 
ptoms had  disappeared,  and  with  them  the  attack 
of  influenza,  for  which  the  aspirin  had  been  given. 
Probably  the  condition  was  one  of  phenol  poisoning 
from  splitting  up  of  the  drug  in  the  stomach,  since  the 
urine  contained  large  amounts  of  phenol. 


TLbc  Operating  Ubeatree* 


GREAT  NORTHERN  HOSPITAL. 
Re-Excision  of  Hip. — ^Mr.  Peyton  Beale  operated 
on  a  woman,  aet.  about  35,  who  had  been  an  inmate  of 
the  Hbspital  on  three  or  four  occasions,  dating  from 
the  year  1887.  In  that  year  she  had  the  head  of  her 
femur  excised  for  tuberculous  disease  of  the  hip-joint. 
The  wound  had  healed,  but  had  broken  down  again, 
and  had  been  scraped  out  several  times.  She  now 
complained  of  several  sinuses  about  the  ischio-rectal 
fossa,  two  on  the  outer  aspect  of  the  hip-joint,  and  one 
about  the  middle  of  the  crest  of  the  ilium,  with  con- 
siderable pain  both  by  day  and  night.  The  affected 
limb  was  about  three  inches  shorter  than  the  sound 
limb,  and  she  was  unable  to  put  the  foot  to  the  ground. 
Seeing  how  very  extensive  the  disease  was  from  the 
number  and  position  of  the  sinuses,  the  patient  was 
advised  that  a  thorough  investigation  should  be  made 
at  the  risk  of  a  very  much  shortened  leg,  and  a  possible 
future  amputation  at  the  hip.  The  woman  being 
placed  on  her  face,  a  curved  incision  was  made  following 
the  fold  of  the  buttock,  passing  through  the  sinuses  in 
the  ischio-rectal  fossa ;  the  gluteal  muscles  were  sepa- 
rated from  the  ilium,  and  the  buttock  was  dissected  up 
so  as  to  form  a  large  flap,  the  base  of  which  extended 
from  the  crest  of  the  ilium  to  the  position  of  the  great 
trochanter,  care  being  taken  of  the  sciatic  nerves. 
Thus  the  hip-joint  was  exposed  from  behind.  It  was 
then  seen  that  three  inches  of  the  upper  end  of  the 


femur  were  carious,  the  bone  being  very  thin.    It  was 
therefore  sawn  off  and  removed  in  pieces.     There  were 
several  sinuses  leading  into  the  pelvis,  and  there  wa> 
no  trace  of  an  acetabulum  to  be  made  out.    An  in. 
cision  was  next  made  over  and  parallel  to  the  crest  of 
the  ilium,  and  through  it  the  inner  aspect  of  the  pdvis 
was   investigated.     Several  pieces   of   necrosed  bone 
were   found   and   removed,   and    the   sinuses  leading 
through  the  pelvis  were  enlarged  with  a  chisel  and 
scraper  so  as  to  permit  of  free  drainage  right  through. 
The  gluteal  flap  was  then  replaced,  about  half  a  dozen 
sutures  being  inserted,  and  strips  of  gauze  were  placed 
between  the  sutures  and  in  the  wound  over  the  iliac 
crest  so  as  to  permit  of  free  drainage.     Mr.  Beale  said 
that  these  cases  were  very  painful  ones  to  deal  with, 
as  the  conttnnoas  discharge  through  the  sinuses  gradu- 
ally weakened  the  patient,  until  he  or  she    got   into 
such  a  condition  that  scraping  out  the  sinuses  was  the 
only  thing  to  be  thought  of.     This,  of  course,  was  a 
comparatively  useless  proceeding,  as  it  was  practically 
impossible   to   reach    the   seat   of   disease.     He  con- 
sidered that  it  was  right  in  the  interest  of  the  patient 
to  attempt  at  any  rate  to  reach  the  disease  and  remove 
it  before  he  or  she  had  become  much  weakened  by  long- 
continued   discharge.     The   shock   of   such   a  radical 
operation  was  necessarily  very  severe,  and  it  was  very 
important  that  the  patient  should  realise  the  risk  of 
such  an  operation  ;   but  through  it,  at  any  rate,  there 
was  a  chance  of  getting  the  disease  away  and  prolonging 
life,  whereas  otherwise  there  was  little  or  no  hope. 
Such  operations  must  always  be  rather  risky,  because 
vessels  and  nerves  were  found  far  out  of  their  normal 
position,    through    cicatricial    contraction    following 
upon  the  original  operation.     It  was  necessary  in  this 
case,  he  pointed  out,  as  in  many  others,  to  investigate 
the  inner  aspect  of  the  pelvis  as  otherwise  any  necrosb 
in  that  situation  could  not  be  dealt  with.     After  snch 
an  operation  one  could  hardly  hope  for  anything  bat 
a  flail  limb,  and  if  the  patient  regained  strength  and 
the  limb  was  found  to  be  useless  it  could  be  subse- 
quently removed.     Of  course,  removal  at  the  time,  he 
remarked,  was  not  to  be  thought  of  on  account  of  the 
excessive  shock. 

ITALIAN  HOSPITAL,  QUEEN  SQUARE. 
Impacted  Foreign  Body  in  the  Lower  End  of 
the  (Esophagus. — Mr.  Lenthal  Cheatle  operated 
on  a  girl.  aet.  20,  who  had  been  admitted  on  account 
of  having  swallowed  a  half-crown  three  days  previously. 
She  was  retching  and-  vomiting,  and  the  vomit 
contained  streaks  of  blood.  She  vomited  immediately 
after  taking  food.  Examination  with  a  bougie  showed 
obstruction  at  the  cardiac  end  of  the  oesophagus. 
A  coin-catcher  caught  the  coin,  which,  however,  was 
so  firmly  impacted  that  a  sufiicient  force  of  traction 
to  remove  the  foreign  body  was  not  deemed  advisable. 
After  admission  the  temperature  was  10 1®  at  night, 
and  the  pain  in  the  chest  went  on  increasing.  Mr. 
Cheatle's  colleague,  Dr.  Naumann,  kindly  X-rayed 
the  case  and  demonstrated  the  coin  in  the  gastric 
end  of  the  oesophagus.  The  abdomen  was  opened  in 
the  middle  line  above  the  umbilicus,  the  stomach 
brought  out  on  to  the  abdominal  wall,  and  a  curved 
longitudinal  incision  made  midway  between  the  two 
curvatures  in  the  anterior  wall  of  the  viscus.  The 
lips  of  the  wound  were  held  up  and  apart,  and  the 
gastric  contents  removed  by  means  of  sponges.  The 
stomach  was  next  put  back  into  the  abdomen,  and 
the  finger  inserted  into  the  oesophagus  through  the 


Oct.  12,  1904. 


LEADING  ARTICLES. 


The  Medical  P&ess.    389 


gastric  opening.  The  coin  could  just  be  felt.  Curved 
laryngeal  forceps  were  passed  along  the  examining 
finger,  the  coin  seized,  and  easily  pulled  downwards. 
The  stomach  wall  was  sewn  up  as  follows : — ^The 
xnucous  membrane  was  joined  by  silk  sutures,  the 
muscular  and  x^eritoneal  coats  were  brought  together 
by  Hals  ted' s  sutures.  The  abdominal  wound  was 
closed  in  the  usual  way.  Mr.  Cheatle  said  that  as  it 
had  not  been  safe  to  leave  the  case  any  longer,  for 
th.e  temperature  was  rising,  the  pain  increasing,  and 
the  patient  starving,  and  as  it  was  dangerous  to 
endeavour  to  pull  the  foreign  body  upwards  with  the 
coin-catcher  on  account  of  the  very  firm  impaction, 
he  had  no  alternative  but  to  attempt  its  removal 
from  below.  He  pointed  out  that  he  had  easily 
found  the  oesophageal  opening  in  the  stomach  by 
passing  his  finger  upwards  along  the  lesser  curvature 
of  the  viscus,  until  the  oesophageal  opening  was 
reached ;  unless  some  method  of  this  kind  be  adopted, 
the  oesophageal  opening  is  surprisingly  difficult  to 
find. 

The  girl  went  out  of  the  hospital  after  a  fortnight 
perfectly  well. 


XTbe  AeMcal  press  and  Circular* 

PaMiabed  •▼•ry  W«dnet(Uy  moraiiw,  PHm  6d«     Pott  iNe,  6|d. 

AiyVBRTUJUUIfTB. 

On    IirBnTKW :— Whole  Pag«,   £6    Os.     Od. ;     Half  Pac*, 

£li  lOi.  Od. ;  Qaarter  Pace,  iBl  St.  (ML ;  Ona-tlglith,  Ifii.  6d. 
Ooaaiderabla  lUdtiotioos  from  the  foregoiag  nalo  an  made  wfaaa 

an  order  is  given  for  a  ■eriea  ol  ioMrtftoaa.     Xerma  on  appUoa- 

tioo  to  the  PaUtoher. 
Sinall  aanouncemenu  of  PraoUoee,  Ametondee,  Yaoanoiaa,  Booka, 

Ao.— Seren  linea  or  under  (70  worda),  4e.  6d.  per  inaertion  : 

Od.  per  line  beyond. 

SUBIOftlPnOMB. 
aubacrlptioni  may  ooromeaoe  as  any  period  of  the  year.  If  paid  In 
adranoe  the  ooat  to  only  21a.  par  annum,  poat  free.  Aa  edition 
la  printed  on  thin  plate  paper  for  foreifn  and  Ooloaial  anb- 
aeribera  at  Ua.  per  annimi.  poat  free.  U  paid  la  adTanoa,  or 
88a.  Od.  credit  rate. 


TLbc  Aedfcal  press  and  Circular. 


"  SALUS  POPULI  SUPHBM A  L£X.' 


WEDNESDAY.  OCTOBER  12.  1904. 


HOSPITAL  ISOLATION  AND  SCARLET 
FEVER. 
This  week  we  publish  the  last  of  our  series  of 
papers  dealing  with  the  question  of  the  utility  of 
hospital  isolation  as  a  means  of  controlling  the 
spread  of  scarlet  fever.  Every  one  of  our  con- 
tributors has  either  openly  stated,  or  strongly 
suggested,  his  disbelief  in  the  ability  of  isolation 
hospitals  to  accomplish  the  purpose  named.  For 
ourselves  we  can  hardly  go  so  far.  Though  con- 
vinced of  the  necessity  of  a  searching  inquiry  into 
the  whole  matter,  we  cling  to  the  belief  that  isola- 
tion must  prevent  a  certain  number  of  attacks  of 
scarlet  fever,  and  that  by  so  doing  the  hospital 
system  must  be  credited  at  least  with  accomplishing 


a  certain  amount  of  good.  Whether  that  good  is 
commensurate  with  the  financial  outlay  involved 
it  must  be  confessed  is  open  to  doubt,  and  this 
would  clearly  form  one  of  the  pertinent  questions 
for  a  Commission  of  Inquiry  to  decide.  Most  of 
our  contributors  have  fastened  on  scarlet  fever 
as  the  disease  towards  which  the  light  of  inquiry 
should  be  turned,  but  Dr.  Marriott,  who  deserves 
the  credit  of  having  first  had  the  courage  to  open 
up  the  subject  of  the  doubtful  utiUty  of  isolation 
hospitals,  pointed  out  in  our  last  issue  how  diffi- 
cult it  would  be  to  confine  attention  to  one  disease. 
The  considerations  that  militate  against  success 
for  the  sjrstem  in  dealing  with  scarlet  fever  operate 
in  no  small  degree  in  the  case  of  diphtheria, 
and  there  is  little  evidence  that  typhoid  fever  out- 
breaks are  appreciably  prevented  by  the  convey- 
ance of  individual  cases  to  hospital.  But  in  the 
two  latter  maladies  the  therapeutic  gain  to  the 
patient  is  undeniable,  to  say  nothing  of  the  virtues 
of  strict  disinfection,  good  nursing  and  careful 
medical  supervision  which  are  admittedly  essential 
to  the  proper  treatment  of  iall  but  the  most  benign 
cases  of  diphtheria  or  typhoid  fever.  In  the  bulk 
of  scarlet  fever  cases  it  cannot  be  pretended  that 
nursing  or  physicking  plays  any  important  rSle 
in  the  recovery  of  the  patient,  and  the  figures 
presented  by  Dr.  Hubert  Biss  in  his  first  paper 
showing  the  comparative  mortaUty-rates  for  home- 
and  hospital-treated  cases  for  London  give  little 
warrant  for  the  assumption  that  scarlet  fever 
patients  in  general  gain  much  from  hospital 
methods.  Moreover,  there  is  a  large  class  of  doubt- 
ful cases  and  of  mixed  infections  which  is  so  in- 
timately related  to  scarlet  fever  on  the  one  hand, 
and  to  diphtheria  on  the  other,  that  no  inquiry 
could  afford  to  leave  them  out  of  account.  In  con- 
templating the  whole  matter  the  mind  must  clearly 
distinguish  for  itself  the  two  issues — the  preven- 
tive influence  of  the  hospitals,  and  the  machinery 
for  individual  treatment  which  they  afford.  The 
two  questions  are  distinct.  It  is  one  thing  to  argue 
that  the  poor  should  be  provided  with  accommoda- 
tion for  their  infectious  sick  when  this  cannot  be 
arranged  for  at  home,  and  quite  another  to  demand 
that  nolens  volens  every  one  of  their  number  who 
suffers  from  a  mild  attack  of  scarlet  fever  or  diph- 
theria shall  be  hurried  into  hospital  for  six  or  eight 
weeks.  It  may  be,  and  we  are  quite  prepared  for 
the  conclusion,  that  hospital  facilities  should  be 
granted— out  of  the  rates,  if  need  be — ^for  practi- 
cally all  cases  of  typhoid  fever,  a  large  number  of 
cases  of  diphtheria,  and  a  proportion  of  cases  of 
scarlet  fever  that  need  more  care  than  their  home 
circumstances  can  allow,  but  the  money  expended 
for  this  purpose  can  only  be  incidentally  regarded 
as  required  for  preventive  medicine.  The  outlay 
would  be  primarily  and  justifiably  eleemosynary, 
just  as  the  outlay  on  our  voluntary  hospitals  and 
workhouse  infirmaries  is  at  present.  And  if  the 
three  diseases  named  are  thus  provided  for,  why 
should  severe  cases  of  measles  and  whooping-cough 
be  denied  the  same  advantages  ?  The  answer  is 
not  obvious.  Such  a  conception  of  the  functions 
of  a  fever  hospital  differs  entirely  from  that  which 


39Q    Thb  Mbdical  Pkxss. 


LEADING  ARTICLES. 


Oct.  12,  IQQ4. 


at  present  prevails,  and  without  abolishing  the 
institutions  on  which  so  much  money  has  been 
spent,  a  Commission  of  Inquiry  might  find  a 
method  by  which  their  up-keep  might  be  made 
less  burdensome  to  the  community  without 
essentially  curtailing  their  usefulness  to  the  sick 
poor.  The  general  opinion  of  the  medical  pro- 
fession has  been  seriously  disturbed  on  the  subject. 
Five  years  ago  the  isolation  hospital  was  regarded 
as  the  one  preventive  measure  on  which  no  dis- 
agreement was  possible,  or  even  admissible.  At 
the  present  moment  all,  or  nearly  all,  our  contem- 
poraries have  expressed  their  doubt  as  to  its  ability 
to  accomplish  its  declared  ends,  and  many  medical 
officers  of  health  have  declared  themselves  in  even 
more  decided  terms.  Our  own  columns  bear  wit- 
ness to  the  same  fact.  Although  it  is  now  seven 
weeks  since  we  published  the  first  of  our  series  of 
papers,  we  have  not  heard  from  any  of  our  readers 
that  they  are  not  in  substantial  accord  with  the 
position  the  writers  have  taken  up  —  a  sign 
we  take  to  indicate  that  the  matter  is  one  on  which 
they,  too,  would  like  the  searchhght  of  inquiry 
turned.  The  question  is  undoubtedly  one  of 
great  pubHc  moment.  Delay  and  uncertainty  are 
irritating,  if  not  positively  dangerous.  After  all 
that  has  been  said  and  written,  it  is  impossible 
to  conceive  tranquilhty  and  confidence  being 
restored  until  the  matter  has  been  sifted  to  the 
bottom. 


"  OUR  VISITORS." 
The  present  week  has  witnessed  a  medico-social 
event  of  considerable  interest,  in  that  the  medical 
men  of  London  have  been  privileged  to  extend  the 
hand  of  good-fellowship  to  a  representative  dele- 
gation of  conffhes  from  across  the  Channel.  Al- 
though a  friendly  feeling  between  practitioners  of 
the  healing  art  has  always  existed,  quite  irrespective 
of  the  political  outlook  of  the  moment,  this  visit 
followed  harmoniously  in  the  wake  of  various  other 
international  functions  of  the  kind  engendered  by 
the  re-awakening  of  cordial  sentiments  between  the 
two  countries.  We  welcomed  our  French  visitors 
the  more  because,  in  truth,  we  suspect  that  they, 
generally,  are  not  as  familiar  with  our  medical  and 
educational  institutions  as  British  practitioners 
are  with  theirs.  One  experiences  a  feehng  of 
satisfaction  at  being  enabled  to  show  them  that, 
although  methods  may  differ,  the  study  and  the 
application  of  medical  science  are  pursued  with  as 
much  energy  and  perseverance  here  as  on  the  Con- 
tinent. For  the  famiharity  of  many  EngUsh  prac- 
titoners  with  French  hospitals  and  schools  we  have 
to  thank  the  unfailing  courtesy  with  which  the 
British  medical  tourist  is  received  in  Paris  and  else? 
where,  especially  if,  in  addition  to  his  desire  to  ex- 
tend his  sphere  of  observation,  there  be  added  a 
working  acquaintance  with  the  French  language. 
Our  visitors  cannot  have  failed  to  notice  the  decen- 
tralisation that  characterises  the  organisation  of 
our  medical  schools,  societies,  and  charities,  by 
the  sturdy  individualism  that  has  achieved  toler- 
ably satisfactory  results  in  spite  of  the  friction  and 
waste  of  energy  inherent  to  this  phase  of  evolution. 


They  will,  we  trust,  carry  away  with  them  the  con- 
viction that  the  absence  of  State  control  is  by 
no  means  incompatible  with  efficiency.  It  is  to 
be  apprehended  that  some  difficulty  was  ex- 
perienced in  enabling  them  to  grasp  the  funda- 
mental difference  between  our  general  hospitals 
supported  by  voluntary  contributions  and  the  not 
less  admirably  equipped  infirmaries  provided  by 
the.  Poor-law  Service.  Surprise  may  have  merged 
into  wonder  when  they  learnt  the  ixnmense  field  d 
clinical  observation  and  study  afforded  by  the 
latter  is  practically  inaccessible  to  our  medical 
students  for  reasons  which  assuredly  will  not  appeal 
to  them.  The  time  at  the  disposal  of  our  visitors 
was  very  short — only  some  three  working  days— 
but,  judging  from  the  programme,  they  were  weB 
filled,  all  the  principal  medical  institutions  of  the 
Metropolis  having  received  a  share  of  attentioa. 
Nor  was  the  social  side  neglected,  for,  apart  from 
the  private  hospitahty  dispensed  on  a  large  scak 
by  individual  members  of  the  profession  to  per- 
sonal friends,  various  lunches  and  receptions  wet 
provided  for  the  benefit  of  substantial  fractions  of 
the  delegation,  ending  to-night  in  a  banquet 
at  the  Hotel  Cecil,  at  which  a  distingnish.ed  and 
numerous  company  of  Enghsh  medical  men  as- 
semble to  greet  their  foreign  guests.  A  visit  <x 
these  lines  is  quite  a  different  matter  from  a  formal 
international  gathering  such  as  a  congress,  the 
members  whereof  become  mere  inconspicuous  itens 
of  a  comprehensive  scheme.  It  is  to  the  congics 
what  the  conversazione  is  to  the  ordinary  busines 
of  a  medical  society,  and  we  should  gladly  see  tlm 
mode  of  intercommunication  developed.  No  pro- 
fession rejoices  in  a  freedom  from  mere  geographic^ 
Umitations  at  all  comparable  to  that  of  medidnt 
Law  and  theology  are  virtually  local  institutiois 
developed,  at  any  rate  in  their  form,  in  response 
to  local  requirements,  but  the  objects  of  medidne 
as  a  curative  art  are  the  same  in  all  places  and  in  all 
ages.  For  this  reason  personal  intercourse  be- 
tween medical  men  of  different  nationahties 
possesses  an  educational  value  not  to  be  des- 
pised. We  are  all  confronted  by  the  same  scien- 
tific problems  and  by  the  same  material  questions 
of  professional  existence,  and  nothing  can  be  more 
useful  or  agreeable  than  to  discuss  these  **  across 
the  walnuts  and  the  wine." 


KING'S    COLLEGE    HOSPITAL    AND    ANTI- 
VIVISECTION. 
The   addresses  at  the  opening   of   the   winter 
sessions  of  our  medical  schools   are   the   annual 
occasion  of  many  oratorical  effects.     In  many  in- 
stances the  speakers  deal  with  subjects    that  lie 
outside     their    scientific     life,     and     not     infre- 
quently the  fruits  of  their  philosophical  ventures 
are    more  or  less  unripe,  grotesque,  and  unsatis- 
factory.    The  address  at  King's  College  Hosptal 
London,  was  for  the  most  part  of  the  high  order 
of    intelligence,    clearness,  and    knowledge    that 
would  naturally  be  associated  with  the  eminent 
physician  by  whom  it  was  deUvered,  Dr.  Thomas 
Buzzard.     One  point  of  his  address,  however,  as 


Oct.  12,  1904. 


NOTES   ON   CURRENT   TOPICS. 


THK  MlDICAL  PlESS.     391 


reported  in  the  general  newspaper  press,  is  of  such 
an  unusual  character  as  to  demand  some  amount 
of   explanation  by  all  who  are  concerned  with 
the  amenities  of  our  common  professional  life.    The 
statement  in  question  may  perhaps  be  capable  of  a 
satisfactory  alternative  reading,  but,  as  it  stands, 
it  certainly  suggests  a  popular  appeal  to  a  section 
of  the  public — ^the  anti-vivisectionists — ^with  whom 
the    medical  profession  generally  is  at  hopeless 
variance.     It  would  be  easy  to  imagine  the  glee 
"With  which  the  supporters  of  that  particular  cult 
"will     gloat    over    Dr.    Buzzard's    announcement. 
For    years    past,    under    the  leadership   of  Mr. 
Stephen  Coleridge,  they  have  conducted  a  particu- 
larly venomous  attack  on  the  particular  London 
hospitals  in  whose  schools  experiments  on  animals 
have   been   performed,   or  whose   medical  staffs 
have  been  either  directly  or  indirectly  connected 
with    any   such   experimentation.     Judge,    then, 
of   their  feelings  when  they  hear  that  the  new 
hospital  south  of  the  Thames  will  be  in  future 
disconnected  from  the  teaching  school,  which  is  to 
retain   its    old    quarters    in    the    old    buildings. 
Further,  to  quote  the  words  of  Dr.  Buzzard,  "  The 
laboratories  of  experimental  pathology  and  also  of 
neuro-pathology   cannot   conveniently   be    trans- 
ferred  to  the  new  hospital,  for  the  council  and 
hospital  staff  are  agreed  that  original  researches  in 
these  subjects,  which  may  involve  experiments  on 
Uving  animals,  shall  find  no  place  within  its  walls." 
This  looks  remarkably  like  a  public  declaration 
that  King's  College  Hospital  appeals  to  the  public 
for  support  on  the  grounds  that  it  is  free  from  the 
taint   of  biological  experiment.     Within  the  last 
few  years  a  small  institution  has  come  into  being 
at   Battersea,  and  has  boldly  declared  itself  an 
anti-vivisectionist    hospital,    but   its   claims    and 
methods  have  not  hitherto  gained  the  approval 
of  the  medical  profession.     At  such  a  time  it  is  un- 
fortunate that  an  institution  of  the  standing  and 
importance    of    King's    College    Hospital   should 
make  even  a  covert  appeal  to  the  pubUc  on  a  simi- 
lar  point.     One  of  the  present  surgeons  of  that 
hospital,  Mr.  Watson  Cheyne,  and  one  of  the  past 
surgeons.  Lord  Lister,  have  been  made  the  objects 
of    particularly   venomous   attacks   by  the   anti- 
vivisectionist  party.     After  all,  the  partial  sever- 
ance of  the  two  functions  of  teaching  and  of  purely 
hospital  work  does  not  mean   that   experiments 
upon  lower  animals  will  not  be  performed  if  deemed 
necessary  in  connection  with  treatment  of  patients 
in  the  wards.     It  simply  implies  that  any  neces- 
sary experimental  investigation  will  be  conducted, 
not  within  the  hospital  walls,  but  in  a  sister  building 
a  mile  or  two  away.     We  cannot  possibly  believe 
that  the  authorities  of  King's  College  in  future 
intend  to  exclude  all  such  investigations,  which 
are   required,  for  instance,  to  identify  doubtful 
cases  of  tuberculosis,  diphtheria,  and  certain  other 
maladies  due  to  the  invasion  of  specific  pathological 
micro-organisms.     It  is  to  be  regretted,  therefore, 
that  a  declaration  of  an  ambiguous  nature  has 
been  permitted  to  reach  the  public  on  a  matter  in 
which  the  interests  of  progressive  medical  science 
are  so  intimately  concerned. 


flotes  on  Current  XCopfcs^ 

Alooholism  and  Insanity. 
The  relationship  of  alcoholism  to  insanity  is 
obviously  one  of  the  most  important  social  prob- 
lems that  could  be  brought  before  the  notice  of 
the  medical  profession,  especially  in  view  of  the 
recent  steady  increase  of  insanity  in  the  United 
Kingdom.  In  another  part  of  the  present  issue 
of  The  Medical  Press  and  Circular  we  print  a 
valuable  and  suggestive  letter  upon  this  subject 
from  the  pen  of  a  distinguished  authority,  to  wit. 
Professor  T.  S.  Clouston,  of  the  Royal  Edinburgh 
Asylum.  From  a  study  of  the  statistics  of  his 
own  asylum  he  concludes  that  during  the  past 
twenty  years  there  has  been  a  steady  increase  in 
the  number  of  cases  of  insanity  due  to  alcoholism. 
That  increase  he  found  to  be  relatively  greater 
among  the  rich  than  among  the  poor.  Few  who 
are  acquainted  with  the  inner  life  of  our  great 
cities  will  differ  from  Dr.  Clouston  in  his  conclusion 
that "  our  city  and  industrial  population  are  drink- 
ing far  too  much  for  their  health,  and  that  if  the 
present  tendencies  go  on  there  is  a  bad  look-out 
for  the  future  of  the  people  who  are  crowded  into 
our  cities."  There  can  be  no  reasonable  doubt 
that  the  drinking  habits  of  the  nation  are  respon- 
sible for  a  good  deal  of  their  madness  no  less  than 
of  many  other  of  their  ills.  Wise  and  well-con- 
sidered legislation  in  the  direction  of  national  tem- 
perance is  one  of  the  most  urgently  needed  of  all 
political  reforms.  Foreign  wars  and  conquests 
may  be  necessary  now  and  then,  but  the  drink 
evil  is  ever  within  our  walls,  a  burning  and  in- 
creasing danger. 

The  Prevention  of  Malaria. 

A  STUDY  of  the  discussion  on  the  prophylaxis 
of  malaria  which  took  place  at  Oxford  is  bound  to 
raise  the  question  as  to  whether  the  present  prac- 
tice in  anti- malarial  operations  is  correct. 
Roughly  speaking,  the  steps  which  are  supposed 
to  be  necessary  to  rid  a  district  of  malaria  consist  in 
destroying  the  breeding-places  of  the  anopheles. 
All  marshes  are  to  be  drained,  all  ditches  and  pools 
emptiest  and  all  water  that  cannot  be  got  rid  of 
covered  with  a  coat  of  oil.  It  will  be  remem- 
bered that,  some  two  or  three  years  ago,  in  order 
to  test  the  validity  of  these  views,  the  Indian 
Government  sanctioned  a  prolonged  experiment 
at  Mian  Mir,  the  management  of  which  was  in 
the  hands  of  officers  of  the  Indian  Medical  Service. 
The  experiment,  which  is  now  concluded,  failed 
to  produce  any  change  in  the  fever  returns,  and  its 
failure  is  held  by  some  critics  as  a  proof  of  the  in- 
efficacy  of  the  methods  we  have  mentioned. 
They  are  said,  and  doubtless  truly,  to  be  in- 
effectual against  what  may  be  called  a  compen- 
satory immigration  of  mosquitoes.  Further, 
it  is  claimed  that,  although  the  harmless  mos- 
quitoes may  be  considerably  diminished  in  num- 
ber by  the  activity  of  a  "  malaria  brigade,"  there 
is  but  Uttle  evidence  that  anopheles  are  affected. 
As  this  work  of  destruction  of  breeding-places  is 
very  costly,  and   is  not  likely  to  be  undertaken 


39^    Thb  Medical  Piess. 


NOTES    ON    CURRENT    TOPICS. 


Oct.  12,  19Q4. 


unless  there  is  a  fair  prospect  of  success,  it  is 
important  to  consider  how  far  such  criticisms  are 
valid.  It  may. be  said  at  once  that  the  Mian  Mir 
experiment  is  insufficient  both  in  scope  and 
accuracy  to  lead  to  any  far-reaching  conclusion. 
Only  a  small  area  of  ground  was  chosen,  a  ridi- 
culously small  sum  of  money  was  spent,  and  the 
locality  was  quite  unsuitable  as  a  site  for  the 
experiment,  since  an  hour's  rainfall  in  that  district 
is  often  enough  to  fill  pools  and  hollows  which  it 
had  taken  weeks  to  empty.  A  failure  under  such 
circumstances  is  in  no  way  a  set-ofi  against  the 
brilliant  success  in  Ismailia,  and  in  lesser 
degree  in  Sierra  Leone,  Lagos,  Havana,  and 
elsewhere.  Ismailia  has  been  practically  cleared 
of  malaria  by  the  drainage  of  waste  pools  of 
water.  Consequently,  in  certain  places  at  any  rate, 
the  "  malaria  brigade  "  is  still  the  strong  arm  of 
prophylaxis.  But,  nevertheless,  it  is  not,  we  fear, 
universally  applicable  and  in  itself  sufficient. 
Anopheles  breed  not  only  in  stagnant  pools,  but  in 
running  water,  and  it  is  impossible  to  stop  the 
irrigation  of  a  country-side  even  to  get  rid  of  such 
a  plague  as  malaria.  In  many  districts  reliance 
will  have,  for  the  present  at  any  rate,  to  be  placed 
on  protection  against  the  anopheles  rather  than  on 
its  destruction.  At  the  same  time,  it  would  be  a 
calamity  if  the  Mian  Mir  episode  were  to  bring  into 
discredit  a  method  of  prophylaxis  which  in  certain 
localities  is  not  only  useful  but  of  preponderant 
importance. 


"  Live  Bails"  and  Accidental  Electrocution. 

The  great  increase  in  the  number  of  electric 
railways  throughout  the  country  makes  it  a  matter 
of  publie  interest  to  consider  their  liability  to 
accidents.  From  every  part  of  the  kingdom 
there  come  reports  of  serious  bums,  shocks,  or 
even  deaths  due  to  accidental  contact  with  the 
live  rail  or  wire.  It  is  noticeable  that  there 
is  practically  no  danger  in  touching  the  live 
rail  unless  one  is  at  the  same  time  resting 
on  the  earth,  for  authorities  state  that  there  is 
probably  no  pressure  of  current  that  would  do 
harm  if  one  could  be  entirely  insulated  from  the 
earth.  Accidents  occur  commonly  by  the  victim 
treading  on  the  live  rail  or  stumbling  on  it, 
or  in  some  cases  grasping  it  ignorantly  in  his  hand. 
Where  the  overhead  system  is  used  it  is  obvious 
that  an  accident  cannot  occur  so  long  as  the  wire 
is  intact.  If  it  breaks,  however,  its  dangling 
end  may  cause  serious  results  by  estabUshing 
a  circuit  with  someone  standing  beneath.  It 
was  formerly  held  that  only  currents  of  high 
voltage  were  likely  to  cause  fatal  results,  but 
this  view  is  now  being  abandoned.  A  brief  contact 
with  2,000  volts  may  not  prove  fatal,  whereas 
loss  of  life  has  resulted  from  contact  with  250 
volts,  the  ordinary  current  used  for  domestic 
lighting  purposes.  There  is  still  some  question 
as  to  the  cause  of  death  when  a  fatal  result 
occurs,  some  observers  maintaining  that  the 
death  is  due  to  respiratory,  and  others  to  cardiac 
paralysis.  Even  in  cases  of  apparent  death, , 
animation  can  often  be  restored  by  the    perform- 1 


ance  of  artificial  respiration.  Professor  Silvanos 
Thompson  has  called  attention  to  the  "  live  rail," 
which,  he  says,  will  be  a  thing  of  the  past  in  a  fev 
years'  time.  There  is  no  doubt  of  the  danger  of 
that  system,  but  the  alternative  overhead  plan  b 
by  no  means  devoid  of  risks,  except,  perhaps 
in  undergroimd  tunnels. 

Preparation  of  tlie  Surgeon's  Hands. 

The  problem  how  to  treat  the  surgeon's  hands 
so  as  to  render  them  aseptic  has  not  yet  been  quite 
satisfactorily  solved  in  this  country.  The  ordinary 
methods  of  scrubbing  and  of  treating  with  anti- 
septics, although  practically  they  seem  to  ansirer 
well,  are  certainly  not  free,  in  theory,  from  bacterio- 
logical objections.  So  much  so  that  some  surgeons 
deUberately  use  sterilised  rubber  gloves  for  them- 
selves and .^their  assistants.  But  these  gloves  ait 
a  great  encumbrance,  and  though  custom  enabb 
a  surgeon  to  ^gain  a  certain  amount  of  dexterity 
in  them,  he  can  never  have  the  same  skill  whes 
using  them  in  delicate  manipulations  as  he  enjoys 
with  the  bare  hand.  An  ingenious  method  has 
been  devised  by  Dr.  John  B.  Murphy,  of  Chicaga 
and  it  has  given  such  excellent  results  in  his  prac- 
tice, and  seems  so  free  from  objection,  that  it  may 
well  be  given  a  trial  over  here.  The  plan  he  adopts 
is  to  use  a  solution  of  rubber  dissolved  in  benzdi 
solution  as  a  pigment  for  the  hands,  and  wba 
this  is  painted  over  and  allowed  to  set  an  imper- 
meable coating  is  formed  which  neither  allovs 
the  wound  to  be  contaminated  by  secretions  from 
the  hands  of  the  siugeon,  nor  the  hands  to  be 
infected  with  purulent  or  other  discharges  froa 
the  patient.  Dr.  Murphy  uses  a  similar  solutka 
in  which  acetone  is  the  solvent  for  appUcation  tt 
the  patient's  skin  in  the  neighbourhood  of  the 
wound,  and  he  is  so  well  satisfied  with  both  mea- 
sures that  he  now  employs  them  in  all  cases.  The 
idea  strikes  us  as  a  good  one,  and  if  it  is  as 
serviceable  in  practice  as  it  sounds  in  theory  the 
solution  should  prpye  a  god-send  to  surgeons  nHio 
suffer  from  cracked  hands  and  homy  fingers. 


Medioal  "Frumps." 

If  "  manners  makyth  the  man,"  no  less  snrdy 
does  dress  make  the  woman,  and  whether  from  a 
desire  to  dissociate  themselves  from  the  fashionabte 
world,    or   from  a   determination  to  carry  their 
ideas  of  the  hygienic  requirements  of  dress  into 
practical   operation,    the   early    medical   women 
certainly  brought  down  a  good  deal  of  ridicule 
upon  themselves  by  their  mode  of  attire.    Tacti- 
cally  this  was  a  mistake.     Clean,   fresh-lookmg 
girls  with  neat  figures  and  pretty  costumes  would 
have  won  their  battle  far  more  easily  than  dowdy 
women  with  sad  colours  and  weirdly  grotesque 
dresses.    Moreover,  impressions  once  created  take 
long    to    efface.     The     male     medical    student 
to   the  public  is  still  the  rowdy,   beer-drinking 
creature  that  Bob  Sawyer  was,  and  female  medical 
students  are  Ukely  to  be  '*  new  "  women  in  the 
eyes  of  the  world  for  many  a  day.     Miss  Murdoch, 
in  her  introductory  address  at  the  School  of  Medi- 
cine for  Women,  deplored  the  fact  that  the  stigma 


_  Oct.  12,  1904. 


NOTES    ON    CURRENT    TOPICS.         Thb  Medical  Pmss.   393 


of  carelessness  in  dress  still  rested  upon  the  woman- 
doctor,  and  urged  her  audience  to  do  their  best  to 
remove  it.  In  her  view  the  female  "  medical " 
should  be  of  the  world  as  well  as  in  it,  and  it  will 
.surely  not  need  much  insistence  to  oblige  the 
sweet  girl-graduates  "not  to  lose  touch  with  theatre 
or  music  ;  to  go  to  parties  ;  to  go  out  into  the 
world  and  exchange  ideas  with  others."  But  there 
is  another  possibility  to  be  faced.  If  the  lady 
student  dons  the  costume  of  the  age  and  mingles 
freely  with  the  giddy  world  there  is  considerable 
danger  that  she  may  soon  find  herself  the  subject 
of  a  vivd  voce  examination  requiring  an  affirmative, 
monosyllabic  answer.  And  if  this  be  given, 
what  sort  of  future  will  there  be  for  female  medical 
education  ? 


Wooden  Heads  and  Wooden  Legs. 

The  enthusiastic  "  first-aider "  has  been  the 
subject  of  a  good  deal  of  chafi  in  the  past,  but  he 
has  certainly  come  to  stay.  Still,  he  wants  a  little 
improvement.  We  pointed  out  recently  that,  ad- 
mirable as  much  of  the  work  of  the  St.  John 
A  mbulance  Association  is,  the  courses  of  instruc- 
tion are  far  too  short,  and  that  though  the  treat- 
ment of  injuries  is  well  taught,  the  diagnosis  of 
those  injuries  is  inadequately  dealt  with.  An 
accident  reported  near  Victoria  Station  the 
other  day — ^if  true — illustrates  this  defect  in 
a  rather  amusing  manner.  A  Mr.  Thomas, 
f  rom  New  Brompton,  arrived  on  a  visit  to  the 
Metropolis,  but  either  through  want  of  acquaint- 
ance with  the  danger  of  London  streets  or  lack 
of  the  necessary  agility,  he  had  the  misfortune  to 
be  knocked  down  by  a  hansom.  The  usual  crowd 
collected,  and,  on  finding  the  subject  of  its  atten- 
tion unable  to  rise,  diagnosed  a  fracture  of  the 
leg.  A  handy  police  constable  arrived  oppor- 
tunely on  the  scene,  and  took  the  case  in  charge. 
Demanding  materials  for  a  splint,  he  was  pro- 
vided with  a  broom-stick,  and,  with  the  aid  of  a 
-workman's  saw  and  some  readily  proffered  hand- 
kerchiefs he  quickly  manufactured  a  capital  sub- 
stitute for  a  "  long  Liston."  The  crowd  gaped  with 
-wonder  .at  the  ingenious  constable,  and  murmurs 
of  admiration  arose  at  his  promptitude  and  dex- 
terity. But,  alas  1  for  human  fallibility,  the  pre- 
parations, like  those  made  by  the  town  rat  for  his 
guest  from  the  country,  were  doomed  to  futility 
through  unexpected  circumstances.  While  the 
constable  worked  and  the  crowd  gaped  the  patient 
sat  up,  rubbed  himself,  and  sprang  on  to  the  sound 
foot.  Before  the  bystanders  could  recover  from 
their  astonishment  and  indignation  the  patient 
vras  nonchalantly  marching  up  the  street,  gaily 
swinging  the  injured  leg ;  it  was  a  wooden  one. 
1 1  is  fair  to  add  that  by  another  and  later  account 
a  makeshift  wooden  leg  was  made  out  of  a  broom- 
handle  by  the  skill  and  readiness  of  the  station 
constable. 


well  to  be  aware  of  the  means  by  which  nervous 
energy  may  be  economised  and  exhaustion  of  the 
tissues  staved  off.  It  will  be  generally  admitted 
that  the  best  work  is  nearly  always  done  by  severe 
concentration  of  the  mental  powers  continued  for 
a  considerable  period  of  time.  The  amount  of 
work  that  can  be  got  through  by  steady  application 
for  a  long  stretch  of  time  is  surprising,  though  when 
the  end  is  accomplished  and  there  is  nothing  left 
to  work  for,  reaction  quickly  takes  place  and  at  the 
end  of  the  day  the  feeling  of  which  the  worker  is 
most  conscious  is  vexation  of  spirit.  This  applies 
more  particularly,  of  course,  to  mental  work,  for 
mere  animal  fatigue  resulting  from  hard  physical 
toil  is  somewhat  easier  to  bear.  The  very  act  of 
sinking  into  an  arm-chair  when  one  is  bodily  tired 
is  in  itself  a  pleasure,  and  if  the  mind  has  been 
comparatively  unoccupied  new  delights  are  ex- 
perienced in  music  or  in  an  interesting  book. 
The  responsibility  attached  to  certain  higher  forms 
of  work  is,  in  nine  cases  out  of  ten,  more  wearying 
than  the  performance  of  the  actual  duties  them- 
selves. Some  types  of  mind  are  totallly  unfitted  to 
hold  responsible  posts  ;  the  mere  knowledge  that 
others  will  be  influenced  by  their  every  act,  either 
for  good  or  evil,  would  be  almost  enough  to  drive 
them  out  of  their  senses.  Such  are  destined  to 
work  under  the  direction  of  others  all  their  lives. 
However  well  balanced  a  mind  may  be,  there  is  a 
limit  to  its  working  capacity,  and  if  this  limit  be 
exceeded  a  breakdown  must  occur  sooner 
or  later.  The  report  of  the  Board  of  Trade  upon 
the  recent  collision  at  a  North  London  terminus 
very  wisely  laid  stress  upon  the  hours  of  duty 
worked  by  a  trusted  signalman  as  being  far  too 
long  for  the  heavy  and  responsible  nature  of  the 
work.  It  is  a  wonder,  indeed,  that  cases  of 
"  error  of  judgment "  do  not  happen  more  fre- 
quently, especially  if  railway  companies  will 
persist  in  economising  at  the  expense  of  servants 
who  are  continually  subjected  to  a  high  degree  of 
nervous  strain. 


Lonff  Hours  and  Nerve  Strain. 

The  physiology  of  fatigue  is  full  of  practical 
importance  to  all  who  lead  the  strenuous  life, 
whether  it  be  of  the  body  or  of  the  mind,  for  it  is 


Boric  Acid  and  Kidney  Disease. 

Much  has  been  written  of  late  about  the  effects 
of  boric  acid  and  borax  upon  the  body  when  these 
substances  are  consumed  in  the  form  of  food- 
preservatives.  As  far  as  the  stomach  is  concerned, 
it  would  appear  that  fairly  large  quantities  of 
boric  acid  may  be  ingested  without  producing 
any  ill  effects,  for  as  much  as  forty-six  grains  have 
been  taken  fasting  without  any  discomfort  or  un- 
toward symptoms.  Some  observers  have  found 
that  the  drug  acts  as  a  mild  aperient,  even  when 
taken  in  the  small  proportion  employed  to  preserve 
milk.  Other  foods,  such  as  corned  beef,  have  been 
known  to  contain  as  much  as  yS^  per  cent,  of 
boric  acid,  a  point  of  some  importance  in  view  of 
the  fact  that  among  certain  classes  of  the  com- 
munity this  is  a  common  form  of  meat-consump- 
tion. It  is  yet  debatable  as  to  whether  the  borated 
foods  endanger  the  public  health.  Fere  has  shown, 
however,  that  the  repeated  use  of  boric  acid  or 
borax  may  be  accompanied  by  a  decided  risk  of 
producing  or  aggravating  lesions  of  the  kidneys. 


394    The  Medical  Pkess.         NOTES    ON    CURRENT    TOPICS. 


Oct,  12.  iy>4. 


Albuminuria  not  infrequently  follows  their  internal  | 
Administration.  Professor  Charles  Harrington,  (a) 
of  Harvard,  has  recently  conducted  a  series  of  ex- 
periments in  order  to  ascertain  if  the  kidneys  are 
commonly  aflEected  by  a  continuous  diet  of  food  i 
preserved  with  boric  acid.  Twelve  healthy  male 
cats  were  selected  and  were  placed  exactly  under 
the  same  conditions.  Six  of  them  received  daily, 
for  a  period  of  nineteen  weeks,  varying  amounts 
of  borax.  One  of  these  animals  died  quite  early, 
but  the  others  were  killed  at  the  end  of  the  ap- 
pointed time.  Of  those  which  had  received  the 
preservative  five  were  found,  post-mortem,  to 
be  suffering  from  lesions  of  the  kidneys  analogous 
to  those  of  subacute  and  chronic  nephritis  in  man, 
microscopical  examination  of  sections  of  the  organs 
showing  the  presence  of  interstitial  infiltration  of 
the  cortex.  In  view  of  these  facts  some  caution 
is  needed  before  we  can  state  absolutely  that  boric 
acid  is  devoid  of  injurious  effects. 

Hygiene  in  the  Bast. 
Hygiene  as  a  science  being  in  these  countries 
the  most  modem  of  all,  we  are  accustomed  to  re- 
gard it  as  if  it  were  equally  new  the  world  over.  As 
a  matter  of  fact  it  is  one  of  the  most  ancient,  and 
from  time  immemorial  the  races  of  the  East 
have  practised  its  maxims  with  exactitude.  We 
noticed  in  a  recent  medical  address  a  casual 
reference  to  the  Japanese  as  probably  the 
most  highly  civilised  race  the  world  has  ever 
seen,  and,  although  the  statement  may  some- 
what stagger  assent,  yet,  if  cleanliness  be  the 
standard  chosen  their  pre-eminence  may  be 
granted.  It  is  doubtless  due  quite  as  much 
to  a  wish  for  immediate  comfort  as  to  a  larger 
view  of  health  that  dwellers  in  warm  climates 
devote  so  much  more  time  to  personal  hygiene 
than  is  dreamt  of  by  the  populace  in  colder 
zones;  but  whatever  be  the  origin  of  the  greater 
cleanliness  of  the  tropics  it  is  interesting  to  note 
the  detailed  attention  that  has  been  given  to  it 
by  prophets  and  lawgivers.  Through  the  Old 
Testament  we  are  all  familiar,  with  the  elaborate 
ritual  of  hygiene  which  was  imposed  upon  the  Jews, 
though,  indeed,  in  their  migration  to  other  cli- 
mates it  tends  to  become  little  less  than  ritual, 
and  to  lose  much  of  its  living  spirit.  Some  of  the 
Jewish  customs,  however,  still  universal,  among 
them,  are  well  founded  in  the  laws  of  health, 
and  much  of  the  viriUty  of  that  wonderful 
people  is  doubtless  due  to  their  continued 
observance.  Such,  for  instance,  are  the  prac- 
tice of  circumcision,  and  the  custom  of  marital 
abstinence  for  a  definite  period  after  men- 
struation. Of  great  importance,  too,  is  the 
rigid  attention  given  to  examination  of  meat  in- 
tended for  food,  disease  in  any  part  being  suffi- 
cient to  condemn  the  entire  carcase.  In  the  chapter 
on  water  in  Avicenna's  work,  written  in  the  eleventh 
century,  and  probably  summarising  the  Arab 
wisdom  of  his  day,  the  clearest  directions  are  given 
to  aid  one  in  judging  good  from  bad  water,  and 

(a;  i^uwr.  J<mm.  Med,  Sci.,  September,  1901. 


boiling  is  recommended  in  all  cases  of  doubt  or 
suspicion.  He  writes  sensibly  of  the  therapeutics 
of  pure  water,  and  he  warns  against  its  conveyance 
in  leaden  pipes  as  productive  of  bowel  complaints. 
It  is  interesting  to  note,  too,  a  saying  attributed 
to  Mahomet,  and  well  borne  out  by  modem  dis- 
covery :  "  If  a  fly  fall  into  a  drinking  water- vessel 
that  vessel  must  be  washed,  for  a  fly  carries  disease 
in  one  of  its  wings." 


Human  Foot^and-Mouth  Diaeaae. 

On  various  occasions  during  epidemics  of  the 
dread  disease  of  cattle  known  as  "  foot-and- 
mouth  disease,"  infection  of  man  has  taken  place. 
The  disease  is  marked  by  vesicles  and  ulcers  oo 
the  mucous  membrane  of  the  mouth,  and  whea 
men  have  been  attacked  the  disease  usually  has 
run  an  acute  and  fatal  course.  Apart,  however, 
from  any  known  connection  with  foot-and-mouth 
disease,  but  occurring  principally  among  butcheis, 
several  cases  of  acute  pemphigus  of  remarkable 
type  have  been  noted.  There  was  usually  a 
severe  infectious  dermatitis  with  hemorrhagic 
bullae,  having  a  special  tendency  to  affect  tk 
mouth,  palate,  and  nostrils.  The  course  was 
rapid  and  .fatal.  In  Boston,  in  1902,  following 
on  the  use  of  infected  vaccine  lymph,  a  series  of 
ten  cases  of  this  type  of  infective  dermatitis  ap- 
peared, while,  curiously  enough,  in  Wake&eH. 
in  1903,  an  epidemic  of  foot-and-mouth  disease 
originated  with  the  inoculation  of  a  calf  with  m- 
pure  virus.  Though  the  fact  that  the  infection  in 
each  case  can  be  conveyed  by  vaccine  lymph  is 
not  sufficient  to  estabUsh  the  identity  of  the  two 
diseases,  yet  it  will  be  seen  that  there  are  sufficient 
grounds  for  suspecting  that  infectious  pemphigie 
in  man  and  foot-and-mouth  disease  in  cattle  aa 
closely  aUied. 


Work  as  a  Therapeutic  Measure. 

An  American  contemporary  in  a  recent  issus 
devotes  an  editorial  article  to  the  discussion  rt 
work  as   a  rational  method   of    treatment,  and 
thinks  that  in  recent  years  its  efl&cacy  has  been 
somewhat   overlooked.     The   importance   of  rest 
is  recognised,  not  merely  by  every  practitioner  of 
medicine  but,  at  any  rate  in  the  abstract,  by  nearly 
every  patient,  and  elaborate  systems  of  treatment 
such  as  Dr.  Weir-Mitchell's,  based  thereon  have 
been  demonstrated  to  be  of  value.     On  the  other 
hand,  while  we  often  advise  ph3rsical  exercise  as  a 
therapeutic  measure,  we  but  rarely  advise  work 
pure  and  simple,  and  there  has  been  no  attempt 
to   systematise    a    method    of    treatment   which 
should  have  work,  either  ph3rsical  or  mental,  as  its 
fundamental  principle.     While  there  are  doubtless 
many  cases  drifting  into  invalidism  where  regular 
and  ordered  work  is  the  only  restorative  needed 
yet  we  think  that  more  often  regulation  of  the 
hours  and  methods  of  working  is  what  is  required. 
It  is  rare  enough  to  meet  with  anyone  suffenng 
from  sheer   overwork,   though   common  to  find 
patients  broken  down  under  uncongenial  toil,,  and 
ill-regulated  hours  of  labour,  and  it  is  in  cases  like 
these  that   the   careful   advice  of    the  ph}'siciafl 


Oct.  12,  1904. 


PERSONAL. 


The  Medical  Press.    395 


may  be  most  useful.  With  those  suffering  from 
sheer  idleness,  however,  we  do  not  think  much  good 
is  likely  to  result  from  the  prescription  of  work, 
unless  some  scheme  could  be  devised  for  carrying 
it  into  effect  with  the  same  rigour  as  is  done  in  the 
case  of  rest  by  Dr.  Weir  Mitchell. 


Eye  Maasaffe. 

The  anti-vivisectionists  have,  by  their  methods, 
unfortunately  ahenated  the  sympathy  of  most 
right  thinking  people,  and  with  every  desire  to  be 
fair,  it  is  nevertheless  impossible,  after  what  has 
taken  place  in  the  past,  to  have  any  dealings  with 
them  now.  Under  the  leadership  of  Mr.  Stephen 
Coleridge,  they  have  practically  declared  war  to 
the  knife  with  the  medical  profession,  and  they 
have  carried  on  their  campaign  by  the  most  dis- 
ingenuous methods.  Perhaps  their  latest  move, 
the  establishment  of  an  "  anti- vivisection  "  hos- 
pital, is  the  most  deliberately  mischievous  of  any 
of  their  performances,  for  it  invites  the  suggestion 
that  **  vivisection  **  is  carried  on  as  a  part  of  the 
general  practice  of  other  hospitals.  No  sane  man 
can  believe  that  they  will  fail  to  avail  themselves 
of  knowledge  that  has  been  gained  by  experiments 
on  animals  ;  indeed,  it  would  be  impossible  for  them 
not  to  do  so.  Inoculation,  moreover,  as  a  means 
of  diagnosis,  is  a  daily  necessity  in  hospitals  where 
scientific  medicine  is  practised.  Unhappily,  the 
anti-vivisectionists  have  found  it  possible  to  obtain 
a  medical  staff.  In  the  case  of  the  eye  department, 
they  have  secured  the  services  of  a  Mr.  Stephen 
Smith,  who  has  recently  set  at  naught  the  recog- 
nised usage  of  the  profession.  Having  "  dis- 
covered "  a  method  of  correcting  defects  of  vision 
by  manipulation  of  the  eye-ball,  instead  of  availing 
himself  of  the  usual  channels  for  submitting  his 
method  to  the  expert  judgment  of  the  profession, 
he  has  seen  fit  to  describe  it  to  a  general  gathering 
of  press  reporters.  He  is  now  engaged  in  an  un- 
edifying  duel  detailed  at  some  length  in  the  Daily 
Mail,  and  has  nominated  as  his  *'  referee  "  a  Dr. 
Ettles,  of  the  Minories.  We  do  not  think  either  of 
these  gentlemen  is  likely  to  raise  himself  in  the 
estimation  of  his  colleagues  by  his  action,  and  both 
of  them  may  easily  do  the  reverse. 


Out  Frenoh  ViBitors. 

Our  visitors  are  having  a  busy  time.  After 
the  reception  at  the  Hotel  Russell  on  Sunday 
evening,  at  which  many  eminent  members  of  the 
p»rofession  in  London  were  present,  the  serious 
business  began  on  Monday  morning  with  a  visit 
to  the  Royal  College  of  Surgeons  of  England, 
"where  the  visitors  were  received  by  the  President 
in  his  robes,  supported  by  members  of  Council. 
The  President  welcomed  them  to  the  College  in 
French,  and  invited,  them  to  visit  the  scene  of 
John  Hunter's  triumphs.  Great  was  the  admira- 
tion excited  by  the  inspection  of  the  museum,  its 
extent,  its  symmetry,  and  the  inimitable  care  with 
-which  the  collection  is  maintained  and  cared  for. 
General  regret  was  expressed  at  the  inadequacy 
of  the  time  at  the  disposal  of  the  visitors  to  take 


Then  followed  a  complimentary  lunch  offered  by 
the  editor  of  the  Lancet  at  the  Imperial  Restaurant, 
which  was  presided  over  by  Mr.  Thos.Wakley,  Junr. 
A  letter  was  read  from  Mr.  Wakley,  Sen.,  who, 
though  prevented  from  being  present  by  his  ad- 
vanced years,  welcomed  his  French  confreres  to 
England  and  expressed  the  hope  that  if  they  did 
not  add  much  to  their  medical  knowledge,  they 
would,  at  any  rate,  carry  away  a  souvenir  of  the 
sympathy  and  affection  which  English  practi- 
tioners felt  for  their  French  brethren,  and  he  re- 
ferred in  touching  terms  to  his  own  experience  of 
French  hospitals  in  days  long  since.  Due  praise 
was  accorded  by  representative  members  of  the 
French  medical  profession  to  the  importance  of 
the  Lancet  as  an  organ  of  professional  interests. 
The  next  item  was  a  visit  to  St.  Bartholomew's 
Hospital,  where  the  visitors  were  received  by  the 
members  of  the  staff  and  conducted  in  sections 
through  the  wards  and  laboratories.  The  home- 
like comfort  of  the  wards  and  the  ample  floor  space 
accorded  to  each  patient  were  much  admired,  and 
after  having  completed  the  inspection  of  the  hos- 
pital the  visitors  were  taken  to  the  palatial  board- 
room, where  the  portrait  of  Henry  VIII.  attracted 
special  attention.  A  visit  to  this  famous  institu- 
tion would  obviously  not  be  complete  without  a 
pilgrimage  to  that  interesting  old  structure,  the 
Xhurch  of  St.  Bartholomew,  the  history  of  which 
was  duly  narrated  by  the  vicar  and  translated  into 
French  for  the  benefit  of  those  who  did  not  under- 
stand English.  After  dinner  the  visitors  adjourned 
in  large  numbers  to  the  magnificent  reception 
organised  by  Dr.  and  Mrs.  Dundas  Grant  at  their 
residence  in  Cavendish  Square,  where  sweet  strains 
were  dispensed  at  intervals  by  Mr.  Edouard  Crosse's 
orchestra.  Mr.  Walter  Kirby,  the  Australian 
tenor,  elicited  warm  applause  by  his  rendering  of 
several  choice  songs.  Metropolitan  practitioners 
were  largely  represented  at  this  gathering,  and 
the  greatest  animation  prevailed  throughout  in 
spite  of  the  apparently  slight  obstacle  due  to  the 
difference  of  language. 

PERSONAL. 


On  Saturday  last,  October  8th,  H.R.H.  the  Duchess 
of  Albany  formally  opened  the  new  operating  theatre 
of  the  London  National  Hospital  for  the  Paralysed  and 
Epileptic  in  Queen's  Square.  After  the  ceremony  the 
Duchess  inspected  the  hospital. 

An  address  was  presented  to  the  Duchess  by  the 
Chairman  of  the  Board,  Mr.  John  Dundas  Power,  and 
later  Sir  Victor  Horsley  announced  a  gift  of  ;£  1,000 
to  endow  a  table  in  the  department  of  nervous  diseases 
research. 


It  transpires  that  the  medical  man  who  rendered 
such  splendid  service  in  the  recent  railway  disaster  at 
Llanelly  was  Dr.  Hepburn,  the  well-known  Professor 
of  Anatomy  in  Cardiff  University  College. 

In  one  account  of  the  accident  it  is  stated  that  in- 
valuable assistance  was  rendered  to  the  injured  by 
Mr.  Harry  Watkins,  of  Brixton  Lane,  London,  who  was 
travelling  in  the  train,  and  who  was  happily  unhurt. 


-   ,  ,  .      ^.  ,.  ,.  We  regret  to  say  that  the  name  of  Dr.  W.  P.Jones, 

cognisance  of  the  multitudmous  objects  of  mterest.     of    Sheffield,  appears    among    the    injured,    with    an 


39^    The  Medical  Peess. 


SPECIAL    CORRESPONDENCE. 


intimation  that    there   is  a  fracture    of    the  pelvis, 
but,  happily,  an  early  recovery  is  expected. 

Mr.  Frederick  Ransom,  a  well-known  citixen  of 
Ipswich,  has  endowed  a  bed  in  the  East  SufiEolk  and 
Ipswich  Hospital  at  a  cost  of  £  1,000. 

The  annual  distribution  of  prizes  in  connection  with 
the  Welsh  Border  Brigade  Bearer  Company  was  made 
by  Colonel  A.  W.  Duke,  M.D.,  R.A.M.C.,  Principal 
Medical  Officer  N.W.  District. 


The  King,  on  the  recommendation  of  the  Home 
Secretary,  has  added  the  name  of  Dr.  Donkin,  one  of 
his  Majesty's  Commissioners  of  Prisons,  to  the  Royal 
Commission  appointed  to  inquire  into  the  care  of  the 
feeble-minded. 


A  presentation  was  last  week  made  to  Dr.  Albert 
Bradshaw.  of  Wattlesborough,  Montgomeryshire,  by 
friends  and  patients,  on  the  occasion  of  his  leaving  the 
district  to  practise  in  Birmingham. 

The  Times  has  announced  the  approaching  marriage 
of  Mr.  T.  Mark  Hovell  with  the  Hon.  Margaret  Cecilia 
Bateman-Hanbury,  daughter  of  the  late  Lord  Bateman, 
and  sister  of  the  present  peer. 

Dr.  J.  F.  J.  Sykes,  Medical  Officer  of  Health  for 
the  Metropolitan  District  of  St.  Pancras,  will  deliver 
the  Presidential  Address  of  the  Incorporated  Society 
of  Medical  Officers  of  Health  at  9,  Adelphi  Terrace, 
London,  on  October  14th  next,  at  5  p.m.  The  annual 
dinner  of  the  society  will  be  held  at  the  Trocadero 
Restaurant  in  the  evening  of  the  same  day. 

Lord  Ludlow  has  been  appointed  a  member  of  the 
weekly  board  of  the  Middlesex  Hospital. 

Sir  Alfred  Fripp,  owing  to  the  pressure  of  engage- 
ments, has  resigned  his  position  as*a  member  of  the 
Advisory  Board  for  Army  Medical  Service.  Sir  Alfred 
has  been  a  member  of  the  Board  since  it  was  established 
three  years  ago. 


Oct.  12.  1904. 


The  rumour  is  contradicted  that  Sir  Frederick  Treves 
is  to  succeed  to  the  office  recently  vacated  by  Sir  Wm. 
Taylor.  K.C.B.,  Director-General  of  the  Army  Medical 
Service. 


Sir  Isambard  Owen,  who  has  been  appointed  prin- 
cipal of  the  Durham  College  of  Science,  and  is  well 
known  in  the  medical  world  as  a  professor  of  St. 
George's  Medical  School,  has  rendered  excellent  service 
to  the  cause  of  higher  education  in  Wales.  A  Welsh- 
man by  birth,  he  was  some  years  ago  appointed  Deputy- 
Chancellor  of  the  University  of  Wales. 

It  is  announced  that  Dr.  Blachford  has  been 
appointed  medical  superintendent  of  the  Bristol  City 
Lunatic  Asylum,  at  Stapleton,  to  fill  the  vacancy 
occasioned  by  the  recent  death  of  Dr.  Benham. 


Dr.  MacLaren,  who  has  held  the  post  of  senior 
surgeon  at  the  Cumberland  Infirmary,  at  Carlisle,  for 
upwards  of  thirty  years,  has  resigned  that  appoint- 
ment, and  Dr.  Lidiard,  Carlisle,  now  becomes  the 
senior  surgeon  at  the  institution. 


Sir  Dyce  Duckworth  has  been  appointed  to  the 
vacancy  in  the  offices  of  Medical  Referee  to  the  Trea- 
sury, and  Medical  Adviser  to  the  Pensions  Commu- 
tation Board,  caused  by  the  resignation  of  Dr.  Lionel 
Beale.  F.R.S. 


The  office  of  Principal  of  the  Durham  Umvenity 
College  of  Science  at  Newcastle-on-Tj-ne  was  rendered 
vacant  by  the  death  of  Dr.  H.  P.  Gumey ,  who  was  killed 
while  mountaineering  in  Switzerland  in  August. 

Dr.  G.  a.  Gibson,  of  Edinburgh.  wiU  open  the 
Winter  Course  of  Post-Graduate  Lectures  in  connection 
with  the  Mount  Vernon  Hospital,  at  the  Central  Out- 
patient Department,  7,  Fitzroy  Square,  I.xmdoo.  with 
an  address  on  "  Certain  Aspects  of  Pleurisy-." 

Dr.  Ernest  W.  White,  for  many  years  Medical 
Superintendent  of  the  City  of  London  Asylum  at 
Dartford,  has  been  granted  a  superannuation  allowance 
of  ;fi,ooo  per  annum. 

Special  oorresponDence* 

[from  our  own   correspondents.] 


The  first  general  meeting  of  the  Medical  Society  of 
London  will  be  held  on  Monday,  October  loth,  at  8  p.m., 
and  the  first  ordinary  meeting  at  8.30  p.m.  on  the  same 
day.  when  the  President,  Mr.  John  Langton,  will 
deliver  the  opening  address. 


SCOTLAND. 

Queen  Alexandra  Sanatorium.  Davos. — ^Lord 
Balfour  of  Burleigh.  Chairman  of  the  Committee  for 
the  Sanatorium,  addressed  the  first  of  a  series  of  meet- 
ings to  be  held  in  the  larger  Scottish  towns  on  behalf 
of  this  institution  in  Glasgow,  on  the  5  th  inst.  The 
scheme  is  to  build  a  thoroughly  up-to-date  sanatorium, 
of  about  one  hundred  beds,  for  the  benefit  of  patients 
able  to  pay  25s.  or  30s.  a  week.  The  committee 
require  about  ;^ 50 ,000  for  a  start,  and  of  this  they  have 
already  got  upwards  of  £6,000.  The  British  nation  was 
the  first  in  Davos  to  have  an  institution  of  this  kind  at 
all,  but  others  have  now  outstripped  us,  and  it  is  hoped 
that  the  new  sanatorium,  in  which  patients  can  be 
treated  for  the  bare  cost  of  maintenance,  -will  bring  us 
level  in  the  race  again. 

Murray's  Royal  Asylum,  Perth. — The  new  viUas 
for  male  and  female  patients  were  opened,  and  the 
new  chapel  dedicated  on  the  29th  ult.  Among  those 
present  were  Lord  Mansfield,  Sir  James  Crichtoa 
Browne,  Provost  Love,  Perth,  and  others.  Murray's 
Asylum,  opened  in  1827,  is  one  of  the  seven  Royal 
asylums  in  Scotland.  It  has  recently  been  modernised, 
and  several  new  villas  have  been  erected  at  a  cost  of 
over  ;f2,ooo  each.  The  chapel  has  been  subscribed  for 
by  i>atients  and  friends  of  the  institution,  and  was 
erected  from  plans  prepared  by  Dr.  Urquhart,  the 
medical  superintendent  of  asylum.  After  the  luncheon 
which  followed  the  ceremony,  Sir  James  Crichton 
Browne  proposed  the  toast  of  the  Murray  Royal 
Asylum  in  a  graceful  speech,  in  which  the  modern  treat- 
ment of  the  insane  was  contrasted  with  that  of  the  old 
days,  in  which  madness  was  regarded  as  demoniacal 
possession  and  sufferers  from  it,  if  not  cured  by  exor- 
cism, as  deserving  of  being  treated  like  wild  beasts, 
starved,  bound,  beaten,  done  to  death,  or  caged  in 
noisome  cells  where  they  were  littered  on  straw,  ex- 
posed to  cold  and  hunger  and  to  nameless  barbarities 
by  their  keepers,  and  sometimes  exhibited  to  gratify 
public  curiosity. 

Chalmers'    Hospital,   Edinburgh. — This   hospital 
will  soon  be  again  ready  for  the  admission  of  patients, 
it  having  been  closed  since  July  pending  the  building 
of  a  new  operating  theatre,  the  installation  of  special 
baths,  and  the  adaptation  of  part  of  the  grounds  to 
open  air  treatment.     The  hospital  owes  its  existence  to 
George  Chalmers,  a  plumber  in  Edinburgh,  who  died 
in  1836,  bequeathing  the  greater  part  of  his  fortune  for 
the  erection  of  a  hospital  for  the  sick  and  hurt.    The 
funds  were  entrusted  to  the  Dean  and  Faculty  of  Ad\'0- 
cates,  who  wisely  allowed  them  to  accumulate  until 
1 86 1,  when  the  building,  opened  in   1864.  was  com- 
menced.    In  accordance  with  the  desire  of  the  testator, 
the  wards  have  been  divided  into  public  or  free  wards, 
and  private  wards.    The  latter  are  the  chief  claim  which 
the  hospital  has  to  fuller  support,  for  they  afiord  a 
'  means  of  obtaining  hospital  treatment  to  those  who, 
too  well-to-do  to  accept  of  charity,  are  yet  unable  to 
pay  the  charges  of  a  private  nursing  home.    During 
1903,  195  patients  were  treated  in  the  public  and  113 
in  the  private  wards,  while  2,578  out-patients  were 


Oct.  1 2,  1904. 


CORRESPONDENCE. 


Tbb  Medical  Press.    397 


dealt  with  in  the  waiting-room.  Dr.  Muirhead  is 
physician  to  the  hospital,  and  Mr.  H.  J.  Stiles  succeeds 
Sir  P.  H.  Watson  in  the  post  of  surgeon. 

BELFAST. 

The  Memorial  to  Dr.  McKeowk. — A  circular 
letter  has  been  issued  by  the  committee  in  charge  of 
the  proposed  memorial  to  Dr.  McKeown.  showing  that 
subscriptions  amounting  to  aboot  jfioo  have  been 
received,  and  asking  for  further  subscriptions.  The 
appeal  is  grounded  chiefly  on  Dr.  McKeown' s  work  as 
a  patriotic  citizen  interested  in  educational  concerns. 
After  detailing  some  of  the  affairs  in  which  he  interested 
himself,  the  letter  proceeds  : — "  It  is  not  intended 
that  a  memorial  should  be  taken  as  an  indorsement  of 
all  the  views  and  all  the  efforts  of  Dr.  McKeown,  but  as 
a  public  recognition  of  the  very  honest  work  of  a  great, 
truthful  Irishman,  who  had  high  ideals.  Dr.  McKeown 
conceived  that  the  relations  between  the  State  and 
the  citizen  should  have  the  same  openness,  and  should 
be  marked  by  the  same  absence  of  underhand  dealing, 
and  of  all  forms  of  wire-pulting  and  back-door  influence, 
as  should  mark  the  relations  of  honest  friends  in  private 
life  and  the  transactions  of  honest  men  in  commerce. 
^Whether  or  not  his  criticisms  of  individuals  or  organi- 
sations or  of  their  methods  were  always  accurate, 
it  is  recognised  that  he  was  in  all  things  single-minded 
and  steadfast,  and  that  he  spoke  the  truth  as  he 
thought  it  in  his  heart."  These  sentences  indicate 
precisely  .  where  Dr.  McKeown's  weakness  lay,  and 
explain  why  he  accomplished  so  little  in  educational 
afiairs.  Trickery  and  wire-pulhng  were  perfect  bogeys 
to  him,  and  he  saw  them  in  every  action  of  those  who 
opposed  him.  He  was  of  the  stuff  that  martyrs  are 
made  of.  not  business  men.  The  form  which  the 
memorial  will  take  has  not  yet  been  decided,  but  it 
is  intended  that  it  shall  be  one  in  harmony  with  Dr. 
McKeown's  public  services. 

The  Forster  Green  Hospital  for  Consumption 
AND  THE  Corporation. — At  a  meeting  of  the  city 
Corporation  last  week  it  was  reported  that  the  Lord 
Mayor  and  several  members  of  the  Corporation  had 
met  with  the  authorities  of  the  Forster  Green  Hospital 
at  a  private  conference,  and  afterwards  had  waited 
on  the  Local  Government  Board  to  discuss  ways  and 
means  for  the  establishment  and  maintenance  of  a 
Sanatorium  for  consumptives.  It  is  clear  from  this 
that  there  is  some  truth  in  the  reports  that  have  been 
circulated,  that  the  Corporation  is  considering  the 
possibility  of  taking  over  and  enlarging  the  Forster 
Green  Hospital,  instead  of  building  a  new  one  for  the 
city. 


CorteaponDence* 

[We  do  not  hold  ouneWei  rasponsibte  for  the  opinions  of  oar 
Oorreepondento.  ] 


ALCOHOLISM  AND  INSANITY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir. — I  entirely  agree  with  your  remarks  in  your 
issue  of  this  date  (October  5  th)  as  to  the  difficulty  and 
fallacy  of  attempting  to  assign  with  definiteness  all 
the  causes  of  any  case  of  mental  disease.  But  in 
most  cases  we  can  by  careful  inquiry  ascertain  the 
•chief  immediate  or  exciting  cause  of  an  attack.  No 
doubt  in  very  many  instances  the  patient's  brain  had 
been  in  so  unstable  a  state  that  a  very  slight  cause 
indeed  would  be  sufficient  to  produce  the  final  and 
marked  mental  upset  for  which  the  patient  had  to  be 
placed  under  treatment  in  a  mental  hospital.  When 
alcohol  becomes  a  chief  etiological  factor  of  insanity 
I  think  it  is  very  important  from  a  social  point  of 
view  that  special  attention  should  be  directed  to  the 
fact,  because  it  is  to  a  large  extent  a  preventable 
cause.  We  all  know  that  unstable  and  hereditarily 
weak  brains  are  those  that  are  most  liable  to  the  alcohol 
craving,  and  when  poisoned  by  exceto  of  the  stimulant 
they  are  specially  apt  to  be  upset  in  their  mental 
working.  I  think  that  such  persons  should  all  be  made 
to  know  the  risk  they  run  from  alcohol.     In  fact, 


those  risks  should  be  made  a  peu*t  of  their  school 
education,  and  the  duty  of  avoiding  them  be  instilled 
into  their  consciences.  At  present  many  persons  sin 
in  this  way  through  ignorance.  Hence  I  and  others, 
notably  Dr.  Conofly  Norman,  of  Dublin,  Dr.  Parker 
and  Dr.  Marr,  of  the  great  Glasgow  asylums,  who  see 
much  of  alcoholic  insanity,  look  on  it  as  a  duty  to 
accentuate  the  facts  in  our  reports  and  spread  as 
widely  as  we  can  our  inferences  from  these  facts.  As 
you  well  know,  the  effects  of  alcohol  on  the  brain  are 
far  more  accurately  observed  now  than  they  were  some 
years  ago,  and  we  can  speak,  therefore,  with  more 
dogmatism  and  authority  on  the  point. 

Now,  when  we  find  that  alcoholic  insanity  is  in- 
creasing in  our  institutions,  that  it  is  in  the  city  asylums 
where  that  increase  is  most  seen,  and  that  within  a 
few  years  past  the  figiires  are  really  alarming,  1  think 
you  will  agree  with  me  that  we  should  fail  in  our  duty 
if  we  did  not  draw  the  attention  of  our  profession  and 
the  public  to  the  matter  by  every  means  in  our  power. 

As  to  the  statistics  of  the  Royal  Edinburgh  Asylum 
in  regard  to  alcoholic  causation  of  mental  disease, 
they  are  very  striking.  As  is  well  known  to  the  pro- 
fession, alcohol  may  act  as  a  cause  of  an  attack  of 
ordinary  insanity,  or  it  may  produce  a  true  "  alcoholic 
insanity,"  accompanied  by  characteristic  symptoms 
such  as  vivid  hallucinations,  pareses,  neuritis,  &c. 
I  find  that  40  per  cent,  has  to  be  taken  off  the  whole 
number  of  cases  in  which  the  alcohol  has  been  a 
distinct  exciting  or  predisposing  factor  to  get  the 
number  of  cases  of  true  alcoholic  insanity.  Treating 
our  statistics  in  this  way,  so  as  to  put  them  on  a 
scientific  basis  and  to  eliminate  error,  I  find  that  for 
the  ten  years  1874-83.  12  per  cent,  of  the  admissions 
of  both  sexes  were  cases  of  alcoholic  insanity ;  that 
for  1884-93  they  amounted  to  13  per  cent. ;  for  1894- 
1903,  17*5  per  cent. ;  and  for  1903,  23  per  cent.  The 
gross  alcoholic  percentage  of  42*3  for  the  men  for 
1903,  to  which  you  refer,  reduced  to  28  per  cen<.  of 
true  alcoholic  insanity,  perhaps  represents  an  excep- 
tional year,  but  it  is  a  fact,  and  is  on  the  whole  on  all 
fours  with  the  Dublin  and  Glasgow  statistics  for  1903* 
The  gross  alcoholic  percentage  in  the  male  admissions 
of  the  two  great  Glasgow  asylums  at  Gartloch  and 
Woodilee  for  1903,  was  33*9  per  cent,  of  the  admissions. 
The  last  English  Blue  Book  shows  that  for  the  whole 
of  England  and  Wales  the  male  pauper  admissions 
showed  an  alcoholic  percentage  of  237  for  the  past 
five  years,  this  including  the  country  asylums,  as 
well  as  those  of  the  large  cities.  In  the  rural  and  non- 
manufacturing  districts,  the  percentage  is  not  nearly 
as  great  as  this,  leaving  a  much  larger  amount  for  the 
cities.  In  the  Montrose  Asylum,  accommodating  the 
rural  part  of  Forfarshire,  the  percentage  for  both 
sexes  for  1903  was  only  8.  Tlie  last  Irish  Kue  Book 
showed  for  1903  a  percentage  of  10*5. 

Our  statistics  of  general  paralysis  for  the  past 
thirty  years  confirm  the  general  inference  that  drink 
and  syphilis,  for  they  go  together  largely  in  this  country, 
are  increasing  in  our  cities.  It  has  risen  from  6  to 
1 3  per  cent,  in  that  time. 

Our  statistics  and  those  of  the  English  Lunacy  Blue 
Books — the  Scottish  Blue  Books  do  not  as  yet  give 
complete  etiological  statistics  of  the  admissions  to 
asylums — seem  to  show  that  neither  alcoholic  insanity 
nor  general  paralysis  are  as  common  in  the  private 
class  of  patients  as  among  the  rate-paid.  In  our 
Craig  House  department  for  the  more  wealthy  private 
patients  we  had  only  9  per  cent,  of  alcoholic  admissions 
for  1903.  In  England  the  private  class  for  the  five 
years  1 898-1902  showed  onty  12*9  per  cent,  of  alco- 
holic causation  for  both  sexes,  against  16*35  among  the 
paupers. 

I  am  well  aware  that  "  figiires  may  be  made  to 
prove  anything,"  and  that  we  have  as  yet  no  ex- 
haustive statistical  inquiry  to  throw  light  on  this 
grave  social  question.  But  I  contend  the  figures  I 
have  quoted  do  make  out  a  strong  prima  facte 
case  for  the  conclusion  that  our  city  and  industrial 
populations  are  drinking  far  too  much  for  their  brain 
health,     that    their   brain     resistiveness    against    the 


398    The  Medical  Press.  LITERARY  NOTES  AND  GOSSIP. 


Oct.  12.  1904. 


evil  efiects  of  alcohol  is  lessening,  and  that  if  the 
present  tendencies  go  on  there  is  a  bad  look-oot  for 
the  futtire  of  the  people  who  are  crowding  into  our 
cities*  and  who.  in  spite  of  improved  sanitation  and  a 
lessened  death-rate,  do  not  seem  to  be  acquiring  the 
self-control  especially  needed  to  resist  the  temptations 
and  dangers  of  an  urban  life.  There  is  no  single  agent 
that  can  do  their  mental  condition  so  much  harm  in 
the  circumstances  in  which  they  are  placed  as  excess 
of  alcohol,  and  none  that  will  affect  their  progeny  so 
badly  in  mind  and  body.  The  process  of  acclimatisa- 
tion of  a  man  or  woman  bred  in  the  country  to  a  city 
life  and  environments  is  a  dangerous  one ;  certain  bad 
results  show  themselves  at  once,  while  others  take 
years  to  do  so.  Alcoholic  insanity  seems  to  be  one 
of  the  latter  kind. 

I  am,  Sir,  yours  truly, 

T.  S.  Clouston,  M.D. 
The  Royal  Edinburgh  Asylum, 
October  5  th,  1904. 

THE    DIMINISHING    BIRTH-RATE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — ^Whatever  bearing  upon  this  question  Dr. 
Woods  Hutchinson's  article  (referred  to  by  a  corres- 
pondent in  The  Medical  Press  and  Circular  of  this 
week)  may  possibly  have  is  not  apparent  in  the  quota- 
tions cited.  All  living  creatures  lower  in  the  scale 
than  man  are  controlled  by  natural  forces  against 
which  they  do  not  contend  by  action  based  upon 
knowledge  and  reason.  Civilised  mankind  alone  have 
obtained  the  power  to  mould  as  they  please  their 
physical  and  moral  development.  The  type  of  future 
man  which  shall  predominate  is  capable  of  production 
with  as  much  certainty  as  the  breeder  of  horses,  cattle 
or  dogs  can  produce  in  time  creatures  of  the  type 
adapted  best  to  his  purposes.  Creatures  below  the 
level  of  man  do  not  sin,  they  have  no  vices ;  men 
are  sinners,  vast  masses  of  them  are  full  of  vice  or 
are  at  best  permeated  by  a  narrow  selfishness,  byjan 
egoism  which  subordinates  every  consideration  to  the 
desire  for  a  life  of  ease  and  "  pleasure  "  for  themselves 
and  those  they  love.  "  Let  us  eat,  drink,  and  be  merry, 
for  to-morrow  we  die."  "What  has  posterity  done  for 
us  that  we  should  sacrifice  for  posterity  ? "  These 
sayings  express  the  sentiments  of  decadent  civilisations. 
If  such  ideas  triumph  as  they  are  doing  in  France  and 
seem  likely  to  do  throughout  the  other  races  of  modern 
European  origin,  the  doom  of  these  nations  is  sealed. 
The  Yellow  Peril  may  in  time  become  a  reality,  and 
if  after  the  lapse  of  a  few  centuries  Macaulay's  New 
Zealander  be  not  found  contemplating  the  ruins  of 
London  from  a  broken  arch  of  the  bridge,  the  glory 
of  the  Empire  may  none  the  less  have  departed,  and 
the  world's  dominion  fallen  from  the  hands  of  the 
Anglo-Saxon  into  those  of  a  more  vigorous  and  wise, 
albeit,  perhaps,  an  Asiatic  people. 

I  am,  Sir,  yours  truly., 

A  Student  of  Sociology. 

October  sth,  1904. 


WHOOPING  COUGH. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — In  an  article  on  the  "  Bacteriology  of  Pertussis" 
(October  5th,  1904),  I  find  the  following  :  "  Moreover, 
for  generations  it  has  been  recognised  as  infectious, 
and  no  observation  has  thrown  any  doubt  or  this 
belief."  May  I  correct  this  statement  in  the  briefest 
manner.  When  I  joined  the  Hospital  for  Sick  Children 
in  Great  Ormond  Street  it  was  the  opinion  of  the 
majority  of  the  staff  that  whooping-cough  was  a  nervous 
disease,  and  the  view  of  Dr.  Niemeyer  was  entertained 
by  many.  In  a  letter  to  the  Lancet,  January  3rd,  1898, 
I  mentioned  how  Sir  Thomas  Watson  had  changed  his 
views  of  the  disease,  and  in  a  paper  read  before  the 
Medical  Society  and  published  in  Vol.  V.  of  its  Trans- 
actions, I  endeavoured  to  show  how  CuUen  was  wrong 
in  classif3ring  whooping-cough  along  with  asthma  as 
a  spasmodic  disease.  I  remember  well  meeting  my  old 
friend  the  late  Dr.  Sturges  one  day  in  St.  James's  Park, 
when  he  said  he  was  coming  round  to  my  view  that 


whooping-cough  was  infectious.  Dr.  Niemeycr's  view 
that  a  birch-rod  was  a  good  remedy  will  give  some 
idea  of  German  pathology.  I  am  rather  amused  to 
find  articles  in  our  medical  journals  winding  up  with 
some  such  name  as  Manicatkle,  or  Czaplewski,  and  I 
hope  that  The  Medical  Press  and  Circular  will  keep 
clear  of  this  curious  weakness. 

I  am.  Sir,  yours  truly, 

Robert  Lee. 

October  7  th,  1904. 

[We  thank  Dr.  Lee  for  calling  attention  to  this  fact. 
There  is  no  doubt  that  the  **  birch-rod  "  standpomt 
was  the  accepted  one  some  twenty  or  thirty  yeais  ago. 
Dr.  Lee  first  insisted  on  the  infectious  nature  of 
whooping-cough.  His  conclusion  was  based  on  clinical 
grounds,  and  a  study  of  3,000  cases.  An  interesting 
account  of  his  researches  will  l>e  found  in  the  Lancet 
January  3rd,  1898. — Ed.] 


EDWIN  HAWORTH,  M.B.,  C.M.Glasg. 
We  regret  to  announce  the  death  of  Dr.  Haworth, 
M.B.,  CM.,  medical  officer  of  health  for  Oswaldtwistle, 
near  Accrington,  Lancashire,  in  his  fiftieth  year.  He 
leaves  a  widow  and  three  young  children.  He  was 
educated  medically  at  the  University  of  Glasgow, 
where,  in  1879,  he  graduated  M.B.  and  C.M« 

DAVID   ROBERT   JONES.   L.R.C.P.Ed.,  L.M. 

Mr.  David  Robert  Jones,  one  of  the  best-known 
public  men  in  North  Wales,  died  at  his  residence. 
Corwen,  on  September  30th.  For  upwards  of  a  quarter 
of  a  century  he  had  been  chairman  of  the  Corwen  Board 
of  Guardians.  He  was  a  native  of  Bala,  was  justice  of 
the  peace  for  Merioneth,  a  member  of  the  govemiog 
body  of  Bala  County  School,  and  held  many  other  puUic 
offices.  He  was  a  prominent  Churchman,  and  leader 
of  the  local  Conservative  party.  His  medical  educatioD 
was  conducted  in  Dublin,  whence  in  1870  he  took  the 
qualification  of  L.R.C.P.Edin.  and  L.M. 

HAMILTON  HODGES.  L.R.C.P.Edin..  &c 
The  death  is  announced  of  Dr.  Thomas  Hamilton 
Hodges,  for  fifteen  years  parish  doctor  at  KiUin,  and 
latterly  of  Yetholm  and  Tweedsmuir.  Dr.  Hodges  was 
bom  at  Stair  in  1849,  a^^  received  his  medical  education 
at  Glasgow,  in  which  city  he  commenced  practice  before 
removing  to  Killin.  where  he  formed  one  of  the 
most  extensive  practices  in  Perthshire.  He  was  a 
J. P.  for  Perthshire.  Dr.  Hodges  retired  to  Tweeds- 
muir about  three  years  ago.  a  paialytic  seizure  having 
obUged  him  to  practically  relinquish  all  medical  work. 
He  took  the  qualifications  of  L.R.C.P.Edin.  and 
L.F.P.S.Glasg.  in  1873. 


Xiterarv  floted  an&  Oossip. 

The  British  Journal  of  Children's  Diseases.     (Edited 
by  George    Carpenter,   M.D.      No.   9.     Vol.  L    Sep- 
tember, 1904.) — This  journal  contains  : — (1)  A  case  of 
hydrocephalus,   in  which  drainage   of    the  ventricles 
into   the  subdural  space  was  established,  by  C.  A. 
Morton,   F.R.C.S.     In  spite  of  the   establishment  of 
a  drain  on  both  sides  of  the  brain,  the  cerebro-spinal 
fiuid  continued  to  collect,   and   the  child  ultimately 
died.     (2)  A  case  of  congenital  stricture  of  the  oeso- 
phagus, by  Bertram  M.  H.  Rogers,  M.D.     The  strictnre 
was  situated  about  an  inch  from  the  lower  end  of  the 
oesophagus,  but   no  account  is  given  of  its  cightoess 
nor  of  the  structure  of  its  walls.     (3)  Some  of  the  less 
commonly  recognised    manifestations   of  rheumatism 
in  childhood,  by  James  Burnet,  M.A.,  M.B.    Among 
the  more  important  of  these  manifestations  Dr.  Bnniet 
includes  tonsilitis,  pharyngitis,    pneumonia,  psoriasis 
and  appendicitis.     Most  of  these  conditions,  he  states, 
are  benefited  by  salicylates.    (4)  On  night  terrors  and 
sleep-walking,  by  the  Rev.  Arthur  L.  Hussey,  M.A 
(5)  An  editorial  on"  Delayed  Chloroform  Poisoning." 


Oct.  12,  1904. 


MEDICAL  NEWS. 


The  Mbdical  Pkess.   399 


The  Boston  Medical  and  Surgical  Journal,  (Vol. 
cli.  No.  8.  August,  I904.)—Two  papers  on  hydro- 
therapeutic  measures  appear  in  this  journal.  In 
l>oth  of  them  the  advantages  of  this  method  of  treat- 
ment is  pointed  out,  and  in  one  of  them,  the  fact  is 
referred  to  that  both  in  England  and  America  the 
subject  has  been  neglected.  That,  however,  there  are 
signs  of  the  advance  of  this  and  other  physical  methods 
of  treatment  is  plain  from  recent  publications.  Dr. 
E.  W.  Taylor,  of  Boston,  contributes  an  interesting 
study  of  a  case  of  sacral  spina  bifida.  Anesthesia 
-was  present  over  a  portion  of  the  gluteal  region  and 
over  the  lower  part  of  both  legs  in  this  case.  This 
anaesthetic  area  corresponded  closely  with  the  area 
marked  out  by  Thortum  and  Head  as  being  supplied 
by  the  sacral  nerves,  and  differed  considerably  from 
the  sacral  nerve  area,  as  described  by  Starr  and  by 
Kocher.  The  appointment  of  Dr.  Osier  to  the  Chair 
of  Medicine  in  Oxford  is  referred  to  by  the  Editor. 
While  expressing  regret  for  his  loss,  the  writer  says 
that  "  the  entire  medical  profession  in  America  may 
ivell  feel  a  certain  pride  in  this  choice  for  the  Regius 
Professorship  at  Oxford." 

American  Medicine.  (Vol.  viii.,  No.  9-  August, 
1904.)— The  subjects  dealt  with  in  this  joumal  are  very 
numerous.  Among  the  reports  of  cUnical  cases  the 
most  interestmg  is  "  A  case  of  fibro-myxo-sarcoma  of 
the  sacrum  of  large  size  successfuUy  treated  by 
cataphoric  operations,  with  preservation  of  the 
sphincter."  by  G.  B.  Massey,  M.D.  An  incision  was 
made  immediately  posterior  to  the  anus,  and  through 
this,  an  electrode  was  passed  up  towards  the  tumour, 
and  a  current  as  high  as  1,600  milliamperes  was  then 
allowed  to  flow  for  three  hours.  Two  appUcations 
resulted  in  the  sloughing  away  of  the  entire  tumour, 
together  with  the  coccyx.  The  wound  cicatr  ised,  and 
the  patient  recovered.  Among  the  "  Original  Articles  " 
is  a  paper  by  CoUin  F.  Martin,  on  the  "injection 
treatment  of  internal  haemorrhoids."  His  technique. 
for  which  he  claims  very  successful  results,  consists 
in  (1)  Stretching  the  external  sphincter  under  nitrous 
oxide  anaesthesia ;  (2)  after  an  interval  of  from  four  to 
seven  days  a  conical  speculum  is  inserted.  Into  this 
the  haemorrhoid  prolapses  when  the  patient  coughs; 
(3)  the  haemorrhoid  is  washed  and  injected  with  about 
7  m.  of  a  carbolic  acid  solution;  (4)  an  icthyol  sup- 
positorv  is  then  inserted.  A  paper  on  "The  bene- 
ficent 'agency  of  peritoneal  exudates,  adhesions, 
aperistalsis  and  meteorism  in  peritonitis"  is  contri- 
buted by  H.  C.  Wetherill,  M.D.  Although  there  may 
be  some  small  grain  of  truth  in  his  contentions,  few 
practical  physicians  will,  we  fancy,  agree  with  most 

of  his  reasoning. 

•     ♦     • 

New  York  Medical  Journal  and  Philadelphia  Medical 
Joumal.  (Vol.  bcxx..  No.  8.  August,  1904.)— The 
Original  Communications  in  this  number  include  :-- 
(I)  "  The  management  of  genital  sores,"  by  E.  Wood 
Ruggles,  M.D.  (2)  "  The  best  method  of  operation 
to  effect  a  radical  cure  of  senile  hypertrophy  of  the 
prostate  gland  :  based  on  the  study  of  150  radical 
operations."  The  author.  Dr.  OrviUe  Horvitz,  comes 
to  the  following  among  other  conclusions: — (i) 
There  is  no  routine  treatment  for  prostatic  enlarge- 
ment, (ii)  The  dangers  of  catheterism  are  greater 
than  those  of  a  radical  operation,  performed  early, 
(iii)  The  proper  time  to  perform  a  radical  operation  is 
when  daily  catheterism  becomes  necessary,  (iv)  In 
90  per  cent,  of  cases  the  gland  can  be  removed  from 
theperinaeum.  The  perineal  operation  of  Bryson  is  con- 
sidered the  operation  of  choice,  (v)  If  the  bladder  be 
hopelessly  disabled  the  results  of  operation  are  negative. 
{%)  "The  Finsen  light  treatment,"  by  R.  H.  Stevens, 
M.D.  The  importance  of  securing  a  properly  made 
lamp  is  insisted  on.  (4)  "The  etiology  and  treat- 
ment of  arterio-sclerosis,"  by  O.  T.  Osborne,  M.D. 
(5)  "Talma's  operation  for  cirrhosis  of  the  liver," 
by  L.  B.  McBrayn.  M.D.  (6)  "  Renal  insufficiency," 
by  Antonio  M.  Crispin.  M.D.  In  this  paper,  the 
author  refers  to  the  importance  of  making  frequent 


estimations  of  the  total  urinary  solids  excreted,  in 
diseases  of  the  heart  and  other  organs.  (7)  "  Surgery 
under  difficulty  in  East  Africa,"  by  Samuel  Gurney, 
M.D. 


AeMcal  flewd* 


Th#  Soelety  for  the  Study  of  laebriety. 

At  the  Quarterly  Meeting  of  the  above  Society  held 
on  Tuesday  afternoon,  October  nth,  Harry  Campbell, 
M.D.,  F.R.C.P..  President,  being  in  the  Chair,  at  the 
Rooms  of  the  Medical  Society  of  London,  Dr.  Charles 
F.  Harford  deUvered  an  address,  entitled  "  The 
Drinking  Habits  of  Uncivilised  and  Semi-civilised 
Races,"  which  will  be  found  under  the  heading  of 
"  Original  Communications,"  page  380. 

Jervit  Street  Hospital,  Dublin. 

The  Governors  and  Guardians  of  Jervis  Street 
Hospital.  Dublin,  will  meet  on  Monday,  the  17th 
inst.,  to  appoint  a  surgeon  in  succession  to  the  late 
Dr.  Cranny,  and  a  physician  in  succession  to  Dr. 
Martin,  who  has  resigned  his  post  as  announced  in  our 
last  issue. 

St.  Manr'i  Ronttal  Medtoal  Sehooli. 

The  list  of  awards  01  entrance  scholarships  at  this 
medical  school,  examination  held  Sept.  20th  and  2xsf, 
is  announced  as  follows  '.-—Open  Scholarships  in  Natural 
Science  (value  ;fi45),  W.  L.  Cowardin.  Open  Scholar- 
ships in  Natural  Science  (value  50  guineas  each),  £. 
W.  Archer,  A.  B.  Porteous.  T.  A.  F.  Tyrrell.  University 
Scholarships  (of  60  guineas  each),  C.  H.  Rothera,  B.A., 
Emmanuel  College,  Camb. ;  and  P.  P.  Laidlaw,  B.A.. 
St.  John's  College,  Camb..  and  K.  A.  Lees,  B.A.. 
King's  College,  Camb.  (equal).  The  Epsom  Scholar- 
ship of  ;^I45  was  awarded  to  T.  C.  C.  Evans,  on  the 
nomination  of  the  headmaster. 

TIM  Royal  Aeademy  of  Medloine  in  Ireland. 

The  annued  meeting  of  the  Royal  Academy  of 
Medicine  in  Ireland  will  be  held  on  Friday,  the  14th 
inst..  when,  in  addition  to  the  usual  election  of  the 
various  sectional  Councils  for  the  ensuing  year,  the 
post  of  general  secretary,  vacant  through  the  resigna- 
tion of  Mr.  J.  B.  Story,  F.R.C.S.,  will  be  fiUed.  Three 
very  strong  candidates  are  in  the  field — ^Dr.  Craig, 
Registrar  of  the  Royal  College  of  Ph3rsicians;  Dr. 
Cronyn,  medical  officer  to  the  South  Dublin  Union  ; 
and  Dr.  Travers  Smith,  physician  to  the  Richmond 
Hospital.  It  is  expected  that  the  voting  wUl  be  very 
close,  and  much  interest  is  manifested  in  the  result. 
Modleal  Sioknots  and  Aoeidont  Society. 

The  usual  monthly  meeting  of  the  executive  com- 
mittee of  the  Medical  Sickness.  Annuity  and  Life 
Assurance  Society  was  held  on  the  30^h  ult.,  at  429, 
Strand,  London,  W.C.  There  were  present  Dr.  de 
Havilland  Hall  (in  the  chair).  Mr.  F.  S.  Edwards, 
Dr.  F.J.  Allan,  Dr.  J.  Pickett,  Dr.  F.  S.  Palmer,  Dr. 
J.  Brindley,  James,  Dr.  J.  W.  Hunt,  Dr.  St.  Clair  B. 
Shadwell,  Dr.  W.  Knowsley  Sibley,  Mr.  William 
Thomas,  and  Dr.  Alfred  S.  Gubb.  The  records  of  the 
Society  for  the  current  year  so  far  agree  closely  with 
previous  experiences.  In  the  first  half  of  every  year 
the  sickness  claims  list  was  found  to  be  heavy,  while 
in  the  second  half  the  amount  of  claims  is  always 
sufficiently  low  to  leave  a  substantial  margin  on  the 
year's  working.  In  this  way  the  funds  of  the  Society 
have  steadily  grown  until  they  now  amount  to  over 
;£  1 80,000.  As  a  considerable  number  of  the  members 
are  permanently  incapacitated  and  thus  compelled 
to  draw  sickness  pay,  all  the  year  round,  a  large  sum 
is  exx)ended  in  providing  what  is  practically  a  per- 
manent provision  for  those  who  will  never  again  be 
able  to  perform  professional  work.  The  letters  read 
from  those  to  whom  this  permanent  allowance  is 
made  leave  little  doubt  that  this  is  one  of  the  most 
valuable  branches  of  the  operations  of  the  Society. 
Prospectuses  and  all  particulars  on  application  to  Mr. 
F.  Addiscott,  Secretary  Medical  Sickness  and  Accident 
Societv,  33,  Chancery  Lane,  London,  W.C. 

ftoyal  CoHoffo  of  Phyilolans  of  Ireland. 

The  annual  meeting  of  the  Royal  College  of  Phy- 
sicians of  Ireland  will  be  held  on  Tuesday,  the  i8th 
inst.,  in  the  College  Hall.     The  election  of  officers  and 


40O    The  Medical  Pkess. 


PASS  LISTS. 


Oct.  12. 


1904 


committees  for  the  ensuing  year  will  take  place.  It 
is  expected  that  Dr.  W.  J.  Smyly  will  be  elected 
President  in  succession  to  Sir  Arthur  Macan.  whose 
term  of  office  has  expired.  The  annual  dinner  will 
be  held  the  same  evening. 

ChQ4hood  Society. 

A  COURSE  of  public  lectures  will  be  given  in  the 
Library  of  the  Sanitary  Institute.  72  Margaret  Street, 
W.,  at  eight  p.m.  : — Thursday,  October  20th,  "  Dis- 
cussion on|Physical  Deterioration,"  opened  by  E.  W. 
Brabrook,  C.B.,  F.S.A.,  Mrs.  A.  Watt  Smyth,  Robert 
Hutchison.  M.D.,  G.  E.  Shuttleworth,  M.D.,  Francis 
Warner,  M.D.  ;  chairman,  Sir  T.  Lauder  Brunton, 
LL.D.,  M.D.,  F.R.S.  Thursday,  October  27th. 
"  Physical  Condition  of  Working  Class  Children,"  by 
T.  J.  Macnamara,  LL.D.,  M.P.  ;  chairman,  Rt.  Hon. 
Sir  John  Gorst,  K.C.,  M.P.  Thursday,  November 
loth,  "  Mental  Hygiene  in  Childhood,"  by  T.  B. 
Hyslop,  M.D.,  M.R.C.P.Edin.  ;  chairman,  Sir  James 
Crichton-Browne,  LL.D..  M.D.,  F.R.S.  ;  Thursday, 
November  24th.  "  Education  of  Girls,"  by  Miss  M.  E. 
Findlay,  B.A.  ;  Chair,  Miss  Alice  Ravenhill. 
Trinity  College,  Dublin. 

The  school  for  the  Royal  Medical  Services,  which 
was  started  in  Trmity  College  during  the  beginning 
of  the  year,  and  has  proved  so  successful  at  the  R.A.M.C 
and  I.M.S.  examinations,  will  commence  its  second 
session  on  November  7th.  The  object  of  the  school 
is  to  enable  Irish  Medical  students,  who  desire  to 
adopt  the  Army  or  Navy  as  a  profession,  to  prepare 
themselves  in  Ireland.  Already  the  school  has  begun 
to  attract  candidates  from  the  other  side  and,  promises 
to  take  an  important  educational  position,  combining, 
as  it  does,  clinical  work  with  lectures  and  practical 
work,  and  offering  special  facilities  for  operative 
surgery. 

UnlvAPtity  of  LivvrpooL 

At  a  recent  meeting  of  the  Council  of  the  University 
the  following  appointments  were  made  in  the  Faculty 
of  Medicine : — ^Lectureship  in  dermatology,  Leslie 
Roberts,  M.D. ;  lectureship  in  laryngology,  John 
Middlemas  Hunt,  M.B. ;  lectureship  in  clinical  patho- 
logy, E.  E.  Glynn,  M.B. ;  lectureship  in  neuro-patholosy 
W.  B.  Warrington,  M.D.,  M.R.C.P. 

Charlnff  Croii  Hospital  Medical  S^ooL 

The  following  entrance  scholarships  have  been 
awarded  at  Charing  Cross  Hospital : — The  Epsom 
Scholarship  ( 100  guineas),  to  Mr.  L.  H.  Taylor ;  the 
Livingstone  Scholarship  (100  guineas),  to  Mr.  C  J. 
Fox ;  the  Huxley  Scholarship  (55  guineas),  to  Mr. 
H.  F.  L.  Hugo  ;  Universities  Scholarships  (each  72 
guineas),  to  Mr.  C.  Beards  and  T.  W.  Wade.  Entrance 
scholarships  have  also  been  awarded  to  Mr.  L.  M. 
Webber  (60  guineas),  Mr.  E.  S.  Calthrop  (40  guineas), 
Mr.  R.  G.  Dainty  (30  guineas),  and  a  Universities' 
Exhibition  of  36  guineas  to  Mr.  J.  J.  S.  Rowe. 

PASS  LISTS. 


The  Royal  University  of  iFolaod. 

The  First  Examination  in  Medicine, — ^The  Examiners 
have  recommended  that  the  following  candidates  be 
adjudged  to  have  passed  the  above-mentioned  exami- 
nation : — 

Pass. — Charles  Alexander,  Edgar  M.  Condy,  Vincent 
Cosgrave,  John  Counihan,  Caroline  J.  Crawford,  John 
B.  Crawford,  Edmund  Doherty,  Edward  Dowling, 
James  E.  English,  Charles  A.  Farrell,  James  Ferguson. 
B.A..  Cornelius  J.  Halpin,  Robert  Harrington,  William 
F.  Hooper,  George  E.  Hull,  Patrick  Keelan,  Sarsfield  P. 
Kerrigan,  Caroline  V.  Lowe,  William  C.  McCuUough, 
Michael  McGing.  John  J.  McGrath,  James  A.  McMurtry, 
Michael  J.  Mulligan,  Arthur  P.  O'Connor  (Sch.), 
James  M.  O'Connor,  John  P.  J.  O'Connor,  Samuel  P. 
Rea,  John  Seymour,  William  H.  Sheffield,  William 
S.  R.  Steven,  Thomas  Taylor,  Eustace  Thorpe,  Verner 
Wiley. 

Exempt  from  further  examination  in  Botany  and 
Zoology. — Henry  A.  Gillespie. 

The  undermentioned  candidates  have  qualified  on 
their  answering  to  present  themselves  for  the  further 
examination  for  honours.     Those  qualified  in  two  or 


more  subjects  may  present  themselves  for  the  Honoiii 
Examination  in  all  subjects  : — 

Charles  Alexander,  John  Counihan,  Caroline  J. 
Crawford,  Edward  Dowhng,  James  E.  English,  Charks 
A.  FarreU,  James  Ferguson,  B.A.,  Sarsfield  P.  Kerrigan, 
Caroline  V.  Lowe,  John  J.  McGrath,  Michael  J.  Mulli- 
gan. Arthur  P.  O'Connor  (Sch.),  James  M.  O'Connor 
Samuel  P.  Rea,  WilUam  H.  Sheffield.  S.  R.  Steven.' 

The  Second  Examination  in  Medicine, — ^The  exami- 
ners have  recommended  that  the  following  candidates 
be  adjudged  to  have  passed  the  above-mentioned 
examination  : — 

Upper  Pfl55.— Joseph  D.  Cummins.  ThomasTS.  S. 
Holmes,  Marshall  F.  Huston,  John  J.  Kearney.  Robert 
G.  Kevin,  James  B.  Lapsley,  Michael  Waldion.  An 
the  above  candidates  may  present  themselves  for  the 
further  examination  for  Honours. 

PflS5.— Raphael  N.  Berman,  Arthur  R,  Bovd, 
William  Bradbury,  Daniel  Broderick.  Edwin  'b. 
Brooke,  Thomas  G.  Buchanan,  Joseph  D.  G.  Burke, 
Robert  J.  Clarke.  Mary  Cowley,  Laurence  J.  Curtin! 
James  Dewar,  James  Dooley,  Joseph  S.  Doyle,  William 
Faith,  Patrick  Ferris,  Eleanor  E.  Finegan,  Thomas 
Forsle,  James  B.  Horgan,  Arthur  H.  Joy,  Richaid 
G.  C.  M.  Kinkead.  Richard  R.  Kirwan,  Robert  Lavallin, 
Solomon  Levy,  Thomas  P.  Linehan,  Wiclif  McCready! 
Augustine  P.  MacMahon.  George  H.  Martin.  James  F 
Neary,  Edward  O'ReiUy,  WiUiam  L.  O'ReiUy,  Chris^ 
topher  F.  X.  O'SulUvan,  John  J.  Sheil.  Hans  C.  Swcrtz, 
Espine  J.  Ward. 

Exempt  from  further  examination  in  Anatomy  and 
Physiology.-^John  Clarke,  Charles  Murphy.  Alexander 
Stevenson. 

Exempt  from  further  examination  in  Practical  CJU- 
mistry, — William  Drowne.  David  O'Sullivan. 

Glasffew  University. 

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  and  Physics  :  John 
Cruickshank,  Peter  Russell  M'Naught.  Albert  Ruther- 
ford Paterson.  In  Zoologv  and  Physics :  David 
Alexander  Thomson,  M.  A.  In  Zoology  and  Chemistry : 
Robert  Rankin  Bow.  In  Botany :  David  Young 
Buchanan,  Frank  Crombie  Macauley,  Frank  Needham 
Marsh.  In  Zoology:  William  Anderson.  William 
M'Kendrick.  In  Physics:  Walter  Gilmour.  John 
WilUam  M'Nee,  William  Wilson  Rorke.  In  Chemistry : 
Walter  Hermann  Kiep,  William  Aikman  Muir.  John 
Young.  Second  Examination. — In  Physiology  :  John 
Anderson,  M.A.,  B.Sc.  In  Materia  Medica  and  Thera- 
peutics :  Peter  MitcheU,  M.A.  Third  Examination.'— 
In  Pathology  and  Medical  Jurisprudence  and  Public 
Health:  William  Blair  Morton  Martin.  In  Medical 
Jurisprudence  and  Public  Health:  Elizabeth  Maud 
M'Vail. 

The  following  passed  the  first  professional  examina- 
tion for  the  degrees  of  Bachelor  of  Medicine  (M.B.)  and 
Bachelor  of  Surgery  (Ch.B.)  in  the  subjects  indicated 
(B..  Botany;  Z.,  Zoology;  P.,  Physics;  C.  Che- 
mistry) : — 

Archibald  Aitchison  (C),  David  Anderson  (C).  James 
George  Anderson  (B..  P.),  William  Anderson  (Z..  C)., 
Thomas  Archibald  (B.,  P.).  WiUiam  Hunter  Stirling 
Armstrong  (B.  Z.).  Alexander  Ballantyne  (B.,  Z.,  C). 
WiUiam  Barr  (B.,  P.,  C),  Charles  Bennett  (B.,  P.). 
Robert  Rankin  Bow  (Z..  C),  Charles  Brash  (Z.,  C). 
WiUiam  Barrie  Brownlie  (B.,  P.),  David  Young  Buc- 
hanan (B.,  P.,  C),  John  Adam  Gib  Burton  (B.).  Hector 
Mackay  Calder  (B..  Z..  C),  John  Cameron  (C),  DonaW 
James  Clark  (B.,  P.,  C).  James  Lang  Cochrane  (B.). 
Alexander  Johnston  Couper  (C),   Rutherford  Cramb 
(B.),  John  Cruickshank  (B..  P.),  James  Cowie  Dick  (C), 
Charles   Duguid   (B.),   WiUiam   Hunter  Duncan  (Z.), 
Philip  Figdor  (B.),  Robert  Dunlop  Black  Frew  (B.,  Z.), 
David  Gibson  (B.),  Alexander  Gordon  Gilchrist  (B.,  P.). 
Walter  Gilmour  (B.),  P.),  George  Stevenson  Gordon 
(B.,  P.),  Hugh  Macvicar  Gossman  (C),  Edward  O'Dris- 
coU  Graham  (B.,  C),  John  Granger  (B.,  P.).  George 
Haddow    (B.),    WilUam    HamUton    (P..    C),   Michael 
Harkin  (B.,  Z..  P.,  C),  John  Primrose  Hay  (B.,  Z.), 


Oct.  12,  1904. 


PASS  LISTS. 


The  Medical  Pkbss.    4'^! 


John  M'Lean  Hendr>'  (B.,  Z.),  Stephen  John  Henry 
(B.,  P.).  James  Hall  Hislop  (C),  WiUiam  Alexander 
Hislop   (B.),    Colin   Hunter   (B.),    Cochran    Johnston 
(B..  Z.),  Walter  Hermann  Kiep  (B.,  Z..  P.,  C),  John 
Parlane  Kinloch  (B.).  David  Neilson  Knox  (B..  P.). 
John  Lang  (B.,   P.),   George  Smith  Livingston  (Z.), 
William    Charles    Macartney    (B.).    Frank    Crombie 
Macaulay    (B.,    P.).    Robert    M'CarUe    (B.).    WiUiam 
M'Connell  (B.,  P.).  Donald  M'Dougall  (B.,  Z.),  Neil 
Maclnnes.  M.A.   (C).  William  M'Kendrick,   (B.,   Z.). 
Francis  WiUiam  Mackichan  (Z.,  C),  Thomas  Mackinlay 
(B.,  P.).  Alexander  M'Kinnon,  (B.,   P.).   John  James 
Mackintosh  (B.,  Z.),  John  MacMUlan  (Z..  C).  Peter 
RusseU    M'Naught    (B.,    P.),    John    William    M'Nee 
(B.,  P.).  Murdo  MacPhail  (B.,  Z.,  C),  Thomas  MarUn 
(B.,   P.),   Wm.   Aubrey  Layard  Marriott   (B.),   Frank 
Needham  Marsh  (B.,  P.),  David  Rogerson  Mathieson 
(B.).  Donald  Meek  (B..  Z.),  WiUiam  Spence  MelviUe 
(B.),  Kenneth  Chisholm  Middlemiss  (B.,  P.).  Robert 
Stewart  MiUer  (P.),    John  Mowat   (B.,    Z.).   WiUiam 
Aikman   Muir    (B.,    C),    Charles    Sutherland    M'Kay 
Murison   (Z.).    Charles   Allison   Murray   (fe.),   Watson 
Noble    (B.,    P.),    Bernhardt    Papiermeister    (B.,    Z.). 
Albert  Rutherford  Paterson  (B.,  P.),  Adam  Patrick, 
M.A.   (C),  Murray  Purvis  (B.,  P.).   Edward  Quigley 
(B.,    C),    Richard   Rae   (C).    Henry   Nimmo   Rankin 
(B..  Z.,  P..  C).  Nicol  M'NicoU  Rankin  (P..  C).  John 
'  Robertson   {Z.),   Robert  Charles  Robertson  (B.,   P.). 
Alfred    Roemmele    (B.,    P.),    William   Wilson    Rorke 
(B.,P.).  William  Rutherford  (B,.P.),  Robert  Ephraim 
Selby  (C.)»  William  Alexander  SeweU  (B..  P.).  James 
Brown  Sim  (B.,C.),  James  Johnston  Sinclair  (B.).  James 
Stewart    Somerville    (B.),    Alexander    Stewart    (B.). 
Donald    Stewart    (B.,    2.).    Edward    Ernest    Stewart 
(B..  P.,  C).  Robert  Wilson  Sutherland  (B.,  P.).  David 
Taylor  (B.,  P.),  Duncan  Macnab  Taylor  (B.,  P.).  David 
Alexander    Thomson,    M.A.,  (B.,  P.),  John    Shedden 
Thomson  (B.,  P.),  Arthur  TurnbuU  (B.,  C).  Robert 
M'Nair  Walker  (B.,  P.).  WilUam  Samuel  Waterhouse 
(B.),   Tom  Paul  Watson  (Z..   C).   Harold  Wellwood 
(Z.,   C),    James   Brown   Whitfield   (B.,   P.).   WiUiam 
Crowley    Whittingham     (B..     P.).     Charles    Percival 
Williamson    (C).    John    Alexander   Wilson    (B..    P.), 
Henry  Joseph  Windsor  (B.,  P.),  Hugh  Young  (Z.,  C). 
John  Young  (Z.,  C).     Women  :  Mabel  Foley  (B..  Z.), 
Eluphemia  Adamson  Hay  (B.,   Z.)>   EUa  Smith  HiU, 
M.A.  (B.,  Z.).  Jeanie  Walker  Jones  (B.,  Z.),  Honoria 
SomerviUe  Keer  (B..  Z.),   Janet  Nnnie  Macvea  (B.), 
Mary  Cochran  MitcheU  (B.,  Z.),  Flora  Morrison  (C), 
Jessie  Deans  Rankin  (B.,  Z.,  C),  OUve  Robertson  (C), 
Winifred   Margaret    Ross   (B.,    Z.,    C),    Jessie   Capie 
RusseU  (B..  Z.),  Margaret  Elizabeth  Rutherfurd  (P.), 
Jemima  WaUace  (B.),  Ethelwyn  Mary  Walters  (B.,  Z.). 

The  foUowing  passed  the  third  professional  exami- 
nation for  the  degrees  of  Bachelor  of  Medicine  (M.B.) 
and  Bachelor  of  Surgery  (Ch.B.)  in  the  subjects  in- 
dicated (P..  pathology  ;  M.,  medical  jurisprudence  and 
public  health) : — 

Andrew  Blair  Aitken  (M.),  George  Allison  Allan  (M.), 
Andrew  Woodroffe  Anderson  (P.),  John  Bain,  M.A.  (P., 
M,),  George  Thomson  Bogie  (M.),  Charles  Burns  (P.), 
John  MiUer  Hopkins  Caldwell  (P.),  Donald  Living- 
stone Carmichael  (M.),  Charles  Game  Angus  Chislett 
(P.),  John  Shaw  Dunn.  M.A.  (M.),  William  Gilchrist 
(P.,  M.),  John  Isdale  Greig.  M.A.,  B.Sc.  (P.,  M.). 
William  Grier  (M.),  John  Hammond  (P.),  Charles 
Francis  Dyer  Hammond  (P.),  James  Duncan  Hart 
(M.).  Frank  HauxweU  (M.),  Robert  M'Cowan  HiU  (M.), 
Ralph  Vincent  HoweU  (P.),  Alexander  Hunter  (P.), 
David  Guthrie  Hunter,  M.A.  (P.,  M.),  James  Hunter 
(M.),  Archibald  YuiU  Hutchison  (M.),  Harry  Stewart 
Hutchison,  B.Sc.  (P.,  M.),  Arnold  Ernest  Jones  (P.,  M.), 
George  Notman  Kirkwood  (M.),  Alexander  Leggat 
(P.,  M.),  Thomas  M*Cosh  (M.).  Duncan  M'Ewan  (M.), 
John  Macintyre  (P.).  William  Macleod  (M.),  John 
M'Millan  (P.,  M.),  Hugh  MacNaught  (M.),  Norman 
Smith  MacNaughtan  (M.),  Richard  Cameron  Mac- 
pherson  (P.,  M.),  WilUam  Blair  Morton  Martin  (P.,  M.), 
Robert  May  (P..  M.),  Henry  Joseph  MilUgan  (P.),  Gavin 
Denholme  Muir  (P.),  John  Dunn  Nisbet  (P.),  Patrick 
Joseph  O'Hare  (M.),  Thomas  Hood  Rankin  (P.),  Thomas 


Thomson  Rankin  (M.),  John  Reid  (P.),  William  RoUand 
(M.),  John  Cooper  RusseU,  M.A.  (P.,  M.),  Edward  Louis 
Augustin  Sieger  (P.),  Arthur  Anderson  Stewart  (M.), 
Daniel  Stewart  (P.,  M.).  John  Logan  Stewart,  M.A. 
(P.,  M.),  Joseph  Roderick  Sutherland  (P..  M.).  Thomas 
Thom  (M.),  WiUiam  Lind  Walker,  M.A.  (M.), 
Alexander  MacMiUan  Watson  (P.),  James  Wyper  (M.). 
Women  :  Jeannie  Thomson  Clark  (M.),  Elizabeth  Maud 
M'VaU  (M.),  Jessie  Deans  Rankin,  M.A.,  B.Sc.  (M.), 
Jane  Reid  Shaw  (P.),  Mary  Spence  (P.),  Christina 
Gibson  Thomlinson  (M.), 

The  following  passed  the  second  professional  exami- 
nation for  the  degrees  of  Bachelor  of  Medicine  (M.B.) 
and  Bachelor  of  Surgery  (Ch.B.)  in  the  subjects  indi- 
cated (A.,  anatomy ;  P.,  physiology ;  M„  materia 
medica  and  therapeutics) : — 

Thomas  Montgomery  Anderson  (A.,  P.),  John  Ander" 
son,  M.A.,  B.Sc.  (A.,  P.,  M.),  Thomas  Barbour,  B.Sc. 
(M.),  WilUam  Rome  Cammock  (A.,  P.,  M.),  George 
CampbeU  (A.,  P.,  M.),  John  Sawers  Clark.  M.A.  (M.), 
Thomas  Lawson  Craig  (M.),  Robert  Donald  (A.,  P,  M.),. 
James  Richan  Drever,  M.A.  (A..  P.,  M.).  Richard  John 
DriscoU  (P.),  James  Dunbar  (P.),  Ernest  MUne  Eaton 
(M.),  William  Miller  Fairlie  (P.),  John  Ferguson  (A., 
P.,  M.),  Thomas  Henderson  Forrest  (A.),  James  Wilfred 
Georgeson  (A.,  M.),  William  GUfillan  (A.,  P.,  M.), 
Arnold  Harris  Gray  (M.),  William  Towers  Hardie 
(P.,  M.),  Lawrence  Hislop  (A,),  John  Keys  (M.),  James 
Dunlop  Kidd  (M.),  James  Towers  Kirkland  (A.), 
Robert  Wright  Leckie  (M.),  George  Ligertwood  (P.). 
Ernest  Bowman  Macaulay  (A.),  Alexander  M'Call 
(A.,  M.),  Thomas  M'Cririck,  M.A.,  B.Sc.  (A.,  P.), 
William  Anderson  M'Kellar  (A.,  P.),  Murdo  Duncan 
Mackenzie  (A..  P,),  AUster  Argyle  Campbell  M'Neil, 
(M.),  Robert  Marshall  (M.),  AUan  Frederick  Miller  (A.), 
James  Robertson  Mitchell  (A.,  P.,  M.),  Peter  Mitchell. 
M.A.  (M.).  Robert  Wright  MitcheU  (P.),  James  Hogg 
Paul  (M.).  Arthur  pepghegan  Paxton  (A.).  Daniel 
M'Kinlay  Reid  (P.,  M.),  l^urdock  Mann  Rodger  (P.), 
Alfred  CecU  Sharp  (M.),  James  Charles  Donaldson 
Simpson  (A.),  James  John  Sinclair  (M.),  William  SmeUie 
(M.),  John  Stevenson  (M.),  John  Torrance  Weir  Stewart 
(P.),  Robert  Todd  (A.,  P.),  Martin  TurnbuU  (A.),  George 
Wallace  (A.),  Hugh  Ferguson  Watson  (P.),  Hugh 
White  (A.,  P.).  David  John  WiUiams  (A..  P.),  Thomas 
Winning,  M.A.,  (P.),  Moses  YOudelevitz  (M.).  Women  : 
Jeannie  Montgomery  Andrew  (M.),  Annie  Rennie  Hird 
(P.),  Katharine  Robina  Margaret  Lucas  (M.),  Edith 
Oversby  (A.).  Vera  Dagmar  Reis  (M.),  Margaret  BaiUie 
Taylor  (A.). 


1904. 


Conjoint  Ixaminatlons  io  Irelaad. 

Candidates    have    passed    the    September, 
Preliminary  Examination  as  undemoted  : — 

With   Honours. — ^Miss  Harriet   MacFaddin,   Messrs. 
E.  C.  Deane,  J.  F.  Gibbons,  J.  M.  Gage,  and  N.  PurceU. 

Passed.— Messrs.  J.  J.  Clarke,  H.  Grav,  J.  T. 
Heffeman.  B.  HiU,  H.  Hunt,  W.  R.  Kelly,  C.  KelsaU, 
E.  P.  McSweeney,  W.  R.  O'Kiefle,  W.  P.  H.  Parker, 
T.  A.  Peel.  C.  D.  K.  Seaver.  H.  B.  Smyth,  P.  T.  Warren, 
and  Miss  C.  F.  WiUiamson.  The  Supplemental 
Preliminary  Examination  will  be  held  on  the  31st 
inst. 


The  GnUd  of  St.  Luko. 

The  Annual  Medical  State  Service  in  St.  Paul's 
Cathedral,  organised  by  the  GuUd  of  St.  Luke,  wUl 
take  place  this  year  on  October  24th,  at  7.30  p.m., 
when  the  Bishop  of  Southwark  will  preach  the  sermon. 
A  choir  of  300  voices,  provided  by  the  London  Gre- 
gorian Choral  Association,  will  render  the  music. 
Members  of  the  medical  profession  are  invited  to 
attend  in  academical  robes.  Admission  to  the  space 
under  the  dome  wiU  be  by  tickets  only. 
Publle  Vaoein&tors. 

The  annual  dinner  of  the  Association  of  Public 
Vaccinators  of  England  and  Wales  wiU  be  held  at  the 
Hotel  CecU.  Strand,  London,  W.C..  on  Friday,  October 
28th,  at  7  p.m.  All  communications  should  be  ad- 
dressed to  Mr.  Charles  Greenwood,  i  Mitre  Court 
Buildings,  Temple,  E.C. 


402    The  Medical  Press.         NOTICES  TO  CORRESPONDENTS. 


Oct.  w,  1904. 


Jtotictei  to 
Corrtsponbtntef,  ^bort  %tUtxet  ^c- 

Jl^^  O0RKVPONDEMC8  requiring:  a  reply  in  this  oolanm  art  partloii. 
larly  requested  to  make  .use  of  a  dUHncHve  8ignatwr$  (frlnitkO^  and 
aroid  the  practice  of  signing  themselres  "Reader,"  "Sabsoriber/* 
**  Old  Subscriber,"  Ac  Much  confusion  will  be  spared  by  attenticn 
to  this  rule. 

Sluzpivo  81CKKK88  (Taunton).— In  1901  trypanosomes  were  dis- 
covered m  the  blood  of  a  European  by  Dr.  J.  £.  Dutton,  Walter 
If  vers  Fellow,  while  on  an  expedition  of  the  Llrerppol  School  of 
Tropical  Medicine  to  Gambia.  In  consequence  of  this  observation 
an  expedition  composed  of  Drs.  Dutton  and  Todd,  was  stnt  in  1902 
by  the  school  to  Sesegambla  to  prosecute  further  researches  In 
trypanosooiiftsis.  The  deteiled  report  of  that  expedition  was 
published  in  1908,  and  contained  a  study  of  the  pathogenetic 
trypanosomata  of  man  and  animals,  several  new  stoles  being 
described. 

•*  THE  LAST  DAYS  OF  SPEOTAGLBS." 

The  newspaper  report  of  a  **  new  method  "  of  treating  errors  of 
refraction  under  this  heading  refers  to  '*  Dr.  Stephen  Smith  of  the 
▲ntivivisection  HospiUl,  Battersea."  It  is  stated  that  the  globe  of 
the  eye  can  be  so  altered  by  massage  as  to  remedy  defective  forms 
and  so  restore  normal  sight.  Most  medioal  men  will  suspend  their 
judgment  until  the  case  is  brought  to  their  notice  through  the  legiti- 
mate channel  of  the  medicAl  societies  and  the  medioal  loumals. 

Dn.  FRO0T.— The  **  Dispensary  Doctor*'  is  not  obliged  to  give  any 
such  certificates. -The  Workman's  Compensation  Act  of  ld97  pro- 
vides  that  an  injured  workman  claiming  under  the  Act  shall*  if 
required  to  do  so  by  his  employer,  present  himself  for  examina- 
t£in  to  a  duly  qualifled  practitioner,  who  is  to  be  provided 
and  paid  by  the  employer.  We  do  not  know  of  any  offloial  scale  of 
charges  that  has  been  drawn  up  for  such  cases. 

Dr.  W.  Daviks.— We  are  not  in  a  position  to  advise  you  as  to  the 
wobabilitiefi  of  practice  in  South  Africa,  but  we  learn  from  our  con- 
temporary The  Smtth  African  MedtUal  Rteord,  that  it  has  been  found 
desirable  to  open  an  agency  department  in  connection  therewith  at 
Capetown,  and  that  practloes  are  both  wanted  and  for  disposal. 

Jfleettngs  of  the  §loaeltes»  ^Ctcttures,  •&£. 

WsDnsDAT,  OcTonm  19th. 

DxamatolooxcalSocibtt  op  LoBTDoa  (11  Chandos  Street,  Oavandish 
Sanare.  W.).— 5.16  p.m.  Demonstration  of  Cases  of  Interest. 

Kk>inH-WEST  LovDOS  MBDi€i.L.^8ocinT  (Bolingbroke  Hospital, 
Wandsworth   Common).— 8.45    p.m.    Paper  :— Dr«  de    H.  Hall : 

MioiCAL  GRADV^TkS'  CoLLKOB  AND  PoLTQUVio  (21  Cfaenies  street 
W  C)  -  4  p.m.    Mr.  J.  Berry  :  •  CUnique.    (Surgical.)  5.15  p.m.  Dr. 
H.'  Mackenzie :  Graves's  Disease  and  its  Treatment. 
THuaanaT,  OeroBBB  ISth.  i 

BarrxsH  Gyn-ccolooical  Socibtt  (30  Hanover  Square.  W.).— 8  p.ml 
Specimens  will  be  shown  by  Dr.  Edge,  Mr.  F.  Jordan,  Dr.  W.  Dun- 
can Dr.  Macnaughton-Jones,  and  others.  Paper  :— Mr.  C.  Martin  : 
The'  Treatment  of  Severe  Prolapse  by  Extirpation  of  the  Uterus 
and  Vagina. 

HarveiakSocxxttopLohdob  (Stafford  Booms,  Titehbome  Street. 
Edgware  Road,  W.).— S90  p.m.  Mr.  C.  B.  Keetley  on  "Plastic 
Surgery."  (Harveian  Lecture.) 

Mbdigal  Gradvatxs*  Colleob  avd  Polyclinic  (22  Ghenies  Street, 
W.C.).— 4p.m.  Mr.  Hutchinson:  CUnique.  (SurgicaL)  5.15p.m. 
Dr  W.  J .  Home  :  Pachydermia  Lar\*ngis. 

MouvT  YEavoK  Hospital  pob  Ooksitmftioh  amt>  Disxasbs  of 
TKB  Ckbst  (7 FitzrcT  Square,  W.).— 5  p.m.  Introductory  Address : 
—  Dr.  G.  A.  Gibson  (EdinDurgh) :  Certain  Aspects  of  Pleurisy.  (Post* 

Graduate  Course.)  

Fbii>at»  Octobbb  14th. 

Clixical  Socibtt  or  ILoztdov  (20  Hanover  Square,  W.).— 
K.SO  P.m.  Presidential  Address.  Papers  :  Dr.  W.  Harris  and  Mr.  Y. 
w  Low  *  The  Cure  of  Infantile  Parak'sis  of  the  Shoulder  by  Nerve- 
erafting  (with  case  to  be  exhibited).— Mr.  W.  G.  Spencer  :  Casee  of 
Inflammation  in  and  around  the  Liver.—Dr.  P.  D.  Turner  and  Mr.  B. 
Johnson:  Traumatic  Axillary  Aneurysm  successfully  treated  after 
Extravasation  had  occurred  by  Proximal  Ligature. 

lixviCAL  Gbadvatss'  Colleob  and  PoLTCLinc  (t2  Ghenies 
Street,  W.C.— 4  p.m.    Dr.  W.J.  Home  :  CUnique.    (Throat.) 

Devon  County  Asylum.— Second  Assistant  Medical  Officer.  Salary 
£150  per  annum,  with  bOArd.  lodging  and  washing.  Applications 
to  the  Medical  Superintendent,  the  Asylum,  Exmlnster. 

Miokleover,  Derby,  County  Aslum.— Senior  Assistant  Medioal 
Officer.  Salary  £160  per  annum,  with  furnished  apartments, 
board,  washing,  and  attendance.  Applications  to  the  Medical 
Superintendent. 

Kent  County  Asylum.  -  Third  Assistant  Medical  Officer.  Salary 
£140  per  annum,  with  board,  quarters,  attendance  and  wash- 
ing. —Applications  to  the  Medical  Supermtendent. 

Horton  Infirmary,  Banbury.— House  Surgeon.  Salary  £80  per  annum, 
with  board  and  residence  in  the  Infirmary.  Applications  to  the 
Honorar}'  Secretary-,  21  Marlborough  Boad,  Banbury. 

WesttSuffolk General  Hospital,  Bury  St.  Edmunds.— House  Surgeon. 
Salary  £100  per  annum,  with  board  and  lodging.  Applications 
to  the  Secretary. 

East  London  Hospital  for  Children  and  Dispensary  for  Women. 
Shadwell,  E.— J&estdeiit  Medical  Officer.  Salary  £100  per  annum, 
with  board,  residence,  and  UundT}'.  Applications  to  Thomas 
Hayes,  Secretary. 


Somerset  and  Bath  Asylum,  Cotford,  Tsunton.— . . 

Officer.    Salary  £100  per  annum,  with  fumldied  apartatmi. 

board,  fuel,  lighting,  and  washing.    Apfriioatioasto  tlw  Mednl 

Superintendent. 
Brecon  and  Radnor  Lunatic  Asylum,TaIgartb,  Brsoonshiic— Hedkal 

Superintendent.   Salary  £460  per  annum,  with  fully  tanii«he4 

house,  coal,  light,  washing,  and  garden  produce.  AppUostioM  to 

J.  H.  Evans. 
Metropolitan    Asylums    Board.— Male    Assistant  Kedical  (meet. 

Salary  £160  per  annum,  with  rations,  lodginfr,  attendanee.  tad 

washing.    Applications  at  the  Office  of  the  iloanl.  BmbsBknent, 

IiondonJB.(;. 
Darlington  Hoepltal  and  Dispensary.— House  Burgeon.    Sakiy  £1|0 

per  annum,  with  board  and  lodging  in  the  Imtitotion.    Ap^ 

cations  to  the  Secretaries.  48  Stanhope  Bead;  Darlington. 
Down  District  Lunatic  Asylum.— Junior  Male  Aasistant  Medial 

Officer.     Salary  £100  per  annum,  with  forniahed  spartmenu. 

ftc.    Applications  to  the  Resident  Medical  Superintendent. 


S^ffoitttmmxB. 


Alwat,  W.  R.  M3.Tdronto,  Clinioal    Aiaistant   to    the  Ghchei 

Hospital  for  Women. 
Akdbbsoh,  a.  W.,  M.B.,  Ch.B.St.And.,  lias  been   appointed  Jiuior 

House  Surg^n  to  Liverpool  Infirmary  for  Children. 
OOPB  RiCARDO,  M.B.C.S.,t  L.R.C.P.,  House  Surgeoft  to  the  Br«h»i 

and  Qove,  and  Preston  Dispensary,  Northern  Brancli. 
Oboss,  W.  P.,  MR.aS.Bng.,  LB.C.P.,  Assistaut  CUorofonniA  u 

St.  Bartholomew's  Hospital. 
ETHBoreTOB-SiUTii,  B.  B.,  B.S.Cantab.,  Senior  House  SurgeoatoS: 

Bartholomew's  Hospital. 
Flavbllb,  J.  M.,  M.&C.S.Bng.,  (Clinical  Assiatant  to  ths  Deput- 

ment  ef  Bleotro-Therapeutlcs,  St.  Bartholomew's  Hospital 
Quviroio.  C.  J.  H.,  MB.C.d.,  LB.C.P.Iiond.,  Seooad  Asaiieut 

Medioal  Officer  to  the  Kensington  Infirmary. 
HoRXK,  W.,  Jobsov,  M.D.OanUb.,  Clinical  Assistant  to  the  Depart- 
ment for  Diseasss  of  the  Throat  and  Nose,  St.  BarthokMBev*! 

HospitaL 
Howbl!.,  C.  M.  H.,  M.B.C.8.1Cog.,  L.R.aP.Loiid.,  Senior  HsaK 

Physioian  to  St.  Bartholomew's  Hospital. 
HuDBOK,  B.»  M.R.C.8.Biig.,  LJUaP-Lond.,  Junior  House  Phjfiidii 

to  Bartholomew's  Hooital. 
Jobhsob;  W.  Cbobbt,  M.B.,  Oh.B.Viot.,  Honorary    Physieias  to 

Pendleton  Branch  Dispensary  of  Salfoid  Royal  HospitaL 
Jovxs,  J.  M..  M.OJCidUgan,  GUnlcal  AsslBtont  to    the  Otebei 

Hospital  for  Women. 
JuoeoH,  A.  H^M.D.Toronto,  (Tllnioal  Assistant  to  the  GhalBea  Ha- 

pital  for  women. 
Lbdwabo,  H.  D.,  M.B.»  B  CCTaatab.,  Senior  Hoaso  Surgeon  to  8l 

Bartholomew's  Hospital. 
LxwiB.  J.  W..  L.B.C.P.,  L.B.G.S.£din.,  L.F.P.&G.,  Gorttfyiag  fa- 

geon  under  the  Factory  Act  for  the  Brynamman  District  of  thi 

counties  of  Carmarthen  and  Glamorgan 
PBiHe,  H.  RaeiHAU),  M.R.aa,  L.R.O.P.LoimL,  I«.D.a,  Asstitw 

Dsntal  Surgeon  to  the  National  Dental  Mospitai. 
Sawtu,  Jambs  E.  H.,  M.A.,    M.D.Oxoa.,    MJL.G.P.,  has  baa 

appointed  Pathologist  at  the  General  Hospital,  Birmingham 

$irth0. 

McN ABB.— On  Ootobec  7th,  at  the  Boyal  Navy  Hoepltal,  PlynoBti 
the  wife  of  Fleet  Surgeon  D.  MoNabb,  B.N.,  of  a  daughter. 

Sbllbr.— On  October  4th.  at  IM  (3ommerolal  Boad,  London,  E ,  tk 
ifhte  of  J.  Douglas  Seller,  M.B.C.S.,  L.R.O.P.,  of  a  dangtler. 


ffHwCXV^tB. 


AirKiHO— Haioh.— On  October  6th,  at  the  Pariah  Chnrefa.  Oiltf, 
Yorks,  George  Paul  Annlng,  M.R.C.S.Bnsr.,  L.B.C.P.LoDdU  d 
Kirkstall,  Leeds,  to  Clara  Evelyn,  elder  daufirhler  of  VnUikk 
Haigh,  late  of  The  Holme,  Bramhope,  now  of  L^-ddon  Tenaoe, 

Baxlbt— HATLXTT.^On  October  0th,  at  St.  Mark's,  Balston,  Al>iiR 
Brook  Batley.  M.B.C  S.Eng.,  L.B.CP.Lond.,  son  of  tbe  Uu 
Joseph  fiatley,  of  Huddersfield.  to  Edith  May,  daughter  oltk 
Ute  Albert  Haylett,  of  Brentford. 

Fothbbbt— BAaaBTf.— On  October  5th.  at  St.  John  theBaptiaV 
Kensington,  Henry  Arthur  Fotherby,  L.B.C.P.,  M.B.Ci.,  4 
Headcom,  Kent,  son  of  H.  I.  Fotherby,  M.D.Lond.,  of  Woo4- 
thorpe  Cote,  Reigate.  to  Jane  (Bee),  eldeat  daughter  of  Dr.  A. 
E.  Barrett,  of  Holland  Park  Avenue,  London. 

gooTT-Ixvur.— On  Sept.  29th,  at  St.  Mark's  Churoh,  Armsgfa,  brliii 
Grace  the  Lord  Primate,  assisted  by  Bev.  G.  E.  ScoU,  Bectorot 
Busbrooke,  DIo.  Cloyne,  Bev.  H,  G%  Soott,  Rector  of  Grefgu, 
Die.  Armagh  (brothers  of  the  brideirroom),  and  Bew.  C 
K.  Inwin,  rectorof  Brantry,  Dio.  Armacrh,  (brother  of  the  bridei 
James  C^iossle  Scott.  M.D.Dubl.,younjrest  son  of  the*1ate  Williaa 
Scott,  MJ).,  R.C.S.Eng.,  of  The  Bawn,  Aughnacloy.  co.  I^roee, 
to  Elizabeth  Ensor,  eldest  daughter  of  the  Yen.  the  ArcMeaooo 
of  Armagh. 


JBtalhB. 

Bishop. -On  October  7th,  at  Edltiburgh,  Isabelhi  Lucy  Kihopb 
F.R.G.S.,  F.B.S.G.S.,  daughter  of  the  late  Rev.  Edward  Bvi 
reotor  of  Wyton,  Huntingdonshire,  and  widow  of  John  Bishop, 
M.D.,  Edinburgh. 

OooPBa.— On  Oct.  9ch,  at  East  Twickenham,  Elisa  Vary  Cooper, 
widow  of  Horace  Cooper,  MJt.C.S.,  J.P.,of  Mariboroogli,  Vtka. 


aged  64  years.  „,     . 

OaTOM.— On  October  7th,    at  Bed^orth    Warwickshire.  Einn 

William Orton,  M.RC.S.Eng.,  L.B.C.P.£dln.,  aged 88.    , 
WaioBT.— On  October  0th,  at  The  Croft,  Hlnderwell,  Torb.,  Jue, 

widow  of  Alexander  Wright,  M.D.,  F.B.C.S.,  aged  SOycsia 


Mt  ^dm\  ^tm  mH  €ivmlM. 


"SALUS   POPULI   SITPREHA   LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    OCTOBER    19,    I904>         .No.    i6. 


(Ptlginal  Communications* 

ON    THE    TREATMENT    OF 

INOPERABLE  CANCER  BY 
HYPODERMIC       MEDICATION. 

By  JOHN  A.  SHAW-MACKENZIE,    M.D.Lond. 

In  the  year  1902  I  was  first  led  to  adopt  the 
method  of  hypodermic  medication  in  the  treatment 
of  disease.  I  had  long  taken  an  interest  in  the 
medicinal  treatment  of  uterine  fibroids,  and  for 
some  years  I  had  been  desirous  of  finding  a  sub- 
stitutive method  of  administering,  among  other 
drugs,  iodide  of  potassium  and  iodine.  When, 
therefore,  Messrs.  Merck,  of  Darmstadt,  introduced 
iodopin — a  combination  of  iodine  and  sesame  oil — 
as  an  efficient  substitute  for  iodide  of  potassium 
generally,  and  administered  subcutaneously, 
ivithout  producing  iodism,  it  occurred  to  me  to 
adopt  this  method  in  the  treatment  of  uterine 
fibroids  and  menorrhagia.  The  opportunity  for 
treating  cases  in  this  way  was  shortly  after  kindly 
given  me  by  Dr.  John  Shaw,  at  the  North- West 
London  Hospital,  and  together  we  obtained  com 
plete  relief  of  symptoms  in  some  cases  with  more  or 
less  shrinkage  of  the  tumour,  and  probably,  in  at 
least  one  case,  its  disappearance.  No  particular 
local  or  general  inconvenience  follows  the  injections, 
which  are  given  well  into  the  intracellular  tissue  of 
the  buttock  in  doses  of  3  to  10  c.c.  The  treatment 
is  a  continuation  of  the  older  iodine  one ;  only  as  it 
seems  to  me  by  a  more  convenient,  rapid  and  direct 
method  of  administration  of  the  drug.  It  does  not 
confine  the  patient  to  bed  or  the  house,  nor  is  there 
apparently  any  disagreeable  effect.  In  another 
case  under  my  care  rapid  shrinkage  at  first,  and 
later  almost  complete  disappearance  of  a  large  and 
undoubted  uterine  fibroid,  for  which  hysterectomy 
had  been  a  few  days  before  independently  recom- 
mended, took  place  under  this  treatment.  This 
patient  at  the  time,  mentioned  to  me  that  a  friend 
of  hers  had  obtained  great  benefit  while  abroad 
from  h3rpodermic  injections  of  iron,  after  large 
quantities  of  iron  mixture  had  been  taken  here 
without  apparent  benefit.  The  preparation  in  this 
case  was  one  of  arsenic  and  iron ;  both  this  and 
various  preparations  readily  obtained  both  here 
and  abroad  approximating  to  that  of  Dr.  Zaxa- 
beletti,  of  Milan.  Extensive  trials  of  these  with  or 
without  strychnia  have  since  been  made  by  Dr. 
Shaw  and  myself,  and  have  proved  to  be  beneficial 
in  certain  cases  of  anaemia,  neurasthenia  and 
malaria.  Again  we  made  trial  of  various  prepara- 
tions of  mercury,  and  a- solution  of  the  benzoate 
which  I  obtained  from  Messrs.  Merck  has  proved 
satisfactory.     Both    the    iron    and    arsenic,  and 


mercury  are  injected  into  the  muscular  tissue  of  the 
gluteus.  It  is  impossible  here  to  enumerate 
the  many  cases  in  which  the  above  hypodermic 
preparations  as  well  as  others,  as,  for  example, 
strychnine  and  spermin,  have  been  singly  or 
alternately  employed,  but  encouraging  results  have 
been  obtained  in  some  cases  of  chronic  endome- 
tritis, pelvic  inflammation  in  women,  rheumatoid 
and  septic  arthritis,  locomotor  ataxy,  and  improve- 
ment in  one  case  of  disseminated  sclerosis. 

Hypodermic  Medication  in  Inoperable  Caru^r. — 
Encouraged  by  the  results  of  hypodermic  medica- 
tion in  the  foregoing  cases  I  was  led  to  try  various 
preparations,  including  the  known  injections  of  the 
cacodylates  and  of  arsenic  in  cases  of  inoperable 
cancer,  but  beyond  some  temporary  improvement 
in  the  general  health,  no  manifest  improvement 
was  obtained.  The  problem  was  to  find  some 
preparation  which  would  give  relief.  In  course 
of  time  at  last,  decided  relief ,  removal  of  pain  and 
foetor,  with  apparent  arrest  of  disease,  was  obtained 
in  two  cases  of  inoperable  cancer  under  the  care  of 
Colonel  T.  Ligertwood,  C.B.,  M.D.,  in  the  Infirmary 
of  the  Royal  Hospital,  Chelsea,  as  already  recorded 
by  Colonel  Ligertwood  and  myself  in  the  July  num- 
ber, 1904,  of  the  Journal  of  the  Royal  Army  Medical 
Corps.  The  first  case  was  a  case  of  carcinoma 
of  thie  tongue  in  an  old  soldier  which  was  treated 
by  hypodermic  injections  of  soap  solution  origin- 
ally recommended  by  Mr.  John  Holden  Webb, 
Melbourne.  The  second  case  was  that  of  carcinoma 
of  the  neck,  treated  by  hypodermic  injections  of 
chian  turpentine — a  new  method  of  treatment  so 
far  as  we  know,  the  drug  itself  having  been 
originally  introduced  by  the  late  Prof.  Clay,  of 
Birmingham,  in  the  treatment  of  cancer. 

Aware  of  disappointments  with  chian  turpentine 
recorded  in  the  past,  its  employment  in  this  case 
suggested  itself  from  the  recollection  of  the  com- 
plete recovery  in  1891  of  a  case  of  presumed  and 
advanced  cancer  of  the  uterus  in  which  Colonel 
Ligertwood  and  I  had  recommended  its  internal 
administration,  subsequently  to  the  opinion  at  the 
time  of  an  eminent  authority  (since  deceased)  of 
the  hopeless  nature  of  the  case  ;  while  the  com- 
bination of  iodine  and  sesame  oil  in  iodopin  sug- 
gested a  similar  combination  of  chian  turpentine 
for  hypodermic  purposes.  It  may  be  recollected 
that  twenty-five  years  ago  the  late  Prof.  Clay 
strongly  recommended  chian  turpentine  by  the 
mouth  in  the  treatment  of  cancer,  and  "  if  perma- 
nent cure  was  not  obtained,  an  amount  of  relief 
secured  to  patients  which  had  not  been  afforded  by 
any  other  plan.'*  The  treatment  was  condemned 
by  others  and  fell  into  disuse,  and  yet  the  results 
obtained  by  Prof.  Clay  in  certain  cases  cannot 
be  doubted.     Since  the  publication  of  the  method 


4^4    'f  HE  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Oct.   19.  1904. 


of  hypodermic  administration  by  Colonel  Ligert- 
wood  and  myself,  Mr.  Augustus  Clay,  the  son  of 
the  late  Prof.  Clay,  has  informed  me  that  he  had 
never  heard  of  chian  turpentine  being  injected 
subc«talieou6l5^  but  hi  the  sabie  tisie  he  remarks 
tjiai  Ins  ^i  qu^  understand  how  very  much  more  • 
trustworthy  the  treatment  may  become  under  this 
method.  Accounting  for  the  difference  in  the 
results  which  followed  the  internal  administration 
of  the  drug  by  his  father  and  others,  he  suggests 
that  in  all  probabiUty  the  explanation  was  to  be 
found  in  the  fact  that  the  drug  was  unassimilated, 
inasmuch  as  large  masses  were  passed  undigested 
by  the  rectum.  This  was  noticeable  in  the  pill 
form  of  administration ;  the  emulsion  giving 
far  better  and  quicker  results.  Mr.  Qay  asserts 
that  he  is  now  using  the  injections  in  a  case  of 
cancer  of  the  rectum.  The  patient  had  previously 
been  taking  large  doses  of  morphia,  but  has  had 
none  since  the  commencement  of  this  treatment, 
and  so  far  relief  from  pain  has  been  obtained. 

Technique, — ^The  injections  of  chian  turpentine 
are  aidministered  deeply  into  the  subcutaneous 
tissues.  Experience  has  shown  that  the  buttock 
is  a  suitable  place.  Given  deeply  into  the  cellular 
tissue  they  occasion  little  or  no  inconvenience  or 
pain.  The  muscular  tissue  itself  must  be  avoided 
as  injections  into  it  cause  pain  and  sense  of  tension. 
I  prefer  the  "  all  glass  "  syringe  made  by  Messrs. 
Burroughs  Wellcome.  The  special  features  of 
this  appUance  are  that  it  is  separable  into  parts 
which,  with  the  needle,  can  be  sterilised  by  boiling 
first,  before  use.  The  method  which  I  adopt,  is  to 
keep  a  separate  needle  for  each  patient  A  some- 
what stout  needle  is  necessary.  An  irido-platinum 
needle  is  preferable,  being  not  liable  to  break  in 
the  deeper  injections  into  the  gluteal  region.  The 
same  applies  to  the  intra-muscular  injections  of 
iron,  arsenic,  and  mercury.  The  site  of  injection 
is  first  sterilised  with  some  antiseptic  solution  ; 
after  which  a  piece  of  ice  is  placed  upon  the  surface, 
or  local  anaesthesia  induced.  The  former  is  a 
simple  means  of  abolishing  all  pain  of  insertion  of 
the  needle,  and  though  this  may  seen  a  minor 
detail,  upon  itdepends,in  many  cases,  a  continuance 
of  hypodermic  medication. 

Dosage, — Colonel  Ligertwood  and  I  found  by 
experience  that  5  minims  of  a  20  per  cent,  com- 
bination of  chian  turpentine  with  oUve  oil,  obtained 
from  Messrs.  Southall  Bros,  and  Barclay  (Bir- 
mingham), is  the  quantity  to  begin  with,  increasing 
by  5  minims  on  alternate  days  up  to  60  minims. 
In  our  first  case  there  was  considerable  rise  of 
temperature  following  the  third  and  fourth  injec- 
tions of  15  minims  and  20  minims  respectively. 
Some  doubt  existed  as  to  the  cause,  inasmuch  as  in 
subsequent  cases  the  same  has  not  been  noticed 
when  gradually  pushed  to  the  full.  Messrs. 
Southall  now  supply  the  injections  of  chian  turpen- 
tine in  small  stoppered  phials  ready  for  use,  as  well 
as  the  emulsion  for  internal  administration. 

Case  I. — Carcinoma  of  the  neck  in  an  old  soldier 
in  the  Infirmary  of  the  Royal  Hospital,  Chelsea, 
under  the  care  of  Colonel  Ligertwood.  There 
was  a  large  hard  fixed  mass,  ulcerating  in  places, 
;and  bleeding  readily  over  the  middle  of  the  right 
3temo-mastoid,  extending  up  towards  the  mastoid 
process,  under  the  ramus  of  the  jaw  and  over  the 
trachea  in  front.  The  head  was  forced  over  to  the 
opposite  side,  great  pain  was  complained  of,  and 
swallowing  was  becoming  difficult.  It  had  com- 
menced primarily  as  a  pimple  in  November,  1903, 


attributed  to  rubbing  of  the  coat  collar,  and 
was  evidently  growing.  Medical  history  sheet 
clean.  Malaria  in  India  forty  years  ago.  Micro- 
scopic examination  of  a  small  piece  taken  from  Ite 
edge  of  the  ulceration  proved  it  to  be  epittoriUoma, 
On  January  zs±h,  1904.,  5  rAtAftiB  of  a  20  fW"  cent. 
combination  of  chian  turpentine  in  olive  oil  (steri- 
lised) were  injected  subcutaneously  into  the  arm, 
the  dose  being  increased  by  5  minims  on  alternate 
days  till  20  minims  were  given.  The  third  injection 
of  1 5  minims  was  followed  by  a  rise  of  temperature 
to  102°,  returning  to  normal  in  the  morning; 
while  after  20  minims  it  rose  to  103 '6®,  necessitating 
reduction  of  the  dose  to  5  and  la  mininis  in  future, 
once  or  twice  a  week,  followed  by  a  rise  of  tempcrar 
ture  to  100°  or  thereabouts.  Briefly,  in  this  case  all 
pain  went  from  almost  the  first  injection  ;  the 
extensive  redness  of  the  surrounding  surface,  which 
reached  to  above  the  mastoid  in  one  direction  and 
on  to  the  upper  chest  in  the  other,  rapidly  subsided, 
leaving  a  faint,  purple  discoloration,  limited  to  the 
immediate  neighbourhood  of  the  gfrowtih  ;  the 
ulceration  decreased  and  the  discharge  assumed 
a  purulent  character  free  from  all  smdil ;  the  bead 
was  no  longer  tilted  and  could  be  moved  freely  in 
all  directions,  the  difficulty  in  swallowing  passed 
away,  and  at  the  end  of  a  month  the  size  had 
dinunished  astonishingly  in  all  directions.  On 
May  30th  the  tumour  was  about  the  size  of  a  hen's 
egg,  remaining  stationary,  but  occasioning  no 
inconvenience ;  sUght  further  shrinkage  had 
continued  from  week  to  week  with  purulent  but 
inoffensive  discharge  from  the  ulcerated  surface. 
The  patient  was  in  the  convalescent  ward  and 
going  out  of  doors  regulariy.  As  I  have  since 
heard  through  Colonel  Ligertwood,  he  had  begun  to 
fail  in  August,  took  to  his  bed,  and  died ;  but  though 
there  had  been  some  haemorrhage  at  times,  there 
was  no  pain  or  extension  of  growth. 

Case   II. — On   August    loth,    1904,    Mr.    

consulted  me.  He  had  been  under  several 
eminent  surgeons  and  physicians  in  town.  He 
was  suffering  from  a  rapidly  growing  pelvic  and 
inoperable  tumour  which  was  first  noticed  in 
January  last.  I  found  a  hard  solid  tumour  filling 
the  abdomen  almost  up  to  the  ensiform  cartilage, 
and  the  right  thigh  and  leg  were  enormously  dis- 
tended. There  had  been  already  some  haemorrhage 
from  the  bladder  on  several  occasions.  He  was 
unable  to  retain  solid  food.  His  wife  vras  carrying 
out  X-ray  treatment  for  him  in  the  country,  bnt 
his  appetite  had  failed  ;  his  weakness  was  great, 
and  the  surgeons  in  town  had  expressed  the  opinioo 
that  the  X-rays  had  not  arrested  the  growth.  I 
wrote  to  his  medical  man  in  the  country,  suggesting 
trial  of  chian  turpentine  injections  and  also  of 
emulsion  of  the  same  by  the  mouth,  which  he  kindly 
agreed  to  carry  out.     August  22nd. — ^I  heard  from 

Mrs. that  so  far  the  injections  had  worked  a 

wonderful  improvement,  that  his  leg  was  soft^, 
his  appetite  better  and  that  he  could  retain  sdids. 
September  9th. — I  again  heard  that  he  was  really 
very  much  better  ;  that  the  tumour  had  receded 
from  the  stomach  in  a  really  wonderful  manner,  and 
that  he  could  eat  solids  as  well  as  ever  and  enjoy 
them.  September  loth. — His  medical  man  wrote 
to  me  corroborating  the  above.    September  17th.— 

Mr. came  up  to  town  to-day  to  see  me,  and  the 

general  improvement  is  very  marked.  The  abdo- 
men is  no  longer  distended  but  supple.  The  tumour 
has  diminished  astonishingly,  and  can  be  made 
out  at  level  of  the   umbilicus,  while   the  leg  is 


Oct.  19.  1904. 


ORIGINAL    COMMUNICATIONS.        The  Medical  Press.    405 


obviously   reduced    in    size.     October  8th.; — ^The 
improvement  so  far  is  maintained. 

Hypodermic  Injections  of  Soap  Solution. — For 
some  years  Mr.  J.  H.  Webb,  Melbourne,  has  been 
successfully  treating  cases  of  inoperable  cancer 
by  hypodermic  injections  of  soap  solution.  When 
this  fact  came  under  my  notice  the  first  difficulty 
I  had  to  encounter  was  that  of  determining  the 
requisite  strength  of  the  solution  and  dosage. 
Unable  to  ascertain  that  the  treatment  had  been 
tried  by  others  I  communicated  with  Mr.  Webb. 
Meanwhile,  Colonel  Ligertwood  and  I  agreed  to 
commence  with  5  minima  of  a  I  per  cent,  solution 
obtained  from  Messrs.  Allen  and  Hanbury,  in- 
creasing by  5  minims  on  alternate  days  to  full  dose 
of  60  minims  every  fourth  day. 

Technique, — The  injections  are  given  into  the 
subcutaneous  tissues.  They  were  given  chiefly 
into  the  outer  surface  of  the  upper  part  of  either 
arm  alternately  or  of  chest  in  the  neighbourhood 
of  the  growth.  They  were  not  altogether  free 
from  some  smarting  or  pain,  which,  however,  soon 
passes  off  or  is  obviated  by  previous  injection  of 
eucaine.  They  appeared  to  be  more  painful  in  the 
leg  and  in  certain  situations  which  vary  individu- 
ally, and  which  I  have  also  noticed  with  other  in- 
jections. Locally,  the  effect  seems  to  vary  from 
some  tenderness  to  painful  inflammatory  areolae 
and  to  lumps  without  suppuration.  The  soap 
solution  readily  passes  through  an  ordinary  fine 
steel  needle,  and  the  same  details  of  syringe 
antisepsis  and  local  anaesthesia  before  insertion  of 
needle,  are  followed  as  previously  noted  in  chian 
turpentine  injections.  For  convenience,  Messrs. 
Allen  and  Hanbury  have  put  up  for  me  one  drachm 
doses  of  the  sterilised  soap  solution  in  small  stop- 
pered bottles.  These  only  require  to  be  warmed 
before  use  and  the  solution  poured  into  the  barrel 
of  the  syringe. 

The  notes  of  cases  treated  by  the  foregoing 
method  will  be  detailed  elsewhere,  with  a  fuller 
description  of  Mr.  Webb's  work  and  treatment. 
AmeUoratioh  was  obtained  in  all  of  them,  chiefly  in 
the  direction  of  decrease  of  tumour,  diminution  of 
f  oetor  and  discharge,  and  cessation  of  pain.  The 
results  obtained  are  such  as  to  justify  the  hope  that 
further  experience  may  perhaps  enable  us  one  day 
to  control  malignant  growths  by  hypodermic 
medication. 

Summary. — From  the  experience  I  have  so  far 
gained,  I  am  satisfied  that  the  treatment  is  worthy 
of  trial.  The  effects  as  shown  in  the  cases  re- 
corded are  diminution  in  the  growth  and  removal 
of  pain  and  foetor,  followed  by  some  restoration 
to  normal  nutrition  as  shown  in  the  improvement 
in  the  general  health  of  the  patient.  So  far;  these 
remarks  apply  to  chian  turpentine.  With  regard 
to  Mr.  Webb's  treatment  I  am  able  to  state  that  my 
experience  so  far  with  it  has  been  attended  with 
similar  results,  and  the  removal  of  some  of  the 
-worst  features — ^pain  and  foetor — confirms  results 
claimed  by  him  for  this  method  of  treatment. 
One  case,  independently  testified  to,  is  that 
of  so  far  apparent  cure  of  recurrent  breast 
cancer,  with  hepatic  metastasis  and  ascites. 
In  neither  case  is  it  possible  to  assert  what  the 
precise  action  is  of  chian  turpentine  on  the  one 
liand  or  of  soap  on  the  other  ;  and — ^whether  Mr. 
Webb  is  right  or  wrong  in  his  theory — in  neither 
case  could  it  have  any  influence  on  ^e  gratifying 
results  which  have  so  far  been  gained  by  these 
methods  of  treatment.     Despite  the  fact  that  an 


extended  trial  is  necessary  in  order  to  arrive  at 
a  definite  conclusion  as  to  the  value  of  this  pljan 
of  treatment,  nevertheless  I  am  personally  satisfied 
that  the  results  justify  its  .trial  in  aU  cases  of 
inoperable  disease,  and  the  urgency  of  cases  of 
inoperable  cancer  has  prompted  me  to  publish 
these  results  of  hypodermic  medication,  in  order 
that  no  time  may  be  lost  in  enabling  others  to  put 
the  treatment  to  a  test  themselves. 


THE  WORK  OF  THE  GENERAL 
MEDICAL  COUNCIL. 

G.     CRICHTON,     M.D. 

"  What's  in  a  name  ?  "  There  is  not  in  truth 
a  '*  General  Medical  Council."  In  1858  the 
Medical  Act  was  passed  establishing  the  *'  General 
Council  of  Medical  Education  and  Registration." 
In  subsequent  Medical  Acts  this  title  is  carefully, 
adhered  to.  The  only  place  in  the  official  Register 
where  •  the  words  "  General  Medical  Council  '* 
appear  is  on  the  page  heading  of  the  treasurer's 
report — evidently   a   proof-reader's   mistake. 

The  primary  object  of  the  Council  was  to  form 
a  Register  of  educated  and  capable  men,  and  unless 
a  man  were  registered  he  was  not  to  practise.     The 
object  of  the  Act  was  the  public  safety,  "That 
persons  requiring  medical  aid  should  be  enabled 
to   distinguish   qualified   from   unqualified   prac- 
titioners."    Those  whom  the  Council  registered 
were  (i)  the  possessors  of  a  diploma  from  a  college, 
or  (2)  of  a  degree  of  a  university,  or  (3)  such  as  had 
obtained  some  kind  of  an  education  and  had  begun 
practice  on  their  own  account,  or  (4)  those  who 
were  surgeons  in  the  Army  or  Navy,  apparently 
without  any  diploma.     For  the  future,  those  only 
were  to  be  registered  who  held  a  diploma  or  a  de- 
gree,  obtained  after  examination  following  on  a 
prescribed   course  of  education.     This,   and   the 
preparation  of  the  Pharmacopoeia,  were  the  sole 
concerns  of  the  General  Council  at  the  first,  and  no 
succeeding  Act  has  enlarged  either  its  functions  or 
its  powers.       As    the   test    of  qualification    was 
examination,  so  the  Council  represented  examining 
bodies  rather  than  education.     It  was  a  council 
of  examiners,    and  so  it   substantially  remains. 
Every  diploma-granting  (i.e.,  examining)  corpora- 
tion or  university  sent  one  member  (some  w^ere 
grouped  and  sent  half  a  member).     They  sent 
examiners  and  teachers,  and  do  now.     Not  every- 
day doctors,  competing  with  quacks  and  patent 
medicines,  struggling  with  clubs,  the  prey  of  the 
dishonest  in  all  ranks,  and  of  out-patient  depart- 
ments and  dispensaries.     Even  the  Crown  mem- 
bers, who  might  have  been  a  leaven,  have  always- 
been  Court  physicians  and  surgeons.     It  was,  and' 
even  now  is,  a  body  of  schoolmasters,  and  with  the* 
common   failing — one   would   not   say    fault — of 
schoolmasters,  they  expect  too  much  from  their 
pupils  ;    examinations  tend  to  become  more  and 
more  oppressive. 

In  the  first  half  of  the  nineteenth  century 
qualification  for  any  hcence  was  held  to  consist 
more  in  **  walking  the  hospital "  than  in  passing 
examinations.  In  preparation  for  the  new  regis- 
tration, 1,000  men  passed  Edinburgh  College  of 
Surgeons  in  one  year.  The  percentage  of  failures 
is  not  stated  !  The  third  class,  mentioned  above, 
who  underwent  some  period  of  study  and  who,  as 
pupU  or  assistant,  picked  up  some  knowledge  of  the 
art,  but  who,  not  having  taken  a  licence,  and,  in 
consequence,    were    ineUgible    for    registration,. 


406    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


lingered  on  for  many  years  as  the  unqualified  assist- 
ant. It  is  onl^  a  few  years  since,  not  without 
some  unavoidable  harshness,  he  was  definitely  ex- 
tinguished. The  examination  in  1 857  of  the  College 
of  Surgeons  of  England  appears  to  have  consisted 
of  one  final — ^in  anatomy,  physiology,  pathology, 
and  surgery.  A  good  knowledge  of  the  bones  was 
essential,  but  admittedly  a  man  might  be  very 
ignorant  of  the  other  subjects.  The  examination 
was  oral  and  lasted  an  hour,  a  quarter  being  given 
to  each  subject. 

If  we  take  up  the  story  twent/  or  twenty-five 
years  later  the  whole  face  of  things  is  chainged. 
One  college  vies  with  another  in  the  severity  of  its 
examinations,  and  the  universities  strive  to  out-do 
them.  The  subjects  for  the  curriculum  are  by  this 
time  settled,  the  Register  is  under  the  care  of  one 
official,  a  satisfactory  Pharmacopoeia  is  in  constant 
use.  Yet  anyone  casually  glancing  at  the  medical 
journals  about  the  year  1882  would  hardly  accept 
that  statement  as  correct,  for  there  is  a  loud 
demand  for  reform.  There  has  been  scarcely  a 
year  in  which  reform  of  the  Medical  Council  has 
not  been  advocated.  But  in  1882  and  onward  a 
determined  efiort  was  made  by  the  British  Medical 
Association.  The  demand  for  district  representa- 
tion was  passed.  A  better  system  of  education, 
a  uniform  standard  of  examination,  were  urgently 
needed,  it  was  said.  The  representatives  of  the 
corporations  stood  in  the  way  of  advance.  If 
general  practitioners  are  represented  in  the  Council 
all  these  reforms  will  immediately  ensue.  From 
about  this  time  dates  the  change  of  name,  so  that, 
in  ordinary  speech,  it  is  now  called  the  "  General 
Medical  Council."  This  shows  a  change  in  the 
popular  mode  of  thought.  It  was  assumed  that 
the  Council — ^reformed — although  the  reform  con- 
cerned only  the  mode  in  which  its  members  were 
to  be  elected,  would  be  the  protector  and  the  guar- 
dian of  the  general  practitioner. 

A  Royal  Commission  was  appointed  in  April, 
1 88 1,  and  it  reported  on  June  26th,  1882.  On 
April  5  th  of  the  following  year  a  Bill  was  intro- 
duced into  the  House  of  Lords.  Its  main  features 
were  a  uniform  State  examination  for  all  students, 
the  number  of  members  to  be  eighteen  (afterwards 
seventeen),  and  four  of  these  to  be  direct  repre- 
sentatives. This  Bill  passed  the  Lords,  but  was 
blocked  in  the  Commons.  However,  in  1886, 
the  present  Act  was  brought  in  by  Sir  Lyon  Play- 
fair.  Instead  of  one  State  examination  were  con- 
joint examinations,  and  five  direct  representatives 
on  a  body  of  about  thirty.  The  object,  functions, 
and  name  of  the  General  Council  were  unchanged. 
It  had  to  do  with  education,  so  that  men  and 
women  may  be  fitted  to  be  on  the  Register,  as 
being  well  qualified  to  treat  disease :  nothing 
more.  Matters  of  great  public  concern  :  The  in- 
cidence of  enteric  during  war,  the  health  of  young 
adults  in  crowded  towns,  or  of  professional  im- 
portance ;  the  favouritism  and  nepotism  and 
corruption  of  public  medical  appointments,  or  fees 
to  medical  witnesses  or  from  clubs,  and  so  on :  these 
are  matters  with  which  the  Council  has  nothing  to 
do.  They  only  touch  occasionally  the  fringe  of 
such  a  question  when  it  may  be  supposed  to  relate 
to  "conduct  infamous  in  a  professional  aspect." 

The  effect  of  "  direct  representation  "  has  been 
undoubtedly  beneficial,  though  indirectly  so. 
There  have  resulted  :  (i)  A  fairly  uniform,  yet 
diverse  system  of  examinations,  complete  as  to  the 
various  subjects ;    surgery,   medicine,   and  mid- 


OcT.  19.  1904. 


wifery,  which  formerly  were  the  subjects  of  sepa- 
rate diplomas  ;  (2)  a  comprehensive  scheme  of 
education  with  an  enormous  amount  of  practical 
work ;  and  (3)  a  constant  interest,  though  yitra 
vires,  shown  by  the  Council,  thus  reinforced 
in  medical  matters  generally,  both  as  regards 
the  public  and  the  profession.  In  addition,  the 
question  of  preliminary  education,  which  had  been 
the  subject  of  discussion  from  the  first,  was  settled. 
But  the  settlement,  after  all,  came  from  without. 
The  schools,  by  their  leaving,  and  the  umvositio 
by  their  matriculation  examinations^  definitdy 
fixed  the  amount  of  knowledge  essential  to  a  sta- 
dent  entering  on  the  study  of  every  profession. 
Yet  no  one  can  doubt  that  the  repeated  discussions 
of  the  Medical  Council  were  of  the  utmost  value  in 
pointing  towards  such  a  settlement.  The  Council 
chamber  was  indeed  almost  the  only  arena  where 
the  matter— of  extreme  national  importance- 
could  be  freely  and  fully  debated. 

Look  back  over  these  forty-five  years.  The 
work  which  the  General  Council  of  Medical  Edu- 
cation  and  Registration  was  established  to  per- 
form is  accomplished.  There  will  still  be  examina- 
tions to  visit,  a  Pharmacopoeia  to  edit,  aji  occasional 
defaulter  to  deal  with.  A  great  task  has  been 
nobly  accomplished.  The  beneficial  results  will 
prove  more  lasting  than  brass.  "  But  (as  Plato 
says)  since  everything  that  has  come  into  being 
must  one  day  perish,  even  a  system  like  ours  will 
not  endure  for  all  time,  but  must  suffer  dissolution." 


THK 

IRISH      POOR-LAW      MEDICAL 
SERVICE,  (a) 

By  MICHAEL  McHUGH,  M.D..  L.R.C.S.I., 
VisitiDflr  PhrBidan  to  St.  Vincent's  HoipiteL 

Following  the  established  custom  on  occasions  such 
as  this,  I  propose  to  take  advantage  of  the  opportunity 
to  draw  attention  to  what  is  undoubtedly  the  most 
important  question  aSecting  the  medical  profession  in 
this  country.  I  allude  to  the  very  unsatisfactory  state 
of  the  Poor-law  Medical  Service.  Public  expressions 
of  opinion  on  this  subject  have  no  doubt  been  not  in- 
frequent during  the'past  few  years,  but  I  feel  neverthe- 
less that  no  apology  is  necessary  for  again  drawing 
public  attention  to  it.  The  chronic  state  of  discontent 
which  the  dispensary  medical  officers  have  constantly 
exhibited,  and  which  I  shall  endeavour  to  show  is  ex- 
ceedingly well  founded,  has  lately  entered  upon  an 
acute  stage  and  matters  have  become  so  critical  that  at 
one  time  we  seemed  to  have  come  within  measurable 
distance  of  a  general  strike  of  the  Poor-law  medical 
officers,  a  body  comprising  50  per  cent.,  roughly  speak- 
ing, of  the  whole  medical  profession  in  Ireland. 

The  present  dispensary  system  in  Ireland  may  be 
said  to  have  come  into  existence  in  1 85 1 »  when  attention 
having  been  forcibly  drawn  to  the  condition  of  the 
poorer  classes  owing  to  the  appalling  catastrophe  of 
the   vears    1847-48,    the   Medicad    Charities    Act  was 
passed.     By  it   the   Poor-law  Commissioners,   acting 
through  the  local  boards  of  guardians,  were  authorised 
to  divide  up  the  whole  of  Ireland  into  dispensary  dis- 
tricts "  with  due  regard  to  the  extent  and  population 
)f  the  districts,"  and  to  employ  a  medical  officer  itx 
the  care  of  the  sick  poor  in  each  of  these  divisions. 
Prior  to  the  passing  of  this  Act,  although  the  workhooses 
had  been  in  existence  since  1841,  the  only  provision 
for^the  medical  treatment  of  the  outside  poor  was  by 
provident  dispensaries,  few  and  far  between,  supported 
by  private  subscription  and  helped  at  times  by  grants- 
in-aid  from  county  funds.     So  few  and  isolated,  hoir« 
ever,  were  these  dispensaries,  that  in  the  County  Maya 

(a)  Introductory  addresa  delivered  at  the  openiztf  of  tlie  Wiotir 
Beiiion  at  8t  Yinoent's  HoipiUl,  Dublin. 


Oct.  19,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Pagsa.    407 


111^1836,  only  one  of  them  had  been^establishcd  in  a 
tlistrict  measuring  72  miles  by  58. 

The  dispensary  districts  formed  as  the  result  of  the 
Act  of  1 85 1  would  seem  to  have  been  parcelled  out 
"Without  regard  to  any  proper  system  or  geographical 
method.  Wherever  a  provident  dispensary  existed  on 
a  landlord's  estate  it  was  apparently  taken  over  as  a 
going  concern  and  constituted  the  centre  of  a  dispen- 
sary district,  whilst  the  intervening  irregular  spaces 
w'ere  subdivided  into  new  dispensary  districts,  without 
any  apparent  regard  to  the  convenience  of  the  peasant, 
and  certainly  not  to  that  of  the  doctor  in  the  discharge 
of  his  duties.  These  districts  extended  and  still  extend 
in  extraordinary  manners,  interlocked  with  one  another 
in  hopeless  confusion,  enclosing  lakes,  mountains,  and 
bog  areas  in  such  a  way  as  to  render  the  giving  of  aid 
to  the  mass  of  the  people  a  matter  of  great  physical 
difiSculty,  apart  altogether  from  the  question  of  ade- 
quate remuneration  to  the  medical  officer. 

This  institution  of  the  dispensary  district  and  doctor, 
defective  as  it  was,  nevertheless  marked  a  great  im- 
provement on  previous  conditions,  being,  on  the  whole, 
a  fairly  successful  eSort  to  place  medical  aid  within 
Teach  of  the  poor  in  all  rural  districts ;  but  it  is  im- 
portant to  note  that,  inasmuch  as  it  placed  in  every 
outlying  portion  of  the  country  a  State-aided  medical 
man,  the  landlord  and  well-to-do  classes  gained  corre- 
spondingly and  probably  even  more  than  did  the 
masses  of  the  people.  It  brought  to  their  doors  a 
trained  medical  man  available  for  their  own  needs, 
and  who  otherwise  would  not  be  there,  whilst  the  State 
paid  him  a  grant  in-aid.  This  is  a  consideration  which, 
I  think,  should  be  strongly  emphasised,  inasmuch  as  it 
shows  that  it  is  more  in  the  interest  of  the  general 
public  even  than  of  the  medical  profession  that  the 
Poor-law  appointments  should  be  held  not  only  by 
competent  men  but  by  the  best  men  procurable,  and  con- 
sequently that  this  important  service  should  be  made  as 
attractive  as  possible  to  the  rising  members 
of  the  profession.  The  desirability  of  this  policy  will 
be  rendered  even  still  more  evident  when  it  is  remem- 
bered that  the  Poor-law  officer  is  also  the  medical 
officer  of  health  of  his  district,  so  that  in  this  most 
important  matter  of  general  sanitation  the  well-being 
of  the  public  is  entirely  in  his  hands. 

As  a  rule,  whenever  a  Government  has  to  deal 
with  the  medical  profession,  it  endeavours  to 
•wring  a  full  and  exhaustive  service  from  the  unlucky 
doctor.  By  the  Act  of  185 1  the  dispensary  medical 
officer  was  bound  "  without  further  fee  or  reward  to 
vaccinate  all  persons  in  his  district."  Ke  was  also 
bound  to  certify  all  dangerous  lunatics,  to  act  as 
sanitary  officer,  to  visit  the  local  Bridewell,  and  all 
without  extra  pay.  It  requires  years  of  struggle  to  get 
these  duties  disentangled  from  the  ordinary  dispensary 
medical  work,  and  to  be  paid  for  separately.  Gradu- 
ally, however,  this  was  done  and  now  the  duties  of 
vaccinator,  registrar  of  births  and  deaths,  and  the 
others  just  mentioned  form  separate  items  of  the 
doctor's  duties,  and  are  paid  for  separately,  though  it 
may  be  stated  that  as  in  other  matters  in  making 
these  extra  payments  the  very  strictest  economy  is 
observed.  *    H        ..  -Jy 

In  other  respects,  it  may  be  stated  generally  that 
the  status  of  the  dispensary  doctor  has  remained  un- 
changed since  185 1,  although  since  that  period  the 
medical  curriculum  has  been  lengthened  from  three  to 
five  years,  and  the  difficulty  of  entering  the  profession, 
both  as  regards  expense,  extension  of  studies,  and 
severity  of  examinations,  has  been  more  than  doubled. 
Fewer  young  men  are  studying  for  the  profession 'and 
fewer  qualify.  Furthermore,  the  Army  and  Navy 
medical  services  have  lately  increased  the  already  high 
inducements  which  they  hold  out  to  junior  qualified 
men,  whilst  the  action  ofTthe  General  Medical  Council 
in  causing  the  dismissed  of  unqualified  assistants  to  the 
number  of  800  in  England  has  greatly  increased  the 

demand  in  that  country  for  young  practitioners a 

demand  which  must  be  largely  supplied  by  the  products 
of   the   Irish  schools  of  medicine.     I   have   already 


pointed  out  how  desirable  it  is,  not  only  in  the  interests 
of  the  poor  but  also  of  all  the  inhabitants  of  a  given 
district,  that  an  efficient  and  competent  medical  officer 
should  be  provided,  and  it  will  be  evident.  I  think, 
from  the  foregoing  that  the  local  authorities  will  have, 
as  time  passes,  greater  difficulty  in  doing  so.  They 
have  to  compete  with  other  public  services  which  have 
adopted  a  levelling-up  attitude,  and  if  they  are  to  do 
so  with  any  prospect  of  success,  they  and  the  Govern- 
ment must  remove  the  undoubted  and  serious 
grievances  of  which^the  Poor-law  medical  officers  have 
to  complain. 

The  first  of  these  grievances  is,  that  the  salaries  paid 
to  these  medical  officers  are  far  from  adequate  and 
no  reasonable  recompense  for  their  arduous  duties. 
In  order  to  demonstrate  this,  I  shall  again  avail  myself 
of  the  valuable  store  of  information  collected  by  Sur- 
geon-General Evatt,  and  made  public  by  him  in  the 
exhaustive  report  which^he  has  furnished  to  the  British 
Medical  Journal.  In  order  to  give  a  clear  idea  of  the 
amount  of  work  devolving  on  the  doctor  and  of  the 
entirely  disproportionate^remuneration  given  him.  Dr. 
Evatt  selects  for  detailed^description  vhat  he  describes 
as  a  typical  union  in  a  typical  county.  The  union 
selected  is  the  Antrim  Union,  of  the  County  Antrim. 
It  contains  six  dispensary  divisions  which,  according 
to  Dr.  Evatt,  are  very  arbitrary  divisions,  often 
ridiculous  in  shape  and  without  logical  geographical 
boundaries.  They  grew  up  haphazard  after  the  famine 
and  have  never  been  fully  and  systematically  con- 
sidered. 

The  first  of  these  districts  examined  is  the  Antrim 
dispensary  district.  This  division  contains  twenty- 
one  mUes  of  territory,  and  a  population  of  5,356  persons, 
the  area  being,  however,  below  the  average  for  all 
Ireland,  which  is  forty- two  square  miles.  For  this 
district  there  is  but  one  medical  officer,  without  the 
assistance  of  either  compounder,  midwife,  or  district 
nurse.  This  medical  officer,  in  the  year  1902,  saw  at 
the  dispensary  648  new  cases,  many  of  wldch  had  no 
doubt  to  be  treated  repeatedly.  He  also  performed 
the  duties  of  dispenser,  making  up  with  his  own  hands 
all  the  medicines  required,  and  kept  the  many  statis- 
tical records.  He  attended  at  the  dispensary  twice 
weekly,  and  also  acted  as  registrar  of  births,  marriages, 
and  deaths,  receiving  one  shilling  an  entry  for  births 
and  sixpence  for  marriages.  He  attended  at  their  own 
far-scattered  homes  over  this  twenty-one  square 
miles  321  fresh  and  separate  cases  of  Ulness,  cases  so 
serious  as  to  be  unable  to  attend  at  the  dispensary  for 
outdoor  treatment,  and  of  which  many,  no  doubt,  re- 
quired frequent  visits,  and  for  those  he  also  made  up 
the  medicine  at  the  dispensary. 

For  these  duties  the  medical  officer  drew  the  mag- 
nificent stipend  of  ;£ioo  a  year  from  the  guardians, 
one-half  of  which  was  paid  by  the  State  from  the  central 
fund  for  reducing  l(x:al  taxation.  He  was  obliged, 
however,  to  keep  a  horse  and  trap  and  a  servant.  Now 
the  officers  of  the  Royal  Irish  Constabulary  have  a 
fixed  allowance  for  a  horse,  ;J50  a  year,  and  for  a  man- 
servant, £4$  a  year.  If  we  calculate  the  upkeep  of 
the  trap  and  harness  for  the  year  at  £$  we  discover 
that  this  medical  philanthropist  did  this  onerous  and 
exhausting  work  and  received  actually  no  wages  for  his 
labours,  his  pay  being  but  equal  to  the  expenses  of 
locomotion. 

Dr.  Evatt  also  analyses  the  conditions  existing  in  the 
five  other  dispensary  districts  of  the  Antrim  Union,  a 
very  similar  state  of  things  being  revealed  in  each  case, 
the  principal  difference  being  that  although  the  dis- 
tricts might  be  larger  the  salary  was  generally  lower. 
In  the  case  of  one  then,  in  fact,  the  Crumlin  district, 
though  the  area  amounted  to  thirty-five  square  miles, 
the  salary  was  £84  19s.  gd. 

Comment  on  such  a  state  of  affairs  is  surely  needl^. 
Bad  as  it  is.  however,  it  may  be  said  that  worse  remains 
behind.  As  has  been  just  mentioned,  the  average  area 
of  the  dispensary  districts  throughout  the  country  is 
given  in  the  Local  Government  official  statements  as 
forty-two  square  miles.    Of  a  total  of  twenty- two 


408    The  Medical  Pkess.  ORIGINAL    COMMUNICATIONS. 


Oct.  19,  1904. 


districts  in  County  Clare,  ten  have  an  area  of  fifty  or 
more  square  miles,  the  Corofin  district  has  an  area  of 
ninety-five,  and  Ballyvaughan  actually  one  of  no 
square  miles.  All  of  these  dispensary  districts  are  in 
the  sole  charge  of  one  medical  officer,  though  several 
of  them  contain  supplementary  out-dispensaries  (as 
many  as  three  or  four  of  these  in  some  cases),  although 
they  have  to  be  attended  on  stated  days  by  the  same 
officer.  In  the  County  Mayo  there  are  no  less  than 
seven  dispensary  districts  of  over  100  square  mUes  in 
area,  all,  again,  in  the  charge  of  a  single  doctor,  with  a 
salary  of  ;iioo,  or  perhaps  a  little  more,  and  rising  in 
only  one  instance  to  ^(150. 

It  is  important  for  obvious  reasons  to  bear  in  mind 
the  huge  size  of  some  of  the  Irish  districts  as  the  area 
affects  the  questions  of  time  and  expense  of  locomotion 
consumed  by  the  doctor  in  visiting  his  patients.  In 
many  of  the  larger  districts  a  second  horse  would  be 
required.  Happily,  as  Dr.  Evatt  has  pointed  out,  we 
have  a  clear  official  ruling  as  to  the  cost  of  maintenance 
of  a  horse.  It  is  laid  down  in  official  documents  to  be 
seen  at  the  head  office  of  the  Royal  Irish  Constabulary. 
According  to  them  the  annual  sum  allowed  for  the  horse 
is  3^50,  and  for  a  servant  £4$  to  cover  food  and  pay, 
adding  expenses  for  repairs.  Dr.  Evatt  concludes  we 
arrive  at  a  sum  which  may  be  considered  sufficient  to 
at  once  wipe  out  all  salary  "for  purely  professional  work 
in  a  majoritv  of  the  Irish  dispensaries,  the  officers  of 
which  may  be  therefore  be  said  to  be  doing  their  work 
gratuitously. 

The  argument  of  the  official  governing  body  is  no 
doubt  that  the  medical  officers  have  their  private 
practice,  and  that  for  their  public  duties  only  a  portion 
of  their  time  is  required.  In  reply  to  this,  it  may  be 
said  that  when  we  consider  the  size  of  the  districts  and 
the  obviously  large  amount  of  dispensary  work  done 
by  the  doctors,  a  very  much  larger  amount  of  work  is 
done  by  them  than  is  contemplated  in  their  salaries. 
Furthermore,  the  constant  exacting  orders  issued  to 
them  by  the  Local  Government  Board,  requisitions  for 
reports,  on  drugs  and  other  matters,  make  considerable 
inroads  on  their  time,  leaving  them  little  leisure  for 
private  practice.  Again,  it  must  be  remembered  that 
Ireland  does  not  possess  for  the  most  part  a  middle- 
class  capable  of  paying  for  medical  attendance  at  its 
market  value,  nor  a  resident  annuitant  class  able  to 
pay  a  medical  man  a  reasonable  fee.  And,  finally,  that 
the  abuse  of  the  system  of  issuing  red  tickets — the 
historic  red  tickets — deprives  the  medical  officer  in 
very  many  cases  of  his  due  by  requiring  him  to  attend 
gratuitously  persons  who  might  reasonably  be  expected 
to  be  able  to  pay.  This  latter  has  been  a  long-standing 
grievance  with  the  medical  officers,  about  which  much 
has  been  written  and  spoken.  There  can  be  no  doubt 
as  to  its  reality,  and  the  simplest  way  of  removing  it, 
and  perhaps  the  only  solution  of  the  difficulty,  is  that 
the  power  to  issue  red  tickets  shall  be  limited  to  the 
relieving  officers. 

One  of  the  most  crying  scandals  in  connection  with 
the  administration  of  the  Poor-law  Medical  Service  is 
the  absence  of  any  settled  system  of  retirement  and 
retiring  allowances.  There  is  no  compulsory  rule 
granting  the  medical  officers  superannuation,  no  matter 
how  long  may  have  been  their  services.  And,  further- 
more, should  any  superannuation  be  granted  by  the 
local  guardians,  the  charge  falls  entirely  on  the  local 
rates,  though  during  the  whole  term  of  service  of  the 
particular  officer  the  State  paid  50  per  cent,  of  his 
salary.  It  would  be  difficult  to  find  a  more  glaring 
anomaly.  The  whole  cost  of  superannuation  has  been 
thrown  on  the  local  rates,  and  deliberately,  by  special 
Act  of  Parliament,  for  it  has  been  enacted  that  though 
the  local  board  of  guardians  may  grant  superannuation 
with  the  consent  of  the  Local  Government  Board,  the 
Act  contains  this  special  proviso,  that  "  no  contribution 
shall  be  made  thereto  out  of  any  moneys  voted  by 
Parliament." 

Will  it  be  believed  that  there  is  also  a  rule  in  existence 
^^hich  ordains  that  no  applicant  for  superannuation 
shall  have  his  claim  for  superannuation  even  considered 


until  he  has  actually  resigned  his  appointment  ?  If  it 
were  not  so  unjust  and  tyrannical  it  would  alinost 
appear  comic.  What  it  really  amounts  to  is  this— 
that  after  a  medical  officer  has  devoted  his  life  aad 
abilities  to  the  service  of  the  sick  poor  he  is  hunseU 
placed  upon  the  rates  and  becomes  the  recipient  prac- 
tically of  outdoor  relief,  for  it  is  in  the  power  of  the 
guardians,  after  he  has  resigned  his  appointment,  either 
to  grant  or  withhold  an  allowance. 

There  are  other  matters,  such  as  the  granting  of  leave 
of  absence,  either  in  case  of  illness  or  foe  the  annua! 
holiday,  or  for  the  purposes  of  scientific  study,  which 
might  be  considered  with  advantage  on  this  occasion,, 
were  it  not  that  the  liniitations  of  time  preclude  me 
from  doing  so. 

In  conclusion,  I  can  only  advert  with  gratifi-cation  to 
the  fact  that  the  claims  of  the  Poor-law  officers  have  of 
late  been  actively  pushed  and  advocated,  and  this  time 
bv  an  organised  body — the  Irish  Medical  Association. 
TTiis  Association  has  made  the  following  demands  oa 
their  behalf,  viz, : — 

1 .  That  a  minimum  salary  of  ;£200  per  annum  shaD 
be  paid  to  each  dispensary  officer. 

2.  That  a  grant  of  one  month's  holiday  annually 
shall  be  made  in  each  case,  with  pay  for  the  locum 
tenens  at  the  rate  of  £4  4s.  weekly  ;    and 

3.  That  suitable  superannuation  shall  \>e  granted  as 
a  right  and  not  as  a  favour. 

These  demands  are  certainly  legitimate  ;  if  they  err 
at  all  it  is  on  the  side  of  moderation,  and  I  feel  con- 
fident that  the  Association  in  putting  them  forward  wfll 
have  the  support  of  all  independent  members  of  Xht 
profession,  and  of  all  right-thinking  men  among  the 
general  pubUc.  It  certainly  has  my  advocacy,  and  I 
shall  esteem  myself  fortunate  if.  in  directing  pubfic 
attention  to  this  important  question.  I  have  helped  id 
any  way  to  mitigate  the  hardships  and  to-  ameliorate 
the  lot  of  that  long-suffering  official,  of  that  friend  of 
the  poor,  of  that  good  fellow,  the  Irish  dispensary 
doctor. 


THE  VALUE  OF   LABORATORY 
WORK    IN    MEDICINE,  (a) 

By  E.    WAYMOUTH     REID,     B.A.Cantab.,     M.R 
F.R.S. 
Dean  of  the  Faoalty  of  Medieine,  St.  Andrews  Univenitjr. 

In  his  opening  remarks  Prof.  Reid  said  he  wished 
to  indicate  some  of  the  services  rendered  to  mankiiid 
by  those  who  devoted  themselves  to  biological  experi- 
mentation.     Until  this  method  was  adopted  for  the 
solution  of  biological  problems,  the  ideas  of  the  pro- 
cesses going  on  in  even  the  simplest  structures  of  a 
living  thing  were  distinctly  bizarre,  so  that  the  great 
healing  art  had  no  true  foundation.     A  capitsJ  in- 
stance of  that  fact  was  to  be  found  in  connection  with 
the    organ    known    as    the  pancreas.     Vesalius  was 
content  to  think  that  it  was  a  general  support  to  the 
parts  around.     Landanus  did  not  doubt  it  expurgated 
those  impurities  of  the  blood  too  gross  to  be  dealt 
with  by  the  ordinary  organs,  while  Wharton  said  it 
ministered  to  th3  nerves  by  taking  up  certain  of  their 
superfluities.     For   nearly   200   years    no   one  had  a 
ghost  of  an  idea  of  the  true  use  of  this  structure.     Then 
came  experimental  inquiry,  largely  at   the  hands  of 
Claude    Bernard,    and    the    "  general     support "  of 
Vesalius,    the    *'  cleanser "    of    Landanus,    and    the 
"  nerve  soother  "  of    Wharton  was  found  to  be  the 
most   important   organ   of  digestion    they  possessed 
Not  long  ago,  as  the  result  of  a  different  class  of  experi- 
ments, came  the  great  discovery  of  an  entirely  different 
and  additional  function  of  the  same  organ,  which  no 
method  could  possibly  have  yielded  but  experimenta- 
tion, and  which  immediately  shed  light  on  their  know- 
ledge of  a  terrible  disease.     Gall  had  for  his  time  a 
very  accurate  knowledge  of  the  structure  of  the  brain 
and  actually  observed  that  loss  of  the  power  of  speedi 

(a)  Atetiaotof  the  Introductory  Address  at  the  Winter 
University  College,  Dundee. 


Oct.  19,  1904. 


CUNICAL    RECORDS. 


Thb  Mxdical  Press.   4^9 


occurred  after  injury  to  a  certain  part  of  the  brain. 
The  result  of  his  deductions  was  his  phrenology, 
^w^hich  tived  no  longer  except  for  the  foolish  who  would 
pay  a  shilling  for  a  pennyworth  of  flattery. 

Thb  Thykoid  Gland. — In  his  own  student  days 
the  lecturer  on  physiology  told  them  what  the  thyroid 
^land  looked  Uke  under  the  microscope,  but  that  was 
all.  A  London  physician,  however,  observed  that 
one  of  the  concomitants  of  a  terrible  disease  was  the 
w^asting  away  of  this  structure,  and  it  was  proved  by 
experiment  that  the  cause  of  the  disease  was  the  ab- 
sence of  the  function  of  this  organ.  The  cure  followed 
in  a  few  years.  Graftings  were  made,  the  gland  material 
was  injected  under  the  skin,  and  it  was  found  that  the 
result  was  the  same  (when  the  gland  material  was 
«eaten  by  the  patient.  The  direct  result  was  that 
not  only  was  the  growth  of  body  and  mind  in  a  certain 
class  of  otherwise  hopelessly  imbecile  children  restored, 
bat  thick-witted  adults,  drifting  into  idiocy,  could 
again  enjoy  their  health.  But  the  consequences  of 
that  most  vigorous  department  of  biological  experi- 
mentation, experimental  pathology,  were  perhaps  of 
greater  interest  to  a  general  audience.  Ever  since  the 
f^eat  discovery  of  the  relationship  of  certain  diseases 
to  parasitic  micro-organisms,  and  of  the  poisons  which 
they  brewed,  this  morbid  physiology  had  attracted  so 
many  ardent  students  that  it  was  now  a  distinct  branch 
of  Imowledge.  The  modem  treatment  of  wounds, 
consumption,  diphtheria,  and  tetanus,  and  of  a  host  of 
other  infectious  diseases  was  the  immediate  result  of 
the  laboratory  zeal  of  the  experimental  pathologist. 
The  benefits  which  these  results  had  conferred,  and  would 
yet  confer,  upon  man  and  animals  must  strike  every 
thoughtful  person  who  would  take  the  trouble  to  master 
a  little  detail.  Much  of  the  remarkable  and  ever- 
increasing  services  rendered  by  the  experimental 
pathologist  had  directly  originated  from  his  study 
of  the  conditions  of  experimental  or  artificially-pro- 
duced immunity  to  disease  in  animals,  and  in  the  course 
of  his  work  he  had  introduced  them  to  one  of  the  most 
remarkable  reactions  of  the  organism,  namely,  the 
production  of  what  were  called  anti-bodies,  in  response 
to  certain  stimuli. 

The  Immunity  Problem. — ^This  inmiunity  problem 
•was  certainly  just  now  without  a  rival  in  its  interest 
to  the  experimental  biologist.  It  had  been  clearly 
proved  that  not  only  power  of  defence  could  be  in- 
creased, but  that  it  could  also  be  conferred,  if  absent, 
"by  Nature.  The  normal  blood  serum  (blood  fluid)  held 
a  number  of  different  protective  substances  in  small 
simounts,  and  the  experimenter  had  discovered  how  to 
increase  the  amount  of  one  of  these  enormously. 
Physiology  had  often  stood  still  for  want  of  chemical 
assistance,  and  in  this  great  immunity  problem  it  was 
T>eginning  to  be  quite  clear  that  the  chemist  must 
step  in  if  only  to  save  them  from  explanations  of  every 
newly-discovered  phenomenon  by  the  assumption  of 
the  existence  of  a  new  substance.  To  the  biologist 
the  discovery  and  study  of  anti-bodies  was  yielding 
the  idea  of  specificity  of  cells  undreamed  of  before. 
Hut  if  enough  was  known  for  practical  purposes,  as 
prophylactic  and  curative  results  indicated,  of  the 
action  of  anti-bodies,  it  could  not  be  said  that  the  deeper 
problem  of  the  machinery  of  their  production  by  the 
organism  was  yet  far  on  the  way  to  solution. 

Professor  Reid  then  referred  to  the  application,  from 
a  medico-legal  standpoint,  of  the  specificity  of  anti- 
bodies in  discovering  whether  a  given  quantity  of 
"blood  belonged  to  a  man  or  to  another  animal.  In 
concluding,  he  said  real  progress  must  be  slow,  and 
shifting  sands  of  working  hypotheses  would  shift  and 
shift  again  ere  the  bedrock  upon  which  to  build  was 
reached. 


Royal  CoIl«g«  of  Surgeons  in  IrelaBd  Fellowship 
Examination. 

Dr.  R.  M.  Smyth,  Assistant  Superintendent,  Nata^ 
Oovemment  Hospital.  Durban,  South  Africa,  having 
passed  the  necessary  examination,  has  been  admitted 
a  Fellow  of  the  College,     j 


Cltntcal  necordd. 


SIR   PATRICK   DUN'S   HOSPITAL. 

Case  of  Perforated  Gastric  Ulcer  Simulating  Appendi' 

dtis, — Operation  Twenty  Hours  Afterwards,-^ 

Recovery, 

By  C.  Arthur  Ball,  M.D., 

AMistant  Burgeon,  Sir  Pfttriok  Dun's  Hot]Atal,  Ihiblin. 

Patient,  a  girl,  aet.  22,  was  admitted  into  Sir 
Patrick  Dun's  Hospital  on  Friday,  June  9th.  On 
admission  she  was  considerably  collapsed,  but  went 
to  sleep  shortly  afterwards  and  slept  for  some 
hours ;  she  then  woke  complaining  of  very  severe  pain 
in  the  abdomen.  I  saw  her  shortly  after  6  p.m.  .She 
stated  that  she  had  been  illsince  the  previous  Saturday, 
suffering  from  severe  pains  in  the  lower  part  of  the 
abdomen,  but  was  able  to  keep  at  her  work  (a  domestic 
servant)  until  Thursday  evening,  about  10. 30, {when 
the  violent  pain  began,  most  severe  in  the  right  iliac 
region ;  this  had  continued  ever  since.  On  Friday 
she  was  given  a  hypodermic  injection,  and  sent  into 
hospital  by  Dr.  Wright,  in  a  cab  from  Dalkey.  She 
had  not  vomited  at  any  time  during  her  illness,  a^d 
had  eaten  her  usual  food ;  her  bowels  had  moved  the 
previous  day. 

On  examination, — ^The  patient  was  evidently  very 
ill;  pulse  120  and  weak;  temperature,  loi  ;  she 
occasionally  hiccoughed;  the  facial  expression  was 
one  of  a  severe  intra-abdominal  lesion ;  the  abdomen 
was  distended ;  the  muscles  over  the  lower  part  were 
rigid ;  the  maximum  pain  and  tenderness  was  over 
the  iliac  regions,  most  marked  on  the  right  side;  a 
small,  acutely  tender  superficial  area  was  noticed  in 
the  epigastric  region  ;  liver  dulness  was  present.  The 
patient  was  obviou^y  suffering  from  acute  general 
peritonitis,  and  on  questioning,  stated  that  she 
had  never  had  pain  after  food,  and  had  never  vomited. 
It  appeared  from  her  history  that  she  had  probably 
been  suffering  from  appendicitis  since  Saturday,  and 
that  an  abscess  in  connection  with  the  appendix  had 
burst  into  the  general  peritoneal  cavity. 

I  operated  immediately,  first  making  a  small  incision 
in  the  middle  line  bcdow  the  umbilicus,  to  explore  the 
pelvis  and  see  if  it  contained  pus.  On  opening  the 
abdomen  no  free  gas  was  noticed,  but  turbid  fluid, 
free  from  smell,  welled  up  into  the  wound  ;  the  intestines 
in  the  pelvis  were  inflamed,  but  not  very  acutely. 
The  pelvic  viscera  were  explored  without  finding 
anything  to  account  for  the  trouble.  An  incision  was 
then  made  over  the  appendix.  It  was  found  very 
long,  running  up  behind  the  caecum,  with  a  kink  in 
it,  and  two  or  three  old  adhesions ;  in  fact,  it  looked 
like  a  typical  "  interval  appendix "  but  was  only 
inflamed  to  the  same  extent  as  the  surrounding  in- 
testines, and  evidently  was  not  responsible  for  the 
peritonitis  present.  An  incision  was  now  made  in 
the  middle  line  above  the  umbilicus ;  the  transverse 
colon  was  adherent  to  the  anterior  abdominal  wall, 
and  completely  covered  with  lymph  exudate ;  the 
adhesions  were  easily  broken  down  and  the  stomach 
examined.  A  perforation  was  found  on  the  anterior' 
surface  of  the  lesser  curvature  near  the  cardiac  orifice, 
about  one  centimetre  in  diameter,  very  patent,  and 
through  which  fluid  poured.  The  induration  around 
the  perforation  was  so  extensive  that  excision  of  the 
area  was  impossible,  and  sutures,  passed  even  some 
distance  from  the  perforation,  cut  out  as  soon  as 
tied.  A  fold  of  healthy  stomach  wall  was  therefore 
brought  over  the  diseased  area,  and  sutured  to  the 
gastro-hepatic  omentum,  which  was  indurated  and 
friable  for  some  distance  away  from  the  stomach. 
This,  while  effectually  sealing  the  perforation,  pro- 
duced a  good  deal  of  deformity ;  however,  fluid  and 
flatus  could  be  easily  passed  from  one  end  of  the 
stomach  to  the  other.  The  cleansing  of  the  peritoneum 
was  then  proceeded  with ;  the  peritonitis  in  the  upper 
half  was  much  more  severe  than  that  met  with  in  the 
lower  part  of  the  abdomen ;  the  viscera  in  the  neigh- 
bourhood of  the  stomach  were  covered  with  lymph 


410    Thb  Mbdical  Press. 


TRANSACTIONS   OF   SOCIETIES. 


Oct.  19.  1904. 


and  adherent  to  one  another,.  These  adhesions 
separated  easily,  and  the  whole  abdominal  cavity 
was  washed  out  with  large  quantities  of  saline  solution, 
until  the  fluid  came  away  quite  clear. 

I  then  considered  the  advisability  of  performing  a 
gastro-enterostomy  as  recommended  by  Mayo  Robson. 
It  would  have  been  very  difficult,  owing  to  the  thickened 
and  inflamed  condition  of  the  intestines  and  stomach, 
and  the  patient's  condition  was  such  that  any  pro- 
longation of  the  operation  unless  necessary  to  save 
her  life  was  inexpedient. 

Rubber  drainage-tubes  were  passed  to  the  renal 
fossae  and  into  the  pelvis ;  the  upper  incision  was  left 
open  and  packed  with  gauze  down  to  the  perforation  ; 
the  two  lower  wounds  were  completely  closed,  with 
the  exception  of  where  the  tube  entered  the  pelvis. 

The  after-history  of  the  case  was  uneventful ;  the 
pulse  and  temperature  gradually  fell  to  normal.  Con- 
valescence was  prolonged  by  the  development,  some 
two  weeks  after  the  operation,  of  an  abscess  in  the 
upper  wound  due  to  the  Bacillus  coli  communis. 

Closely  questioning  the  patient  afterwards,  she 
admitted  having  suffered  from  indigestion  last  Christ- 
mas year,  which  lasted  till  the  following  May.  She 
had  a  slight  recurrence  of  this  last  Christmas.  She 
also  gives  a  history  of  two  attacks  of  pain  in  the  right 
iliac  fossa  which  may  have  been  appendicitis. 

She  left  hospital  on  July  i8th,  perfectly  well,  the 
alteration  in  the  contour  of  her  stomach  apparently 
causing  no  trouble. 

The  following  points  in  the  case  are  of  interest : — 

1.  Twenty  hours  had  elapsed  between  the  per- 
foration and  the  operation,  during  which  time  the 
patient  underwent  the  journey  of  nine  miles,  from 
Dalkey,  sitting  in  a  cab,  a  trying  ordeal  which  she 
could  hardly  have  borne  without  the  morphia  which, 
by  masking  S3rmptoms,  was  to  some  extent  responsible 
for  the  delay  in  having  recourse  to  operation. 

2.  As  has  occasionally  occurred,  the  history  and 
symptoms  pointed  to  appendicitis. 

3.  Vomiting  was  absent  both  before  and  after  the 
operation. 

XTraitdactione  of  Societies* 


WEST    LONDON    MEDICO-CHIRURGICAL 
SOCIETY. 

NOTES  ON  PSYCHOLOGY. 

At  the  opening  meeting  of  the  twenty-third  session 
of  the  above  Society,  held  at  the  West  London  Hospital, 
on  Friday,  October  7th,  the  President,  Charles  M. 
Tuke,  Esq.,  M.R.C.S.,  occupied  the  chair,  arid  de- 
livered an  address  on  Psychology. 

The  President  very  naturally  chose  the  special  work 
to  which  he  has  devoted  his  life  for  the  subject  matter 
of  his  address.  He  referred  to  the  able  address  of  the 
late  President,  in  which  he  dealt  with  the  enormous 
advance  made  in  medical  knowledge  during  the  last 
fifty  years.  But,  striking  and  real  as  that  advance 
undoubtedly  was,  it  might  be  asked  if  the  treatment 
of  insanity  had  also  advanced  during  that  time.  He 
replied  that  progress  had  been  made  in  that  branch 
of  medical  science  almost  as  great  as  in  any  other  direc- 
tion— an  advance  not  perhaps  marked  by  any  one  great 
discovery,  but  chiefly  by  the  general  adoption  of  a 
principle  which  had  been  of  enormous  value  to  thou- 
sands, and  had  conferred  honour  on  those  who  initiated 
it,  and  also  on  the  whole  profession  of  medicine.  This 
system — the  non-restraint  system — is  now  universal, 
but  in  considering  the  advances  of  medical  science, 
its  flrst  recognition  must  mark  an  epoch,  and  it  is 
almost  impossible  to  believe  that  its  general  adoption 
dates  from  only  some  sixty  years  ago.  By  very  in- 
teresting references  to  ancient  history  and  quotations 
from  Plato,  Euripides,  Hippocrates.  Coelius  and  Galen, 
&c.,  he  compared  the  treatment  of  insanity  among 
the  ancients  with  more  modem  methods,  and  drew 
attention  to  the  surprising  fact  that  it  is  not  possible 
to  trace  a  gradual  improvement  in  the  history  of  the 
treatment  of  insanity — the  same  story  of  deplorable 


ignorance:  neglect,  cruelty,  and  even  imprisonment 
in  chains  and  Duming  obtaining  almost  universally^ 
until  the  close  of  the  eighteenth  century.  It  was  not 
untU  1792  that  the  name  of  Pinel  recalls  a  noble 
change  in  the  whole  system,  flfty-three  patients  being 
liberated  from  chains  by  hiwi  in  that  year  at  Bicctre, 
and  the  non-restraint  system  inaugurated  in  France. 
In  England,  in  the  same  year,  William  Tuke  founded 
an  institution  in  York  called  the  Retreat,  which 
was  conducted  on  lines  almost  identical  with  the 
non-restraint  system,  and  it  is  to  William  Tuke  and 
his  grandson,  Samuel  Tuke,  that  so  much  of  the  credit 
is  due  in  obtaining  the  appointment  of  a  committee 
of  the  House  of  Commons  in  181 5  to  inquire  into  the 
condition  and  management  of  asylums.  From  that 
time  dates  the  disappearance  of  ignorance  and  cradty, 
and  the  rise  of  a  high  standard  of  moral  management, 
also  the  building  of  new  asylums  superintended  by 
men  of  intelligence,  sympathy  and  humanity.  Lincoln 
Asylum  (under  Mr.  Gardner  Hill  and  Dr.  Charles- 
worth)  and,  on  a  larger  scale,  Hanwell  Asylum  (under 
Dr.  Conolly)  were  very  conspicuous  examples  of  the 
new  treatment.  In  dealing  with  the  laws  regarding 
the  insane,  Mr.  Tuke  empluisised  the  strides  made  in 
the  right  direction  by  the  Vagrant  Act  in  1744.  and 
also  the  noble  work  done  by  Lord  Ashley  (afterwards 
Lord  Shaftesbury),  through  whose  efforts  the  Com- 
missioners in  Lunacy  were  appointed.  In  the  sSth 
Report  of  the  Commissioners  the  number  of  persons 
certified  as  insane  in  England  and  Wales  on  January 
1st,  1904,  was  1 17,199,  a  return  which  showed  a  slight 
annual  increase  at  a  greater  rate  than  the  growth  of  the 
population.  But  this  increase  was  more  apparent 
than  real;  it  was  almost  wholly  among  the  pauper 
patients,  and  could  perhaps  be  accounted  for  by  the 
fact  that  cases  are  now  more  readily  recognised  and 
certified  than  formerly,  and  also  because  with  the 
improved  sanitation  and  medical  treatment,  aged 
cases  are  accumulating  in  asylums.  The  provisions 
of  the  law  regarding  both  "  Chancery  patients  "  and 
the  "voluntary  boarder"  were  clearly  explained, 
and  the  lunacy  law  was  shown  to  be  very  ample,  both 
for  the  patient  and  his  property.  Mr.  Tnke  gave 
valuable  and  practical  advice  as  to  the  treatment  of 
the  so-called  "  nerve  cases,"  and  spoke  in  the  highest 
praise  of  borough  and  county  asylums — their  one 
fault,  if  any,  being  that  they  had  become  too  huge. 
Could  the  medicsil  superintendent,  however  skiUui 
and  able,  keep  in  medical  touch  and  give  individnal 
attention  to  2,000  cases,  or  even  1,000  ?  After  dealing 
with  the  causes  and  classifications  of  insanity.  Mr. 
Tuke  concluded  a  very  interesting  and  able  address 
by  strongly  advocating  the  need  of  public  education, 
for  great  strides  as  the  science  of  psychology  had  made, 
still  further  progress  and  more  successful  results  woold 
follow  when  the  public  were  educated  to  realise  folly 
that  temperance,  sobriety,  and  chastity  were  the 
essentials  of  Christian  civilised  communities. 


THE    SOCIETY    OF    MEDICAL     OFFICERS 
OF    HEALTH. 

The  annual  dinner  of  this  Society  was  held  at  the 
Trocadero   Restaurant   last   Friday.     The   chair  was 
taken  by  the  President,  Dr.  J.  F.  J.  Sykes,  and  among 
the  company  present  were  Dr.  Pye  Smith,  Dr.  Groves,. 
Sir  T.  Stephenson,  Mr.  Andrew  Clark.  Dr.  Tatham, 
Alderman  T.  Idris,  Dr.Whitelegge,  C.B.,  Mr.  Courthope- 
Munro,  Dr.  Parsons,  Dr.  Beaton,  Mr.  T.  Cutler,  Dr. 
Shirley  Murphy,  and  Dr.  Priestley.     Dr.  Whitdegge. 
proposing    "The    Municipal    Authorities,"    said f no 
public  authority  could  afford  to  make  a  mistake  in  the 
selection  and  the  support  of  their  medical  officers  of 
health;    and    he  was    glad  to  think  that  municipal 
authorities  were  alive  to  this,  and  were  offering  induce- 
ments to  men  of  the  highest  qualifications  to  engage 
in  public  work.     Alderman  T.  Idris    (Mayor  of  St 
Pancras)  responded.     Dr.  Pye  Smith  proposed  "The 
Incorporated  Society  of  Medical  Ofl&cers  of  Health." 
He  said  the  connection  of  the  medical  profession  with 
preventive  medicine  was  of  the  most  honourable  aod 


Oct. 


19.  1904. 


GERMANY. 


The  Medical  Pkess.    4^^ 


satisfactory  kind.     Investigation  into  zymotic  diseases 
had  thrown  a  bright  light   on  methods  of  preventing 
disease  and  of    curing  and  relieving   them.     He  was 
proud  of  the  public  spirit,  the  unselfish  devotion,  the 
courage  in  opposing  vested  interests  and  indifference 
inedi<^  officers  of  health  had  displayed.      It  was  due 
to   their  persistent   efforts   through   generations   that 
this   country   had   taken   the   lead   in  improvements 
that  had  made  it  one  of  the  most  healthy  in  the  world. 
r>r.    Sykes,    in   returning    thanks,    congratulated    the 
members  on  the  fact  that  they  now  numbered  937,  and 
the  main  body  of  these  were  acting  medical  officers 
of  health.     He  held  it  to  be  essential  that  in  the  course 
of  their  duties  they  should  make  themselves  acquainted 
'with  some  branches  of  architectural  construction,  for 
in  these  days  the  tendency  was  to  pack  the  populations 
of  towns  in  a  manner  that  was  injurious  to  public 
health  and  led  to  that  physical  deterioration  of  which 
so  much  was  heard.     In  all  classes  of  society    there 
"was   this   tendency   to   overcrowd,   and   the   medical 
profession  should  join  hands  with  architects  and  agree 
among   themselves    as    to   the  limits  of  aggregation 
of   population.     Mr.   Andrew  Clark,   replying   to   the 
toast  of  "  Kindred  Societies,"  proposed  by  Dr.  Groves, 
said  the  British  Medical  Association  were  endeavouring 
to  forward  a  Bill  in  Parliament  to  get  rid  of  the  in- 
security of  tenure  of  office  of  which  medical  officers 
complained,   and   he  hoped   that  during  the  coming 
Session  that  Bill  would  become  law  and  medical  officers 
would  no  longer  be  under  liability  to  removal  from 
office  in  consequence  of  doing  what  they  considered  to 
be  their  public  duty. 

france* 

[fbom  our  own  correspondent.] 

Pamb,  October  l«tli,  1904. 
Treatment  of  Lumbago. 
In  the  neuralgic  form,  the  following  wafers,  accord- 
ing to  Dr.  Capitan,  are  very  successful : — 
Phenacetin,  gr.  iv ; 
Acetanilide,  gr.  j  ; 
Antipyrin,  gr.  vj  ; 
Salophane,  gr.  v ; 
Bromide  of  potassium,  gr.  iv. 
For  one  wafer ;  three  daily. 

When  the  patient  is  of  a  gouty  family,  five  grains 
of  salicylate  of  lithine  might  be  added. 

In  the  myalgic  forms,  pyramidon  acts  well.  How- 
ever, it  must  be  given  in  somewhat  large  doses,  from 
twenty  to  thirty  grains  a  day.  The  urine  will  become 
red,  and  give  a  large  deposit  of  urates.  The  patient 
should  be  watched  and  the  largest  dose  reached  only 
progressively. 

Certain   patients   derive  considerable   benefit  from 
the  association  of  antipyrine  with  salicylate  of  soda : — 
Antipjrrine,  dr.  j  ; 
Salicylate  of  soda,  dr.  j ; 
Water,  oz.  ij. 
Four  or  five  teaspoonfuls  daily. 
In  every  case  of  lumbago,  and  in  addition  to  one  or 
other  of  the  above  remedies,   ten   grains  of  hydro- 
chlorate    of    quinine    should    be  given  morning  and 
evening. 

The  local  treatment  should  not  be  neglected.  A 
good  liniment  is  as  follows  : — 

Salicylate  of  methyl,  dr.  ij ; 
Tincture  of  belladonna,  dr.  ij ; 
Laudanum,  dr.  ij ; 
Spirits  of  camphor,  oz.  iv. 
Where  the  pain  is  clearly  localised,  excellent  results 
can    be    obtained    from    subcutaneous   injections    of 
antipyrine : — 

Antipyrine,  dr.  j  ; 
Hydrochlorate  of  cocaine,  grs.  v  ; 
Water,  dr.  iij. 


Massage,   graduated  movements,   and  warm  baths 
terminate  the  treatment. 

Treatment  of  Tinea  Tonsurans  by  Prof.  Gaucher. 
Children. — Cut  the  hair  as  close  as  possible  once  a 
week.     Every  two  days  wash  the  head  with  soap  and 
warm  water.       Morning  and  evening,   massage    the 
scalp,    triturating    the    diseased    spots    energetically. 
After  the  massage,  prolonged  friction  by  means  of  a 
tooth-brush  with  the  following  liniment : — 
Spirits  of  camphor,  oz.  iv ; 
Castor  oil,  dr.  j ; 
Tincture  of  cantharides,  dr.  j. 
Adtilts. — Not  necessary  to  cut  the  hair,  which  offers 
the    advantage  of    masking    the    spots.     The    head 
will  be  washed  once  a  week  with  tar  soap.     Repeated 
and  frequent  massage  will  be  done  by  the  patient  or 
someone  els^  in  the  family.      Every  evening  friction 
with : — 

Eau  de  Cologne,  oz.  iss; 
Spirits  of  lavender,  oz.  iss  ; 
Tincture  of.  capsicum,  dr.  j. 
The  following  ointment  might  be  substituted  for 
the  above  liquid  preparations  : — 

Peruviatt  balsam,  grs.  xx; 
Salicylic  acid.  grs.  xx  ; 
Resorcin,  grs.  xx; 
Lanoline,  oz.  iss  ; 
Vaseline,  oz.  iss. 
At  the  same  time  the  patient  will  be  recommended 
to  rub  the  head   every  morning  with   the   following^ 
slightly  stimulant  mixture  : — 

Essence  of  turpentine,  oz.  ss  ; 
Spirits  of  camphor,  oz.  iij  ; 
Liquid  ammonia,  dr.  j. 
Or  in  the  case  of  a  woman  : — 

Corrosive  sublimate,  grs.  iv  ;  ; 

Glacial  acetic  acid,  min.  xx; 
Resorcin,  dr.  ss.  ; 
Hydrate  of  chloral,  dr.  j  ; 
Tincture  of  cantharides,  dr.  j ; 
Tincture  of  jaborandi,  dr.  j.  ; 
Proof  spirit,  oz.  vij ;  :         - 

Castor  oil,  oz.  j ;    • 
;:  Ess.  of  violets,  q.s. 


Octmaws^ 


[from  our  own  correspondent.] 


BnLDr,  Ootober  l«th,  19M. 

In  the  Allgetneine  medixinische  Zeitblatt-Zeitung,  17 r 
1904,  Dr.  Enis  reports  a  case  of 
Herpes^Zoster  of  a  Recurring,  Intermittent  or 
Periodic  Type. 

The  patient  first  came  under  treatment  during  a 
free  interval,  and  complained  of  paraesthetic  symptoms 
in  the  left  half  of  the  mouth.  Examination  of  the 
cavity  revealed  nothing  abnormal.  The  writer  pre- 
scribed quinine,  but  without  effect ;  then  nine  drops 
daily  of  Fowler's  solution,  again  without  effect ;  later  on, 
pills  of  ergot  and  quinine  bromide  were  ordered.  In  six 
months  1 20  pills  had  been  taken.  Thirty  pills  were  taken 
during  a^period  of  treatment,  then  they  were  stopped 
for  a  longer  or  shorter  period,  and  then  begun  with 
again.  This  time  there  was  no  recurrence,  and  the 
paraesthetic  symptoms  disappeared.  Further  obser- 
vation of  the  case  might  possibly  have  shown  how 
much  of  the  improvement  was  due  to  the  treatment 
and  how  much  to  a  more  favourable  season  of  the  year, 
the  disease  generally  recurring  at  cold  seasons  and 
getting  better  during  the  warmer  ones  ;  but  the  patient 
was  lost  sight  of  through  change  of  residence. 

At  the  Medical  Society,  Hr.  Glucksmann  spoke  on 


412    Thb  Medical  Press. 


AUSTRIA. 


Oct.  19.  1904. 


CESOPHAGOSCOPY  I     ITS  AlMS,   ADVANCES,   AND  VaLUE. 

He  thought  it  was  a  pity  that  oesophagoscopy  was 
practised  by  so  few.  The  reason  for  this  neglect  lay 
in  some  difficulties  that  could  be  easily  overcome,  and 
in  not  being  able  at  the  very  first  to  recognise  what 
became  visible. 

The  first  to  see  into  the  human  oesophagus  was 
Kussmaul,  who  examined  the  sword  swallower  in  1868. 
The  first  oesophagoscope  was  constructed  by  Mikulicz, 
and  several  others  had  effected  improvements  on  it. 
CEsophagoscopy  was  not  intended  to  displace  the  other 
methods  of  examining  the  parts,  such  as  by  the  sound, 
but  to  aid  them.  By  it,  carcinoma  of  the  gullet  could 
be  diagnosed  when  sounding  failed  to  discover  it, 
although  there  had  been  difficulties  of  swallowing, 
and  stenosis  from  caustics  had  been  rendered  visible 
when  the  sound  had  passed  through  it.  On  the  other 
hand,  symptoms  had  been  seen  to  be  due  to  spasm  only 
when  everything  had  pointed  to  carcinoma. 

It  had  a  therapeutical  value  when,  in  a  case  of 
stenosis,  it  permitted  the  passing  of  a  filiform  bougie 
by  visual  aid.  In  all  'conditions  of  softening  the 
speaker  held  the  oesophagoscope  to  be  more  sparing 
than  the  sound,  as  the  latter  mftt  pass  the  contracted 
part  in  order  to  discover  it,  whilst  the  former  allowed 
it  to  be  seen  from  above. 

In  speaking  of  the  future  of  oesophagoscopy.  he  said 
that  since  the  introduction  of  the  method  of  operating 
in  rarefied  air  a  new  future  had  been  opened  to  surgery, 
both  of  the  thorax  and  of  the  oesophagus ;  the  oeso- 
phagoscope would  be  called  in  to  facilitate  early  dia- 
gnosis of  disease  of  the  oesophagus.  He  also  considered 
oesophagoscopy  to  be  a  step  in  the  direction  of  gastro- 
scopy.  The  present  methods  of  gastroscopy  were  not 
practicable  ones  ;  they  were  too  dangerous,  and  the 
stomach  resented  the  introduction  of  instruments. 

Hr.  Eisner  was  of  opinion  that  systematic  washing 
and  cleansing  of  the  oesophagus  would  often  render  the 
disagreeable  employment  of  the  oesophagoscope  un- 
necessary. By  this  means  he  had  gradually  dilated  a 
very  narrow  stricture  in  a  boy.  In  the  case  of  malig- 
nant stenosis  also  the  oesophagus  could  often  be  kept 
free  for  a  long  time  in  this  way. 

Hr.  Boas  did  not  think  oesophagoscopy  of  much 
practical  value.  The  early  diagnosis  of  malignant 
disease  was  not  much  furthered  by  it,  neither  would 
gastroscopy  help  much  in  the  diagnosis  of  cancer  of 
the  stomach.  Kelling,  among  others,  had  shown  that 
gastroscopy  could  diagnose  cancer  of  the  stomach 
early  enough  for  a  radical  operation  to  be  carried  out, 
but  that  did  not  indicate  any  great  advance. 

At  the  Dermatological  Society, 

Epithelial  Cancer 
was  discussed.  Hr.  Unna  recommended  the  use  of 
the  Rontgen  rays.  Hr.  O.  Petersen  (St.  Petersburg) 
would  treat  rather  expectantly  in  the  early  stages  before 
the  glands  became  implicated.  He  would  use  con- 
tinuous soda  solutions,  the  Finsen,  Rontgen,  or  radium 
treatme  nt,  and  freezing,  but  more  especially  the  Finsen 
treatment.  The  dosage  of  radium  was  still  uncertain, 
and  sometimes  long-lasting  irritations  were  set  up. 
No  cure  had  resulted  from  freezing,  although  improve- 
ment had  taken  place.  A  case  of  v.  Bergmann's  that 
had  been  cured  was  shown  by  Dr.  Schlesinger.  He 
preferred  operation :  the  results  of  surgery  might  be 
ideal  if  the  public  could  be  taught  to  bring  the  cases 
•early.  So  much  time,  too,  was  spent  in  Rontgen 
treatment  that  it  was  too  late  for  operation.  The 
Rontgen  ra)rs  were  less  active  the  deeper  they  pene- 
trated, and  deep  action  was  the  chief  aim  of  all  cancer 
treatment.     Inoperable  cases  might  be  submitted  to 


Rontgen  treatment.     If  this  was  energetic  enougli  it 
certainly  had  a  curative  effect. 

V.  Marschalko  had  cured  an  ulcerated  tumour  the 
size  of  an  apple  in  a  woman,  aet.  27p  ^^  ^O'*'  weeks,  and 
in  eight  months  there  had  been  no  recurrence.  Lesser 
(Berlin)  had  quite  satisfied  himself  that  rodent  ukec 
could  be  cured  by  Rontgen  treatment.  Deep  cani- 
nomata  belonged  to  the  knife  and  not  to  Rootga 
treatment.  Holzkneckt  said  the  future  belonged  to 
radium.  Kiel  was  of  opinion  that  if.  out  of  ten  cases 
nine  could  be  cured  by  Rdntgen  treatment,  and  all  by 
surgical  procedures,  it  was  the  duty  of  the  surgeon  to 
cure  all,  even  if  a  cicatrix  was  certain  to  be  left,  and 
the  same  with  rodent  ulcer.  Petrini  had  had  good 
results  from  the  combined  methods. 


Hnstrta. 


[from  our  own  CORRXSPONDSirr.] 


TinnrA,  Oeftober  l«tti,  UM. 

Alcoholic  Trfatment  of  Erysipelas. 

At  the  Prague  meeting,  Walko  spoke  in  high  praise 
of  the  treatment  of  erysipelas  by  means  of  alcoholic 
compression  in  the  form  of  bandages  applied  to  the 
part  affected  with  wadding  or  gauze  well  saturated 
with  a  96  per  cent,  solu  tion  of  alcohol.  He  considers  the 
"  Alcoholcellit "  prepared  by  Dieterich  an  eixelleot 
form  of  applying  the  alcohol  to  the  part.  This  pre- 
paration is  in  the  form  of  a  jelly,  containing  60  per 
cent,  of  alcohol,  and  protected  from  evaporation  by 
being  packed  in  lead  cases  which  are  air-tight.  When 
needed  the  case  is  opened  and  the  jelly  spread  over  the 
affected  part  with  a  spatula.  Over  this  is  placed  a 
layer  of  Billroth's  "  battist,"  or  impermeable  cambric, 
and  the  whole  supported  by  a  bandage.  By  this 
means  the  alcohol  is  given  off  slowly  and  remains  long 
in  contact  with  the  part  to  which  it  is  applied,  and 
continues  active  for  twelve  or  twenty-four  hours. 
Another  firm  prepares  a  gauze  with  this  "  Alcoholcellit" 
under  the  name  of  "  Duralcolbinden,"  which  is  reputed 
to  contain  96  per  cent,  of  alcohol. 

Neustadtl  said  he  had  obtained  excellent  results 
from  alcoholic  applications  in  osteo-periostitisand  tuber- 
culous tendo-vaginitis.  He  spoke  highly  of  it  in  the 
treatment  of  tuberculous  lymphadenitis  and  chronic 
arthritis. 

Spasmus  Nutans. 

Raudnitz  showed  the  meeting  a  child  to  support  his 
theory  of  nystagmus  being  caused  by  confining  chil- 
dren to  dark  rooms.  In  addition  to  the  nystagmus 
there  was  a  vibratory  shaking  of  the  head.  He  related 
how  he  had  kept  five  dogs  four  months  in  a  dark 
kennel,  all  of  which  acquired  nystagmus  and  two  of 
them  shaking  of  the  head — one  of  which  he  produced 
as  interesting. 

One  month  was  sufficient  in  some  to  produce  the 
nystagmus.  These  facts,  he  thought,  were  potent 
enough  to  establish  his  theory  that  dark  rooms  and 
gloomy  neighbourhoods  were  sufficient  to  produce 
spasmus  nutans. 

Ganghofer  was  of  opinion  that  there  was  some  truth 
in  Raudnitz'  theory,  as  the  greater  number  of  cases  he 
had  met  with  were  drawn  from  dark  dwellings,  but 
he  had  also  received  them  from  faultlessly  clear,  bright 
homes,  where  light  was  abundant. 

Fischl  could  not  understand  how  these  experiments 
of  Raudnitz  proved  anything,  far  less  the  theor>'  be 
endeavoured  to  propound  for  the  origin  of  spasmus 
nutans,  because  children  when  very  young  had  the 
eyes  closed,  and  as  th^y  grew  older  they  turned  their 


Oct.  19.  1904- 


THE    OPERATING    THEATRES. 


The  Medical  Prbss.    413 


•«yes  to  the  light  no  matter  how  imperfect.     In  all 

•Ki-wellings  there  are  either  doors  or  windows  that  admit 

•of  a  certain  amount  of  light,  which  would  be  open  for 
the  child  to  exercise  its  vision,  and  therefore  in  a  diffe- 
rent position  to  dogs  entirely  excluded  from  light  for 

.months.  Children  in  dark  rooms  instinctively  turn 
their  eyes  towards  any  gleam  of  light,  therefore  the 
analogy  fails  when  these  experiments  are  compared. 
ECHINOCOCCUS  Hepaticus. 
Springer  showed  a  child,  aet.  12,  on  whom  he  had 
performed  laparotomy  for  echinococcus  of  the  liver. 
By  this  operation  he  attached  the  cystic  portion  to  the 
"wall  of  the  abdomen  and  after  six  days  had  elapsed  he 

•opened  the  cyst  and  cleared  out  the  sac,  which  after- 
wards healed  np  favourably  and  left  the  patient  healthy 

-and  well. 

Peritonsal  Tuberculosis. 
Thones  gave  an  anal3rsis  of  80  cases  which  he  had 
treated  according  to  Kummel  and  Braun's  method, 

•operating  for  tubercle  in  the  peritoneum.  He  thought 
the  whole  question  lay  between  puncture  and  laparo- 
tomy, but  the  latter,  in  his  opinion,  was  the  most  effec- 
tual where  operation  was  indicated.  If  the  disease 
be  active,  as  in  phthisis,  the  operation  should  be  de- 
ferred, but  where  exudation  and  adhesions  are  present. 

^laparotomy  should  be  performed,  as  prolonged  internal 
treatment  gives  very  doubtful  results.  In  the  discussion 
Hippel  rejwrted  three  cases  of  ileo-caecal  tuberculosis 

-on  which  he  had  operated,  but  all  of  them  died  sub- 
sequently of  anal  fistula.  He  believed  this  was  due  to 
the  separation  of  adhesions  in  the  bowel  affected.  He 
is  now  persuaded  that  this  part  of  the  bowel  should 
have  been  resected  after  separating  the  adhesions. 

Treatment  after  Purulent  PBRrroNrris  and  Fatty 
Necrosis. 
Bertelsmann  described  the  history  and  dangers  of 

profuse  peritonitis  followed  by  collapse  due  to  the 
•empty  condition  of  the  heart.     To  overcome  this  diffi- 

-ciilty  he  intravenously  injects  three  and  a  half  litres  of 
salt  infusion  and  increases  it  according  to  Heinecke's 
theory  to  twenty  litres  in  the  following  days.     In  a 

*case  of  fatty  necrosis  of  the  peritoneum,  this  form  of 

^treatment  -was  a  perfect  success. 

Oppenheimer  discussed  the  different  forms  of  pulse 

that  required  this  treatment,   and  the  difference  of 

temperature  that  existed  in  peritoneal  affections :  be- 

'tween  the  temperature  in  the  axilla  and  the  tempera- 

•lure  of  the  anus.  The  greater  the  difference  of  these 
't-wo  temperatures  the  more  gloomy  was  the  prognosis. 

"Haberer  thought  that  many  of  these  cases  with  diffuse 
effusions  died  not  from  the  relaxation  of  the  heart  but 

rtoxaemia.     In  such  cases  he  could  not  see  where  salt 

•solutions  when  injected  into  the  blood  could  be  of  much 

•service. 

Rehn  'was  of  'Opinion  that  death  was  usually  accom- 
rplished  by  bacterismia  and  not  by  toxaemia. 

Ube  ^peratino  Ubcattcs. 

ST.  MARK'S  HOSPITAL  FOR  FISTULA. 
Laparotomy — Peculiar  Condition  of  the  Viscera. 
— ^Mr.  Swinford  Edwards  operated  on  a  Russian, 
'«t.  57,  w^o  had  had  trouble  with  his  rectum  (as  it 
-was  reported)  for  fifteen  years.  On  examination  of 
'the  passage  he  was  found  to  have  a  contracted  anus, 
and  above  this,  as  far  as  the  finger  could  reach,  the 
•rectum  was  stenosed,  thickened  and  firmly  attached  to 
the  surrounding  tissues.  The  sensation  communicated 
-to  the  explorer's  finger  was  as  if  the  pelvis  was  filled 
♦with  new  '^owfh,  fcut  no  typical  cylindroma  could  be 


detected  within  the  rectum.  For  this  condition  Mr. 
Edwards  proposed  a  left  iliac  colotomy.  The  abdo- 
minal wall  was  opened  in  the  left  iliac  region  by 
splitting  the  various  muscular  layers  in  the  direction 
of  their  fibres.  On  opening  the  abdominal  cavity  no 
trace  of  the  sigmoid  flexure  could  be  discovered.  There 
were  hard  masses  and  nodules  to  be  felt  in  various 
portions  of  the  mesentery.  Believing  that  this  was  a 
case  of  malposition  of  the  sigmoid,  Mr.  Edwards  re- 
peated the  operation  in  the  right  iliac  fossa,  and  here 
the  colon  was  found,  indurated  and  firmly  fixed  to  the 
iliac  fossa  and  to  the  posterior  lumbar  region.  The 
appendices  epiploicae  were  likewise  indurated  and  con- 
tained separate  nodules.  The  whole  of  the  large  in- 
testine to  be  felt  through  this  incision  gave  a  sensation 
to  the  finger  as  though  the  parts  had  been  hardened  in 
formalin.  Colotomy  here  seemed  impossible,  and  as 
there  were  no  acute  symptoms  of  obstruction  the 
(^erator  postponed  attempting*  to  open  possibly  the 
transverse  colon  until  a  later  date.  Both  incisions  were 
closed  by  suturing  first  with  silk  the  peritoneum, 
secondly  the  muscles,  and  thirdly  the  skin  and  apo- 
neurosis, the  last  with  silkworm-gut.  Mr.  Edwards 
said  that  the  pathology  of  the  case  was  wrapped  in 
obscurity,  as  against  the  theory  of  carcinoma  was 
the  long  period  over  which  the  disease  had  extended ; 
nor  was  it  an  ordinary  example  of  columnar-celled  car- 
cinoma of  the  bowel.  Against  it  being  tuberculous 
was  the  fact  of  the  density  of  the  induration  and  the 
small  amount  of  purulent  discharge.  The  history  of 
the  case. was  somewhat  obscured,  as  the  patient  was 
unable  to  speak  a  word  of  English,  and  only  two  or 
three  words  of  German.  The  operator  remarked  that 
he  had  before  come  across  two  cases  of  misplaced 
sigmoid  colon,  that  it  is  to  say  when  this  portion  of 
the  intestine  passes  across  the  abdomen  to  the  right 
side,  lying  over  the  caput  coli  before  turning  over  the 
brim  of  the  pelvis.  In  both  of  these  the  sigmoid  was 
opened,  colotomy  being  performed  in  the  right  iliac 
fossa.  In  the  present  case,  Mr.  Edwards  was  unable 
to  determine  whether  the  large  intestine  discovered  in 
the  right  iliac  fossa  was  the  sigmoid  or  the  commence- 
ment of  the  large  intestine,  owing  to  the  parts  being  so 
indurated  and  firmly  bound  down.  It  would,  he 
thought,  be  interesting  to  know  what  the  subsequent 
course  of  the  case  may  be,  and  what  the  microscope 
may  show.  He  suggested  that  it  might  be  an  infiltra- 
ting form  of  carcinoma  engrafted  on  old-standing 
tuberculous  disease,  although  he  had  never  met  with 
a  like  case. 

Operation  for  Anal  Tumour. — ^The  same  surgeon 
operated  on  an  old  woman,  aet.  about  65,  who  had  had 
pain  and  rectal  discharge  for  some  months  past. 
There  was  an  external  orifice  of  a  fistula  in  the  right 
posterior  quadrant ;  corresponding  with  this,  about  an 
inch  and  a  half  up  the  bowel,  was  a  large  internal 
orifice  surrounded  by  a  considerable  mass  of  what  felt 
like  granulation  tissue ;  between  the  internal  and 
external  orifices  the  induration  was  considerable, 
forming  a  tumour  the  size  of  a  small  hen's  egg.  Mr. 
Edwards  mentioned  that  the  patient  had  been  admitted 
for  rectal  cancer,  but  he,  mistrusting  this  diagnosis, 
determined  to  lay  the  parts  open  as  when  operating  for 
ordinary  fistula  in  order  to  examine  the  cut  surface  of 
the  tumour,  and  subsequently  to  proceed  as  the  exigen 
cies  of  the   case  seemed   to    demand.     The  patient 


414    The  Medical  Press. 


LEADING  ARTICLES. 


Oct.  19.  19Q4. 


having  been  placed  on  her  right  side,  a  probe-pointed 
director  was  passed  through  the  Astulons  tract,  and 
the  probe  point  brought  out  at  the  anus.    The  inter- 
vening tissues  were  then  divided  and  the  cut  surface 
of  the  tumour  exposed  to  view.     It  presented  a  pecu- 
liar glistening  appearance,  and  reminded  one  of  grains 
of  boiled  sago.     The  surface  of  each  section  measured 
about  one  and  a  half  inch  by  one  inch.       Mr.  Edwards 
excised  both  portions  of  the  growth  for  microscopical 
examination.     After   this   the   wound   presented    the 
ordinary  appearance  of  a  wound  after  operation  for  a 
deep  fistula.     Mr.  Edwards  remarked  that  in  this  case 
the  rectal  condition  gave  a  sensation  to  the  examining 
finger  as  of  an  ordinary  rectal  carcinoma,  accompanied 
by  a  small  fistula,  but  against  the  malignant  theory 
was,  in  the  first  place,  the  position  of  the  growth,  which 
was  situated  in  the  right  side  of  the  bowel,  just  within 
the  external  sphincter.    Cylindrical-celled  epithelioma, 
he  said,  usually  attacked  the  bowel  somewhat  higher 
up,  and  when  of  the  nature  of  squamous-celled  epithe- 
lioma it  usually  started  about  the  junction  of  the  skin 
and  mucous  membrane,  involving  first  the  anal  outlet, 
which  the  growth  under  consideration  did  not ;  more- 
over, there  was  a  fistulous  track  running  right  through 
the  tumour,  which  was,  to  say  the  least,  very  uncommon 
in  rectal  cancer.     Pain,  too,  was  marked  by  its  absence, 
which,  he  thought,  would  not  have  been   the  case  in 
rectal  carcinoma  so  low  down.     From  all  these  con- 
siderations Mr.  Edwards  was  inclined  to  look  upon  it 
as  some  curious  form  of  inflammatory  induration,  on 
the  exact  nature  of  which  he  hoped  light  would  be 
thrown  after  an  examination  of  the  removed*  growth. 
ROYAL  EAR  HOSPITAL. 
Operation      for      Nasal      Obstruction.  —  Mr. 
Yearsley  operated  on  a  woman,  set.  45,  who  com- 
plained of  complete  obstruction  on  the  right  side  of 
the  nose,  with  constant  colds  in    the    head,  severe 
frontal  headache  radiating  from  the  root  of  the  nose, 
and  paroxysmal  attacks  of  sneezing.     There  was  loss 
of  smell,  occasional  deafness,   and   the  patient  was 
quite  unable  to  breathe  adequately  through  the  nose. 
.The  complete  obstruction  had  lasted  since  an  attack 
of  pneumonia  in  the  winter  of  1903,  although  before 
that  she  was  often  slightly  stuffy  in  the  nose,  and 
prone  to  catch  cokl.     On  examination,   the  septum 
nasi  was  seen  to  be    much  deviated  to  the  right ;  the 
concavity  on  the  left  side  being  occupied  by  a  greatly 
enlarged    middle    turbinal   body;    the   right   middle 
turbinal  could  be  partly  seen  behind  the  deviated 
septum  and   extended   downwards  into   the  inferior 
meatus.     Digital  examination  revealed  a  large  pad 
of  adenoids  in  the  naso-pharynx.    The  patient  having 
been  chloroformed  and  the  nose  sprayed  with  i  in  1,000 
adrenalin  solution,   the  left  middle  turbinal  was  re- 
moved by  cutting  through  its  attachment  to  the  outer 
wall  of  the  nose  with  scissors,  until  a  small  neck  of 
bone  was  left.     As  it  was  difficult  to  pass  a  snare  wire 
round   the   turbinal,   the  neck  of  bone  was  broken 
through  with  Doyen's  forceps.     The  septum  was  next 
partly  sawn  through  with  a  nasal  saw  and  straightened 
by  means  of  septum  forceps,  thus  enabling  the  operator 
to  reach  the  hypertrophied  left  middle  turbinal,  which 
was   taken   away   by   means   of   scissors   and   snare. 
Finally,  a  large  pad  of  adenoids  was  removed  with 
Kirstein's  curette.    Mr.  Yearsley  said  that  the  case 
illustrated  the  result  of  the  effect  on  the  nose  of  the 
neglect   of  adenoids.       It  was  quite   true   that    the 


symptoms  of  adenoids  often  abated  at  or  about 
puberty,  but  this  was  as  often  due  to  the  enlargement 
of  the  post-nasal  space  as  to  the  disappearance  of  the 
adenoids  themselves.  In  this  case  probably  the  nasal 
condition  was  largely  owing  to  the  frequent  acute 
catarrhs  induced  by  the  adenoids.  Obstruction  iroai 
enlarged  middle  turbinals  was  very  common;  these 
bodies  frequently  become  what  are  practically  large 
bony  cysts  from  chronic  inflammatory  processes.  Owing 
to  the  fact  that  the  course  taken  by  the  inspired  air  is  1 
parabola,  the  highest  part  of  which  reaches  to  about 
the  centre  of  the  middle  meatus,  any  enlargement  oi 
the  middle  turbinal  naturally  causes  obstruction  to 
nasal  breathing.  The  pressure  of  enlarged  middle 
turbinals  upon  the  septum  is  a  frequent  cause  of  nasal 
headache ;  such  headaches  are  very  characteristic  and 
often  very  severe.  They  commence  at  the  root  of 
the  nose  and  radiate  upwards  over  the  frontal  region. 
In  such  cases  removal  of  the  middle  turbinals  qnicUf 
results  in  the  disappearance  of  this  distressing  sym- 
ptom. 


RaoianRiD  foe  Traxdomiov  Ahioad. 

XTbe  AeMcal  press  anb  Circular. 

PabHdMd  erwry  Wednesday  morning,  Prioe  6d.      Port  trae,  5)«. 

ADVBBTIBBlIEIffTB. 

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£f  lOi.  Od.  ;  Quarter  Pace,  £1  6e.  Od. ;  One-eighth,  12>.  dd. 
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an  Older  Is  given  for  a  series  of  insertioiia.     Terms  od  appUa 

.tloo  to  the  PttUisfaer. 
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SUBIOBIPTIOm. 
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Ube  AeMcal  press  anb  Circular.    ] 


'SALUS  POPULI  SUPRBMA  LEX. 


WEDNESDAY.  OCTOBER  19.  1904. 


L'ENTENTE  CORDIALE— "  AU  REVOIR." 
The  French  "  medical  caravan  "  has  departed 
after  three  days  of  strenuous,  labour.     Their  hours 
were  counted »  and  each  had  its  allotted  taek— if 
the  word  may  also  be  made  to-  include  sundry  fes- 
tivities, public  and  private,  that  toomed  large  on 
the  programme.     We  are  fain  to  confess  that  our 
visitors  showed  themselves  indefatigable.    If  they 
did  not  inspect  every  one  of  our  large  general  hos- 
pitals in  detail,  if  some  of  them  snatched  a  fearful 
joy  by  visiting  the  Wallace  Collection  or  the  Nation^ 
Gallery  instead  of  being  conducted  round  Cobey 
Hatch  or  the  University  laboratories,  the  majoritr 
rallied  to  the  bugle-call  of  duty  and  fell  into  the 
ranks  at  the  appointed  hour.     While  we  are  toa 
experienced  to  be  rendered  vain  by  the  admiratioii 
so  freely  bestowed  on  our  medical   and  scientific 
monuments,  much  of  which,  no  doubt,  was  mere 


Oct. 


19,  1904 


LEADING  ARTICLES. 


The  Medical  Press.    415 


politeness,  we  certainly  retain  the  impression  that  our 
visitors  took  away  with  them  ideas  and  impressions 
"tliat  may,  in  their  eager  hands  and  fertile  brains, 
influence  current  views  in  France.     Nothing,  per- 
il aps,  impressed  the  more  discriminating  of  our 
visitors  so  much  as  the  colossal  results  obtained 
in  this  country  by  iadividual  and  collective  effort 
in  the  provision  of  hospital  and  laboratory  accom- 
modation, a  contrast  to  the  absolute  dependence 
of    similar   institutions   on  the   State   elsewhere. 
In  commenting  on  this  fact  it  is  in  no  wise  our 
intention  to  compare  the  one  method  with  the 
otfier,  for  each  has  its  peculiar  advantages  and  its 
inherent    drawbacks.     Centralisation    no    doubt 
makes  for  economy  of  administration,  but  it  is 
destructive  of  individual  initiative  ;  independence 
of  State  control  confers  plasticity  upon  the  or- 
ganisation, but  paves  the  way  to  abuses  of  its  own. 
The  difference  is  seen  in  the  ample  floor  space 
allotted  to  each  bed  in  English  hospitals.     This  is 
rendered  possible  by  the  fact  that,  being  a  private 
institution,  conducted   in   accordance   with  rule, 
no  patient  is  accepted  in  excess  of  the  available 
accommodation.     The    French    hospital,    on    the 
contrary,  is  a  municipal  institution,  and  as  such  .is 
obliged  to  admit  applicants  even  though  their 
reception  necessitates  more  or  less  overcrowding 
of  the  wards.     Foreigners  look  with  undisguised 
admiration    tinctured   with   envy   at   the  claires 
silhouettes  des  nurses  charmantes,  whose  presence 
gives  a  brightness  and  suavity  to  otherwise  de- 
pressing surroundings.     The  gaily  decorated  chil- 
dren's wards,  the  ample  provision  of  tojrs  and 
flowers,  the  general  air  of  comfort  and  almost  hap- 
piness that  pervades  them,  touched  them  to  the 
quick,  and  the  sincerity  of  their  appreciation  was 
apparent.     We  venture  to  think  that  they  were 
not  less  surprised  and  pleased — ^we  are  speaking  of 
those  who  only  knew  the  Enghsh  as  painted  by 
French  tradition — ^to  find  what  a  genial  host  is 
masked  by  the  external  austerity  of  the  typical 
Englishman.     Certainly  the  effort   made  to  en- 
tertain our  guests  rose  to  the  occasion,  and  nothing, 
absolutely  nothing,  was  left  undone  to  make  their 
visit  both  agreeable  and  instructive.     It  would, 
of  course,  be  easy  to  find  fault  with  the  programme, 
and   some   would   reproach   the   organisers  with 
having  attempted  too  much,  others  with  having 
achieved  too  little,  but,  in  truth,  the  organisers 
acted  in  deference  to  the  maxim  that  qui  trap 
embrasse  mal  Hrient,     As  it  was,  the  individual 
members  of  the  band  were  enabled  to  choose  their 
intellectual  pabulum  and  direct  their  steps  ac- 
cordingly.    One  of  the  most  charming  features  of 
the  visit  was  the  spontaneity  and  enthusiasm  with 
which  the  medical  practitioners  of  the  Metropolis 
threw  themselves  into  the  work.     Beginning  with 
the   tactful   visit  of  Sir  William  Broadbent  and 
several  distinguished  colleagues  to  the  station  to 
receive  the  guests  and  guide  them  to  their  quarters, 
the    same    pleasant    foresight    enveloped    them 
throughout,  and  each  vied  with  the  other  in  the 
endeavour  to  make  the  reception  worthy  of  the 
occasion.  The  King  himself  took  cognisance  of  the 


terminal  banquet  on  Wednesday  evening,  and  with 
the  graceful  courtesy  that  endears  him  to  his* 
people,  expressed  the  interest  he  took  in  this  in- 
cident of  the  entente  cordiale.  The  banquet  was 
literally  and  figuratively  a  "  huge  success,"  up- 
wards of  four  hundred  convives  of  the  two  nationah- 
ties  being  sandwiched  at  the  endless  array  of  tables. 
The  cuisine  was  worthy  of  the  Hotel  Cecil,  and  the 
post-prandial  oratory  attained  the  giddiest  heights 
of  French  eloquence.  A  touch  of  humour  was 
provided  by  the  entertainers  speaking  French  and 
the  guests  English.  We  were  pecuharly  fortunate 
in  being  honoured  with  the  presence  of  Professor 
Poirier,  whose  reputation  as  an  orator  is  now  firmly 
estabhshed  north  of  the  Channel.  The  sober  elo- 
quence of  Professor  Chauffard,  M.  Lucas-Cham- 
pionni^re  and  Dr.  Huchard  testified  to  the  quali- 
ties of  lucidity  and  harmony  that  stamp  the  great 
French  clinical  lecturers  and  confer  a  charm  on 
their  utterances.  Receptions  of  this  magnitude 
cannot,  of  course,  be  every-day  occurrences.  We 
hope,  however,  that  our  French  confrhes  will  take- 
this  one  to  mean  that  they  are  always  welcome 
in  our  schools,  that  we  entertain  feeUngs  of  sincere 
regard  and  affection  for  them,  and  that  we  look 
forward  to  working  with  them,  hand  in  hand,  for 
the  relief  of  suffering  and  the  greatness  of  hu- 
manity. 

TWO   THOUSAND    OPERATIONS    FOR 
APPENDICITIS. 

"  Everything,"  said  John  Bright,  "  that  can 
be  said  on  the  subject  of  education  has  been  said' 
hundreds  of  times  over,"  and  the  same  is  almost 
true  of  appendicitis.  But  with  that  disease  con- 
tinually confronting  him,  and  the  question  of  the 
right  moment  of  surgical  interference  still  a  matter 
of  opinion,  the  practitioner  may  derive  advantage- 
from  the  experience  of  a  surgeon  Uke  Mr.  John  B. 
Murphy,  who  has  two  thousand  operations  for 
appendicitis  to  his  credit.  In  the  American  Journal 
of  Medical  Sciences  for  August,  Mr.  Murphy 
anal3rses  these  cases,  their  symptoms  and  course, 
and  gives  his  opinion  on  the  treatment  of  the- 
condition  in  decided  words.  In  dealing  with  the- 
pathogenesis  of  appendicitis  he  mentions  having^ 
found  foreign  bodies  in  2  per  cent,  of  his  cases, 
a  proportion  that  is  higher  than  is  generally  sup- 
posed to  prevail  over  here,  whilst  in  no  less* 
than  38  per  cent,  fascal  concretions  were  pre- 
sent. Bacteriological  examination  was  dihgently 
pursued,  and  in  order  of  frequency,  he  noted  Bacil- 
lus^coli  communis.  Staphylococcus  pyogenes  aureus* 
and  albus,  streptococcus,  pneumococcus,  BaciUus* 
tuberculosis  and  actinomycosis  as  the  predominat- 
ing organisms.  With  regard  to  the  semeiology. 
Murphy  is  very  emphatic  in  the  importance  of 
pain  as  the  initial  symptom  of  an  attack ;  in  the- 
whole  of  his  cases  it  was  the  first  fact  in  the  illness. 
Indeed,  when  vomiting  or  pyrexia  precedes  the- 
abdominal  pain,  he  disbelieves  the  diagnosis, 
and  if  the  patient's  temperature  has  been  raised^ 
for  a  day  or  two  before  the  onset  of  pain,  he  gener- 
ally suspects  typhoid  fever.    The  pain  of  appen- 


4l6    Thb  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Oct.  19.  1904. 


dicitis  is  usually  colicky  in  character,  and  reaches 
its  maximum  intensity  in  about  four  hours,  when 
in  the  majority  of  cases  it  begins  to  subside.  Al- 
though pain,  in  his  opinion,  is  invariably  the  pri- 
mary symptom,  he  is  equally  sure  that  fever  always 
occurs,  sooner  or  later,  in  a  genuine  case,  and 
these  two  signs,  combined  with  vomiting  and 
tenderness  in  the  right  iliac  region,  and  perhaps 
the  whole  abdomen,  constitute  the  important 
features  of  the  onset  of  an  attack.  The  character 
of  the  pulse  is  of  little  help,  and  leucocytosis  is  of 
no  value  beyond  showing  that  absorption  of  septic 
products  is  taking  place  ;  indeed,  it  is  not  always 
present,  even  when  pus  has  formed.  After  de- 
scribing the  modes  by  which  appendicitis  may 
terminate,  either  by  resolution  or  by  abscess- 
formation  and  further  infection.  Murphy  proceeds 
to  describe  some  of  the  less  common  sequels 
that  he  has  met  with,  two  of  the  most  interesting 
being  portal  thrombosis  and  thrombo-phlebitis  of 
the  iliac  veins  with  general  embolism.  Writing 
from  the  standpoint  of  a  surgeon,  and  a  very  dis- 
tinguished surgeon  too,  it  is  natural  that  purely 
medical  treatment  should  find  but  small  favour 
at  Mr.  Murphy's  hands,  and  one  reads  without 
surprise  that  every  death  from  appendicitis  is  due 
to  not  calling  in  a  ph3rsician  early  enough,  or  to  the 
dilatoriness  of  the  physician  or  surgeon  when  he 
is  called  in.  It  is  all  very  well  for  the  physician 
to  make  an  early  and  accurate  diagnosis,  but  he  is 
not  justified  in  deferring  operation  because  the 
final  results  in  appendicitis  are,  on  the  whole, 
favourable,  whilst  the  surgeon,  on  his  side,  must 
not  run  the  risk  of  doing  a  primary  radical  opera- 
tion when  an  inflammatory  condition  is  present, 
but  rather  defer  it  to  a  later  period.  The  man 
who  is  having  more  than  three  or  four  deaths  in 
a  hundred  operations  is  either  receiving  the  patron- 
age of  incompetent  and  procrastinating  men,  or 
he  is  doing  too  much  manipulation  in  the  peri- 
toneal cavity  under  unfavourable  pathological 
-conditions.  Such,  at  least,  are  Mr.  Murphy's 
views.  He  then  illustrates  from  his  own  records 
the  influence  that  current  medical  opinion  has  upon 
the  mortality  from  the  disease.  He  divides 
his  operations  into  series  of  a  hundred  each  and 
<:ompares  the  fataUty  of  the  various  groups.  As 
would  have  been  expected,  the  highest  death-rate, 
1 1  per  cent.,  occurred  in  the  first  group,  and  the 
lowest,  2  per  cent.,  in  the  last.  With  regard  to 
the  latter,  we  may  say  that,  considering  that 
operative  cases  of  sdl  sorts  are  included  in  it,  and 
that  each  of  the  two  deaths  were  due  to  causes 
not  directly  connected  with  appendicitis,  the 
result  is  one  reflecting  the  greatest  credit  both  on 
xhe  operator  and  on  the  practitioners  who  sought 
iiis  assistance.  He  points  out,  however,  that  the 
mortality  in  his  earlier  groups  fell  steadily  till 
1896,  when,  at  the  meeting  of  the  American 
Medical  Association  at  Atlanta,  a  great  deal  of 
feeling  was  expressed  against  frequent  abdominal 
operations,  especially  those  for  appendicitis. 
He  traces  to  this  cause  the  fact  that  the  mortality 
of  his  next  hundred  cases  rose  to  seven,  as  general 


practitioners  hesitated  before  advising  operatioo. 
This  prejudice  gradually  wore  off  till  1900,  whea 
again  a  movement  in  favour  of  conservatism  set 
in — ^a  state  of  opinion  that  found  its  reflecUoa 
again  in  a  rise  in  Murphy's  operation  fatality: 
this  time  to  6  per  cent.  On  this  side  of  the 
Atlantic  there  is  still  a  general  feeling  that  tbe 
mild  cases  of  catarrhal  appendicitis,  in  which  the 
constitutional  symptoms  are  slight,  are  best  treated 
by  the  expectant  method,  the  question  of  operation 
being  reserved  for  the  period  of  quiescence,  and 
we  do  not  think  that  even  Mr.  Murphy's  far- 
reaching  figures  disprove  the  wisdom  of  this  cootse. 
We  certainly  agree  with  him,  however,  that  it  is 
not  safe  to  allow  a  patient  who  has  had  an  attack 
of  appendicitis  to  wait  till  another  has  taken  place 
before  considering  the  question  of  removal.  Mr. 
Murphy's  brilliant  results  in  operations  undotakea 
between  attacks,  only  one. death  in  thirteen  hun- 
dred cases,  should  give  courage  to  the  most 
diffident. 


flotes  on  Cnrtent  tCopfc9« 


The  Hypodermic  Medication  in  Cancer. 

In  another  part  of  our  present  issue  readers  will 
find  an  interesting  article  by  Dr.  Shaw-Mackenzie 
on  the  treatment  of  inoperable  cancer  by  hypo- 
dermic medication.     Although  the  writer  cannot 
claim  any  cases  of  cure,  he  has  nevertheless  ob- 
tained results  of  a  distinctly  encouraging  natnrc 
such  as  relief  of  pain  and  shrinkage  of  tumour- 
growth.     Some   granulomata,    such    of    those  of 
syphihs,   become  definitely  absorbed    under  the 
influence  of  drugs  introduced   into   the   .System. 
There  is  nothing  on  the  face  of  it  to  show  why  a 
similar  result  may  not  be  obtainable  in  the  case 
of  malignant  neoplasms,  provided  the  right  drug 
and  the  right  method  of  administration  be  ascer- 
tained.    Dr.  Shaw-Mackenzie  has  made  the  pioneer 
move  in  the  necessary  experimentation,  and  it  is  to 
be  hoped  that  other  investigators  will  follow  in 
his  footsteps.     His  full  research  is  not  published 
in  the  article  that  appears  in  the  present  number  of 
The  Medical  Press  and  Circular,   but  those 
who  wish  to  study  the  matter  in  detail  will  find 
the  opportunity  in  a  pamphlet  shortly  to  be  pub- 
hshed.     Hypodermic    medication    forms    one  of 
many  ways  in  which  we  may  hope  one  day  to  solve 
the  problem  of  how  to   cure    cancer,    a  subject 
which  still  offers  to  the  scientific   enthusiast  one 
of    the    greatest — perhaps    the  greatest— crowns 
awaiting  the  heroes  of  medicine. 


Oonservatism  in  Surfirery, 

The  Huxley  Lecture  deUvered  by  Sir  William 
MacEwen  at  the  opening  of  the  Winter  Session  of 
Charing  Cross  Hospital  has  received  somewhat 
more  public  attention  than  is  usually  awarded  to 
such  pronouncements.  This  is  in  some  degree  dae 
to  the  lecturer  appearing  more  or  less  in  the  rSit 
of  critic  of  current  surgical  practice,  but  perhaps 
still  more  to  the  fact  that  his  address  had  to  do  with 


Oct.  19.  1904. 


NOTES    ON    CURRENT   TOPICS. 


The  Medical  Press.    417 


the  appendix  caeci,  an  organ  which  looms  very  large 
in  the  mind  of  the  pubhc.  There  is  perhaps  Httle 
that  is  new  in  Sir  William  MacE wen's  address,  but 
there  is  much  that  has  not  been  so  well  said  by  any 
other.  He  raises  the  voice  of  calm  reason  and 
common  sense  against  the  meddhng  interference 
of  the  tinkering  surgeon.  He  beheves  that  the 
normal  healthy  body  is  a  more  perfect  organism 
than  the  maimed  creature  which  would  remain 
after  the  "  improvements  "  some  surgeons  advise, 
even  though  nothing  has  been  improved  away 
but  the  apparently  useless  and  functionless. 
There  are  many  parts  of  the  human  anatomy 
-whose  function  is  as  yet  unknown,  but  we  are  far 
from  justified  in  believing  that  they  are  useless. 
More  particularly,  Sir  WiUiam  MacEwen  applies 
his  argument  to  the  case  of  the  appendix  and  the 
caecum,  and  though  his  observations  are  not 
complete,  he  brings  forward  cogent  reasons  for  the 
opinion  that  both  structures  have  very  definite 
purposes  to  fulfil.  He  points  out  that  in  all 
herbivorous  animals  csecai  digestion  takes  place 
to  considerable  amount,  while  in  some  it  is  more 
important  than  gastric  digestion.  The  secretion 
of  the  glands  of  the  caecum  and  appendix  is  affected 
by  the  ingestion  of  food,  and  the  fluid  has  in  all 
probabihty  a  definite  digestive  value.  But  apart 
from  any  hypothesis  as  to  the  functions  of  the 
appendix,  in  the  great  majority  of  men  it  causes  no 
trouble,  and  there  is  httle  justification  for  the 
removal  of  so  innocent  an  organ.  This  caution 
against  too  radical  surgery  has  been  given  by  others 
before  the  Huxley  Lecturer,  but  it  gains  much  from 
his  sound  common  sense  as  well  as  from  his  caustic 
-wit. 


A  Short  Way  With  Lunatics. 

The  discussion  started  some  months  ago  by 
the  pubtication  of  a  pamphlet  recommending  the 
sterilisation  of  degenerates  has  received  a  certain 
revival  by  Dr.  Fred  Smith's  paper  before  the 
Forensic  Section  at  the  Oxford  meeting  of  the 
British  Medical  Association.  Though  much  more 
moderate,  both  in  scope  and  expression,  than  the 
other  paper,  yet  the  plans  proposed  lie  much  in  the 
same  direction,  and  one  cannot  but  think  that  Dr. 
Smith  has  been  influenced  by  Dr.  Rentoul.  He 
takes  a  very  pessimistic  view  as  to  the  curability  of 
lunacy  in  general,  and  he  applies  this  view  in 
particular  to  the  case  of  the  criminal  insane. 
Assuming  that  the  criminal  lunatic  is  unHkely  to  be 
cured,  why  not  place  him  beyond  the  power  of 
repeating  his  crime  ?  His  execution  is  not  to  be 
regarded  in  any  way  as  a  "  punishment,"  but 
merely  as  a  safeguard,  bearing  in  mind  that  he  is  a 
useless  and  probably  harmful  member  of  society. 
In  the  case  of  child-murder  by  mothers,  usually  a 
result  of  puerperal  insanity.  Dr.  Smith  thinks 
a  recurrence  of  the  crime  can  be  adequately  pre- 
vented by  the  performance  of  the  operation  of 
oophorectomy,  followed  by  a  detention  under 
observation  for  whatever  period  may  be  found 
necessary  in  each  individual  case.  In  the  case  of 
criminals  whose  insanity  is  due  to  alcoholism  or 


other  drug  habit,  he  advises  castration,  foUowedby 
conditional  release,  as  a  guard  against  the  multi- 
plication of  degenerates.  If,  however,  there  should 
be  the  shghtest  lapse  from  teetotaUsm,  the  patient 
should  be  returned  to  the  asylum.  Excellent  as 
these  suggestions  might  be  if  we  were  starting  to 
build  up  a  brand  new  civilisation,  we  think  they 
are  hardly  Ukely  to  have  much  effect  on  the  present 
condition  of  European  thought. 

Overlyinfir  of  Inftote. 

Though  all  medical  men  in  practice  among 
the  poor  are  frequently  brought  into  contact 
with  cases  of  overlain  infants,  it  is  doubtful  if 
many  are  fully  aware  of  the  enormous  mortality 
from  this  cause.  In  London  especially,  the  number 
of  children  killed  in  this  way  is  so  alarming  that  it 
can  best  be  realised  by  stating  that  the  number  of 
deaths  from  "  suffocation  in  bed  "  during  the  past 
ten  years  is  equal  to  that  from  typhoid  fever,  being 
Httle  under  two  thousand  each  year.  When  it  is 
remembered  that  these  children  are  as  likely  as  not 
to  be  quite  healthy,  one  can  gauge  to  some  extent 
the  loss  the  nation  is  sustaining.  In  most  cases, 
too,  it  is  probable  that  the  deaths  are  the  result  of 
pure  accident,  though  in  some,  drunkenness  in  the 
mother  may  be  the  principal  cause.  It  is  noticed 
that  the  greatest  number  of  deaths  from  this  cause 
occur  on  Saturday  nights,  when  there  is  most 
probably  a  greater  indulgence  in  drink  than  on 
other  evenings  of  the  week.  On  the  other  hand, 
Saturday  is  the  busiest  day  of  the  week  for  most 
wives  of  working-men,  so^that  they  are  inclined, 
although  perfectly  sober  and  temperate,  to  sleep 
most  soundly  on  that  night.  Much  good  might 
be  done  in  the  way  of  prevention  by  the  visitation 
of  mothers  by  tactful  female  visitors  who  should 
advise  the  use  of  cots  for  young  infants,  and  should 
dissuade  from  suckling  in  bed.  Instruction  on  the 
subject  might  also  be  given  to  the  girls  in  Board 
Schools,  who  should  certainly  receive  regular  teach- 
ing on  the  care  of  infants. 


Treatment  of  Neuralfiria  by  Ixuections  of 
Air. 

The  use  of  hypodermic  injections  of  air  to  pro- 
duce local  anaesthesia  is,  of  course,  well  known, 
but  various  French  physicians  have  in  recent 
times  extended  this  principle  to  the  treatment  of 
obstinate  neuralgias.  Cordier,  of  Lyons,  experi- 
mented on  several  cases  of  obstinate  sciatic  neur- 
algia, with  very  considerable  success.  In  more 
than  half  the  cases  treated,  one  injection,  varying 
in  amount  from  a  quarter  to  half  a  litre,  gave 
permanent  and  complete  reUef,  while  in  only  two 
cases  was  there  failure.  Similarly,  Mongour  and 
Carles,  of  Bordeaux,  were  successful  in  the  treat- 
ment of  post-herpetic  intercostal  neuralgia,  a  com- 
plaint most  obstinate  to  other  methods  of  treat- 
ment. The  mode  of  procedure  is  very  simple; 
No  apparatus  is  necessary  beyond  an  ordinary 
Pravaz  or  Roux  needle,  which  can  be  attached  to 
any  simple  air-pump,  such  as  a  common  bicycle-^ 
inflator,  or  a  rubber  bag.     If  it  is  thought  necessary 


4i8    The  Medical  Peess.  NOTES    ON    CURRENT    TOPICS. 


Oct.  19,  1904, 


to  filter  the  air,  a  glass  tube  containing  a  cotton 
plug  can  be  interposed  between  the  pump  and  the 
needle.  Air  can  be  injected  until  the  patient 
declares  that  the  pain  has  disappeared.  1 1  will  take 
«ome  days  for  the  gas  to  be  absorbed,  and  until  this 
occurs,  the  part  should  be  gently  stroked  each  day. 
Only  one  caution  is  necessary — to  avoid  a  vein. 
The  method  has  much  clinical  evidence  in  its  favour 
and  deserves  a  trial  in  this  country. 

Transplantation  of  the  Urethr€L 
The  Annals  of  Surgery  for  last  month  contain 
an  account  of  some  ingenious  attempts  by  Mr. 
J.  H.  Pringle,  of  the  Royal  Infirmary,  Glasgow, 
to  repair  the  urethra  by  substitution.  Operations 
were  performed  on  three  different  subjects,  the 
urethras  of  young  bullocks  being  used  to  replace 
the  damaged  or  absent  urethra  in  the  patients.  In 
one  case,  that  of  a  boy  with  hypospadias,  seven 
centimetres  of  urethra  from  a  bullock  were  trans- 
planted ;  but  although  the  graft  "  took  "  well  it 
ivas  found  impossible  to  effect  union  at  the  juncture 
of  new  urethra  with  the  old,  and  finally  the  im- 
planted tissue  sloughed.  The  whole  of  it  was  ex- 
cised, and  a  fresh  graft,  consisting  of  nine  centi- 
metres of  bullock's  urethra,  was  inserted  in  its 
place.  After  some  trouble  this  became  soundly 
incorporated  with  the  Uving  tissues,  and  the  boy 
finally  left  the  hospital  well.  He  had,  however,  to 
pass  a  bougie  to  keep  the  canal  patent.  Of  the 
other  two  patients,  one  was  a  man  of  fifty,  who 
had  an  abscess  of  the  penis  that  led  to  gangrene 
and  sloughing  of  the  urethra.  After  six  weeks 
of  supra-pulic  and  perineal  drainage,  Mr.  Pringle 
endeavoured  to  provide  him  with  a  new  urethra 
from  a  bullock;  but  though  the  graft  grew  well,  a 
fistula  remained  at  the  junction  with  the  old 
aperture  in  the  urethra,  and  several  attempts  did 
not  succeed  in  closing  it.  The  third  case  was  that 
of  a  young  man  whose  perineal  urethra  was 
ruptured  by  an  accident.  The  transplanted  ure- 
thra became  quickly  joined  to  the  surrounding 
tissues,  but  a  tiny  sinus  remained  in  the  perinaeum. 
This  seemed  on  the  point  of  healing  when,  un- 
fortunately, the  patient  died  suddenly  after  an 
operation  for  abscess  of  the  kidney.  On  the  whole, 
the  degree  of  success  obtained  by  Mr.  Pringle  may 
well  encourage  him  to  continue  using  this  original 
method. 


The  Studious  Habit. 
To  few  of  the  sciences  does  the  aphorism  that 
"  knowledge  is  power  "  apply  with  so  much  force 
as  that  of  medicine.  The  helplessness  of  ignorance 
is  never  so  apparent  as  when  the  practitioner  is 
iace  to  face  with  a  great  pathological  problem,  the 
ins  and  outs  of  which  are  seemingly  involved  in 
hopeless  obscurity.  Some  forms  of  disease  wiU, 
of  course,  baflfle  the  most  learned  at  times,  yet 
there  are  occasions  when  the  veil  is  lifted  as  if  by 
magic  at  the  approach  of  superior  wisdom.  There 
is  no  road  to  the  higher  learning  save  by  the  narrow 
and  arduous  track  of  ceaseless  study.  In  the  busy 
days  which  make  up  the  round  of  active  profes- 


sional Ufe  there  remains  a  minute  fraction  of  ^mt 
in  which  the  hard-pressed  medical  man  may  devote 
his  spare  energy — ^if  there  be  any  left — ^to  the  dirty 
of  keeping  in  touch  with  the  latest  work  or,  it 
may  be,  to  the  task  of  investigating  for  himseSi 
some  of  Nature's  pathological  secrets.  Desultory 
reading  may  not  appear  fruitful,  yet  if  once  the 
necessity  of  continual  self-culture  be  recognised, 
systematic  habits  of  study  will  soon  be  formed. 
In  this  habit  has  lain  the  success  of  many  who, 
but  for  the  formation  of  the  studious  habit  early 
in  Ufe,  would  have  been  condenuied  to  a  mediocre 
existence.  The  art  of  "redeeming  the  time" 
from  this  point  of  view  has  yet  another  advantage, 
which  was  dwelt  on  by  the  Bishop  of  Oxford 
in  his  opening  address  before  the  West  Londn 
Post-Graduate  College  on  October  13th,  namdy, 
that  a  provision  for  old  age  is  thus  laid  up.  When  ' 
the  body  is  past  work  and  the  easy  chair  becomes 
more  of  a  necessity,  the  mind  will  perforce  torn 
itself  inwards,  and  happy  is  he  to  whom  length  of 
years  forms  no  bar  to  the  acquisition  of  knowledge, 
and  whose  study  is  veritably  a  mental  haven  d 
refuge. 


Poisoninfir  by  Boiic  Acid. 

SoMB  years  ago,  at  the  transition  period  between 
vigorous  antisepsis  and  modem  asepsis,  it  was 
the  custom  in  surgery  to  make  use  of  boric  add 
in  large  quantities.  The  general  beUef  was  that 
its  absorption  was  quite  harmless,  and  it  wk 
apphed  with  the  greatest  freedom  to  raw  surfaces 
and  operation  wounds.  Though  this  custom  is 
now  happily  nearly  obsolete,  yet  there  is  still  in 
some  quarters  a  tendency  to  make  use  of  the  dry 
powder  or  of  a  solution  in  the  treatment  of  abscess 
cavities,  without  much  regard  to  the  possibiUties 
of  free  absorption.  That  such  practice  is  not 
free  from  danger  is  shown  by  the  fact  that  several 
deaths  have  been  recorded  from  boric  acid  poison- 
ing under  exactly  these  circumstances.  Dr. 
Charles  Best,  of  Chicago,  who  reports  the  most 
recent  case,  (a)  and  collects  particulars  of  four  other 
fatal  cases,  points  out  that  all  of  them  resulted 
either  from  prolonged  irrigation  with  saturated 
solution  of  boric  acid,  or  packing  of  large  cavities 
with  the  dry  powder.  The  usual  symptoms  of 
severe  boric  poisoning  are  profuse  vomiting,  a 
papular  rash  over  the  face  and  chest,  and  a  weak, 
irregular  pulse.  Post-mortem  but  little  was 
discovered — some  cloudy  sweUing  or  fatty  de- 
generation of  the  hepatic  and  renal  cells,  and  in 
one  case  small  subpericardial  haemorrhages. 


A  Massage  School. 
The  word  massage  has  in  the  past  covered  a 
multitude  of  sins,  from  gross  quackery  to  barely- 
disguised  immorahty.  So  distasteful  were  the 
abuses  accompanying  its  practice  that  for  many 
years  a  number  of  medical  men  would  have  nothing 
to  do  either  with  massage  or  with  masseois. 
Even  now  it  cannot  be  said  that  the  art  of  massage 
is  entirely  in  the  right  hands,  or  conducted  in  the 


(a)  Joum.  fif  tk»  AvMT.MfA.  AttociaHvn,  September  17th,  UM. 


Oct.  19,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    419 


nglit  way,  and  we  are  glad  to  learn  that  a  school 
lor  teaching  massage  in  all  its  forms  is  about  to  be 
opened  under  the  auspices  of  the  National  Hospital 
for  the  Paralysed   and  Epileptic,  Queen  Square. 
P^-actitioners  ought  to  be  able  to  judge  of  the 
ability  of  a  masseur  or  a  masseuse  to  carry  out  his 
directions,  and  the  minimum  that  can  be  accepted 
as  evidence  is  the  possession  of  a  diploma  from 
3oiiie  respectable  institution  framed  on  right  lines. 
Tbe  private  teachers  who  profess  to  give  instruction 
at   present  are  by  no  means  always  persons  of 
recognised  status  or  skiU,   and  their   "  course " 
liardly  carries  conviction  of  competency  with  it. 
Xhe    Committee    of  ^Queen  Square  have  an  ad- 
mirable opportunity,  and  may  be  expected  to  place 
tlie  matter  in  a  satisfactory  position.     It  is  dis- 
appointing to  learn  that  their  course  of  instruction 
is    to  last  three  months  only.     Considering  the 
high  fees  that  masseurs  can  earn,  and  the  com- 
plexity that  the  art  is  acquiring,  a  year  would  be 
none  too  long  to  require  of  their  students.     When 
a  nturse  after  three  years*  training  can  look  to 
making  only  two  guineas  a  week,  besides  her  board 
and  lodging,  it  seems  unfair  that  a  masseuse  after 
three  months  can  be  in  a  position  to  earn  a  pound 
or  more  a  day  for  considerably  less  work.     We 
hope  it  is  not  too  late  for  the  Committee  to  re- 
consider the  matter,  especially  as  Swedish  move- 
ments are  to  be  included  in  the  curriculum. 


The  Value  of  Meat  Extracts. 
The  nitrogenous  extractives  of  muscle  are  both 
numerous  and  complex.  The  relation  of  these  sub- 
stances to  urea  and  uric  acid  was  early  demon- 
strated by  chemical  physiologists,  and  the  identifica- 
tion of  camic  acid  with  anti-peptone,  announced  by 
Siegfried  and  subsequently  confirmed  by  Blake 
and  Fraenkel,  was  an  important  contribution  to 
our  imperfect  knowledge  of  the  question  of 
proteid  constitution.  From  the  practical  aspect, 
however,  it  has  been  found  that  creatin,  creatinine, 
xanthine,  and  allied  bodies  which  are  capable  of 
being  extracted  from  fresh  meat  have  compara- 
tively Uttle  food  value.  The  use  of  the  word 
"  extract "  in  this  connection  is  somewhat  unfor- 
tunate, since  to  the  average  individual  the  word 
is  apt  to  indicate  the  concentrated  essence  of  all 
that  is  nourishing  in  meat.  All  meat  extracts  are 
popularly  supposed  to  be  very  strengthening,  and 
any  statement  to  the  contrary  is  met  with  in- 
credulity. Even  good  home-made  beef-tea,  that 
mystic  concentration  of  fleshy  strength,  does  not 
deserve  the  high  opinion  which  is  usually  placed 
upon  it,  but  it  may  be  safely  asserted  that  the  best 
infusion  of  beef  contains  very  little  assimilable 
proteid,  its  virtue  consisting  entirely  in  the  stimu- 
lating property  possessed  by  the  numerous  extrac- 
tives dissolved  therein.  The  relative  merits  of 
meat  extracts  and  beef-tea  have  been  exercising 
the  minds  of  the  Holbom  Board  of  Guardians. 
One  of  the  medical  officers  of  the  Board  had  de- 
clared that  "  it  was  impossible  to  tell  what  animal 
it  (meat  extract)  is  made  from  and  whether  it  had 
died  from  disease."    There  is  much  truth  in  this 


statement,  though  we  are  glad  to  know  that  some 
well-known  firms  really  do  turn  out  wholesome 
products  that  are  above  suspicion.  On  the  score 
of  expense,  beef-tea  is  preferable,  and  as  a  savoury 
stimulant  there  is  nothing  better  in  sickness  or 
convalescence,  and  it  is  generally  most  acceptable 
to  the  patient. 


Nurses  for  Middle-Class  Homes. 
We  are  glad  to  note  that  a  scheme  is  on  foot  for 
providing  people  of  the  middle-class  with  the 
services  of  a  nurse  in  their  own  homes.  As 
opinions  on  the  subject  have  been  requested,  we 
may  say  with  confidence  that  there  is  hardly  a 
practitioner  who  would  not  welcome  such  an 
arrangement,  provided  it  were  properly  organised 
and  managed.  As  matters  stand  at  present  the 
poor  in  most  parts  of  the  country,  and  in  nearly 
all  the  large  towns,  can  have  the  benefit  of  a 
nurse's  assistance  in  times  of  sickness  through  one 
or  another  of  our  existing  philanthropic  agencies. 
No  such  provision  is  made  for  the  poorer  middle- 
class.  Without  advocating  that  nursing  by  mem- 
bers of  the  family— which  is  certainly  a  duty,  and 
should  be  a  privilege— ought  to  be  superseded  in 
general,  one  knows  that  in  many  cases  additional 
skilled  help  is  needed  in  dressing  wounds,  giving  nu- 
trient enemata,  and  similar  manipulations,  and  this 
among  people  of  small  means  who  do  not  wish  to 
avail  themselves  of  public  charity.  A  nurse's 
fees,  especially  in  long  iUnesses,  are  often  beyond 
the  resources  of  the  smaller  tradesmen  and  clerks, 
and  with  the  raising  of  the  standard  of  sick-nursing 
that  is  going  on  around  us,  no  reduction  of  fees 
can  be  looked  for.  To  place  the  services  of  a 
skilled  nurse  within  the  reach  of  such  people 
would  be  a  worthy  and  enUghtened  piece  of 
philanthropy,  and  we  hope  that  the  scheme  may  be 
carried  through  successfully.  It  is  proposed  to 
give  the  nurses'  services  gratuitously ;  this,  we 
think,  would  be  a  mistake.  The  working  expenses 
of  the  institutions  would  fall  entirely  on  the  funds 
provided  if  this  were  so,  and  the  scope  of  their 
operation  would  be  proportionately  curtailed. 
Charging  small  fees,  whose  amount  was  adapted 
to  the  patients'  means,  would  not  only  relieve  the 
income  of  the  committee  of  a  heavy  burden,  but 
would  be  acting  on  the  higher  principle  of  making 
people  help  themselves — ^as  far  as  they  are  able. 


The  Hygiene  of  the  Elevator. 
A  CONTEMPORARY  has  somewhat  humorously 
suggested  that  a  sound  article  might  be  written 
upon  the  subject  of  "  The  Lift,  or  Elevator,  and 
its  Influence  on  the  Ph3rsique  of  Nations."  Such 
a  title  might  not  commend  itself  to  the  writer  of 
an  M.D.  thesis,  as  the  number  of  pathological 
lesions  resulting  from  the  habitual  use  of  the  ele- 
vator is  not  great.  It  may,  indeed,  be  urged  by 
those  who  love  to  cavil  against  the  application  of 
hygienic  tests  to  the  affairs  of  daily  Ufe  that 
were  the  Uft  Uttle  better  than  a  death-trap  it 
would  hardly  signify,  seeing  that  the  time  spent  in 
one   by  the   average  passenger  is  so  short.     The 


420    Thk  Medical  Press. 


NOTES    ON   CURRENT    TOPICS. 


Oct.  19,  1904, 


attendant  himself,  however,  would  fare  ill  if  such 
were  the  case.  The  view  has  been  put  forward, 
and  it  is  even  now  held  by  some  conservative  folk, 
that  the  lift  encourages  habits  of  laziness,  especially 
in  the  young,  and  that  the  older  and  more  sensible 
method  of  stair-climbing  is  far  more  beneficial  to 
the  muscular  system.'  Perhaps  chlorosis  and 
anaemia  were  not  so  common  fifty  years  ago,  but 
there  is  nothing  like  a  good  mount  up  six  or  eight 
flights  of  stairs  to  detect  the  slightest  degree  of 
cardiac  incompetency  accompanying  these  com- 
plaints, which  are  so  frequently  met  with  among 
our  city  youths  and  maidens.  An  individual 
suffering  from  organic  disease  of  the  heart  would  be 
sorely  tried  by  climbing  such  heights,  whereas  by 
the  use  of  the  lift  he  is  enabled  to  carry  on  his 
business  without  discomfort  or  increased  risk. 
As  a  time-saving  appliance  the  elevator  has  be- 
come an  absolute  necessity,  for  hurry  is  the  order 
of  the  present  age.  From  the  surgical  standpoint 
more  might  be  done,  perhaps,  in  the  way  of  pro- 
viding better  safeguards  at  the  entrance  of  Hft- 
holes,  as  lamentable  accidents  not  infrequently 
occur  from  neglect  of  such  precautions.  The 
ventilation  of  many  elevators  is  far  from  perfect, 
and  in  busy  establishments  the  lift-man  or  boy 
must  suffer  from  the  effects  of  breathing  bad  air. 

The  Central  Midwives*  Board  and  the 
Rotunda  Hospital. 

In  our  present  issue  we  publish  a  letter  from 
the  Master  of  the  Rotunda  Hospital,  in  which  he 
informs  us  that  the  serious  difference  of  opinion, 
between  the  Board  and  the  hospital  authorities, 
as  to  what  constituted  a  properly  trained  nurse 
had  been  at  last  arranged  to  the  mutual  satis- 
faction of  both  parties.  We  are  very  glad  that 
this  is  so,  and  desire  to  congratulate  them  on  the 
fact.  Common  sense  must  have  taught  that  it  was 
a  manifest  impossibility  to  refuse  to  recognise 
nurses  trained  as  are  those  at  the  Rotunda  Hospital, 
and  if  the  hospital  authorities  have  found  it  possible 
to  make  the  alterations  suggested  by  the  Board 
without  interfering  with  the  value  of  the  hospital 
training  for  either  nurses  or  students,  it  is  well  that 
they  should  do  so.  If  the  present  training  of  the 
midwife  is  to  be  improved  it  can  only  be  by  the 
careful  and  intelligent  supervision  of  a  Board  so 
instituted  as  to  be  suitable  for  its  purpose,  and  by 
the  loyal  assistance  of  the  training  centres.  If, 
however,  the  actions  of  the  Board  appear  to  be 
governed  by  prejudice  and  illogicity,  it  cannot  com- 
plain if  they  are  resisted  by  training  centres  which 
did  not  require  reform.  While  we  are  referring 
to  this  subject,  we  desire  to  express  our  deep  regret 
at  the  unexpected  death  of  Mr.  Heywood  John- 
stone, M.P.,  who  was  largely  responsible  for  the 
creation  of  the  Board.  We  have  at  times  been 
compelled  to  disagree  on  different  points  with  his 
pohcy  on  the  question  of  the  training  of  midwives, 
but  that  his  actions  were  solely  directed  to  the 
effecting  of  a  very  necessary  improvement  in  the 
present  class  of  midwife  we  are  sure.  It  was, 
however,  a  pity  that  he  did  not  allow  himself  to  be 


more  guided  by  the  advice  of  the  profession  wttch 
was  best  calculated  to  give  such  advice.  Had  he 
done  so  the  piece  of  legislation  with  which  bis  name 
will  be  always  associated  would  have  been  xnoie 
ef&cacious,  and,  we  fancy,  more   permanent 


The  Hygrromed. 

The  hygromed  is  a  little  instrument  invented  by 
Dr.  Wetherill,  of  Philadelphia,  or  rather  adapted 
by  him  from  the  spiral  hygrometer,  with  the  ob- 
ject of  measuring  accurately  the  degree  of  moisture 
of  the  skin  in  disease.  Dr.  Wetherill's  first  step 
after  completing  the  construction  of  the  instru- 
ment was  to  test  its  value  and  authenticity  on 
normal  folk,  and  it  was  not  till  he  had  made  a 
thousand  different  observations,  and  ascertained 
the  ranges  of  variations  in  health,  that  he  begai 
using  the  hygromed  in  disease.  It  is  now  ten  yeais 
since  he  began  work,  and  he  thinks  the  results  be 
has  obtained  show  that  there  is  a  distinct^  if  limited, 
scope  for  his  instrument  in  the  examination  of  tbe 
sick.  His  most  practical  observations  are  tbose 
made  in  cases  of  renal  disease,  especially  in  threat- 
ening uraemia.  He  found  that  when  a  fall  in  the 
quantity  of  urine  was  compensated  for  by  an 
increased  transpiration  of  the  skin,  the  patient's 
condition  was  not  appreciably  changed,  but  when 
in  renal  disease  he  found  a  progressive  diminuttos 
in  the  dryness  of  the  skin,  the  danger  of  unemii 
was  great.  In  oedema,  the  skin  was  shown  to  be 
possessed  of  less  moisture  than  over  parts  that  were 
not  oedematous,  and  after  hot  baths,  aithonfh 
perspiration  was  induced  at  the  time,  the  moistme 
of  the  skin  remained  below  normal  for  some  day? 
afterwards.  In  exophthalmic  goitre  cutaneoiis 
excretion  of  water  was  increased  by  10  percent, 
and  in  paralysis  the  skin  was  generally  drier  oa 
the  helpless  than  on  the  sound  side.  Many  other 
interesting  observations  have  been  recorded  of  the 
condition  of  cutaneous  excretion  in  fever  and  other 
conditions,  and  this  clever  little  instrument  may 
not  unhkely  soon  find  its  way  into  the  clinicai 
apparatus  of  the  physician. 

The  Therapeutical  Society. 

The  appearance  of  the  second  volume  of  the 
Transactions  of  the  Therapeutical  Society  reminds 
us  of  the  excellent  objects  of  the  founders.  It 
bears  testimony  to  the  excellence  of  its  woit 
namely,  the  desire  to  advance  the  knowledge  d 
pharmacology  and  therapeutics,  in  the  list  of  papers 
which  have  been  read  and  discussed  during  the  year 
1903-04.  The  ground  covered  by  the  Society  is 
of  the  widest,  as  may  be  gathered  from  the  range 
of  titles,  which  include  an  account  of  the  aconites* 
the  pharmacology  of  the  saponins,  the  action  of 
bodies  in  a  particulate  state,  photography  is 
natural  colours,  inguinal  trusses,  blood'  leucocytes, 
and  so  on.  Variety  is  certainly  to  be  found  here 
for  a  wide  diversity  of  therapeutical  palates.  The 
present  president,  Sir  W.  Thistleton-Dycr,  wiB  be 
succeeded  by  Sir  Lauder  Brunton.  The  popD- 
larity  of  the  Society  is  attested  by  the  rapidly-is- 
creasing   roll   of   membership.     During   the  past 


•Oct.  11$.  1904. 


SPEaAL    CORRESPONDENCE. 


The  Medical  Peess.    421 


year^e  number  has  been  increased  by  no  less  than 
-sixty-two  Fellows,  twenty-seven  of  whom  are 
'<k)rresponding  Fellows  living  abroad.  Further 
<letails  of  the  Society  can  be  obtained  from  the 
honorary  secretary.  Dr.  T.  E.  B.  Brown,  Willes- 
^<ien  Lane,  Lbndon,  N.W. 


Bjre  Maaaage. 

With  reference  to  the  comments  in  our  last  issue 
upon  "  Eye  Massage,"  we  are  assured  by  Dr.  Ettles, 
lof  the  Minories,  that  he  has  not  been  nominated 
by  Mr.  Stephen  Smith  as  his  "  referee,"  as  stated 
in  our  article,  nor  is  he  in  any  way  "  connected  with 
that  gentleman  or  his  hospital."  This  informa- 
tion was  founded  on  statements  in  at  least  one 
lx>ndon  daily  newspaper.  We  are  glad,  however, 
to  pubhsh  this  disavowal  on  the  part  of  Dr.  Ettles. 
^nd  we  regret  that  such  misleading  information 
appeared  in  a  public  newspaper.  Dr.  Ettles,  more- 
over "  is  not  an  anti-vivisectionist,  nor  does  he  at  all 
-agree  with  Mr.  Smith's  method  of  correcting  defects 
of  vision  by  manipulation  "  ;  at  the  same  time,  we 
must  clearly  state  that  no  such  attitude  was  hinted 
.at  in  our  remarks. 


PERSONAL. 


Accompanied  by  Queen  Alexandra,  the  King  has 
graciously  consented  to  lay  the  foundation-stone  of 
the  new  King's  College  Hospital  to  be  erected  at 
I>enmark  HUl,  Camberwell,  on  a  site  presented  by  the 
Hon.  W.  D.  F.  Smith.  M.P. 


His  Majesty  the  King  has  graciously  consented 
to  give  his  patronage  to  the  Sanitary  Institute,  which 
^vas  founded  in  1876,  and  is  carrying  on  a  large  work 
in.  teaching  and  examining  in  hygiene  and  sanitary 
science,  and  maintains  in  London  a  permanent  museum 
of  sanitary  appliances. 

Lord  Kelvin  will  present  the  prizes  at  the  St. 
-George's  Hospital  Annual  Distribution,  on  October 
28th  next. 

Sir  William  Collins,  M.D.,  has  been  re-elected 
President  of  the  Medico-Legal  Society  for  the  coming 
year. 


Sir  Patrick  Manson,  K.C.M.G.,  M.D.,  will  deliver 
an  address  on  the  significance  of  fever  in  patients 
from  warm  climates  at  the  autumn  meeting  of  the 
^Vest  Somerset  Association  Branch,  to  be  held  at 
Taunton  on  November  4th. 


Sir  William  Mulock  recently  embodied  an  amend- 
ment to  the  Post  Office  Act  in  the  Canadian  Parlia- 
ment with  the  view  of  prohibiting  the  passage  of 
<^uack  advertisements  through  the  post. 

Professor  W.  R.  Smith  is  announced  as  Conser- 
vative and  Unionist  candidate  for  the  representation 
in  Parliament  of  the  Glasgow  and  Aberdeen  Universiti«*s. 
As  the  prexiously  selected  candidate,  Sir  Henry  Craik, 
is  still  before  the  constituency,  the  path  of  the  LiberU 
party  seems  likely  to  be  somewhat  cleared  of  obstacles 
if  Dr.  Smith  persists  in  his  candidature. 


Professor  Koch,  on  his  way  to  Africa,  is  at  present 
pa3dng  a  visit  to  Paris,  where  he  has  several  times 
visited  the  Pasteur  Institute  and  the  Academy  of 
Medicine. 


At  the  Inauguration  Ceremony  of  the  Univrrsity 
•of  Leeds  the  honorary  degree  of  Doctor  of  Scie^i.'** 


was  conferred  upon  a  number  of  distinguished  scientific 
men,  amongst  whom  were  Sir  Arthur  Rucker,  Sir 
T.  E.  Thorpe,  the  well-known  chemist,  and  Professor 
L.  C.  Miall,  the  biologist. 

The  honorary'  D.Sc.  was  conferred  upon  the  follow- 
ing physicians  and  surgeons  : — Sir  William  Broadbent, 
Mr.  C.  G.  Wheelhouse,  Mr.  Jonathan  Hutchinson, 
F.R.S.,  Mr.  T.  Pridgin  Teale.  Dr.  John  Hughlings 
Jackson,  Mr.  A.  W.  Mayo  Robson,  and  Dr.  Tempest 
Anderson,  the  ophthalmologist  and  authority  on 
volcanoes. 


Dr.  H.  Leslie  Roberts  has  been  appointed  to  the 
newly-created  post  of  lecturer  on  dermatology  in  the 
University  of  Liverpool. 

Mr.  C.  Carter  Braine  will  take  the  chair  at  the 
annual  dinner  of  the  Society  of  Anajsthetists,  to  be 
held  on  October  21st,  at  the  Hotel  M6tropole,  London. 


Mr.  C.  St.  Aubyn  Farrer,  Westboume  Park  Road, 
London,  W.,  will  be  pleased  to  hear  from  any  medical 
men  wishing  to  take  part  in  the  forthcoming  inaugura- 
tion of  the  Association  of  Medical  Diplomates  of  Scot- 
land. 


Sir  Lauder  Brunton,  M.D.,  F.R.S.,  has  just  re- 
turned to  London  after  his  visit  to  the  United  States. 


Mr.  James  Craig,  F.R.C.P.I.,  Physician  to  the 
Meath  Hospital,  Dublin,  and  Registrar  to  the  Royal 
College  of  Physicians,  has  been  elected  General  Secre- 
tary of  the  Royal  Academy  of  Medicine  in  Ireland. 

It  has  been  extensively  rumoured  during  the  past 
week  that  the  post  of  President  of  the  Queen's  College, 
Cork,  is  to  be  filled  by  the  appointment  of  Professor 
Reginald  Windle,  Professor  of  Anatomy  in  the  Univer- 
sity of  Birmingham.  It  is  probable  that  by  the  time 
we  go  to  press  this  rumour  will  have  been  confirmed. 

Surgeon-General  Evatt  has  arrived  in  Ireland  at 
the  request  of  the  Irish  Medical  Association.  We  under- 
stand that  he  proposes  to  hold  a  series  of  meetings 
through  the  country  at  which  the  present  condition  of 
the  Poor-law  Medical  Service  will  be  discussed,  and 
that  he  has  also  been  asked  to  assist  at  the  reorgani- 
sation of  the  Association  itself. 


Special  (Sotte9pon{)ence. 

[from  our  own  correspondents.] 


SCOTLAND. 
Parliamentary  Representation  of  Glasgow  and 
Aberdeen  UNivERsrriES. — ^The  Universities  of  Glas- 
gow and  Aberdeen  Conservative  and  Liberal  Unionist 
Association  have  recently  issued  a  circular  recom- 
mending Professor  W.  R.  Smith,  M.D.Aberd.,  D.Sc.Ed.. 
barrister-at-law  and  J. P.  for  the  County  of  London,  as 
a  candidate  for  the  vacancy  which  will  arise  at  the 
next  general  election  owing  to  the  retirement  of  the 
Right  Hon.  J.  A.  Campbell,  M.P.  In  making  the 
selection  the  Association  were  influenced  by  the  recom- 
mendations of  a  Committee,  to  whom  they  referred 
the  subject — that  the  candidate  should  be  a  medical 
man,  and  that,  if  possible,  he  should  be  an  Aberdeen 
graduate.  The  medical  Faculties  of  the  Universities 
have  never  hitherto  been  directly  represented  in  Parlia- 
ment, and  for  the  past  twenty-four  years  the  member 
has  been  connected  with  the  University  of  Glasgow, 
although  a  general  understanding  exists  that  nomina- 
tion should  be  exercised  alternately  in  favour  of  a 
graduated  each  University.  Apart  from  all  questions 
of  politics,  we  cannot  but  desire  that  the  medical 
representatives  in  Parliament  should  be  added  to, 
especially  when,  as  in  the  case  of  Professor  Smith,  the 
candidate  is  one  who  would  fo  materially  add  weight 
to  the  votes  of  his  professional  brethren  in  St.  Stephens. 


422     The  Medical  Press. 


CORRESPONDENCE. 


Professor  Smith  has  for  the  past  fifteen  years  been 
Professor  of  Forensic  Medicine  and  Director  of  the 
Laboratories  of  State  Medicine  at  King's  College.  He 
has  been  medical  ofl&cer  of  the  London  School  Board, 
and  medical  officer  of  health  for  Woolwich.  He  has 
taken  a  prominent  part  in  all  matters  concerning  public 
health,  has  filled  the  office  of  President  of  the  Royal 
Institute  of  Public  Health,  and  is  a  member  of  the 
Metropolitan  Asylums  Board.  It  is  unfortunate, 
however,  that  his  candidature  cannot  be  supported  by 
the  official  party  associations  of  the  Universities,  who 
have  already  a  candidate  in  the  field.  From  a  com- 
munication which  has  appeared  in  the  daily  press  it 
appears  that  the  official  associations  of  the  two  Uni- 
versities met  in  the  spring  of  this  year  and  unani- 
mously resolved  to  recommend  to  the  constituency  as 
its  next  member  Sir  Henry  Craik,  who  is  about  to  vacate 
the  office  of  secretary  to  the  Scottish  Education  Depart- 
ment. Under  the  circumstances  the  rivalry  between 
the  candidates  is  not  one  of  politics,  since  both  are 
Unionists,  but  consists  in  the  fact  that  the  original 
official  candidate  is  apparently  to  be  opposed  by  a  non- 
official  medical  candidate.  Both  parties  assert  that 
they  have  considerable  prospect  of  success.  The 
outcome  of  the  affair  will  be  watched  with  interest ; 
we  note  in  the  last  clause  of  the  London  Association's 
circular  that  Professor  Smith  "  has  not  at  present 
signified  his  assent  to  become  a  candidate,  and  prefers 
not  to  do  so  until  the  general  wishes  of  the  graduates 
are  known."  It  seems  that  very  little,  if  anything, 
of  Dr.  Smith's  candidature  was  known  in  Scotland  until 
the  circular  was  actually  issued. 

Caledonian  Medical  Society. — ^The  greater  part 
of  the  current  number  of  the  Caledonian  Medical 
Journal  is  occupied  by  an  account  of  the  proceedings 
in  connection  with  the  annual  meeting.  The  society 
now  numbers  230  members,  of  whom  90  reside  in 
Scotland,  107  in  England,  and  18  in  "  other  "  foreign 
countries,  chiefly  South  Africa.  The  following  office- 
bearers for  the  year  1905  were  elected : — ^President, 
W.  Stewart,  M.D. ;  Vice-President,  W.  A.  Mackmtosh, 
M.D. ;  Secretary  and  Treasurer,  S.  R.  Macphael,  M.D.  ; 
Council,  David  Blair,  M.D.  George  Gilson,  M.D., 
John  Keay,  M.D.,  W.  Murray  Lester,  M.D.,  Alex. 
McDonald,  M.D.,  and  Professor  W.  Japp-Sinclair. 
The  chief  feature  of  the  meeting  was  an  address  by 
the  retiring  president,  Dr.  George  Mackay,  on  "Ancient 
Gaelic  Medical  Manuscripts,"  in  which  it  was  suggested 
•  that  the  Caledonian  Medical  Society  should  consider  it 
their  duty  to  share  in  tran^ribing,  translating  and 
rendering  intelligible  to  their  contemporaries  these 
interesting  documents.  The  proceedings  concluded  by 
the  annual  dinner,  held  in  the  Caledonian  Station  Hotel. 

Medical  Presentation. — Dr.  Andrew  Graham, 
Currie,  a  well-known  Midlothian  practitioner,  on  the 
occasion  of  his  semi- jubilee  of  practice  in  the  district, 
was  entertained  at  a  dinner  in  the  Craig  Memorial 
Hall,  Currie,  on  the  14th  inst.  Sir  James  Gilson  Craig, 
who  presided,  presented  Dr.  Graham  with  an  illu- 
minated address,  and  a  cheque  for  ;£ioo,  and  Mrs. 
Graham  with  a  silver  tea  service  and  salver  in  the  name 
of  his  numerous  patients  and  friends  in  the  district. 

BELFAST. 

The  Belfast  Guardians. — The  members  of  the 
Belfast  Board  of  Guardians  do  not  seem  to  be^as 
gallant  as  is  expected  of  Irishmen,  for  at  their  meeting 
last  week,  when  they  proceeded  to  appoint  a  resident 
medical  officer,  they  rejected  three  lady  applicants  and 
appointed  the  one  man  who  applied  1  The  successful 
applicant.  Dr.  Patton,  had  been  doing  temporary  duty 
in  the  workhouse,  and  came  into  the  board-room  in  the 
usual  white  jacket,  to  which  one  of  the  guardians 
promptly  took  exception,  saying  the  candidate  should 
have  appeared  before  them  properly  dressed.  The 
chairman  explained  that  this  was  the  usual  profes- 
sional costume,  but  the  worthy  grocer  refused  to  be 
comforted,  and  maintained  that  the  doctor  was  not 
sufficiently  respectful  to  his  employers. 

The  Neu-  Sanatorium.  —The   Local   Government 


Oct.  19.  1904. 


Board  having  sanctioned  the  purchase  of  the  Abbey 
at  Whitehouse  as  a  Workhouse  Sanatorium  for  Coo- 
sumptives,  arrangements  are  being  made  for  the  use 
of  the  same.  It  is  proposed  to  accommodate  twenty- 
five  patients,  as  well  as  the  administrative  staff,  in  ti» 
house,  and  twenty-five  patients  more  in  newbaildiii^ 
in  the  grounds.  It  is  also  proposed  to  appoint  a  resi- 
dent medical  officer  at  ;£i20  per  annum,  with  rations 
and  apartments,  and  a  visiting  medical  officer  to  vm 
every  day,  at  ;£iso  per  annum.  Dr.  Ritchie,  a  medkal 
member  of  the  board,  objected  to  the  proposed  sabriss 
as  too  high,  but  did  not  say  at  what  figure  he  woold 
rate  the  services  of  his  piofessional  brethren. 

The  Danger  of  Nitric  Acid. — ^A  case  was  heard  at 
Lurgan  Quarter  Sessions  last  week  in  which  a  minor, 
by  his  mother,  sued  for  £20  damages  against  a  local 
chemist  who  he  had  consulted  about  warts  on  his  hand. 
The  chemist  gave  a  small  bottle  of  nitric  acid,  labeled 
"  Poison.*'  and  told  him  to  touch  the  head  of  the  wan 
with  the  cork  of  the  bottle.  He  did  so,  and  suffered 
so  much  that  the  finger  had  to  be  amputated  in  the 
Lurgan  Infirmary.  His  Honour  held  that  the  fact  that 
the  boy  had  been  told  to  apply  the  acid  with  the  end  a 
the  cork  was  sufficient  warning  to  the  mother  to 
exercise  due  care  in  its  use.  He  was  sorry  for  the  boy's 
sake  that  he  was  compelled  to  dismiss  the  case. 

Notification  of  Infectious  Diseases — Test  Case. 
— A  case  of  some  interest  to  medical  men  was  heard  at 
Newtownards  Petty  Sessions  last  week,  when  tht 
Urban  Council  sued  the  mother  of  a  child  who  had 
suffered  from  scarlatina  for  not  notifying  the  case,  and 
also  sued  Dr.  Parke,  the  mwiical  man  in  charge  of  the 
case,  for  not  notifying  it  sufficiently  promptly.  The 
mother  of  the  child  was  fined  los.  and  is.  6d.  costs, 
and  the  case  against  Dr.  Parke  was  then  taken.  It 
appeared  that  the  child  was  removed  to  hospital  od 
Sunday,  and  that  Dr.  Parke  sent  in  his  note  on  Monday 
evening.  The  Act  says  that  the  case  is  to-  be  notified 
"  forthwith,"  and  on  the  ground  of  his  delay  Dr.  Parke 
was  fined  a  similar  amount  to  the  mother  of  the  cM± 


Corte9pon&ence« 

[We  do  not  hold  ounelves  responBible  for  the  oplnioni  of  1 
Oorraipondenta.] 


KING'S    COLLEGE    HOSPITAL-   ANI>   ANTI- 
VIVISECTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  am  sorry  to  find  that  a  passage  in  the 
Address  which  I  delivered  at  King's  College* on  October 
4th  has  given  rise  to  some  misapprehension;  which  I  vill 
ask  you  kindly  to  give  me  the  opportunity  of  correctiii^. 
The  passage  in  question  is  as  follows  :-^"  The  laboia- 
tories  of  experimental  pathology  and  also  of  neonh 
pathology  cannot  conveniently  be  transferred  to  the 
new  hospital,  for  the  council  and  hospital  staff  are 
agreed  that  original  researches  in  these  subjects  which 
may  involve  experiments  out  living  animals  shall  find 
no  place  within  its  walls."  In  the  scheme  described  m 
the  address  a  strong  dividing  line  is  drawn  between 
the  *'  early  "  and  the  '*  advanced  "  studies.  The  fonner 
will  be  carried  on  at  King's  College  in  the  Strand,  the 
latter  at  the  new  hospital  at  Caml>erwelL  Bot  the 
subjects  referred  to  in  the  passage  clearly  belong  to 
"  advanced  "  studies,  and,  therefore,  might  naturally 
be  expected,  under  the  scheme,  to  form  part  of  the 
student's  education  at  the  hospitaL  They  cannot, 
however,  as  I  have  said,  be  conveniently  transferred 
to  the  hospital  for  the  reason  assigned.  It  appeared 
desirable,  therefore,  to  call  attention  to  what  is  as 
important  exception  to  the  general  rule; 

These  studies  have  always  been  carried  on  in  the- 
labor.itories  at  King's  College,  never  in  King's  College 
Hospital,  and  there  will  be  no  change  therefore  in  the- 
:;.usting  arrangement.  As  regards  experiments  on 
living  animals,  such  as  inoculations.  K)r  diagnost^ 
purposes,  these  have  never  been  performed  in  King's 
College  Hospital,  but  always  in  the  appropriate  labora- 
tories at  King's  College.     In  view,  however,  of  the 


Oct.  19,  1904. 


LITERATURE. 


The  Medical  Pkess.    423 


greatly  increased  distance  between  the  hospital  and 
King's  College  in  the  future  it  will  obviously  be  neces- 
sary that  provision  should  be  made  at  the  hospital  for 
investigations  of  this  nature. 

There  was  not  the  slightest  intention,  in  the  passage 
to  which  you  take  exception,  to  imply  any  antagonism 
on  the  part  of  the  council  ^d  medical  staff  to  the  em- 
plojonent  of  experiments  on  living  animals. 
I  am,  Sir,  yours  truly, 

Thomas  Buzzard. 

Grosvenor  Street,  October  14th,  1004. 

[Inoculations  for  diagnostic  purposes,  it  is  clear  from 
the  foregoing  explanation,  will  in  future  be  made  at 
King's  College  Hospital.  They  are  technically  "  vivi- 
sections," and  therefore  traverse  the  general  inference 
from  the  passage  quoted  from  the  address. — Ed.] 


LIEUT.-COLONEL  GEORGE  RYAN,'*  R.A.M.C. 
The  death  is  announced  at  Ryde,  Isle  of  Wight,  of 
Lieutenant-Colonel  George  Ryan,  late  R.A.M.C,  at 
the  age  of  59.  He  entered  the  Service  in^March,  1868, 
as  Assistant-Surgeon,  becoming  Surgeon  in  1873, 
Surgeon-Major  in  1881,  and  Surgeon-Lieutenant- 
Colonel  in  1889,  when  he  retired.  Lieutenant-Colonel 
Ryan  served  in  the  Zulu  war  of  1879.%  He  took  the- 
L.R.C.S.  and  L.R.C.P.  Edinburgh  in  1867. 


THE   CENTR.\L   MIDWIVES    BOARD. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  view  of  the  attention  that  has  been  lately 
drawn  to  the  proceedings  of  the  Central  Midwives' 
Board  in  connection  with  the  status  of  Irish  trained 
mid  wives  to  practise  their  profession  in  England,  I 
take  the  opportunity  through  your  columns  to  announce 
that  the  points  at  issue  between  this  Board  and  the 
Governors  of  the  Rotunda-Hospital  have  been  amicably 
arranged. 

The  Central  Midwives'  Board  have  formally  inti- 
mated their  intention  to  ask  the  Privy  Council  to 
modify  their  rules  so  as  to  permit  our  hospital  to  be 
placed  on  the  register  of  Institutions  whose  certificates 
•will  be  accepted. 

Our  thanks  are  particularly  due  to  you.  Sir,  for  your 
able   and  untiring  advocacy  of   the  claims  of   Irish 
trained  nurses  to  equal  recognition  with  those  educated 
in  other  parts  of  the  United  Kingdom. 
I  am,  Sir,  yours  truly, 

E.  Hastings  Tweedy, 

Master,  Rotunda  Hospital. 

Dublin,  Oct.  12th,    1904. 


ALCOHOLISM  AND  INSANITY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— We  may,  I  think,  congratulate  ourselves  on 
the  fact  that  Professor  Clouston  has  taken  up  this 
matter  of  the  relation  of  alcohol  to  insanity.  The 
scientific  aspects  of  the  matter  are  still  imperfectly 
understood ;  indeed,  they  amount  to  little  more  than 
'well-informed  and  reasonable  speculation.  The  ad- 
vent of  an}'  candid,  clear-headed,  and  specially 
equipped  investigator  is,  therefore,  to  be  hailed  with 
delight  by  all  interested  in  this  great  social  problem, 
-whose  vital  bearing  it  would  be  indeed  hard  to  over- 
estimate. Speaking  as  a  medical  man,  it  has  always 
seemed  to  me  the  main  difficulty  in  approaching  the 
question  is  that  of  separating  cause  from  effect.  Does 
the  drunkard  make  the  lunatic  or  the  lunatic  the 
drunkard  ?  In  other  words,  is  the  alcoholism  causative 
or  symptomatic  ?  In  any  case,  the  evil  of  alcohol,  as 
pointed  out  by  Dr.  Ck>ustcn,  is  preventable,  and  be 
the  margin  of  this  form  of  madness  great  or  small,  it 
should  be  done  away  with  among  a  civilised  and  self- 
respecting  community.  But,  then,  so  also  should 
alcoholic  cirrhosis  of  the  liver  and  delirium  tremens. 
The  quality  of  the  alcoholic  drink  is  another  factor 
of  prime  importance ;  bad  liquor  spells  ruin  to  body 
and  to  mind.  The  way  in  which  the  humblest  citizen 
may  help  his  countrymen  to  rise  to  better  things  is 
by  voting  in  favour  of  wise  restrictive  legislation  upon 
the  production  and  the  distribution  of  aScoholic  drink 
both  as  regards  quality  and  quantity.  1 1  is  to  be  hoped 
that  the  matter  thus  ably  opened  up  by  Dr.  Clouston 
will  be  widely  discussed  by  competent  critics. 
I  am.  Sir,  yours  truly, 

David  Walsh. 

Hanover  Street,  London,  W. 
October   17  th,  1904. 


WILLIAM  CHATTAWAY,  F.I.C.,  F.C.S. 
Mr.  William  Chattawav,  the  superintendent  of 
the  Apothecaries'  Hall,  died  on  the  7th  inst.  at  the  age 
of  43,  after  undergoing  an  operation  for  appendicitis. 
He  was  a  Fellow  of  the  Institute  of  Chemistry  and  the 
Chemical  Society,  an  ex- Vice-president  of  the  Society 
of  Public  Analysts,  and  at  the  time  of^^his^death  filled 
the  office  of  Public  Analyst  for  Hammersmith  and 
Colchester. 


EDWARD    WILLIAM    ORTON,    L.R.C.P.Ed., 
M.R.C.S.Eng. 

At  Bedworth,  on  the  7th  inst.,  the  death  occurred  of 
Mr.  Edward  W.  Orton,  one  of  the  best-known  medical 
practitiqners  in  North-east  Warwickshire.  He  was 
the  last  of  the  old  school  of  sporting  doctors  of  that 
part  of  Warwickshire,  and  to  within  a  few  years  ago* 
was  a  regular  follower  of  the  Atherstone  foxhounds. 
Deceased  was  6^  years  old,  and  had  held  many  public- 
appointments,  including  that  of  Medical  Officer  and 
Public  Vaccinator  of  the  Bedworth  District.  He  wa* 
educated  medically  at  Queen's  College,  Birmingham, 
and  in  1870  took  the  London  M.R.C.S.,  and  the  Edin- 
burgh L.R.C.P.  and  L.M. 


JAMES  WALLACE,  M.A..  M.D.Glasg.,  L.R.C.S.Ed. 
Dr.  James  Wallace,  Medical  Officer  of  Health 
for  Greenock,  was  found  dead  in  bed  on  the  morning 
of  the  loth  inst.  He  retired  to  rest  on  Sunday  night 
apparently  in  his  usual  health.  He  was  in  his  eightieth 
year,  and  was  one  of  the  oldest  physicians  in  Scotland. 
Deceased  had  held  numerous  appointments,  including 
that  of  Physician  to  Greenock  Infirmary  and  Examiner 
in  Surgery  and  Clinical  Surgery  in  Glasgow  University. 
He  took  the  Glasgow  degree  of  M.D.  in  1850.  L.R.C.S. 
Edin.  and  F.F.P.S.Glasg.  in  1851. 


Xtterature. 


REPORT  OF  THE  PRISONS  BOARD,  IRELAND.(a^ 
Of   19  preliminary    pages  of  this    blue-wrappered 
volume,  the  "Report"  proper  occupies  but  13.    An 
Appendix,  of  matters  manifold,  constitutes  the  bulk  of 
the  contents,  as  it  runs  to.i 59  pages.     Such  a  document 
as  the  present  possess,  of  course,  an  interest  for  civilised 
humanity  in  general,  and  for  the  theorising  philanthro- 
pist in  particular  ;   but  most  particularly  of  all  for  the- 
most  practical  of  all  living  philanthropists,  the  truly- 
representative  medical  man  who  is  devoted   to   the- 
practice  of  his  profession.    The  present  report  presents 
but  comparatively  trifling  variations  in  the  statistic8- 
of    committals    from    those  of    the    last    preceding. 
"  The    number    of     criminal     prisoners    committed' 
to  the  local  prisons  during  the  year  1903  was  32,294, 
and  the  daily  average  number  in  custody  2,296.     These 
figures  show  a  decrease  of  10 1  and  30  respectively, 
compared  with  the  corresponding  figures  for  the  previous^ 
year.     In  addition  to  the  numbers  above,  74  prisoners 
were  committed  to  local  prisons  during   1903,  under- 
civil  process,  being  an  increase  of  12  compared  with  the- 
previous  year.     The  number  committed  to  bridewells 
during  the  year  was  455,  being  227  less  than  during  the- 
previous  year."     The  compilers  of  the  present  report 
"  concur  in  the  conviction  expressed  by  the  Prison 

(a)  "  Twenty-sixth  Report  of  the  General  Prisons  BoArd.  Ireland' 
19(N^<M ;  With  an  Appendix.  Dablin :  Alex.  Thorn  and  Co  ,  Umited». 
1904. 


4^    Thx  Medical  Psess. 


MEDICAL  NEWS. 


Oct.  19.  X904. 


Commissioners  for  Scotland  in  their  last  Annual  Report 
as  follows  :  '  It  is  our  conviction  that  short  sentences 
of  imprisonment  are  not  only  useless  for  reformation, 
but  actually  harmful  to  the  prisoner/  **  As  a  large 
proportion  of  such  punishments  are  inflicted  on  parties 
convicted  of  the  time-honoured  practice  of  being  "  drunk 
and  disorderly,"  it  is  very  easy  to  comprehend  the 
accuracy  of  this  view.  And  as  the  bulk  of  such  cases 
are  always  supplied  by  the  dregs  of  the  population  of 
the  cities  and  larger  towns,  they  do  not  very  well  repre- 
sent any  portion  of  the  general  morality  of  a  nation. 
Cities  are  always  cities,  and  always  will  be  so  long  as 
human  nature  and  its  unsatisfactory  craving  remain  the 
same.  Turning  to  the  table  which  sets  forth  the  number 
of  sentences  to  penal  servitude  passed  in  Ireland  at 
various  periods,  the  view  is  much  more  encouraging. 
The  first  year  included  in  this  table  is  1855,  the  last  is 
1903.  The  number  convicted  in  the  former  year  was 
5 1 8,  in  the  latter  79.  The  decline  was  not  uniform ;  after 
having  dropped  to  68  in  the  year  1897,  it  rose  to  91  in 
1898  ;  in  1899  the  number  was  89  ;  in  1900  it  fell  to  59  ; 
another  wave  carried  it  up  to  75  in  190 1  ;  after  which 
it  dropped  in  1902  to  57,  the  lowest  record  of  all.  As 
Ireland  has  for  the  past  quarter  of  a  century  been 
gradually  passing  through  the  throes  of  a  revolution,  the 
records  of  brutal  and  otherwise  atrocious  crime  perpe- 
trated in  the  country  during  that  period  are  decidedly 
encouraging.  Even  in  the  worst  years  of  the  **  agita- 
tion," when  agrarian  outrages  were  at  their  highest 
record  level,  the  proportion  of  murders  to  the  total 
population  of  Ireland  was  one  of  the  lowest  of  any 
community  in  the  world.  The  reins  of  Government 
have  now  been  transferred  to  the  people  ;  we  sincerely 
hope  that  one  of  the  most  conspicuous  results  of  the 
change  will  be  a  progressive  diminution  of  crime.  The 
philosophy  of  history  teaches  that  in  all  countries  and  in 
all  ages,  the  inevitable  result  of  the  ruthless  administra- 
tion of  draconic  laws  has  been  an  increase  of  the  worst 
forms  of  crime.  When  the  philosophic  physician  and 
enthusiastic  naturalist,  Andreas  Sparmann,  M.D., 
visited  South  Africa  (1772- 1776),  his  observations 
on  the  relationships  of  the  Dutch  Colonists  and  their 
Hottentot  slaves,  and  Hottentot  and  Bosjesman  neigh- 
bours inclined  him  to  entertain  the  surmise  that  the 
earliest  practice  of  cannibalism  among  the  savage 
races  of  any  country  was  a  result  of  brutal  oppression. 
Breaking  on  the  wheel  and  subsequent  impalement 
was  a  frequent  termination  of  the  life  of  a  recalcitrant 
slave.  The  impaled  and  mangled  convict  often  lived 
ior  several  days.  The  Cape  passed  into  the  hands  of  the 
English,  and  such  forms  of  capital  punishment  were 
abolished.  When  John  Barrow  visited  the  colony  a 
quarter  of  a  century  later,  he  found  that  the  executions 
had  become  so  few  after  the  amelioration  of  the  law  that 
one  of  the  two  hangmen  had,  in  a  state  of  want  and 
despair,  officiated  on  himself ! 

AeMcal  Views. 


The  Boyal  City  of  Dublin  Hospital. 

At  a  meeting  of  the  Directors  of  this  hospital,  held 
on  Thursday  last,  the  vacancy  in  the  visiting  staflF  due 
tn  the  death  of  Dr.  J.  L.  Lane,  Gynaecologist  to  the 
hospital,  was  announced,  and  it  was  decided  to  hold 
the  elec  tion  abou  t  the  middle  of  November.  We  und er- 
stand  that  already  some  half-a-dozen  candidates  ^.re 
in  the  field. 

Tho  Medleo-Legal  Bodoty. 

The  third  annual  general  meeting  was  held  on 
October  nth  at  the  rooms  of  the  Society,  22,  Albe- 
marle Street,  W.,  when  the  following  officers  were 
appointed  for  the  ensuing  session: — President,  Sir 
Wm.  Collins,  F.R.C.S.  Vice-Presidents,  Dr.  Matthew 
Hay,  Dr.  Bostock  Hill,  Mr.  C.  H.  Hopwood,  K.C.,  Sir 
Thomas  Stevenson,  M.D.,  and  Mr.  Justice  Walton. 
Treasurer,  Mr.  John  Troutbeck,  M.A.  Council.  Dr. 
Danford  Thomas,  Dr.  J.  G.  Carson,  Dr.  Harvey  Little- 
john,  Dr.  Wm.  McCaUin,  Earl  Russell,  Mr.  Walter 
Schroder,  Dr.  Clave  Shaw,  Dr.  F.  J.  Smith,  and  Dr, 
Wynn  Westcott.  "  Secretaries,  Mr.  R.  Henslowe  Wel- 
lington and  Dr.  Stanley  B.  Atkinson. 


Royal  Academy  of  lUdielna. 

The  annual  meeting  of  the  Royal  Academy  of  Medi- 
cine in  Ireland  was  held  in  the  Royal  College  of  Physi- 
cians on  Friday  last,  when  the  following  officers  for  the 
ensuing  year  were  elected : — ^President,  Sir  Thornley 
Stoker ;  General  Secretary,  James  Craig ;  Secretary 
for  Foreign  Correspondence,  Sir  J.  W.  Moore. 

Medical  Section. — President,  the  President,  R.C.P. ; 
J.  B.  Coleman,  W.  R.  Dawson,  H.  C  Dmry.  T.  P. 
Kirkpatrick,  G.  Peacocke,  F.  C.  Purser.  R.  Tiavcrs 
Smith,  W.  Langford  Symes,  W.  J.  Thompson,  W.  A. 
Winter. 

Surgical  Section. — President,  the  President,  R.C.S. ; 
Alexander  Blayney,  T.  E.  Gordon,  John  Lentaigne. 
R.  B.  M'Causland.  R.  C.  B.  Maunsell,  Sir  Lamben 
Ormsby,  John  B.  Story,  E.  H.  Taylor,  W.  Taylor. 

Obstetrical  Section. — President,  A.  J.  Smith;  Pad 
Carton,  R.  H.  Fleming,  R.  A.  Fljmn,  J.  H.  Glenn.  A  J. 
Home,  H.  JeUett,  F.  W.  Kidd,  W.  C.  NeviUe.  R.  D. 
Purefoy,  T.  H.  Wilson. 

Pathological  Section. — President,  H.  C.  Earl ;  A.  tt 
Benson,  H.  C.  Mooney,T.  G.  Moorhead,  A.  C.  O'SuUivac, 
A.  R.  Parsons,  F.  C.  Purser.  J.  A.  Scott,  John  B.  Stonr, 
A.  H.  White. 

Section  of  Anatomy  and  Physiology. — Presidcat 
Edward  Taylor,  A.  Birmingham,  D.  J.  Coffey,  A.  F. 
Dixon,  A.  Eraser,  J.  Alfred  Scott. 

Section  of  State  Medicine.-^Presideat,  Sir  J.  Moore; 
W.  R.  Dawson,  F.  C.  Martley,  J.  M.  Redmond.  W.  A 
Winter. 

Professor  Fuchs,  of  Vienna  was  elected  an  Honorarr 
Fellow.  A  resolution  of  thanks  to  the  retiring  General 
Secretary  was  unanimously  adopted. 

Glasgow  Eastern  Medloal  Soetety. 

The  opening  meeting  of  the  session  ^was  held  oa 
October  5th,  when  the  President,  Dr.  James  Dunlop. 
delivered  an  address  on  the  Sanatoria!  Treatment  of 
Consumption.  The  following  were  elected  office 
bearers  for  the  session  1904-05  ; — President,  Dr.  James 
Dunlop.  Vice-President,  Dr.  Miller  Seinple.  Secre- 
tar\'.  Dr.  P.  S.  Buchanan.  Treasurer,  Dr.  J.  ^Viison 
Mathie.  Reporting  Secretary,  Dr.  Hugh  H.  Borland. 
Sealkeeper,  Dr.  Thomas  Russell.  Council,  Dr.  Joseph 
Green,  Dr.  John  A.  C.  Macewen,  Dr.  A.  Laarie  Watson. 
Dr.  John  Anderson,  Dr.  W.  Adam  Bums,  and  Dr.  John 
W.  Finlay.  Auditors,  Dr.  Robert  W^ilson  and  Dr. 
T.  C.  Barras. 

Moath  Hospital. 

The  Session  at  the  Meath  Hospital  was  opened  on 
Tuesday  by  Mr.  Conway  Dwyer,  who  delivered  an 
interesting  address  on  "  The  Evolution  of  Modern 
Surgery,"  which  we  hope  to  publish  in  our  next  number. 
Sir  Francis  Cruise,  M.D.,  occupied  the  chair.  On  the 
motion  of  Sir  Thomas  Myles,  seconded  by  Sir  Lambert 
Ormsby,  a  vote  of  thanks  was  passed  to  Mr.  Dwyer. 
A  similar  vote  to  the  Chairman  was  passed,  on  the 
motion  of  Sir  John  Moore. 

Glasgow  Southern  Vedical  Society. 

The  opening  meeting  of  the  tenth  session  of  this 
Society  was  held  on  October  6th,  and  the  following 
office-bearers  were  elected  for  the  ensuing  year:— 
Honorary  President,  Mr.  H.  E.  Clark.  President.  Dr. 
J.  Hamilton.  Vice-Presidents,  Professor  R.  Stockman 
and  Dr.  T.  K.  Munro.  Treasurer,  Dr.  T.  Forrest. 
Secretary,  Dr.  J.  Weir.  Editorial  Secretary,  Dr.  R.  W. 
Forrest.  Sealkeeper,  Dr.  A.  Wauchope.  Extra  mem- 
bers of  Council,  Dr.  John  Stewart,  Dr.  D.  MacgUvray. 
and  Dr.  R.  J.  Carroll.  Court  Medical,  Mr.  T.  Richmond 
Dr.  J.  C.  A.  Smith,  Dr.  G.  H.  Edington,  Dr.  A.  Rox- 
burgh, and  Dr.  John  Brown.  Governor  of  Victoria 
Infirmary,  Dr.  C.  E.  Robertson. 

8t.  Vincent's  Hospital,  Dublin. 

Dr.  M.  McHugh  delivered  the  introductory  address 
at  the  opening  of  the  winter  session  at  St.  Vincent's 
Hospital,  Dublin,  on  Wednesday,  in  which  he  dealt 
with  the  position  and  demands  of  the  dispensary  doctors 
who,  he  said,  numbered,  roughly,  50  per  cent,  of  the 
profession  in  Ireland.  His  address  is  published  in 
another  column.  Mr.  O'Neill,  Chairman  of  the  Dublin 
District  Council,  in  moving  a  vote  of  thanks  to  Dr. 
McHugh,  said  that  whenever  the  local  bodies  made  an 


Oct.  19.  1904. 


PASS  LISTS. 


The  Medical  Press.    425 


effort  to  do  even  a  minor  justiceTto  the  unfortunate 
dispensary  doctors,  the  Local  Government  Board 
erected  every  barrier  and  obstacle  that  they  could 
possibly  conceive  in  order  to  prevent  these  remedial 
measures  being  carried  out.  His  advice  to  the  pro- 
fession was  to  organise  and  agitate.  Dr.  Cox  seconded. 
Tlie  Chairman  (Mr.Waldron,  M.P.)  thought  the  demands 
reasonable.  Surgeon-General  Evatt,  C.B.,  was  moved 
to  the  second  chair,  and  a  vote  of  thanks  was  passed 
to  Mr.  Waldron  on  the  motion  of  Mr.  McArdle, 
seconded  by  Mr.  Tobin,  which  was  passed  unani- 
mously. 

Dublin  Hospital  Appolatments. 

Dr.  D.wid  Gray,  who  filled  the  position  of  House 
Surgeon  for  some  time  past  at  Jerxds  Street  Hospital, 
has  been  appointed  House  Surgeon  at  the  Westmore- 
land Lock  Hospital.  Dr.  L.  J.  Farrell  succeeds  Dr. 
Gray  as  principal  house  surgeon,  and  Dr.  W.  B. 
Loughman  is  appointed  to  ml  the  vacancy  on  the 
Jervis  Street  Hospital  staff. 

Sottth-WMt  LoBdon  Mwlieal  Soototy. 

The  annual  dinner  of  this  Society  was  held  at  the 
Caf^  Monico,  Piccadilly  Circus,  London,  W.,  on  Octo- 
ber 7th,  when  about  50  members  and  guests  were 
present.  The  chair  was  taken  by  Mr.  E.  F.  White,  the 
President.  The  toast  of  "  The  Society  "  was  proposed 
by  Dr.  W.  H.  Allchin,and  responded  to  by  the  President. 
Surgeon-Major  Mark  Robinson  proposed  **  Our  Kindred 
Societies  and  Visitors,"  to  which  Sir  R.  Douglas  Powell 
and  Mr.  F.  F.  Burghard  replied. 

Society  for  the  Relief  of  Wldowi  and  Orphans  of 
■edieal  Men. 

At  the  quarterly  Court  of  Directors,  held  on  Wed- 
nesday last,  October  12th,  at  11,  Chandos  Street, 
London,  W..  Dr.  Blandford,  treasurer,  in  the  Chair, 
three  new  members  were  elected  and  the  death  of  a 
member  reported.  There  were  no  fresh  applications 
for  grants.  The  death  of  a  widow  was  announced,  who 
had  received  ;^957  since  January,  1^79.  Applications 
for  renewal  of  grants  were  received  from  52  widows, 
1 3  orphans,  and  3  orphans  on  the  Copeland  Fund,  and 
it  was  resolved  that  £1,293  ^®  distributed  at  the  next 
court  subject  to  the  report  of  the  visitors.  On  the 
motion  of  the  acting  treasurer  it  was  decided  to  give 
at  Christmas  j^io  to  each  of  the  52  widows,  l^  to  each 
of  the  1 3  orphans,  and  £$  to  each  of  the  3  orphans  on 
the  Copeland  Fund — in  all,  £$7 A*  The  expenses  of  the 
quarter  were  £60  14s.  6d. 

I&teniAtional  Congress  of  Surgeons. 

President  Loubet  opened  the  seventeenth  Inter- 
national Congress  of  Surgeons  in  Paris  on  Monday  last, 
and  yesterday  Dr.  Doyen,  the  free  lance  of  the  pro- 
fession in  that  city,  was  announced  to  read  a  highly 
contentious  paper  on  "  The  New  Treatments  of  Cancer," 
of  which  we  shall  probably  hear  more  anon. 

PASS  LISTS. 
University  of  Durham— Faeulty  of  Medtolne. 

The  following  degrees  in  Medicine  and  Surgery 
were  conferred  on  October  1st : — 

Doctor  in  Medicine. — John  S.  Hall,  M.B.,  B.S.Dur., 
John  R.  Halliday,  M.B.Dur.,  Frank  Jeffree,  M.B.Dur., 
Alfred  Parkin,  M.B.,  B.S.Dur.,  F.R.C.S.,  Godfrey 
de  Bee  Turtle,  M.B.,  B.S.Dur.,  and  William  H. 
Wigham,  M.B.Dur. 

Doctor  in  Medicine  for  Practitioners. — Ernest  D. 
Bower.  M.R.C.S.,  F.R.C.S.E.,  Beaumont  H.  Comer- 
ford,  M.R.C.S.,  L.R.C.P.,  Philip  H.  Dunn.  M.R.C.S., 
L.R.C.P..  John  K.  Frost,  M.R.C.S..  L.S.A.,  D.P.H., 
William  V.  Furlong.  L.R.C.S.I..  L.R.C.P.E.,  Frank 
K.  Holman,  M.R.C.S.,  L.R.C.P.,  Richard  M.  Hugo, 
L.R.C.P.I..  L.M..  F.R.C.S.I.,  Thomas  S.  Jones, 
M.R.C.S.,  L.R.C.P.,  F.  St.  John  Kemm.  L.R.C.P. 
and  S.,  L.S.A.,  Arthur  C.  A.  Lovegrove,  L.S.A., 
Thomas  H.  Mitchell,  L.R.C.P.  and  S.E.,  Herbert 
E.  Rowell,  M.R.C.S.,  L.R.C.P.,  George  J.  Smith, 
L.R.C.P.  and  S.,  L.M..  James  B.  Wall.  L.R.C.P.  and  S., 
George  R.  Williams,  M.R.C.S.,  L.R.C.P. 

Master  in  Surgery  {M.S.). — Lachlan  G.  Eraser, 
M.D:,  B.S.Dur.,  and  Alfred  H.  Proctor.  M.B.,  B.S.Dur. 

Bachelor  in  Medicine  {M.B.). — John  A.  Bell,  Henry 
M.  Braithwaite,  Arthur  Budd,  Llewelyn  A.  H.  Bulkeley, 


Lewis  A.  Clutterbuck,  L.R.C.P.  and  S.Ed.,  L.R.C.P.I.^ 
William  E.  Falconar,  Harold  E.  Featherstone, 
Margaret  D.  French,  Norman  H.  Hume,  Thomas  C. 
Hunter,  Sophia  B.  Jackson,  William  W.  Jones,  George- 

E.  Lloyd,  Colin  F.  F.  McDowall,  Stanley  Robson, 
William  T.  Sewell.  Arthur  L.  Sheppard.  WilUam  £. 
Stevenson,  William  L.  Tindle,  Janet  A.  Vaughan, 
Samuel  G.  Webb. 

Bachelor  in  Surgery  {B.S.). — John  A.  Bell,  Henry 
M.  Braithwaite,  Arthur  Budd,  Llewelyn  A.  H.  Bulkeley, 
Lewis  A.  Clutterbuck,  L.R.C.P.  and  S.Ed.,  L.R.C.P.I., 
Harold  E.  Featherstone,  Margaret  D.  French, 
Norman  H.  Hume,  Thomas  C.  Hunter,  Sophia  B, 
Jackson,  WilUam  W.  Jones,  George  E.  Lloyd,  Colin 

F.  F.  McDowall,  Stanley  Robson,  William  T.  Sewell^ 
Arthur  L.  Sheppard,  William  E.  Stevenson,  Janet  A, 
Vaughan,  Samuel  G.  Webb. 

Diploma  in  Public  Health  (D.P.H.).— Charles  R. 
Stewart,  M.B.,  B.S.Dur..  and  John  Stokes,  M.D., 
B.S.,  L.S.Sc.Dur.,  M.R.C.S. 

Royal  Otflleies  of  Fhyiioia&i  ftad  ftirfeoBS  of  Bdmbnvgb,  uitf 
FMwy  of  Fhy  ttolMW  aad  Bnrgeoai  of  COsagow. 

The  following  gentlemen,  having  passed  the  re- 
quisite examinations  of  the  Conjoint  Board,  were- 
admitted  Diplomates  in  Public  Health : — James- 
Allison,  M.B.,  CM..  Kershaw  Dinshah  KhambatU, 
L.M.  and  S..  L.R.C.P.  and  S.E.,  Alfred  Robert 
Maclurkin,  M.B.,  Ch.B.,  Daniel  Mackinnon,  M.B., 
Ch.B.,  Richard  Staward,  F.R.C.S.E.,  Alexander 
Mouat,  M.B.,  Ch.B.,  Lambert  Kenneth  Rodriguez, 
L.R.C.P.  and  S.E.,  Herbert  Francis  Lechmere  Taylor. 
M.B.,  CM.,  Herbert  De  Carle  Woodcock,  M.R.C.S. 
Eng..  L.R.CP.  Lond.,  and  David  Dryburgh  Gold, 
M.B.,  CM. 

At  the  same  Sederunt,  Messrs.  James  Alexander 
Raebum,  M.B.,  Ch.B.,  and  Mowbray  Taylor,  M.B., 
CM.,  passed  the  first  examination  in  Public  Health  ; 
and  Mr.  Robert  Dods  Brown,  M.B..  Ch.B.,  passed 
the  second  examination  in  Public  Health. 
Society  of  Apothecaries  of  London. 

At  the  primary  examination  the  following  candi- 
dates passed  in  the  subjects  indicated  : — 

Part  //.—Anatomy:  L.  W.  Bradshaw,  Leeds; 
A.  C  Dickson,  Guy's  Hospital ;  J.  W.  Harrison,  St.. 
Mary's  Hospital;  L.  R,  Nezet,  Edinburgh;  H.  N. 
Ritchie,  Sheffield  ;  and  N.  C  Wallis,  London  Hospital. 
Physiology  :  R.  Beesley,  Manchester  ;  L.  W.  Bradshaw 
and  T.  P.  Braim.  Leeds;  J.  W.  Harrison,  St.  Mary's 
Hospital;  W.  P.  Pinder,  Leeds;  H.  N.  Ritchie, 
Sheffield;    and  N.  C  WalUs,  Ix)ndon  Ho.*«pital. 

The  Boyal  Univenity  of  Ireland. 

The  Third  Examination  in  Medicine — Autumn,  1904. 
The  examiners  have  recommended  that  the  follow- 
ing candidates  be  adjudged  to  have  passed  the  above-^ 
mentioned  examination : —  ^.     ,       « 

Upper  Pass. — James  J.  A.  Gannon.  Charles  R.. 
Harvey*,  Robert  J.  Ledlie,  Victor  J.  McAllister, 
Patrick  T.  McArdle*,  Charles  B.  Pearson*,  Percy  B. 
Ridge,  Charles  H.  G.  Ross,  James  Shaw*,  Thomas 
Tobin*,  James  Wamock*.  M.A.  Those  marked  with 
an  *  may  present  themselves  for  the  further  examina- 
tion for  honours.  ,    ^  „     , 

Pass. — Harry  L.  Bristow,  Francis  X.  J.  Callaghan, 
John  A.  Clarke,  John  Dempsey,  John  Dunlop,  Patrick 
J.  Dwyer.  Isaac  Flack,  WUliam  J.  Hill.  James  Horgan. 
Charles  G.  Knight.  Samuel  W.  Kyle.  Morgan  Leane. 
Thomas  J.  McAllen,  Samuel  McCormac,  Robert  A.M.L. 
McCrea,  Jerome  B.  Murphy,  Joseph  Nunan,  Joseph 
A.  O'Halloran,  Maurice  A.  Power,  William  B.  Purdon, 
Patrick  Reid.  Maria  Rowan,  Richard  V.  Slattery,  B.A.,. 
Peter  Walsh,  Ernest  J.  Watson,  and  Jemina  B.  'NATiite. 


The  Army  Medical  Service  Advisory  Board,  the 
members  of  which  are  Sir  C  B.  BaU.  M.D.,  Sir  E. 
Cooper  Perr\'.  M.D.,  Sir  Frederick  Treves,  Bart., 
K.C.V.O.,  F.R.C.S.,  and  Dr.  J.  GaUoway,  has  been  re- 
appointed_for  a^further  period  of  three  years. 


426    THE  MEDICAL  P.ES8.        NOTICES  TO  CORRESPONDENTS. 


Oct.  19.  1904- 


JlotkeB  to 
Correg|nmbtntg>  ^hort  JUOtxsf,  &c. 

to  this  rale. 

OueniAL  A.TKII«  or  L«tim  toUnd.!  for  pubUottton  .ho^d  be 

X^  »m.  »d  Idrw  .1  th.  writ*,  not  n,c.-«my  lor  pubha.. 

*|on,bat»»<»Meno»ofid.n«tT.  .    „  .. 

C^WBWto"  «e  ktodly  r«,u«t«l  to  •end  thdr  wmm.anto.aon. 

<SinT«-*«. 'to  I«ta«d.  to  th.  DubUnomo..  <»  ort«  t^r;^ 

^^I^.-Bn»teUO««tU>l«app«HnKtotW.  jo«rn.lo«b.  h«i 
^V^rfno-1  „to  pro»Vlta»«itho..gi».  notto. to  th» pubUAer  or 

XT^"^  ,^onHedi..rt.-,«.F.r,r  U  unnvoid- 

n»  MM.  I*  .far*""  ori  to  «ow««,  wmethtoe  W  m*  P"«y  »o 
"»"  *• '^i&'wuitlSllt  thrt  bowl  nii^  .wm, 

DeSed  oSt  with  oU  the  wofl.  of  Ifetn. 
Bat  what  U  it.  contenUibouU  teem 
Wlthpoppy  Woona  »nd  ni«ndr.r>«»» 

tat.  thooich  dtehed  up  aim  jmno  ««», 
Tew  ioarmet.  would  content  to  try 

AbSwlolw-wneddlrfteU.:  ,.  _  ,^ 
Or  beer  more  love  Uum  even  BheHy  bore 
TwMd  hemlock.  Morito.  M»d  heUebore  l-sni^tt;. 

wU?"  li  ^^Si  .u5~t  wUl  be  de.lt  with  to  onr  next. 
IMFOSmOMS  ON  MEDICAL  MBS. 

h*ve  the  Pr^f^P^i^JlS  uie  dSitS^lC  tewould  .applement^te  kind- 
about  coverjt.  he  Mked  the  d^octor  i^ne^w  ^j.  ^^^^j^  ^  ^^^ ,  , 

.. __  * *u^  patient's 

will  not 


neae  by  lending  him  th®,™®'^?. 
the  man  of      '''"^— 
hand,  and 
quite  do  in  your 


MOKDAT.  OCTOBXB  24tll. 


JkMy  ChronicU, 


Mttiin^  of  the  §odcltt«,  ICwturw.  &£. 

WlDNUDAT,  OCTOBKE  19th. 

ti«^Af  MicjBOBCOPiCAL  Society  f20  Hanover  Square,  W.).—Sp.m. 
dSd.  HfsS?t(P^d«it)  :  Demonstration  on  the  Eeconstruotion 

w  cT  4D m.  Mr.O.Byall:  Cllnlque.  ^Surgic^l.)  6.16 pjn.  Sir 
^;D^FrlppfRe^^t  Variations  in  the  Techniqueof  Certain  ^mmon 
Operations. 

Thuesdat,  OcroBEE  20th. 
Medical  Oeaduates'  CJolleoe  aid  Poltcliicic  (22  Ohenles  Street, 
^MBDWAL^WEADUA^^^^^.^^^.    CUnique.    (Surgical.)    6.16  p.m. 

"^MliSi'y^O^ui.^^^  CONSHMPnOH    AEP  DISEASES  OP 

Prostrate.)  ^^^^^^^  ^^^^^^  j^^t^ 

Mbdioal  Geapuaies'  CJollege  and   PoLjctnrw    ^   Ohenles 

«^A:!::'^^T'£?-ST?'DvVt^^  cha«ios 

8t?2^?W  V-l™«?  c2;e2'wuTbeY^^  by  Dr.  0. 0  kawtigrne^ 
tSpbI  Hutchinson    Mr.  S.  Stephenson,   Dr.  L.  Guthne,  Wt.  A, 

S^ot  Congenital  Diaphragmatic  Hernia. 


OOOHTOIiOOICAL    SOCIETY   OF  GeBAT    BBTTIAJf  (20    HM«W  gquin 

W  )!-8p.m.  Mr.  J.  F.  Colyer,  L.B.O.P.Lond.,  M Jl.0.8,  L.D.J, 
Bng.  "  Some  recent  additions  to  the  Museum  of  the  Society.' 
(Ukistrated  by  Lantern'filides.) 

Tuesday  Octobbb,  «5th. 
Thbeapbuticai.  Society  (Apothecarle*' Hafl,  B.C.).--4 jxnu  li^ 
Oe^S^Meeting.    After  which  paper  wiU  be  rewibyj^.  Hanii: 
0?^Sme  Therapeutical  Applications  of  the  Continnons  Curt«t. 


SacanoeB. 


Horton  Infirmary,  Banbury.— House  Surgeon.  Salary  ^  per  aoiniB. 
with  board  and  residence  hi  the  Inflrmnry.  Applieauoostothc 
Honorari'  Secretary,  21  Marlborough  BomI.  Banbury. 

Darltogton  Hospital  and  Dispensary.— Moose  amgeon.    Salary  £19 
per  annum,  with  board  and  lodging  in  the  loatittttioo.     j 
cations  to  the  Secretaries.  48  Stonbope  Koad,  Darlington. 

Somerset  and  Bath  Asyliun,  Cotford,  Taunton, -Angytant  M 

Officer.  Salary  £100  per  annum,  with  fumUhed  anar^iaii; 
board,  fuel,  Hghting,  and  washing.  Ap^lioations  to  the  Medicil 
Superintendent. 

Down  District  Lunatic  Asylum.-^ttnior  Male  Assistant  JUOiai 
Officer.  Salary  £lO0  per  annum,  with  f  ornwhed  apartniwtt, 
ftc.    AppUcations  to  the  Resident  Medical  SupermteDdat 

East  London  Hospital  for  OhUdren  and  Dispensary  for  Wobmi. 
ShadweU.  X.>iiesideut  Medical  Ottoer.  Salary  iSlOOpcr  mhb, 
with  boaid,  residence,  and  laundry.  Afptioatioas  tolhow 
Hayes,  Secretary.  .  .,     ,  ^^ 

Devon/County  Atrium. -Second  Assistant  Medleal  Officer.  SiIiq 
£150  per  annum,  with  board,  lodging  and  washing.  AppUostn 
to  the  Medical  Superintendent,  the  Asylum.  Ssminaser. 

Wakefield  West  Riding  Asylum.— Assistant  Medical  Oiacer.  Sdnr 
£140  per  annum,  with  apartments,  board,  wastdng.  and  inn- 
dance.    Applications  to  the  Medical  Director  at  tbe  A^ytnn. 

Bory  InflrmarVw— Jnnior  House  Surgeon.  9<^lftry  «80  per  assmB, 
with  board,  residence  and  attendance.  Applications  to  tk 
Hon.  Seoretaiy,  Dispensary,  Knowaley  Street,  Buiy.  Isi- 
oashire. 

The  Munoipal  Corporation  of  Port  Elisabeth.— Medical  Offlor  rf 
Health.  8aUiy£660per  annum.  Applications  to  Danes  nd 
Soper,  Agents  of  the  Municipal  Corporation  of  Fort  Bisalieik. 
64  St.  Mary-aze,  London,  E.O.  ^      ,.  ,.  «^ 

Boyal  London  Ophthalmio  Hospital  (Moorflelds'Kye  Hospital).!^ 
Road,  E.C.  -Senior  House  Surgeon.  Salary  £100  per  •nnosi^ 
board  and  residence  in  the  Hospital.  Applicatfons  to  Bobot  J, 
Bland,  Secretary. 

^IpiromtmeniB. 

Blackfobd,  Jaxbs    YurOEBT,    M.D..    B.a.Darh.9     L.B.C.PJMi. 

M.R.C.8.,  Medical  Superintendent  at  the  City  and  Ooestj 

Asylum.  Fishponds,  Bristol.  ,.      _  *.<..<..«.... 

GoBir,  ALBBET,  A.,  M.B..  Ch.B.Edin.,  Honorary  Assistant  Phyaau 

to  the  Blackburn  and  East  Lancashire  Inflrmajrv. 
Hbathcote,  ewTEY.  Chaelbs,  M.B..  B.Oh.Vict.,  Medical  OffloerlR 

*v.  «. — ^^-   c    T^    District    by    the    Keynaham  Boaid  4 


.  Loe 


the  Fewton  St. 

Guardians. 
Lbiosstee,  MOETOB  Bdmvhd, M.D.Brux.,  L.B.C.P.,  I.  RC J Jdia, 

L.F.P\S  Glasg.,  Medical  Officer  for  the  Lerryn  District  of  the 

Liskeard  (Cornwall)  Board  of  Guardians.       ,  ^    „  ^ 

Maetih,  Johb  M.  H.,  M.D.Viot.,  F.B.0.8.Eng.,  J.P.,  Honorary  Oca 

suiting    Surgeon    to    the   Blackburn   and     East   Lancadure 

Inflrmary. 
MoBOAN.    Thomas    Whitwoeth    Sewbll,    M.B.C.S.Eng.,     L5.A, 

Medical  Officer  for  the  Preston  District  by  the  Keynshsm  Boaei 
'   of  Guardians. 
Sawyee,  James  E.  H.,  M.A..  M.D.Oxon.,M.R.aP.IiOnd.,  Pattotopa 

at  the  General  Hospital,  Birmingham.  .^  ^.    ,  «_ 

Stbvbbsoh,  Bolakd  a.,  L.R.O.P.,  M.aC.8.Bng..   Medial  Saper 

intendent  at   the    London  Open-air    Sanatorium,  Piaewood. 

Wokiiurham,  Berks. 
Wadmoee7j.  Cheisophee,  L.B.C.P.Lood..   M.R.O.aEng.,  Asnrtia 

Besident  Medical  Officer  at  the  London  Sanatorium,  Fmewood. 

Wokingham,  Berks. 


J^irtke. 


Abeam.— On  October  l8th.  at  Reading,  the  wife  of  G.  Stewnt 

Abram   B.A..  M.B.,  ofason. 
HAaRM.-dn  October  lOtb,  at  12  BuckinghaEft  Place.  Brlghtoa,  th« 

wUe  of  Henry  Arthur  CUf  ton  Harris,  M.B.C.S.,  Lr.C.P.,  of  1 

daughter. 


4Rarmge0. 


atikotok— Tooth.— On  October  16th,  at  St.  Andrew's,  Weils  Stieet, 
^ntincHugh Alington,  Lieut.  R.N..  eon  of  Admiral AJiogtos. 
of  awinhoperLincolnsbure,  to  Janet  Marcfaant,  dangfatcr  ol 
Howard  H/Tooth,  M.D..  C.MG.,  of  S4  Hartey  Street.  Loodos. 
W. 


Beicewell.— On 


^£«th0. 


[CEWELL.-On    October    16th,  'iJS!°'V!^\2i  ^rf'^^ 
Be^,  widow  of  the  late  Henry  Brickwell,  M.R.C.S.,  LAA.  « 


THOM?oi!^n  October  16th.  at  8,  Wert  P|}*  ««f «f ^er.J'* 
Thornton,  the  widow  of  the  Ute  Philip  Thornton.  MB.C.8. 

ROYAL  CITY  OF  DUBLIN  HOSPITAL 

A  vacancy  existo  for  the  position  of  GyiMBOOl*^-*       ^" 
to  be  sent  <m  or  before  2»tbtost.,to  the  Hon.8 
lir.  G.  Jameson  Johnston. 


Wit  ^diml  ^xm  mA  €itmht 


^BALUS   POPnU   SUPBEMA   LEX-' 


Vol.  CXXIX. 


WEDNESDAY,    OCTOBER    26,    1904.  No.   17. 


®rf dftial  Communfcattons. 

THE  LACK  OF  PRACTICAL 

METHODS    IN   MODERN    SUR. 

GICAL   EDUCATION,  (a) 

By  EDMUND  OWEN,  F.R.C.S., 
Conralting  Surgeon  to  St.  Xwy's  Hospital,  London. 

From  the  intimate  acquaintance  which  I  have  with 
"William  Hey,  the  illustrious  founder  of  this  Leeds 
•Oeneral  Infirmary,  I  feel  convinced  that  if  he  could 
•come  back  for  a  day  or  two  and  follow  you  about,  he 
Avould  say  that  the  present  system  of  medical  education 
^«\  as  unsatisfactory ;  and  I  Jeel  equally  sure  that  if 
lie  had  been  brought  under  this  system,  English  surgery 
would  have  been  robbed  of  one  of  its  brightest  lumi- 
naries. 

Hey  was  enabled  without  any  interference  to  devote 
Xhe  whole  of  his  first  winter  to  the  practical  study  of 
anatomy.  He  seldom  spent  less  than  twelve  hours  a 
-day  at  anatomy,  which  he  considered  as  the  foundation 
•of  surgical  science.  You  would  consider  yourselves 
fortunate,  I  dare  say,  if  you  could  manage  to  secure 
Jhree  hours  on  end  in  the  dissecting-room — and  even 
then  you  would  probably  be  tempted  to  leave  off  in 
the  middle  of  your  interesting  work  in  order  to  attend 
some  demonstration,  for  you  have  been  brought  up  in 
the  belief  that  the  knowledge  of  anatomy  is  best  ac- 
•quired  by  being  taught  it.  This  was  not  Hey's  opinion. 
He  \vas  a  practical  anatomist  at  the  beginning  and 
always,  and  when  he  became  a  practical  surgeon  he 
still  kept  a  close  hold  upon  his  anatomy.  He  was  a 
most  strenuous  worker,  and  knew  exactly  how  to  set 
about  his  studies,  and  how  to  obtain  the  greatest 
•advantage  from  them.  "  Being  aware,"  says  his  friend, 
*'of  the  disadvantage  of  engaging  himself  with  a  multi- 
plicity of  objects  at  the  same  period,  it  was  his  method 
to  direct  his  principal  attention  to  one  subject  at  a 
time  without,  however,  absolutely  neglecting  others 
when  his  leisure  would  permit."  That  is  to  say,  when 
be  was  working  at  anatomy  he  might,  if  he  could  spare 
the  time  from  it,  attend  a  lecture  upon  some  outside 
subject,  but  not  otherwise. 

Had  he  been  living  at  the  present  time  the  Dean  of 
his  medical  school  would  be  told  that  he  was  not  work- 
ing at  practical  chemistry,  or  histology,  or  that  he  was 
not  attending  some  course  of  lectures  which  absolutely 
failed  to  interest  him,  and  from  which  he  was  unable 
to  learn  anything.  If  Hey  had  been  a  student  at  the 
present  time  he  would  have  been  strangled  by  the  red 
tape  with  which  he  would  find  his  course  hampered. 
Faflure  at  Surgical  Examinations. 
A  few  months  ago,  the  President  of  the  Royal  College 
■of  Surgeons,  Mr.  John  Tweedy,  called  attention  to  the 
fact  that  students  were  not  acquitting  themselves  as 
satisfactorily  at  their  final  examinations  in  surgery  as 
was  formerly  the  case ;  he  regarded  the  matter  as 
worthy  of  serious  consideration,  and  he  asked  if  any 
explanation  of  the  fact  were  forthcoming,  and  if  any- 


(a)  Abflteact  of  an  Addrass  deliversd  to  the  students  of  the 
Leeds  Medical  School,  October  18th,  1«M. 


:^ing  could  be  done  towards  remedying  it.  In  an 
attempt  to  answer  this  question,  I  woald  say,  in  the 
first  place,  that  no  equivalent  has  ever  been  devised 
for  the  old  apprenticeship  system,  and,  in  consequence, 
every  year  the  student's  training  is  becoming  less 
practicaL  We  h(^>ed  that  the  "  fifth  year  of  study  " 
was  going  to  make  good  some  of  the  deficiencies 
left  in  our  schieme  of  educatioti.  but  we  have 
been  grievously  disappointed.  I  am  not  going  to  ask 
for  a  restoration  of  the  apprenticeship  system  ;  to  go 
back  to  it  would  be  aft  undesirable  as  impossible  ;  still 
the  system  was  not  without  great  merits,  for  it  made  a 
man  quick,  handy,  and  resourceful.  It  enabled  him 
confidently  to  recognise  and  treat  a  fnicture  or  dis- 
location, and  to  apply  a  'splint  and  a  bandage  in  a 
manner  which  would,'  I  expect,  put  most  of  you  to 
shame.  The  senior  student  of  former  days  could  bleed 
a  man,  and  he  could  pass  a  catheter,  and  he  might  be 
trusted  to  do  every  operation  in  minor  surgery  long 
before  he  had  begun  to  think  of  his  final  examination. 
But  at  the  present  day  students  are  not  practical. 
They  fall  lamentably  short  in  their  clinical  work,  up 
to  which,  I  need  hardly  remii^4  you,  their  entire  educa- 
tional course  is  supposed  to  lead.  Their  clinical  know- 
ledge is  to  be  their  chief  future  asset  in  their  daily 
professional  life,  for  the  training  of  the  medical  student 
is  not  to  make  him  a  biologist,  a  chemist,  or  even  au 
anatomist,  but  to  teach  him  to  recognise  disease  with 
precision,  and  to  deal  with  it  with  satisfaction  to  the 
sick  people  under  his  care.  I  have  no  hesitation  in 
affirming  that,  in  these  respects,  the  training  of  the 
medical  student  of  to-day  is  not  nearly  as  thorough  and 
efficient  as  it  was  in  the  time  of  William  Hey. 

Surgical  Veneering. 

The  students  of  to-day  are  depending  far  too  much 
upon  **  coaching."  They  seem  to  think  that  time  spent 
in  steady  work  at  the  bedside  and  with  the  patient 
might  be  more  profitably  employed  in  some  special 
form  of  tuition.  I  regret  to  say  that  year  by  year 
they  are  coming  less  into  personal  contact  with  patients. 
They  listen  to  demonstrati6ns  on  cases ;  they  discuss 
the  problems  of  disease  with  their  tutors,  and  they 
occasionally  attend  a  clinical  lecture,  but  actual  work 
with  the  patients  themselves  is  every  year  diminishing. 
The  result  is  that  they  fail  lamentably  in  the  clinical 
part  of  their  tests.  They  do  not  know  how  to  set  about 
investigating  a  case  with  a  view  to  diagnosis.  They 
do  not  understand,  for  instance,  how  to  handle  a  case 
of  hip-disease,  and  still  less  to  estimate  the  amount  of 
deformity  at  the  joint.  They  do  not  know  how  to 
investigate  a  case  of  infantile  paralysis,  and  many  of 
them  seem  to  have  had  no  personal  experience  with 
the  translucency  test  for  hydrocele.  All  these  methods 
of  procedure  are  in  daily  use  in  the  out-patient  depart- 
ment and  in  the  wards,  where  the  senior  students  ought 
to  be  spending  most  of  their  time.  But  they  are  not 
there ;  they  trust  to  acquiring  a  minimum  clinical 
veneer  at  the  "  college-class."  They  tdl  me  that  they 
have  not  time  for  work  in  the  wards  i 

In  the  course  of  a  vivd  voce  examination  in  surgery, 
with  the  object  of  making  it  a  personal,  living  matter, 
and  of  getting  a  practical  answer  from  the  candidate, 
it  was  often  my  custom  to  introduce  a  subject  thus  : 


428    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Oct.  26.  1904. 


"  You  have  seen  a  case  of  so  and  so  ?  **  Then,  on  the 
candidate  saying  '*  Yes,"  I  would  ask  him  to  describe 
the  case  and  the  treatment  of  it,  just  as  if  we  were 
looking  at  it  together  in  the  hospital-ward.  But  of 
late  I  have  had  to  give  it  up,  because  of  the  frequency 
with  which  the  reply  was  that  he  had  '*  never  seen 
such  a  case."  It  is  disheartening  to  an  examiner  to  be 
told,  for  instance,  that  the  candidate  has  never  seen  a 
case  of  infective  osteo-myelitis.  I  can  quite  under- 
stand that  a  student  has  never  seen  a  patient  with 
erysipelas,  or  delirium  tremens,  for  such  cases  are  now 
promptly  taken  from  a  general  ward  and  placed  in  beds 
which,  are,  unfortunately,  far  removed  from  the 
student's  sphere  of  exercise.  And  I  can  realise  the 
fact  that  he  may  never  have  seen  a  case  of  pyaemia, 
or  of  traumatic  spreading  gangrene,  for  the  simple 
reason  that  surgical  cleanliness  has  made  such  diseases 
—common  enough  in  my  student  days— of  comparative 
rarity.  But  the  cases  to  which  I  refer  are  such  as  one 
constantly  finds  in  a  general  surgical  ward.  "  What  1 
never  seen  a  man  with  extravasation  of  urine  ?  " 
"  No."  "  What !  never  seen  a  case  of  renal  calculus  ?  " 
"  No." 

Ask  any  of  your  surgical  friends  who  were  students 
in  the  seventies  and  eighties  if  they  found  time  for 
making  a  practical  acquaintance  with  surgical  cases, 
and  you  will  probably  be  told  that  they  spent  a  couple 
of  hours  in  the  wards  in  the  morning  with  the  house 
surgeon,  and  that  they  were  there  again,  and  in  the 
operating  theatre,  for  another  two  hours  with  the 
surgeon  of  the  day,  not  only  when  they  were  dressers 
but  subsequentlv,  and  that  on  many  days  they  were 
hanging  about  the  surgical  department  of  the  hospital 
until  late  in  the  evening.  I  have  no  doubt  that,  many 
of  you  would  adopt  that  plan  if  you  were  a  little  more 
masters  of  your  time.  But  you  reply  that  you  have 
not  time  enough  for  all  that  you  have  to  dol 

The  "  Fifth  Year." 

''Not  sufficient  time?"  says  the  student  of  forme*^ 
days.  "  Why,  the  General  Medical  Council  have  given 
you  a  fifth  year  of  study ;  we  had  but  four  years !  " 
Yes,  this  is  true,  but  it  has  turned  out  a  bitter  dis- 
appointment. It  has  considerably  increased  the  ex- 
pense of  medical  education,  but  it  has  missed  its  mark 
entirely.  It  ought  to  have  been  made  "  the  practical 
year,"  but  the  authorities  have  allowed  it  to  be  frit- 
tered away,  and  for  all  the  practical,  professional  good' 
that  the  medical  student  obtains  from  it,  he  might 
almost  as  well  have  spent  it  at  school. 

One  of  the  chief  reasons  for  students  not  having 
"  sufficient  time  "  for  practical  surgery  is  that  many  of 
them  have  been  kept  back  by  their  chemical  work. 
The  examinations  in  chemistry  for  medical  students 
suggest  that  the  examiners  think  that  chemistry  is 
going  to  be  the  chief  occupation  of  the  individual 
when  he  is  in  practice.  It  is  much  the  same  with 
physics,  and  the  sooner  that  its  standing  is  placed  at 
a  common-sense  level  the  better.  The  Medical  Council 
have  already  accomplished  so  much  in  the  cause  of 
education  that  it  is  not  improbable  that  they  will  ere 
long  see  fit  to  make  some  change  in  the  direction  of 
greater  freedom,  and  one  which  will  help  towards 
sbcuring  for  the  student  an  increasing  store  of  practical 
knowledge. 

On  all  sides  I  hear  complaints  of  this  want  of  prac- 
tical knowledge  on  the  part  of  those  who  have  recently 
obtained  their  qualification.  Thus,  a  general  prac- 
titioner finds  himself  in  need  of  an  assistant,  and  he 
applies  to  some  friend  upon  the  staff  of  his  old  hospital 
to  send  him  a  Ukely  man.  In  answer  to  his  appli- 
cation one  of  the  most  promising  students  is  sent,  one. 
may  be,  who  took  the  prizes  in  biology  and  chemistry. 
But  in  a  little  while  the  practitioner  writes  to  say  that 
the  so-called  "  assistant "  is  no  help  whatever;  that 
though  he  is  an  adept  in  the  art  of  prescribing  drugs 
of  doubtful  value  but  of  undoubted  expense,  he  knows, 
practically,  nothing  of  his  profession  ;  that  he  cannot 
be  trusted  in  anything ;  that  all  his  work  must  be 
closely  supervised ;    that  his  diagnoses  are  as  extra- 


vagant as  they  are  improbable  ;  and  that  though  hs 
can  talk  eloquently  about  Bassini's  operation  he  cannot 
diagnose  a  simple  hydrocele;  that  he  mistate 
scarlet  fever  for  measles,  and  swollen  cervical  gbads 
for  mumps ;  that  he  treats  the  diarrhoea  of  intestinal 
cancer  with  chalk  and  opium  (without  ever  thinking  q» 
making  a  digital  examination  of  the  rectum) ;  and  that 
he  applies  a  fomentation  to  the  painful  knee  of  a  boy 
with  early  hip-disease. 

Let  me  urge  upon  you  to  get  through  your  prelimi- 
nary science  examinations  as  quickly  as  possible,  so 
that  you  may  the  longer  occupy  yourselves  in  dinical 
work.  Do  your  best  to  attend  regularly  in  the  oat- 
patient  department,  and  never  for  one  moment  fancy 
that  you  are  wasting  time  because  so  few  of  these 
applying  for  relief  are  the  subjects  of  diseases  of  an 
unusual  type.  When  you  get  into  actual  xnractice  the 
experience  thus  acquired  will  prove  far  more  serm- 
able  to  you  than  that  which  has  been  obtained  m 
listening  to  clinical  lectures  upon  certain  rare  cases, 
or,  may  I  say  it,  than  the  instruction  which  yon 
obtained  in  "  special  classes  "  ! 

As  things  are,  the  dreaded  examination  becomes  doe 
before  the  candidate  is  ready  to  meet  it.  He  feeb 
that  he  does  not  know  his  work,  but  he  is  under  the 
impression  that  the  most  likely  way  of  leading  his 
examiners  to  think  that  he  does  is  by  obtaining  a  sur- 
gical polish  at  the  hands  of  an  experienced  "  coach." 
This  gentleman  is  probably  an  able  and  energetic 
young  surgeon,  who  has  already  acquired  considerable 
reputation  both  as  a  student  and  a  teacher,  in  addition 
to  which  he  is  possibly  regarded  as  an  astrologer  of 
some  merit.  That  is  to  say,  by  making  a  prolonged 
and  careful  study  of  the  past  examinations,  he  has 
acquired  the  art  of  guessing  what  questions  are  going 
to  be  set  at  the  forthcoming  one.  He  has,  in  other 
words,  elaborated  a  "  system,"  which  sometimes  works 
out  with  extraordinarily  good  results.  But  the 
literary  style  imparted  by  some  of  these  coaches— if 
I  see  it  correctly  reflected  in  the  paper- work  of  their 
pupils — ^is  not  a  high  one.  For  a  very  favourite  method 
of  writing  an  answer  to  a  question  consists  in  drawing 
one  or  two  straight  lines  vertically  down  the  folio, 
and  inserting  in  the  respective  columns  the  symptoms 
of  one  disease  as  compared  with  those  of  another,  or 
the  headings  of  the  schemes  of  treatment  appropriate 
for  them.  This  method  is  constantly  recurring  is 
answer  to  questions  involving  differential  diagnosis, 
the  columns  being  as  destitute  of  verbs  as  are  the  pages 
of  an  auctioneer's  catalogue.  I  do  not  know  how  this 
method  originated',  but  I  rather  think  that  certain 
coaches,  in  the  endeavour  to  impart  knowledge,  tabu- 
lated, exact  and  concentrated,  plan  out  their  teaching 
in  this  manner  upon  a  blackboard  in  front  of  the  class. 
It  is  science  in  the  tabloid  form.  Some  of  the  papers 
written  by  senior  students  would,  so  far  as  Uterary  merit 
is  concerned,  scarcely  reflect  credit  upon  a  p-jpil  from 
a  Board  School,  and  if  I  might  presume  to  address  a 
few  words  to  "  coaches,"  I  would  say  that  unless  they 
themselves  write  decent  English  they  cannot  impart 
the  art  to  their  students.  And  if  they  deign  to  in- 
quire to  what  source  I  would  refer  them  for  style.  I 
would  say,  the  (>ospels,  the  "  Pilgrim's  Progress."  and 
the  "  Sentimental  Journey." 

The  current  style  of  English  medical  literature  is; 
for  the  most  part,  tedious  to  the  last  degree,  and  now 
that  dear  old  Mitchell  Banks'  pen  is  for  ever  dry,  ther^ 
are  few  to  brighten  the  pages  of  our  journals  and  to 
charm  the  reader. 

You  should  make  an  attempt  at  style  even  in  your 
ward-notes  ;  and  so,  later  on,  when  you  are  preparing 
a  full  account  of  your  own  extraordinary  success  in 
the  treatment  of  a  series  of  medical  cases  with  some 
new  and  fashionable  drug  (and  you  must  be  quicks 
for  new  and  fashionable  drugs  are  soon  found  to  have 
lost  their  efficacy),  or  some  wonderful  results  obtained 
in  operative  surgery,  take  pains  with  the  preparation 
of  your  paper,  and  if  you  cannot  make  it  attractive, 
at  least  make  it  readable — and  not  too  long. 

By  the  present^scherae  of  education  far  too  mrKh 


Oct.  26.   1904. 


ORIGINAL    COMMUNICATIONS.        Th»  Medicaid  Pew.    429 


jdeaching  enters  into  the  daily  life  of  the  medical  student. 
He  is  lectured  to.  catechised,  and  crammed  until  a  sort 
of  intellectual  dyspepsia  is  induced  in  him,  and  he  is 
iinable  to  learn.  Moreover,  from  want  of  proper  mental 
•exercise,  he  has  almost  lost  the  desire  to  learn.  All  his 
intellectual  food  is  served  to  him  hot,  finely  divided, 
and  peptonised.  His  wisdom-teeth  are  of  no  further 
use.  He  goes  up  for  his  practical  examinations  at 
regular  intervals,  and  he  comes  back  rejected.  "  Poor 
fellow,"  say  bis  friends,  •'  how  unlucky  he  is !  He 
<certainiy  deserves  to  pass,  for  he  is  such  a  steady 
"wcMTker." 

I  was  once  asking  a  candidate  to  describe  the  opera- 
tion of  herniotomy,  and  his  description  ran  thus : — 
'*  Then  you  enlarge  your  wound  and  expose  your  sac  *'  ; 
and.  later,  "  Then  you  separate  your  omentum  from 
the  wall  of  your  sac."  I  maintain  that  when  a  can- 
•didate  is  asked  to  describe  his  method  of  treatment  he 
has'  no  right  to  use  this  second  personal  pronoun. 
"When  I  have  put  my  question  I  want  the  answer*  to 
-suggest,  as  it  were,  the  candidate  performing  the  very 
•operation  step  by  step.  Again,  I  was  asking  a  can- 
didate to  describe  the  early  stages  of  a  certain  disease, 
and  he  said,  "  And  then  your  inguinal  glands  become 
enlarged,  and  you  break  out  in  secondaries  "  !  WTien 
I  asked  him  to  be  somewhat  more  impersonal  in  his 
xeply,  it  did  not  seem  to  dawn  on  him  that  he  had  been 
thoughtless,  for  he  quickly  went  back  to  the  use  of 
the  second  personal  pronoun,  and  did  not  leave  me 
until  I  was  a  hopeless  physical  wreck  I 

"  Oh."  says  the  candidate,  in  answer  to  the  question 
•as  to  what  treatment  he  would  advise  in  a  case  of  diplo* 
coccic  disease  of  the  knee-joint.  "  you  might  try  " — 
notice  the  pronoun  and  the  auxiliary  verb—"  Scott's 
dressing."  When  asked  what  Scott's  dressing  is,  he 
has  not  the  least  idea.  Asked  how  he  would  treat  a 
•case  of  mammary  carcinoma  with  wide^spread  impli- 
•cation  of  the  cervical  glands,  he  replies,  "  '-  You  '  might 
remove  the  breast  "  I 

Ought  a  man  who  talks  like  this  to  be  trusted  in 
^actual  practice  ? 

I  do  not  condemn  altogether  the  so-called  college- 
•classes  and  the  special  instruction  classes.  Possibly 
the  system  of  education  and  the  exigencies  of  exami- 
nations have  rendered  them  almost  a  necessity  ;  and 
it  may  be  that,  to  a  limited  extent,  they  perform  a  use- 
ful function  in  our  schools.  But  what  I  must  insist  on 
is  that  students  ought  not  to  be  encouraged  to  place 
as  much  reliance  on  them  as  they  do  at  present.  For 
though  they  may  help  a  man  to  scrape  through  an 
examination,  they  ought  not  for  a  moment  to  be  re- 
garded as  the  chief  means  of  obtaining  the  minimum 
amount  of  a  working  knowledge  of  surgery  likely  to 
satisfy  official  tests,  and  still  less  of  equipping  him  for 
actual  practice.  But  I  regret  to  say  that  of  late  years 
it  has  become  the  custom  for  the  hard-pressed  student 
to  desert  orthodox  clinical  methods,  and  to  consider 
as  their  equivalent,  if  not  their  superior,  the  cram- 
•classes  of  the  .surgical  coach. 

ON   THE  TREATMENT   OF 

INTRACTABLE  PROLAPSE 
BY  EXTIRPATION 

OF    THE 

UTERUS  AND  VAGINA,  (a) 

By  CHRISTOPHER  MARTIN,  M.B.,    F.R.C.S. 

Every  gynscologist  who  ha&  much  hospital 
-experience  must  have  had  cases  of  severe  total 
prolapse  of  the  uterus  and  vagina,  which  are  in- 
tractable to  ordinary  measures,  cases  in  which  no 
pessary  can  be  retained,  and  in  which  the  ordinary 
plastic  and  suspensory  operations  fail  to  give  more 
than  temporary  relief.     It  was  such  a  case  that 

(a)  Betd  at  ft  meetinf  of  the  British  Gynneological  Society,  atd 
specimen  shoT^-n,  October  18th,  1904. 


led  me  in  1899  to  devise  and  perform  the  operation 
of  extirpation,  not  only  of  the  nterus  but  also  of 
the  whole  of  the  vaginal  canal,  as  a  radical  cure. 
I  have  now  carried  out  this  proceeding  in  four 
cases.  The  final  after  result  has  been  excellent, 
and  the  cure  of  the  prolapse  complete.  It  is,  how- 
ever, a  very  severe  remedy.  The  operation  is  a 
long,  tedious  and  bloody  one,  and  attended  with  a 
good  deal  of  shock.  There  is  a  considerable 
danger  of  wounding  the  bladder,  the  ureters  and 
the  rectum.  Convalescence,  in  all  my  cases,  was 
slow  and  complicated  with  suppuration  in  the 
depth  of  the  pelvis.  I  should  only,  therefore,  feel 
justified  in  recommending  this  operation  in  cases, 
where  other  and  milder  measures  have  been  tried 
and  have  failed,  and  where  the  patient's  discomfort 
is  very  great.  It  is  to  be  kept  in  reserve  as  a 
dernier  ressort  and  not  performed  as  a  routine 
line  of  treatment.  For  obvious  reasons  it  should 
not  be  performed  in  married  or  marriageable 
women. 

I  do  not  propose  to  discuss  at  length  the  treat- 
ment of  ordinary  prolapse.  In  a  great,  majority 
of  cases  all  that  is  required  is  a  well-fitting  pessary, 
and  for  marked  procidentia  I  know  of  no  instru- 
ment so  satisfactory  as  Simpson's  shelf  pessary. 
When  no  pessary  can  be  retained,  or  where  the 
patient  objects  to  its  use,  aplastic  operation  should 
be  performed  to  support  the  uterus.  In  such 
cases  I  am  in  the  habit  of  doing  ventro-fixation  of 
the  uterus  combined  with  an  extensive  colpo- 
perineorrhaphy.  The  results,  as  a  rule,  are  very 
satisfactory.  Occasionally,  however,  it  will  be 
found  that  the  uterus  breaks  away  from  the 
abdominal  wall,  or  remains  attached  to  it  merely 
by  a  long  thin  band  of  adhesions,  or  becomes 
elongated  and  stretched,  so  that  whilst  the  fundus 
is  still  adherent  to  the  anterior  abdominal  wall,  the 
cervix  is  outside  the  vulva.  At  the  same  time  the 
vagina  gradually  dilates,  the  perineal  scar  stretches, 
and  slowly  the  condition  of  total  prolapse  becomes 
re-established.  In  such  cases  vaginal  hysterectomy 
may  be  performed.  But  whilst  it  is  obvious  that 
if  the  uterus  be  removed  it  can  no  longer  be  pro- 
lapsed, the  operation  does  not  cure  the  rectocele 
and  cystocele.  In  one  case  in  which  I  performed 
vaginal  hysterectomy  for  prolapse,  the  vagins^ 
afterwards  protruded  as  a  large,  polony-like  swelling 
and  turned  completely  inside  out. 

We  may  now  pass  on  to  a  brief  description  of  the 
object  and  the  steps  of  the  operation  of  extirpation 
of  the  uterus  and  vagina.  The  main  aim  of  the 
operation  is,  after  removal  of  the  uterus  and 
vagina,  to  bring  together  the  fascia  of  the  pelvis 
in  such  a  way  as  to  make  a  firm  fibrous  diapluragm 
extending  from  one  side  of  the  pelvis  to  the  other, 
and  having  adherent  to  it  the  bladder  in  front  and 
the  rectum  behind.  In  this  way  a  firm,  solid, 
pelvic  floor  is  built  up,  measuring  in  depth  from 
peritoneum  to  perinaeum'some  three  or  four  inches. 
We  produce,  in  fact,  a  pelvic  floor  closely  resembling 
that  which  obtains  in  the  male  pelvis. 

In  its  broad  outlines  the  operation  closely 
resembles  that  of  the  radical  cure  of  hernia.  Thus 
the  contents  of  the  hernia  are  removed,  the  peri- 
toneum is  closed,  the  fascia  is  brought  together 
with  buried  sutures,  and  finally  the  cutaneous 
wound  is  closed. 

The  patient  should  be  kept  in  bed  for  several  days 
before  the  operation,  the  functions  of  the  stomach 
and  the  bowels  regulated,  and  her  general  health 


430    The  Medical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Oct.  a6,  1904. 


improved  as  mnch  as  possible.  The  vagina  should 
be  rendered  as  aseptic  'as  possible  by  frequent 
antiseptic  douches.  Should  the  prolapse  be 
irreducible,  the  parts  should  be  well  washed  with 
soap  and  water  and  lysol,  swabbed  with  methylated 
spirit  and  then  wrapped  in  gauze  or  Unt  soaked  in 
a  solution  of  biniodide  of  mercury.  If,  as  is  often 
the  case,  the  cervix  or  vagina  be  ulcerated  from 
friction  against  the  patient's  clothes,  an  attempt 
should  be  made  before  the  operation  to  get  the 
ulcers  healed  by  keeping  the  patient  in  bed  and 
applying  antiseptic  dressings.  If  any  ulcers  remain 
they  should  be  swabbed  with  pure  carbolic  acid 
at  the  commencement  of  the  operation. 

The  patient  having  been  anaesthetised  and  placed 
in  the  lithotomy  position,  the  vulva,  the  vagina  and 
cervix  are  again  thoroughly  cleansed  with  lysol, 
followed  by  spirit  and  biniodide  of  mercury. 

The  cervix  is  seized  with  vulsella  and  drawn 
forwards.  An  incision  is  made  in  'the  mesial  line 
through  the  vaginal  mucous  membrane  from  the 
posterior  lip  of  the  cervix  to  the  edge  of  the 
perinseum.  From  the  latter  point  two  curved 
incisions  are  carried  forward,  one  on  either  side  at 
the  junction  of  the  vaginal  mucous  membrane  and 
the  skin  of  the  labium,  meeting  in  front  about  half 
an  inch  behind. the  meatus  urinarius,  that  is,  near 
the  posterior  edge  of  the  vestibule.  It  will  be  seen 
that  these  incisions  completely  encircle  the  ostium 
vaginae,  and  roughly  correspond  to  the  line  of 
attachment  of  the  hymen. 

The  mucous  membrane  of  the  posterior  and 
latere  vaginal  walls  is  now  dissected  o£E  with 
scissors  and  turned  forwards,  but  at  this  stage  the 
mucous  membrane  of  the  anterior  vaginal  wall  is 
not  interfered  with.  The  peritoneum  of  the  pouch 
of  Douglas  is  next  opened  by  a  transverse  incision, 
and  the  fundus  of  the  uterus  exposed  and  drawn 
downwards.  The  broad  ligaments  are  ligatured 
and  divided  from  above  downwards,  either  internal 
to  or  external  to  the  ovaries  and  tubes.  Should 
a  ventro-fixation  have  previously  been  performed, 
the  attachment  of  the  fundus  to  the  abdominal 
wall  must  be  severed  with  scissors. 

The  fundus  having  been  seized  with  forceps  is 
drawn  downwards,  acutely  retroflexing  the  uterus, 
and  exposing  the  bottom  of  the  utero-vesical 
pouch.  The  peritoneum  at  the  bottom  of  this 
pouch  is  divided  transversely  and  the  bladder 
stripped  ofE  the  cervix  with  the  finger.  The 
mucous  membrane  of  the  anterior  vaginal  wall  is 
next  dissected  off  the  bladder  and  urethra  with 
scissors  and  removed,  together  with  the  uterus,  in 
one  piece.  This  separation  of  the  anterior  vaginal 
wall  is  the  most  difficult  and  tedious  part  of  the 
operation,  and  unless  great  care  is  exercised  the 
bladder  or  ureters  may  be  wounded.  It  usually 
causes  free  haemorrhage  from  the  veins  of  the 
vaginal  plexus. 

Each  bleeding  point  must  be  seized  and  ligatured 
with  fine  silk  or  catgut.  It  is  very  important  to 
control  all  haemorrhage  completely  before  proceed- 
ing with  the  next  step  of  the  operation.  In  every 
one  of  my  cases  there  has  been  a  collection  of 
grumous  pus,  due,  I  think,  to  the  breaking  down  of 
blood  effused  from  these  numerous  small  veins. 
All  bleeding  having  been  controlled,  the  abdominal 
cavity  is  closed  by  a  purse-string  suture  of  fine 
silk  passed  through  the  peritoneum  of  the  pouch 
of  Douglas,  the  back  of  the  bladder,  and  the  top 
of  the  broad  hgaments. 

Eelow  this  purse-string  suture  the  broad  ligament 


of  one  side  is  sutured  to  that  of  the  other  with  fine 
chromicised  catgut.  Below  this  the  pelvic  fascia 
of  one  side  of  the  pelvis  is  sutured  to  that  of  the 
other  side  of  the  pelvis  with  fine  interrupted 
chromicised  catgut,  beginning  above  at  the  base  of 
the  broad  ligaments  and  working  gradually  down 
to  just  above  the  vulva.  In  this  way  a  firm  dia- 
phragm, stretching  from  one  side  of  the  pelvis  to 
the  other  and  supporting  the  bladder  in  front  and 
the  rectum  behind,  is  built  up  of  connective  tissue 
derived  from  the  pelvic  fascia.  This  is  really  the 
most  important  part  of  the  operation.  I  do  not 
attempt  to  suture  the  bladder  or  the  rectum  to  thb 
fascia.  They  afterwards  become  firmly  attached 
to  it. 

The  vulva  and  wound  are  then  closed  with  fine 
silkworm-gut  sutures  which  approximate  the 
posterior  halves  of  the  labia. 

If  the  haemorrhage  from  the  deeper  part  of  the 
wound  has  not  been  completely  arrested,  I  should 
recommend  the  insertion  of  two  small  rubber 
drainage-tubes,  one  in  front  of  the  fascial  column 
and  one  behind  it.  These  should  be  removed  at 
the  end  of  twenty-four  hours. 

The  vulva  is  dusted  with  iodoform  and  a  pad  of 
iodoform  gauze  is  applied.  The  patient's  uiiae 
shpuld  be  drawn  off  with  a  catheter  for  about  a 
week,  and  she  should  be  kept  in  bed  for  about  three 
weeks. 

As  I  have  already  said,  it  is  a  long  and  difficult 
operation  and  is  attended  with  a  good  deal  of  risk 
to  the  patients,  who  are,  as  a  rule,  elderly  women 
and  often  in  feeble  health.  The  prolapsed  cervix 
and  vagina  are  apt  to  be  ulcerated  from  friction 
against  the  patient's  clothes,  and  the  discharge 
from  these  ulcers  may  lead  to  infection  of  the 
wound  and  suppuration.  There  is  free  hemor- 
rhage during  the  course  of  the  operation,  not  so 
much  from  a  few  arterial  trunks  but  from  the 
numerous  veins  of  the  vaginal  plexus.  There  is 
considerable  risk  of  wounding  the  bladder,  the 
ureters  and  the  rectum.  After  the  operation  there 
is  a  good  deal  of  shock,  and  shock  in  old,  feeble 
women  is  a  serious  matter.  The  convalescence  is 
apt  to  be  a  tedious  one  and  in  all  my  cases  was 
compUcated  with  deep-seated  suppuration  in  the 
wound.  The  after  results,  however,  are  excellent, 
and  to  my  mind  justify  me  in  recommending  this 
operation  in  suitable  cases.  Let  me  now  very 
briefly  refer  to  the  four  cases  in  which  I  have  per- 
formed the  operation. 

Case  I. — Mrs.  K.,  a  widow,  aet.  53,  was  sent  to 
me  by  Dr.  Leech,  of  Birmingham,  suffering  from 
stone  in  the  bladder  and  complete  prolapse  of  the 
uterus.     She  had  evidently  had  the  stone  for  a 
long  time,' and  the  straining  which  it  gave  rise  to 
no  doubt  aggravated  the  prolapse.     I   took  her 
into  the  Women's  flospital  at  Birmingham,  and 
on  July  22nd,  i8p5>  removed   a  large  calculus  by 
the  operation   of  vaginal  cystotcnny.     The  inci- 
sion healed  by  the  first  intention.  On  August  i6th  in 
the  same  year,  I  performed  the  operation  of  ventro- 
fixation,   together     with     perineorrhaphy.     The 
wounds  healed  well,  and  the  residt  was  satisfac- 
tory for  about  two  months.     In  November,  iSg^. 
she  began  again  to  have  some  C3rstocele,  and  I 
inserted  a  small  pessary.     Gradually  the  prolap» 
of  the  anterior  and  posterior  vaginal  walls  recurred, 
and  in  spite  of  pessaries  of  £dl  shapes  and  siies 
became    total.     In    October,    1896,    the  vaginal 
prolapse  was  so  marked  that  I  again  took  her  into 
the  hospital  and  performed  extensive  anterior  and 


Oct.  26,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.   43^ 


posterior  colporrhaphy  together  with  perineor- 
rhapy.  As  before,  the  immediate  result  was  satis- 
factory, but  it  was  only  for  a  time.  In  January, 
1897,  t^®  cystocele  recurred,  and  I  had  again  to 
resort  to  pessaries.  From  this  time  onwards,  she 
attended  as  an  out-patient  with  steadily  increasing 
prolapse  until,  in  1899,  the  uterus  was  once  more 
quite  outside  the  vulva,  the  vagina  turned  com- 
pletely inside  out  and  ulcerated  from  friction 
against  the  clothes.  I  then  decided  to  perform 
total  extirpation  not  only  of  the  uterus,  but  of  the 
whole  vagina.  I  explained  to  the  patient  exactly 
what  I  proposed  to  do  and  she  readily  consented  to 
have  anything  done  that  would  afiord  her  relief 
and  Enable  her  to  carry  on  her  work,  that  of  a 
charwoman.  The  operation  was  performed  on 
May  1 1  th,  1899.  The  patient  was  put  back  to  bed 
in  a  state  of  collapse,  but  raUied  after  free  stimula- 
tion with  ether,  brandy,  and  strychnine.  After 
this  she  continued  to  progress  satisfactorily  until 
about  the  tenth  day,  when  her  temperature 
began  to  show  a  marked  evening  rise  and  morning 
fall.  This  continued  until  the  fourteenth  day, 
when  it  reached  103°  F.  A  pair  of  sinus  forceps 
were  then  thrust  into  the  depth  of  the  vaginal 
wounds  and  a  large  collection  of  grumous  pus 
(evidently  broken  down  blood)  evacuated.  After 
this,  she  made  a  straightforward  recovery,  and 
left  the  hospital  on  the  twenty-fourth  day.  After 
leaving  the  hospital  she  continued  to  improve,  and 
when  I  saw  her  again,  on  June  30th,  she  was  quite 
well.  I  examined  her  in  the  early  part  of  July, 
1 90 1,  and  found  her  condition  most  satisfactory. 
She  was  perfectly  comfortable,  and  had  complete 
control  of  the  bladder  and  rectum.  The  vulvar 
scar  was  firm  and  quite  painless,  and  in  her  own 
words,  "  Life  was  now  a  pleasure  instead  of  a 
continual  misery."  Since  then  1  have  seen  her 
from  time  to  time  (the  last  occasion  being  October 
loth,  1904).  She  has  remained  perfectly  well  and 
is  very  comfortable. 

Case  II. — ^Mrs.  J.  L.,  aet.  $6,  was  sent  to  me  by 
Dr.  Simpson,  of  Rugby,  suffering  from  extreme 
prolapse.  She  was  a  widow  and  earned  her  living 
as  a  cook.  She  had  had  one  child  over  thirty 
years  ago.  There  was  a  history  of  gradually  increas- 
ing prolapse  for  over  twenty  years.  She  had  worn 
in  turn  instruments  of  various  kinds  (Hodge, 
ring,  cup  and  stem,  shelf,  and  Gariel's  ball  pessary). 
Finally,  nothing  would  stay  in,  and  she  had  to 
support  the  totally  prolapsed  uterus  with  a 
diaper.  In  June,  1901,  she  underwent  a  plastic 
operation  on  the  perinaeum  at  one  of  the  London 
hospitals  ;  but  this  gave  only  a  very  temporary 
benefit.  On  October  17th,  1901,  I  performed 
total  extirpation  of  the  uterus  and  vagina.  For 
the  first  ten  days  the  patient  made  a  good  recovery. 
Then  her  temperature  began  to  go  up  at  night  to 
101°  or  102®,  with  morning  remissions.  Her  pulse 
was  never  over  ninety-five.  I  evacuated  some 
pus  with  the  sinus  forceps  on  the  fifteenth  day. 
After  this  she  did  well  and  went  home  on  November 
19th,  four  and  a  half  weeks  after  the  operation. 

I  saw  the  patient  on  December  17  th,  and  again 
in  February,  1902.  She  could  walk  well,  and  go 
up  and  down  stairs  without  any  discomfort.  There 
was  no  feeling  of  bearing  down.  She  had  no  dis- 
charge and  the  bowels  and  the  bladder  acted  nor- 
mally. The  vulvar  wound  was  strong  and  firm, 
and  showed  no  signs  of  bulging  when  she  strained. 
She  returned  to  her  work  as  a  cook  and  I  hear  has 
since  remained  well. 


Case  Ul.— (Specimen.)— Mrs,  IS,.  M.,  a  widow, 
aet.  45,  was  sent  to  me  by  Dr.  Baldwin,  of  Birming- 
ham. The  uterus  was  totally  prolapsed  and  the 
cervix  ulcerated.  There  was  a  constant  discharge 
of  blood  and  of  muco-pus.  Thirteen  years  before 
she  had  been  operated  on  by  another  Birmingham 
surgeon,  who  repaired  her  perinaeum.  I  found  it 
impossible  to  insert  any  pessary,  and  the  condition 
was  so  bad  that  I  decided  to  extirpate  her  uterus 
and  vagina.  The  operation  was  performed  on 
November  22nd,  1902,  when  I  removed  her  uterus, 
ovaries  and  tubes,  and  the  whole  of  the  vagina.- 
The  operation  was  performed  in  the'  method  al- 
ready described.  The  broad  ligaments  were  liga- 
tured with  silk,  the  pelvic  fascia  sewn  with  chro- 
micised  cutgut  and  the  vulvar  wound  with  silk- 
worm-gut. The  patient  did  not  make  a  good 
recovery.  Her  temperature  went  up  the  second 
day  and  fluctuated  for  some  days  between  99°  and 
102®.  The  deeper  part  of  the  wound  became 
infected.  Finally,  a  pair  of  sinus  forceps  were 
thrust  in  and  a  deep  collection  of  pus  evacuated. 
After  this,  she  progressed  quite  satisfactorily,  and 
left  the  hospital  on  December  28th,  five  weeks  after 
the  operation.  The  wound  had  then  healed  and  all 
discharge  had  ceased.  I  saw  nothing  of  her  until 
April,  1903,  when  she  came  to  the  hospital  com- 
plaining of  discharge  from  the^lva»V  On  ex- 
amining her  I  found  a  deep  sinns  in  the  perinaenmr 
I  took  her  into  hospital  again  and  explored  thi» 
sinus  under  chloroform,  and  was  able  to  fish  out 
some  buried  chromicised  catgut  sutures,  which  had 
become  infected  and  had  not  been  absorbed. 
After  this,  the  sinus  healed  up  and  the  patient's 
condition  improved. 

I  last  saw  her  about  a  week  ago,  and  then  found 
she  had  still  a  httle  discharge  and  that  the  vulvar 
cicatrix  was  red  and  irritable.  Although  she  was 
infinitely  better  than  she  was  before  the  operation, 
I  suspect  there  is  still  a  buried  suture  in  the  septum 
between  the  rectum  and  the  bladder  causing 
irritation.  This  case  was  the  least  satisfactory 
of  the  series. 

Case  IV.— Mrs.  J.  L.,  a  widow,  aet.  63.  was  sent 
to  me  by  Dr.  Cowen,  of  Malvern.  She  had  had 
prolapse  for  over  twenty  years.  Many  years  ago 
Mr.  Lawson  Tait  repaired  her  perinaeum,  but  in 
about  a  couple  of  months  the  cicatrix  stretched, 
and  she  was  soon  as  bad  as  ever.  She  wore  numer- 
ous instruments  (such  as  rings,  balls,  cup  anxi  stem, 
and  shelf  pessaries),  but  nothing  would  keep'  in. 
During  the  last  few  months  the  parts  have  been 
badly  ulcerated  from  friction.  When  I  examined 
her  I  found  the  uterus  totally  prolapsed,  and  the 
vagina  turned  inside  out  and  ulcerated.  On 
February  29th,  1904,  I  performed  total  extirpation 
of  the  uterus  and  vagina,  but  did  not  remove  the 
ovaries  or  tubes.  The  peritoneum  and  broaid 
ligaments  were  sutured  with  fine  silk,  the  pelvic 
fascia  with  gossamer-gut,  and  the  vulva  with  silk- 
worm-gut. A  small  rubber  drainage-tube*  was 
inserted  into  tfie  posterior  angle  of  the  wound. 
It  was  a  tedious  and  bloody  operation  and  the 
patient  was  put  back  to  bed  rather  collapsed,  but 
rallied  on  free  stimulation.  Her  temperature 
remained  normal  for  the  first  fortnight.  On  the 
fifteenth  day  it  rose  to  ioo-6**,  and  two  days  later  a 
free  discharge  of  blood  and  pus  took  place  from 
the  wound.  After  this,  she  made  a  straightforward 
recovery  ;  she  got  up  on  the  twenty-third,  and 
left  the  hospital  on  the  twenty-sixth  day  after 
the  operation. 


432    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Oct.  26,  1904. 


I  last  saw  her  on  April  25th,  about  two  months 
after  the  operation.  The  wound  was  completely 
healed,  she  had  no  discharge,  and  no  pain  nor  dis- 
comfort of  any  kind. 

I  In  relating  the  cases  I  have  not  attempted  to 
minimise  the  dangers  and  drawbacks  of  the  opera- 
tion, and  shaU  be  glad  of  any  suggestions  or  criti- 
cism from  members  of  the  Society  which  would 
improve  the  technique*  In  particular  I  shall 
welcome  any  suggestions  which  will  help  me  to 
prevent  the  occurrence  of  the  troublesome  suppura- 
tion which  complicated  the  convalescence  of  all 
my  cates,  and  which,  to  my  mind,  is  .the  chief  dis- 
advantage of  the  proceeding.  I  hope,  however,  in 
any  future  case  to  avoid  th^  suppuration  by  more 
careful  disinfection  of  the  field  of  operation,  by 
more  careful  arrest  of  haemorrhage,  by  the  use  of 
drainage-tubes  to  prevent  discharges  collecting, 
and  by  the  employment  of  perfectly  sterile  absorb- 
able suture  material. 

Curiously  enough.  Dr.  Edebohls,  of  New  York, 
devised  and  performed  an  almost  precisely  similar 
operation  in  April,  1900,  nearly  twelve  months 
after  my  first  case.  His  description  of  the  opera- 
tion appeared  in  the  New  York  Medical  Record^  on 
October  12th,  1901  ;  while  I  published  an  account 
of  my  .first  operation  in  the  British  Medical  oumal 
on  .October  5th,  1901,  just  one  week  before  Dr. 
Bdebohls.,  So  that  I  feel  that  whatever  merit 
itiiere  may  be  in  the  operation  must  be  shared  by 
Dr.  Edebohls,  who  quite  independently  planned 
and  carried  out  the  same  surgical  operation. 


THE 

TREATMENT  AND 

CLASSIFICATION    OF    PAUPER 

CONSUMPTIVES 

IN   IRISH  WORKHOUSES,  (a) 

By  ALFRED  E.  BOYD.  M.B.,  D.P.H., 

Bon.  8«o.  of  the  National  AMOcUtion  for  the  Prevention  of  Tabeica- 
losis,  Dublin  Branch. 

,  Tuberculosis,  a  disease  which  is  now  known 
to  be  preventable,  is  still  in  Ireland  the  most 
<^mmon  cause  of  death. 

During  1902,  the  last  year  for  which  corrected 
figures,  are.  available,  11,837  persons  died  of  this 
disease  in  Ireland  as  compared  with  12,335  ^  1901, 
and  an  average  of  12,716  annually  in  the  ten  years 
1891-1900.  The  death-rate  for  1902  was  27  per 
1,000  of  the  population  as  against  2*8  for  1901, 
and  an  annual  average  of  2-8  for  the  ten  years 
1 891-1900.  The  highest  county  rates  were — ^Dublin 
<x>unty  borough,  47  per  1,000  ;  Belfast  county 
borough,  4'0  ;  Dublin  county,  3*5  ;  Cork  county 
.-and  county  borough,  3*0.  The  lowest  were  Cavan, 
1*5  ;  Roscommon,  i-6 ;  Mayo,  Fermanagh,  Long- 
ford, and  Donegal,  each  17.  The  rate  for  all  forms 
•of  tuberculous  disease  in  the  urban  districts  having 
a  population  of  10,000  and  upwards  was  4*1  per 
1,000,  while  in  the  rural  districts  it  was  2*1  per 
1,000. 

Speaking  generally  then,  tuberculosis  is  a  disease 
:.  affecting  urban  rather  thaA, rural  districts,  and  the 
'  eastern  rather  than  the  western  counties  of  Ireland. 
Of  the  1 1*837  deaths  from  tuberculosis  registered 
in  1902,  consumption,  its  commonest  manifesta- 
tion, caused  9,400  and  of  these  1,303  died  in  our 
workhouses.     Half  the  total  number  of  deaths  in 

(a)  Paper  readat  the  Conferenoe  of  the  Irish  Worlchous-s  Aaeocia- 
ftion,  held  at  Limericlc,  Octoher  5th,  1904. 


all  Ireland  of  those  between  15  and  35  years  of  a^e 
are  caused  by  consumption  ;  the  death-rate,  there- 
fore, is  but  a  poor  indication  of  the  misery  arising 
from  this  dread  disease.  In  the  words  of  Mr. 
Culverwell,  Fellow  of  Trinity  College,  DuUin, 
"  it  is  the  adult,  the  wage  earner,  the  man  who  has 
incurred  the  responsibihties  of  life,  the  man  to 
whom  a  family  looks  for  support,  or  the  mother  on 
whose  care  the  welfare  of  young  children  depends, 
who  are  its  most  frequent  victims."  These  arc 
taken,  often  after  a  prolonged  struggle,  and  those 
dependent  on  the  victims  are  too  often  left  without 
the  means. of  support  and  become  a  burden  to  (he 
rates.  Again  to  quote  Mr.  Culverwell — "  Assuming 
that  on  an  average  each  of  the  12,000  people  who 
die  annually  in  our  country  of  tuberculosis  is  worth 
only  5s.  a  week  to  the  community,  and  that  he 
would  Uve  for  ten  years  longer  if  there  were  no 
tuberculous  germ  in  Ireland,  then  each  death  is  a 
loss  of  over  £130,  and  the  total  loss  is  12,000  times 
this  or  ;£i, 560,000  a  year."  (a) 

Apart  from  all  considerations  of  humanity  and 
Christian  charity,  it  is  in  the  interest  of  everyone  to 
do  what  in  him  hes  to  check  this  appalling  wastage 
of  national  capital  and  to  preserve  to  our  country 
the  flower  of  Irish  manhood. 

Patients  suffering  from  this  disease  are  now 
denied — and  rightly  so — admission  to  our  general 
hospitals,  because  it  is  recognised  that  con- 
sumption is  an  infectious  disease,  a  slow  fever, 
conveyed  from  man  to  man,  most  usually  by 
the  inhalation  of  the  dried  expectoration  of 
consumptives  in  the  form  of  germ-infected  dust, 
or  of  the  spray  scattered  by  consumptives  in  the 
act  of  coughing. 

There  are  no  sanatoriums  in  the  country  available 
for  the  very  poor,  although  we  hope  soon  to  see  at 
least  two  at  work,  in  Cork  and  Belfast  respectively, 
and  were  there  such  they  would  still  leave  the  ad- 
vanced cases,  those,  in  fact,  who  are  most  dangerous 
to  the  community,  unprovided  for.  The  Homes 
for  the  Dying  and  Incurable  can  only  accommodate 
a  small  proportion  of  such  cases,  the  great  majorit}*^ 
must  therefore  perforce  seek  reUef  in  the  workhouse 
infirmaries  or  remain  at  home,  usually  sleeping  in 
the  same  room,  too  often  in  the  same  bed,  with 
their  relatives,  to  whom  their  presence  is  a  con- 
stant source  of  danger.  No  wonder,  then,  that 
consumption  "  runs  in  families  "  as  the  result  of 
this  constant  exposure  to  the  risks  of  infection  in 
the  home,  and  that  the  disease  Was  deemed  to  be 
hereditary  until  its  true  nature  was  revealed  by 
modern  science.. 

In  what  direction,  then,  is  reform  needed 
in  order  that  the  Irish  Poor-law  system  may 
deal  adequately  with  its  responsibilities  in  regard 
to  this  problem  of  the  housing  and  classifica- 
tion of  the  consumptive  poor  ?  The  first  essential 
is  that  provision  should  be  made  in  all  workhouses 
for  the  complete  isolation  of  consumptives  from 
other  patients,  and  for  their  classification — those 
in  whose  case  there  is  prospect  of  amelicxation  or 
cure  being  separated  from  those  in  whom  the 
disease  is  advanced  and  whose  case  is  hopeless. 
In  over  one  half  of  the  unions  in  thi«  country 
separate  accommodation  is  now  provided,  and  in 
this  respect  greater  success  seems  to  have  been 
achieved  by  the  Irish  Local  Government  Board 
than  by  the  kindred  body  in  England,  where  the 
proportion  of  Boards  doing  anything  in  thig  niatter 

(a)  "OoiwumptJoii :  itj«  Hlfttory  and  How   to   Proent  its 
Spwud."    B.  P.  CulvorweU,  F.T.C.D. 


Oct.  26,  1904. 


ORIGINAL    COMMUNICATIONS. 


Thb  Medical  Pkbss.    433 


is  said  to  be  under  18  per  cent.  There  still  remains, 
however,  the  grave  objection  felt  by  so  many  of  the 
respectable  poor  to  availing  themselves  of  treat- 
ment in  workhouse  infirmaries  unless  driven 
thither  by  dire  poverty,  and-  the  consequent 
numbers  of  sufierers  remaining  in  their  homes  aad 
proving  sources  of  infection  to  others. 

In  any  scheme  for  the  amalgamation  of  Poor- 
law  unions,  provision  could  surely  be  made  for  the 
setting  apart  of  existing  buildings,  where  such  are 
suitable  for  the  reception  of  consumptive  patients, 
and  for  the  remodelling  of  at  least  a  portion  of  each 
building  so  set  aside,  so  that  it  might  be  suited  to 
the  carrying  out  of  open-air  treatment  in  such  cases 
as  are  Ukely  to  derive  benefit  from  the  method. 
The  degrading  associations  of  pauperism  being 
removed,  many  who  now  r^ard  the  workhouse 
infirmary  with  abhorrence  would  gladly  avail 
themselves  of  treatment  under  circumstances  far 
more  hygienic  than  they  can  command  at  home, 
while  many  of  those  who  are  beyond  hope  of  cure 
would  willingly  submit  to  segregation  for  the  sake 
of  those  dear  to  them,  when  the  risks  of  their 
staying  at  home  are  made  clear  to  them. 

In  many  instances,  however,  existing  buildings 
could  not  be  satisfactorily  adapted  to  suit  modem 
open-air  methods  without  considerable  expenditure 
of  money.  In  such  circumstances  I  would  venture 
to  suggest  that  the  method  now  being  tried  at  the 
great  Poor-law  infirmary  at  Stobhill,  Glasgow, 
might  be  followed.  Advanced  cases  there  are 
kept  in  isolated  blocks,  while  suitable  cases  in  the 
early  stages  of  the  disease,  where  the  prospect  of 
improvement  is  good,  are  treated  in  tents  on  the 
lawn  of  the  infirmary.  Each  tent  holds  six  beds 
and  the  patients  pass  all  their  time  practically  in 
the  open  air.  The  capital  expenditure  involved 
as  regards  these  patients  is  trivial,  and  their  cost 
to  the  ratepayers  is  merely  that  of  maintenance. 
A  similar  method  has  been  foUo¥red  during  the  past 
few  months  at  the  Royal  National  Hospital  for 
Consumption  at  Newcastle,  co.  Wicklow,  as  well 
as  elsewhere.  The  results  obtained  have  been 
hopeful  and  the  patients  soon  get  used  to  their 
outdoor  life.  This  method  seems  to  me  to  offer 
more  prospect  of  efficiently  treating  great  numbers 
of  consumptive  poor  than  can  be  achieved  by  any 
building  scheme  involving  large  capital  outlay, 
while  the  delay  which  the  erection  of  buildings 
entails  is  entirely  obviated. 

If,  however,  existing  buildings  are  capable  of 
being  remodelled,  and  if  the  conditions  as  regards 
surroundings,  subsoil,  protection  from  prevailing 
winds  and  sufficiency  of  sunshine  are  favourable, 
French  windows  might  be  substituted  for  those  at 
present  in  use,  and  these  should  be  made  to  open 
on  to  light  iron-work  verandahs,  or  galleries  on  to 
which  the  patient's  bed  may  be  wheeled  on  suit- 
able days  at  the  discretion  of  the  nurse  in  charge, 
acting  on  the  instructions  of  the  medical  officer. 

As  an  example  of  the  cost  of  such  alterations  it 
may  be  mentioned  that  the  Bath  Board  of  Guar- 
dians have  allocated  two  wards — for  males  and 
females — for  the  accommodation  of  twenty  con- 
sumptives. These  wards  have  been  altered  and 
made  suitable  for  carrying  out  open-air  treatment. 
They  have  separate  airing  courts  in  which  are  placed 
shelters  and  dining-rooms,  so  that  those  who  can 
leave  their  beds  may  remain  out  in  these  courts 
practically  all  day.  All  this  has  been  done  for  an 
initial  exx)enditure  of  £j,gcx>,  which  has  been 
borrowed  with  the  sanction  of  the  Local  Govern- 


ment Board,  repayment  being  spread  over  a  period 
of  ten  years,  (a) 

Where  no  suitable  buildings  are  available  for 
treating  cases  with  a  view  to.  cure,  and  if  the' idea  of 
keeping  patients  in  canvas  tents  is '  sCoUted  as 
impracticable,  resort  must  be  had  to  building. 
All  such  sthemes  are  costly;  thus  the  Eastby 
Sanatorium  of  the  Bradford  Board  of  Guardians, 
which  is  built  on  the  paviUon  system,  and  which 
when  finished  is  to  accommodate  42  patients,  will 
cost,  it  is  estimated,  ;f22i  per  bed. 

The  West  Derby,  Liverpool,  and  Toxteth  Park 
Joint  Poor-law  Hospital  for  Consumption  iprovides 
accommodation  for  24  patients,  the  average  cost 
per  bed,  exclusive  of  land,  being  ;f  338.  If,  however, 
the  number  of  beds  is  increased,  the  average  cost 
of  each  will  be  materially  reduced,  as  the  adminis- 
trative block  has  been  included  in  the  buildings 
already  erected,  (b)  ' 

Dr.  Reinhardt  estimates  that  a  sanatorium 
built  on  the  chalet  principle  to  atcomniodAte- 
100  patients  can  be  eriected  at  an  averse  cost  of 
£166  piei-  bed.  (c)  Sp&tiig  genef-flily,  thfe^'mctet 
feasible  scheihe  seems  t6  be  the  aiAalgsultatiKtaf  of 
Unions,  the  setting  free  of  one  set  of  buildings^  for 
the  use  of  consumptives  of  the  jmned  area,  the 
separation  of  the  incurable  from  those  in  the  early 
stages  of  the  disease,  and  the  treatment  of  the 
latter  in  wards  adapted  to  open-air  requiremeiits, 
in  tents  or  in  open-air  revolving  shelters  as  each 
individual  case  may  seem  most  suited  to.  The 
initial  cost  of  such  a  scheme  need  not  necessarily 
be  great,  while  in  the  long  run  its  provision  would 
be  true  economy  in  preserving  life  among  those 
already  consumptive  and  in  preventing  the  spread 
of  the  disease  among  the  community.  Without 
some  such  scheme  how  can  the  poor  be  treated  with 
any  reasonable  hope  of  arresting  the  disease  ? 
And  how  can  they  be  kept  from  being  factors  in 
the  spread  of  infection  ?  ^' 

The  isolation  of  consumptives  and  their  treat- 
ment under  special  conditions  removes  from  the 
community  the  chief  source  of  the  spread  of  the 
disease,  while  the  educational  effect  on  the  public 
of  the  means  taken  in  well-managed  institutions  to 
prevent  infection  must  have  a  wide-spread  influ- 
ence in  checking  its  development. 

In  conclusion,  let  me  remind  you  that  this  disease 
is  one  of  the  two  great  causes  of  the  decrease  of 
the  population  of  our  country. 

We  lose  40,000  each  year  by  emigration,  and 
12,000  from  tuberculosis.  Those  who  are  lost  to 
the  country  from  both  causes  belong  to  the  same 
class — they  are  those  in  early  adult  Ufe.  There 
are  factors  at  work  in  the  industrial  hfe  of  our 
country,  which  we  all  hope  will  have  an  influence  in 
checking  the  national  loss  arising  from  emigration. 
May  I  express  the  hope  that  the  other  great 
source  of  the  decrease,  the  prevalence  of  tubercu- 
losis, arising  as  it  does  in  great  measure  from 
neglect  and  ignorance  in  bygone  years,  may  receive 
that  attention  from  our  pubUc  bodies  which  it 
deserves  and  that  the  means  by  which  its  prevalence 
is  being  decreased  in  other  lands  may  soon  be 
adopted  throughout  our  country  ?  If  our  boards 
of  guardians  and  sanitary  authorities  work  hand 
in  hand,  if  they  act  promptly  and  energetically, 
the  death-rate  from  this  cause  can  be  materially 

(a)  *'  Board*!  of  Chiardians  and  the  Crusade  against  Consmnp- 
tion."    L.  A.  Weatherly,  M.D.    "  Tuberculosis,"  April,  1904. 

(b)  IhH. 

{e)  ''The  Health  lUsort,"  October,  1903. 


434    The  Medical  Press. 


TRANSACTIONS    OF   SOCIETIES. 


Oct.  26.  1904. 


reduced,  and  a  corresponding  decrease  in  misery 
and  pauperism  will  ensue. 

Clfntcal  1Recor{)9. 


CANCEROUS  UTERUS  REMOVED  BY  COM- 
BINED    VAGINAL     AND     ABDOMINAL 
HYSTERECTOMY,  (a) 
By  William  Duncan,  M.D.,  F.R.C.S. 

The  uterus  shown  was  removed  from  an  exceed- 
iingly  stout  nulliparous  lady,  at.  42,  who  consulted 
J>z:  Duncan  in  July  last  for  menorrhagia,  which 
liad  lasted  four  months.  She  had  been  twice 
married;  fifteen  years  ago  she  consulted  Dr. 
Duncan  for  the  same  condition,  when  the  uterus 
was  dilated  and  curetted.  A  mucous  pol3rpus 
was  removed  and  a  complete  cure  resulted.  On 
■examination  per  vaginam,  the  vagina  was  very 
small ;  cervix  uteri  healthy  ;  sound  passed  3^ 
inches^  and  caused  bleeding  (the  patient  was  so 
stout  that  a  bimanual  examination  was  not  possi- 
ble)y  She  looked  healthy  and  well,  and  suffered 
no  pain  or  offensive  discharge.  On  dilatation  of 
the.  uterus  under  anaesthesia,  the  curette  brought 
away  a  lot  of  cheesy  material ;  this  was  examined 
by  Mr.  Targett,  who  reported :  "  These  curettings 
from  the  interior  of  the  uterus  are  thickly  infiltrated 
with  a  soft  columnar-celled  carcinoma  of  the  villous 
type."  A  week  later  Dr.  Dimcan  removed  the 
uterus  by  hjrsterectomy,  and  as  the  vagina  was 
•so  very  small  and  the  patient  so  stout,  he  adopted 
the  combined  method.  When  anaesthetised  the 
patient  was  placed  in  the  hthotomy  position  and 
an  incision  made  all  round  the  cervix  ;  the  bladder 
was  separated  up,  and  Douglas's  pouch  opened. 
Next  the  abdomen  was  opened,  and  the  uterus 
removed  in  the  usual  way,  but  with  the  greatest 
difficulty  owing  to  the  excessive  thickness  of  the 
abdominal  walls  and  also  to  the  fact  that  the 
broad  ligaments  were  very  short  and  did  not  allow 
the  uterus  to  be  pulled  up  much.  The  patient  had 
a  normal  temperature  on  the  eighth  day.  Dr. 
Duncan  thought  that  perhaps  it  would  have  been 
easier  to  have  cut  through  the  perinaeum  to  the 
anus  and  then  have  performed  vaginal  hysterec- 
tomy (as  he  has  done  on  other  occasions)  rather 
than  to  have  adopted  the  combined  method. 

CYST   OF   THE    RIGHT   FALLOPIAN   TUBE 
(  ?  ECTOPIC     GESTATION).   —  DOUBLE 
TWIST    IN    THE    PEDICLE    AND    COM- 
MENCING NECROSIS  OF  CYST  WALL,  (a) 
By  Bedford  Fen  wick,  M.D., 

Ph.v8icuui  to  the  Hospital  (or  Women,  Soho  Hquare. 

The  patient  was  aet.  46,  unmarried.  Men- 
struation commenced  at  14,  and  has  been  per- 
fectly regular  every  twenty-four  days,  lasting  three 
days,  and  otherwise  quite  normal.  She  came  to 
the  Out-patient  Department  of  the  Hospital  for 
Women,  Soho  Square,  on  October  6th,  stating  that 
in  August  last  the  period  was  fifteen  days  late, 
lasted  four  da3rs,  and  was  very  scanty,  ceasing 
on  September  5th,  since  which  time  she  had  seen 
nothing.  On  September  30th,  she  had  a  sudden, 
severe  pain  in  the  lower  part  of  the  abdomen, 
lasting  three  or  four  hours,  and  gradually  passing 
off.  On  the  morning  of  October  6th,  the  same  pain 
suddenly  returned  and  became  very  severe.  On 
examination,  the  vagina  was  found  to  be  large  and 

(a)  Bead  at  a  meeting  of  the  British  Oynncological  Society,  and 
«p6oimen  shown,  Octoher  18th,   904. 


lax,  a  tense  swelling  was  felt  in  front  of  the  uterus, 
fixed  and  extremely  tender.  Her  temperature 
was  103°  F.,  pulse,  no.  She  seemed  very  ill,  aod 
was  at  once  sent  into  the  wards,  and  I  performed 
abdominal  section  the  next  day.  The  uterus  was 
pushed  down  into  the  pelvis  by  a  cystic  sweUing, 
thick-walled  and  perfectly  black  in  colour ;  it 
was  attached  by  soft  recent  adhesions  to  the  bladder 
in  front  and  the  uterus  behind.  A  pint  of  black 
blopd  was  drawn  off  from  it,  and  the  cyst  lifted 
out  of  the  abdomen,  and  it  was  then  found  to  have 
a  long  pedicle,  twice  twisted.  On  removal,  a 
small,  black  ovary  was  found  adherent  to  the  outer 
edge  of  the  C3rst  wall,  and  the  cj^t  itself  was  found 
to  be  a  dilatation  of  the  outer  third  of  the  right 
Fkllopian  tube.  There  was  no  rupture,  but  there 
was  commencing  peritonitis.  The  left  tube  and 
ovary  were  perfectly  normal.  The  sac  seems  lined 
with  membrane,  and  contains  apparently  some 
firm,  organised  clots  ;  but  as  it  may  be  the  wish 
of  the  Society  to  refer  the  specimens  to  a 
pathological  committee,  I  have  not  disturbed 
these  in  any  way.  It  will  be  observed  that  the 
tube  is  extremely  constricted  about  one  inch  from 
the  comu  of  the  uterus,  where  the  double  twist  was 
found,  and  the  surface  of  the  cyst  is  perfectly 
black,  and  shows  signs  of  commencing  sloughing 
of  its  wall. 

The  important  question  arises  as  to  whether  this 
is  a  simple  haemato-salpinx  or  an  ectopic  gestation. 
In  favour  of  the  latter,  is  the  dilated  condition  of 
the  vagina,  the  definite  and  large  dilatation  of  the 
outer  third  only  of  the  tube,  not  of  its  whole  length, 
and  the  considerable  quantity — at  least  one  pint— 
of  blood  which  it  contained.  Presuming  that 
further  investigation  proves  this  supposition  to  be 
correct,  I  need  scarcely  point  out  the  rarity  of  the 
case.  I  can  only  remember  having  seen  one  similar 
example,  and  it  must,  therefore,  be  most  unusual 
It  is  further  interesting  to  observe  the  rapidity 
with  which  necrosis  and  peritonitis  were  being 
induced,  and  the  extreme  danger  which  the  patient 
would  have  suffered  if  she  had  not  been  immediately 
operated  upon.     She  made  an  uneventful  recovery. 


XCranBactioiiB  of  Scctetfes, 


BRITISH  GYN.l^COLOGICAL  SOCIETY. 
Meeting  held  October  13TH,   1904. 


Professor  John  W.  Taylor,  F.R.C.S.,   in  the  Chair. 


Specimens. 

Dr.  Bedford  Fenwick  showed  as  a  strangulated 
ectopic  gestation  a  necrotic  sac  removed  from  a  single 
woman,  aet.  46.  The  operation  had  been  performed 
under  the  diagnosis  of  ovarian  cyst,  though  certain 
points  in  the  history  pointed  to  extra-uterine  gestation. 
He  had  met  with  one  very  similar  case,  and  as  he 
thought  the  Society  might  wish  to  refer  the  specimen 
for  an  independent  pathological  report,  he  had  not 
himself  made  any  section  of  the  sac.  Notes  of  the 
case  will  be  found  on  this  page  ("Clinical  Records"). 

After  some  remarks  from  Dr.  Daubbr  and  the  Pre- 
sident, it  was  agreed  that  the  specimen  should  be 
referred  to  a  pathological  committee. 

Dr.  Frederick  Edge  showed  the  following  speci- 
mens : — (i)  Microscopical  section  from  a  case  of  glan- 
dular carcinoma  of  both  ovaries  removed  with  perfect 
immediate  result,  but  with  fatal  recurrence  within  fonr 
months.  The  patient  was  xt.  48,  and,  apart  from  the 
tumours,  was  in  good  health  and  condition.  The 
operation  was  performed  at  the  Women's  Ho^ital, 
Birmingham,  on  May  26th,  1904.     The  tumour  on  the 


Oct.  26,  1904. 


TRANSACTIONS    OF    SOCIETIES. 


Thb  Mbdical  Prsss.   43S 


right  side  extended  to  the  liver,  and  was  of  peculiar 
shape,  resembling  a  vegetable  marrow  with  one  side 
pushed  into  concavity;  the  pedicle  on  this  side  was 
oroad  and  fleshy,  no  doubt  owing  to  increase  in  the 
Tiiuscular  tissue  of  the  broad  ligament,  and  he  there- 
fore divided  it  and  secured  the  vessels  separately.  The 
other  tumour  was  much  smaller  and  was  tied  straight 
-ofif.  Any  adhesions  were  omental  and  all  bleeding 
points  were  secured  ;  no  drainage  was  used,  and  the 
patient  made  an  easy  and  uninterrupted  recovery.  On 
August  17th,  in  Dr.  Edge's  absence,  the  woman  was 
readmitted  into  the  hospital  by  his  colleague,  Mr. 
Fumeaux  Jordan,  on  account  of  pain  and  intestinal 
obstruction,  but  as  this  was  found  to  be  incomplete  and 
intermittent,  the  abdomen  was  not  opened.  Large 
masses  of  growth  could  be  felt  in  the  pelvis  and  omen- 
tum; these  rapidly  increased  and  she  died  on 
September  7  th,  three  weeks  after  her  readmission,  that 
is,  within  three  and  a  half  months  of  the  ovariotomy. 
The  section,  which  was  prepared  by  Dr.  Smallwood 
Savage,  showed  that  the  tumours  were  glandular 
carcinoma. 

(2)  A  large,  many-lobed  myomatous  uterus  success- 
fully removed  by  supravaginal  hysterectomy.  The 
patient  was  a  small,  thm  woman,  aet.  42,  and  the  opera- 
tion had  been  performed  on  account  of  pain,  symptoms 
of  pressure  on  the  bladder  and  bowels,  and  enlargement 
of  the  growth.  The  lobular  masses  ran  under  the  peri- 
toneum in  several  directions  and  were  enucleated  from 
their  beds.  The  peritoneum  and  floor  of  the  pelvis 
ivere  injured  to  such  an  extent  that  the  abdominal 
cavity  could  not  be  closed  by  a  complete  transverse 
suture,  and  as  the  extensive  opening  up  had  led  to  free 
oozing.  Dr.  Edge  thought  it  better  to  open  the  vagina 
and  drain.  During  the  following  night  there  was 
sudden  and  very  severe  haemorrhage,  and  it  seemed 
that  he  would  have  to  reopen  the  abdomen.  Fortu- 
nately the  bleeding  ceased  and  did  not  recur,  and  there 
was  no  other  disturbing  symptom.  Though  there  had 
been  such  extensive  laceration  of  the  tissues,  there  was 
no  fever,  and  this  absence  of  reaction  after  such  severe 
surgical  wounds  he  attributed  to  the  use  of  antiseptic- 
ally  impregnated  sutures  and  the  prevention  of  the 
so-called  **  implantation  infection  "  more  than  to  any 

•  other  factor.  His  silk  sutures  are  boiled  in  solution  of 
corrosive  sublimate  or  of  biniodide  of  mercury,  and 
used  straight  out  of  the  solution ;  silkworm-gut  is 
treated  in  the  same  way ;  catgut  is  boiled  in  xylol, 
preserved  in  alcohol  and  corrosive  sublimate  (i  :  1,000) 
and  used  out  of  the  preserving  medium.     Even  if  the 

•  outer  surface  of  the  ligature  or  suture  be  soiled  by  the 
band,  the  antiseptic  material  is  afterwards  given  off 
by  them  and  kills  the  germs  or  inhibits  their  infective 
action  until  the  normal  currents  are  re-established  and 
the  phagocytic  agents  are  able  to  destroy  the  micro- 
organisms. 

Mrs.  ScBARLiEB  mentioned  a  case  similar  to  the  one 
first  related  by  Dr.   Edge.     She  removed  twp  solid 

-  malignant  ovarian  growths  with  thin,  ordinary  pedicles, 
and  had  no  reason  to  suppose  that  the  operation  was 
in  any  way  incomplete,  but  the  woman  died  about 
six  months  later  from  a  secondary  growth  affecting  the 
transverse  colon. 

Mr.  FuRNEAUx  Jordan  said  that  when,  in  the 
absence  of  Dr.  Edge,  he  was  called  to  the  case,  he  ex- 
pected to  have  to  operate  for  intestinal  obstruction, 
but  by  the  aid  of  injections  the  bowels  were  freely 
relieved  and  he  could  then  feel  a  small  lump  behind 
the  cervix.  As  the  only  history  he  had  was  that  the 
tumour  removed  ivas  a  sohd  ovarian  one,  and  he  had 
no  hint  of  its  malignant  nature,  and  as  the  obstruction 
had  been  relieved,  he  did  not  interfere,  and  in  a  few 
days  was  glad  he  had  abstained  from  doing  so,  for  in 
those  few  days  the  growth  had  increased  so  rapidly  in 
size  that  it  rose  right  out  of  the  pelvis  and  could  be 
felt  in  the  abdominal  wall. 

Dr.  Edge  said  that  it  would  have  been  natural  for 
Mr.  Jordan  to  suppose  that  after  such  a  recent  opera- 
tion the  obstruction  was  due  to  intestinal  adhesion  to 

:the  stump  or  pedicle.    A  fatal  termination  from  the 


recurrence  of  such  a  maligoant  growth  within  three 
and  a  half  months  after  a  complete  operation  had  not, 
so  far  as  he  knew,  been  previously  recorded. 
Mr.  J.  FuRNBAux  Jordan  showed  ; — 

1.  Double  Tuberculous  Pyosalpinx, — A.  H.,  aet.  21, 
single  ;  general  health  good.  For  some  four  months 
had  indefinite  pain  in  the  lower  part  of  the  abdomen, 
but  did  not  think  it  was  anything  serious.  One  day. 
when  having  her  bath,  felt  a  lump  in  the  lower  left 
part  of  the  abdomen.  The  pain  becoming  worse,  she 
went  to  her  doctor,  who  asked  me  to  see  her.  On 
examining  her  I  could  feel  the  top  of  two  distinct 
swellings  above  the  pelvic  brim.  Since,  apart  from 
the  pain,  she  complained  of  nothing  and  there  was  no 
interference  with  her  general  good  health,  I  thought  it 
was  an  ovarian  cyst.  It  was  two  or  three  weeks  before 
I  could  admit  her  into  the  Women's  Hospital,  and  by 
that  time  the  pain  had  become  very  severe.  On 
April  X9th  last  t  removed  by  abdominal  section  the 
two  tuties  you  see  here,  the  larger  one  from  the  right 
side.  A  few  tubercles  were  dotted  about  the  peri- 
toneum of  the  broad  ligament.  One  ovary,  quite  free 
from  tubercle.  I  left  alone  ;  the  other  I  removed.  The 
patient  now,  six  months  after  the  operation,  is  in 
excellent  health. 

2.  Cystoma  of  Left  Ovary. — ^Mrs.  H.,  aet.  28,  was  four 
months  pregnant  and  complained  of  excessively  fre- 
quent micturition  and  constant  bearing  down  pain. 
On  examination  I  found  the  uterus  pushed  up  into  the 
abdomen  and  the  pelvis  completely  filled  by  a  tense, 
elastic  tumour.  Oix  May  8th  last.  I  operated  at  the 
Midland  Nursing  Home  by  the  vaginal  route,  and 
through  a  small  incision  into  Douglas's  pouch  I  tapped 
the  cyst,  pulled  it  out,  amd  ligatured  the  pedicle.  The 
cyst  was  a  good  bit  larger  than  it  appears  to  be,  the 
walls  being  stretched  and  thinned.  Fortunately  there 
were  no  adhesions.  Pregnancy  was  uninterrupted. 

Mr.  Jordan  said  that  he  was  not  now  so  keen  on 
the  vaginal  route  for  operating  as  formerly ;  but  this 
case  of  the  removal  of  a  cystoma  from  a  pregnant 
woman  without  any  interruption  of  the  pregnancy 
showed  that  there  were  cases  in  which  the  vaginal  way 
had  very  great  advantages  and  should  certainly  be 
chosen. 

Dr.  William  Duncan  said  that  tuberculous  pyo- 
salpinx  wais  met  with  in  some  women  who  appeared 
to  be  the  picture  of  health,  and  it  was  remarkable  how 
well  such  cases  did  even  though,  at  the  time  of  the 
operation,  they  might  seem  to  be  most  unfavourable, 
and  the  whole  of  the  peritoneum  might  be  studded 
with  millet-seed  tubercle.  He  instanced  a  case  in  his 
own  practice  which  afforded  a  typicad  specimen  of 
double  tuberculous  pyosalpinx,  now  in  the  museum 
of  the  Middlesex  Hospital,  both  tubes  being  distended 
with  cheesy  pus.  Five  years  after  the  operation  the 
patient  was  in  perfect  health.  Tumours  complicating 
pregnancy  were  always  of  very  great  interest,  amd 
when  ovarian  should  invairiably  be  removed  at  what- 
ever period  of  the  pregnancy  they  might  be  detected. 
But  he  must  join  issue  with  Mr.  Jordan  as  to  the 
vaginal  route,  for  he  thought  the  abdominal  route 
should  always  be  chosen.  He  would  be  sorry  to 
open  the  vaginal  vault,  hoping,  but  by  no  means  sure, 
that  there  were  not  adhesions  that  might  make  the 
removal  of  the  tumour  difficult  or  impossible.  As 
a  good  example  of  the  superiority  of  the  abdominal 
route  and  of  the  tolerance  of  the  womb,  even  during 
labour,  to  surgical  proceedings,  he  mentioned  that  in 
a  young  married  woman  in  whom  a  contracted  pelvis 
was  suspected,  he  found  not  only  a  pelvis  justo  minor, 
but  a  hard  tumour  fixed  to  the  satcrum,  which  would 
have  prevented  delivery  by  the  natural  way.  \t  term, 
labour  having  begun,  he  opened  the  abdomen,  and 
determined  to  try  and  remove  the  tumour  before  de- 
ciding to  open  the  womb ;  he  extended  the  incision  to 
the  ensiform  cartilage,  drew  out  the  uterus,  and  was 
then  able,  with  much  difficulty,  to  remove  the  ssicral 
tumour,  a  dermoid.  He  returned  the  uterus  to  the 
abdomen  amd  closed  the  wound  at  ten  in  the  morning ; 
the  patient  was  delivered  by  foroeps  at   two  o'clock 


436    Thb  Medical  Pkkss.         TRANSACTIONS   OF   SOCIETIES. 


Oct.  20,  1904. 


the  same  afternoon,  and  made  a  perfect  recovery  without 
any  rise  of  temperature. 

Dr.  Macnaughton-Jonks  said  that  it  was  not  un- 
common to  have  absence  of  pain  in  pyosalpinx,  and 
instanced  some  cases  in  which  this  immunity  was  pre- 
sent, notably  one  he  had  recorded  at  the  Obstetrical 
Society,  in  which  there  was  a  large  double  pyosalpinx. 
The  pelvis  was  filled  by  a  large  effusion  containing  two 
pus  sacs,  and  the  bladder  was  distended  from  pressure. 
The  patient  had  never  complained  of  pain,  and  the 
symptom  for  which  she  sought  relief  was  incontinence 
of  urine.  He  had  brought  a  case  of  tuberculous  sal- 
pingitis before  the  Society  three  years  ago,  which  was 
unilateral,  and  the  sac  similar  to  one  of  those  shown 
by  Mr.  Jordan.  It  was  primary  tuberculosis,  and  the 
lady  had  since  had  two  pregnancies,  one  of  which  was 
a  twin  birth.  The  lesson  to  be  learned  from  these 
cases  was  that  the  risk  entailed  by  the  non-removal 
of  such  pus  sacs  was  very  serious.  As  to  the  second 
specimen,  the  choice  of  operation  for  ovarian  cystoma 
by  the  vagina  would  depend  upon  the  diagnosis,  the 
unilocular  nature  of  the  cyst,  and  the  absence  of  ad- 
hesions. Given  accuracy  of  diagnosis  on  these  points, 
there  could  be  then  no  doubt  that  the  vaginal  route 
would  be  the  preferable  one,  but  such  diagnosis  was 
sometimes  extremely  difficult.  Operation  on  ovarian 
cystoma  in  pregnancy  was  now  the  accepted  rule,  but 
the  time  of  selection  was  from  the  end  of  the  second 
to  the  fourth  month. 

Dr.  Bedford  Fen  wick  said  that  the  case  of  tuber- 
culous tubes  shown  by  Mr.  Jordan  was  one  in  which 
he  felt  the  greatest  interest  because,  apart  from  the 
excellent  results  obtained  by  Mr.  Jordan,  the  case 
opened  up  a  very  large  and  important  question.  He 
had  operated  on  a  considerable  number  of  these 
patients,  and  with  results  which  had  more  and  more 
impressed  him  with  the  advisabiUty  of  early  operation 
in  all  cases  of  pelvic  disease  which  appeared  to  be 
tuberculous  in  character.  Most  abdominal  surgeons 
had  met  with  cases  of  tuberculous  peritonitis  in  which 
the  mere  opening  of  the  peritoneal  cavity,  even  if 
nothing  else  was  done,  had  been  followed  by  the  dis- 
appearance of  the  peritoneal  mischief  and  more  or 
less  rapid  improvement  in  the  patient's  health.  But 
it  almost  appeared  as  if  the  logical  lesson  of  that  fact 
had  not  been  entirely  appreciated  ;  his  experience 
compelled  him  to  believe  tluit  there  were  a  large  number 
of  cases  of  tuberculous  disease  in  women,  which  origi- 
nated in  the  ovaries  or  tubes ;  and  that  the  early  re- 
moval of  the  primary  disease,  even  if  secondary  mis- 
chief had  Appeared,  must  be  productive  of  some  good, 
and  might  even  lead  to  cure.  At  any  rate,  he  had  seen 
a  number  of  cases  in  which  the  latter  event  had  occurred, 
and  might  mention  one  excellent  illustration  of  it. 
A  woman,  a^.  about  33,  had  been  admitted  into  his 
wards  for  ovarian  and  tubal  disease  and  general  peri- 
tonitis. It  was  evidently  tuberculous  in  character, 
and  the  apices  of  both  lungs  contained  cavities,  whilst 
the  patient  was  reduced  to  a  state  of  extreme  emacia- 
tion and  exhaustion.  Before  operating,  he  pointed  out 
that  his  hope  in  these  cases  was  by  removing  the 
original  source  of  disease  to  prevent  further  general  in- 
fection, and  certainly  to  cure  the  tuberculous  peri- 
tonitis, and  assist  the  patient  in  fighting  against  the 
pulmonary  extension.  In  that  case,  both  ovaries  and 
tubes  were  found  to  be  extremely  diseased,  and  the 
whole  pelvic  contents  matted  together,  whilst  the  in- 
testines and  peritoneum  were  thickly  studded  with 
miliary  tubercles.  He  removed  the  diseased  appen- 
dages. The  peritonitis  completely  cleared  up,  the  lungs 
commenced  to  improve  at  once,  and  when  she  left  the 
hospital  she  had  gained  more  than  a  stone  in  weight, 
and  the  pulmonary  cavities  were  healing.-  Some 
months  afterwards,  when  she  reported  herself,  her 
general  condition  was  excellent  in  every  way.  It  was 
almost  needless  to  say  that  equally  good  results  could 
not  always  be  obtained.  When,  for  example,  the 
lumbar  or  thoracic  glands  had  become  infiltrated,  so 
that  secondary  foci  of  infection  had  developed,  one 
could  not  hope  for  complete  cure,  but  as  it  must  take 


some  time  for  secondary  developments,  he  was  coa- 
vinced  that  early  operation  afforded  the  best  grooBd 
for  hope  that  a  complete  cure  might  be  effected,  and 
that  it  was  not  only  common  sense  and  surgical  science 
in  these,  as  in  every  other  case,  to  remove  as  speedily 
as  possible  the  fons  et  origo  malt,  but  that,  in  these  cases 
of  tuberculous  pelvic  disease,  there  w^as  a  great  pcssi- 
bility,  by  early  operation,  not  only  of  removing  the  local 
disease  from  which  the  patient  suffered,  but  also  of 
saving  her  from  the  gravest  secondary  developments. 

Dr.  E.  Tennison  Collins  agreed  with  Dr.  Mac- 
naughton-Jones  that  if  in  diagnosis  one  could  be  sure 
that  the  cyst  was  unilocular  and  non-adherent,  opera- 
ting by  the  vaginal  route  was  both  simple  and  rapid 
He  recalled  two  cases  of  his  own.  in  one  the  cyst  was 
large,  and  in  the  other,  though  not  so,  it  was  rapidly  in- 
creasing in  size  ;  in  each  case  he  opened  the  abdomen 
by  a  sinall  incision,  both  went  on  to  term,  and  did  well 
As  it  turned  out  there  were  no  adhesions  in  either  case. 
He  was  glad  to  hear  Dr.  Duncan  speak  so  emphaticaOy 
in  favour  of  the  abdominal  route. 

Dr.  Edge  remarked  that  though  much  of  his  ex- 
perience accorded  with  that  of  Dr.  Bedford  Fenwidc. 
he  could  not  be  so  enthusiastic  about  the  effect  of  re- 
moving tuberculous  appendages  upon  tubercnloos 
lesions  already  present  in  the  lungs.  On  the  whole  the 
results  of  his  operations  had  been  favourable,  bat  tn- 
no  means  so  brilliant  as  described  that  evening.  For 
instance,  after  an  operation  of  the  kind  last  summer, 
the  wound  healed  well,  and  all  seemed  satisfactory  for 
a  fortnight,  when,  suddenly,  the  patient's  mental  con- 
dition changed,  miliary  tuberculosis  set  in,  and  she  died 
in  a  fortnight.  There  was,  it  is  true,  an  abscess  cavity 
in  the  lung. 

The  President  said  that  he  entirely  agreed  with  Dr. 
Edge.  Nor  very  long  ago,  after  a  difficult  operatkn 
for  the  removal  of  a  tuberculous  pyosalpinx.  he 
obtained  a  comparatively  good  result  for  two  or  three 
weeks,  but  the  patient  afterwards  succumbed  to  tuber- 
culous meningitis.  With  regard  to  operating  by  the 
vaginal  route  in  pregnancy :  A  tumour  in  pregnancy 
which  gave  distinct  evidence  of  fluctuation,  and  of 
being  a  cjrst,  and  not  a  dermoid,  was  very  rarely 
adherent ;  and  it  was  infinitely  better  to  attack  it  by 
the  vagina,  especially  if  the  C3rst  was  blocking  tb& 
pelvis  below  the  pregnancy.  In  a  case  very  similar 
to  Mr.  Jordan's,  which  he  brought  before  the  Obstetrical 
Society  some  years  ago.  the  operation  was  a  small  one. 
the  cyst  could  be  quite  easily  removed,  there  was  do 
abdominal  wound,  and  the  pregnancy  was  not  inter- 
fered with  at  all.  In  such  cases  he  considered  the 
vaginal  route  ideal. 

Mr.   Furneaux   Jordan,   in   reply,    said   that  the 
President  had  to  a  great  extent  answered  all  that  had 
been  advanced  against  operating  by  the  vagina.    Dr. 
Duncan,  however,  seemed  to  think  that  if  the  cyst  had 
been  adherent  he  (Mr.   Jordan)  would  have  been  in  a 
serious  difficulty,  and  in  this  he  could  not  agree.    He 
could  have  proceeded  at  once  to  operate  from  the 
abdomen  and  the  patient  would  have  been  none  the 
worse  for  the  small  opening  that  had  been  made  in 
the  vaginal  vault.     The  case  was  an  excellent  illos- 
tration  of    the  fact  that,  as  the  President  had  said, 
when  there  were  no  adhesions  and  the  tumonr  was 
below  the  pregnancy,  the  vaginal  route  was  the  right 
one.     To  say  or  infer  that  he  would  adopt  the  vagmal 
route  in  every  case  would  be  absurd.     The  President 
and  Dr.  Edge  had  also  answered  some  of  the  remarks 
that  had  been  made  as  to  the  effects  of  operations  for 
pelvic    tuberculosis.     The    benefit    upon    tubcrcnlons 
peritonitis  of  merely   opening  the  abdomen  was  well 
known,  but,  as  regards  the  wider  operation  for  the  re- 
moval of  tuberculous  pyosalpinx,  it  was  most  difficult 
to   give   any   prognosis,    especially   where   there  wa» 
general  peritonitis  and  extensive  deposits  in  the  mesen- 
tery.    One  case  would  get  well  and  perhaps  the  next, 
apparently  quite  simils^.  would  not.     One  could  not 
say  why,  but  only  hope  for  success  knowing  the  \iesx 
had  been  done. 

Dr.  William  Duncan  showed  a  specimen  of  cancer 


Oct.  26.  1904. 


TRANSACTIONS   OF   SOCIETIES. 


The  Medical  Press.    437 


of  the  body  of  the  uterus,  and  read  notes  of  the  case, 
vhich  will  be  found  on  page  434. 
.  Mr.  BowREMAN  Jessett  did  not  understand  why  a 
combined  vaginal  and  abdominal  operation  should  have 
been  required  ;  a  uterus  of  the  size  shown  was,  in  his 
opinion,  comparatively  easy  to  remove  by  the  vagina. 
Of  course,  in  very  fat  women  there  was  more  difficulty, 
but  that  could  be  overcome  by  making  a  deep  incision 
on  one  or  even  both  sides  of  the  rectum  through  the 
perinaeum  and  para-vaginal  tissue,  extending  to  the 
fornix.  He  had  practised  this  method  for  several 
years,  and  believed  he  adopted  it  before  it  came  to  be 
known  on  the  Continent  as  Schuchardt's  incision. 

Dr.  Heywood  Smith  said  that  in  the  hands  of  one 
accustomed  to  use  it  the  sound  would  give  information 
of  any  tortuosity  of  the  canal  or  roughness  of  the 
internal  surface  of  the  uterus ;  if  it  were  possible  to 
diagnose  malignant  disease  in  that  way  it  might  be 
better  to  remove  the  uterus  at  once  without  curetting. 

Dr.  F.  A.  PuRCBLL  said  that  at  the  Cancer  Hospital. 
where  they  had  to  remove  many  uteri,  they  had  found 
that  in  a  patient  such  as  Dr.  Duncan  had  described, 
the  abdominal  route  was  practically  out  of  the  ques- 
tion. With  the  aid  of  the  incisions  Mr.  Jessett  had 
described,  and  which  Mr.  Jessett  and  he  himself  had 
developed  independently,  ample  room  could  be  got  to 
secure  the  broad  ligaments  and  bring  down  the  uterus. 

Dr.  Macnaughtok- Jones  said  that  he  could  not 
a^ee  with  Dr.  Purcell's  remarks  as  to  the  removal  by 
the  abdominal  route  being  out  of  the  question  in  any 
case  of  uterine  cancer.  Wertheim,  v.  Rosthom,  and  a 
considerable  proportion  of  the  most  distinguished 
g3maecologists  operated  by  the  abdomen  in  all  cases, 
though  a  large  number  of  men  of  equally  high  repu- 
tation thought  the  best  results  were  to  be  hoped  for 
from  early  vaginal  extirpation.  The  contrast  in  prac- 
tice had  been  well  reviewed  by  Olshausen,  at  Osrford, 
quite  recently. 

Mr.  Charles  Ryall  said  that  in  some  cases  in  which 
vaginal  hysterectomy  seemed  almost  impossible,  it 
was  found  that  the  abdominal  operation  was  not  any 
easier.  'For  the  patient's  sake,  the  best  operation  was 
the  quickest,  and  where  time  was  the  object  he  would 
pull  down  the  uterus,  and  having  opened  the  anterior 
and  posterior  fomices,  would  split  it,  and,  to  avoid 
the  loss  of  half  an  hour  in  trying  to  get  ligatures  on 
the  broad  hgaments,  would  apply  forceps. 

Dr.  J.  J.  Macan  asked  whether  anyone  would  now 
seriously  advocate  the  bisection  of  the  body  of  a  can- 
cerous uterus. 

Dr.  Herbert  Snow  asked  for  the  grounds  upon  which 
Dr.  Duncan  had  based  his  diagnosis,  and  what  were 
the  cUnical  symptoms.  He  thought  the  use  of  the 
sound  unnecessary  and  undesirable  for  the  diagnosis 
of  uterine  cancer. 

Dr.  Edge  asked  Dr.  Duncan  what  degree  of  eleva- 
tion he  was  able  to  obtain.  It  seemed  hardly  possible 
for  any  woman  to  be  so  stout  that,  with  full  elevation 
and  complete  retraction,  one  would  not  have  a  better 
attack  on  the  fundus  from  the  abdomen  than  by  any 
vaginal  route. 

Dr.  Duncan,  in  reply,  pointed  out  that  he  had  laid 
much  stress  upon  the  extreme  narrowness  of  the  vagina 
of  this  patient  as  the  reason  in  the  first  place  why  he 
had  not  undertaken  a  vaginal  operation,  which  he 
agreed  with  Mr.  Jessett  to  be  the  way  of  best  attacking 
a  cancerous  uterus.  In  answer  to  Dr.  Snow,  he  said 
that  he  used  the  sound  because,  owing  to  the  woman's 
obesity,  it  was  impossible  to  ascertain  the  size  of  her 
womb  by  bimanual  palpation.  There  were  no  clinical 
symptoms  pointing  to  malignant  disease,  but  as  he 
had  mentioned,  Mr.  Targett  hg.d  made  a  report 
upon  the  microscopical  examination  of  scrapings  from 
the  cavity,  and  he  had  no  doubt  as  to  the  diagnosis. 
He  hardly  ever  made  use  of  the  sound,  either  for 
diagnosis  or  treatment,  and  naturally  would  not  have 
done  so  had  he  had  reason  to  suppose  that  there  was 
cancer  of  the  fundus.  Time  was  no  doubt  most  im- 
portant, and  more  than  an  hour  taken  over  an  abdo- 
minal operation  certainly  miUtated  against  the  patient's 


recovery,  but,  as^Jong  as  the  time  did  not  exceed  an 
hour,  he  thought  it  did  not  much  matter.  He  felt 
sure  that  Mr.  Ryall  would  not  advocate  the  bi- 
section of  a  cancerous  uterus  if  he  had  had  the  same 
unfortunate  results  from  forceps  thsit  had  occurred  to 
himself,  and  would  give  up  forceps  in  favour 
of  ligatures.  Replying  to  Dr.  Edge  :  He  was  not  able 
to  obtain  satisfactory  elevation  as  the  operation  took 
place  at  the  patient's  house,  and  no  table  suitable  for 
the  Trendelenberg  position  was  to  be  had. 

Mr.  Ryall  said  that  he  would  prefer  bisecting  even 
a  cancerous  uterus  to  leaving  it  behind  unremoved. 
With  regard  to  Dr.  Duncan's  remarks  about  forceps : 
these,  when  applied  to  blood-vessels,  did  not  act  like 
a  string  tied  round  an  indiarubber  water  tube,  but, 
by  causing  stasis,  led  to  the  coagulation  of  the  blood 
in  the  vessels,  and  When  coagulation  had  occurred  there 
was  no  reason,  if  ordinary  care  was  employed,  why 
they  might  not  be  taken  off  without  any  haemorrhage. 
They  had  been  successfully  used  by  gynaecologists  in 
thousands  of  cases. 

Dr.  Macnaughton- Jones  showed  "Two  Micro- 
scopic Sections " :  the  first  from  A  Case  of  Hystero- 
salpingo-odphorectomy  for  Haemorrhag^c  Endometritis 
due  to  Glandular  Endometritis,  and  said  that  the  case 
was  interesting  more  from  a  clinical  and  pathological 
than  from  an  operative  point  of  view.  The  diiferentia- 
tion  of  the  various  forms  of  haemorrhagic  endometritis 
included  therein  was  another  matter,  and '  a  most 
difficult  one.  He  hoped  on  a  future  occasion  to  in- 
dicate the  histological  differentiation  of  the  various, 
forms  of  endometritis  which  lead  up  to  what  is  called 
haemorrhagic  endometritis.  In  addition  to  the  speci- 
men shown  there  was  another  on  the  table  which  he 
had  shown  at  the  Society  before  ;  he  had  brought  that 
uterus  and  adnexa  that  it  might  be  compared  with  his 
own  specimen.  Here  the  adnexa  of  one  side  had  been 
first  removed,  and  subsequently  those  of  the  other,  for 
cystic  disease ;  finally,  the  uterus,  for  haemorrhagic 
endometritis.  The  patient  was  now  perfectly  well. 
The  pathological  report  was  that  the  adenomatous 
change  was  extending  from  the  endometrium  into  the 
substance  of  the  uterus.  In  the  case  now  before  the 
Society  for  the  first  time,  the  patient,  who  consulted  him 
in  November,  1902,  was  in  her  43rd  year,  and  was  over 
six  feet  in  height.  She  had  cardiac  complications, 
and  was  completely  blanched  from  constant  haemor- 
rhage. After  a  mcmth's  rest  she  was  curetted,  and  the 
report  stated  that  there  was  nothing  malignant,  and 
only  some  slight  glandular  changes  in  the  endometrium. 
Hei:  health  improved,  and  the  haemorrhage  ceased  for 
a  time.  It  recurred  later,  and  she  consulted  him 
again  in  April  of  the  present  year.  She  was  again 
curetted.  The  report  then  furnished  to  him  by  Dr. 
Cuthbert  I.XKkyer  was  that  the  endometrium  presented 
large  round -celled  infiltration  of  the  stroma,  the  tubules 
having  in  many  instances  become  distended  into  small 
cysts.  A  few  of  these  were  large  enough  to  be  dis- 
tinguished by  the  naked  eye.  The  curettings  were 
under  the  microscope,  and  the  changes  described  by 
Dr.  I^ockyer  were  quite  evident.  After  a  brief 
respite,  the  patient  again  suffered  from  recurrence  of 
the  hsemorrhage.  and  in  August  he  performed  com- 
plete salpingo-oophorectomy,  from  which  she  com- 
pletely recovered.  There  was  an  interesting  point  with 
regard  to  the  specimen.  After  removing  the  uterus 
he  split  and  cut  up  either  comu  in  the  usual  fashion, 
and  out  of  one  exuded  what  appeared  to  be  pus,  to  the 
extent  of  about  one  and  a  half  teaspoonfuls.  He 
thought  it  was  a  case  of  suppurating  endometritis, 
but  a  further  examination  showed  that  it  was  not 
pus.  An  abstract  of  the  histological  report  is  of 
interest  i-^— The  uterus  has  been  slit  open  towards  the 
left  comu,  as  directed,  and  sections  cut  in  this  situation. 
They  reveal  a  healthy  fibro-muscular  wall,  but  a 
thickened  endometrium  covered  by  a  pultaceous  de- 
posit consisting  of  epithelial  debris.  The  endometrium 
shows  two  pathological  changes,  advancing  pari  passu, 
viz.  :  interstitial  fibrosis  and  desquamation  of  the 
gland     tubules,   both    changes    being  well    marked* 


438    The  Medical  Press. 


GERBIANY. 


Oct.  26,  1904. 


There  was  no  sign  of  an  abscess  cavity.  The  extreme 
desquamation  of  the  glands  amply  accounts  for  the 
mass  of  shed  epithelium  and  debris,  which  looked  not 
unlike  true  pus.  The  waU  of  the  uterus  at  its  thickest 
part  measures  one  inch.  There  is  a  small  circular 
fibroid  the  size  of  a  marble  in  the  left  uterine  wall, 
just  above  the  line  of  amputation.  The  right  ovary 
was  cystic'  the  left  also  ;  two  small  blood  cysts  and 
both  tubes  showed  evidence  of  chronic  salpingitis* 

The  second  was  a  rather  unique  specimen,  which  he  had 
brought  from  Bonn  that  week,  from  Professor  Schroeder , 
assistant  to  Professor  Fritsch,  of  that  University.  It 
was  the  section  of  an  ovary  from  a  still-bom  child 
dying  in  birth,  and  showed  typical  commencing  ovarian 
cystoma. 

Owing  to  the  lateness  of  the  hour  these  specimens 
were  not  discussed. 

Mr.  Christopher  Martin  then  read  a  paper  on 
"The  Treatment  of  Severe  Prolapse  by  Extirpation  of 
the  Uterus  and  Vagina."  which  wiU  be  found  on 
page  429. 

The  discussion  of  this  paper  was  postponed. 

jTrance* 

[PftOlC  OUR  OWN  CORRESPONDENT.] 


Pabib,  October  28rd.  1904. 
Treatment  of  Arterio-Sclerosis. 

The  name  of  arterio-sclerosis  is  given,  says  Dr. 
Debrive,  to  a  chronic  affection  of  the  small  arteries, 
whose  walls  are  invaded  by  sclerous  tissue.  These 
lesions  are  habitually  generalised  and  attack  the 
arterioles  of  theViscera — liver,  kidneys,  brain,  heart,  &c. 
— producing  in  those  organs  anatomical  and  functional 
troubles,  giving  to  the  disease  its  particular  character. 

The  cause  of  arterio-sclerosis  is  very  varied — 
arthritis,  gout,  chronic  rheumatism,  obesity.,  diabetes. 
Besides  these,  certain  infectious  maladies,  as  typhoid 
fever,  syphilis,i  paludism,  &c.,  can  modify  the  arterial 
walls  by  their  effect  on  the  blood  and  produce  sclerosis 
in  time.  Slow  and  prolonged  poisoning  of  the  blood 
is  one  of  the  most  powerful  factors  in  the  production 
of  the  disease.  Saturnism,  smoking,  and  alcoholism 
have  been  incriminated.  The  same  may  be  said  of 
physical  and  mental  strain  {surmenage). 

Besides  these  etiological  conditions,  age, '  with  the 
progressive  waste  of  the  tissues  resulting  from  the 
wear  and  tear  of  the  organism  and  the  incomplete 
elimination  of  the  waste,  is  capable  of  producing 
alone  arterio-sderosis.  Very  few  aged  persons  or  even 
younger  adults  are  exempt.  The  male  sex  is  much  more 
frequently  attacked  than  the  female  sex;  and  heredity 
plays  a  certain  role.  For  Professor  Huchard  the  mode 
of  action  of  the  causes  of  arterio-sclerosis  is  arterial 
hypertension  gradually  provoking  vascular  irritation, 
ending  in  sclerosis.  The  internal  tunic  of  the  small 
arteries  is  thickened,  with  tendency  to  obliteration, 
and  the  troubles  of  the  circulation  resulting  from  the 
iesions  can  provoke  gangrene  or  necrosis. 

In  its  initial  period ,  arterio-sclerosis  presents  no 
signs  of  precise  location.  The  patient  complains  of 
manifold  troubles,  dyspnoea  in  walking,  or  on  slight 
■efforts,  accompanied  by  a  disagreeable  sensation  of 
constriction  in  the  thorax.  The  digestion  is  laborious; 
after  the  repast,  the  face,  generally  pale,  becomes 
•coloured,  and  at  the  same  time  he  complains  of  pal- 
pitations and  a  tendency  to  sleep.  The  temporal 
arteries'  generally  regular,  pulsate  violently.  The 
pulse  is  regular  but  rather  strong  [and  rapid; 
the  arteries  are  hard.  Auscultationof  the  heart  reveals 
a  loud  dyostatic  sound  at  the  aortic  orifice,  the  other 
sounds  are  also  sharp  and  regular ;  the  organ  is  generally 
hypertrophied.    The    urine  is  abundant  and  limpid. 


Such  are  the  symptoms  of  arterio-sclerosis  at  its  com- 
mencement. Progressively  these  different  manifesta- 
tions of  the  malady  finish  by  predominating  in  a  vas- 
cular territor}'.  Of  aJl  the  organs,  the  kidney  is  the 
most  frequently  aflfected,  after  which,  comes  the  heart, 
and  finally  the  brain. 

The  renal  type  of  arterio-sclerosis  develops  in- 
sidiously without  any  other  manifestation  than  that  of 
arterial  hypertension.  It  is  characterised  anatomically 
by  interstitial  nephritis.  ClinicaUy,  polyuria  is  observed, 
slight  albuminuria,  palpitations  with  a  bruii  de  galop. 
Patients  affected  with  arterio-sclerosis  succumb  fre- 
quently to  nephritis,  heart  disease,  haemorrhage,  or 
softening  of  the  brain.  Consequently  the  pcogposis 
is  generally  grave,  although  it  varies  with  each  par- 
ticular case ;  renal  or  cardiac  insufficiency  renders  it 
very  sombre. 

The  Treatment  of  Arterio-Sclbrosis. 
The  treatment  consists  of  two  parts :  hygienic  and 
medical.  The  quantity  of  aliments  should  t>e  reduced 
to  a  simple  sufficiency.  Meat,  the  principal  cause  ol 
alimentary  intoxication,  should  be  consumed  with  the 
greatest  moderation.  Game)  pork,  salt  meats,  should 
be  proscribed,  as  well  as  fish,  preserved  meat,  asparagus, 
tomatoes,  mushrooms.  Milk  should  be  the  exclusive 
diet  where  the  patient  complains  of  oppressioo, 
headache  or  insomnia.  As  regards  liquids,  water  is 
the  best,  but  a  little  white  wine  well  diluted  with 
water  may  be  given  at  meals  if  the  patient  desires  it. 
The  only  therapeutic  agent  which  appears  to  act  bene- 
ficially in  retarding  the  evolution  of  arterio-sclerosis 
is  iodide  of  potassium.  It  should  be  given  in  small 
doses,  from  5  to  10  grains,  daily  for  a  long  time, twenty 
days  a  month  ;  and  continued  for  a  year  or  more, 
Trinitrin  is  recommended  where  dyspnoea  or  vertigo 
exists,  in  the  dose  of  2  drops  morning  and  evening  of 
the  I  percent,  solution.  As  soon  as  the  heart  gives 
signs  of  weakness,  strophanthus  or  spartein  may  be 
ordered,  but  digitalis  is  counter-indicated  as  long  as 
hypertension  exists  ;  it  "will  be  reserved  for  the  period 
of  (£dema. 

Tninecek,  of  Prague,  has  invented  a  serum,  of  which 
the  following  is  the  composition,  to  supply  the  salts 
wanting  in  the  blood  in  arterio-sclerosis,  and  which 
seems  to  have  given  some  good  results  in  the  initial 
period : — 

Sulphate  of  soda,  0*44  centigr.; 

Chloride  of  sodium,  4*92  centigr.; 

Phosphate  of  soda,  0*15  centigr.; 

Carbonate  of  soda,  0*21  centigr.; 

Sulphate  of  potash,  0*40  centigr*; 

Water,  100  grammes. 
He  injects  under  the  skin  from  i  to  7  centimetre  cubes. 

Oermanp. 

[from  our  own  correspondent.] 


Berlin,  October  22Qd.  190L 
Further  DiscussipN  on  Light  Treatments. 
At  the  International  Derma tological  Congress,  Hr. 
Freund  (Vienna)  reported  his]experiiftents.  in  conjunc- 
tion with  Oppenheim,  as  to'measuring  the  action  of  the 
Rontgen  rays.     Gaucher  and  Werther  had  seen  inflam- 
mation   of    the    kidneys    after    Rdntgen    treatmeat 
Buschki  and  Schmidt  (Berlin)  had  come  to  the  following 
conclusions  :   (i)  It  was  possible  to  cause  deeper  layen 
of  epithelium  to  disappear  without  severe  changes  fa 
the  overlying  skin.     (2)  Necrosis  and  also  molecolar 
destruction  in  the  sense  of  simple  atrophy  could  be 
rough t  about  in  the  epithelium  of  glandular  organs 
by  the  Rdntgen  rays.     (3)  Under  suitable  couditioDsa 


Oct.  26.  1904. 


AUSTRIA. 


The  Medical  Pxbss. 


439 


change  or  a  suppression  of  function  in  a  gland  could 
be  brought  about  by  them  without  any  grave  anato- 
mical changes. 

Hr.  Scblotz  (Konigsberg)  related  the  results  of  his 
•experiments   on    the   action   of   concentrated    lights. 
The  action  of  the  Finsen  light,  he  said,  did  not  depend 
•alone  on  the  action  of  the  very  frangible  ultra-violet 
^nd  blue-violet  rays,  which  by  their  absorption  brought 
•about  actual  chemical  action  (chemically  active  rays), 
but  also   on  the  action  of  the  lesser  frangible  rays, 
^•hich  caused  warmth  by  their  absorption.     A  portion 
of   the  chemically  active  rays  might  even  penetrate 
<leeper  layers  of  tissue ;  the  physiological  effect  of  these 
rays  was  but  small,  however.     The  physiological  ixtion 
■of    these  chemically  active  rays  diminished  rapidly, 
therefore,  in  the  deeper  tissues.     The  heat  rays  had  a 
greater  penetrating  pow^er,  and  their  action  on  the 
superficial  layers  could  be  governed  at  will  by  cooling 
apparatus.     It  might  easily  be  that  the  effect  of  the 
heat  rays  as  regarded  deeper  structures  did  not  dimi- 
nish, but,  on  the  contrary,  increased.     The  intensity  of 
the  action  of  light  rays  on  the  different  parts  of  the 
skin  naturally  depended  on  the  rate  of  absorption,  and 
as  the  diseased  tissues  of  lupus  were  darker  in  colour 
than  the  normal  skin,  and  in  consequence  of  this  the 
rate  of  absorption  would  be  greater  in  the  diseased  than 
in  the  normal  tissue,  so  the  rays  of  light  would  act 
electively  on  the  lupoid  tissues.     On  this  probably  de- 
pended the  favourable  action  of  light  in  the  treatment 
of  lupus.     The  action  of  the  whole  of  the  light  rays 
might  be  heightened  by  suitable  colouring  of  the  deeper 
layers  of  skin,  but  the  procedure  of  colouring  would 
be  of  little  use  in  the  case  of  lupus  as  the  light  already 
acted  electively. 

In  a  discussion  on  radium  treatment,  the  same 
speaker  summarised  his  conclusions  as  follows : — The 
physiological  action  of  the  rays  from  radium  on  the 
w^hole  resembled  that  from  the  Rontgen  rays.  It 
differed  from  it,  however,  in  the  following :  The 
radium  rays  had  a  greater  effect  on  the  vessels ;  they 
had  a  more  powerful,  deep  action,  and  they  had  a  not 
inconsiderable  bactericidal  action.  From  a  thera- 
peutical point  of  view  the  action  of  the  radium  rays 
was,  on  the  whole,  similar  to  that  of  the  Rontgen  rays. 
The  action  of  the  radium  rays  was  more  energetic  than 
that  of  the  Rontgen  rays  in  the  following  :  The  radium 
rays  acted  more  powerfully  and  more  favourably  in 
malignant  new  growths  of  the  skin,  especially  carcino- 
ma ta.  The  radium  rays  acted  better  in  telangiectases 
and  small  angioma  ta.  Above  all,  the  radium  rays 
could  easily  be  applied  in  many  parts  of  the  body,  and 
especially  in  cavities,  where  the  Rontgen  rays  could  not 
be  applied. 

The  Deutsch  nted,  Zeitung,  No.  yy,  has  a  reference  to 
the  case  in  which  a 

Croquet  Ball  was  Retained  in  the  Vagina  for 
•  Years. 
The  patient  was  a  country-woman,  set.  60,  who  com- 
plained of  pain  in  the  lower  part  of  the  abdomen  and 
in  the  vagina,  also  of  shortness  of  breath,  cough,  and 
a  purulent  vaginal  discharge.  She  had  been  married  48 
years,  had  borne  two  children,  the  first  34  years  ago, 
and  the  second  a  year  and  a  half  later.  The  menses 
began  at  20,  and  recurred  at  four  weeks'  interval, 
lasting  five  to  seven  days.  After  heavy  work  the 
patient  felt  the  womb  falling.  She  applied  to  a  mid- 
wife, who,  however,  gave  her  no  assistance,  and  in 
consequence  of  this  she  herself  attempted  to  get  relief 
by  inserting  various  objects  into  the  vagina.  After  the 
birth  of  the  second  child  the  womb  fell  further  still,  and 
she  passed  a  croquet  ball  into  the  vagina.     After  that 


she  had  no  more  symptoms  of  falling  of  the  womb  nor 
any  pains,  and  the  functions  of  both  bowel  and  bladder 
were  performed  normally.  On  examining  ^*r  vaginam, 
the  introitus  was  found  to  be  very  much  contracted, 
and  behind  the  introitus  the  finger  came  upon  a  round, 
hard  body.  A  muco-purulent  discharge  issued  from 
the  vagina.  The  urethra  was  of  normal  calibre,  and 
clear  urine  was  passed  ;  neither  was  the  rectum  unduly 
pressed  upon.  The  rounded  foreign  body  was  lying 
loose  in  the  vagina,  it  could  be  grasped  with  forceps 
and  moved  freely.  On  account  of  the  great  narrowing 
of  the  vagina  below,  however,  it  was  impossible  to 
remove  the  ball  entire^  it  had,  therefore,  to  be  broken 
up  with  a  strong  pair  of  forceps.  The  wood  of  the  ball 
was  unchanged ;  it  was  still  fresh  and  firm.  There 
was  severe,  colpitis,  and  in  places  superficial  ulcers  were 
present.  Patient  discharged  on  the  fifth  day.  The 
uterus  was  then  small  and  atrophied,  and  in  the  vagina 
where  the  ball  had  been  there  was  a  ring-shaped  con- 
traction. There  had  been  no  perforation.  There  was 
no  pain. 


Bu0trfa« 


[from  our^own  corrbspondbnt.] 

Vienna,  October  28rd,  1904. 
Recurring  Ulcus  Ventriculi  Pepticum. 

At  the  Prague  meeting  Schloffer  showed  a  very 
interesting  case  of  recurring  ulceration  of  the  stomach 
for  which  he  had  to  perform  gastro-cnterostomy  five 
times  within  two  and  a  half  years.  The  patient,  set .  3  3 , 
had  again  developed  the  same  condition  of  ulceration, 
and  stenosis  at  the  site  of  operation,  which  would 
again  necessitate  laparotomy. 

Tuberculin  Reaction. 

Zupnik  read  an  exhaustive  paper  to  the  members  on 
the  classification  and  reaction  of  bacteria.  Commencing 
with  their  analogy  to  plant  life  he  attempted  to  group 
them  according  to  species  and  genera,  into  what  he  terms 
a  natural  system  having  well-defined  marks  of  dis- 
tinction. His  whole  system  was  established  on  mor- 
phology-colouring and  pathological  properties  of  the 
bacteria.  As  an  example  of  these  he  selected  Koch's 
acid-colouring  species,  which  were  known  as  the  tuber 
cuUn  bacilli.  Their  morphology  was  by  true  division 
with  a  Babes-Ernst  body  in  the  interior  of  the  germ. 
A  culture  in  clear  bouillon  gives  a  characteristic 
surface  and  its  .  pathology  produces  tubercle.  This 
family  seem  to  give  rise  to  different  products  ;  for 
example,  he  would  quote  twelve  experiments  on  guinea- 
pigs  with  the  different  forms  of  Koch's  species;  six 
of  them  reacted  with  injections  of  Hochster's  tubercu- 
linum  vetus  as  positive.  This  family  appears  to  be 
closely  connected  with  the  harzstreptothrix,  as  tuber- 
culin injections  will  react  positively  on  lepra  actino- 
mycosis as  well  as  tuberculosis,  although  in  several  expe- 
riments four  different  fomis  of  strep tothrix  were  found. 
From  this  and  other  experiments  Zupnik  concluded  that 
the  tuberculin  reaction  gave  no  diagnostic  proof  of  this 
particular  bacteria,  although  it  defined  the  species. 

The  same  reasoning  was  applied  to  typhus  and  para- 
typhus  serum,  which  did  not  define  the  x)articular 
bacilli,  but  only  the  species  of  typhus  bacilli,  which 
might  include  the  dysenteric,  psittacosis,  typhunurium 
and  enteritidis,  as  well  as  the  coli  family.  These  again 
were  subdivided  by  the  agglutination  phenomenon  or 
the  Gruber-Widal  action,  which  could  not  be  held  as 
a  specific  etiological  test.  Again,  these  species  of 
bacteria  produce  pathological  changes  which  clinically 
and  anatomically  resemble  each  other,  such  as  lepra 


44^    I'HS  Medical  Press. 


THE    OPERATING    THEATRES. 


Oct.  26.  1904. 


tuberculosis  and  Peru  verruga,  all  resembling  each 
other  in  having  the  tuberculous  bacillus.  He  also  re- 
corded another  clinical  disease  of  the  kidney  which  had 
its  origin  from  Koch's  bacillus,  though  apparently  be- 
longing to  another  tuberculous  family  which  he  would 
designate  the  smegma  bacillus.  In  the  discussion, 
Salus  said  that  the  family  of  tuberculous  bacilli  produced 
a  chemical  constituent  which  was  not  afFecteii  by  the 
acid,  and  the  same  product  could  also  be  extracted 
from  the  bacillus  itself.  He  believed  there  were  different 
bacteria  belonging  to  the  same  species  producing  simi- 
lar metamorphoses  and  the  same  disease.  He  thought 
the  experiments  with  the  smegma  bacillus  did  not 
prove  the  presence  of  tubercle  owing  to  the  absence 
of  caseation,  which  did  not  exist,  and  which  genuine 
tubercle  always  produced  when  inoculated,  The 
tubercles  alone  were  not  characteristic,  and  required 
the  caseation  as  proof.  He  admitted  that  different 
toxic  substances  could  be  extracted  from  the  bacillus, 
many  of  whith  were  specific,  such  as  tuberculin,  which 
had  no  characteristic  phenomenon  in  the  production  of 
tuberculosis,  and  had  no  immunising  power  on  animals. 
Zupnik  replied  that  caseation  in  Koch's  bacillus  was 
neither  characteristic  nor  proof  of  its  genuineness  as 
streptothrix  and  Pfeiffer's  pseudo  tuberculous  bacilli 
all  produced  cheesy  conditions  in  the  tissues.  As  to 
the  nephritic  tuberculosis  the  diagnosis  was  the  same 
in  all  bacteriological  examinations,  while  the  urine 
drawn  from  the  ureter  gave  the  same  result,  such  as 
acid  reaction,  numerous  leucocytes  taking  up  acid 
colouring  matter  having  genuine  Koch's  bacilli.  In 
forty  guinea-pigs  which  were  inoculated  with  pure 
cultivated  Koch's  bacilli  only  the  smegma  bacilli 
were  found. 

Fistula  of  Bladder  and  Bowel. 
Kleinhaus  showed  a  female,  aet.  47,  who  had  been 
confined  sixteen  times,  and  suffered  from  a  fistula 
passing  from  the  bladder  into  the  bowel.  The  uterus 
and  adnexa  were  normal,  as  well  as  the  tissue  around 
the  cervix  and  fistula.  He  assumed  that  this  condition 
was  produced  by  an  attack  of  perivaginitis  phleg- 
monosa  dessicans  described  by  Marcomiet  in  1865. 
This  appears  to  have  been  induced  by  puerperal  in- 
fection and  injuries  during  delivery.  It  is  possible  to 
assume  that  infectious  thrombi  in  the  vessels  of  the 
vagina  and  portio  were  the  starting  point  of  the  in- 
flammations. 


Ube  Operating  Ubeatres* 

NORTH-WEST  LONDON  HOSPITAL. 
Two  Cases  of  Intermittent  Nasal  Obstruction 
WITH  Hydrorrhcea. — Mr.  Mayo  Collier  operated  on 
two  cases  of  intermittent  nasal  occlusion  with  hydror- 
rhcea. The  first  case  was  that  of  a  man,  aet.  50,  who 
had  suffered  for  the  last  twenty-seven  years  from 
sudden,  almost  complete  nasal  occlusion  associated 
with  an  outpouring  of  a  large  quantity  of  clear  fluid. 
The  attacks  were  so  sudden  that  from  a  condition  of 
complete  and  perfect  nasal  respiration  the  occlusion 
would  suddenly  come  on,  rendering  the  patient  utterly 
miserable  and  quite  unfit  to  continue  his  work  for 
several  hours  to  come.  He  stated  that  he  had  been 
examined  and  operated  upon  on  several  previous  occa- 
sions with  only  slight  temporary  benefit.  He  had  been 
iadvised  to  give  up  all  alcohol  and  tobacco  and  undergo 
a  course  of  medicine  and  dieting.  This  he  had  done 
religiously  without  apparently  any  benefit.  Mr. 
Collier  described  the  condition  of  the  nose  on  admission. 
The  whole  mucous  membrone  was  intensely  red  and 


congested,  there  was  much  hypertrophic  thickening  oi 
the  lower  turbinal  body,  culminating  posteriorly  is  i 
left  posterior  hypertrophy,  which  almost  completdT 
occluded  the  posterior  nasal  opening.  There  v«  a 
fringe  of  thickening  hanging  from  the  middle  turbinil 
body  of  almost  polypoid  consistence.  On  the  right 
side  there  was  a  large  ridge  involving  the  right  nasal 
cavity  and  touching  the  right  lower  turbinal  body. 
Mr.  Collier  said  two  previous  operations  had  been  doa 
in  this  case  with  the  object  of  removing  the  postericr 
hypertrophy  on  the  left  side  and  reducing  the  lowc 
turbinal  body.  These  operations  had  resulted  in  con- 
siderable improvement,  so  much  that  the  intermittent 
nasal  obstruction  on  the  left  side  had  completely  dis- 
appeared, and  the  discharge  had  been  reduced  consido* 
ably.  He  said  he  proposed  now  to  remove  the  whole 
of  the  ridge  on  the  right  side  so  as  to  restore  nasal  re- 
spiration. The  patient  was  anaesthetised  with  chloro- 
form and  placed  in  a  semi-recumbent  position  on  bis 
left  side.  Mr.  Collier  made  an  incision  along  the  lomr 
aspect  of  the  ridge  with  a  scalpel,  and  introduced  a  fine 
Bosworth's  saw.  After  considerable  trouble  (the  ridge 
being  very  hard),  the  parts  were  sawn  through  and  re- 
moved entire  with  forceps.  Some  subsequent  chisellin» 
had  to  be  resorted  to  in  order  to  complete  the  opera- 
tion. Mr.  Collier  next  demonstrated  the  complete 
freedom  now  obtained,  by  introducing  a  large  piece  of 
sponge  on  artery  forceps,  which  now  passed  easily 
from  front  to  back.  There  was  considerable  haemor- 
rhage during  the  operation,  which,  he  said,  would 
rapidly  subside  as  the  air  passed  backwards  and 
forwards.  No  plugging  or  dressing  was  resorted  to. 
but  the  patient  was  returned  to  bed.  Mr.  ColUer  said 
that  in  these  cases  no  plugging  was  requisite,  the  air 
quickly  arresting  the  bleeding  and  leaving  a  dr>'  dot 
on  the  wounded  surface. 

The  second  case  was  that  of  a  young  man,  ajt.  24. 
who  had  suffered  very  much  for  several   years  from 
almost  a  similar  condition  as  that  seen  in  the  previous 
case.     The    condition   of    the    nasal    cavities   in  the 
present  case  was  one  of  marked  lower  turbinal  hyper- 
trophy with  anterior  and  posterior  enlargements.    The 
attacks  of  sudden  occlusion  were  so  severe  that  tbe 
patient  had  been  quite  unable  to  follow  his  occupatioa 
from  want  of  rest  at  night  and   generally  impaired 
health.     Mr.  Collier  said  that  in  this  case  he  had  pre^ 
viously  removed  the  two  anterior  hypertrophies  and 
reduced  the  turbinal  bodies  on  both  sides  with  the 
galvano-cautery.     He   now   proposed    to    remove  the 
posterior  hypertrophies  w^ith  a   cold    snare.     Twenty 
per  cent,  solution  of  cocaine  with  adrenal   was  placed 
on  both  hypertrophies,  and,  with  the  aid  of  good  light. 
Jarvis's  snare  was  introduced,  first  on  one  and  then  od 
the  other  side,  and  a  structure  *as  large  as  a  chem- 
removed  by  slowly  tightening  the  loop  on  the  masses. 
There  was  no  haemorrhage,  and  the  parts  were  appa- 
rently bloodless.     Mr.  Collier  said  it  was  quite  unsafe 
to  leave  the  wound  without  plugs  or  using  the  gah'ano- 
cautery ;    he  preferred  the  latter,  as  the  former  would 
leave  the  patient  in  a  miserable  condition,  and  the  pliip 
would  probably  have  to  be  renewed  in  twenty-four  hours. 
If  the  galvano-cautery  were  carefully  applied  and  the 
exact  site  of  the  wound  could  be  seen,  there  was,  he 
considered,  no  danger  of  injuring  the  Eustachian  tube 
or    pharynx.     Mr.    Collier    carefully    marked  on  the 
galvano-cautery  instrument   the   exact   depth  of  the 
wound  and  seared  the  cut  surfaces  on  both  sides  with 


Oct.  26,  1904 


LEADING  ARTICLES. 


Thb  Medical  Press.   44I 


the  cautery  point.  With  this  precaution,  he  remarked, 
there  was  no  danger  of  subsequent  haemorrhage,  and 
the  patient  would  enjoy  immediate  benefit  of  restored 
nasal  respiration  and  the  advantage  of  the  astringent 
and  drying  effects  of  the  currents  of  air. 


JtMawTBMD  roft  TEimnraMiOM  Abboad. 

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Published  «Tery  Wednewlfty  moniiw.  Price  5d.     Poet  free,  6*4. 

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SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY.  OCTOBER  26,  1904. 


ST.  BARTHOLOMEWS  REBUILDING. 
The  affairs  of  St.  Bartholomew's  Hospital 
appear  to  have  drifted  more  or  less  into  the 
position  usually  described  tersely  as*'  a  deadlock." 
That  fact  may  be  pretty  safely  inferred  from  the 
reported  resignation  of  the  Treasurer,  Sir  Trevor 
Lawrence,  and  the  Secretary,  Mr.  Cross.  Both 
these  gentlemen  have  been  strongly  committed 
to  the  policy  which  involved  the  extension  of 
the  present  site  of  the  ancient  City  institution, 
and  of  rebuilding  thereon  at  enormous  cost. 
That  policy  hais  from  the  outset  been  vigorously 
opposed  by  The  Medical  Press  and  Circular, 
and  we  have  no  hesitation  in  saying  that  our 
objections  have  never  yet  been  satisfactorily 
answered.  The  formal  inquiry  into  the  question 
of  the  advisability  of  retaining  the  City  site,  held 
by  the  body  known  as  "  The  Lord  Mayor's  Com- 
mittee," was  not  of  such  a  nature  as  to  inspire 
confidence.  Neither  the  composition  nor  the 
methods  ipf  that  body  seemed  to  us  worthy  of 
adoption  in  investigating  a  matter  of  great 
public  and,  indeed,  national  importance. 
The  suspicion  that  the  final  resolution  was  simply 
an  expression  of  dogmatic  and  personal  opinion, 
rather  than  the  verdict  of  an  impartial  tribunal, 
was  rendered  inevitable  by  the  refusal  of  the  Lord 
Mayor's  Committee  to  publish  the  evidence  placed 
at  its  disposal.  The  transaction,  indeed, 
savoured  rather  of  the  tactics  of  company  pro- 
moting than  of  the  publicity  and  candour  that 
should  be  courted  by  every  self-respecting  medical 
charity.     If  the  reasons  for  retaining  St.  Bartho- 


mew's  Hospital  on  its  present  site  were  cogent 
and  overwhelming,  as  the  Lord  Mayor's  Committee 
led  us  to  beUeve,  what  possible  objection  could 
there  be  to  letting  the  public  know  the  why 
and  the  wherefore  of  their  belief  ?  To  withhold 
suchinformation  was  to  suggest  that  the  Committee 
had  a  weak  case,  that  they  were  acting  under 
powerful  personal  pressure,  that  they  dared  not 
state  both  sides  of  the  question ;  in  short, 
that  they  were  registering  in  their  report  a  private 
prejudice  an^  opinion  in  place  of  a  reasoned 
verdict.  Our  own  objections  to  the  scheme  were 
clearly  and  repeatedly  stated.  Coming  from  a 
medical  journal,  they  were  entitled  to  a  detailed 
public  reply.  There  is  no  need  to  reproduce  them 
here  at  length.  Briefly  stated,  we  objected  to 
the  enormous  cost  of  the  scheme  as  a  larger  modern 
hospital  could  have  been  erected  for  a  far  less 
sum  in  the  suburbs  ;  secondly,  the  day  population 
of  the  City  of  London  no  longer  demanded  a 
vast  residential  hospital,  nor  was  it  desirable  to 
treat  patients  in  the  vitiated  atmosphere  of  a  vast 
city  area  ;  thirdly,  the  abstraction  of  a  million 
of  money,  the  amount  required  for  reconstruction, 
would  infallibly  damage  other  deserving  medical 
charities ;  lastly,  there  being  every  Hkelihood 
that  the  greater  part  of  medical  education  would, 
in  the  near  future,  be  centralised,  the  erection  of 
costly  school  buildings  would  be  thereby  rendered 
superfluous.  Remonstrance  proved  of  no  avail ; 
the  public  was  asked  to  subscribe  ;f5oo,ooo,  and 
it  was  determined  to  rebuild  the  hospital  on  the 
present  site.  The  upshot,  after  an  interval  of 
nine  months,  has  been  what  some  of  the  daily 
newspapers  do  not  hesitate  to  describe  as  a 
"  fiasco."  It  is  stated  that  the  total  sum  con- 
tributed has  been  £35,000  in  place  of  the  ;^50o,ooo 
asked  for  by  the  hospital  authorities,  or  the 
milHon  that  the  completion  of  the  reconstruction 
scheme  will  require.  Already  the  hospital  has 
drawn  ;£i  50,000  from  capital  to  pay  for  the  pur- 
chase of  the  ground  from  Christ's  Hospital  needed 
for  the  extension  of  site.  Indeed,  it  looks  as  if 
St.  Bartholomew's  had  been  plunged  into  a  finan- 
cial morass,  from  which  it  will  tax  the  resources 
of  another  committee  to  extricate  its  fortunes. 
The  governors  of  the  hospital  are  even  applying,  in 
their  extremity,  to  King  Edward's  Hospital  Fund 
for  assistance.  The  full  significance  of  that  fact 
becomes  evident  only  when  we  recall  the  fact 
that  Sir  Savile  Crossley,  the  Secretary  of  the 
King's  Fund,  was  a  member  of  the  Lord  Mayor's 
Committee  who  opposed  the  reconstruction 
report  in  a  minority  of  one,  and  who  afterwards 
withdrew  from  that  committee.  Now  that  Sir 
Trevor  Lawrence  has  resigned  his  post  as  Treasurer 
of  St.  Bartholomew's,  it  may  be  possible  to  re- 
open the  question.  In  that  case  it  would  be 
advisable  to  appoint  a  representative  committee 
or  Commission  of  Inquiry  chosen  from  men  of 
recognised  standing  and  judgment  not  connected 
with  the  City.  The  suppressed  evidence  of  the 
Lord  Mayor's  Committee  could  then  be  produced 
and  laid    before   the  pubUc.      It   is   difficult   to 


44^     I'HE  Medical  Press. 


NOTES    ON    CURRENT    TOPICS. 


Oct.  2t.  i»i4. 


conceive  how  any  body  of  educated  men  in  the 
present  day  could  advocate  a  hole-and-corner 
treatment  of  a  question  of  universal  public  in- 
terest. The  welfare  of  St.  Bartholomew's  Hos- 
pital must  concern  every  medical  man  as  it  does 
every  citizen  in  the  United  Kingdom.  Let  us 
thresh  the  matter  out  on  that  understanding  in 
the  full  Ught  of  day. 


SCIENTIFIC  PALMISTRY. 

Palmistry,  as  expounded  by  self-styled  ,"  pro- 
fessors "  of  the  art,  has  been  considerably  to  the 
fore  during  the  last  few  months  in  consequence  of 
the  prosecutions  that  have  been  instituted  in 
different  parts  of  the  country,  to  test  the  validity 
of  taking  money  for  telling  people  a  farrago  of 
nonsense  about  themselves,  their  past,  and  their 
future.  Happily,  the  law  has  been  able  to  show 
that  there  are  certain  occasions  on  which  it  is  not 
**  a  ass,"  and  the  prisoners  have  been  pretty 
generally  convicted.  The  offence  in  law  that 
cheiromants  commit  is  that  of  predicting  the  future; 
the  mere  practice  of  palmistry  is  not  illegal  so 
long  as  it  confines  itself  to  the  delineation  of  cha- 
racter, though  the  puzzle  will  always  remain  why 
people  wish  to  be  told  what  they  should  know 
better  than  anybody  else,  namely,  their  own  quali- 
ties and  shortcomings.  However  that  may  be, 
the  subject  of  palmistry  and  its  influence  over  the 
human  mind  is  not  without  interest  to  the  ana- 
tomist and  the  psychologist,  and  the  study  of  the 
hand  has  important  medico-legal  bearings  that  are 
well  worth  attention.  Palmistry  itself  as  prac- 
tised by  its  ordinary  exponents,  even  when  rigidly 
confined  to  the  portrayal  of  character,  is  beneath 
contempt,  for  the  study  devoted  by  them  to  the 
subject  is  so  little  profound  that  in  many  of  their 
treatises  the  lines  of  the  hand  and  fingers  are  not 
even  correctly  described.  A  mass  of  crude  as- 
trology is  mixed  up  with  incorrect  anatomical 
detail,  and  the  traditions  of  the  sixteenth  century 
are  eagerly  copied  from  one  book  to  another  ; 
however,  enough  meretricious  nonsense  results  to 
attract  silly  people  to  resort  to  the  authors  for 
advice.  Pitiable  as  this  is,  there  is  an  idea  abroad 
with  regard  to  cheiromancy  that  there  is  "  soQie- 
thing  in  it,"  and  it  cannot  be  denied  that,  though 
scientific  palmistry  has  yet  to  be  developed,  the 
hand  is,  or  ought  to  be,  a  useful  guide  to  a  man's 
character  and  habits.  The  hand  is  admittedly 
the  most  complex  and  perfect  piece  of  mechanism 
ever  conceived,  and  especially  in  the  development 
and  specialisation  of  its  outer  half,  and  belongs 
more  intimately  and  peculiarly  to  man  than  any 
single  organ,  except  the  brain.  The  relation  be- 
tween the  brain  and  the  hand  was  insisted  on  by 
Aristotle;  Anaxagoras  ascribed  the  superiority 
of  man's  wisdom  to  the  possession  of  the  hand  ; 
Galen  thought  that  because  man  was  the  most 
sagacious  animal,  he  was  endowed  with  the  pos- 
session of  hands  ;  and  recently  the  leading  medical 
philosopher  of  the  day.  Professor  Chfford  AUbutt, 
deplored  the  abandonment  of  the  hands  as  an 
educational  instrument  by  modem  and  mediaeval 


physicians.  The  hand,  in  fact,  in  virtue  not  onk 
of  its  tactile  sensibility,  but  also  of  its  musadar 
sense,  is  one  of  the  chief  sense-organs  of  the  body, 
and  it  is  certainly  the  chief  exponent  of  the  viB, 
Its  shape,  its  development,  the  texture  of  its  skin, 
and  the  fashion  of  its  fingers  are  determined  br 
occupation  and  habit,  operating  on  hereditarilr- 
acquired  characteristics  and  predisposition.  Tbr 
whorls  on  the  skin  covering  the  terminal  phalanges  d 
the  thumb  and  fingers  are  now  known  to  be  pecuEa: 
to  the  individual,  and  M.  Bertillon  has  shovi 
how  valuable  they  are  for  purposes  of  identificatioc. 
As  an  expression  of  the  personal  character  and 
habit  the  hand  is  only  second  in  rank  to,  if  no: 
actually  equal  with,  the  face,  and  though  the  sig- 
nificance  of  physiognomy  has  been  carried  to 
undue  extremes  by  some  of  its  adherents,  no  oat 
attempts  to  deny  the  part  played  by  the  face  ig 
the  portrayal  of  the  character  and  the  emotioas. 
The  physiognomy  of  the  hand,  if  it  may  be  s» 
termed,  has  been  little  studied  by  scientific  ob- 
servers— a  great  pity,  as  their  place  has  been  iM 
by  charlatans  and  humbugs,  who  have  taken  the 
opportunity  to  fill  their  own  pockets  by  the  pr& 
ceeds  of  their  quackery.  The  foundations  fori 
true  science  of  palmistry  have  been  laid  by  sodi 
works  as  Sir  Charles  Bell's  classic  book  on  the 
hand,  and  Sir  George  Humphry's  writings  on  tlif 
same  subject,  while  Dr.  Warner,  in  his  ''  Phyacal 
Expression,"  has  carried  the  matter  further  br 
describing  and  figuring  various  types  of  hands 
pertaining  to  certain  dispositions.  The  topic  is 
one  of  extreme  interest,  and  as  there  appears  id 
be  a  demand  on  the  part  of  the  public  to  knor 
about  their  hands,  it  may  be  hoped  that  a  meat 
of  providing  them  with  authentic  informational 
the  subject  may  be  forthcoming.  The  only  war 
to  prevent  them  from  having  recourse  to  *'  pro- 
fessors "  who  read  the  hands  for  a  guinea,  cr 
''  madames  "  who  do  the  same  for  a  shilling «: 
church  bazaars,  is,  provide  them  with  a  trustworthy- 
substitute.  Scientific  palmistry  may  not  have>^ 
many  wonders  to  reveal  as  old-time  cheiromancy, 
but  it  would  at  least  tell  the  truth.  Even-  ot- 
servant  physician  is  something  of  a  physiognomist, 
it  would  not  detract  from  his  reputation  if  he  veir 
able  to  elicit  all  that  the  patient's  hand  could  te)i 
him. 


notes  on  aurrent  Uopics. 

The  Midwives  Aot. 

It  seems  unlikely  that  the  Midwives  Act  in  it^ 
present  form  will  ever  become  popular  with  the 
medical   profession.     One   of   its    radical  defect^ 
is  experienced  in  the  oft-repeated  assertion  tliat 
it  caUs  into  being  an  inferior  kind  of  unqualiiied 
medical  practitioner.      Another  vital  flaw  is  tie 
absence  of  any  financial  arrangement  as  to  the 
payment  of  medical  men  when  called  in  by  mid- 
wives  to  attend  "  difficult  cases."    Xow  that  the 
views  of  the  medical  profession  have  been  set 
aside  in  favour  of  sentimental  legislation,  Go\m- 
ment  will  have   to  provide   a  fair  remuneration 
for  its    expert   services.     The   Medical  GuM  o 


Oct.  26.  1904. 


NOTES    ON    CURRENT    TOPICS.         The  Medical  Press.    44^ 


Manchester,  an  alert  and  practical  body,  have 
lost  Uttle  time  in  coming  to  a  conclusion  as  to 
Mrhat  constitutes  a  right  and  proper  recognition  of 
the  kind.  At  their  last  quarterly  meeting  they 
adopted  the  following  resolution  : — "  That  when 
medical  practitioners  choose  to  attend  confine- 
ments at  the  request  of  mid  wives,  the  minimum 
fee  charged  should  be  a  guinea,  to  be  paid  at  the 
time  when  possible.  This  should  be  carried  out 
for  the  present  as  a  tentative  arrangement  till 
fresh  legislation  dealing  with  medical  fees  has 
been  brought  forward."  Bad  as  the  principles  in- 
volved in  this  Bill  appear  to  us,  its  administration 
bids  fair  to  become  infinitely  worse.  Already  the 
Board  that  controls  its  destinies  has  appointed 
unqualified  women  to  inspect  and  control  purely 
medical  matters.  We  regret  that  any  members  of 
the  medical  profession  should  be  so  forgetful  of 
their  duty,  and  their  dignity,  as  to  sanction  any 
arrangement  of  the  kind.  Dr.  Ward  Cousins,  who 
has  throughout  offered  a  determined  opposition 
to  this  and  to  other  steps  derogatory  to  the 
interests  of  the  profession,  deserviss  the  thanks 
of  all  his  medical  brethren.  We  trust  that  no 
medical  man  in  the  United  Kingdom  will  accept  a 
less  fee  than  one  guinea  when  called  in  by  a  mid- 
wife. 


Friffht,  or  Fear-Illness. 

The  influence  of  the  mind  in  producing  disease 
is  a  subject  that  has  fascinated  various  pens,  but 
one  cannot  say  that  much  light  has  been  thrown 
on  the  extraordinarily  delicate  relationship  that 
exists  between  mental  processes  and  bodily  illness. 
Ladies  in  novels,  after  their  love  troubles  have 
been  sufficiently  elaborated,  have  a  convenient 
habit  of  succumbing  to  the  affection  known  as  a 
"  broken  heart,"  and  children,  in  the  same  class  of 
literature,  run  a  terrible  risk  of  developing  that 
equally  obscure  malady,  brain-fever,  when  the 
writer  feels  it  necessary  to  gather  up  the  sympa- 
thies of  the  reader  for  a  final  crushing  exposure  of 
the  brutality  of  the  parents.  Romance- hterature, 
however  crude  it  may  be,  always  reflects  experience 
in  some  form  or  another,  and  noveUsts  who  tread 
on  delicate  pathological  ground  have  a  certain 
basis  of  fact  which  is  none  the  less  real  because 
it  is  overloaded.  Army  surgeons  can  tell  many  a 
story  with  closed  doors — ^which  they  would  not 
venture  on  in  speeches  at  miUtary  dinners — ^about 
the  effects  of  fear  on  the  constitution  of  the  raw 
recruit — *'  funkitis  "  as  it  was  christened  during 
the  Boer  War.  That  fear  can  produce  severe  and 
perhaps  even  permanent  change  in  the  mental 
and  physical  organisation  has  been  shown  often 
enough,  and  an  interesting  illustration  in  point  is 
recorded  in  Lady  Thompson's  account  in  the 
Cornhill  Magazine  of  her  experiences  in  Kastoria, 
whilst  distributing  the  Macedonian  Relief  Fund. 
This  province  had  been  ravaged  by  the  Turks  the 
previous  summer,  and  Lady  Thompson  says  that 
there  was  an  illness,  more  or  less  serious  and  some- 
times even  fatal,  peculiar  to  Macedonia,  openly 
confessed  to  by  the  sufferers  and  known  by  the 


doctors  as  straeh  (fear).  The  victims  were  not 
only  those  whose  houses  have  been  burned  and 
relations  killed,  but  many  who  had  spent  weeks- 
and  months  in  suspense,  hiding  in  out-of-the-way 
comers  of  the  mountains.  They  were  often  unable 
to  walk  and  to  speak,  or  even  to  stand  upright,  and 
yet  organically  they  were  sound  and  uninjured. 
Women  seem  to  have  been  more  affected  than  men,, 
but  both  sexes  suffered.  The  Condition  would 
appear  to  have  been  one  of  profound  hysteria,  such 
as  is  met  with  under  some  forms  of  mental  distress, 
but  this  does  not  help  us  much  to  its  actual 
pathology.  The  sufferers  were  thoroughly  over- 
come with  severe  mental  prostration,  and  it  is 
doubtful  if  they  will  ever  be  the  same  as  they 
were  previously. 

Professional  Penalty  for  Extortion. 

It  is  not  often  that  a  medical  society  is  called  on 
to  reprove  one  of  its  members  for  demanding  a 
high  fee  for  professional  services,  yet  this  is  what 
has  recently  occurred  in  Germany.  A  physician 
of  good  standing,  I:  eing  consulted  by  an  American 
millionaire  for  appendicitis,  advised  operation,  and 
recommended  a  surgeon.  The  operation  was  per- 
formed, and  the  physician  then  sent  in  a  bill  for 
four  hundred  pounds  for  his  advice.  The  patient 
objected  to  the  amount  and  tendered  a  smaller 
fee.  The  physician,  however,  insisted,  and  initiat- 
ing legal  proceedings,  had  the  patient  arrested  and 
kept  in  custody.  There  is,  of  course,  no  ethical 
law  by  which  the  fees  of  medical  men  are  con- 
trolled, and  it  is  well  recognised  that  a  physician 
is  justified  in  varying  his  fee  according  to  the  means, 
of  the  patient.  There  is,  however,  a  decent  though 
variable  limit  to  the  demands  of  a  man  honourable 
in  his  profession,  and  we  think  that  his  confreres 
acted  rightly  in  dissociating  themselves  from  the 
physician  in  question  when  he  attempted  by  legal 
means  to  put  a  foreigner  at  disadvantage  for  the- 
recovery  of  an  obviously  extortionate  fee. 

A  Paradise  of  Bonesetters, 
Rae,  the  Scotch  miner-bonesetter,  is  not  to  have- 
things  all  his  own  way  up  at  Blantyre.  The 
railway  trains  still  disgorge  the  lame,  the  halt,, 
and  the  impotent  in  considerable  crowds,  attracted 
by  the  extravagant  claims  of  his  wonderful 
"  system."  Indeed,  it  is  reported  that  cripples, 
are  coming  from  Germany,  Sweden,  Denmark, 
South  Africa,  and  America  to  subject  themselves 
to  his  manipulations,  and  altogether  he  seems  to  be 
having — as  the  schoolboys  say — *'  a  good  time 
of  it."  But  on  the  principle  that  competition  is 
good  for  trade,  two  other  "  specialists  "  have  set 
up  in  the  neighbourhood  so  that  they  may  enjoy 
the  crumbs  that  fall  from  Rae's  operating  table. 
One  of  these  individuals,  Thomas  Gilchrist  by 
name,  has  indeed  "  gone  one  better  "  by  announc- 
ing that  he  takes  sciatica  into  his  therapeutical 
province,  and  as  Rae  does  not  seem  to  be  much  of 
a  hand  at  sciatica,  patients  having  that  troub  e  go 
on  to  Gilchrist.  But  dwellers  south  of  the  Tweed, 
to  whom  the  pre-eminence  of  country  is  dear,  will  be 


444    The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


;glad  to  hear  that  Scotland  is  not  to  go  unchallenged 
for  its  supremacy  in  bonesetting,  for  another 
performer,  an  EngUshman,  named  Fred  Barker,  is 
hastening  to  the  scene,  and  is  about  to  start  in 
business  midway  between  Rae  at  Blantyre  and 
Gilchrist  at  Wishaw.  Mr.  Barker  one  would  judge 
to  be  something  of  a  capitalist,  as  he  offers  to  pay 
/SCO  to  any  philanthropic  institution  if  his  system 
of  manipulative  surgery  is  not  pronounced 
superior  to,  and  productive  of  more  benefit  than, 
the  scalpel  of  the  local  doctors.  If,  on  the  other 
band,  he  comes  off  victor  in  the  contest  he  is  pre- 
pared to  give  ;f25o  to  found  a  school  of  bloodless 
surgery  in  Lanarkshire.  With  so  many  provincial 
universities  coming  into  being,  this  new  one  (if 
founded)  may  make  things  uncomfortable,  but  we 
fear  its  handsome  endowment  will  hardly  succeed  in 
retaining  a  professor  unless  he  be  also  allowed  the 
privilege  of  private  practice  in  his  wonderful  arts. 
Altogether  things  seem  very  merry  up  in  Lanark- 
shire, and  Carlyle's  quoted  estimate  of  the  British 
population  does  not  seem  likely  to  be  falsified 
thereby  in  the  near  future. 


The  National  Epileptdc  Colony. 

On  Thursday  last,  October  20th,  the  Epileptic 
Colony  at  Chalfont  St,  Peter,  in  Buckinghamshire, 
conducted  by  the  National  Society  for  the  Employ- 
ment of  Epileptics,  marked  an  important  stage 
in  its  rapid  evolution  by  the  opening  of  an  ex- 
cellently arranged  and  well-equipped  administra- 
tive building,  which,  like  so  miich  in  connection 
with  the  Colony,  has  been  made  possible  by  the 
judicious  munificence  of  Mr.  Passmore  Edwards. 
The  opening  ceremony  clearly  indicated  the  keen 
interest  taken  by  both  profession  and  public  in 
the  rational  and  hygienic  care  of  the  epileptic. 
Lord  and  Lady  Rothschild  attended,  and  Sir 
Wilham  Broadbent  and  Dr.  Buzzard  took  part  in 
the  proceedings,  and  Dr.  Fletcher  Beach,  Dr. 
Shuttleworth,  Dr.  Aldren  Turner,  Dr.  Kelynack, 
and  others  were  present.  Much  praise  is  due  to 
Mr.  Nicholls,  the  chairman,  for  his  wise  pioneers  hip 
in  the  development  of  the  Colony.  The  new 
house  contains  ofl&ces,  rooms  for  the  staff,  and  a 
thoroughly  modem  and  up-to-date  kitchen.  The 
various  buildings  which  constitute  the  Colony 
are  excellent  for  their  purpose,  and  the  whole 
•conduct  of  the  place  appears  to  be  characterised 
by  scientific  precision  and  sound  common  sense. 
There  is  much  ground  which  allows  of  a  free  and 
open-air  Hfe  and  useful  outdoor  employment. 
This  new  but  now  large  and  flourishing  Colony 
should  be  well  known  to  medical  men,  who  are  so 
frequently  called  upon  to  advise  regarding  the 
protection  and  upbringing  of  epileptics. 

The  New  President  of  the  Royal  College 
of  Physioiane,  Ireland. 

Dr.  W.  J.  Smyly,  who  was  elected  President 
of  the  Royal  College  of  Physicians  of  Ireland  at 
its  last  meeting,  is,  as  is  well  known,  one  of  the 
most  prominent  of  British  gynaecologists.  Dr. 
Smyly  entered  the  medical  profession  through  the 
portals  of  Dublin  University  in  1872.     In   1877, 


Oct.  26,  1904. 


he_  became  a  Fellow  of  the  Royal  CoUege  oi 
Surgeons,  a  distinction  which  he  subsequently 
reUnquished  in  order  to  take  the  FeUowship  of  the 
College  of  Physicians.  In  1882,  he  was  appointed 
gynaecologist  to  the  City  of  Dublin  Hospital,  in 
succession  to  Dr.  Arthur  Macan,  who  has  been 
elected  to  the  vacant  Mastership  of  the  Rotunda 
Hospital.  In  the  latter  post.  Dr.  Smyly  again 
succeeded  Dr.  Macan,  and  during  the  next  seven 
years  laid  the  foundation  of  his  wide  reputation. 
During  his  Mastership,  the  new  gynaecological 
wing  of  the  hospital  was  built,  and  many  im- 
portant reforms  were  introduced,  notably  nursing 
by  trained  nurses  under  a  trained  lady  super- 
intendent. So  successful  were  these  reforms  that 
in  the  last  year  of  his  Mastership  the  mortality 
rate  in  the  maternity  department  was  reduced  to 
the  lowest  that  had  ever  been  known  in  the 
hospital--only  one  death  occurring  amongst  the 
1,524  patients  that,  were  confined.  On  leaving 
the  hospital.  Dr.  Smyly  was  appointed  gynaeco- 
ogist  to  the  Adelaide  Hospital,  a  post  which  he 
still  holds.  Amongst  his  other  distinctions  may 
be  mentioned  the  Presidency  of  the  British 
Gynaecological  Associations  and  of  the  Obstetrical 
Section  of  the  Royal  Academy  of  Medicine  in 
Ireland. 


Venous  Thrombosis  in  Typhoid  Fever. 

The  toxins  elaborated  by  the  Bacillus  typhosus 
within  the  body  are  so  insidious  in  their  action, 
and  so  far-reaching  in  their  effects,  that  no  system 
can  be  said  to  be   exempt   from    one   or  other 
complication    or    sequela.    Modem    pathological 
research   has   shown   that  *  the    vascular   system 
bears  much  of  the  brunt  of  the  poison  of  typhoid 
fever,  especially  in  the  later  stages  of  the  disease. 
It  has   recently    been    found   that   evidences  of 
functional  and  even  organic  disease  of  the  hean 
may  be  traced  to  an  antecedent  attack  of  enteric 
.fever,  while  arterio-sclerotic  changes  within  the 
vessels  have  also  been  pointed  out  as  a  not  infre- 
quent   sequel    of    this    affection.     That    venous 
thrombosis    is    another    complication    likely   to 
occur  in  the  course  of  typhoid  fever,   or  during 
convalescence  therefrom,  is  shown  by  an  analysis 
of   forty-two   cases   of  this   condition    made  by 
Professor  W.   S.  Thayer,   (a)  of  Baltimore.    Of 
these   the   left  side  was   aiiffected   in   twenty-six 
cases,  while  the  femoral  vein  was  thrombosed  in 
twenty-one   instances.     The   condition    generally 
makes  its  appearance  about  the  third  week  of  the 
disease,  but  in  some  cases  it  may  be  considerably 
delayed.     The  on.4et  is   usually  associated  with 
sudden  pain  in  the  affected  part»  chills  and  fever. 
Some  swelling  of    the    thrombosed    vein  nearly 
always  occurs,  and  there   may  be  oedema  of  the 
adjacent  integument.     If  the  blood  be  examined  at 
this  period  a  leucocytosis  will  be  found  coincidently 
with  the  appearance  of  the  thrombosis.    In  ooe 
fatal  case  the  B.  typhosus  was  obtained  in  pure 
culture  from  the  thrombus.     The  after-results  of 
venous  thrombosis  are  important,  as  in  aknost  all 

(a)  Med.  New§,  October  Ist,  1904. 


Oct.  26.  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    445 


the  cases  more  or  less  permanent  disability  of  the 
affected  limb  follows.  Such  symptoms  as  cramps, 
stifEness,  and  swelling  of  all  the  tissues  of  the  leg 
were  found  several  years  after  the  attack.  The 
risk  of  embolism  is  one  which  must,  of  course, 
be  specially  guarded  against. 

Baron  Dinifldale. 

Baron  Dimsdale,  whose  miniature-portrait 
has  been  so  wantonly  stolen  from  the  National 
Portrait  Gallery,  lives  in  history  as  the  medical 
man  who  received  the  largest  iee  for  any  single 
service.  Bom  of  Quaker  parents  in  Essex^inthe 
year  17 12,  and  educated  at  St.  Thomas's  Hospital, 
he  rapidly  rose  to  fame  as  a  physician,  and  became 
a  Fellow  of  the  Royal  Society.  It  was  in  connec- 
tion with  inoculation  for  small-pox  that  he  chiefly 
attained  celebrity.  This  practice  had  been  intro- 
duced into  England  by  Lady  Mary  Montagu  and 
others  in  the  early  part  of  the  eighteenth  century, 
and  was  widely  practised  till  about  1740,  when  in 
consequence  of  many  fatalities  occurring  among 
the  inoculated,  it  fell  into  disfavour.  Sutton,  how- 
ever, in  1763,  announced  a  method  by  which  he 
could  assure  that  the  resulting  attack  of  small-pox 
should  be  mild,  and  he  speedily  gathered  a  large 
practice.  Dimsdale  modified  the  Suttonian 
method,  and  in  his  turn  gained  a  wide  connection, 
but  though  the  matter  had  been  frequently  dis- 
cussed, the  so-called  secret  on  which  Sutton  and 
IXmsdale  built  up  their  success  has  never  been 
accurately  determined.  Dimsdale's  peculiar  luck 
came  in  his  being  summoned,  in  1768,  to  Russia  to 
inoculate  the  Empress  Catherine  and  her  son,  the 
Grand  Duke.  Fortunately  for  him  the  operations 
were  both  successful,  and  he  was  rewarded  with  a 
fee  of  ;£io,ooo,  an  allowance  of  £2^000  for  travelling 
expenses,  an  annuity  of  ;^5oo,  and,  as  though 
pecuniary  reward  was  not  sufficient,  was  created 
Baron  of  the  Russian  Empire,  Councillor  of  State, 
and  Body  Physician  to  the  Empress.  He  returned 
to  England,  and  soon  afterwards  was  elected 
M.P.  for  Hertford,  in  which  town  he  practised  the 
combined  callings  of  banker  and  physician.  In 
1 78 1  Dimsdale  was  sent  for  to  Russia  again.  This 
time  he  inoculated  the  Grand  Duke,  who  was  after- 
wards the  Emperor  Alexander,  and  the  Duke's 
brother  Constantine ;  his  services  were  again 
rewarded  with  handsome  fees  and  further  titles. 
Dimsdale  lived  for  nearly  twenty  years  to  enjoy 
his  honours  and  emoluments,  and  dying  at  the  ripe 
age  of  eighty-eight,  was  buried  at  Bishop's 
Stortford  in  the  Quaker's  burial-ground.  Baron 
Dimsdale  may  not  have  been  one  of  the  greatest 
physicians,  but  he  was  certainly  one  of  the  best 
rewarded. 


Cyto-DiafirnoBis  in  Nervous  Diseasee. 

Within  the  last  few  years  attention  has 
been  drawn  to  the  help  that  may  accrue  to 
diagnosis  from  the  study  of  the  cells  contained 
in  the  fluids  of  the  body.  There  is  no  doubt  that, 
for  instance,  the  cellular  elements  of  a  pleural 
effusion  vary  to  a  considerable  extent  with  the 


cause  at  work.  This  is,  however,  the  simplest 
case  that  occurs,  and  we  think  that  there  has  been,, 
in  some  quarters,  a  tendency  to  expect  equally 
speedy  results  from  an  examination  of  the  fluids 
of  other  serous  cavities.  Some  writers,  for  in- 
stance, have  recorded  rosy  accounts  of  the  great 
assistance  given  to  the  diagnosis  of  nervous- 
diseases  by  the  examination  of  the  cells  in  the 
cerebro-spinal  fluid.  It  has  been  held  that  an 
increase  in  the  number  of  lymphocytes  in  that 
fluid  is  pathognomonic  of  meningeal  irritation,, 
and  that  it  particularly  occurs  in  the  early  stages- 
of  general  paralysis  of  the  insane  and  tabes- 
dorsaUs — the  so-called  parasyphiUtic  conditions^, 
FuDer  investigation,  however,  shows  that  these 
conclusions  are  somewhat  hasty.  Far  from 
lymphocytosis  of  the  cerebro-spinal  fluid  being 
confined  to  parasyphiUtic  cases,  it  has  beea 
found  in  such  varying  inflammations  as  herpes 
zoster,  sciatica  and  parotitis,  and  in  such  intoxi- 
cations as  are  due  to  tetanus,  uraemia,  and  syphilis. 
At  present  one  can  hardly  go  further  than  the 
statement  that  while  lymphocytosis  is  usually 
associated  with  tabes  and  general  paresis,  it  is 
by  no  means  to  be  relied  on  as  diagnostic.  It 
is,  at  best,  but  one  point  to  be  taken  into  con- 
sideration in  basing  a  diagnosis  on  general  grounds. 


Fro0t-Bite  in  Tibet. 
From  a  medical  point  of  view  perhaps  the 
greatest  hardship  undergone  by  our  troops  in  the 
Tibet  Expedition  was  the  exposure  to  great 
cold.  Although  in  all  campaigns  soldiers  are 
accustomed  to  suffer  from  both  cold  and 
exposure,  yet  a  British  army  is  rarely  subjected 
to  the  Arctic  cold  encountered  in  the 
passage  of  the  Himalayas.  Lieutenant  Davys, 
I.M.S.,  one  of  the  medical  officers  attached  to  the 
expedition,  has  placed  his  observations  on  record,  (a) 
and  has  given,  in  particular,  an  interesting  study 
of  {[frost-bite.!^  Very  rarely  .^does  ]Jcold,  of  itself, 
produce  local  necrosis,  though  this  may  occur  if 
the  cold  is  both  severe  and  long  continued.  Much 
more  coimmonly  necrosis  occurs  as  the  result  of 
carelessly  applied  ^heat.  In  Manitoba,  where 
frost-bite  is  common,  serious  results  rarely  follow 
except  in  the  case  of  new  arrivals  in  the  country, 
who,  in  their  ignorance,  immediately  apply  heat 
to  the  affected  part.  Similarly,  among  our  troops 
in  Tibet,  the  soldiers,  entirely  tmused  to  the 
condition,  as  Dr.  Davys  notes,  '*  used  to  hold  the 
frost-bitten  part  practically  in  the  fire."  When 
this  is  done,  a  violent  rapid  oedema  ^takes  place, 
causing  pressure  on  the  already  damaged  tissue, 
followed  by  moist  gangrene.  As  treatment, 
in  mild  cases  rubbing  is  of  itself  effectual, 
but  in  more  severe  cases  other  steps  must 
be  taken  to  raise  the  temperature  very 
gradually.  The  usual  method  is  to  immerse  the 
part  in  a  vessel  of  ice-cold  water,  whose  tem- 
perature is  then  slowly  raised  by  its  being  placed 
over  a  fire,  friction  being  kept  up  throughout. 
In  the  most    severe    cases,  where    necrosis    has 


(a)  Indian  Med.  Gaz,,  July,  1904. 


446     The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Oct.   26.    T904. 


actually  taken  place.  Dr.  Davys  found  operative 
measures  invariably  necessary, 

A  New  Cancer  Treatment. 

Dr.  Doyen,  of  Paris,  informs  us  that  he  has  not 
found  the  specific  treatment  for  cancer  any  more 
than  he  has  discovered  the  cancer  microbe.  He 
has  discovered  in  the  neoplasic  tissues  a  micro- 
organism which  he  has  named  micrococcus 
neoformans,  of  which  the  cultures,  weakened  by 
certain  processes  and  additions  of  quinine  or  of 
arsenic,  form  the  basis  of  his  anti-cancerous  serum. 
At  the  French  Surgical  Congress,  held  last  week, 
he  gave  the  technical  details  of  the  manufacture 
of  his  antineoplasic  liquids,  and  insisted  upon  the 
fact  that  the  production  of  toxins  obtained  by 
the  cultures  of  micrococcus  neoformans  was 
delicate,  and  so  slow  that  two  or  three  years 
elapsed  before  it  was  ready  to  be  utilised  thera- 
peutically. Doyen  brought  forward  statistics  of 
242  cases  of  cancer  of  all  sorts  treated  by  his 
method.  The  following  are  the  results  : — Forty- 
two  apparently  absolute  cures,  some  of  them 
now  of  four  years  standing.  In  128  cases  the 
treatment  has  given  no  result  because  it  was 
commenced  too  late  or  interrupted  too  soon. 
Six  patients  died  accidentally  who  were  cured 
of  their  cancer,  and  the  cases  of  twenty  others 
have  not  been  followed  up.  The  following  con- 
ditions are  suitable  for  serum  treatm  ent,  namely, 
all  cases  of  malignant  tumours  which  are  doomed 
to  relapse  after  operation  ;  all  confirmed  cancers 
in  which  total  removal  cannot  be  practised ; 
all  tumours  inoperable  from  the  fact  of  their 
size  or  because  important  organs  are  involved. 
Dr.  Doyen  has  kindly  sent  us  a  report  of  his 
address  published  in  the  BtUleiin  Medical^  and 
from  it  we  learn  that  he  has  considered  the  possi- 
bility of  an  anti-cancer  vaccination  giving  im- 
munity for  a  considerable  period  to  susceptible 
persons. 


Chronic  X-ray  Dermatitis. 

Certain  daily  newspg-pers  have  raised  the  ghost 
of  a  well-known  ma}ady— as  is  their  wont — ^and 
have  done  their  best  to  make  the  blood  of  the  public 
turn  to  water  with  their  turnip-lieaded  wonder. 
The  fact  that  workers  with  the  Kontgen  rays  are 
subject  to  an  extremely  chronic,  distressing  and 
incurable  inflammation  oi^  the  hands  has  at  length 
penetrated  the  recesses  of  Fleet  Street.  The 
further  fact  that  several  cases  of  cancer  have 
developed  in  connection  with  chronic  X-ray 
injury  seems  to  have  inexpressibly  inflamed  the 
editorial  imagination ;  the  yellow  press  of  the 
kingdom  has  been  accordingly  flooded  with 
startling  headhnes,  pictures,  interviews  and  brist- 
ling columns  horrid  with  fact  and  fancy.  Among 
the  interviews  we  regret  to  see  one  with  a  Midland 
worker  in  the  X-rays,  who  has  apparently  so  far 
forgotten  the  unwritten  rules  of  the  medical  pro- 
fession as  to  furnish  his  experiences  to  a  reporter, 
to  be  published  under  his  own  name.  The  views 
of  a  London  specialist  have  been  quoted  copiously  in 


relation  to  a  book,  for  which  notice  he  is  obviously 
not  answerable.  As  a  matter  of  fact  the  chronic 
dermatitis  of  R6ntgen-ray  workers  has  been  known 
for  a  long  time,  and  was  described  fully  some 
six  or  seven  years  ago  in  the  book  which  is  the 
standard  EngUsh  authority  on  the  Rontgen  rays 
in  medical  work. 


Imperial  Sanitary  Gomnfunribner  far  India. 

The  scheme  of  sanitaiy  administratioa  for  India 
that  was  recommended  by  the  Plague  Commission 
has  been  some  years  in  meeting  with  recognition 
at  the  hands  of  the  responsible  Government,  but 
with  plague  still  rife  in  the  country  tfhe  staff  of  the 
medical  department  seems  to  have  been  too  bus>' 
to  attend  to  other  duties  than  ti«  immediate 
occasion  required.  The  Government  have  at  last 
determined,  to  start  putting  the  scheme  into  opera- 
tion, and  their  first  step  has  been  the  appointment 
of  an  Imperial  Sanitary  Commissioner  for  the 
whole  Empire,  whose  duties  will  be  entirely  severed 
from  those  of  the  Director-General  of  the  Medica] 
Service.  This  is  certainly  a  step  in  the  right 
direction  and  the  salary  fixed  for  the  new  post. 
Rs.  2,000  to  Ris.  2,500  a  month,  is,  on  the  principle 
that  people  value  a  man's  advice  at  what  they  pay 
him  for  it,  an  earnest  that  his  recommendations 
will  be  regarded  seriously.  A  somewhat  refreshing 
feature,  too,  is  the  fact  that  a  comparatively  junior 
ofiScer,  Major  Leslie,  has  been  appointed  to  the 
position,  which  looks  as  though  the  Government 
wished  to  begin  with  an  open  mind,  free  froin 
tradition  and  bias.  The  Sanitary  Commissioner 
will  advise  the  Local  Government  as  to  the  princi- 
ples on  which  their  health  organisation  should  be 
moulded,  and  how  it  should  work,  as  he  will  have 
under  his  charge  the  very  important  department 
dealing  with  the  institutes  and  laboratories  for 
carrying  on  research-work  and  the  manufacture  of 
curative  and  -  minimising  sera  in  India.  To  the 
Imperial  Government  he  will  act  as  sole  adviser  on 
all  sanitary  questions,  and  his  recommendations 
will  not  have  to  pass  through  the  office  of  the 
Director-General.  It  seems  rather  curious  that 
the  creation  of  an  office  which  is  practically  that  d 
a  Minister  of  Public  Health  should  be  recognised 
as  necessary  and  salutary  in  one  of  our  dependen- 
cies, whilst  in  the  Mother  Country  any  proposal  to 
create  a  similar  post  is  hardly  regarded  seriously. 

PERSONAL. 

Dr  Lionel  H.  '»Veatheri:v  w^ill  preside  at  the 
annual  dinner  of  the  Bristol  Medical  School,  to  be  held 
on  October  28  th,  on  which  occaaiou  Sir  William  Church 
will  be  the  guest  of  the  evening,  and  earlier  in  the  day 
will  distribute  the  prizes  on  behalf  of  the  Faculty  of 
Medicine  of  the  University  College,  Bristol. 


The  Sanatorium  at  Quarrier's  Homes,  Bridgc-of- 
Weir,  recently  acquired  by  the  Paisley  Association  for 
the  Prevention  of  Consumption,  was  formally  opened 
on  the  15th  inst.,  by  Sir  Thomas  Glen-Coats,  Bart.. 
of  Ferguslie  Park,  Paisley. 


Dr.  Andrew  Graham,  of  Currie,  on  the  occasion  of 
his  semi-jubilee   of     practice    in     the     district,   was 


Oct.  26.  1904. 


SPECIAL    CORRESPONDENCE. 


The  Medical  Psess.    447 


-entertained  last  week  at  a  complimentary  dinner  in  the 
"Oibson  Craig  Memorial  Hall,  Currie. 


The  new  crematorium  of  the  City  of  London  Ceme- 
tery*, Little  Ilford.  Essex,  was  opened  by  William 
Joseph  Downes,  Esq,,  Chairman  of  the  Sanitary  Com- 
mittee, acting  as  the  Burial  Board  of  the  City  of 
I-ondon,  Tuesday  (yesterday). 


It  is  the  intention  of  his  friends  in  Belfast  to  enter- 
tain Professor  Lorrain  Smith  at  a  public  dinner  before 
his  departure  from  Queen's  College  to  take  up  his  duties 
-at  the  Victoria  University.     The  dinner  will  probably 
take  place  on  November  3rd. 

We  are  officially  informed  that  the  Secretary  of 
State  for  War  has  approved  of  the  re-appointment  for 
a  further  period  of  three  years  of  the  present  civilian 
members  of  the  Advisory  Board  for  Army  Medical 
•Services :— Sir  C.  B.  Ball,  M.Ch.,  Dr.  J.  Galloway, 
Sir  E.  Cooper  Perry,  M.D.,  Sir  F.  Treves,  Bart.. 
K.C.V.O.,  C.B. 

It  is  announced  that  Sir  Trevor  Lawrence,  the 
treasurer  of  St.  Barthok>mew's  Hospital,  and  Mr.W.  H. 
-  Cross,  the  clerk  of  the  institution,  have  handed  in  their 
resignations,  with  intimation  that  they  are  willing  to 
carry  on  the  work  until  suitable  successors  have  been 
found. 


On  the  i8th  inst.,  Sir  Frederick  Treves  opened  a  new 
hospital  at  Crewkeme,  erected  at  a  cost  of  ;£s,ooo. 


Dr.  Amelia  Wilkes  Lines,  who  recently  celebrated 
her  eightieth  birthday,  is  the  oldest  practising  woman 
doctor  in  the  world.  She  was  the  first  woman  to  re- 
ceive a  diploma  in  the  State  of  New  York,  and  has 
practised  in  America  since  1854. 


Dr.  Byrom  Bramwsll  will  preside  at  the  dinner  of 
the  Edinburgh  University  Club  at  the  Criterion  Res- 
taurant, on  Wednesday,  November  9th,  1904.  Ticket  s 
may  be  obtained  from  the. Honorary  Secretaries,  James 
Taylor.  49  Welbeck  Street,  London^  W.,  and  G.  A. 
Sutherland,  73  Wimpole  Street,  W. 

Mr.  J.  Halsey  Morton  has  been  appointed  assistant 
secretary  to  the  Mount  Vernon  Hospital  for  Consump- 
tion and  Diseases  of  the  Chest,  Hampetead,  and  North- 
wood,  Middlesex. 


The  Fit2patrick  Lectures  t>efore  the  Royal  College 
of  Physicians  of  I^ndon  will  be  delivered  by  Dr.  J.  F. 
Pa^Tie,  w^hdse  first  lecture  will  deal  with  **  English 
Medicine  in  the  Anglo-Norman  Period  and  Gilbertus 
Ahglicns,"  while  the  second  lecture  will  discuss  "  Ricar- 
dus  Anglicus  and  the  Teaching  of  Anatomv  in  the 
Middle   Ages." 

The  Bradshaw  Lecture  before  the  same  College  will 
be  given  by  Dr.  F.  Foord  Caiger  on  November  15  th, 
on  '*  The  Treatment  of  Enteric  Fever,*' 


The  Horace  Dobell  Lecture  of  the  London  Physicians 
will  be  delivered  by  Dr.  E.  Klein,  F.R.S..  on  Novem- 
ber 22nd,  the  subject  being  "  The  Life-History  of 
Saprophytic  and  Parasitic  Bacteria  and  their  Mutual 
Relation." 


At  the  Royal  College  of  Surgeons  of  England  the 
Bradshaw  L^ecture  will  be  given  on  December  ist  by 
Mr.  A.IW.  Mayo  Robson,  vice-president,  on  "  Cancer  and 
its  Treatment  "  ;  and  the  Hunterian  Oration  by  the 
president,  Mr.  John  Tweedy,  on  February  14th,  1905. 


At  a  meeting  of  the  Aberdeen  University  Unionist 
Association  on  October  14th,  the  executive,  after  full 
•consideration  of  the  circumstances,  again  heartily  and 


unanimously  approved  of  the  prospective  candidature 
of  Sir  Henry  Craik,  K.C.B..  LL.D.,  and  at  the  same 
time  disavowed  any  connection  with  another  Associa- 
tion recently  formed  under  a  similar  title  to  their  own. 

Lord  BALForR  of  Burleigh,  Chancellor  of  the 
University  of  St.  Andrews,  on  Monday,  October  t/th, 
formally  opened  the  new  buildings  which  have  been 
erected  at  a  cost  of  £20,000  for  the  accommodation  of 
the  Medical  School  of  University  College,  Dundee, 
which  is  now^  an  integral  part  of  that  ancient  University. 

Of  the  total  cost  of  the  new  St.  Andrews  buildings 
the  University  Court  provided  ,1^14,000,  and  Sir  William 
OgUvy  Dalijleish  gave  a  donation  of  ;fS,ooo. 

The  annual  dinner  of  the  past  and  present  students 
of  the  National  Dental  Hospital  will  be  held  at  the 
Trocadero  Restaurant  on  Saturday,  November  19th, 
when  the  chair  will  be  taken  by  Mr,  Andrew  Clark, 
D.Sc,  F.R.C.S. 

Dr.  William  Cox,  of  Winchcombe,  Gloucestershire, 
who  has  given  his  services  to  the  parish  church  as 
honorary  choirmaster  and  organist  for  thirty- two  years. 
has  recently  been  presented  with  a  life-size  portrait  of 
himself,  together  with  a  tea  service  and  salver  in 
massive  silver. 


The  London  companies  of  the  Royal  Army  Medical 
Corps  (Volunteers)  will  attend  divine  service  at  St.  Bar- 
tholomew the  Great  on  October  30th,  when  a  sermon 
will  be  preached  by  the  Rev.  Sir  Borradaile  Savory, 
Bart.,  Rector  of  the  church  and  Acting  Chaplain  of 
the  companies. 

We  are  informed  that  the  Awards  Committe  of  the 
St.  Louis  Exhibition  has  conferred  upon  the  Wellcome 
Chemical  Research  Laboratories  a  grand  prize  and  three 
gold  medals,  in  recognition  of  the  importance  and  edu- 
cational value  of  the  chemical  and  pharmacognostical 
researches  conducted  under  the  direction  of  Dr. 
Frederick  B.  Power. 


Lieutenant-Colonel  Williamson.  R.A.M.C.,  at 
present  on  the  Aldershot  Medical  Staff,  has  been 
appointed  Administrative  Medical  Officer  in  India. 

Th£  Paris  Matin  announces  the  death  of  Dr.  Till^ux. 
Professor  of  Surgery,  President  of  the  Academy  of 
Medicine,  and  Grand  Officer  of  the  Legion  of  Honour. 

Dr.  Arthur  Newsomb  (Medical  Officer  of  Health 
for  Brighton)  last  week  delivered  an  address  at  the 
inaugural  meeting  of  the  York  Medical  Society,  select- 
ing as  his  subject  "  Social  Evolution  and  Public  Health.'* 

Special  (Corredpon&ence* 

[from  our  own  correspondent.] 


SCOTLA?tD. 
NEW  MEDICAL  SCHOOL  AT  DUNDEE. 
Lord  Balfour  of  Burleigh,  Chancellor  of  the 
University  of  St.  Andrews,  opened  the  new  buildings 
at  University  College,  Dundee,  on  the  17th  inst. 
Hitherto  the  development  of  medical  teaching  at 
Dundee  has  been  greatly  hampered  by  the  inadequacy 
of  the  premises  in  which  it  has  been  carried  on,  but  the 
new  accommodation  provided  will,  it  is  hoped,  meet 
all  demands  for  many  years  to  come.  Little  attention 
has  been  paid  to  architectural  adornment,  the  main 
object  having  been  to  secure  internal  efficiency  and 
convenience.  The  lecture-rooms  have  accommodation 
for  a  total  of  500  students,  and  there  is  a  specially  fine 
dissecting-room  equipped  with  all  the  most  modern 
appliances  for  the  teaching  of  anatomy.  Lord  Balfour, 
in  performing  the  opening  ceremony,  said  that  the  day 
marked  the  completion  of  the  first  step  which  was  in 
view — namely,  the  establishment  of  a  great  medical 


44^    "^Bs  Medical  Press. 


CORRESPONDENCE. 


Oct.  26,  19014. 


school  in  Dundee — when  the  union  between  St.  Andrews 
University  and  University  College,  Dundee,  was  first 
proposed.  Though  unforeseen  difficulties  had  arisen, 
the  union  was  finally  accomplished  in  1897,  at  which 
date  Dundee  had  chairs  which  provided  for  the  educa- 
tion of  students  during  the  first  two  years  of  their 
course.  After  the  union  new  chairs  were  added,  and 
now  a  complete  medical  curriculum  could  be  gone 
through  in  Dundee.  The  new  premises  had  cost  only  a 
little  in  excess  of  the  estimated  ^20,000  ;  they  would 
accommodate  classes  for  anatomy,  physiology,  patho- 
logy, materia  medica,  surgery,  obstetrics,  medical  juris- 
prudence, itc.  with  museums,  laboratories  and  class- 
rooms for  various  subordinate  subjects.  While  con- 
gratulating all  those  concerned  on  the  rapid  progress 
which  had  been  made  during  the  two  years  which  had 
passed  since  Mr.  Carnegie  laid  the  foundation-stone, 
Lord  Balfour  said  that  they  must  not  yet  think  they 
were  in  such  a  position  that  they  could  afford  to  "  rest 
and  be  thankful."  Other  important  developments 
were  to  be  inaugurated,  even  during  the  present  session. 
Property  had  been  acquired  which  was  about  to  be 
converted  into  a  University  library  and  a  students' 
union.  A  munificent  benefactor,  Mr.  Fleming,  of  London, 
had  given  a  large  sum  for  a  gymnasium  and  fives  court. 
The  speaker  concluded  by  hoping  that  the  new  medical 
school  would  fulfil  all  the  bright  future  foretold  for  it. 
Speeches  were  also  made  by  Principal  Donaldson,  the 
Earl  of  Camperdown,  and  Principal  Yule  Mackay,  spd 
the  proceedings  terminated  by  a  luncheon  at  which 
about  one  hundred  gentlemen  were  present. 

St.  Andrews  University  Rectorship. — ^At  a  recent 
meeting  of  the  students  there  was  a  practically  unani- 
mous opinion  expressed  in  favour  of  electing  Mr. 
Andrew  Carnegie  for  a  second  term  of  ofiice  as  Lord 
Rector.  The  name  of  Mr.  Andrew  I-ang  was  also  pro- 
posed ;  he  has  many  warm  friends  among  the  students, 
but  the  measure  of  support  given  him  at  the  meeting 
was  not  such  as,  meantime  at  least,  would  warrant  his 
nomination. 

Proposed  Age  Limit  at  the  Royal  Infirmary, 
Edinburgh.— It  is  understood  that  the  Joint  Committee 
of  the  managers  and  contributors  to  the  Royal  Infir- 
mary appointed  in  the  early  part  of  the  year  to  con- 
sider the  question  have  drawn  up  a  report  recommend- 
ing that  it  be  left  entirely  to  the  managers  to  grant  or 
refuse  applications  from  members  of  the  staff  for  an 
extension  of  five  years  in  their  appointments.  The 
original  proposal  was  that  the  physicians  ai^d  surgeons 
should  retire  at  sixty-five,  and  objection  was  then  taken 
to  the  exclusion  of  the  University  professors  from  the 
operation  of  the  rule.  Apparently  the  CoAimittee  have 
simply  reported  in  favour  of  the  status  q%U) — a  minority 
of  two  favoured  the  adoption  of  the  age  limit. 

Opening  ov  the  Session  at  Edinburgh  Univer- 
sity.— ^The  medical  classes  were  opened  for  the  winter 
on  the  1 8th,  for  the  most  part  without  any  formal  intro- 
ductory lectures,  the  professors  at  once  beginning  the 
year's  work.  Professor  Chiene,  however,  commenced 
his  lectures  on  surgery  by  an  address  on  the  respon- 
sibility of  surgeons,  and  Professor  Simpson  devoted 
the  first  lecture  of  the  course  on  obstetrics  to  a  his- 
torical sketch  of  the  teaching  of  midwifery  in  the 
eighteenth  century,  in  which  he  showed  that  the 
Edinburgh  chair  was  the  oldest  in  Europe,  its  date 
anticipating  that  of  the  Florentine  Chair  of  Midwifery 
(1728)  by  two  years. 

Queen  Alexandra  Sanatorium  at  Davos.— Lord 
Balfour  addressed  a  meeting  in  Edinburgh  in  favour  of 
this  object  on  October  i8th,  the  outcome  being,  in 
addition  to  the  intimation  of  several  substantial  dona- 
tions, the  formation  of  a  Committee  to  secure  help  for 
the  scheme  in  the  Edinburgh  district.  Since  the  Glas- 
gow meeting  was  held  about  a  week  ago  the  Lord 
Provost  of  Glasgow  has  received  nearly  £200  for  the 
same  object.  

A  SUM  of  nearly  ;£  15,000  has  now  been  received  on 
behalf  of  the  present  year's  collection  for  the  Hospital 
Saturday  Fund,  the  result  mainly  of  weekly  or  other 
periodical  contribution?  in  the  workshops,  Ac,  of 
London. 


Correspondence. 

[We  do  not  hold  oanelvca  rcq>oosnile  for  the  opiniOTs  of 
Oorrespondenta.] 


THE  TREATMENT  OF  INOPERABLE 
CANCER. 
To  the  Editor  of  The  Medical  Press  and  Circclar. 
Sir, — ^While  thanking  you  for  your  kind  reference 
to  myself  in  the  editonal  columns,  respecting  my 
paper,  ''  On  the  Treatment  of  Inoperable  Cancer  by 
Hypodermic  Medication,"  published  in  your  last  issue, 
I  would  like  to  make  it  plain  that  I  do  not  claim  to  be 
the  originator  of  this  method  of  treatment,  but  only 
to  draw  attention  to  the  use  of  chian  turpentine,  and 
to  the  use  of  the  soap  solution  of  Mr.  J.  H.Webb. of 
Melbourne,  in  this  connection. 

I  am.  Sir,  yours  truly, 

John  A.  Shaw-Mackenzie. 
42  Green  Street,  Park  Lane,  W.. 
October  20th,  1904. 


To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  your  "Notes  on  Current  Topics"  of  lastfweek, 
you  say  that  "  Dr.  Shaw-Mackeiude  has  made  the 
pioneer  move  in  the  necessary  experimentation."  •.«.. 
in  cancer.  Though  I  consider  this  an  exceedinglv 
small  matter,  as  experiments  with  hypodermic  injec- 
tions in  the  treatment  of  cancer  are  neither  original  to 
Dr.  Mackenxie  nor  to  myscdf ,  yet  for  the  sake  of  accu- 
racy I  would  like  to  say  that  I  suggested  to  Dr. 
Mackenzie  that  he  should  try  hypodermic  injections 
in  cancer,  and  told  him  what  I  was  then  using  in  that 
way. 

I  am.  Sir,  yours  truly, 

George  H.  Keith. 

7  Manchester  Square.  W.,  Oct.  21st,  1904. 

[The  modification  of  the  above-quoted  statement  had 
already  reached  .us  from  Dr.  Shaw-Mackenzie  himself. 
Our  reference  was  rather  to  the  particular  techmiqwt 
than  to  the  principle. — ^£d.] 

A  DISCLAIMER, 

To  the  Editor  of  The  Medical  Press  and  CiRcrLAR. 

SiR, — I  have  seen  an  article  in  your  paper,  entitled 
"  Eye  Massage,"  in  which  occurs  the  following  sen- 
tence : — **  Under  the  leadership  of  Mr.  Stephen  Cofe- 
ridge,  they  (the  anti-vivisectionists)  have  practijalfjr 
declared  war  to  the  knife  with  the  medical  professioB." 

I  desire  to  say  that  I  have  never  in  my  hie  attacked 
the  medical  profession,  and  I  shall  therefore  feel  obliged 
if  you  will  ht  so  good  as  to  produce  any  utterance  of 
mine  that  you  think  affords  you  any  justification  for 
this  statement  of  yours. 

I  have  been  told  that  there  are  some  thirty  or  fortf 
thousand  members  of  the  medical  profession,  and  I 
know  there  are  but  359  licensed  vivisectors  in  this 
country,  and  not  even  all  of  these  hold  medical  degrees. 

You  might  with  as  much  justice  accnae  a  man  <rf 
attacking  the  art  and  profession  of  music  because  he 
objects  to  hurdy-gurdies. 

As  to  Mr.  Stephen  Smith  and  eye  massage,  as  the 
National  Anti- Vivisection  Society  which  I  represent 
and  I  myself  individually  have  never  had  any  connec- 
tion of  any  kind  with  the  Anti- Vivisection  Hospital. 
I  fail  to  see  why  my  name  should  be  introduced  into 
your  article  on  the  subject. 

I  am.  Sir,  yours  truly, 

Stephen  Coleridge. 

92  Victoria  Street,  London,  S.W., 
Oct.  1 8th,  1904. 

[We  insert  the  above  letter  with  pleasure,  as 
we  should  be  sorry  to  treat  an  opponent  in  any 
way  open  to  a  suspicion  of  unfairness.  We  do  not, 
of  course,  hold  the  Hon.  Stephen  Coleridge  respon- 
sible for  all  the  acts  of  anti-vivisectionists  gener- 
ally, nor  did  we  state  that  he  or  the  National  Anti- 
vivisection  Society  were  particularly  concerned  in  the 
establishment  of  the  Anti-vivisection  Hospital.  He 
will,  however,  excuse  us  for  designating  him  as  leader 


Oct.  26,  1904. 


CORRESPONDENCE. 


449 


of  the  anti-vivisectibn'movement.  although  many  anti- 
vivisectionists  do  not  follow  his  banner,  for  since  Miss 
■Cobbe's  retirement  he  has,  by  his  energy  and  champion- 
ship, come  to  be  regarded  as  the  protagonist  of  the 
cause.  As  Mr.  Coleridge  has  lost  few  opportunities 
of  attacking  hospitals  with  medical  schools  attached 
to^them — institutions  which  are  representative  of  all 
that  is  best  in  the  thought  and  feeling  of  the  medical 
profession — ^besides  many  medical  men  from  Lord  Lister 
-downwards,  he  can  hardly  complain  that  he  is  misrepre- 
sented when  we  say  he  "  practically  "  wages  war  agamst 
the  medical  profession.  A  man  who  continually 
attacks  hurdy-gurdies  may,  not  improperly,  be  said  to 
be  waging  war  with  the  organ-grinding  profession.  The 
principle  of  trying  to  divert  public  subscriptions  from 
hospitals  in  which  any  member  of  the  staff  has  ever 
performed  an  experiment  on  a  lower  animal  is  one 
against  which  we  protest,  and  as  late  as  September  20th 
of  this  year  Mr.  Stephen  Coleridge  attempted  to  in- 
fluence such  a  diversion  of  funds  by  letters  to  the  Daily 
News  and  Morning  Leader.  The  gross  statistical  fallacy 
by  which  Mr.  Coleridge  arrived  at  the  results  he  put 
forward  in  that  letter  were  exposed  by  Mr.  Dowton  at 
the  time. — Ed.] 

THE  MIDWIVES  ACT. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — ^The  Midwives  Act,  as  you  are  ai^are,  has  very 
seriously  altered  the  position  of  the  medical  man  with 
regard  to  the  practice  of  midwifery,  the  greater  part  of 
^which  will  probably  in  the  future  be  done  by  registered 
midwives.  The  Act  compels  the  midwife,  under  certain 
scheduled  conditions,  to  demand  the  assistance  of  a 
medical  man,  and  to  state  in  writing  the  nature  of  the 
necessity.  The  Act  does  not,  however,  make  any 
a^rrangement  for  the  payment  of  the  doctor's  fees,  nor 
is  it  compulsory  on  the  doctor  to  obey  the  midwife's 
-summons. 

The  Medical  Guild  has  fuUy'considered  the  question, 
and  at  the  last  quarterly  meeting  the  following  resolu- 
tion was  adopted  : — "  That  when  medical  practitioners 
choose  to  attend  confinements  at  the  request  of  mid- 
-wives  the  minimum  fee  charged  should  be  a  guinea,  to 
T^e  paid  at  the  time  when  possible.  This  should  be  car- 
ried out  for  the  present  as  a  tentative  arrangement 
till  fresh  legislation,  dealing  with  medical  fees,  has  been 
brought  forward." 

The  whole  question  is,  of  course,  in  a  transitory  .stage, 
and  it  is  important  not  to  do  anything  against  the 
interests  of  the  profession  by  ill-considered  individual 
action,  especially  by  cutting  down  the  minimum  fee. 
We  are.  Sir,  yours  truly, 
D.  Owen, 
J.  H.  Tavlor, 
;       Hon.  Sees,  of  The  Medical  Guild. 
Manchester,  October,  1904. 

[We  entirely  approve  of  the  attitude  adopted  by 
the  Medical  Guild  with  regard  to  this  important  matter, 
and  desire  to  urge  strongly  on  medical  men  the  neces- 
sity for  united  action.  If  a  firm  stand  is  made  now, 
the  public  will  be  compelled  to  recognise  the  rights  of 
the  medical  profession.  Otherwise,  an  attempt  will  be 
made  to  establish  a  custom  of  medical  attendance  in 
these  cases  at  a  ridiculous  fee. — Ed.] 


PROPOSED  STERILISATION  OF  CERTAIN] 

DEGENERATES. 

To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  your  issue  of  October  loth,  you  refer  to  the 
above  grave  question  under  the  somewhat  sensational 
heading.  "  A  Short  Way  With  Lunatics."  Now  such  a 
heading  is  hardly  in  keeping  with  that  fair  style  we  are — 
thank  Heaven  ! — accustomed  to  meet  with  in  The 
Medical  Press  and  Circular.  If  I  adopt  your 
description-—"  A  Short  Way  With  Lunatics  "—it 
would,  to  me  at  least,  mean' that  lunatics  are  to  be 
killed.  Had  you  said,  "  A  Short  Way  With  Lunacy" 
no 'one  could  honestly  object. 

I  am  more  than  pleased  to  see  that  Dr.  F,  J.  Smith — 


recognising  that  lunacy  and  other  forms  of  degeneracy 
are  so  greatly  on  the  increase  and  that  there  is  no  real 
cure — has  followed  me  in  adopting  my  suggestion  of 
sterilisation  of  special  degenerates.  I  would,  however, 
differ  just  a  little  from  him.  He  advisei  that  a  woman 
with  puerperal  mania  who  has  murdered  her  child  should 
undergo  oophorectomy.  I  would  not  wait  in  such  case 
for  the  murder  of  her 'child.  If  she  developed  insanity 
during  pregnancy,  the  puerperium,  or  suckling,  I  would 
advise  that  she  be  forthwith  sterilised,  and  I  question 
if  it  would  not  be  a  good  thing  for  our  race  if  abortion 
were  brought  on  if  she  developed  insanity  a  few  months 
after  conception.  Dr.  Smith's  plan  of  waiting  until 
the  child  IS  murderrd  is,  perhaps,  good,  in  so  far  as  it 
would  prevent  the  poor  degenerate  child  from  living 
under  a  mental  curse  handed  down  from  its  parent,  or 
even  becoming  ultimately  a  mother.  I  would,  however, 
•suggest  that  the  child  be  sterilised.  Please  note,  I  do 
not  for  an  instant  suggest  that  Dr.  Smith  advocates  the 
kilHng  of  the  child  by  its  insane  mother.  I  have  come 
in  contact  with  so  much  cackling  and  garmlous  accusa- 
tions of  having  advocated  suicide  by  the  insane,  when 
I  published  my  book  upon  the  above  proposal,  that  I 
am  now  willing  to  labour  a  point  with  words,  so  that 
the  meanest  intellects — if  honest — can  understand. 
I  am,  Sir,  yours  truly, 

Robert  R.  Ren'toi'l. 
Liverpool,  October  22nd.  1904. 

ALCOHOL  AND  INSANITY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — As  a  temperance  reformer,  let  me  first  thank 
you  for  the  attention  and  ablie  treatment  which  the 
question  of  the  abuse  of  alcohol  constantly  receives  in 
your  paper.  The  l^ture  by  Dr. ' Clouston,  published 
in  The  Medical  Press  and  Circular  of  October  12th, 
furnishes  most  powerful  arguments  to  the  cause  of 
temperance,  and  the  value  of  these  arguments  would 
not  be  much  discounted  if  the  suggestion  made  by 
Dr.  Walsh  to-day  (October  19th)  were  to  turn  put 
correct.  Whether  in  some  instances  incipient  insanity 
develops  dipsomania,  or  in  other  cases  alcoholism  pro- 
duces insanit3^  it  is  equally  evident  that  much  good 
would  be  done  if  drinking  could  be  diminished,  or,  at 
least,  if  no  alcoholic  drink  should  be  procurable  save 
such  as  is  of  the  purest  and  least  toxic  manufacture. 
The  harm  done  by  beer  is  infinitesimal  compared  to 
that  brought  about  by  the  raw  spirits  which  the 
majority  of  drunkards — the  poorer  classes — consume. 
It  is  spirit-drinking  which  carries  most  to  ruin,  and  the 
ruin  is  more  quickly  and  certainly  brought  about  owing 
to  the  fact  that  the  spirit  is  crude",  unrefined,  and  loaded 
with  fusel  oil  and  other  kinds  of  impurity.  I  am  not 
a  believer  in  the  power  of  laws  to  do  away  xvith  drun- 
kenness, but  I  think  the  Legislature  might  well  attempt 
to  prevent  the  sale  of  all  alcoholic  drinks  which  by 
their  preventable  impurity  act  as  powerful  poisons 
upon  the  pitiable  victims  of  drink  craving. 
I  am.  Sir.  yours  truly, 

A  Temperance  Reformer. 

October  19th,  1904. 


PUBLIC  SCHOOLS  AND  FLOGGING. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — ^Why  is  it  that,  in  almost  every  controversy  on 
the  fiogging  question,  some  public  school  man  comes 
forward  to  assure  the  public  that  he,  even  he,  was 
himself  flogged  in  his  boyhood  ?  Does  he  do  so  from  a 
philanthropic  desire  to  supply  an  element  of  comedy 
to  a  somewhat  dry  discussion  ?  Or  does  he  imagine 
that  his  own  early  birchings  are,  in  some  mysterious 
way,  really  relevant  to  the  point  at  issue  ?  Thus,  in 
the  recent  inquiry  into  the  birching  scandal  at  the 
Sparkhill  Police  Court,  Biriningham,  the  Chairman,  Mr. 
R.  H.  Amphlett,  K.C.,  is  reported  to  have  observed 
that  "  he  knew  the  birch  verj'  well  when  he  was  at 
Eton."  I  can  quite  believe  it ;  but  what  possible 
bearing  has  it  on  an  inquiry  into  the  conduct  of  a 
superintendent  of  police  who  birched  a  boy  illegally  ? 
Can  it  be  that  these  gentlemen  who  obtrude  their 


450    Thb  Medical  Peess. 


MEDICAL  NEWS. 


Oct.  26.  1904 


private  experiences  in  a  public  discussion  intend  us  to 
understand  that,  in  view  of  the  superlative  excellence 
to  which  they  have  now  attained,  any  punishment 
which  they  undenvent  in  youth  must  of  necessity  be 
good  for  other  people,  whether  in  itself  legal  or  illegal  ? 
If  that  be  their  meaning,  the  reasoning  does  not  seem 
very  cogent ;  indeed,  their  lack  of  logic  raises  sad  sus- 
picions that  they  were  birched  in  vain.  We  prefer  to 
think  that  they  merely  wish  to  enliven  the  proceedings 
by  a  jocose,  though  irrelevant  remark.  Perhaps  Mr. 
Amphlett  will  enlighten  us  ? 

I  am.  Sir,  yours  truly. 

Puzzled. 

October,  1904. 

[The  use  of  the  birch  generally  is  a  subject  on  which 
the  views  of  the  medical  profession  could  hardly  fail 
to  be  most  interesting  and  valuable. — ^£d.] 

•PUBLIC  OPINION"  AND  THE  HOSPITAL 
PENNY  FUND. 
To  the  Editor  of  The  Medical  Press  and  Circular, 
Sir, — Owing  to  the  fact  that  the  above  fund  has  been 
severely  attacked  by  the  Hospital  and  various  other 
newspapers,  we  should  be  glad  if  you  will  make  the 
following  fact  known  through  the  medium  of  your 
journal.  The  principal  of  these  attacks  has  been  that 
25  per  cent,  of  the  total  received  for  the  hospital 
stamps  goes  into  the  promoter's  pockets.  This  is  not 
the  case ;  the  whole  of  the  prizes  and  expenses  in  the 
administration  of  the  fund  is  paid  out  of  the  25  per 
cent,  in  question,  and  this  absorbs  that  amount,  which 
has  been  arrived  at  after  very  careful  consideration. 

Mr.  George  Herring,  who  has  been  concerned  in 
almost  every  class  of  scheme  for  obtaining  money  for 
the  hospitals,  Mrrites  us  as  follows : — 

Dear  Sir, — I  think  your  opponents  have  treated 
the  scheme  unfairly.  If  they  objected  on  the  score 
of  its  being  immoral  to  give  prizes  in  the  cause  of 
charity,  it  is  a  point  which  each  person  must  judge 
for  himself;  but  if  on  the  score  of  the  deduction  of 
25  per  cent..  I  confess  candidly  that  at  bazaars  and 
other  society  methods  of  collecting  money  for  chari- 
ties, upwards  of  50  per  cent,  is  frequently  deducted  for 
expenses.  I  faU  to  see  the  objection  to  your  de- 
ducting the  25  per  cent.  Then,  as  I  understand, 
you  propose  to  deposit  or  properly  guarantee  the 
^5,000  prizes,  therefore  the  hospitals  must  benefit 
to  the  extent  of  ;£  15,000  before  you  are  recouped. 
It  is,  therefore,  you  that  run  the  risk,  and  in  my 
mind  a  great  risk,  as  you  are  opening  up  fresh  ground 
which  can  only  be  worked  by  an  army  of  energetic 
workers,  who  expect  money  prizes,  and  do  not  work 
for  charity  only,  but  for  themselves.  Hence,  I  see  no 
objection  to  the  25  per  cent.  Having  written  you 
my  views  I  yet  counsel  you  not  to  force  the  scheme, 
if  the  hospitals  are  not  in  favour  of  it,  as  I  think  the 
public  will  not  take  your  side  against  the  general 
verdict. — Yours  truly. 

(Signed)  George  Herring. 
1  Hamilton  Place,  Piccadilly.  W. 

October  13  th,  1904. 
Upon  tbiB  letter  we  had  lengthy  interviews  with 
Mr.  Herring,  who  is  thoroughly  interested  in  the  scheme, 
and  considers  it  should  be  atxepted  in  a  universal  way. 
Mr.  Herring  is  further  strictly  in  siccord  with  our  views 
on  the  suggestion  made  by  the  Hospital  in  the  last 
week's  issue  of  that  journal,  in  calling  a  meeting  of 
the  leading  authorities  of  the  whole  of  the  London 
hospitals.  We  arc  taking  an  early  oppCM-tunity  of 
doing  this,  and  the  meeting  will  be  acnnounced  in  the 
course  of  a  few  days. 

Other  important  announcements  will  be  made  at 
this  meeting,  which  we  hope  will  satisfy  both  the 
hospitals  and  the  Press  as  to  the  genuine  work  of  the 
fund. 

I  am.  Sir,  yours  truly, 
The  Hospital  Penny  Fund, 
M.  H.  Goldman.  Secretary. 
13  Henrietta  Street,  and  31  Maiden  Lane,  W.C. 
October  19th,  1904. 


[The  principal  objections,  so  far  as  we  know,  that 
have  been  made  to  this  scheme  advocated  by  Public 
Opinion,  is  that  (a)  a  large  percentage  of  receipts  (ail 
to  reach  the  hospitals;  (h)  a  big  advertisement  is 
secured  for  the  journal  concerned  ;  (c)  the  Committee 
is  not  sufficientlv  representative  either  of  the  medical 
charities  or  of  the  public  ;  {d)  the  prize  system  is  bad. 
Without  here  going  into  the  merits  of  the  case  it  may- 
be stated  broadly  that  {c)  and  {d)  seem  to  us  the  most 
pertinent  points  for  inquiry. — Ed.] 

^Mtnatv* 

ROGER   PORTINGTON  GOODWORTH,    J.P., 
M.R.C.S..  L.S.A. 
We  regret  to  announce  the  death  on  October  jth 
of  Dr.   Roger  Portington  Goodworth,   of   Winterton, 
near  Doncaster.     Bom  in  1846.  Dr.  Goodworth  was 
a  son  of  William  Henry  Goodworth.  a  surgeon  in  the 
West    Riding   of   Yorkshire.     Later    he    entered    the 
medical  school  of  the  London  Hospital,  whence  he  took 
the  qualification  of  M.R.C.S.Eng..   L.S.A.Lond.,   and 
L.R.C.P.Edin.  in  1876.  and  not  long  afterwards  went 
into  partnership  with  the  late  Mr.  Sadler  of  Winterton. 
Dr.  Goodworth  was  appointed  a  Justice  of  the  Peace 
for  the  County  of  Lincoln,  and  also  served  for  some 
years  upon  the  County  Council.     In  politics  he  was  a. 
Conservative,  while  he  was  a  strong  supix>rter  of  the 
Established    Church.     A    man    of    wide    sympathies, 
he  has  left  a  large  circle  of  friends  and  patients  to  lament 
his  loss.     He  is  succeeded  by  Frederick  Henr>'  Hand. 
M.D..  M.R.C.S. 

DR.  FREDERICK  HENRY  Hl^ME. 
Dr.  Frederick  Henry  Hume,  of  Islington,  who 
died  early  last  month,  devoted  the  greater  part  of  his 
professional  career  to  work  in  that  neighbourhood.  A 
student  of  St.  Thomas's  Hospital  Medical  School,  he 
became  M.R.C.S.Eng.  and  L.S.A.  in  1864.  and  gradu- 
ated M.D.  some  twenty  years  later  at  St.  Andrews. 
He  was  a  man  of  great  energies,  and  held  a  large  num- 
ber of  appointments,  which  he  conscientiously  attended 
to  until  a  few  years  ago,  when  be  became  crippled  with 
gout. 

DR.    J  AS.    B.    RUSSELL.    OF    EDINBURGH. 

The  death  has  occurredj  at  Edinburgh,  of  Dr.  James 
Burn  Russell,  in  his  sixty-seventh  year.  He  gradaated 
at  the  University  of  Glasgow  in  1858,  and  was  elected 
a  Fellow  of  the  Glasgow  Faculty  of  Physicians  in  1869. 
For  many  years  he  held  the  office  of  Public  Officer  of 
Health  at  Glasgow,  and  was  the  first  to  bring  into  pro- 
minence in  that  city  the  question  of  the  housing  of  the 
poor.  Six  years  ago  he  left  Glasgow  for  Edinburgh, 
when  he  was  appointed  medical  member  of  the  Local 
Government  Board  for  Scotland. 


AeMcal  Vlewa. 


Royal  Con#go  of  Phsrtlef  ans  of  IrMand.' 

At  the  stated  annual  meeting  of  the  Royal  College 
of  Physicians  of  Ireland,  held  on  St.  Lnke's  Day.  the 
following  ofiicers  were  elected  for  the  coming  yw : — 

President.—'^.  J.  Smyly,  M;D. 

Vice-President. — E.  E.  Lennon. 

Censors, — E.  E.  LenuoA,  Alfred  R.  Parsons,  M.D., 
J.  H.  R.  Glenn,  M.D.,  W.  R.  Dawson,  M.D. 

Additional  examiners  to  take  the  place  of  an  absent 
censor  or  examiner. — ^Medicine :  W.  J.  Thompson.  M.D.: 
Midwifery :  W.  C.  Nevill.  M.D. ;  Medical  Jurispru- 
dence and  Hygieiie :    A.  Nixon  Montgomery. 

Hxamifier  for  the  Licence  to  Practise  Midwifery.— 
A.  J.  Home,  Henry  JeUett,  M.D. 

Examiners  for  the  Membership. — Clinical :  J.  Magee 
Finny,  M.D..  E.  E.  Lennon ;  Practice  of  Medicine. 
Walter  G.  Smith,  M.D.,  Alfred  R.  Parsons,  M.D.; 
Pathology :    H.  C.  Earl,  M.D.,  A.  C.  O'SuUivan.  M.D. 

Additional  Examiners  under  the  Conjoint  Examina- 
tion Scheme. — Biology  :   E.  MacDowel  Cossjrave,  M.D. ; 


Oct.  26.  1904. 


MEDICAL  NEWS. 


The  Medical  Pkess.    451 


Chemistry :  Professor  Lapper,  N.  M.  Falkinef,  M.D.  ; 
Physics  :  George  J.  Peacocke,  M.D. ;  W.  A.  Winter, 
M.D. ;  Pharmacy,  Materia  Mejdica,  and  Therapeutics  : 
H.  C.  Dniry,  M.D.,  Martin  Dempsey,  M.D. ;  Physio- 
logy, H.  C.  Earl.  M.D. ;  Pathology :  A.  C.  O'SuUivan, 
M.D. ;  Medicine:  J.  Mvirphy,  R.  Travers  Smith, 
M.D. ;  Hygiene  and  Forensic  Medicine,:  Henry  T. 
Bewley,  M.D. 

Examifters  for  Afo  Conjoint  Diploma  in  Public  Health. 
— Meteorology,  Sir  John  Moore,  M.D. ;  Hygiene: 
Henry  T.  Bewley,  M.D. ;  Chemistry  :  Prof essor  Lapper. 

Extern  Examiners  in  Preliminary  Education. — Pro- 
fessor W.  E.  Thrift,  F.T.C.D .,  Mr.  William  Kennedy 
K.T.C.D. 

Representative  on  the  General  Medical  Council. — ^Sir 
John  Moore,  M.D. 

Representatives  on  the  Committee  of  Management. — 
J.  M.  Finny,  M.D.,  Walter  G.  Smith,  M.D.,  James 
Craig,  M.D. 

Treasurer,  H.  T.  Bewley,  M.D. ;  Registrar,  James 
Craig,  M.D. ;  Librarian,  R.  G.  J.  Phelps ;  Architect, 
A.  E.  Murray,  C.E. ;  Law  Agents,  Messrs.  Stephen 
Gordon  and  Son;  Agent  to  the  Trust  Estate,  C.  U. 
I'ownshend,  J. P. 

Dr.  J.  A.  Matson,  Dr.  T.  P.  C.  Kirkpatrick,  and  Dr. 
F.  C.  Purser  were  elected  Fellows  of  the  College. 

In  the  evening  the  annual  banquet  of  the  President 
and  Fellows  took  place  in  the  College  Hall. 

The  New  President  of  Queen's  CoUeffe,  Cork. 

As  we  go  to  press,  it  is  officially  announced  that  Dr. 
Bertram  Coghill  Windle  has  been  appointed  to  the 
Presidency  of  the  Queen's  College,  Cork,  in  succession 
to  Sir  Rowland  Blennerhassett,  Btutt.,  who  has  resigned. 
Professor  Windle  is  a  distinguished  Irishman.  He  was 
educated  at  Trinity  College,  Dublin,  and  subsequently 
held  different  anatomical  posts  in  Ireland  and  England, 
until  finally  he  was  elected  Professor  of  Anatomy  in 
the  University  of  Birmingham.  He  is  also  a  member 
of  the  General  Medical  Council. 

Royal  CoUoffe  of  iurareoDs  of  Enfflaad. 

Notice  wiU  be  found  in  another  column  of  the  annual 
meeting  of  Fellows  and  Members  of  the  College,  which 
will  be  held  on  Thursday,  November  17  th,  at  3  p.m. 
when  a  report  from  the  Council  will  be  laid  before  the 
meeting.  Fellows  and  Members  can  obtain  copies  of 
the  report  on  application  to  the  Secretary,  and  can, 
if  they  so  desire,  register  their  names  as  wishing  to 
receive  the  Report  annually.  A  printed  copy  of  the 
■  a)<enda  will  be  issued  to  any  Fellow  or  Member  who 
may  apply  for  one  on  or  after  November  14th. 
Freneh  Asylum  Soaadal. 

A  SENSATIONAL  case  will  shortly  come  before  the 
Paris  Courts  in  which  revelations  are  expected  regard- 
ing the  conduct  of  lunatic  asylums.  An  action  is 
being  brought  by  Mdme.  Pierron  against  her  husband 
for  illegal  detention  in  an  asylum.  The  Pierron  couple 
-were  adways  quarrelling,  and  it  was  alleged  that  M. 
Pierron  got  a  lunacy  certificate  signed  by  Dr.  I^urens, 
and  then  informed  the  police,  w^ho,  in  face  of  the  certi* 
ficate,  ordered  the  lady  to  an  asylum.  After  three 
days,  however,  the  medical  officer  of  the  asylum.  Dr. 
Gamier,  examined  her,  and  pronounced  her  to  be  sane. 
She  was  accordingly  released,  but  meanwhile  the 
husband  had  sold  up  the  home  and  disappeared. 
After  a  long  illness.  brougl|t  on  by  her  sufferings,  Mdme. 
Pierron  commenced  an  action.  Dr.  Laurens  being  sued 
also  for  compLrity. 

Largest  Hospital  in  the  World. 

The  new  infirmary  in  Berlin  promises  to  be  the 
largest  hosp't?!  in  the  world.  When  finished  next 
year  it  will  contain  2,000  beds.  In  connection  with 
the  hospital  which  will  be  knoM'n  as  Rudolph  Vir- 
chow's  Krai'i*enhaus.  there  will  be  a  pathological 
and  anatomical  institute,  a  medico-mechanical  in- 
stitute, a  magnificently-appointed  pharmacy,  and  a 
separate  house  for  Rontgen-ray  appliances.  The  en- 
tire staff  of  physicians,  nurses  and  servants  will  number 
650.  There  wiU  also  be  a  school  for  training  nurses. 
The  largest  hospital  at  present  in  Germany  is  near 
Hamburg,  with  i  ,630  beds.  The  new  hospital  will  not 
only  be  the  largest  in  the  world,  but  its  builders  boast 


that  from  h^^gienic  and  sanitary  points  of  view  it  will 
surpass  all  others,  both  in  Europe  and  America. — 
Chronicle, 

Awards  at  the  St.  Louis  Exhibition. 

Gratifying  evidence  of  the  recognition  extended  toi- 
British  commercial  enterprise  is  furnished  by  the 
honours  awarded  by  the  Committee  of  the  St.  Louis 
Exhibition  to  Messrs.  Burroughs  Wellcome  and  Co.'s. 
exhibit  of  "  Wellcome  "  Brand  Chemicals.  "  Tabloid  " 
and  other  pharmaceutical  products,  and  *'  Tabloid  " 
and  medical  equipments.  Three  grand  prizes  and  three 
gold  medals  have  been  conferred  for  the  scientific  ex- 
cellence of  these  products.  The  same  firm  has  also- 
been  awarded  for  its  Wellcome  Chemical  Research 
Laboratories  the  distinction  of  a  grand  prize  and  three 
gold  medals,  in  recognition  of  the  importance  and 
educational  value  of  the  chemical  and  pharmacognos- 
tical  researches  conducted  in  these  laboratories  under 
the  direction  of  Dr.  Frederick  B.  Power.  Also  one 
grand  prize  and  one  gold  medal  for  the  Wellcome 
Physiological  Research  Laboratories  for  bacterio- 
logical research  and  preparations,  and  for  educational 
work.  The  Grand  Prix  has  been  awarded  to  the 
ApoUinaris  Company,  Limited,  for  the  Apollinaris 
natural  mineral  water. 

Mr.  Wm.  Martindale,   manufacturing    chemist,    of 
London,   has  been   awarded  a  Silver  Medal   for    his 
exhibit  of  fine  chemicals,  pharmaceutical  products  and 
emergency  preparations.  Galenical  and  surgical. 
The  Royal  Waterloo  Hospital  for  Children  and  Women. 

The    Royal   Waterloo    Hospital  for   Children    and' 
W^omen   is   being  rebuilt   and  enlarged,   and  is   now 
rapidly  approaching  completion.  The  following  have  re- 
cently announced  their  gracious  intention  of  becoming 
patrons  of  this  Institution : — T.R.H.   the  .Duke  and 
Duchess   of  Connaught,    H.R.H.    Princess    Henry   of 
Battenberg,  H.R.H.  Princess  Frederica   Baroness  |Voa 
Pawel  Rammingen,  T.S.H.  Prince  and  Princess  Alexan- 
der of    Teck,  H.R.H.  the     Grand    Duke     of   Hesse, 
H.R.H.  Prince  Charles  of    Denmark,  H.R.H.  Princess 
Charles    of    Denmark,    H.R.H.    the    Crown    Princess 
of  Greece.     The  above  list  is  in  addition  to  T.M.  the 
King  and  Queen,  T.R.H.  the  Prince  and  Princess  of 
Wales,   H.R.  and  I.H.   the  Duchess  of  Saxe-Coburg. 
and  Gotha.  H.R.H.  the  Princess  Christian  of  Schleswig- 
Holstein,  H.R.H.  The  Duchess  of  Albany,  and  H.M. 
the  Queen  of  the  Hellenes,  who  for  many  years  have 
most  graciously  given  their  patronage  and  support. 
Jervis  Street  Hospltol,  Dubltii. 

At  3  meeting  of  the  Governors  of  this  Hospital,  on 
October  17  th,  Mr.  Mathew  Burke  Savage  was  unani- 
mously elected  physician  to  the  hospital  in  the  room, 
of  Dr.  W.  J.  Martin,  who  has  resigned,  and  Mr.  J.  F.  L. 
Keegan,  surgeon  to  the  hospital,  in  the  room  of  the- 
late  Dr.  J.  J.  Cranny. 

Kioff  Edward's  Coronation  National  Fund  for  Nurses. 

A  MEETING  of  the  Council  of  the  above  society  was 
held  on  the  12th  inst.  The  Right  Hon.  the  Earl  of 
Mea^h,  President  of  the  Council  of  Management,  pre- 
sided. The  hon.  treasurer's  accounts  for  the  quarter 
ending  October  nth  ^ere  read  and  passed,  and  appli- 
cations for  membership  from  nurses  were  considered 
and  confirmed.  The  hon.  secretaries  drew  the  atten- 
tion of  the  council  to  the  fact  that  the  subscription  of 
the  nurses  as  members  and  the  interest  of  the  money 
invested  was  not  sufficient  to  allow  the  society  to  render 
help  as  freely  as  it  would  wish  to  those  nurse  members 
who  are  incapacitated  through  ill-health.  The  council 
appointed  a  sub-committee,  consisting  of  Sir  Andrew 
Reed,  K.C.B.,  Sir  William  Thomson.  C.B.,  F.R.C.S.,. 
Mr.  Andrew  Beattie,  D.L.  and  hon.  secretaries  with^ 
power  to  add  to  their  number,  to  consider  the  matter. 


We  regret  to  learn  that  Dr.  Hewetson,  of  Reigate, 
was  seriouslyi  njured  in  a  motor-car  collision  on^onday. 
Both  he  and  his  servant  were  thrown  violently  to  the 
ground,  and  on  examinationby  Dr.  Ross  to  whose  house 
he  was  taken,  it  was  found  that  he  had  received  such 
injuries  internally  that  it  was  impossible  to  re- 
move him.  The  servant  was  also  cut  about  the  legs>. 
and  the  car  was  smashed. 


452    The  Medical  Press.         NOTICES  TO  CORRESPONDENTS. 


Oct.   26.  1904. 


£LiAm6  to 
(^oxtt&povibtvASf  ^hort  ^tetters,  ^ 

f^^  OOBABSPONDBMn  req«iriiiff  »  reply  in  this  oolumn  are  purtloa- 
Iftrly  requested  to  nubke  use  of  s  diMneHv9  Signatwn  or  Initial,  and 
4tvokl  the  practice  of  sigrning  themselves  "Beader,"  "Subscriber," 
•*  Old  Subscriber."  8to.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

<lu«iiiAL  Akticlbs  or  Lrtrrs  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  publida- 
tion,  but  as  evidence  of  identity. 

BtPUinv.—Reprints  of  articles  appearinfr  in  this  Journal  can  be  bad 
At  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

THE  VERNON  HABCOURT  INHALER. 

A  correspondent  has  drawn  our  attention  to  a  recent  death  luide' 
•chloroform  at  University  College  Hospital.  He  writes  as  follows:— 
'*  What  about  the  Vernon  Harcuurt  Inhaler  ?  The  Hospital  where 
this  c  sualcy  occurred,  being  the  home  of  that  Apparatus,  It  would  be 
interesting  to  learn  has  it  been  used  in  that  case  ?  If  not,  why  not  ?  " 
The  newspaper  cutting  enclosed  by  our  correspondf  nt  did  not  state 
how  the  chloroform  was  administered.  It  would  be  interesting  to 
4kacertain  the  point,  which  no  doubt  would  be  readily  done  by  the 
hospital  authorities.  The  question  of  safety  in  anasthetics  is  one  of 
supreme  importance  and  the  inventor  of  the  appliaoce  in  question 
is  mr  too  scientidc  a  man.  to  treat  adverse  facts -if  present— in  any- 
thing but  a  spirit  of  absolute  candour. 

Stbathcona's  Horss.— a  correspondent,  B.A.110.,  asks  if  any 
special  prevalence  of  alopecia  areata  has  been  noted  in  connection 
vSuiti  the  late  South  African  War.  In  reply  it  mav  be  stated  that  a 
dermatologist  whom  we  have  consulted  has  met  with  a  large  number 
of  oases.  The  wearing  of  close  fitting  uniform  caps,  sometimes  for 
weeks  together,  and  the  difficulties  in  the  way  of  personal  cleanliness 
wouldi  to  a  great  extent,  account  for  the  existence  of  the  malady  in 
unusual  amount.  Enteric  fever  would  be  another  i^redispoeing 
factor. 

L.S.A.  (Bournemouth).— The  enterprising  Bournemouth  firm  that 
offered  t  wen ty  per  cent,  commission  to  all  clergymen  upon  sales  of 
•  J>r.  Auzona^s  Remedy  for  Gout,"  may  now  karn  the  composition  of 
that  vaunted  specific.  An  analysis  of  the  nostrum,  recently,published 
in  the  t*h^rmac*utieal  Journal  shows  it  to  consist  mainly  of  syrup  of 
4>uckthorn  and  citric  acid.  In  a  medical  journal  further  comment  is 
unnecessary.  ▲  prosecution  for  fraudulent  pretences  in  rei)reaenting 
A  compound  of  that  kind  as  curative  of  gout  might  oonceivably  be 
sustamed  in  a  court  of  Justice. 

AxTi-QuACE  (Wandsworth).— We  understand  that  in  New  York, 
the  public  is  becoimug  al&rmed  by  the  enormous  extent  of  the 
spurious  drug  business  Chemists  complain  that  the  revelations 
-have  led  to  a  general  decline  in  their  legitimate  business.  Amongst 
the  incriminating  papers  seised  is  a  circular  for  druggists'  use,  con- 
taining a  list  of  thirty-seven  drugs  and  illegal  articles  put  up  to 
imitate  genuine -land  vastly  more  expensive  goods.  It  is  only  a 
matter  of  time  for  any  thinking  and  self-respecting  country  to  realise 
and  exterminate  this  cruel  industry.  Great  Britain  is  now  the  dump- 
ing ground  of  American  quacks. 


jaijctings  flf  the  §>omlie»,  JUttxuxts,  itz, 

Wbdvudat,  OctobeA  86th. 

HnsTEBiAV  SociVTT  (Loudou  lostitucion,  Finsbury  Circus,  E.C.) . 
—•8  p.m.  Exhibition  of  Cases.  8.S0p.m.  Clinical  Evening. 
.  Mkdigal  OfiADUATM'  CoLLSOB  ARD^  PoLTOLUTic  (2S  Ohcnies  Street, 
W.C).  4  p.m.  Mr.  H.  Collier  :  Clinique.  .Buigical.)  5.L5  p.m.  Sir. 
A.  D.  Fripp :  Becent  Variations  In  the  Technique  of  Certam  Com- 
mon Operations. 

Nobth-East  howDQV  Po«T-G»AjDUATx  CouiBOB  (North-Eastem  Fever 
Hospital  St.  Ana  s  Rjad.N.)  -2.30.  p.m.  Dr.  ^.  Cuff  :  J>emonstca 
tion  on  Fevers. 

Thubsdat,  Octobbb  27th. 

BRITISH  Balxkolooical  ajtd  Clim ATOboeicAi.  SbciBTT  (201  Hanover 
Square.  W.).— 8.30  p.m.  General  Meeting.  9  p.m.  Presiden- 
tial  Address:— Dr.  W.  B.  Davies :  The  Spa  Treatment  of  Arthritis 
Deformans. 

Nbvbolooical  SdciBTT  OP  THE  UsrirBD  KiiroDoif  (11  Chandos  Street, 
Caveodish  Square,  W  ).— 8  80  p.m  Clinical  Meeting.  Exhibition  of 
Clinical  Cases. 

Mbdical  Qbaduatbs'  Collboe  abd  Poltclxbic  (22  Chenles  Street, 
W.C.I.— 4  P  m.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  6.16  p.m.. 
Dr.  W.  Bwart :  The  Preventive  Treatmeut  and  the  Protective  Treat- 
ment of  Chronic  Heart  Disease. 

MouvT  Vbrvon  Hospital  fob  CovsuMrnoH  amd  Disbabbs  er 
THE  Chest  (7  Fitsrey  Square,  W.).-^5  p.m.  .  Lecture  j  Dr.  J.  £• 
Squire  :  The  Arrest  of  Pulmonary  Tuberculosis  (demonstration  of 
oases).  (Poet-Graduate  Conne.) 

.  Nobtr-Ba8t  LokdOb  Post-Obadcatb  CottLBQB  (Totfeenham  Hos- 
nital,  N.). — 1.80  pjn*  Lecture:— Dr.  A.  Giles :  Diagnosis  of.  Pelvic 
Tumours. 

Fbidat,  October  28th. 

Cubical  Socibtt  or  Lobdov  (20  Hanover  Square,  W.).— 8  p.m. 
Exhibition  of  Clinical  Cases  followed  by  discussion.  Patients  will 
be  in  attendance  from  8  to  9  p.m. 


MbdIOAL    GiBAAUATBa'  CaUXQM   ABD.   POL^CLIVIC     (12    Clleab. 

street,  W.C— 4  p.m.  Mr.  N.Macleho«e  :    Clinique.     (Eye.)        ^ 


IB^dttncs. 


Bury  Infirmary  ."^Junior  House  Suzgeon.     Salary  £80'  per  aonan. 
with  board,  residence  and  attendance.     AppiicAtiooe  to  tfe 


Hon.     Seoretu^', 
cashire. 


Dispensary,  Knowaley  StMet*    Bmr,  Ln- 

Boyal  London  Ophthslm&c  Hospital  (Moorfields  Eye  Hoepitai;,  dtv 
Boad.  E.C.  {Senior  House  burgeon.  (Salary  £100  peraiuram,  mwk 
board  and  residence  in  the  Hospital*  ApplicatioaB  to  Mobert  J. 
Bland,  Secretary. 

Down  District  Lunatic  Asylum,Downpatrick.— JUn.  ICale 
Officer.  Salary  £100  per  annum,  with  f  arnuhed  a. 
ftc.    Applications  to  the  Besident  Jledical  Soperintendeat. 

The  Mount  Vernon  Hospital  lor  Cormaraptkm  and  Dieeaoss  of  the 
Chest,  Hampstead  and  Norwood,  Middlesex.-  Senfor  Reaidest 
Medical  Ofllcer.  Salary  £100  per  annum.  ApiiUcatlonsto  WiUfsa 
Morton.  Secretary.  7  Filsioy  Square,  W. 

London  County  Council  Asylum,  Horton,  Epeom.— Foarth  Assatant 
Medical  Officer.  Salary  £180  per  annum,  with  boaid,  fomisbed 
apartments  and  washing.  Applications  to  Ife.  W.  Paitn4|r, 
Asylum's  Committee  Office,  6  Waterloo  Place,  8.  tf. 

City  of  London  Afl!>'lum,  near  Dartfoid,  Kent. — Medical  Supetintea- 
dent.  Salary  £800  per  annvun,  with  onfamiahed  boose,  coal, 
light,  laundry,  and  garden  produce.  -Applicatioiia  to  Cliarin 
Fituh.  Clerk  to  the  Visiting  Committee,  QuildfaaU.E.C. 

Parish  of  St.  Marylebone  Infirmary,.  Rock  ham  Street,  I^adbrob 
Grove  Boad,  Netting  Hill,  W.-l^le  Assistant  Medical  Oflien. 
Salary  £1N)  per  annum,  with-  furnished  ai^trtmenta.  ratK», 
and  washing.  Applications  to  Henry  T.  Dudman,  Clerk  to  the 
Bosrd,  Guardians^  Ofllces,  Northumberland  tttreett  MaryleboK 
Boad,  W. 

Wameford  Hospital,  Leamington.^Bouse  Surgeon.  Salary  £]« 
per  annum,  with  board,  washing,  and  apartmente.  AppticatKiM 
to  G.  T.  Poole,  Sfcretaiy. 

Nottingham  Children's  Hospital.— House  Surgeon.  Salary  £Ki> 
per  annum,  with  board  and  residence.  Applications  to  A.  F. 
Kirby,  Secretary,  Albion  Chambers,  King  Street.  KottinglMm. 


Clabkb,  W.tT.,  M.D.Toronto,  CUnloal  iafdstant  to  the  Chelsea  Boi- 

pital  for  Women. 
CoLRBiDOE,  A.,  M.B.CS.,  L.B.C:P.Lond.,  Clinical  Assistant  to  the 

Chelsea  Hospital  for  Womin. 
OuMMiBos.  William,  M.B.,  B.Ch.,  B:U.L,  Physician  to  the  Clevedoc 

Hydropathic  Institution,  Somerset. 
GiDDiMOB,  O.  T.,  M.D.Durh.,  Public  Vaccinator  of  Beckenham. 
LiTTLBB,  B.  M.,  F.R.C.S  F.ng.,  Honorary  Assistant  Medical  Officer 

to  the  Southport  Infirmary. 
Llotd,  W.  GiBBS.  M.Sc.,  M.B.,  Ch.B.Vict.,    Medioal  OIBoer  aM 

Public    Vaccinator     to   the    Walton    Workhouse    Infiraiarr, 

Liverpool. 
Ncttall,  J.  8.  W.,  M.B.,  Ch.B.Viot.,  Assistant  Medical  Officer  te 

the  Walton  Wot&hous  einfirmary,  Liverpool. 
Smith,  B.   Casbils,   M.B.,  Ch.B.01asg ,     House  Surgeon    to   tke 

Victoria  Hospital  for  Children,  Chelsea. 


^ittiiB. 


Coplet.— On  October  14th,  at  Palace  Street,  Drogheda,  the  vife  of 

Dr.  S.  Copley,  of  a  daughter. 
Jambs.— On  (>ctober  18th;  at  Hungeiford,  Berlcs.  the  wife  of  Boteit 

Blake  Jamefi,  M.R.CJ9.£ng.,  L  B.C.P.Lond.,  of  a  eon. 
LiBo.— On  October  20th,  at  12  Harley  House.  London,  the  wife  of 

Maurice  E.  Ling,  M.D.,  of  a  son. 
Swales.  -On  October  18th,  at  Oak  Villa,  West  Kirby,  Cheshire,  the 

wife  of  Edward.^ wales,  M^B.CS^,  L  JLC.  P.Lond.,  of  a  sob. 


CoPFBY— FmsdBBALD.— OnOctober  18th,  at  Mitelielstown,bythslkr. 
P.  Casey,  of .  St.  Colman's  College,  Fermoy ,  asvisted  by  the  ler. 
William  Casey,  P.P..  abbeyfcale  (both  cousins  of  the  bride ,  the 
Very  Bev.  Canon  Rice,  P.P.,  M1tChe>stow2),  Rev.  T.  O'Donofflm, 
Rev.  Fathet  Flannery,  and  the  Bev.  O.  W.  Ellard,  Dr.  Kdmrd 
B  Coffey,  14  Westbourpe  Place,  Queenetown,  and  late  of  ¥»n- 
ham*  Surrey,  to.  Nellie  Teresa,  only  daughter  of  Mr.  PatiieiL 
'  Fitzgerald,  Mitcl^elstown. 

FosTBB— Watsok.— On  Octobe*  82nd,  at  St.  Peter's,  Bsnwster, 
William,  seoond  son  of  the  late  Birkett  Poatsr,  member  of  the 
Royal  Society  of  Painters  in  Water-colours,  te  Mart',  daoEhter  of 
the  late  Wilham  Watson,  M.R  C,8.,  of^  Lancaster. 


JBe«tk«. 


Bishop.— On  October  28nd,  at  ^^e  Platts,  Watford,  Georgina  Ehretia, 
widow  of  the  late  Thomas  Bishop,  Beiq;,  of  Bramcote,  Notts,  asd 
dAUfhter  of  the  late  John  Pldouck,Esq.,  MJ>.,  of  Watfoid,  in  her 

•-     89th  year. 

KBLsoir.-rOn  October  18th,  at  his  residence,  Beckington.  Guerasej. 
Frederic  Hughes  Kelson,  H.RC.S.L.,  formerly  of  Oeykm,  in  hie 
86th  year. 

MooBB.— On  Sunday*  October  28rdi  at  his  residence,  9  Upper 
MerrioQ  Street,  Dublin,  Bobert  Henry  Moore,  F.RCSX,  in  hii 
88th  year.    Funeral  private.    No  flowers,  by  request. 

Slack.— On  October  84th,  at  Derwent  HIU,  Keswicdc,  Anae  Aini- 
worth  Slack,  widow  of  the  late  Bobert  Slack,  M.D.  aged  71. 


^k  ^diml  ^vm  mA  ^xmUv. 


*'8ALU8   POPUU   8UPBEMA    LEX-' 


Vol.  CXXIX. 


WEDNESDAY,    NOVEMBER    2,    1904. 


No.   18. 


pni9  Clinical  Xecturcs* 

TAPPING  OF~THE  LUMBAR 
REGION. 

By  Dr.  G.  MILIAU, 
Chtf  de  OUniqot  de  la  Fftcolte  a  I'Hopital  St.  Loula. 


[specially     reported    by    our    FRENCH 
CORRESPONDENT.] 


Under  the  name  of  lumbar  puncture  is  designed 
a  little  operation,  consisting  in  piercing  the  dural 
cul-de-sac  by  a  trocar  and  giving  issue  to  the 
cephalo-rhachidian  liquid. 

This  operation  was  xnractised  for  the  first  time 
by  Quincke,  of  Heel,  in  1890.  This  author  inserted 
liis  trocar  into  the  third  or  fourth  lumbar  space  in 
the  middle  line  in  children,  and  half  an  inch  to  the 
xight  of  this  line  in  adults.  It  was  Chipault  who 
recommended  the  puncture  to  be  made  between 
the  fifth  lumbar  vertebra  and  the  sacrum,  for  the 
reason  that  this  space  is  larger  than  those  between 
the  lumbar  vertebrae,  and  that  it  corresponds  to  the 
most  dilated  portion  of  the  subarachnoid  cul-de- 
sac.  In  this  space  also  there  is  less  risk  of  wound- 
ing the  caudal  nerves.  Tufl&er,  however,  who  was 
a  great  partisan  of  anaesthesia  by  cocaine  injected 
into  the  medulla,  preferred  the  fourth  lumbar  space 
as  more  easy  to  find,  it  being  situated  exactly  on 
the  line  drawn  between  the  two  iUac  crests. 

Operation. — To  puncture  the  lumbar  space  a 
long  and  strong  platinum  needle  is  used.  The 
pointed  extremity  is  bevelled,  while  the  other 
is  formed  so  as  to  adapt  itself  to  a  Pravaz  syringe. 
The  patient  being  seated,  the  body  bent  forwards, 
and  the  arms  well  in  front,  after  having  traced 
with  great  care  the  line  joining  the  two  iliac  crests 
and  disinfected  the  region  so  as  to  render  it  com- 
pletely aseptic,  the  operator  introduces  the  needle 
on  this  Hne  to  the  right  of  the  vertebral  column, 
and  about  half  an  inch  of  a  vertical  Une  drawn 
between  the  spinous  apophyses.  The  needle  is 
directed  forwards  and  a  Uttle  inwards  ;  it  passes 
through  successively  the  skin,  subcutaneous 
cellular  tissue,  lumbar  aponeurosis  and  the  sacro- 
lumbar  muscles.  It  passes  between  the  two 
vertebrae,  perforates  the  yellow  ligament,  and  after 
piercing  the  membranes  it  penetrates  in  the  cul-de- 
sac.  Immediately  drops  of  a  more  or  less  Umpid 
liquid  issue  from  the  free  extremity  of  the  needle. 
Such  is  in  all  simpUcity  the  operation  of  tapping 
the  cephalo-rhachidian  Uquid. 

Accidents. — Matters,  however,  do  not  always 
terminate  so  happily.  Obstacles  may  be  met 
with  ;  accidents  may  occur  which  the  practitioner 
should  bear  in  mind.  At  first,  although  the  different 


parts  of  the  operation  may  have  been  followed 
with  care,  it  may  happen  that  no  Uquid  flows  out. 
There  has  been  a  "  miss.*'  The  reasons  for  this 
disappointment  are  various.  Instead  of  piercing 
the  membranes,  the  needle  may  have  pushed  them 
before  it,  making  a  cap  of  them,  so  to  speak,  as  has 
sometimes  happened  in  thoracentesis  for  pleurisy, 
or  that  the  needle,  having  gone  too  far,  penetrated 
the  Cauda  equina  and  was  not  consequently 
in  the  cul-de-sac.  To  overcome  these  obstacles 
it  is  generally  only  necessary  to  insert  farther  or  to 
withdraw  the  trocar  or  give  it  a  certain  rotary 
movement.  A  small  clot  of  blood  may  block  the 
instrument.  In  such  an  event  aspiration  may  be 
made  with  a  Pravaz  syringe.  Sometimes  aIso> 
it  occurs  that  the  tiquid  \sall  not  come  out  by^ 
reason  of  want  of  pressure.  By  making  the  patient 
cough,  this  accident  is  remedied. 

Besides  these  accidents,  which  constitute  a 
simple  contretemps  in  the  operation,  there  are  others 
deserving  attention.  Blood  may  issue  instead  of 
the  cephalo-rhachidian  Uquid  by  reason  of  a  vein 
being  wounded  by  the  needle,  and  this  sometimes 
persists.  In  such  case  the  trocar  may  be  with- 
drawn and  inserted  in  another  place.  Care  should 
be  taken  not  to  push  in  the  needle  too  far.  M. 
Abadie  recommends  one  inch  in  children  and  twe 
to  three  inches  in  adults.  After  the  operation, 
the  patient  may  complain  of  rhachalgia ;  staggering 
gait,  vertigo,  convulsions  and  a  rise  of  tem- 
perature have  been  observed  more  than  once. 

Generally  speaking,  all  these  phenomena  possess 
but  Uttle  gravity.  Simple  rest  in  bed  is  sufficient. 
The  same  might  be  said  of  vomiting,  sometimes 
observed.  Attention,  however,  should  be  paid 
to  the  cephalalgia,  which  is  rarely  absent  after  this 
operation.  It  is  a  sensation  of  weight  accompanied 
by  lancinating  pains  lasting  from  a  few  hours  to 
three  or  four  days.  Frequently  it  is  very  painful,, 
so  that  the  patient  is  obliged  to  remain  motionless 
in  bed.  It  disappears,  however,  without  leaving 
any  trace.  Sudden  death  has  been  observed 
after  puncture  of  the  cord.  This  unfortunate 
termination  is  announced  by  a  violent  headache, 
respiratory  troubles,  precipitation,  weakness  and 
irregularity  of  the  heart  beats,  in  a  few  moments 
the  patient  falls  into  coma,  the  breathing  stops  and 
no  artificial  means  are  capable  of  re-establishing  it. 
In  the  statistics  of  Gumpecht,  seventeen  cases  oi 
sudden  death  are  registered.  It  must  be  said^ 
however,  that  this  accident  occurred  only  in  sub- 
jects affected  with  grave  lesions  oi  the  brain 
(tumours,  ventricular  congestion),  and  in  cases 
where  the  quantity  of  the  cephaUc  fluid  removed 
was  considerable  ( two  to  three  ounces).  This  fatal 
accident  is  considered  due  to  a  too  brusque  decom- 
pression of  the  nervous  elements.     To  avoid  it. 


454     1*HE  Medical  Pxess. 


ORIGINAL    COMMUNICATIONS. 


Nov.  2.  1904- 


6nly  a  small  quantity  should  be  withdrawn,  from 
one  to  two  drachms. 

As  a  Therapeutic  Means. — When  Quincke 
imagined  the  lumbar  puncture,  his  idea  was  to  act 
against  affections  producing  a  hypersecretion  ot  the 
cephalo-rhachidian  liquid  and  an  excess  of  pressure 
in  the  cerebro-spinal  arachnoid  cavity.  He 
practised  numerous  punctures  and  others  followed 
nis  example,  but  the  results  have  been  so  contra- 
dictory that  it  is  impossible  to  say  ii  the  operation 
can  be  considered  as  capable  of  rendering  real 
service.  We  have  got  no  farther  than  that.  In 
congenital  hydrocephalus,  the  lumbar  puncture  has 
replaced  that  of  the  lateral  ventricles.  Repeated 
tapping,  withdrawing  from  an  ounce  to  two  ounces 
of  the  liquid,  have  been  practised.  Generally, 
the  immediate  result  is  very  good,  the  convulsions 
disappear,  the  Umbs  recover  their  movements, 
the  sight  is  improved  as  well  as  the  psychic  func- 
tions. But  this  improvement  does  not  continue, 
the  patient  gradually  relapses  into  his  former 
condition.  Quincke  and  Stadelmann  have  con- 
cluded that  the  operation  had  Uttle  or  no  effect  on 
the  disease.  In  certain  subjects  affected  with 
cerebral  tumours,  it  frequently  happens  that  hyper- 
secretion of  the  cephalo-rhachidian  liquid  produces 
compression  on  the  brain  and  the  medulla,  pro- 
voking headache,  optic  neuritis,  stupor,  and  epilepti- 
form convulsions.  Lumbar  puncture  has  reUeved 
some  of  these  symptoms  and  might  be  tried. 

In  all  the  varieties  of  meningitis  the  operation 
has  been  tried  in  a  S3rstematic  manner.  According 
to  M.  Abadie  it  gives  excellent  results  in  that  variety 
which  Quincke  mentioned  under  the  name  of 
simple  serous  meningitis.  In  several  cases  of 
syphilitic  meningitis  it  reheved  the  first  symptoms, 
giving  time  for  the  specific  treatment  to  act.  But 
in  tuberculous  meningitis  the  results  are  very 
contradictory — nil  in  some  cases,  transitory  in 
others  ;  while  in  a  few  they  were  very  encouraging. 
The  headache,  which  is  a  very  distressing  sym- 
ptom, generally  yields  to  the  operation,  and  for  this 
reason  one  would  be  justified  in  having  recourse 
to  it. 

Acute  uraemia  has  been  also  treated  by  the  lumbar 
puncture.  Two  typical  cases  of  Dr.  MacVail  have 
been  already  published.  Two  patients,  suffering 
from  the  convulsive  and  comatose  form  of  uraemia 
in  the  course  of  Bright's  disease,  were  cured  by  the 
operation.  These  patients  had  been  already 
treated  by  injections  of  pilocarpine  and  applica- 
tions of  hot  air,  but  without  success.  An  ounce 
of  the  cephalo-rhachidian  hquid  was  drawn  off,  and 
under  tiie  influence  of  this  intervention  the 
coma  yielded,  the  patients  recovered  consciousness 
and  the  convulsive  seizures  ceased.  On  the  other 
hand,  the  oedema  gradually  disappeared  and  the 
albumin  diminished,  while  the  quantity  of  urine 
increased. 

But  the  lumbar  puncture  is  not  only  employed  to 
evacuate  simply  a  certain  quantity  of  cephalo- 
rhachidian  hquid,  it  is  utilised  also  to  introduce 
therapeutic  agents  into  the  subarachnoid  spaces, 
especially  since  Sicard  proved  that  absorption  by 
this  means  was  superior  to  the  subcutaneous 
method.  In  patients  affected  with  tetanus  this 
author  injected  antitetanic  serum,  chloride  of 
sodium,  to  a  man  suffering  from  general  paralysis, 
and  bromide  of  potassium  to  epileptics.  Inj  ections 
of  cocaine  beneath  the  arachncdd  membrane  to 
produce  anaesthesia  were  imagined  by  Bier  and 
vulgarised  by  TuflSer.     Many  surgeons  tried  this 


method,  but  with  different  results,  and  finally, 
through  grave  accidents,  it  was  abandoned. 

Lumbar  Puncture  as  a  Means  of  Diagnosis.— 
The  lumbar  puncture  allows  the  cephalo-rhachidian 
liquid  to  be  studied  in  all  its  characters — chemical, 
physical,  bacteriological,  and  cjrtological.  In  the 
normal  condition,  this  liquid  is  clear,  cok>nile98, 
limpid  as  running  water,  and  gives  no  deposit 
when  at  rest.  These  different  characters  can  be 
considerably  modified.  If  the  liquid  can  remain 
clear  in  cases  of  hydrocephalus  or  of  hypersecretion 
consequent  on  a  cerebral  tumour  ;  if  it  can  issue 
clear  but  becoming  clouded  on  rest  in  tuberculous 
meningitis ;  it  is  discoloured  at  the  outset  in  cocdc 
meningitis  and  absolutely  purulent  in  suppurating 
meningitis,  coloured  red  in  fractures  of  the  skuU 
and  in  a  large  number  of  cases  of  traumatism  of 
the  cranium.  The  bacteriological  examination 
has  given  the  following  results  :  in  the  normal 
state  the  liquid  contains  no  microbe,  but  in  coccic 
meningitis  are  found  streptococcus,  staphylo- 
coccus or  the  pneumococcus  ;  in  cerebro-spinal 
meningitis  the  diplococcus  of  Weichselbaum,  in 
tuberculous  meningitis  the  bacilli  of  Koch,  but  not 
always. 

The  importance  of  the  demonstration  of  these 
different  agents  in  the  hquid  obtained  by  the 
lumbar  puncture  is  very  considerable  as  it  permits 
diagnosis  of  the  existence  and  nature  of  the 
meningitis. 

Conclusions. — From  what  has  been  already 
said  tapping  in  the  lumbar  region  is  an  operation  of 
easy  execution,  and  if  done  with  care  and  not  too 
much  hquid  is  withdrawn  no  accidents  will  occur. 
The  operation  has  not  given  as  yet  any  curative 
results  in  the  treatment  of  the  different  maladies 
for  which  it  has  been  employed.  But  it  has 
afforded  important  rehef  to  some  symptoms — 
headache,  certain  pains  and  cerebral  accidents  in 
some  cases  of  uraemia. 

In  rendering  possible  the  study  of  the  different 
characters  of  the  hquid  in  morbid  affections,  the 
lumbar  puncture  is  a  means  of  diagnosis,  precise 
and  useful  in  the  different  cases  of  meningitis, 
especially  that  of  a  tuberculous  nature. 


EDUCATION     UNDER     THE 
MIDWIVES     ACT.  (a) 

Bv  EWEN  J.  MACLEAN.  M.D.,  M.R,C.P.Loiid.. 
F.R.S.Edin., 

Lecturer  on  Midwifery  a^.  the  University  College  of  South 
Wales  and  Monmouthflhire ;  Senior  GynaBOologist  to  the 
Cardiff  Infirmary ;  Consultdng  G>'n£eoologi8t  to  the  forth  and 
Mountain  Ash  Cottage  Hospitals. 

Practically  alone  among  civilised  and  progressive 
countries  England,  until  quite  recently,  has  been 
without  a  system  of  registration  and  supervision  of 
midwives.  France,  Russia.  Sweden,  Germany,  and 
Switzerland  have  long  paid  much  attention  to  the 
education  and  State  control  of  midwives.  In  Japan 
the  regulations  for  midwives  are  very  strict.  No  mid- 
wife may  attend  a  case  unless  she  has  the  Japanese 
certificate.  Their  written  examination  lasts  four  days. 
When  a  midwife  attends  she  is  supposed  to  take  a 
pupil  with  her,  so  that  practically  two  nurses  attend 
every  case.  It  is  true  that  attention  has  for  many 
years  been  called  to  this  anomaly  of  ours,  and  since 
1890  several  Bills  have  been  presented  to  Parliament, 
some  even  passing  a  second  reading  ;  but  not  until  1902 
did  a  measure  dealing  with  the  subject  receive  the 
Royal  assent. 

(a)  Inaugural  lecture  of  the  Course  of  Lectures  to  MldwiTtn, 
delivered  at  the  University  College,  Cardiff,  on  October  Mlh, 

19C4v 


Nov.  2,  1904. 


ORIGINAL    COMMUNICATIONS.         The  Medical  Pees*.    455 


The  delay  in  legislation  has  certainly  not  been  due 
to  any  lack  of  material  to  which  that  legislation  might 
apply,  for  it  is  estimated  that  throughout  the  country 
no  fewer  than  500,000  women  annually  are  attended  by 
mid  wives.  Probably  33,000  are  so  attended  in  South 
Wales  and  Monmouthshire. 

In  France,  where  some  form  of  registration  is  trace- 
able as  early  as  1292,  the  municipalities  have  taken 
strong  measures  to  enforce  education  and  supervision 
of  midwives.  In  Italy,  where  special  regulations  were 
issued  in  1890,  the  mortality  from  child-birth  and 
child-bed  has  fallen  from  235  per  million  in  1887  to 
85  in  1902.  In  our  own  country  during  the  same 
period  the  mortality  has  not  even  fractionally  im- 
proved. It  is  estimated  that  in  every  ten  years  we 
lose  46,000  mothers  in  child-birth,  and  half  of  this 
appalling  total  of  deaths  is  caused  by  puerperal  fever — 
a  disease  for  the  most  part  preventable.  The  average 
mortality  from  puerperal  fever  and  accidents  of  child- 
birth for  England  and  Wales  was  47  per  i  ,000  births  ; 
for  London,  3-9 ;  while  that  for  South  Wales  was  as 
high  as  6*1. 

But  it  may  be  asked  whether  these  high  mortality- 
rates  have  any  special  reference  to  midwives.  The  asser- 
tion is  rendered  probable  from  the  fact  that  an  average 
proportion  of  60  to  70,  or  even  in  some  districts  as 
many  as  90,  per  cent,  of  the  confinements  are  attended 
by  midwives.  It  is  rendered  practically  certain  when 
we  remember  that  in  lying-in  institutions,  where 
vastly  improved  methods  are  in  vogue,  the  child-birth 
mortality  has  been  markedly  reduced.  In  other  words, 
the  practice  of  the  midwives.  which  covers  so  over- 
whelming a  proportion  of  the  labours  throughout  the 
country,  has  not  been  brought  into  line  with  the  more 
enlightened  methods  which  the  advance  of  science  has 
plac^  in  our  hands. 

Let  it  be  emphasised  here  that  there  can  be  no 
attempt  to  abolish  the  calling  of  the  midwife.  Mid- 
wives  are  a  necessity  for  the  poor,  and  for  many  of  the 
mothers  of  the  working  classes  who  cannot  afford  a 
doctor's  fee.  The  advantages  of  instruction  and  super- 
vision should  long  ago  have  been  placed  within  her 
reach,  and  it  is  in  order  that  malpraxis  may  be  checked 
and  that  effective  knowledge  may  be  added  to  kindli- 
ness of  service  that  this  new  legislative  measure  has 
been  brought  into  operation.  The  practice  of  existing 
midwives  must  be  levelled  up  and  those  who  intend  to 
follow  this  calling  must  now  show  evidence  of  at  least  a 
moderately  efficient  training  and  knowledge. 

The  Midwives  Act  has  formulated  a  central  authority 
in  London  and  throughout  the  counties  and  county 
boroughs  of  England  and  Wales,  local  authorities,  for 
the  purpose,  as  stated  in  the  preamble,  of  securing  "  the 
better  training  of  midwives  and  to  regulate  their 
practice."  The  central  authority,  known  as  the 
Central  Midwives  Board,  is  charg^  with  the  carrying 
out  of  all  the  provisions  of  the  Act  with  the  approval 
of  the  Privy  Council.  These  duties  include  the  regu- 
lation of  the  course  of  training  of  midwives,  the  issue 
of  certificates  after  examination,  the  annual  publica- 
tion of  a  Midwives'  Roll,  and  the  regulating,  super- 
vising, and  restricting  within  due  limits  the  practice 
of  midwives.  The  Act,  it  may  be  here  noted,  applies 
only  to  England  and  Wales. 

After  April  ist,  1905.  no  woman  will  be  able  to  style 
herself  a  midwife  unless  certified  under  the  Act.  The 
penalty  is  a  fine  not  exceeding  ^5.  After  April  ist, 
19 10,  no  woman  will  be  allowed  to  practise  for  gain  as 
a  midwife  unless  certified,  under  a  penalty  not  exceed- 
^8  £^^'  These  provisions  do  not  affect  the  case  of  one 
rendering  assistance  in  emergency  nor  the  practice 
of  those  attending  confinements  under  the  direction  of 
a  doctor.  Up  to  March,  1905,  claim  to  be  certified  may 
be  made  by  those  holding  a  certificate  in  midwifery 
from  the  Royal  College  of  Physicians  of  Ireland,  the 
Obstetrical  Society  of  London,  the  Coombe  Lying-in 
Hospital,  and  Guinness' s  Dispensary,  the  Rotunda 
Hospital,  or  such  other  certificate  as  may  be  approved 
by  the  Central  Midwives'  Board.  Further,  women  who 
can  satisfy  the  Central  Board  that  they  have  been  in 


actual  practice  as  midwives  for  at  least  one  year  prior 
to  July  31st,  1902,  and  that  they  bear  a  good  character, 
may  claim  to  be  certified  under  the  Act.  Those  who 
do  not  come  within  one  of  these  categories  are  required 
to  pass  the  examination  of  the  Central  Midwives  Board 
before  obtaining  a  certificate,  and  their  names  will  be 
entered  on  a  separate  Roll.  The  first  of  these  exami- 
nations will  be  held  in  July,  1905 

But  whilst  this  central  controlling  board  exists,  the 
ke)mote  of  the  practical  efficiency  of  the  Act  is  devolu- 
tion. Every  Council  of  a  county  or  a  county  borough 
throughout  England  and  Wales  is  the  local  supervising^ 
authority  over  midwives.  These  bodies,  however,  can 
delegate  their  duties  to  committees  or  to  the  district 
councils  if  they  think  proper.  Such  committees  may- 
consist  wholly  or  partly  of  members  of  the  Council, 
and  women  are  eligible  to  serve  on  the  committees. 

The  local  authorities  appoint  an  executive  officer, 
and  the  medical  officer  of  health  is,  fmm  his  position 
and  knowledge  of  administration,  eminently  fitted  to 
serve  in  that  capacity.  In  the  great  majority  of 
instances,  the  medical  officer  of  health  has  been  so 
appointed. 

The  local  authority  exercises  general  super^sion  over 
all  midwives  practising  within  the  area  of  the  county 
or  county  borough,  and  has  to  investigate  charges  of 
malpractice,  negligence  or  misconduct,  and  report  the 
same  to  the  Central  Midwives  Board. 

Every  certified  midwife  must,  before  commencing  to 
practise,  give  notice  in  writing  to  the  local  authority 
ot  her  intention,  and  must  repeat  the  notice  in  January 
ot  each  year  during  the  period  in  which  she  continues 
to  practise.  She  must  give  every  facility  to  the  local 
authority,  and*their  executive  officer,  for  carrying  out 
supervision,  and  she  will  be  prohibited  from  engaging 
in  any  i)nhealthy  occupation. 

Dr.  Ward  Cousins,  of  Portsmouth,  in  an  interesting 
paper  on  the  Midwives  Act,  (a)  notes  that  in  Sweden 
the  midwife  has  to  be  examined  every  year  by  the 
medical  officer  of  health,  and  should  her  knowledge  be 
lound  deficient  on  any  material  subject,  she  can  be 
suspended  from  practice  for  a  time. 

Under  the  Act.  the  midwife  is  permitted  to  attend 
normal  labour  only,  and  she  is  compelled  to  send  for  a 
qualified  registered  practitioner  in  every  emergency. 
The  course  of  training  and  the  subsequent  examtnationr 
will  deal  specially  with  the  recognition  of  danger  and! 
abnormality  in  either  mother  or  child. 

The  midwives  in  Switzerland  are  required  to  make  a 
solemn  affirmation  on  receiving  their  certificates.  They 
promise  on  oath  to  practise  their  profession  with  re- 
verence, patience,  and  earnest  endeavour,  and^  on 
every  occasion,  to  send  for  a  physician  in  all  abnor- 
malities. For  exceeding  her  sphere  of  practice  the 
midwife  is  liable  to  a  fine  of  from  to  ta  1,000  francs. 
Under  an  Act.  upon  the  medical  man  who  is> 
called  in  by  the  midwife  upon  the  occurrence  of  certain 
sjrmptoms  falls  the  duty  01  notiKdng  puerperal  fever  and 
other  infectious  disorders.  The  midwife  does  not 
diagnose  the  disease,  but  sends  for  the  doctor.  Infor- 
mation of  all  cases  of  fever  should  be  forwarded  at 
once  to  the  local  supervising  authority.  The  record 
of  the  midwife  will  show  the  number  of  cases  which 
have  occurred  in  her  practice  and  the  name  of  the 
doctor  who  assisted  her. 

After  any  attendance  upon  a  case  of  puerperal  fever 
or  any  other  disease  supposed  to  be  infectious,  the 
midwife  must  disinfect  he^df  and  her  appliances  and 
have  her  clothing  thoroughly  disinfected  before  going, 
to  another  case,  and  the  local  supervising  authority 
may  suspend  a  midwife  from  practice  if  suspension 
appears  necessary  to  prevent  the  spread  of  disease. 

Dr.  Ward  Cousins,  in  the  address  from  which  I  have 
quoted,  says:  **  I  believe  that  the  work  of  the  mid- 
wives  in  promoting  reform  in  the  houses  of  the  poor 
will  have  a  wide  and  wholesome  influence  ...  1 
think  it  is  not  too  much  to  hope  that  indirectly  the  silent 
work   of   educated   midwives  will  prove  a  wholesome 

(a)  Annual  meeting  of  the  British  Medical  AssocfatioB^  iros. 

D 


4i6    Thk  Mepicjo.  Press. 


ORIGINAL    COMMUNICATIONS. 


Nov.  2.  1904. 


stimulus  to  the  higher  classes  of  society  and 
arouse  their  sympathy  in  the  great  work  of  improving 
the  dwelling-houses  of  the  labouring  classes  of  our 
country.  .j     ^ 

From  the  foregoing  short  statement  it  is  evident 
that  the  eflftcacy  of  the  measure  will  depend  in  large 
part  on  the  thoroughness  with  which  the  various  local 
supervising  authorities  carry  out  its  administration  ; 
and,  further,  whilst  many  strict  regulations  as  to  super- 
vision and  practice  are  given,  much  is  left  to  local 
initiative  in  providing  the  education  needed  for  the 
new  class  of  mid  wives  which  the  Act  will  create.  It 
will  be  appropriate  here  to  remind  midwives  that  it 
will  be  to  their  interest  to  acquaint  themselves  fully 
with  the  new  conditions  under  which  they  must  now 
work.  It  is  not  enough  for  them  to  become  certified 
merely  and  to  continue  to  practise  on  the  same  lines 
as  heretofore.  They  should  consider  the  advisability 
oi  attending  a  course  of  lectures  where  their  duties  are 
taught  and  their  responsibilities  defined.  The  Central 
Midwives  Board  include  this  as  an  important  section 
in  a  recognised  course  of  lectures.  The  executive 
officers  of  the  various  local  authorities  are  doing  all 
in  their  power,  by  printed  notices  and  other  literature, 
to  bring  these  points  under  the  notice  of  midwives. 

As  to  the  training  of  pupil  and  ot  practising  midwives 
who  wish  to  bring  themselves  into  line  with  the  stan- 
dard of  knowledge  required  by  the  Act,  various  centres 
are  being  established.  Birmingham  and  Manchester, 
for  instance,  are  building  large  maternity  hospitals  to 
which  out-patient  departments  will  be  attached. 

As  to  our  own  locality,  the  course  of  lectures  we 
inaugurate  to-day  is  the  outward  and  visible  sign  of 
the  determination  of  the  supervising  authorities  of  the 
county  and  borough  to  deal  with  the  problem  of  the 
efficient  education  of  midwives.  It  is  to  the  point  to 
say  that  if  that  problem  be  solved  in  South  Wales,  it 
may  be  solved  anywhere.  It  is  appropriate,  therefore, 
that  we  should  be  the  first  in  the  field,  for  this  course 
of  lectures  in  connection  with  the  medical  faculty  of 
the  University  College  is  the  first  of  its  kind  in  the 
Kingdom.  Its  establishment  has  met  with  the  warm 
approval  ol  the  Central  Midwives  Board,  and  others 
are  Ukely  to  follow  the  example. 

In  January  of  this  year.  Dr.  Walford,  the  able 
medical  officer  of  health  for  the  county  borough,  in  a 
paper  on  "  The  Local  Administration  of  the  Midwives 
Act,"  suggested  that  steps  should  be  taken  to  form  a 
locai  trsSnitig  centre  for  midwives.  The  suggestion 
was  acted  upon,  and  the  Committee  formed  in  connec- 
tion therewith  were  supported  by  Principal  Griffiths, 
by  Dr.  T.  H.  Morris,  Chairman  of  the  County  Education 
Committee,  and  by  Professor  Hepburn,  Dean  of  the 
Medical  Faculty,  and  the  course  was  made  conditional 
to  certain  financial  grants,  and  those  who  are  most 
concerned— namely,  the  working  classes  and  the  poor— 
wiU  be  grateful  for  the  pubUc  spirit  shown  by  the 
contributing  councils.  The  Glamorgan  County  Council 
make  an  annual  grant  of  £100  and  have  the  power  to 
nominate  twenty-one  candidates  for  free  studentships. 
The  Cardiff  County  Borough  Council  give  a  grant  of 
£$0  per  annum  and  claim  the  nomination  of  nine  free 
students.  .  . 

When  we  turn  to  discuss  the  practical  training  we 
are  met  by  an  aspect  of  the  question  which  is  not  with- 
out difficulty.  A  candidate  for  examination  must 
bring  evidence  not  only  of  having  attended  a  recog- 
nised course  of  lectures,  but  also  ot  having  attended 
personally  twenty  cases  under  the  supervision  of  a 
qualified  practitioner  or  of  a  certified  midwife  recog- 
nised by  the  Board  or  in  connection  with  a  recognised 
institution. 

The  question  w^ill  naturally  be  asked,  How,  when,  and 
where  may  this  experience  be  obtained  ?  Unless  the 
change  from  the  old  order  to  the  new  is  to  be  a  more 
gradual  process  than  the  provisions  of  the  Act  would 
lead  one  to  suppose,  it  is  clear  that  all  available  cases 
must  be  utilised.  In  all  probability  the  busy  qualified 
practitioner  will  have  little  time  for  the  necessary 
supervision.     The  bulk  of  the  certification  as  to  attend- 


ance on  cases  will  be  effected  by  recognised  certified 
midwives  and  by  institutions.  It  would,  of  conrEe,  be 
desirable  that  qualified  medical  practitioners  shoald 
give  the  time  for  supervision,  but  the  probabilities  do 
not  lie  in  that  direction. 

Doubtless,  in  course  of  time,  and  in  pursuance  of  the 
law  of  supply  and  demanid,  midwives  vested  by  the 
Board  with  the  power  of  certification  will  become  estab^ 
lished  in  the  outlying  districts,  but  pupils  desirous  of 
becoming  eligible  for  examination  within  a  reasonable 
period  of  time  will  naturally  seek  their  experience  ia 
the  more  populous  centres  and  large  towns.  The  rural 
districts,  however,  will  assuredly  supply  a  considerable 
number  of  the  cases. 

In  this  connection  it  is  permissible  to  refer  to  the 
fact  that  the  Cardiff  and  District  Branch  of  the 
Q.V.J.  Institute  have  adready  added  a  materoity 
department  to  their  work.  That  department  will  be 
recognised  by  the  Central  Midwives    Board   for  the 

Practical  training  of  pupil-midwives.  The  cases  vill 
e  attended  under  the  supervision  of  experienced  cer- 
tified midwives  and  of  the  Superintendent  of  the 
department. 

It  is  anticipated  that  in  January  of  next  year,  i.e..  in 
three  months  time,  the  department  will  be  separately 
housed  and  ready  to  undertake  the  practical  training  of 
a  certain  number  of  non-resident  and  of  resident  pupil- 
midwives. 

Such,  in  outline,  is  the  information  which,  up  to  the 
present,  I  am  able  to  put  before  you.  As  we  are  prac- 
tically the  first  to  carry  a  scheme  of  the  kind  into 
operation,  our  work  and  experience  will  be  watched  by 
other  centres  in  the  country,  and  those  of  us  who  are 
associated  in  the  educational  aspect  of  the  Midwives 
Act  are  resolved  that  no  effort  on  our  part  shall  be 
spared  to  give  the  best  possible  effect  to  the  provisioos 
of  a  measure  which  so  nearly  concerns  the  welfare 
especially  of  the  working  classes  and  the  poor,  and  also, 
in  a  wider  sense,  of  the  community  as  a  whole. 

A  COMBINED 

UTERINE     APPLICATOR    AND 

BLUNT   CURETTE     IN 

GYNECOLOGY. 

By  ALEXANDER  DUKE,   F.R.C.P.I. 

For  those  gynaecologists  who  prefer  the  applica- 
tion of  liquid  escharotics  to  the  cervical  canal  and 
uterine  cavity,  as  in  cases  of  cervicitis,  chronic 
endometritis,  &c.,  the  instrument  depicted  will  I 
think,  be  found  useful,  combining  two  instruments 
in  one,  and  devoid  of  the  defects  common  to  al 
other  "  applicators  "  with  which  I  am  acquainted 
The  illustration  represents  a  combination  of  my 
"  cervical  curette,"  designed  for  the  removal  d 
cervical  mucus  and  various  secretions  filling  up 
and  hanging  from  the  cervix  and  os,  with  the 
ordinary  probe  or  appUcator,  not  to  be  used  by 
wrapping  cotton  wool  round,  but  as  a  sliding  piston 
to  compress  cottonwool,  or  bit  of  round  lamp- 
wick  placed  in  cage. 


.i^^aV^ 


After  theuse  ascurette(A)  and  when  well  cleansed, 
the  cage  is  unscrewed,  and  a  piece  of  either  absorb- 
able cotton  wool  or  round  lamp-wick  inserted; 
the  cage  is  then  screwed  on,  dipped  in  the  escharotic 


Nov.  2,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Pxbss.   457 


otLosen  and  introduced  into  the  uterus.  The  pressure 
of  thumb  and  support  of  fingers  on  side-rests 
i«dll  push  up  central  rod  and  the  contents  of  cotton 
wrool  or  wick  be  extruded  where  required. 

Advantages  claimed  —  (i)  Surface  cleaned 
by  the  curette  (rotary  action)  prepares  it  for  the 
application  ol  the  caustic  (which  is  not,  as  often 
happens,  absorbed  by  discharge  or  squeezed  out  by 
contraction  of  ceivix  on  aimed  probe  alone,  and 
so  practically  useless) ;  (2)  no  fluid  can  be  squeezed 
out  ol  cotton  wool  or  lamp-wick  by  con ti  action  ol 
ceivix,  the  wire  cage  effectually  preventing  this  ; 
and  (3)  free  exit  lor  any  excess  ol  caustic  fluid 
during  withdrawal  oi  applicator,  the  contents  ol 
cage  just  mopping  surlace  ;  no  dribbling  il  con- 
tents ol  cage  be  properly  charged.  By  the  use  ol 
my  combination  instrument  the  cure  ol  chronic 
endometritis,  &c.,  will  be  hastened,  the  choice 
ot  escharotics  being  left  to  the  judgment  ol  the 
operator,  as  each  case  must  be  treated  on  its  own 
merits. 


NUTRITION  IN  WASTING 
DISEASES   OF  CHILDREN  AND 
ADULTS, 

By  DAVID   WALSH,   M.D.Edin., 

Senior  PhTsidan*  Weitern  Skin  Ho«pital,  London,  W.»  Ac. 

Of  recent  years  there  has  been  a  marked  ten- 

<lency  to  lessen  the  use  of  drugs  in  the  treatment 

of  not  a  few  diseases.     As  we  all  know,  many 

complaints  formerly  treated  by  physic  are  now 

forthwith  handed  over  to  the  operating  surgeon. 

In    a  host  of  other  maladies  the  medical  man 

nowadays  turns  for  aid  to  ph)rsical  methods,  such 

as    the   "  high  frequency "   electrical  current  or 

hot  air  baths,  or  to  the  old-fashioned  remedies  of 

good  food,  travel,  exercise,  pure  air,  andsea-bathing. 

In  the  present  article  the  chief  point  that  will  be 

dealt  with  is  that  of  food-nutrition  in  relation  to 

wasting  disease. 

The  subject  was  suggested  to  the  writer  by 
various  medical  friends,  who  reported  excellent 
results  in  such  cases  from  the  use  of  a  particular 
food,  Sanatogen.  On  inquiry,  I  found  that  the 
nutrient  product  in  question  had,  during  the  past 
five  years  or  so,  been  extensively  used  in  Germany, 
where  it  had  been  favourably  spoken  of  by  many 
eminent  men,  including  Professors  Ewald,  Tobold, 
Neisser,  Walther,  von  Schroetter,  Duhrssen  and 
others.  Their  results,  published  in  various  medical 
journals,  were  so  remarkable  as  to  suggest  a  kind 
of  specific  nutrient  value  in  this  new  food.  On 
further  reference  I  found  that  Sanatogen  was 
being  advertised  in  the  Lancet,  British  Medical 
Journal,  Medical  Press  and  Circular,  and 
other  leading  professional  journals.  There  could 
be  no  doubt,  therefore,  as  to  its  acceptance  and 
standing  in  the  medical  world.  At  the  same  time 
it  seemed  desirable  to  learn  more  as  to  its  quaUties 
by  a  systematic  clinical  investigation.  Accord- 
ingly, it  was  determined  to  put  the  matter  to  a 
careful  trial.  This  has  been  done  in  a  series  of 
selected  cases,  some  of  them  taken  from  private 
and  others  from  hospital  practice,  in  wluch  all 
details  have  been  accurately  noted.  My  results, 
briefly  stated,  have  confirmed  those  of  the  above 
mentioned  Continental  observers.  They  have 
been  sufficiently  striking  to  warrant  the  behef 
that  in  Sanatogen  we  have  a  nutrient  food  of 
more  or  less  specific  absorbabihty  into  the  system. 


and  hence  of  considerable  nutritive  value  in  all 
cases  of  acute  or  chronic  tissue  starvation. 

The  composition  of  Sanatogen  is  stated  to  be 
95  per  cent,  of  pure  casein  (milk  albumin)  with 
5  per  cent,  of  glycero-phosphate  of  sodium.  Many 
foods  have  [an  apparently  equal  nutritive  value, 
but  every  medical  practitioner  knows  how  difficult 
it  is  to  nourish  a  patient  suffering  from  disease- 
emaciation.  The  wasted  body  remains  wasted  in 
spite  of  abundant  feeding  with  eggs,  milk,  pep- 
tonised  foods,  meat  extracts,  and  the  round  of 
invaUd  diet.  Do  we  not  all  recognise  the  fact 
that  the  starving  tissues  are  fed,  not  by  the  food 
swallowed  by  the  patient,  but  by  the  amount  of 
nutrient  matter  absorbed  by  the  gastric  and 
intestinal  mucous  membrane  ?  If  we  could 
ensure  the  absorption  of  nutriment  into  the  blood, 
the  problem  of  nutrition  in  disease  would  be 
reduced  to  a  matter  of  mere  chemistry  and  me- 
chanical feeding.  Failing  that  somewhat  remote 
contingency,  it  is  conceivable  that  some  way  may 
be  found  of  preparing  a  foodstuff  as  to  render  it 
readily  absorbable  in  the  aUmentary  canal,  no 
matter  how  disturbed  and  weakened  the  digestive 
functions  may  have  become.  Judging  from 
clinical  results,  Sanatogen  appears  in  many  cases 
to  possess  some  such  power  of  ready  absorbability, 
without  which  the  richest  foodstuff  represents 
simply  so  much  foreign  matter  in  the  stomach  and 
intestines.  My  own  experiences  are  here  recorded 
as  a  simple  extension  and  confirmation  of  the 
remarkable  statements  of  the  distinguished  Con- 
tinental authorities  already  cited.  It  is  to  be 
hoped  that  medical  men  here  in  the  United 
Kingdom  will  ascertain  for  themselves  the  value 
of  this  dietetic  remedy  in  wasting  diseases,  in 
convalescence,  and,  indeed,  wherever  there  is 
evidence  of  general  malnutrition. 

A  certain  number  of  the  cases  experimented 
upon  were  those  of  wasting  children,  or  *'  wasters," 
as  they  are  technically  called.  One  of  the  greatest 
difficulties  with  which  the  physician  can  be  faced, 
either  in  hospital  or  in  private  practice,  is  to 
restore  the  general  nutrition  of  these  httle  patients. 
In  spite  of  the  utmost  care  in  the  regulation  of 
diet  the  mortality  among  these  children  is 
extremely  high.  The  wasting  is  obviously  a 
sign  of  defective  nutrition,  and  the  loss  of  body- 
weight  persists  regardless  of  the  quantity  or 
quadity  of  the  food  introduced  into  the  stomach. 

The  explanation  is  probably  that  nutrient 
matter  is  not  absorbed  because  of  some  atrophy 
or  imperfect  development  of  the  structure  or 
functions  of  the  glandular  and  absorptive  ap- 
paratus of  the  stomach  and  intestines.  Wasting 
from  insufficient  food  may  be  taken  as  the  simplest 
form  of  infantile  atrophy.  Creneral  tissue  star- 
vation may  also  be  due  to  the  taint  of  tubercle, 
especially  in  the  form  of  tabes  mesenterica  or  of 
syphilis.  Rickets  is  another  predisposing  cause, 
although,  happily,  it  is  becoming  much  less 
frequent  nowadays.  Other  causes,  again,  are 
"  fevers "  and  various  invasions  by  pathogenic 
organisms. 

The  prominent  symptoms  of  almost  all  forms 
of  infantile  wasting  are,  diarrhoea,  vomiting  and 
anaemia.  The  chief  point  about  the  wasting  is 
its  persistency — ^repeated  weighing  reveals  no 
increase  in  weight.  The  diarrhoea  is  a  constant 
symptom,  with  stools  that  are  as  a  rule  green  and 
offensive,  but  at  times  they  are  yellow  with 
greenish  streaks.     The  vomiting  is  persistent  and 


458    The  Mbdical  Press. 


ORIGINAL    COMMUNICATIONS. 


Nov.  2.  1904- 


urgent,  and  occurs  inmiediately  after  food  of  any 
kind  whatever.  The  anatnia  is  characterised  by 
erythrocytes  of  not  more  than  two  millions  to  the 
cubic  miUi metre,  while  the  leucocytes  are  increased 
to,  say,  12,000,  and  the  haemoglobin  value  may  be 
anjrthing  between  36  and  64  per  cent.  These 
patients  are  apt  to  get  pneumonia,  usually  of  the 
broncho-pneumonic  but  sometimes  of  the  lobar 
variety. 

In  looking  for  the  cause  of  infantile  wasting  with 
the  above  train  of  symptoms,  the  physician  will 
naturally  note  any  past  or  present  evidence  of 
"snuffles,**  rash, delayed  closing  of  fontanelles,  or 
of  any  of  the  various  bony  or  glandular  changes 
associated  with  tubercle,  rickets,  or  syphilis. 
Whether  specific  drugs  be  or  be  not  required,  it 
goes  without  saying  that  dietetic  treatment  must 
always  be  of  first  importance  in  such  conditions. 
My  own  experience  of  Sanatogen,  as  shown  in  the 
appended  cases,  is  that  it  stays  the  diarrhoea — ten 
or  twelve  motions  a  day  are  thereby  reduced  to 
one  or  two  ;  it  stops  the  vomiting,  and  it  improves 
general  conditions  and  causes  the  patient  to  put 
on  flesh.  Rnally,  it  brings  about  some  amount  of 
irnprovement  in  the  coloured  corpuscles,  which 
increase  at  the  rate  of  about  10,000  per  cmm. 
daily.  These  results,  due,  as  I  believe  they  are, 
to  such  simple  means,  are  worthy  of  the  careful 
attention  of  every  medical  man  who  is  called 
upon  to  deal  with  wasting  diseases. 

Case  /. — A.  B.,  male  child,  aet.  one  month ; 
brought  to  hospital  with  a  history  of  diarrhoea, 
vomiting  and  wasting  from  birth.  There  wercj 
usually  from  eight  to  ten  green,  slimy  and  offen- 
sive motions  in  the  twenty-four  hours.  The 
child  had  "snuffles,"  and  was  covered  with  a 
syphilitic  rash  all  over  the  body.  It  was  breast- 
fed, but  a  little  cow's  milk  diluted  with  one-third 
lipie  water  had  been  given  from  time  to  time. 
The  weight  was  only  4J  pounds.  Treatment 
included  grey  powder,  inunctions  of  mercurial 
ointment,  and  the  administration  of  subnitrate 
of  bismuth,  both  in  small  and  in  large  doses. 
The  incessant  vomiting,  however,  went  on  un- 
chepked,  and,  humanly  speaking,  there  seemed 
to  be  not  the  least  chance  of  recovery.  At  this 
point  all  medicinal  treatment  was  discontinued, 
and  the  infant  ordered  a  teaspoonful  of  Sanatogen 
in  a  mixture  ojE  milk  and  cream  every  four  hours. 
This  combination  was  taken  well,  and  in  less  than 
ti^enty-four  hours  the  vomiting  and  diarrhoea 
had  ceased.  The  child  gained  half  a  pound  in 
weight  in  a  week,  and  made  a  good  recovery. 

Th^  foregoing  case  speaks  for  itself.  It  has 
an  extremely  suggestive  value  as  regards  the 
relation  of  general  nutrition  to  the  curative  action 
of  specific  drugs  upon  the  body.  The  following 
case  illustrates  the  use  of  Sanatogen  in  stopping 
diarrhoea  and  vomiting  in  a  wasted  child,  where 
there  was  no  evidence  of  any  specific  disease. 

Case  II, — C.  D.,  a  female  child,  aet.  four  months  ; 
brought  with  a  history  of  almost  continuous 
diarrhoea  since  birth.  There  were  many  motions 
daily,  of  a  yellow  colour  streaked  with  green,  and 
very  offensive.  Milk,  cream,  and  many  kinds  of 
*'  infant  foods  "  had  been  tried  in  vain  ;  nearly 
all  of  them  excited  vomiting.  The  child  weighed 
only  six  pounds,  was  thin  and  pale,  with  an 
irregular  temperature  ranging  between  98°  and 
101°.  There  was  no  evidence  of  syphiUs  nor  of 
tubercle.  The  red  blood  corpuscles  numbered 
4,150,000,    the    leucocytes     11,000,    whilst    the 


haemoglobin  value  was  61  per  cent.  Sanatogen 
given  in  two-drachm  doses  every  four  hours 
promptly  stopped  the  diarrhoea  and  lessened  the 
vomiting.  In  four  days  the  temperature  had 
fallen  to  normal,  and  at  the  end  of  a  week  the 
red  cells  had  risen  to  4,230,000  and  haemoglobizi 
value  to  62-5  per  cent.  The  treatment  was,  con- 
tinued for  some  time,  and  careful  weighing  showed 
that  the  child  gained  weight  at  the  rate  of  about 
a  quarter  of  a  pound  a  week. 

The  following  cases  show  the  value  of  this  new- 
form  of  food  nutrition  in  various  wasting  con- 
ditions : — 

Case  III. — F.  F.,  female,  single,  aet.  18,  waitress 
in  a  London  tea-shop  ;  complaining  of  palpitation 
and  shortness  of  breath.  For  three  years  she 
had  suffered  periodically  from  attacks  of  ana*mia 
and  amenorrhoea.  She  was  liable  to  fainting 
fits,  especially  when  actively  engaged  in  a  hot 
room.  The  conjunctivae  and  the  mucous  mem- 
brane of  the  Ups  were  pale.  Her  red  blood 
corpuscles  numbered  3,500,000  per  cmm.,  with  a 
haemoglobin  value  of  42  per  cent.  She  lived 
chiefly  on  tea  and  bread  and  butter,,  and  it  was 
only  with  much  difficulty  she  was  able  to  continue 
her  emplo3rment.  After  relief  of  constipation  she 
^vas  ordered  Sanatogen  in  milk  as  a  staple  article 
of  dietary.  This  she  took  without  difficulty,  and 
in  a  fortnight  her  red  cells  improved  at  the  rate 
of  10,000  a  day.  Her  symptoms  gradually  sub- 
sided, and  at  the  end  of  a  month  she  was  able 
to  take  her  meals  with  a  good  appetite,,  and  was 
free  from  all  appearances  of  anaemia. 

Case  IV. — G.  H.,  a  married  woman,  ae*.  yS^ 
suffering  from  melancholia.  She  had  sustaiind 
a  severe  shock  from  the  sudden  loss  of  her  favourite 
child.  She  took  to  her  bed  and  practically 
refused  all  food  with  the  exception  of  beef-tea, 
milk  and  jelly.  She  lost  weight  rapidly,  and 
suffered  from  profuse  sweating  at  night.  No 
sign  of  tubercle,  however,  could  be  detected  in  the 
lungs  or  elsewhere.  She  was  anaemic,  and  her 
red  corpuscles  numbered  only  3,800,000  per  cjnsL,. 
with  haemoglobin  48  per  cent.  She  was  placed 
on  Sanatogen,  and  at  onoe  began  to  improve. 
Her  mental  equilibrium  was  restored,,  she  deve- 
loped fresh  energy,  and  at  the  end  of  a  fbrtnigfat 
was  able  to  resume  her  home  duties.  Her  red 
cells  had  by  that  time  risen  to  4,000,000  per  amm. 
and  the  haemoglobin  to  52  per  cent.  The  im- 
provement in  this  case  was  most  striking  and 
suggestive. 

Case  F. — ^T.  J.,  an  elderiy  widow^  lady,  had 
suffered  for  many  years  from  chronic  bronchitis 
and  emphysema.  Of  late  she  had  developed 
glycosuria  ;  the  amount  of  urine  passed  in  the 
day  measuring  on  an  average  six  pints,  with  a 
specific  gravity  of  1025.  She  lost  little  flesh  and 
there  were  no  other  symptoms  of  diabetes.  She 
had  been  carefully  dieted  by  a  physician,  under 
whose  direction  all  sugair  and  starch  were  ex- 
cluded. Unfortunately,  from  the  state  of  her 
teeth  she  was  unable  to  masticate  the  various 
substitutes  for  bread  which  were  from  time  to 
time  suggested.  Her  heart  was  dilated,  and  she 
suffered  much  from  dyspnoea  on  exertion,  even 
when  the  latter  was  slight,  such  as  going  slowly 
upstairs.  Flatulence  was  another  great  trouble, 
and  eructations  were  almost  incessant.  The 
dietary  was  relaxed,  and  she  was  placed  on  one- 
ounce  doses  of  Sanatogen  in  milk  every  four 
hours.     In  less  than  a   week  'jah  fier  subjective 


Nov.  2,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Pxess.    45Q 


^symptoms  had  disappeared,  and  the  urine  was 
^ree  from  sugar.  Her  powers  of  walking  gradually 
x-etumed,  and  in  a  month  she  was  able  to  walk 
Iralf  a  mile  on  level  ground  twice  a  day  without 
much  inconvenience. 

Case  VI. — K.  L.,  a  girl,  aet.  3,  brought  to 
xne  by  her  mother  for  advice  on  account  of 
*•  weakness."  Family  history  good;  child  fairly 
'well  nourished ;  had  enteritis  of  four  weeks' 
<luration  when  one  month  old,  and  bronchitis 
lasting  three  weeks  with  two  convulsions  at  the 
a^e  of  one  year.  Has  always  been  **  delicate  **  and 
nervous  ;  cannot  walk  far,  as  she  complains  of 
pain  in  her  knees.  Teeth  good  ;  moderate  "  knock- 
JKnee  "  ;  height  S7i  inches  ;  weight  32^^  pounds 
(fifteen  months  previously  32  pounds).  No  or- 
ganic or  constitutional  disease  was  found.  The 
<3niy  suspicious  point  was  the  almost  stationary 
^weight,  which  in  an  ordinary  healthy  child  of  her 
age  should  clearly  have  increased  many  pounds 
in  the  course  of  fifteen  months.  She  was  ordered 
Sanatogen,  one  teaspoonful  twice  daily,  and  at 
once  began  to  put  on  weight  at  an  average  of 
Ixalf  a  pound  weekly.  The  error  of  nutrition,  in  this 
instance  of  obscure  origin,  appears  to  have  been 
«fEectually  remedied  by  a  simple  dietetic  treat- 
ment. 

Case  VII, — ^M.  N.,  a  gentleman,  of  middle 
age,  who  had  suffered  for  eleven  months  from 
«pitheUoma  of  the  soft  palate.  About  the  second 
^week  in  September,  1904,  he  had  reached  an 
extreme  stage  of  emaciation,  and  had  taken  for 
several  weeks  to  his  bed,  from  which  he  had 
t>efore  that  time  been  carried  downstairs  in  a 
chair,  Sanatogen  was  ordered  in  teaspoonful 
<loses  twice  daily  in  milk.  A  marked  improve- 
ment in  the  general  condition  rapidly  followed. 
The  hollows  in  the  cheeks  and  temples  became 
much  less  visible,  and  after  a  time  the  patient 
actually  walked  downstairs,  and  interested  him- 
self in  painting  picture-frames  and  so  on.  More 
striking  still  was  the  fact  that  he  several  times 
asked  for  and  ate  a  boiled  egg,  although  he  had 
:taken  nothing  but  **  spoon "  diet  for  months 
previously.  In  this  case  Sanatogen  produced  a 
•distinctly  favourable  effect  on  the  general  nutrition 
and  condition.  The  improvement  was  far  more 
marked  than  happens  in  the  occasional  "  turn  for 
-the  better ''  met  with  in  most  cases  of  malignant 
disease,  and  lasted  for  many  weeks. 

Although  I  have  had  no  experience  personally 
of  the  use  of  Sanatogen  in  convalescence  from 
enteric  fever,  a  medical  friend  has  found  it  in- 
valuable under  those  circumstances.  Anything 
^hat  can  help  one  to  tide  over  the  anxious  period 
•of  typhoid  convalescence  will  be  sure  of  a  warm 
welcome  by  medical  men.  For  many  years  it 
was  the  invariable  rule  both  in  hospital  and  in 
private  practice  not  to  give  any  food  beyond 
milk,  cream,  and  beef-tea  until  the  temperature 
had  been  normal  for  ten  da3rs.  During  that  time 
of  probation  patients  craved  for  food  incessantly, 
and  suffered  much  distress  from  restless  nights 
and  from  the  pangs  of  hunger.  This  rule  was 
gradually  relaxed  ;  first  cofiEee  and  then  mashed 
bananas  and  cream  were  allowed,  and  the  time  of 
probation  shortened.  It  is  now  admitted  by 
many  good  authorities  that  soUd  food  may  be 
.^ven  in  nulk  after  the  fourth  day  of  normal 
temperature  with  absolute  safety.  The  comfort 
of  the  patient  is  thereby  much  increased,  and  his 
convalescence   shortened.    In    this    and    in    the 


other  conditions  above  mentioned,  Sanatogen 
deserves  a  careful  trial  by  medical  practitioners,  as 
a  readily  assimilable  form  of  semi-soUd  food.  It 
is  readily  prepared,  moreover,  a  point  of  some 
importance  in  the  sickroom. 

On  the  Continent,  Professor  Ewald  (a)  has 
spoken  warmly  of  the  value  of  Sanatogen  in 
enteric  fever.  He  administered  that  food  to  a 
patient  on  the  fifth  day  after  admission  to  hospital 
early  in  the  third  week  of  an  attack  of  typhoid 
fever.  As  the  result  of  experimental  investi- 
gations he  concluded  that  Sanatogen  is  valuable, 
on  account  of  its  ready  absorbability,  in  all  cases 
of  physical  weakness,  "  as  well  as  in  the  acute 
stages  of  all  those  maladies  which  are  accom- 
panied by  high  rise  of  temperature  and  particu- 
larly in  enteric  fever."  Dr.  Eduard  Rybiezka  (6) 
advocates  the  use  of  the  same  preparation  in 
convalescence  from  the  malady  in  question. 

Case  VIII. — A  lady,  aet.  50,  single,  complaining 
of  stifE  joints  and.  wasting.  Her  mother  died  of 
phthisis,  also  a  brother.  When  young  she  had  an 
attack  of  St.  Vitus'  dance,  after  falling  downstairs. 
Between  20  and  25  she  suffered  from  chronic 
cough,  and  was  treated  for  incipient  consumption. 
General  health  had  been  good  ever  since,  and 
she  had  been  of  active  habits,  and  took  a  great 
deal  of  outdoor  exercise.  Seven  or  eight  years 
ago  her  hands  began  to  get  stiff  and  painful,  and 
later  the  feet,  elbows  and  knees  were  involved. 
The  hands  showed  the  typical  deformities  of 
advanced  osteo-arthritis  ;  the  fingers  were  en- 
larged at  the  joints,  and  those  of  the  right  de- 
flected outwards  and  clawed ;  large  swellings, 
both  bony  and  bursal,  were  present  on'  the  backs 
of  hands  and  wrists.  The  right  hand  was  worse, 
as  the  fingers  were  partly  clawed  into  the  palm 
and  the  wrist  also  partly  locked.  There  were 
tender  spots  on  the  hands,  but  for  the  most 
part  tenderness  and  pain  were  absent.  The  feet, 
elbows  and  knees  were  more  or  less  involved  ; 
the  elbows  could  not  be  straightened,  and  there 
was  a  great  deal  of  *'  egg-shell  "  deposit  about 
the  knees,  especially  the  right.  There  had 
recently  been  a  considerable  loss  of  weight, 
although  the  appetite  remained  good.  A  careful 
search  failed  to  reveal  tubercle  in  the  lungs  or 
elsewhere,  and  no  disease  of  heart,  kidne3rs,  or 
other  organs  accounted  for  the  loss  of  weight 
This  patient  was  treated  by  the  super-heated 
air  method,  introduced  and  perfected  by  the  late 
Mr.- Tallerman.  The  joints  soon. gained  in  power 
of  movement,  and  the  joint  swellings  diminished 
rapidly  in  size.  At  the  same  time  the  general 
health  improved  greatly.  Sanatogen  was  ordered 
at  the  outset  in  teaspoonful  doses  twice  daily. 
The  patient  was  first  seen  on  October  nth,  when 
she  weighed  6st.  9 lbs.  Sanatogen  was  first  given 
on  the  14th  in  teaspoonful  doses  thrice  daily, 
increased  gradually  to  two  teaspoonfuls.  The 
weight  began  to  increase  at  once,  and  on 
October  28th  the  weight  was  6st.  nibs. 

This  case  shows  the  value  of  a  readily  absorb- 
able food  in  the  perverted  nutrition  of  a  general 
disease  Uke  osteo-arthritis.  The  great  loss  of 
weight  is  met  with  occasionally  in  cases  of  rheu- 
matoid arthritis  in  which  there  is  no  gross  organic 
disease.  A  well-known  physician  has  recently 
published   several  cases   of   extreme  wasting  in 

(a)  ZeiUchrifl  fur  dUMitche  and  physikaliKhs  Therapit.     Voa 
Leyden.    Article  bv  Dr.  0.  A.  Ewald. 
(A)    Wiener  klihiseke  fVoehtntchrift,  1900.    Vol.  ix. 


460    The  Medical  Press. 


CLINICAL    RECORDS. 


Nov.  2,  1904. 


connection  with  pulmonary  osteo-arthopathy. 
In  my  experiences  the  joint  changes  in  these 
cases  are  the  essential  feature,  and  the  thoracic 
trouble  an  accidental  compMcation  of  more  or 
less  severity.  For  some  years  past  I  have  had 
a  large  experience  of  osteo- arthritic  cases  at  the 
Tallerman  Free  Institute,  Scores  of  chronic 
osteo-arthritic  or  rheumatoid  conditions  were 
seen  ;  a  fair  number,  perhaps  2$  per  cent, 
of  them,  showed  marked  wasting,  but  I  can  recall 
only  two  or  three  in  which  there  was  serious 
advanced  disease  of  heart  or  lungs.  At  the 
same  time  slight  valvular  murmurs  were  common 
enough,  as  might  be  expected  from  the  frequent 
history  of  rheumatic  fever  in  osteo- arthritic  cases. 


aiinical  IRecotDs. 


Radiogram   of  Hand    in   Chronic   Osteo- 
arthritis. 

It  may  be  of  interest  to  insert  here  a  radiogram 
which  1  have  taken  of  the  left  hand  of  this 
patient.  It  shows  in  various  joints — as  about  the 
phalanges  and  wrist — the  typical  light  bony  out- 
growths near  the  articulations^  with  destruction 
of  cartilages  and  part!y  of  epiphyses  w^ell  seen  in 
the  first  and  fourth  metacarpo  -  phalangeal 
joints.  These  appearances  diflfer  markedly  from 
the  bone  changes  in  chronic  gout,  where  parts  of 
the  bones  are  cut  out  sharply  as  if  by  a  gouge. 
The  thumb  is  dislocated  from  the  metacarpal 
bone  and  its  metacarpo -phalangeal  joint  is  dis- 
organised. The  styloid  process  of  the  idna  is 
hypertrophied  (it  is  tender  to  pressure).  The 
wrist  bones  generally  are  obscured  by  effused 
material.  The  hgure|is  a  good  specimen  of  the 
condition  of  bone  met  with  in  rheumatoid  or, 
as  it  is  nowadays  more  commonly  called,  "  osteo-" 
arthritis^  while  the  typical  fusiform  thickening 
of  the  fingers  in  that  disease  is  particularly  well 
shown. 


FOR 


NORTH-EASTERN   HOSPITAL 
CHILDREN. 
A  Case  of  Infantile  General  Paralysis  of  the' Insane. 
By  George  Carpenter,  M.D., 

Editor  of  the  BritUh  Journal  0/  Children'*  DUeasef,  Late  FhyiFiciaa 
to  the  EyeJkiR  Hospital  for  Hick  Children :  Senior  Attifltent 
Physician  to  the  North-Bastem  Hoepital  for  Chikben. 

Elizabeth  C,  aet.  11^  years,  was  admitted 
into  the  North-Eastem  Hospital  for  Children  in 
July,  1903.  It  was  stated  that  she  was  in  perfect 
health  until  April,  1902,  when  she  was  lost  for  a 
night,  and  ever  since  then  had  been  *'  queer  in  the 
head."  She  has  gradually  been  getting  worse 
mentally  ever  since,  being  obstinate  and  screaming 
on  the  slightest  provocation.  There  has  been 
occasional  frontal  headache  ;  she  has  slept  badly 
and  taken  her  food  badly  ;  she  has  never  had  any 
fits  or  seizures  ;  ten  years  ago  she  had  measles. 
There  is  no  family  history  of  insanity.  Several 
healthy  children  were  bom  to  the  parents.  Next 
a  child  was  bom  dead,  this  was  followed  by  a  living 
child,  then  the  patient,  and  lastly  ^  boy  of  eight 
years,  who  is  sufEering  from  nerve  deafness  in  both 
ears. 

State  on  Admission. — She  has  an  unusually 
thick  covering  of  subcutaneous  fat,  and  her  skin  is 
natural.  Mentally  she  has  two  well-defined  states. 
She  lies  awake  most  of  the  twenty-four  hours,  and 
talks  incoherent  nonsense  to  herself  quite  quietly 
and  oblivious  of  her  surroundings.  Such  remarls 
as  "  The  goldfish  are  very  happy,"  *'  No,  Bobby  is 
all  right,"  and  so  on,  can  be  heard  by  those  stand- 
ing by  her  cot.  During  this  her  face  wears  a  placid, 
self-pleased  expression  which  caUs  to  mind  the 
fatuous  type  of  the  general  paral3^is  of  the 
insane  patient. 

On  being  crossed  by  contradicting  one  of  her 
statements,  or  by  disturbing  her  physically,  she 
bursts  into  an  attack  of  loud  screaming  and  weep- 
ing, which  lasts  for  a  few  hours.  She  will  usually 
answer  simple  questions,  and  is  obedient  to  such 
demands  as  putting  out  the  tongue  until  this  sod- 
den storm  be  evoked.  She  has  hallucinations  of 
pleasant  objects,  such  as  flags,  ladders,  and  bowls 
of  water,  which  are  quite  common.  Auditory  and 
olfactory  hallucinations  have  not  been  noticed 
She  continually  mocks  other  children's  cries  or 
street  cries,  and  imitates  them  well.  She  docs 
not  know  her  mother. 

Her  amis  and  legs  are  moved  well,  the  former 
better  than  the  latter.  She  can  walk,  and  there 
is  some  shght  spasticity  of  the  lower  limbs.  There 
is  a  flickering  tremor  of  the  lower  facial  muscles 
when  smihng  or  talking.  The  tongue  is  protruded 
normally,  and  has  an  occasional  tremor.  There  is 
a  fine  tremor  of  both  hands,  which  is  most  marked 
on  first  gripping  an  object.  The  plantar  reflexes 
show  typical  Babinski  response  on  both  sides. 
The  elbow-jerks  are  active.  The  supinator- 
jerks  are  abnormally  increased.  The  knee-jerks 
are  very  active  and  equal.  There  are  no  clonuses. 
So  far  as  can  be  ascertained  sensation  is  unim- 
paired. Her  organs  are  normal.  She  cries  fre- 
quently when  the  desire  occurs  for  micturition 
or  defalcation,  but  has  deficient  power  of  retention,, 
so  that  both  evacuations  are  passed  involuntarily. 
Her  feet  are  cold  and  red,  and  sometimes  blue — 
she  has  pes  cavus. 

She  has  a  long  face  and  depressed  bridge  of  the 
nose.    The    facial    muscles    are    generally    well 


Nov,  2,  1904. 


TRANSACTIONS    OF   SOCIETIES.  The  Medical  Peess.   461 


developed,  and  there  is  no  local  wasting.  There 
are  no  radiating  scars  about  the  mouth.  She  has 
typical  Hutchinson's  teeth.  Her  pupils  are  equal. 
They  do  not  react  at  all  to  light,  and  the  accommo- 
dation cannot  be  tested.  The  fundus  oculi  was 
examined  under  an  anaesthetic.  The  optic  discs 
vrere  pale,  and  there  was  a  small  patch  of  choroid- 
itis in  the  left  eye.  Vision  was  very  defective, 
l>eing  lost  to  all  but  light.  There  was  no  reaction 
to  a  threatening  movement. 

The  case  is  of  interest  owing  to  the  youth  of  the 
patient  and  from  the  imdoubted  corroborative 
evidences  of  congenital  syphilis  associated  with 
that  condition. 

[Shown  to  the  Society  for  the  Study  of  Disease 
in  Children,  November  20th,  1903.] 

TCtandacttond  of  Societies* 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday,  October  28th. 


The  President,  Dr.  Frederick  Taylor,  in  the  Chair. 


CLINICAL    EVENING. 

Dr.  F.  E.  Batten  showed  a  case  of  Acute  Ataxia 
in  a  boy,  aet.  3^,  due  to  Encephalitis  Cerebelli.  Patient 
had  measles  in  March,  1904.  During  convalescence 
he  became  unconscious,  and  remained  so  for  a  week. 
He  then  had  convulsions  and  tremors,  and  on  becoming 
conscious  he  could  not  sit  up  or  speak.  A  month  later 
he  had  marked  inco-ordination  01  both  legs  and  arms. 
There  was  no  paralysis.  The  knee-jerks  were  well 
marked,  and  a  tendency  to  ankle-clonus.  He  swallowed 
well,  and  spoke  in  a  low,  hesitating  manner.  Since  then 
only  slight  improvement  has  occurred.  He  has  com- 
plained of ' '  pins  and  needles  "  in  his  limbs.  His  mother 
complains  that  since  his  illness  his  moral  sense  has 
become  much  perverted. 

The  President  recalled  a  case  he  saw  some  twenty- 
five  years  before,  which  at  the  time  he  considered  to 
be  one  of  disseminated  sclerosis,  although  Dr.  Moxon, 
who  also  saw  the  case,  did  not  think  so.  Now,  the 
case  seemed  to  him  to  be  one  of  cerebellar  encephalitis, 
almost  exactly  simulating  the  one  shown.  His  case 
completely  recovered  in  two  or  three  years,  although 
there  was  no  diminution  in  the  ataxy  for  eighteen 
months. 

Dr.  Batten  said  that  on  account  of  Luciani's  well- 
known  experiment  demonstrating  the  connection  be- 
tween the  cerebellar  lobe  and  the  heterolateral  cere- 
bral cortex  he  was  of  opinion  that  the  cerebral  cortex 
in  this  case  must  have  been  also  damaged,  thus  ex- 
plaining the  non-improvement.  He  was  interested 
to  hear  of  Dr.  Taylor's  case,  as  it  would  incline  him  to 
give  a  better  prognosis  in  his  own. 

Dr.  E.  D.  Macnamara  showed  a  case  of  Acute  As- 
cending Paralysis ;  Tetracoccus  found  in  the  Spinal 
Fluid.  The  patient,  aet.  30,  a  waiter,  admitted 
under  Dr.  Murrell,  August  3rd,  1904,  with  the 
history  of  commencement  of  loss  of  power  in  legs  eleven 
days  before,  which,  within  three  days,  had  culminated 
in  absolute  palsy.  Three  days  before  admission  there 
was  weakness  of  the  arms,  difficulty  in  swallowing,  and 
double  vision.  There  is  a  history  of  syphilis  at  twenty- 
four,  which  was  actively  treated.  There  was  on  ad- 
mission total  paralysis  of  the  legs  except  of  the  right 
hallux,  weakness  of  the  arms,  defective  articulation 
and  ocular  movements,  and  both  pupils  were  almost 
inactive  to  light.  No  reflexes  were  obtained  in  the 
lower  limbs  ;  the  other  reflexes  were  normal,  as  also  the 
electrical  reactions.  There  were  no  subjective  sensory 
symptoms,  nor  other  objective  signs.  After  August  8th 
improvement  commenced,  and  has  continued.  Speech, 
ocular  movements,  the  pupil  reaction,  and  the  arm 
movements  have  been  recovered.  He  can  move  his 
legs,  and  the  knee-jerks  are  returning,  but  he  cannot 
yet  walk. 


Dr.  Farquhar  Buzzard  referred  to  the  tetracoccus 
he  had  found  in  a  case  of  Landy's  paralysis  last  year ; 
the  organism  was  pathogenic  to  animals,  as  was  shown 
by  Dr.  Eyre.  The  tetracoccus  shown  that  night  was  not 
unlike  the  one  he  had  found,  but  he  could  not  express 
a  positive  opinion  on  such  a  slight  examination.  The 
different  conditions  described  under  Landy's  paralysis 
fell  into  three  groups :  ( i )  The  true  Landy's  paralysis, 
characterised  by  sudden  general  paralysis  of  all  the 
muscles,  though  more  of  the  large  ;  a  few  of  the  cases 
get  quite  well.  (2)  A  type  of  paralysis  equally  sudden 
and  disabling,  but  having  the  distribution  of  a  peri- 
pheral neuritis.  ( 3 )  Acute  ascending  meningo-myelitis, 
marked  sensory  and  sphincter  trouble  being  present. 

Dr.  F.  E.  Batten  compared  the  present  case  to  a 
toxic  paralysis,  such  as  a  diphtheritic  one.  The  fact 
of  recovery  was  against  its  being  due  to  organisms 
actually  in  the  nervous  system. 

Dr.  Macnamara,  in  reply,  pointed  out  that  when 
Landy's  paralysis  recovers,  it  usually  does  so  com- 
pletely, as  one  would  expect  from  an  acute  specific 
infection.  Dr.  Eyre  was  at  present  testing  the  patho- 
genicity of  the  cultures,  but  so  far  had  obtained  no 
positive  result. 

Dr.  J.  H.  Bryant  showed  two  cases,  brother  and 
sister,  of  the  Peroneal  Type  of  Family  Amyotrophy. 
The  girl,  aet.  12,  had  whooping-cough  at  four,  after 
which  she  could  not  walk  properly,  and  she  was  treated 
for  infantile  paralysis  of  the  legs  by  orthopaedic  ap- 
paratus. At  5}  she  had  scarlet  fever,  and  measles  at 
6  and  8  years.  In  1900  wasting  of  the  hands  was  first 
noticed,  the  muscles  of  the  thenar  and  hypothenar 
eminences,  and  the  interossei  in  the  upper  hmb,  the 
small  muscles  of  the  feet,  the  peronei,  tibialis  anticus, 
and  extensor  longus  hallucis  in  the  lower  limb.  The 
boy,  aet.  8,  was  first  noticed  to  become  weak  after 
.measles  at  2 J,  his  legs  frequently  gave  way,  and  he 
could  not  lift  his  big  toes.  When  first  seen,  in  1903, 
the  paralysis  of  the  extensor  longus  hallucis  was  the 
most  marked.  The  paralysis  has  increased,  and  the 
feet  are  now  in  a  position  of  talipes  equino- varus.  A 
paternal  uncle  is  similarly  suffering  from  weakness  and 
wasting  of  the  legs  and  hands.  His  wasting  began 
at  the  age  of  three,  and  he  is  now  bed-ridden. 

Mr.  Jackson  Clarke  showed  a  case  of  Hard  Fibroma 
of  the  Scapula  and  Spine,  in  a  female,  aet.  24.  The 
left  scapula  was  painful,  elevated,  and  fixed  by  a 
rounded  tumour  situated  at  the  iniddle  of  the  vertebral 
border.  An  exploration  in  May,  1901,  exposed  a  hard, 
white  growth,  which  hardly  bled  at  all.  It  filled  the 
subscapular  fossa,  and  was  attached  to  the  ribs.  As 
much  as  possible  of  the  growth  was  removed.  Since 
this  operation  the  tumour  has  slowly  extended  up- 
wards along  the  spine,  causing  much  pain. 

Mr.  W.  G.  Spencer  expressed  the  opinion  that  the 
condition  might  be  a  spreading  fibrous  myositis,  thus 
bringing  it  into  line  with  myositis  ossificans. 

Mr.  Jackson  Clarke  was  sure  that  the  mass  was  of 
new  formation, on  account  of  the  definite  capsule  present. 

Mr.  H.  A.  J.  Fairbank  showed  two  cases  of  Sprengel's 
Shoulder.  A  girl,  aet.  4,  had  right  scapula  situated  at  a 
higher  level  than  the  left ;  also  placed  nearer  the  middle 
line,  as  seen  when  the  arms  were  hanging  by  the  side. 
The  angle  of  the  scapula  is  rounded  off.  A  band  runs 
from  the  occiput  to  the  verterbal  border.  The  mobility 
of  the  scapula  is  diminished,  as  seen  when  the  arms 
are  held  horizontally  forward.  There  is  no  defect  in 
the  shoulder-joint  or  other  asymmetry.  A  girl,  aet.  12, 
has  the  left  scapula  at  a  higher  level.  The  mobility 
is  very  much  diminished,  with  muscular  weakness,  but 
there  is  no  sign  of  a  fibrous  band  or  bony  ridge.  The 
right  leg  is  wasted,  apparently  from  infantile  paralysis  ; 
the  dorsal  spine  is  curved  to  the  left,  the  lumbar  to  the 
right ;  and  the  right  side  of  the  face  is  flattened.  In 
neither  case  is  there  any  family  history  of  such  a  de- 
formity. 

Mr.  Jackson  Clarke  showed  a  skiagraph  of  a  similar 
case.  He  considered  that  three  factors  were  essential — 
spine,  rib,  and  scapular  deformity,  there  being  a  vary- 
ing degree  of  each  in  a  given  case. 


462    Thb  Medical  P«ess.         TRANSACTIONS    OF   SOCIETIES. 


Nov.  2.  1904. 


Mr.  RuPBRT  BucKNALL  referred  to  similar  cases  of 
his  own,  and  discussed  the  various  theories  explaining 
the  deformity — such  as  malposition  of  the  arm  m  uUro, 
primary  defects,  &c.  The  ridge  passing  from  the 
scapula  to  the  spine  indicated  a  defect  in  the  meso- 
blast,  which  forms  the  muscle  round  the  scapula. 

Mr.  Fairbank,  in  reply,  said  that,  in  his  opinion, 
the  condition  was  one  of  primary  defect.  In  favour  of 
this  were  the  associated  defects  of  the  vertebrae  and 
ribs.  There  was  probably  a  gradation  between 
Sprengel's  cases  ana  the  cases  described  by  Willett 
and  Walsham,  in  which  a  bony  mass  joined  the  scapula 
to  the  spine.  He  considered  the  ridge  in  his  case  to  be 
fibrous  contraction  of  the  muscle,  secondary  to  the 
unusual  position  of  the  scapula. 

Mr.  Jackson  Clarke  showed  a  case  of  Unilateral 
Congenital  Dislocation  of  the  Hip,  reduced  by  the 
method  of  Lorenz.  The  girl,  aet.  7,  had  a  typical  dis- 
placement at  the  right  hip,  which  was  reduced  in 
August,  1903,  as  confirmed  by  a  skiagraph.  The  ab- 
ducted position  was  maintained  for  a  year.  The  child 
is  now  walking  about  without  apparatus,  with  the  head 
of  the  femur  in  position.  The  treatment  is  not  yet  con- 
cluded. 

Mr.  Noble  Smith  showed  a  case  of  Unilateral  Con- 
genital Dislocation  of  the  Left  Hip.  A  girl,  aet.  6} 
years,  with  the  above  was  operated  upon  by  the 
Paci-Lorenz  method  in  January,  1894.  The  limb 
was  maintained  abducted  for  six  months.  The  joint 
.  is  now  firm  and  movable,  and  the  position  of  the 
femur  is  shown  in  a  skiagraph.  He  also  showed 
a  case  of  Double  Congenital  Dislocation  of  the  Hip.  A 
girl,  now  aet.  7^,  was  operated  on  by  the  Paci-Ix)renz 
method  in  January,  1903,  and  the  abducted  position 
maintained  for  six  months.  The  joints  are  now  firm 
and  in  a  normal  position,  as  shown  by  a  skiagraph. 
The  child  continues  to  improve  in  gait. 

Mr.  Tubby  asked  what  evidence  there  was  that  the 
head  of  the  femur  was  in  the  acetabulum.  He  knew 
of  none  except  by  operation.  It  was  well  known  that  a 
skiagraph  of  an  anterior  dislocation,  taken  at  a  certain 
angle,  would  portray  an  apparently  perfect  joint. 
Many  cases  reduced  by  Lorenz' s  method  could  be  shown 
to  be  merely  an  anterior  dislocation  instead  of  a  pos- 
terior. 

Mr.  Jackson  Clarke  knew  of  no  such  evidence, 
and  even  thought  that  an  open  operation  often  failed 
to  decide  the  point.  Actual  demonstration  of  the  re- 
duction could  only  be  obtained  by  watching  Lorenz 
operate.  After  all,  the  important  point  was  •  that 
whether  a  true  reduction  occurred  or  not  perfect 
function  was  restored,  although  some  stiffness  might 
follow  in  the  most  successful  cases. 

Mr.  Noble  Smith,  by  means  of  a  model,  gave  a 
demonstration  of  the  movements  involved  in  me- 
chanism of  reduction.  He  agreed  with  Mr.  Clarke  in  his 
remarks  on  the  difference  between  performing  the 
operation  before  seeing  Lorenz  do  it,  and  after. 

Mr.  A.  H.  Tubby  showed  a  case  of  Ulceration  of  the 
Tongue,  with  Destruction  of  the  Soft  Palate,  of  Un- 
certain Origin.  The  affection  of  the  tongue  com- 
menced with  a  hard  lump,  first  noticed  in  January, 
1904.  There  had  been  previous  deafness  on 
both  sides  for  six  months.  There  is  now  a  rapidly 
«preading,  large,  ragged  ulcer  of  the  tongue,  destruc- 
tion of  the  soft  palate  has  occurred,  and  there  is  ulcera- 
tion of  the  naso-pharynx.  There  is  no  history  of 
syphilis,  and  anti-syphilitic  treatment  has  failed. 
The  microscopic  examination  yielded  negative  results. 

Mr.  Charters  Symonds  was  of  opinion  that  the  man 
was  tuberculous. 

Mr.  Tubby  discussed  the  diagnosis  between  con- 
genital syphilis,  tubercle,  chronic  glanders,  and 
actinomycosis. 

Mr.  W.  G.  Spencer  showed  a  case  two  years  after 
Excision  of  the  Sac  of  a  Spina  Bifida  (Meningo-mye- 
locele). — A  boy,  now  aet.  2J,  was  operated  upon  when 
six  months  old.  The  cauda  equina  and  nerves  were 
dissected  out  and  laid  in  the  groove,  which  was  closed 
by  two  rows  of  sutures.     A  firm ''scar  now  covers  the 


groove,  the  legs  are  used  well,  and  there  is  no  hydro- 
cephalus. 

Dr.  Newton  Pitt  showed  a  case  of  von  Reckling- 
hausen's Disease.  A  female,  aet.  49,  had  at  birth  a 
tumour  to  the  left  of  the  sternum,  and  later  numerous 
painless  subcutaneous  nodules  were  noticed.  New 
tumours  have  appeared  from  time  to  time,  many  within 
the  last  five  years,  which  at  first  were  firm  and  pro- 
minent, and  then,  as  they  increase  in  size,  they  become 
softer.  In  1877  Mr.  Golding  Bird  removed  a  large  un- 
encapsuled  tumour  from  the  left  calf ;  the  tumour  on 
the  left  chest  then  formed  a  pendulous  pigmented  mas 
five  inches  in  length.  It  was  remov^  in  1895,  2uid 
weighed  3 J  lbs.  Also  in  1877  a  raised,  pigmented, 
hairy  mole  with  a  molluscum  tumour,  4  by  li  inches, 
was  removed  from  the  right  cheek.  The  patient  has 
now  a  diffuse  fibroid  swelling  of  the  left  calf,  with  ir- 
regular scarring  resulting  from  the  operation  ;  a  recur- 
rence of  molluscum  fibrosum  tumours  in  the  right 
cheek  ;  innumerable  raised  tumours,  from  i  to  }  of  an 
inch  across,  scattered  over  the  limbs  and  face,  and,  to 
a  less  extent,  on  the  body,  the  skin  over  them  being 
not  generally  pigmented.  There  are  no  obvious  signs 
of  involvement  of  the  large  nerve-trunks, 

Mr.  O.  L.  Addison  showed  for  Mr.  A.  E. 
Barker  a  case  of  Lymphangiectasis  with  escape 
of  Chyle.  A  man,  aet.  20,  has  a  cystic  swelling 
of  varying  dimensions  above  Pouparfs  ligament, 
and  enlargement  of  the  thigh.  The  disease  has 
been  noted  since  the  age  of  seven  years.  Chyle  escapes 
from  an  opening  in  Scarpa's  triangle.  If  the  escape  is 
temporarily  prevented  by  a  pad  an  enlargement  occurs 
in  the  iliac  region.  Then  the  chyle,  when  allowed, 
escapes  in  a  stream,  and  the  patient  feels  relief  from 
tension. 

Mr.  O.  L.  Addison,  replying  to  questions  put  by 
Dr.  French,  said  that  the  fluid  was  chylous,  and  not 
lymphatic,and  so  the  obstruction  must  be  of  the  thoracic 
duct.  He  drew  attention  to  the  fact  that  the  fluid 
escaped  under  pressure,  spurting  to  three  or  four  inches, 
whereas  in  all  the  cases  previously  reported  the  fluid 
had  only  trickled.  There  had  been  no  suggestion  as  to 
the  cause  of  the  condition. 

The  following  cases  were  shown  by  Mr.  Charters 
SvMONDs  : — (i)  Simultaneous  Ligature  of  the  Common 
Carotid  and  Subclavian  Arteries  for  Aortic  Aneurysm. 

Mr.  W.  C.  Spencer  referred  to  cases  operated  on  by 
Mr.  Christopher  Heath.  In  those  he  had  seen  the 
results  were  not  good. 

Mr.  Rupert  Bucknall  had  seen  several  of  Mr. 
Heath's  cases  in  which  good  results  were  obtained.  He 
had  himself  operated  on  one  case  which  was  rapidly 
growing.  After  ligature  first  of  the  left  common  caro- 
tid, and  then  of  the  left  subclavian  artery,  hardening 
took  place.  The  man  returned  to  work  for  two  years, 
then  died  of  phthisis.  At  the  autopsy  the  aneuiysm 
was  found  to  be  healed.  He  thought  that  the  line  of 
treatment  was  of  great  benefit  and  worthy  of  wider 
recognition. 

(2)  A  case  of  Bony  Union  after  Fracture  of  the  Patella 
without  Wiring. 

(3)  A  case  of  Popliteal  Aneurysm  after  Ligature  of 
the  Superficial  Femoral  artery. 

NORTH     OF     ENGLAND    OBSTETRICAL      AND 

GYNAECOLOGICAL  SOCIETY. 
Meeting  held  at  Liverpool,  Friday,  October  2Ist. 


Dr.  W.    J.   Sinclair,    President,    in    the   Chair. 

Dr.  R.  Favell  (Sheffield)  showed  a  dermoid  cyst  of 
the  ovary  and  an  ectopic  gestation,  interesting  for  the 
reason  that  each  had  had  the  appendix  vermiformis 
adherent  to  it.  He  referred  to  Howard  Kelly's  paper 
on  the  subject,  in  which  115  cases  are  tabulate. 

Specimens  were  also  shown  by  Drs.  W.  E.  Fother- 
GiLL  and  Murray  Cairns,  and  Dr.  Lloyd  Roberts 
exhibited  an  improved  needle-holder.  Dr.  E,  Emry^ 
Roberts  gave  a  lantern  demonstration  of  the  first 
stage  of  implantation  of  the  ovum  of  the  guinea-pig. 

Dr.  Arnold  Lea  (Manchester)  detailed   a  case  of 


Tffov.  2,  1904. 


TRANSACTIONS    OF    SOCIETIES.  The  Medical  Peess.   463 


RUPTURE   OF  THE    UTERUS. 

"Which  took  place  «t  the  seventh  month  of  the  fourth 
^pregnancy  of  a  woman,  aet.  24.     She  ^^as  admitted  to 
the  Maternity  Hospital  for  sudden  profuse  bleeding  due 
~to  placenta  praevia.    Twenty  hours  after  admission  a 
<le  Ribes  bag  was  inserted  into  the  cervix.    Five  hours 
later  the  pulse  had  gone  up  to  124.    Dr.  Lea  arrived 
at  the   hospital   shortly   sLfterwards   and   found    the 
l>atient's  condition  was  good.    The  bag  was  removed, 
and  under  chloroform  bipolar  version  was  performed, 
the  hand  not  being  introduced  into  the  uterus,  and  a 
inacerated  seven  months  foetus  was  readily  extracted. 
The  patient's jpiilse  then  became  very  rapid,  and  her 
skin  pallid.    The  placenta  was  easily  expressed,  and 
the  uterus  appeared  to  contract  well.    A  deep  tear  of 
the  left  side  oi  the  cervix  was  sutured.    The  pulse  re- 
mained 130  to  134,  but  the  patient  was  quite  comfort- 
able when  placed  in  bed.     A  quarter  of  a  grain  of 
morphia  was  given,  and  also  a  rectal  injection  of  saline 
solution  with  an  ounce  of  brandy.     Half  an  hour  later 
she  became  suddenly  blanched,  her  pulse  failed  com- 
pletely, and  she  died  in  five  minutes,  obviously  from 
•internal  haemorrhage.    There  had  been  no  bleeding 
per  va^inam,  and  the  uterus  appeared  well  contracted. 
An  autopsy  was  made  twelve  hours  after  death.     The 
X>eritoneal  cavity  contained  nearly  a  pint  of  blood, 
-which  had  escaped  through  a  rent  in  the  posterior  layer 
•of  the  left  broad  ligament.    There  was  a  lateral  tear 
three  inches  in  length  in  the  lower  uterine  segment ;  this 
iiad  led  to  the  formation  of  a  huge  haematoma  between 
the  layers  of  the  left  broad  ligament,  and  this  had 
uniptured,  through  a  linear  rent,  into  the  peritoneal 
•cavity.     The  uterine  muscle  was  pale,  soft  and  appa- 
rently degenerated,  and  the  placental  site  where  the 
tear  occurred  was  thinned.     Regarding  the  cause  of 
-rupture.  Dr.  Lea  said  there  was  a  great  probability  that 
the  patient  had  had  S)rphiLis,  her  previous  children 
being  bom  prematurely,  either  dead  or  dying  shortly 
•alter  birth.    The  rupture  occurred  at  the  plac^tal  site, 
there  was  no  evidence  of  a  retraction  ring,  the  mem- 
branes being  ruptured   shortly  before  delivery  was 
•effected.     He  thought  the  rupture  probably  occurred 
spontaneously  whilst  the  de  Ribes  bag  occupied  the 
lower  segment  of  the  uterus  as  shown  by  the  rise  of 
pulse  to  126.     Extraction  probably  made  the  tear  com- 
plete.   The  three  factors  in  the  causation  were  thus, 
degeneration    of    muscle,    probably    syphilitic ;     low 
situation   of   placenta ;     aggravation   of   rupture   by 
version  and  extraction.     The  tear  was  at  first  incom- 
plete, leading  to  the  formation  of  a  haematoma  of  the 
broad  ligament.     Sudden  rupture  of  the  posterior  layer 
•of  the  broad  'ligament  permitted  free  bleeding  into  the 
coelom,  and  death  followed.     Discussing  the  symptoms 
of  this  form  of  rupture,  Dr.  Lea  remarked  they  were 
•often  obscure.     In  his  case  there  was  an  absence  of  all 
pain,  of  external  Weeding,  whilst  the  uterus  appeared 
by  abdominail  examination  to  be  firmly  contracted. 
The  foetus  lay  high  up,  but  not  more  so  than  normal. 
In  short,  the  sole  characteristic  was  increase  of  pulse- 
rate,  and  even  this,  owing  to  the  previous  haemorrhage, 
.had  not  had  sufficient  stress  laid  upon  it.     Had  the 
tear  been  rec(>gni8ed  immediately  after  delivery,  Dr. 
L.ea  said  he  considered  the  proper  treatment  would 
have  been  to  pack  with  gauze. 

Dr.  Lloyd  Roberts  (Manchester)  in  commenting  on 
the  case,  thought  that  everything  possible  had  been 
•done. 

Dr.  Walter  (Manchester)  thought  the  case  illus- 
trated the  risk  attendant  on  the  use  of  de  Ribes'  bag. 
He  had  known  of  two  instances  in  which  the  bag  had 
<lisappeared  entirely  within  the  uterus.  It  was  im- 
4>ortant,  when  employing  it.  to  be  quite  certain  as  to 
the  quantity  of  water  pumped  into  it. 

Dr.  W.  K.  Walls  (Manchester)  said  his  experience 
•embraced  two  similar  cases,  and  he  considered  that 
the  rupture  was  due  to  the  delivery  and  not  to  the 
*>ag. 

The  President  thought  it  possible  that  the  tear 
might  have  occurred  during  the  introduction  of  the  bag. 
Dr.  Lea  briefly  replied. 


Dr.  W.  K.  Walls  reported  a  case  in  which  a  mass 
of  multiple  fibro-myomata  of  the  uterus  occupied  a 
large  ventral  hernia.  The  patient  was  married,  aet.  44. 
and  the  menopause  occurred  at  35  ;  no  pregnancies. 
History  of  three  operations  five  years  previously,  pre- 
sumably laparotomy.  The  large  ventral  hernia  con- 
tained a  soUd  mass  and  also  fluid ;  the  skin  was  ulce- 
rated in  places ;  behind  the  hernia  a  solid  mass  ex- 
tended from  pubes  to  umbilicus.  The  cervix  uteri  was 
drawn  up  out  of  reach.  At  the  operation  the  sac  con- 
tained about  a  dozen  fibroids  varying  in  size  from  a 
hen's  egg  to  an  orange.  Supra- vaginal  hysterectomy  • 
was  performed  and  a  good  recovery  ensued.  The  mass 
of  tumours  (shown)  weighed  1 1  lbs. 

The  case  was  discussed  by  Drs.  Lloyd  Roberts  and 
T.  B.  Grimsdale,  and  Dr.  Walls  replied.  j 

LIVERPOOL  MEDICAL  INSTITUTION. 
Msktino  held  October  20th,  1904. 


The  President,  Dr.  James  Barr,  in  the  Chair. 
Mr.  Charles  G.  Leb  read  a  short  paper  on  the 

SIMPLE  extraction  OF  CATARACT  BY  TEALB'S  METHOD. 

He  briefly  referred  to  the  various  incisions  that  from 
time  to  time  had  been  adopted,  and  said  that  all  of 
these,  being  placed  either  behind  or  at  the  circum- 
ference of  the  cornea,  rendered  it  almost  imperative  to 
excise  a  portion  of  the  iris.  If,  therefore,  it  were 
deemed  necessary  to  perform  an  iridectomy  as  part  of 
the  operation,  then  the  better  plan  is  to  do  it  some  days 
or  weeks  before  the  extraction,  as  this  method,  although 
it  involves  two  sittings,  made  less  demand  upon  the 
patient's  self-control,  and  enables  the  operator  to  see 
clearly  each  step  of  the  operation,  since  no  blood 
collects  in  the  antenor  chamber,  as  happens  when  the 
iridectomy  and  the  extraction  are  both  done  at  the 
same  time.  The  chief  objection  to  this  procedure  lay 
in  the  two  operations,  and  consequently  the  danger 
from  sepsis  was  doubled.  Having  in  his  private  prac- 
tice last  year  lost  an  eye  from  suppuration  of  the 
cornea,  after  a  preliininary  iridectomy,  Mr.  Lee  deter- 
mined to  try  if  the  iridectomy  might  not  be  dispensed 
with  as  an  essential  part  of  the  operation.  He  had 
himself  frequently  performed  simple  extraction,  but 
owing  to  the  inctsion  being  placed  at  the  periphery  of 
the  cornea,  prolapse  of  the  iris  had  too  often  occurred. 
Some  twenty  years  ago  he  had  seen  Mr.  Pridgin  Teale 
extract  cataracts  without  an  iridectomy,  by  means  of 
an  incision  wholly  in  the  corneal  structure,  and  almost 
midway  between  the  centre  of  the  pnpU  and  the  circum- 
ference of  the  cornea,  so  he  determined  to  try  this 
method.  Two  characteristic  features  of  the  operation 
were  insisted  upon — the  knife  employed  (Hartley's)  and 
the  site  of  the  section.  Details  of  the  first  eight  cases 
which  Mr.  Lee  had  operated  upon  by  this  method  were 
given,  from  which  it  appeared  one  patient  obtained 
visual  acuity  of  6-6,  three  obtained  6-9,  and  none  less 
than  6-18.  In  no  case  was  any  difiiculty  experienced 
in  carrying  out  the  Uchmqnd  of  the  operation.  Since 
these  results  were  obtained  by  an  operator  to  whom 
the  method  was  novel,  it  was  submitted  that  it  was 
well  deserving  of  a  trial  by  adl  who  wished  to  advance 
the  art  of  ophthalmic  surgery. 

Dr.  K.  A.  Grossmann  said  he  had  performed  simple 
extraction  for  many  years  and  was  well  satisfied  with 
the  results  obtained  ;  but  emphasised  the  importance 
of  carefully  selecting  the  cases  suitable  for  it.  He  used 
a  knife  with  a  very  narrow  blade,  as  he  considered  the 
triangular-shaped  knife  too  broad,  for  it  hampered  the 
freedom  and  delicacy  of  movement  necessary  in  so 
delicate  an  operation. 

Mr.  George  E.  Walker  described  an  operation 
which  he  had  performed  for  upwards  of  twenty  years, 
which  aimed  at  the  same  result  as  that  mentioned  by 
Mr.  Lee,  and  which  he  considered  easier  of  performance. 
The  puncture  and  counter-puncture  are  made  in  the 
sclerotic,  and  by  a  series  of  sawing  movements  the  in- 
cision finishes  at  a  point  midway  between  the  centre  of 
the  pupil  and  the  top  of  the  cornea.     In  this  operation 


464    The  Medical  P«ess.  TRANSACTIONS    OF   SOCIETIES, 


Nov.  2,  1904. 


prolapse  of  the  iris,  if  it  occur,  is  seldom  considerable, 
and,  as  a  rule,  easily  reduced. 

Mr.  Charles  H.  B.  Shears  said  that  many  of  the 
most  experienced  operat(»^,  both  in  this  country,  on 
the  Continent,  and  in  America,  still  performed  the  coni- 
bined  operation,  and  for  his  own  part  he  employed  it 
as  the  routine  treatment,  reserving  the  simple  method 
for  cases  with  hard,  brown  lenses. 

Mr.  R.  J.  Hamilton  used  a  narrow-bladed  knife  and 
made  the  incision  within  the  sclero-comeal  margin. 
He  considered  that  operators  had  the  best  results  who 
could  employ  either  the  simple  or  the  combined 
method. 

Mr.  Richard  Williams  said  it  did  not  matter  a 
great  deal  which  method  of  operating  was  adopted ; 
but  it  was  of  great  importance  that  the  surgeon  should 
be  an  expert  in  whatever  method  he  might  select. 
Personally,  he  performed  the  combined  method  of 
operating  as  he  considered  it  the  safer  and  the  easier 
of  the  two. 

Dr.  W.  Murray  Cairns  read  a  paper  on  the 
practice  of  asepsis  in  obstetrics, 
in  which  he  made  a  strong  plea  for  the  more  careful 
conduction  of  labour.  At  the  outset  he  difierentiated 
between  aseptic  obstetrics  and  tisepsis  in  obstetrics. 
Precautions  to  be  taken  for  the  maintenance  of  the 
status  asepticus  before,  during,  and  after  labour,  on 
the  part  of  the  surgeon,  nurse  and  patient,  were  fully 
set  forth.  The  advantages  and  diMdvantages  atten- 
dant upon  the  use  of  aseptic  rubber  gloves  in  obstet- 
rical work  were  fully  dscussed.  and  the  hope  was  ex- 
pressed that  a  material  more  suitable  forintra-uterine 
manipulation  than  rubber  has  hitherto  proved  might 
be  discovered.  A  form  of  obstetric  bag  adapted  to 
modem  aseptic  requirements  was  described.  Asepsis 
in  relation  to  (a)  physiological,  and  (6)  pathological 
labour  was  reviewed.  In  regard  to  the  former,  meddle- 
some manipulation  was  very  strongly  condemned  ; 
"  hands  off  "  was  declared  to  be  the  keynote  of  aseptic 
labour.  The  use  of  lubricants  was  in  general  to  be 
deprecated ;  if  used  at  all,  lubricants  should,  it  was 
contended,  be  sterilised.  The  conditions  under  which 
the  douche  should  and  should  not  be  used  were  laid 
down.  Douching,  ante-  and  post-partum,  in  strictly 
normal  cases,  was  declared  unnecessary.  In  all  in- 
fective conditions,  douching,  both  ante-  and  post- 
partum, was  considered  necessary,  and  it  was  recom- 
mended that  it  should  always  in  such  cases  be  anti- 
septic and  administered  by  the  surgeon.  The  advan- 
tage of  asepsis  over  antisepsis  was  shown  to  be  of  con- 
siderable importance  in  the  case  of  individuals  who 
showed  idios3rncrasy  towards  antiseptics.  A  strong 
warning  was  given  lest  the  preliminary  canons  of  clean- 
liness be  overlooked — soap,  water,  nail-brush,  and 
patience. 

Dr.  E.  T.  Da  vies.  Dr.  Llewellyn  A.  Morgan.  Dr. 
Alexander  Stokes,  Dr.  J.  H.  Finegan,  Dr.  T.  B. 
Grimsdale,  Dr.  J.  H.  Willett,  and  Dr.  Nalini  H.  Blau* 
took  part  in  the  discussion. 


THE  SOCIETY  FOR  THE  STUDY  OF  DISEASE 
IN  CHILDREN. 

At  a  meeting  of  the  Society,  held  on  October  21st, 
at  II  Chandos  Street,  W.,  Dr.  Fletcher  Beach  in 
the  Chair,  four  new  members  were  elected  and  twenty- 
one  were  nominated  for  ballot  at  the  next  meeting. 

Dr.  C.  O.  Hawthorne  showed  a  case  of  Hypertrophy 
of  the  Right  Lower  Limb.  The  patient  was  shown  to 
the  Society  in  1902  ("  Transactions,"  II.,  p.  114)-  The 
patches  previously  described  as  haemorrhagic  on  the 
front  of  the  leg  ulcerated  some  twelve  months  ago,  and 
have  never  healed.  The  question  to  be  now  decided 
was  the  advisability  of  amputation. 

Mr.  A.  Edmunds  advocated  a  prolonged  trial  of 
hospital  treatment  before  recourse  to  amputation. 

Dr.  O.  F.Grunbaum  showed  a  Microcephalic  Infant 
with  Trophic  CEdema  of  the  Feet,  and  a  sister  and 
brother  with  Congenital  Hereditary  Trophic  CEdema. 
The  maternal  grandmother  of  the  two  latter  was  also 
affected.     The  girl,  aet.  7,  showed  swelling  of  both  lower 


limbs  from  the  knee  downwards,  with  hanh,  thick 
skin  of  normal  colour.  The  oedema  was  hard*  bat 
pitted  on  continued  pressure.  The  aixe  of  the  legs  did 
not  diminish  on  raising  the  feet,  but  could  be  temr 
porarily  decreased  by  applying  a  rubber  bandage. 
The  child  had  not  complaineid  of  pain.  The  bfotber, 
aet.  5  months,  showed  a  similar  condition,  and  the 
hypertrophy  of  the  skin  was  more  easily  demonstrated. 
In  both  cases  the  oedema  was  symmetricaL  The  cases- 
were  discussed  by  the  Chairman,  tix,  A.  H.  Tubby. 
Dr.  F.  Parkes  Weber,  Dr.  J.  Porter  Parkinson.  Mr. 
G.  Pemet.  and  Dr.  C.  O.  Hawthorne,  and  Dr.  Grun- 
baum  replied. 

Dr.  L.  Guthrie  showed  (by  permission  of  Dr.  G. 
Ogilvie)  a  case  of  Cerebral  Diplegic  Athetosis  in  a  boy,. 
aet.  6,  who  had  convulsions  on  the  sixth  day  of  an 
attack  of  measles  last  February.  He  was  unconsdons 
for  seven  weeks,  speechless,  paralysed  on  the  right  side* 
and  lost  sphincter  control.  At  present  he  was  regain- 
ing speech,  did  not  seem  mentally  deficient ,  and  had 
some  sphincter  control.  There  was  no  hemiplegia. 
He  could  not  sit  or  stand,  and  had  t3rpical  athetcMd 
movements  of  the  trunk  and  extremities. 

Dr.  Guthrie  also  showed  a  case  of  Polio-encepha- 
litis (Cerebellar),  occurring  during  measles  last  February. 
Intelligence  was  normal;  speech,  monotonous  and 
scanning  ;  slight  tremor  and  ataxia  of  the  upper  limbs, 
and  marked  inco-ordination  of  the  lower  ones  were- 
present.  The  gait  was  typical  of  cerebellar  disease. 
In  commenting  on  the  cases.  Dr.  Guthrie  said  that 
both  were  probably  instances  of  polioencephalitis 
during  measles.  In  the  boy  the  cortical  and  sub- 
cortical centre  were  chiefly  involved,  and  in  the  girl 
mainly  the  cerebellum. 

Dr.  R.  Hutchison  showed  a  case  of  Habit  Spasm 
in  a  boy,  aet.  10.  The  spasm  chiefly  affected  the- 
muscles  of  the  right  side  of  the  neck,  had  been  present 
for  two  years,  and  had  resisted  all  treatment. 

Mr.  Donald  Armour,  Dr.  G.  A.  Sutherland,  Dr. 
Porter  Parkinson,  Dr.  C.  H.  Milbum  (of  Hull),  and  the 
Chairman  discussed  the  case. 

Dr.  Hutchison  also  showed  a  case  of  Bromide- 
Rash  in  a  child,  aet.  2.  The  spots  were  of  the  fleshy 
sort  usually  met  with  in  young  children. 

Drs.  Poynton  and  Parkes  Weber  made  some  remarks. 

Mr.  Arthur  Edmunds  showed  a  case  of  Infantile 
Paralysis  with  permanent  involvemient  of  the  abdo- 
minal muscles.  The  attack  had  been  very  generalised 
and  very  severe.  Now  there  was  marked  ballooning 
of  the  abdominal  wall,  in  the  area  corresponding  roughly 
with  the  distribution  of  the  efghfh  and  ninth  dorsaT 
nerves. 

Dr.  Sutherland  pointed  out  that  without  the 
history  and  the  other  evidence  of  infantile  paralysis 
the  case  might  have  been  mistaken  for  one  of  congenital 
absence  of  muscle  in  the  abdominal  wall,  the  cause  of 
which  was  not  well  understood. 

Mr.  N.  Bishop  Harm  an  showed  a  case  of  CongenitaT 
Bilateral  and  Symmetrical  Dislbcation  of  the  Crystal- 
line Lenses.  He  suggested  opening  the  anterior 
chamber  and  removing  the  capsule  of  the  lens  by  seizing 
it  with  Couper*s  capsule-forceps. 

Mr.  Sydney  Stephenson  showed  a  case  of  CcrebraT 
Degeneration  with  fundus  changes  in  a  boy,  aet.  7. 

Mr.  P.  LocKHART  Mummery  showed  a  boy,  aet.  8, 
with  a  dermoid  cyst  of  the  auricle  in  an  unusual  situa- 
tion, rather  too  high  up,  in  Ms  opinion:,  ta  be  due  to  a 
persistent  portion  of  the  intermaxillary  cleft. 

Dr.  Edmund  Cautley  showed*  a  child,  aet.  3,  with 
Congenital  Heart  Disease,  Paralysis  of  the  Left  Superior 
Rectus,  and  an  Abnormal  Artery  on  the  back  of  the 
Left  Forearm.  He  thought  the  murmur  due  to  a 
direct  communication  between  the  aorta  and  pulmo- 
nary artery,  or  to  a  patent  ductus  arteriosus. 

Dr.  Cautley  also  showed  a  child,  aet.  21  months, 
with  a  microcephalic  head,  imbecility,  a  moderate 
degree  of  spasticity,  and  irregular  movements  of  the 
limbs  and  trunk.  He  regarded  it  as  due  to  a  com- 
bination^of  microcephaly  and  cerebral  changes. 


Nov.  3,  1904. 


FRANCE. 


Thb  Mbdical  Pbbss.    465 


The  Chairman  and  Dr.  Parkinson  commented  on 
the  case. 

A  photograph  of  Trichotillomania  was  shown  by  Mr. 
George  Fernet,  and  one  of  extensive  Herpes  Zoster 
of  the  Left  Arm  by  Dr.  G.  Carpenter. 

Mr.  R.  C.  Clement  Lucas  read  a  paper  "  On  an 
ni-Developed  Upper  Lateral  Incisor  Tooth  as  a  Fore- 
runner of  Hare-lip  or  Cleft  Palate." 

Dr.  £.  Gilford  read  a  paper  on  "  Two  Cases  of 
Congenita]  Diaphragmatic  Hernia.'*  In  each  case  the 
child  was  aet.  4  months,  and  had  had  no  abdominal 
symptoms.  One  was  moribund  on  admission  to  hos- 
pital, and  was  supposed  to  be  suffering  from  sinus 
thrombosis.  The  other  was  admitted  for  bronchitis 
and  pardxysm£d  dyspnoea.  After  death  the  third  part 
of  the  duodenum,  the  whole  of  the  small  intestine,  and 
the  ascending  colon  had  passed  through  an  opening 
at  the  posterior  part  of  the  right  half  of  the  diaphragm. 
In  neither  case  was  there  a  sac.  The  cases  were  re- 
markable in  their  similarity  to  each  other,  and  their 
dissimilarity  from  other  recorded  instances. 

The  meeting  then  adjourned. 


THE  CHILDHOOD  SOCIETY. 
Meeting  held  October  20th,  1904. 


Sir  T.  Lavdbr  Brunton,  Bart,  M.D.,  in  the  Chair. 


A  discussion  on 

physical  deterioration 
vras  opened  by  Mr.  £.  W.  Brabrook,  C.B.,  who  said 
there  was  no  evidence  based  on  science  to  show  dete- 
rioration. The  best  evidence  could  be  gathered  from 
large  friendly  societies,  such  as  the  Manchester  Unity, . 
with  its  miUion  of  members.  True,  sickness  was  in- 
creasing, but  length  of  life  also.  Then  the  healthy  and 
sensible  were  less  inclined  to  marriage,  so  the  recruiting 
of  population  came  largely  from  the  physically  inferior. 

Mrs.  A.  Watt  Smyth  spoke  strongly  on  the  subject 
of  milk  dcp6ts,  urging  that  mischief  done  in  infancy 
could  never  be  undone,  and  advocating  also  the  teaching 
of  simple  cooking  to  both  boys  and  girls,^and  the  selling 
of  these  meals  at  a  minimum  charge  to  the  children  as 
in  Germany. 

Dr.  RoBT.  Hutchison  differed  from  Mrs.  Watt 
Smyth  concerning  "  irreparable  mischief/'  as  puny 
children  sent  to  industrial  schools  often  developed  into 
sturdy  ones.  The  milk  dep6ts  were  becoming  more 
necessary  as  the  art  and  habit  of  natural  feeding  was, 
for  reasons  he  could  not  then  enter  into,  becoming  less 
common.  Food  among  the  poor  was  not  £dways 
scanty,  but  ill-chosen,  and  quantities  of  white  bread, 
jam,  and  tea  chosen  instead  of  wholesome  things  such 
as  porridge  and  milk.  Even  in  High  schools  the  inter- 
val, often  8  to  1.30,  was  too  long,  and  rich  children 
were  often  left  to  nurses.  A  type  of  man  suited  to 
congested  city  life  was  forming ;  the  large  frame  was 
dying  out  and  a  small;  wiry  type  coming  in.  Every- 
thing depended  on  food,  a  well-fed  child  could  stand 
cold  and  want  of  clothes. 

Dr.  Shuttlbworth  thought  deterioration  was  not 
more  common,  but  more  noticed.  Society  was  be- 
coming alive  to  defects,  but  still  averse  to  providing 
funds  for  the  necessary  investigations  and  prevention. 

Dr.  Warner  was  of  opinion  that  the  modem  system 
of  building  high  blocks  of  houses  and  excluding  the  sun 
from  the  children's  only  playground — the  street — 
would  eventually  be  a  poweiiul  factor  in  deterioration. 
Moreover,  modern  mothers  should  be  taught  to  buy 
nourishing  food  and  how  to  cook  it,  as  education  as  well 
as  Ught  and  air  were  essential  to  good  growth.  He 
would  suggest  schools  being  built  out  of  the  town  and 
cheap  cars  be  run  to  take  the  children  to  school. 

The  Chairman  concluded  that  it  was  evident  that 
much  remained  to  be  done  in  the  way  of  steady  inves- 
tigation of  facts  and  circulating,  by  demonstration  and 
literature,  the  right  rules  which  govern  healthy  living. 


irtance* 

[PXOM   OUR   OWN  CORRBSPONDBNT.] 

Paui,  October  80th.  1904. 
Tapping  the  Bladder. 

Tapping  the  bladder  consists  in  inserting,  above  the- 
pubis,  a  trocar  or  needle  of  an  aspirator  into  the 
bladder  to  evacuate  the  contents.  Tapping  through 
the  perinaeum  or  the  rectum  employed  by  the  old  sur- 
geons has  been  completely  abandoned  to-day.  This 
little  operation,  says  M.  Tuffier,  is  easily  performed, 
and  presents  in  itself  no  danger.  It  is  possible  to 
wound  an  important  organ  or  the  peritoneum,  but  by 
taking  a  little  precaution  the  patient  will  run  no  risk. 
The  bladder  is  in  direct  contact  with  the  abdomen, 
and  is  situated  immediately  above  the  symphysis 
pubis,  and  when  it  contains  about  ten  ounces  of  liquid 
the  anterior  peritoneal  cul-de-sac  is  at  a  distance  of  fronb 
half  to  one  inch  from  the  symphysis,  a  distance  suffi- 
cient to  allow  the  bladder  to  be  reached  without  injury 
to  the  neighbouring  parts.  However,  it  may  happen^ 
that  the  peritoneum  from  adherence  with  the  symphysis 
may  be  wounded ;  this  accident,  thanks  to  antisepsis, 
and  asepsis,  is  of  little  importance. 

The  trocar  should  be  inserted  in  the  median  line,  as- 
it  is  here  that  the  peritoneum  is  situated  the  highest 
up ;  but  before  operating,  the  surgeon  must  assure 
himself  by  palpation  and  percussion  that  the  bladder- 
is  really  distended.  The  instrument  used  can  be  a^ 
straight  trocar,  or  the  needle  of  a  Dieulafoy  or  Potain- 
aspirator.  As  in  every  operation,  of  no  matter  what, 
kind,  the  teguments  should  be  shaved  and  washed  with 
a  sublimate  solution  and  alcohol. 

The  patient  lies  on  his  back,  the  legs  stretched  out, 
the  operator  seizes  the  needle  firmly  in  his  right  hand,, 
and,  fixing  with  the  index  of  the  left  hand  the  spot  of 
insertion  (half  an  inch  above  the  edge  of  the  pubis), 
he  pushes  it  boldly  in.  The  sensation  of  resistance 
conquered,  the  impression  that  the  extremity  of 
the  needle  is  free,  indicates  that  the  bladder  has  been, 
reached.  If  the  bladder  is  greatly  distended,  it  is 
preferable  not  to  empty  it  completely,  for  fear  of  intra-r 
vesical  haemorrhage  ;  it  is  better  to  renew  the  operar 
tion  a  few  hours  afterwards  if  necessary. 

The  operation  thus  performed  causes  but  very  little 
suffering,  and  is  inofiensive.     It  can  be  repeated  as  fre-- 
quently  as  may  be  judged  necessary,  for  it  is  less  grave 
than  catheterism  imprudently  executed.     Before  with- 
drawing the  needle  care  should  be  taken  to  allow  air 
to  penetrate  into  the  aspirator  so  as  to  avoid   the- 
possible  infiltration  ol  a  lew  drops  of  urine  into  the* 
tissue.     Tapping  the  bladder  is  indicated  in  every  case*^ 
of  acute  urinary  retention,  where  it  is  impossible  to< 
evacuate  the  reservoir  by  careful  catheterism,  as,  for 
instance,  in  hypertrophy  of  the  prostate;  rupture-  of~ 
the  urethra,  fracture  of  the  pelvis,  and  in  certain  forms- 
of  stricture.     It  sometimes  occurs  that  in  stricture  it  is 
impossible  to  pass  the  smallest  catheter  ;  if  retention  oi 
urine  exists,  tapping  should  be  immediately  resorted^ 
to,  and  this  operation  is  not  only  useful  to  the  patient, 
but  produces  decongestion  of  the  region  of  the  urethra,, 
permitting  the  easy  passage  of  a  bougie. 

In  acute  retention  from  hypertrophy  of  the  prostate. . 
puncture  of  the  bladder  is  very  frequently  indicated, 
and  is  absolutely  necessary  ia>  the  case  of    a  patient 
who  has  been  subjected  to  vain  attempts  at  passing  a. 
catheter,  and  where  a  false  direction  may  be  feared. 
In  old  persons,  where  the  urine  is  more  or  less  infected, 
the  hypogastric  incisioa  should  be  pseferred  to*  the^ 
puncture. 


466    Tbk  Medical  Pkbss. 


AUSTRIA. 


Nov.  2,  1904. 


Migraine  in  Children. 
Antypyrine,  xxx  grains. 
Cafieine,  x  grains. 
Syrup,  vi  drachms. 
Water,  ad.  ii  ounces. 
A  teaspoonful  at  the  moment  of  the  attack. 

Octmaws. 

[from  our  own  correspondent.] 


BuLiH.  October  29th,  lOOi. 

ACETOPYRINE. 

This  new  antipyretic  is  said  {DetUsch.  med.  Zeitung, 
'77,  '04)  to  be  an  excellent  agent  for  reducing  tempera- 
tare,  also  that  it  has  no  injurious  efiect  on  the  heart. 
hi  toxic  doses  it  is  a  respiratory  poison  ;  in  medicinal 
doses  respiration  is  rendered  more  shallow.  Being 
excreted  through  the  kidneys  it  increases  diuresis  ; 
it  reduces  the  size  of  the  spleen.  The  pancreatic  secre- 
tion is  enormously  increased,  and  this  would  lead  one 
to  conjecture  that  it  would  be  useful  in  the  pancreatic 
form  of  diabetes.  The  perspiratory  stage  comes  on 
late  and  lasts  only  a  short  time.  If  other  observers 
confirm  the  conclusions  arrived  at  by  Dr.  Zwintz,  to 
whom  we  are  indebted  for  the  exposition  of  the  pro- 
iperties  of  acetopyrine,  there  will  be  hope  that  in  it 
vwe  shall  find  a  useful  addition  to  our  armamentarium. 
A  Substitute  for  Iodoform — Almatein. 

Almatein  is  the  name  given  by  the  makers  to  a  new 
"Combination  "Of  haematoxylin  with  formaldehyde, 
and  intended  as  a  substitute  for  iodoform,  for  this 
useful  but  most  objectionably-smelling  drug  is  still  in 
frequent  use.  A  considerable  number  of  cases  are 
recorded  by  Bertini  in  which  it  was  used  in  septic 
^wounds,  phlegmons  and  the  like,  and  always  with 
*marked  success.  The  powder  is  odourless,  and  that, 
no  doubt,  ^will  commend  it  to  all  users  of  iodo- 
form on  other  ^people,  and  it  is  also  free  from  any  toxic 
properties.  The  makers  are  Lepetit  Dollfuss  and 
Gausser. 

The  Isolated  Uterus. 

In  the  Archiv,  /.  Gynakol.,  73,  '04,  is  an  article  by 
IE.  N.  Kurdincrwsky  describing  the  uterus  after  re- 
moval from  the  body.  The  isolated  uterus,  the  writer 
;says,  can  be  seen  on  the  second,  and  even  on  the  third 
•day,  to  make  very  energetic  contractions,  and  to  form 
.a  curve.  In<«>ne  case  the  uterus  lived  forty-nine  hours 
:forty  minutes.  The  observer  succeeded  in  reproducing 
the  act  df  birth  in  all  its  individual  parts,  from  the 
•commencement  to  the  end.  The  contractions  caused 
the  separation  'of  the  ovum.  The  cornu  thrust  its 
•contents  into  the  cavity  of  the  uterus.  Then  ener- 
getic contraction  of  the  ligamentum  latum  began ; 
(these  forced  the  ovum  into  the  vagina.  The  investiga- 
.tion  showed  that  the  birth  act  could  be  carried  out 
in  conij>leteindQpendence  of  the  cerebro-spinal  system. 
>Cold  and  warmth  acted  equally  energetically  on  the 
uterus,  and,  generally  speaking,  it  was  these  oscillations 
.that  supplied  the  stimulus  to  contraction.  The  isolated 
•uterus  was  but  iittle  susceptible  to  electric  stimulation. 
These  observations  bring  prominently  forward  the 
^eaX  probability  of  a  local  innervation. 

Hydrastin  did  not  act  on  the  vessels  of  the  isolated 
uterus.  £rj;ot  acted  peripherally  on  the  uterus  quite 
independently -ei  any  contracting  effect  on  its  vessels, 
liarcotic  poisons  affected  the  uterus  but  very  little. 
Adrenalin  strengthened  the  contractile  activity  of 
the  uterusjnoze^han  any  agent  looked  upon  as  specific. 
This,  along  with  its  great  power  of  contracting  vessels, 
«ought  to  lead  to  further  careful  clinical  study  of  the 
cemarkable  exan^ple  of  organo-therapeutics. J     ^  ^ . 


At  the  Congress  of  Scientists  and  Ph3rsicians,  Hor 
Magnus  Hirschfeld  showed  some  cases  of 

Transition  between  the  Male  and  Female, 
one  of  which  excited  a  good  deal  of  interest.  The  case 
was  that  of  a  woman  bom  in  East  Prussia  in  1862. 
who  really  was  a  man.  Believed  to  be  a  female  at  her 
birth,  she  was  brought  up  as  one  ;  at  sixteen  her  voice 
changed,  and  at  twenty  her  beard  grew,  so  that  daily 
shaving  was  necessary.  Her  inclinations  were  de- 
cidedly male  ;  she  would  rather  be  a  soldier  than  any- 
thing. Towards  men  she  had  such  a  strong  feding  oC 
repulsion  that  she  refused  four  offers  of  marriage  which 
gentlemen  who  had  been  attracted  by  the  statdy 
and  resolute  "  dame  "  made  to  her.  On  the  other  hand, 
she  repeatedly  fell  in  love  with  members  of  the  female 
sex.  When  she  was  examined,  it  was  found  that  the 
reproductive  glands  were  male.  Then  it  was  proposed 
that  she  should  dress  and  behave  as  a  man,  but  she 
declined,  as  she  could  not  face  the  sensation  that  sach  a 
complete  volte  face  would  be  sure  to  cause  among  her 
acquaintances. 

Dr.  V.  Kruedener  relates  a  case  of 
Herpes  Zoster  in  the  Region  of  the  First  Left 

Branch  of  the  Trigeminus. 
The  patient  was  a  man,  set.  50,  who,  after  a  severe 
chill,  had  marked  redness  of  the  forehead,  and  the 
skin  became  covered  with  vesicles,  which  in  part  were 
black  in  colour  owing  to  a  partial  gangrene  of  the  parts. 
The  following  terminal  branches  were  affected  over  the 
whole  region  supplied  by  them:  the  lachrymal,  supra- 
orbital, frontal,  supratrochlear,  infratrochlear  and  the 
nasociliary.  A  few  vesicles  were  on  the  bridge  of  the 
nose,  and  the  redness  extended  about  one  centimetre 
over  the  middle  line,  this  being  in  agreement  with  the 
observations  of  Zander  on  the  subject,  to  the  effect  that 
the  region  supplied  by  the  trigeminus  of  one  side 
passes  just  over  the  middle  line  to  the  opposite  side. 
The  nature  of  the  disease  had  been  made  a  little  more 
clear  of  late.  If  the  Gasserian  ganglion  was  to  be 
viewed  as  a  spinal  ganglion,  resemblance  between  the 
diseases  of  both  would  be  shown.  Treatment  had 
to  be  directed  to  the  nerve ;  aspermin  and  sweating 
brought  about  an  improvement  in  a  few  days. 

Btt0trfa« 

[from  our  own  correspondbnt.] 


YxENNA,  Ootober  aOih,  1  01. 
The  Diagnosis  of  Tuberculosis. 

At  the  Breslau  meeting,  Kraemer  criticised  the  latest 
opinions  of  Naegele  on  the  frequent  changes  of  tubercle 
in  the  lung.  The  chalky  nature  of  tubercle,  he  affirmed, 
was  not  yet  proved,  neither  could  we  be  assured  that 
it  was  infectious,  nor  on  the  increase  if  statistics  are  to 
be  believed. 

In  the  diagnosis  of  tuberculosis  in  the  lung,  Frey- 
muth  recommended  the  administration  of  Koch's  old 
tuberculin  in  the  form  of  pill  covered  with  keratin. 
This  acted  as  promptly  in  exciting  the  febrile  reaction 
as  when  injected  subcutaneously.  Different  inten- 
sities of  fever  were  measures  of  the  progress  of  the 
disease,  and*as  the  bacilli  did^not  appear  in  the  sputa 
at  the^commencement  of  the  disease,  a  few  pills  of 
tuberculin  were  of  great  value  in  the  diagnosis  of 
obscure  cases.  One  point  he  wished  to  impress  on  his 
hearers  was  that  when  given  internally  the  fever  was 
not  as  intense  in  the  very  early  stages  as  in  sub- 
cutaneous administration,  which  may  be  proved  by 
giving  a  stomachic  dose  and  subsequently  a  very  small 
subcutaneous  injection,  the  system  seeming  more 
sensitive  after  an  internal  dose.  ^ 


Nov.  2.  1904- 


THE    OPERATING    THEATRES. 


The  Medical  Prbss.    467 


Nourney  said  he  was  a  great  believer  in  tuberculin 
treatment,  after  several  years'  experience  with  small 
doses  not  exceeding  0*0001  gramme.  This  was 
equally  efficacious  in  the  cure  of  lupus. 

Holdheim  recorded  the  history  of  two  cases  under 
treatment  with  tuberculin  for  two  years  with  ultimate 
cure.  Other  fifteen  cases  were  greatly  improved  by 
its  application. 

Pauli  regretted  the  general  disuse  of  tuberculin  in  the 
treatment  and  early  diagnosis  of  tubercle  in  the  lung. 
Tuberculin  was  of  no  value  as  a  diagnostic  in  patients 
under  twenty-two  years  of  age. 

Schneider  would  not  discuss  the  propriety  of  the  use 
or  disuse  of  tuberculin,  but  urged  enthusiasts  to  be 
guided  by  the  pulse  frequency  in  their  prognosis  of 
cases.  If  the  pulse  ranges  above  100  per  minute  the 
case  is  a  very  grave  one,  and  may  become  aggravated 
by  many  forms  of  treatment. 

HvPERiEMic  Treatment  of  Phthisis. 

WassermauQu  gave  a  description  of  his  theory  of  the 
p>assive  hyperaemic  treatment  in  phthisis.  He  accepts 
the  dictum  that  tuberculosis  is  the  result  of  anaemia 
of  the  lung,  and  contends  that  gymnastics  are  the 
rational  method  of  dealing  with  phthisis.  With  the 
same  object  in  view  he  causes  a  narrow  opening  fgr 
inspiration,  leaving  the  mouth  free  and  open  for  ex- 
ploration. With  an  instrument  of  this  kind  the 
breathing  is  laboured,  while  the  force  produced  causes 
passive  hyperaemia  in  the  lung,  which  ultimately  pro- 
duces a  healthy  condition  of  the  organ.  In  all  his 
experiments  with  this  treatment  he  has  never  met  with 
luemoptosis. 

Bacterial  Action  of  Serum  in  Typhoid. 

Stem  gave  many  examples  of  bacterial  action  in 
blood  serums,  particularly  the  typhoid  bacilli,  when 
treated  in  the  test  tube.  He  applied  fresh  blood  of  a 
typhoid  case  to  a  bouillon  culture  to  prove  that  the 
blood  serum  of  typhus  had  no  more  action  than  the 
blood  serum  of  a  healthy  man.  The  interest  of  this 
experiment  lay  in  the  newly  drawn  blood,  which  he 
attempted  to  prove  was  less  active  than  the  bacilli 
after  cultivation.  He  thought  this  was  the  cause  of 
many  of  our  failures  in  the  production  of  immunity 
by  different  sera,  and  was  of  the  opinion  that  this  de- 
stroyed the  theory  of  an  intermediary  body  or  immune 
principle  that  it  was  necessary  for  the  protection  of 

typhoid.  ^ 

^'^  Recurrent  Typhoid. 

Hodlemoser  gave  his  experience  of  an  epidemic  of 
typhoid  recurrens  which  raged  for  a  long  time  in 
Herzegovina.  He  tried  on  several  occasions  to  culti- 
vate a  serum,  in  the  hope  of  producing  immunity,  but 
found  it  difficult  owing  to  the  recurrent  spirillum  dis- 
appearing during  the  interval,  and  at  the  same  time 
affirmed  that  the  Obermeier  spirillum  was  very  difficult 
to  cultivate. 

XTbe  0petatind  Zbcattc9. 

KING'S  COLLEGE  HOSPITAL. 
Combined  Suprapubic  Lithotomy  and  Prosta- 
tectomy.—Mr.  Carless  operated  on  a  man,  aet.  66, 
who  had  been  sent  into  the  hospital  complaining  of 
pain  before,  during  and  after  micturition,  and  asso- 
ciated irritability  of  the  rectum,  the  bowel  emptying 
itself  every  time  micturition  was  attempted.  These 
symptoms  had  gradually  increased  during  the  last  four 
months,  and  the  pain  now  continued  for  about  twenty 
minutes  in  all.  It  was  located  deeply  in  the  perinaeum, 
and  did  not  extend  to  the  tip  of  the  penis.  There  had 
never  been  haematuria,  but  the  urine  contained  some 


muco-pus,  together  with  phosphatic  and  oxalate- 
crystals.  A  certain  amount  of  mucus  was  evacuated, 
by  the  bowel.  On  palpation  nothing  abnormal  could, 
be  felt  through  the  abdomen,  but  on  rectal  examinatioiL 
the  prostate  was  found  to  be  considerably  enlarged.. 
On  the  introduction  of  a  sound,  the  presence  of  one  or 
more  vesical  calculi  was  determined.  The  patient  was 
anaesthetised,  his  pelvis  raised  and  the  bladder  washed 
out  with  boric  acid  lotion,  about  half  a  pint  being  left 
in.  The  usual  suprapubic  incision  was  then  made^ 
and  the  bladder  exposed.  A  silk  sling  was  passed 
through  the  vesical  wall  on  either  side  of  the  middle 
line,  and  the  viscus  incised  from  above  downwards. 
The  mucous  membrane  was  secured  on  either  side  with. 
Spencer  Wells'  forceps  and  held  well  up ;  it  was 
found  to  be  thick  and  congested.  On  the  introduction! 
of  the  finger  the  prostate  was  found  to  be  large  and  pro- 
jecting into  the  cavity,  and  in  the  pouch  behind  it  a. 
whole  colony  of  stones  was  discovered  ;  they  were  re- 
moved by  forceps  and  fingers,  and  were  found  to  be- 
nineteen  in  number.  The  mucous  membrane  at  the 
back  of  the  prostate  was  next  incised  and  the  enlarged 
prostate  enucleated  without  difficulty,  coming  away 
in  two  portions,  the  urethra  apparently  being  left  be- 
hind ;  this  was  facilitated  by  pressing  the  prostate  up* 
wards  with  the  fingers  of  the  left  hand  in  the  rectum^ 
A  sterilised  india-rubber  glove  had  been  worn  thus  far 
on  the  left  hand  ;  it  was  then  removed,  so  that  the  left 
hand,  after  purification,  could  be  used  in  the  remainder 
of  the  operation.  The  incision  in  the  bladder  was  closed 
around  a  tube  passed  into  it  by  catgut  stitches  which, 
missed  the  mucous  membrane.  The  upper  part  of  the 
space  between  the  recti  muscles  was  closed  by  similar 
sutures,  and  the  upper  part  of  the  skin  round  ap- 
proximated. The  cavity  then  left  was  packed  with, 
gauze,  and  an  ordinary  dressing  applied.  Mr.  Carless 
pointed  out  that  the  absence  of  the  tjrpical  symptoms^ 
of  stone  in  this  case  was  due  to  the  calculi  being  located; 
behind  the  prostate,  so  that  they  were  not  brought  ini 
contact  with  the  internal  meatus  during  micturition^. 
They  were  of  a  light  brown  colour  and  most  ol  thenv 
quite  smooth,  though  many  had  blunt  projections  on 
one  or  other  side.  One  of  them  was  long  and  narrow- 
shaped,  somewhat  like  a  banana.  They  were  probably- 
composed  of  uric  acid.  The  prostatic  enlargement, 
he  said,  was  of  the  ordinary  senile  character,  and  the- 
masses  removed  showed  well  that  they  consisted  of 
multiple  rounded  bodies,  probably  adenomata  united 
together  to  form  one  mass,  which,  however,  was  easily- 
broken  into  two  along  the  anterior  and  posterior  com- 
missures. Mr.  Carless'  firm  opinion  was  that  most 
cases  of  prostatectomy  consisted  of  an  intra-glandular 
enucleation  of  adenomatous  masses.  In  this  particular 
instance,  he  remarked,  the  growth  was  apparently- 
peeled  off  the  urethra,  which  could  be  felt  in  the  cavity- 
left  behind  ;  it  was  probably  a  matter  of  very  little 
importance  whether  the  urethra  was  retained  or  not 
during  the  process  of  cicatrisation  that  followed.  Thfr 
mucous  membrance  of  the  bladder  was  approximated 
to  that  of  the  membranous  urethra,  and  the  cavity 
was  always  sufficiently  large  to  obviate  any  likelihood, 
of  the  development  of  stricture. 

ROYAL  FREE  HOSPITAL. 
Enucleation  of  the  Eye  for  Injury. — ^Discovery 
OF  A  Needle  -038  m.m.  Long  Embedded  and  Hidden: 
IN  the  Eye  and  Orbit. — The  case,  which  had.  been. 


4t>8    Thb  Medical  Pkess. 


LEADING  ARTICLES. 


Nov. 


2,    1904. 


.admitted  under  the  care  of  Mr.  Work  Dodd,  was  that 
.of-  a  man,  aet.  37,  who  gave  the  following  history  : 
In  the  morning  the  patient  had  been  shaking  out  a  new 
shirt,  which  was  very  stiff  with  starch,  when  a  china 
button  on  the  sleeve  cuff  hit  him  full  in  the  left  eye. 
He  had  sudden  and  acute  pain,  and  said  it  felt  as  if  the 
eye  had  been  knocked  out.  On  looking  at  it  in  the 
glass  he  saw  a  spot  of  blood  on  the  inner  side  of  the 
eyeball.  The  man  walked  to  the  hospital,  and  stated 
that  he  did  not  lose  his  sight  till  he  got  there.  Nothing 
abnormal  could  be  discovered  on  admission  concerning 
the  past  history  or  in  the  general  condition  of  the 
patient.  Locally  the  left  eye  was  hyper aemic  and  very 
painful,  and  nearly  all  sight  was  lost  in  it,  barely  per- 
ception of  light  being  left.  On  examination  for  an 
external  wound  from  the  blow,  there  was  a  doubtful 
spot,  which  might  have  been  a  solution  of  continuity, 
on  the  inner  side  just  above  and  -002  m.m.  from  the 
edge  of  the  cornea  opposite  the  insertion  of  the  internal 
rectus  muscle.  The  anterior  chamber  was  filled  with 
blood.  The  tension  was  extremely  low,  -  2.  For  the 
first  two  days  the  patient  improved  slightly  under 
treatment  (mercurial  purge,  atropine,  and  boracic 
lotion),  but  on  the  third  day  there  was  a  good  deal  of 
chemosis  and  the  cornea  looked  very  hazy.  On  the 
fifth  day  this  condition  was  unchanged,  and,  in  addition, 
the  eyeball  was  proptosed  and  there  was  considerable 
orbital  cellulitis  and  what  appeared  to  be  hypopyon. 
Mr.  Dodd  decided  on  enucleation  of  the  eye,  and  sug- 
gested before  operation  the  presence  of  a  foreign  body. 
The  operation  was  performed  in  the  usual  manner. 
The  optic  nerve  was  severed  as  far  away  from  the  eye 
as  possible.  On  the  eyeball  being  extracted  from  the 
orbit,  thebrolcen  end  of  a  needle  about  -038  m.m.  (ijin.) 
long  was  seen  projecting  from  the  inner  part  of  the 
eyeball,  which  last  was  itself  full  of  pus.  The  direction 
01  the  needle  was  from  the  apex  of  the  orbit  outwards 
and  forwards  to  a  point  outside  the  cornea  oil  the 
anterior  surface  of  the  eyeball,  but  there  was  no  hole 
in  this  situation  through  which  the  needle  could  have 
entered.  There  was  nothing  in  the  interior  of  the  eye- 
ball to  indicate  the  track  of  the  needle  ;  there  was, 
however,  a  small  hole  through  which  pus  exuded  about 
•002  m.m.  to  the  inner  side  of  the  corneal  margin.  A  care 
f  ul  search  was  made  in  the  orbit  and  in  the  eyeball  for 
ttie  point  of  the  needle,  but  it  was  not  found.  Mr,  Work 
Dodd  said  that  the  most  peculiar  thing  about  the  case 
was  that  the  history  of  injury  from  the  china  button 
and  sleeve  was  remarkably  clear,  and  was  given  and 
repeated  without  any  hesitation  or  doubt  by  the  man, 
who  was  intelligent  in  all  his  assertions.  Therefore,  it 
must  be  accepted  as  a  fact  that  the  accident  did  occur. 
On  the  other  hand,  there  was  entire  absence  of  any 
history  pointing  to  a  needle  being  concerned  in  the 
accident,  and  he  thought  this  showed  how  little  the 
surgeon  can  rely  upon  the  history'  given  by  a  patient. 
(It  may  be  mentioned,  however,  that,  after  the  opera- 
tion, the  patient,  on  being  sho^Ti  the  needle,  remem- 
bered that,  some  time  previously,  he  had  been  sewing 
a  button-hole  in  the  shirt  and  had  left  a  needle  hanging 
on  a  short  end  of  thread.)  Mr.  Dodd  pointed  out  that 
the  man  had  been  treated  for  two  or  three  days  for 
contusion  and  bleeding  into  the  globe,  but  as  the  eye 
did  not  clear  up  and  became,  on  the  contrary,  inflamed, 
and  pus  having  formed,  he  commenced  to  have  the 
suspicion  of  the  presence  of  a  foreign  body.  The  pre- 
sence of  the  needle,  however,  in  the  eye  and  orbit,  he 


said,  came  as  a  great  surprise,  and  its  method  of 
arrival  in  these  localities  was,  he  considered,  very 
difficult  to  ascertain.  It  was  possible  for  the  needle 
to  have  stuck  itself  into  the  eye  as  a  result  of  shaking 
the  shirt  violently,  and  then  to  have  been  hammered 
home  through  the  ball  by  the  cuff  and  china  batton. 
the  hand  being  probably  at  once  pressed  against  the 
eye,  the  whole  occurring  as  one  action.  A  pointless 
needle  •o38m.m.long  would  have  to  travel  with  enormous 
rapidity  to  pierce  through  the  sclera  in  front  and 
behind,  besides  passing  through  the  interior  of  the 
globe  and  finishing  up  towards  the  orbital  apex.  The 
ophthalmoscope,  he  remarked,  could  be  of  no  assistance 
in  this  case,  as  the  eye  was  full  of  blood :  and  the  fact 
that  the  tension  of  the  eye  was  below  normal,  a  condition 
which  is  not  uncommon  after  contusion  of  the  globe, 
would  not  necessarily  point  to  a  rupture  or  to  a  per- 
toration.  These  two  conditions,  and  also  the  presence 
of  a  foreign  body,  lower  the  tension  of  the  globe.  Mr. 
Dodd  said  he  was  glad  that  he  had  suggested  the  pre. 
sence  of  a  foreign  body  in  the  eye.  He  had  only  done 
so  because  experience  had  taught  him  to  be  always  on 
his  guard  in  this  respect.  He  pointed  out  also  that, 
as  there  had  been  no  indication  of  any  such  thing, 
there  had  been  no  resort  to  X-rays. 

Ten  days  after  the  operation  the  patient  left   the 
hospital  perfectly  well. 

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"SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY.  NOVEMBER  2.  1904. 


THE  "BORSTAL"  SYSTEM. 
While  so  much  talk  is  being  expended — ^and 
rightly  expended — on  the  ways  of  the  "  degenerate" 
and  the  methods  of  dealing  with  him,  a  glance  at 
the  other  side  of  the  picture  may  be  taken  with 
advantage.  Ultra-humanitarianism  may  bring 
derision  on  the  heads  of  all  who  are  stri\'ing  to 
estabUsh  a  more  humane  code  of  ethics,  just  as 
the  reproach  of  barbarism  is  frequently  brought 


Nov.  2,  1904. 


LEADING  ARTICLES. 


The  Medical  Pkess.    469 


against  those  who  err  on  the  side  of  severity,  but 
there  is  no  denying  the  fact  that  the  humanitarians 
are  on  the  up-grade.     How  far  the  principles  of 
altruism   are   compatible   with,    that   is    to   say 
a.dvantageous    to,    the    existence    of    a    civilised 
«tate  is  an  interesting  problem  that  remains  to  be 
^worked  out.     The  evidence  of  the  last  century 
is  all  in  favour  of  the  social  advance  of  that  state 
in  which  regard  for  others  is  substituted  for  brutal 
indifference.     The    reason    may    not    always    be 
apparent,  but  the  fact  remains,  and  to  medicine 
must  be  assigned  the  first  place  as  a  civilising 
and   humanising  force.     The   work  and  mission 
of  the  medical  profession  brings  and  keeps  its 
members  in  constant  contact  with  every  class  of 
society  down  to  the  lowest,  and  this  at  the  time 
when    the    softer    feelings   are   most   apparent ; 
namely,  in  the  time  of  sickness.     Consequently 
one    finds     the  influence   of   medicine   generally 
on  the  side  of  mercy — to  the  great  advantage  of 
society  generally.     In  no  domain  more  than  in 
tliat  of  crime  and  criminology  is  this  apparent, 
and  in  no  field  has  medicine  greater  triumphs  to 
show.     The  desire  for  revenge  and  for  punish- 
ment  is   one   of  the   most   elemental  of  human 
forces,  and  the  sheer  stupidity  of  giving  it  un- 
restricted play  in  dealing  with  delinquents  has 
"been  demonstrated  in  the  criminal  annals  of  every 
country  that  possesses  annals.     Humanity  in  the 
treatment  of  offenders  has  shown  itself  to  be  not 
only  the  right   but   the  wise  course,  and  the  old 
savage  punishments  are,  happily,  passing  out  of 
fashion.     The  report  of  the  Directors  of  Convict 
Prisons,  just  issued,  gives  a  full  account  of  the 
working  of  the  so-called  "  juvenile-adult  "  S3rstem 
that  has  been  inaugurated  at  Borstal,   and  we 
may  say  at  once  that  the  verdict  of  the  Directors 
is    wholly    favourable.     This    system   was    inau- 
gurated  as  an   experiment    to   exploit    the   plan 
of  treating  young  criminals  with  a  view  to  curing, 
instead   of   merely   punishing,  them.     From    the 
London  prisons  were  collected  cases  of    youths 
sentenced  to  terms  of  imprisonment  of  six  months 
and  upwards,  and  these  lads  were  put  to  learn 
useful   trades,   such  as  carpentering  and  brick- 
laying, under  beneficent   supervision,  instead  of 
performing  the  old  routine  of  purposeless  prison 
tasks.     The  conduct   of   the  prisoners  under  the 
new  set   of  circumstances  completely  changed  ; 
they  showed  great  anxiety  to  improve,  and  they 
were    granted    extra    privileges,    became    great 
readers  and  good  chess-players.     Nor    was    this 
improvement  only  temporary.     So  far  a  hundred 
and    twenty-two    "  juvenile-adults "    have    been 
discharged,  and  of  these,  fifty-four  are  now  known 
to  be  in  employment  and  leading  useful  lives, 
whilst   thirty  have  been  lost   sight   of.     Of   the 
remainder,   only   twenty-four  have  been  re-con- 
victed,   and    fourteen    are   still    unplaced.     Con- 
sidering that  more  than  a  hundred  of  these  cases 
were  hardened  young  criminals,  fifty-one  of  them 
having  been  convicted  more  than  once,  and  twelve 
more  than  three  times  ;  that  they  were  discharged 
in  London  where  thev  had   either  no  homes  or 


thoroughly  bad  homes,  and  where  every  tempta- 
tion existed  to  gUde  back  to  their  old  haunts  ; 
and  that  the  task  of  supervision  after  discharge 
is  extremely  difficult,  one  is  not  surprised  that 
the  Directors  write  enthusiastically  about  the 
success  of  the  scheme.  They  are  now  planning 
to  extend  it  so  as  to  reach  not  only  London,  but 
the  whole  of  England  and  Wales,  and  to  establish 
it  on  a  permanent  basis.  Two  elements  are 
necessary  for  a  complete  cure — time  in  the  prison 
and  supervision  afterwards.  The  first  depends 
on  the  sentences  passed,  but  it  must  be  borne  in 
mind  that  the  lengthening  of  sentences  is  opposed 
to  the  whole  trend  of  modern  enlightened  philan- 
thropic feeling.  In  order  to  secure  the  second 
condition  the  Directors  .suggest  the  formation  of  a 
"  Borstal  Association,"  a  permanent  voluntary 
agency,  to  watch  over  and  interest  people  in  the 
youths  when  they  finally  leave  prison.  We  are 
glad  to  note  that  this  Association  is  already  on 
foot,  the  Home  Secretary  having  consented  to 
act  as  president,  and  the  Archbishop  of  Canterbury, 
the  Bishop  of  London,  the  Lord  Chief  Justice, 
Mr.  Asquith  and  others,  as  patrons.  Now,  at 
last,  it  seems  that  rationsd  methods  are  to  have 
a  fair  chance  in  the  treatment  of  criminals, 
and  that  the  old,  blundering  brutality — for  it 
has  been  nothing  less — is  to  become  as  extinct 
as  it  now  is  in  our  asylums  for  the  insane.  At 
least  we  hope  so,  for  it  is  too  early  to  speak  de- 
finitely yet.  The  introduction  of  lectures  on 
nursing,  sanitation,  and  such-Hke  subjects  into 
female  convict  prisons  that  has  just  been  started 
by  some  philanthropic  ladies — lectures  that  are 
greatly  appreciated  by  the  prisoners — looks  like 
confirmatory  evidence,  and  we  trust  the  day  may 
not  be  far  distant  when  criminal  therapeutics 
will  become  a  distinct  branch  of  psychiatry.  At 
all  events,  we  venture  to  congratulate  the  Directors 
of  Convict  Prisons  on  the  success  of  the  Borstal 
experiment,  and  to  wish  the  Borstal  Association 
ready  and  substantial  support  in  its  enlightened 
labour?. 


TREATMENT  OF  TRIGEMINAL  NEURALGIA. 

Although  never  in  itself  dangerous  to  life, 
trigeminal  neuralgia  frequently  becomes  one  of  the 
most  serious  and  intractable  of  diseases.  Suffer- 
ing from  incessant  and  severe  pain,  to  which  no- 
thing gives  any  real  reUef ,  it  is  no  wonder  that  the 
patient  becomes  sometimes  a  moral  and  physical 
wreck,  broken  down  by  want  of  sleep  and 
rest,  a  victim  to  drug-habits,  ultimately  degenerat- 
ing, perhaps,  into  insanity,  or  developing  a 
fatal  tendency  to  suicide.  In  such  severe  neural- 
gias medical  treatment  is,  as  a  rule,  unavailing, 
but,  of  course,  it  should  be  given  a  thorough  trial 
before  surgical  methods  are  thought  of.  The 
latter  are,  however,  upon  their  trial  at  present,  and 
there  are  many  cases  unfortunately  in  which 
they  appear  necessary.  Historically,  the  earUest 
operation  practised  for  neuralgia  was  a  neurotomy 
or  neurectomy  of  one  or  more  branches  of  the 


47Q    Thb  Medical  Press. 


NOTES    ON    CURRENT    TOPICS. 


Nov.  2,  1904::- 


trigeminal  nerve.  Very  often  this  is  found  to 
give  considerable  relief,  though  in  some  cases  it 
entirely  fails,  and  in  all  the  neuralgia  tends  to 
recur.  It  is,  however,  a  quite  safe  operation, 
and  should  always  be  considered  before  graver 
methods  are  adopted.  The  graver  methods  which 
are  in  vogue  at  present  agree  in  the  common 
feature  of  intracranial  neurectomy.  Some  sur- 
geons think  it  sufficient  to  remove  the  sensory 
root  of  the  fifth  nerve,  while  others  advise  the 
partial  or  complete  excision  of  the  Gasserian 
gangUon.  There  is  but  Httle  difference  in  the 
final  result  whichever  practice  is  adopted,  though 
undoubtedly  the  removal  of  the  gangUon  presents 
some  difficulties  of  technique  and  special  dangers 
absent  in  the  more  simple  neurectomy.  At  the 
same  time,  it  is  believed  that  there  is  somewhat 
less  UkeUhoodof  recurrence  when  the  gangUon  is 
removed.  It  need  hardly  be  pointed  out  that 
the  operation  is  one  of  the  most  serious  that  can 
be  undertaken,  and  that  it  is  never  justified  unless 
the  disease  has  shown  itself  intractable  to  less 
radical  methods.  On  the  other  hand,  it  is  in- 
advisable to  postpone  the  operation  until  the 
patient  has  been  reduced  by  pain  and  loss  of 
rest  to  such  a  condition  of  weakness  as  to  render 
any  operation  a  danger.  In  the  performance  of 
the  operation  itself,  the  chief  risk  is  from  haemor- 
rhage, though  many  deaths  are  reported  from 
shock,  from  sepsis,  and  from  injury  of  the  brain. 
The  mortaUty  during  recent  years  has  probably 
been  20  per  cent.,  a  high  figure  when  it  is 
remembered  that  the  disease  itself  is  not  fatal. 
The  difficulty  and  danger  of  the  operation  will 
probably  act  as  a  bar  to  its  adoption  by  other 
than  daring  surgeons,  and  there  is  at  the  present 
day  a  tendency  to  look  back  to  extracranial 
proceedings  with  the  hope  that  some  treatment 
may  be  found  which,  if  not  as  complete  in  its 
finsil  result  as  intracranial  neurectomy,  will  yet 
offer  hope  of  prolonged  reUef .  A  simple  procedure, 
and  one  that  has  already  given  good  results,  is 
that  recommended  by  Sir  VVilham  Bennett  and 
by  Mr.  John  B.  Murphy,  of  Chicago,  namely,  the 
injection  into  the  nerve-trunks  of  weak  solutions 
of  osmic  add.  The  nerves  are  exposed  and  a  few 
drops  of  a  2  per  cent,  solution  of  the  acid  are 
injected  at  several  points.  Murphy  advises  that 
all  the  main  branches  of  the  fifth  nerve  should 
be  treated  in  this  way,  as  it  is  well  known  that 
once  the  neuralgia  has  affected  the  nerve,  all  the 
branches  are  likely  ultimately  to  suffer.  Murphy's 
cases  are  too  recent  to  permit  one  to  say  that 
osmic  acid  gives  permanent  cure,  but  in  many  of 
his  cases  and  also  of  Bennett's  there  has  been  a 
complete  cessation  of  pain  for  periods  of  from 
one  to  four  years.  As  the  operation  is  entirely 
devoid  of  risk  it  is  hkely  that  it  will  become 
fashionable  in  the  near  future,  even  if  it  should 
be  found  that  the  effect  is  not  permanent.  It  is 
better  that  a  simple  operation  should  be  repeated 
when  necessary  than  that  the  life  of  a  patient 
should  be  endangered  by  a  superfluous  intra- 
cranial operation. 


Botes  on  Current  XTopfca* 

Soap  Before  SchooL 
The    Education    Committee    o£    the    LondaD^ 
County  Council  have  begun  weU  in  appointing  a 
nurse  to  examine  children  with  regard  to  deanli- 
ness  before  entering  school  in  the  monungs»and 
to  refer  those  who  appear  unsuitable  to  a  doctor,. 
who  has  authority  to  refuse  admission..    This  is  as 
it  should  be.     Underfeeding  may  or  may  not  be 
due   to  parental  neglect,   under-washing  always- 
is.     It  is  monstrous  to  expect  clean  and  caiefol 
parents   to  send   their   children    to   sit   next   to- 
filthy  urchins  with  verminous  heads,,  and  it  is 
mere  waste  of  time  to  insist  on  other  hygienic 
requirements  when  the  primary  step  in  all  bealtk 
questions,  namely,  cleanliness,  remains  untouched. 
Unfortunately  the  powers  of   the  education  au- 
thority seem  Umited  with  regard  to  this  question, 
for  at  Worship  Street  Pohce  Court  the  other  day» 
a  batch  of  summonses  against  parents  for  non- 
attendance — ^the  non-attendance  being  due  to  the 
children  having  been  sent  back   for  dirtiness — 
were  dismissed.     An  obvious   loop-hole  exists   if 
this  is  the  state  of  the  law,  for  a  careless  parent 
may   purposely   neglect    to     keep    his   children 
clean,  and  then  plead  that  they  were  excluded 
from    school  when  he    did   send  them.      When 
the  summons  is  taken  out,  the  children  can  be 
cleaned  for  the  purpose  of  appearing  in  court. 
In  the  cases  reported  there  seems   to  have  been 
more  misunderstanding,  for  the  parents  are  said 
to  have  cleaned  the  children  and  taken  them  back 
to  school,  and  been  again  refused  admission.     If,. 
however,  difficulties  are  likely  to  arise  it  would 
certainly  be  wise   to  have  full  powers  conferred 
on  the  officers  of  education  authorities  to  deal 
with  dirty  children,  or  rather  their  parents,  for 
the  County  Council  Education  Committee  seem 
determined  to  deal  with  what  has  been  a  reproach 
in  days  past,  and  it  will  be  a  great  pity  if  their 
efforts  are  thwarted   or  hampered  by  insufficient 
powers.     If  the  teaching  of  the  simple  laws  of 
hygiene    is    to    be    introduced    into    elementary 
schools,  as  we  all  hope,  the  first  lesson  had  better 
be  an  object-one  of  the  detergent  virtues  of  soap 
and  water,  and  in  so  far  as  example  is  better  than 
precept  will  the  pupils  be  impressed  with    the 
value  of  the  instruction  afforded.     Cleanliness  is 
subordinate  to  godhness  only  in  the    sphere  of 
morals  ;  it  is  subordinate  to  nothing  in  the  ^>faere 
of  hygiene. 

Imaginatioii  as  a  Cause  of  Deaths 

There  are  two  or  three  stories  going  the  round 
of  the  newspapers  at  present  which  illustrate  the 
powerful  effect  the  imagination  can  exercise  over 
the  phenomena  of  life.  In  one  case  a  gurl,  suffering 
from  despondency  of  spirits,  is  said  to  have 
swallowed  some  harmless  fluid  in  mistake  for  car- 
bolic acid.  She  immediately  declared  that  she 
had  poisoned  herself,  and  soon  died,  though 
we  are  left  without  any  information  as  to  the 
nature  of  the  symptoms,  or  of  the  lesions  discovered 


Nov.  2,  1904. 


NOTES    ON    CURRENT    TOPICS.         Th»  Medical  Pmss.    47i 


post-mortem.     An  equally  peculiar  case  is  reported 
from  Hull.     A  young  woman  asked  at  a  chemist's 
-shop  for  some  laudanum,  but  the  attendant,  notic- 
ing that  she  was  in  an  excited  condition,  supplied 
her    with    port    wine.      Shortly    afterwards    she 
was  discovered  apparently  suffering  from  opium 
poisoning,   and  the  usual  anti-opium  treatment 
was  successful.     Though  we  have  no  authority 
beyond  newspaper  currency  for  either  of  these 
-stories,  there  is  nothing  in  them  inherently  im- 
pHDssible.     Apart  from  the  extraordinary  mimicry 
•of  which  hysterical  subjects  are  capable,  there  are 
several    well  -  authenticated    instances    in  which 
death  has    been   the   result   of   quite   imaginary 
-causes,  or  rather  of  the  fright  resulting  therefrom. 
Pterhaps  the  best  known  of  these  is  the  case  of  the 
jester  of  a    Scottish  Court,  who,  in    punishment 
:for  some  offence  being  threatened  with  beheading 
by  a  party  of  courtiers,  was  then  made  to  kneel 
before  an  improvised  block,  and  struck  on  the  neck 
with  a  wet  towel.     To  the  astonishment  of  the 
party,  he  did  not  move,  and  was  actually  found  to 
be  dead. 


Identifioatton  by  Finger  Prints. 

The  inquiry  that  has  just  been  made  into  the 

-case  of  Mr.  Beck  has  not  unnaturally  excited 
wide-spread  interest,  and  every  respectable  citizen 
would  be  glad  to  know  that  the  recurrence  of 
such  a  heinous  blunder  will  be  as  impossible  in 
the  future  as  it  has  always  been  thought  to  have 
been  up  to  the  present.  Every  man  has  at  least 
one  "  double,"  and  most  people  would  gladly 
sacrifice  any  reflected  glory  that  might  shine  on 
them  through  the  achievements  of  their  doubles 
for  the    comfortable  assurance    that  the  latter's 

•crimes  could  not  posably  be  visited  on  their 
heads.  Fortunately,  that  practical  branch  of 
anthropology  which  deals  with  identification  has 
made  great  strides,  and  the  S3rstem  now  in  use  by 
the   police  is  a  great  advance  on  the  haphazard 

^methods  in  vogue  before  1894.  In  that  year  a 
committee  was  appointed  by  the  Home  Office  to 
inquire  into  the  matter,  and  their  recommenda- 
tions were  accepted.  At  present  each  prisoner 
has  an  identification  card  bearing  on  one  side 
accurate  measurements  of  the  essential  bodily 
characteristics,  together  with  a  photograph  and 
particulars  of   complexion,  hair,    eyes,  scars,  and 

■other  distinctive  marks,  whilst  on  the  reverse  are 
places  for  the  finger  prints.  A  Scotland  Yard 
inspector  mentioned  in  evidence  in  a  recent  case 
that  the  Department  have  no  less  than  70,000 
impressions  of  finger-marks,  and  that  no  two  of 
these  are  exactly  alike.     As  showing  the  difficulty 

•of  obtaining  official  recognition  for  a  new  art — 
for  the  reading  of  finger-prints  is  little  less — it  may 
be  interesting  to  recall  that  Sir  William  Herschel 
introduced  it  into  Bengal  in  1877,  and  reported 
favourably  on  its  general  apphcability.  He 
probably  derived  his  inspiration  from  finding  the 
practice  of  signing  documents  by  thumb-marks 
prevalent  in  certain  parts  of  India,  but  in  spite  of 
Jiis  advocacy  the   plan  was   discarded  after  his 


departure.  The  f credit  for  having  reduced  the 
study  of  ^finger-prints  to  an  exact  science  belongs, 
of  course,  to  Mr.  Francis  Galton.  and  it  was  he  who 
was  able  by  his  two  great  works,  "  Finger-Prints  " 
and  "The  Decipherment  of  Blurred  Finger- 
Prints,"  to  convince  the  world  that  the  subject 
had  practical  bearings  beyond  those  of  a  hobby  for 
anthropologists.  Under  the  auspices  of  M.  Ber- 
tillon  the  method  was  many  years  ago  adopted 
in  France.  The  registration  of  the  papillary 
ridges  of  the  fingers  in  indehble  form  constitutes 
the  most  exact  single  record  of  identity  at  present 
known,  and  is,  moreover,  obtained  so  easily  that 
the  future  may  hold  important  developments  for 
the  art  in  commercial  and  general  hfe,  beyond 
even  what  it  has  already  done  for  the  detection  of 
criminals. 


Florence  Nic^tdDgale. 

The  recent  publication  of  a  biography  of 
Florence  Nightingale  brings  to  memory  the  fact 
that  it  is  just  fifty  years  ago  that  the  patron  saint 
of  the  nursing  profession  and  her  heroic  followers 
sailed  in  the  time  of  dire  need  to  succour  their 
wounded  and  suffering  countrymen.  We  have 
said  the  patron  saint,  for  if  ever  a  woman  deserves 
secular  canonisation  that  woman  was  Florence 
Nightingale — the  founder  of  modem  nursing  with 
its  inestimable  blessings  to  the  sick,  and  breaker  of 
red-tape  in  the  Army  Hospital  Service  of  her 
time.  The  remarkable  fact  about  Florence 
Nightingale's  character  was  that  with  a  fund  of 
sympathy  and  skill  in  nursing  individual  cases  of 
sickness,  she  combined  truly  remarkable  powers 
of  organisation,  and  while  it  is  by  the  former  that 
her  memory  will  live  and  be  cherished,  to  her 
administrative  skill  and  boldness  must  be  assigned 
the  real  power  she  exerted  among  the  authorities. 
Her  influence  on  the  soldiers  is  illustrated  by  a 
touching  story  told  by  Sidney  Herbert.  One  of 
the  wounded,  speaking  of  the  experiences  of  his 
ward,  said  that  Miss  Nightingale  always  found 
time  for  a  smile  and  a  bright  word  for  some  of  the 
sufferers,  though  their  numbers  were  too  great 
to  allow  of  her  recognising  and  speaking  to  all ; 
"  but,"  he  added,  "  we  could  kiss  her  shadow  as 
it  fell,  and  lay  our  heads  on  the  pillow  again 
content."  Strong  woman  as  she  was,  the  Crimean 
war  broke  Miss  Nightingale's  constitution,  and 
she  has  led  a  retired  and  mostly  an  invalid  life 
since  she  returned  to  England,  under  the  alitis  of 
"Miss  Smith,"  which  she  assumed  to  avoid  the 
ovation  prepared  for  her.  Even  in  her  seclusion 
she  has  worked  hard  and  steadily  for  the  raising  of 
status  and  the  training  of  nurses,  and  from  them 
she  has  never  demanded  a  lower  standard  than  she 
lived  up  to  herself.  The  age  of  eighty-four  still 
finds  her  alive  to  the  movements  that  are  taking 
place  in  the  service  she  loves,  but  her  active 
work  is  over.  One  might  have  thought  that 
the  fiftieth  anniversary  of  her  departure  for  the 
Crimea  would  have  been  seized  upon  by  nurses  as 
an  opportunity  for  a  celebration,  for  it  would  be 
a  real  and  serious  loss  if  the  example  of  Florence 


47^     The  Medical  Pkxss. 


NOTES   ON   CURRENT   TOPICS. 


Nov.  2,  1904- 


Nightingale  were  to  fade  from  the  memories  of 
her  modem  successors. 


Municipal  Dentistry, 

We  have  often  urged  in  these  columns  that 
some  method  of  dealing  with  children's  teeth  is 
urgently  needed,  and  that  it  would  be  a  great 
advantage  if  such  inspection  and  treatment  could 
be  made  available  for  the  working-classes  generally. 
The  amount  of  ill-health  and  digestive  trouble 
attributable  to  unsound  teeth  is  incalculable, 
and  returns  from  every  source  show  the  evil  to 
be  increasing  to  an  extent  that  can  almost  be 
termed  alarming.  The  difficulties  that  stand  in 
the  way  are  each  of  interest  in  the  question,  and 
the  all-important  question,  of  expense  ;  certain  it 
is  that  the  latter  will  never  be  solved  till  the  former 
changes  considerably.  To  those  who  are  disposed 
to  make  the  matter  a  practical  one,  the  experiences 
of  Germany  should  be  of  help.  Some  of  the  large 
towns  in  that  country  have  both  the  power  and 
wiU  to  appoint  municipal  dentists,  and  these 
officers  are  already  at  work.  In  Strasburg  last 
year  2,666  children  were  subjected  to  dental 
inspection,  with  the  result  that  no  fewer  than 
2,912  teeth  were  found  too  much  decayed  to  be 
saved,  and  were  therefore  extracted,  whilst  699 
were  stopped.  The  plan  that  is  followed  is  for 
each  teacher  himself  to  take  his  class  to  the 
dentist,  who  examines  the  children  one  after 
another,  noting  on  a  card  the  state  of  the  teeth 
as  he  finds  them.  When  defects  are  found  the 
patients  are  ordered  to  come  up  on  a  Saturday, 
and  the  extractions  and  fillings  are  then  performed. 
Not  only  is  the  importance  of  sound  teeth  being 
recognised  in  Germany,  but  Russia — one  of  the 
most  backward  of  the  great  civilised  powers  in 
questions  of  public  health — is  also  taking  the 
matter  up,  and  nine  municipal  dental  institutes 
for  the  supervision  of  teeth  have  been  set  up  in 
St.  Petersburg  alone.  These  facts,  surely,  may 
serve  to  strengthen  the  hands  of  those  who  would 
like  to  see  similar  advantages  conferred  on  our 
elementary  school  children. 


Intravenous  Injection  01  Salicylates. 

In  the  administration  of  many  drugs  it  is  known 
that  more  excellent  results  can  be  obtained  when 
intravenous  or  subcutaneous  injection  is  practised 
than  when  the  drug  is  given  by  the  mouth.  Cer- 
tain drugs,  too,  lose  some  ofJ|their  power  when 
absorbed  through  the  stomach,  so  that,  if  a 
full  effect  is  to  be  gained,  some  other  method  of 
administration  must  be  practised.  This  seems 
to  be  the  case  with  the  salicyl  compounds,  and 
for  some  time  various  physicians  have  been  in 
the  habit  of  injecting  salicylate  of  sodium 
hypodermically  with  better  result  than  is  ob- 
tained by  the  usual  method  of  administration. 
More  recently  intravenous  injection  [has  [been 
recommended,  and  has  been  practised  with  suc- 
cess by  Mendel  and  others.  He  usually  gives 
four-grain  doses,  repeating  them  at  intervals  of 
from  twelve  hours  to  three  days.     In  no  case  were 


any  ill-effects  noticed.  In  the  technique  of  in- 
jection the  same  precautions  are  necessary  as  is 
intravenous  injection  for  any  other  purpose. 
The  vein  should  be  fully  dilated  before  inserting 
the  needle,  and  care  should  be  taken  that  the 
needle  really  pierces  the  vein.  In  repeating  the 
process,  a  different  vein  should  be  selected.  The 
method  of  treatment  seems  to  have  a  wide  appli- 
cation, not  only  in  acute  rheumatism,  for 
rapid  relief  has  been  given  in  snch  conditions  as 
lumbago,  and  the  flying  pains  to  which  rheumatic 
patients  are  so  subject  in  damp  weather. 

Orgranisms  in  Sore  Throat. 

It  has  been  the  experience  of  most  clinical 
bacteriologists  who  have  to  do  with  the  study  of 
cultures  from  the  throat  to  meet  from  time  to  time 
with  cases  which  present  every  clinical  appearance 
of  diphtheria,  but  where  nevertheless  the  diphtheria 
bacillus  is  absent.  Different  observers  have  noted 
various  organisms  as  beingf ound  repeated y  in  such 
cases,  but  few  of  them  have  established  a  causal 
relation  with  the  same  rigour  as  has  recently  been 
done  by  Dr.  Stone  in  the  States  with  regard  to  a 
diplococcus  discovered  by  him.  (ja)  The  diplo- 
coccus  in  question  was  separated  in  about  a  him- 
dred  cases,  most  of  which  belonged  to  a  quite 
definite  type.  There  was  an  acute  inflammatiaa 
of  the  throat,  accompanied  by  a  severe  toxaemia, 
which  usually  subsided  on  the  second  day.  In  about 
half  the  cases  there  was  a  membrane  present,  white 
in  colour,  tenacious,  and  indistinguishable  in. 
appearance  from  the  membrane  of  diphtheria. 
There  was  also  swelling  of  the  tonsils  and  oedema 
of  the  soft  palate  and  uvula.  In  addition  to  cases 
of  this  description  Stone  found  the  diplococcus  vol 
several  cases  of  folUcular  tonsfllitis,  and  in  a  few 
cases  of  scarlet  fever,  but  in  no  case  was  it  found 
in  a  healthy  throat,  although  over  two  hundred 
such  were  examined.  The  appearance,  stain- 
ing, and  cultural  reactions  of  the  organism  are 
sufiiciently  distinctive,  and  a  positive  result  is 
got  by  the  inoculation  of  animals.  In  all  the 
ordinary  laboratory  animals  the  org^anism  proved 
to  be  pathogenic,  a  diphtheritic  exudate  appearing 
on  the  serous  membranes,  from,  which  the  organism 
was  recovered  in  pure  cultmre.  In  no  case,  how- 
ever, did  an  exudate  appear  on  the  mucous  mem- 
branes of  the  laboratory  animals. 

Meat  Eiztracts  in  Medicine. 
The  exact  place  of  meat  extracts  in  the  feeding 
of  invalids  is  hardly  yet  grasped  by  practical 
physicians.  That  view  is  borne  out  by  the 
sweeping  statements  that  so  often  run  the  round 
of  the  press,  both  lay  and  medical,  to  the  effect 
that  the  average  meat  extract  contains  no-  susten- 
ance or  nutriment^  and  that  it  is  merely  a  stimu- 
lant. The  average  journalist  seems  to  think  that 
when  he  has  uttered  those  sapient  remarks  there 
is  nothing  more  to  be  said  on  the  matter.  Reflect 
for  a  moment  what  stimulation  means  as  a  weapon 
in  the  hands  of  the  physician  faced  at  the  bedside 
with  the  problem  of  how  to  stay  the  havoc  wrought 

(a)  Mtdkal  Record,  Aug:a8«  18th,  1901,. 


Nov.  2,  1904. 


NOTES    ON   CURRENT    TOPICS. 


by  a  failing  circulation  and  a  thwarted  nutrition. 
As  a  stimulant  alcohol  is  often  his  sheet  anchor. 
In  many  a  case  we  have  no  hesitation  in  sa3^ng 
that  a  good  meat  extract  is  a  thousand  times 
better  than  whisky  or  champagne,  inasmuch  as 
its  stimulation  is  not  followed  by  the  reaction 
and  depression,  bodily  and  mental,  induced  by 
alcohol.  Many  a  time  have  we  seen  a  patient 
tided  over  the  rocks  into  the  haven  of  recovery 
by  the  use  of  the  beef -tea  and  meat  extracts  that 
scientists  of  the  study-table  order  love  to  deride. 
Medical  men  and  nurses  will  do  well  to  think  for 
themselves,  and  be  guided  by  their  own  experience 
rather  than  by  the  long-drawn  theories  of  others. 
Let  them  choose  good  extracts  made  by  {good 
firms,  and  if  they  want  more  nutriment  therewith 
let  them  add  milk  or  cream  or  whites  of  eggs. 

"  Sundown  "  Journalism. 

There  are  many  men  of  nervous  temperament 
-who  never  seem  fully  ahve  to  their  work  until  the 
end  of  the  day.  The  dullard  of  the  breakfast- 
table  becomes  transformed  into  the  after-dinner 
wit,  while  the  maiden  throws  off  the  listless 
languor  of  morning,  to  emerge  later  as  the  beautiful 
Star  of  evening.  But  while  the  fire  of  nervous 
energy  is  at  its  brightest  the  ashes  of  wear  and 
tear  are  faUing  at  their  fastest.  It  is  hardly  to 
be  expected  that  real  hard  work  which  shall 
stand  the  test  of  time  can  be  performed  late  at 
night,  when  both  body  and  mind  have  toiled 
laboriously  throughout  a  long  day.  And  yet  it 
is  well  known,  especially  in  the  journalistic  world, 
that  a  considerable  proportion  of  *'  copy "  is 
written  [^by  the  light  of  midnight  ^oil.  Dr.  T. 
D.  Crothers,  in  a  paper  read  before  the  American 
Medical  Editors'  Association,  has  drawn  attention 
to  the  unequal  literary  work  sent  in  to  medical 
editors,  even  by  the  same  authors,  which  he 
attributes  to  the  fact  that  much  of  it  is  done  after 
sundown.  The  literary  life  is  one  of  stress  and 
strain,  and.  the  more  so  if  it  be  combined  Mdth 
other  occupations.  In  this  is  probably  to  be 
sought  the  explanation  of  the  "  literary  patch- 
work "  which  is  sometimes  painfully  obvious, 
even  in  standard  text-books  by  eminent  clinical 
teachers.  The  recognition  by  authors  them- 
selves of  their  inabihty  to  do  really  good  work 
when  tired  out  has,  unhappily,  led  them  to  the 
use  of  artificial  brain  stimulants.  Dr.  Crothers 
considers  that  many  of  the  articles  which  appear 
in  the  medical  journals  of  his  own  country  convey 
a  distinct  impression  that  they  have  been  written 
under  the  influence  of  extreme  fatigue  or  of  drugs, 
which  may  account  for  the  hopeless  note  of  failure 
recognisable  in  not  a  few  of  the  ephemeral  periodi- 
cals of  modem  times,  lay  as  well  as  medical. 


Medioal  Men  in  Lay  Newspapers. 

The  letters  of  medical  men  to  the  daily  news- 
papers on  professional  subjects  are  multiplying 
beyond  all  bounds.  Now,  either  this  is  or  is 
not  an  offence  against  medical  ethics.  The 
London  College  of  Physicians  denounce  all  adver- 
tising, direct  or  indirect,  but  we  find  its  Censors, 


The  Medical  Pkess.    475 


Members  and  Fellows,  nay,  even  its  ex-Presidents; 
communicating  this,  that,  or  the  other  infor- 
mation under  signature  to  the  Times  and  other 
public  prints  on  cottage  hospitals,  consumption 
cures,  cancer.  X-ray  methods,  and  what-not. 
The  Colleges  are  no  whit  greater  offenders  than 
many  of  the  members  of  the  honorary  staffs  of 
leading  Metropolitan  and  provincial  hospitals.. 
What  can  be  said,  then,  if  the  rank  and  file  of  the 
profession  follow  suit,  and  flood  the  correspondence 
columns  of  the  daily  press  with  their  views  upon 
any  or  every  matter  within  the  range  of  medical, 
literature  ?  Where  the  offenders  are  to  be  found 
in  every  class  it  is,  perhaps,  invidious  to  mention;' 
onel  Yet  we  think  the  letter  of  Dr.  J.  Stensoir 
Hooker  to  the  Daily  News  [oi  October  24th  may- 
be briefly  alluded  to  as  an  example  of  the  super- 
fluous and  misplaced  energy  in  question.  He 
informs  readers  of  that  journal  that  the  "violet- 
leaf  cure  "  of  cancer  has  been  tried  at  the  Bromp- 
ton  Cancer  Hospital,  and  found  wanting.  He 
then  proceeds  to  suggest  that  red  clover  top  is 
worthy  of  trial  in  the  disease  mentioned.  Surely 
Dr.  Hooker  should  have  made  this  suggestion  to 
medical  men  in  the  columns  of  the  medical  journals  ^ 
and  not' to  the  general  public.  However,  many 
hospital  surgeons  and  physicians  have  led  the; 
way  in  the  same   undesirable  direction. 


A  Sursreon's  Aooount  of  the  Russian 
Outrage. 

The  secretary  ^of  the  Royal  National  Mission^ 
to  Deep  Sea  Fishermen  has  received  the  following 
*♦  human"  document  from  the  surgeon  onboard 
the  hospital  ship  Joseph  and  Sarah  Miles ^  which 
has  the  three  seriously  wounded  men  on  board 
from  the  Crane  : — 

"  Hospital  Mission  Ship,  jfoseph  and  Sarah  MiUs, 
"Great  Northern  Fleet,  October  24th,    1904. 

"  Dear  Mr.  Wood — Before  this  reaches  you,  perhaps 
you  are  acquainted  with  the  sad  news  of  a  dastardly 
raid  on  our  fishing  fleets  last  Friday  night  by  some- 
foreign  battleships.      The  incident  came  upon  us  so 
sudden  and  unawares,  that  we  cannot  yet  realise  what 
it  could  be.     Happily  our  fleet  had  no  casualty  on  that 
fateful  night,  but  the  Gamecock  fleet,  which  was  work- 
ing close  to  us,  fared  very  badly.     One  of  their  trawlers- 
sank  in  a  few  minutes  after  being  hit  by  four  shells, 
killing  two  of  the  crew  and  badly  wounding  the  rest.. 
Four  of  their  other  trawlers  were  also  hit.     The  ship- 
wrecked crew  were  luckily  rescued  from  a  watery  grave 
by  the  crew  of  another  trawler,  whose  first  thought,  of 
course,  was  to  look  out  for  their  own  mission  ship, 
but  before  they  could  find  the  Alpha^  they  sighted 
our  ship,  so  they  steamed  up  to  us  and  shouted  out  for 
urgent  help  as  some  of  the  wounded  men  were  bleeding 
to  death.      The  sad  news  in  itself  was  enough  to  stagger- 
us.     We  hauled  up  our  gear  at  once  and  launched  out 
our  boat,  and  soon  I  was  aboard  the  trawler  with  two  of - 
our  ciew,  I  have  never  witnessed  such  a  gory  sight  as  I 
did   on  board   the  trawler.     Two  men  lay  on    deck 
with  their  heads  nearly  blown  to  pieces.     In  the  cabin- 
the  scene  was  more  heartrending  still,  when  I  saw  six 
men  stretched  about  anyhow,  bleeding  and  groaning, 
with  the  agony  of  their  wounds.     Under  the  circum- 
stances, I  had  them  all  removed  on  board  our  ship. 
With  all  these  wounded  men  on  board,  our  floating- 
hospital  looked  Uke  a  veritable  battlefield.     Indeed,  it 
presented  a  most  pathetic  sight.  It  kept  me  busy  witlu 
knife  and  needle  the  whole  of  that  day,   and  it  was  . 
not  until  late  in  the  night  that  I  had  the  satisfaction* 


474      THg  MBDICAL   PtESS. 


PERSONAL. 


Nov.  2.  1904. 


•of  seeing  them  all  safe  and  snug  in  their  cots,  as 
far  as  circumstances  allowed.  But  of  the  six  patients 
three  have  been  allowed  to  return  to  their  homes,  as 
•they  were  progressing  satisfactorily.  Of  the  remaining 
three,  one  is  quite  out  of  danger,  but  the  other  two 
being  very  serious  cases,  I  am  still  anxious  about  them, 
and,  circumstances  permitting,  I  shall  have  to  send  then 
on  to  London  it  they  do  not  progress  favourably. — 
Believe  me  to  be  yours  sincerely,  H.  Ankles  aria." 


Dr.  Bttles  as  "  Medical  Referee." 
A  FORTNIGHT  ago,  writing  on  the  alleged  new 
treatment  (it  is  really  old  as  the  hills)  of  errors 
•of  refraction  by  massage,  we  alluded  to  a  public 
trial  of  the  matter  proposed  between  Dr.  Stephen 
Smith,  its  "inventor,"  and  a  London  optician, 
Mr.  Aitchison.  On  the  authority  of  a  daily 
newspaper,  we  stated  that  Dr.  Ettles,  of  the 
Minories,  had  been  appointed  as  referee  by  Dr. 
'Stephen  Smith.  This  notice  was  followed  a  few 
days  later  by  a  letter  from  a  legal  gentleman 
•representing  Dr.  Ettles,  disclaiming,  on  the  part 
of  his  client,  all  acquaintance  with  Dr.  Stephen 
Smith  or  his  methods,  and  sympathy  with  anti- 
-vivisection.  On  receiving  this  letter  we  at  once 
proceeded  to  publish  that  correction,  and  to 
make  amends  as  far  as  possible  for  the  mis- 
apprehension which  seemingly  we  had  been  led 
into  on  the  strength  of  published  statements  in  a 
London  newspaper.  It  now  appears,  from  a 
.letter  in  the  St  James's  Gazette  of  October  28th 
aast,  signed  by  Mr.  James  Aitchison,  that  it  was 
Ihe  who  appointed  the  referee.  "  Dr.  Ettles,  the 
ophthalmic  surgeon,"  he  writes,  "whom  I 
appointed  to  act  for  me,  states— '  Mr.  Smith  will 
only  submit  to  a  test  on  his  own  terms,  and  as 
those  are  of  such  a  character  as  to  make  the  thing 
an  aKsolute  farce,  it  is  out  of  the  question  to  give 
way  any  further.' "  Dr.  Ettles,  it  appears,  is 
racting  as  referee  for  an  optician,  not,  as  we  were 
led  to  believe,  for  a  qualified  medical  man.  Further 
comment  upon  this  incident  is  needless  in  the 
columns  of  a  medical  journal. 


Poisoninisr  by  Boot-Blackinfir. 

A  FATAL  case  of  poisoning,  apparently  unique  in 
the  annals  of  toxicology,  is  reported  in  an  American 

•contemporary,  (fl)  A  young  man,  having  spent 
some  hours  at  a  dancing  party,  suddenly  fainted  in 
a  public  cafe  and  passed  into  a  state  of  stupor. 
Although  treated  with  injections  of  strychnine,  his 

'Condition  became  worse  and  he  died  four  hours 
later  from  paral3^is  of  the  circulatory  apparatus, 
no  clue  being  apparent  as  to  the  cause  of  the 
illness.  Po5/-mor/em,  also,  the  findings  were  nega- 
tive, except  that  there  was  an  acute  [desquama- 
tive nephritis,  and  fatty  degeneration*of  the  cells, 
both  of  the  liver  and  kidney.     The  tentative  dia- 

'gnosis  of  poisoning  was  made,  but  the  cause  was 
quite  unknown.      Some  days  later,  however,   a 

•bottle  of  shoe-blacking  was  found  in  the  victim's 
room,  and  it  was  discovered  that  on  the  evening 

K>f  his  death  he  had  soaked  in  this  blacking  the 
tan  uppers  of  a  pair  of  canvas  boots,  and  that  the 

•colouring  had  penetrated  his  stockings,  staining 

(m)  Jottm.  Amer.  Jfetf.  A9Mc.,  October  let,  1904. 


his  feet  and  ankles.  Chemical  investigation  of  tbe 
substance  revealed  that  the  solvent  in  the  blacking 
was  nitrobenzol,  an  extremely  poisonous  Eqvid, 
much  used  in  the  manufacture  of  cheap  perfumn 
and  soaps.  Several  cases  of  poisoning  by  mtio- 
benzol  were  already  on  record.  In  some,  serious  re- 
sults followed  a  mere  breath  or  two  of  the  vapour,  in 
others  on  a  small  dose  of  the  liquid,  but  we  think 
this  is  the  first  where  the  result  is  due  to  abeorptioo 
through  the  skin.  The  occurrence  draws  attention 
to  the  danger  of  using  such  a  highly  toxic  sub- 
stance in  the  preparation  of  so  many  promiscuous 
wares  as  soaps,  shoe-polish,  perfumes,  and  con- 
fections of  various  sorts.  It  is  a  matter  of  wonder 
that  workers  in  factories  where  it  is  employed  do 
not  frequently  suflFer. 

PERSONAL. 
His  Majesty  the  King  has  been  graciously  pleased 
to  confer  the  title  ■*  Royal "  upon  the  Sanitary  In- 
stitute, the  headquarters  of  which  is  at  the  well-knova 
Parkes  Museum,  Margaret  Street,  London,  and  to 
signify  his  pleasure  that  the  Institute  be  known  hence- 
torth  as  the  Royal  Sanitary  Institute. 


Dr.  F.  W.  Mott,  F.R.S.,  will  deliver  the  Bowman 
Lecture  of  the  Ophthalmological  Society  to-morroir, 
(Thursday)  at  9  p.m.,  on  •'  The  Visual  Cortex."  Th€ 
Nettleship  Medal  will  be  presented  to  Mr.  Priestley 
Smith  before  the  lecture.  All  members  of  the  professioa 
are  cordially  invited  to  attend. 


The  gold  medal  of  the  British  Medical  Association 
has  been  awarded  to  Sir  Constantine  Holman  for  his 
distinguished  services  to  the  British  Medical  Associa- 
tion, through  the  South-Eastem  Branch,  on  the  Central 
Council  as  treasurer  and  as  vice-president ;  zni, 
further,  for  his  life-long  and  successful  labours  for  the 
improvement  of  the  financial  conditions  of  the  medical 
charities. 


A  COTTAGE  hospital  has  been  opened  at  Tredegar 
by  Lord  Tredegar,  situated  in  the  park  which  he  had 
previously  presented  to  the  town. 


Professor  Robert  Koch  is  to  be  the  recipient  of 
the  Nobel  Prize  in  medicine  this  year. 


It  is  announced  that  the  new  Maternity  Hospital  for 
Belfast  will  be  opened  by  Countess  Grosvenor  ca 
November  7th. 


Dr.  T.  Orme  Dudfield  read  a  paper  on  *'  The 
Need  of  Sanatoria  for  Consumptives,  and  How  it  may 
be  Supplied,"  at  a  special  meeting  of  the  Charity  Or- 
ganisation Society  on  Monday  last,  at  4.30  p.m..  at 
the  Royal  United  Service  Institution. 

The  opening  demonstration  of  the  winter  session  of 
1904-05  at  the  Brompton  Hospital  for  Consumption 
will  be  given  by  Dr.  Percy  Kidd  to  day  (Wednesday), 
at  4  p.m.,  on  "  Some  Points  in  the  Prognosis  and 
Treatment  of  Pneumonia." 


It  is  announced  that  his  Majesty  the  King  has  been 
pleased  to  appoint  Dr.  Bertram  C.  A.  Windle  to  be 
president  of  Queen's  College,  Cork,  in  the  room  of  Sir 
Rowland  Blennerhassett,  who  has  resigned.  Dr. 
Windle  is  at  present  Dean  of  the  Medical  Faculty  and 
professor  of  Anatomy  and  Anthropology  in  the  Uni- 
versity of  Birmingham. 

The  current  issue  of  the  Leys  Fortnightly,  the  maga- 
zine of  the  Leys  School,  offers  congratulations  to  an 
Old  Leysian,  Mr.  J.  P.  Mummery.  F.R.C.S..  L.R.C.P., 
on  his  appointment  as  one  of  the  honorary  medical 


Nov. 


2.    1904. 


SPECIAL    CORRESPONDENCE. 


The  Medical  Press.    475 


staff  of  King  Edward  VII.'s  Hospital  for  Officers  ; 
also  Assistant-Surgeon  to  the  North-Eastern  Hospital 
ior  Children,   Hackney  Road. 

Dr.  M.  M.  Loudon,  of  Arundel,  last  week  received  a 
handsome  presentation  from  friends  and  patients  on 
the  occasion  of  his  wedding. 

On  the  28  th  ult.  the  foundation-stone  of  the  new 
building  of  the  Liverpool  Infirmary  for  Children  was 
laid  by  the  Lady  Mayoress,  Lady  Hampson. 

Last  week  the  remains  of  the  late  Lady  Dilke  were 
cremated  at  Woking. 


Professor  Koch  has  returned  to  Berlin  from  Paris, 
where  he  had  gone  to  thoroughly  inspect  the  Pasteur 
Institute,  for  which  he  is  said  to  be  full  of  praise  and 
admiration.  He  leaves  for  South  West  Africa  in 
December.  

Sir  Squire  Bancroft  will  distribute  the  prizes  and 
deliver  an  address  to  the  students  of  Charing  Cross 
Hospital  on  Wednesday,  November  23rd,  1904,  at 
4  o'clock.  

At  a  special  meeting  of  the  governors  of  London 
Hospital  last  week  Dr.  Cecil  Wall  was  elected  assistant 
physician. 


Dr.  St.  Aubyn  Farrer,  on  Monday  last,  presided 
over  a  most  successful  inaugural  general  meeting  of 
the  newly-formed  association  of  Medical  Diploma tes 
of    Scotland. 


Surgeon-Major  General  T.  Walsh  has  been 
awarded  a  good  service  pension  in  recognition  of  his 
long  and  meritorious  services  in  the  Army  Medical 
Department.  During  the  past  forty-six  years,  he  has 
served  in  many  parts  of  the  world,  taken  part  in  several 
campaigns,  and  has  been  thrice  mentioned  in  Des- 
patches. 


THE   NEW   PRESIDENT   OF  THE   ROYAL 
COLLEGE  OF  PHYSICIANS  OF  IRELAND. 


WM.    J.    SMYLY,    M.D.     T.C.D.,    F.R.C.P. 


Special  (£otre9poitdence. 

[from  our  own  correspondents.] 
SCOTLAND. 

Inaugural  Address  of  the  Royal  Medical 
Society. — The  winter  session  of  the  Society  was  opened 
on  October  28th,  by  Sir  James  Crichton  Browne,  who. 
addressed  the  Society  on  "  The  Tendency  of  Medical 
Education."  It  was  just  forty  years,  he  said,  since, 
as  a  fourth-year's  student,  he  took  possession  of  the 
Chair  of  the  Society  with  feelings  of  exultation  that  had 
known  no  parallel  since.  Not  the  least  momentous 
educational  advantage  the  Society  might  exert  was  to- 
keep  alive  some  vestige  of  idealism  among  the  members, 
It  could  not  be  doubted  that  the  present  tendency 
of  medical  education  was  towards  materialism.  By 
the  very  nature  of  his  work  the  student  was  accustomed 
to  submit  everything  to  outward  and  palpable  tests. 
He  was  nurtured  on  hard  facts  which  tended,  as  Oliver 
Wendell  Holmes,  averred,  to  breed  a  despotic  frame 
of  mind  in  those  wrapped  up  in  them.  He  was  in  con- 
stant danger,  unless  strongly  fortified  by  natural  piety, 
of  having  his  perceptions  materialised  and  of  losing  in 
breadth  what  he  might  gain  in  concentration.  Science, 
when  so  exclusively  pursued,  while  it  expanded  the 
mind  in  some  directions,  contracted  it  in  others.  A 
large  and  varied  culture  was  necessary  for  the  full  en- 
joyment and  utilisation  of  life,  a  truth  which  was- 
too  apt  to  be  lost  sight  of  in  these  days  of  rampant 
specialism.  Physiological  and  pathological  study  of 
the  brain  and  nervous  system  tended  more  than  any- 
thing else  to  materialise  the  student's  conceptions. 
From  the  medical  point  of  view  it  was  convenient  to* 
speak  of  mental  modification  in  terms  .of  brain  function, 
and  this  serviceable  style  of  expression  fostered  a 
habit  of  thought,  and  so,  more  and  more,  the  student 
was  disposed  to  accept  the  teachings  of  leaders  of  revolt, 
who  contemptuously  dismissed  their  most  cherished 
beliefs,  hopes  and  aspirations,  and  taught  that  there 
was  neither  creative  mind,  future  being,  nor  free  will^ 
and  that  life  and  consciousness  were  of  inorganic  origin. 
Haeckel,  with  his  "  Riddle  of  the  Universe  "  had  doubt- 
less confirmed  many  students  in  materialism.  Haeckel 
however,  with  all  his  subtlety,  could  not  get  rid  of  God, 
but  merely  substituted  an  inane  fetish  of  his  own 
which  he  labelled  substance.  Nor  was  he  more  success- 
ful in  disposing  of  mind  and  convincing  them  that  it 
was  merely  a  mechanical  function  of  that  form  of 
matter  which  he  called  ps3^hoplasm.  Like  Bathybius, 
psychoplasm  was  being  discredited  by  the  progress  of 
science.  Though  matter  was  the  vehicle  of  mind, 
it  was  dominated,  transcended,  and  moulded  by  it. 
To  medical  men  a  belief  in  the  higher  reality  was  a  sus- 
taining thought,  amidst  all  the  suffering  and  death 
through  which  their  path  must  lead.  This  was  a  world 
of  small  cognition,  but  of  mighty  inference,  and  to  the 
thoughtful  the  inference  might  dominate  the  cognition, 
and  the  things  of  faith  be  more  real  than  those  of  sense. 
Materialism  was  a  sorry  creed  negatived  by  those  uni- 
versal human  afflictions  that  would  not  be  buried  in  the 
grave,  and  must,  to  the  theologist,  at  least,  have  a 
motive  and  objective.  Doubt  was  needful  as  a  stage 
in  the  mind's  progress,  but  it  was  no  abiding  place, 
and  in  scepticism  there  was  no  rest,  for  most  sceptics 
were  harai»ed  by  doubts  of  their  own  scepticism.  Let 
them  contemplate  the  brain,  then,  not  as  a  mere  collec- 
tion of  atoms  or  a  mass  of  phosphorised  fat,  but  as  a 
psycho-active  body,  from  which,  as  long  as  life  lasted, 
a  sheave  of  emanation  issued  infinitely  more  mysterious 
than  radium.  There  was  the  neuron,  and  behind  it 
the  psychon,  and  they  must  regard  man,  not  merely 
as  a  material  object  among  other  material  objects, 
but  as  a  "  reasonable  soul  and  human  flesh  subsisting." 
The  meeting  was  presided  over  by  Dr.  C.  J.  Shaw, 
senior  president  of  the  Society,  and  was  closed  by  a 
cordial  vote  of  thanks  to  Sir  James  Crichton  Browne. 

Students'  Residence  at  Edinburgh  Maternity 
Hospital. — ^The  Milne  Murray  Lodge,  though  it  has 
been  occupied  for  some  two  months  now,  was  only 
formally  opened  on  the  28th  ult.  The  opening  ceremony 


47^    Thb  Mbpical  Paass. 


OBITUARY. 


Nov.  2.  1904. 


was  attended  by  a  large  company,  including  Sir  John 
Tuke.  M.P..  Sir  HaUiday  Croom,  Sir  John  Sibbald. 
and  many  other  medical  men.  Professor  A.  R. 
Simpson,  in  declaring  the  institution  open,  alluded  to 
the  importance  of  the  work  which  the  students  had  to 
study.  The  Lodge  accommodates  twelve  students ; 
it  is  situated  in  Lauriston  Park,  immediately  behind 
the  Maternity  Hospital. 

BELFAST. 

Royal  Victoria  Hospital. — The  winter  session  at 
the  Belfast  Medical  School  was  opened  last  week  with 
an  address  given  at  the  Royal  Victoria  Hospital  by 
Mr.  Andrew  Fullerton,  F.R.C.S.I.  The  speaker  dwelt 
first  on  the  necessity  of  a  good  preliminary  training  in 
chemistry,  biology,  and  physics,  for  the  student  who 
wished  to  make  the  most  use  of  his  hospital  experience. 
Comparing  the  new  hospital  with  the  old  one,  he  said 
that  the  public  were  inclined  to  show  their  appreciation 
of  the  new  by  abusing  the  advantages  it  am>rded,  and 
in  this  connection  he  touched  on  the  general  question 
of  hospital  abuse,  both  in  Ireland  and  England.  The 
necessity  for  attention  to  clinical  work  was  impressed 
on  the  students.  It  might  be  all  very  well,  Mr.  Fuller- 
ton  said,  to  read  up  the  account  of  a  muscle  or  of  a 
physiological  experiment  in  a  book,  but  it  was  a  poor 
business  to  read  the  symptoms  of  a  disease  when  they 
could  actually  see  them  at  the  bedside  of  the  patient. 
On  the  other  hand,  how  pleasant  it  was  to  read  up  a 
disease,  the  symptoms  01  which  one  had  just  studied 
in  the  ward.  The  laziest  and  most  indolent  student 
could  hardly  fail  to  get  a  fair  idea  of  the  more  common 
surgical  and  medical  ailments  if  he  attended  the  hos- 
pital extern  and  wards  diligently,  even  if  he  did  not 
read  a  line.  Dealing  with  club  and  dispensary  practice, 
Mr.  Fullerton  said  that  it  had  been  the  ruin  of  the 
medical  profession,  and  the  fate  of  the  club  doctor  was 
often  too  miserable  for  description.  The  matter  would 
not  be  satisfactorily  dealt  with  till  young  medical  men 
refused  to  take  posts  vacated  by  those  who  had  been 
sweated  and  imposed  upon  beyond  endurance.  At 
the  conclusion  of  the  address  a  vote  of  thanks  was 
moved  by  Professor  Sinclair,  seconded  by  Professor 
Byers,  and  supported  by  Dr.  Henry  O'Neill,  and 
passed  with  enthusiasm  by  the  students. 

The  New  Workhouse  Sanatorium. — At  their 
last  meeting  the  Belfast  Guardians  had  under 
consideration  the  constitution  and  pay  of  the 
nursing  and  medical  stafis  of  the  new  sana- 
torium at  Whitehouse.  They  propose  that  the 
salary  of  the  resident  medical  oihcer  be  £i^ 
per  annum,  w^ith  rations  and  apartments,  but  that  in- 
stead of  making  a  permanent  appointment,  they  should 
give  the  post  to  any  one  of  the  medical  officers  of  the 
city  worxhouse  who  desired  it.  for  a  period  of  six 
months  at  a  time.  The  salary  of  the  visiting  medical 
officer  is  also  fixed  at  l\20  per  annum,  and  it  was 
arranged  that  Dr.  Hail,  the  senior  medical  attendant  of 
the  workhouse,  should  be  asked  to  take  this  post 
temporarily.  One  of  the  guardians,  Dr.  Ritchie, 
thought  that  they  could  not  expect  Dr.  Hall  to  devote 
much  time  to  the  work  at  such  a  small  salary,  and  pro 
posed  that  he  should  be  paid  i,2QO,  increasing  to  £300  ; 
but  the  proposal  did  not  find  favour  with  the  majority. 
The  Small-pox  Outbreak. — During  the  first  ten 
days  of  October  no  fresh  cases  of  small-pox  "were  dis- 
covered in  Belfast,  but  since  then  there  have  been  seven- 
teen cases,  including  nine  last  week.  Four  of  the  cases 
were  removed  in  one  day  from  a  house  in  the  Sandy 
Kow  district  of  Belfast,  and  two  more  cases  from 
the  same  house  shortly  sifter ;  four  of  these  six  cases 
\mn%  unvaccinated  children.  Two  other  unvaccinated 
children  in  the  same  street  have  contracted  the  disease 
and  have  been  removed  to  the  hospital  at  Purdysbum, 
where  eight  of  the    seventeen  patients     now    under 

treatment  are  unvaccinated !  Nearly  all  the  cases 
at  present  under  treatment  belong  to  the  same  con- 
nection, the  adults  of  the  different  families  working 

together.  The  general  type  of  the  disease  is  com- 
paratively mild,  but  the  unvaccinated  cases  are,as  usual, 

severe,  and  at  least  one  is  likely  to  prove  fatal. 


CotTe9pont)ence« 

THE  VERNON  HARCOURT  INHALER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir. — In  your  issue  of  October  26th  you  pubUsh 
a  letter  from  an  anonymous  correspondent  in  reference 
to  a  death  which  recently  occurred  under  chloroform 
at  University  College  Hospital.  One  usually  ignores 
unsigned  letters,  but  as  you  extend  your  editorial  aegis 
over  your  anonymous  correspondent's  letter,  and  say 
rightly  that  one  should  not  shrink  from  adverse  criti- 
cism, I  will  answer  the  two  queries  contained  in  the 
communication  in  question.  First,  the  *'  Vernon  Har- 
court  "  inhaler  was  not  used  on  the  occasion  referred  to. 
In  the  second  place,  I  am  informed  by  the  house-surgeon 
who  administered  the  chloroform  that  he  was  compelled 
to  use  a  Schimmelbusch's  mask  with  a  drop  bottle  as 
the  seat  of  operation  rendered  the  employment  of  a 
closely-fitting  mask,  such  as  that  attached  to  the 
*'  Vernon  Harcourt "  inhaler  an  impossibility.  As  a 
matter  ot  fact,  I  regret  that  he  did  not  use  the  last- 
named  apparatus  during  the  induction  of  narcosis,  lor  I 
am  convinced  that  it  affords  the  best  chance  of  safety 
for  patients  who,  like  the  poor  woman  who  died,  nm 
so  grave  a  risk  during  the  induction  of  anaesthesia, 
o^-ing  to  antecedent  disease  and  habits.  Narcosb 
having  been  established,  the  open  method  could  for 
the  convenience  of  the  operation  have  been  adopted. 
I  am.  Sir.  yours  truly. 

Dudley  Buxton. 

82,  Mortimer  Street,  Cavendish  Square.  W. 


THE  TREATMENT  OF  INOPERABLE  CANCER. 
To  the  Editor  of  The  Medical  Press  and  Circular 

Sir. — With  reference  to  the  communicatioii  trooi 
Mr.  George  E.  Keith,  published  in  your  last  issue, 
reverting  to  my  paper  on  the  treatment  of  "  inoperaUe 
cancer."  I  desire,  with  your  permission,  to  make  one 
or  two  comments  thereon.  It  is  necessary  in  the  first 
place  to  point  out  to  your  readers  my  position  with 
respect  to  Mr.  G.  Keith  and  the  treatment  which  I 
have  advocated  in  my  paper.  In  1902  I  conuneiiced 
treating  cases  of  uterine  fibroid  by  means  of  hypo- 
dermic injections  of  iodipin.  My  procedure  and 
details  of  treatment  were  freely  made  known  to  Mr. 
G.  Keith,  and  published.  Having  learned  all  I  had 
to  teach.  I  was  startled  later  to  hear  he  had  introduced 
a  mixture  for  hypodermic  use  in  cases  of  cancer.  I 
have  no  vrish  to  deprive  Mr.  G.  Keith  of  any  credit 
which  may  be  his  due.  but  I  was  certainly  aware  at  the 
time  of  hypodermic  medication  in  cancer.  Subse- 
quently, on  mquiry  as  to  the  precise  composition  of  his 
mixture,  he  refused  to  divulge  its  nature  except  on  the 
promise  that  I  would  not  reveal  it  till  he  was  ready  for 
publication.  Acting  on  this  promise  I  have  neither 
revealed  it  nor  tried  it. 

I  have  only  one  word  more  to  add.  viz.,  that  Mr. 
G.  Keith's  mixture  was  neither  chian  turpentine  nor 
soap  solution,  and  I  therefore  still  claim  that  the 
administration  of  chian  turpentine  by  h3rpodennic 
medication  is  original,  as  far  as  I  am  concerned,  and  ia 
justice  to  myself  and  others.  I  would  ask  Mr.  G.  Keith 
to  make  known  the  mixture  he  told  me  of. 
I  am.  Sir.  yours  truly. 

John  A.  Shaw-Mackbnzib. 
1 42  Green  Street.  Park  Lane.  W.. 
October  27th,  1904. 


0bftnars* 

JAMES  BURN  RUSSELL.  B.A.,  M.D.Glas..  LL.D. 
Scotland  has  lost  a  distinguished  member  of  the 
medical  profession  in  thp  person  of  Dr.  James  Bum 
Russell.  M.D.,  LL.D..  medical  member  of  the  Local 
Government  Board  for  Scotland,  and  formerly  medical 
officer  of  health  for  Glasgow,  who  died  suddenly  in 
Edinburgh  at  the  age  of  sixty-seven.  He  was  formerly 
physician-superintendent  of  the  City  of  Glasgow  Fever 
Hospital,    assistant    medical    officer    of    the    Town's 


Nov.  2,    .1904 


MEDICAL  NEWS. 


The  Medical  Pkess.    477 


Hospital,  Glasgow,  and  medical  officer  of  health  for 
the  city.  In  1885  the  University  of  Glasgo\%  con- 
ierred  on  him  its  honorary  LL.D.  degree;  in  1891 
he  carried  off  the  Stewart  prize  of  the  British  Medical 
Association,  and  in  1899  won  the  Bisset  Hawkins 
Memorial  Medal  of  the  Royal  College  of  Physicians, 
1-ondon.  He  was  a  Fellow  of  many  learned  societies. 
Dr.  Russell  had  paid  much  attention  to  the  question 
oi  the  housing  of  the  poor  and  had  written  largely  on 
public  health.  While  his  loss  to  public  health  work 
in  Scotland  will  be  great,  it  will  be  little  less  felt  by  a 
large  circle  of  friends  and  fellow  workers. 

ANGEL  MONEY,  M.D.Lond.,  F.R.C.P. 
The  news  of  the  sudden  death  of  Dr.  Angel  Money, 
at  Sydney,  will  be  read  with  regret  by  those  who  knew 
hinx"  formerly  in  London.  He  entered  as  a  student  of 
the  Medical  Faculty  of  the  University  of  London  in 
1 874,  when  his  brilliant  qualities  soon  brought  him  into 
prominence,  and  his  ability  and  enthusiasm,  coupled 
as  they  were  with  untiring  industry,  soon  attracted 
attention.  He  became  house  physician  and  house 
surgeon  at  University  College  Hospital.  Subsequently 
.he  was  appointed  physician  to  out-patients  and  house- 
surgeon  to  the  General  Lying-in  Hospital.  Lambeth, 
-where  he  did  good  work  in  investigatmg  the  condition 
of  the  heart  in  the  later  months  of  pregnancy.  He 
was  later  appointed  medical  registrar  to  the  Hospital 
for  Sick  ChUdren,  Great  Ormond  Street,  and  assistant 
physician  in  1885.  In  1887  ^^  became  assistant  physi- 
cian and  assistant  professor  of  clinical  medicine, 
University  College  Hospital.  He  worked  hard  and 
wrote  much,  among  his  books  being  "  A  Treatise  on 
Disease  in  Children  "  ;  he  was  a  constant  attendant  and 
a  frequent  speaker  at  the  medical  societies  in  London, 
when  he  was  attacked  by  illness.  He  was  com- 
pelled to  resign  his  appointments,  and  in  1892  he  went 
out  to  Sydney.  Here  again  he  acquired  a  considerable 
practice.  His  health  gave  way  again,  and  a  career 
,  of  brilliant  promise  was  cut  short. 

DR.  ROBERT  H.'MOORE,  F.R.C.S. 
We  regret  to  have  to  chronicle  the  death  of  one  of 
the  oldest  medical  men.  and  probably  the  oldest  dental 
surgeon  in  Ireland,  Dr.  R.  H.  Moore,  of  29.  Uppen 
Memon  Street,  Dublin,  who  died  on  October  24th,  in 
his  eighty-ninth  year.  Robert  Henry  Moore  studied 
his  profession  at  the  School  of  the  Royal  College  of 
SurgeAons  in  the  early  thirties,  and  in  1844  obtained 
the  Fellowship  of  the  College.  He  was  at  an  early  stage 
in  his  career  apprenticed  to  Mr.  Samuel  McLean,  who 
was  one  of  the  most  important  dental  surgeons  of  his 
day.  So  earnestly  did  he  devote  himself  to  the  prac- 
tice of  the  special  branch  of  his  profession  which  he  had 
selected,  that  not  only  did  he  enjoy  a  large  practice, 
but  also  filled  the  post  of  Surgeon-Dentist  in  Ordinary 
to  several  successive  Lords-Lieutenant  of  Ireland.  He 
also  represented  the  dental  profession  on  the  Council  of 
the  Royal  College  of  Surgeons,  and  when  the  Incorpo- 
rated  Dental  Hospital  was  established  he  was  elected 
its  senior  consulting  dental  surgeon.  Dr.  Moore  lived 
a  strenuous  active  life,  and  when  he  retired  from  active 
practice  he  had  well  earned  the  rest  he  obtained. 
He  leaves  many  friends  to  mourn  his  loss. 

SPECIAL    BEPOBT    OP 
THE    CENTRAL     MIDWIVES     BOARD. 

MSSTING  HELD   OCTOBER  27TH«    I9O4. 

The  President,  Dr.  Champnbys,  in  the  chair. 

The  President  began  by  proposing  a  vote  of  condo- 
lence with  the  widow  and  ^niily  of  Mr.  Heywood  John, 
stone,  saying  the  Board  would  always  remember  him  as 
a  genial  and  practical  helper  in  all  its  concerns.  The 
vote  was  unanimously  carried.  Among  mmor  busi- 
ness it  was  discussed  whether  a  certified  midwife  acting 
as  nurse  under  a  doctor  was  bound  to  give  notice  to 
the  authorities,  the  president  remarking  that  a  midwife 
might  be  one  month  in  Yorkshire  and  the  next  in 
London. 

Mr.  Ward  Cousins  argued  that  sometimes  a  midwife 
was  "practising" — i.e.,  conducting — the  case  alone, 
and  sometim  es  not. 


The  President  considered  a  midwife  acting  under  a 
doctor  to  be  only  a  glorified  monthly  nurse,  but  if  she 
were  resident  and  practising  in  a  place  she  ought  to 
give  notice  to  the  authorities,  which  was  then  put  to  the 
vote  and  carried. 

It  was  also  agreed  to  discuss  in  camera  three  cases 
of  a  legal  nature  at  an  extra  meeting  to  be  held  on  No- 
vember 3rd.  Applications  for  approval  as  institutions 
for  the  training  ot  mid  wives  under  Section  3  were  con- 
sidered from  the  Secretary  of  State  for  War  on  behalf 
oi  hospitals  for  soldiers'  wives  and  children  at  Chat- 
ham, Portsmouth,  and  Woolwich,  it  being  decided  to 
grant  such  permission  in  due  proportion  to  the  number 
of  births,  as  these  institutions,  in  common  with  another, 
the  Withington  Infirmary,  had  clearly  not  understood 
the  rule  of  personal  supervision,  but  had  allowed  several 
students  to  claim  attendances  at  one  lying-in. 

The  final  consideration  of  the  examination  scheme 
was  then  proceeded  with,  which,  in  its  amended  form, 
we  publish  in  another  column. 

Mr.  Ward  Cousins  next  inquired  whether  a  midwife 
could  give  a  notification  of  a  still  birth  to  the  authori- 
ties, the  President  replying  that  the  question  would 
be  decided  by  the  General  Medical  Council. 

Miss  Paget  then  moved  that  the  period  of  the  ap- 
proval of  any  certified  midwife  (duly  qualified  so  to 
act)  for  the  purpose  of  signing  Forms  III.  and  IV.  under 
Rule  C.  I  (2)  shall  expire  on  March  31st  next  following 
such  approval,  but  may  be  renewed  from  time  to'  time 
for  the  period  of  one  year  as  often  as  the  Board  shal 
think  fit.  Provided  that  no  approval  granted  by  the 
Board  before  March  31st,  1905,  shall  require  renewal 
before  March  31st,  1906,  which  was  carried.  The 
date  of  next  meeting  was  fixed  for  November  24th. 

AeMcal  flew9. 

Royal  Army  Medical  Corps  (Volunteen). 

The  following  appointments  have  been  ofiicially 
gazetted  : — Surgeon  Lieutenant-Colonel  J.  Can  the, 
M.B.,  7th  Middlesex  (London  Scottish)  Volunteer  Rifle 
Corps,  and  Honorary  Lieut.-Colonel  Commandant 
Maidstone  Companies,  Royal  Army  Medical  Corps 
(Volunteers),  is  appointed  to  the  Honorary  Colonelcy 
of  the  Companies. 

Royal  College  of  Surgeons  of  Edinburgh. 

At  a  meeting  of  the  College  held  on  the  19th  ult. 
the  following  gentlemen,  having  passed  the  requisite 
examinations,  were  admitted  Fellows  of  the  College  : — 
Wilfrid  Allport.  M.B..  B.S.Lond.,  M.R.C.S.Eng.. 
L.R.C.P.Lond.,  Birmingham  ;  Simon  Alexander  Ballan- 
tyne,  M.B.,  Ch.B.£din.,  Abington ;  Donald  Duff, 
L.R.CS.E..  Glasgow;  Harold  Dyer,  M.R.C.S.Eng., 
L.R.C.P.Lond.,  South  Croydon ;  Duncan  Campbell 
Lloyd  FitzwiUiams.  M.B.,  Ch.B.Edin.,  Edinburgh; 
James  Graham,  M.B.,  CM.Edin.,  Cockermouth ;  Donald 
Alexander  Hingston,  M.D.,  Laval,  Montreal ;  Chris- 
topher Tredwell  Holford.  M.R.C.S.Eng.,L.R.C.P.Lond.. 
Birmingham ;  Edwin  Henry  Irwin,  M.B.,  CM.Edin., 
Co.  Monaghan ;  Robert  Bathgate  Johnston.  L.R.C.S.E., 
Edinburgh ;  Nicholas  John  Kalomiris,  M.R.C.S.Eng., 
L.R.C.P.Lond.,  London,  S.E. ;  James  Graham 
McBride,  M.B.,  Ch.B.Edin.,  Edinburgh;  Daniel  Sayre 
BCackay,  M.D.,  CM.  McGill,  L.R.C.S.E..  Nova  Scotia ; 
Mrigendralal  Mitra,  L.M. ft  S..  Punjab,  Calcutta; 
WilBam  Newlands,  M.B.,  Ch.B.Edin..  Edinburgh; 
Robert  Ramsey,  M.B..  Ch.B.Glasg..  Glasgow ;  Athel- 
stan  John  Henton  Saw,  M.D.,  Ch.B.Camb.,  Perth, 
West  Australia ;  Fred  William  Sumner.  M.B.,  Ch.B., 
Camb.,  M.R.C.S.Eng,  L.R.C.P.Lond.,  Preston,  Lanes.  ; 
John  Charles  Venuiker.  M.D.,  Ch.B.Durh.,  j;i.R.C.S. 
Eng.,  L.R.C.P.Lond.,  London,  W. ;  David  Llewelyn 
Williams,  L.R.C.S.E.,  Edinburgh ;  and  Oswald  Samuel 
Wraith,  L.R.C.S.E.,  M.D.Durh.,  Darwen,  Lanes. 
Soolety  of  Apotheearies  of  London. 

The  following  candidates,  having  passed  the  neces- 
sary  examinations,  have  been  awarded  the  Diploma  of 
the  Society  (L.S.A.),  entitling  them  to  practise  medicine 
surgery,  and  midwifery:  A.  A.  Angelis,  W.  H.  A. 
Elliott,  B.  H.  Hirst,  E.  E.  Tucker. 


478    Tm  Msdical  PtBss.        NOTICES  TO  CORRESPONDENTS. 


Nov.  2,  1904. 


Jtotices  to 
(Eorredponl^tntef,  ^hort  %tUtte,  itL 


tS^  OoiKMPOirosMfB  reqviring  a  reply  in  this  oolumn  «re  partten- 
\§r\j  reqoMted  to  make  use  of  a  dUtincHve  Sigwatwn  or  InUiaX,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber,'* 
•'  Old  Subscriber,"  he.  Much  confusion  wiU  be  spared  by  attention 
to  this  rule. 

OKieiHAL  Articlbs  or  Lnma  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  identitv* 

Rsru]rrB.~Beprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

ComnuBinou  are  kindly  requested  to  send  their  communications 
|f  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
ofBoe ;  if  resklent  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
Che  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

Mr.  ▲.  B.  HoLDSV.— Your  communication  wss  received  as  the 
jouri  al  was  on  the  press. 

Mr.  Flebtwood.— In  reply  to  your  queries  :  (a)  the  subject  is  a 
complicated  one  and  has  not  been  finally  determined,  (b)  The  value 
particularly  attached  to  the  employment  of  Mellln's  Food  is  its 
exceptional  richness  in  maltose,  the  analogue  of  lactose,  (c)  Dr. 
Baig's  work  ought  to  be  consulted. 

R.  L.— See  reply  to  Mr.  Holden. 

"  PARTING  18  SUCH  SWEET  SOBBOW. " 

Nature  removes  our  teeth  and  hair  ; 

And  while  we  thiiik  It  most  unfair, 

Haider  it  is  to  understand 

Why  we  should  part  with  PitMtate  Gland  I 

Perhaps  Appendix  in  addition 

Before  we're  summoned  to  Perdition. 

The  Proetate  Gland  !    TbejProstate  Gland  ! 

You  hear  of  it  on  every  hand, 

**  Appendicitis  filled  a  page. 

Now  Prostatitis  is  the  nge,** 

And  while  the  gland  sum  ly  is  ample 

Just  make  an  extract.  Try  a  Sample ! 

It  really  might  be  found  to  answer 

Perchance  a  real  cure  for  Cancer. 

"  Man  wanUbut  little  here  below  " 

When  Prostate  and  Appendix  go.— A  J). 

SssEKivaTOir.— There  is  not  the  slightest  danger  in  any  ordinary 
X-ray  exposure  conducted  by  a  skilled  medical  man.  At  the  same 
time  it  has  been  well  known  for  five  or  six  years  that  operators  are 
liable  to  intmctoble  injuries  that  may  assume  a  malignant  type.  Hers 
again  the  careful  operator  may  readily  ensure  himself  against  injury 
by  taking  ordinary  precautions.  The  newspapers  have  rediscovered  a 
recent  history,  a[na  we  regret  the  names  of  medical  men  should 
be  involved.* 

W.O.S.— It  is  impossible  to  discuss  matters  that  have  not  a  direct 
or  indirect  medical  interest  in  the  columns  of  a  medioal  journal,  how- 
ever interesting  such  matter  may  be  from  a  philosophical  polo t  of  view. 
The  inunense  ground  covered  by  the  solentiflc  and  the  politico- social 
and  eoonomle  phases  of  medical  life  renders  the  pressure  on  space 
more  and  more  exactisg. 

JEleetittgB  rf  the  §0neltt«,  %ztimtB,  i^t. 

Wbdhisdat,  Novbmbbk  2nd. 

Obbtsteical  Socistt  op  Lohdoh  (20  Hanover  Square,  W.).— 8  p.m. 
Specimens  will  be  shown  by  Dr.  H.  H.  Dauber  ana  others.  Paper  :— 
Dr.  H.  R.  Spencer  :  Three  Cases  of  Cancer  of  the  Cervix  oomplicatlog 
Labour  in  advanced  I^^pancy,  the  Patients  remaining  well  Eleven, 
Eight  and  a  half,  and  Eight  Years  after  High  Amputation  of  the 
Cervix. 

Mmdigai.  OEADVATks*  CoLLEOs  AHi)  PoLTCLivxc  (23  Chenies  Street, 
W.C).  4  p.m.  Mr.  J.  CanUie  :  Cliniqoe.  (Surgical.)  S.lSp.m.  Dr. 
D.  WiUiams  :  The  Theraveutios  of  some  Common  Ailments. 

North-East  LoiTDON  Post-Graduat>  Collbob  (North-Eastern  Fever 
Hospital  St.  Ann's  Boad,  N.) -2.Sa  p.m.  Dr.  H.  Cuff:  Demonstia- 
tion  on  Feveis. 

•  Thursday,  NovBMBBB  3rd. 

RoxTOBX  SoaBTT  (20  Hanover  Square,  W.).— ^.15  p.m.  Ordinary 
General  Meeting.    The  Presidential  Address. 

North-East  Londov  Cunical  Socxbtt  (Tottenham  Hosj>ita1,  N.). 
— 4pju.    Clinical  Cases. 

Mbdioal  Graduatbs'  Colleqb  avd  Poltcliric  (22  Chenies  Street, 
W.C.).~4  p.nu  Mr.  Hutohinsoa  :  Clinique.  (Surgical.)  6.16  p.m. 
Dr.  W.  Bwart :  The  TreAtment  of  Acute  Heart  Disease  and  Loss  of 
Compensation. 

MoinrT  VcRVoif  Hospttal  for  Covsumptioh  abd  Dibbasbs  or 
THB  CHBBT  (7  FitzToy  Square,  W.).— 6  p.m.  Lecture  :  Mr.  H. 
Barwell :  Principles  of  Treatment  of  Lar}-ngeal  Cases  (illustrated 
by  cases).  (Poet-Graduate  Course.) 


Friday,  Novbwbsr  4tli. 

WBSTKlBTMBDIO-CHIRUR6ICAL80CIBTT(BnymI    Kcot 

Greenwich  Road,  &E.)..>8  45  p  m.  Paper  :-I>r.  Tanier :  TbeTrtabT 
ment  of  Scarlet  Fever,  Diphtheria,  and  Enteric  Pever  at  tbe  ttoetk- 
Eastem  Hospttal. 

.  ^*2I  London  Mbdico-Criruroicai.  Socibtt  (  West  London  B«i. 
Irftal,  Hanunersmith,  W.l— a  p.m.  Clinical  Evening.  Caeca  wili  k 
shown  by  Dr.  P.  S.  Abraham,  Dr.  A.  E.  Buseell,  Mr.  A.  Baldra,lir. 
•B.  L.  Paton,  Mr   G.  Simpson,  and  others. 

Socibtt  of  Akjbsthbtists  (20  Hanover  Square,  W.).— Dfaoaasion  of 
Uie  Venon-Haroourt  Chloroform  Inhaler  (opened  by  Mr.  B.  WiBeat. 
^/u  ^-  ^'"♦o"'  I>r-  8»lk.  Dr.  Probya-WiUtaros.  Dr.  nomieM,  a«i 
others  will  take  part. 

Labtboolooical  Socibtt  of  Lobdob  (20  Hanover  Square.  WJ. 
6  p.m.  Cases,  Specimens.  Aa..  will!  be  shown  by  ICr.  B.  B.  Wagfct^ 
Mr.  P.  de  SanU,  Dr.  E.  F.  Potter,  Mr.  A.  H.  ChcaUe.Mr.  A.  Boberti, 
Dr.  Kelson.  Mr.  H.  B.  Robinson,  and  others. 

Medical  Graduates'  Collbob  ahd    Poltclibic    («2 
Street,  W,C.-4  p.m.  Dr.  L.  Lack  :    CUnique.     (Throat.) 


Roy^  London  Ophthalmic  Hospital  (MoorfleldB  E^e  Hospital),  Ostf 
Road,  E.C.  -  tJenior  House  burgeon.  Salary  £100  peri 
ix>ard  and  residence  in  the  Hospital.    ApplicatfoBB 
to  Robert  J.  Bhuyl,  Secretary. 

Wameford  Hospital,  Leamington.— Houec  Surgeon.  Salaiy  £10» 
P*r,*^"?»  IP^^  board,  washing,  and  apartments.  ApplioaUow 
to  O.  T.  Poole,  Secretary. 

City  of  London  Asylum,  near  Dartford,  Kent.— Vedical  Bnpetlota- 
dent.    8«lMry  £800  per  annum,  with  unfurnished  house,  oea], 
IJ^.  t  ^!t?"1^'  *?*  garden  produce.      Applicationa  to  Cbuies 
Jitch.  Clerk  to  the  Visitingr  Committee,  Guildhall.  E.a 

Nottingham    Children's  Hoepit8l.--Hou8e  Surgeon.      Salary  £liO 

eer  annum,  with  board  and  residence.       Applicationa  to  A.  F 
•.^i.w*'**^ V,^**^**'^/  Albion  Chambers,  King  Street,  NoUingham. 
'*®'L'l^  ^**^^  A8ylum.-8econd  Assistant  Medical  Oflleer.    SslHy 

£160  per  annum.     ApplicatioB  to  the  Besident  Licenee.  Beek^ 

ham  House,  Peckham,  8.E. 
St    Mary's   Hospital   for    Sick  Children,  Plaistow,  E.-Be8kh9irt 

Mwilcal  Officer.    Salary  £100  per  annum,  with  board,  te$M 

and  laundry.    Applications  to  Percy  J.  Glenton,  Secntarj. 
Wolverhampton    and    Midland    Counties    Eye   Inftrmaiy.-B 

Surgeon.      Salary  £70  per  annuBi.  with  rooms,  boaid,  and  wnsb- 

log.     Applications  to  the  Socretarj-. 
B03-al  Portsmouth  Hospital.— Senior  House  Surgeon.  Salaiy   a» 

per  annum,  with  board,  residence,  Ac.     ApplioatMns  to  J.  S. 

Keil.  Secretary. 
Smedley'sHydropathic  Establishment,  Matlock.-Beskient  Fhv^»> 


Salary  £160  per  anuunu 
SmecQey'a,  Matlock. 


Applicationa    to  Dr. 


JlppointtneniB. 

BucHANAM,P.S.,M.B.,  Ac..  Outdoor  Midwifery  Depaitment,  <aM> 

gow  Public  Dispensary.  *        •—         -.    i— - 

Grabt,  W.P.,  M.8o..  M.B.,  Ch.B.Vict.,  M.B.O.a,  L.&C.P..  Joniflr 

House  Surgeon  to  the  Birkenhead  Borough  Boapital. 
Kaloiiirw,N    L.R.aP.Lond.,  F.B.O.S.,  Clinical  jTsaislant  to  the 

Chelsea  Hospital  for  Wom<m. 
Nairb,  a.  Balfoub,  L.B.C.P.  &  S.Bdin.,  L.F.P.aG]asff.    Pathdkv^ 

and  Assistant  Medical  OfBoer  to  the  West  BidlttgAaylamTwS 

ORMBaoD,  Hbkrt  Lawrbbcb,  M.D.,  B.Oh.,  B.U.L.  L.R.O.F.Lo«L 

MB.t!8.,  Medioal  Officer  for  the  Hinbury  biaSet  bytt? 

Thombury  Gauidians.  •««c*  wy   im 

Pairb,  Alrxamdbr,  M.D.,  B.S.Lond..  D.P.H.,  Joint  Fktholocist  wUh 

Dr.  D.  J.  Morgan  to  the  Cancer  Hospital.  ^^ 

Pabbobb,    Waltbr    Brock,    M.R.C.S.,    L.B.CP.Lond..    Assiflnnt 

Anesthetist  to  the  Royal  Dental  Boq}ital,  Leicester  SquaM. 
Ross,  J.  A..  M.a.  Ch.B.£dIo.,  Junior  House  Surgeon  to  the  Groydsn 

BovimLL,  WiLFRBD  E.,  M.a,  B.Oh.Vlct.,  Third  Assistant  Medkal 
Officer  at  the  Manchester  Union  Infirmary,  CmmnaaU. 

Tailor,  £.  Graham,  M.B.,  Ac.,  Gynnoological  Departm^t  of  Glss- 
gow  Public  Dispensary. 

Wall,  B.  C.  B.,  M.D.Lond.,  Assistant  Physician  at  the  London  Hoa> 

Wallacb.  a.  Tatlob,  L.D.S.R.C.S.Eog.,  Honorary  Dentsl  SnrsMs 
to  the  Convalescent  Home  at  Westem-super-Mnre. 

Gilliat— D17RB.-0B    October    a7th,    at    St.    NIehoIaa's  ChuidL 

Bathampton,  Somerset,  Algernon  Edward  Gttliat,  eldest  son  eC 

.    Mr.  Algernon  GUiat.  of  Stoke  Poges.  Bucks,  to  Eva  Marlorv 

only  surviving  daughter  of  the  late  Dr.  Doug?as  Duke  of  GkaM^ 

France,  and  of  Mrs.  Duke,  of  1  Sydney  Place,  Bath.    ' 

LouooN— Brioob.— On  October  27th,  at  the  Parish  Church.  BritmO 
Salome,  Marcus  Moore  iLoudon,  M.D.,  of  :Arundel.  Sussex,  to 
Florence  Mary,  only  daarhter  of  the  late  Hickson  JMm,  of 
Isle  worth,  and  of  Mrs.  Buggs,  of  Brltwell  Priory,  OxfotdsSc! 

Mackbhzib.— At  Foo-Chow,  A.  £.  Maud,  the  beloved  wife  of  Rev. 

Marcus    Mackenzie.    M.B.    (C.M.S.,    Puh-ning,    China),    and 

daughter  of  the  late  Bev.  J.  A.  Aston,  of  St.  John*s.  DeptlMd, 

Bged20. 
Williabs-Frbbmak.  -  On  October  28th,  at  Weyhill,  Andover,  Lena. 

Augusta,  infant  daughter  of  John  P.  WUliRms^Freeman,  MJ>^ 

aged  10  month 


^h  ^tAm\  ^vm  mA  ^itmht 


"SALUB   POPUU   SUPBEHA   LEZ-' 


Vol.  CXXIX. 


WEDNESDAY,    NOVEMBER    9,    1904, 


No.    iq. 


iPddinal  Communications. 


CANCER  OF  THE 


LARYNX. 

M.D.BerUn, 


(«) 


By  Sir  FELIX  SEMON,  CV.O. 
F.R.C.P.Lond. 
FhysicitD-ExtaAordipary  to  his  Majesty  the  King. 
Mr.  Prssident  and  Gentlemen. — The  ke3aiote  of 
the  observations  which  I  shall  have  the  honour  of 
addressing  to  you  was  struck  in  a  discussion  on  malig- 
nant disease  of  the  larynx  at  the  meeting  of  the  Ameri- 
can  Laryngological   Association  in    1902,   when   Dr. 
Bryson  Delavan  stated  that  it  was  time  "  that  the 
discussion  of  these  subjects  upon  theoretical  grounds 
should  give  place  to  careful  studies  of  what  was  actually 
being  accomplished  by  practical  men." 

It  is  a  matter  of  history  that  the  case  of  the  late 
German  Emperor  represents  the  turning  point  of 
modem  knowledge  of  cancer  of  the  larynx.  Until 
then,  that  knowledge  had  been  incomplete  and  un- 
satisfactory. Very  little  was  known  about  the  early 
symptoms  and  early  laryngoscopic  appearances  of  the 
disease,  and  as  a  rule  its  existence  was  only  recognised 
ivhen  it  was  in  an  advanced  stage.  Up  to  1878  many 
cases  were  in  such  circumstances  treated  by  thjrrotomy, 
an  operation  wh:ch,  though  positively  ideal  in  early 
stages  is  quite  insufficient,  as  we  now  know,  when  the 
disease  is  more  advanced.  The  results  were  naturally 
disastrous  and  led.  after  Paul  Bruns'  sweeping  con- 
demnation in  1878,  (h)  to  almost  complete  abandon- 
ment for  a  time  of  thjrrotomy  in  malignant  disease  of 
the  larynx.  The  more  severe  forms  of  radical  opera- 
tion— total  and  hemi-laryngectomy — enthusiastically 
welcomed  when  first  introduced,  did  not  at  once  justify 
the  hopes  which  had  been  raised,  and  in  the  early 
"  eighties  "  of  the  last  century  the  outlook  for  the  un- 
fortunate patient  afflicted  with  laryngeal  cancer  was 
grave  in  the  extreme. 

There  can  be  no  doubt  that  the  sympathetic  interest 
with  which  the  whole  world  followed  the  melancholy 
course  of  the  Emperor  Frederick's  illness  gave  a  sudden 
and  universal  impetus  towards  a  closer  study  and  better 
understanding  of  that  formidable  disease.  First  came 
the  revival  of  the  deplorable  doctrine  of  the  late  Mr. 
Lennox  Browne.  {c)viz.,  that  benign  laryngeal  growths 
were  specially  liable  to  undergo  malignant  degeneration 
after  intralaryngeal  operation.  This  was  followed  by 
the  publication  of  my  "  Collective  Investigation,"  (d) 
undertaken  with  the  help  of  most  of  the  prominent 
laryngologists  of  the  world,  to  test  the  truth  of  this 
assertion.  The  material  thus  collected  enabled  me  not 
only  to  show  the  complete  want  of  foundation  of  Mr. 
Browne's  contention,  but  also  to  establish  more  de- 
finitely than  had  hitherto  been  done  the  differential 
diagnosis  between  benign  and  the  early  stages  of 
malignant  neoplasms  of  the  laryox,  and  to  discuss  fully 


(a)  Abetnusb  of  mi  Addrees  delivered  before  the  Laryn^logical 
Seetion  of  the  New  York  Academy  of  Medicine,  November  2nd.  1904. 

{b)  "  Die  Lanrnffotomie  sor  Entfernunff  Endolaryngealer  Neubil* 
dungen/'  1878.  Berlin.    August  Hirsohwald. 

(c)^8ee,  for  instance.  *'  Zor  Frairede  Btdioalopwafeion  bel  Bdearti- 
"  "       kel'a  Afckivft 


aren  Kehikopf*Nettbildang«ii," 
Bd.  IT.,  H.  8.  1897. 


Fraenkel'i 


\ivfur  Lmrymgotogig 


i  the  position  and  relative  importance  of  the  microscopic 
examination  of  intralauryngeally  removed  fragments  of 
I  new  growths  for  the  difierential  diagnosis  between  the 
benign  and  malignant  forms. 

Before  the  report  of  the  "  Collective  Investigation," 
which  was  published  in  instalments,  had  been  con- 
cluded. Professor  Bemhard  Fraenkel.  of  Berlin,  pub- 
lished his  remarkable  paper,  "Laryngeal  Cancer,  its 
Diagnosis  and  Treatment,"  (a)  in  which,  besides 
studying  the  histological  characteristics  of  larjmgeal 
cancer,  he  advocated  anew  in  suitable  cases  the  treat- 
ment by  intralaryngeal  operation,  which  he  had  first 
proposed  in  1886.  In  reply,  I  lost  no  time  in  urging  in 
the  concluding  chapter  of  the  "  Collective  Investiga- 
tion "  some  of  the  objections  which  seemed  to  me 
obvious  against  adopting  intralaryngeal  instrumen- 
tation as  a  suitable  means  of  combating  laryngeal 
cancer.  About  the  same  time  Mr.  H.  T.  Butlin  {h)  in- 
augurated a  new  era  in  the  treatment  of  intrinsic  cancer 
of  the  larynx  by  showing  that  owing  to  our  diagnostic 
progress  it  was  possible  to  obtain  the  same  results  in 
early  cases  by  thyrotomy  which  had  previously  been 
beUeved  to  be  unobtainable  by  anything  short  of  hemi- 
laryngectomy.  From  this  time  onwards  the  remark- 
able national  cleavage  took  place  which  characterises 
our  present  situation.  Previously  to  the  Emperor's 
illness,  however  imperfect  and  unsatisfactory  our  know- 
ledge of  laryngeal  cancer  may  have  been,  there  had 
at  any  rate  bieen  no  national  differences,  and  the  opinions 
with  regard  to  diagnosis  and  treatment  which  dominated 
our  actions  were,  whether  right  or  wrong,  entertained 
by  the  whole  laryngological  world.  From  1889,  all 
this  changed.  A  number  of  German  laryngologists, 
headed  by  Jurasz  (c)  and  following  Fraenkel's  lead, 
advocated,  and  still  advocate,  intralaryngeal  opera- 
tions in  apparently  suitable  cases  of  malignant  disease 
of  the  larynx.  They  have  found  allies  in  France,  in 
Spain,  and  in  America,  whilst  apart  from  myself,  the 
employment  of  intralar3aigeal  surgery  in  cases  of 
malignant  disease  of  the  larynx  has  been  deprecated 
by  Schrotter,  Chiari,  and  Paul  Bruns.  On  the  other 
hand,  my  own  statements  concerning  the  diagnostic 
importance  of  some  of  the  early  signs  of  laryngeal 
cancer  have  met,  I  am  afraid,  with  but  little  attention 
in  other  countries  besides  Great  Britain,  and,  similarly, 
it  is  astonishing  to  observe  how  little  impression  the 
reports  of  British  successes  obtained  by  thjrrotomy  in 
suitable  cases  seem  to  have  made  upon  the  minds  of 
operators  on  the  continent  of  Europe  and  in  America. 
In  1900,  Dr.  John  Mackenzie  read  at  the  meeting  of 
the  American  Laryngological  Association  a  paper  en- 
titled "  A  Plea  for  the  Early  Naked-eye  Diagnosis  and 
removal  of  the  Entire  Organ,  with  a  Neighbouring 
Area  of  Possible  Lymphatic  Infection  in  Cancer  of  the 
Lar3mx."  The  contentions  of  this  remarkable  paper, 
with  but  few  exceptions,  run  straight  against  all  estab- 
lished teaching.  The  author  demands  naked-eye  dia- 
gnosis of  malignant  disease  of  the  larynx  in  its  early 
stages  to  the  complete  exclusion  of  the  intralaryngeal 
removal  of  a  fragment  for  the  purposes  of  microscopical 


(d)  Introductory  Bemarks  to  the  Diaenssion  of  the  Opezmtive 
Treatment  of  MalKnant  Disease  of  the  Larynx,  at  the  meeting  of  the 
British  Medical  Association  at  Swansea,  July,  190S,  BrU.  Medjimrn,, 
October  Slst.l909L 


(a)  Brit,  Me'i.Uurtt,,  May  .  8th,  June  4th  (Bdito.ial),  11th,  18th 
and  26th,  and  July  16th.  1887. 

{h)  » Internationale  Centralblatt  f iir  Larjngologie,"  1888-89. 

{c)  Heymann's  "Handbuch  der  lAryngofefie,"  Bd.  I,  Zweita 
Balfte,  1896. 


480    The  Medical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Nov. 


9.  i9at- 


examination.     The  latter  he  rejects  in  Mo,  and  ur^es 
against  its  employment  that  the  removal  of  tissues  f  :r 
exanination  suojects  the  patient  to  the  dangers  of  auto- 
infection  at  the  point  of  incision  and  to  metastasis  else- 
where, that  it  stimulates  the  local  growth  of  cancer,  and 
that  the  method  is  often  inconclusive,  misleading,  and 
sometimes    practicably    impossible.     In    the    further 
course  of  his  observations  he  emphatically  condemns 
thyrotomy.  and  his  teaching  culminates  in  the  state- 
ment that  there  was  only  one  rational  method,  in  the 
majority  of  cases  at  least,  of  dealing  with  cancer  of  1 1? 
larynx  :    *'  Early  total  extirpation  of  the  entire  organ 
with  its  tributary  lymphatics  and  glands,  whether  the 
latter  be  apparently  diseased  or  not,  is  the  only  possible 
safeguard    against    local    recurrence    or    metastasis." 
When  I  first  read  this  paper  I  was  not  inclined  to  take 
it   seriously.     Throughout   it   substitutes    theory    for 
practice    to    such    a    degree,    threatens    hypothetical 
dangers  which  experience  has  shown  practically  to  be 
non-existent,    totally    disregards    the    actual    results 
obtained  by   trustworthy   observers,   and   indiscrimi- 
nately demands  extreme  measures  where  experience  has 
shown  milder  ones  to  suffice,  that  I  considered  a  de- 
tailed refutation  unnecessary,  and  therefore  referred  to 
it  in  a  chaffing  spirit  in  the  course  of  some  lectures  I 
delivered  in  190 1.  (a)     But,  to  my  regret,  the  matter 
has  not  ended  there.     In  1902,  Dr.  Mackenzie,  in  a 
further  discussion  on  cancer  of  the  larjmx,  which  took 
place  at-  the  meeting  of  the  American  Laryngological 
Association,  declared  that  he  abided  by  his  views,  and 
since  then  I  have  been  credibly  informed  that  these 
views  have  exercised  a  perturbing  influence  upon  not 
a  few  minds  on  this  side  of  the  Atlantic.     I  shall  there- 
fore content  myself  with  discussing  the  four  most  im- 
portant of  Dr.  Mackenzie's  assertions  only.     These  are 
the   following :     ( i )   That   the  naked-eye  method   of 
diagnosis  is  a  comparatively  neglected  method ;    (2) 
that  the  microscopical  examination  of  a  fragment  intra- 
laryngeally  removed  is  to  be  totally  rejected  ;   (3)  that 
early  total  extirpation  of  the  entire  organ  with  its 
tributary  lymphatics  and  glands,  whether  the  latter  be 
apparently  diseased  or  not,  is  the  only  possible  safe- 
guard against  local  recurrence  or  metastasis ;    and  (4) 
that  thyrotomy  is  not  up-to-date  surgery,  is  in  direct 
defiance  of  the  rules  that  should  govern  us  in  the  treat- 
ment of  laryngeal  cancer,  and  is  a  reversion  to,  and  a 
resurrection  of,  a  method  of  procedure  that  was  dis- 
credited and  abandoned  half  a  century  ago. 

I.  According  to  Dr.  Mackenzie,  the  naked-eye  dia- 
gnosis is  a  comparatively  neglected  method.  What  is 
the  real  state  of  this  question  ?  In  the  introduction  I 
have  referred  to  my  endeavours  to  promote  the  know- 
ledge of  the  subjective  signs  and  laryngoscopic  appear- 
ances of  the  early  stages  of  malignant  disease  of  the 
larynx.  Having  in  1886  {b)  and  1888  (c)  enumerated 
in  two  communications  of  mine  some  of  these  signs,  I 
reverted  to  the  subject  at  greater  length  in  the  "  Collec- 
tive Investigation  "  I  undertook  in  1888  and  devoted 
an  entire  chapter  of  my  report  to  a  systematic  descrip- 
tion of  the  minute  details  which  in  a  number  of  cases 
had  enabled  me  to  diagnose  laryngeal  cancer  at  a  com- 
paratively early  period.  This  description  has,  so  far 
as  I  know,  remained  up  to  this  moment  the  last  word 
on  the  subject.  When  I  returned  eight  years  after- 
wards to  this  question  (d)  I  stated,  even  more  emphati- 
cally than  I  had  done  in  1 888,  verbatim  as  follows :  "  Un- 
fortunately, with  the  only  exception  of  those  cases  in 
which  it  is  possible  to  intralaryngeally  remove  a  frag- 
ment of  the  new  growth  and  to  establish  its  epithelio- 
matous  nature  by  the  help  of  the  microscope,  not  one 
single  sign  in  the  early  stages  of  malignant  neoplasm  of 
the  larynx  is  in  itself  so  characteristic  that  it  estab- 
lishes with  absolute  certainty  the  malignant  nature  of 
the  formation.     The  contour,  the  seat,  the  condition  of 


(a)  "  Some  Thoucrhts  on  the  Principles  ol  Local  Treatment  In  Dis- 
eeees  of  the  Upper  Air-Pesaegee,"  Brit.  Med,  Jonm.,  October  9th, 
1901. 

{k)  A  Cise  of  Partial  Extlrpati>n  of  the  Larynx.  Ac,  "Ttangac- 
tions  of  the  Olinical  Society  of  London,"  1904. 

(c)  **  Die  Kraplrheit  Kaiser  Priedrioh  dee  Dritten."  Internationales 
Centrablatt  fur  Laryngoloflrie,  Bd.  V,  H.  2, 1888. 

(d)  FiaenkeVs  Arckiojur  L^rymgoljgie,  vol,  vii,  Dritter  Heft 


the  surface,  the  colour  of  the  new  growth  itsell.  the 
condition  of  the  neighbourhood,  the  mobility  of  the 
vocal  cord,  the  age  of  the  patient,  other  subjective 
symptoms,  they  all  may  and  will  ass  15/  the  experienced 
eye  in  making  the  diagnosis,  particularly  when  several 
of  them  jointly  raise  such  suspicion,  but  all  of  them  are 
not  absolutely  characteristic  in  the  earliest  stages,  and 
the  possibility  of  a  mistake  is  not  excluded  in  some  less 
characteristic  cases."  Butlin.  too,  has  correctly 
characterised  the  situation  when  he  said  in  his  intm- 
ductory  paper  on  the  occasion  of  a  discussion  on  the 
early  radical  treatment  of  laryngeal  cancer  {a)  thai 
"  we  were  still  in  this  position,  and  were  likely  to  re- 
main in  it  for  a  good  many  years  to  come.  That  we  most 
admit  that  there  are  three  classes  of  cases  :  The  first, 
in  which  anyone  and  everyone  can  make  the  diagnosis : 
the  second,  in  which  the  better  instructed  or  more 
experienced  make  it  and  others  do  not ;  and  the  third 
class  in  which  the  conditions  are  so  obscure  that  no 
one  can  make  the  diagnosis,  unless  the  larynx  is  opened 
and  in  some  of  which  it  is  even  then  difficult  to  be  sure 
of  the  nature  of  the  disease." 

That,  gentlemen,  is,  I  maintain,  a  true  description 
of  the  present  state  of  matters.     However  much  we 
all  desire — and  I  do  not  yield  to  Dr.  Mackenzie  in  that 
respect — further  to  advance  our  clinical  knowledge  of 
the  early  stages  of  laryngeal  cancer,  we  have  not  made 
diagnostic  progress  since  1888.     Although,  no  doubt, 
in  the  great  majority  of  cases  an  experienced  observer 
will  make  the  correct  diagnosis  of  intrinsic  cancer  ot 
the  larynx  in  its  early  stages  from  clinical  signs  alone, 
the  possibility  of  occasional  errors  is  anything  but  ex- 
cluded.    They  have  occurred  in  the  practice  of  other 
experienced  observers  and  they  have  occurred  in  my 
own.     And  what  is  most  important  in  view  of  Dr. 
Mackenzie's    light-hearted    advice — viz.,     to    perform 
extirpation   of   the   whole   larynx   with   its   tribntarr 
lymphatics  and  glands  on  the  strength  of  naked-eyt 
diagnosis  alone — ^is  the  fact  noticed  by  others  (b)  asvdl 
as  by  myself  .that  when  an  error  in  diagnosis  is  committed 
it  is  more  commonly  on  the  side  of  regarding  an  innocent 
growth  as  a  malignant  one  than  a  malignant  growth  as  an 
innocent  one.     In  the  present  connection,  speaking  on 
the  strength  of  large  personal  experience.  I  only  wish  to 
say  that  I  maintain  most  strongly  that  our  clinical 
knowledge  of  these  stages  is  not  yet  perfect  and  that 
occasional  diagnostic  mistakes  are  unavoidable.    Dr. 
Mackenzie  himself  admits  that  "  there  is  unfortunately 
no  solitary  unequivocal  symptom  or  laryngoscopic  sign 
of  cancer,"  and  seems  to  allow  that  "  after  weighing 
carefully  all  the  facts  of  the  case  in  our  possession  a 
reasonable  doubt  may  remain  as  to   the  diagnosis." 
Just  so  ;  but  what  is  the  logical  conclusion,  gentlemen, 
to  which  all  the  foregoing  drives  us  ?     Surely  that  it  is 
the  positive  and  imperative  duty  of  every  observer  to 
resort  to  every  method  of  diagnosis  that  could  possibly 
help  him  in  establishing  a  certain   diagnosis  before 
radical  operation  of  any  kind  is  performed. 

2.  Here  we  come  to  the  second  of  his  contentions— 
viz.,  to  the  total  rejection  of  the  microscope  as  a  dia- 
gnostic help  in  cases  of  suspected  laryngeal  growth. 
His  reasons  for  opposing  intralaryngeal  removal  of  a 
piece  for  microscopic  examination  are  that  such  remoi-al 
"  subjects  the  patient  at  once  to  the  dangers  of  anto- 
infection  at  the  point  of  incision  and  to  metastasis 
elsewhere,  that  it  stimulates  the  local  growth  of  cancer, 
and  that  the  method  is  often  inconclusive,  misleading, 
and  sometimes  practically  impossible." 

I  fully  admit  the  possibility  of  auto-infection  in 
laryngeal  cancer,  particularly  when  the  surface  oppo- 
site to  an  ulcerating  new  growth  sho.^ld  have  lost  its 
covering  epithelium.  But  when. this  theoretical  possi- 
bility has  been  aamitted  and  when  the  practical  ques- 
tion is  now  asked  :  How  often  has  such  inocolatioi 
been  actually  observed  ?  I  am  happily  in  the  positioj 
to  state  that  so  far  as  my  literary  knowledge  goes, 
there  are  only  three  cases  recorded  as  examples  of 
local  auto-infection  in  laryngeal  cancer.     Seeing  the 

(a)  BrU.  If«d.  Jburn.,  Ootober  SOtb.  IttS,  p.  1084. 
{b)  Ibid.  Vol.  ii,  lOOS,  p.  1124  (Dr.  Jobwm  Home). 


Nov.  9,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    4^1 


enormous  number  of  cases  in  which  during  the  last 
forty  years  fragments  of  growth  have  been  intra- 
larjmgeally  removed  for  purposes  of  microscopic 
examination,  this  one  fact  suffices  for  me,  and,  I  venture 
to  think,  will  suffice  for  most  men  of  a  practical  turn  of 
mind,  to  dismiss  Dr.  Mackenzie's  alarming  assertion 
as  too  theoretical  to  come  within  the  range  of  practical 
politics. 

Seeing  the  help  that  the  microscope  has  so  often  given 
me  in  difficult  cases  of  this  kind,  I  personally  have  no 
hesitation  in  following  my  great  teacher's,  the  late 
Professor  Traube,  principle,  that,  when  one  is  con- 
fronted with  two  evils  one  ought  to  select  the  smaller. 
In  other  words,  I  am  absolutely  in  favour  of  micro- 
scopic examination  whenever  this  is  possible. 

But  Dr.  Mackenzie  says,  thirdly,  that  "  the  method  is 
often  inconclusive,  misleading,  and  sometimes  practic- 
ally impossible."  Here  I  must  again  refer  to  the 
"Collective  Investigation"  and  express  my  regret 
tliat  our  author  should  have  so  entirely  disregarded 
the  lessons  taught  therein.  Within  the  limits  of  this 
address  I  cannot  enter  more  fully  upon  this  question. 
1 1  has  been  thoroughly  threshed  out  in  the  "  Collective 
Investigation  "  and  its  result  has  been  summarised  in 
the  following  conclusions  : — 

3.  The  first  of  these  is  that  early  total  extirpation  of 
the  entire  organ  with  its  tributary  lymphatics  and 
glands,  whether  the  latter  be  apparently  diseased  or 
not,  should  be  performed  as  the  only  possible  safeguard 
against  local  recurrence  or  metastasis  in  practically  all 
cases  of  malignant  disease  of  the  larynx  as  soon  as  the 
diagnosis  had  been  established.     It  is  true  that  in  the 
last  part  of  the  paper  it  is  admitted  that  there  may  be 
"  exceptional "  cases  in  which  a  "  very  small  growth, 
distinctly  drcumscribed,  remote  from  the  middle  line, 
and  not  of  a  specially  malignant  type,  may  possibly 
be  removed  with  safety "  by  extirpation  of  half  of 
the  larynx  and  the  lymphatics  on  the  corresponding 
side.     But  even  this  admission  is  made  grudgingly, 
and  from  the  whole  tenor  of  the  paper  and  the  context 
of  the  paragraph  ia  question  it  is  perfectly  obvious  that 
operation  for  cancer  of  the  lar3mx,  to  be  in  the  author's 
opinion  complete,  ought  to  embrace  nothing  less  than 
removal  of  the  whole  organ  with  its  lymphatic  vesseU 
and  glands.     This  recommendation  is  based  upon  the 
author's  contention  that  the  severity  of  surgical  inter- 
ference, when  dealing  with  cancer,  ought  to  be  the 
same  in  whatever  part  of  the  body  a  malignant  growth 
may  be  met  with.     This  contention  again  shows  a  pro- 
found disregard  of  practical  experience.     Whilst  no 
sane  i)erson  has  ever  asserted  that  cancer  is  one  thing 
in  one  part  of  the  body  and  another  thing  in  another, 
both  careful  clinical  observation  and  the  results  of 
surgical  interference  have  incontestably  shown  that — 
other  circumstances  being  equal — both  the  severity  of 
the  required  interference  and  recurrence  after  operation 
depend  to  a  degree,  the  practical  importance  of  which 
can  hardly  be  over-estimated,  upon  the  question  of  the 
primary  localisation  of   the   malignant   new  growth. 
Every  surgeon  when  called  upon  to  give  a  prognosis 
and  to  operate  in  a  case  of  epithelioma  of  the  lip,  the  ear, 
or  the  penis,  knows  that  the  prognosis  with  regard  to 
recurrence  is  infinitely  better,   the  amount  of  inter- 
ference required  much  smaller,  than  in  a  case  of  epithe- 
lioma of  the  tongue  or  pharynx,  or  in  a  case  of  cancer 
of  the  breast.     These  facts  are  so  fundamental  and  so 
generally  admitted  that  1  hardly  think  a  single  surgeon 
will  be  prepared  to  deny  them. 

After  a  full  review  of  the  operative  side  of  the  ques- 
tion, the  lecturer  proceeded :  From  the  foregoing 
observations  I  trust  you  will  have  seen  that  I  am  cer- 
tainly not  an  extremist,  and  I  may  further  tell  you 
that,  acting  upon  my  views,  I  have,  in  the  course  of 
the  last  year  alone,  myself  sent  three  patients  suffering 
from  advanced  malignant  disease  of  the  larynx,  and 
in  whose  cases  operative  interference  had  been  refused 
by  British  surgeons,  to  Professor  Gluck.  Even  the 
fact  that  unfortunately  two  of  them  have  within  a  few 
months  after  operation  developed  recun*ence  would  not 


gentlemen,  I  think,  is  absolutely  certain — i.e.,  that  such 
grave  operations  ought  only  to  be  undertaken  under 
two  conditions — (i)  that  the  diagnosis  was  absolutely 
certain  ;  and  (2)  in  the  event  of  there  being  no  possibi- 
Uty  of  saving  the  patient  by  a  less  mutilating  operation. 
With  regard  to  the  first  of  these  conditions  it  is  one 
of  the  most  surprising  omissions  in  Dr.  Mackenzie's 
paper  that  he  should  not  have  referred  by  one  single 
word  to  the  terrible  situation  which  would  be  created 
for  both  the  patient  and  the  surgeon  in  the  event  of  so 
serious  an  operation  as  that  proposed  by  him  being 
undertaken  on  the  strength  of  a  mistaken  diagnosis. 

Four  methods  here  come  into  consideration — intra- 
larjmgeal  removal,  subhyoid  phaiyngotomy,  thyro- 
tomy,  and  hemilaryngectomy.  With  regard  to  the 
intralar3aigeal  method,  I  have  unfortunately  had  to 
differ  on  so  many  points  from  Dr.  Mackenzie  that  it 
gives  me  genuine  pleasure  to  say  that  at  any  rate  I 
am  at  one  with  him  when  he  says  that  "  operation  for 
laryngeal  cancer  through  the  mouth,  done  almost 
universally  to-day,  it  seems  to  me  should  no  longer 
come  within  the  range  of  serious  consideration."  I 
reject  intralaryngeal  operations  in  cases  of  laryngeal 
cancer — which,  by  the  way,  I  believe  to  be  not  nearly 
so  universally  practised  as  Dr.  Mackenzie  assumes — 
not  because  I  deny  the  possibility  of  curing  a  few 
patients  by  this  method,  but  because,  in  my  opinion, 
the  game  is  not  worth  the  candle. 

The  second  contingency — subhyoid  pharyngotomy — 
can  be  dismissed  in  very  few  words.  Although  I  have 
lately  heard  privately  that  better  results  have  been 
obtained  more  recently,  I  am  waiting  for  confirmation 
of  these  tidings  before  I  see  my  way  to  recommend 
adoption  of  this  method  in  cancer  of  the  larynx. 

4.  But  how  about  thyrotomy  ?  Here  we  come  to 
the  last  and  perhaps  the  most  extraordinary  of  Dr. 
Mackenzie's  assertions.  As  already  stated,  he  un- 
reservedly condemns  this  operation  in  the  following 
terms  :  "  Thyrotomy  with  curettement  or  removal  of 
all  apparent  (visible)  parts  diseased  is  not  up-to-date 
surgery,  is  in  direct  defiance  to  the  rules  that  should 
govern  us  in  the  treatment  of  cancer,  and  is  a  reversion 
to,  and  a  resurrection  of,  a  method  of  procedure  that 
was  discredited  and  abandoned  half  a  century  ago." 
I  know  that  Dr.  Mackenzie  is  absolutely  incapable  of 
deliberately  making  a  misleading  statement,  but  in 
speaking  of  thyrotomy  as  being  not  up-to-date  surgery, 
as  being  in  direct  defiance  of  the  rules  that  should 
govern  us  in  the  treatment  of  cancer,  and  being  a  re- 
version to,  and  a  resurrection  of,  a  method  of  procedure 
that  was  discredited  and  abandoned  over  half  a  century 
ago,  he  none  the  less  creates  as  wrong  an  impression 
in  the  mind  of  the  uninitiated  reader  as  if  he  had  in- 
tended to  produce  it. 

In  the  introduction  to  this  paper  1  have  reminded 
you  that  thyrotomy  for  laryngeal  cancer  was  in  1878 
discredited  and  subsequently  practically  abandoned 
because  in  those  days  advanced  and  therefore  a  ptiori 
unsuitable  cases  were  subjected  to  an  operation  the 
teckniqu4  of  which  at  that  time  was  anything  but 
methodically  developed.  If  twenty  years  afterwards, 
with  improved  technique,  that  operation  has  again 
been  resorted  to  in  a  class  of  cases  totally  different 
from  those  in  which  it  has  been  unsuccessfully  employed 
at  a  previous  period,  it  surely  is  not  fair  to  describe  a 
progressive  and  beneficial  development  of  that  charac- 
ter as  '*  a  reversion  to,  and  resurrection  of,  a  method  of 
procedure  that  was  discredited  and  abandoned  half  a 
century  ago."  If  during  that  period  its  true  nature 
be  recognised,  and  an  operation  be  performed  which 
not  merely  removes  the  tumour  itself  but  a  sufficient 
area  of  healthy  tissue  in  all  directions  round  it,  the 
patient  has  a  reasonable  chance  of  being  lastingly  cured. 
Such  an  operation  is  modem  thyrotomy  as  first  sug- 
gested by  Mr.  Butlin.  Fifteen  years'  experience  has 
shown  that  by  its  employment  the  disease  can  be  com- 
pletely and  lastingly  eradicated,  and  to  describe  it  9,s 
an  "  incomplete  and  therefore  hazardous  and  unsur- 
gical "  operation  is  wide  of  the  mark.^    •  1 


deter  me  from  consenting  to,  or  even  advising  on,  future        And  now  as  to  the  results  of  the  operation  so  much 
operation  in  similar  circumstances.     But  one  thing,  |  deprecated  by  Dr.  Mackenzie.     I^st  year  at  Swansea  I 


482     The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Nov.  2.  1904. 


reported  from  my  own  practice  twenty  thyrotomies 
with  or  without  removal  of  small  fragments  of  cartilage 
in  cases  of  undoubtedly  malignant  disease  of  the  larynx, 
with  nineteen  recoveries,  two  quite  doubtful  recur- 
rences, and  one  death,  (a)  I  am  now — irrespective 
of  the  incomplete  operation  which  had  to  be  repeated — 
in  possession  of  the  notes  of  twenty  thyrotomies  per- 
formed for  undoubted  malignant  disease  of  the  larynx 
between  1891  and  1904  wiUi  one  death,  two  doubtful 
recurrences,  and  seventeen  lasting  cures,  bringing  the 
percentage  of  successful  cases  in  my  own  practice 
within  that  period  up  to  85  per  cent.  In  addition  to 
the  twenty  cases  just  named.  I  have  performed  three 
further  thyrotomies  in  the  course  of  the  present  year. 
All  three  patients  have  made  an  excellent  recovery. 
In  one  of  them,  however,  in  which  the  patient  had,  in 
spite  of  my  urgent  advice,  unduly  postponed  the 
operation,  recurrence  has,  unfortunately,  taken  place, 
and  I  have  had  to  perform  partial  larjmgectomy  on 
the  eve  of  my  departure  for  America.  The  other  two 
cases  are  of  too  recent  date  to  be  included  as  yet  in  the 
class  of  permanently  cured  cases. 

From  the  foregoing  facts  it  will  not  surprise  you  if  I 
most  warmly  recommend  the  performance  of  thyro- 
tomy  in  suitable  cases  of  intrinsic  laryngeal  cancer. 

Permit  me  earnestly  to  repeat  my  advice  that  thyro- 
tomy  should  be  performed  only  when  the  new  growth  is 
still  limited  to  the  intrinsic  region  of  the  lar3mx,  is  still 
circumscribed,  is  not  too  extensive,  and  does  not  in- 
filtrate too  deeply,  and  that  in  such  circumstances  a 
sufficient ^zone  of^healthy  tissue  should  be  included  in 
the  area  to.be  removed  everywhere  in  sufficient  distance 
from  (the  new  growth.  Should  it  be  found,  in  the 
course  of  operation  in  a  case  which  seemed  on  larjmgo- 
scopic  examination  to  fall  under  this  category,  that  the 
disease  is  more  extensive  than  had  been  presumed  from 
laryngoscopic  appearances,  the  operator  must  not 
hesitate  to  extend  his  operation  into  hemilaryngec- 
tomy,  or  if  both  sides  of  the  larynx  should  be  involved 
into  total  extirpation.  It  is  only  by  the  observance  of 
this  cardinal  rule  that  thyrotomy  will  gain  the  place 
which  is  due  to  it  among  radical  operations  for  cancer 
of  the  ]ar3aix. 

The  second  request  I  have  to  make  is  this :  Whilst 
thyrotomy  is  still  on  its  trial  everywhere  except  in 
Great  Britain,  let  me  ask  you  to  proceed  strictly  on 
the  lines  suggested  by  Mr.  Butlin  and  myself.  I  do 
not  believe  in  the  finality  of  our  present  technique,  and 
I  willingly  admit  that  it  may  be  possible,  when  once 
thyrotomy  has  everywhere  gained  its  place  among 
recognised  operations  for  larjmgeal  cancer,  to  improve 
upon  the  method  of  operation  by  means  of  which  we 
have  obtained  such  satisfactory  results.  But  whilst 
the  operation  is  still  on  its  trial  do  not  complicate 
matters  by  prematurely  introducing  modifications. 

The  only  remaining  operation  to  be  discussed  is  hemi- 
laryngectomy,  or  partial  extirpation  of  the  larynx. 
Already  last  year  at  Swanesa  I  expressed  my  conviction 
that  partial  extirpation  of  the  larynx  will  come  to  be 
more  rarely  performed  in  proportion  to  the  diagnosis  of 
malignant  disease  being  arrived  at  more  and  more 
early,  when  thyrotomy  will  suffice.  I  should  not  offer 
any  objection  to  extirpation  of  the  corresponding 
l3rmphatic  glands  even  if  apparently  unaffected  in 
cases  of  hemilaryngectomy  for  cancer,  although,  as 
my  third  case  shows,  even  that  measure,  when  onco 
metastasis  has  actually  occurred,  does  not  give  the 
patient  a  guarantee  against  recurrence.  That  such 
extirpation  should,  as  a  matter  of  duty,  be  performed 
in  cases  of  hemilaryngectomy  if  the  glands  are  in  the 
least  shotty  or  visibly  enlarged  goes  without  saying, 
but  in  such  cases  the  prognosis  anyhow  is  unfortunately 
very  doubtful. 

And  now,  gentlemen,  I  am  at  the  end  of  my  task.  I 
have,  as  promised,  nailed  my  colours  to  the  mast  of 

(a)  I  take  this  opportunity  to  oorreot  a  slip  of  the  pen  which 
I  jU8t  find  is  committed  in  my  paper  published  in  Fraenkel's 
**Arckiv  '  in  1887.  It  is  stated  there  <p.  412)  that  I  had  lost 
"  two  *•  patients  from  thyrotomy  performed  by  myself.  On 
reference,  however,  to  my  orisinal  article  {loe,  ctl,)  it  will  be 
seen  that  one  of  those  cases  (C^se  6  of  the  tables)  was  not  one 
of  thsnotomy.  but  of  partial  extirpation  of  the  larynx. 


practical  experience  as  against  theoretical  possibilities 
At  the  same  time  I  trust  I  have  succeeded  in  showing 
you  that  the  principles  upon  which  my  views  are  based 
are  not  purely  empirical,  and  are  in  all  points  in  ooo- 
cord  equally  with  the  experiences  of  practice  and  with 
the  achievements  of  science.  Let  me  summarise  what 
I  have  endeavoured  to  establish  under  the  form  of  the 
following  theses,  which  may  serve  as  a  basis  for  the 
discussion  which  I  understand  is  to  follow  the  reading 
of  this  address: — 

I.  It  is  of  the  greatest  importance  that  the  diagnosb 
of  larjmgeal  cancer  be  made  at  the  earliest  possible 
moment.  For  this  purpose  it  is  most  essential  that  the 
still  prevailing  notion — vir.,  that  malignant  disease  erf 
the  larynx  is  from  the  first  attended  by  all  sorte  of 
grave  constitutional  symptoms — ^be  completely  eradi- 
cated and  that  the  attention  of  the  general  practitioner 
should  again  and  again  be  drawn  to  the  fact  that  there 
are  no  more  promising  cases  for  radical  operation  than 
those  in  which  the  disease  is  at  first  manifested  br 
nothing  else  than  by  obstinate  hoarseness,  occnrrmg. 
without  any  apparent  cause,  in  middle-aged  and 
elderly  persons. 

-  2.  Clinical  diagnosis  arrived  at  from  the  history  and 
subjective  symptoms  of  the  case,  from  laryngoscopic 
examination,  from  accessory  circumstances  of  import- 
ance, such  as  the  patient's  age.  Sec,  has  reached  a 
certain  degree  of  perfection,  and  enables  us  in  a  good 
many  cases  to  make  a  correct  diagnosis  at  an  «riy 
stage  of  the  disease ;  it  is.  however,  by  no  meam 
absolutely  perfect,  and  occasional  mistakes  occur  even 
in  the  practice  of  those  most  experienced. 

3.  In  these  circumstances  clinical  diagnosis  ought. 
whenever  possible,  to  be  confirmed  before  radical  opera- 
tion of  any  kind  is  undertaken,  by  the  intralaryngeal 
removal  and  microscopic  examination  of  a  fragment  or 
fragments  of  the  new  growth.  This,  however,  should 
only  be  done  if  the  patient  previously  consents  to 
immediate  radical  operation  being  undertaken  in  the 
event  of  the  microscope  confirming  the  clinical  dia- 
gnosis. Should  this  be  the  case,  the  practitioner's 
position  will  have  been  materially  strengthened.  The 
microscope,  however,  is  by  no  means  infallible  in  these 
cases.  Should  its  evidence  be  negative  or  inconclusive 
the  intralar3nigeal  removal  and  microscopic  exami- 
nation of  fragments  should  either  be  repeated,  if  neces- 
sary, several  times,  or,  if  the  clinical  symptoms  do  not 
warrant  postponement,  exploratory  thyrotomy  should 
be  undertaken. 

4.  The  intralaryngeal  method  is  from  its  ven- 
nature  unsuitable  for  the  radical  removal  of  malignaat 
new  growths  of  the  larynx. 

5.  Subhyoid  pharyngotomy,  apart  from  being  applic- 
able in  a  very  small  number  of  cases  only  of  malignant 
disease  of  the  larynx,  is  still  sub  fudice  with  regard  to 
its  advisability  in  such  cases. 

6.  Thyrotomy,  if  undertaken  in  suitable  cases,  and 
at  a  sufficiently  early  period,  and  if  performed  on  the 
modern  lines  which  experience  has  shown  to  be  success- 
ful, is  a  perfectly  ideal  operation  in  intrinsic  cancer  of 
the  larynx. 

7.  Hemilaryngectomy  comes  into  question  only 
when  it  is  found  after  opening  the  larynx  that  mcie 
thyrotomy  will  not  suffice.  When  performed  it  may 
be  accompanied  by  removal  of  the  tributary  lymphatics, 
even  if  apparently  not  diseased. 

8.  Total  larjnigectomy  should  be  exclusively  re- 
served for  extrinsic,  and  for  those  cases  of  intrinsic, 
cancer  in  which  both  sides  of  the  organ  are  affected, 
and  in  which  the  disease  has  proceeded  too  far  to  be 
eradicated  by  milder  measures.  When  performed  ir 
should  be  accompanied  by  the  removal  of  the  laryngeal 
lymphatics  on  both  sides  of  the  neck. 

If  the  adoption  of  these  principles  should  meet  with 
your  approval,  gentlemen,  there  will  be  an  end  to  the 
deplorable  schism  which  has  of  late  separated  tbf 
surgeons  and  laryngologists  of  various  countries  with 
respect  to  the  diagnosis  and  treatment  of  malignant 
disease  of  the  larynx,  and  we  may  justly  hope  that  in 
striving  shoulder  to  shoulder  we  shall  advance  science 
and  benefit  our  patients. 


I 


Nov.  9,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    483 


A  HELPFUL  AGENT 

IN  THE 

TREATMENT  OF  SURGICAL 
DEBILITY. 

By  J.   S.  PURDY.  M.B.,   C.M.Aberd.,   D.P.H.Camb., 
Of  London. 

The  condition  of  depression  or  exhaustion  occurring 
in  sargical  patients  is  so  conunon  and  ofttimes  so  re- 
bellious to  treatment  that  any  measure  which  seems 
to  offer  material  help  in  that  direction  is  welcomed 
eagerly  by  surgeons  generally.  Many  surgical  cases 
manifesting  obvious  and  striking  signs  of  impoverish- 
ment of  blood,  nutrition,  or  nervous  force  owe  their 
origin  and  continuance  to  one  or  more  conditions 
2inienable  to  operative  procedures  only.  Equally  true 
is  it  that  perhaps  even  a  larger  number  of  cases  do  not 
regain  their  normal  standards  of  health  with  satisfying 
rapidity  after  operations,  or  are  in  a  debilitated  state 
ivhich  necessitates  postponement  of  operations,  and  it 
is  in  these  cases  that  surgeons  are  compelled  to  seek 
the  aid  of  tonic  and  reconstructive  drugs. 

The  object  of  this  communication  is  to  record,  briefly, 
general  and  specific  observations  upon  this  point  made 
during  the  past  two  years  in  the  surgical  wards  and 
out-patient  departments  of  two  large  metropolitan 
hospitals,  where  cases  are  sufficiently  numerous  and 
facilities  ample  to  obtain  valuable  clinical  data  upon 
the  subject.  In  the  management  of  these  cases,  so 
many  extraneous  and  contributing  factors  enter  that 
it  is  sometimes  difficult  to  determine  how  much  of  the 
benefit  is  due  to  the  medicines  administered,  and  how 
much  must  be  attributed  to  hygienic  measures,  suitable 
dieting,  careful  nursing,  &c.  Nevertheless,  these 
factors  are  more  or  less  constantly  present,  and,  with 
the  added  guidance  of  experience,  one  is  enabled  to 
iorm  fairly  accurate  deductions  as  to  the  rSle  played  by 
drugs  in  the  sum  total  of  general  improvement.  These 
points  have  been  given  due  consideration,  and  after 
two  years'  comparisons  of  various  tonics  and  recon- 
structives  in  pre-  and  post-operative  surgical  conditions 
we  believe  we  are  justified  in  stating  that  iron  vitellin 
must  be  considered  as  a  valuable  aid  in  the  treatment  of 
what  may  be  termed  surgical  debility.  British  phy- 
sicians are  proverbially  conservative  in  accepting  inno- 
vations in  any  phase  of  practice,  and  particularly  in  the 
matters  of  new  drugs  and  new  operations ;  perhaps 
such  new  departures  are  scrutinised  with  more  care  in 
this  country  than  elsewhere,  and  we  are  not  given  to 
accepting  the  statements  of  others  without  personal 
verification.  In  this  connection,  it  is  interesting  to 
note  that  several  of  the  most  distinguished  and  con- 
servative British  physicians — ^MurreU,  Phillips,  Tirard, 
Carpenter  and  others — have  published  careful  scien- 
tific studies  of  iron  vitellin  which  substantiate  that  this 
drug  has  physiological  effects  of  a  nature  which  endow 
it  with  unique  value  in  certain  clinical  conditions. 
Our  observations  corroborate  those  already  published, 
although  ours  were  confined  almost  entirely  to  cases 
of  a  surgical  nature. 

The  cases  in  which  we  have  administered  iron  in  this 
form  may  be  divided  into  four  general  groups  : — 

1.  Surgical  convalescence. 

2.  Anaemia  from  haemorrhage. 

3.  Preliminary  to  operations  of  a  more  or  less 
serious  character. 

4.  In  the  class  of  out-patients  suffering  from  imme- 
diate or  remote  effects  of  syphilis,  tuberculosis,  osseous 
necrosis,  &c. 

The  points  about  the  clinical  effects  of  iron  vitelUn 
which  seem  to  be  worthy  of  emphasis  are  illustrated 
best  by  brief  notes  of  cases  in  which  much  of  the  im- 
provement noted  was  clearly  ascribable  to  the  action 
of  the  remedy. 

A  robust  woman,  aet.  23,  presented  herself  with  an 
acute  and  especially  virulent  attack  of  gonorrhoea, 
involving  the  entire  genito-urinary  tract,  including  the 
uterus.     Disobedience  of  house  rules  as  to  rest  and 


local  treatment  led  in  ten  days  to  the  development  of 
chills,  fever  and  delirium.  Examination  revealed 
signs  of  double  pyosalpinx,  which  demanded  immediate 
operation.  She  was  curetted,  the  uterus  packed, 
abdominal  cavity  opened  and  both  pus  tubes  removed. 
Pelvic  peritonitis  rather  diffuse  was  present.  Her 
condition  was  grave  and  for  the  ensuing  five  days,  with 
a  temperature  of  104",  and  {pronounced  symptoms  of 
sepsis,  her  recovery  was  considered  doubtful.  On  the 
sixth  day  after  operation,  her  temperature  began  to 
fall,  and  on  the  tenth  day  had  reached  normal.  The 
toxaemia  seemed  to  have  ravaged  the  blood  particu- 
larly. Her  lips  and  conjunctivae  were  colourless,  the 
skin  ^  waxy-green,  prostration  very  marked.  Haemo- 
globin was  20  per  cent.,  red  blood  corpuscles  1,700,000. 
Stomach  intolerant  of  food  and  medicines.  She  was 
given  koumiss,  broths,  as  much  as  she  liked,  and  iron 
vitellin  in  tablespoonful  doses,  three  times  daily.  One 
week  later,  haemoglobin  was  45  per  cent.,  red  blood 
corpuscles,  3,000,000.  Two  weeks  later  haemoglobin 
52  per  cent.,  red  blood  corpuscles,  3,200,000.  Three 
weeks  later  haemo8[lobin  6$  per  cent.,  red  blood 
corpuscles,  3,700,000  ;  colour,  strength,  appetite, 
digestive  power,  all  strikingly  improved.  Five  weeks 
after  the  operation,  and  two  days  before  she  left  the 
hospital,  her  haemoglobin  was  87  per  cent.,  red  blood 
corpuscles,  4,200,000.  The  rapidity  of  the  action  of 
iron  vitellin  in  restoring  the  blood  constituents  in  this 
case  was  probably  due  to  the  condition  known  as  "  iron 
hunger,"  brought  about  by  the  rapid  destruction  of 
the  blood  elements  by  the  toxins. 

Toxic  anaemia  similar  to  the  case  just  cited  is  by  no 
means  uncommon,  and  occurs  in  practically  all  cases 
where  the  systemic  infection  has  been  at  all  marked. 
The  difficulty  in  treating  these  patients  with  food  and 
medicine  directed  to  restoring  the  wasted  tissues  is 
increased  by  an  irritable,  non-retentive  condition  of 
the  stomach.  In  all  of  the  cases  treated  thus  far  with 
iron  vitellin  in  no  instance  has  the  remedy  been  re- 
jected, nor  has  it  ever  induced  signs  of  irritation  of 
the  stomach  or  intestines.  We  have  been  very  much 
struck  with  this  fact  in  the  post-operative  treatment  of 
four  cases  of  septicaemia  in  which  gastric  irritability 
was  most  marked.  Two  of  these  cases  were  sepsis 
following  criminal  abortion,  one  case  of  pyo thorax,  and 
one  large  superficial  abscess  of  the  liver,  in  all  of  which 
operations  were  performed ;  systemic  infection  followed 
with  consequent  toxic  anaemia,  and  in  which  iron 
vitellin  was  used  successfully  in  combating  the  anaemia 
and  adynamia. 

We  have  made  observations  also  of  the  effect  of  the 
remedy  upon  the  blood  in  twelve  cases  of  severe  ex- 
sanguination  as  the  result  of  accidental  haemorrhage. 
Eight  of  these  occurred  during  labour,  four  of  which 
were  cases  of  placenta  praevia ;  the  remaining  four 
cases  were  the  result  of  severe  arterial  haemorrhage  in 
consequence  of  lacerated  wounds.  Of  the  total  of 
twelve  cases,  in  ten  of  them  iron  vitellin  restored  the 
blood  constituents  to  normal  in  periods  varying  from 
two  to  five  weeks ;  in  two  cases,  both  debilitated  women, 
the  blood  constituents  remained  below  the  normal 
standard  after  six  weeks'  treatment. 

Surgical  debility,  so  caJled,  is  a  rather  complicated 
pathological  condition  in  which  anaemia  is  entirely 
subsidiary  to  very  obvious  disturbance  of  general 
nutrition.  In  this  class  of  cases  tonic  and  recon- 
structive drugs  are  employed,  as  a  matter  of  routine, 
with  widely-varying  degrees  of  success.  No  one  drug 
or  combination  of  classes  of  drugs  prove  uniformly 
efficient,  and  the  choice  of  remedies  is  usually  decided 
by  a  consideration  of  the  individual  indications,  not 
the  least  of  which  is  the  condition  of  the  gastro-in- 
testinal  tract.  From  our  observations,  extending  over 
a  period  of  two  years,  we  believe  that  iron  vitellin 
gives  perhaps  the  best  percentage  of  good  results  as  a 
remedial  factor  in  the  general  hygienic  measures  applied 
in  the  treatment  of  surgical  debility.  The  following  is 
a  case  in  point : — 

A  woman,  aet.  27,  married,  had  recurrent  attacks  of 
appendicitis  of  moderate  severity,  extending  over  a 


484    The  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


Nov.  9.  1904. 


period  of  three  years.  She  had  also  prolapsed  ovary, 
adherent  tube  on  right  side,  dysmenorrhoea.  For  two 
years  she  had  steadily  failed  in  general  health  and  had 
lost  20  lbs.  in  weight.  She  was  operated  on  in  January, 
1903,  the  enlarged,  inflamed  appendix,  the  right  tube 
and  ovary,  removed.  Recovery  from  the  operation 
was  uncomplicated,  but  the  patient  remained  paUid. 
weak,  nervous  and  irritable,  had  anorexia,  nausea  and 
vomiting.  Five  weeks  after  the  operation,  when  the 
above  symptoms  were  present,  she  was  placed  on  a 
partial  rest-cure  regime,  was  given  massage,  electricity, 
careful  diet,  and  a  tablespoonful  of  iron  vitellin  three 
times  daily.  At  that  time  her  haemoglobin  was  55  per 
cent.,  red  corpuscles.  3,000,000.  Under  the  combined 
therapeutic  measures  applied,  she  gradually  gained  in 
strength  and  flesh,  her  stomach  became  receptive  and 
retentive,  and  the  nervous  irritability  disappeared. 
Four  weeks  later  she  had  gained  10  lbs.  in  weight,  had 
no  troublesome  symptoms,  haemoglobin  was  80  per  cent, 
and  red  corpuscles  4,300,000,  and  she  was  given  per- 
mission gradually  to  resume  her  wonted  occupations. 

The  following  case,  belonging  to  a  different  category, 
is  illustrative  of  another  type  of  cases  in  which  we  have 
used  the  remedy  to  obvious  advantage : — 

A  man,  set.  61,  plethoric,  considerably  adipose,  had 
been  under  treatment  for  two  years  for  prostatic  en- 
largement, with  retention  of  urine  and  gradually  in- 
creasing attacks  of  cystitis.  For  two  years  his  general 
health  had  failed,  and  for  six  months  it  was  deemed 
necessary  to  operate,  but  pallor,  lassitude,  inabiUty  to 
take  sufficient  nourishment,  and  presence  of  chronic 
dysi>epsia.  and  red  blood  corpuscles  2,550,000,  haemo- 
globin 55  per  cent.,  indicate  too  great  general  dis- 
turbance. He  was  sent  to  Aix-les-Bains  in  May,  1903, 
where  his  dyspepsia  yielded  satisfactorily  to  the  regime 
practised.  The  only  tonic  used  was  iron  vitellm,  a 
tablespoonful  in  ^^ter  after  meals  and  at  bed- time. 
After  five  weeks'  stay  at  the  baths  his  general  condition 
has  become  remarkably  improved,  and  he  returned 
hotne  on  June  15th,  when  his  haemoglobin  showed  82 
per  cent.,  red  blood  corpuscles,  4,550,000.  On  June 
22nd,  the  Bottini  operation  was  performed,  and  the 
patient  made  a  satismctory  recovery,  and  is  at  present 
in  excellent  health. 

Our  observations  upon  the  use  of  iron  vitellin  among 
surgical  out-patients  are  chiedAy  of  value  in  determining 
its  general  tonic  action  rather  than  specific  effects  upon 
the  blood,  as  with  but  few  exceptions  systematic  blood 
examinations  were  either  impossible  or  deemed  un- 
necessary. In  syphilitic  patients,  of  the  secondary 
and  tertiary  stages,  we  were  able  to  confirm  the  state- 
ments already  ]9ub]ished,  that  iron  vitellin  is  a  valuable 
adjunct  to  antisyphilitic  treatment,  in  that  it  has  a 
beneficial  action  upon  the  anaemia  so  constantly  pre- 
sent, and  improves  the  general  nutrition,  which  is 
usually  below  par.  These  effects  were  noted  in  the 
aiiaemia  accompanying  the  eruption  of  secondary 
syphilis  and  in  the  anaemia  and  malnutrition  of  the 
gummata  and  necrosis  of  the  tertiary  stage. 

This  general  tonic  action  of  the  remedy  is  perhaps  its 
chief  claim  for  consideration,  and  is  the  first  effect  to 
strike  the  attention  of  both  the  surgeon  and  the  patient. 
It  is  particularly  noticeable  in  the  manaigement  of 
tuberculosis  of  the  glands,  bones  and  joints  when  the 
remedy  is  administered  conjointly  with  appropriate 
surgical  treatment,  and  judicious  application  of  such 
valuable  aids  as  good  food,  &c. 

Another  class  of  surgical  out-patients  in  which  we 
have  used  iron  vitellin  with  conspicuous  success  is 
illustrated  by  the  following  brief  notes  : — A  nurse  had 
become  very  much  nm  down  in  consequence  of  a 
whitlow  and  onychia,  the  thumb-nail  having  been  re- 
moved. She  was  given  iron  vitellin,  a  tablespoonful 
three  times  dadly.  Her  appetite  improved,  pallor 
gradually  disappeared,  there  was  no  constipation,  and 
she  rapidly  regained  health  and  strength. 

Another  case  was  that  of  a  man  who  was  very  much 
debilitated  and  was  suffering  from  repeated  crops  of 
boils.  Arsenic  and  calcium  sulphide  were  given  with- 
out appreciable  effect.    A  fortnight's  treatment  with 


iron  vitellin  effected  a  striking  improvement  in  the 
general  health  with  coincident  disappearance  of  the 
boils. 

This  communication  must  be  looked  npoo  as  a  pureh 
clinical  one,  with  no  ambition  to  dead  with  the  scientific 
phases  of  the  questions  involved  in  a  study  of  the  broad 
problems  of  anaemia  and  malnutrition,  whether  they 
be  of  surgical  or  medical  cases. 

These  questions  properly  fall  within  the  sphere  at 
the  haematologist,  the  physiologicad  chemist,  and  the 
physician.  It  seems,  however,  to  the  practicad.  sorgeoD 
that  in  dealing  with  these  conditions  the  pure  scientist 
is  too  prone  to  unduly  emphasise  one  feature — ia 
instance,  systematic  blood  exatminations — ^when  called 
upon  to  determine  the  effect  of  any  given  plain  of  tcnic 
treatment,  medicinal  or  physical.  Far  more  importaai 
is  it  in  forming  such  opinions  to  consider  the  effect  upoa 
the  blood  constituents  as  but  a  subsidiary  feature,  and 
to  give  due  weight  to  the  effect  of  treatment  upon  the 
appetite,  the  ability  to  digest  and  assimilate  food,  and 
upon  the  general  nutrition  as  reveaded  to  the  physkaaa 
by  a  glance  or  by  inquiry,  unassisted  by  ttue  precise 
methods  of  investigation,  such  as  blood  examinatinii^ 
In  other  words,  the  practical  value  of  such  treatmeBt 
is  in  proportion  ais  it  produces  visible  improvement  m 
the  general  condition  of  the  patient. 


CLINICAL   NOTE   ON 

MEDITERRANEAN   FEVER. 

By   CHARLES  HELFIELD,  M.A.,  M.B.,  M^. 

Having  taken  some  interest  in  the  etiology  and 
pathology  of  Mediterranean  fever,  and  having 
had  the  opportunity  of  living  on  the  coasts  of  the 
Mediterranean,  I  watched  aU  cases  of  fever  that 
fell  to  my  confrhes  and  my  lot  to  treat  as  atten- 
dant or  consultant;  I  therefore  beg  to  offer  a 
word  to  its  effect. 

Out  of  perhaps  300  cases  attended  by  ns  I  dis- 
covered that  the  micrococcus  melitensis  of  Bmoe 
was  not  only  conveyed  by  the  air,  but  it  was 
capable  of  being  introduced  into  the  system  by 
food  and  drink.  Bacteriological  examinations 
corroborated  our  suspicions  in  finding  the  badQi 
in  water  kept  in  jug  or  filter  from  which  the  patient 
under  our  care  had  dran'c  before  he  or  ste  com- 
plained of  any  symptoms — t.^.,  headache,  giddiness 
vomiting,  or  a  profuse  perspiration,  and  in  six  cases 
out  of  ten  the  micrococcus  could  be  found  in  fresh 
fruits,  such  as  figs  and  prickly  pears  (opnntia^. 
This  same  disease,  though  endemic  in  Egypt  and 
the  Red  Sea,  appears  under  different  aspects* 
forms,  symptoms,  and  course,  and  cannot  in  anv 
way  be  compared  to  those  occurring  at  Maha, 
Naples,  Tunis,  and  Sicilian  ports.  At  Malta  the 
variety  generally  seen  can  be  easily  diagnosed 
by  the  splenic  enlargement,  its  relapses,  constipa- 
tion; and  the  temperature  reaches  up  to  104% 
but  generally  it  is  undulatory  and  always  with  pro- 
fuse sweating ;  the  first  symptom  is  diarrhoea. 
Delirium  is  very  often  present  during  the  first 
fortnight's  illness,  and  the  patient  feels  very  irri- 
table. The  complications  are  arthritis,  tender- 
ness over  the  spleen  and  liver,  neuralgia,  and,  in 
rare  instances,  orchitis.  In  Sicily  the  variety  is 
similar  to  that  of  Malta  fever,  but  it  tends  to  be 
more  mahgnant  in  its  type  ;  the  onset  is  sudden 
and  the  mortality  is  nearly  5  per  cent.  In  Egypt 
or  at  the  Red  Sea  ports,  (he  variety  is  intermittent 
of  a  short  duration — ^five  weeks  the  utmost — the 
symptoms  are  those  of  ordinary  pyrexia  and  the 
mortality  is  0-5  per  cent. 

What  I  desire  to  illustrate  is  the  urgency  of 
obtaining  the  reaction  in  every  case  of  fever  that 


Nov.  9,  1904. 


THE  OUT-PATIENT  DEPARTMENTS.   Thb  Medical  PEEas.    485 


falls  to  the  practitioner's  lot,  just  to  ascertain  the 
qusdity  of  the  fever  ;  the  reaction  can  be  had  in  all 
varieties,  and  in  every  case  on  the  fourth  day. 
As  for  the  treatment,  rest  is  essential ;  the  patient 
must  get  at  short  intervals  plenty  of  nutritious 
fluid  diet,  the  skin  should  be  sponged  at  least 
four  times  a  day  with  brandy  or  whisky 
and  water,  no  alcohol  should  be  given  intern- 
ally unl^  urgently  required,  and  the  drug 
that  proved  ^ith  us  most  beneficent  and  cura- 
tive was  kairin  in  5 -grain  doses,  with  3  of  oleum 
eucaljrpti  three  times  a  day,  with  a  hypodermic 
injection  of  strychnine,  1-50,  once  a  day.  Quinine 
is  hurtful,  and  other  drugs  and  intestinal  disin- 
fectants useless  ;  constipation  must  be  treated 
vrith  an  enema  of  castor  oil  and  warm  water  daily. 
Mediterranean  fever  seldom  attacks  people 
li\'ing  in  the  country,  or  the  lower  classes,  and 
w^hen  it  does  it  is  of  a  very  short  duration,  but  it  is 
most  liable  to  attack  the  better  classes,  town  people 
and  those  in  busy  life. 

A  NEW  UTERINE  MOP. 

By  S.  JERVOIS  AARONS,  M.D.,  M.R.C.P. 
The  dif&culty  and  amount  of  time  wasted  in 
removing  the  wool  from  the  ordinary  Playfair's 
probe  after]  it  has  been  used  led  me  to  try  and 
devise  some  means  by  which  the  mop  might  be 
more  easily  and  quickly  removed.  It  occurred 
to  me  that  a  cap  of  some  absorbent  material 
-which  would  fit  over  a  conical  probe  would  serve 
the  purpose,  and  such  a  cap,  or  mop,  I  have 
had  made ;  this  slips  over  a  conical  or 
tapering  metal  probe,  and  is  held  in  position 
by  a  small  bayonet  catch,  which  effectually 
prevents  it  from  twisting  round  or  leaving 
the  probe. 

The  drymops  weigh  1 3  grains(-79  grammes); 
after  being  used  they  weighed  39  grains 
(2*5  grammes) ;  they  are  therefore  suffi- 
ciently absorbent  for  the  purpose. 

The  advantages  over  the  ordinary  Play- 
fair's  probe  are  : — 

1 .  Ease  and  rapidity  of  dressing  the  probe. 

2.  Ease  and  rapidity  of  removing  the  mop 
after  use. 

3.  Both  mops  and  probes  are  easily 
sterihsed. 

4.  The  tapered  part  of  the  probe,  being 
made  of  plated  copper,  can  be  bent  to  any 
desired  shape. 

The  caps  are  put  up  in  sterilised  packets 
of  four,  or  they  may  be  had  separately  but 
not  sterihsed. 
Both  probe  and  caps  were  made  for  me  by  the 
Galen  Manufacturing  Co.,  Ltd.,  Wilson  Street, 
New  Cross  Road,  S.E.,  and  my  thanks  are  due 
to  them  for  so  successfully  carrying  out  my 
suggestions. 

The  Caneer  HospiUl,  Bpompton. 
We  are  asked  to  announce  that  Lady  Ludlow  has 
kindly  promised  to  open  the  new  nurses'  home  erected 
in  the  hospital  grounds  on  November  14th,  at  3  p.m. 
The  nurses  at  present  are  accommodated  at  the  top  of 
the  hospital  building  in  cubicles.  The  new  home  wjil 
provide  separate  bedrooms  for  each  nurse,  and  a  sepa- 
rate sitting-room  for  the  sisters  and  nurses.  The  cost 
of  erecting  and  equipping  the  home  is  about  ;f 5.500. 
but  the  committee  feel  that  the  expenditure  is  justifiable 
bearing  in  mind  the  arduous  duties  nurses  at  such  a 
special  hospital  have  to  perform. 


®ut^pattent  Z>epartment0» 

TOTTENHAM  HOSPITAL. 
Dermatohgical  Cases  under  the  Care  of  G.  Norman 
Meachen.  M.D.,  M.R.C.P. 
Case  I. — Tar- A  cm  in  a  Psoriatic, — ^The  patient  was 
a  young  man,  aet.  19,  an  ex-postman,  who  said  he  had 
suffered  from  psoriasis  since  early  childhood.  He  did 
not  seek  advice  so  much  for  this  complaint  as  for  a 
troublesome  eruption  around  his  shoulders.  The 
history  was  that  he  consulted  a  chemist  upon  his  own 
account  a  year  ago  for  his  chronic  skin  disease,  and 
obtained  from  him  some  crude  tar  ointment,  which 
he  had  been  vigorously  rubbing  into  the  skin  of  his 
back.  From  previous  experience  he  had  learned  that 
tar  was  "  good  for  psoriasis."  His  grandmother  had 
suffered  from  the  same  affection,  but  no  other  members 
of  the  family  were  affected.  There  was  no  history  of 
rheumatic  fever.     His  general  health  was  good. 

On  examination,  several  typical  lesions  of  psoriasis, 
in  varying  stages  of  evolution,  were  seen  upon  the 
trunk  and  limbs,  but  the  most  noticeable  thing  was 
a  profuse  papulo-pustular  eruption  about  the  shoulders 
and  interscapular  region.  Interspersed  between  the 
papules  were  a  large  number  of  comedones.  The  face 
was  clear,  but  there  were  several  scaly  places  in  the 
scalp. 

Dr.  Meachen  remarked  that  acne-like  eruptions  were 
not  infrequently  seen  in  those  who  worked  with  tar 
and  pitch,  but  it  was  not  at  all  common  to  meet  with 
true  acne  picealis  as  a  result  of  tar  medication  in 
psoriasis.  The  application  of  the  old-fashioned  pitch 
plaster  sometimes  led  to  erythema  and  even  to  der- 
matitis, owing  to  the  continuous  local  action  of  a  mild 
irritant.  This  youth  had  been  applying  tar  ointment 
daily  for  a  twelvemonth  without  any  medical  advice 
under  the  impression,  which  was  a  very  common  one, 
that  the  more  energetically  he  rubbed  in  the  medica- 
ment the  quicker  he  would  be  cur.d.  It  might,  per- 
haps, be  questioned  why  the  acne  should  only  have 
appeared  upon  the  shoulders  and  not  upon  the  limbs 
or  other  parts  of  the  body,  for  he  had  applied  the 
ointment  everywhere.  It  must  be  remembered,  how- 
ever, that  the  severest  cases  of  acne  were  often  seen 
upon  the  back  and  interscapular  region,  these  parts, 
together  with  the  face,  being  the  seat  of  election  for 
the  disease.  Pathologically  speaking,  the  lesions 
were  produced  through  a  blocking  of  the  sebaceous 
ducts  with  tar,  the  presence  of  which  acted  as  a  local 
irritant,  leading  to  inflammatory  changes  within  the 
follicles  and  dilated  portions  of  the  ducts.  Funincu- 
losis  was  also  seen  as  a  result  of  the  external  application 
of  tar. 

A  weak  sulphur  lotion  was  prescribed  for  the  back 
together  with  the  compound  sulphur  ointment,  while 
a  mild  creolin  ointment  was  ordered  for  the  scaly  patches 
upon  the  limbs.  For  the  scalp  the  ung.  hydrarg. 
ammon.  was  prescribed. 

Case  II. — Canities  following  Alopecia  Areata. — A 
little  girl,  act.  8,  was  brought  with  several  large  patches 
of  white  hair  upon  the  scalp.  A  year  previously  she 
had  been  treated  for  alopecia  areata,  but  she  had 
ceased  to  attend  the  out-patient  department  for  some 
months.  Shortly  before  the  hair  fell  out  she  had  an 
attack  of  scarlet  fever,  during  which  time  the  mother 
said  the  hair  was  not  cut  off.  She  had  had  no  other 
illnesses. 

On  inspection  the  child  presented  a  remarkable 
appearance,  nearly  one-quarter  of  the  left  side  of  the 
scalp  being  covered  with  silvery  white  locks.  The 
adjacent  hair  was  dark  brown  in  colour.  The  eyebrows 
and  eyelashes  were  normal.  The  general  health  was 
good,  though  the  child  was  of  an  excitable  disposition. 

Dr.  Meachen  pointed  out  that  the  growth  of  hair 
which  occurred  upon  an  alopecic  patch  was  generally 
of  a  somewhat  paler  tint  than  that  which  was  lost,  but 
it  was  distinctly  uncommon  for  actual  grey  hair  to 
appear,  especially  in  a  young  child.     The  appearance 

D 


486    Th«  Medical  Press.  TRANSACTIONS    OF    SOCIETIES. 


Nov.  9,  1904. 


of  the  well-known  downy  growth  upon  the  previously 
smooth  and  billiard  ball-like  area  was  always  a  most 
hopeful  sign,  and  with  the  progress  of  time  pigment 
began  to  be  deposited  withm  the  hair  shafts.  The 
whole  question  of  the  production  of  pigment  was  rather 
complicated,  since  its  visibility  depended  not  only 
upon  its  absolute  quantity,  but  also  upon  the  degree 
in  whicA  air-bubbles  were  present  between  the  cells 
ot  the  cortical  layers.  A  return  to  the  natural  colour 
was  exceedingly  rare,  though  cases  had  been  recorded 
of  such  a  transition. 

As  regards  treatment,  extensive  canities  might,  in 
many  cases,  justify  the  systematic  use  of  hair  dyes. 
This  little  girl  did  not  like  going  to  school  because  the 
other  children  made  fun  of  her.  Silver  nitrate  in 
plain  solutions  of  i  to  3  per  cent,  was,  on  the  whole, 
the  best  reagent  for  this  purpose,  though  corrosive 
sublimate  and  pyrogallol  were  also  largely  employed. 
The  parents  of  the  child  were  strongly  impressed  with 
the  idea  that  if  the  hair  had  been  entirely  shaved  off 
dunng  the  attack  of  fever  it  would  have  come  back 
the  natural  colour !  There  was  a  semblance  of  truth 
in  this  supposition,  but  clinical  evidence  was  insuffi- 
cient to  enable  us  to  state  definitely  one  way  or  the 
other. 


Scttlsb  f)ealtb  IRcdottd* 


[by  our  special  medical  commissioner.] 

XV.— TORQUAY. 

Torquay  has  won  high  repute  as  a  health  resort, 
and  rightly  holds  a  foremost  place  among  winter 
stations.  It  is  situated  in  a  bay  on  the  north  side  of 
Tor  Bay,  and  has  a  south  exposure.  Its  physical 
features  are  widely  diversified  and  well  fit  it  as  a  natural 
sanatorium.  Comfortable  shelter  is  afforded  by  the 
hills  of  the  Torquay  promontory,  which  rise  to  448  feet. 
The  geological  formation  is  mainly  Middle  Devonian 
limestone  and  Lower  Devonian  grits  and  slates,  and 
there  is  very  little  clay,  and  what  does  occur  is  of  the 
nature  of  marl.  Careful  meteorological  observations  are 
taken  twice  daily  at  the  Borough  Station,  which  is 
admirably  equipped  with  modem  instruments  of  pre- 
cision. [We  are  indebted  to  Dr.  Thomas  Dunlop, 
M.O.H.  for  Torquay,  for  a  copy  of  his  Annual  Report 
for  1903,  and  much  other  information  of  service.] 
Mr.  Frederick  Marsh  is  the  official  meteorologist.  The 
mean  barometric  reading  for  last  year  was  29*935. 
The  temperature  figures  testify  to  the  equability  of  the 
climate.  The  maximum  mean  was  567** ;  the  mini- 
mum mean.  47*1®  ;  the  maximum  and  minimum  mean, 
51*9°;  and  the  mean  range,  9*6°.  The  duration  of 
bright  sunshine  as  recorded  by  the  Jordan  photographic 
twin  instrument  was  1,645-1  hours,  and  as  recorded  by 
the  Campbell-Stokes  standard  instrument.  1,699*6 
hours.  The  total  rainfall  amounted  to  41*15,  which 
was  much  above  the  average  of  recent  years.  The 
mean  humidity  was  78,  as  taken  by  Mason's  hygro- 
meter. During  the  latter  part  of  the  year  west  winds 
prevail,  but  in  the  spring  the  winds  are  chiefly  easterly. 
The  population  is  33.810.  the  birth-rate.  15*8  per  i. 000, 
and  the  gross  death-rate  13*4  per  1,000;  but  on 
eliminating  the  deaths  of  visitors  it  comes  out  at  ii'i; 
per  1,000.  The  water-supply,  which  is  abundant  and 
constant,  is  derived  from  upland  surface  gathering 
ground  about  fifteen  miles  from  Torquay  on  the 
borders  of  Dartmoor.  The  water  contains  a  small 
amount  of  lime  and  magnesia.  The  drainage  system 
has  been  well  designed  and  is  maintained  in  a  tho- 
roughly efficient  manner. 

Torquay  is  admirably  supplied  with  means  for  out- 
door recreation,  the  public  pleasure  grounds  and 
gardens,  roads  and  foot-paths,  are  peculiarly  well 
fitted  for  the  needs  of  the  health-seeker,  whilst  the 
immediate  neighbourhood  offers  endless  attractions  as 
a  centre  for  charming  excursions.  There  is,  however, 
a  lack  of  those  attractions  under  cover  which  are  so 
sedulously  catered  for  at  Continental  health  resorts 
during  the  winter  months,  the  absence  of  which  at 


Torquay  is  considered  a  serious  drawback  to  those  in 
search  of  amusement  as  well  as  health. 

There  are  many  excellent  hotels  and  boarding-houses, 
and  suitable  apartments  may  always  be  obtaii^ ;  but 
Torquay  is  in  great  measure  a  residential  haven  lor  the 
aged,  and  those  invalided  or  injured  in  life's  coofiict. 

Torquay  is  an  admirable  winter  resort  for  those  ^Hm. 
while  enfeebled  and  unable  to  stand  the  expoMue  of 
most  of  our  British  stations,  need  a  home  resideace 
with  open-air  life.  The  aged  here  find  the  burden  of 
advanced  life  much  lightened.  The  constitntiaDaDy 
delicate  and  those  invaUded  by  actual  disease  are 
afforded  shelter  and  can  maintain  a  hygienic  life  m 
comfort  and  carry  on  some  form  of  work  with  pleasure 
and  profit.  Torquay  is  a  very  desirable  winter  centre 
for  convalescents. 

For  many  cases  of  pulmonary  disease  it  provides 
conditions  particularly  alleviative.  While  it  is  un- 
desirable for  most  incipient  cases  of  phthisis  it  is  vdl 
fitted  for  many  chronic  and  advanced  cases,  partico- 
larly  where  the  bronchitis  involvement  is  conspicoons. 

For  elderly  persons,  the  subjects  of  chronic  broo- 
chitis,  emphysema,  asthma,  renal  disease,  and  those 
requiring  a  comparatively  warm,  sheltered,  equable 
climate,  with  opportunities  for  gentle  exercise  and 
quiet  amusement,  Torquay  may  be  strongly  recom- 
mended. 

The  hillsides  are.  of  course,  unsuited  to  many  cardiac 
cases  and  subjects  of  vascular  deterioration.  For 
neurasthenics  and  those  suffering  from  some  forms  of 
nervous  derangement.  Torquay  during  winter  days 
can  offer  much  that  is  desirable. 


XTrattdactlons  ot  Societled. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  Pathology. 
Meeting  held  Friday,   October   28th.   1904. 


H.  C.  Earl,  M.D.,  in  the  Chair. 


LYMPHATIC   LEUKiEMIA. 

Professor  E.  J.  McWeeney,  M.D.,  read  a  paper 
entitled  **  Hematological  Observations  on  a  Case  of 
Chronic    and  one  of  Acute  Lymphatic    Leuk«mia." 
The  first  case  was  that  of  a  man,  act.  55.  admitted  to 
the  Mater  Misericordiae  Hospital  on  September  2nd, 
suffering  from  splenic  tumour,  glandular  enlargemeat 
and  asthma.     The  most  remarkable  point  in  the  pre- 
vious history  was  an  injury  to  left  side  of  the  abdomen, 
sustained  last  January,  after  which  a  sensation  of  dis- 
comfort developed — a  possible  traumatic  origin  being 
thus  suggested.     The  cervical  glands  began  to  enlarfje 
about  E^ter  ;   the  splenic  tumour  was  first  noticed  in 
May.     Blood-count    on    admission  :     R.,     3,908,000; 
W.,    163,000.     Two    days   later    the    count   was  R., 
2,848.000 ;      W..     206,000.     The     differential     coont 
yielded   pol)rmorphs.   7*8;  large   mononuc!ears.  2-3; 
lymphocytes,  89*5  ;  eosinophile  and  mast  cells,  o  per 
cent.;   a   few   normoblasts.      On   September   25th  he 
developed  lobar  pneumonia,  to  which  he   succombed 
on  the  28th.     There  was  no  diminution  of  the  total 
leucocyte-count  consequent  on  the  infection,  and  no 
increase  of  polynuclear  elements  in  the  peripheral  blood 
on  the  day  preceding  death.     The  count  on  that  day 
was  R.,  3.048.000  ;   W.,  332,000  ;  percentage  of  mono- 
nuclears,    92-4.     On     the     other     hand,     the  blood 
taken  from  the  lung  at  the  autopsy  twelve  hours  after 
post-mortem  yielded  20-5  per  cent,  of  polynudears,  as 
well  as  0-5  per  cent,  of  eosinophiles,  and  3-5  per  cent, 
of  myelocytes,  neither  of  which  could  be  found  in 
the  peripheral  blood  during  life.     The  spleen  weighed 
51  02?.,  was  marb'.ed  with  red  and  grey  patches,  and 
contained    infarcts.     Microscopically    the   trabecular 
system  was  much  reduced,  and  the  follicles  obliterated 
by  a  uniform  distribution  of  rather  large  mononuclear 
elements.     Mitoses  were  hard  to  find  ;  there  was  much 
iron-containing  pigment ;  no  giant  cells.     The  glands 
were  all  much  enlarged,  highly  vascular,  distinctioo 
between    follicles    and     sinus     obliterated ;    mitoses 


Nov.  9,  1904. 


TRANSACTIONS    OF    SOCIETIES.  The  Medical  Press.    487 


numerous.  The  marrow  of  the  femur  and  humerus  was 
of  the  normal  character  ;  that  of  the  sternum  was 
lymphoid.  The  liver  (283  oxs.),  kidneys  and  supra- 
renaJs  showed  typical  lymphoid  infiltration.  The 
absence  of  blood  change  consequent  on  pneumococcal 
infection  and  the  absence  of  the  marrow  change  were 
the  two  most  interesting  features  of  the  case. 

Case  2. — AcuU  Lymphatic  Leukamia. — Patient  was 
a  boy,  aet.  9  ;  six  weeks  ill  on  admission,  with  moderate 
fever  (100°  to  101°) ;  swollen  glands,  epistaxis  and  great 
prostration.  The  spleen  was  moderately  enlarged, 
as  was  also  the  liver.  Petechia  on  skin  of  abdomen 
and  legs.  Blood-count  on  admission:  R.,  1,898,000; 
W.,  212,000;  lymphocytes,  large  and  small,  being 
98  per  cent.,  with  only  0*5  per  cent,  of  polymorphs. 
Many  of  the  l3rmphocytes  showed  signs  of  degenera- 
tion. On  puncturing  the  skin  through  a  droplet  of 
Unna's  polychrome  methylene  blue,  their  nuclei  took 
the  stain  at  once.  No  hard  and  fast  line  of  separation 
could  be  drawn  between  small  and  large  forms  ;  the 
latter  were  very  labile.  Eosinophile  and  mast  cells 
absent ;  normoblasts  in  small  numbers,  megaloblasts 
absent.  The  case  ran  a  rapid  course,  dying  nineteen 
days  after  admission  from  the  uncomplicated  dis.ase. 
Blood-count  on  day  of  death  was,  R.,  820,000  ;  W., 
723,000,  99-5  per  cent,  of  which  were  lymphocytes. 
Several  fields  had  to  be  searched  before  a  polymorph 
was  encountered.  At  the  autopsy  (three  hours  after 
post-mortem)  the  heart  was  distended  with  puriform 
blood.  Thymus  much  enlarged  ;  weighed  46  jrrammeF. 
All  the  serous  membranes  covered  with  petechiae.  All 
the  glands  were  moderately  enlarged,  soft  and  hy- 
peraemic,  but  not  confluent.  Spleen  (12  02.)  seemed 
almost  normal,  save  for  the  enlargement.  Liver  en- 
larged with  enormous  leukaemic  infiltrations,  the  intra- 
lobular capillaries  being  literally  plugged  with  lym- 
phocytes. The  kidneys  were  also  most  extensively 
infiltrated,  and  x>resented  a  very  peculiar  appearance. 
The  lymphoid  structures  of  the  intestine  were  enlarged. 
The  marrow  of  femur  and  tibia  was  hyperaemic  and 
typically  lymphoid  (splenoid  of  Ziegler).  It  consisted 
almost  entirely  of  large  peculiarly  lentish  lymphocytes. 
Normoblasts  frequent,  megaloblasts  few.  Coarsely 
granular  cells  absent.  The  blood  was  examined 
bacteriologically  ten  dajrs  previous  to  death,  5  c.c. 
being  withdrawn  from  a  vein  near  the  elbow  and  placed 
in  a  flask  containing  500  c.c.  of  ordinary  peptone  broth, 
and  incubated.  No  growth  occurred,  and  after  four 
days  the  blood  cells  seemed  unaltered  in  the  sediment. 
No  trace  of  protozoa.  This  case  afiorded  a  highly 
favourable  opportunity  for  the  study  of  acute  lym- 
phaemia,  as  the  autopsy  was  complete,  and  the  tissues 
■were  fixed  within  five  hours  of  death.  The  paper  was 
illustrated  by  numerous  microscopic  preparations  and 
coloured  drawings,  as  well  as  by  the  specimens  pre- 
served at  the  autopsy. 

Professor  White  said  that  during  the  past  year  he 
had  seen  a  case  of  the  so-called  spleno-medullauiy 
leukaemia  in  which  there  was  apparently  a  direct 
connection  between  an  injury  and  the  disease.  The 
patient  fell  down  the  hold  of  a  ship,  and  hurt  himself 
about  the  abdomen,  but  was  able  to  work  on  for  a  fort- 
night, after  which  he  went  into  hospital,  and  died  in  a 
few  weeks  of  leuksemia.  Another  point  in  Professor 
McWeeney's  case  was  the  fact  that  the  patient  died  so 
quickly  of  pneumonia.  In  one  of  the  cases  of 
leukaemia  (common  variety)  he  had  seen,  the  patient, 
a  woman,  left  hospital  to  go  home,  but  missed  her  train 
auid  had  to  come  back  ;  she  almost  immediately  de- 
veloped a  sharp  attack  of  erysipelas,  and  died  in  twenty 
or  thirty  hours,  showing  the  little  resistance  these 
patients  have  a^^ainst  infectious  diseases.  With  regard 
to  Hodgkin's  disease,  he  did  not  think  it  was  typical 
to  find  giant  cells,  and  believed  that  when  giant  cells 
were  found,  we  were  probably  dealing  with  some 
chronic  infection,  possibly  tuberculous,  instead  of 
Hodgkin's  disease. 

Dr.  Craig  said  that  Professor  McWeeney*s  cases 
rather  upset  the  ordinary  clinical  teaching ;  for  in- 
stance, he  had  been  accustomed  to  teach  that  the  in- 
crease of  leucocytes  was  not  so  great  in  lymphatic  as 


in  spleno-meduUary  leukaemia,  but  Professor  McWeeney 
had  said  that  in  the  acute  case,  at  least,  the  red  and 
white  corpuscles  were  almost  equal  in  number.  Another 
po  nt  was  that  myelocytes  were  never  present  in  lym- 
phatic leukaemia.  With  regard  to  the  case  of  acute 
leukaemia,  he  said  it  was  of  special  interest  because 
occasionally  this  disease  occurs  among  children,  and 
when  the  enlarged  glands  appear,  they  are  supposed 
to  have  acute  genersd  tuberculosis. 

Dr.  Earl  agreed  with  Dr.  McWeeney  as  to  the  pre- 
sence of  giant  cells  in  Hodgkin's  disease,  and  he  was 
certain  that  in  the  two  or  three  cases  of  real  Hodgkin's 
disease  which  he  had  examined  he  had  found  glands 
which  were  not  those  of  tuberculosis. 

Dr.  McWeeney,  in  replying,  said  that  Professor 
White's  observation  as  to  the  traumatic  origin  of  a  case 
of  the  spleno-meduUary  variety  was  very  interesting, 
especially  the  short  duration.  The  case  would  appear 
to  have  been  acute  myelaemia,  which  is  very  rare, 
whereas  lymphaemia  is  sometimes  acute,  but  he  was 
not  certain  that  any  acute  spleno-meduUary  cases  had 
been  recorded.  With  regard  to  his  statement  about 
the  presence  of  giant  cells  in  Hodgkin  s  disease,  he 
based  it  on  a  report  of  the  pathologist  of  the  Ayer 
Pathological  Laboratory,  who  had  examined  fifteen 
cases  of  the  disease,  and  had  met  giant  cells  which  it 
was  easily  seen  were  not  tuberculous.  They  arose  from 
some  irritation  of  the  large  endoth  lial  plates  in  lym- 
phatic glands.  In  Germany  Hodgkin  s  disease  is 
called  pseudo-leukaemia,  ats  the  patient  looks  as  if  he 
is  going  to  have  it.  If  the  same  cause  produced  Hodg- 
kin's disease  as  produced  leukaemia,  then  you  would 
expect  to  find  giant  cells  in  the  glands  ;  but  you  do  not. 
The  explanation  sometimes  given  is  that  in  Hodgkin's 
disease,  owing  to  some  peculiarity  of  the  cap^sule 
of  the  gland  the  greatly  increased  lymphoid  cells  in  it 
and  in  the  sides  of  the  gland  are  so  pressed  on  that  they 
cannot  get  cut  into  the  blood  ;  whereas,  if  the  same 
stimulus  attacks  a  gland  with  soft  sides,  dc ,  the  new 
lymphocytes  do  get  out,  causing  leukaemia.  With 
regard  to  Dr.  Craig's  remarks,  he  said  it  was  very 
haird  to  stick  to  both  the  pathological  and  clinical 
aspects,  but  there  could  be  no  doubt  that  there  are 
many  cases  of  lymphatic  leukaemia  which  give  very  large 
counts.  Myelocytes  were  always  present  in  lymphatic 
leukaemia,  but  they  wanted  looking  for. 

AORTIC  ANEURYSM   PERFORATING  THE  CESOPHAGUS. 

Dr.  Matson  showed  a  specimen  of  the  above  taken 
from  a  woman,  aet.  50.  History  of  alcoholism,  but  none 
of  syphilis.  Patient  had  been  sulject  to  attacks  of 
rheumatic  fever.  Two  years  ago  she  had  an  attack  of 
bronchitis,  in  which  she  expectorated  a  good  deal  of 
blood. 

Dr.  Travers-Smith  asked,  did  the  patient  vomit 
blood? 

Dr.  Craig  said  that  during  the  past  year  he  had  seen 
two  cases.  The  first  w^as  a  man  complaining  of  sym- 
ptoms referred  to  the  stomach.  He  left  hospital  and 
came  back  in  a  dying  condition  with  an  aneurysm 
which  ruptured  into  the  oesophagus.  The  second  case 
was  one  which  he  had  met  with  seven  years  ago.  and 
six  years  ago  he  read  a  paper  stating  that  this  pat  ent 
with  an  aneurysm  of  the  innominate  artery  had 
been  cured.  He  then  went  about  in  good  health,  having 
only  some  dulness  at  the  right  of  sternum  and  at  the 
inner  end  of  the  right  clavicle.  During  April  of  the 
present  year  this  gentleman  died  suddenly  in  bed,  and 
the  post-mortem  report  showed  that  an  innominate 
aLueurysm  wsls  present.  It  was  the  size  of  an  apple, 
and  haul  walls  an  inch  thick.  The  dilated  portion  still 
contained  some  blood  in  the  centre.  It  lAas  solid  out- 
side, amd  was  adherent  to  the  sternum,  which  it  had 
half  eaten  through.  In  the  descending  part  of  the  arch 
of  the  aorta  was  an  ameurysm  the  size  of  a  child  s 
head.  It  had  burst  into  the  asophagus,  the  latter, 
with  the  stomach,  being  full  of  blood.  This  patient 
had  been  cured  of  the  innominate  aneurysm,  haid  gone 
about  for  seven  years,  and  had  grown  fat  and  lived  a 
healthy  open-air  life,  but  how  long  the  second  aneurysm 
existed  wais  not  known.  This  case  was  of  interest 
from  the  sequel. 


488    The  Medical  Press.  TRANSACTIONS    OF    SOCIETIES. 


Nov.  9,  1904. 


Dr.  Matson  said,  in  reply,  his  patient  vomited  a 
considerable  amount  of  blood,  and  there  was  a  good 
deal  of  blood  in  her  stomach. 

AORTIC    ANEURYSM    RUPTURING    INTO    PLEURA. 

Dr.  GiLLMAN  MooRHEAD  exhibited  a  case  of  aneu- 
rysm of  the  aortic  arch,  which  had  ruptured  into  the 
pleura.  The  specimen  was  obtained  from  a  man,  £t.  3$ , 
by  occupation  a  sailor,  and  who  had  contracted  syphMs 
ten  years  previously.  The  only  symptom  complained 
of  was  that  of  cough.  Rupture  occurred  suddenly  during 
sleep  after  the  patient  had  been  under  treatment  for 
four  dajrs.  Almost  the  entire  wall  of  the  sac  was 
necrotic,  brittle  and  very  thin,  and  only  a  small  amount 
of  soft  clot  was  present.  One  hundred  ounces  of  blood 
were  found  in  the  left  pleural  cavity.  The  curious  point 
about  the  case  was  that  rupture  had  not  occurred  while 
the  patient  was  at  work,  as  he  had  been  up  to  within  a 
week  of  his  death. 


SHEFFIELD   MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  October  27TH,  1904. 


The  President,   Dr.  Arthur  Hall,  in  the  Chair. 


Mr.  Pye-Smith  showed  the  following  cases  and 
specimens: — (i)  Large  gall-stone  removed  on  Sep- 
tember 6th  from  the  common  duct  of  a  woman,  aet.  50, 
where  it  had  become  impacted  subsequent  to  the  re- 
moval, two  and  a  half  years  before,  of  thirty-six  stones 
from  the  gall-bladder,  which  was  suppurating.  The 
duct  was  sewed,  a  gauze  drain  being  left  in  contact 
with  it.  No  bile  escaped,  and  the  case  did  well.  (2) 
Eight  facetted  gall-stones  removed,  on  September  7th, 
from  the  common  and  hepatic  ducts  of  a  man,  aet.  46, 
who  had  had  severe  jaundice  for  nine  months.  Six  of 
the  calculi  were  at  the  lower  end  of  the  common  duct 
and  two  in  the  hepatic  duct.  They  were  all  extracted 
by  an  opening  at  the  level  of  the  top  of  the  duodenum. 
The  duct  could  not  be  easily  sutured  and  was  drained 
through  a  stab  wound,  which  closed  in  a  month.  The 
patient  did  well,  but  was  not  yet  quite  free  from 
jaundice.  (3)  A  fine,  spiked,  mulberry  calculus, 
weighing  670  grains,  removed,  on  September  20th,  by 
suprapubic  lithotomy  from  a  man,  set.  28.  (4)  A 
small  sequestrum  of  bone,  about  ^  inch  in  dia- 
meter, and  a  silkworm-gut  suture,  both  of  which 
were  encapsuled  in  firm  scar-tissue,  removed  on 
October  i8th  from  the  end  of  the  stump  of  the  forearm 
of  a  man,  aet.  36,  who  had  been  shot  in  the  hand  two 
years  previously.  Immediate  amputation  had  been 
performed  (in  Worcestershire),  and  the  wound  healed 
m  six  months,  after  two  smaill  pieces  of  bone  had  come 
away.  The  stump  continued  to  be  painful  and  tender, 
though  the  skin  was  in  good  condition.  Two  tender 
spots  were  found  over  two  small  hard  lumps.  After 
their  excision  the  pain  and  tenderness  disappeared. 

Dr.  Sinclair  White  showed  the  following  cases  : — 
(i)  A  girl,  aet.  7,  with  congenital  double  dislocation  of 
the  hip,  on  whom  he  proposed  to  operate  by  the  open 
method.  (2)  A  man,  aet.  25,  whose  right  upper  extre- 
mity had  been  removed  for  a  round-celled  sarcoma  of 
the  upper  arm  by  Berger's  inter-scapular-thoracic  am- 
putation. The  patient  had  made  a  rapid  recovery. 
(3)  A  man,  aet.  46,  whose  right  scapula  had  been  re- 
moved in  March,  1900,  for  sarcoma.  There  had  been 
no  recurrence  of  the  growth.  He  had  a  very  useful 
arm,  but  was  unable  to  elevate  the  upper  arm  beyond 
an  angle  of  45  degrees.  In  a  more  recent  case  still, 
better  movements  had  been  obtained  by  uniting  the 
trapezi  :s  and  levator  anguli  scapula  to  the  deltoid  and 
the  serratus  magnus  to  the  rhomboid  muscles. 

The  President  showed  cases  of  (i)  aphasia,  (2) 
Spinal  progressive  muscular  atrophy,  (3)  multiple  naevi 
of  the  face. 

Dr.  D.  Burgess  read  notes  of  a  fatal  case  of  cardiac 
hypoplasia  in  a  young  woman,  and  showed  a  child 
with  intention  tremors. 

Mr.  R.  Favell  showed  (i)  a  specimen  of  the 
ruptured  tubal  gestation, 
together  with  an  adherent  vermiform  appendix.     The 


patient,  a  married  woman,  aet.  32,  married  five  years, 
never  pregnant,  regular  twenty-eight  days,  lasting  ioar 
days.  The  last  period  first  week  in  ApriL  Seoood 
week  in  May  began  to  have  a  coloured  discharge 
accompanied  with  frequent  attacks  of  pain.  The 
bloody  discharge  continued  for  three  weeks,  then  for  a 
week  it  ceased,  coming  on  again  and  then  continuing 
to  the  time  of  operation.  By  the  vagina :  A  teose 
cystic  swelling  was  fe'.t  in  right  lateral  fornix,  the 
uterus  pushed  over  to  the  left.  Section  was  done  on 
July  I  St.  three  months  after  her  last  period.  The 
right  tube  was  greatly  distended  with  organised  blood- 
clot,  the  embryo  being  found  in  the  upper  part  of  lobe. 
The  tube  was  ultimately  adherent  to  the  parietal  and 
pelvic  peritoneum,  the  vermiform  appendix  was  in- 
flamed and  much  thickened,  being  intimately  adherent 
in  its  whole  length  to  the  tut)e.  This  was  removed 
with  tube. 

(2)  dermoid  cyst  of  ovary  adherent  to  VERMIFORll 
APPENDIX. 

The  patient,  aet.  32,  two  children,  youngest  aet.  8. 
had  noticed  swelling  in  lower  atxlomen  f^r  twelve 
months.  Six  weeks  before  operation  she  was  seized 
suddenly  with  acute  pain  across  the  hypogastric  region. 
accompanied  with  sickness  and  faintness.  The  swelling 
lay  right  across  the  hypogastrium,  rising  two  and 
a  half  inches  down  the  pubis.  By  the  vagina :  The 
tumour  was  found  lying  in  front  of  the  uterus  and 
evidently  adherent.  On  section,  the  dermoid  was 
found  to  intimately  adhere  to  the  parietal  peritoneam, 
to  the  uterus,  the  smaill  intestine,  and  to  the  vermifonn 
appendix  ;  great  difficulty  was  found  in  separating  the 
adhesions.     The  patient  made  a  good  recovery. 

Dr.  D.  Gray  Newton  read  notes  of  a  case  of  a 

GALL-STONE    PRODUCING    ACUTE    INTESTINAL 
OBSTRUCTION, 

successfully  removed  by  abdominal  section,  aind  shoved 
specimen 7.  The  patient,  a  woman,  aet.  66,  eight  years 
ago  had  her  first  attack  of  biliary  colic,  and  then  was 
free  except  for  some  dyspeptic  symptoms  till  last  year, 
when  she  had  another  attack,  this  time  accompanied 
by  jaundice  which  passed  off  in  a  week  or  so.  The 
present  attack  occurred  in  May  of  this  year,  which  was 
relieved  somewhat  by  small  and  frequent  doses  of 
morphia,  but  early  one  morning  (4  a.m. )  she  experienced 
an  extra  severe  attack  of  pain,  which  did  not  last  long, 
and  afterwards  the  patient  expressed  herself  as  being 
more  free  from  pain  than  she  had  done  since  the  attack 
began.  This  will  be  seen  to  coincide  in  all  probability 
to  the  passage  of  the  gall-stone  from  the  gall-bladder 
into  the  duodenum.  Later  on  in  the  day  she  began  to 
be  sick,  and  unable  to  retain  anything  in  her  stomach, 
the  vomit  becoming  faecal.  After  consultation  with 
Dr.  Sinclair  White  we  both  came  to  the  conclusion  that 
the  obstruction  was  due  to  an  impacted  gall-stone,  and 
advised  an  operation.  The  patient  was  conveyed  to  a 
Surgical  home.  After  the  preliminary  surgical  toilette. 
the  abdomen  was  opened  in  the  middle  line  above  the 
umbilicus,  and  a  search  made  for  the  obstruction.  A 
hard  substance  was  felt  in  the  intestine.  That  portioo 
of  bowel  was  brought  to  the  surface,  surrounded  with 
gauze  and  opened  in  the  longitudinal  axis  of  the  gut. 
Thereafter    the    stone    was    extracted.     It    weighed 

2  drachms  6  grains,  and  measured  in  the  long  circum- 
ference  3^  inches,   and   in   the   short     circumference 

3  inches.  The  mucous  membrane  of  the  intestine  was 
united  by  catgut,  and  the  serous  coat  with  fine  salk. 
The  deep  portion  of  the  abdominail  wound  was  brought 
together  by  a  continuous  catgut  suture  ;  the  super- 
ficial portion  with  silkworm-gut.  After  the  operation 
the  stomach  was  washed  out  with  saline  solution  till 
the  returning  fluid  wats  quite  clear.  The  patient  made 
an  uninterrupted  recovery. 

NORTH-EAST  LONDON  CLINICAL  SOCIETY. 

Clinical  Evening  held  Thursday,  November  jrd, 

1904. 

Dr.  R.  Murray  Leslie,  President,  in  the  Chair. 


Dr.   a.   J.   Whiting  showed   (i)   a   case  of  Acute 


Nov.  9,  1904- 


TRANSACTIONS  OF  SOCIETIES.  Thb  Medical  Press.    489 


Anterior  Poliomyelitis  in  a  boy,  aet.  9.  The  disease 
was  of  two  months  duration,  of  sudden  onset,  and  all  four 
limbs  were  affected.  (2)  An  infant,  act.  2,  with  Spastic 
Diplegia  of  Cerebral  Origin.  The  lower  limbs  were 
quite  rigid  and  the  hands  were  tightly  clenched.  The 
child  was  also  distinctly  microcephalic,  and  was  very 
noisy  in  the  ward.  The  case  excited  considerable 
interest  and  was  discussed  by  several  of  the  members. 
(3)  A  man  with  '*  Head-Tetanus,"  which  had  appeared 
after  an  injury.  (4)  A  woman  affected  with  Glosso- 
Labio-Pharyngeal  Paralysis. 

The  President  remarked  that  several  cases  of  the 
latter  disease  which  had  come  under  his  notice  had  met 
with  a  sudden  fatal  termination. 

Dr.  J.  W.  Hunt  exhibited  a  man,  act.  59,  with  Cancer 
of  the  Neck.  The  history  was  that  six  months  ago 
stiffness  of  the  skin  of  the  neck  was  observed,  and  a 
hide-bound  condition  of  the  cervical  tissues  upon  the 
right  side  had  gradually  developed  since  that  date. 
A  small  portion  removed  under  chloroform  showed 
microscopical  evidences  of  malignant  disease.  The 
question  of  the  possibility  of  relieving  the  pain  by 
exposing  the  patient  to  the  X-rays  or  to  radium  was 
discussed  by  several  of  the  members. 

Dr.  Norman  Meachen  showed  a  young  man,  aet.  18, 
the  subject  of  Tar- Acne.  The  patient,  who  was  also 
affected  with  psoriasis,  had  applied  tar  to  his  back  and 
shoulders  somewhat  vigorously  during  the  past  year. 

Dr.  R.  B.  Marjoribanks  showed  a  skiagraph  of  an 
interesting  deformity  of  the  hand  in  a  man,  affecting 
the  middle  and  ring  fingers. 

Dr.  F.  J.  Tresilian  (Enfield)  showed  a  little  girl 
with  a  Thyro-Glossal  Duct  Cyst,  which  was  of  long 
duration,  but  was  said  to  have  increased  in  size  lately. 

Mr.  Herbert  W.  Carson  remarked  that  the  cyst  was 
probably  dermoid  in  origin,  and  he  advocated  excision 
in  the  submental  region. 

Mr.  Carson  then  exhibited  two  cases  of  Fractured 
Patella  in  men  treated  by  operation.  The  fragments 
of  the  patella  in  both  cases  were  not  wired,  but  sutured 
with  catgut  in  the  peri-patellar  aponeurosis  in  a  circu- 
lar fashion.  The  duration  of  the  operation  was  con- 
siderably shortened  by  this  procedure  and  the  diffi- 
culties consequent  upon  the  employment  of  silver  wire 
were  avoided. 

Mr.  Carson  also  showed  a  man  with  a  Primary 
Chancre  of  the  Lower  Lip. 

Dr.  T.  D.  Manning  (Hoddesdon)  exhibited  a  man 
with  an  Acute  Vesicular  Eruption  localised  to  the  hands. 
The  lesions  consisted  of  tense  vesicles,  some  of  which 
had  become  purulent,  and  were  situated  upon  the 
thenar  and  hypothenar  eminences  and  dorsum  of  the 
hands.  The  central  portion  of  the  palms  was  only  very 
slightly  a^ected.  The  condition  was  strongly  sugges- 
tive of  cheiro-pompholyx,  especially  as  the  patient 
suffered  from  sweating  of  the  hands. 

Dr.  Meachen,  while  admitting  the  close  resemblance 
of  the  eruption  to  pompholyx,  considered  it  to  be  a 
vesicular  eczema,  in  view  of  the  fact  that  the  lesions 
were  of  small  size,  and  grouped  in  profusion  upon  the 
dorsum  of  the  hands  and  sides  of  the  fingers,  the 
central  portion  of  the  palms  being  practically  spared. 

Dr.  D.  M'Caskie  concurred  in  this  view,  the  opposite 
opinion,  namely,  that  the  eruption  was  of  the  nature 
of  a  dysidrosis,  being  advanced  by  Dr.  Tresilian. 

The  President  showed  a  young  woman,  the  subject 
of  Chronic  Pulmonary  Tuberculosis,  in  whom  a  Pneumo- 
thorax had  developed  upon  the  left  side.  The  patient 
was  able  to  go  about  quite  well,  and,  in  fact,  walked 
into  the  room. 

Dr.  G.  P.  Chappel  exhibited  a  specimen  of  the  liver 
from  a  case  of  Acute  Yellow  Atrophy,  which  had  re- 
cently been  admitted  into  the  Tottenham  Hospital 
under  his  care.  The  patient  was  a  girl,  aet.  21,  who 
had  become  infected  with  S3rphilis  four  months  ago. 
Jaundice  appeared  soon  afterwards,  and  vomiting, 
mental  symptoms,  and  increasing  weakness  led  to  her 
admission  into  hospital.  The  liver  dulness  was  greatly 
diminished,  and  death  resulted  from  coma.  At  the 
autopsy  the  liver  was  very  small,  weighing  only  25  ozs., 


and  it  presented  all  the  characteristic  features  of  the 
disease.  Leucin  and  tyrosin  crystals  were  found  in  the 
urine. 

The  President  remarked  that  recent  childbirth  and 
an  antecedent  syphilis  were  not  at  all  uncommon  pre- 
disposing causes  of  this  rare  affection. 


THE  CHILDHOOD  SOCIETY. 


Meeting  held  October  27TH,  1904. 


the    physical    condition    of    the    working-class 

children. 

the  proper  feeding  of  children. 

Sir  John  Gorst,  M.P.,  opening  the  meeting  of  the 
Childhood  Society  to  discuss  a  paper  read  by  Dr. 
Macnamara,  M.P.,  said  the  question  of  the  proper 
feeding  of  children  was  important  to  the  future  great- 
ness of  Great  Britain  as  a  world  power.  As  the  law 
compelled  children  to  be  sent  to  school  it  should  see 
they  were  in  a  fit  condition  to  receive  instruction. 

Dr.  Macnamara,  M.P.,  then  read  his  paper  on  the 
subject.  After  thirty  years'  practical  experience  as 
teacher  and  member  of  the  London  School  Board  he 
had  come  to  two  conclusions — (i)  that  80  per  cent,  of 
the  children  were  better  off  now  than  ever ;  this  improve- 
ment was  due  to  compulsory  education,  physical 
training,  and  the  influence  of  this  on  home  life  ;  (2) 
That  the  remaining  20  per  cent,  were  in  an  almost 
hopeless  condition.  Food,  clothing,  and  housing  were 
bad.  Especially  was  the  food  unsuitable  and  insuffi- 
cient, not  only  in  big  cities  but  in  agricultural  districts. 
The  London  School  Board  had  had  several  meetings 
on  the  subject,  and  at  a  special  meeting  in  1898  con- 
cluded that  it  should  no  longer  be  left  to  charitable 
relief  but  ought  to  be  a  public  obligation.  Also  that 
where  parents  neglected  their  children  through  drunken- 
ness or  idleness,  the  Board  should  have  power  to  pro- 
secute them.  Dr.  Macnamara  considered  this  last 
clause  very  important  and  regretted  that  it  was  re- 
jected finally  by  the  Board.  He  suggested  remedies 
for  the  evil  which  was  crippling  so  many,  mentally 
and  ph3rsically,  and  explained  a  scheme  already  working 
in  Paris  that  strengthened  instead  of  weakened 
parental  responsibility.  This  scheme  was : — ^That 
dining-rooms  should  be  connected  with  each  school, 
and  parents  be  invited  to  buy  coupon  tickets  for  whole- 
some and  substantial  meals  served  in  these  rooms. 
Gratis  tickets  to  be  given  to  those  who  could  not  pay 
for  them,  after  inquiry.  All  coupons  to  be  printed 
precisely  the  same  way,  the  money  for  gratis  coupons 
to  be  recovered  if  possible  by  the  officers  of  the  Board 
or  deducted  from  the  parents'  wages.  He  thought 
many  parents  of  the  well-to-do  artisan  class  would  find 
it  convenient  and  economical  to  avail  themselves  of  this 
communal  system.  A  halfpenny  rate  for  feeding 
children  would  finally  cost  the  ratepayers  less,  as  the 
number  of  healthy  wage-earners  would  be  increased. 
A  system  of  medical  inspection  would  also  improve 
the  condition  of  the  school-children.  Evening  classes 
of  cooking,  hygiene,  and  domestic  economy  for  young 
women  would  l^  of  great  advantage.  All  boys  between 
14  and  20  should  be  compelled  to  give  two  evenings  a 
week  to  training,  under  State  auspices,  which  would 
include  gymnastics,  formations  of  companies  and  drill, 
and  use  of  rifles.  He  strongly  urged  this,  although  it 
sounded  like  conscription  ;  and  also  drastic  changes  in 
the  present  state. 

Dr.  Carr,  chief  officer  of  the  L.C.C.,  thought  the 
reports  of  underfeeding  were  often  exaggerated.  He 
did  not  approve  of  the  coupon  system,  as  it  was  open 
to  so  much  abuse  ;  the  wisest  thing  was  to  take  the 
child  away  from  parents  who  could  not  feed  it.  Hygiene 
was  more  important  than  some  subjects  now  taught  in 
the  schools. 

Sir  John  Gorst,  in  moving  a  vote  of  thanks  to  Dr. 
Macnamara,  insisted  that  children  ought  to  be  pro- 
tected by  law  from  the  neglect  of  parents,  though  at 
present,  short  of  employing  the  criminal  law,  it  was 
not  possible  to  do  so. 


49^    The  Medical  Press. 


GERMANY. 


Nov.  9,  1904. 


fvancc. 

[from  our  own  correspondent.] 


Paris,  November  6th,  1004. 
Blood-letting  in  Eclampsia. 

The  treatment  of  eclampsia.  saysM.  Mace,  has  under- 
gone important  modifications  in  modem  times. 
Among  the  means  employed  against  it  there  is  one 
which  had  by  turns  the  favour  and  the  reprobation  of 
medical  men,  pi?.,  blood-letting.  •'  For  my  part," 
said  M.  Depaul,  "  I  do  not  hesitate  to  declare  that 
the  success  obtained  I  owed  to  blood-letting.  I  am 
one  of  those  who  are  the  warmest  partisans  of  this 
method  of  treatment.  After  having  employed  in  very 
numerous  cases  the  different  methods  of  treatment 
recommended  against  eclampsia  myself,  I  do  not 
hesitate  to  place  blood-letting  in  the  hrst  rank."  Since 
then,  the  partisans  of  ble^ing  at  the  Maternity  of 
Paris  are  Dr.  Porak  and  myself,  and  we  find  in  this 
method  considerable  advantages. 

Blood-letting  is  beneficial,  and  frequently  the  medical 
attendant  will  congratulate  himself  on  having  employed 
it.  if  he  has  dons  so  largely,  sometimes  repeating  it  on 
the  same  patient. 

The  eclamptic  patient  suffers  from  poison  of  all  the 
organs  by  the  retention  in  the  maternal  organism  of 
toxic  products  which  determine  disorders  in  the  func- 
tions of  all  the  cells,  provoking  convulsive  seizures, 
either  from  the  condition  of  the  blood  or  from  oedema 
existing  in  the  nerve  centres.  The  oedema  of  the 
cellular  tissue  is  frequently  manifest  in  the  extremities, 
but  clinical  experience  has  shown  that  this  oedema 
can,  in  certain  affections,  be  localised  in  the  bulb,  &c., 
and  produce  very  grave  accidents. 

Eclampsia,  which  announces  itself  by  convulsive 
attacks — a  terrifying  and  visible  symptom — ^furnishes 
to  the  medical  attendant  a  certain  number  of  other 
symptoms  which  are  also  important,  arterial  hyper- 
tension, for  instance.  Hence,  congestion  of  the  kidneys, 
the  possibility  of  the  rupture  of  a  small  vessel  under  the 
influence  of  high  pressure,  and,  unfortunately,  among 
the  arteries  which  yield  the  most  frequently  are  those 
of  the  nerve  centres.  Such,  in  a  few  words,  are  suffi- 
cient considerations  to  indicate  the  necessity  of  blood- 
letting. 

Peter  recommended  it  against  the  renal  congestion, 
which  he  considered  the  only  cause  of  eclampsia. 
Playiair  reserved  it  for  cases  where  there  were  evident 
sig^ns  of  cerebral  congestion  with  vascular  tension, 
lividity  of  the  face,  bounding  pulse  and  strong  pulsa- 
tions of  the  carotids. 

Professor  Bouchard  proved  by  experiments  that  in 
eclampsia  the  drawing  of  twelve  ounces  of  blood 
eliminated  one  drachm  of  poison,  and  to  arrive  at  the 
same  result  by  purging  the  patient,  diarrhoea  bordering 
o  I  cholera  should  be  provoked,  which  would  thus  com- 
promise the  life  of  the  patient. 

At  the  Maternit6  w-n  bl^ed  all  eclamptic  patients 
systematically  as  soon  as  they  arrive,  without  regard 
to  symptoms,  and  we  bleed  largely.  The  least  amount 
drawn  was  twenty-five  ounces,  sometimes  renewed 
in  the  same  day.  By  this  means  we  remove  a  certain 
quantity  of  poison,  poison  whose  nature  is  not  yet  well 
defined,  but  whose  constant  presence  is  the  cause  of  the 
accidents. 

The  results  of  blood-letting  might  be  mentioned  as 
follows : — decrease  of  the  toxic  elements  of  the  blood, 
decrease  of  the  vascular  pressure,  decrease  of  the  sym- 
ptoms of  asphyxia,  decrease  of  oedema. 
H/BMOPTYsis  IN  Phthisis. 
Chloride  of  calcium,  drs.  j  ; 
Syrup  of  opium,  oz.  j  ; 
Water,  02.  v. 

A  tablespoonful  every  two  nours ;    or 

Hydrochlorate  of  hydrastinin,  gr.  ij  ; 
Water,   oz.  v. 
A  dessert-spoonful  every  half-hour  ;   or 

Hydrochlorate  of  hydrastinin,  gr.  x  ; 
Water,  oz,  iiss. 


For  subcutaneous  injection.     A  full  S3rnnge  (i  gr.) 
once  or  twice  in  the  twenty-four  hoars ;   or 
Hip.  powder,  gr.  j  ; 
Dover's  powder,  gr.  ij. 
For  one  wafer :  One  every  hour  until  nausea  sets  in. 


[from  our  own  correspondent.] 


Bbklim.  NoTembar  OCh,  ISOl. 
Alcohol  as  a  Food. 

Hr.  Rosemann  has  an  article  on  this  subject  in 
Pfliiger's  Archiv,  Bd.  100,  which,  considering  the 
amount  of  attention  that  is  being  at  present  bestowed 
on  the  alcohol  question  in  Germany,  is  of  interest 
According  to  the  writer,  the  views  of  the  unconditional 
opponents  of  alcohol  with  regard  to  the  question  of  its 
nutritive  value  are  not  in  accordance  with  actuality. 

Of  the  quantity  of  alcohol  introduced  into  the  system, 
a  little  over  2  per  cent,  leaves  the  body  unconsumed. 
The  elasticity  given  assists  the  bodily  functions,  and 
limits  the  consumption  of  other  food  material  intro- 
duced. The  albumen-sparing  action  is  not  noticeable 
during  the  first  few  days  of  its  use,  but  later  on  it 
becomes  evident  as  in  the  case  of  carbohydrates  and 
fats.  The  interesting  fact  of  the  absence  of  albu- 
men-sparing property  during  the  first  few  days  of  its 
use  cannot  be  explained  by  its  washing  out  remaining 
terminal  products  of  tissue  change.  Rosemann  sums 
up  the  results  of  all  experiments  on  the  subject  to  the 
effect  that  alcohol  in  regard  to  its  action  as  a  food 
stands  exactly  on  the  line  of  carbohydrates  and  fats. 

As  regards  its  poisonous  action  in  large  doses,  he 
does  not  believe  that  moderate  doses  of  alcohol  have 
any  poisonous  action.  For  the  determination  of  this 
question,  however,  no  material  is  at  hand,  and  it  would 
be  difficult  to  procure  it.  Bismarck  and  Goethe  would 
scarcely  have  done  more,  or  lived  longer,  if  they  had 
been  total  abstainers. 

In  any  case,  the  use  of  alcohol  as  a  food  to  the 
healthy  individual  is  not  in  any  way  prejudiced  by  any 
supposed  poisonous  by-effects.  He  would  in  no  way 
minimise  its  practical  and  most  valuable  action  as  a 
food. 

Intestinal  Antisepsis. 

In  a  discussion  on  this  subject  (Merck's  Archir), 
Dr.  Soln  Cohen  made  a  suggestion  that  may  lead  to 
useful  results.  Everyone  knows  the  difficulty  there 
is  in  isolating  and  capturing  any  specific  bacillus  that 
may  be  causing  mischief  in  the  intestinal  canal,  and 
valuable  time  may  easily  be  lost  in  making  such 
bacteriological  investigations  as  shall  identify  the 
offender.  In  order  to  shorten  the  way  out  of  this 
difficulty  he  suggests  the  use  of  combined  intestinal 
antiseptics,  guaiacol  carbonate  (duotal),  benzo-naphthol 
and  bismuth  salicylate.  By  this  combined  method  he 
believes  that  the  septic  action  of  many  groups  of  bac- 
teria will  be  materially  limited. 

The  Genesis  of  Pulmonary  Phthisis. 

A  discussion  on  this  subject  took  place  at  the 
Naturforscherversammlung,  introduced  by  Hr.  Au- 
frecht,  of  Magdeburg.  He  had  never  observed  that 
phthisis  began  by  inspiration  into  the  healthy  lung. 
The  diseased  walls  of  the  blood-vessels  caused  the 
caseous  tubercle  of  the  human  subject.  The  tubercle 
bacilli  forced  themselves  into  the  blood-vessels,  possibly 
through  the  tonsils,  the  glands  of  the  neck,  and  media- 
stinum. 

Petruschky  laid  the  commencement  of  phthisis  in 
childhood ;  scrofulous  glands  indicated  it.  Timely 
and  efficient  tuberculin  treatment  gave  a  prospect  oi 
recovery. 

Wassermann  held  tubercle  in  the  veins  to  be  acci- 
dental. In  a  case  in  his  own  practice  the  cervical 
glands  were  first  diseased  and  later  on  pulmonary  con- 
sumption set  in. 

Lugenbuhl  did  not  understand  what  Petruschky 
meant,  and  the  latter  explained  that  tuberculoos 
women   might   get  over   their   confinements  withont 


Nov.  9,  1904. 


AUSTRIA. 


The  Medical  Press.    49^ 


danger,  and  that  prophylactic  treatment  of  young 
children  wth  tuberculin  might  enable  them  to  avoid 
grave  tuberculosis  in  their  offspring. 

In  the  Section  for  Gynaecology,  Hr.  Schenck  de- 
scribed his 

Comparative  Examination  of  Blood. 
He  could  prove  that  the  resorption  of  tissue  elements 
during  involution  of  the  uterus  played  a  part.  He  was 
also  able  to  recognise  a  distinction  between  the  strepto- 
cocci of  the  normal  lochia  and  the  streptococcus 
pyogenes.  The  difference  was  morphological,  and 
also  in  staining  characteristics  and  culture.  Polano, 
Wurzburg,  found,  contrary  to  the  general  assumption, 
that  in  the  human  subject  the  antitoxin  passed  from 
the  mother  to  the  foetus  through  the  placenta,  and 
that  this  was  the  case  in  both  active  and  passive  immu- 
nisation. Living  cells  were  not  bound  by  simple 
physical  laws,  and  he  instanced  the  varied  composition 
of  the  chemical  elements  of  the  protoplasm  in  the 
different  parts  of  the  body. 

Veronal  Poisoning. 

Three  cases  are  reported  by  Dr.  P.  A.  Fenger  Just 
{Deutsch.  med,  Zeit,,  Bd.  83,  1904).  The  first  was  that 
of  a  woman,  aet.  25,  who  for  sleeplessness  had  taken 
various  hypnotics  without  any  special  result.  She 
took  then,  in  the  evening,  7^  grains  of  veronal  for  a 
week  together,  with  eight  hours'  restful  sleep.  After 
the  ninth  dose  she  had  a  heat  and  such  itching  about 
the  ears,  arms,  and  legs  that  she  could  not  stay  in  bed. 
There  was  thirst,  and  then  a  rash  of  confluent  reddish- 
violet  spots  all  over  the  body,  which  disappeared  in 
ten  days. 

Case  2  was  also  one  of  a  neurasthenic  single  woman, 
aet.  28.  A  dose  of  7}  grains  of  veronal  for  six  nights 
in  succession  acted  well,  but  the  seventh  was  followed 
by  symptoms  similar  to  those  described  in  the  preceding 
case. 

The  third  case  was  that  of  a  woman,  aet.  52,  who  had 
liad  an  abscess  opened  in  the  right  hypochondrium, 
from  which  a  large  quantity  of  stinking  pus  was 
evacuated.  Being  sleepless,  she  was  given  7}  grains  of 
veronal  every  evening  for  five  evenings  ;  then  for  two 
evenings  3J  grains  were  given,  and  after  the  second 
the  same  itching  and  rash  appeared.  In  three  days  it 
was  gone. 


austtfa. 


[from  our  own  correspondent.] 

Vienna,  November  5th,  19W. 
Hepatic  Cirrhosis. 
At    the    Naturforscher    meeting,    Kretz    gave    an 
exhaustive  description  of  the  various  causes  of  hepatic 
cirrhosis   which  may  be  concisely  stated  in  the  shape 
of  a  few  axioms  : — 

1.  Interstitial  hepatitis  does  not  produce  granular 
cirrhosis  of  the  liver,  but  parenchymatous  changes 
from  repeated  attacks  and  recovery  lead  to  degenera- 
tive cirrhosis. 

2.  The  elastic  fibres  gradually  disappear  from  the 
fibrous  tissue  of  the  organ,  leaving  the  vessels  supported 
by  the  hard  degenerated  pa  enchyma  of  the  organ. 
The  arterial  portion  of  the  liver  is  not  the  first  portion 
to  be  attacked  b.t  is  gradually  invaded  from  the 
parenchymatous  centre. 

3.  In  his  third  section  he  laboured  the  question  of 
hepatic  cirrhosis  being  a  morbid  entity,  or,  in  other 
words,  having  a  specific  virus.  He  contended  that  it 
was  not,  as  it  depended  upon  cell  degeneration  for  its 
origin  ;  these  degenerated  cells  localised  themselves, 
forming  a  neoplasm,  which  finally  invaded  the  whole 
organ,  subsequently  displacing  the  whole  of  the 
healthy  tissue. 

The  etiology  of  the  disease  depended  on  all  the  causes 
that  produced  degenerative  chang^  in  the  parenchyma, 
such  as  poisons,  imperfect  metabolism,  bacterial  action, 
&c.  There  is  also  another  source  of  injury  to  the 
hepatic  cells  through  the  haematic  circulation  or  the 
capillaries  of  the  gall-ducts. 


Naunyn  thought  these  different  forms  of  cirrhosis 
could  not  be  diagnosed  with  any  hope  of  accuracy, 
although  for  classification  pathologically  he  would 
willingly  arrange  them  as  incipient  cirrhosis,  atrophic 
or  ascetic  cirrhosis,  biliary  or  hypertrophic  cirrhosis, 
and  Eantic  or  hypersplenic  cirrhosis.  These  different 
forms  of  cirrhosis  do  not  depend  upon  the  different 
causes  of  the  morbid  process,  but  rather  on  the  com- 
plications of  cirrhotic  cholangitis,  which  may  be  con- 
sidered an  intestinal  ascending  cholangitis,  which  is 
not  the  direct  cause  of  the  disease  but  a  factor  leading 
to  the  morbid  process.  The  differential  diagnosis  of 
intestinal  and  splenic  cirrhosis  is  not  clearly 
established,*  although  the  haemogenic  form  is  conceiv- 
able and  logical,  in  the  latter  case  haemolysis  plays 
an  active  part  in  the  cirrhogenic  cholangitis,  which 
may  be  termed  descending  cholangiolitis. 

The  symptoms  of  this  disease  are  sometimes  obscure, 
owing  to  the  variety  of  disturbances  affecting  the  func- 
tion of  the  liver.  Alimentary  levulosuria  is  a  doubtful 
condition  as  we  do  not  yet  know  exactly  whether  the 
sugar  is  directly  taken  from  the  blood.  The  diagnosis 
of  cirrhosis  depends  chiefly  on  the  anatomical  changes. 
Leichtenstein  was  the  first  to  announce  that  cirrhosis 
of  the  liver  was  preceded  by  enlargement  of  the  spleen, 
and  that  cirrhosis  of  the  liver  never  preceded  this  con- 
dition, but  later  investigation  has  proved  that  the  early 
stage  of  the  disease  has  the  hardened  condition  of  the 
liver  as  early  as  it  can  t>e  distinguished  in  the  spleen. 
Banti's  cirrhosis  has  nothing  specific  to  distinguish  it, 
as  the  large  spleen,  anaemia  and  haemorrhagic  diathesis 
are  common  to  all  the  forms  of  the  disease,  although  age 
may  be  suspected  ais  an  important  factor  in  the  de- 
velopment of  the  hypersplenic  form,  which  has 
strangely  been  called  pseudo-Banti's  disease,  appa- 
rently depending  upon  a  toxaemic  albuminoid  which  is 
cured  by  extirpation  of  the  spleen.  Closer  inspection 
of  the  anatomy  shows  that  this  form  of  cirrhosis  is 
not  the  genuine  hepatic  hardening,  but  only  an  in- 
creased growth  of  the  hepatic  cells  in  the  acini.  This 
condition,  he  affirmed,  often  took  place  in  cases  of 
lithiasis  or  after  hepatic  colic.  He  was  inclined  to 
believe  in  the  cause  being  an  infectious  inflammation 
of  the  gall-duct  as  cholangitis  cirrhotica  was  a  frequent 
and  important  co.nflicationin  the  symptoms  commenc- 
ing w^ith  fever,  vomiting,  and  icterus.  He  could  not 
accept  cholangitis  ascendens  as  a  cause  of  cirrhosis  as 
the  transformation  of  cholelithiasis  into  cirrhosis  has 
never  been  observed.  In  his  opinion  the  etiology  of 
cirrhosis  was  alcohol,  which  may  sometimes  be  asso- 
ciated with  lues,  typhoid,  and  the  puerperium.  The 
changes  observed  in  the  bowel  and  spleen  by  Bleich- 
roder  are  not  specific  symptoms,  but  are  common  to 
all  hepatic  changes.  Neither  can  the  blood  be  used 
for  diagnostic  purposes  as  no  specific  blood  change  can 
be  defined,  yet  we  are  unable  to  deny  the  possibility  of 
a  haematogenic  origin  as  the  toxin  ^i  may  pass  from  the 
bowel  into  the  haematic  circulation  and  produce  irre- 
parable damage  to  the  follicles  of  the  corpuscle,  which 
may  be  one  explanation  for  Kretz  regularly  finding 
"  haemachromatose  "  in  the  liver.  It  is  common  know- 
ledge, however,  that  alcohol  injures  the  erythrocytes 
of  the  blood  and  retains  them  in  the  liver  till  they 
become  destroyed,  leaving  the  debris  in  the  organ  as  a 
centre  of  destruction. 

Aufrecht  wished  it  to  be  clearly  understood  that 
interstitial  inflammation  did  not  exist  in  cirrhosis,  but 
only  an  apparent  increase  of  the  fibrous  tissue  owing 
to  the  solution  of  the  acini,  which  gave  the  section  of  a 
cirrhotic  liver  a  smooth  appearance.  He  gave  it  as 
his  opinion  that  the  initial  stage  of  cirrhosis  could  not 
be  diagnosed  as  many  simple  enlargements  disappear 
quite  easily  without  any  evil  consequences,  although 
others  may  end  in  acute  atrophy  and  beco.ne  decidedly 
cirrhotic. 

Chiari  directed  the  attention  of  the  members  to  the 
enormous  growth  of  the  parenchyma  in  cirrhotic  con- 
ditions. It  was  never  constant  in  quantity,  but  varied 
considerably  as  clinical  differences  went  to  prove.  In 
addition  to  this  there  was  often  a  secondary  inter- 


49^    The  Mbdical  Pkess. 


THE    OPERATING    THEATRES. 


stitial  process.  He  related  a  numDer  of  cases  that 
ended  fatally  in  necrosis. 

Bebes  showed  a  photograph  of  a  primary  parenchy- 
matous centre,  which  partiaPy  passed  through  secon- 
dary degeneration. 

Bleichroder  related  the  results  of  his  histological 
examination  of  the  stomach,  bowel,  spleen,  and  marrow 
in  hepatic  cirrhosis,  whicn.  he  said,  resembled  perni- 
cious anaemia  in  every  detail. 

Freymouth  said  that  he  once  diagnosed  a  case  of 
incipient  cirrhosis  after  having  performed  laparotomy 
for  a  neoplasm  in  the  liver  I 

Steinberg  disagreed  with  Bleichroder's  conclusions 
as  the  breaking  down  of  the  lymphocytes  in  the  blood- 
vessels or  the  changes  in  the  fibrous  cells  could  not  be 
shown. 

Hansemann  said  that  he  had  seen  two  cases  of  cir- 
rhosis that  had  arisen  from  inflammation  of  the  gall- 
ducts.  He  was  not  a  believer  in  the  alcoholic  etiology 
of  cirrhosis  because  many  men  and  women  drank  to 
excess  and  no  cirrhosis  ever  occurred. 


Nov.  9,  19C4. 


[from  our  own  correspondent.] 

BuDAPMT.  NoTemher  6th,  1004. 

At  the  October  meeting  of  the  Interhospital  Medical 
Association,  held  here,  Dr.  T.  G^p^r  introduced  the 
subject  of 

Early  Diagnosis  in  Mental    Diseases. 

He  defined  insanity,  according  to  Burr,  as  a  "  {xro- 
longed  departure  from  the  individual's  normal  standard 
of  thinking,  feeling,  and  acting."  A  comprehensive 
definition  would  include  ment.-il  defect  from  whatever 
cause,  and  mental  perturbation  of  whatever  dec;ree. 
Any  or  all  of  the  elemental  processes  of  sensation, 
perception,  ideation,  reasoning,  judgment,  memory, 
may  be  impaired  in  insanity.  In  his  paper,  the  nature 
and  degree  of  impairment  of  these  elemental  processes 
and  of  emotion  and  volition  in  different  forms  of 
insanity,  were  touched  upon.  Subjects  discussed  at 
greater  length  were  the  distinction  between  confirmed 
inebriety  and  true  insanity  of  alcoholic  origin ;  the 
differential  diagnosis  of  alcoholic  pseudoparesis  and 
paretic  dementia ;  certain  phases  of  hysteria,  and  the 
diagnostic  difficulties  pertaining  to  paranoia  and  re- 
current mania.  Neurasthenia  was  a  euphemism  often 
employed  to  obviate  the  necessity  of  plain  speaking,  or 
might  be  used  erroneously  to  explain  symptoms  in  the 
early  stages  of  an  organic  malady.  The  self- deception 
on  the  part  of  the  physician  or  his  inaccuracy  in  dia- 
gnosis led  to  improper  methods  of  management,  and 
the  prescription  of  travel  often  n>ade  for  such  patients 
was  deplored  and  incidentally  hospital  care  for  neuras- 
thenic cases  was  advised. 

Dr.  Makkay  delivered  an  address  on  the 
Prevention  of  Heart  Diseases. 

He  discussed  in  what  manner  the  principles  of  pre- 
vention could  be  applied  to  various  heart  affections. 
He  regarded  the  removal  of  all  chronically  diseased 
tonsils  (this  was  first  recommended  by  Dr.  R.  Babcock, 
of  Chicago)  as  of  the  utmost  importance  in  all  persons 
who  had  once  had  an  attack  of  inflanmiatory  rheuma- 
tism, whether  the  heart  had  been  damaged  or  not.  If 
infection  could  be  prevented,  cardiac  inflammation 
could  likewise  be  obviated.  This  statement  applied 
to  other  affections  than  rheumatism.  He  then  men- 
tioned syphilis  and  gonorrhoea,  saying  that  these 
diseases  sometimes  attacked  the  cardiac  structures. 
Pneumonia,  chorea,  scarlatina,  are  sometimes  accom- 
psmied  or  followed  by  acute  or  chronic  endocardial 
mischief,  while  influenza  or  diphtheria  may  attack 
the  myocardium  in  an  inflammatory  way,  so  as  to 
seriously  impair  its  integrity.  Until  we  could  prevent 
such  infections,  we  could  not  guard  against  the  cardiac 
structures  being  attacked.  The  author  discussed 
chronic  myocardial  diseases,  the  toxic  influence  of 
syphilis,  alcohol,  and  chronic  lead  poisoning,  fatty 
heart,  and   particularly  cardiac   overstrain,   as   it   is 


observed  in  the  young,  and  sometimes  in  the  ^uddl^ 
aged,  and  apparently  healthy,  as  the  result  of  excesave 
physical  exertion,  and  mentioned  tvpical  examples  of 
this  kind. 

Hereditary  Syphilis. 
Dr.  Justus  has  said  that  the  symptoms  of  hereditarr 
sjrphilis  are  generally  manifest  at  birth,  or  appear 
within  the  first  two  or  three  months.  They  are  the 
sanie  as  in  the  acquired  disease  of  adults,  but  difler  in 
their  sequence,  and  in  the  regularity  of  their  appear- 
ance. In  tardy  hereditar>-  syphilis,  tertiary  signs  may 
make  their  appearance  as  late  as  the  twentieth  year. 
He  divides  these  cases  into  two  classes.  vU.,  where 
syphilitic  manifestations  were  present  in  earliest  yonth 
and  had  disappeared  with  proper  treatment ;  and, 
secondly,  where  these  late  signs  gave  the  first  suspicion 
of  infection.  This  class  is  not  recognised  by  many 
syphilographers  ;  however,  two  undoubted  cases  were 
described  by  Continental  authors.  It  generally  appears 
as  a  bilateral  aflection  of  the  knees,  either  an  arthralgia, 
a  simple  chronic  hydrops,  a  syphilitic  tumour  albas,  or 
a  deforming  arthritis.  It  is  often  extremely  difficalt 
to  diagnose,  but  if  no  direct  history  is  present,  anti- 
syphilitic  treatment  should  be  resorted  to  in  aQ 
symmetrical  cases,  which  resist  other  measures,  espe- 
cially if  there  are  marked  fluctuations  in  the  course. 
Often  the  presence  of  a  parenchymatous  keratitis  viU 
assist  diagnosis. 


XTbe  Operating  Zbcatvcs. 

ST.  THOMAS'S  HOSPITAL. 
Operation  for  Perforated  Gastric  Ulcer.— 
Mr.  Battle  operated  on  a  man.  act.  52,  who 
had  been  under  the  care  of  his  colleague.  Dr. 
Hector  Mackenzie.  The  patient  had  been  com- 
plaining of  stomach  symptoms  for  two  or  three 
years,  and  had  been  admitted  under  the  care  of 
Dr.  Mackenzie  for  an  increase  of  these  sjrmptoms. 
which  led  to  the  diagnosis  of  simple  ulcer  of  the  stomach 
situated  near  the  pyloric  extremity  associated  with 
dilatation  of  that  organ.  The  man  complained  of  a 
good  deal  of  epigastric  pain  and  of  vomiting,  the  quan- 
tity of  material  brought  up  being  rather  large,  and 
three  days  before  operation  he  had  been  put  on  rectal 
feeding,  because  his  pain  had  been  so  severe.  At  ten 
o'clock  on  the  previous  night  he  had  complained  of 
increase  in  the  pain,  and  had  become  much  worse. 
When  seen  shortly  before  operation  he  was  lying  on 
his  back,  with  a  pale  face  and  distressed  expression, 
breathing  rapidly,  but  not  employing  his  diaphragm 
or  abdominal  muscles  more  than  was  absolutely  neces- 
sary. He  had  much  abdominal  pain,  chiefly  in  the 
upper  part  of  the  abdomen.  On  examination,  the 
latter  was  found  to  be  slightly  distended,  rigid  and 
without  movement  on  respiration.  It  was  tender 
on  pressure,  and  there  was  evidence  of  considerable 
fluid  throughout,  both  in  the  flanks  and  above  the 
pubes.  The  liver  dulness  was  not  lost,  nor  was  there 
evidence  of  free  gas  in  the  peritoneum.  Operation 
was  performed  about  eighteen  hours  after  the  time  of  the 
probable  perforation.  A  median  incision  was  fast 
made  in  the  epigastric  region  ;  on  opening  the  peri- 
toneum a  large  quantity  of  sour-smelling  greenish  fluid 
escaped.  The  omentum  and  lower  margin  of  the 
stomach  were  attached  to  the  under  surface  of  the  liver 
by  means  of  recent  exudation,  but  these  attachments 
separated  directly  the  finger  encountered  them  as  it  was 
passed  towards  the  pyloric  end  of  the  stomach  in 
search  of  the  perforation  or  of  evidence  of  chronic 
thickening.     At  this  point  there  was  an  escape  of  free 


Nov.  9,  1904. 


THE    OPERATING    THEATRES. 


The  Medical  Press.    493 


gas.  The  finger  readily  located  the  ulcer,  the  opening 
being  so  large  that  the  end  of  the  finger  could  be  easily 
passed  through  it  into  the  stomach ;  its  margin  was 
very  sharply  cut,  and  the  area  of  induration  extended 
for  about  an  inch  and  a  half  around  it.  The  stomach 
was  dilated.  The  pyloric  end  was  drawn  forward  and 
held  in  position  by  Mr.  Birks,  the  house  surgeon, 
whilst  sutures  were  inserted.  On  account  of  the  size  of 
the  ulcer  two  sutures  were  passed  to  approximate  the 
edges  of  the  perforation  ;  then  a  row  after  Lambert's 
method  to  cover  it  over  completely,  and  finally  an 
additional  suture  to  take  off  some  of  the  tension,  which 
seemed  to  try  some  of  the  second  row  of  stitches. 
The  silk  employed  was  No.  2,  because  it  was  found  that 
smaller  sizes  than  this  cut  their  way  out  at  once. 
Another  opening  was  made  in  the  middle  line  above 
the  pubes  and  the  whole  peritoneal  cavity  thoroughly 
cleansed  with  warm  saline  solution  until  the  liquid  no 
longer  had  any  colour  or  sour  smell.  The  fluid  which 
had  escaped  in  the  first  instance  from  the  perforation 
must  have  amounted  to  several  pints,  as  it  filled  the 
pelvis  and  the  flanks,  and  had  collected  to  a  large 
amount  in  the  splenic  region  and  about  the  right  lobe 
of  the  liver.  The  upper  wound  was  closed  in  three 
layers  by  means  of  interrupted  sutures,  whilst  a 
drainage-tube  was  left  in  the  pelvis,  coming  out  through 
the  lower  wound.  Towards  the  end  of  the  operation 
the  patient's  pulse  failed  somewhat  and  he  began  to 
show  signs  of  collapse ;  an  infusion  into  the  left  arm 
of  two  pints  of  normal  saline  improved  his  condition 
rapidly,  and  he  soon  recovered.  Mr.  Battle  pointed 
out  that  the  ulcer  had  been  found  in  the  position 
where  the  physician  had  diagnosed  its  presence,  and 
the  other  conditions  were  as  expected  ;  the  only  un- 
usual thing  about  the  case,  he  thought,  was  the  large 
size  of  the  opening  into  the  stomach  and  its  extremely 
sharp-cut  cicatricial  edges.  The  diagnosis  even  in  the 
absence  of  proof  of  free  gas,  he  said,  was  quite  easy, 
and  the  patient  was  already  in  an  exceptionally  good 
condition  as  the  result  of  nearly  three  days'  treatment 
by  rectal  feeding.  The  ulcer,  together  with  the  in- 
flammatory swelling  round  it,  did  not  appear  to  actually 
obstruct  the  pylorus,  but  was  close  to  it,  and  there  was 
no  donbt  that  obstruction  had  been  present,  as  was 
shown  by  the  dilated  condition  of  the  stomach,  for 
which  he  thought  it  might  possibly  be  necessary  to  do 
a  gastro-enterostomy  at  a  later  date. 

The  operation  relieved  the  man  at  once,  his  pain  being 
completely  gone  when  he  recovered  consciousness,  and 
since  that  time  he  has  progressed  most  favourably. 

GREAT  NORTHERN  HOSPITAL. 

Suprapubic  Cystotomy. —  Hour-glass  Bladder. 
— ^Mr.  Peyton  Beale  operated  on  a  man.  aet.  54,  whose 
history  was  as  follows  :  He  was  a  shunter  in  the  employ 
of  the  Great  Northern  Railway,  and  had  been  able  to 
work  until  about  six  months  ago,  when  he  complained 
of  pain  in  the  left  loin  extending  to  the  abdomen  and 
to  the  left  leg  ;  he  also  passed  some  blood  with  his 
urine,  and  was  treated  by  a  doctor  for  stone  in  the 
left  kidney.  He  was  sent  to  the  hospital  by  Dr. 
G.  R.  Williams.  On  examination  under  an  anaesthetic 
a  sound  was  passed  into  the  bladder  as  a  routine  process, 
and  after  some  slight  obstruction  had  been  encountered 
about  the  membranous  urethra  a  stone  was  easily  felt 
lying  at  the  base  of  the  bladder,  not  encysted  ;  one  or 
more  smaller  stones  were   also   to  be   felt.     It  was 


noticed  that  the  capacity  of  the  bladder  was  small, 
and  it  was  known  that  the  man  had  increased  frequency 
of  micturition  and  passed  only  three  or  four  ounces  of 
urine  at  a  time  ;  but  these  being  not  unusual  symptoms 
injconnection  with  stone  or  stones  in  the  bladder, 
nothing  much  was  thought  of  them.  On  abdominal 
palpation  there  was  nothing  to  indicate  any  derange- 
ment of  the  left  kidney.  As  there  had  clearly  been 
some  old  urethral  trouble  whereby  the  urethra  would 
only  now  admit  a  No.  6  instrument,  it  was  thought 
advisable  to  perform  suprapubic  cystotomy  in  pre- 
ference to  a  perineal  operation.  A  few  days  later, 
therefore,  suprapubic  cystotomy  was  performed,  a 
Lister's  sound  having  been  introduced  into  the  bladder 
and  the  stone  again  detected.  The  bladder  was  easily 
reached  and  at  once  recognised  ;  but  in  a  higher  posi- 
tion than  was  expected  from  its  apparent  size  at  the 
first  sounding.  The  bladder  was  opened  and  was 
found  to  contain  no  urine,  nor  could  the  sound  and 
stone  be  detected  in  it.  On  further  examination  the 
instrument  and  stone  could  just  be  reached  by  the  tip 
of  the  forefinger  very  deep  down  in  the  pelvis.  It  was 
then  evident  that  this  latter  was  the  functional  bladder, 
and  that  the  large  cavity  above  was  completely  shut 
off  from  it.  It  should  be  remembered,  Mr.  Beale  now 
pointed  out,  that  previous  attempts  at  distending  the 
bladder  by  fluid  injections  had  been  quite  unsuccessful- 
As  the  portion  of  bladder  containing  the  sound  and 
stone  could  not  be  reached  through  the  suprapubic 
wound  sufficiently  to  enable  the  stone  to  be  satisfac- 
torily dealt  with,  the  upper  part  of  the  bladder  was 
stitched  up  and  the  abdominal  wound  closed  in  the 
usual  way.  Mr.  Beale  said  that  the  case  was  interesting 
for  two  reasons  :  First,  because  all  the  man's  sym- 
ptoms pointed  to  a  derangement  of  the  left  kidney. 
In  all  urinary  cases  he  considered  it  advisable  always 
to  examine  the  patient  under  an  anasthetic  and  ex- 
plore the  bladder  at  the  same  time,  because  it  was  a 
very  noticeable  fact  that  a  stone  might  exist  in  the 
bladder  for  a  long  period  without  giving  rise  to  classical 
symptoms.  Secondly,  the  hour-glass  contraction  was 
of  interest ;  such  cases,  he  thought,  were  very  difficult 
to  deal  with,  for  when  the  stone  was  lying  in  a  small 
bladder  lithotrity  was  not  desirable  even  if  the  urethra 
was  normal.  By  suprapubic  cystotomy  it  was  often, 
as  in  this  case,  he  said,  not  possible  to  remove  the 
stone  satisfactorily;  and  in  his  experience  if  perinra^ 
section  or  lithotomy  were  performed  a  permanent  fistula 
was  a  very  common  complication,  due  apparently  to 
the  fact  that  the  small  bladder  continually  expelled 
the  urine  as  it  entered  it  and  allowed  little  if  any 
of  the  fluid  to  accumulate  in  it. 


The  Boyml  Vnlvwnity  of  Ireland. 

At  a  meeting  of  the  Senate,  on  Thursday,  October  27  th, 
the  results  of  the  recent  examinations  were  received 
and  Honours  exhibitions  and  prizes  awarded.  It  was 
resolved  that,  subject  to  certain  restrictions,  the 
books  in  the  University  library  and  the  University 
grounds  should  be  made  available  for  graduates  of 
the  University  during  portions  of  the  year. 

The  following  have  received  the  M.D.  Degree : — 
George  Adams  Hicks,  M.B.,  B.Ch.,  B.A.O.,  Daniel  Lee, 
M.B..  M.Ch.,  M.A.O.,  John  Elder  Macllwaine,  M.B., 
B.Ch.,  B.A.O.,  Michael  Joseph  Mahony.  M.B.,  B.Ch.. 
B.A.O.,  John  Hope  Reford,  B.A.,  M.B..  B.Ch.,  B.A.O., 
John  Stewart  Ferguson  Weir,  M.B.,  B.Ch.,  B.A.O. 


494    Thb  Medical  Press 


LEADING   ARTICLES. 


Nov.  9,  1904. 


BMismtsD  FOB  TsAHixianox  AnoAv. 

^be  Ae&tcal  press  an&  Circular. 

PublJihed  every  Wedneedaj  morainir,  Prioe  6d.      Poet  free,  5id. 

ADTBBTIBBMEim. 
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£2  lOe.  Od.  ;  Quarter  Page,  £1  6e.  Od. ;  One^ghth,  12a.  Od. 

Oonsklerable  Reductions  from  the  foregoing  scale  are  made  wfaea 
an  order  is  given  for  a  series  of  insertions.  Terms  on  applica- 
tion to  the  Publisher. 

Small  announcements  of  Practices,  Assistanoies,  Vacancies,  Books, 
Ac.— Seven  lines  or  under  (70  words),  4s.  Od.  per  insertion  ; 
Cd.  per  line  beyond. 

BUBSOBIPTIOire. 

SubscripUons  may  commence  at  any  period  of  the  year.  If  paid  in 
advance  the  cost  is  only  21s.  per  annum,  post  free.  An  edition 
is  printed  on  thin  plate  paper  for  foreign  and  Ck>loDial  sub- 
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28s.  6d.  credit  rate. 


XTbe  AeMcal  pre^s  an&  Circular* 


SALUS  POPULI  SUPREMA  LEXJ 


WEDNESDAY,  NOVEMBER  9,  1904, 


THE  SMALL  HOSPITALS  AND  THE  FUNDS. 
The  smaller  hospitals  of  the  Metropolis,  and 
to  a  less  extent  of  the  provinces,  have  during 
recent  years  been  faced  with  increased  difficulties 
in  maintaining  their  existence.  The  struggle  has 
been  no  doubt  partly  due  to  the  scarcity  of  money 
which  has  resulted  from  depressed  trade  and 
depleted  national  wealth.  Another  cause  has 
been  the  diversion  of  huge  sums  of  money  in 
answer  to  appeals  issued  to  the  public  by  the 
great  general  hospitals  one  after  the  other, 
in  some  cases  to  be  repeated  after  a  few  years* 
interval.  The  chief  cause  of  the  decline  of  the 
small  hospitals,  however,  has  in  all  probability 
been  the  policy  of  the  Sunday  and  the  King 
Edward's  Hospital  Funds,  which,  whether  inten- 
tionally or  otherwise,  has  resulted  in  the  with- 
holding of  grants  and  injury  to  the  reputation  of 
a  host  of  small  but  deserving  medical  charities. 
The  relation  of  the  lesser  hospitals  to  the  Funds 
is  peculiar.  When  the  Funds  were  started  as 
collecting  and  distributing  agencies,  the  small 
hospitals  sacrificed  the  income  derived  from 
special  collections  in  places  of  worship.  They 
next  lost  the  support  of  many  subscribers  who 
withdrew  or  refused  subscriptions  on  the  ground 
that  they  contributed  to  the  Funds.  Finally, 
the  Hospital  Sunday  and  the  King  Edward's 
Hospital  Fund  have  in  many  cases  refused  grants 
to  small  hospitals.  It  will  be  seen,  therefore, 
that  in  this  case  the  poor  hospital  has  lost  much 
and  gained  nothing.  Furthermore,  the  refusal 
by  a  Fund  of  a  grant  to  any  particular  hospital  is 
looked  upon  by  the  general  public  as  a  slur  upon 
the  character  of  that  institution.  So  that  loss 
of  character  as  well  as  of  income  is  the  inevitable 


fate  of  the  small  hospitals  under  the  Fund 
methods  of  distribution  of  alms.  In  othsr 
words,  the  days  of  the  small  hospital  are  numbered 
under  the  control  of  the  Funds.  We  venture  to 
assert  that  this  result  is  due  to  the  deliberate 
policy  of  those  who  administer  these,  aod 
was  never  contemplated  by  the  public  whose 
money  had  previously  been  given  freely  to  the 
medical  charities^  great  and  small.  It  is  necessair 
here  to  state  clearly  that  the  Hospital  Saturday 
Fund  supports  loyally  and  consistently  the  smaller 
hospitals.  The  Saturday  Fund  is  controlled 
mainly  by  representatives  from  the  hospitals  and 
from  the  classes  who  are  benefited  by  the  hos- 
pitals, and  they  are  accordingly  from  that  point 
of  view  pecuharly  fitted  to  judge  what  chairitie 
do  and  do  not  deserve  support.  We  find  the 
Saturday  Fund  extending  the  hand  of  practical 
sympathy  and  help  to  the  smaller  hosiHtals, 
whereas  the  sister  Funds  have  to  a  great  extent 
taken  away  both  income  and  character.  Which 
is  right,  the  Hospital  Saturday  on  the  one  hand, 
or  the  Hospital  Sunday  and  the  King  Edward's 
Funds  on  the  other  ?  The  administration  of  all 
these  Funds  is,  happily,  in  the  hands  of  honouraUe 
men;  but  while  that  of  the  Saturday  Fund,  as 
already  pointed  out,  is  democratic,  that  of  the 
other  two  may  be  termed  aristocratic  and  even 
autocratic.  The  latter  term  may  sound  hanb. 
but  it  is  not  easy  to  find  any  adequate  alterna- 
tive to  express  the  policy  of  a  Fund  that 
deprives  small  hospitals  both  of  income  and  of 
character  without  clearly  stating  the  principles, 
general  and  particular,  upon  which  their  action 
is  based.  The  principles  of  the  Hospital  Sunday 
and  the  King  Edward's  Funds  cannot  be  gauged 
from  ordinary  observation  and  reasoning.  If 
there  be  one  principle  paramount  in  those  Funds 
it  is  the  advocacy  of  payments  by  hospital  patients. 
If  the  principle  be  right,  it  follows  that  the  hospital 
which  receives  the  greater  part  of  its  costs  of 
treatment  from  patients  is  the  better  hospital 
Yet  the  Funds  deny"  grants  to  institutions  where 
patients'  payments  exceed  a  certain  proportion  of 
income.  The  economy  with  which  a  hospital  k 
managed  and  the  smallness  or  absence  of  debt 
appear  not  to  influence  grants  except  perhaps  in 
inverse  proportion.  Why  should  not  the  small 
hospitals  and  the  poorer  classes  be  adequately 
represented  on  the  Hospital  Sunday  and  the  King 
Edward's  Funds  as  they  are  on  the  Hosptal 
Saturday  Fund  ?  Far  be  it  from  us  to  say  one 
word  against  the  good  faith  and  the  immaculate 
honour  of  both  those  Funds.  They  are  pubhc 
bodies,  however,  and  are  therefore  open  to 
criticism.  We  are  no  less  willing  to  praise  their 
virtues  than  we  are  ready  to  criticise  their  defects. 
The  faults,  we  believe,  may  readily  be  remedied. 
Our  great  and  wise  King,  who  created  one  of  these 
bodies,  may  with  a  stroke  of  the  pen  revise  the 
constitution  of  his  Hospital  Fund,  so  as  to  make 
it  more  generally  representative  of  all  classes, 
and  at  the  same  time  remove  w^hat,  in  onr 
opinion,  constitutes  a  grave  injustice  to  the  smaD 


Nov.  9,  1904. 


LEADING   ARTICLES. 


Th»  Medical  Press.    495 


hospitals,  which  are  in  many  instances  carefully 
administered,  ably  officered  and  old-established 
institutions,  invaluable  alike  to  the  public  and  to 
the  medical  profession. 


THE  VITAL  STATISTICS  OF  IRELAND. 
The  fortieth  report  of  the  Registrar-General 
for  Ireland,  which  has  recently  been  issued, 
does  not  show  any  new  factor  influencing 
the  population,  which  continues  to  decrease 
in  practically  the  same  proportion  as  during  the 
past  ten  years.  The  total  number  of  births  last 
year,  presenting  precisely  the  same  rate  per 
thousand  of  the  population  as  the  average  for 
the  past  ten  years,  was  101,831,  exceeding  the 
number  of  deaths  by  24,473.  This  shows  a  fair 
natural  increase  in  the  population,  but,  unfortu- 
nately, it  is  more  than  counterbalanced  by  the 
loss  through  emigration,  amounting  to  39,789. 
It  wUl  be  seen  that  the  decreasing  population  is 
not  due  to  any  vital  causes,  but  to  economic 
and,  as  some  hold,  to  sentimental  ones.  There  is 
little  doubt  that  the  economic  position  of  Ireland 
is,  during  the  last  few  years,  improving,  so  that 
it  is  disappointing  that  the  emigration  figures 
are  as  high  as  ever.  Trade  in  both  large  and 
small  towns  is  livelier  than  in  the  eighties,  agri- 
culture is  conducted  by  more  intelligent  methods, 
and  the  settlement  of  the  land  question  gives 
the  occupier  an  interest  in  his  toil  he  never  had 
before.  Nevertheless,  the  steady  drain  of  the 
best  blood  of  Ireland  continues  from  Derry  in 
the  North  as  from  Queenstown  in  the  South. 
It  is  truly  an  appalling  fact  that  every  year  the 
loss  by  emigration  is  more  than  half  that  by 
death.  Under  the  circumstances  it  is  matter 
for  surprise  that  the  death-rate  is  so  moderate 
as  we  find  it — last  year  17^  per  thousand — 
since  it  is  the  young  and  strong  who  go,  and 
the  old  and  infirm  who  stay.  Melancholy 
reading  as  is  the  Report  as  a  whole,  there  are 
yet  some  points  of  relief.  The  vitality  of  the 
people  is  by  no  means  low,  as  evidenced  by  the 
high  birth-rate  taken  in  proportion  to  the  marriage- 
rate,  and  it  is  probably  some  evidence  of  prosperity 
that  the  latter  shows  during  the  past  few  years 
a  steady  increase.  The  number  of  persons  married 
as  minors  is  very  small — of  men,  1*57  per  cent., 
of  women,  650 — and  is  in  marked  contrast  to 
the  numbers  noted  in  industrial  populations.  The 
rate  of  illegitimate  births  shows  a  similar  con- 
trast. The  percentage  of  children  bom  out- 
side wedlock  is  only  26,  varying  from  0-5  in  the 
agricultural  population  of  Connaught  to  S'3  i^ 
partially  industrial  Ulster.  A  point  of  interest 
in  the  fist  of  certified  causes  of  death,  showing, 
too,  the  remarkable  vitality  of  the  Irish  people, 
is  the  number  of  deaths  returned  as  due  to  "  old 
age,"  many  of  them  at  ages  exceeding  ninety-five 
years,  and  176  at  ages  over  one  hundred.  **  Old 
age,"  indeed,  is  made  accountable  for  the  highest 
number  of  deaths,  with  the  exception  of  tuber- 
culosis. WhUe  in  England  and  Scotland  the 
mortality  due  to  tuberculosis  has  steadily  dimin- 


ished during  the  past  thirty  years,  in  Ireland  it 
has  remained  stationary,  with,  in  late  years,  a 
slight  tendency  to  rise.  The  problem  of  the 
check  of  consumption  is  one  of  the  utmost  public 
importance.  Public  men  are  busy  in  schemes  to 
lessen  Irish  emigration,  and  we  wish  them  every 
success,  but  we  think  that  enough  attention  is 
not  given  to  the  more  easily  preventable  loss  of 
population  by  tuberculous  disease.  A  few,  but 
only  a  few,  boards  of  guardians  are  awake  to 
its  real  importance,  though  the  medical  profession 
does  its  best  to  call  attention  to  the  matter. 
The  death-rate  from  cancer  continues  to  increase 
in  Ireland,  having  reached  its  highest  point  last 
year.  We  think,  however,  that  the  Registrar- 
General  is  right  when  he  points  out  that  the 
increase  is  more  apparent  than  real,  since  diagnosis 
and  classification  are  becoming  more  accurate. 
The  zymotic  death-rate  is,  as  one  would  expect, 
low,  influenza  being  the  most  important  zymotic 
disease  tabulated. 


MILK-BORNE  DISEASE. 
A  CASE  of  the  greatest  interest  to  milk-consumers 
— that  is  to  say,  to  the  whole  British  public— came 
last  week  before  the  courts  of  justice.  The  facts 
disclosed  were  that  a  lady  was  taken  ill  in  July, 
1903,  with  typhoid  fever,  and  eventually  died. 
In  the  district  in  which  she  lived  there  were  at  or 
about  the  same  time  twenty-one  cases  of  the 
disease,  and  twelve  of  these  patients  drew  their 
milk  supply  from  one  dairy.  The  medical  officer 
of  health  made  inquiries  and  he  came  to  the  con- 
clusion that  the  source  of  the  outbreak — at  any 
rate,  as  regarded  the  latter  twelve  cases — was  due  to 
the  milk  they  had  been  drinking.  The  lady's 
husband  brought  an  action  against  the  dairy 
company  for  the  loss  he  had  sustained  by  reason  of 
the  death  of  his  wife  and  for  the  out-of-pocket 
expenses  he  had  incurred  through  her  illness. 
In  evidence  it  was  stated  that  a  case  of  typhoid 
fever  had  occurred  in  a  cottage  connected  with 
one  of  the  farms  whence  the  company  drew  their 
milk,  and  it  was  contended  by  the  plaintiffs  and 
denied  by  the  defendants  that  there  was  sufficient 
evidence  to  connect  this  case  with  the  outbreak 
among  the  consumers.  The  plaintiff's  counsel 
relied  not  only  on  the  general  principle  that  a 
purveyor  is  bound  to  supply  food  that  is  not 
injurious  to  health,  but  also  on  the  special  state- 
ment in  the  company's  advertisements  that  they 
were  in  a  position  to  guarantee  their  milk  to  be 
free  from  disease  germs.  Mr.  Lawson  Walton, 
for  the  defence,  submitted  that  the  evidence 
was  not  sufficient  to  support  the  plaintiff's  con- 
tention, but  the  judge  (Mr.  Justice  Grantham) 
held  that  the  case  was  one  of  fact  and  must  be 
decided  by  the  jury.  Witnesses  were  called  on 
both  sides  to  prove  whether  or  no  the  case  of 
typhoid  at  the  farm  had  any  etiological  relation 
to  the  cases  amongst  the  consumers,  and  eventu- 
ally the  jury  decided  for  the  plaintiff,  only  award- 
ing him,  however,  £106,  the  amount  at  which  they 
assessed   his  out-of-pocket  expenses.     Judgment 


496    The  Medical  Press. 


NOTES    ON    CURRENT    TOPICS. 


Nov.  9,  1904. 


was  therefore  given  for  that  amount  with  costs. 
In  some  ways  it  is  unfortunate  that  the  particular 
company  against  whom  this  verdict  was  given 
should  have  been  the  first  to  suffer  in  an  action  of 
the  kind,  for  they  are  known  to  take  elaborate  pre- 
caution to  guard  their  milk  from  contamination, 
and   it  appears  to  have  been  through  a  breach 
of  their  stringent  rules  that  the  milk  from  this 
farm  ever  got  into  the  general  supply.     Moreover, 
when  suspicion  was  aroused  and  the  circumstances 
were  brought  to  light,  the  milk  from  the  particular 
farm  was  at  once  withdrawn.     There  will  always 
be  a  possibility  of  flaws  in  the  best  organisations, 
and  in  this  case  the  company  had  to  suffer  from  a 
fault  that  could  only  be  indirectly  attributed  to 
them — ^that  is,  assuming  that  the  case  of  typhoid 
at  the  farm  was  really  the  cause  of  the  outbreak. 
As  to  this,  although  the  jury  held  that  it  was  the 
cause,  there  was  a  good  deal  of  conflicting  evidence, 
and  indeed,  in  the  present  state  of  medical  know- 
ledge it  is  seldom  possible  to  establish  an  irre- 
futable chain  of  evidence  in  circumstances  of  the 
kind.     However  hardly  in  this  instance  the  jury's 
verdict  may  press  on  the  company,  we  are  inclined 
to  see  in  the  principle  of  this  action  a  method 
for   solving  the   problem  of  the   present   highly 
unsatisfactory  state  of  the  milk  trade  generally. 
It  has  now  been  held  by  a  judge,  and  confirmed 
by  a  jury,  that  the  sale  of  milk  carries  with  it  an 
implied  warranty  as  to  its   wholesomeness,  and 
that  in  the  event  of  damage  resulting  to  the  con- 
sumer an  action  for  damages  will  lie  against  the 
vendor.     In  the  event  of  disease  arising  from  any 
contamination   of   milk,   any   and   every   person 
injured  thereby  will  hsLve  sl  prima  facie  case  against 
the  purveyor  ;  and  the  recognition  of  this  liability 
by  the  trade  cannot,  one  would  think,  but  tend  to 
make  them  take  their  responsibilities  far  more 
seriously.     As   we  have  more  than  once  pointed 
out,  the  difficulty  in  setting  this  important  trade 
into  satisfactory  order  lies  in  the  multipUcity  of 
hands  through  which  the   milk   passes  before  it 
finds  its  way  into  the  domestic  jug,  and,  where 
responsibility  is  divided,  it  is  notoriously  hard  to 
fix  blame.     Now  that  it  has  been  held  that  the 
vendor  is  the  responsible  party,  he  will  probably 
take  every  care  to  see  that  he  is  not  let  in  for 
expense  and  damage  by  those  from  whom  he  draws 
supplies,   and   thus   the  whole   array   of   agents 
who  have  to  do  with  the  supplies  of  milk — farmers, 
servants,  railway  companies,  and  collectors — ^will 
be  made  aware  of  their  duties  and  responsibilities 
to  the  purveyor  and,  through  him,  to  the  public. 
Our  remarks  do  not  apply  with  any  particular 
force  to  any  particular  dairy  company,  but  to  the 
whole  of  those  persons  handling  milk  who  intervene 
between  the  cow  and  the  consumer.     It  is  aston- 
ishing to  compare  the  energy  with  which  municipal 
authorities  pounce  on  dairymen  who  water  their 
milk  with  the   complaisance  of  those  authorities 
towards  vendors  who  sell  milk  that  is  stale,  dirty, 
and  perhaps  infected  with    disease.     But    what 
legislation  and  administration  have  failed  to  do, 
what  a  sanitary  department  and  a  standing  army 


of  inspectors  have  been  powerless  to  touch,  now 
appears  likely  to  be  accomplished  in  the  near 
future  if  we  are  to  take  this  verdict  as  representing 
the  feeling  of  the  public.  Milk,  which  is  only  pre- 
served from  going  sour  by  the  addition  of  boric 
acid  or  formalin,  and  which  contains  sufficient 
bacterial  products  to  give  diarrhoea  to  many  a 
score  of  babies,  may  now  get  the  vendor  into 
trouble  through  the  most  effective  channel — namely 
the  pocket.  In  acclaiming  the  verdict  as  a  minia- 
ture Magna  Charta  to  the  milk-drinking  pnUic, 
we  are  only  sorry  that  the  blow  fell  in  the  particular 
direction  where  it  did. 


Vlotee  on  Current  iToptcs. 


Direct  Bronchosoopy. 

A  GREAT  deal  of  the  progress  in  medicine  de- 
pends on  the  progress  made  by  the  other  arts  and 
sciences,  and  medical  diagnosis  and  surgical  treat- 
ment has  been  immensely  facilitated  by  the  inven- 
tive genius  of  a  few  men  who  have  been  aWe  to 
place  instruments  of  precision  in  the  hands  of 
medical  men.  The  laryngoscope  and  ophthalmo- 
scope are  now  everyday  implements  with  most 
practitioners,  and  several  other  **  scopes  "  are 
daily  coming  to  be  regarded  as  an  essential  part 
of  the  consulting-room  furniture.  Few,  however, 
are  yet  practised  with  the  bronchoscope,  and  still 
fewer  have  had  the  opportunity  of  operating  vdih 
its  aid.  Indeed,  a  great  deal  of  scepticism  has  been 
expressed  as  to  the  practical  utility  of  the  inven- 
tion. Two  German  surgeons,  Nehrkom  and  Kil- 
liau,  have  lately  been  describing  their  manipula- 
tions with  its  aid,  and  in  their  hands  it  appears  to 
have  been  highly  useful.  Killiau  reports  his 
sixteenth  case  of  removal  of  a  foreign  body  from 
the  bronchi  by  the  assistance  of  the  bronchoscope, 
and  Nehrkom  describes  three  similar  cases  that 
were  under  his  care.  The  former  was  consulted 
by  a  man  aged  fifty-six,  who  had  inhaled  a  piece 
of  chicken  bone  whilst  drinking  a  plateful  of  soup 
two  months  previously.  Convulsive  choking 
followed  the  passage  of  the  bone  into  the  air- 
passages,  and  though  this  gradually  passed  off  the 
patient  continued  to  have  noisy  dyspnoea.  The 
foreign  body  remained  and  could  not  be  remo\'ed 
by  the  surgeons  he  consulted.  Physical  signs  in 
the  chest  pointed  to  the  left  bronchus  being  partly 
occluded,  and  the  mucous  membrane  of  that  tube 
was  seen  by  the  bronchoscope  to  be  reddened. 
Killiau  operated  under  an  anaesthetic,  passing  the 
instrument  well  down  into  the  bronchus,  and  by 
its  aid  he  was  able  to  seize  the  bone  with  long 
forceps.  When  withdrawn  the  bone  was  covered 
with  foetid  pus,  but  the  patient  made  a  good  re- 
covery. Nehrkorn's  three  patients  were  all  chil- 
dren in  whom  beans  had  become  lodged  in  the 
bronchus,  and  though  he  managed  by  the  aid  of 
the  bronchoscope  to  remove  these  foreign  bodies 
in  two  cases,  in  a  third  he  had  to  perform  trache- 
otomy and  pass  the  instrument  through  the  wound. 
All  recovered  satisfactorily.  To  use  the  broncho- 
scope skilfully  requires  some  little  practice,  hot 


Nov.  9,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Fsess.    497 


it  should  certainly  prove  a  great  help  in  those 
difficult  and  dangerous  cases  of  obstruction  of  the 
bronchi  by  foreign  substances  for  which  so  far 
surgery  has  been  able  to  do  but  little. 

Surgioal  Treatment  in  Gout. 

The  medical  treatment  of  podagra  is  not 
altogether  satisfactory ;  neither  is  the  surgical  treat- 
ment. The  swollen  big-toe  joint  with  its  tra- 
ditional associations  of  port  wine  and  bad  temper, 
has  always  been  regarded  as  one  of  the  special 
preserves  of  the  physician  ;  but  nothing  is  sacred 
nowadays  from  the  operating  surgeon,  and  one 
cannot  be  astonished  that  he  has  now  turned  his 
attention  to  the  gouty  joint.  The  first  occasion 
was  accidental,  or  rather  the  result  of  mistaken 
diagnosis.  Riedal  (a)  was  called  to  see  a  middle- 
aged  gentleman  who,  the  night  following  a  hard 
day's  shooting,  was  awakened  by  severe  pain  in 
the  right  great  toe-joint.  The  joint  was  much 
swollen  and  intensely  painful ;  the  skin  over  it 
hot  and  shiny ;  the  body  temperature  102°  F. 
Finding  that  the  patient  had  a  condition  of  hallux 
valgus,  Riedal  thought  that  his  trouble  was  caused 
by  suppuration  in  a  bursa  over  the  metatarso- 
phalangeal articulation  which  communicated  with 
the  interior  of  the  joint.  He  therefore  operated. 
No  bursa  was  found,  and  instead  of  pus  the  joint 
was  filled  with  urates  and  serous  fluid  under 
pressure.  He  decided  to  continue  the  operation, 
and  after  removing  the  deposit  he  took  away  the 
capsule  of  the  joint  and  drained  the  wound.  The 
patient  was  entirely  free  from  pain  and  fever  after 
he  came  round  from  the  anaesthetic,  and  never  had 
any  further  trouble  in  the  toe  although  he  Uved 
for  fifteen  years  afterwards.  It  was  not  till 
twelve  years  later  that  Riedal  could  persuade 
another  patient  to  allow  him  to  operate  for  gout, 
but  one  old  lady  was  at  last  found  to  consent,  and 
he  again  opened  and  drained  the  great  toe- joint, 
after  removing  the  capsule.  In  her,  too,  a  com- 
plete and  gratifying  recovery  followed.  No  relapse 
took  place  for  the  eight  remaining  years  of  her  Ufe. 
One  is  hardly  surprised,  therefore,  that  the  surgeon 
should  think  that  in  certain  cases  of  monarticular 
gout,  operative  treatment  may  be  as  justifiable 
as  it  was  successful  in  the  two  cases  recorded. 
In  this  country,  however,  accustomed  as  people 
are  to  the  idea  of  being  subjected  to  the  surgeon's 
knife,  we  fancy  they  are  not  yet  prepared  to  submit 
their  gouty  joints  to  his  tender  mercies. 

The  Cape  as  a  Health  Resort. 
For  many  years  South  Africa  has  enjoyed,  in 
common  with  Australia,  New  Zealand,  and 
Colorado,  a  high  reputation  as  a  health  resort  for 
patients  suffering  from  pulmonary  phthisis.  Recent 
events,  moreover,  which  have  made  South  Africa 
appear  for  the  time  the  land  of  promise,  have 
directed  the  attention  of  many  invalids  to  that 
country.  Under  the  circumstances,  it  is  important 
that  physicians  at  home  should  be  in  a  position 
to  offer  advice  to  their  patients  who  may  intend 
to  emigrate,  not  merely  on  the  subject  of  the 

Jd)'Dent.  med.  Wochensch  ,  AiiSTUSt  25th,  1904. 


choice  of  destination,  but  as  to  the  necessary 
conditions  of  life  and  probable  chance  of  employ- 
ment. The  most  important  point  to  be  decided 
is  whether  a  patient  should  be  advised  at  all 
to  go  abroad.  There  is  no  doubt  that  in  many 
cases  a  patient,  in  an  advanced  stage  of  phthisis, 
with  cough,  expectoration,  and  pyrexia,  will  not 
lengthen  his  life  one  day  by  a  change  of  climate. 
On  the  other  hand,  he  merely  suffers  the  misery 
of  his  last  illness  among  strangers  in  a  foreign 
land,  away  from  all  the  comforts  of  home  and 
friendship.  Still,  hope  being  what  it  is,  one  rarely 
Ukes  to  leave  untried  what  may  after  all  be  a 
chance  of  recovery,  and  one  can  recall  many 
cases  of  recovery  even  among  the  apparently 
hopeless.  In  going  to  South  Africa,  a  patient, 
even  in  early  stages  of  consumption,  must  be 
.  upplied  with  sufficient  means  to  keep  him  for 
at  least  a  year  or  two.  Otherwise  he  will  probably 
find  his  choice  of  employment  limited,  and  he 
may  be  forced  into  work  which  will  prove  disas- 
trous to  his  health.  Great  attention  must  be 
paid  to  the  choice  of  residence,  the  altitude  being 
the  most  important  factor.  In  the  low  altitudes 
in  Cape  Colony,  up  to  eight  hundred  feet,  there 
is  plentiful  vegetation  and  much  moisture,  while 
in  the  high  altitudes  of  the  Great  Karroo,  two 
to  five  thousand  feet,  conditions  are  quite  opposite. 
It  may,  however,  be  wiser  for  the  physician  at 
home  to  leave  the  decision  of  a  suitable  locality 
to  a  confrere  at  Cape  Town,  and  indeed,  a  patient 
should  always  be  warned  to  lose  no  time  in  placing 
himself  under  a  competent  physician  on  his 
arrival  in  a  new  country. 


Ohloroform  Anadsthesia. 
It  can  hardly  be  said  that  the  discussion  on 
chloroform  anaesthesia  which  took  place  at  the 
annual  meeting  of  the  British  Medical  Association 
has  advanced  our  knowledge  of  the  subject  to  any 
appreciable  extent.  Indeed,  there  was  but  little 
attempt  to  treat  the  subject  as  a  whole  and  most 
of  the  discussion  centred  round  Mr.  Vernon  Har- 
court's  inhaler.  It  will  be  remembered  that  when 
this  apparatus  was  first  introduced,  it  was  received 
with  such  a  chorus  of  praise  that  one  might  have 
been  forgiven  for  imagining  that  the  last  word  had 
been  said  as  regarded  the  method  of  chloroform 
administration.  It  was  claimed,  not  so  much  by 
the  distinguished  inventor  as  by  others,  that  with 
this  apparatus  over-dosage  was  impossible,  and 
chloroform  mortaUty  was  to  be  a  thing  of  the  past. 
Further,  the  inhaler  was  so  simple  in  its  use  that 
even  the  most  ignorant  practitioner  could  employ 
it  with  safety  to  the  patient  and  comfort  to  him- 
self. That  these  exaggerated  claims  have  not 
been  borne  out  is  made  abundantly  evident  by  the 
criticisms  to  which  it  has  been  subjected  by  com- 
petent anaesthetists  like  Mr.  Crouch,  of  St.Thomas's, 
and  Dr.  Levy,  of  Guy's.  It  is  their  experience  that 
not  only  is  it  possible  for  over-dosage  to  occur,  but 
that  unless  the  chloroform  bottle  is  rigidly  seoured 
against  shaking  there  is  no  guarantee  that  the 
percentage  of  chloroform  vapour  in  the  inspired  air 


498    Thb  Medical  Pkess.  NOTES    ON    CURRENT    TOPICS. 


Nov.  9,  1904- 


is  kept  within  safe  limits.  In  addition  there  is  the 
very  strong  practical  objection  that  the  period 
of  induction  is  extremely  long,  the  average 
apparently  being  at  least  fifteen  minutes.  As 
Mr.  Crouch  remarked,  "  even  the  most  good- 
natured  surgeon  declined  to  wait  the  necessary 
time."  On  the  other  hand.  Dr.  Dudley  Buxton 
has  used  the  apparatus  with  success  in  several 
hundred  cases,  though,  as  far  as  we  know,  no  details 
of  them  have  yet  been  made  known,  and  it  was 
more  than  hinted  in  the  Oxford  discussion  that 
there  were  others  in  which  he  had  not  been  so 
fortunate.  Speaking  as  generally  as  we  can  from 
the  evidence  at  present  before  us,  Mr.  Harcourt's 
inhaler  seems  a  useful  invention  when  in  skilled 
hands,  but,  like  all  other  chloroform  inhalers, 
requires  great  care  in  using,  and  by  no  means 
reUeves  the  anaesthetist  of  his  responsibility  in  the 
choice  of  chloroform  as  an  anaesthetic.  We  do 
not,  indeed,  understand  why  there  has  been  such  a 
pother  as  to  the  best  method  of  administering 
chloroform.  In  these  countries  there  is  but  little 
necessity  for  its  use  at  all,  seeing  that  in  the 
great  majority  of  cases  it  offers  no  particular 
advantages  over  ether,  ethyl  chloride  or  gas. 
When  a  useful  apparatus  for  administration 
becomes  an  inducement  to  use  chloroform  for  such 
operations  as  extractions  of  teeth,  as  has  actually 
occurred  with  the  Harcourt  inhaler,  its  introduc- 
tion may  prove  an  evil  rather  than  a  blessing. 

The  Siffniflcance  of  the  Di&zo  Reaction. 

The  value  of  a  clinical  test  becomes  obviously 
impaired  when  once  it  is  found  that  there  are 
important  and  frequent  exceptions  to  its  positive 
reaction.  The  test  discovered  by  Ehrlich  in 
1882,  known  as  the  "  diazo  reaction,"  consists 
in  adding  a  mixture  of  sulphanihc  and  hydrochlo- 
ric acids  containing  sodium  nitrite  to  a  typhoid 
urine,  when,  on  alkaUsing  with  ammonia,  a  cherry- 
red  or  garnet  ring  is  produced.  This  appearance 
was  at  first  supposed  to  be  distinctive  of  typhoid 
fever,  but  subsequent  investigations  showed  the 
contrary.  Other  diseases,  such  as  tuberculosis, 
scarlet  fever  and  measles,  were  found  to  give 
positive  results  with  Ehrlich's  test,  so  that  the 
hope,  which  was  first  entertained,  of  being  able 
to  diagnose  enteric  fever  in  the  early  stages  by 
examination  of  the  urine  was  not  fulfiUed.  Many 
observers  have  since  pursued  exhaustive  investi- 
gations upon  the  subject  with  results  that  are  not 
altogether  unfruitful.  In  1902,  the  Health  De- 
partment of  New  York  City  undertook  the  exa- 
mination of  typhoid  urines  by  the  diazo  reaction, 
and  it  was  found  that  this  test  was  more  constant 
even  than  the  Widal  reaction.  Dr.  W.  Taylor 
Cummins,  (a)  of  Pennsylvania,  has  himself 
gone  over  the  ground  again,  having  examined 
436  urines  with  regard  to  their  behaviour  to  the 
diazo  reaction.  In  typhoid  fever,  58*6  of  the 
cases  gave  positive  results,  a  somewhat  smaller 
proportion  thaji  that  obtained  by  most  other 
observers.  Dr.  Cummins  concludes  that  a  relapse 
(a)  Univ.  Penn,  Med,  Bull.,  September,  1904. 


may  be  diflFerentiated  from  a  complicatioa  in 
the  latter  disease.  It  is  also  stated  to  be  of  pro- 
gnostic import  in  tuberculosis,  as  the  reactioo 
does  not  appear  until  late  in  the  course  of  the 
malady,  and  then  persists  until  death.  Typhoid 
urines  gave  a  positive  result  with  greatly  diluted 
reagents,  whereas  tuberculous  urines  did  not  so 
respond. 


An  Ophthalmic  Surereon  on  Legal  Evidence. 

Mr.  Malcolm  McHardy  has  on  several  occasions 
secured  the  sympathy  of  the  medical  profession 
on  the  way  in  which  his  name  has  been  brought 
before  the  notice  of  the  public.  The  first  occasion 
was  when  the  well-known  professor  of  ophthal- 
mology fell  overboard  from  a  yacht,  and  was  rescued 
after  a  perilous  immersion.  This  adventure  was, 
we  beheve,  recounted  to  the  newspaper  reporters 
by  a  friend  unversed  in  the  usages  of  the 
medical  world.  His  most  recent  appearance 
in  pubUc  is  due  to  his  own  deeply  rooted 
dislike  to  attendance  in  Court  to  give  e\i- 
dence  on  behalf  of  a  htigant  formerly  under 
his  care  as  a  hospital  patient.  An  appearance 
of  that  kind  undoubtedly  involves  a  good  deal 
of  inconvenience  and  loss  to  a  busy  consoitant. 
Fortunately,  it  is  rarely  required,  and  in  any 
case  must  be  accepted  as  one  of  the  drawbacks 
necessarily  attached  to  the  holding  of  a  public 
post.  As  the  Courts  can  compel  the  attendance 
of  medical  men  attached  to  hospitals,  we  fail 
to  recognise  the  pertinence  of  the  indignant  letter 
of  protest  which  Mr.  McHardy  has  w^ritten  to  the 
Editor  of  the  Times.  Such  a  remonstrance, 
moreover,  would  have  been  hardly  less  effective, 
and  certainly  would  have  been  more  in  consonance 
with  the  traditions  of  the  medical  profession,  had 
it  been  signed  with  a  nom  de  plume  instead  of 
Mr.  McHardy 's  name  and  an  appended  list  of 
professional  proofs. 

The  Chair  of  Surgrery  in  Dublin. 
After  forty  years  of  service  on  the  teaching 
staff  of  the  School  of  Ph3rsic  in  Ireland,  it  is 
announced  that  Mr.  Edward  Bennett  has  begged 
to  be  relieved  of  part  of  the  duties  of  the  Chair  of 
Surgery.  From  1864  to  1873  he  held  the  post  of 
University  Anatomist,  and  it  is  not  too  much  to 
say  that  during  most  of  that  time  he  had  practical 
control  of  the  Department  of  Anatomy.  To  him, 
more  than  to  any  living  man,  is  due  the  setting  up 
of  a  high  standard  of  teaching  of  that  subject  in 
DubUn,  a  standard  maintained  by  his  colleagues 
and  successors,  Macalister,  Little,  Brooks,  and 
Cunningham.  In  1 87  3 ,  he  was  appointed  Professor 
of  Surgery,  and  he  still  holds  that  post.  The 
Board  of  Trinity  College  has,  however,  granted 
his  request  to  be  allowed  to  direct  his  teaching 
duties  in  theoretical  and  operative  surgery,  and 
to  devote  his  time  to  the  care  of  the  surgical 
museum,  of  which  he  is  curator.  This  museom 
contains  a  wealth  of  material,  for  the  greater  part 
collected  and  arranged  by  Mr.  Bennett  himself, 
and  it  is  a  matter  of  great  importance  that  he  will 


Nov.  9,  1904. 


NOTES    ON    CURRENT    TOPICS.         The  Medical  Pebss.    4qq 


now  have  leisure  to  complete  the  descriptive 
catalogne  on  which  he  has  been  long  engaged. 
The  completion  of  this  work  may  be  looked  forward 
to  as  the  consummation  of  his  forty  years'  scientific 
work  in  DubUn.  And  it  is  with  pleasure  we  learn 
that  the  Board  of  Trinity  College  has  arranged 
for  its  publication  in  the  University  Press  Series. 
Mr.  Bennett  intends  still  to  continue  his  duties  as 
Clinical  Teacher  and  Surgeon  at  Sir  Patrick 
Dun's  Hospital.  His  old  pupils  all  over  the  world, 
in  whose  respect  and  affection  he  holds  the  highest 
place,  will  join  in  wishing  him  many  years  of  health 
and  activity  in  the  work  he  loves. 


"  Ether  Day." 
It  is  well  that  the  world  should  keep  green  the 
memory  of  its  benefactors,  and  the  more  so  from 
the  fact  that  the  virtues  of  illustrious  men  are  often 
ill-recognised  and  ill-rewarded  during  their  Ufe- 
time.  Perhaps  one  of  the  greatest  of  all  human 
discoveries  was  the  discovery  of  anaesthetics,  to  be 
ranked  alone  with  that  of  antiseptic  or  aseptic 
surgery.  On  Monday,  October  17th  last,  the 
celebration  of  the  fifty-eighth  anniversary  of  the 
fi.rst  administration  of  ether  as  a  surgical  anaesthe- 
tic was  held  at  the  Massachusetts  General  Hospital, 
Boston.  The  amphitheatre,  where  the  meeting 
took  place,  was  arranged  as  nearly  as  possible  to 
resemble  its  appearance  on  the  historic  occasion  of 
October  i6th,  1846.  An  address  was  deUvered  to  a 
densely  packed  audience  by  Dr.  J.  Collins  Warren, 
Mosely  Professor  of  Surgery  at  Harvard  Univer- 
sity, the  grandson  of  Dr.  John  C.  Warren,  who 
performed  the  first  operation  under  ether.  He 
detailed  the  facts  of  the  discovery,  which  is  still 
incorrectly  described  in  many  quarters.  Mr. 
Jackson,  scientific  chemist  at  Boston,  first  sug- 
gested the  use  of  ether  as  an  anaesthetic  to  a  dentist 
of  the  same  city,  Mr.  Morton.  The  latter  admin- 
istered ether  for  the  first  time  to  a  patient  upon 
whom  Dr.  Warren  operated  in  the  Massachusetts 
Hospital.  It  would  be  a  good  idea  to  place  a 
statue  of  Sir  Humphry  Davy  alongside  that  of 
Dr.  Warren  and  Sir  James  Simpson  in  a  prominent 
place  in  London,  as  three  of  the  greatest  heroes  of 
humanity  and  benefactors  of  mankind  the  world 
has  ever  known. 


Death  in  "  A  Pleasant  Oonfection." 
Whatever  views  may  be  held  by  the  medical 
profession  as  to  their  practical  exclusion  from  the 
court  of  the  London  coroner,  Mr.  Troutbeck,  it  is 
clear  that  the  newspaper  reporter  eagerly  gleans 
the  crumbs  of  wisdom  that  fall  from  that 
gentleman's  table.  It  may  be  presumed,  perhaps, 
that  the  natural  sagacity  attached  to  that  particu- 
lar species  of  hybrid  legal  inquiry  is  raised  to 
an  unimpeachable  standard  of  authority  because 
the  medical  evidence  comes  through  the  mouth 
of  Dr.  Freyberger,  the  Pathologist,  or  what- 
ever his  official  title  may  be,  of  the  London  County 
Council.  At  an  inquest  last  week  the  learned  doctor 
stated  that  he  had  examined  a  chocolate  cake 
similar  to  that  administered  to  a  deceased  child  of 
six  and  that  it  tasted  like  santonin,  which  was 


often  legitimately  used  as  a  medicine  under  certain 
circumstances,  but  should  never  be  given  except 
under  medical  directions.  With  the  latter  part 
of  the  statement  every  medical  man  will  cordially 
agree.  It  is  nothing  short  of  a  public  scandal  that 
dangerous  drugs  such  as  narcotics,  irritants  and 
corrosives  should  be  sold  wholesale  to  the  public, 
often  under  the  specious  guise  of  "a  pleasant 
preparation,"  as  in  the  case  under  notice,  or 
protected  by  a  patent  stamp.  There  is  another 
side  to  Dr.  Freyberger's  evidence.  Santonin  has 
an  extremely  faint,  bitter  taste.  If  that  were 
perceptible  to  Dr.  Freyberger  beneath  the  disguise 
of  a  chocolate  cake,  then,  indeed,  we  begin  to 
understand  his  claims  to  be  considered  a  great 
pathologist.  As  a  toxicologist  the  newspaper  re- 
port does  not  mention  that  he  appUed  the  recog- 
nised tests  for  santonin,  but  Mr.  Troutbeck,  after 
all,  has  not  had  the  benefit  of  a  scientific  education, 
and  so  would  not  be  Ukely  to  cavil  at  the  extremely 
difficult  appeal  to  the  sense  of  taste. 


The  Belt  in  Whoopinfir-Ooufirh. 

Among  those  who  are  so  unfortunate  as  to  suffer 
from  sea-sickness,  one  of  the  favourite  methods 
of  rehef  is  the  application  of  pressure  over  the 
stomach.  There  is  no  doubt  that  this  lessens 
the  tendency  to  continued  vomiting,  and  the  same 
principle  has  been  applied  with  some  success  in  the 
vomiting  of  pregnancy.  More  recently,  Dr. 
Kilmer,  of  New  York,  has  introduced  the  use  of  an 
abdominal  elastic  belt  in  the  treatment  of  whoop- 
ing-cough. He  employs  an  elastic  bandage  reach- 
ing from  the  axillae  to  the  hips,  keeping  it  slightly 
on  the  stretch.  Underneath  the  elastic  he  first 
applies  a  stockinette  binder  to  protect  the  skin. 
The  results,  both  as  regards  cough  and  vomiting, 
are  most  satisfactory.  In  only  one  case  out  of 
eighteen  did  he  fail  to  stop  the  vomiting,  while  in 
one-third  of  the  cases  the  cough  was  either  greatly 
lessened  or  stopped.  That  the  sequence  of  events 
was  really  causal  was  shown  by  the  recurrence  of 
the  cough  and  vomiting  in  one  case  when  the  belt 
was  removed  by  the  child's  mother.  The  method 
is  so  simple  in  its  application,  and  so  entirely  harm- 
less, that  it  will  doubtless  receive  a  wide  trial,  and 
it  may  possibly  prove  of  some  use  in  the  treatment 
of  a  troublesome  condition. 


Anaesthesia  in  Operations  on  the  Naso- 
pharynx, 
'  There  are  certain  surgical  operations  which,  on 
account  as  well  of  their  brevity  as  of  their  site, 
form,  as  regards  the  choice  of  a  suitable  anaes- 
thetic, a  class  by  themselves.  These  are  the  brief 
operations  on  the  mouth,  nose,  and  throat  which 
rarely  require  more  than  two  minutes'  time  avail- 
able for  work.  Such  are  many  dental  operations^ 
and  such  operations  on  the  throat  as  removal 
of  tonsils  or  adenoid  growths  and  snaring  of 
polypi.  It  is  necessary  in  most  of  these  cases 
for  the  anesthetist  to  produce  at  the  start  a  suffi- 
cient anaesthesia  to  carry  the  surgeon  through 
the  whole  operation.  When  induction  has  been 
made,  the  anaesthetist  removes  his  apparatus  and 


500     The  Medical  Pkess. 


NOTES  ON  CURRENT  TOPICS. 


Nov-  9,  1904- 


hands  over  the  patient  to  the  surgeon.  Under  the 
circumstances,  great  discrimination  is  necessary 
in  the  choice  of  an  anaesthetic,  and  it  is  obvious 
that  this  will  be  governed  by  quite  different  con- 
siderations from  those  that  obtain  in  other  cases. 
Until  recently  chloroform  has  been  on  the  whole 
the  favourite  agent,  and  there  is  no  doubt  that 
as  regards  quiet  anaesthesia,  freedom  from  irrita- 
tion of  the  larynx  and  absence  of  coughing,  it 
gives  excellent  results.  It  presents,  however, 
the  serious  disadvantage  that  it  can  never  be 
given  in  safety  to  a  patient  in  the  sitting  posture, 
an  attitude  chosen  by  many  surgeons,  and  that 
in  any  case  it  introduces  the  risk  of  sudden  syncope. 
Nitrous  oxide,  while  a  perfectly  safe  anaesthetic 
agent,  rarely  gives  the  desirable  quietude,  and 
it  gives  an  awkwardly  brief  anaesthesia.  Mr. 
Luke,  of  Edinburgh,  who  has  a  large  experience 
of  anaesthetic  work  of  this  class,  is  incUned  to 
leave  the  choice  finally  between  ether  and  ethyl 
chloride.  While  the  former  is  very  constant  in  its 
action,  it  sometimes  produces  cyanosis  with 
troublesome  bleeding,  and  induces  cough  with 
consequent  collection  of  mucus  at  the  site  of 
operation.  Ethyl  chloride,  on  the  other  hand, 
gives  a  calm  and  comfortable  anaesthesia  which 
by  an  adroit  administrator  can  be  made  to  last 
up  to  four  minutes,  though  so  long  a  time  is 
rarely  required.  In  addition,  the  patient  recovers 
very  quickly,  and  is  seldom  annoyed  by  vomiting 
or  other  troublesome  sequelae.  On  the  whole,  it 
would  seem  that  ethyl  chloride,  either  alone  or 
in  the  mixture  known  as  "  somnoform,"  is  the 
most  suitable  agent  in  this  class  of  cases. 


Folk-Medicine  in  Fife. 
The  study  of  folk-medicine  is  not  merely  one 
of  those  hobbies,  interesting  and  amusing,  which 
add  zest  to  the  life  of  a  medical  man  working  in 
a  country  district.  It  is,  if  properly  considered, 
a  valuable  contribution  to  historical  psychology, 
exhibiting  those  peculiarities  of  point  of  view  and 
of  belief  which  are  the  remnants  of  a  mental 
attitude  of  a  much  earlier  era.  Most  items  of  folk- 
medicine  as  they  are  found  at  present  belong 
in  origin  to  one  of  two  classes.  They  are  on  the 
one  hand,  charms,  incantations,  or  sacrifices 
directed  to  the  appeasement  of  gods  or  demons, 
or,  on  the  other,  crude  precepts  empirically 
derived.  These  latter,  being  judgments  from 
experience,  do  not  differ  in  kind  from  the  practices 
of  legitimate  medicine,  but  merely  in  the  degree 
of  their  scientific  justification.  In  many  customs, 
of  course,  the  propitiatory  idea  and  the  judgment 
of  experience  are  inextricably  blended,  ajid,  indeed, 
the  latter  is  adways  put  forward  as  the  ostensible 
reason  of  the  practice.  Dr.  Rorie,  of  Fifeshire, 
in  a  recent  coUection  (a)  gives  many  interesting 
customs  observed  in  his  neighbourhood.  A  case 
of  sacrificial  cure  is  that  of  the  application 
of  three  puppy  dogs,  split  up  and  applied  hot,  to  a 
septic  arm.  Though  the  animal  varies,  this 
custom  has  been  noted  practically  all  over  the 

(a)  Edin.Mcd,  Jotirn.,  June,  1904. 


world.  A  curious  remedy  for  enuresis  is  the 
broth  or  powder  made  from  boiled  or  roasted 
mice.  A  decoction  of  black  slugs  is  a  cure  foe 
rheumatism,  and  the  juice  of  white  slugs  for 
phthisis.  As  in  many  other  localities,  the  smell 
of  fresh-turned  earth  is  regarded  as  possessing 
peculiarly  beneficial  power,  and  miners  suffering 
from  exposure  to  impure  air  were  made  to  lie 
with  the  face  over  a  fresh-cut  hole  in  the  earth. 
If  Dr.  Rorie  were  not  a  good  Scot,  we  shoukl 
think  he  was  poking  fun  at  the  good  people  of 
Fife  when  he  tells  us  of  the  horror  with  which 
they  regard  "  a  rash  drink  o'  water,"  and  their 
behef  in  the  various  dangers  which  follow  the 
incautious  use  of  that  dangerous  and  insipid 
fluid. 


Every 
the    worst 
known    as 
ing    of 
serious 


Aerophaffy. 

horsey "  man  knows  that  one  of 
tricks  a  horse  can  learn  is  that 
"wind -sucking,"  or  the  swallow- 
air,  which,  though  not  fraught  with 
consequences,  leaves  the  horse  in  unfit 
condition  for  violent  exercise.  Mathieu  has 
recently  drawn  attention  to  a  similar  habit  which 
exists  in  the  human  race,  although  the  persons 
afflicted  are  rarely  aware  of  the  condition.  In 
fact,  they  think  that  air  is  passing  in  the  opposite 
direction,  and  they  may  complain  of  eructations. 
In  the  act  of  air-swallowing,  the  patient  closes 
his  lips,  bends  his  head  forward,  and  makes  a 
swallowing  movement,  and  if  at  the  time  the 
stomach  be  auscultated  an  explosive  ringing 
sound  is  heard  as  the  bubble  enters  it.  If  large 
quantities  of  air  be  swallowed,  considerable  dis- 
tension, of  course,  occurs,  until  relief  is  given  by 
a  violent  eructation.  In  fact  the  habit  seems 
sometimes  to  spring  from  the  attempt  to  produce 
this  result.  Where  there  is  a  moderate  degree  of 
flatulent  dyspepsia,  for  instance,  discomfort  is 
relieved  by  the  belching  of  wind,  and  swallowing 
of  air  may  be  a  necessary  antecedent  of  this  act 
Mathieu  distinguishes  several  types  of  aerophagy, 
of  which  the  most  important  are  the  dyspeptic 
and  the  hysterical.  In  the  latter  condition, 
enormous  quantities  of  air  may  be  swallowed 
quite  silently  and  unconsciously,  and  may  only 
become  felt  by  the  ensuing  flatulence  and 
tympanitis. 


The  Heajrt  in  Tuberculosia. 

Since  the  announcement  by  Rokitansky,  in 
1846,  of  the  theory  of  the  supposed  antagonism 
between  valvular  heart  disease  and  pulmonary 
tuberculosis,  many  observers  have  sought  to 
bring  forward  cUnical  evidence  in  its  favour.  It 
is  generally  beUeved  that  valvular  disease  affect- 
ing the  left  side  of  the  heart  has  a  more  or  less 
retarding  influence  upon  the  progress  of  chronic 
phthisis,  or  even  that  individuals  so  affected  are 
to  some  extent  exempt  from  the  attacks  of  the 
tubercle  bacillus.  The  explanation  which  has 
been  offered  for  this  antagonism  is  that  a  sort  of 
immunity    is     conferred     through     the     venous 


Nov.  9,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Pkess.     5^1 


stagnation  and  consequent  chronic  congestion  which 
is  maintained  throughout  the  pulmonary  circulation. 
That  this  "  immunity  "  is  by  no  means  absolute, 
nor,  indeed,  constant,  is  proved  by  the  fact  that 
the  concomitance  of  the  two  affections  not  infre- 
quently occurs.  Dr.  G.  A.  Norris,  (a)  of  Phila- 
delphia, has  found  that  smallness  of  the  size  of 
the  heart,  which  was  at  one  time  thought  to  be 
an  important  predisposing  cause  of  tuberculosis, 
is  generally  discovered  at  the  post-mortem  ;  but 
he  considers  that  this  may  be  equally  the  result 
of  the  generally  impoverished  condition  of  all 
the  bodily  tissues.  On  the  other  hand,  patients 
suffering  from  pulmonary  stenosis  are  exceedingly 
prone  to  contract  phthisis,  and  this  is  not  sur- 
prising when  it  is  borne  in  mind  that  this  particu- 
lar cardiac  lesion  is  frequently  associated  with 
congenital  abnormalities  which  do  not  improve 
the  general  poorly  aerated  condition  of  the  blood. 
Actual  tuberculosis  of  the  heart  itself  is  decidedly 
rare,  but  it  has  been  estimated  that  some  degree 
of  tuberculous  endocarditis  is  met  with  in  some- 
thing under  5  per  cent,  of  all  cases  of  phthisis 
Submitted  to  an  autopsy.  Degeneration  of  the 
cardiac  muscle  commonly  occurs  in  pulmonary 
tuberculosis,  which  probably  accounts  for  the 
failure  of  digitalis  in  many  cases  of  phthisis. 

The  Influence  of  Attention  upon  Work. 

As  a  state  of  consciousness,  attention  is  psycho- 
logically considered  to  be  that  condition  in  which  a 
single  idea  is  predominant  over  aU  others.  Active 
attention  necessarily  implies  concentration  of  the 
whole  mind  upon  the  matter  in  hand,  and  without 
this  no  true  mental  impression  can  be  made. 
Read  in  this  light  the  popular  phrase  of  "  giving 
one's  mind  to  one's  work  "  has  a  deep  psycho- 
logical significance.  The  inattentive  child,  whose 
thoughts  are  instantly  diverted  by  the  buzzing 
of  a  fly  or  the  patter  of  raindrops  upon  a  window- 
pane,  can  no  more  hope  to  master  his  lesson  than 
the  student  who  habitually  allows  his  mind  to 
run  off  on  side  issues.  Lack  of  concentration  is 
fatal  to  success,  especially  in  matters  scientific, 
where  secrets  can  be  learnt  only  by  steady  and 
patient  application.  However  desirable  or  attrac- 
tive the  quality  of  versatility,  it  must  be  kept 
under  control  by  all  who  would  seriously  contribute 
to  the  sum  of  human  knowledge.  Many  indi- 
viduals of  undoubted  genius,  of  high  mental 
quaUties,  are  unable  to  undertake  original  research, 
simply  because  they  cannot  focus  their  undivided 
attention  upon  one  topic.  It  is  true,  of  course, 
that  certain  purely  mechanical  work  may  be 
performed  practically  without  attention,  as  may 
be  seen  in  the  case  of  a  pianist  carrying  on  a 
conversation  with  a  friend.  But  although  manual 
work  may  be  to  a  large  extent  independent  of 
voluntary  attention,  it  is  also  far  better  performed 
when  directed  and  accompanied  by  mental 
processes.  This  fact  has  recently  been  scientific- 
ally confirmed  by  M.  F6re,  who,  by  taking  ergo- 
graphic  records,  has  found  that  the  working 
( 1)  Amer.  Journ.  Med.  ScL,  October,  19M. 


capacity  of  the  middle  finger  for  weight-lifting 
is  considerably  impaired  if  the  attention  be  con- 
centrated upon  some  other  part  of  the  body. 
We  have,  therefore,  a  physiological  basis  for  the 
Ciceronian  dictum — "  Quicquid  agas,  agere  pro 
viribus.*' 


Oraniotomy. 

A  GOOD  deal  of  discussion  has  been  going  on  in 
various  countries  lately  as  to  the  performance  of 
craniotomy  on  living  children.  In  Protestant 
countries  the  view  generally  held  is  that  there 
should  be  no  hesitation  in  sacrificing  the  child's 
Hfe  if  thereby  the  mother  can  be  saved,  whilst 
Roman  Catholics  are  incUned  to  attach  greater 
importance  to  the  child's  existence.  In  modem 
midwifery,  though  craniotomy  is  still  much  in 
vogue  in  deUvering  a  child  already  dead,  there  is 
a  considerable  change  in  practice  with  regard 
to  living  children,  now  that  Caesarian  section  and 
symphysiotomy  can  be  performed  with  such  good 
prospects  to  both  subjects.  Whilst  prepared  to 
spare  no  effort  to  bring  a  living  child  into  the 
world,  most  obstetricians  would  hardly  go  so  far 
as  to  say  with  Pinard  that  embryotomy  of  the 
living  child  is  a  thing  of  the  past.  Strict  surgical 
practice  will,  however,  generally  find  itself  in 
accordance  with  the  moral  dictates  of  the  question, 
and  the  effort  to  spare  both  hves  is  usually  made. 
How  seldom  embryotomy  is  necessary  if  skilled 
attendance  is  at  hand  is  shown  by  the  results  of 
Veit's  practice  in  the  towns  of  Leiden,  Erlangen, 
and  Leipsic.  In  eight  thousand  deliveries  con- 
ducted under  his  supervision  he  has  never  once 
had  recourse  to  it,  and  he  holds  that  it  can  always 
be  avoided  if  the  diagnosis  of  the  obstructive 
condition  is  made  sufficiently  early.  Veit  has 
performed  Caesarian  section  twenty  times,  and 
symph3rsiotomy  six  times  in  his  series  of  cases ; 
and  the  fact  that  he  has  only  lost  two  mothers 
and  two  children  compares  very  favourably  with 
the  usual  mortaUty  results  attached  to  embry- 
otomy. Even  those  who  are  not  prepared  to 
agree  with  Veit,  that  embryotomy  is  never  called 
for,  cannot  but  congratulate  him  upon  his  success. 

The  Medical  Diplomates  of  Scotland. 

The  newly-formed  Association  of  medical  men 
holding  one  or  more  of  the  various  diplomae  of 
the  Scotch  Colleges  is  the  latest  of  the  many 
bodies  that  have  sprung  up  in  the  medical  pro- 
fession of  late  years.  It  has  been  formed  mainly 
with  an  eye  to  the  interests  of  practitioners  in 
parts  of  the  Kingdom  other  than  Scotland,  where 
it  may  be  presumed  that  there  is  no  need  for 
protection.  Medical  practitioners  holding  these 
particular  qualifications  form  a  strong  body  in 
England,  Wales,  and  Ireland.  One  of  their 
chief  grievances  lies  in  the  fact  that  they  are 
excluded  from  the  honorary  staff  appointments 
at  most  of  the  large  hospitals,  MetropoUtan  as 
well  as  provincial,  outside  Scotland.  In  London  a 
flagrant  example  is  to  be  found  in  the  person  of 
an    accomplished    assistant    surgeon    who,    after 


502     The  Medical  Psess. 


PERSONAL. 


Nov.  9.  1904. 


twenty  years'  service,  was  kept  out  of  the  full 
surgeoncy  because  he  did  not  hold  an  English 
qualification.  A  similar  injustice  is  repeated 
again  and  again  in  many  a  provincial  town  and 
country  hospital.  Subscribers  to  medical  charities 
cannot  be  expected  to  understand  the  slur  they 
cast  upon  honourable  men  by  enforcing  restrictions 
worthy  of  a  trades  union  rather  than  of  a  liberal 
profession.  It  is  to  be  hoped  that  the  new  Asso- 
ciation will  succeed  in  throwing  open  all  hospital 
appointments  to  Scotch,  and,  incidentally,  also  to 
Irish  Diplomates.  Among  its  Vice-Presidents  are 
Professor  Clouston,  Sir  Patrick  Heron  Watson, 
Sir  J.  Halliday  Croom,  Sir  Alfred  Cooper,  Sir 
James  Clark,  Sir  Anderson  Critchett,  Sir  John 
Reed,  Sir  John  Sibbald,  Sir  John  Tyler,  and  Sir 
William  Whitla.  Full  information  as  to  the 
objects  and  proposed  work  of  the  Association 
may  be  procured  from  the  energetic  Honorary 
Secretary,  Mr.  Heather  Bigg,  F.R.C.S.,  56  Wim- 
pole  Street,  London,  W. 

PERSONAL. 

The  health  of  the  Prince  of  Wales  at  the  end  of  last 
week  formed  the  subject  of  detailed  sensational  state- 
ments in  certain  newspapers,  the  editors  of  which  have 
not  hesitated  to  assert  that  consumption  was  detected 
some  years  ago  in  the  Royal  patient  by  Sir  Frederick 
Treves — a  surgeon,  by  the  way — ^just  before  the  Prince's 
voyage  in  the  Ophir,  The  rumour — on  the  face  of  it 
ridiculous — has  been  already  officially  contradicted. 

Sir  William  Mitchell  Banks,  M.D.,  F.R.C.S.,  of 
Liverpool,  who  died  in  August  last,  has  left  estate  of 
the  gross  value  of  £22,S27  us.  2d.,  including  net  per- 
sonalty sworn  at  £21,6^2  19s.  5d.  By  his  will,  dated 
July  5th,  1887,  his  widow  is  appointed  sole  executrix. 

At  a  recent  meeting  of  the  Australian  State  Cabinet, 
Dr.  W.  E.  Jones,  superintendent  of  the  Brecon  and 
Radnor  Asylum,  was  appointed  Inspector-General  of 
the  Asylums  for  the  Insane  in  Victoria. 


Dr.  H.  E.  Scowcroft  has  resigned  the  appointment 
of  District  Surgeon  of  Raub,  Pahang.  Federated  Malay 
States. 


Dr.  J.  M.  Rhodes,  Chairman  of  Committee,  re- 
cently laid  the  foundation  stone  of  the  buildings  of  the 
Colony  for  Sane  Pauper  Epileptics  at  Langton,  near 
Blackburn,  the  first  of  its  kind  established  in  the 
United  Kingdom. 


The  President  of  the  Seventh  French  Medical  Con- 
gress, recently  held  in  Paris,  was  the  famous  patho- 
logist and  histologist  Professor  Comil. 

At  the  French  Congress  one  of  the  most  important 
communications  was  that  of  Professor  Chantemesse  on 
"The  Serum-therapy  of  Enteric  Fever,"  by  which 
method  he  claimed  to  have  reduced  the  mortality  to 
f  per  cent. 


The  new  Belfast  Maternity  Hospital  was  opened  on 
Monday,  November  7th,  by  the  Countess  Grosvenor. 

The  winter  session  inaugural  address  of  the  Royal 
Medical  Society  of  Edinburgh  was  delivered  on  Octo- 
ber 28th  last  by  Sir  James  Crichton-Browne. 

At  a  meeting  on  November  ist,  of  the  Faculty  of 
Medicine  of  the  University  of  London.  Mr.  Butlin 
delivered  his  valedictory  address  on  his  retirement 
from  the  office  of  Dean,  a  position  which  he  resigns  by 


virtue  of  a  rule  that  limits  the  period  of  office  to  four 
years. ^ 


Dr.  James  Kingston-Fowler  was,  at  the  same 
meeting,  unanimously  elected  to  the  important  post  of 
Dean  of  the  Faculty  of  Medicine  of  the  University  of 
London. 


Mr.  a.  Pearce  Gould  was  at  the  same  time  elected 
Vice-Dean  of  the  Faculty. 

Dr.  p.  H.  Pve-Smith  has  been  reappointed  repre- 
sentative of  the  University  of  London  on  the  General 
Medical  Council. 


Mr.  Francis  Galton.  F.R.S.,  has  endowed  a 
Fellowship  in  the  London  University  for  the  promotion 
of  the  study  of  eugenics,  defined  as  "  the  study  of  the 
agencies  under  social  control  that  may  improve  or 
impair  the  racial  quaJities  of  future  generations,  either 
ph5rsically  or  mentally." 


On  St.  Luke's  day  last,  October  i8th.  Sir  John  Banks. 
K.C.B.,  attained  his  sixtieth  year  of  Fellowship  of  the 
Royal  College  of  Surgeons  of  Ireland.  Although  Sir 
John  has  for  some  years  retired  from  active  participa- 
tion in  the  affairs  of  the  College,  he  still  takes  a  keen 
interest  in  its  welfare.  At  the  meeting  of  the  College 
held  on  Friday  last  a  resolution  of  congratulation  on 
the  occasion  of  the  diamond  jubilee  of  his  election  to  the 
Fellowship  was  carried  by  acclamation. 

Sir  Charles  Ball,  F.R.C.S.,  has  resigned  the  office 
of  representative  of  the  Royal  College  of  Surgeons  in 
Ireland  on  the  General  Medical  Council.  We  are  in- 
formed that  Mr.  Swanzy,  whose  name  as  an  ophthalmic 
surgeon  is  well  known,  and  who  is  the  present  vice- 
president  of  the  College,  and  Sir  Thomas  Miles,  ex- 
president  of  the  College,  have  offered  themselves  as 
candidates  for  the  office. 


Dr.  Cecil  Shaw  has  been  appointed  lecturer  on 
ophthalmology  and  otology  in  the  Queen's  College. 
Belfast,  in  succession  to  the  late  Dr.  McKeown.  Dr. 
Shaw  already  holds  the  posts  of  Assistant-Surgeon  at 
the  Belfast  Ophthalmic  Hospital,  and  of  Ophthalmic 
Surgeon  to  the  Mater  and  Ulster  Hospitals. 

Professor  Lorrain  Smith,  who  is  leaving  Belfast 
to  take  up  his  appointment  at  the  Victoria  University, 
Manchester,  was  on  Thursday  last  presented  by  his 
colleagues  and  friends  with  a  handsome  souvenir  at  a 
complimentary  dinner,  particulars  of  which  will  be 
found  in  the  letter  by  our  Belfast  correspondent. 

We  learn  that  the  teaching  duties  of  the  Chair  of 
Surgery  in  Trinity  College,  of  which  Professor 
Bennett  has  been  relieved,  have  been  committed  to 
Mr.  Edward  H.  Taylor,  F.R.C.S.I.,  Examiner  in  Ana- 
tomy to  Dublin  University,  and  Surgeon  to  Sir  Patrick 
Dun's  Hospital. 


Professor  Windle's  resignation  of  the  Birmingham 
chair  of  anatomy  was  formally  communicated  to  the 
council  of  the  University  at  its  last  meeting,  when  the 
following  resolution  was  unanimously  passed  : — "  That 
the  Council  receives  the  resignation  of  Dr.  Windle  with 
regret,  and,  while  congratulating  him  on  his  important 
educational  and  administrative  appointment  in  Ireland 
under  the  Crown,  takes  the  opportunity  of  thanking 
him  for  his  long  and  distinguished  services  to  the 
School  of  Medicine  in  Mason  College  and  to  the  Medical 
Faculty  of  this  University,  both  as  dean  and  as  pro- 
fessor, as  well  as  to  the  general  cause  of  higher  educa- 
tion in  the  Midlands." 


Harvelan  Society  of  London. 
The  annual  dinner  of  the  society  will  be  held  at  the 
Monico  Restaurant  on  Thursday,  November  24th,  at 
7  for  7.30  p.m.     The  chair  will  be  taken  by  the  Presi- 
dent, Dr.  C.  Theodore  Williams. 


Nov.  9,  1904. 


SPECIAL    CORRESPONDENCE. 


The  Medical  Press.    5^3 


Special  corredponDence. 

FROM   OUR   OWN   CORRESPONDENTS.] 


SCOTLAND. 

Glasgow  Ophthalmic  Institution. — On  the  ist  inst. 
a  course  of  post  graduate  lectures  and  demonstrations 
was  inaugurated  by  Dr.  A.  Maitland  Ramsay,  who 
dehvered  an  instructive  address  on  "  Eye-strain  and 
its  Consequences."  The  lecture  was  ilUustrated  by 
means  of  lantern-slides,  microscopic  preparations,  the 
opaque  projector,  and  by  Kuhne's  optical  box.  Mr. 
Hedderwick,  the  chairman  of  managers  of  the  Glasgow 
Royal  Infirmary,  presided,  and  expressed  his  gratifica- 
tion at  the  large  attendance  of  medical  men,  as  showing 
that  the  Institution  was  not  only  an  agent  for  the  relief 
of  suffering,  but  was  also  fulfilling  an  educational  pur- 
pose in  the  City. 

BELFAST. 

Complimentary  Dinner  and  Presentation  to 
Professor  Lorrain  Smith. — A  farewell  dinner  to 
Professor  Lorrain  Smith,  on  the  occasion  of  his  leaving 
Queen's  College,  Belfast,  for  Victoria  University, 
Manchester,  was  held  in  the  Grand  Central  Hotel, 
Belfast,  on  Thursday  evening,  November  ist.  The 
President  of  Queen's  College  presided,  and  practically 
all  Dr.  Smith's  late  colleagues  at  the  College  and  at  the 
Royal  Victoria  Hospital,  Belfast,  were  present,  as  well 
as  many  of  his  past  pup  Is  and  lay  friends.  After  the 
usual  loyal  toasts  the  President  proposed  the  toast  of 
"  Our  Guest."  In  doing  so.  he  contrasted  the  state  of 
pathological  teaching  in  Belfast  ten  years  ago,  when 
Dr.  Smith  was  appointed,  and  now,  when,  thanks  to 
the  munificence  of  the  late  Sir  James  Musgrave,  they 
had  an  endowed  professorship,  and  through  the  joint 
action  of  the  Government  and  the  college,  a  proper 
building  had  been  provided,  with  rooms  for  lectures, 
research,  &c.,  and  modern  appliances.  No  small  share 
in  these  changes  was,  he  said,  due  to  Professor  Lorrain 
Smith,  who  had  also  made  that  laboratory  an  ultimate 
court  of  appeal  on  medical  questions  from  all  Ulster. 
The  Civic  authorities,  too,  had  availed  themselves  of 
Dr.  Smith's  services,  and  he  had  been  called  in  as  an 
expert  in  various  diflScult  questions  regarding  the  pre- 
valence of  typhoid,  the  contamination  of  water,  and 
the  disposal  of  sewage.  President  Hamilton  also  re- 
ferred to  Dr.  Smith's  help  on  the  College  Council,  the 
Victoria  Hospital,  and  on  the  examining  board  of  the 
Royal  University,  and  concluded  by  wishing  him  all 
success  in  the  new  sphere  to  which  he  was  going. 

The  toast  having  been  enthusiastically  honoured. 
Dr.  Smith,  in  reply,  explained  that  the  founding  of  the 
School  of  Pathology  had  only  been  possible  by  the 
greatest  self-sacrifice  on  the  part  of  the  other  teachers 
of  the  medical  school,  for  the  funds  at  the  disposal  of 
the  school  were  so  small  that  the  necessary  money 
for  outfit  and  upkeep  could  only  be  got  by  stinting 
other  departments.  In  spite  of  that,  the  new  depart- 
ment was  administered  in  no  grudging  spirit,  and  never 
a  word  of  complaint  reached  him.  To  the  men  in  the 
college  who  spent  their  lives  working  for  their  depart- 
ments, and  whose  lifework  was  being  crippled  by  the 
absence  of  funds,  he  wished  to  make  on  that  occasion 
the  fullest  and  heartiest  acknowledgment..  But  for 
their  self-sacrifice  and  pubUc  spirit  the  medical  school 
would  that  day  have  been  without  anything  worthy 
of  the  name  of  a  pathological  department.  It  was  a 
matter  of  pride  to  him  that  during  his  term  of  offire 
about  one  hundred  post-graduate  students  passed 
through  the  department,  and  a  number  of  them  stayed 
to  work  at  research  as  long  as  their  time  permitted. 

Dr.  R.  J.  Johnstone  then  presented  Dr.  Smith  with 
a  solid  silver  tray,  on  which  was  inscribed  :  "To  Pro- 
fessor Lorrain  Smith,  from  his  old  friends  and  pupils 
at  the  pathological  laboratory.  Queen's  College,  Belfast, 
1895-1904."  He  explained  that  this  was  not  ifrom  the 
medical  profession  generally,  but  just  a  souvenir  from 
some  of  the  men  who  had  enjoyed  many  happy  hours 
of  work,  tempered  by  the  fumes  of  tobacco,  in  the 
laboratory.     Dr.    Johnstone    dwelt   specially   on    the 


research  work  carried  out  by  Dr.  Smith's  pupils,  and 
the  enthusiasm  with  which  he  fired  them»  and  the  way 
in  which  the  school  acquired  under  his  guidance  a 
character  of  its  own.  As  an  instance,  he  mentioned 
Dr.  Houston's  work  on  the  pathology  of  the  blood. 

Dr.  Smith,  in  reply,  thanked  his  old  friends  and  pupils 
very  warmly,  and  dwelt  on  the  happ^  fellowship  of  the 
laboratory  workers  all  through  his  time  at  the  college. 
The  first  worker  with  him  had  been  Dr.  Cecil  Shaw, 
whom  he  was  glad  to  congratulate  on  his  recent  appoint- 
ment on  the  College  stafi,  as  lecturer  on  ophthalmology. 
Others,  too  numerous  to  mention  by  name,  had  fol- 
lowed, and  many  continued  to  work  during  all  the  time 
he  was  there.  He  had  the  utmost  pleasure  in  receiving 
the  handsome  piece  of  plate,  and  thanked  them  all  for 
the  kind  sentiments  expressed  on  their  behalf  by  Dr. 
Johnstone. 

Appointments  to  the  Royal  Victoria  Hospital. 
The  following  appointments  have  been  made  at  this 
hospital :  Drs.  Crymble,  Davis,  and  KiUen  to  be  house 
surgeons ;  Dr.  Lowry  to  be  house  physician ;  Dr. 
Mcflwaine  to  be  medical  registrar ;  Dr.  Irwin  to  be 
surgical  registrar ;  Dr.  H.  Stevenson  to  be  hon.  anaes- 
thetist ;  and  Dr.  Beattie  to  act  as  temporary  patho- 
logist to  the  hospital. 

aottcdponDence. 

THE  TREATMENT  OF  INOPERABLE  CANCER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Had  Dr.  Mackenzie  read  my  letter  a  little  more 
carefully  he  would  have  seen  that  I  was  claiming  noth- 
ing, and  it  was  therefore  unnecessary  for  him  to  say 
that  he  did  not  wish  to  deprive  me  of  any  credit.  All 
I  desired  to  do  was  to  correct  the  impression  which 
you,  Mr.  Editor,  and  others  had  received,  that  he  was 
the  pioneer  in  the  treatment  of  cancer  of  hypodermic 
injection.  I  do  not  agree  with  the  correctness  of  the 
statements  in  Dr.  Mackenzie's  letter ;  but  I  need  not 
trouble  you  with  such  trivial  matters  except  to  say 
that  I  do  not  know  why  Dr.  Mackenzie  appears  to  be 
so  annoyed  with  me,  as  I  gave  him  full  credit  for  his 
work  with  Merck's  iodipin  on  the  only  occasion  I  pub- 
lished anything  on  the  subject.  It  is,  however,  neces- 
sary to  refer  to  Dr.  Mackenzie's  last  sentence  in  which 
he  asks  me  "  in  justice  to  himself  and  others,"  to 
publish  now  what  I  was  using  nearly  two  years  ago. 
Why  in  justice  to  him  I  cannot  imagine,  as  he  already 
knows  what  I  was  experimenting  with,  but  his  curiosity 
will  perhaps  be  gratified  when  I  tell  him  that  at  present 
I  am  experimenting  with  arsenic.  It  would  never 
occur  to  me  even  to  think  of  publishing  with  only  the 
Support  of  two  cases,  one  dead  and  the  other — nature 
of  tumour  apparently  not  diagnosed — under  treatment 
for  less  than  two  months  !  Besides,  I  do  not  wish  to 
run  the  risk  of  having  an  objectionable  advertisement 
in  one  of  the  Sunday  papers  as  Dr.  Mackenzie  has  had 
to  put  up  with.  My  brother  and  I  have  had  better 
results  at  the  beginning  of  more  than  one  experiment, 
and  when  Dr.  Mackenzie  has  had  a  few  more  un- 
successful cases  he  will  not  be  so  ready  to  publish  what 
he  hopes,  but  will  wait  until  he  knows.  In  this  work 
one  may  hope  for  success,  but  must  expect  dissappoint- 
ment.  There  have  been  too  many  "  cures  "  lately — 
salt,  molasses,  violets,  Schmidt,  mul3rptol,  &c.,  and  I 
regret  that  Dr.  Mackenzie  is  trying  to  add  to  their 
number  on  such  very  insufficient  grounds.  Doctors 
understand  the  value  of  such  evidence,  but  readers  of 
the  Dispatch  do  not. 

I  am,  Sir,  yours  truly, 

George  E.  Keith. 

7,  Manchester  Square,  W.,  Nov.  4th,  1904. 

THE  LACK  OF  PRACTICAL  METHODS  IN 
SURGICAL  TEACHING. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  am  glad  to  see  that  Mr.  Edmund  Owen  does 
not  feel  well  pleased  with  the  present  state  of  things 
in  the  practical  work  of  our  medical  schools  and 
education.  Nowadays  many  men  are  beginning  to  find 
out  that  the  system  that  has  grown  up  during  the  past 


504     The  Medical  Pkess. 


OBITUARY. 


Nov.  941004. 


forty  years  or  so  is  not  satisfactory.  To  what  extent 
they  have  to  thank  themselves  for  this  we  can  leave 
them  to  consider.  There  is  one  thing  quite  certain, 
and  that  is  they  did  nothing  to  stop  it.  There  has 
been  no  proper  chnical  teaching  in  our  hospital  schools, 
and  specialism  has  been  preferred. 

The  consequences  are  beginning  to  be  felt,  and  it  is 
well  for  those  who  find  fault  to  look  to  what  they  did 
themselves  to  prevent.  Mr.  Edmund  Owen  and  many 
like  him  let  things  go  in  a  good-tempered,  indiflferent 
way,  and  now  they  deservedly  suffer. 

I  am.  Sir,  yours  truly,  R.  L. 

Kensington,  Nov.  ist,  1904. 

MUNICIPAL  DENTISTRY. 
To  the  Editor  of  The  Medical  Press  and  Circi^lar. 
Sir, — It  is  impossible  to  deny  the  fact  that  at  the 
present  day  a  considerable  proportion  of  children  of 
every  class  display  signs  of  dental  degeneration,  and 
that  among  the  poor  these  signs,  as  well  as  the  presence 
of  decayed  teeth,  are  more  common  ;  but,  statistics 
having  been  accumulated  only  within  recent  years, 
and  this  to  a  partial  extent  only,  there  exists  no  scienti- 
fic basis  whatever  for  the  opinion  that  dental  deteriora- 
tion is  extending  or  that  dental  caries  is  more  prevalent 
among  the  present  than  former  generations.  It 
seems  a  little  grotesque  to  read  that  in  St.  Petersburg 
nine  municipal  dental  institutes  have  been  set  up. 
whilst  the  population  throughout  Russia  is  allowed 
to  live  in  sanitary  surroundings  worse  than  Oriental, 
and  to  suffer  from  periodical  preventable  famine  with 
epidemic  diseases  due  to  filth  and  want.  It  will  be 
not  much  less  ludicrous  if  we  in  England  follow  this 
example  before  setting  to  work  to  remove  the  first 
causes  of  the  evil,  and  to  apply  remedies  which  shall 
result  in  production  of  a  race  showing  physical  su- 
periority in  every  direction,  including  the  teeth. 
In  this  way  it  would  pay  better  first  to  establish 
municipal  dairies  where  the  poor  could  obtain  milk 
up  to  a  high  standard  of  quality  and  purity.  Rickets, 
one  of  the  commonest  causes  of  tooth  decay,  is  largely 
due  to  lack  of  proper  food  in  the  way  of  milk.  In 
many  municipalities,  especially  where  tradesmen 
dominate  the  local  authority,  the  Food  and  Drugs  Acts 
are  either  very  slightly  attended  to,  or  altogether 
ignored  ;  and  the  poor  are  supplied  with  milk  of  the 
most  inferior  quality.  Reform  of  these  abuses  is 
more  urgently  called  for  than  municipal  dentistry. 
The  housing  question,  the  question  of  educating  poorer 
class  mothers  in  elementary  knowledge  of  hygiene 
and  the  feeding  of  infants,  and  many  other  questions  of 
the  same  kind,  all  under  discussion  at  the  present 
moment,  and  all  bearing  upon  the  subject  of  physical 
deterioration — all  these  questions  call  for  attention 
and  solution  before  provision  of  municipal  dentistry 
is  brought  to  the  front.  The  question  of  providing 
meals  for  ill-fed  school-children,  which  has  lately  been 
dealt  with  in  an  important  correspondence  in  the 
Times,  seems  also  somewhat  more  urgent  than  munici- 
pal dentistry.  Money  is  needed  for  coercion  of  neglect- 
ful parents,  and  perhaps  for  provision  of  food  and 
cooking  arrangements  at  the  schools.  To  starving 
children  good  teeth  are  not  the  most  urgent  necessity, 
Municipal  dentistry  is  not  more  urgently  called 
for  than — for  one  example  out  of  fifty — municipal 
hair-cutting  and  head  cleansing.  I  could  name  a 
village  in  Surrey  at  this  moment  in  which  the  ma- 
joritv  of  the  children  are  affected  with  ring-worm, 
which  prevents  them  from  attending  school.  Ths 
has  spread  so  widely  in  consequence  mainly  of  the 
foul  and  often  verminous  conditions  in  which  the 
unkempt  heads  of  the  children  are  habitually  left 
by  their  careless  parents.  Many  of  these  children  are 
suffering  from  adenoids  and  chronic  nasal  catarrh 
caused  in  great  measure  by  the  damp,  dark  and 
unwholesome  dwellings  in  which  they  are  lodged, 
[f  local  governing  bodies  are  to  spend  more  money, 
it  ought  surely  to  be  on  matters  of  prime  importance, 
not  upon  grandmotherly  projects  such  as  municipal 
dentistry.  I  am,  sir,  yours  truly, 

Henry  Sewili. 


®bituars. 


MR.  HERBERT^WILLIAM  ALLINGHAM.  F.R.C.S. 
ENG. 
Telegraphic  information  has  been  received  from 
Marseilles  announcing  the  death  by  misadventure.  00 
the  4th  inst.,  of  Mr.  Herbert  William  Allingham. 
F.R.C.S.,  of  25,  Grosvenor  Street,  London,  while  on 
his  way  to  Egypt  for  the  benefit  of  his  health.  He  was 
the  eldest  son  of  the  «eminent  surgeon,  Mr.  William 
Allingham,  F.R.C.S.,  who  is  still  living,  and  was  bom 
on  April  17th,  1862.  After  receiving  his  education  at 
Chatham  House  School,  Ramsgate,  and  University 
College  School,  London,  he  entered  as  student  at  St. 
George's  Hospital,  where,  at  the  time  of  his  death,  he 
held  the  position  of  Senior  Assistant  Surgeon  and 
Lecturer  on  Operative  Surgery.  He  became  M.R.C.S. 
Eng.,  in  1882  and  F.R.C.S.  in  1887.  In  1889  he  married 
Fraulein  Alexandrina  von  der  Osten.  who  died  in 
January  of  the  present  year.  Her  death  was  most 
keenly  felt  by  him,  and  the  breaking  down  of  his  health 
dates  from  this  bereavement,  from  the  effects  of^which. 
he  confessed  to  the  writer  of  these  lines  a  short  time 
since,  he  was  quite  unable  to  free  himself,  and  the 
profession  which  he  had  loved  and  pursued  with  so 
much  enthusiasm  had  ceased  to  possess  the  same  interest 
for  him.  His  professional  career  was  one  of  exceptional 
brilliancy,  and  his  reputation  as  an  operator  of  great 
skill  and  judgment  was  world-wide.  He  held  the 
position  of  Surgeon  to  the  Household  of  his  Majesty 
the  King  when  Prince  of  Wales,  and  was  subsequently 
appointed  Surgeon  to  the  Household  of  his  Majesty  the 
King.  He  was  also  Surgeon  in  Ordinary  to  his  Ro>'aI 
Highness  the  Prince  of  Wales,  and  one  of  the  Honorary 
Surgeons  to  King  Edward  VII.'s  Hospital  for  Officers. 
Mr.  Herbert  Allingham  was  formerly  surgeon  to  the 
Great  Northern  Central  Hospital,  and  assistant  surgeon 
to  St.  Mark's  Hospital  for  Fistula.  He  was  the  author 
of  several  valuable  works,  that  on  *'  Diseases  of  the 
Rectum  "  having  reached  the  seventh  edition,  and  his 


Nov.  9,*  1904. 


LITERATURE. 


The  Medical  Press.    505 


new^work  on  "  Operative  Surgery,"  has  proved  a  dis- 
tinct success.  He  had  also  in  the  press  another  bro- 
chure on  '*  Appendicitis." 

The  untoward  death  of  Herbert  AUingham  from 
an  overdose  of  morphia  in  the  zenith  of  his  professional 
career  will  come  as  a  profound  shock  to  the  medical 
world  as  well  as  to  a  large  and  distinguished  circle  of 
friends.  Although  a  young  man  he  had  already  years 
ago  achieved  brilliant  success  whether  judged  from 
social  or  professional  standpoints.  Following  in  the 
footsteps  of  his  father  he  early  specialised  in  the  direc- 
tion of  rectal  surgery.  His  book  on  the  *'  Diagnosis  and 
Treatment  of  Diseases  of  the  Rectum  "  has  become 
a  classic.  He  made  numerous  other  important  con- 
tributions to  medical  literature,  and  was  a  member  of 
various  learned  societies.  By  his  death  the  profession 
has  been  deprived  of  one  of  the  most  brilliant  surgeons 
of  the  younger  generation. 


MEETING    OF    THE    GENERAL    MEDICAL 

HH  COUNCIL. 

We  are  ofl&cially  informed  that  the  Autumn 
Session  of  the  General  Medical  Council  will  be 
held  at  the  OflBce  of  the  Council,  at  2  p.m.,  on 
Tuesday,  22nd  inst.,  and  following  days,  at  which 
Sir  William  Turner,   K.C.B.,  will  preside. 


Xiteratute. 


HAMILTON  ON  "  RAILWAY  AND  OTHER 
ACCIDENTS."  (a) 
This  much-needed  book  supplies  a  gap  in  medical 
literature,  and,  moreover,  fulfils  that  function  in  an 
effective  fashion.  The  author  has  written  for  lawyers 
as  well  as  for  medical  men — two  professional  classes 
that  require  special  information  on  the  matter  of  real 
and  imaginary  and  pretended  disorders  of  traumatic 
origin.  The  subject  is,  of  course,  a  complicated  one. 
The  interests  of  the  plaintiff  as  well  as  of  the  defendant 
must,  of  course,  be  protected.  The  shock  of  a  railway 
accident,  moreover,  may  upset  the  mental  balance  of 
a  sufferer,  and  so  inflict  one  of  the  many  remote  in- 
juries for  which  a  railway  company  may  be  called  upon 
to  make  compensation.  A  finer  degree  of  partial 
mental  injury  may  present  a  knotty  point  for  pro- 
tracted legal  discussion.  We  heartily  endorse  the  au- 
thor's position  when  he  says  : — "  The  time  has  certainly 
come  for  some  one  who  is  initiated,  and  has  sufficient 
knowledge  to  urge  the  proper  and  honest  presentation 
of  medical  facts  in  Court  by  the  plaintiff  as  well  as  by 
the  defendant,  for  it  does  not  do  to  pervert  medical 
truths,  which  in  their  way  are  quite  as  settled  as  the 
axioms  of  law."  The  absolute  necessity  of  special 
knowledge  and  caution  can  be  gathered  from  the  ex- 
perience of  an  EngUsh  physician  in  over  two  hundred 
alleged  railroad  injuries.  Of  these  thirty- two  were 
frauds  or  cases  of  wilful  exaggeration,  twenty-one  sub- 
stitution cases  in  which  there  was  a  history  of  gout, 
phthisis,  chronic  epilepsy,  alcoholism  "  female 
diseases/'  or  conviction  of  previous  ill-health ;  six 
w^omen  alleged  that  the  symptoms  of  the  menopause 
were  due  to  injury ;  three  had  been  in  previous  acci- 
dents, seven  were  the  subjects  of  fright  or  suggestion, 
and  one  case  of  glycosuria  was  attril9uted  to  an  acci- 
dent, but  was  shown  to  be  of  previous  origin  ;  and  in 
another  old  syphilis  was  made  to  do  duty  ;  in  one  case, 
in  which  insanity  was  claimed  to  be  the  result  of  an 
accident,  it  was  proved  to  have  antedated  it.  In 
forty-four  there  is  a  history  of  "  no  exaggeration," 
or  the  patient  made  a  moderate  claim ;  of  the  above 
cases,  therefore,  it  will  be  seen  ihat  in  at  least  two-fifths 
there  was  a  suspicion  of  fraud.  This  is  the  best  book 
we  have  seen  on  the  subject,  and  it  must  at  once  take 
a  high  place  of  authority  and  reference. 

(a)  '*  Bailway  uid  Other  Aooidents."  67  A.  M.  HamUtOD(M.D., 
lato  Olinioal  ProfMior  of  Mentel  Diseuein  Con: ell  Cottage  Hoepi- 
tal,  fto.,  Ac    London:  Battliere an dl  Cox.    1901.    Price 68.  nek. 


TEXT-BOOK  OF  CLINICAL  ANATOMY,  (a) 
By  the  time  the  student  has  reached  the  study  of 
clinical  medicine  and  surgery,  his  anatomical  acquisi- 
tions, cumbered  as  they  too  often  have  been  by  details 
which  have  little  practical  bearing,  are  apt  to  be  rele- 
gated to  the  garret  of  his  mental  equipment,  and  the 
fact  that  in  his  ward  work  he  receives  instruction  in 
"  medical  "  (not  to  speak  of  "  surgical  "  and  "  gynaeco- 
logical") anatomy    tends  to  lead  him  to  divorce  the 
systematic  knowledge  he  has  so  laboriously  acquired 
from  everyday  work,  while  when  his  memory  requires 
refreshing  he  too   readily  tends  to  refer  to  some  con- 
venient diagram  in  a  book  on  clinical  diagnosis  rather 
than  wade  through  the  pages  of  an  anatomical  text- 
book, seeking  for  the  grain  of  information  among  an 
intolerable  heap  of,  to  him,  now  useless  facts.     That 
this  is  not  as  it  should  be  is  daily  more  and  more  being 
recognised  by  anatomical  teachers,  who  now  pay  much 
greater  attention  to  applied  and  topographical  anatomy 
than,  say,  a  decade  ago,  and  the  volume  now  before  us  is 
an  expression  of  this.     The  author  has  essayed,  and 
to  a  large  extent  succeeded,  in  giving  a  complete  pre- 
sentment of  the  main  facts  of  clinical  anatomy,  sur- 
gical and  medical,  within  a  comparatively  reasonable 
compass.     No  doubt  the  anatomist  might  find  errors  of 
detail  or  slight  descriptive  inaccuracies,  but  from  the 
clinician's  standpoint   the  volume  is   almost   wholly 
satisfactory.     Dr.   Eisendrath   naturally  pursues   the 
regional  method,  and  in  each  section  tells  the  student 
what  he  can  feel  with  his  fingers  and  see  with  his  eyes, 
before  proceeding  to  describe  deep  structures  and  their 
relations.     We  note  with  satisfaction  that  throughout 
the  book  sufficient  attention  is  paid  to  the  anatomical 
peculiarities  of  the  child.     The  rather  dry  bones  of 
anatomy  are  partially,  at  least,  clothed  and  resuscitated 
by  references   to  cUnical   symptoms   and   pathology 
generally,  and  while  we  admit  the  importance  of  this 
in  giving  a  live  interest  to  the  pages  of  facts,  we  are 
not  sure  but  that  the  size  of  the  book  might  have  been 
reduced  without  affecting  its  usefulness  by  a  judicious 
curtailment,  both  of  these  clinical  details  and  of  some 
of  the  short  descriptions  of  operations.     The  illustra- 
tions throughout  maintain  a  high  level  of  merit,  but 
here  again  the  pathological  ones,  few  as  they  are,  might 
for  the  most  part  have  been  omitted  without   any 
great  loss.     We  had  hoped  to  find  greater  use  made  of 
radiographs.     A  few  plates  showing  the  ossification  of 
some   of   the   chief   epiphyses   at    different   ages,    for 
example,  could  readily  have  been  obtained,  and  would 
have  given  information  which  generally  requires  a  good 
deal  of  search  when  it  is  wanted.     Another  omission 
which  strikes  us  is  the  inadequate  space  given  to  the 
anatomy  of  the  nervous  system  ;   there  is,  for  instance, 
no  drawing  of  the  base  of  the  brain — one  to  which  a 
student  often  wishes  to  refer — and  cerebral  topography 
in    general    is    scantily    dealt    with.     Assuredly    the 
student  will  not  get  enough  anatomical  information 
to  be  of  service  in  the  diagnoses  of  nervous  cases  from 
Dr.  Eisendrath.     When  a  second  edition  of  the  book 
is  called  for,  as  we  are  sure  it  will  be,  we  trust  that 
space,  which  could  easily  be  got  by  a  judicious  con- 
densation  of   the   pathologicsd   information,    will   be 
found  to  rectify  the  omissions  referred  to,  when  the 
student  will  have  in  one  volume  a  most  convenient 
work  of  reference  to  which  he  will  rarely  turn  in  vain. 

NEW  BOOKS  AND  NEW  EDITIONS. 
The  following  have  been  received  since  the  publica- 
tion of  our  last  list : — 

The  Abbrdebn  Univsrsfty  Prsss,  Ltd.  (Aberdeen). 

University  of  Aberdeen — Proceedings  of  the  Anatomical  and  Anthro 
pological  Society,  I903-X904.    Illustrated.    Pp.  155. 
Edward  Arnold  (London). 
Lectures  on  Diseases  of  Children.    By  Robert  Hutchison,  M.D., 
F.R.C.P.    Pp.  338.    Price  8s.  6d.  net. 
AsRER  AND  Co.  (LooBon). 
St.     L(niis,     X904.    German    Educational     Exhibition.    Medicine. 
Pp.  169. 


(a)  "A  Text-book  of  Clinical  Anatomy.*'  By  Daniel  M  EiaeL- 
drath,  Professor  of  Clinical  Anatomv  in  the  UoiTersity  of  Illinois 
Philadelphia :  W.  B.  Saunders  and  Co.    1904.    2la.  net. 


5o6     The  Medical  Press. 


MEDICAL  NEWS. 


Nov.  9,  1904. 


Baillieke,  Tindall  and  Cox*  (Loodon). 
Handbook  of  Diseases  of  the  Ear.    By  Richard  Lake,  F.R.C.S.Eog. 

Second  Edition.    lUustrated.    Pp.  342.    Price  6s.  net. 
The   After-Treatment   of    Operations.      By    Lockhart    Mummery, 
F.R.C.S.£ttg.f    B.A.,    M.B.,    etc.    Second    Edition.    lUustrated. 
Pp.  240.    Fnce  5s.  net. 
The  Nutrition  of  the  Infant.    By  Ralph  Vincent,  M.D.    Second 

Edition,  revised  and  enlaxKed.    Pp.  321.    Price  los.  6d.  net. 
Guide  to  the  Examination  of  the  Throat,  Nose,  and  Ear,  for  Senior 
Students  and  Junior  Practitioners.    By  William  Lamb,  M.D., 
C.M.Edin.,  etc.    lUustrated.    Pp.  152.    Price  5s.  net. 
Malignant  Diseases  of  the  Larjmx  (Carcinoma  and  Sarcoma).    By 

Philip  R.  W.  De  Sauti,  F.R.C.S.    Pp.  X07.    Price  45. 
Aids  to  the  Study  of  Sanitary  Law.    By  Harry  Critchley,  M.A.,  M.D., 

D.P.H.,  etc.    Pp.  82.    Price  2S.  6d.,  ck>th,  2S.  paper. 
Burden   Camels ;    Their    Bfanagement  and   Diseases.    By   H.    M. 

Lenox-Conyn«^am,  Capt.  A.V.D.    Pp.  24.    Price  is.  6d.  net. 
Transactions  of  the  Medico-Legal  Society  for  the  Years  2902,  Z903, 
and  1904.    Edited  bv  Stanley  B.  Atkinson,  MA.,  M.B.,      Vol.  I. 
Pp.  xoo.    Price  7s.  M. 
John  Bale,  Sons  and  Danixlsson,  Ltd.  (London). 
Medical  Hints  and  Notes  on  Egypt  as  a  Winter  Resort.    By  Arthur 

J.  M.  Benttey,  M.D.    Pp.  43*    Price  is. 
Notes  on  Assouan.    By  G.  Dundas  Edwards,  M.A.,Camb.,  M.R.C.S., 
etc.,  etc.    Pp.  36.    Price  is.  net. 
John  Bevan  and  Sons  (Torquay). 
Letters  on  Health  and  Happiness.    By  John  A.  Bevan,  M.D.,    Pp. 
68.    Price  2S.  6d.  net. 
Akchibau)  Constable  and  Co.,  Ltd.  (London). 
Clinical  and  Pathological  Observations  on  Acute  Abdominal  Diseases. 
By  E.  M.  Coxner,  B.Sc.,  Lond..  etc..  etc.    Pp.  08.    Price  3s.  6d.  net. 
The  Surgery  of  the  Diseases  of  the  Appendix  Venniformis  and  their 
Complications.    By  Wm.  Henry   Battle,  F.R.C.S.,  and  E.    M. 
Comer,  M.B.,  etc.,  etc.    Pp.  208.    Price  7*.  6d.  net. 
J.  AND  A.  Churchill  (London). 
Urine  Examination  Made  Easy.    By  Thomas  Carrutheis,  MA.,  M.B., 
Ch.B.    Pp.  32.    IS.  6d.  net. 
Cornish  Bros.  (Birmingham). 
On  the  Sterilisation  of  the  Hands.    By  Charles  Leedham-Green,  M3., 
F.R.C.S.    Pp.  X02.    Price  2s.  6d.  net. 
Charles  Griffin  and  Co.,  Ltd.  (London). 
Text-book  of  Human  Physiok>gy .    By  Dr.  L.  L andois.    Fifth  Edition. 
lUlustrated.    Pp.  1027. 
H.  K.  Lewis  (London). 
Medical    Electricity:    A  Practical  Handbook   for  Students   and 
Practitioners.    By  H.  Lewis  Jones,  M.A.,  M.D.    Fourth  Edition. 
lUustrated.    Pp.  536.    Price  X2s.  6d.  net. 
Deaths  in  ChiUbed  ;  A  Preventible  Mortality.    By  W.  >Viniams,  MA. 
M.D.,  etc.    Pp.  99.    Price  2s.  6d.  net. 
Longmans  Green  and  Co.  (London). 
The  Essentials  of  Chemical  Physiotogy.    By  W.  D.  Halliburton,  M.D., 
F.R.S.  Fifth  Edition.    Pp.  236.    Price  4s.  6d.  net. 
Frank  F.  Lisiecki  (New  York). 
The  Surgical  Treatment  of  Bright's  Disease.    By  George  M.  Edebolils, 
A.M.,  MJ).,  etc.    Pp.  327. 
The  London  Argus  Library  of  Fiction  (London). 
A  Spartow,  a  Mouse,  and  a  Man.    By  George  H.  R.  Dubbs,  M.D. 
Pp.  68.    Price  6d. 
London  County  Council  (London). 
The  Fifteenth  Annual  Report  of  the  Asylums  Committee  and  the 
Sub-Committees  for  the  year  ending  March  31st,  1904.    Pp.  230. 
Price  2S. 
Macmillan  and  (^.,  Ltd.  (London). 
The  Food  of  the  Gods  and  How  it  Came  to  Earth.    By  H.  G.  WeUs. 


Pp.  317.    Price  6s. 
George  PrrMAN  and  Sons,  Ltd.  (London). 
The  Blind  Man's  World  ;  An  Ens lish  Version  of  Entxe  Avengles.    By 
Dr.  Emil  J  aval.    Translated  by  W.  Ernest  Thomson,  MA.,  M.D. 
Pp.  158.    Price  3s.  net. 
Rebman,  Ltd.  (London). 
The  Diseases  of  Women.    By  J.  Bland-Sutton,  F.R.CS.Eng.,  and 
Arthur  E.  Giles,  M.D.,  etc.    Fourth  Edition.    lUustrated.    Pp. 
520.    I*rice  lis.  net. 
St.  Andrew's  Ambulance  Association  (Glasgow). 

Home  Nureixig  and  Hygiene.    By  J.  Wallace  Anderson,  M.D.,  and 
George  H.  Edington,  M.D.    Pp.  156. 
W.  B.  Saunders  and  Co.  (Philadelphia). 
A  Text-Book  of  Clinical  Diagnosis  bv  Laboratory  Methods.     By  L. 
Napofeon  Boston,  A.M.,  M.D.    Illustrated.    Pp.  549.    Price  z8s. 
net. 
Sudan  Govsrhmevt  (Kartoum). 
First  Report  of  the  WeUcome  Research  Laboratories  at  the  Gordon 
Memor.al  College,  Kartoum.     By  the  Director,  Henry  Balfour, 
M.D.,  B.Sc.,  etc.    Pp.  88.  with  Coloured  P.ates. 
Taylor  and  Francis  (London). 

Calendar  of  the  Royal  CoUege  of  Surgeons  of  England,  August  ist, 

1904.    Pp.  350. 

Untversity  Press  (Liverpool). 

Liverpool  School  of  Tropical  Medicine  ;   Memoir  XIII.    Reports  of 

the  Trypanosomiasis  Expedition  to  the  Congo,  X903-X904.    By 

J.  E.  Dulton,  M.B. ;    J.  L.  Todd,  M.D. ;    and  C.  Christy,  M.B. 

Pp.  XX2. 

John  Wright  and  Co.  (Bristol). 
An  Introduction  to    I>etmat:>k>gy.       By  Norman   Walker    M.D. 
lUuitrated.    Pp.  384.    Price  9s.  6d.  net. 

Xabotatots  notes* 

B.  EUCAIN  LACTATE  (SCHERING.) 
A  PREPARATION  manufactured  by  Messrs.  Schering 
of  Berlin,  at  the  suggestion  of  Professor  Langgaard, 
to  take  the  place  of  eucain  and  cocain.  It  combines 
the  advantages  of  the  low  toxicity  associated  with 
eucain  with  a  high  degree  of  solubility — up  to  29  per 


cent,  in  water  at  room  temperature.  B.  encain  lactate 
is  a  white  non-hygroscopic  powder  very  readily  soloUe 
in  hot  water ;  less  so  in  cold.  The  eucain  base  is 
this  salt  is  somewhat  less  than  in  the  ordinary  B.  eucain ; 
thus  slightly  stronger  solutions  are  necessary.  The 
London  agents  are  Messrs.  A.  and  M.  Zimmermann. 
THE  SCHLEUSSNER  X-RAY  PLATES. 

Workers  with  the  X-rays  are  always  on  the  look-oot 
for  a  good  plate,  which,  when  found,  is  a  treasure 
indeed.  We  have  been  asked  to  test  the  Schleussoer 
plates,  and  have  much  pleasure  in  stating  that  for 
all-round  X-ray  purposes  they  are  as  good  as  any  that 
have  come  under  our  notice.  At  the  same  time  the 
price  is  not  excessive,  a  drawback  that  appUes  to 
several  sensitive  plates  specially  introduced  for  this 
special  kind  of  work.  We  have  tried  the  SchleossDcr 
plate  with  various  developers,  and  personally  have 
obtained  the  best  results  with  ordinary  "  pyio  *• 
developer,  with  which  we  have  obtained  beantifoDy 
modulated  but  clear  pictures.  The  excellent  illostra- 
tion  which  appeared  on  page  460  of  The  Medical  Press 
AND  Circular  (November  2nd.  1904)  was  taken  cm 
one  of  these  plates,  which  are  placed  on  the  market 
by  Messrs.  Christy  and  Co.,  and  may  be  purchased 
from  the  usual  vendors  of  photographic  plates.  We 
should  advi&e  all  radiographers  to  give  them  a  trial. 
MESOTAN. 

A  NBw  salicylic  remedy  for  the  external  treatmeat 
of  rheumatic  affections  has  been  introduced  by  the 
Bayer  Company.  The  remedy  is  mixed  with  aa 
equal  quantity  of  olive  oil  and  brushed  on  the  affected 
part  several  times  daily.  It  is  said  to  relieve  pais 
and  have  a  curative  effect  upon  all  pain  of  a  rheomatic 
origin.  The  success  obtained  by  Continental  anthoritics 
with  Mesotan  certainly  warrants  an  extensive  trial  by 
medical  men  in  the  United  Kingdom.  It  is  described 
by  the  manufacturers  as  a  substitute  for  gaaltheria 
oU,  but  it  has  a  far  less  pronoonced  odour  and  is  of 
greater  faciUty   of  absorption. 


AeMcal  newB. 


The  Medleal  Sickness  and  Aeeident  Society. 

The  usual  monthly  meeting  of  the  executive  com- 
mittee of  the  Medical  Sickness,  Annuity  and  Life  A  - 
surance  Society,  was  held  at  429,  Strand.  London, 
W.C.  on  the  28th  ult.  There  were  present  Dr.  da 
Havilland  Hall,  in  the  chair  ;  Dr.  Walter  Smith.  Dr. 
M.  Greenwood,  Mr.  F.  S.  Edwards.  Dr.  W.  Knowslev 
Sibley.  Dr.  A.  J.  Rice  Oxley,  Mr.  H.  P.  Symonds 
(Oxford).  Dr.  Fredk.  S.  Palmer.  Mr.  Edwd.Bartlett. 
Dr.  J.  Brindley  James,  Dr.  St.  Clair  R.  Shadwell. 
Dr.  F.  J.  Allan,  Dr.  J.  W.  Hunt,  and  Dr.  J.  B.  BalL 
The  amounts  showed  a  great  improvement  in  the  sick- 
ness claims,  which  were  unusually  heavy  in  the  early 
part  of  the  year.  Since  June  the  amount  paid  away 
has  been  appreciably  under  the  expectation,  and  there 
is  little  doubt  that  the  whole  year's  working  will  show 
a  good  margin  in  favour  of  the  Society.  On  the  other 
hand  the  general  depression  in  business  which  has  been 
somewhat  severely  felt  by  many  members  of  the  medical 
profession,  shows  itself  in  the  lowered  numbers  of  new- 
members  joining  the  Society.  The  last  two  years  have 
been  exceptionsdly  good  in  this  respect,  and  there  is  no 
reason  to  fear  that  as  soon  as  the  present  temporary 
depression  has  passed  away  the  social  advantages  to 
be  obtained  by  joining  the  Society  will  not  induce  a 
large  number  to  join  it.  Prospectus  and  all  informa- 
tion on  application  to  Mr.  F.  Addiscott.  secretary. 
Medical  Sickness  and  Accident  Society,  ^^,  Chancery 
Lane,  London,  W.C. 

Central  Midwlves  Board. 

At  the  last  meeting  of  this  Board  (a  report  of  which 
appeared  in  our  last  issue)  a  scheme  of  *'^*^™«" 
tions  was  adopted  of  which  the  following  are  the  most 
important  provisions: — A  list  of  examiners,  subject 
to  annual  revision  by  the  Board,  both  for  Loodoa 
and  the  provinces,  shall  be  prepared  by  the  Centra) 
Mid  wives  Board  from  those  who  are  willing  to  serve  aod 


Nov.  9,  1904. 


MEDICAL  NEWS, 


The  Medical  Press.    5^7 


act,  when  required,  by  the  Board.  Examinations  will 
be  partly  oral  and  practical,  and  partly  written,  and 
shall  be  conducted  by  not  fewer  than  two  examiners. 
The  first  examination  will  be  held  in  July.  1905.  and 
iuture  examinations  four  times  a  year,  or  oftener  if 
necessary,  in  London  and  the  provinces,  simultaneously 
on  the  same  papers.  The  first  provincial  centres  are 
to  be  Bristol,  Manchester,  Newcastle-on-Tyne.  The 
remuneration  of  an  examiner  is  fixed  at  the  rate  of 
seven  shillings  for  each  candidate  examined.  The 
scheme  further  provides  that  the  examiners,  both  Lon- 
don and  provincial,  shall  be  invited  to  meet  at  the 
olBices  of  the  Central  Midwives  Board  as  often  as  may 
be  necessary,  and  that  the  duties  of  the  London  exam- 
iners shall  be  (a)  To  consider  examination  questions 
suggested  by  provincial  examiners  ;  (b)  to  set  all  the 
X>apers  of  examination  questions  both  for  London  and 
the  provinces.  Two  of  the  examiners,  with  the  assist- 
ance of  one  of  the  medical  members  ot  the  Central 
Midwives  Board  to  be  appointed  for  the  purpose,  shall 
undertake  this  duty  in  rotation.  The  remuneration  of 
the  examiners  shall,  in  respect  of  this  duty,  be  two 
guineas  each  ;  (c)  to  conduct  the  examination,  written 
and  oral,  of  all  candidates  presenting  themselves  for 
examination  in  London ;  (d)  to  report  to  the  Central 
Midwives  Board  the  result  of  each  examination  held  in 
London.  From  these  regulations  it  appears  that  the 
principal  duty  of  the  provincial  examiners  is  to  set  ex- 
amination questions,  and  that  these  questions  are  to 
be  then  censored  by  the  London  examiners,  and  pre- 
sumably, if  thought  suitable,  are  then  to  be  made  use  of. 
We  con  f ess  that  we  are  unable  to  understand  how  any 
provincial  obstetrician  of  repute  could  accept  the  post 
ol  examiner  under  such  conditions.  It  may.  be,  however, 
that  the  reflations  given  above  are  capable  oi  another 
interpretation  from  that  which  the  phraseology  ne- 
cessitates. 

Royal  Ear  Hospital. 

The  new  premises  of  the  Royal  Ear  Hospital  in  Dean 
Street,  Soho.  are  now  completed,  and  the  out-patient 
department  is  in  full  swing.  With  regard  to  out- 
patients special  care  has  been  taken  on  the  one  hand 
to  secure  the  comfort  of  the  patients,  who  are  seen 
singly,  and  on  the  other  to  provide  the  surgeons  with 
every  modem  up-to-date  contrivance  both  for  dia- 
gnosis and  for  operative  and  general  treatment.  The 
in-patients'  department,  which  will  shortly  be  opened, 
consists  of  three  wards,  one  for  children,  one  for  women 
on  the  first  floor,  and  one  for  men  on  the  second  floor. 
Alongside  the  latter  is  the  operating  theatre,  which 
boasts  of  capital  natural  light,  and  is,  of  course,  replete 
with  all  the  necessary  appliances  of  modern  surgery. 
The  children's  ward  has  a  high  dado,  which,  dealing 
with  nursery  rhymes,  should  have  a  most  soothing 
effect  on  the  little  sufferers.  This  hospital,  which 
claims  to  be  the  oldest  institution  for  the  special  treat- 
ment of  aural  and  allied  diseases,  not  only  in  this 
country  but  in  Europe,  was  originally  founded  as  far 
back  as  18 16  in  Dean  Street,  Soho,  under  the  name  of 
Royal  Dispensary  for  Diseases  of  the  Ear  ;  in  1876  it 
migrated  to  Frith  Street,  and  in  1883  the  Committee 
opened  a  department  for  in-patients.  It  is  computed 
that  upwards  of  1 50,000  patients  have  received  advice 
and  treatment  at  the  institution  since  its  foundation. 
Irish  Modlcal  Schools*  and  Graduates*  AssoclatiOD. 

The  autumn  general  meeting  of  this  association  will 
be  held  at  the  Hotel  Cecil,  Strand,  on  Tuesday,  Novem- 
ber 22nd,  at  6.30  p.m.  The  autumn  dinner  will  be 
held  on  the  same  evening,  when  the  association  will 
dine  at  the  Grand  Hall  of  the  Hotel  Cecil,  at  7.30  p.m., 
the  President,  Surgeon-General  C.  Sibthorpe.  C.B.,  in 
the  Chair.  The  hon.  secretaries  will  be  glad  to  forward 
forms  of  application  for  membership  to  members  who 
may  have  friends  to  propose  for  election  to  the  asso- 
ciation. New  members  joining  on  November  22nd 
may  attend  the  dinner. 

Royal  Colloge  of  Surgeons  in  Ireland. 

The  lectures  of  the  Winter  Session  commenced  on 
Tuesday,  November  ist.     The  prizes  of  the  previous 


session  were  distributed  by  Mr.  Arthur  Chance,  pre- 
sident, as  follows : — 

Barker  Anatomical  Prize — ^^31   los.,  C.  Cooper. 

Mayne  Scholarship — £1$,  A.  N.  Crawford. 

Carmichael  Scholarship — £1$,  J.  Preadiville. 

Gold  and  Silver  Medals  in  Operative  Surgery. — Gold, 
J.  S.  Dunne ;  silver,  P.  D.  Sullivan  and  J.  C.  Murphy 
(equal). 

Stoney  Memorial  Gold  Medal  in  Anatomy, — J. 
Prendiville. 

Descriptive  Anatomy — Junior. — D.  P.  Clement, 
First  prize  {£2)  and  Medal ;  G.  S.  Levis,  second  prize 
(;^i)  and  certificate.  Senior — D.  Adams,  first  prize 
(£2)  and  Medal;  P.  G.  M.  Elvery;  second  prize  {£i) 
and  certificate. 

Practical  Anatomy — First  Year. — G.  S.  Levis,  first 
prize  {£2)  and  medal ;  D.  P.  Clement,  second  prize  (^i) 
and  certificate.  Second  Year. — P.  G.  M.  Elvery,  first 
prize  {£2)  and  medal ;  T.  A.  Buchanan  ;  second  prize 
{£1)  and  certificate. 

Practice  of  Medicine. — R.  Bury,  first  prize  {£2)  and 
medal;  P.  D.  Sullivan;  second  prize  (^i)  and  certi- 
ficate. 

Practical  Histology. — H.  C.  Garden,  first  prize  {£2) 
and  medal;    D.  Adams,  second  prize  {£1)  and  certifi 
cate. 

Practical  Chemistry. — R.  H.  F.  Taaffe,  first  prize 
{£2)  and  medal ;  F.  C.  Warren,  second  prize  {£1)  and 
certificate. 

Public  Health  and  Forensic  Medicine. — M.  Cohen, 
first  prize  {£2)  and  medal ;  T.  H.  Massey.  second  prize 
{£1)  and  certificate. 

Materia  Medica. — F.  C.  Warren,  first  prize  {£2)  and 
medal  ;   J.  B.  Kelly,  second  prize  {£1)  and  certificate. 

Biology. — J.  C.  S.  Day,  first  prize  {£2)  and  medal ; 
T.  C.  Boyd  and  H.  W.  White  (equal),  second  prize 
(^i)  and  certificaie. 

Surgery. — J.  S.  Dunne,  first  prize  {£2)  and  medal ; 
R.  Bury  and  F.  Lybum  (equal)  second  prize  {£i)  and 
certificate. 

Midwifery. — J.  S.  Dunne,  first  prize  {£2)  and  medal ; 
R.  A.  Browne,  second  prize  (£1)  and  certificate. 

Physiology. — D.  Adams,  first  prize  {£2)  and  medal  ; 
T.  Sheehy,  second  prize  {£1)  and  certificate. 

Chemistry. — D.  P.  Clement,  first  prize  {£2)  and 
medal ;  A.  E.  S.  Martin,  second  prize  {£1)  and  certifi- 
cate. 

Pathology. — L.  Lucas,  first  prize  {£2)  and  medal  ; 
P.  D.  Sullivan,  second  prize  (;^i)  and  certificate. 

Physics. — A.  E.  S.  Martin,  first  prize  {£2)  and  medal ; 
W.  G.  Ridgway,  second  prize  (£1)  and  certificate. 

The  Tottenham  Hospital  Dinner. 

A  FESTIVAL  dinner  in  aid  of  the  funds  of  the  Totten- 
ham Hospital  was  held  at  the  Savoy  Hotel,  Strand,  on 
November  2nd,  1904,  under  the  presidency  of  Lord 
Bumham.  a  large  and  influential  company  being 
present.  In  the  course  of  his  remarks  from  the  chair, 
Lord  Bumham  sketched  the  growth  of  the  institution 
from  its  foundation,  and  pointed  out  the  immense 
work  which  was  being  done  by  the  hospital,  situated 
as  it  was  in  the  midst  of  a  densely-populated  portion 
of  North-East  London.  He  referred  to  one  of  the 
cherished  treasures  of  the  institution — an  autograph 
letter  from  the  late  Empress  '  Augusta — which  bore 
testimony  to  the  splendid  work  performed  by  the  Tot- 
tenham Hospital  Sisters  in  the  Franco-German  War, 
nor  was  the  high  standard  lowered  in  the  present  day. 
All  that  was  now  required  was  further  extension  of 
the  building.  Sir  Francis  Cory-Wright  (chairman  of 
the  Hospital  Committee)  announced  that  operations 
would  not  be  delayed  much  longer,  as  tenders  for  the 
building  were  to  be  received  shortly.  The  Secretary 
(Mr.  F.  W.  Drewett)  then  read  out,  amid  cheers,  the 
stewards*  lists,  which  amounted  to  ;i4.oo2  los.  Mr. 
John  Langton  responded  on  behalf  of  the  medical  staff, 
and  Dr.  Percy  Kidd  proposed  the  health  of  the  chair- 


508 


The  Medical  Press. 


NOTICES  TO  CORRESPONDENTS. 


Nov.  9,  1904. 


Jtotices  to 
Correspoitbtnts,  ^hort  %xtitx»f  &c 


Jl^  OoBKisroiiDSMn  reqviring  a  reply  in  this  oolumn  are  partica- 
larly  requested  to  make  use  of  a  diaUneHim  Signahurt  or  IfdHtO,  and 
avoid  thepraotioeolsig^g  themselves  "Reader/*  "Subscriber," 
**  Old  Bubsoriber/'  to.  Much  oonfusion  will  be  spared  by  attention 
to  this  rule. 

OsraiNAL  Aktiolss  or  LsmBS  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. 

GoHfUBVTORS  are  kindly  requested  to  send  their  communication  s 
|f  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
ofBoe ;  if  resident  in  Ireland,  to  the  I>ublin  office,  in  order  to  save  time 
in  re-fonntfding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

Ubiqu«.— The  coroner  has  absolute  power  in  the  matter,  and  as  the 
nresidine  judge  of  his  court  he  directs  the  jury  as  he  pleases 
—occasionally,  it  happens,  but  very  rarely' th it  bhe  jury  returns 
a  veidiot  contrarv  to  nis  opioion.  __      __ 

*     "*  THE  DIMINI8HINO  BIRTHBITE. 

ANeo-MalthusUn  writes  calling  our  attention  to  the  dose  con- 
nection which  he  maintains  is  to  be  found  between  the  land 
monopoly  and  the  diminishing  birthrate.  In  reply  we  can  only  say 
it  seems  likely  that  anything  that  unduly  increases  the  cost  of  hving 
must  necessarily  make  it 'more  difficult  to  rear  families,  and  hence 
to  make  pArents  disinclined  to  procreate  children.  In  making  this 
general  admission  we  express  no  opinion  as  to  the  pros  and  oons.  of 
so-called  land  monopoly,  and  the  special  laws  affecting  that  class  of 
property  and  the  absence  of  taxation  of  gound  values  are  somewhat 
outside  the  scope  of  a  medical  journal.  The  diminishing  birth-rate, 
however,  is  clMrly  enough  a  fitiing  subject  for  medical  discussion. 
It  is.  however,  highly  complex  and  raises  issues  that  can  be 
adequstely  dealt  wUh  only  by  a  consideration  of  the  social,  the 
medical,  the  political,  the  statistical,  and  the  economic  circumstances 

^  BxDFOBD.— Our  advice  is  to  take  no  further  notice  of  the  claim, 
but  should  another  acrimonious  letcerbe  received  the  correspon- 
dence had  better  be  placed  in  the  h«nds  of  a  solicitor,  or  referred 
to  the  Medical  Defence  Union,  if  our  correspondsnt  happens  to  be 
a  member  of  that  useful  society.  .  „  „  ,  „„„„ 
FBIGHT  OB  FEAB  ILLNESS. 
A  Correspondent,  refcrrinir  to  our  annotation  on  this  snbieot  con- 
irratulates  us  on  **this  singularly  timely  article  in  view  of  the  severe 
attack  of  '  f unkitis '  from  which  the  Baltic  Fleet  is  suffering  at  the 
moment ";  and  suggests  that  we  "  should  send  a  specially  marked 
copy  of  the  current  number  to  his  roalesty  the  Csar,  and  another  to 
Admiral  Bozhdestveniki.  care  of  Admiral  Togo. 

JUetings  of  the  goacUce,  %ttiwct0,  &c, 

WBDXrnDAT,  NOVKMBKR  0th. 

DsRMATOLOeiCALSociRT  OF  LoMDOS  (llOhandos  street,  Cavendish 
Square,  W.).— 5.15  p.m.  Demonstration  of  Cases  of  Interest. 

Souxn-WxtT  LoHDON  MxDiCAL  SociMT  (Bolingbroke  Hospitol, 
Wandsworth  Common  ).-9  p.m.  Paper  :- Dr.  W.  W.  H.TAte: 
The:  Diagnosis  and  Treatment  of  Tubal,  OesUtion  in  the  Early 
Weeks 

HvxTxniAV  SocisTT  (London  Institution,  Finsbury  Circus,  E.C.). 
9  pra.H  Lecture;— Dr.  B.  Bradford:  The   Treatment  of  Bright's 

DueasCb 

MiroiOAL  Oraduaim' CoLLEOX  AKD  PoLTCLiHic (28  Chcnies  street, 
W.C.).-  4  p.m.  Mr.  B.  W.  Roughton  :  Clinique.  .Surgical.)  6.15p.m. 
Mr.  P.  0.  Wallis  :  Injuries  to  and  Diseases  of  Joints. 

Nobth-East  Lokdoh  Post-Gbaduatb  Colleob  (North-Eastem  Fever 
Hospital.  St.  Anns Boad, N.) -2.30.  p m.  Dr. H.  Cuff  :  Demmstra- 
tion  on  Ftevets.  «      „  /^      .    r       n     ^ 

Cbvtbal  L02nK>R  TeaoAT  and  Ear  Hospital  (Gray  s  Inn  Road 
W.C.).— 6  p.m.    Demonstration  :—Dr    Wylle  :  Naso-Pharynx. 

THURBDAT,  NOVEMBKR  10th. 

BRrriSB  Gtkjkcolooica].  Socisty  (SO  Hanover  Square,  W.).— 8  p.m 
Papers :— Dr.  Maooaughton- Jones  :'£mbedded  Adnexa.  Carcinoma  of 
FaUepian  Tube,  HsBmorrhagic  Endometritis.— Dr.  B.  Fenwick : 
Uterine  Fibroids  associated  with  Ovarian  Disease.  Adjourned  Dis^ 
cussion  on  Mr.  C.  Martin's  paper  on  the  Treatment  of  Severe  Pro- 
Upse  by  BxUrpatioo  of  the  Uterus  and  Vagina. 

Ophthalmolooical  Socixtt  of  the  UmTRD  KiHODOM  (11  Chandos 
Street,  Cavendish  Square,  W.).-8  p.m.  Card  Specimens  will  be 
shown  by  Mr.  Doyne  and  Mr.  Stephenton.  8  80  p.m.  Paper :— Mr. 
S.  Bnell :  Intraocular  Tumour  covering:  the  Optic  Disc. 

Mbdioal  Grapcatks*  Collbob  and  PoLTCLuric  (22  Ohenies  Street, 
W.C.).-4  p.m.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  ^6.16  p.m. 
Dr.  W.  Bwart :  The  General  Management  and  Special  Methods  of 
Treatmen  t  of  Heart  Cases.  .^ 

MovHT  YERiroii  Hospital  for  Coksumptiok  abd  Disbabbs  of 
THB  Chbst  (7  Fitzroy  Square,  W.).-5  p.m.  Lecture:  Dr.  O. 
Johnston:  Aortic  Aneurysm  (iUustrated  by  oases).     (Post-Orsduate 

North-East  Lohdon  Po8T-GRADUATBOoLLBOH(Tottenham  Hospital, 
N.).— 4.30  p.m.  Lecture:— Mr.  H.  W.  Carson:  Middle-Ear 
Ctftarrh. 


Frxdat,  NomairBBR  Ilth. 

Thb  Ibtcorporated  Socibtt  of  Mbdical  Opficbrs  of  Hbalth  a 
Adelphi  Terrace,* Strand,  London,  W.C.).— 7.aOp.m.  FRper:— Dr.O. 
A.  Beron :  Instruction  in  HygiMe  in  unirersitisB  «^  Sehsdh  a 
Proposal. 

British  liARTVCK>LOCiiCAL-RBivoL0a  cal  abd  Otolooical  Asas- 
ciATiov  (Medical  Society's  Booms.  11  Ohaodos  Street,  Oaveidnk 
Square,  W.).— 8.80  p.m.    Council  Meeting.    4  P-m.   BxhlhitlQa  of 
Cases,  Specimens,  and  Instruments.    4.16  p.m.  Qeoeral  MeeUs^ 
Presidential  Address.    Dr.  Home;    Pachydermia  Lazyngis. 

Port  Sanitary  Association  (Westminster  Palace  HioteL— 1| 
noon.    Meeting. 

Clivical  Socirtt  of  Lokdob  (20  Hanover  Square,  W. )—%  bjk. 
Paper :- Mr.  C,  R.  Eeyter:  A  Case  of  CongeniUl  ElevatiOR  elite 
Scapula.— Dr.  F.  D.  Turner  and  Mr.  B.  Johnson  :  Tvmuraatie  AxfflnT 
Aneurysm  successfully  treated  after  Extxavaaation  hadoocnaed  Vr 
Proximal  Ligature— Mr.  B.  Robinson  and  Mr.  E.  M.  Goiav: 
Aneurysm  of  the  Intracranial  Part  of  the  Left  Internal  Carotid 
caused  by  a  Bullet  Wound  through  the  Bight  Bye.— Mr.  8.  Psget : 
A  Case  of  Appendix  Abscess  followed  by  Abecees  in  the  Left  Dae 
Region. 

MbdiOal  Orapuatbs'  Collbgb  and  Poltcxibic  (12  Ghesiei 
Street,  W.C— 4  p.m.  Dr.  StClair  Thomson  :    Clinique.    (Throat.) 

Peckham  House  Asylum.— Second  Assistant  Medical  Officer.  Skluy 
£150  per  annum.  Applications  to  the  Resident  IiicefiSBS,  Peek- 
ham  douse,  Peckham,  8.E. 

Birmingham  City  Asylum.  Bubery  Hill,  near  Birmlngfaam.— JosMr 
Assistant  Medical  Omoer.  Salary  £150  per  annum,  with  bond 
Ac.    Applications  to  the  MedicaS  Sapertntendent. 

Manchester  Jewish  Hospital.— Besident  Medical  Officer.    Bahuy  ftt 

S5r  annum.     Applications  to   Secretary,     Jewish    Bo^iui 
heetham,  Manchester. 
Bracebrid^     A«ylum,  near    Lincoln.— Junior    Assistant    Medial 

Officer.    S^Ury  £126  per  annum,  with    furnished  aMrtnasl^ 

&c.    Applications  to  W.  T.  Page,  Jun .,  Solicitor  and  Cleik  tofbe 

Visiting  Committee.  5  Bank  Street,  lanooln. 
St  Mary's'  Hospital,  Oxford  Street,  Manche«ter.-Ho«ise  Snigcoa 

and  Besident  Obstetric  Assistant  Surgeon.       Saluy  £100  yer 

annum,  with  board  and  residence.  Applications  to  the  Secretaiy. 
University  of    Birmingham  (Faculty  of    Medicine).— Fkofenor  of 

Anatomy.    Salary  £800  per  annum.    Applications  to  GeOb  H. 

Morley  Secretary. 
Boyal  Berkshire  HospitaI,ReadiDg.- House  Physician.  Salaiy  £8Dper 

annum,  with  board,  lodging,  and  washing.    Appiieatlons  to  tiie 

becretar}*. 
Royal  Dental  Hospital  of  London.  Leicester  Square.— Patron;  Hii 

Majesty  the  King.- Dental  Supermtendent.     Salary  £250  pir 

annum.    Applications  to  J.  Francis  Pink,  Seoretaiy. 
Fisherton  House  Asylum,  Saliobury.— Medical  Superintendent.  Sskiy 

£400  per  annum,  with  board,  lodlging,  and  washing.    Applin- 

tions  to  Dr.  Fmch,  Salisbury. 
County    Asylum,   Mickleover,   Derby.  -  Junior    Assistant    Mcdkd 

Officer.    Salary  £120  per  annum,  with  faniahed  apartmrati, 

board,  washing,  and  attendance.    Applications  to  the  Medisil 

Superintendent. 
Leicester  Infirmary.    House  Surgeon .    Salary  £100  per  annnm,  with 

board,  apartmente,  and  washing.  Applications  to  Harry  Jdanos, 

House  Governor  and  Secretary,  the  Infirmary.  Leicester. 
Royal  PortemouthHospital.— Senior  House  Surgeon.    Sakiy  £M 

per  annum,  with  board,  residence,  Ac.     ApplicatkNis  te  J.  8. 

Neil,  Secretory. 
Catholic  University  of  I  eland.    Joint  Professor  of  Anatomy.  4ppii> 

cations  to  the  Registrar  of  the  Medical  SchooL     (See  AdvL) 


^ptrointmeniB. 


Aarobs,  S.  Jervois,  M.DEdln.,  M.C'C-P.Lond..  Pathologlife  asd 
Curator  of  the  Museum  Boapital  for  Women,  Sobo  Square,  W. 

BsADSHAW,  Thomas  B.,  M.D.Dub.,  F.R.C.P.Lond.,  Examiner  is 
Medicine  in  the  University  of  London. 

Brockbabk,  Fi.  M..  M.D.Vict,  M.R.C.P.Lond.,  Junior  Physidaa  tP 
the  Children's  Hospital  and  Dispensary,  Manchester. 

BuCHABAB,  P.S.,  M.B.Gla8g.,  in  Charge  of  the  Out-door  Midwifery 
Department  of  the  Glasgow  Public  Dispensary. 

BvRMBT,  C  D.  Frakcis,  M.R.C.S.,  Divisional  Sut^eon  to  the  I 
Division  Metropolitoi  Police  (Deptford),  and  also  Dtvislonsl  8a^ 
geon  to  the  police  stotioned  at  Deptford  Victualling  Tant  (Wool- 
wich Division'. 

CouTTS.  E.  N.,  M.B  Toronto.  L.R.C.P.d;  S.Edin.»  Resident  Pkysieais 
to  the  Ro}al  Infirmary,  Glasgow. 


BLDiccK.-OnNoveinber4tb,at8t.Huy'aOnre,  Staflacd,  the  vilt 
ot  F.  HUnea  Blumer,  H.B.,  of  a  son. 

MAONAMARA-njBRMADT.  On  November  6th,  at  Nasira  Aosaai,  Isdii, 
John  Radley  Macnamara,  F.R.C.3.(I),  Medical  Officer,  Amtn 
Compy.,  to  Natolie  Maude,  youngest  daughter  of  Captain  Jtr- 
mam,  B.N.,  of  the  Cottage,  Orondall,  Hants. 


deaths* 


Allibguam.    On  Nov.  6th.  at  Marseilles,  Herbert  W. 
F.B.C.S. ,  of  25  Gros venor  Street,  London.    Aged  43. 


m  ^dm\ 


m&   ^itmht 


"SALUS   POPUU   SUFBEHA   LEZ.' 


Vol.  CXXIX. 


WEDNESDAY,    NOVEMBER    i6,    1904.        No.    20, 


9tiainal  Communications. 

THE 

VARIOUS  PHASES 

OF  A 

HOSPITAL'S     WORK,    {a) 

By  Sir  C.  J.  NIXON,  M.D., 
PhyiicUa  to  the  Mater  MiMricordin  Ho«pital,  Dublin. 

After  some  introductory  remarks  dealing  with  the 
past  history  of  the  hospital,  and  a  reference  to  the 
loss  it  had  sustained  by  the  death  of  Mr.  Patrick 
Hayes,  its  senior  surgeon.  Sir  Christopher  Nixon  said 
that  it  was  in  regard  to  the  utilisation  of  the  hospital 
for  the  purposes  of  research  that  his  address  was 
especially  concerned,  and  he  asked  his  hearers  to  bear 
with  him  whilst  he  endeavoured  to  put  forward  this 
claim  as  strongly  as  he  was  able.  The  progress  of 
hospital  work,  he  continued,  in  its  relation  to  the 
prevention  and  treatment  of  disease  may  be  said  to 
be  slow  and  uneventful  until  the  time  of  Lister.  It  is 
true  that  physicians  like  Addison  and  Jenner  made 
record  discoveries  by  pursuing  cases  of  disease  from 
the  clinical  standpoint  to  the  post-mortem  room,  and 
no  doubt  many  interesting  problems  in  the  biology 
of  disease  were  made  clear  by  these  and  other  obesrvers. 
But  the  stimulus  to  laboratory  investigation  dates 
from  the  discovery  of  Lister,  who  utilised  to  the  fullest 
extent  the  labours  of  Pasteur.  That  discovery  was 
altogether  the  result  of  his  observations  in  hospital, 
for  nowhere  except  in  a  large  general  hospital  could  he 
have  found  materials  for  that  method  of  treatment 
which  has  revolutionised  not  merely  surgery,  but  the 
medicine  of  our  day.  As  an  illustration  of  the  effect 
of  the  Listerian  treatment  of  wounds,  I  believe  I  am 
correct  in  stating  that  the  mortality  after  major 
operations  has  been  reduced  from  40  to  3  per  cent. 

Who  can  estimate  the  gain  to  humanity  of  the  result 
of  this  one  instance  of  hospital  research  work  ?  It 
is  almost  entirely  to  research  work  undertaken  in  the 
laboratory  that  pathology  may  be  said  to  have  attained 
■  its  present  position.  A  comparatively  few  years  ago 
the  work  of  the  pathologist  was  left  to  the  assistant 
medical  officers — indeed,  largely  to  the  senior  students. 
There  existed,  no  doubt,  in  an  imperfectly  organised 
form,  the  machinery  for  recording  notes  and  compiling 
facts  in  connection  with  the  biology  of  disease,  of 
comparing  these  with  conditions  found  after  death, 
and  for  making  generalisations  from  both  data.  But 
there^iWere  no  means  of  pursuing  inquiries  into  the 
modes  of  origin  of  disease,  nor  was  any  attempt  made 
to  determine  the  nature  of  obscure  conditions  which 
could  only  be  investigated  by  the  use  of  instruments 
of  precision  not  then  employed.  In  Dublin  in  1894 
the  first  step  was  taken  in  the  United  Kingdom  to 
place  pathology  in  its  legitimate  position.  The  Royal 
University,  at  the  instigation  of  Sir  William  Thomson 
and  myself,  made  the  regulation  that  pathology  and 
bacteriology  should  be  made  a  special  subject  of  the 
medical  curriculum,  and,  at  the  same  time,  a  professor- 
ship was  created  in  the  Medical  School  of  the  Catholic 


(a)  An  AddreM  delivered  at  the  opening  of  the  Winter  Benion 
of  the  Mater  Miserioordia  HospitaJi  Dublin. 


j  University,  and  the  professor  was  appointed  pathologist 
I  to  the  hospital.  Since  then  the  clinical  physician 
I  and  surgeon  have  had  the  advantage  of  his  services. 
I  Those  who  are  familiar  with  the  work  of  the  clinician 
can  fully  appreciate  how  much  it  is  bound  up  with 
that  of  the  pathologist.  In  many  cases  not  merely 
does  the  diagnosis  of  the  existing  morbid  condition 
depend  upon  the  report  furnished  from  the  laboratory 
— a  report  most  frequently  made  as  a  result  of  some 
bacteriological  or  chemical  investigation — ^but  the  line 
of  treatment  to  be  pursued  is  based  upon  the  conditions 
which  this  investigation  has  determined.  There  is  no 
difficulty  in  realising  why  this  should  be.  The  physician 
studies  the  disease  almost  exclusively  from  its  biological 
aspect ;  the  pathologist  in  addition  investigates  it, 
with  all  the  modem  instruments  of  precision  at  his 
hand,  from  the  physical,  chemical,  and  bacteriological 
standpoint.  In  many,  if  not  most,  cases  it  is  impossible 
to  divorce  the  two  methods  of  observation ;  hence 
the  clinician  and  the  pathologist  may  be  regarded  as 
the  complement  of  each  other.  Let  me  illustrate  my 
meaning  by  an  example.  There  is  frequently  con- 
siderable difficulty  in  diagnosticating  between  two 
severe  forms  of  anaemia,  a  profound  chlorosis  and 
progressive  pernicious  anaemia.  There  are  no  special 
signs  or  symptoms  by  which  the  physician  can  distin- 
guish one  from  the  other,  and  it  is  only  when  the  blood 
has  been  subjected  to  a  physical  and  chemical  examina- 
tion that  a  correct  conception  of  the  existing  condi- 
tion can  be  formed — a  conception  which  carries  with 
it  the  knowledge  of  the  life  or  death  of  the  patient. 

But  the  work  of  the  physician  and  pathologist  does 
not  stop  here.  The  case  of  chlorosis  is  quite  clear. 
Employing  the  known  remedies,  the  patient,  almost 
as  a  matter  of  certainty,  recovers.  But  quite  different 
is  the  case  of  pernicious  anaemia,  in  which  the  accuracy 
of  the  diagnosis  is  attested  by  the  inevitable  death  ^of 
the  patient.  Since  Addison  and  Biermer  drew  atten- 
tion to  the  condition  in  1867  a  great  deal  has  been 
learned  in  connection  with  the  disease  and  with  the 
changes  produced  by  it  in  the  various  organs  and 
tissues  of  the  body.  But  as  yet  the  primary  condition 
which  produces  the  blood  change  is  unknown.  We 
are  unable  to  say  whether  it  is  caused  by  some  chemical 
disturbance  which  interferes  with  cell  nutrition  and 
so  disturbs  the  uniform  composition  of  the  blood,  or 
by  some  ferment  or  toxin  which  affects  the  vitality 
of  the  blood-cells  and  leads  to  their  excessive  destruc- 
tion. How  are  these  obscure  points  to  be  cleared  up  ? 
As  yet  every  form  of  treatment  of  the  disease  has 
proved  futile  because  of  our  ignorance  of  the  primary 
disturbance  of  health.  It  is  only  by  carefully  noting 
each  case  under  observation,  observing  every  sign 
indicative  of  functional  and  organic  disturbance, 
experimenting  with  medicines  that  favourably  influence 
the  course  of  the  affection,  and,  above  all,  employing 
the  physical,  chemical,  and  bacteriological  methods 
of  investigation  at  our  disposal  that  we  shall  be  able 
to  solve  the  mystery  that  at  present  envelopes  the 
origin  of  the  disease.  Such  a  condition  is  quite  as 
hopeful  for  solution  as  was  myxoedema  but  a  few 
years  ago.  The  clinical  investigation  of  this  disease 
led  us  to  recognise  a  blood  state  which  reduced  the 
patient  to  almost  a  condition  of  imbecility ;  was 
capable  of  being  produced  by  a  removal  of  the  thyroid 


510    The  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


gland,    whilst    further    investigation    established    the 
identity  of   the  disease  with  cretinism,  the  condition 
represented  by  those  deformed  and  stunted  specimens 
of   humanity  which   the    traveller  meets  with  among 
the  inhabitants  of  Switzerland  and  northern   Italy. 
After  a  certain  stage  the  steps  of  inquiry  passed  beyond 
the  domain  of  the  clinical  observer,  and  the  work  of 
investigation   was   undertaken    by    the   chemist   and 
e3q)erimental   pathologist.     The   brilliant   results   ob- 
tained by  Horsley  by  removing  the  thjo-oid  gland  in 
monkeys,   and   the  adoption  of  a  line  of  treatment 
suggested  by  him  and  Murray  of  supplying  thyroid 
gland   substance    to   animals   and   human   beings   in 
which  the  gland  was  absent    is  perhaps  an  instance 
of  as  great  a  triumph  of  the  art  of  medicine  as  it  is 
possible  to  record.     Not  alone  is  the  cretinoid  condition 
removed  in  adults,  but  even  cretins,  those  creatures 
who    seemed    so    little    removed    from    mere    animal 
existence,  became  bright  and  intelligent,  and,  if  treated 
at  an  early  age,  had  their  bodily  growth  and  normal 
configuration  restored.     I  dwell  upon  this  condition 
because  it  affords  an  illustration  of  what  the  experi- 
mental  mode   of  investigation   is  likely   to   lead   to. 
It  would  be  altogether  beyond  the  scope  of  this  address 
to  advert  at  any  length  to  what  has  been  achieved 
by  experimental  research,  or  to  state  in  detail  how 
much   mankind   owes   to   it   in   connection   with   the 
treatnaent  of  diphtheria,   tetanus,  rabies,  and  in  the 
investigations    of    the    various    diseases    caused    by 
parasitic  micro-organisms.     It  is  this  method  which, 
m  the  study  of    immunity,  has  led  to  the  artificial 
production   in  the  blood  of   those   substances,  toxins 
which    will,    without    doubt,    protect    the    individual 
against  the  poison  of  t5rphoid  fever,  pneumonia,  the 
deadly  tubercle  bacillus,  and  perhaps  from  that  dread 
disease,  cancer.     When  we  consider  how  many  morbid 
conditions  there  are  in  which  there  is  the  most  inti- 
mate  knowledge   of   the   functional  disturbance   and 
organic    changes   which    exist — where    the   biological 
history  is  carefully  compared  with  the  changes  noted 
after  death,  and  where  only  one  link  is  wanted  to 
explain    the    disturbed    mechanism — one    can    realise 
how  limited  in  usefulness  would  the  clinical  observer 
be  if  he  were  content  merely  to  register  his  failures, 
and  make  no  attempt  to  solve  the  riddles  that  daily 
present  themselves.     Let  me  mention  some  common 
mstances  of  disease,    the  obscurity  of  whose  origin 
still  remains  to  be  solved.     We  are  all  familiar  with 
the  symptoms  and  signs  of  diabetes,  of  the  patho- 
logical changes  produced  by  it,  but  we  are  yet  in 
absolute  ignorance  of  the  initial  point  of  departure 
from  normal  function.     A  similar  difficulty  presents 
itself  in  exophthalmic  goitre,  every  symptom-complex 
of  which  has  been  made  the  subject  of  detailed  and 
elaborate    investigation.     Subtle    nervous    conditions 
like  paralysis  agitans,   chorea,   and  epilepsy  are  yet 
inexplicable   as    to    their   mode    of   origination.     We 
cannot   presume    to   more    than    theorise   upon    their 
etiology.     In   pneumonia   and   acute  rheumatism   we 
are  equally  in  doubt.     We  do  not  know  the  conditions 
which  in  the  one  disease  make  the  individual  a  suitable 
host  for  the  pathogenic  micro-organism,  whilst  in  the 
other  we  are  unable  to  determine  whether  a  chemical 
agent  or  a  microbe  sets  in  motion  the  morbid  state. 
It  would   be  easy  to  multiply  instances  of  disease, 
of  the  common  forms  of  disease,  in  which  we  physicians 
have  to  play  the  rdU  of  empirics  as  regards  treatment, 
and  in  which  this  humiliating  position  of  empiricism 
must  largely  predominate  until  some  advanced  degree 
of  certainty  is  reached  by  an  accurate  knowledge  of 
the   true  nature  of  the  morbid  condition ;   but  until 
that  time  comes  I  am  afraid  we  must  in  many  cases 
be  content  to  accept  humbly  the  old  definition  of  a 
physician,  that  he  is  a  satisfaction  to  the  mind  of  a 
patient.     The   public   are   not   given,    even   granting 
this    mental    capacity,    to    analyse    the    methods    of 
investigation    and    treatment  employed   in  any  case 
of  disease.     An  individual   has  some  particular   ail- 
ment,  and  he  wants   to  get   cured   of  it.     There  is 
not  much  use  explaining  to  him  that  we  are  not  as 


Nov.  i6. 


190^ 


yet  certain  of  the  way  in  which  the  disturbance  of 
his  health  is  set  up,  and  that  his  condition  can  be 
only  dealt  with  symptomatically.     We  may  talk  to 
him  very  learnedly,  and  look  more  wise  than  even  a 
physician  could  really  be,  but  the  patient  teUs  you  ij. 
came  to  be  cured,  and  he  expects  you  to  work  a  mirade 
on  his  behalf.     Such  an  instance  is  an  answer  to  Uk 
distmguished  physicist  who  some  days  ago  addressed 
the  students  of  a  London   hospital.      He  very  tmlv 
pomted  out   that  the  fundamental  studies  of  medicine 
were  of  a  strictly  materialistic  nature,  that  they  be- 
longed  to   a   different  world   from    that   which  con- 
stituted   the  main  object  of  a   student   of  medkine 
and   that  we  should  not   deal  with   living  men  and 
women  as  if  they  represented  a  meri  physical  mechan- 
ism, as  mere  laboratory  or  chemical  specimens.    Bnt 
unfortunately,   as  we  know  nothing  of   the  problem 
which  constitutes  life,  we  have  no  other  methods  of 
analysis    of    processes  of  disease   except   by  noting 
physical   and    chemical    phenomena,    and    comparing 
these  in  any  given  case  with  a  normal  standard  and 
that  normal  standard  is  one  that  is  condition^  b? 
the  principle  of  life.     What  is  meant  to  be  conveyed 
by  the  lesson  is  that  we  are  not  to  regard  our  patiwts 
as  merely  a  piece  of  very  fine  mechanism,  constructed 
by  a  skilled  artificer,  which  wiU  not   bear  rough  or 
uninteUigent  interference,  but  as  a  type  of  the  most 
supreme  specimen  of  delicate  structure  endowed  with 
the  unknown  principle  of  life,  and  therefore  to  be  dealt 
with  on  a  plane  apart  from   ordtnarv  physical  and 
chemical    methods    of    investigation.  '  I    venture  to 
consider  this  Une  of  argument  may  b  c  onsidered  to 
be  what  is  known  as   a   sciomachy,  a    battle  with  a 
shadow.     Where,  I  ask.  is  there  the  slightest  gronnd 
for  believing  that  a  single  thought  or  act  in  connectkm 
with    the   sufferer   in  any   hospital    is  not  associated 
with  his  well-being,  and  in  what  instance  is  there  anv 
advance  of  knowledge  that  is  not  utilised  for  his  beni^ 
L        o       obscure  cases  it  is  our  duty  to  unravel  the 
web  and  in  doing  this  by  the  finite  means  at  ourdis- 
posal   we   are   steadily  pressing  onward    to   the  goal 
which  marks  the  limit  of  human  progress  in  medicine. 
It  IS  only  m  this  way  we  may  hope  to  satisfv  those 
who  come  to  us  for  relief. 

And  here  I  think  it  my  duty  to  freely  acknowledg.^ 
the  thoroughly  progressive  spirit  in  which  the  Sisten 
of  Mercy  have  administered  the  affairs  of  this  hospital 
their  readiness  at  all  times  to  accede  to  the  recom^ 
mendations  of  the  Medical  Board  in  all  matters  which 
are  essential  to  the  welfare  of  the  patients  and  of  the 
institution  generally,  and  to  their  never-failin?  con- 
sideration  and  courtesy  towards  both  the  staff  and 
the  students. 

It  was  this  spirit  of  progress  which  impeUed  those 
responsible   for   the   management   of   the    hospital  to 
provide  the  necessary  facilities  for  the  carryine  on  those 
researches  which  will  lead  to  our  more  accurate  know- 
ledge  of  disease  and  its  treatment.     They  have  pro- 
vided us  with  a  laboratory  which,  under  the  direction 
of  the  pathologist  of  the  hospital.  Professor  McWeener. 
will  be  utilised  for  the  process  of  the  science  and  art 
of  medicine.     Professor  McWeeney    will     be  clad  to 
show  our  visitors  over  the  laboratory  and  explain  to 
them   the   points   of  interest   in   connection   with  it. 
Upon  him  will  rest  a  great  responsibiUtv.  tfie  charw 
of  the  pathological  department  of  a  great   hospital, 
and  I  will  only  say  of  him  that  I    believe  him  to  be 
intellectually  fitted  for  the  post.     There  is  a  remarkable 
point  worthy  of  notice  in  connection  with  the  patho- 
logical     department     of     the     hospital.      The     Ro^-al 
University  grants  studentships  in  two  subjects  of  the 
medical  curriculum— physiology  and  pathology.    The 
pathological  studentship  is  awarded   every  alternate 
year,  and  since  its  foundation  five  studentships  have 
been   awarded.     Out   of   these   five,    four   have  been 
gained  by  former  students  of  the    hospital— the  first 
by  our  own  professor.  Dr.  McWeeney;  the  second  bv 
the  distinguished  assistant  physician  of  St.  Vincent's 
Hospital.  Dr.  Dargan ;  and  the  third   by  Dr.  Cniian 
the  assistant  surgeon  to  this  hospital;  and  the  fourth 


Nov.  1 6,  1904. 


ORIGINAL    COMMUNICATIONS, 


The  Medical  Press.    5^*^ 


by  Dr.  Denis  Farnin.  Much,  it  is  hardly  necessary  to 
say.  is  expected  from  a  triumvirate  representing  such 
brilliant  attainments. 

The  encouragement  given  by  the  managers  of  the 
hospital  to  the  employment  of  scientific  methods  of 
investigation  of  disease  necessitated  an  encroachment 
upon  its  slender  resources.  But  the  enlightened 
•spirit  which  provided  those  facilities  for  research  is 
bound  to  have  its  reward  in  perfecting  our  means  of 
combating  disease  and  alleviating  human  suffering, 
To  me,  personally,  the  opening  of  a  new  laboratory  is 
an  occasion  of  extreme  interest.  I  have  been  connected 
A%'ith  the  hospital  for  thirty-six  years ;  I  have  noticed 
its  steady  development  and  progress,  and  now,  in 
the  forty-third  year  of  its  existence,  it  may  be  said  to 
be  entering  upon  a  new  career  of  usefulness.  It  has, 
as  you  are  all  aware,  an  intimate  connection  with 
the  Catholic  University  School  of  Medicine,  and  I 
venture  to  express  a  hope  that  the  bond  between 
the  two  institutions  will  be  even  more  strongly  cemented 
in  the  future.  A  great  schbol  of  medicine — ^and  the 
Catholic  University  School,  with  all  its  drawbacks  as 
to  position,  structural  proportions,  and  lack  of  endow- 
ment, can  claim  to  be  by  far  the  largest  school  in 
Ireland,  a  distinction  which  many  will  regard  as  of 
some  importance — should  be  in  the  closest  relation 
with  a  great  hospital,  so  that  the  research  work  of 
each  would  be  facilitated  and  augmented.  In  this 
way  the  tone  and  status  of  medicine  in  Ireland  would 
gradually  reach  the  level  of  that  attained  by  the  great 
Continental  schools.  There  should  be  no  hesitation 
in  accepting  this  view.  Before  the  introduction  of 
the  modem  methods  of  precision  in  the  diagnosis  of 
disease  the  Dublin  school  was,  in  many  instances, 
in  advance  of  the  great  schools  in  Germany.  France, 
and  Austria.  Graves,  Collis.  Corrigan.  Stokes,  and 
Adams  constitute  a  quintette  of  original  observers, 
each  one  of  whom  is  handed  down  to  posterity  as  the 
discoverer  of  the  special  disease  which  bears  his  name. 
But  just  as  the  sister  country  has  fallen  so  much 
behind  in  all  scientific  work,  and  as  her  industries 
have  been  to  a  large  extent  monopolised  by  America 
and  Germany,  so  medicine  in  Ireland  has  not  held  its 
own  in  research.  Yet  it  may  be  asked,  is  there  any 
quality  of  brain  power  in  Ireland  which,  under  favour- 
able conditions,  would  prevent  it  from  successfully 
competing  with  that  of  the  Germans  or  the  French  ? 
To  have  signal  results  I  hold  you  must  have  a  com- 
bination of  a  great  hospital  with  a  great  school. 
Given  a  completely  equipped  school  of  medicine, 
having  each  department  thoroughly  organised, 
manned  by  a  competent  staff  of  professors  and  assist- 
ants, and  collaborating  its  work  with  a  great  hospital, 
which  the  spirit  of  the  time  has  made  ideal  in  all  Us 
departments,  then  I  do  not  say  I  believe,  but  I  feel 
confident,  the  genius  of  Irishmen  will  make  their 
country  a  home  for  scientific  progress  in  medicine.  It 
is  scarcely  possible  to  conceive,  with  the  encourage- 
ment that  is  being  given  to  the  various  conditions 
bound  up  with  industrial  and  agricultural  life  in  Ire- 
land, and  with  such  indications  as  are  presented  of 
the  dawning  of  prosperity  and  progress,  that  no  con- 
sideration will  be  given  by  the  State  to  a  profession 
from  which  it  extracts  so  much  profit.  I  say  this 
notwithstanding  that  the  opportunity  which  was 
recently  afforded  to  the  Government  of  settling  the 
University  question  in  such  a  way  as  would  provide 
a  school  of  medicine  commensurate  with  the  require- 
ments of  students  of  the  country  at  large  was  not. 
unfortunately,  availed  of.  The  report  of  the  Royal 
Commission  on  University  Education  in  Ireland 
appears  likely  to  share  the  fate  of  most  Royal  Com- 
missions, the  reports  of  which,  so  far  as  Ireland  is 
concerned,  result  in  vitalising  the  conditions  they  were 
appointed  to  remedy.  It  is  stated  that  the  present 
Government  has  fallen  back  no  less  than  34  times 
on  Royal  Commissions,  at  a  cost  to  the  country  of 
;^392,ooo.  In  Ireland  we  have  had  several,  and  in 
most  of  them  the  outcome  was  uniform — no  result 
Indeed,  in  connection  with  higher  education  in  this 


country,  one  would  feel  inclined  to  urge  the  friends  of 
the  University  of  Dublin  to  demand  the  appointment 
of  a  Commission  to  consider  the  present  condition  of 
the  higher,  general,  and  technical  education  available 
in  Ireland  inside  Trinity  College,  Dublin.  No  matter 
what  the  Commissioners  report,  it  is  almost  a  certainty 
that  the  status  quo  will  be  maintained,  and  the  Uni- 
versity will  be  able  to  repeat  MacMahon's  response 
at  Malakoff — "  J'y  suis,  j'y  teste,**  Still,  if  a  comment 
may  be  made  upon  the  recent  report  on  University 
Education  presented  to  his  Majesty,  it  is  not  to  say 
that,  prepared  as  we  may  be  for  the  policy  of  laissez 
faire  which,  in  regard  to  Ireland,  appears  to  be  a 
characteristic  of  our  Government,  still,  one  would  hope 
there  is  a  limit  which  no  self-respecting  Government 
would  outstep  in  dealing  with  a  country  which  it 
professes  to  govern,  and  with  a  body  of  men  to  whom 
it  entrusted  an  almost  sacred  mission.  The  con- 
demnations and  recommendations  of  the  Commis- 
sioners are  so  destructive  in  their  nature  that  in  face 
of  them  to  maintain  an  institution  which,  in  the 
words  of  the  Act  establishing  it,  was  to  promote  the 
advancement  of  learning  in  Ireland,  appears  to  be 
"  a  mockery,  a  delusion,  and  a  snare."  The  three 
main  findings  of  the  Commission  were  that  the  Royal 
University  lowered  the  ideal  of  University  education, 
that  its  system  of  making  appointments  to  the  Senate 
and  offices  of  the  University  was  indefensible,  and 
that  the  system  adopted  by  it  of  indirectly  endowing 
certain  colleges  must  be  condemned.  It  is  scarcely 
conceivable  that  no  action  would  be  taken  upon  this 
report,  coming  from  a  body  of  experts  appointed 
by  practically  the  same  Government  which  abolished 
the  Queen's  University  and  substituted  in  its  place 
the  Royal  University,  or  that  any  Government  would 
be  so  inconsiderate,  to  say  the  least, -as  to  continue 
to  impose  upon  the  members  of  the  Senate  the  duty 
of  administering  the  affairs  of  an  educational  body 
which  was  the  subject  of  so  strong  a  censure.  Or 
is  its  policy  to  be  represented  by  the  lines — 

"  I  see  the  right,  and  I  approve  it,  too ; 
Condemn  the  wrong,  and  yet  the  wrong  pursue  "  ? 

There  must  be  some  change  effected,  and  with  the 
change  I  hope  will  come  the  realisation  of  my  ideal — 
a  great  and  thoroughly  equipped  school  and  hospital 
bound  together  by  the  closest  bonds  of  union,  and 
working  for  the  common  object,  the  progress  of  our 
profession. 

In  connection  with  the  question  of  Commissions, 
appointed  to  redress  Irish  grievances,  I  should  like  to 
advert  briefly  to  one  which  for  the  moment  excited 
keen  interest  amongst  the  hospital  charities  of  Dublin. 
In  March,  1885,  a  memorial  from  the  Medical  Board 
of  this  hospital  was  presented  to  the  then  Lord 
Lieutenant,  Earl  Spencer,  praying  that  an  inquiry 
should  be  held  into  the  conditions,  as  regards  work 
done,  and  the  management  of  each  hospital  in  Dublin, 
with  a  view  to  a  redistribution  of  the  Parliamentary 
grant  annually  voted  for  the  maintenance  of  some  of 
these  hospitals.  The  prayer  of  the  memorial  was 
acceded  to,  and  in  April,  1887,  a  Commission  was 
appointed  to  make  inquiry  into  the  management  and 
working  of  the  hospitals  in  the  city,  the  conditions 
upon  which  annual  grants  from  the  public  funds  were 
given  for  the  support  of  certain  hospitals,  and  whether 
any  redistribution  of  such  annual  grants  was  expedient 
and  advisable.  The  Commissioners  sat  for  a  period 
extending  over  some  five  months,  and  examined  ^6 
witnesses,  from  whom  valuable  information  was 
obtained  upon  all  points  in  connection  with  hospital 
management,  none  more  valuable  than  that  given  by 
my  colleague,  Mr.  Chance,  the  President  of  the  College 
of  Surgeons.  The  Commissioners,  seven  in  number, 
unanimously  signed  a  report  which  made,  amongst 
others,  the  following  important  recommendations:  — 
(a)  That  the  annual  grant  should  be  commuted  for 
a  capital  sum,  to  be  invested  in  the  names  of  trustees, 
and  the  interest  thereon  should  be  paid  to  a  central 

D 


5^2    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Nov.  16,  1904- 


board  to  be  distributed  by  them  to  such  hospitals  as 
should  fulfil  certain  specified  conditions.  (6)  The 
conditions  laid  down  to  entitle  any  hospital  to  a  share 
in  the  distribution  of  the  grant  referred  to  the  number 
of  beds  occupied,  the  number  of  students  attending 
clinical  instruction,  the  number  of  nurses  and  proba- 
tioners trained,  the  general  eflEiciency  of  the  institution, 
and  the  energy  of  the  directors,  as  evidenced  by  the 
amount  of  money  collected  in  the  shape  of  private 
subscriptions,  donations,  and  bequests.  I  would  not 
be  justified  in  saying  that  the  report  gave  universal 
satisfaction,  but  I  believe  I  am  within  the  strict  limits 
of  truth  in  stating  that  the  feeling  which  prevailed 
amongst  members  of  the  profession  and  of  the  public 
generally  was  that  a  solution  eminently  fair  and 
practical  had  been  arrived  at,  and  that,  with  due 
regard  to  vested  interests,  the  recommendations  of 
the  Commissioners  would  be  given  effect  to.  This  view 
was  confirmed  by  the  course  taken  by  the  Government 
of  the  day,  for  in  August,  1889,  a  Bill  giving  effect 
to  all  the  proposals  specified  in  the  report  of  the 
Commission  was  introduced  by  Mr.  Jackson,  the  Chief 
Secretary  for  Ireland  for  the  time  being.  And  now 
occurred  an  action  of  a  mysterious  nature.  For  some 
cryptic  reason — there  never  was  the  least  attempt  to 
explain  the  why  or  wherefore — the  Bill,  after  being 
read  a  second  time,  was  withdrawn,  and  the  report  of 
the  Dublin  Hospital  Commission  shared  the  fate  meted 
out  to  the  many  Commissions  which  preceded  and 
followed  it.  I  would  hardly  think  it  necessary  to  touch 
upon  this  matter  but  for  the  dim  shadows  that  are 
appearing  heralding  the  advent  of  some  fiscal  arrange- 
ment by  which  all  Irish  moneys  will  be  dealt  with  by 
a  purely  Irish  Executive,  If  this  should  come  about, 
whether  by  "  devolution "  or  some  more  advanced 
and  more  stable  scheme  of  reform,  I  should  hope  the 
demand  for  equitable  consideration  of  each  hospital 
in  Dublin   will  be  complied  with. 

I  have  only  to  add  a  few  words  to  the  students  of 
what  I  am  justified  in  calling  a  national  institution. 
This  hospitai,  if  developed  on  the  lines  indicated  in 
my  address,  cannot  but  be  ultimately  associated  with 
the  progress  of  medicine  in  Ireland.  It  may  be  that 
some  of  those  whom  I  have  the  pleasure  of  addressing 
may  play  an  active  part  in  rendering  it  a  pioneer 
in  the  advancement  of  that  knowledge  which  is  essential 
to  the  well-being  of  our  race.  With  the  most  striking 
evidences  presented  to  us  of  the  almost  illimitable 
powers  of  man's  productiveness  in  every  department 
of  physical  science,  especially  during  the  latter  half 
of  the  century  just  passed,  in  which  the  record  of 
wonders  appears  to  have  been  reached,  it  is  not  likely 
that  the  science  of  medicine  will  stand  still.  There  are 
indications  that  we  are  moving  in  the  direction  of 
some  great  discoveries  in  connection  with  the  preven- 
tion and  treatment  of  disease  which  will  be  no  less 
startling  than  those  of  the  physicist  and  chemist, 
with  this  distinction — that  whilst  they  deal  with 
material  substances,  our  lot  concerns  alone  the  well- 
being  of  our  own  species — man.  Our  profession  is 
not  one  that  brings  either  ease  or  wealth  in  its 
train.  To  the  vast  majority  of  those  who  embrace  it 
as  a  calling  there  is  but  little  beyond  a  well-earned 
competence.  But  with  its  many  drawbacks  it  has 
within  it  elements  of  human  interest  which  contrast 
favourably  with  the  sordid  and  debasing  elements  of 
other  pursuits.  We  certainly,  in  our  profession,  have 
a  great  incentive  to  live  up  to  Sydney  Smith's  noble 
ideal — Let  every  man  be  occupied,  and  occupied  in 
the  highest  employment  of  which  he  is  capable,  and 
die  with  the  consciousness  that  he  has  done  his  best. 


The  Royal  University  of  Ireland. 
His  Majesty's  Royal  Warrants  have  been  received 
appointing  Rt.  Hon.  Lord  Killanin,  Sir  William  Thom 
son,  C.B.,  M.D.,  and  Dr.  Bertram   C.  A.  Windle,  Pre- 
sident of  Queen's  College,   Cork,   to  be  members  of 
Senate. 


THE 

STERILISING   OF   SURGICAL 
DRESSINGS,  (a) 

By  A.  SCOT  SKIRVING,  M.B.,  CM.,  F.R.C.S.  Ed., 

ABslstant  Surgeon,  Royal  Infinnazy,  Edinburgh, 

Some  eighteen  months  ago,  in  considering  the 
cause  of  an  operation  case  becoming  septic,  Mr. 
Skirving  had  investigated  the  subject  of  sterilisa- 
tion of  dressings  by  the    ordinary    methods   in 
vogue,    in    particular    by    the     Schimmelbusch- 
Lautenschlager    steriliser    and     drum.       Though 
much  had  been  written  on  the  subject  of  sterilis- 
ing the  skin,  the  hands  of  the  surgeon,  catgut 
hgatures,  &c.,  there  was  not  very  much   recent 
literature  on  the  treatment  of  surgical  dressings, 
and  this  had  led  the  writer  to  consider  the  whole 
question .     Passing  from  the  simple  and  trustworthy 
methods  of  sterilising  by  boiling   and  immersioa 
in  antiseptic  solutions,  the  most  generally  used 
means,  that  of  steam  steriUsation,  had  to  be  con- 
sidered.   There  were  three  difficulties  in  sterilising 
in  this  way  : — First,  as  to  the  steam  itself  ;  second, 
the  steriliser  ;   and  third,  the  drum.    The  first  of 
these  difficulties,  the  kind  of  steam  which  it  was 
best  to  employ,  was  the  greatest,  involving,  as  it 
did,  abstruse  questions  of  thermo-dynamics.   The 
following  terms  were  applied   to  steam : — Steam 
in    equilibrium,  steam   in   motion,    steam   under 
pressure,   steam   not   under    pressure,    saturated 
steam,  and  superheated  steam.     Ambiguity  often 
arose  in  using  the  two  last  expressions.   Saturated 
steam  was  steam  carrying  a  certain  amount  of 
water  in  suspension,  its  temperature,  of  course, 
depending  on  the  pressure.     As  long  as  this  steam 
remained  in  contact  with  the  water  from  which 
it  was  produced,  its  temperature  was  the  same  as 
that  of  the  water.     Once  away  from  the  water, 
however,  its  temperature  might  be  raised  without 
altering  its  pressure,  and  steam  so  treated  was 
said  to  be  superheated.    If  saturated  steam  were 
mixed  with  water  at  the  same  temperature,  none 
of    the    water  was    evaporated  ;  if   superheated 
steam    were    employed    in  the  same    way   some 
water  was  evaporated.     The  greater  the  extent  to 
which    steam    was    superheated,    the     more  did 
it  assume  the  properties  of  a  gas.     It  was  im- 
portant to  surgeons  to  know  that  saturated  steam 
had  far  more  steriUsing  power  than  superheated 
steam,  as  Braatz  and  Esmarch's  researches  showed. 
For  example,  anthrax  spores  were  killed  in  five 
minutes  by  saturated  steam  at  100°,  but  survived 
superheated   steam   at    no®   for   thirty   minutes, 
and  at  120°  for  twenty  minutes.    Now,  a  number 
of   sterilisers    and    disinfectors     avowedly    made 
use   of    superheated    steam,   especially   those    in 
which  no  circulation  of  steam  takes  place,  and  in 
which  steam  is  admitted  externally  for  warming 
purposes  at  a  higher  pressure   and   temperature 
than  that  in  the  interior  of  the  apparatus.  Further, 
it   was    probable   that   superheating    took   place 
accidentally  in    a   fair   number   of   sterilisers  in 
which  this  was   not  included — e.g.,   some  small 
sterilisers   with  steam  only   at  100*^0.,  and. not 
under   pressure,   if  preUminary   warming   of  the 
dressing  is  carried  out  before  the  steam  is  ad- 
mitted.    To  avoid  this,  fore-warming  ought  not 
to  be  allowed  to  exceed  60°.    As  to  the  question 
of  steam   under  pressure,   but  not  superheated, 

(a)  Abstract  of  Paper  read  before  the  Edinhoigli  Medico-Chi- 
rurglcal  Society,  November  2nd,  1904. 


Nov.  1 6,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press. 


313 


experiments  conclusively  proved  that  its  bac- 
tericidal power  was  enormously  increased  when 
the  pressure  was  raised.  It  was,  of  course,  ques- 
tionable whether  laboratory  organisms  were 
exactly  comparable  to  those  growing  in  wounds 
as  regards  their  power  of  resistance  ;  and  it  seemed 
as  though  different  strains  of  cultivated  organisms 
varied  somewhat  in  their  powers  of  resistance. 
Next,  as  to  the  question  of  air  in  sterilisers.  Air, 
as  was  well  known,  was  a  feeble  germicide,  and  it 
was  a  serious  menace  to  effective  sterihsation  if 
the  air  in  the  apparatus  was  not  completely  ex- 
pelled, as  when  the  lower  tap  was,  through  careless- 
ness or  accident,  not  opened  at  the  commencement 
of  the  operation.  He  had  made  a  number  of 
experiments  on  the  temperature  in  the  centre  of 
various  dressings  under  different  conditions  as  to 
time,  pressure  and  packing.  These  had  convinced 
him  that  air  was  often  not  completely  expelled  from 
the  sterilisers,  there  being  sometimes  a  very  con- 
siderable difference  of  temperature  between  the  top 
and  bottom  dressings  after  five  or  six  minutes.  This 
was  due  to  the  pressure  of  air,  which,  being  heavier 
than  steam,  collected  at  the  foot,  and  was  a  bad 
conductor  of  heat.  Vendors  of  sterilisers  were  too 
apt  to  omit  to  supply  information  on  the  extreme 
importance  of  allowing  air  to  escape  at  the  begin- 
ning of  sterilisation.  In  the  old  Schimmelbusch 
sterihser,  now  frequently  discarded  in  favour  of  its 
high  pressure  derivative,  this  could  not  happen,  and 
it  also  had  the  advantage  of  providing  a  continuous 
current  of  steam  during  the  whole  process.  The 
effect  of  packing  the  drums  too  tightly  was  very 
marked :  a  difference  of  20°C.  might  be  obtained  by 
crowding  a  drum  with  too  much  dressing.  Turning 
to  drums,  the  defects  of  Schimmelbusch*s  pattern 
were  pointed  out.  The  hinges,  shutters  and  bolts 
were  all.  drawbacks  ;  the  lid  soon  ceased  to  fit 
closely,  and  the  shutter  mechanism  was  im- 
perfect. A  drum  was  then  exhibited  which 
the  speaker  had  devised.  It  had  a  sliding- 
on  Hd,  with  a  deep  flange,  round  the  lower  part  of 
which  a  series  of  large  holes  was  pierced.  The 
dressings  were  contained  in  a  gauze  basket  inserted 
into  the  drum,  the  hd  was  put  on,  but  not  thrust 
home,  so  that  steam  entered  the  drum  through 
the  holes  in  the  hd  ;  when  sterihsation  was  over 
the  hd  was  pushed  firmly  down,  so  that  this  com- 
munication was  blocked.  The  bottom  of  the  drum 
had  a  small  hole,  occluded  by  a  screw  cap,  by 
which  water  could  be  drained  off  if  need  be.  In 
using  the  drum,  Mr.  Skirving  had  found  that  the 
dressing  was  much  more  effectually  sterihsed  when 
the  drum  was  put  into  the  sterihser  upside  down, 
the  explanation  being  that  convection  of  heat 
then  came  into  play,  the  hot  steam  ascending 
from  the  entrance  holes  in  the  hd,  now  lower- 
most, and  reaching  the  top  of  the  dressing  much 
more  quickly  than  it  would  descend  to  the  bottom 
when  the  drum  was  placed  upright,  with  the  holes 
in  the  hd  at  the  top.  The  great  point  about  the 
drum  was  that  it  would  preserve  dressings  sterile 
for  a  considerable  period,  which  was  not  the  case 
with  ordinary  patterns,  as,  owing  to  their  com- 
phcated  construction,  they  were  never  hermetic- 
ally sealed,  as  Mr.  Skirving's  pattern  practically 
was.  The  question  of  heating  by  convection  was 
of  some  importance.  In  all  drums  heating  of  the 
contents  resulted  from  (i)  diffusion  of  hot  steam  ; 
(2)  conduction  of  heat.  If  the  steam  enters 
by  the  bottom,  convection  is  added.  Convec- 
tion, as  physicists  knew,  was  the  important   factor 


in  heating  a  given  quantity  of  water  to  a  definite 
maximum  temperature,  and  this  idea  might  be 
considered  in  the  vexed  question  as  to  whether 
steam  is  best  admitted  to  sterihsers  from  below 
or  from  above.  His  final  advice  was,  purchasers 
of  sterihsers  ought  to  get  instructions  from  the 
makers,  not  from  intermediate  sources.  In  hos- 
pitals the  ideal  plan  was  to  have  a  central  sterUiser 
managed  by  a  thoroughly  competent  person.  All 
small  sterihsers  should  have  pressure  and  tem- 
perature gauges,  which  should  be  tested  from 
time  to  time.  Occasional  bacteriological  tests 
should  also  be  made,  and  the  condition  of  the 
drums  should  be  supervised. 

THE   SPA  TREATMENT   OF 
ARTHRITIS   DEFORMANS. 

By  W.  BOWEN-DAVIES,  L.R.C.P.,  M.R.C.S., 
LUndcindod  Wells. 

I  HAVE  chosen  the  term  *'  arthritis  deformans  ** 
after  the  German  and  American  schools,  as  I 
think  it  a  better  name  for  the  disease  than  the 
more  often  used  "  rheumatoid  arthritis "  or 
"  rheumatic  gout,"  for  in  the  majority  of  cases 
there  seems  to  be  very  little  rheumatism  and 
less  gout  to  do  with  this  condition. 

The  disease  is  a  different  one,  and  requires  a 
totally  different  treatment,  and  it  is  important 
that  it  should  be  dissociated  from  rheumatism  and 
gout,  for  the  treatment  is  quite  dissimilar.  There 
are,  however,  very  few  patients  suffering  from 
"  arthritis  deformans "  who  have  not  at  one 
time  or  another  taken  drugs  and  adopted  the 
diet  that  would  be  suitable  in  rheumatism  qr 
gout,  such  as  colchicum  or  the  salicylates,  or  used 
a  low  diet  free  from  meat  and  alcohol.  Now,  all 
this  treatment  is  decidedly  detrimental  to  any 
patient  suffering  from  arthritis  deformans,  and 
cannot  be  otherwise  than  harmful. 

I  happen  to  have  had  exceptional  opportunities 
of  studying  this  disease  during  the  last  few  years, 
both  in  hospital  and  out ;  this  must  be  my  apology 
for  bringing  forward  a  type  of  disease  so  common 
to  all  of  those  who  practise  at  spas,  for  though  it 
does  not  directly  lead  to  death,  it  certainly  does 
to  the  most  abject  misery  and  progressive  de- 
formity. 

I  have  never  quite  satisfied  myself  why  this 
disease  is  practicsdly  confined  to  the  female  sex, 
but  there  is  no  doubt  that  it  is  common  about 
the  menopause,  and  that  it  is  influenced  greatly 
by  uterine  and  ovarian  disturbance.  Again, 
mental  shock  is  a  very  common  cause  of  the 
onset  of  the  disease,  and  any  acute  disease,  not 
necessarily  rheumatic  fever,  is  sometimes  followed 
by  it. 

Influenza  seems  specially  to  cause  it.  I  remem- 
ber one  of  the  first  cases  that  impressed  itself 
upon  my  memory  j  it  was  a  very  instructive 
one.  A  woman,  aged  about  30,  who  had  no 
gouty  or  rheumatic  history,  the  wife  of  a  farmer 
in  seemingly  prosperous  circumstances.  She  had 
two  children  when  I  saw  her  first,  and  arthritis 
deformans  had  already  a  good  hold  of  her.  Her 
lassitude  was  extremely  marked,  and  she  had 
evidently  made  up  her  mind  for  a  "  sofa  "  life. 
Shortly  afterwards  her  husband  was  suddenly 
killed,  and  it  was  found  that  his  affairs  were  in 
a  most  unsatisfactory  state ;  she  was  left  with 
her  two  children  without  a  penny.     Her  husband's 


514    Thx  Medical  Press. 


CLINICAL    RECORDS. 


Nov,  x6.  1904. 


friends  came  forward  and  offered  to  adopt  the 
two  children.  This  she  would  not  consent  to  ; 
she  said  she  would  not  part  with  them,  but  would 
make  a  home  for  them  in  a  neighbouring  village. 
This  she  did,  and  to  gain  a  livelihood  for  herself 
and  them  she  took  in  washing  ;  most  of  her  time 
was  spent  at  the  wash-tub. 

I  lost  sight  of  her  for  three  years,  when  she 
called  on  me.  I  hardly  knew  her,  she  looked  so 
well,  and  the  joints  had  almost  recovered  their 
suppleness,  the  lassitude  had  disappeared,  in 
fact,  the  disease  was  cured. 

Now  what  had  caused  this  wonderful  trans- 
formation ?  Undoubtedly  the  change  in  her  life, 
the  excessive  exercise  she  took  daily,  the  scrubbing 
and  rubbing.  She  said  she  felt  the  pain  very 
much  at  first,  but  after  a  time  there  was  only 
extreme  weakness,  which  lasted  longer,  but  eventu- 
ally passed  away. 

Many  lessons  are,  I  think,  to  be  learned  from 
this  case,  the  benefit  quickly  obtained  from  the' 
regular  exercise  and  what  was,  to  her,  hard  work. 
She  told  me  she  took  little  medicine,  except  cod- 
liver  oil,  of  which  she  partook  largely. 

Diet. — It  seems  to  me  important  that  food 
should  be  taken  not  oftener  than  three  times  a 
day.  What  may  be  called  "  nips  "  of  food  or 
drink  are  bad,  and  three  times  a  day  is  often 
enough  to  call  upon  the  deranged  digestive  organs 
to  act.  A  little  alcohol  does  good,  and  may  be 
taken  in  the  form  of  sound  malt  liquor,  stout 
preferable,  or  a  light  wine,  such  as  Moselle,  or  a 
weak  old  whisky  and  water,  but  never  between 
meals.  Fats  should  be  partaken  of  freely,  especi- 
ally milk  in  any  shape  or  form.  Extract  of  malt 
is  a  useful  addition  to  the  cod-liver  oil.  Lightly- 
cooked  eggs  are  always  useful.  Fresh  butter 
should  be  taken  freely,  at  least  a  quarter  of  a 
pound  daily.  The  diet  should  certainly  be 
generous  and  nourishing. 

As  I  have  said  before,  plenty  of  exercise  in 
the  open  air  is  absolutely  necessary,  and  the  more 
bracing  the  atmosphere  the  better.  Every  joint 
should  be  fuUy  bent  and  extended  each  day, 
the  patient  should  be  advised  to  take  long  steps 
in  walking,  and  not  to  sit  on  low  chairs.  Indeed, 
in  one  case,  I  recollect  a  patient  who  disregarded 
this  advice,  and  usually  sat  on  an  extremdy  low 
drawing-room  seat,  which  allowed  the  hips  and 
knees  to  contract,  until  she  could  only  walk  in  a' 
sitting  posture  ever  afterwards. 

At  Llandrindod  Wells  most  cases  naturally 
come  under  the  mineral  water  treatment,  and 
derive  much  benefit  from  the  waters  and  baths. 
*  They  usually  take  the  waters  in  this  form  :  The 
hot  saline  from  three  to  six  tumblers  before 
breakfast,  with  a  fifteen  minutes'  walk  after  each, 
and  either  the  sulphur  in  five  or  ten  ounce  doses, 
with  a  twenty  minutes'  walk  after  each,  between 
eleven  and  twelve  o'clock,  and  sometimes  between 
three  and  six  o'clock  as  well,  or  the  chalybeate 
three  or  four  wineglassfuls  two  or  three  times  a 
day  after  meals  ;  of  course  this  entails  exercise. 
The  baths  are  found  to  be  most  useful,  but  never 
the  reclining  bath,  always  in  the  form  of  needle 
spray  sulphur  baths,  or  what  we  have  found 
most  useful  in  this  complaint,  some  form  of 
hot  air  bath,  very  hot.  It  is  common  advice 
to  avoid  cold  and  damp,  and  in  all  these  cases,  no 
doubt,  this  is  very  good  advice,  but  patients  often 
make  this  an  excuse  for  not  venturing  out  of 
the  house  at  all,  excepting  in  the  finest  weather. 


Something  has  been  said  about  the  contagioiis- 
ness  of  arthritis  deformans.  All  I  can  say  is,  that 
in  my  experience  of  thirty-four  years,  and  nearly 
a  thousand  cases  of  this  disease,  I  have  only  twice 
seen  two  members  of  the  same  family  affected 
with  it,  and  could  not  make  out  any  family  history 
of  the  disease.  I  have  never  come  across  any 
cases  that  would  give  me  any  reason  to  consido: 
that  the  disease  in  any  way  has  been  spread  by 
contagion,  nor,  in  my  opinion,  is  it  hereditary. 
One  curious  point  has  been  observed,  namely, 
that  during  the  active  progress  of  the  disease 
the  evening  temperature  continues  about  99**  or 
100°,    and  never  much  higher. 

The  pulse,  too,  is  usually  found  to  be  about  100 ; 
this  continues  for  years,  and  is  itself  a  valuable 
diagnostic  sign.  The  extreme  lassitude  and  want 
of  energy  which  are  so  marked  in  these  cases  is 
also  a  valuable  sign  which  seems  always  to  be 
benefited  by  prolonged  and  active  exercise  in  the 
bracing  air.  The  cure  seems  a  painful  one,  but  is 
attended  by  wonderful  results,  if  used  diligently 
before  the  disease  becomes  incurable. 

There  is  no  doubt  that  few  diseases  are  more 
curable,  if  this  is  perseyered  with  when  the  disease 
is  tn  an  early  stage. 

Clinical  Kecords. 


A  CASE  OF  TRICUSPID  INCOMPETENCY. 
By  S.   J.  Ross,  M.D. 

The  patient  is  a  man,  aet.  53,  who  for  the  past 
nine  years  has  had  a  winter  cough.  There  is 
no  history  of  rheumatism  or  any  other  illness. 

Four  years  ago  he  noticed  that  his  cough  was 
more  troublesome,  and  his  ankles  began  to 
swell  towards  the  evening.  He  had  marked 
dyspnoea.  Two  years  ago  when  I  first  saw 
him  his  condition  was  as  follows  : — ^Marked 
cyanosis  of  Ups  and  cheeks,  chest  barrel-shaped, 
lungs  markedly  emphysematous  and  rdles  to 
be  heard  all  over  the  chest.  Cardiac  dulness 
masked  by  emphysematous  lung.  Epigastric 
pulsation  very  marked.  No  murmur  to  be 
heard  ;  heart's  action  very  irregular.  Pulse. — 
100,  very  small,  very  irregular.  Liver  dulness 
depressed  and  increased,  spleen  enlarged.  Urine, 
sp.  gr.  1030,  acid,  albuminous  ;  ankles  very 
oedematous. 

Steadily  his  condition  became  worse,  and 
signs  of  cardiac  dilatation  became  more  marked. 
A  limited  soft  systohc  murmur  is  to  be  heard  in  the 
tricuspid  area. 

Hepatic  pulsation  very  marked.  Venous  pul- 
sation in  the  veins  of  the  neck,  the  expansion 
being  synchronous  with  systole,  collapse  with 
diastole.  During  attacks  of  coughing  the  veins 
attain  an  enormous  size.  All  his  organs  were 
congested.  Lungs, — Cough  very  troublesome, 
with  slight  haemoptysis.  Liver. — Pulsating, 
slight  jaundice  ;  haemorrhoids.  Kidneys. — ^Urine 
greatly  diminished  in  quantity,  of  high  specific 
gravity,  and  almost  solid  with  albumen;  spleen 
enlarged.  Stomach. — Vomiting  frequent,  and 
occasional  traces  of  blood  in  the  vomited  matter. 
Extremities  of  anterior  abdominal  wall  oedema- 
tous. Ascites  very  marked.  Brain. — Irritable, 
and  insomnia  a  troublesome  symptom. 

Treatment. — ^With  rest  in  bed  and  an  ex- 
clusively milk  diet,  together  with  the  administra- 
tion of  digitaUs,   the   condition   of   the  patient 


Nov.  1 6,  1904. 


TRANSACTIONS    OF   SOCIETIES,       Thb  Msdical  Pmsst.    515 


rapidly  improved.  When  digitalis  was  rejected 
strophanthus  was  retained,  which  acted  equally 
efficiently,  but  more  slowly.  The  improvement 
was  so  marked  that  the  patient  insisted  upon 
getting  up  after  ten  days'  treatment,  and  having 
a  less  restricted  diet,  which,  of  course,  invariably 
ends  in  a  relapse.  During  one  of  these  relapses 
digitalis  failed  to  act,  the  urine  steadily  decreased 
in  quantity.  Caffeine  citrate  with  sodium 
benzoate  was  tried,  and  acted  rapidly  and 
efficiently,  the  urine,  which  had  dropped  to 
twelve  ounces  in  twenty-four  hours,  after  forty- 
eight  hours'  treatment  rose  to  forty-eight  ounces. 
For  the  insomnia  trional  and  paraldehyde  were 
successfully  employed  ;  the  former  drug  requires 
watching,  as  cases  are  recorded  in  which  its 
emplo3rment  has  induced  acute  nephritis.  Ten 
grains  at  bed-time  appears  an  efficient  dose. 
Hypodermic  injections  of  strychnine  were  from 
time  to  time  necessary. 

There  was  no  change  in  the  condition  of  the 
patient  until  three  hours  before  death,  which 
took  place  on  June  28th.  Then  cerebral  Cheyne- 
Stokes  respiration  appeared,  in  which  there  was 
sudden  arrest  and  sudden  return  of  respiratory 
movement.  Cyanosis  became  very  marked. 
The  patient  lapsed  into  coma  and  died. 

Remarks. — ^The  cause  of  the  patient's  heart 
condition  was  doubtless  primarily  pulmonary 
emphjrsema,  so  that  the  tricuspid  incompetency 
was  caused  by  a  dilatation  of  the  tricuspid 
orifice  associated  vrith  failing  compensation, 
rather  than  a  true  valvulitis.  At  no  period  of 
the  illness  was  there  any  fever.  The  strictly 
limited  area  over  which  the  murmur  could  be 
heard  is  worthy  of  note.  The  marked  benefit 
resulting  from  rest  and  the  administration  of 
digitalis   was  very  striking  in  this  case. 

EttrtBb  vealtb  Kesotts* 


XVI.— BATH. 

It  is  claimed  that  the  virtues  of  the  thermal  springs, 
on  which  in  great  measure  depends  the  reputation  of 
Bath,  were  known  in  pre- Roman  days.  It  is  certain  that 
during  the  Roman  occupation  of  Britain  Bath  gained 
great  distinction  as  a  health  station.  During  the 
eighteenth  century  it  became  a  resort  for  the  fashion- 
able faddist ;  but  of  late  years  the  place  has  been  deve- 
loped on  sound  rational  lines,  and  the  baths  and  waters 
can  now  be  employed  with  something  like  scientific 
precision,  (a) 

Bath  now  occupies  a  foremost  place  among  British 
spas,  {b) 

The  hot  springs  which  give  Bath  its  unique  value 
appear  to  have  their  source  beneath  the  new  red 
sandstone  and  lias  in  the  palaeozoic  rocks.  Meteoro- 
logical observations  have  been  regularly  made  at  the 
stations  equipped  by  the  Corporation,  and  also  at  the 
Bath  Royal  Literary  and  Scientific  Institution,  (c) 

The  mean  temperature  for  last  year  was  50*2° ; 
the  mean  daily  range,  13*3**;  the  humidity,  78;  the 
total  rainfall,  42-57  inches;  and  the  total  duration  of 
bright  sunshine,  1,378  hours.  The  thermal  waters  are 
derived  from  three  springs — the  Hot  Bath  of  120°  F. ; 
the  King's  Bath  of  1 14°  F. ;  and  the  Cross  Bath  of 
104°  F.  In  chemical  constitution  they  are  all  similar. 
Calcium  sulphate  forms  the  most  plentiful  ingredient, 
varying  from  80  to  100  grains  per  gallon.  The  total 
mineral  matters  are  from  140  to  165  grains  per  gallon. 

Local  enterprise  has  now  provided  perfect  arrange- 

(a>  See  article  by  the  late  Dr.  W.  M.  Ord  and  Dr  A.  E.  Qarrod,  in 
■'  CKmates  and  Baths  of  Great  Britain."    Vol.  I.    1895. 

{h)  See  **  Medical  Guide  to  the  Hot  Mineral  Baths  of  Bath.'*    1901. 

(e) "  Thirty-elthth  Annual  Report  of  the  Medical  Officer  of  Health," 
By  Dr.  W.  H.  Symons.    1004. 


ments  for  the  comfort  and  convenience  of  visitors. 
The  Grand  Pump  Room,  Roman  promenade,  and  various 
baths  are  in  every  way  excellent.  All  forms  of  hydro- 
pathic treatment  are  provided,  and  skilled  attendants 
are  always  at  hand  to  see  that  medical  orders  are  fully 
and  scientifically  carried  out. 

The  Bath  waters  can  be  used  externally,  taken  in- 
ternally, or,  as  is  generally  the  case,  employed  in  both 
forms.  Therapeutically,  Bath  is  of  greatest  service  in 
cases  of  gout  and  gouty  derangements  of  all  kinds, 
rheumatism  in  its  chronic  forms,  and  in  the  remnants 
of  disorder  left  by  an  acute  attack,  osteo-arthritis  in 
some  of  its  less  progressive  varieties  ;  in  muscular  and 
arthritic  derangements,  such  as  lumbago,  gonorrhoeal 
and  some  other  forms  of  arthritis ;  in  sciatica  and  some 
cases  of  neuralgia,  and  chronic  neuritis ;  in  certain 
cutaneous  affections,  such  as  eczema,  acne,  psoriasis, 
senile  prurigo,  and  particularly  skin  lesions  due  to  con- 
stitutional disorder.  In  some  cases  of  nervous  de- 
terioration, derangement  of  digestion,  gouty  respira- 
tory affections,  and  some  diseases  peculiar  to  women, 
a  course  at  Bath  will  often  accomplish  much. 

Bath  should  not  be  advocated  for  patients  with  any 
form  of  acute  disorder.  Tuberculous  cases  usually  do  ill. 
It  is  not  a  good  resort  for  "  surgical "  cases.  Epileptics 
are  said  to  gain  no  benefit.  Marked  cardiac  disease 
and  aneurysm  or  other  vascular  affections  are  to  be  re- 
garded as  contra-indications.  Bath  offers  many  attrac- 
tions to  the  aged  and  the  invalid  who  desires  a  quiet  yet 
not  altogether  retired  life,  where  while  in  the  world  he 
may  not  necessarily  be  of  the  world.  The  city  is, 
moreover,  well  provided  with  hotels  of  all  kinds,  and 
excellent  apartments  can  always  be  obtained.  Bath  is 
107  miles  from  London,  and  can  be  readily  reached  by 
the  Great  Western  Railway  in  a  little  over  two  hours. 

Trtansactions  of  Societies. 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  November  iith,  1904. 


The  President,   Dr.  Taylor,   in   the  Chair. 


Mr.  C.  R.  Keyser  narrated  the  case  of  a  girl,  let.  9. 
who  was  admitted  into  hospital  in  December,  ic^3> 
with  a  Congenital  Elevation  of  the  Scapula.  The  de- 
formity had  been  noticed  for  one  month  only.  There 
was  no  history  of  injury,  and  no  similar  case  was  known 
in  the  family.  The  left  shoulder  was  2J  inches  higher 
than  the  right ;  there  was  no  osseous  ridge  connecting 
it  to  the  spine.  The  third  dorsal  vertebra  was  pro- 
minent and  displaced  slightly  to  the  left.  There  was 
no-  paralysis  of  the  arm  or  of  any  local  muscle.  Evi- 
dences of  slight  rickets  were  present.  Cases  of  this 
class  were  rare,  and  fell  into  four  groups :  ( i )  Those 
having  an  osseous  ridge  joining  the  scapula  to  the 
spine  ;  (2)  those  with  absence  of  one  or  more  muscles 
of  the  shoulder  or  girdle  ;  (3)  those  with  a  long,  everted, 
supra-spinous  portion  of  the  scapula  ;  (4)  those  in  which 
the  scapula  was  small,  but  in  which  no  other  abnor- 
mality of  bone  or  muscle  was  present.  This  group 
comprised  most  of  the  cases.  The  affection  was  usually 
unilateral,  and  occurred  more  frequently  on  the  left 
side.  Other  deformities,  such  as  spina  rigida,  were 
often  present.  Sprengel's  theory  as  to  the  pathology 
of  the  condition  was  that  the  arm  was  misplaced  be- 
hind the  back  in  utero.  The  formation  of  the  bony 
ridge,  which  was  present  in  some  of  the  cases,  was  dis- 
cussed, and  references  made  to  other  recorded  examples 
of  the  deformity. 

Mr.  Rupert  Bucknall  had  seen  an  exactly  similar 
case,  and  several  cases  closely  resembling  the  one 
described.  The  bulk  of  evidence  was  against  the  con- 
dition being  an  acquired  one  or,  as  Sprengel  thought, 
dtie  to  malposition  in  utero.  If  the  latter  theory  were 
true,  one  would  expect  to  get  deformity  of  the  arm  and 
hand.  The  question  of  the  osseous  ridge  was  a  very 
interesting  one.  He  thought  that  it  was  probably  not 
of  supra-scapular  origin,  for  if  the  muscles  were  care- 
fully examined,  whether  they  were  shortened,  fibroid. 


5l6    The  Medical  Press.  TRANSACTIONS    OF    SOCIETIES. 


Nov.  1 6,  1904. 


or  bony,  their  condition  always  accurately  accounted 
for  the  position  of  the  scapula,  that  bein^  sometimes 
elevation,' sometimes  rotation,  and  sometimes  adduc- 
tion. If  the  rhomboids  were  affected,  adduction 
occurred ;  if  the  trapezium,  elevation.  Often  the 
osseous  ridge  did  not  accurately  correspond  with  the 
muscle,  i.e..  it  was  not  confined  to  one  given 
muscle.  This  fact  had  been  read  as  indicating  that 
the  change  occurred  in  very  early  life,  before  differen- 
tiation of  the  muscles  had  taken  place.  This  theory 
also  was  in  line  with  the  presence,  in  these  cases,  of  de- 
formities in  the  spine  and  elsewhere. 

Mr.  Kevser  said  that  the  presence  of  cartilage  be- 
tween the  scapula  and  spine  did  not  fit  in  with  the 
primary  muscular  defect  theory. 

Dr.  Philip  Turner  and  Mr.  Raymond  Johnson 
described  a  case  of  Traumatic  Axillary  Aneurysm,  in 
which,  after  extensive  extravasation  had  occurred,  a 
successful  result  was  obtained  by  the  application  of  a 
ligature  to  the  axillary  artery  in  the  first  part  of  its 
course.  The  patient,  a  woman,  aet.  70,  fell  downstairs 
on  to  the  left  shoulder,  the  injury  being  followed  by 
much  bruising  of  the  part  and  paralysis  of  the  hand 
aBd  forearm.  Three  weeks  later,  it  was  found  that  a 
pulsating  tumour  as  large  as  a  tangerine  orange  was 
present  in  the  anterior  part  of  the  axilla  ;  the  pulse  at 
the  wrist  was  not  perceptible.  After  the  lapse  of 
several  months  great  improvement  had  occurred  in 
the  muscular  power,  and  the  radial  pulse  was  again 
perceptible.  During  the  third  year  after  the  accident, 
some  gradual  increase  was  noticeable  in  the  size  of  the 
aneurysm,  without,  however,  any  symptoms  of  pres- 
sure. Nearly  three  years  after  the  onset,  a  small 
bruise  appeared  over  the  posterior  axillary  fold  ;  and 
a  few  days  later  a  considerable  extravasation  occurred, 
with  intense  pain  and  extensive  discoloration  of  the 
skin.  The  axillary  artery  was  tied  in  the  first  part  of 
its  course.  On  the  morning  of  the  operation,  it  was 
found  that  blood  was  just  beginning  to  leak  through  a 
small  opening  which  had  formed  spontaneously  in  the 
discoloured  skin.  All  pulsation  in  the  axilla  was 
arrested  by  the  ligature,  but  no  anxiety  was  at  anj*^ 
time  felt  as  to  the  vitality  of  the  limb,  the  circulation 
in  which  remained  good.  The  opening  in  the  skin  of 
the  axilla  continued  to  discharge  slightly  until  about 
three  weeks  after  the  operation,  when  a  very  free 
escape  of  the  extravasated  blood  occurred,  and  after 
slightly  enlarging  the  opening  a  quantity  of  coagulum 
was  removed.  From  this  time  the  discharge  quickly 
lessened,  the  swelling  gradually  and  completely  sub- 
sided, and  the  final  result  was  in  every  respect  satis- 
factory. It  was  pointed  out  that  the  chief  practical 
interest  of  the  case  consisted  in  the  fact  that  a  trau- 
matic axillary  aneurysm,  after  the  occurrence  of  ex- 
tensive extravasation,  was  successfully  dealt  with  by 
the  proximal  ligature.  According  to  the  usual  teach- 
ing on  this  subject  such  a  favourable  result  was  hardly 
to  be  expected  in  such  circumstances  and  at  such  an 
age.  Probably  the  long  duration  of  the  aneurysm  had 
a  favourable  effect,  by  causing  the  collateral  supply  to 
be  well  established.  The  treatment  adopted  was  far 
less  severe  than  the  alternative  method  of  freely  open- 
ing up  the  axilla  and  dealing  with  the  artery  at  the 
site  of  the  aneurysm.  Reference  was  made  to  certain 
cases  recorded  by  Major  Birt,  of  traumatic  aneurysm 
from  bullet-wounds,  in  which  the  treatment  by  proxi- 
mal ligature  was  adopted  with  success.  In  two  cases 
of  diffused  extravasation  into  the  axilla  a  successful 
result  followed  ligature  of  the  subclavian  artery  in  the 
third  part  of  its  course.  * 

Mr.  H.  Betham  Robinson  and  Mr.  Edred  Corner 
narrated  a  case  of  Aneurysm  of  the  Intracranial  Part 
of  the  Left  Internal  Carotid  Artery,  caused  by  a  bullet 
wound  through  the  right  eye  entering  about  the  right 
outer  canthus  and  completely  destrojring  the  globe. 
There  was  no  wound  of  exit.  '^Tien  admitted  into  St. 
Thomas's  Hospital  immediately  after  the  accident,  the 
patient  was  unconscious  and  showed  signs  of  cerebral 
irritation.  The  right  eye  was  at  once  excised.  On 
the  seventh  day  the  left  eye  was  suffused  and  the 
cornea  dull ;    on  the  eleventh  day  there  was  severe 


epis taxis,  controlled  by  plugging  the  nares ;  and  on 
the  thirteenth  another,  more  severe.  The  cornea 
ulcerated,  and  on  the  twenty-tourth  day  sensation  iwas 
absent  over  nearly  all  the  distribution  of  the  upper 
two  divisions  of  the  fifth  nerve ;  ptosis  and  paralysis 
of  the  sixth  nerve  occurred  ;  complete  ophthalmo- 
plegia externa  occurred  on  the  thirty- third  day.  After 
several  attacks  of  haemorrhage,  which  always  came 
from  the  right  nostril,  the  same  side  as  the  destroyed 
eye,  Mr.  Comer  ligatured  the  internal  and  external 
carotids  on  the  right  side.  On  the  sixth  day  after  this 
she  woke  up  completely  blind,  this  being  thought  to  be 
due  to  some  lesion  of  the  optic  nerve  behind  the 
entrance  of  the  central  vessels.  There  was  a  transient 
hemiplegia  on  the  left  side.  From  now  onwards  there 
was  no  further  haemorrhage,  and  her  general  conditkm 
gradually  improved,  the  partial  paralysis  passed  off. 
and  consciousness  returned.  On  the  195  th  day  die 
was  sent  to  a  convalescent  home,  being  quite  well,  no 
bleeding  having  occurred  since  the  11 8th  day.  This 
period  of  improvement  lasted  for  another  twenty  days. 
She  was  then  readmitted  for  another  severe  haemor- 
rhage from  the  right  nostril,  which  was  stopped  by 
plugging.  Three  days  later  a  very  violent  haemor- 
rhage occurred,  and  she  died  in  three  minutes.  At  the 
autopsy  the  bullet  was  found  to  have  pierced  the  inner 
wall  of  the  right  orbit,  traversed  the  body  of  the 
sphenoid,  and  entered  the  interior  of  the  skull  ck>se 
to  the  left  anterior  clinoid  process.  From  this  point 
it  had  turned  backwards  and  lodged  on  the  under 
surface  of  the  brain  close  to  the  calcarine  fissure.  A 
splinter  of  bullet  had  branched  to  the  left  and  lodged 
in  the  under  surface  of  the  hinder  part  of  the  tempoio- 
sphenoidal  lobe.  Close  to  the  anterior  clinoid  process 
was  a  small  anenr3rsm  of  the  left  internal  carotid  artery. 
and  lodged  in  its  wall  was  a  splinter  of  bone.  The  sac 
communicated  with  the  track  of  the  bullet,  and  so 
with  the  right  side  of  the  nose,  along  which  the  ^tal 
bleeding  had  taken  place. 

Mr.  Stephen  Paget  described  the  case  of  a  girl, 
ast.  13,  whom  he  operated  on  for  Acute  Appendicular 
Abscess.  Five  ounces  of  thick,  foetid  pus  were  evacuated. 
Nine  days  afterwards  another  abscess  appeared  in  the 
left  iliac  region  between  the  bladder  and  rectum,  and  a 
pint  of  pus  was  again  evacuated.  The  patient,  after 
recovery,  complained  on  several  occasions  of  colicky 
pain  in  the  abdomen.  Fifteen  months  later,  she  was 
seized  with  severe  pain  and  vomiting.  The  abdomen 
was  opened  and  a  coil  of  gut  was  found  to  be  nipped 
by  an  adhesion  which  extended  transversely  across  the 
abdomen.  From  this  operation  the  child  made  a 
perfect  recovery.  Stress  was  laid  on  the  following 
points : — ^The  appendix  was  removed  at  the  first 
operation,  so  that  the  extension  of  suppuration  to  the 
left  iliac  region  was  not  due  to  a  septic  appendix  having 
been  left  in  the  wound.  The  intermittent  pains  that 
followed  the  earlier  operations  were  accompanied  by 
nocturnal  epilepsy,  which  perhaps  caused  the  gut  to 
get  caught  by  the  sulhesion.  These  pains  were  vaguely 
attributed  to  stretched  adhesions,  and  their  true  sig- 
nificance not  realised.  After  double  suppuration  in 
the  abdomen,  acute  intestinal  obstruction  was  likdy 
to  be  caused  by  an  adhesion  between  the  two  foci  and 
not  at  either.  No  epileptic  fits  occurred  while  the 
wounds  were  open,  but  began  as  soon  as  these  healed. 

Dr.  French  asked  whether  it  was  the  rule  for  the 
fits  to  cease  in  epilepsy  while  operation  wounds  were 
present.  Perhaps  anti-epileptic  treatment  ynLS  being 
carried  out  more  vigorously  at  this  time. 

Dr.  Pasteur  inquired  as  to  the  frequency  of  adhe- 
sions after  abdominal  operatioiis. 

Mr.  McGavin  said  that  the  question  of  post-operative 
adhesions  was  a  very  important  one.  They  might  be 
expected  to  occur  after  an  acute  inflammatory  con- 
dition such  as  that  present  in  Mr.  Paget's  case.  He 
referred  to  a  case  in  which  laparotomy  was  done  for 
tuberculous  peritonitis  and  no  adhesions  found.  Later, 
acute  intestinal  obstruction  occurred,  and  the  child 
died,  the  parents  refusing  operation. 

Mr.  R.  P.  Rowlands  described  a  similar  occuntnce 
many  years  after  an  ovariotomy. 


Nov.  16,  1904. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Psess.    517 


Mr.  ZuM-BuscH  had  operated  on  many  cases  of 
ventral  hernia  consequent  on  appendix  operations. 

Mr.  Paget  stated  that  no  bromide  had  been  adminis- 
tered to  the  child  during  her  stay  in  hospital,  as  the 
epilepsy  was  only  discovered  shortly  before  her  dis- 
charge. He  remarked  on  the  great  variations  in  the 
number  of  adhesions  that  occurred  in  different  patients, 
instancing  the  occasional  cases  of  extreme  and  fatal 
prolapse  through  colotomy  wounds  as  evidence  that 
sometimes  no  adhesions  at  all  were  present. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  November  2nd,   1904. 


Professor    John    Chiene,   President,  in   the  Chair. 

Mr.  C.  W.  Cathcart  showed  (i)  a  patient  after 
operation  for  faecal  fistula ;  and  (2)  a  case  of  scirrhous 
erythema  after  removal  of  both  mammae  for  scirrhus. 

Mr.  Alexis  Thomson  showed  (i)  a  boy,  aet.  15,  after 
nephropexy  for  floating  right  kidney.  The  youth  of 
the  patient  was  commented  on  as  unusual.  (2)  A 
-woman,  aet.  27,  after  conservative  operation  for  hydro- 
nephrosis. The  kidney  was  displaced  down,  and  the 
ureter,  though  not  kinked,  did  not,  on  account  of  the 
level  at  which  it  entered  the  kidney,  drain  the  pelvis 
of  the  organ  properly.  There  was  a  large  sacculation 
below  the  exit  of  the  ureter.  The  treatment  consisted 
in  raising  the  kidney,  and  fixing  it  in  its  normal  position, 
so  that  the  ureter  drained  the  most  dependent  part  of 
the  pelvis.  (3)  A  case  of  popliteal  aneurysm  treated 
by  excision  of  the  sac  after  distal  ligature ;  though  it 
relieved  the  symptoms,  this  had  failed  to  cure  by 
causing  coagulation  in  the  sac. 

Dr.  G.  A.  Gibson  showed  a  specimen  of  sarcoma  of 
the  root  of  the  left  lung  involvmg  the  pericardium. 

Mr.  Scot  Skirving  showed  a  drum  for  sterilising  and 
storing  dressings. 

Mr.  Scot  Skirving  read  a  paper,  entitled 

questions  regarding  the  sterilising  of 
.  dressings, 
a  full  abstract  of  which  will  be  found  on  page  512. 

The  ]>aper  was  discussed  by  Messrs.  MacgiUivray, 
Cathcart,  Caird,  and  Dr.  Littlejohn. 

Dr.  Melville  Dunlop  read  a  paper  on 
syphilitic  synovitis  in  children. 

The  condition  was  one  deserving  of  wider  recognition 
than  it  had  generally  received,  and  was  much  more 
frequent  than  was  usually  supposed.  After  a  brief 
reference  to  the  literature  of  the  subject,  the  speaker 
said  that  syphilitic  arthritis  was  very  often  confused 
with  other  forms  of  chronic  joint  disease,  but  that  it 
was  of  great  importance  to  recognise  its  true  character, 
as  otherwise  it  was  very  likely  to  be  treated,  unsuccess- 
fully, as  if  it  were  tuberculous.  It  might  occur  either 
in  acquired  or  hereditary  syphilis,  but  was  much  more 
common  in  the  latter.  Sometimes  an  acute  synovitis 
was  met  with  before  the  eruption  appeared  ;  gummata 
of  the  joints  had  been  described,  chiefly  as  secondary 
to  gummata  in  the  adjacent  bone,  this  form  being 
liable  to  confusion  with  sarcoma.  All  these,  however, 
were  rare  in  childhood.  The  common  forms  of  syphi- 
litic synovitis  in  children  were  two  in  number — (i) 
synovitis  secondary  to  syphilitic  epiphysitis  in  infants, 
due  to  extension  of  the  mischief  from  the  epiphysial 
line:.  In  these  cases  there  was  first  the  epiphysitis 
Tunning  on,  sometimes,  to  separation  of  the  end  of  the 
bone,  with  degenerative  changes  in  the  articular  carti- 
lages. If  suppuration  occurred  it  was  due  to  a  secon- 
dary infection,  not  to  syphilis  alone  ;  the  pus  might 
invade  the  articulation,  causing  an  abscess  in  the  joint. 
The  condition  usually  developed  rapidly  during  the 
first  three  months  of  life.  It  afiected  the  arms,  and 
particularly  the  distal  joints,  in  preference  to  the  legs, 
was  usually  symmetrical,  one  side,  however,  being 
worse  than  the  other.  On  examination,  swelling  could 
be  felt  in  the  neighbourhood  of  the  epiphysis,  the 
joint  contained  a  Uttle  fluid,  tenderness  might  be 
present  or  absent,  and  powerlessness  of  the  limb — 
syphilitic  pseudo-paralysis — was  an  almost  constant 


accompaniment.  When  separation  of  the  epiphysis 
occurred,  there  was  unnatural  mobility;  crepitus, 
however,  was  rare.  The  prognosis  was'  good  as  to 
restitution  of  the  function  of  the  limb  ;  shortening  did 
not  tend  to  occur,  and  suppuration  was  rare.  Two 
illustrative  cases  were  briefly  recorded.  (2)  True 
primary  chronic  syphilitic  synovitis. — This  was  a  late 
tertiary  manifestation,  it  w  as  very  insidious,  and  was 
often  discovered  accidentally.  The  disease  usually 
occurred  in  children,  aet.  between  8  and  15,  at  the  age 
at  which  interstitial  keratitis  was  frequent.  The 
arthritis  was  very  symmetrical,  and  of  all  joints  the 
knees  were  most  likely  to  be  involved,  the  ankles  and 
elbows  much  less  commonly,  while  no  instance  of 
affection  of  the  shoulders  or  hips  had  been  recorded. 
The  disease  did  not  attack  the  two  joints  simulta- 
neously, but  at  an  interval  varying  from  two  or  three 
weeks  to  several  years.  In  this  respect,  in  its  favour- 
able course,  and  in  its  date  of  onset,  it  presented  certain 
resemblances  to  interstitial  keratitis,  with  which,  as  a 
matter  of  fact^  it  was  not  uncommonly  associated,  and 
it  was  to  the  ophthalmologists  that  some  credit  was 
due  in  the  recognition  and. recording  of  the  affection. 
Generally  speaking,  one  joint  was  more  severely 
affected  than  its  neighbour.  The  onset  was  very 
gradual  and  quite  painless,  and,  except  for  some  stiff- 
ness, the  function  of  the  limb  was  not  interfered  with. 
In  consequence  of  the  latency  of  the  symptoms,  the 
condition  was,  therefore,  very  liable  to  escape  the 
notice  of  unobservant  patients.  On  examining  the 
joint  a  swelling  was  found,  due  entirely  to  synovial 
effusion,  with  sometimes  slight  thickening  of  the 
synovial  membrane.  There  was  no  redness,  no  start- 
ing pains  at  night,  no  creaking,  and  no  pain  or  tender- 
ness ;  only  slight  loss  of  mobility.  It  had  been  stated 
that  as  many  as  75  per  cent,  of  cases  of  keratitis  showed 
some  degree  of  this  joint  lesion.  The  other  stigmata 
of  syphilis — Hutchinson's  teeth  and  deafness — might 
be  present ;  nodes  were  particularly  frequent.  The 
condition  was  by  no  means  uncommon  ;  Dr.  Dunlop 
had  met  with  some  sixteen  cases.  Relapses  were  very 
liable  to  take  place.  Little  was  known  as  to  the  patho- 
logical changes,  as  the  cases  were  seldom  fatal.  On  the 
whole  they  seemed  to  be  slight — a  little  hjrperaemia 
of  the  synovial  membrane,  some  thickening  of  the 
Angers  in  some  cases,  sometimes  villous  outgrowths 
developed  in  the  synovial  pouches,  in  one  or  two 
instances  small  gummata  had  been  present.  The 
diagnosis  rested  on  the  bilateral  symmetry  of  the  arth- 
ritis, the  insidious  onset,  absence  of  pain,  and  slight 
loss  of  function.  As  to  the  treatment,  although  not 
all  cases  responded  to  anti-syphilitic  remedies,  the 
disease  was  usually  very  amenable  to  mercury  and 
potassium  iodide.  Several  cases  illustrating  the 
various  points  raised  were  reported. 

Dr.  Chalmers  Watson  gave  a  communication,  of 
which  the  following  is  a  very  brief  resumi,  illustrated 
by  a  lantern  demonstration,  on 
GOUT :    OUR  present  position  with  regard  to  its 

ETIOLOGY. 

All  our  views  of  gout,  he  remarked,  were  coloured 
by  the  influence  of  Garrod's  teaching  that  uric  acid  is 
the  primary  factor  in  the  disease,  and  this  theory  has 
been  almost  universally  accepted,  e.g.,  by  Ebstein,  von 
Noorden.  Roberts,  and  others.  Of  late  years,  how- 
ever, this  view  has  been  questioned  by  clinicians, 
among  whom  Goodhart's  name  might  be  mentioned. 
The  author's  investigations  had  led  him  to  abandon 
the  view  that  uric  acid  was  an  important  etiological 
factor,  the  steps  leading  to  this  being,  shortly,  as 
follows : — 

A.  Chemical. — Uric  acid  was  found  in  the  blood 
in  a  number  of  diseases  having  no  known  relationship 
to  gout,  thus  conflrming  the  work  of  previous  observers. 
In  leucocythaemia,  for  instance,  uric  acid  was  present 
in  quantities  far  exceeding  that  found  in  gout,  and  it 
was  impossible  to  imagine  that  if  the  uric  acid  acted  as 
a  poison  its  action  should  not  be  greater,  the  more 
there  was  of  it  in  the  tissues.  Further,  an  analysis  of 
the  urine  in  acute  gout  showed  no  disturbance  of  the 


5i8    The  Medical  Press.  TRANSACTIONS    OF    SOCIETIES. 


Nov.  1 6.  1904. 


uric  acid  secretion,  either  before,  during,  or  after  the 
paroxysm ;  and  the  same  results  were  g6t  in  the 
administration  of  nucleins  to  gouty  persons. 

B.  Histological. — The  morbid  appearances  observed 
in  gout  in  the  lower  animals  and  chronic  gout  in  man 
do  not  support  the  uric  acid  theory,  but  rather  suggest 
an  infective  condition.  After  removing  urates  from  a 
gouty  joint  remarkable  hyaline  structures  are  seen  in 
the  position  occupied  by  the  crystals.  There  seemed 
no  more  reason  for  ascribing  gout  to  the  presence  of 
the  crystals  than  to  l  the  presence  of  these  hyaline 
structures.  In  these,' by  special  stains,  Dr.  Watson 
had  demonstrated  masses  of  rods,  apparently  micro- 
organisms. He  was  of  opinion  that  the  uratic  crystals 
gave  the  general  inflammatory  condition  of  the  gouty 
tissues  its  specific  character,  but  were  not  otherwise 
essential  features  of  it. 

C.  Clinical. — The  features  of  an  acute  attack — the 
manner  of  onset,  temperature  curve,  and  blood  changes 
indicative  of  a  disturbance  of  the  marrow  function — 
all  suggested  the  operations  of  an  infective  agent. 
The  general  conclusions  arrived  at  were  that  uric  add 
is  not  an  important  etiological  factor  in  the  production 
of  gout.  This  should  be  considered  in  relation  to  the 
recent  views  of  Woods  Hutchinson,  Poynton,  and 
Gore.  There  is  an  infective  element  in  the  disease, 
and  the  uric  acid  gives  to  the  inflammation  its  specific 
character.  According  to  this  view  the  source  of  in- 
fection is  the  alimentary  tract,  and  an  injudicious 
dtetary — mc?.t  orJ|Jrink — acis  mainly  in  virtue  of  its 
influence  on  the  bacteria  normally  present  in  the  diges- 
tive tract.  Reference  was  also  made  to  the  hkely 
limes  lor  fruitful  investigations,  an  inquiry  into  the^ 
siate  ot  the  blood  and  marrow  beine  suggested  as  not* 
unlikely  to  throw  fresh  light  on  the  disease. 

Dr.  GuLLAND  was  not  inclined  to  accept  Dr.  Watson's 
thesis  as  proved,  and  did  not  consider  that  he  had  by 
any  means  o"^'erthrowii  the  uric  acid  theory. 

Dr.  Taylor  thought  that  influence  of  the  nervous 
system  in  producing  gout  must  be  taken  into  account. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Section  of  Surgery. 

Meeting  held    Friday,  November  4TH.   1^04. 

The  President,  Mr.  Arthur  Chance,  in  the  Chair. 


Exhibits.    ' 

Mr.  Kennedy  exhibited  a  patient  after  nephrectomy, 
and  the  diseased  kidney  which  had  been  removed  ; 
also  cases  of  excision  of  the  knee-  and  elbow-joints. 

Mr.  Edward  H.  Taylor  exhibited  a  man,  xi.  39, 
whose  left  lower  extremity  he  had  amputated  through 
the  hip-joint  for  an  osteo-sarcoma  of  the  femur;  (2) 
specimens  of  rectal  cancer  removed  by  the  trans-sacral 
and  by  the  combined  sacro-abdominal  method  ; 
also  (3)  some  unusual  forms  of  urinary  (bladder) 
calculi. 

Mr.  R.  J.  Montgomery  exhibited  a  patient  showing 
the  result  of  operation  for  ectropion  of  both  lower 
eyelids. 

Sir  Thomas  Myles  exhibited  (i)  some  recent  cases 
of  gastro-jejunostomy ;  (2)  carcinomatous  and  tuber- 
culous kidneys  removed  by  nephrectomy;  and  (3)  a 
large  fibroma  removed  from  the  region  of  the  lesser 
peritoneal   sac. 

Mr.  W.  S.  Haughton  exhibited  (i)  case  of  omento- 
hepatopexy ;  (2)  case  of  excision  of  astragalus  for  dis- 
location of  thirteen  months'  standing  ;  (3)  case  showing 
new  method  of  '*  screwing  "  fractured  olecranon. 

Mr.  Maunsell  exhibited  (i)  examples  of  different 
forms  of  goitre ;  and  (2)  some  pathological  vermiform 
appendices. 

Mr.  J.  B.  Story  exhibited  an  improved  mask  to  ex- 
clude buccal  microbes  from  operation  wounds. 

Mr.  Seton  Pringle  exhibited  an  ano-coccygeal 
tumour. 

Mr.  A.  B.  Mitchell  (Belfast)  exhibited  a  specimen 
showing  the  condition  of  parts  after  gastro-jejunos- 
tomy, followed  subsequently  by  jejuno-jejunostomy 
for  the  relief  of  regurgitant  vomiting. 

Mr.  A.  B.  Mitchell  (Belfast)  read  a  paper  entitled 


'*  Inefficient  Operations  for  Gastric  Llcer."  The 
paper  was  based  on  the  rei5ults  of  four  diflferent  openi- 
tions,  which  gave  relief  for  a  time,  but  in  all  of  which 
the  symptoms  subsequently  recurred. 

Case  I. — A  small  ulcer  on  the  anterior  wall  of  the 
stomach  was  freely  excised.  Recovery  was  rapid, 
and  for  about  a  year  the  patient  remained  in  excellent 
health ;  then  the  old  pain  recurred,  and  though 
some  relief  was  obtained  n^om  drugs  and  diet,  her  con- 
dition was  far  from  satisfactory. 

Ccue  II, — A  large  ulcer,  which  had  existed  for  about 
twelve  years,  was  infolded  by  a  row  of  continnons 
sutures  which  extended  four-fifths  round  the  stomach. 
The  immediate  result  was  all  that  could  be  desired, 
but  about  eighteen  months  after  operation  the  sym- 
ptoms returned,  and  the  patient  was  soon  as  bad  as 
ever.  A  posterior  gastro-jejunostomy  gave  complete 
and  probably  permanent  relief.  The  relapse  was 
due  to  the  development  of  another  ulcer  higher  up  in 
the  stomach,  all  trace  of  the  former  ulcer  having  dis- 
appeared. 

Case  III. — A  case  of  well-marked  hour-glass 
stomach  had  been  treated  by  gastro-gastrostomy. 
The  patient,  who  had  been  a  chronic  invalid  for  cnftr 
twenty  years,  was  promptly  restored  to  health  and  she 
remained  well  for  one  year,  then  relapsed.  Perfora- 
tion occurred,  and  she  was  operated  upon  and  re- 
covered, and  finally  a  gastro-jejunostomy  was  done 
in  order  to  afford  permanent  relief. 

Case  IV. — A  gastro-duodenostomy  was  done  for 
rehef  of  long-standing  stomach  trouble.  The  im- 
mediate result  was  most  satisfactory,  but  as  the  sym- 
ptoms relapsed  in  about  eighteen  months,  a  postehor 
gastro-jejunostomy  was  performed  with  good  result. 
These  cases  were  placed  on  record  because  a  true 
account  of  unsuccessful  operations  is  essential  to  a 
scientific  estimate  of  the  best  line  of  surgical  treatmcTit. 
Mr.  Mitchell  expressed  the  opinion  that  permanent 
relief  could  not  be  secured  except  b^'  an  operation  that 
did  away  with  the  action  of  the  pyloric  sphincter,  and 
secured  prolonged  drainage  of  the*  stomach.  He  now 
always  performed  posterior  gastro-jejunostomy.  He 
related  two  cases  of  regurgitant  vomiting.  In  the 
first  an  anastomosis  between  the  ascending  and  de- 
scending loops  of  jejunum  was  made,  but  the  resnit 
was  very  disappointing.  The  patient  recovered  well 
from  the  operation,  but  got  no  relief  from  the  \'x>mitintf. 
and  died  of  exhaustion.  (Specimen  shown.)  In 
the  second  the  bowel  was  divided,  and  a  Y-operation 
performed.     The  result  was  entirely  satisfactory'. 

Sir  Thomas  Myles  stated  that  his  experience  of  gas- 
tro-jejunostomy for  gastric  ulcer  was  small,  but  he  bad 
performed  the  operation  for  other  conditions,  such  as 
pyloric  obstruction  and  malignant  disease.  He 
thought  it  would  be  a  matter  of  considerable  interest 
in  cases  where  gastro-jejunostomy  had  been  performed 
for  the  relief  of  gastric  ulceration  with  hyperchlorhy- 
dria  to  ascertain  the  condition  of  digestion  afterwards. 
For  regurgitant  vomiting  he  found  relief  was  usually 
afforded  by  propping  the  patient  up  in  bed.  He  had 
never  found  it  necessary  to  perform  a  second  operation 
after  gastro-jejunostomy.  and  had  operated  in  sixty- 
one  cases  without  a  death.  In  order  to  prevent  a 
spur  forming  at  the  site  of  the  gastro-intestinal  junction 
he  usually  sutured  the  jejunum  along  nearly  the 
entire  length  of  the  posterior  wall  of  the  stomach. 

Mr.  Mitchell,  in  reply,  stated  that  experience  had 
led  him  to  prefer  gastro-jejunostomy  to  other  opera- 
tions in  cases  of  gastric  ulcer.  With  regard  to  regur- 
gitant vomiting,  he  had  observed  that  when  gastro- 
jejunostomy was  done  for  pyloric  obstruction  there 
was  never  any  trouble  in  this  respect,  and  latterly, 
when  performing  gastro-jejunostomy,  he  had  beoi 
in  the  habit  of  puckering  in  the  pylorus  with  three 
or  four  sutures,  thus  doing  away  with  the  action  of 
the  pyloric  sphincter,  and  these  cases  were  amongst 
the  most  satisfactory  which  he  had  had. 

Mr.  W.  S.  Haughton  read  a  pap>er  entitled  : — 
the     healing    of     wounds  :      aseptic     t'.      anti- 
septic METHOns. 
Mr.  Haughton,  after  paying  a  tribute  to  the  greatncfs 


Nov.  i6.  1904. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Press.    5^9 


of  Lister's  disoovery,  said  that  aseptic  technique 
^vras  the  natural  outcome  oi  the  principles  of  Listerism. 
There  was  no  antagonism  between  antiseptic  and 
aseptic  methods,  when  properly  used — i.e.,  to  reinforce 
each  other  when  special  circumstances  required.  But 
there  was  considerable  antagonism  between  the  so- 
called  schools  arising  from  the  different  value  each 
school  attributed  to  the  power  of  chemical  germicides 
and  ordinary  cleanliness.  His  opinion  of  the  leading 
features  of  the  aseptic  surgeon  were  his  appreciation 
of  real  cleanliness,  his  capacity  for  cleansing  and  steri- 
lising his  operation  environment ;  his  ability  to  main- 
tain the  aseptic  chain  unbroken  in  a  long  operation ; 
a.nd  his  "  al^tinence  *'  (to  use  Kocher's  own  word) 
from  touching  sepsis  between  operations  by  using 
rubber  gloves  for  all  septic  dressmgs,  Stc.  He  then 
gave  Professor  Kocher's  classification  of  the  channels 
of  wound  infection — viz.,  through  air,  contact,  inocula- 
tion, implantation,  wound  necrosis,  and  incubation, 
describing  how  each  might  be  prevented,  and  the  full 
details  of  this  technique  by  which  they  were  prevented. 
Speaking  of  skin  disinfection,  Mr.  Haughton  gave  the 
results  of  his  own  experiments  from  time  to  time,  the 
latest  being  done  for  him  by  Dr.  Earl,  which  corro- 
borated those  of  Kocher,  Ahlfeld,  Needham  Green 
and  others — setting  great  value  on  the  hot- water- 
dilute-alcohol  method  (75-80  per  cent.),  which  was 
equal,  if  not  superior  to,  hot-water-sublimate  methods, 
and  probably  also  gave  a  longer  period  of  safety  by 
hardening  the  skin.  Mr.  Haughton  advocated  rubber 
gloves  in  all  operations — aseptic  and  septic — as  liga- 
tures were  freely  infected  by  drawing  them  tight 
across  the  skin  of  the  operator's  fingers,  and  em- 
phasised their  value  between  operations,  in  dressing 
or  examining  septic  or  mucous  surfaces.  He  further 
stated  that  more  purely  aseptic  technique  in  his  own 
practice  gave  more  ideal  healing  of  wounds.  While 
primary  union  and  absence  of  fever  were  the  rule  in  his 
antiseptic  days,  they  were  still  the  rule  in  his  aseptic 
technique  ;  but  in  addition  there  was  an  almost  com- 
plete absence  of  pain,  even  in  the  most  extensive  pro- 
cedures, more  rapid  healing,  which  was  also  firmer  and 
developed  less  fibrous  tissue.  Furthermore,  in  acci- 
dental wounds,  such  as  compound  fractures  and 
lacerated  contused  wounds,  he  attained  a  higher  per- 
centage of  aseptic  healing  when  these  were  only  treated 
by  scrupulous  and  prolonged  cleansing,  using  normal 
warm  saline  solution  instead  of  any  antiseptic  ger- 
micide. In  conclusion,  he  said  the  less  one  relied 
on  chemical  germicides,  and  more  on  prolonged  cleans- 
ing, sterilisation  by  boiling,  and  warm  normal  saline 
solution,  the  more  satisfactory  were  the  results  both  to 
patient  and  surgeon. 

Mr.  Lenta iGNE  said  that  as  to  the  definition  of  asep- 
tic and  antiseptic  surgery,  he  understood  aseptic 
surgery  to  mean  where  nothing  went  into  the  wound 
in  the  shape  of  an  antiseptic,  chemical  or  otherwise, 
and  antiseptic  surgery,  where  septic  processes  in 
wounds  had  to  be  fought  by  the  aid  of  chemical  anti- 
septics. He  considered  it  a  matter  of  impossibility 
in  general  surgical  practice  to  avoid  occasional  contact 
with  sepsis,  and  accordingly  he  did  not  consider  one 
could  rely  solely  on  aseptic  measures. 

Mr.  ToBiN  thought  the  ideal  condition  of  things 
would  be  that  in  which  all  surgeons  used  the  same 
methods.  It  would  be  well,  too,  if  surgical  nurses 
were  all  trained  on  similar  lines.  He  did  not  think 
the  danger  likely  to  follow  from  puncture  of  rubber 
gloves  during  an  operation  very  great. 

Professor  Bennett  agreed  with  Mr.  Haughton  as  to 
the  advantage  of  using  alcohol  as  a  final  disinfectant 
in  cleansing  one's  hands  and  the  surroundings  of  a 
wound.  He  had  found,  however,  that  alcohol  applied 
to  the  skin  of  his  arms  produced  severe  urticaria ;  he 
had  found  no  unpleasant  consequences  from  employ- 
ing it  for  his  hands. 

Colonel  McNeece,  R.A.M.C,  Sir  Thomas  Myles, 
Mr.  Wheeler  and  Dr.  Earl  also  discussed  the  paper. 

In  reply,  Mr.  Haughton  thought  that  abstinence 
from  sepsis  should  be  the  constant  aim  of  the  aseptic 
surgeon,  and  the  best  way  to  do  this  was  by  wearing 


rubber  gloves  when  dealing  with  septic  cases  of  all 
kinds.  In  the  treatment  of  actually  septic  wounds 
he  thought  weak  antiseptics  were  better  than 
those  of  greater  strength,  as  the  latter  acted  injuriously 
upon  the  tissues.  He  considered  alcohol  at  a 
strength  of  70  per  cent,  was  better  than  full  strength 
when  employed  for  the  hands.  He  thought  silk  was  an 
absolutely  satisfactory  ligature  material  for  burying 
in  wounds,  if  No.  i  were  used.  At  the  conclusion  of 
his  paper  Mr.  Haughton  showed  a  series  of  lantern  shdes 
illustrating  various  points  in  aseptic  technique. 

LIVERPOOL    MEDICAL    INSTITUTION. 
Meeting  held  November  5RD,  1904. 


Dr.  James  Barr,  President,  in  the  Chair. 

Dr.  Grossman  demonstrated  a  case  of  "double 
congenital  anophthalmos "  in  an  otherwise  well- 
developed  child,  eight  months  old.  The  lids  were 
well-formed,  though  only  half  an  inch  in  length,  and 
the  conjunctival  sac  was  a  narrow  funnel  barely  half 
an  inch  deep.  In  the  inner  half  of  the  right  lower 
lid,  a  bluish  subcutaneous  cyst,  about  half  an  inch  in 
diameter,  was  very  conspicuous,  a  so-called  coloboma 
cyst.  No  trace  of  a  rudimentary  eye-ball  was  to  be 
felt,  or  seen.  This  was  the  third  case  of  the  same 
nature  shown  by  Dr.  Grossman  before  the  Institution 
within  the  last  four  years. 

AN  IMPROVED  INHALER  FOR  ETHVL  CHLORIDE. 

Dr.  Stenhouse  Williams  exhibited  an  inhaler  for 
the  administration  of  ethyl  chloride.  The  apparatus 
was  so  constructed  that  the  bottle  containing  the 
ethyl  chloride  is  held  in  position  over  a  tube  with  a 
stop  tap  which  passes  directly  into  the  bag  of  a 
Clover's  inhaler.  By  this  means  as  much  ethyl 
chloride  as  is  required  is  sprayed  into  the  bag,  and 
then  the  tap  turned  off ;  the  administration  may 
thus  be  continued  indefinitely. 

Mr.  G.  P.  Newbolt  showed  a  male  patient,  aet. 
38,  from  whom  he  had  removed  a  large  colloid 
carcinoma  of  the  caecum,  six  months  previously.  The 
growth  had  caused  no  obstruction  ;  it  was  removed 
through  a  transverse  abdominal  incision,  the  resulting 
scar  being  an  excellent  one.  He  also  related  a  case 
of  intestinal  obstruction  occurring  in  a  female,  aet. 
53,  for  which  he  had  performed  left  inguinal  colotomy. 
There  was  a  marked  sigmoid  curve,  and  the  faeces 
passed  through  the  lower  opening  of  the  colotomy 
wound.  Three  months  later  the  carcinomatous 
growth  causing  the  obstniction,  and  the  artificial 
anus«  were  simultaneously  excised.  The  patient 
made  an  excellent  recovery. 

.Mr.  K.  W.  Monsarrat  read  an  account  of  a  case  of 

FRACTURE   OF   THE    FEMUR   IN    A   H-«M0PHILIAC. 

The  patient  was  a  boy.  aet.  8.  At  the  seat  of 
fracture  there  was  an  enormous  local  effusion 
which  progressively  increased  up  to  the  fourteenth 
day,  and  was  accompanied  by  a  steady  rise  of  tem- 
perature. His  personal  history  indicated  haemophilia, 
and  he  showed  signs  of  the  disease  elsewhere  during 
his  stay  in  hospital.  Union  of  the  fracture  took  place 
early ;  by  the  end  of  the  fourth  week  it  was  already 
firm.  The  local  effusion  simulated  an  inflammatory 
condition,  and  before  the  personal  history  was  inquired 
into,  it  was  looked  upon  as  probably  of  this  nature. 

Mr.  Douglas  Crawford  referred  to  a  case  of 
haemophitia  with  effusion  into  the  knee-joint,  in  which, 
on  account  of  the  pain  and  temperature,  simulated 
acute  arthritis.  He  opened  the  joint,  and  a  satis- 
factory recovery  followed. 

Dr.  Hugh  R.  Jones  read  a  paper  on  the  distribution 
of 

PHTHISIS    AND    CANCER    IN    ENGLAND    AND    WALES. 

Having  pointed  out  the  difference  in  the  age  and  sex 
incidence  of  the  two  diseases,  he  drew  attention  to 
certain  similarities  in  their  history  and  distribution. 
It  was  proved  that  cancerous  persons  had  a  family 
history  of  phthisis  greater  than  obtains  in  the  general 
population,  and  that  a  high  percentage  of  phthisical 
persons   had   a  cancerous   family   history.     The   two 


520    The  Medical  Press. 


TRANSACTIONS    OF    SOCIETIES. 


Nov.  1 6,  1904. 


diseases  are  more  prevalent  near  the  sea-line.  .Cancer 
areas  either  overlap,  or  are  contiguous  to,  phthisical 
areas.  In  central  England,  both  cancer  and  phthisis 
are  below  the  average.  The  death-rate  from  phthisis 
reaches  its  zenith  at  the  35-45  age.  period,  the  period 
at  which  the  cancer  death-rate  begins  to  increase. 
He  pointed  out  the  frequency  with  which  arrested 
phthisis  and  obsolete  tubercle  were  found  in  cancerous 
persons.  He  believed  that  the  recorded  increase  in 
cancer  was  in  part  real,  and  not  altogether  explained 
by  improved  diagnosis,  nor  by  the  increased  popu- 
lation living  at  higher  age  periods,  owing  to  the  fall 
in  the  general  death-rate,  which  would  not  affect  the 
cancer  death-rate,  but  probably  due  to  the  fall  in 
the  phthisis  death-rate,  resulting  in  members  of 
phthisical  families  surviving  to  the  cancer  age,  such 
persons. being  more  prone  to  cancer  than  the  general 
population. 

Dr.  William  Carter  thought  that  on  the  question 
of  cancer  and  phthisis  one  might  well  consider,  side 
by  side  with  statistics,  certain  great  changes  in  the 
national  habits.  Ever  since  the  JR^gistrar-General's  office 
had  been  founded,  some  seventy  years  ago,  a  steady 
advance  in  the  mortality  from  cancer  had  been  recorded. 
Within  th^t  period  bleeding,which  at  first  was  universal, 
had  been  totally  discarded ;  the  use  of  mercurial 
compounds,  the  greatest  of  antiseptics,  like  bleeding 
once  universal,  had  been  largely  abandoned.  The 
consumption  of  meat  per  head  of  the  population  had 
probably  increased  many  times  over,  and  the  people 
who  had  lived  simple  natural  outdoor  lives  had  become 
aggregated  in  dense  masses  in  towns.  It  was  quite 
open  to  consideration  whether  all  these  great  facts 
might  not  be  related  to  each  other. 

Dr.  R.  J.  M.  Buchanan  recognised  the  importance 
of  the  peculiar  fact  that  in  many  ciases  of  cancer 
obsolete  tubercle  was  found  post-mortem,  and  also  the 
close  relationship  in  family  history  between  tuber- 
culosis and  cancer ;  but  he  did  not  consider  that  the 
increased  death-rate  from  cancer  proved  increase  of 
incidence  as  real,  or  that  it  in  any  way  depended  upon 
the  lowered  death-rate  from  phthisis.  The  prophy- 
laxis exercised  against  tuberculous  infection  by  lowering 
both  the  incidence  and  death-rate  from  phthisis  had 
resulted  in  more  persons  now  living  until  they  reached 
that  period  of  life  in  which  cancer  is  recognised  as 
most  likely  to  occur. 

Mr.  K.  W.  MoNSARRAT  said  he  did  not  consider 
that  any  particular  relationship  had  been  established 
as  existing  between  cancer  and  phthisis. 

Dr.  J.  Hill  Abram  thought  the  chart  of  Dr.  Jones, 
illustrating  the  marked  difference  between  the  ap- 
parent and  the  corrected'  death-ra'.e  from  cancer, 
was  very  important,  and  demonstrated  the  great  care 
necessary  in  dealing  with  figures. 

LARYNGOLOGICAL     SOCIETY     OF     LONDON. 


Meeting  held  Friday,  November  4TH,    1904. 


A  MOST  interesting  specimen  of 

ACTINOMYCOSIS   IN   THE   TONSIL 

of  a  female  child,  together  with  bacteriological  sections, 
was  shown  by  Mr.  Arthur  Cheatle  and  Dr.  Emmery. 
It  was  agreed  that  this  was  probably  the  second  case 
only  which  had  ever  been  recorded  of  actinomycosis 
in  that  region. 

Several  specimens  of  malignant  disease  in  the  upper 
air  passages  of  the  dog  and  cat  were  shown  by  Professor 
Hobday  and  Mr.  ee  Santi,  and  an  interesting  case  of 
probably  extrinsic  malignant  disease  of  the  larynx  in 
a  man,  set.  64,  by  Dr.  Furniss  Potter. 

The  case  was  unusual  in  the  fact  that  it  had  lasted 
some  eighteen  months  without  any  glandular  infection. 
It  was  looked  upon  as  a  particularly  suitable  case  for 
laryngectomy. 

An  interesting  specimen  of  a  foreign  body — a  collar- 
stud — was  brought  forward  by  Dr.  Paterson,  the 
foreign  body  having  been  removed  by  direct  laryngo- 
scopy, Killian's  method,  from  a  child,  aet.  12  months. 

Mr.  Waggett  brought  forward  a  diagnostic  speci- 


men from  an  oesophageal  stricture  removed  by  KiSian's 
method.  He  pointed  out  that  cesophagoscopy  in 
England  seemed  not  to  be  as  well  known,  as  a  method 
of  diagnosing  strictures  of  the  oesophagu-.  as  it  should 
be. 

Mr.  de  Santi  showed  a  case  of  curious  erythema  of 
the  soft  palate  and  tonsillar  region  in  a  giii  The 
question  was  as  to  the  nature  of  the  trouble.  One  or 
two  members  looked  upon  the  case,  though  unique,  as 
probably  of  the  nature  of  angioma. 

Dr.  Kelson  showed  a  case  of  lar3mgeal  growth  in  a 
boy,  aet.  6,  the  interest  of  which  was  that  the  growth 
had  been  removed  in  the  sit  ting-up  posture  by  endo- 
laryngeal  forceps  and  deep  anaesthesia. 

Mr.  H.  B.  Robinson  showed  a  case  of  pharyngeal 
obstruction  from  a  diaphragm  which  stretched  betwea 
the  back  of  the  tongue  and  the  posterior  wail  of  the 
pharynx. 

Dr.  Law  showed  a  case  of  stenosis  of  the  trachea. 
ozaenic  in  nature,  and  Dr.  Dundas  Grant  a  microscopic 
slide  of  an  extrinsic  laryngeal  growth,  the  diagnoas 
resting  between  sarcoma  and  fibroma. 


CHILDHOOD     SOCIETY. 

Meeting  held  November  ioth,   1904. 

Sir  James  Crichton  Browne  in  the  Chair. 

Dr.  Theo.  B.  Hyslop  began  by  saying  that  alienists 
had  before  them  a  problem  asserting  itself  with  over- 
whelming force,  the  percentage  of  insauiity  having 
quadrupled  itself  in  fifty  years,  these  figures  not 
including  imbeciles,  hysterics,  drunkards,  neuras- 
thenics, or  the  feeble-minded,  but  simply  those  under 
control.  With  regard  to  physical  training  in  youth,  it 
had  to  be  borne  in  mind  that  school  games  involved 
a  wide  range  of  mentaJ  activity,  and  the  boy  fresh 
in  from  a  strenuous  game  was  not  fitted  to  use  his 
brain  to  a  similar  effort.  Athleticism  and  games  must 
be  complementary.  A  severe  strain  in  either  coune 
when  young  was  felt  all  through  life. 

All  were  agreed  as  to  education,  but  to  force  any 
mental  effort  on  stunted,  underfed  children  was  both 
inhuman  and  impolitic.  Half  the  children  in  Board 
Schools  were  unfit  for  lessons,  amd  it  would  be  cheaper 
to  feed  them  than  to  pay  for  them  afterwards  as  pauper 
lunatics. 

Acute  mania  haul  not  increased  so  much  as  that 
weak-mindedness  which  might  be  regaurded  as  a  pro- 
duct of  the  last  few  decades. 

The  mental  condition  at  the  present  day  was  one 
of  psychorrhoea  gravida.  There  was  diffuse  consdoos- 
ness.  ill  aissortment  of  ideas,  and  a  lau;k  of  seriality 
of  thought  eaisily  passing  into  a  state  of  insanity. 

That  loss  of  memory  so  frequently  noted  in  the 
papers  really  marked  a  form  of  epilepsy.  There  was 
a  want  of  economy  in  brain  power.  It  did  not  appear 
that  education,  so-called,  had  done  much  when  efforts 
had  to  be  made  in  the  way  of  workhouses,  alms- 
houses and  asylums  to  keep  pace  with  increasiof; 
insanity. 

In  concluding,  Dr.  Hyslop  spoke  of  our  unphysio- 
logical  daily  habits.  The  turning  night  into  day  and 
having  to  sleep  when  the  bradn  should  be  at  its 
brightest.  Theatres  and  concert  halls  should  be 
closed  at  ten.  In  fact,  we  were  tw^o  hours  too  late 
in  everything,  and  the  results,  although  apparent  in 
us,  were  manifested  chiefly  in  our  progeny. 

Sir  James  Crichton  Browne,  in  reply,  said  it  was 
impossible  to  ignore  the  weakness  of  a  social  system 
which  led  to  increase  in  wastrels,  criminals,  lunatics 
and  juvenile  delinquents,  and  the  remedy  lay,  as  Dr. 
Hyslop  had  pointed  out,  in  proper  care  of  the  yoang 
when  the  aissociation  fibres  of  bradn  were  forming 
irresistible  habits  of  mind  and  body.  Clever  people 
had  more  of  these  fibres  than  others,  but  in  all  brains 
they  were  forming  pathways  made  indelible  by  use. 
Our  annual  lunacy  returns  ought  to  silence  the  genial 
optimist  who  drugs  the  public  by  pretending  these 
are  unreliable.  Brudenall  Carter  says  the  attempt 
to  explain  away  the  larger  number  of  lunatics  is 
puerile.     Physical    deterioration    must    involve    the 


Nov.  1 6,  1904. 


GERMANY. 


The  Medical  Press.    52 1 


Drain,  and  inquiry  into  its  cause  and  cure  was  quite 
as  momentous  as  that  into  cancer  or  tuberculosis. 

He  (Sir  J.  C.  Browne)  also  agreed  with  Dr.  Hyslop  that 
from  a  purely  scientific  point  of  view  some  kind  of 
religious  instruction  was  necessary. 


ASSOCIATION    OF    PORT    SANITARY 
AUTHORITIES. 
The  annual  meeting  of  this  association  was  held  at 
the  Westminster  Palace  Hotel.     Alderman  C.  H.  Giles 
chairman  of  the  Liverpool  Port  Sanitary  Authority,  was 
elected  President,  in  succession  to  Dr.  Fraser  (Hull), 
and  took  the  Chair.     In  thanking  the  members  for  the 
honour  conferred  upon'  him,  he  said  the  Association 
increased  every  year  in  importance,  and  it  was  doing 
good  work  for  the  community  at  large.     Alderman 
Hindmarsh    was    elected    Vice-president,    and    other 
officers  were  appointed.     Mr.  R.  Sheriton  Holmes,  the 
hon.  solicitor,  read  some  notes  on  "  The  Association  of 
Port  Sanitary  Authorities*  Expenses  Bill,"  which  pro- 
vides for   the  expenses  of  representatives  attending 
meetings  and  the  payment  of  a  subscription  to  the 
funds  of  the  Association.     He  suggested  that  the  sixty 
port  sanitary  authorities  in  England  should  be  asked 
to  memorialise  the  Government  in  favour  of  taking  up 
the  Bill,  and  a  resolution  to  that  effect  was  adopted. 
In  a  paper  on  "  The  Recent  Case  of  Plague  in  the  River 
Tyne,"  Dr.  W.  E.  Harker  said  it  was  probable  that  the 
patient  developed  the  disease  by  direct  inoculation  from 
rat  infection,  although  no  definite  point  of  entrance  or 
insect  bite  could  be  demonstrated  on  the  skin.     The 
case  afforded  further  proof  of  the  great  danger  of 
plague-infected   vermin   on  board  ship.     Dr.   E.   W. 
Hope  (Liverpool)  and  other  members  said  the  case 
illustrated  the  importance  of  the  systematic  destruc- 
tion of  rats  in  all  vessels  coming  from  plague-infected 
ports.     A  discussion  on  '*  Amendments  in  the  By-laws 
relating  to  Infectious  Disease  "  was  opened  by  Dr. 
Hope,  who  said  the  present  penalty  of  40s.  for  breaches 
of  the  regulations  by  masters  of  vessels  was  wholly 
inadequate.     He  suggested  that  it  should  be  raised  to 
£$0  or  ;£ioo.    The  question  of  the  desirability  of  the 
taking  of  samples  of  food  for  analysis  by  port  sanitary 
authorities  under  the  Food  and  Drugs  Acts  was  brought 
forward  by  Dr.  J.  Wright  Mason  (Hull),  and  after  a 
brief  discussion  the  matter  was  referred  to  the  council. 
The  meeting  also  referred  to  the  council  for  considera- 
tion the  subject-matter  of  a  resolution  by  Dr.  A.  M.  N. 
Pringle,  the  Medical  Officer  of  Health  of  the  Manchester 
port  sanitary  authority — which  that  gentleman  after- 
wards withdrew — ^in  favour  of  the  control  of  the  sani- 
tary arrangements  of  mercantile  vessels,  both  during 
and  after  construction,  being  vested  in  port  sanitary 
authorities. 


gland,  firstly,  cutaneous  epithelioma,  which  is  deve- 
loped in  the  skin  ;  the  deep  tissues  are  not  affected, 
and  the  malady  is  easily  recognised.  Then  comes 
chancre  of  the  nipple,  observed  generally  in  young 
women  ;  the  tumour  is  round  and  the  edges  indurated. 
Syphilitic  gummata  can  be  found  in  the  mammary 
gUmd,  but  the  ulcerous  and  phagedenic  character  of 
the  affection  is  sufficient  to  remove  any  doubts. 

Other  affections  more  rare  might  si miiate  cancer,  such 
as  submammary  tumours  (cold  costal  abscess,  exostosis, 
lipoma),  which  push  the  gland  forward.  The  same 
may  be  said  of  certain  tumours  which  have  been  con- 
founded with  cancer.  Cold  abscess  of  the  breast, 
mammary  tuberculosis  characterised  by  tuberculous 
granulations  disseminated  throughout  the  gland. 
'Cystic  disease  of  the  breast,  described  in  France  by 
Reclus,  is  a  bilateral  tumour,  symmetrical  from  the 
outset.  The  ganglions  are  not  affected,  and  the  affec- 
tion remains  stationary. 

Chronic  mammitis  is  one  of  the  affections  most  fre- 
quently confounded  with  cancer.  This  malady  appears, 
like  the  encephaloid  tumour,  at  the  close  of  uterine 
life,  and  is  to  be  found  in  patients  who  had  heretofore 
abscess  of  the  breast.  In  palpating  the  gland  from 
before  backwards,  small,  irregular  masses  are  felt,  pain- 
ful to  pressure.  Encephaloid  cancer  is  not  painful  to 
pressure,  is  not  bilateral,  as  is  frequently  the  case 
with  the  chronic  affection.  The  diagnosis  is  often 
difficult,  and  frequently  only  the  treatment  will  clear 
up  the  nature  of  the  affection.  Elevation  and  com- 
pression by  cotton  wool  of  the  breast  produces  im- 
provement and  retrogression  of  the  masses  in  chronic 
mammitis,  while  no  such  favourable  modification  is 
ever  observed  in  cancer. 

Adenoma  of  the  breast  is  easy  to  recognise.  It  is 
a  little  tumour  which  appears  in  young  women ;  it  is 
round,  capsulated,  and  painful.  Sarcoma  is  recognised 
at  first  glance.  It  is  an  enormous  mass  run  over  with  a 
network  of  subcutaneous  veins,  and  presenting  cystic 
degeneration  in  places.  The  development  is  rapid, 
and  no  ganglions  are  found  in  the  axilla.  The  pro- 
gnosis is  subordinate  to  the  variety.  Scirrhus  can 
last  twenty  years,  but  it  can  also  degenerate,  hence  the 
danger.  The  encephaloid  form  kills  in  two  years,  but 
there  are  many  exceptions  to  this  rule. 

The  treatment  is  naturally  total  ablation  in  both  cases 
as  early  as  possible,  and  by  this  means  life  is  prolonged 
two  or  four  years,  or  even  more. 

Another  method  of  operating  for  cancer  is  ablation 
of  the  ovaries.  According  to  M.  Regn^s,  of  Marseilles 
this  operation  is  capable  of  producing  retrogression  0£ 
the  tumours. 


jftance. 


[from  our  own  correspondent.] 


Pakts,  November  13  th,  1904. 
Cancer  of  the  Breast. 
There  exist  two  kinds  of  cancer,  says  Professor 
Mauclaire :  encephaloid  and  scirrhus.  Two  other  affec- 
tions in  the  cancer  group  must  be  detached,  sarcomata 
and  cysts.  Encephaloid  cancer  is  characterised  by  an 
insidious  and  painless  d^but,  wherein  lies  a  grave  danger, 
as  women  do  not  take  much  notice  of  it,  and  in  the 
meantime  the  tumour  develops  both  in  depth  and  in 
surface.  The  adhesions  it  contracts  with  the  skin 
produce  the  classical  orange-peel  appearance. 

Soon  the  nipple  retracts,  ganglions  appear  in  the 
axilla,  and  the  skin  ulcerates.  It  is  necessary  to  dia- 
gnose at  the  outset  such  a  grave  affex;tion,  as  the  ave- 
rage duration  is  from  eighteen  months  to  two  years. 
Scirrhus  is  found  generally  in  aged  persons,  while 
the  ence{>haloid  form  attacks  women  between  forty  and 
torty-five  years  of  age.  The  former  constitutes  a 
tumour  of  small  dimensions,  hard,  producing  atrophy 
of  the  gland.  The  duration  of  the  malady  is  from  ten 
to  fifteen  years.  Either  of  these  forms  should  be 
distinguished  from  numerous  other  affections  of  the 


Germans. 

[FROM   OUR   OWN    CORRESPONDENT.] 


BsRLur.  Norember  ISth,  190*. 
At  the  Naturfdrscherversammlung,  Hr.  Kovesi  gave 
a  communication  on 

Dropsy  iir  Renal  Disease, 
based  on  observations  made  in  the  First  Medical 
Klinik,  Budapest.  As  regards  its  origin,  there  was  no 
unanimity  of  opinion.  After  investigation  of  the  tissue 
changes  and  cryoscopic  examination  of  patients  in 
X6rani's  Klinik,  it  was  believed  to  lie  in  the  deficient 
excretion  of  water.  For  the  purpose  of  the  functional 
testing  of  the  kidneys  he  recommended  the  dilution 
investigation  [Berl.  kl.Wochenschr.,  Bd.  15,  1900),  which 
rendered  it  possible  to  test  the  power  of  the  kidneys  to 
eliminate  water.  The  organism  with  renal  disease  had 
no  power  of  compensating  the  deficiency  in  the  excre- 
tory power  in  any  extra-renal  way,  therefore  para- 
lysis of  the  water-secreting  apparatus  caused  retention, 
thus  storing  up  fluid  in  the  body.  The  retained  water 
associated  itself  with  the  blood.  It  must  therefore 
cause  hydraemia.  It  might  be  assumed  that  the 
wall  of  the  capillary  vessel  offered  a  certain  resistance 
to  heightened  filtration  pressure,  which  must  be  over- 
come before  dropsy  can  arise,  but  it  was  not  the  only 


522    Thx  Medical  Pkess. 


AUSTRIA. 


Nov.  16.  1904. 


factor.  When  the  tissue  was  damaged  in  its  elasticity 
in  consequence  of  the  burdensome  high  pressure,  its 
power  of  forcing  the  tissue  juices  into  the  lymph  tracts 
was  also  injured.  In  cases  of  mechanical  blocking  of 
urine  special  conditions  prevailed,  in  consequence  of 
which  the  cases  ran  a  tolerably  monotonous  course 
without  oedema  and  without  any  typical  uraemia,  but 
generally  with  symptoms  of  increasing  bodily  and 
mental  decay.  This  subject  had,  however,  not  been 
much  inquired  into,  and  for  this  reason  no  decisive 
importance  had  been  given  to  it.  No  cases  of  oede- 
matous  nephritis  were  observed  in  which  any  essential 
limitation  of  the  dilution  fluid  could  not  be  determined. 
Occasionally,  in  cases  of  nephritis,  oedema  of  inflam- 
matory origin  independ?nt  of  the  typical  insufficiency 
of  elimination  might  be  met  with.  The  typical 
nephritic  oedemata,  however,  were  independent  of  the 
kidney  condition.  Considered  from  the  clinical  side, 
the  secretion  of  water  and  the  capacity  of  dilution  of 
the  kidne3rs  outside  the  condition  of  these  organs  them- 
selves depended  on  functional  power  of  the  heart.  The 
speaker  considered  the  genesis  of  dropsy,  both  in  renal 
and  cardiac  diseases,  to  be  the  same.  He  attributed 
dropsy  from  heart  affection  to  renal  stasis  due  to 
hydraemic  plethora  and  favoured  by  diminution  in  the 
rate  of  flow  of  the  blood. 

Hr.  Kretz,  Vienna,  spoke  on 

Cirrhosis  of  the  Liver, 
and  said  it  was  not  dependent  on  interstitial  hepatitis, 
but  the  parenchyma  itself  had  become  changed  by 
regeneratory  healing  of  multiple  attacks  of  degenera- 
tion. The  appearance  of  elastic  fibres  in  the  connec- 
tive tissue  of  the  cirrhotic  liver  was  essentially  depen- 
dent on  the  fresh  melting  together  of  parts  of  paren- 
chyma with  free  arterial  supply,  and  already  built 
around  or  walled  in.  The  first  anatomical  change  did 
not  lie  in  the  connective  tissue,  but  in  the  patch-like 
degeneration  of  the  parenchyma  and  in  the  subsequent 
wedp[ing  in  of  regenerated  tissue  in  the  regicxi  of  the 
section  of  parenchyma  with  a  better  arterial  supply. 

Cirrhosis  of  the  liver  was  not  a  morbid  entity ;  the 
liver  change  was  rather  an  anatomical  sequence  of  re- 
peated degeneration  of  liver  cells  with  parenchymatous 
new  growths  thrust  in  between.  Etiologically,  the 
disease  might  be  set  up  by  any  of  the  pathogenic  in- 
fluences that  caused  degeneration  of  the  parenchyma  ; 
by  abnormal  tissue  changes,  by  poisons,  by  bacterial 
injuries,  and  the  injurious  substance  might  reach  the 
liver  cells  either  by  way  of  the  blood  tracts  or  by  the 
bile  capillaries. 

Hr.  Naunyn,  Strassburg,  had  come  to  the  following 
conclusions.  There  were  distinctly  various  forms  of 
the  disease.  It  was  well  to  distinguish  (a)  commencing 
cirrhosis  ;  (b)  the  common  ascitic  cirrhosis  (the  atrophic 
form) ;  (c)  biliary  (hypertrophic)  cirrhosis ;  (d)  the 
hypersplenic  form  of  Banti's  disease.  The  difference 
of  these  forms  did  not  rest  on  any  original  difference  in 
the  morbid  process,  but  on  the  complicating  cirrhotic 
cholangitis,  which  was  present  in  varying  degree  and 
in  the  most  varied  manner.  This  cirrhotic  cholangitis 
was  an  enterogenous  ascending  cholangitis  ;  it  was 
not  the  cause  of  the  cirrhosis  birt  a  complication  which 
affects  the  organ  already  cirrhotic.  The  separation  of 
enterogenous  and  splenogenous  forms  had  no  basis  of 
fact,  but,  on  the  other  hand,  the  hematogenous  origin 
was  probable.  There  might  be  haemolytic  processes  in 
play,  and  if  a  cirrhogenous  cholangitis  was  present  it 
would  be  a  descending  cholangitis  of  haemolytic  origin. 

Hitherto  only  the  alimentary  levulosuria  was  re- 
cognised as  a  symptom  of  disturbed  hepatic  function, 
but  even  of  this  it  has  not  been  proved  that  it  cannot 
be  caused  by  the  direct  entrance  of  sugar  into  the  blood. 
Diagnos'.ical'y,  therefore,  characteristic  anatomical 
changes  were  requisite.  Lichtenstein's  praecirrhotic 
splenic  tumour  was  not  proof  of  the  "  up-to-the-present- 
not-diseased-condition."  Banti's  disease  was  not 
specific.  The  cases  resembling  biliary  colic  were  caused 
by  infectious  inflammation  of  the  bile  passages. 
Etiologically,  alcohol  was  almost  the  only  substance  to 
be  accused.  The  changes  found  by  Bleichroeder  were 
only  consequences  of  the  liver  disease. 


Aufrecht  said  there  was  only  an  apparent  increase  in 
the  connective  tissue,  and  this  was  caused  by  shrinkiD^ 
of  the  acini.  Chiari,  Prague,  laid  stress  oa  the  encxmoos 
new  growth  of  the  liver  parenchyma,  and  also  the  inter- 
stitial secondary  processes — ^frequently  necrosis  of  the 
liver.  V.  Hansemann,  Berlin,  considered  the  alcoholic 
origin  of  the  disease  still  undecided. 


Hnstna* 


[from  our  own  corssspomssht.] 


Vienna,  November  12th,  1904. 

Quantitative  Analysis  of  Blood  Oxidation. 

At  the  meeting  of  the  "  Natur.orscher,"  JoUes 
presented  a  report  on  the  analysis  of  blood  and  iu 
catalytic  power  for  oxidising.  In  this  investigatioa 
he  was  assisted  by  Dr.  Oppenheim  who  provided  him 
with  an  extensive  supply  of  clinical  materiaL  The 
principle  of  this  analysis  is  founded  on  the  comparative 
changes  that  take  place  in  hydrogen  peroxide  (H,  O^^ 

His  method  of  procedure  is  to  take  0*05  cubic 
centimetre  of  blood  in  a  capillary  tube  and  pUce  it  in 
a  measured  50  centimetres  flask  with  30  cubic  centi- 
metres of  a  physiological  salt  solution.  The  tub; 
is  finally  rinsed  out  with  another  20  cubic  centi- 
metres of  the  salt  solution,  making  up  the  flask 
to  the  50  centimetre  mark.  Ten  centimetres  of  this 
blood  solution  is  now  mixed  with  30  cubic  centimetres 
of  the  peroxide  of  hydrogen,  and  the  mixture  allowed 
to  stand  for  two  hours  at  sjmmer  temperature.  The 
next  process  is  to  acidify  wi  h  H,  834.  Add  a  few 
drops  of  an  iodide  cf  potassium  solution,  and  then  titrate 
with  the  thio  sulphate  solution.  The  difference 
obtained  between  the  10  cubic  centimetres  of  the 
blood  solution,  or  O'oi  of  the  blood  and  a  peroxide 
of  hydrogen  solution  (H,  O,),  will  give  the  catalytic 
power  of  the  blood.  This  catalytic  number  will  be 
found  to  range  between  18  and  30  in  normal  t)lood. 
but  more  commonly  between  20  and  26.  Male  and 
female  blood  do  not  differ,  neither  does  the  arterial 
differ  from  the  venous. 

In  special  diseases,  however,  like  tuberculosis, 
nephritis,  and  carcinoma,  the  value  falls  to  between 
I  and  10.  This  may  be  of  considerable  clinical  value 
in  cases  of  doubt,  and  where  confirmation  is  required. 

Tesla's  Current  in  Tubercle  of  the  Lung. 

Stenbeck  drew  the  attention  of  the  meeting  to 
Tesla's  current  in  cases  of  pulmonary  tuberculosis. 
Doumer,  Oudin,  and  others  had  obtained  good  results 
according  to  their  descriptions,  but  he  was  now  con- 
vinced firom  long  experience  that  the  current  must 
be  very  strong  before  any  beneficial  effects  can  be 
realised. 

The  so-called  "effluvien"  must  be  15  or  30  centi- 
metres, or  about  6  to  12  inches,  to  be  of  any  use. 
while  the  "  inductorium  "  should  be  50  to  60  centi- 
metres for  a  spark.  Without  change  of  residence  or 
food  these  cases  when  so  treated  take  on  body-weight 
and  subjectively  seem  greatly  improved.  Notwith- 
standing this  favourable  result,  it  would  be  premature 
to  form  any  conclusive  judgment  on  the  point. 
Internal  Effects  of  Formaldehyde. 

Jakobson  gave  a  history  of  the  drug  and  its 
physiological  effects  on  the  human  orgranism.  The 
best  way  of  administering  the  remedy  was  with 
sugar  or  milk,  which  reheved  the  irritation.  In  his 
own  experiment  31  per  cent,  of  the  drug  admin  stered 
passed  off  by  the  kidneys,  the  rest  being  decomposed 
into  formic  acid,  carbonic  acid,  and  the  remainder 
entering  into  combination  with  albumen. 

Rosenberg  said  that  he  had  used  formaldehyde 
in  many  hundreds  of  cases  without  a  single  bad  resalt. 
although  his  treatment  ranged  over  angina,  scarlet 
fever,  diphtheria,  erysipelas,  and  cystitis.  The  dose 
prescribed  never  exceeded  i  to  2  decigrammes  per  day 
in  the  form  of  a  x  per  cent,  solution,  with  jnilk 
of  sugar,  or  in  tablets. 

Weintraud  remarked  that  formaldehyde  forms  aD 
insoluble  combination  with  urea  and  uric  acid,  which 


Nov.   1 6,   1904. 


THE    OPERATING    THEATRES. 


The  Mi^dical  Pkess.    523 


may  explain  the  poor  results  obtained  from  citarin 
where  it  is  in  combination  with  an  alkali. 

Stern  said  that  he  had  used  large  doses  of  urotropin, 
and  never  could  find  formaldehyde  in  the  blood  serum. 

MuUer  observed  that  although  it  was  true  the 
elimination  of  uric  acid  was  checked,  the  action  on 
calculi  in  the  bladder  was  powerful.  Gout  was  not 
benefited  by  its  use. 


XLbc  ^petatlno  ^beattes* 

KORTH-WEST  LONDON  HOSPITAL. 
Operation     for    Syphilitic    Stenosis    of    the 
Larynx. — ^Mr.  Mayo  Collier  operated  on  a  case  of 
stenosis  of  the  larynx,  that  first  came  under  his  care 
some  ten  years  ago.     He  said  this  was  a  unique  case 
of  its  kind.     The  patient,  a  female,  aet.  28.  had  pre- 
sented herself  at  his  out-patient's  department  ten  years 
ago   complaining  of  extreme  difficulty  of  breathing. 
The  history  of  the  case  was  the  following :    She  had 
been  married  four  years.     Six  months  afterwards  she 
had  been  affected  with  a  secondary  eruption  and  a  sore 
throat,  and  subsequently  gave  birth  to  a  child  that  died 
in   early  infancy.      Since    then    she  complained  con- 
tinuously of  laryngeal  troubles,  associated  with  cough 
and  expectoration  of  blood-stained  sputa.     On  exami- 
nation it  was  found  that  the  whole  of  the  upper  opening 
of  the  larynx  was  occluded  by^a  cicatricial  membrane 
leaving  but  a  small  opening,  the  calibre  of  a  lead  pencil, 
near  the  root  of  the  epiglottis  ;  the  epiglottis  itself  had 
disappeared  and  was  now  represented  by  a  stump  the 
size  of  .a  small  pea.     Mr.  Collier  ascertained  the  woman 
had  been  affected  with  syphilis  in  early  matrimony, 
the  husband  having  suffered  from  well-marked  syphilis. 
The   then  condition  had  been  brought  about  by  an 
attack  of  acute  laryngeal  catarrh,  rendering  the  ex- 
tremely  limited  opening  for  respiration  still  further 
curtailed.     The  case  was  immediately  ad.mitted  into 
the  hospital  and  tracheotomy  performed.     Mr.  Collier 
said  that  at  the  end  of  fourteen  days  the  patient  left 
the    hospital    wearing    a    tracheotomy    tube,    which 
afforded   satisfactory  space  for  respiration.     On   two 
subsequent  occasions  the  patient  was  re-admitted  into 
the  hospital,  and  an  attempt  was  made  to  enlarge  the 
stenosed  upper  orifice  of  the  larynx.     Under  cocaine 
on  both  occasions  an  incision  was  made  to  the  right  and 
left  of  the  stenosed  orifice ;  the  cicatricial  tissue  was  so 
firm  and  rigid,  however,  that  no  increase  of  space  was 
obtained.     The  patient  now  presented  herself,  having 
worn  a  tracheotomy  tube  for  nine  years,  and  having  in 
the  interval  acted  in  the  capacity  of  cook  in  various 
establishments,  complaining  of  difficulty  of  breathing, 
difl&culty  of  replacing  the  tracheotomy  tul)e,  and  serious 
hemorrhage  at  each  attempt.     Mr.  Collier  dilated  on 
the  importance  of  this  case,  and  the  fact  that  the  patient 
had  been  quite  comfortable  for  some  nine  years  without 
any  attacks  of  laryngeal  catarrh  or  bronchitis,  and 
had  been  continuously  in  domestic  service  during  -the 
whole  of  this  period.     With  a  good  light  and  with  the 
assistance  of  a  pair  of  dilators  he  demonstrated  to 
those  around  a  mass  of  granulations  not  only  extending 
into  the  trachea  but  surrounding  the  outer  opening  of 
the  tracheotomy  wound.     He  demonstrated  with  the 
laryngeal   mirror   the   upper  opening  of   the  larynx, 
which  apparently  was  unaltered  since  his  first  exami- 
nation some  nine  years  ago.     It  was  now,  as  then,  of 
the  size  of  a  cross  section  of  an  ordinary  lead  pencil. 
He  said  that  this  case  was  most  encouraging  so  far  as 
the  operation  of   tracheotomy  was  concerned.     The 


patient  had  been  able  to  change  the  tracheotomy  tube 
daily,  and  had  enjoyed  a  period  of  comparative  com- 
fort for  some  nine  years.  It  was,  he  thought,  astonish- 
ing that  the  granulations  round  the  tube  should  not 
have  given  trouble  before  this.  After  placing  the 
patient  in  a  semi-recumbent  position,  with  the  aid  of 
a  good  light  he  introduced  a  20  per  cent,  solution  of 
cocaine  and  adrenalin  into  the  tracheal  wound ;  with 
the  aid  of  a  pair  of  tracheal  dilators  he  demonstrated 
to  those  around  a  fringe  of  polypoid  granulations  in- 
vading the  tracheal  canal ;  externally  a  similar  mass 
of  granulations  on  a  level  with  the  skin  was  equally 
apparent.  He  next  introduced  a  curved  Jarvis*  snare, 
and  removed  the  granulations  one  by  one  in  each  direc» 
tion.  The  external  granulations  were  removed  with 
a  pair  of  scissors  and  forceps,  and  a  large-sized  silver 
tracheotomy  tube  introduced,  and  the  patient  re- 
turned to  bed.  Mr.  Collier  remarked  that  in  these 
cases  of  syphilitic  stenosis  of  the  larynx  the  patient 
in  the  course  of  time  did  not  improve,  for,  as  a  rule, 
the  stenosed  orifice  became  more  occluded  and  there 
was  a  great  tendency  to  cicatricial  contraction  of  any 
opening  made  into  the  trachea  or  elsewhere.  He  in- 
tended to  retain  this  patient  in  the  hospital  till  she  was 
able  to  wear  a  silver  tracheotomy  tube  of  the  largest 
size  before^discharging  her ;  after  which  it  was  possible 
she  might  go  another  nine  years  without  further  surr 
gical  assistance. 

Polypus  of  the  Rectum.  —  The  same  surgeon  ope- 
rated on  a  girl.  aet.  14,  who  had  suffered  for  the  last 
four  or  five  years  from  rectal  irritation  associated  with  a 
discharge  of  bloody  mucus.  The  history  of  the  case 
was  that  the  child  had  complained  of  some  irritation 
about  the  rectum  and  bladder  for  several  years,  there 
had  been  frequency  of  micturition,  with  pain  and 
tenesmus  after  stools  for  a  considerable  period.  Exa- 
mination showed  a  polypus  about  the  size  of  a  filbert 
nut  attached  to  a  long  pedicle,  which  was  hanging 
froi^  the  right  wall  of  the  rectum.  Mr.  Collier  pointed 
out  that  in  this  case  the  sphincter  ani  was  apparently 
quite  inert,  the  finger  could  be  introduced  with  the 
greatest  ease,  and  the  polypus  withdrawn.  He  with- 
drew the  poljrpus  with  a  pair  of  catch  forceps,  applied 
a  ligature  at  the  base  of  the  pedicle  and  removed  it 
with  scissors.  He  remarked  that  this  was  an  unusually 
typical  and  simple  case,  and  required  no  after-treat- 
ment or  dressing.  He  said  the  condition  of  the 
sphincter  ani  was  apparently  due  to  the  presence  of 
the  polypus  within  its  lumen. 

A  New  Seholarthlp  tat  Pharmaey  Students. 
Messrs.  Fairchild  Bros,  and  Foster,  of  NewYork, 
in  order  to  mark  their  "  appreciation  of  the  friendly 
relations  which  have  existed  for  many  years  between 
the  firm  and  the  pharmacists  of  this  country,"  have 
inaugurated  a  scholarship  of  the  annual  value  of  £$0, 
with  consolation  prizes  of  £$  each,  to  be  awarded  to 
the  proxime  accessit  in  each  country — England,  Ireland, 
Scotland  and  Wales — the  examination  centres  being 
London,  Manchester,  Dublin,  Edinburgh,  and  Cardiff. 
The  first  examinations  will  be  held  simultaneously  in 
July  next  year.  Candidates  must  be  between  twenty 
and  twenty-two  years  of  age,  and  duly  registered  and 
affiliated  to  either  the  Pharmaceutical  Society  of 
Great  Britain  or  the  Pharmaceutical  Society  of  Ireland. 
The  subjects  of  the  examination  are  simply  those  with 
which  the  student  would  be  expected  to  have  ample 
acquaintance  in  any  reasonably  equipped  pharmacy. 
Further  particulars  may  be  obtained  by  application 
to  the  secretary  of  the  Committee  of  Trustees,  A.  E. 
Holden,  Bath  House,  59  Holbom  Viaduct,  London, 
E.C. 


524    Th»  Mkdical  Press. 


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SALUS  POPULI  SUPKEMA  LEX/' 


WEDNESDAY.  NOVEMBER  i6,  1904. 


THE  ABUSE  OF  HOSPITALS. 
The  complaint  against  hospital  abuse  is  as  old 
as  the  hills,  and  the  demand  for  its  reform  dates 
from  a  period  prior  to  the  birth  of  medical  jour- 
nalism. In  spite  of  the  lapse  of  years,  however, 
no  great  practical  step  has  hitherto  been  taken 
towards  putting  a  stop  to  the  evil  in  question. 
The  crux  of  the  whole  matter' lies  in  the  fact  that, 
the  medical  charities  are  controlled  by  philan- 
thropists  who  are  not  in  touch  with  the  main  body 
of  the  medical  profession,  while  the  honorary 
medical  staffs  of  those  institutions  apparently 
know  little,  and  care  less,  about  the  practice  which 
their  gratuitous  service  abstracts  from  outside 
practitioners.  If  the  hospital  surgeons  and  phy- 
sicians generally  took  up  a  firm  and  sympathetic 
position  upon  the  whole  subject,  we  believe  that 
within  a  week  the  question  of  hospital  abuse  could 
be  reduced  to  a  satisfactory  basis  of  settlement 
throughout  the  United  Kingdom.  That  pro- 
position we  commend  to  the  notice  of  Mr.  F.  Harris 
White,  the  energetic  secretary  of  the  East  London 
Medical  Society.  As  most  of  our  readers  will 
doubtless  remember,  while  others  have  been  con- 
tent to  sit  still  and  grumble,  the  Society  in  ques- 
tion has  brought  matters  to  a  head  by  a  polite 
but  insistent  criticism  of  the  way  things  are  con- 
ducted at  the  London  Hospital.  That  particular 
charity  is  no  better  and  no  worse  than  other  in- 
stitutions of  the  kind,  but  it  provides  for  an  enor- 
mous population,  and  happens  to  fall  within  the 
field  of  operation  of  the  Society  of  which  Mr. 
Harris  White  is  secretary.  Last  May  a  deputation 
of  that  body  waited  on  the  Board  of  Management 
of  the  Ix)ndon  Hospital  to  ask  for  reform  of  certain 
abuses  in  the  administration  of  relief.  The  first 
great  step  gained  was  an  admission  of  the  existence 
of  the  abuses  complained  of,  although  they  had 
previously  been  repeatedly  denied  in  the  public 
press     by    prominent    members    of    the    I^ndon 


Hospital  Committee.     The  Medical  Society's  com- 
plaint fell  under  the  two  heads  of  the  system  of  part 
payment  by  patients  and  of  want  of  scrutiny  as  to 
means  of    applicants    for    relief.      The     hospital 
authorities  admitted  the  existence  of  abuses,  as 
already  stated,  and,  further,  that  in  the  casualty 
room  scrutiny  was  non-existent.     The  precantioas 
now    adopted    seem  good,   so  far  as  they  go,  hot, 
while  not  abandoning  the  part  paynaent  system, 
they  put  up  notices  stating  that  patients'  pay- 
ments are  for  dressings  and  other  value  received, 
and  not  for  medical  advice.     Other  steps  induds 
the  obviously  essential  one  of  registering  the  ad- 
dress of  patients,  which  the  authorities  place  ai 
the  disposal  of  local  practitioners  who  may  wisfc 
to  inspect  them.     It  seems  clear,  however,  tha: 
no  hospital  should  be  permitted  to  shirk  its  re- 
sponsibilities by  thus  foisting  a  system   of  e^ion- 
age  upon  the  members  of  an  honourable  profession. 
It  is  the  hospital  that  sins  in  giving  charital^ 
aid  to  the  well-to-do  and  not  the  outside  general 
practitioner.     A  similar  objection  applies  to  the 
offensive  and  grotesque  suggestion  of  the  hospitil 
that  outside  medical  men  should  \dsit  the  out- 
patient departments  in  order  to  detect  unsuitable 
patients.     This    proposal    is    in    itself    sufficient 
amply  to  illustrate  and  to  emphasise  the  con- 
temptuous   attitude    of    hospital    philanthropists 
in  countering  the  home-thrusts  of  an  injured  pro- 
fession.    Fortunately,  the   East   London  Medicad 
Society  is  able  to  press  a  skilful  as  well  as  a  strong 
attack  where  generations  of  unorganised  protest 
have  failed  to  make  the  faintest  impression.     The 
hospital  next  proposes  to  send  patients  who  can 
pay   small   fees   to   the    Metropolitan    Pro\'ident 
Dispensary  over  the  road.     This  comical  evasion 
of  a  just  demand  certainly  does  not  add  to  the 
respect  to  which  the  London  Hospital  manage- 
ment should  be  entitled,  and  we  trust  they  ^nll 
abandon  this  unworthy  suggestion.     They  propose 
to  call  in  the  aid  of  the  Jewish  Guardians  and  d 
the  Charity  Organisation  Society  to  exclude  nn- 
sm table   patients.     The  latter   body   is   certainly 
hkely  to  drive  away  patients,  but  we  were  under 
the  impression  their  help  had  been  secured  yeaxs 
ago  by  the  London  Hospital.     The  most  reassuring 
proposal  by  the  committee  is  that  the  home  of 
every   patient   should   be    visited    the    day  after 
admission,  and  if  found  to  be  unsuitable  he  or  she 
is  to  be  discharged   and    a   donation    demanded 
on  behalf  of  the  hospital.     This  sounds  well  if  it 
could  be  made  practicable  in  so  large  an  institu- 
tion.    The  upshot  of  these  negotiations  Mill,  we 
trust,  be  an  amicable  working  agreement  between 
the  London  Hospital  and  the  medical  profession  of 
East    London.     Should    that    happy    result  not 
follow,   it   is   possible   for  .the    members  of  the 
Medical  Society  in  question  to  bring  pressure  of 
a  most  convincing  and  effectual  nature  on  the 
consulting  surgeons  and  physicians  of  the  honorary 
staff  of  the  hospital,  as  we  have  already  pointed 
out,  in  whose  hands  the  key  of  the  situation  most 
undoubtedly  lies.     The  honorary  staff  is  to  a  great 
extent  dependent  on  the  goodwill  and  friendship 


Nov.  i6,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    525 


of  the  outside  general  practitioner,  and  the  work 
of  the  hospital  depends  on  the  gratuitous  services 
of  the  medical  and  surgical  staff. 


MUSIC  AND  MEDICINE. 
The  field  of  therapeutics  is  rapidly  widening,  and 
the  resources  of  every  art  are  being  continually 
tapped  to  add  to  the  weapons  of  the  physician. 
"  Sweetness  and  light"  have  to  a  great  extent 
supplanted  nastiness  and  draughts  in  the  treat- 
ment of  disease,  and  the  patient  of  to-day  may 
console  himself  amidst  the  trials  of  modem  life 
"with  the  reflection  that  his  lot  in  the  hour  of  sick- 
ness was  not  cast  in  the  "  good  old  times."  To 
bring  music  into  requisition  as  a  means  of  dealing 
with  the  sick  has  long  been  hankered  after  by  one 
person  and  another,  but  beyond  the  now  orthodox 
asylum  band,*  little  progress  has  been  made  in  the 
application  of  sweet  sounds  to  disturbed  bodies 
and  brains.  The  subject  is,  however,  being  taken 
seriously  in  hand  by  a  certain  body  named  the 
St.  Cecilia  Guild,  who  have  mapped  out  an  am- 
bitious programme  for  themselves.  They  propose 
first  to  study  by  investigation  the  extent  of  the 
influence  of  music  on  the  heart,  blood  pressures 
and  respiration  ;  at  least,  that  is  the  initial  item 
mapped  out  in  their  prospectus.  We  do  not  wish 
to  damp  their  enthusiasm,  and  we  shall  be  very 
glad  if  they  are  able  to  add  anything  useful  to 
medical  knowledge  as  the  result  of  these  in- 
vestigations, but  we  rather  fear  that  the  line  of 
research  that  they  are  proposing  to  follow  will 
prove  a  somewhat  barren  one.  True,  Dogiel 
has  announced  in  his  work,  "  Experiments  on 
Men  and  Animals,"  that  music  is  capable  of 
raising  or  depressing  the  blood  pressure  under  vary- 
ing circumstances — such  as  the  disposition  and  sus- 
ceptibility of  the  subject,  and  the  nature  of  the 
music  performed — and  he  has  found  also  that  the 
pulse-  and  respiration-rates  were  affected  under 
the  same  conditions — a  result  attributed  to  the  in- 
fluence of  stimulations  of  the  auditory  nerve  acting 
reflexly  on  the  vaso-motor  nerves  through  the 
sympathetic  system.  Without  gainsaying  the 
accuracy  of  these  statements,  it  has  yet  to  be 
shown  that  the  influence  of  music  is  sufficiently 
potent  and  durable  to  produce  effects  on  sick 
p)eople  that  are  of  practical  utility.  Music  can 
undoubtedly  make  a  strong  appeal  to  the  emotions 
of  sympathetically-attuned  persons,  but  its  in- 
fluence soon  passes  off,  and  is  not  in  bulk  much 
greater  than  that  exerted  by  the  reading  of  an 
exciting  or  soothing  story-book.  The  St.  Cecilia 
Guild,  however,  seem  to  have  made  up  their 
minds  on  the  therapeutical  utility  of  music,  for 
their  second  object  is  to  organise  a  body  of  special 
musicians,  vocal  and  instrumental,  who  will  be 
available  at  .any  time  of  the  day  or  night  to  attend 
on  patients  at  the  doctor's  order,  and  perform 
music  of  the  character  he  prescribes.  No  doubt 
can  exist  as  to  the  enthusiasm  of  a  player  who  is 
ready  at  a  moment's  notice  to  turn  out  of  bed  to 
perform  Beethoven's  Moonlight  Sonata  or  to  re- 
count the  vagaries  of  Bill  Bailey  according  to  the 


whim  of  the  invalid  or  the  fancy  of  the  doctor, 
but  we  are  inclined  to  think  that  in  the  present 
state  of  medical  opinion  the  slumbers  of  the  mem- 
bers of  the  Guild  and  that  of  the  patients'  neigh- 
bours are  not  likely  to  be  seriously  encroached 
upon — ^in  this  country  at  least.  In  order,  how- 
ever, to  ob\'iate  any  remonstrances  from  disturbed 
and  unappreciative  persons,  an  alternative  course 
has  been  devised,  namely,  to  establish  some 
central  building  for  the  continuous  performance 
of  music  which  can  be  enjoyed  by  telephone  or 
electrophone  by  the  sufferer  in  his  bedroom.  This 
plan  is  certainly  open  to  less  objection,  butlh^e 
is  something  rather  pathetic  in  the  idea  of  these 
willing  ministers  to  the  sick  discoursing  music, 
with  an  infinity  of  expression  and  care,  without 
knowing  whether  or  not  they  are  being  listened  to, 
or  if  their  performance  is  one  that  is  suited  to  the 
patient's  particular  case.  For,  if  music  is  to  be 
beneficial  in  its  effects,  the  first  consideration  is 
that  it  should  be  appropriate  to  the  state  it  is 
desired  to  induce.  "  BiU  Bailey  "  might  act  as  a 
charming  lullaby  to  a  Cockney  child,  but  there 
are  others  who  would  find  it  positively  irritating. 
If  that  were  the  item  selected  for  continuous  per- 
formance through  the  telephone  on  any  particular 
night,  some  sufferers,  at  least,  would  find  sleep 
f luther  off  than  ever  after  listening  to  its  haunting 
melody.  Dr.  Kennedy,  of  Brookl)ai,  believes 
that  the  field  of  action  of  music  reaches  into  aU 
departments  of  medicine,  including  siurgery  and 
dentistry,  and  would  have  the  occupant  of  the 
dental  chair  soothed  and  sustained  by  the  quieting 
influence  of  music.  In  a  paper  read  before  the 
Medical  Society  of  King's  (N.  Y.),  he  warmly  advo- 
cated the  extended  use  of  music  in  the  treatment 
of  the  sick,  and  gave  demonstrations  of  the  methods 
of  administration  and  of  the  effect  music  of  a 
certain  character  might  be  expected  to  produce. 
Perhaps  the  most  practical  suggestion  that  has 
been  put  forward  as  yet  is  that  music  should  be 
used  as  an  adjunct  to  anaesthetics,  calming  and 
diverting  the  patient's  mind  till  consciousness  is 
lost.  It  is  said  that  a  number  of  test  cases  have 
been  treated  by  this  method  in  Germany,  and  that 
there  was  absence  of  distress  and  resistance  on  the 
part  of  the  patient,  and  also  absence  or  reduction 
of  nausea  and  sickness  following  the  operation. 
This  is  good  news,  of  course,  but  most  medical  men 
will  hope  that  the  fact  may  not  become  too  widely 
known.  .  The  paraphernalia  of  the  anaesthetist 
are  sufficiently  cumbersome  already  without  his 
having  to  add  a  gramophone  or  musical-box  to 
his  equipment.  The  real  fact  would  seem  to  be 
that  the  use  of  music  as  a  therapeutic  agent  is 
but  a  small  one,  and  though  it  may  have  some  use 
as  an  ancillary,  it  is  not  likely  to  have  much  as 
principal  agent  in  the  treatment  of  patients. 


notes  on  Current  Tropics* 

Psittaoosis. 
Domestic  animals  are  not  always  unadulterated 
blessings,  and  unless  well  watched  and  cared  for 


526    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


Nov.  1 6.  1904. 


may  become  sources  of  infection  to  the  house- 
hold   in    which    they   live.      Cats    may    convey 
diphtheria  ;  dogs  give  rise  to  worms,  whilst  birds 
have    been    suspected    of  tuberculous    leanings. 
Vickery  (a)  quotes  several  outbreaks  in  house- 
holds of  a  condition  remarkably  like  typhoid  in 
which    the    infection    probably    originated    from 
parrots.     The  disease,  as  a  rule,  sets  in  sharply 
with  febrile  symptoms,  but  the   onset   may  be 
insidious.     The  fever  is  continuous  and  ends  by 
lysis  ;    constipation  is  usual,  but  there  may  be 
diarrhoea;   enlarged   spleen   is   invariable  and    a 
roseolar   eruption   may   be   associated   with  it ; 
whilst  foci  of  pneumonia  commonly  are  found  in 
the  lungs.     Vickery  himself  has  met  with  a  group 
of  three  cases  of  such  an  illness,  which  followed  the 
arrival  of  a  parrot  in  the  house.     The  bird  suffered 
from  a  bloody  diarrhoea,  and  died,  passing  the  time 
of  its  illness  in  one  of  the  sitting  rooms.     There 
were  four  members  in  the  household,  and  of  these 
the  only  one  not  affected  had  little  to  do  with  the 
bird.     The    first    patient   was   the    servant   who 
looked  after  it,  and  she  sickened  eighteen  days  after 
the  parrot's  arrival ;  the  other  two  victims  followed 
in  a  few  days.     From  the  descriptions  given  of 
psittacosis,  Vickery  is  of  opinion  that  his  cases 
should    be    placed    under    that    heading.     The 
bacteriological  examination  results  were  indefinite, 
but  none  of  the  ordinary  recognisable  organisms 
were  found.     As  the  bacteriology   of    psittacosis 
is  doubtful,  the  findings  were  so  far  in  its  favour. 
It  is  always  well  to  inquire  after  the  health  of 
domestic  pets  when  any  member  of  a  household  is 
taken  ill  from  obscure  causes,  and  even  the  parrot 
in  his  cage  should  not  escape  the  general  suspicion. 

Clever  Malincrerinfir* 
The  man  Cecil  Brown  Smith,  sentenced  to 
three  months'  penal  servitude  last  week  at  the 
Guildhall  for  collecting  alms  under  false  pretences, 
is  quite  a  notaUe  figure  in  the  annals  of  crime. 
His  career  of  late  years  presented  one  of  those 
extraordinary  patchworks  that  we  are  accustomed 
to  associate  with  a  certain  class  of  criminal — 
obtaining  money  under  false  pretences  in  the  day, 
leading  a  respectable  domestic  life  at  home  in  the 
evening,  and  varying  these  proceedings  with 
playing  billiards,  visiting  places  of  entertainment, 
and  preaching  at  Salvation  Army  meetings. 
But  the  real  interest  of  the  case  from  the  medi- 
cal point  of  view  was  his  imitation  of  paralysis. 
Some  time  ago  Smith  had  an  accident  and  declares 
that,  as  the  result  of  this,he  suffered  from  paralysis 
of  the  right  side.  That  he  did  so  is  not  very  clear, 
but  he  was  certainly  an  inmate  of  St.  Thomas's 
and  afterwards  of  the  National  Hospital  ior 
Paralysis.  Whatever  was  wrong  with  him  at  the 
time  he  recovered  sufficiently  to  enjoy  himself 
after  his  manner  soon  after  coming  out,  and  whilst 
in  hospital  he  had  learned  a  profitable  way  of 
earning  a  living.  This  was  by  feigning  rig;ht 
hemiplegia — as  he  had  seen  it  in  the  wards,  and 
posing  as  a  paralysed  beggar  in  the  Citv.     His 


imitation  is  said  by  those  who  saw  him  to  have 
been  wonderful,  the  side  of  the  face  being  dravn 
down,  the  right  arm  and  hand  stiff  and  rigid,  and 
the  right  lower  limb  dragged  wearily  along.  So 
good  was  his  impersonation  of  the  part  that  he  was 
freely  made  the  recipient  of  alms  by  generous 
passers-by,  and  he  earned  upwards  of  six  pounds  a 
week  by  the  deception.  Even  when  examined  by 
the  surgeon  at  the  police-station  he  was  not  non- 
plussed, as  he  had  noticed  in  hospital  the  tests 
applied  to  patients  for  purposes  of  diagnosis,  and 
how  to  counterfeit  the  responses  of  those  who  were 
really  diseased.  It  was  only  when  he  found  the 
game  was  up  by  the  appearance  of  .witnesses  who 
had  seen  him  in  full  possession  of  his  powers  that 
he  shook  off  his  paralysis  and  appeared  in  the  dock 
in  his  natural  active  condition.  His  case  was 
certainly  one  of  the  most  successful  and — if  we 
may  say  so — artistic  in  the  history  of   malingering. 


Munioipalities  and  Bacteriolocry. 

As  our  readers  are  aware,  many  of  the  more 
progressive  municipalities,  at  home  as  well 
as  abroad,  have  seen  fit  to  undertake  the  bacterio- 
scopic  examination  of  suspected  clinical  material, 
thereby  giving  aid  to  the  practitioner  in  his  laboars 
on  behalf  of  the  public  health.  Liverpool. 
Manchester,  and  many  other  cities  have  appointed 
bacteriologists  whose  duty  it  is  to  examine 
material  sent  to  them  by  any  medical  man  in  the 
town.  For  instance,  in  Manchester,  every  prac- 
titioner is  supplied  by  the  Medical  Officer  of  Health 
with  apparatus  for  the  transmission  of  sputum, 
diphtheritic  membrane,  blood  for  the  agglutinatioci 
test,  and  so  on,  and  he  is  encouraged  to  ask  the 
help  of  a  skilled  bacteriologist  retained  by  the 
city  in  such  questions  of  diagnosis.  The  question 
of  the  appointment  of  a  bacteriologist  to  the 
City  of  Dublin  has  been  under  discussion  now  for 
some  time,  the  Public  Health  Committee  having 
recommended  such  an  appointment.  Dublin  can 
certainly  not  afford  to  overlook  any  precaution 
which  might  improve  the  public  health,  as  it 
still  maintains  its  pre-eminence  as  almost  the  most 
unhealthy  city  in  Europe.  It  is,  moreover,  deci- 
mated by  tuberculosis,  and  the  early  diagnosis  of 
phthisis  would  undoubtedly  tend  toward  the 
public  good.  Nevertheless,  the  Dublin  Corpora- 
tion has  decided  to  postpone  the  question  for 
two  years.  This  decision  is  all  the  more  culpable 
as  the  expense  would  be  inconsiderable.  There 
are  several  laboratories  in  Dublin,  public  and 
private,  with  any  one  of  which  it  would  be  easy  to 
arrange  the  examination  of  clinical  material  at 
moderate  rates,  and  where  the  payment  could 
be  arranged,  either  at  a  fixed  sum  per  annum 
or  in  proportion  to  the  work  done. 


(a)  Med,  Ifew$,  October  S2ad,  i904. 


Beoent  Appointmente  at  the  Boyal 
University. 
The  Council  of  the  Royal  University  Graduates* 
Association,  an  association  which  appears  to  be 
almost  entirely  limited  to  Belfast  graduates,  haw 
adopted  a  strongly  worded  resolution  in  protest 
against  the  manner  in  which  the  recent  x-acancies 


Nov.  1 6,  1904. 


NOTES    ON    CURRENT    TOPICS.  Thb  Medical  Piess.    527 


on  the  Senate  of  the  University  have  been  filled. 
The  resohition  is  as  follows  : — 

'*  We,  the  Council  of  the  Royal  University 
Graduates'  Association,  desire  to  express  our  deep 
Sense  of  indignation  at  the  grave  injustice  inflicted 
upon  the  North  of  Ireland  by  the  Irish  Govern- 
ment in  their  recent  appointments  to  the  three 
Crown  vacancies  on  the  Senate  of  the  University. 
Notwithstanding  the  fact  that  the  Belfast  Medical 
School  contributes  more  than  half  of  all  the  can- 
didates in  the  Faculty  of  Medicine,  the  Irish 
Government  have  appointed  as  successor  to  the 
late  Dr.  \V.  A.  M'Keown,  Sir  W.  Thomson,  a 
I>ublin  surgeon,  who  does  not  represent  any 
school  connected  with  the  University,  and  whose 
appointment  leaves  the  Belfast  Medical  School 
without  a  single  life  representative  on  the  Senate 
or  on  the  Medical  Committee.  We  regard  the 
selection  of  Sir  W.  Thomson  as  a  studied  slight  to 
graduates  of  the  University,  in  view  of  the  fact 
that  during  the  time  he  represented  the  Convoca- 
tion on  the  Senate  his  policy  was  objectionable  to 
the  graduates,  and  recently  when  he  sought  re- 
election he  was  defeated  by  a  large  majorit^^  The 
Council  cannot  but  consider  that  the  action  of 
the  Government  is  a  retrograde  departure  from 
principles  on  which  the  University  was  estabhshed, 
and  a  deliberate  attempt  to  neutralise  the  very 
meagre  influence  originally  bestowed  upon  the 
Convocation  by  the  Crown.  The  Council,  there- 
fore, are  reluctantly  forced  to  the  conclusion  that 
the  Government,  by  their  depriving  the  large  and 
important  community  whose  views  the  late  Dr. 
M'Keown  so  ably  advocated  of  a  representative 
on  the  Senate,  are  deliberately  endeavouring  to 
promote  a  spirit  of  discontent  with  the  present 
University  system,  in  order  the  more  effectively 
to  crush  opposition  to  any  future  proposals  to  in- 
troduce the  denominational  element  into  Univer- 
sity education  in  this  country." 

If,  as  is  stated  here,  these  appointments  mean 
that  the  Belfast  Medical  School  is  left  without  a 
representative  on  the  Council,  we  have  no  hesita- 
tion in  expressing  our  opinion  that  the  School  has 
been  treated  unfairly. 


Physical  Culture. 
One  of  the  crazes  at  the  moment  is  for  physical 
culture,  and,  various  instructors  in  the  art  are 
kept  busy  teaching  weakly  youths  and  corpulent 
gentlemen  how  to  attain  the  proportions  of  Apollo 
and  the  bloom  of  health  by  a  few  simple  exercises. 
Far  be  it  from  us  to  deny  that  such  a  movement 
is  both  wholesome  and  health-giving,  and  far 
more  desirable  than  many  of  the  silly  fashions  that 
periodically  seize  people  with  more  money  than 
brains,  and  more  imagination  than  common  sense. 
The  appetite  for  physical  betterment  has  been 
carefully  whetted  by  various  devices,  and  physical 
culture  schools  are  now  among  the  most  paying 
investments  for  brawny  men  with  a  modicum  of 
brains.  But  as  inevitably  happens  with  all 
craftsmen  who  deal  with  the  human  body  and  who 
acquire  a  circle  of  clients,  the  temptation  to  leave 
the  latter  and  enter  into  a  wider  sphere  of  practice 
has  become  too  great,  and  these  professors  of 
ph3rsical  culture  have — ^some  at  least  of  them — 
yielded  to  it.  One  of  the  best-known  of  these 
teachers  has  lately  taken  large  ofl&ces — and  advertised 


that  he  can  treat  dyspepsia,  constipation,  insomnia, 
and  various  other  ailments  by  his  method,  and  that 
this  treatment  can  be  carried  on  by  correspondence, 
and  so  arranged  that  the  sufferer  can,  at  small 
cost  and  without  interference  with  his  ordinary 
avocations,  effect  the  cure  in  his  own  bedroom 
As  medical  men  in  the  past  have  been  disposed  to 
look  not  unfavourably  at  the  physical  culture 
movement,  and  some  have  even  sent  patients  for 
a  course  of  exercise  under  its  exponents,  it  behoves 
them  to  notice  to  what  use  their  patronage  has 
been  put,  and  what  its  effect  has  been.  In  future 
we  think  they  will  be  well  advised  to  inquire  into 
the  methods  adopted  by  any  teacher  they  recom- 
mend, and  to  give  a  wide  berth  to  those  who, 
besides  and  beyond  their  legitimate  business, 
advertise  to  treat  and  cure  diseases.  As  the 
world  wags  every  man  seems  to  think  himself 
endowed  by  Nature  with  the  gift  of  healing,  a 
delusion  which  the  law  assists  by  confining  its 
attention  to  legally  qualified  practitioners  of 
medicine,  while  a  horde  of  quacks  are  allowed  to 
prey  on  the  public  unhindered. 


The  Heart  in  Diphtheria. 

The  poison  of  nearly  all  the  acute  specific  fevers 
seems  to  focus  itself  with  special  intensity  upon  the 
vascular  system  and  upon  the  heart  in  particular. 
The  early  and  also  the  remote  effects  of  typhoid 
fever  upon  the  circulatory  system  are  of  great 
cUnical  importance,  and  scarcely  less  so  are  the 
various  morbid  conditions  of  the  heart  that  may 
be  met  with  in  the  course  of  true  diphtheria. 
How  many  times  has  not  a  suddenly  fatal  collapse 
occurred  during  apparent  convalescence  Irom  this 
disease  simply  owing  to  the  slightly  increased 
strain  thrown  upon  the  heart  in  the  act,  say,  of 
sitting  up  in  bed  !  •  Nor  has  cardiac  weakness  or 
actual  organic  disease  always  been  a  marked  feature 
in  such  cases.  Much  may  be  learnt  concerning  the 
cardiac  complications  of  diphtheria  from  a  valuable 
communication  by  Drs.  Franklin  White  and 
Howard  Smith,  (a)  of  Boston,  U.S.A.,  who  have 
made  a  study  of  946  cases  of  this  affection  with 
fecial  regard  to  its  effect  upon  the  heart.  These 
observers  have  found  that  irregularity  of  the  pulse 
occurred  in  60  per  cent,  of  all  the  cases,  this  being 
more  marked  in  young  patients.  Of  the  cardiac 
murmurs  which  were  present,  the  majority  deve- 
loped within  the  first  few  days  of  the  illness,  lasted 
several  weeks,  and  in  78  per  cent,  they  .were  present 
at  the  time  of  discharge.  Acute,  sudden  cardiac 
dilatation  was  not  common,  all  the  fatal  cases 
showing  a  gradual  heart  failure.  Slowness  of  the 
pulse  was  rare,  but  extreme  bradycardia  often 
heralded  a  fatal  issue.  The  most  important  sign 
of  organic  heart  disease  in  diphtheria  is  stated  to 
be  the  presence  of  the  galloping  rhythm,  and  fol- 
lowing this,  the  appearance  of  vomiting  is  to  be 
regarded  as  of  ominous  import.  This  latter 
symptom  would  seem  to  indicate  vagus  degenera- 
tion, and  in  a  few  cases  this  has  been  found  postr 
mortem  by  Councilman.       Frequent  examination 

(a)  BtMnn  Med,  and  Surj.  Journ.,  October  20th.  1904. 


528    The  Medical  Piess.  NOTES    ON    CURRENT    TOPICS. 


Nov.  i6,  1904. 


of  the  heart  is  necessary,  and  in  all  cases  more  or 
less  prolonged  rest  in  bed  is  advisable,  especially 
when  the  pulse  remains  persistently  rapid. 

The  Jubilee  of  Modem  Nursiiifir* 

The  hfe  of  the  present  generation  has  been  so 
completely  in  the  age  of  scientific  nursing  that  it 
is  only  the  older  among  us  who  remember  a  time 
when  the  trained  nurse  was  not.  Her  position  is 
now  so  well  estabhshed — second  only  to  that  of 
the  medical  adviser  himself — ^that  we  find  it  hard 
to  reaUse  that  it  is  only  fifty  years  to  a  few  days 
since  the  first  band  of  EngUsh  trained  nurses  was 
organised  by  Miss  Florence  Nightingale.  In 
1847  ^  request  was  pubhshed  for  nurses  to  volun- 
teer for  service  in  the  Haslar  Naval  Hospital, 
but  not  a  single  volunteer  appeared.  In  1854, 
when  the  Crimean  war  had  been  some  months  in 
progress,  it  was  borne  in  on  the  authorities  that 
the  sick  and  wounded  soldiers  were  not  receiving 
the  care  they  should,  and  Miss  Nightingale,  who 
had  some  years  before  undergone  a  year's  training 
at  Kaiserswerth,  was  invited  to  organise  a  nursing 
service.  She  arrived  with  her  band  of  thirty- 
seven  nurses  at  Scutari  on  November  5th,  1854, 
and  from  that  date  begins  modem  Enghsh  nursing. 
It  would  be  waste  of  paper  and  ink  to  draw  atten- 
tion in  detail  to  the  revolution  in  the  treatment  of 
the  sick  which  has  taken  place  since  then.  The 
system  inaugurated  by  Miss  Nightingale  has 
been  the  basis,  not  merely  of  every  system  of 
mihtary  nursing,  but  of  the  care  of  the  sick 
as  practised  to-day  in  every  civihsed  country. 
Of  Miss  Nightingale's  hfe-long  interest  in 
the  profession  she  created  |it  is  equally  un- 
necessary to  speak.  Her  donation  of  the  testi- 
monial presented  to  her  by  the  nation  in  1857  to 
the  foundation  of  a  training  school  for  nurses  in 
connection  with  St.Thomas's  Hospital  is  merely  one 
example  of  this  interest.  The  medical  profession 
is  glad  to  join  in  congratulations  to  one  to  whom 
suffering  humanity  owes  much. 


A  New  Dental  Joumcd. 
We  are  glad  to  notice  the  arrival  of  a  weekly 
paper,  the  Denial  Surgeon,  devoted  to  the  interests 
of  the  dental  profession  and  the  study  of  dental 
science.  It  is  sure  to  meet  a  distinct  want,  for, 
however  excellent  may  be  a  monthly  or  quarterly 
review,  it  contains  a  different  kind  of  material, 
and  calls  for  a  different  kind  of  reading  from  a 
weekly  newspaper.  The  standard  of  education  in 
the  dental  profession  is  being  steadily  raised  in 
recent  years,  and  the  practitioner  takes  a  wider 
interest  in  the  doings  of  his  fellows  than  formerly. 
A  weekly  paper  which,  in  addition  to  articles  of 
scientific  value,  gives  in  interesting  fashion  items 
of  passing  news,  should  appeal  to  a  wide  audience. 
It  is  of  importance,  too,  that  there  should  be  a  free 
medium  for  discussion  on  the  various  political 
questions  which  are  of  interest  to  our  dental 
brethren.  Even  more  than  ourselves,  they 
suffer  from  unqualified  competition,  and  the 
competition  of  companies,  while  there  are  various 


ethical  questions,  such  as  the  permissibility  of 
advertising,  which  have  yet  to  be  settled.  The 
first  number  of  our  contemporary  is  bright  and 
interesting,  and  we  have  pleasure  in  wishing  our 
youngest  contemporary  a  long  and  useful  career. 


The  Surgreon's  Post  in  French  Duels. 
The  recent  disgraceful  assault  on  General  Andre^ 
an  old  man,  in  the  French  Senate,  has  led  to  a  crop 
of  duels.  Needless  to  say,  these  encounters  were 
for  the  most  part  void  of  bloodshed,  although  by 
an  unforseen  accident  one  of  the  combatants  sus- 
tained a  cut  in  the  wrist.  It  is  to  be  hoped  that 
the  wounded  hero  will  treasure — for  the  rest  of  his 
life — ^the  lesson  gained  by  his  bloody  experience, 
so  that  in  succeeding  duels  he  may  treat  the  cold 
steel  of  his  adversary  with  distant  respect,  accord- 
ing to  the  fashion  of  his  cooler -headed  countrymen. 
An  even  more  terrible  experience  awaited  the  sur- 
geon in  attendance  at  one  of  these  duels.  The 
fight  was  to  be  settled  with  pistols,  and  he  stood 
midway  between  the  duellists  at  what  he  thought 
to  be  a  safe  distance.  At  the  first  discharge  both 
bullets  whistled  close  to  the  head  of  the  surgeon, 
who  thereupon  retired  several  yards  further  from 
the  zone  of  fire.  In  vain,  however,  was  his  strategy-, 
for  on  the  next  exchange  of  shots  one  cut  through 
the  brim  of  his  hat  and  the  other  grazed  his  knce. 
The  surgeon  then  beat  a  precipitate  retreat  from 
the  field  of  battle.  Clearly  the  safest  plan  for  him, 
if  he  ever  summons  up  enough  courage  to  attend 
another  duel,  is  to  insist  upon  both  duellists  aiming 
at  the  surgeon.  The  medical  profession  is  one  of 
peace,  and  it  would  be  a  pity  to  deprive  it  of  one 
of  the  few  opportunities  of  figuring  in  warlike 
events  by  neglect  of  a  few  commonsense  regula- 
tions that  could  readily  be  framed  by  anyone  con- 
versant with  the  French  duel. 


The  Aldershot  Poisoninfir  Outbreak- 

The  origin  of  the  wholesale  poisoning  which  took 
place  last  week  at  Aldershot  still  remains  a  myster>*. 
A  number  of  non-commissioned  officers  and  men — 
according  to  some  accounts  not  less  than  a 
hundred— of  the  Yorkshire  Light  Inf antr>',  were 
attacked  with  sudden  sickness  and  prostration,  but 
we  are  glad  to  learn  that  all  have  made  a  rapid 
recovery,  with  the  exception  of  a  corporal,  whose 
condition  was  at  one  time  critical.  The  nature 
of  the  illness  and  the  history  of  the  outbreak 
point  with  unmistakable  directness  to  the  source 
of  the  mischief  in  some  form  of  food-poisoning. 
Indeed,  a  circumstantial  account  has  already  been 
circulated  in  which  the  irritant  has  been  traced 
to  an  Irish  stew  which  the  men  had  for  dinner  on 
Thursday  last.  It  is  said  that  those  who  ate 
roast  meat,  the  alternative  dish,  escaped  the 
attack.  If  the  stew  is  proved  to  have  been  at 
fault,  it  still  remains  to  be  found  out  whether 
the  case  is  one  of  ptomaine  poisoning  from  bad 
meat,  or  one  of  contamination  from  metaUic 
or  unclean  cooking  vessels.  The  whole  matter  is 
to  be  sifted  to  the  bottom  by  a  Board  of  Officers 
summoned   by  the  Principal   Medical  Officer  to 


Nov.   1 6.  1Q04. 


PERSONAL. 


The  Medical  Press.    ^29 


nvestigate  the  affair.  The  rarity  of  occurrences 
of  the  kind  go  far  to  prove  the  absolutely  careful 
supervision  of  food  and  of  kitchens  that  must 
be  in  force  in  our  great  military  camp  at  Alder- 
shot. 


PERSONAL. 
The  list  of  Birthday  Honours  includes  the  names 
of  four  members  of  the  medical  prof e:sion,  upon  whom 
the  honour  of  Knighthood  has  been  conferred  by  His 
Majesty  the  King. 


Professor  William  J^pp  Sinclair,  one  of  the 
recipients,  the  well-known  Manchester  physician,  is 
fifty-eight  years  of  age.  He  is  M.A.  and  M.D.  of 
the  University  of  Aberdeen,  and  is  at  present  Professor 
of  Obstetrics  in  Manchester  University.  He  withdrew 
from  the  Liberal  Party  in  the  Home  Rule  split  in 
1886. 


Dr.  Charles  Haves  Marriott,  J. P.,  another  of 
the  new  Knights,  began  his  connection  with  Leicester 
forty-four  years  ago  by  becoming  house  surgeon  at 
the  local  Infirmary.  He  resigned  the  honorary 
surgeoncy  of  that  institution  in  1901. 


Sir  Shirley  Murphy,  as  he  now  becomes,  has 
long  been  prominent  in  public  health  work.  Educated 
at  Guy's  Hospital,  he  became  a  member  of  the  English 
Royal  College  of  Surgeons  in  1870.  He  has  been 
Lecturer  upon  Public  Health  at  St.  Mary's  Hospital 
School,  and  among  other  distinguished  posts  has  been 
President  of  the  Society  of  Medical  Officers  of  Health. 
His  most  important  post  has  been  that  which  he  now 
fills  with  distinction,  namely,  that  of  the  Medical 
Officership  of  Health  of  the  Administrative  County 
of   London. 

Major  Allen  Perry,  the  fourth  (Knight,  took  his 
various  medical  degrees  between  1884  and  189?.  He 
was  for  three  years  at  the  Royal  Westminster  Oph- 
thalmic Hospital,  and  was  then  junior  house  surgeon 
at  the  Poplar  Hospital  for  Accidents,  and  a  house 
physician  at  the  London  Hospital.  His  present  posi- 
tions are  those  of  Principal  Medical  Officer  and  In- 
spector General  of  Hospitals  of  the  Island  of  Ceylon. 

At  the  opening  meeting  of  the  Aberdeen  University 
Medical  Society,  at  Marischal  College,  on  November 
4th  last,  an  interesting  address  on  "  The  Medical 
Student  and  his  Profession  "  was  delivered  by  Mr. 
J.  Scott  Riddell,  senior  surgeon  of  the  Aberdeen 
Royal   Infirmary. 


Lecture  on  Glanders  at  King's  College,  5  p.m.,  No- 
vember 25  th  and  December  9th.  Members  of  the 
medical  profession  are  invited. 


Dr.  W.  Watson  Glenn y,  of  Omeath,  has  been 
appointed  to  the  magistracy  of  county  Louth,  and 
Dr.  John  McFadyean  to  a  magistracy  of  Govan. 

Mr.  Arthur  H.  Trevor  has  been  appointed  Secre- 
tary to  the  Commissioners  in  Lunacy  in  the  place  of 
Mr.  L.  L.  Shadwell,  who  has  been  appointed  a  Com- 
missioner in  Lunacy. 

Dr.  a.  D.  Clinch,  of  Clondalkin,  has  been  elected 
President  of  the  Irish  Rugby  Football  Union.  He  is 
an  old  International  player,  and  sometime  captain  of 
the  Dublin  Universitv  j'ootball  Team. 


Dr.  T.  Gregory  Foster,  B.A.,  Ph.D.,  principal 
of  University  College,  London,  has  been  elected  a 
representative  of  the  College  on  the  Senate,  in  the 
place  of  Dr.  G.  Carey  Foster,  resigned. 

Mr.  H.  T.  Butlin.  D.C.L.,  F.R.C.S.,  has  been 
elected  a  representative  of  the  Royal  College  of 
Surgeons  of  England  on  the  Senate  of  University 
College,  London,  in  the  place  of  Sir  Henry  Howse, 
resigned. 


Dr.  Basil  M.  Wilson  has  entered  the  Civil  Service 
of  Fiji  a^  a  Government  Medical  Officer. 


Mr.  Curtis  C.  A.  Jones  has  taken  up  duty  as  a 
Medical  Officer  of  Lagos.  He  acts  as  an  assistant  in 
the  general  and  medical  sanitary  work  of  Lagos  town. 

The  British  Chaplain  at  Berlin,  the  Rev.  J.  H. 
Fry,  recently  opened  a  private  hospital  which  has 
been  founded  on  behalf  of  English  and  American 
patients  desirous  of  receiving  more  individual  nursing 
than  that  obtainable  in  the  Berlin  hospitals. 

The  Committee  of  the  Bristol  Lunatic  Asylum  have 
appointed  as  the  new  superintendent  in  place  of  the 
late  Dr.  Benham,  Dr.  James  Vincent  Blachford, 
who  has  been  assistant  medical  officer  since  1896. 


Wk  understand  that  Dr.  W.  H.  Hamer  has  been 
selected  as  head  of  one  of  the  branches  of  the  London 
County  Council  public  health  department  at  a  salary 
of  .^850.  rising  to  £i,(yoo,  and  an  assistant  medical 
officer  will  be  appointed  in  place  of  Dr.  Young,  who 
has  resigned. 


Professor  Cash,  F.R.S..  on  the  3rd  instant, 
delivered  his  presidential  address  to  the  Aberdeen 
Medico-Chirurgical  Society  on  the  subject  of  dosage. 


Dr.  E.  H.  Taylor  has  been  appointed  assistant  to 
Professor  E.  H.  H.  Bennett,  who  now  fills  the  Chair  of 
Surgery  in  the  School  of  Physic,  Trinity  College, 
Dublin.  

A  CIRCULAR  letter,  signed  by  a  large  number  of 
influential  medical  men.  has  been  issued  in  support 
of  the  candidature  of  Sir  Henry  Craik  for  the  Parlia- 
mentary representation  of  the  Universities  of  Glasgow 
and  Aberdeen.  

Dr.  James  Brisbane  will  preside  at  the  annual 
dinner  of  the  Glasgow  University  Club  in  London,  on 
the  23rd  instant.  Further  particulars  can  be  obtained 
of  the  Honorary  Secretaries,  63  Harley  Street,  W. 

The  distinguished  recognition  of  a  royal  medal  has 
been  conferral  by  the  Council  of  the  Royal  Society 
upon  Colonel  David  Bruce,  R.A.M.C,  F.R.S.,  for 
his  researches  and  discoveries  in  the  causation  of 
various  tropical  diseases. 

Professor  John  McFadyean,  M.B.,  B.Sc,  Principal 
of  the  Royal  Veterinary  College,  will  deliver  the  Harben 


The  King  has  been  pleased,  on  the  recommendation 
of  the  Secretary  for  Scotland,  to  appoint  Dr.  W. 
Leslie  Mackenzie  to  be  the  medical  member  of  the 
Local  Government  Board  for  Scotland,  in  room  of 
Dr.  Russell,  deceased. 


The  funeral  of  Dr.  Vintras,  principal  physician  of 
the  French  Hospital  in  London,  will  take  place  at 
the  Church  of  Notre  Dame  de  France.  The  French 
Ambassador  will  be  present. 


Mrs.  Nosworthy,  of  Newlands,  Dawlish,  has  offered 
to  defray  the  whole  cost  (estimated  at  ten  thousand 
pounds)  of  the  erection  of  a  new  operating  theatre 
at  the  Royal  Devon  and  Exeter  Hospital  at  Exeter. 

Dr.  R.  H.  Flemming  has  been  appointed  to  the 
post  of  Gynaecologist  to  the  Royal  City  of  Dublin 
Hospital,  in  succession  to  the  late  Dr.  J.   L.  Lane. 


The  Matep  Mlserlcordlss  Hospital,  Dublin. 
The  medical  session  at  this  hospital  was  formally 
opened  on  the  8th  inst.,  when  an  interesting  address 
was  delivered  by  Sir  Christopher  Nixon,  M.D.,  on 
"  The  Various  Phases  of  a  Hospital's  Work."  The 
address  will  be  found  in  another  colunm. 


53Q     Thb  Medical  Press. 


CORRESPONDENCE. 


Nov.  16.  1Q04. 


Spectal  correaponDence* 

[from  our  own  correspondents.] 


SCOTLAND, 

Parliamentary  Representation  of  the  Univer- 
sities OF  Glasgow  and  Aberdeen. — The  Glasgow 
University  Conservative  and  Liberal  Unionist  Associa- 
tion and  the  Aberdeen  Unionist  Association  have 
issued  a  circular,  dated  November  8  th,  in  reply  to  that 
recently  referred  to  in  this  column,  sent  out  by  the 
Universities  of  Glasgow  and  Aberdeen  Conservative 
and  Liberal  Unionist  Association  in  support  of  the 
candidature  of  Professor  W.  R.  Smith,  M.D.,  who  is 
opposing  Sir  Henry  Craik,  the  official  nominee  of  the 
party  associations.  The  new  circular  states  that  Sir 
Henry  Craik's  nomination  was  decided  on  after  careful 
consideration  of  both  committees,  on  which  the  medical 
profession  is  largely  represented.  Sir  Henry  Craik  was 
a  Snell  exhibitioner,  and  after  leaving  Glasgow  Univer- 
sity, went  to  Balliol  College,  gaining  high  honours  at 
Oxford.  In  1882,  he  was  made  LL.D.  of  Glasgow. 
His  life  has  been  devoted  to  educational  work,  first  in 
the  English  Education  Office,  and  subsequently  as 
secretary  to  the  Scottish  Education  Department,  from 
the  year  1885  (in  which  it  was  established)  until  the 
present  time,  His  "  recognised  position  as  a  man  of 
letters,  and  his  unique  experience  of  the  working  of 
educational  systems  both  of  Scotland  and  England, 
peculiarly  qualify  him  to  represent  a  University  con- 
stituency." Sir  Henry  Craik's  Committee  contains  the 
names  of  a  number  of  the  medical  profession,  among 
others  those  of  Sir  Wm.  Gairdner,  Sir  Hector  Cameron. 
Sir  Wm.  MacEwen,  Drs.  McCall  Anderson,  Mitchell 
Bruce,  Cossair  Ewart,  Freeland  Fergus,  David  W. 
Findlay,  Matthew  Hay,  Yule  Mackay,  T.  G.  McKen- 
drik,  and  Samson  Gemmel. 

Age  Limit  for  the  St.\ff  of  the  Edinburgh 
Royal  Infirmary.  — The  special  Committee  appointed 
to  deal  with  this  question  has  just  issued  a  long  report 
which  was  submitted  to  the  Court  of  Contributors 
on  the  14th  inst.  We  may  recapitulate  shortly,  from 
the  report,  the  circumstances  which  lei  to  the  appoint- 
ment of  the  Committee.  Towards  the  end  of  1903,  the 
managers  of  the  Infirmary  decided  that  the  ordinary 
physicians  and  surgeons  should  be  retired  at  the  age  of 
sixty-five,  the  rule  not  to  apply  to  those  serving  their 
second  or  third  term  of  five  years  in  charge  of  wards 
nor  to  Professors.  When  this  rule  came  before  the 
Court  of  Contributors  for  confirmation,  a  motion  was 
carried  putting  the  professors  on  the  same  footing  as 
the  ordinary  staff,  but  at  the  adjourned  meeting  this 
was  in  effect  overthrown  by  the  appointment  of  a 
committee  to  confer  with  a  committee  of  the  managers, 
and  to  report.  This  special  Committee  met  on  several 
occasions,  and  now  report  as  follows  : — The  clerk  of 
the  Royal  Infirmary  made  an  exhaustive  search  through 
the  minutes  of  the  Infirmary,  and  prepared  excerpts 
therefrom  as  to  the  relationship  of  the  University  and 
Royal  Colleges  to  the  Infirmary.  These  were  printed 
and  circulated  to  all  interested  parties,  and  it  may  be 
here  stated  that  they  indicate  clearly  that  the  pro- 
fessors hold  their  wards  at  the  pleasure  of  the  managers, 
and  not  under  any  right  or  agreement,  and  this  has  been 
admitted  by  the  senators  in  a  subsequent  communica- 
tion to  the  Committee,  but  hitherto  professors  have 
retained  the  charge  of  wards  without  question,  so  long 
as  they  continued  to  occupy  their  chairs.  In  reply 
to  requests  for  an  expression  of  their  views  on  the  sub- 
ject, the  Royal  College  of  Physicians,  the  Royal  College 
of  Surgeons,  and  the  Staff  of  the  Infirmary  favoured  an 
age  limit ;  the  University  was  against  it.  The  Com- 
mittee then  ascertained  the  rules  and  practice  regu- 
lating the  appointment  of  the  ordinary  staff,  the  numbo" 
of  wards  and  beds  under  the  care  of  each  member  of 
the  staff,  the  dates  of  appointment  as  assistants  oi 
the  members  of  the  ordinary  staff,  and  of  their  sub- 
sequent promotion  to  full  rank;  and  the  dates  of 
appointment  of  the  present  assistant  staff.  Having 
fully  considered  the  whole  question,  the  Committee 
think  that  a  compulsory  age  limit  is  inexpedient,  and 


recommend  ( i )  that  the  rule  fixing  an  age  limit  be  not 
adopted,  (2)  that  accordingly  the  resolution  requiring 
professors  to  retire  at  the  age  of  sixty-five  be  rescinded, 
and  (3)  that  in  future  each  Professor  and  physician  and 
surgeon  in  charge  of  wards  may,  on  the  expiry  of  his 
appointment,  apply  for  reappointment,  when  the 
managers  shall  give  careful  consideration  to  his  case, 
and  when,  if  the  managers  deem  it  expedient,  he  may 
be  reappointed  for  such  term  as  they  may  fix.  These 
recommendations  will,  the  Committee  think,  render  an 
age  limit  superfluous.  In  the  case  of  the  ordinal)' 
staff,  an  age  limit  of  sixty-five,  looking  to  past  expe- 
rience, would  practically  never  become  operative. 
Under  the  proposed  rule  the  managers  will  have  the 
special  control  of  the  duration  of  ofl&ce  of  members  of 
the  staff,  and  professors,  and  will  have  it  in  their  power 
to  renew  for  five  years,  or  less,  or  to  resolve  that  there 
shall  be  no  reappointment.  The  report,  of  which  the 
gist  is  given  in  the  preceding,  is  signed  by  eight  mem- 
bers of  the  Committee.  Two  members  dissent  froBi 
the  foregoing  conclusions  and  recommendations,  on  the 
ground  that  in  the  interests  of  the  patients  and  o( 
medical  and  surgical  science  an  age  limit  is  desirabk. 

It  is  to  be  presumed  that  the  whole  matter  is  now 
.settled,  though  it  awaits  final  confirmation  of  the  meet- 
ing of  the  contributors. 

BELFAST. 

The  Small-pox  Epidemic. — During  the  last  fort- 
night nine  more  cases  of  small-pox  have  been  dis- 
covered, and  removed  to  the  hospital  at  Purdyshum. 
Of  these  only  one  appears  to  be  severe,  the  patient 
being  a  man  of  forty  without  vaccination  marks  or 
history  of  vaccination.  Two  cases  have  died  duiing 
the  fortnight — one  an  unvaccinated  child,  and  the 
other  a  man  of  thirty-seven,  said  to  have  been  vacci- 
nated, but  on  whom  no  marks  could  be  found.  It 
is  rather  amusing  to  note  that  the  present  has  been 
chosen  as  an  appropriate  time  for  an  anti-vaccination 
campaign  in  Belfast.  A  series  of  meetings  has  been 
held  during  the  past  week,  at  which  an  imported 
lecturer  has  harangued  small  audiences,  generally 
under  the  chairmanship  of  a  member  of  the  Board  erf 
Guardians.  To  judge  from  appearances,  not  much 
harm  is  likely  to  be  done.  The  Belfast  public  has 
always  got  a  fair  amount  of  excitement  out  of  its 
religion  and  pohtics,  and  has  never  taken  kindly  to 
the  numerous  fads  which  flourish  so  luxuriantly  across 
the  Channel. 

The  Ulster  Medical  Society. — ^The  opening 
meeting  of  this  Society  was  held  in  the  Medical  In- 
s  itute,  Belfast,  on  Thursday  evening,  November  9th- 
Dr.  John  Campbell,  who  has  been  president  for  the 
past  two  years,  having  introduced  his  successor,  Dr. 
William  Calwell  and  vacated  the  chair,  received  a 
hearty  vote  of  thanks,  on  the  motion  of  Professor 
Symington,  seconded  by  Dr.  Hadden  (Portadown). 
Dr.  Calwell  delivered  an  address  on  **  Some  Aspects 
of  Metabolism,  chiefly  Clinical,"  which  will  appear 
in  a  subsequent  issue  of  this  journal.  At  the  conclu- 
sion of  the  address,  a  vote  of  thanks  was  moved  b>- 
Dr.  J.  Walton  Brown?,  and  seconded  by  Professor 
Lindsay. 

The  report  of  the  Council  stated  that  the  annual 
dinner  has  been  arranged  for  Saturday,  December  3r»l, 
when  Sir  Lauder  Brunton  will  unveil  the  bust  of  Sir 
WiUiam  Whitla,  which  has  been  executed  for  the 
memoers  of  the  Society  by  Miss  Kathleen  Shaw.  A 
number  of  guests  from  Dublin  and  from  acro^  the 
Channel  are  expected  to  be  present. 

Corre0ponDence* 

LOCAL  SUPERVISION  OF  CERTIFIED 
MIDWIVES. 
To  the  Editor  of  The  Medical  Press  and  Circular 
Sir, — The  .  success  of  the  Midwives  Act  of  1902 
greatly  depends  upon  the  efficiency  of  the  supervision 
of  the  local  supervising  authorities  appointed  by  the 
Councils  of  the  Counties  and  County  Boroughs  through- 
out England  and  Wales,  and  also  upon  local  efforts 
ior  assisting  the  midwives  to  acquire  the  knowledge 


Nov.  i6.  1904. 


LITERARY  NOTES  AND  GOSSIP. 


Th«  Medical  Press.    5.^1 


^*'hich  is  essential  for  the  correct  discharge  of  their 
new  duties. 

Up  to  the  present  time  the  midwives  throughout 
the  land  have  been  carrying  on  their  work  without 
any  restrictions^  and  it  is  a  fact  that  the  greater  part 
of  these  women  have  never  received  any  instruction 
or  training,  and  are  in  every  sense  incapable  and 
ignorant  of  their  responsibilities.  I  have  often  been 
told  by  my  medical  brethren  that  many  women  who 
liave  been  acting  as  midwives  for  years,  and  who 
have  recently  obtained-  certificates  under  Section  2 
of  the  Act.  do  not  understand  that  they  are  under 
strict  local  supervision  and  control,  and  that  in  every 
difficulty  and  in  every  deviation  from  the  normal 
they  are  bound  to  send  for  professional  assistance. 

Now  there  must  be  urgent  need,  if  these  statements 
axe  true,  for  the  development  of  a  scheme  to  assist 
the  existing  midwives  to  learn  their  new  duties,  and 
to  work  in  conformity  with  the  provisions  of  the  Mid- 
iwives  Act.  Without  help  it  is  impossible  for  them  to 
reach  a  standard  of  knowledge  equal  to  their  responsi- 
bilities. But  how  is  this  assistance  to  be  provided  ? 
Surely  it  is  a  question  which  demands  the  serious 
consideration  of  all  local  supervising  authorities,  and 
there  can  be  no  doubt  that  in  every  large  centre  is 
"will  be  easy  for  the  local  authorities  to  secure  means 
for  the  enlightenment  of  the  women  placed  under 
their  control.  Without  such  help,  it  will  not  be 
possi  le  to  speedily  clear  the  lying-in-room  of  the 
ignorance,  superstition,  and  sanitary  impurity  which 
have  been  the  cause  of  the  terrible  mortality  among 
the  poor  parturient  women  of  our  country.  The 
instruction  in  elementary  topics  would  prove  a  great 
boon  to  practising  midwives,  and  it  could  be  given  by 
lectures,  by  oral  examination,  and  by  exhibiting  the 
method  of  reporting  the  details  of  practice  and  of 
carrying  on  the  work  in  accordance  wUh  the  rules 
framed  by  the  Central  Midwives  Board.  I  believe 
that  in  every  area  medical  practitioners  will  be  found 
willing  to  assist  the  local  supervising  authorities  in 
this  important  object. 

I  have  read  with  much  pleasure  the  able  address 
of  Dr.  Ewen  Maclean,  which  he  deUvered  at  the 
University  College,  Cardiff,  on  the  Education  of  Mid- 
wives,  and  I  wish  a  copy  of  this  valuable  lecture 
could  be  sent  to  all  the  members  of  the  County  Councils 
throughout  the  country. 

I  am.  Sir,  yours  truly, 

J.  Ward  Cousins, 
Representative  of  the  R.C.S.  of  England 
on  the  Central  Midwives  Board. 

November  8th,  1904. 

INOPERABLE  CANCER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir,— I  beg  to  say  that  the  abdominal  case  noted  by 
Dr.  J.  A.  Shaw-Mackenzie,  in  his  paper,  "On  the 
Treatment  of  Inoperable  Cancer  by  Hypodermic 
Medication,"  in  The  Medical  Press  and  Circular, 
October  19th,  has  been  tinder  my  care,  and  I  can  so 
far  corroborate  the  results  obtained  with  the  hypo- 
dermic injections  of  Chian  turpentine  I  have  given. 
I  am.  Sir,  yours  truly, 

Frank  Box  all. 
Rudgwick. 

CHLOROFORM  ANAESTHESIA. 
To  the  Editor  of  the  Medical  Press  and  Circular. 
Sir. — In  an  editorial  article,  November  9th,  headed 
"  Chloroform  Anaesthesia,"  you  refer  by  name  to 
me,  and  after  mentioning  that  I  have  used  the  Vernon 
Harcourt  chloroform  inhaler  with  success  in  some 
hundred;  of  cases,  you  add  "as  far  as  we  know,  no 
details  of  them  (the  cases)  have  yet  been  made  known, 
and  it  was  more  than  hinted  in  the  Oxford  discussion 
that  there  were  others  in  which  he  had  not  been  so 
fortunate."  Allow  me  to  say  it  is  quite  untrue  that 
any  suggestive  hint  or  more  than  hint  was  made 
publicly  at  the  Oxford  discussion  in  reference  to  cases 
of  anaesthesia  under  chloroform  conducted  by  me; 
had  there  been  it  would  at  once  have  been  answered. 


All  my  cases  have  been  noted,  and  in  no  single  case 
has  death  or  any  dangerous  symptom  due  to  chloroform 
arisen.  Any  hint  or  "  more  than  hint "  suggesting 
such  death  or  dangerous  symptom  is  devoid  of  all 
truth. 

I  am.  Sir,  yours  truly,  ''  "%\ 

Dudley  W.   Buxton. 
London,  W.,  November   14th. 


Xiteraty  Ttotes  an&  Goeaip. 

Messrs.  Longbcans,  Green  and  Co.  wul  publish 
next  month  a  "  Text-book  of  Medical  Practice,"  by 
various  contributors,  edited  by  Dr.  William  Bain. 
Apart  from  the  practical  character  of  the  book,  the 
special  features  are  that  the  anatomy,  histology,  and 
physiology  of  each  organ  or  system  precede  the 
description  of  the  diseases,  and  that  the  various  sec- 
tions are  contributed  by  general  physicians  and 
specialists. 

««* 

Messrs.  Bailliere,  Tindall,  and  Cox  will  pub- 
lish  next  week,  in  their  popular  "  University  Series," 
the  ninth  edition  of  Dr.  Macnaugh ton- Jones'  "  Manual 
of  Diseases  of  Women."  This  book  has  met  with  a 
success  almost  phenomenal,  and  the  new  edition  is 
announced  to  contain  between  six  and  seven  hundred 
coloured  and  plain  plates  and  other  illustrations,  the 
text  being  revised  to  date,  and  all  the  latest  British, 
Continental  and  American  methods  in  gynaecology 
portraved. 

♦♦♦ 

An  important  addition  to  the  literature  of  Cities 
and  of  Civics  has  just  been  made  by  Messrs.  Geddes 
and  Co.,  of  Edmburgh  and  Westminster,  and  the 
St.  George's  Press,  Boumeville,  by  the  issue,  en  the 
loth  inst.,  cf  "  City  Development,  a  Study  of  Parks, 
Gardens,  and  Culture  Institutes  ;  a  Report  to  the 
Carnegie  Dunfermline  Trust,"  by  Professor  Patrick 
Geddes,  at  21s.net.  Professor  Geddes  has  approached 
his  task  of  designing  the  improvement  of  a  city  at  once 
with  local  survey  and  with  general  ideas,  and  thus  his 
book  will  be  found  to  appeal  to  citizen  and  city 
improver,  municipal  councUlor  and  official,  architect 
and  gardener,  educational  and  social  worker,  &c., 
to  antiquary  and  to  Nature-lover  also. 
*«« 

The  term  ''  fever  "  embraces  so  many  illnesses,  from 
mumps  to  typhus  and  yellow  fever,  that  a  book 
such  as  the  "  Manual  of  Fever  Nursing,"  shortly  to  be 
issued  by  Messrs.  Kegan  Paul,  of  Dryden  House,  should 
prove  useful.  It  is  written  by  Professor  Webb  Wilcox, 
and  deals  exhaustively  with  fevers,  their  causes  and 
symptoms,  and  their  treatment  in  accordance  with 
the  present  state  of  practice.  The  clinical  charts  and 
directions  for  nursing  suitable  for  different  cases  should 
make  this  a  valuable  handbook  for  nurses. 

"  Letters  on  Health  and  Happiness  "  is  the  title 
of  a  little  work  by  John  A.  Bevan,  M.D.,  Torquay. 
No  one  can  say  that  at  the  present  there  is  a  lack  of 
counsellors  in  regard  to  matters  relating  to  personal 
and  public  hygiene,  but  although  knowledge  comes, 
wisdom  lingers,  and  even  though  the  path  to  heaven 
be  paved  with  good  intentions,  happiness  is  by  no 
means  assured.  Dr.  Bevan,  in  these  well-intentioned 
letters,  tells  us  that  his  object  is  to  remove  suffering, 
to  restore  health  and  strength,  to  prevent  irremedi- 
able organic  disease,  and  to  prolong  the  blessing  of  a 
cheerful  mind  in  a  healthy  body  to  a  genial  longevity. 
There  is  much  information  unconventionally  expressed 
in  these  unpretentious  pages,  and  although  we  cannot 
endorse  much  of  the  patholog3^  we  cordially  admire 
the  spirit  which  has  prompted  the  pubUcation  of  these 
Mit^  lasters. 

41** 

Another  professional  journal  has  been  launched 
during  the  last  few  days  by  the  energy  of  its  publishers, 
Messrs.    Bailliere,    Tindall,    and     Cox,     entitled    the 


532     The  Medicai,  Prkss. 


MEDICAL  NEWS. 


Nov.  I6.  iqQ4, 


Denial  Surgeon.  Hitherto  the  dental  section  has 
been  catered  for  by  two  or  three  monthlies,  but,  like 
all  other  professions,  the  dental  has  strongly  expressed 
its  desire  for  a  more  frequent  medium  of  inter-com- 
munication, which  has  now  been  met.  We  have  the 
first  two  weekly  numbers  before  us,  edited  by  Mr. 
Robert  Manning,  who  will  be  assisted  by  a  consider- 
able number  of  dental  surgeons,  the  majority  of 
whom  are  attached  to  the  dental  schools  and  hospitals 
in  the  leading  centres  of  the  United  Kingdom.  These 
initial  numbers  are  distinctly  creditable,  both  to  the 
editorial  staff,  and  to  the  publishers,  and  if  future 
issues  can  be  maintained  at  such  a  high  standard,  no 
prophetic  acumen  is  needed  to  foretell  the  chances 
of  such  a  publication.  Our  new  contemporary  has 
our  best  wishes. 


(Pbituari?. 


ACHILLE  VINTRAS,  M.D.Scotland,  M.R.C.S._ 
England. 

The  news  of  the  death  of  the  senior  physician  of  the 
French  Hospital  and  Dispensary  will  be  received  with 
regret  by  a  large  circle  of  friends  and  acquaintances. 
After  a  long  and  busy  life,  Dr.  Vintras  died  on  the  9th 
inst.,  at  Brighton,  at  the  age  of  seventy-five.  His 
medical  education  was  conducted  at  St.  Mary's 
Hospital,  and  in  Paris.  In  1858  he  became  M.R.C.S. 
of  England,  and  the  year  after  he  took  the  degree  of 
Doctor  of  Medicine  of  St.  Andrews  University.  He 
was  an  Officer  of  the  French  Legion  of  Honour,  and 
Physician  to  the  French  Embassy  in  London,  as  well 
as  holdinjf  many  other  distinguished  posts.  His  death, 
which  took  place  in  the  French  convalescent  home  he 
directed  at  Brighton,  will  be  greatly  felt  by  the  French 
colony  in  London,  in  which  he  has  been  for  so  many 
years  a  prominent  figure.  Dr.  Vintras'  literary  con- 
tributions were  principally  confined  to  books  and 
papers  on  the  Mineral  Waters  and  Health  Resorts  of 
France,  his  other  essays  being  two  small  pamphlets 
on  "  The  Treatment  of  Diabetes "  and  *'  Animal 
Vaccination." 


Ac&tca(  Vlew0« 


DONALD  MLEOD,  M.D.Glasgow. 
We  regret  to  announce  the  death  of  Dr.  Donald 
M'Leod,  who  has  earned  the  title  of  father  of  the  medical 
profession  in  Kilmarnock.  He  died  at  his  residence 
on  the  9th  inst.,  aged  83.  He  had  practised  in  the 
town  for  fully  half  a  century,  but  retired  about  eighteen 
months  ago.  For  a  long  period  he  was  medical  officer 
to  the  Parochial  Board  and  Parish  Council.  He  was  a 
physician  of  exceptional  skill.  His  medical  education 
was  conducted  at  Glasgow  University,  where  he  took 
the  degree  of  M.D.  in  1850. 


DR.  C.  D.5F.  PHILLIPS. 
We  regret  to  record  the  death,  at  i  Hyde  Park 
Square,  London,  on  Sunday  last,  the  13th  inst.,  of 
Dr.  Charles  Douglas  Fergusson  Phillips,  late  of 
Henrietta  Street,  Cavendish  Square,  W.,  at  the  age  of 
74.  Dr.  Phillips  qualified  in  185?,  and  was  M.D. 
Aberdeen,  LL.D.Aberd..  LL.D.Edm.,  F.R.C.S. 
Ed.,  F.R.S.Ed.,  M.R.C.P.Lond..  and  Hon.  Fellow 
of  the  Medico-Chirurgical  College  of  Pennsylvania. 
He  was  at  one  time  Lecturer  on  Materia  Medica  and 
Therapeutics  at  the  Westminster  Hospital,  London, 
and  subsequently  Examiner  in  these  subjects  in  the 
Universities  of  Edinburgh,  Glasgow,  and  Aberdeen. 
He  was  the  author  of  a  well-known  work  on  Materia 
Medica,  the  third  edition  of  the  first  volume  of  which 
was  published  only  a  few  months  ago.  He  had 
retired  from  practice,  and  was  the  Chairman  of 
the  Universities  of  Glasgow  and  Aberdeen.  Liberal 
Unionists*  Association.  The  immediate  cause  of 
death  was  the  Stokes-Adams  syndrome,  and  he  was 
attended  in  his  last  illness  by  his  old  friend  and  col- 
league. Dr.  Murrell. 


Medical  Aid  to  i 
In  response  to  a  request  made  by  the  Missions  to 
Seamen,  Messrs.  Burroughs  Wellcome  have  givei 
that  Society  a  case  of  tabloid  medicines,  with  a  copy  oi 
their  "  Brief  Medical  Guide  for  Explorers,  3li*- 
sioners,  etc,"  to  be  used  only  in  circumstances  o«t- 
side  the  reach  of  medical  aid.  They  were  given  as 
outfit  for  the  Bristol  Channel  Mission  steamer  Eirem 
in  her  visits  to  lightships  and  other  vessels  in  the  oote- 
anchorages  for  use  by  the  Roadstead  Chaplain  of  the 
Missions  to  Seamen. 

Bntpance  SchotarsUps :  Westminster  Hospital  ledlfld 
School. 

The  examinations  for  the  entrance  scholarships  at 
th'.s  school  have  resulted  as  follows :  Epsom  Schobi 
ship  of  no  guineas,  Mr.  H.  F.  R.  Davison ;  Univers- 
ties  Scholarship  of  40  guineas,  Mr.  R.  W.  Ironside. 
Natural  Science  Scholarship  of  60  guineas,  Mr.  H.  1 
Hingston ;  Governors*  Scholarship  of  40  guinefta 
Mr.  W.  R.  Asplen ;  First  Scholarship  in  Arts  of  fo 
guineas,  Mr.  C.  G.  Richardson  ;  Second  Scholarslup  a 
Arts  of  30  guineas.  Mr.  H.  Evans ;  Science  Schobi- 
ship  of  40  guineas,  Mr.  A.  O.  MitchelL 

The  New  President  of  Queen'e  CoUese.  Cofric. 

The  more  than  enthusiastic  reception  which  the 
newly-elected  President  of  the  Queen's  Collie,  Cork 
received  on  his  arrival  at  his  new  sphere  of  duty  sfaoeki 
be  a  sufficient  answer  to  those  of  our  £ontempoirah& 
who  openly  stated  that  his  election  was  the  result  of 
a  political  job,  and  that  the  President  would  not  be 
favourably  received  in  Cork.  Professor  Windle  was 
met  on  his  arrival  at  the  railway  station  by  a  piocessaoB 
of  some  three  hundred  students,  who  loudly  cheered 
him.  Mr.  J.  Horgan,  a  leading  Cork  citizen,  intro- 
duced the  more  senior  of  the  students  to  the  Presideat 
and  presented  Mrs.  Windle  with  a  bouquet  of  flovm 
The  following  address  of  welcome  was  then  read:— 
Address  from  the  Students  of  the  Queen's  College 
Cork,  to  Bertram  C.  A.  Windle.  Esq.,  F.R.S-.  D.Sc. 
FS.A.     -    ?-r     ^ 

Dear  Sir. — We,  the  students  of  the  Queen's  Cdtefe 
Cork,  tender  to  you  a  thousand  welcomes  to  our  dtj. 
Your  appointment  to  the  high  and  honourable  positkic 
of  President  of  our  College  has  given  pleasure  eot 
only  to  us  whose  lives  are  spent  within  its  halls,  bet 
also  to  great  numbers  of  thinking  Iri^  people,  wlio 
are  glad  to  recognise  in  you  a  worthy  representative 
of  the  better  system  of  government  which  is  happily 
beginning  to  prevail  in  many  spheres  of  natkmal  mi 
We  recognise  that  you  are  a  fellow-countryman  \x§ 
every  claim  that  a  man  can  urge  to  be  called  sodt 
You  have  shown  a  deep  interest  in  the  language  and 
glories  of  the  ancient  Gael,  and  we  would  suggest  that 
here,  in  the  heart  of  the  great  province  of  Munster. 
you  wiU  find  scope  for  renewed  efforts  in  the  cause  oi 
intellectual  and  national  regeneration.  We  are  vdl 
aware  of  your  brilliant  literary  attainments,  and  k 
these  days,  when  too  many  people  abandon  them- 
selves to  the  pursuit  of  a  solitary  subject  and  lose, 
in  the  fastnesses  of  the  museum  or  the  dissecting 
chamber,  those  qualities  necessary  for  the  civilised 
intercourse  of  life,  we  rejoice  to  meet  with  one  who, 
as  you,  leaps  the  barriers  of  anatomy  and  wanders 
away  to  the  sunnier  regions  of  archaeological  and 
Shakespearian  research.  We  trust,  then,  that  under 
your  presidency  Queen's  College.  Cork,  may  continue. 
with  ever-increasing  vigour,  the  great  work  of  profes- 
sional education  which  it  has  so  long  carried  oat. 
and  we  again  wish  you  welcome  and  prosperous  dap 
in  this  "  Faire  Citie  "  of  the  South. — Sign^  on  behalf 
of "^ the  Students, 

Faculty  of  Medicine— W.  C.  T.  Robey,  M.  White.  J. 
C.  Hart,  T.  P.  Sheedy,  E.  Forl>es ; 

Faculty  of  Engineering — Arthur  Ridge.  Thomas  J. 
Waters ; 

Faculty  of  Arts — D.  L.  Kelleher.  David  Horgan. 

After  reaching  the  College  quadrangle,  the  Presidtiit 
made  a  short  speech  to  the  students,  in  the  course  ot 


Nov.   1 6.    1904. 


PASS  LISTS. 


which  he  testified  to  his  pleasure  at  having  returned 
to  his  native  country.  The  proceedings  then  termin- 
ated amidst  renewed  cheering. 

Catholic  Uaivepslty  Medical  School. 

Medical  and  Scientific  Society,  Session  1904-5. — The 
following  officers  have  been  elected  for  the  ensuing 
session  :  President,  Professor  Antony  Roche  ;  Hon. 
Sees,  and  Treasurer.  A.  N.  M'Loughlin,  O'Connell 
O'SuUivan,  J.  B.  Butler;  Committee.  Professor  D.  J. 
Coflfey,  Professor  E.  J.  M'Weeney.  Dr.  Dargan,  Dr. 
M'LoughUn,  Dr.  Blayney,  Dr.  O.  Faman.  F.  J.  Madden, 
R.  Slattery,  T.  T.  O'Farrell,  W.  R.  O'Farrell,  J.  Elwood, 
'VV.  P.  Dunne.  The  inaugural  meeting  will  take  place 
at  the  Medical  School,  Cecilia  Street,  on  Thursday. 
November  24th,  when  the  President  will  deliver  an 
address. 

Diphtheria  Outbreak  in  Ireland. 

An  epidemic  of  diphtheria  has  broken  out  in  the 
I>rumUsh  dispensary  district,  Co.  Longford,  and  twenty- 
four  deaths  from  the  disease  have  occurred. 

PASS  LISTS. 

Queea'i  College.  Galway. 

The  following  scholarships  and  exhibitions  have  been 
awarded  by  the  Council  :— 

Faculty  of  Medicine. — Senior  Scholarship  in  Anatomy 
and  Physiology  :  John  L.  Dunlop,  B.A.  Fourth  Year  : 
Scholarship,  James  J.  A.  Gannon  ;  Exhibition,  Joseph 
M.  A.  Costello.  Third  Year :  Scholarships,  John 
Hughes,  Christopher  F.  X.  O'SuUivan  ;  Exhibitions, 
Joseph  D.  G.  Burke,  Richard  G.  C.  M.  Kinkead,  John 
\y.  Garry.  Second  Year :  Scholarships,  Edward 
DowUng,  Michael  J.  Mulligan  ;  Exhibition,  George 
Deery.  First  Year  :  Literary  Division,  Scholarships, 
Michael  G.  Devine ;  Exhibitions,  Bartly  Byrne. 
Michael  G.  O'Maney ;  Science  Division  Scholarships, 
Thomas  G.  Rothwell ;  Exhibitions.  James  A.  Brown, 
Jame  M.  Riorth. 

Trinity  College,  Dublin. 
Michaelmas  Term,  1904. 
Previous  Medical  Examination.  —  The  following 
-passed  in  Anatomy  and  Institutes  of  Medicine  : — Henry 
J.  Keane,  Henry  D.  Woodroflfe,  Albert  J.  T.  M'Creery, 
John  C.  Baker,  Francis  O'B.  Kennedy  equal ;  Lang- 
ford  V.  Hunt  and  James  G.  G.  Moloney,  equal ;  Henry 
P.  Hart,  Herbert  AUport. 

Physics  and  Chemistry  : — Arthur  H.  Laird,  John 
Oray  and  Julian  B.  Jones,  equal ;  William  E.  A. 
Moore,  Wellesley  R.  Allen,  Richard  D.  Fitzgerald, 
John  H.  Morton,  equal ;  Cecil  J.  Grene,  Henry  R. 
Kenney.    James  D.  K.  Roche. 

Botany  and  Zoology  : — Henry  de  C.  Dillon,  Harold 
S.  Sugars. 

Previous  Dental  Examination  . — Anatomy  and  In- 
stitutes of  Medicine  : — Charles  R.  Kidd.  Arthur  K. 
Macdonald. 

Materia  Medica  : — Charles  R.  Kidd. 

Royal  College  of  Surgeons  In  Ireland. 
The  Carmichael  Prize  of  ^£120  for  the  best  essay 
"  On  the  State  of  the  Medical  Profession  in  its  Different 
Departments  "  has  been  awarded  by  the  College  to 
Dr.  Michael  Foster  Reaner. 

Royal  College  of  Physieians  of  Edinburgh,  Royal  College  of 
Burgeons  of  Edinburgh,  and  Faeuliy  of  Physloiane  of 
Gtaegow. 

The  quarterly  examinations  of  the  above  Board, 
held  in  Edinburgh,  were  concluded  on  the  2nd  inst., 
with  the  following  results : — 

Final  Examination. — Of  eighty-four  candidates 
entered,  the  following  thirty-eight  passed  the  examina- 
tion, and  were  admitted  L.R.C.P.E.,  L.R.C.S.E..  and 
L.F.P.  and  S.G. : — Joseph  van  Someren  Taylor,  China  ; 
Henry  Lawrence  Ludovici,  Colombo ;  John  Roddick 
Byers»  Canada ;  Stuart  Evans,  Ottowa ;  William 
Murray,  Middlesbrough ;  John  Browne  Grogan  Mul- 
ligan. Belgium  ;  James  Francis  O'Mahony,  co.  Cork  ; 
Ernest  Temple  Curran,  Ontario ;  Thomas  Cassels, 
Mangalore ;  James  Patrick  Barry,  New  Zealand ; 
Geo.  Galen  Baxtholomew.  Scotland  ;  Carel  Theodorus 
Moller,  South  Africa  ;  John  Michael  Moriarty,  Ireland  ; 


The  Medical  Press.     5  33 


Samuel  Mortimer  Lyon,  Ontario ;  James  Ringland 
Lawther.  co.  Down ;  Damadar  Babaji  Mandhle, 
Bombay  ;  Maneckji  Pirozshaw  Kerrawalla.  Bombay  ; 
Colin  Gamer,  Preston  ;  Lilian  Mary  Grandin,  Jersey  ; 
James  Harvie,  Lesmahagow ;  John  Pringle  Tolmie! 
Inverness ;  Harvey  McKay.  Toronto ;  Alan  Cunliffe 
Vidal,  Eton  '■  Ruston  Nusserwanji  Coorlawala,  Satara  ; 
Robert  Wilfrid  Simpson,  Glasgow ;  James  Joseph 
Egan,  Galway ;  Mohamed  Ebrahim  Sufi,  Lucknow ; 
Rowland  Hill  Harris.  Maine,  U.S.A.;  Henry  Bentley, 
Manchester  ;  William  Dick,  co.  Tyrone  ;  John  Douglas 
Staley,  Youlgreave ;  Thomas  Alexander  Wiltshire 
Walker,  Hyderabad  ;  Edwin  Herbert  Freeze,  Canada  ; 
Timothy  Archdeacon,  co.  Cork;  James  William 
McEwan,  U.S.A.;  Walter  Longley,  Leeds ;  Kashibhai 
Vaghajibhai  Amin,  Ahmedabad ;  and  John  Black 
MofFatt,  Airdrie  ;  and  ten  passed  in  the  division  of 
medicine  and  therapeutics ;  three  in  surgery  and  sur 
gical  anatomy ;  six  in  midwifery,  and  six  in  medical 
jurisprudence. 

Royal  College'ofPhyeiclani  and  Surgeons. 

Candidates  have  passed  as  undernoted  : —  " 

Third  Professional. — Passed  in  all  subjects  :  A.  P. 
Barrett,  M.  D.  Healy,  C.  W.  O'Keeffe,  John  Prendi- 
vUle,  C.  H.  Waddell,  and  Rupert  Welply.  Completed 
examination  :  L.  A.  Andrews,  C.  J.  Bergin,  T.  S.  Black- 
well,  John  Burke,  W.  J.  Connolly,  R.  F.  O'T.  Dickinson. 
T.  A.  Fisher,  Cormac  Gordon,  J.  J.  Hogan,  John 
M'Quillan,  William  Roche,  William  Sheahan.  Edmund 
Smith.  J.  R.  Talbot.  N.  R.  Ussher.  J.  J.  Vasquez,  and 
G.  F.  Wright. 

Final  Examination. — Passed  in  all  subjects  :  J.  R. 
P.  Allin.  Completed  Examination  :  Michael  Ambrose. 
E.  C.  Byrne,  H.  A.  Cecil,  Selby  Clare,  F.  X.  Costello. 
H.  B.  Evans,  P.  E.  Harrison,  M.  C.  O.  Hurly,  E.  C. 
Jennings,  R.  W.  D.  Leslie.  M.  J.  Lochrin,  V.  H. 
MacSwiney,  E.  C.  Mulligan,  J.  C.  Murphy,  T.  J. 
O'Donnell,  B.  H.  Petfers,  John  Pratt,  S.  H.  Robinson, 
A.  J.  Swanton,  and  Edmond  Walsh. 

Supplemental  Preliminary  Examination,  Autumn, 
1904. — Candidates  have  passed  this  Examination  as 
undernoted : — With  honours :  O.  W.  J.  Wynne. 
Passed :  J.  V.  M.  Byrne.  C.  P.  Corbett,  E.  J.  Curran, 
Thomas  Duncan,  L.  M.  Ewart,  Charles  Greer,  Joseph 
Marmion,  H.  S.  Meade,  John  Men  ton,  Rodk.  O'Connor. 
R.  S.  White,  and  W.  H.  Wray. 

CoiUoliit  Eyamiaatloai  In  Ireland. 

Candidates  have  passed  this  examination  as  under- 
note«1 : — 

First  Professional. — Passed  in  all  subjects  :  James  J. 
Barry.  A.  H.  T.  Wamock.  Completed  examinations  : 
Stephen  J.  Barry,  J.  Brere ton-Barry,  Thos.  G.  Brown. 
Noel  M.  Herbert,  L.  C.  Johnston.  H.  G.  M.  Miles, 
K.  A.  P.  R.  Murray,  Joseph  McDonagh,  D.  S.  Mac- 
Dowell,  Pierce  Noonan.  Martin  C.  O'Hara,  Richard 
P.  Power,  F.  Blood  Smyth,  and  Bernard  Wallace. 

Second  Professional. — Passed  with  honours  :  John 
Molyneux,  J.  F.  Walsh,  John  McNamara,  Patrick  J. 
McKevell,  Charles  J.  B.  Dunlop.  Passed  in  all  sub- 
jects !  H.  C.  Burbidge,  M.  Beauchamp  Dooley, 
R.  de  S.  B.  Herrick,  A.  A.  Murphy,  Patrick  J.  Murray. 
Completed  Examination :  William  Carroll,  A.  L. 
Clarke,  James  Joseph  Clarke,  James  J,  Corr.  George  A. 
Francis,  Stanislaus  A.  Furlong,  John  Holmes,  J.  P. 
O'Kane,  W.  Roche  O'Farrell,  WilUam  A.  Ryan,  James 
V.   Sage.  G.  B.  Spencer,  and  Lionel  D.  Woods. 

The  Bishop  of  Durham  has  deUvered  judgment  in 
the  appeal  by  Miss  Cadell,  a  lady  doctor  practising  in 
London,  against  the  decision  of  the  warden  of  the 
University  refusing  to  permit  her  to  sit  for  the  final 
examination  in  medicine  at  Durham.  Dr.  Cadell  had 
previously  failed  in  this  examination  and  had  in  letters 
made  allegations  of  favouritism  and  partiality  against 
the  examiners.  The  University  authorities  thereupon 
refused  to  permit  her  to  sit  again.  She  appealed  to  the 
Bishop,  who  is  Visitor  of  the  University.  He  decided 
that  her  letters  were  offensive  and  a  breach  of  Univer- 
sity discipline.  He,  therefore,  upheld  the  warden's 
decision  and  dismissed  the  appeal. 


534    The  Medical  Pebss.         NOTICES  TO  CORRESPONDENTS. 


Nov.  16.  1904. 


Satiwi  to 


i^T  OoBUBFOHDun  reqmirinff  »  reply  in  this  oolumn  are  particu- 
laSv  reQQMted  to  make  lue  ot  a  distincHvt  SigruUwre  or  InUial,  and 
vow  ^e  practice  oliigninir  themaelves  "Beader,"  "Subecriber." 
**  Old  Subecriber/*  ace  Much  oonhision  will  be  apared  by  attention, 
to  this  rule. 

OaieiHAb  ArtioIiIB  or  LvmRS  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  publloa- 
t  ion,  but  as  evidence  of  Identity. 

ConntxBOTOftS  are  kindly  requested  to  send  their  communications 
if  resident  In  Snf^and  or  the  Colonies,  to  the  Editor  at  the  London 
oflloe ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
ihe  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 
Publisher. 

Bvruvts.— Keprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  pubb'sher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

H.b.  (Crewkerne).— "  Suet,"  properlv  speakintr,  is  obtained  from 
the  abdominal  fat  of  the  eheep.  punfied  by  melting  and  straiDing. 
It  is  used  for  preparing  mercurial  ointment  It  consists  chiefly  of 
stearine  and  differs  in  various  points  from  beef  suet. 

DEATH  AT  THE  CARD  TABLS.- 

Whilb  playing  at  cards  with  his  son-in-law,  Simpson  Jaoobi  eighty- 
one,  a  retired  shipping  agent,  of  Shepherd  s  Bush,  suddenly  dropped 
the  cards  and  died.  At  the  inquest  last  week  it  was  stated  that 
death  was  due  to  the  rupture  of  an  aneurysm  in  the  aorta,  caused 
probably  by  excitement.  In  former  times  this  would  infallibly  have 
been  alluded  to  as  a  visitation  of  Providence. 

A  BiBMlHOHAM  Stubeiit.— The  constancy  and  inconstancy  of 
employment  necessarib'  afecto  the  prevailing  rate  of  wages 
H  iff  her  wages  are  required  to  keep  a  man  employed  only  part  of 
his  time.  That  general  rule,  however,  does  not  apply  to  the  "  part 
time  "  liedical  Officer  of  Health,  because  his  income  is  derived 
mainly  from  general  practice  He  can  thus  afford  to  take  less  than 
the  average  standard  salary  due  to  a  public  health  post-and 
gives  leas  in  return, 

^tttxxtQB  of  the  §odt\kB,  JUttwctB,  *jc 

WSDVISDAT,   NOVSMBBS  16th. 

RoTAL  MiCBosoopiCAL  SocixTT  (20  Usnover  Square,  WJ.— 8  p.m. 
Paper  .->Mr.  A.  E.  Conrady  :  Theories  of  Microscopic  vision.  (A 
Vindication  of  the  Abbe  Theory.) 

BoTAL  HsTBosoiiOOiCAL  SocinT  (Institution  of  Civil  Engineers, 
Great  George  Street.  Westminister,  8. W.). -7.80  p.m.  Papers:— 
Liehtenant  0.  Boyds,  B.N. :— Meteorological  ObserviDg  in  the 
Antarctic.  Mr.  F.  J.  Brodie  :  Decrease  of  Fog  in  London  during 
Becent  Years.  Mr.  B.  L.  Holmes  :  Hurricane  in  Fiji,  Jan.  2l8t- 
22nd,  1904. 

Mrdioal  Oradvatm*  Oollxob  akp  Poltoukio  (2S  Chenies  Street, 
W.C ).  4  p.m.  Mx.  L.  Cheatie  :  Clinique.  .Suigical.)  6.16  pjn. 
Mr.  F.  C.  wallis  :  Injuries  to  and  Diseases  of  Joints. 

North-East  Lohooh  Poer-GRADUATX  Colliob  (North-EasternFever 
Hospital  St.  Ann's  Boad,N.)—2.da  p,m.  Dr.  H.  Cuff  :  Demonstia- 
tion  on  Fevets. 

Cbhtbai.  Lonpob  Tbboat  Ain>  Ear  Hospital  (Gray's  Inn  Bead 
W.C.).— 6  p.m.  Demonstration  :— Mr.  S.  Low  :  Oro  and  Laryngo- 
Pilar  ynx. 

THUBflDAT,  NOVBMBBB  17th. 

Mbpioal  Qrapuatxb*  C^llbob  ahd  PoLTOLunc  (22  Chenies  Street, 
W.C.).- 4  p.m.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  5.16  p.m. 
Dr.  C.  T.  'VnUiams :  The  Principles  of  Treatment  of  Pulmonary 
Tuberculosis. 

MouHT  Ybbbok  Hospital  for  OovsuMPtioir  ahp  Disxasbs  or 
THB  CHBST  (7  FitzToy  Square,  W.).— 6  p.m.  Lecture  :  Dr.  F. 
P.  Weber:  Climates  and  Health  Besorts  in  the  Treatment  of  Pul- 
monary Tuberculosis.     (Post-Oraduate  Course.) 

North-East  Lonpoh  Pobt-GrapuatxOoi  LBOB(Tottenliam  Hospital, 
N.).— 4.30    p.m.      Lecture  :— Dr.  Chappel :  CUnical  Medicine. 

FRIPATfiNOYRMBBR  18th. 

BociBTT  for  thr  Stupt  op  DisbasR  tB  OiiiLPRBV  (11  Chandos  Street, 
W.).^6.80  p.m.  Cases  will  be  shown  by  Dr.  J.  Taylor,  Mr.  J.  H. 
Evans,  Mr.  D.  Drew,  Dr.  J.  P.  Parkinson,  Mr.  8.  Stephenson,  and 
Dr.  H.  Campbell.  SpecimenR  will  be  shown  by  Dr.  B.  Bogers.  Dr.  J. 
M.Fortescue-Brickdale,  Dr.  G.  Carpenter,  Dr.  8.  Curl,  and  Mr.  D. 
Drew. 

Mbpical  Orapuatbs'  Collbor  avp  PoLTCLonc  (83  Chenies 
Street,  W.C— 4  p.m.  Mr.E.  Clarke:  Clinique.    (Eye.) 

MONPAT,  NOVBMBBR  2lSt. 
NoRTM-EASTLOHBOB  PuST-ORAPUArS  (^OiiLBOB  (T<AtUkhua  HOBpi- 

tal).— 4.30  p.m.    Leature :  Mr.  CantUe  :  Livar  Aboess  and  its  Tni^ 
ment. 

TUSSPAT,  No  VBMBBR  82nd. 

ThxbapbvtiOal  BociiTT  (apothecaries  (HaU,  E.a).— 4  p.m. 
Dr.  O.  Sharp  on  Strycbnoa  Tonfera  Benth  and  other  Paralysers  of 
the  Motor  Nerve  Ending.  * 


^nvmazB. 

County    A^ylmn.   Mickleover,   Derby.- Junior    AasiataBt   Mc<fieal 

Officer.    Salary  £120  per  annum,  with  (iiniabed  apavtasana 

board,  ^vashlng,  and  attendance.    Applications  to  the  Mcdiai 

Snneriotendent.  ^^ 

Leeds  UBion.~Assiatont  Medical  Officer.    Salary  £i»  pet  mauam. 

with  board,  washing,  apartments,  and  atteodaaoe.    ftrnflifslMn 

to  James  H.  Ford.  Ckrk,  Poor-law  Offices,  South  Psrafe.  Lenk. 
Manchester  Corporation.— Medical  Officer.   Satoi  y  £250  per  abbbb. 

Anphoations  to  the  Chairman  of  the  Midwives  f^uperriaiivCo*- 

mittee.  Public  Health  Office,  Town  HaU,  Mancbemer. 
Wakefleld     West     Biding    Asylum.- Assistant    Medical    Officer. 

Salu^'    £140   per  aoDum.   with    apartments,  bsard.   wwiaaB 
aodatcendance.     Applications  to  the  Medical  Director. 
University  of    Birmingham  (Faculty  of    Medtcine).-Pxoflcsiv  tf 

Anatomy.    Salary  £800  per  annum.    Applicationa  lo  Geo.  B. 

Morley,  Secretory. 
Braoebridge    Asylum,  near    Lmcoln.— Junior   As^istaat    Mefiiri 

Officer.    Salary  £126  per  annum,  with   furniahed  a/peotaeBlL 

S?-i*.^P?!***"^!?'  •»  ^  T.  Page.  Jun.,  Solicitor  and  Clerk  tolte 

Visiting  Committee,  5  Bank  8t»ees,IJiicohi. 
Bermondsey  Parish.— First  Assistant  Medical  Officer.    Sala-y  £151 

per  annum,  together  with   rations,  washing,  fomished  nait- 

mento,  and  attendance.    Applications  to  E.  Ktts  Fentos.  Gei, 

Giutfdians' offices,  283.  Tooley  Street,  as. 
^*^^f^^^*  General  lufirmsry— Senior    House    Surgeon.    Sblarr 

£100  per  annum,  witii  board  and  resklence.    ApplicatioDS  to  tks 

Chairman  of  the  House  Committee. 
Gloucester  General  Inflrmary  and  Eye  Inatitution.-House  1. 

Salary   £100  per  annum,  with  board,  residence,  and  i ,. 

Applications  to  the  Secretary.  ^ 

Manchester  Boyal  Infirmary.-Besident  Suigical  Officer.     Sikir 

£IS0  per  annum,  with  board  and  residence.     Applicatioos  to  W. 

USauiidcr,  Superintendent  and  Secretary. 
HoUowa/  Sanatorium  Hospital  for  Insane  Vuginia  Water.  SuTrev.- 

Junior  Assistaiit  Medical  Officer  (Lady).  Salary  iBl&O per  aa^a 

withboard  JodgiDg^  washinflr,  attendance.  &  c.    Applicatioos  to 
T   .^**;Wj?-^oo".«edic»l  Superintendent.  nJT  t 

Leicester  Inflrmary. — House  Surgeon .    Salary  £100  per  aninuir«i& 

board,  spartments.  and  ^"ashing.  AppllcatioDs  to  Harry  JofaBSSD. 

House  Q2^«;no»- and  Secretary,  tiie  Inflrmary.  Leioeater. 
Monkstown  Hospital —Bes: dent  Medical  Officer.      Salarr£40p« 

annuni.    Applications  to  the  Hon.  Score tary.     (See  Adn.) 
County  Mayo  Inflrmsry.--*8sl8Unt  Surgeon,  ll»o  to  act  aa  Cob- 

pounder.  Salary  £109  per  annum,  with  apartmenta,  ottcmtaaoe. 

(S"  \Pf*^**°"'^  ^'-  ^-  OMaUcy  Knott,  aeaidcntSaiJS 


^pjrohrtmentB. 


BAB8T,  C.  T.  U.,  L.B.C.P  ,  L.R.C.S.Edin  ,  Certifying  Sargeon  osdcr 

it*®  J^^^^y,-^®*  '°'  '*>«  Wallsend  District  of  the  county  <tf 

Northumberland. 
Babbbb.  Fbakk,  M.B.,  B.S.Lond.,  F.B.C.S.Eng..  Hondrary  SoneiB 

to  the  Boyal  Orlhop«Bdic  asd  Spinal  Hoepital.*Bii  mingham. 
Davis,  William  Hbbrt,  M.R.  B.Ch.  B.U.I.,  House  Sumonto  the 

Boyal  Victoria  Hospital  Belfast.  ^*^ 

FORTUBB,  John,  M<B.,C.M.Edin.,  Third  Asaistant  Medical  Oflieer  to 

the  Devon  County  Asylum. 
GirrORD,  Gbobos  T..  M.D.Durb  ,  M.B.C.S.Eng..  Honorary  ^"^nn 

Surgeon  to  the  Blaukbum  and  Bast  Laacaahire  Infirmary. 
iKOLis,  p.W..  M.D.Glasg.,  Certifying  Surgeon  under  the  WtiBr 

Act  for  the  Jarrow  District  of  the  county  of  Dnrfaam 
Latham,  W.,  L.B.  \P.I .  M.B.C.S.Eng.,  Certifying  i^ur^eon  under 

the  Factory  Act  for  the  London  and  North  Veatern  BaOaaT 

Company  8  Works   at  Rarieetown.  in  the  NewtonlcWmoe'i 

District    of     the    county    of  lAncaater. 


^hs. 


S:Z2i'J'*^^^i^'L  ^»  '*  Debenham.  Suffolk,  the  wife  of 
MowardHenry,  M.B.,  ofason. 
Malcolm.-  On  Nov.  lith,  at  18  Portmaa  Street,  London. W..the  wife 
of  John  D.  Malcolm,  FJft.C.S.Bdin.,  of  a  soil.  ^ 


4BtorrkgcB. 


Blacrbr-Bowxb.— On  Nov.  8th,  at  St.  Mary's  Churoh.  TorraartM. 
Glos  George  Francis  Blaokei%  M.D..  F.ft.CJ>.,  tbiid  «»SxS 
missionary  Qenersl  Latham  lUacker.  to  Shirley  Elvina  Boeea, 
second  daughter  of  Bev  T.  J.  Bowen,  Rector  of  TormaricM 

Brown-Nobmabpt.— On  Nov.  12th  at  Bombay,  Capt.  Bobr  Bimn. 
M.D.,  B.A.M.C.,  of  Lucknow.  eMest  son  ot  Dr.  iSSTawSTi 
Btrood,  Kent,  to  PauUne  Mary  Elvina,  eldeat  dan^hteS^k 
Normandy,  of  Sutton,  Surrey.  «»««nwr  or  nuK 

^'"•^J^T^^^i'^r;^"?^!-,  "4*»  »fc,Co*<>S^.  John  Newport  Eikicr. 
M.B.Lon4.,  Adra,  Indian  Assistant  Medical  Officer  oftliel^ 
gal  Nsgpnr  Kailway,  eldest  son  of  Walter  John  Kflner  mSl 

Wvat?r;kt^MRo'?'ri^?^Sjr*-^"'^  daughiS'of  J<£ 
Wyatt  Fratt,  M.B.C.S.,  L.B.C.P..  Otioy.  late  of  WiveliaooBbe 
Somerset.  * 


^tilths. 

PmujM.-On  Kot.  IStb,  at  bia  reaidenM.  1,  Byd.  Paik  Sqnur. 


Ik  ^dial  ^vm  m&  ^itmht 


•«8ALnS   POPUU   STTPREMA   LEX-' 


Vol.  CXXIX.  WEDNESDAY,    NOVEMBER    23,    1904.        No.   21. 


Original  Communicatiottd. 

CASES   ILLUSTRATING  THE 

MODERN  SURGERY  OF  JOINTS. 

By  J.  JACKSON  CLARKE,  M.B.Lond.,  F.R.C.S., 
SatseoD  to  the  North-West  London  tnd  City  OnhopMlic  Hotplteli. 

Case  I. — Internal  Derangement  of  the  Right 
Knee.  —  A  vigorous  man,  aet.  22,  first  con- 
sulted me  on  March  8th,  1904.  His  right  knee 
first  became  troublesome  seven  years  previously, 
after  a  sprain  received  in  pla3dng  football.  He 
was  obliged  to  leave  the  field  with  his  knee  flexed. 
Swelling  of  the  knee  rapidly  ensued.  The  knee 
was  bamdaged,  and  the  patient  was  advised  to 
walk.  Gradual  recovery  followed.  Since  that 
time  the  trouble  has  recurred  at  intervals,  an 
anaesthetic  being  occasionally  required  to  over 
come  the  fixed  flexion  at  the  joint.  It  is  of 
interest  to  note  that  his  father  has  a  similar, 
but  less  pronounced  trouble  with  one  of  his 
knees.  As  to  the  past  treatment,  he  had  worn 
a  support  consisting  of  lateral  steel  bars  jointed 
at  the  knee,  and  provided  with  spring  patellar 
trusses,  but  without  any  benefit.  Shortly  before 
his  first  visit  to  me,  in  landing  from  a  steamer, 
patient's  knee  underwent  a  twist,  and  aigain 
became  locked.  An  anaesthetic  was  administered, 
and  the  limb  manipulated,  but  this  time  without 
success,  the  knee  remaining  bent,  swollen,  and 
painful.  Patient  was  able  to  walk  a  little,  the 
knee  being  kept  stifl  and  slightly  bent.  On 
examination,  there  was  a  very  marked  pit,  or 
sulcus,  at  the  inner  side  of  the  knee — a  character- 
istic sign  of  detachment  of  the  internal  semi- 
lunar fibro-cartilage.  (See  Fig.  i.)  The  joint  was 
distended  with  fluid,  which  made  the  sulcus 
the  more  striking.  I  recommended  arthrotomy 
and    removal  of   the  detached  tissue. 

Operation. — On  March  12th  I  made  a  curved 
incision  over  the  sulcus,  amd  through  this  I 
opened  the  capsule  of  the  joint  as  far  back  as 
the  anterior  border  of  the  internal  lateral  liga- 
ment. After  all  bleeding  had  been  stopped  the 
synovial  membrane  was  opened  to  the  same 
extent  as  the  capsule — ^it  was  thickened,  its  joint 
surface  was  granular  and  stained  a  brownish 
colour.  Much  synovial  fluid,  also  stained  brown 
from  effusion  of  blood,  escaped,  and  more  was 
forced  out  by  pressing  on  the  joint.  The  displaced 
tissues  were  now  visible,  and  they  comprised  not 
only  the  semilunar  cartilage,  but  a  fibrous  band 
(part  of  the  capsule)  as  thick  as  an  index  finger, 
which  had  been  detached  with  it.  This  mass  lay 
between  the  femoral  condyles,  only  its  anterior 
end  being  visiWe.  This  was  grasped  by  Spencer 
WeUs  forceps  close  up  to  the  anterior  attachment, 
and  cut  through  behind  the  forceps  and  its  free 


end  grasped,  and  by  drawing  on  this  by  a  second 
pa^  of  forceps  and  flexing  the  knee,  I  was  able 
to  remove  the  anterior  two-thirds  by  means  of 
curved  scissors.  Most  of  the  tissue  grasped  by 
the  anterior  forceps  was  also  removed.  The  joint 
now  offered  no  resistance  to  extension.  The 
remaining  fluid  was  expressed,  the  synovial 
membrane  and  the  capsule  were,  closed  by  separate 
continuous  silk  stitches,  and  the  skin  by  interr 
rupted  silkworm-gut;  the  joint wasfirmly bandaged, 
and  an  amterior  malleable  splint  applied.  Repair 
was  uneventful,  the  temperature  remained  normal^ 
and  the  superficial  stitches  were  removed  on  the 
eighth  day.  After  this  the  patient  wore  a  flannel 
bandage,  practising  gentle  passive  movements, 
A  slight  impairment  of  flexion  was  present,  but. 
had  disappeared  by  April  i8th,  on  which  date 
the  fluid  had  all  but  disappeared  from  the  joint, 
and  the  patient  was  allowed  to  walk  as  much  as: 
he  felt  inclined,  only  being  debarred  from  run- 
ning and  other  athletic  exercises.  On  September 
ist,  all  the  fluid  had  disappeared,  and  the  joint 
and  limb  were  normal  in  strength  and  function. 
Remarks. — ^This  case  is  an  exsmiple  of  the  most 
severe  of  the  various  conditions  that  are  grouped 
together  under  the  heading  of  ''  Internal  Deramge- 
ment  of  the  Knee-joint."  The  internal  meniscua 
formed  only  a  minor  portion  of  the  mass  of  tissue 
that  had  been  torn  from  the  capsule.  When  the^ 
joint  was  opened,  I  found  it  impossible  to  draw 
the  band  to  the  inner  side  of  the  condyle,  so  I 
contented  m3rself  with  cutting  off  as  much  as  I 
could  reach  by  passing  the  curved  scissors  as 
far  as  was  safe  between  tiie  condyles.  In  operating 
on  these  cases,  as  far  as  my  experience  gees, 
there  is  not  much  to  choose  between  a  curved 
transverse  (Annandale's)  incision  and  a  vertical 
one.  As  a  point  in  diagnosis,  the  presence  of  a 
marked  sulcus  is  noteworthy — its  deepest  part 
was  caused  by  the  attau:hment  of  the  anteriol^ 
and  detached  band  of  tissue.  The  accident  was 
predisposed  to  by  a  family  tendency  to  looseness 
of  the  joints. 

Case    II. — Ankylosis  of  the  Right  Hip-joint. — 

Osteotomy    of    the   Femur. — Percy  ,  aet.    25, 

sent  to  me  by  Dr.  Morley  (Portsmouth)  in 
January,  1904.  A  robust  young  man  presenting 
fixed  flexion  (35°)  and  adduction  of  the  right  hip, 
and  when  standing  marked  lordosis.  He  had  to> 
wear  a  boot  raised  two  inches  to  compensate 'for 
the  apparent  shortening,  and  he  limped  in  walk- 
ing. A  skiagraph  showed  complete  obhteration 
of  the  joint  cavity  without  dislocation.  The 
history  given  was  that  in  1884  patient  was  sent 
to  the  Alexandra  Hospital  for  disease  in  the  right 
hip.  He  remained  there  one  year,  extension  being 
appHed  in  bed.  At  the  end  of  this  time  he  was 
sent  to  Bournemouth  for  six  months.      During 


53^    I^HE  Medical  Press. 


ORIGINAL    eOMMUNICATIONS. 


Nov.  23.  1904 


1888-89  two  abscesses  formed  in  the  hip,  and 
were  opened.  The  subsequent  treatment,  con- 
cluded ifi  1890,  left  patient  |ree  from  pain,  but 
with  the  limb  fixed  m  its  present  position.  At 
the  patient's  raqvest  I  admitted  him  to  the  City 
Orthopedic  Hospital  for  treatment  of  the 
deformity. 

OperaHan, — After  ascertaining  that  these  was 
no  movement  at  the  joint  by  exerting  strong 
leverage  upon  the  thigh,  I  'decided  to  per- 
form a  subtrochanteric  osteotomy,  removing 
a  wedge  of  bone,  with  its  base  directed 
externally  and  posteriorly,  and  then  to  wire 
the  fragments  together.  This  done  and  the 
wound  closed  except  at  its  lower  angle,  where 
a  drain  was  insert^  for  twenty-four  hours,  the. 
modified  Thomas's  hip-splint,  with  a  foot-piece, 
previously  prepared,  was  applied.  The  patient 
had  no  pain  whatever,  and  repair  was  rapid,  so 
that  on  July  ist  (four  weeks  after  operation)  I  was 
able  to  allow  the  pati^xt  to  stand  up  to  be  photo- 
grapfhed.  (See  Fig.  2.)  On  August  12th,  he  was 
allowed  to  walk  without  the  splint,  some  stiffness  in 
the  knee,  where  there  was  some  genu  valgum  from 
the  previous  abnormal  direction  of  the  limb,  being 
patient's  only  complaint.  Patient  left  the  hos- 
pital on  September  loth,  1904,  walking  comfort- 
ably with  his  boot, raised  only  half  an  inch,  and 
when  seen  two  months  later  he  was  free  fr6fil 
most  of  the  limp  in  his  gait  that  was  present 
before  operation. 

Comm&ni, — ^Removal  of  a  wedge  Oi  bone  in 
this  operation  enables  the  fragments  to  be  firmly 
oo-apted  by  a  broad  surface,  and  if  the  wedge 
does  n6t  comprise  the  whole  width  of  the  bone, 
it  does  liot  entail  any  shortening.  Wiring  of  the 
fragments  sc^cures  the  patient  against  pain  or 
delay  of  repair,  owing  to  movement  and  shorten- 
ing frdm  over-riding  of  the  fragments.  The 
Thomaid's  hip-splint  is  far  more  efficient  in  pre- 
venting any  flexion  at  the  seat  of  operation, 
and  far  more  comfortable  and  convenient  for 
nursing  than  any  other  form  of  splint  that  I 
have  used  after  this  operation — subtrochanteric 
osteotoifiy  or  G  ant's  operation. 

Case  HI. — Ankylosis  of  Many  Joints  following 

Acute  Osteo' Arthritis. — Isobella ,at  30,  thin, 

very  anS&inic,  perspires  a  great  deal ;  sent  to 
me  at  the  City  Orthopaedic  Hospitdljand  I  sent  her 
to  the  Nbrth-West  London  Hospital,  where  she  was 
admitted  on  September  30th,  1903.  Patieirt  a 
helpless  Cripple,  unable  to  stand,  walk,  or  feed 
herself.*  Three  years  prevfously  she  was  taken 
ill  with  what  was  diagnosed  as  **  acute  rheumatoid 
arthritis,"  which  affected  most  of  her  joints ; 
tlie  following  list  indicates — 

1.  Temporo-maxillary  joints:  stiff,  but  not  com- 
pletely fiixed,  and  improving. 

2.  Spine :  stiffness  and  pain  in  the  lower  cervical 
and  upper  dorsal  regions ;  improved  under  treat- 
neot. 

5.  Shoulders  :  slightly  stiff,  getting  worse  ;  some 
grating  developed  later. 

4.  Elbows :  complete  bony  ankylosis^  in  rect- 
angular position  ;   muscles  greatly  wasted. 

5p  Wrists  and  fingers:  joints  swollen,  stiff,  painful, 
ajni  deformed. 

6l  Hip^^oints :  apparently  normal. 

7.  Knees:  both  flexed  to  a  rig^  angle, some 
tbiffkming  of  S3movial  membrane,  tenderness, 
«Mich  pain  on  passive  movement,  which  is  very 
IMtod. 


8.  Ankles  :  both  swollen  from  superficial  cedema, 
and  probably  also  effusion  into  joints  ;  botii  feet 
dropped  into  equinus  position. 

In  this  case  I  had  the  advantage  of  the  hdp 
of  my  colleague,  Dr.  W.  Knowsley .  €Mey,  who 
undertook  the  supervision  of  a  course  of  radiauit 
heat  baths,  from  which  the  patient  derived  modi 
relief  to  the  pain  in  the  joints.  The  plan  of 
surgical  treatment  that  I  formed  v^as  :---(i)  by 
excision  of  the  jcdnt  to  free  the  movements  of 
the  right  elbow  ;  (2)  to  correct  the  flexion  of  the 
knees  and  the  equinus  deformity  of  the  feet, 
and  finally,  if  the  patient  desired  it,  ta  excise 
the  left  ^Ibow.  This  plan  was  carried  out  with 
gratifying  success.  The  right  elbow  was  excised 
on  October  ist,  the  ham-strings  were  divided 
by  open  incisions,  and  the  tendines  Achilb 
were  elongated  o^  November  17th.  Then  walloi^ 
instruments  designed  by  myself  were  adjusted, 
and  the  patient  left  the  hospital  on  Aptil  i6£h. 
1904,  able  to  walk  about  unassisted  for  the  fiat 
time  for  over  three  years.  Quite  recently  !dK 
came  to  me  to  sak  to  have  the  shoukler-jonls 
operated  upon.  I  found  that  the  grating  in  tea 
had  increased,  but  I  decided  to  wait  b^bre  1 
ii^  them,  in  order  to  watch  \idiether  any  i 
ment  occurs  under  a  course  of  salicylate  < 
and  tartrate  of  iron.  At  the  ptesent  tHVpr  fte 
range  of  active  flexion-extensipn  moveni^.k 
the  right  dbow  is  as  shown  in  Figs.  3  and4« .  1^ 
power  of  supination  and  pronation  is  limitri  Jig 
the  stiffness  at  the  wrist.  The  muscqlttr  IMM 
in  the  arm  is  now  good.  Thel^neeskavel 
quite  stiff  in  the  straight  position,  but  tli^i 
hsrve  regained  an  almost  nonnal  range  e( 
ment. 


Fig.  I. — The  iimer  as- 
pect of  a  knee  show, 
ing  a  depression  be- 
low the  front  of  the 
inner  condyle. 


Fig.  2.— a  modified  Thomas's  hip^^plint  pitd  after 
sahtxochanteric  osteotoinyi     (JProm  a  plKitognph.) 

Remarks. — The  case  is  one  of  many  similar  ones 
that  have  come  to  my  notice  during  the  last  ten 
years,  umilar  in  all  re^>ects,  save  that  tUs  was 
the  only  one  in  which  bony  ankylosis  w«s  ] 


Nov.  as,  1904. 


ORIGINAL    COMMUNICATIONS. 


Tbx  Mxdical  Psbss.   337 


2uid  the  only  one  in  which  the  knees  became 
rigid  after  operation.  The  ages  of  onset  have 
varied  from  two  (infantile  rheumatoid  arthritis) 
to  forty-five  years.  All  have  begun  more  or 
less  acutely,  and  in  all  many  joints  have  been 
afiected.  All  have  been  bedridden  from  deformity, 
being  imable  to  walk  from  pain  and  sharp  flexion 
at  the  knees  and  the  equinus  position  of  the  feet. 
After  correction  of  the  deformities  and  the  applica- 
tion of  walking  instruments,  all  have  been  enabled 
to  walk,  and  that  in  an  increasing  degree,  and 


Fig.  3. — A  patient  after  excision  of  the  elbow,  showing 
degree  01  vdontary  flexion. 


Fig.  4. — ^The  same  patient  showing  degree  of  voluntary 

extension, 
with  marked  progressive  amelioration  of  the  joint 
S3rmptoms  and  improvement  of  the  general  health. 


The  bone  that  was  found  joining  the  surfaces  in 
both  elbow- joints  existed  only  at  scattered  points, 
fibrous  adhesions  being  present  elsewhere.  The 
patient's  temperature  was  normal  throughout 
the  time  that  she  was  in  hospital. 

pniB  Clinical  Xectures. 
DIALYTIC  TREATMENT    OF 

AFFECTIONS  OF  THE 

STOMACH. 

By  .Professor    G.     HAYEM. 

[specially  reported   by   our  PARIS 
CORRESPONDENT.] 

We  have  always  in  our  service  a  certain  number 
of  patients  suffering  from  gastric  ulcer.  This 
morning,  I  am  going  to  speak  to  you  of  one  of  them 
whose  history  appears  interesting,  and  at  the  same 
time  I  will  give  you  some  information  on  a  method 
of  treatment  to  which  I  have  given  the  term 
"  dialytic." 

The  man,  of  Bulgarian  origin,  aet.  30,  is  em- 
ployed in  an  ofl&ce.  His  father  died  at  sixty-five 
of  some  malady  unknown  to  us,  while  his  mother 
still  enjoys  good  health.  No  trace  of  nervous 
affections  could  be  found  in  his  family.  About 
seven  years  ago  the  patient,"  who  was  at  the  time 
an  engine-driver,  fell  from  the  engine  flat  on  his 
face,  with  extended  arms.  Carried  to  his  house, 
he  complained  of  pain  in  his  stomach.  During 
ten  days  all  food  taken  was  rejected.  The  medical 
attendant  treated  him  for  ulcer  of  the  stomach, 
and  put  him  on  hydric  treatment  for  a  week,  with 
alimentary  enemas,  and  afterwards  allowed  a  glass 
of  milk  every  two  hours. 

At  the  end  of  two  months  the  patient  was  able  to 
resume  his  work.  Soon  after,  however,  the  gastric 
pains  radiating  to  the  back  rendered  the  milk  diet 
again  necessary,  and  after  some  treatment  by 
magnesia,  bismuth,  bicarbonate  of  soda,  and 
codeine,  the  patient  decided  to  enter  the  hospital. 

Since  we  have  had  him  under  our  care,  he  has 
not  vomited  either  food  or  blood,  but  he  suffers 
from  his  stomach  about  half  an  hour  after  meals. 
The  pain  is  situated  two  fingers'  breadth  ai>ove 
the  umbilicps  and  is  increased  by  pressure.  The 
patient  complains  of  a  burning  sensation  in  the 
epigastrium  and  is  always  constipated.  With  the 
e^ppeption  of  the  stomach,  all  the  other  organs 
are  healthy,  but  the  moral  condition  is  deplorable. 
The  patient  is  in  a  state  of  perpetual  anxiety  ;  he 
thinks,  that  his  malady  is  very  grave  and  can 
support  no  noise.  The  analysis  of  the  contents 
of  the  stomach  showed  hydrochloric  acid  in  excess. 
The  above  symptoms  point  to  the  existence  of 
gastric  ulcer,  probably  of  traumatic  origin.  We 
submitted  the  patient  to  the  usual  treatment  of 
round  ulcer,  which  I  have  frequently  had  occasion 
to  mention  to  you  ;  it  comprises  one  of  the  saline 
solutions  which  form  part  of  the  medicatioit  which 
I  have  called  the  disdytic  treatment. 

Having  made  a  study  of  the  principal  drugs  used 
in  gastric  affections  as  above,  I  have  come  to  the 
conviction  that  all  agents  susceptible  of  irritating 
the  mucous  membrance  of  the  intestine  should  be 
proscribed.  Clinical  experience  has  proved  to  me 
that  the  troubles  of  which  dyspeptic  patients  com- 
plain are  considerably  improved  by  saline  solu- 
tions, and  these  are  the  only  remedies  I  use  in 
the  treatment  of  this  group  of  affections. 


53^    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Nov.  23.  1904. 


.  I  use  the  term  dialytic  medication  because  I 
believe  that  these  solutions  act  partly,  at  least,  by 
their  physical .  qualities.  These  solutions  are 
abundantly  furnished  under  different  forms  by 
the  natural  mineral  waters,  but  I  seldom  pre- 
scribe them  because  they  are  of  a  complex  com- 
position, and  the  effects  on  the  organism  have 
not  been  exactly  defined,  and  I  contend  that  just  as 
good  effects  can  be  obtained  from  the  artificial 
saline  solutions.  Their  composition  is  more 
simple  and  presents  the  additional  advantage  of 
being  capable  of  variation  ad  infinitum. 

To  acquire  sufficient  experience  I  reduced  tc^  a 
very  small  number  the  saUne  solutions  I  employ, 
and  now  know  their  effects,  having  prescribed 
them  hundreds  of  times. 

I  limited  myself  to  the  study  of  four  saline  drugsr: 
chloride  of  sodium,  sulphate  of  soda,  bicarbonate 
of  soda  and  phosphate  of  soda. 

Leaving  aside  for  the  moment  all  theoretical 
explanation,  I  am  going  to  simply  discuss  the 
practical  side  of  the  question. 

The  solutions  I  studied  are  five  in  number,  fonn- 
ing  two  categories — ^the  solutions  which  act  chiefly 
on  the  stomach  and  those  which  act  on  the  intes- 
tine. I  have  numbered  these  solutions  for  the 
purpose  of  our  lecture.  The  first  category  is  repre- 
sented by  solutions  of  unequal  composition. 

No.  I  is  as  follows  : — 

Bicarbonate  of  soda,  dr.  ^ ; 
Sulphate   of  soda,   dr.    i  ; 
Chloride   of   sodium,    grs.    20 ; 
Water,  one  quart. 
This  solution  can  be  employed  in  cases  of  gastritis 
with  hyperpepsia  ;  it  is  Carlsbad  water  simplified, 
and  is  used  as  prescribed  at  that  watering-place. 

In  the  morning*  fasting,  the  patient  takes  ten 
ounces  in  repeated  doses  (a  third  part  every  twenty 
minutes)  warmed  to  blood  heat.  This  dose  is 
increased  by  an  ounce  and  a  half  each  day  until  a 
pint  has  been  reached.  The  cure  should  not 
exceed  twenty-five  days.  The  counter-indication 
to  this  solution  is  dilatation  from  want  of  tone  of 
the  stomach.  The  stomach  which  empties  itself 
with  difficulty  should  be  otherwise  treated. 

Disease  of  the  heart  with  tendency  to  oedema 
constitutes  another  counter-indication  as  well  as 
cancer.  I  warn  you  against  employing  this 
solution  with  patients  suffering  from  cancer.  How 
often  do  we  see  each  year  cancer  patients  going  to 
take  a  cure  at  Carlsbad  and  returning  completely 
depressed  ?  ^ 

The  second  solution  is  as  follows  : — 
Chloride  of  sodium,  dr.  i  ; 
Sulphate  of  soda,  dr.  ^  ;        *     "* 
Water,  one  quart.  IT* 

Employed  generally  cold  at  the  dose  of  nine 
ounces  taken  at  once,  an  hour  before  breakfast. 
The  duration  of  the  cure  is  six  weeks. 
The  indications  of  this  solution  are  very  numerous. 
It  can  be  used  in  slight  hypopepsia  with  weak 
secretion  ;  it  answers  to  immediate  indications  by 
which  we  begin  in  the  majority  of  cases. 

The  third  solution  : — 

Chloride  of  sodium,  dr.  i  ; 

Phosphate  of  soda,  dr.  ^  ; 

Water,  one  quart. 

Is  to  be  prescribed  in  cases  of  intense  hypopepsia 

or  apepsia,  and  is  especially  indicated  in  debilitated 

subjects. 


i; 


Solution  No.  4  ;— 

Chloride  of  sodium  dr. 
Sulphate  of  soda,  dr.  i 
Water,  one  quart. 
Is  to  be  given  warm  in  cases  of  large  liver  and 
atony  of  the  intestine. 

Solution   No.  5  : — 

Chloride  of  sodium,  dr.  i  J  ; 
Sulphate  of  soda«  dr.   2^  ; 
Water,  one  quart. 
About  twice  the  strength  of  No.  4,  this  solution  is 
given  in  similar  cases,  half  a  glass  fasting,  and  if 
well  borne  another  half-glass  a  quarter  of^an  honr 
after. 

You  have  observed  that  all  our  solutions  contain 
chloride  of  sodium,  and  before  concluding,  I  wiA 
to  give  you  some  information  concerning  the  rSU 
played  by  salt  in  the  treatment  of  gastric  afiectioos. 
Solutions  containing  chloride  of  sodium) take  a 
special  place  on  account  of  the  chloride  constitutiQB 
of  the  blood  and  gastric  juice.  Other  things  being 
equal,  the  more  chloride  of  sodium  furnished  to  tbt 
organism,  the  richer  is  the  gastric  secretion  in 
chloride  products.  Thus  the  solution  which  (I 
employ  in  the  hypopeptic  conditions  contains  a 
relatively  large  proportion  of  chloride  of  sodium 
(5-1000). 

On  the  other  hand,  the  chlorides  should  be 
diminished  in  hypopepsia,  and  this  has  been  done 
empirically  for  a  long  time  by  prescribing  the  milk 
diet,  especially  in  cases  of  idcer.  But  the  effects 
produced  by  this  hypochloridation  depend,  in  part 
at  least,  on  the  state  of  the  mucous  membrane  of 
the  stomach.  The  results  are  variable  according^ 
to  the  nature  of  the  case,  whether  it  beoneof  mixed 
or  parenchymatous  gastritis.  Where  there  is 
hyperpepsia  in  either  of  these  affections,  the  milk 
diet  tends  at  first  to  diminish  the  chlorides,  but  to 
obtain  a  permanent  effect,  it  should  be  continued 
several  months.' 

Widal  and  J  aval  having  recently  drawn  atten- 
tion to  alimentation  without  salt  in  a  case  of 
Bright's  disease,  some  doctors  proposed  the  rigime 
without  salt  for  hyperpepsia,  yet  the  same  result 
could  be  obtained  by  giving  large  doses  of  bismuth, 
and  a  cure  with  the  artificial  solutions  of  Carlsbad, 
which  cause  the  digestive  troubles  and  dilatation 
to  disappear  if  present. 


CONSTIPATION. 

By  TOM  ROBINSON,  M.D.St.  And. 

Any  medical  man  who  is  brought  into  contact 
with  the  public  must  be  impressed  with  the 
number  of  individuals  who  are  in  the  habit  of 
taking  aperient  medicines.  The  habit  is  not  con- 
fined to  any  age,  dass,  or  sex,  but  it  certainly 
predominates  among  women.  Some  will  swallow 
gallons  of  the  mineral  waters  during  the  year; 
others  will  fly  to  the  commoner  aperients,  such  as 
Epsom  salts  or  compound  liquorice  powder  ;  many 
even  drop  into  the  pernicious  habit  of  talung  as 
frequently  as  every  night  a  pill  or  comprised 
tabloid  containing  aloes.  The  habit  is  continued 
until  the  muscles  of  the  bowels  lean  so  long  upon 
these  crutches  that  they  become  weak,  and  the 
victims  suffer  from  windy  colic,  internal  rumblings, 
and  often  considerable  irritation  of  the  mncoos 
membrane  of  the  intestinal  canal.  The  feeblcnes 
of  the  bowels  may  be  so  marked  as  to  lead  to  com- 
plete stoppage. 

In  these  few  remarks  on  constipation  it  is  my 


Nov.  33,  1904, 


ORIGINAL    COMMUNICATIONS. 


The  Mbdical  PkeM.    539 


intention  to  eliminate  all  those  cases  wWch  are 
caused  i>y  any  growth  or  other  mechanical  pres- 
sure. And  I  shall  not  either  show  cause 
why  it  is  often  of  enormous  advantage  to  ad- 
minister what  our  predecessors  so  well  called  a 
*'  brisk  purge." 

Rightly  or  wrongly  the  ordinary  citizen  has  a 
fixed  and  unalterable  idea  that  for  his  well-being' 
it  is  of  absolute  necessity  that  once  every  twenty- 
four  hours  the  bowels  must  act.  Our  problem  is 
how  we  are  to  produce  this  peace  of  mind  without 
^ving  aperients.  Our  mode  of  procedure  must 
be  based  upon  the  axiom  that  all  effects  have  a 
<:au8e.  The  cause  of  sluggish  bowels  are  three- 
fold :— 

(a)  Insufficient  and  unwise  diet. 
(6)  The  habitual  taking  of  purgatives. 
(/)  Deficiency  in  the  muscular  energy  of   the 
bowel. 

In  considering  insufficient  and  unwise  diet,  we 
must  remember  that  faeces  only  represent  the 
waste  products  of  the  body  ;  hence  it  follows  that 
the  diet  must  embrace  a  sufficient  quantity  of 
food  which  cannot  be  digested,  and  which,  passing 
along  the  bowel  way,  stimulates  that  bowel  to  con- 
traction, and  by  so  doing  urges  on  the  faecal  wave. 
Brown  bread  and  figs  stsmd  out  as  common, 
•examples.  These  are  often  not  sufficient,  and  we 
must  find  other  means. 

Some  time  ago  I  was  in  the  country  and  was 
watching  some  bullocks  during  the  winter  months, 
when  the  farmefs  usually  house  them  and  give 
them  linseed  cake,  and  one  could  not  help  being 
impressed  with  the  easy  way  in  which  these 
bullocks  defaecated.  This  easy  action  of  the  bowels 
also  takes  place  in  grazing  beasts.  The  thought 
struck  me,  why  not  give  my  costive  patients 
linseed?  one  cannot  give  them  grass.  On  returning 
to  my  work,  I  soon  had  an  opportunity  for  putting 
my  idea  into  practice,  and  ordered  my  first  patient 
who  was  the  victim  of  constipation  to  take  one 
teaspoonf  ul  of  flax  seed  floating  in  a  goblet  of  cold 
water  every  morning  before  breakfast,  and  to 
repeat  the  remedy  again  in  the  forenoon  until  the 
bowels  resumed  a  healthy  function,  impressing 
upon  the  patient  the  fact  that  time  must  elapse 
before  the  desired  condition  ensued.  In  three 
days  the  desired  condition  did  ensue,  and  now, 
so  far  as  I  know,  the  sufferer  is  happy  every 
morning  owing  to  the  fact  that  at  a  given  hour 
faacal  relief  is  obtained. 

There  is  one  after-factor  in  the  treatment,  which 
is  to  insist  on  the  patient  drinking  at  least  three 
pints  of  liquid  every  twenty-four  hours.  We 
must  at  the  same  time  absolutely  forbid  the 
taking  of  any  aperients.  It  is  often  asserted  that 
some  of  our  mineral  waters,  the  pills  and  tabloids 
of  commerce,  do  not  cause  constipation.  This 
must  be  a  fundamental  error.  Constipation 
follows  the  habitual  use  of  lany  aperient  medicine. 
It  is  a  natural  law,  because  every  purgative  acts 
by  virtue  of  its  power  to  increase  the  fluidity  and 
quantity  of  the  faecal  relief — ergo^  after  taking 
aperients  these  must  b^^  diminished. 

Time  and  a  healthy,  regular,  outdoor  life  will 
bring  abput  the  last  condition,  which,  of  course, 
is  the  final  one.  Give  the  thirty  feet  of  intestinal 
tubing  plenty  of  work  to  do  and  its  muscular  coat 
will  become  lusty.         • 


some  aspects  of 

Metabolism-chiefly 

clinical.  (^) 

.  By  WILLIAM  CALWELL,  M.A.,  M.D., 

Preaident  of  the  Ulster  Medical  Society :  PhysicUn  t«the  Belfast 
Royal  Victoria  Hospital. 

Part    I. 

Gentlemen, — An  inevitable  difficulty  presents  itself 
of  the  selection  of  a  subject  on  which  to  adrlr  s«  you. 
The  embarrassment  of  riches  in  matters  to  be  handled 
is  jg[reat.  There  are  the  University  question,  medical 
education,  medical  politics,  and  medical  ethics,  the 
hospital  system  of  the  day,  when  philanthropists  look 
askance  upon  the  iniquity  of  demorali  ing  children  in 
the  street  by  giving  them  a  penny,  but  with  com- 
placency devote  thousands  in  supplying  to  their  parents 
what  they  are  in  many  cases  wdl  able  to  procure  for 
themselves,  or  would,'  had  they  not  squandered  their 
wages  in  miserable  and  unrestrained  drunkenness. 
No  one  will  deny  that  care  should  be  taken  of  the 
flotsam  and  jetsam  of  our  urban  population,  and  a 
helping  hand  given  to  the  industrious  but  unfortunate, 
whether  from  accident  or  disease,  in  life's  struggle  ; 
but  we  cannot  hide  from  ourselves  that  indiscriminate 
charity  emasculates  the  energy,  self-respect,  and  in- 
dependence of  the  recipient,  and  tends  to  breed  a  rank 
and  overgrown  vegetation  sadly  needing  the  impartial 
weeding  of  Nature. 

The  relations  between  the  various  professions  o^er 
a  rich  mine  to  furnish  material  for  introductory 
addresses.  Since  the  Beck  case,  the  law  will  probably 
be  somewhat  less  bumptious,  and  wiU  curb  its  mild 
jokes  on  doctors  differing  and  mistaken  diagnoses. 
However,  we  of  medicine  live  in  glass  houses  ;  and  our 
decisions  are  occasionally  of  the  same  trustworthiness 
as  that  of  the  Beck  case,  even  those  that  are  delivered 
m  our  final  courts  of  appeal.  .  The  value  of  much  of 
our  more  abstruse  and  specialised  scientific  work  has 
lately  been  debated.  As  aiheducational  procedure  it  is 
invaluable  ;  as  a  means  of  examination  of  a  patient  it 
is  also  of  the  greatest  service  ;  but  microscopic  sections 
and  bacterial  growths,,  blood  films  and  cryoscopy  are 
all  liable  to  mistakes  and  fallacies,  just  as  auscultation 
and  percussion  are,  and  the  interpretation  of  results 
is  all  based  upon  experience.  The  laboratory  is  not 
a  final  court  of  appeal,  but  is  simply  a  witness  giving 
evidence,  and  that  evidence  may  be  most  valuable, 
accurate  and  decisive,  or  useless,  faulty,  and  of  no 
moment.  The  responsibility  rests  with  the  prac- 
titioner ;  it  cannot  be  delegated  to  others ;  it  may  be 
shared,  or  refused  altogether  ;  but  it  is  the  ina  ienabie 
duty  of  the  medical  man  in  charge  of  a  case  to  collect 
all  the  evidence  he  can.  and  come  to  a  conclusion 
himself  ;  and  it  is  a  pernicious  doctrine  to  preach  that 
a, man  who  has  never  seen  the  patient  should  diagnose 
the  disease. 

I^eaving,  however,,  these  subjects,  as  they  furnish 
matter  of  daily  debate  and  of  correspondence  in  our 
papers,  and  as  I  have  little  or  no  especial  experience 
or  taste  in  them,  I  turn  to  a  more  personal  choice.  In 
looking  over  my  own  small  contribution  ,  which  I  had 
the  honour  of  making  to  this  or  other  medical  gather- 
ings, or  to  journals,  I  find  there, are  two  classes  of 
disease  which  engaged  attention  somewhat  more, 
perhaps,  than  others.  For  ten  years'!  was  medical 
attendant  at  the  Throne  donsumptiye" Hospital,* and 
I  believe  I  was  the  first  in  Ireland  to  advocate  ahd  to 
adopt  the  present  method  of  treatment.'^!'  viSited 
some  of  the  German  sanatoria  and  described  my  sub- 
sequent experiences  on. more  than  oii^  occasion:  *  But 
since  this  revolution  of  hyper-ai  ration  and  '  hyper- 
alimentation but  little  new  in  principle  hafe  bfeen 
developed.  It  would  be  worse  than  useless  to  reiterate 
the  old  discussions ;  the  trial  has  taken  place,  the 
advocates  have  aired  their  eloquence,  the  judge  has 
summed  up,  and  now  the  jury,  composed  of  thousands 

(a)  O  eniiifr  Address  delivered  before  the  Ulstec  Medical  Society, 


549    T9X  Mbdical  Pskss. 


ORIGINAL    COMMUNICATIONS. 


N6¥.  23,1904. 


of  consumptive  scattered  over  the  realms  of  all  civi- 
lised kingdoms,  are  debating  in  their  own  chests  and 
tissues  whether  the  hygienic  treatment  is  a  beneficent 
angel  or  a  quack,  a  base  fraud  and  deo^ption.  The 
deliberations  of  the  jury  are  not  yet  approaching  an 
end,  and  for  the  next  ten  or  fifteen  years  they  should 
be  left  in  peace.  Some  new  series  of  statistics  or  some, 
paper  embbdying  the  results  of  experience  are  added 
from  time  to  time.  No  final  verdict  can  be  given  yet. 
My  ovm  opinion  is  unchanged.  One  may  not  approve 
of'  all  the  details,  but  the  method  is  an  immense 
advance  to  a  higher,  more  logical,  brighter  and  happier 
life,  not  only  among  the  consumptive,  but  in  every 
path  of  life. 

In  1899,  two  years  before  the  publication  of  Ma^^ 
Robson's  "  Diseases  tyf  the  Stomach  and  their  Surgical 
Treatment,"  I  read  a  short  paper  at  Portsmouth  on 
organic  adhesions  of  the  stomach  as  a  cause  for  some 
forms  of  dyspepsia,  and  recommended  mechanical 
interference.  Since  then,  experience  has  grown  and 
earlier  opinions  have  been  modified.  But  it  is  now  a 
recognised  principle  that  cases  of  chronic  dyspepsia 
showing  signs  of  ulceration,  past  or  present,  of  cica^ 
trisation  and  adhesions,  should  not  be  allowed  to 
starve  into  a  painful,  miserable,  and  too-long-delayed 
death,  but  should  take  their  courage  in  their  hands  and 
risk  the  great  issue  for  the  chance  of  lormerly  undreamt- 
of recovery.  Here  surgery  has  achieved  one  of  its 
most  signa'  victories.  It  is  true  that  the  description 
of  the  old  English  surgeon  is  not  quite  banished  ;  some 
of  the  operations  are  still  *'  terrible  in  the  doing  and 
melancholy  in*  the  event "  ;  but  when  we  consider  the 
hopelessness  of  the  case,  and  the  large  portion  of 
success  that  attends  interference,  we  must  congratulate 
ourselves  on  the  merits  of  the  school  cf  surgery  in  our 
midst,  not  merely  in  abdominal  work,  but  in  the  general 
principles,  iech  iq  e,  of  our  surgery  as  a  whole.  As 
part  of  this  second  point  on  which  I  have  laid  stress, 
both  before  my  fellow  medical  men  and  in  teaching  at 
the  bedside,  I  may  mention  the  constant  connection 
of  chlorosis  and  gastric  ulcer,  so  that  it  has  become  a 
fad  with  me -as  all  somewhat  novel  and  strange  con- 
victions are  politely  termed  by  one's  friends — ^that  the 
so-called  tea-dyspepsias  of  anaemic  girls  are  really  small, 
rapidly  forming,  and  happily  crften  rapidly  healing 
gastric  ulcers ;  and  that  such  ulcers  are  a  local  mani- 
festation of  a  constitutional  affection.  They  are  often 
overlooked,  but  at  times  prove  their  importance  in  an 
unmistakable  manner  and  usurp  the  throne  of  the 
premier  disease.  I  have,  however,  no  new  facts  to  put 
before  you  on  either  of  these  issues.  Besides,  like  the 
consumptive  problem,  the  principle  has  been  affirmed  ; 
we  require  the  experience  of  years  to  mould  it,  so  that 
the  finally  developed  procedure  may  pass  into  the 
accepted  canons  of  our  art. 

I  have  been  endeavouring  to  classify  for  my  own 
edification  diseases  of  the  stomach  other  than  cancer 
and  ulcer,  but  have  found  the  connections  between 
pure  gastric  and  gastro-intestina^-hepatic  affection  so 
close  that  it  is  nearly  impossible  to  draw  a  line  of  de- 
marcation. I  thought,  therefore,  of  abandoning  a 
frontal  attack,  and  approach  n  ^  the  stomach  from  the 
other  or  hepatic  side  before  dealing  further  with  gastric 
or  intestinal  derangements. 

Durin  both  stu  lies  of  phthis's  and  gastric  troulls, 
if  I  may  so  dignify  these  very  incomplete  observations, 
the  groundwork  or  constitut  on  of  a  patient  oc  which 
we,  as  professional  artists,  had  to  work  was  forced 
upon  my  attention  not  once  or  twice,  but  at  every  turn 
and  move.  However,  of  a  man's  inherited  qualities 
the  study  is  entrancing,  but,  as  regards  practical  thera- 
peutics, somewhat  wanting  in  hope.  We  cannot  treat 
a  patient's  grandfather,  although  the  Chinese  may 
ennoble  him,  and  nothing  less  than  the  unremitting 
treatment,  preventive  and  curative,  of  fojar  grand- 
parents and  two  parents  could  remove  the  vice  of 
blood  and  tissue  from  some  patients.  The  effect  by 
his  environment  on  the  other  hand,  is  all  important, 
and  the  effect  of  environment  on  the  problems  of  meta- 
bolism constantly  recur  in  dealing  with  disease  in  the 
province  of  the  physician.     It  is  one  personally  I  have 


been  drawn  closely  to  latterly,  and  I  propose  to  nalEe 
a  somewhat  rapid  survey  of  the  subject  from,  a  cliakal 
aspect. 

Evolution  does  not  give  much  help.  Plants  are  able 
to  form  their  protoplasm  from  the  constituents  of  the 
atmosphere,  or  the  inorganic  matter  of  the  earth.  By 
the  sun's  rajrs  and  their  own  inherent  vital  tv  they 
build  organic  matter  of  high  potential-  eneiigy  fram 
CO^.  ammonia,  nitrates,  and  mineral  salts.  The 
earliest  appear  to  be  sugar  and  starch,  and  by  syntlie» 
tats  and  proteids  follow.  One  need  have  little  doabt 
that  could  the  evolutionary  chemist  of  biology  tathom. 
the  secrets  of  comparative  physiology  he  would  be 
able  to  trace  the  various  stages  of  growth  in  liaes 
radiating  from  the  most  elementary  organic  mdecufe 
in  various  directions  of  vegetable  and  animal  life ;  and 
in  that  radius,  at  the  end  of  which  is  man.  ending  io 
some  mol  cule  more  complicated  than  that  of  tiw- 
proteid  of  haemoglobin. 

In  mental  disease,  help  is  obtained  by  a  study  of 
comparative  mental  physiology,  in  which  we  may 
include  not  only  the  study  of  animal  mind  of  various 
stages  of  evolution,  but  adso  the  growth  of  the  child's 
mind  with  various  stages  of  development.  I  have  no 
doubt  also  that  most  interesting  facts,  important  in 
the  light  they  would  throw  on  the  etiology  and  treat- 
ment, will  be  discovered  in  metabolism.  At  present, 
however,  such  few  details  as  I  have  been  able  to  gieaa 
are  not  of  sufficient  importance  to  warrant  noie  m  de- 
taining you  longer  than  simply  throwing  oat  the  sug- 
gestion. Reversion  to  ancestral  types  may  be  present, 
but  so  far  its  study  is  not  of  practical  importance. 
The  same  may  be  said  of  child  development. 

In  order  to  refresh  our  minds  on  some  points  oi 
elementary  physiology,  I  shall  very  briefly  run  over 
the  accepted  dicta  of  the  changes  which  food  undergoes 
after  the  action  of  the  digestive  juices  has  been 
exercised  upon  them. 

Of  proteid  matter,  the  peptone  formed  in  the  ali- 
mentary canal  is  converted  by  the  agency  of  the 
columnar  epithelial  cells  of  the  mucous  membrane  of 
the  intestine,  back  again  to  some  more  ordinary  fonn. 
of  serum  and  globulin  albumen  ;  for  no  trace  of  peptone 
is  found  in  the  portal  vein,  although  serum  and  globulin 
albumen  is  found  in  excess  during  a  {M-oteid  meal. 
Injection  of  small  quantities  of  peptone  into  the  portal 
vein  gives  rise  to  peptonuria. 

In  the  liver,  no  doubt,  this  albumen  undergoes  some 
further  change,  possibly  some  of  it  is  converted  into 
glycogen,  but  physiologists  are  rather  in  a  fog  in  this 
region,  and  the  intricacy  of  the  subject  is  such  that  the 
most  careful  investigations  and  experiments  fail  to 
allow  more  than  probable  surmises.  It  then  circulates 
through  the  bod^  in  solution  in  the  serum  ;  some  small 
portion  is  assimilated  by  the  fixed  and  floating  cells 
and  tissues,  but  the  great  mass  of  absorbed  albumen 
remains  in  solution,  and  seems  to  act  as  a  source  of 
energy  without  being  taken  up  into  the  tissues  and 
organised.  The  exact  subsequent  changes  form  a  sub- 
ject of  conjecture,  or  perhaps  of  logical  inference,  and 
are  as  mvsterious  as  the  movements  of  the  Japanese 
army  in  Manchuria.  It  were  too  great  a  prerogative 
even  for  the  presidential  chair  to  inflict  upon  you  a 
tithe  of  the  names  assigned  to  analogous  changes  in  the 
test  tube  ;  finally,  however,-  we  meet  with  nrea  at  the 
end  of  these  long  subcuticular  wanderings,  most  pro- 
bably formed  in  the  liver  and  excreted  by  ^le  kidneys. 

Of  the.  carbohydrates,  the  starches  or  pdly-saoclia- 
rides,  and  the  cane-sugars  or  di-saccharides,  are  reduced 
by  the  saliva  and  pancreatic  secretions  to  a  mono- 
saccharide such  as  dextrose.  In  the  columnar  epi- 
thelial cells  of  the  villi,  some  change  comes  over  this 
dextrose,  as  the  carbohydrate  found  in  the  portal  vein 
has  a  lower  cupric  oxide  reducing  power  thaii  dextrose. 
In  the  liver  a  return  to  the  poly-saccharides  is  found  in 
glycogen.  What  happens  next  is  a  matter  of  dispute. 
Pavy  sajrs  sugar  does  not  and  should  not  reach  the 
general  circulation ;  others  say  that  the  glycogen  is 
slowly  given  off  as  some  form  of  sugar,  w^luch  is  used 
up  in  the  fixed  ceHs  and  in  the  lymph  circulation,  and 
disappears  as  water  and  carlxmic  di-oxide. 


Nov. 


23.  1904> 


BRITISH  HEALTH  RESORTS. 


Thb  Mkdical  Prj^s.    541 


Fats  are  rolit  in  the  intestine  into  fatty  acids  and 
glycerine.  The  former  are  reconverted  into  neutral 
lats  by  the  columnar  epithelial  cells  of  the  intestinal 
mucosa  ;  and  these  fats  are  oxidised  in  the  circulation 
into. CO^  and  HO. 

The  principles  of  the  complicated  chemical  changes 
are  not  difficult  to  understand.  On  the  one  hand,  by 
the  agency  of  ferment  the  larger  molecules  of  both 
proteid  and  carbohydrate  are  split  up  into  smaller ;  this 
process  is  accompanied  by  hydration  ;  there  is  a  con- 
version of  a  high  potential  energy  into  a  lower ;  but 
the  molecule  can  now  be  absorbed.  The  process  is 
exemplified  in  albumen  and  peptone,  starch  and 
dextrose,  perhaps  glycogen  and  dextrose,  where  the 
ferment  is  an  internal  secretion  of  the  liver.  On  the 
other  hand,  by  the  agency  of  living  protoplasmic  matter. 
dehydation  takes  place,  there  is  a  combination  of 
molecules,  a  formation  of  a  molecule  of  higher  potential 
energy,  a  synthesis  of  living  matter,  an  absorption  into 
the  living  protoplasm  of  a  ceH.  As  examples  of  this 
synthesis,  we  may  adduce  the  formation  of  fat  from  a 
carbohydrate,  or  of  the  complex  conjugated  proteid  as 
nuclein  from  simple  proteid,  fat.  and  carbohydrate. 
In  the  exercise  of  functions  these  complex  compounds 
are  broken,  and  this  disintegration  is  mostly  a  question 
of  oxidation.  It  is  impossible  to  assign  many  of  these 
substances  to  their  exact 'place  in  the.  circuit  of  meta- 
bolism. Pavy  assigns  a  great  importance  to  the  proto- 
plasmic agency  by  the  intestinal  villi  in  the  conversion 
of  a  dextrose  into  a  high  carbohydrate,  so  that  no  sugar 
should  reach  the  blood  circulation.  In  these  ceils 
he  says  there  is  a  transformation  cf  the  sugar  into  fat. 
a  synthesis  into  proteid  and  a  transmutation  into 
glycogen.  We  can  easily  understand  how  these  deli- 
cate and  complicated  processes  may  be  thrown  out  of 
gear. 

(7*0  be  eonel'udtd.) 

Clinical  Kecorbd. 


A   CASE   OF  OVARIAN   DISEASE   ASSOCIATED 
WITH  UTERINE  FIBROIDS,  (a) 

By  Bedford  Fsnwick.  M.D., 
Phyticfaiii  to  the  Hospital  tor  Wom«o,  8oho  Square. 
The  specimen  which  I  now  show  was  taken  from  a 
patient,  act.  44.  and  unmarried,  who  Was  sent  to  me 
by  Dr.  Richmond,  of  Wimbledon.  Ten  years  ago,  she 
was  told  by  a  well-known  obstetric  physician  that  she 
had  a  fibroid  tumour,  but  it  would  disappear  at  the 
change  of  life.  It  almost  seems  too  much  to  hope  that 
this  antediluvian  superstition  will  ever  Se  decently 
buried,  because  one  is  constantly  meeting,  with  it  in 
the  case  of  patients  with  uterine  fibroids  who  have 
passed  through  years  of  needless  suffering  and  danger 
whilst  waiting  for  a  menopausic  millennium.  For  the 
past  six  months,  the  patient  has  suffered  from  increas- 
mg  pain  in  the  abdomen,  especially  on  the  right  side, 
and  from  increasing  loss  of  flesh  and  strength,  t  per- 
formed abdominal  section  on  October  24tfa,  and  had 
some  difficulty  in  lifting  up  the  mass  as  it  was  com- 
pletely moulded  into  the  shape  of  the  pelvis.  It  was 
also  exercising  considerable  pressure  on,  and  causing 
some  displacement  of.  the  left  side  of  the  bladder.  I 
performed  hysterectomy  in  the  usual  manner,  and  as 
both  ovaries  were  grossly  diseased,  removed  them  with 
the  tumour.  I  then  observed  that  the  left  ureter  was 
greatly  dilated,  bemg  about  three  times  its  normal 
calibre,  evidently  due  to  the  effect  of  compression  on 
the  base  of  the  bladder  by  the  tumour.  I  had  pre- 
dicted this  condition  before  operation,  and  had  the 
urine  measured  carefully  for  a  week  previously,  the 
average  amount  being  only  35  oz.  a  day.  Directly 
after  the  tumour  was  removed,  the  bladder  rapid  y 
filled,  proving  that  there  must  have  been  a  considerable 
collection  of  urine  in  the  ureter  and  calyx  of  the  left 
kidney,  and  after  the  operation  the  average  amount  of 
urine  per  diem  rose  at  once  to  55  oz.  I  feel  confident 
that  sufficient  stress  is  not  laid  upon  the  danger  to  the 

(ai    Rend  at  a  mtetinff    of    the   British    G3 neecologloal 
Society,  Novemter  icth,  3904. 


kidney  caused  by  pressure  on  the  ureter  by  fibroids  of 
the  uterus.  Indeed.  I  regard  this  as  one  of  the  most 
serious  and  insidious  complications  to  which  these 
patients  are  liable.  I  desire  to  call  special  attention 
to  the  gross  disease  in  both  the  ovaries  attached  to  the 
tumour.  The  left  ovary  was  converted  into  a  blood 
cyst  containing  8  oz.  or  9  oz.  of  black  blood.'  The 
right  Ovary  contained  about  4  oz.  of  congealed  t>K)od, 
about  half  its  cavity  being  filled  with  a  dense  nodular 
growth,  which  has  thinned  the  capsiile  at  one  part  to 
a  thickness  of  only  one- tenth  of  an  inch.  The  growth 
cut  like  scirrhus.  and  I  am  indebted  to  Dr.  Aarons  for 
the  sections  which  are  shown  to-night,  and  wnich  prove 
that  the  growth  is  a  fibro-adenoma.  In  the  next  place 
1  wish  to  call  attention  to  the  remarkable  size  of  the 
ovarian  arteries,  which  are  four  or  five  times  their 
normal  calibre.  Dr.  Aarons  has  kindly  also  made 
sections  of  these,  and  it  will  be  observed  that  the 
Middle  coat  of  the  artery  is  greatly  hypertrbphied. 
It  will  be  within  the  memory  of  the  Society  that  a  dis- 
tinguished Fellow,  at  a  meeting  some  two  years  ago, 
showed  a  number  of  microscopic  sections  proving  t£it 
the  uterine  arteries  are  greatly  thickened  in  cases  of 
fibroid  disease  of  the  uterus,  and  that  he  expressed  his 
belief  that  this  condition  was  the  cause  of  the  fibroid 
change.  I  then,  and  have  since,  ventured  to  point  out 
that  tliere  is  rel^son  to  belil^Ve  that  the  increased  hlypcr- 
trophy  of  the  uterine  artenes  is  the  conseqifefnde  and 
not  the  cause  of  the  fibroid  change,  and  precisely  re- 
sembles the  hypertrophy  of  the  muscle  of  the  heart  Or 
of  other  arteries  in  the  body  where  the  circulation  is 
called  upon  to  overcome  an  increased  difficulty  or 
obstruction  to  the  blood  stream.  And  this  cas**,  and 
others  which  I  have  shown,  in  which  the  similar  hyper- 
trophy of  the  ovarian  arteries  occurs,  goes  further  to 
prove  my  argument.  But  there  is  a  practical  point  to 
which  I  have  also  drawn  attention,  and  which  this  case 
strongly  supports :  that  whenever  we  have  fibroid 
t^  ickening  to  any  marked  degree  at  the  fundus  of  the 
uterus — that  is  to  say,  where  the  ovarian  arteries  enter 
the  uterine  tissue — then,  and  then  only,  will  thei^  be 
mrch  obstruction  to  the  fldwthrougn  the  ovarian  ves- 
Sf  Is ;  then,  and  then  only,  do  we  find  hypertrophy  of 
the  muscular  coat  of  the  ovarian  artery ;  and  then,  and 
I  am  inc  ined  to  believe  then  only,  do  we  find  ovarian 
disefise  associated  with  the  presence  of  the  uterine 
growth.  I  would  venture  to  emphasise  these  facts, 
because  they  have  assisted  me  much  in  practice  in  this 
way :  that  when  I  find  the  fundus  fairly  free  from 
fibroid  growths  I  always  leave  the  ovaries  with  an 
easy  conscience,  but  when  there  are  fibroids  on  one  or 
both  sides  cf  the  fundus,  and  considerable  enlargement 
of  the  ovarian  artery,  I  have  always  found  snffideni 
disease  in  one  or  both  ovaries  to  make  it  evidentty 
advisable  that  they  snould  be  removed. 

Xritidb  vealtb  Hesorts. 


[by  our  special  medical  commissioner.] 
XVII.— PENZANCE. 

Cornwall  has  been  described  as  the  foot  of  Engtaadr 
the  Lizard  the  heel,  and  the  Land's  End  the  toe. 
Towards  the  western  portion  of  the  arch  lies  Mount's 
Bay,  and  on  it  Penzance,  which  for  long  has  won  dis- 
tinction as  a  most  desirable  winter  resort  for  invalids, 
and  a  charming  holiday  centre  in  spring  and  during 
early  summer.  It  is  the  metropolis  of  the  western  part 
of  the  Delectable  Duchy,  and  forms  an  admirable  resi- 
dence for  cases  which  require  to  live  an  open-air  life 
during  winter  days,  and  yet  are  reluctant  to  leave  the 
shores  of  the  homeland. 

The  town  is  situated  on  the  side  of  a  decUvity  on  the 
north-west  shore  of  Mount's  Bay.  It  is  sheltered  and 
yet  Ues  open  to  the  exposure  of  the  bay,  and  whfle 
afiording  the  comforts  of  a  land  residence,  provides 
the  advantages  of  a  marine  climate.  Penzance  records 
show  that  it  enjoys  the  highest  mean  annual  tempeira- 
ture  of  any  British  station  on  the  Royal  Meteorological 
Society's  list.  There  is  almost  complete  absence  of 
extremes  of  temperature.     The  decree  of  humidity  is 


542    TttE  Medical  Press. 


TRANSACTIONS    OF   SOCIETIES. 


Nov.  23,  1904- 


comparatively    low,    and    much    sunshine    prevails. 

'  During  the  si<c  months  comprised  in  the  first  and  last 
quarters  of  the  year  it  holds  the  record  for  warmth 

'  in  the  British  Isles. 

Snow  is  seldom  seen,  and  severe  frosts  are  rare. 
Penzance  has  been  well  characterised  as  "  A  Paradise 
for  invalids."  (a)  The  c  im  tological  report  of  Mr.  C.  H. 
Benn,  the  Borough  Meteorologist,  for  1903  {b)  affords 
the  following  data  : — '*  The  mean  temperature  for  the 

'  year  was  52-41*'  F.  The  mean  temperature  for  t  e 
winter  months  was  48*31°  F.  The  winter  mean  range 
was  7*37**.  The  total  sunshine  is  recorded  as  being 
1,752  hours  25  minutes,  a  daily  average  of  4  hours 
48  minutes  and  2  seconds.  The  mean  humidity, j^ 
returned  as  79  per  cent.,  and  the  rainfall  last  year, 
which,  of  course,  was  unusually  heavy,  was  51*11  inches. 
Penzance  may  well  be  selected  as  a  good  winter  home 
for  invalid  and  delicate  cases  who  need  outdoor  lif^ 
a  marine  climate,  and  are  interested  in  artistic  in- 
fluences. Newl}m,  which  is  now  practically  a  suburb 
of  Penzance,  has  given  its  name  to  a  renowned  school 
or  artists. 

Patients,  the  subjects  of  chronic  respiratory  affec- 
tions, find  much  that  is  congenial  and  attractive  in 
this  western  seaside  sation.  Many  tuberculous  cases 
here  weather  the  winter  well.  Renal  cases  are  also 
said  to  gain  benefit.  There  is  difference  of  opinion  as 
to  the  value  of  the  place  in  the  management  of  asthma. 
Some  cases  of  anaemia,  and  not  a  few  cutaneous  dis- 
orders, reap  no  benefit..    For   the  convalescent   and 

'  those  who  are  to  be  considered  vigorous  invaUds,  the 
neighbourhood  of  pQzp^ance  can  offer  much  that, 
is  peculiarly  attractive. 

Thie  Isles  of  Scilly,  w^iich  lie  off  the  Cornish  coast  in 

'  the  Atlantic,  if  it  were  not  for  the  difficulty  of  reaching 
them,  might  form  a  veritable  marine  sanatorium,  (c) 
Penzance  is  321  miles  distant  from  Paddington,  but 
the  enterprise  of  the  Great  Western  Railway  has  ren- 
dered the  journey  easy,  and  the  invalid  cam  now  travel 
in  comparative  luxury  in  seven  hours. 

r. 

lEransactiond  Of  Socfetfee* 

BRITISH    GYNiECOLOGICAL    SOCIETY. 


Meeting  held  November  ioth,  1904. 


Professor  John  W.  Taylor,  M.D.,  F.RC.S.,  Presi- 
dent, in  the  Chair. 


E^CHIBITS.  _ 

.  .DiL  Macnaughton- Jones,  read  the  pathological 
reports  on  two  cases  of  embedded  adnexal  tumours, 
which  had  been  completely  hidden  by  perimetritic 
exudation,  and,  later,  exhibited  with  the  epidiascope 
sections  of  the  tube  illustrative  of  desquamative  sal- 
pingitis. He  raised  the  question  of  the  necessity  of 
hysterectomy  if  the  uterus  were  not  materially 
affected. 

Dr.  R.  H.  Hodgson  asked  whether  he  correctly 
Imderstood  Dr.  Macnaugh ton- Jones  to  attribute  all 
the  pain  in  salpingo-oopheritis  to  peritonitis.     Surely 

'  pain  in  an  ovary  or  tube  did  not  necessarily  imply 

•  the  presence  of  any  peritonitis. 

Dr.   Heyw-)od  Smith  said  that  in  deciding  as  to 

^the  removal  of  the  uterus  in  ovarian  disease  one  had 

to  consider  the  age  of  the '  patient  and  whether  she 

•  was.  or  was  not,  married.  In  his  experience,  the 
removal  of  the  ovaries  alone  did  not  interfere  with 
sexual  appetite,  which,  when  the  uterus  was  also 
taken  away,  was  very  much  deteriorated. 

The  President  concurred  with  Dr.  Macnaughton- 

Jones  that  it  was,  as  a  rule,  an  advantage  to  retain 

.a  uterus    that    was    comparatively  healthy ;    at  the 

1  same  time,  even  in  abdominal  operations,  he  found 

{a  OonsuU  "A  Pictorial  and  Deacriptive  Gaide  to  PeuZAuce," 
published  by  Ward  Lock  and  Co. 

(6|  Thi  *  Annual  Kep  irt  of  the  Medical  Officer  of  Health  (Dr.  B. 
Davey  B  nmq)  to  the  eenaaaoe  Urb  ui  Distri«-t  Couneil.  '    1908 

(c)  See  ••  Lyonease :  a  Uaadbook  for  the  Isles  of  ."^oilly  '  By  J  C 
Tonkiti  and  Prescott  Row.    Pab.i8hed  by  the  Homeland  AasocUtion. 


himself  more  and  more  inclined  to  b^in  by  curetting 
the  uterus  if  he  had  any  reason  to  think  there  vezs 
any  endometritis. 

Dr.  Macnaughton- Jones,  in  reply,  said  that  he 
had  expressed  no  opinion  in  regard  to  the  pain  ;  Dr. 
Cuthbert  Lockyer's  report  did,  towever,  refer  to  the 
considerable  influence  which  contractions  of  the  h>-per- 
trophied  muscular  tissue  of  the  so-called  uterine 
platysma  had  on  the  clinical  aspect  of  snch  cases. 
He  had  been  recently  informed  by  a  patient  from  whom 
he  had  removed  both  ovaries,  and  on  a  subsequent 
occasion  the  uterus  also,  that  her  sexual  appetite 
had  not  been  in  the  least  affected. 

Dr.    Bedford  Fenwick  read  notes  on  a  case  of 

ovarian    disease    associated    with    uterine 

fibroids, 

which   will   be   found   under    the    heading    "  Clinical 

Records,"  upon  page  541,  and  exhibited  specimens. 

The  President  said  that  he  had  occasionally,  but 
only  occasionally,  found  large  blood  cysts  of  the 
ovary  in  association  with  myoma  of  the  uterus,  in 
one  instance  as  large  as  an  ordinary  water  bottle, 
and  in  another  as  large  in  diameter  as  an  adult's 
arm.  and  containing  a  quantity  of  black  blood.  In 
the  cases  he  could  call  to  mind  the  tubes  had  been 
quite  free,  and  it  did  not  seem  that  such  cysts  could 
be  directly  connected  with  menstruation,  or  with 
regurgitation  of  blood  from  the  tubes.  The  patho- 
genesis of  these  cysts  was  very  obscure,  and  he  would 
be  glad  to  hear  if  Dr.  Bedford  Fenwick  had  formulated, 
or  knew  of,  any  theory  about  the  matter. 

Mr.  Christopher  Martin  said  that,  in  his  opinion, 
the  most  urgent  of  all  indications  for  operative  inter- 
ference in  fibroids  was  pelvic  pressure,  especially 
pressure  upon  the  bladder  and  ureters.  But  pressure 
on  the  ureter  in  many  cases  added  enormously  to 
the  risk  of  the  operation,  especially  when  the  tumour 
was  very  adherent  in  the  pelvis.  In  removing  such  a 
tumour  not  long  ago  (a  fibroid  embedded  in  the  pelvis) 
he  found  one  and  a  half  inch  of  the  ureter  lying  in  a 
groove  dt  the  side  of  the  mass  removed.  He  performed 
nephrectomy  on  the  corresponding  side,  but  the 
patient  died  the  next  day  from  shock.  In  regard  to 
Dr.  Fenwick's  theory  of  the  causation  of  ovarian 
disease  by  pressure  of  a  fibroid  on  the  ovarian  artery, 
that  would  not,  he  thought,  justify  the. removal  of 
an  ovary  apparently  healthy  ;  it  was  reasonable  to 
suppose  that  when  the  tumour,  and  the  pressure, 
were  removed  the  circulation  in  the  ovary  would 
become  normal  again.  Except  for  gross  disease,  it 
was  better  not  to  remove  an  ovary. 

Dr.  Fenwick,  in  reply  to  the  President's  question, 
said  that  he  had  looked  up    the  text-books  on  this 
very  point  some  two  or  three  years  ago,  and  had  been 
unable  to  find  any  explanation  given,  and  in  several 
no  mention  was  made  of  the  ovarian  changes  in  fibroid 
disease  of  the  uterus.     The  theory  he  had  ventured 
to  advance  at  this  Society  was,  of  course,  only  a  theory, 
and  nothing  more  ;    but  it  seemed  to  him  to  be  not 
only  plausible,  but  sufficient  to  explain  the  pathology. 
Increased   power  in   the    ovarian    artery,   combinoi 
with  increased  difficulty  in  the  ovarian  circulation  at 
the  uterine  fundus,  must  inevitably  mean  a  constant 
hyper-congestion  of  the  intervening   tissues,   that  is 
to  say,  in  the  ovary  itself  ;  and  the  effect  of  such  con- 
gestion must  be  not  only  the  production  of  inflam- 
matory changes,  but,  in  the  case  of  such  an  organ  as 
the  ovary,  a  greater  Ukelihood  of  cystic  degeneration ; 
and,  given  the  formation  of  a   cyst,    the  greater  pro- 
bability of  rupture  of  a  vessel,  or  of  exudation  of  serum 
into  the  cavity,    of   rapid  increase  in  the  cystic  area ; 
or,   in  other  words,   of   the  production  of  the  very 
condition  shown  in  the  specimen  he  had  just  brought 
before  the  Society,  and  he  would  point  out  that  even 
if  there  was  no  rupture  of  a  blood-vessel,  the  vascu- 
lar changes   would    still  explaiu    the    production  of 
other  forms  of  degeneration  which  are  known  to  be 
associated  with  ovarian  disease. 

Dr.  Hey  wood.  Smith  showed  a  uterus,  containing 
numerous  fibroid  tumours,  one  in  process  of  toughing ; 
the  right   ovary  was  converted    into   a   large  blood 


Nov.  23.  1904. 


TRANSACTIONS  OF  SOCIETIES. 


Th»  Medical  Priss.    543 


Cyst,  the  left,  though  slightly  enlarged,  had  not  been 
removed,  as  the  patient  was  young.  An  interesting 
p>oint  in  the  case  was  that  the  ]>atient's  temperature 
had  been  persistently  subnormal,  and  that,  in  spite 
of  the  sloughing  tumour,  there  had  been  no  symptom 
to  suggest  suppuration. 

Dr.  Hey  WOOD  Smith  also  showed,  for  Dr.  Alexander 
Duke,  a  device  ipr  the  removal  of  wet  wool  from  a 
Playfair's  probe,  often  in  some  hands  a  difficult  pro- 
ceeding. It  consists  of  a  little  metal  frame  with  a 
slot  wider  at  one  end.  The  probe  is  passed  through  the 
wide  end,  and  on  being  pushed  towards  the  narrower 
part,   the  wool  is  then  easily  slipped  ofi. 

Dr.  Bedford  Fen  wick  pointed  out  that  in  Dr. 
Heywood  Smith's  specimen  the  ovarian  artery  was 
greatly  hyper trophied,  being  at  the  point  where  it 
was  divided  nearly  double  the  normal  size. 

The  President  said  that  in  connection  with  the 
interesting  specimen  shown  by  Dr.  Macnaughton-Jones 
at  their  last  meeting  they  had  to  discuss  the  condition 
known  as  haemorrhagic  endometritis. 

Dr.  Macnaughton-Jonbs  said  he  had  brought  the 
specimen  again,  but  had  little  to  add  to  his  remarks 
at  the  last  meeting.  Cases  of  glandular  endometritis 
attended  with  persistently  recurrent  haemorrhage 
might  pass  into  what  was  practically  a  form  of  per- 
nicious anaemia,  in  which  the  condition  of  the  woman 
was  almost  as  bad  as  if  she  were  snfiering  from 
malignant  disease,  and  if  bleeding  recurred  there  was 
no  hope  but  removal  of  the  uterus. 

Mr.  Charles  Ryall  said  that  some  years  ago  he  had 
shown  to  the  Society  two  specimens  removed  by  hyster- 
ectomy, and  his  treatment  met  with  a  good  deal  of  ad- 
verse criticism  at  the  time,  but  in  the  condition  de- 
scribed by  Dr.  Macnaughton-Jones,  extensive  hyper- 
plasia of  the  endometrium  with  increase  of  the  muscular 
aind  fibrous  tissue,  and  general  thickening  of  the  uterine 
wall  and  some  endsurteritis,  the  curette,  though 
repeatedly  resorted  to,  seldom  gave  relief,  inde^, 
generally  made  things  worse ;  and  for  obstinately 
recurring  haemorrhage  in  such  cases,  removal  of  the 
uterus  was  the  best  treatment. 

Dr.  J.J.  Macan  reminded  the  Fellows  that  the' term 
"  haemorrhagic  endometritis  "  was  originally  applied 
by  Slaviansky  some  fifteen  years  ago  to  cases  of  pro- 
fuse uterine  haemorrhage  associated  with  inflammation, 
afiecting  chiefly  the  glandular  elements  of  the  endo- 
metrium, during  an  epidemic  of  cholera.  The  term, 
as  Veit  mentions,  has  been  also  applied  to  uterine 
haemorrhages  occurring  during  the  course  of  the 
exanthemata.  A  report  of  one  such  case  will  be  found 
in  the  number  of  the  Society's  journal  now  in  the 
press. 

Dr.  Macnaughton-Jones,  in  reply,  said  that  he 
could  understand  the  term  haemorrhagic  endometritis 
being  used  in  connection  with  the  exanthemata,  for 
during  eleven  years'  work  in  a  large  fever  hospital 
he  had  seen  many  cases  of  haemorrhage  from  the  uterus, 
but  he  attributed  that  haemorrhage  to  a  change  in 
the  blood  rather  than  to  any  aflection  of  the  uterus. 
The  condition  he  had  brought  under  the  notice  of  the 
'  Society  was  generally  the  result  of  long  pathological 
change,  and  the  question  wais,  not  so  much  the  cause 
of  the  haemorrhage,  as  the  passing  of  some  of  these 
caises  of  glandular  hypertrophy  and  desquamation 
into  a  state  approaching  mailign  adenoma. 

Discussion  on  Mr.  Christopher  Martin's  paper  on  the 
treatment  of  intractable  prolapse  by  extir- 
pation   OF   THE    UTERUS    AND    VAGINA. 

{Vide  ante  MsriCAL  Press  and  Circular, 
October  26th.  1904.  Page  429.) 
Dr.  J.  A.  Mansell  Moullin  saiid  Mr.  Martin  had 
brought  before  the.  Society  a  new  operation  for  the 
treatment  of  this  distressing  condition.  Mr.  Martin 
recognised  the  futility,  or,  at  any  rate,  the  temporary 
nature  of  the  benefit  to  be  derived  from  the  many 
operations  hitherto  devised  for  the  correction  of 
prolapse.  The  operation  now  proposed  did  not  rest 
on  the  cutting  away  and  puncturing  of  tegumentaxy 
structures,  but  on  a  more  soUd  and  scientific  basis, 
namely  the    union  and  reconstruction  of  the  fascia 


to  form  a  pelvic  floor  resembling  that  of  the  male 

pelvis.     It  was  well  known  that  to  repair  a  hernia 

occurring  in   the  cicatrix  of    an  abdominal  incision 

it  was  essential   to  expose  and  unite  the  cut  edge  of. 

the  transversaUs  fascia.     If  this  was  done  eflectually, 

a  good  result,  was  certain,  otherwise,  the  c^ration* 

was  in  vain.     Mr.  Martin  tells  us  that  the  pelvic  fascia, 

which  splits  to  enclose  the  upper  portion  of  the  vagina, 

does  not  itself  become  prolapsed,  but  that  the  ut<*rufr 

and  vagina  are  prolapsed  amd  stretched  away  from. 

it.     When  these  latter  are  removed,  the  cut  margin 

,  of  the  fascia  can  «be  readily  distinguished  and  united 

with  sutures  to  the  opposite  side,  thus  obliterating 

'  the  opening  through  which  the  vagina  passes,  and 

fbrxning  a  continuous  pelvic  floor.    Mr.  Martin  does 

.  not  conceal  the  fact  that  the  operation  is  a  formidable 

one,    and   attended    by   many   risks.     An    improved 

'  technique    may  possibly  enable  us  to  add  it  to  our 

Ytsmedies  for  use  in  severe  cases. 

Dr.  R.  H.  Hodgson,  aiXet  complimenting  Mr.  Martin 
on  the  fraink  way  in  which  he  had  given  the  detaila 
of  his  cases,  said  that  it  was  noticeable  that  the  fever 
and  suppuration  which  in  three  cases  did  not  occnr 
till  after  ten  days,  in  the  fourth  appeared  on  the 
second  day  after  the  operation.  It  seemed,  therefore* 
probable  that  this  fourth  case, was  one  of  infection  >at^ 
the  time  of  operation  ;  the  others,  due  to  some  change 
in  blood  rclots  formed  in  the  wound.  The  great  tendency. 
of  blood-clots  in  the  pelvis  to  undergo  decomposition 
might,  he  suggested,  be  due  to  their  proximity  to 
the  rectum,  and  to  the  difference  between  the  cover- 
ings of  the  intestine  outside  and  within  the  abdominal 
cavity.  He  had  himself  suggested  some  years  aga 
that  prolapse  might  be  remedied,  or  prevented,  by 
amputating  the  uterus  at  the  internal  os,  drawing 
down  the  free  edges  of  the  broad  ligaments  through 
the  cervix,  and  so  making  all  the  parts  taut.  Tl^ 
would  save  the  vagina,  which  it  was  desirable  to  do, 
even  in  a  woman  getting  on  in  years. 

Dr.  Bedford  Fenwicx  said  that  he  considered  the 
Society  owed  a  debt  of  gratitude  to  Mr.  Martin  iqs 
the  excellent  paper  he  had  brought  before  them,  and 
personally  he  much  admired  the  skill  and  courage 
displayed  in  the  operation  Mr.  Martin  had  described^ 
because,  to  anyone  who  was  constantly  accustomed, 
to  operate  on  the  abdomen  or  vagina,  it  needed  no 
words  to  expladn  the  difficulties  of  the  operation  in 
question.  There  were  one  or  two  matters  which  had 
paurticularly  struck  him  in  Mr.  Martin's  description. 
In  the  first  place,  he  could  not  understand  the  special 
advantage  of  removing  the  mucous  membrane  from 
the  anterior  wall  of  the  vagina,  but  as  Mr.  Martin  did 
it,  it  seemed  to.  him  to  explain  all  the  suppuration 
to  which  Mr.  Martin  referred  ;  for  example,  he  appar- 
ently left  an  ^entirely  raw  surface  in  the  canal,  which 
was  closed  by  granulation,  which  involved  the  forma- 
tion of  pus.  If  the  lower  part  oi  the  canal  closed 
fMTst,  as  it  most  probably,  would  do,  then  the  pus  must 
collect  at  the  top  of  the  canal,  and  of  course  the  septic 
conditions  to  which  Mr.  Martin  referred  naturally  fol- 
lowed. Mr.  Martin,  indeed,  seemed  to  have  realised 
this,  because  he  in  each  case  passed  a  pair  of  forceps 
along  the  canal,  liberated  the. accumulated  pus,  and 
the  patient  at  once  recovered.  If  he  (Dr.  Fenwick)  ■ 
were  going  to  perform  this  operation,  he  would  eertainly  ^ 
feel  inclined  to  modify  it,  therefore,  to  the  extent  of 
leaving  the  mucous  membrane  on  the  anterior  wall- 
untouched,  and  thus  saving  what  everyone  would  - 
know  to  be  the  most  difficult  part  of  the  operation.* 
Then  by  stitching  its  edges  together  one  could  reduce 
the  canal  to  the  diameter  of  an  ordinary  pencil,  amd 
in  the  great  majority  of  severe  caises  he  could  not  but 
think  that  colporrhaphy  to  this  extent  would  bo 
sufficient  to  entirely  cure  the  patient.  Moreover,  ■  it 
would  leave  no  suppurating  surface,,  it  would  not 
interfere. with  the  relations  of  the  uterus  and  ovaries, 
but  it  would  to  all  intents  and  purposes  close  the  canal 
into  and  through  which  prolapse  of  the  rectum  or 
bladder  could  occur.  Then,  again,  in  Mr.  Martin's 
operation  he  could  not  but  think  that  there  must  be 
a  great  practiced  difficulty  sometimes  in  finding  the 


544    THE' Medical  Prkss. 


TRANSACTIONS   OF  SOCIETIES. 


Nov.  23.  1904- 


pelvic  fascia,  and  when  it  had  been  found  in  drawing 
It  together  sufficiently  to  close  the  base  of  the  pelvis, 
which,  as  he  understood  the  procedure,  was  the 
actentific  principle  on  which  Mr.  Martin's  operation 
was  founded,  and  which,  as  a  principle,  both  anatomical 
and  pathological,  he  cordially  accepted.  Nature  had 
created  a  wide  separation  between  the  fascia,  and  in  his 
experience  it  was  in  some  cases  not  easily  found.  He, 
therefore,  was  inclined  to  believe  that  cases  might 
occur  in  which  the  edge  of  the  fascia  could  not  be 
defined,  and  others  in  which  it  would  not  be  possible, 
by  anf  permissible  traction,  to  dra¥&  the  edges  of  the 
iiati^*inio9.  sufficiently  accurate  position  to  Obtain 
firm  uhion. 

Dr.  Macnaughton-Jonbs  commented  on  the  faidf 
that  only  on  the  rarest  occasions  was  such  an  operation 
called  for,  as  acknowledged  by  Mr.  Martin  himself.  He 
(Dr.  Macnaughton- Jones)  had  on  three  occasions 
removed  the  uterus  and  then  performed  free  colpof^ 
rhaphv.  In  these  cases  the  bladder  and  bowel  were 
down  m  the  procident  sac.  They  were  all  permanently 
relieved.  It  was  rarely  indeed  where  even  this  step 
was  necessary.  A  Schroeder's  operation,  consisting  of 
colporrhaphy  and  high  amputation  of  the  cervix, 
with  a  deep  perineorrhaphy,  was  sufficient  in  the 
maj^ty  of  instances,  combined,  if  need  be,  with  a 
venlrofixation,  or  better  still,  an  Alexander- Adams 
operation.  So  far  back  as  1889  Professor  A.  Martin 
(now  of  Greifswald)  had  performed  complete  extirpa- 
tion of  the  vagina  and  uterus  for  both  cancer  and 
procidentia.  The  operation  differed  in  the  two  in- 
stancfesl  In  3,000  cases- of  procidentia,  up  to  the  end 
of  <965."Prtyfes80r  Martin  h&d  perfonded  total  extirpa-' 
tion^niJOk^teen  times.  He  removed  the  adnexa  also. 
In  commencing  all  such  operations  a  good  deal  of 
bleeding  might  be  avoided  by  early  ligature  of  the 
vaginal  branches  on  the  utenne  trunks.  The  rarity 
of  the  operation  did  not  detract  from  the  boldness  or 
ingenuity  of  the  procedure. 

t>r.  Jervois  Aarons  said  that  he  was  much  struck 
with  the  ingenuity  of  Mr.  Martin's  operation.  He  had, 
since  the  paper  was  road;  seen  a  case  of  prolapse 
which  recurred  after  hysteropexy,  perineorrhaphy  and 
anterior  and  posterior  colporrhaphy,  and  for  such  a 
ease',  especially  in  a  woman  i^st  the  menopause, 
the  method  promised  relief  otherwise  unattainable.  - 

The  PRESIDENT  said :  I  have  watched  with  very.great 
ifiter^t  the  work  of  my  colleague,  Mr.  Christopher 
Martin,  on  the  extirpation  of  the  uterus  and  vagina  lor 
the  treatment  of  severe  prolapse,  and  can.  from  my 
own  observation,  confirm  a  good  deal  of  what  he  ha£ 
told  us.  But  wnile  I  can  and  do  most  heartily  admire 
the  use  of  thought  and  skill  which  are  united  in  the 
performance  of  this  long  and  difficult  operation  (for 
there  is  one  part  at  least  in  its  performance  when»  if  I 
remember  rightly,  as  the  uterus  is  turned  downwards 
and  backwards,  all  ordinary  relations  are  more  or  less 
reversed,  and  every  attention  and  care  is  necess^^ 
to  understand  as  well  as  to  perform  the  work).  I  am 
not  fully  satisfied  after  all  is  completed  that  the  best 
has  been  done  for  the  x>atient.  The  loss  of  the  vagina 
is  a  serious  loss,  and  wnat  Mr.  Martin  regards,  and 
rightly  regards,  as  the  essential  part  of  the  operation — 
the  rebuilding  up  of  the  stretched  pelvic  fascia-— can  be 
obtained  in  another  way,  I  think,  without  tne  loss  of 
the  whole  vftgina.  If,  sifter  starting  to  repair  a  peri- 
n«eiim  by  Mr.  Tait's  method  oi  flap-splitting,  the  upper 
flap  of  the  posterior  vaginal  wall  be  grasped  by  the  left 
tlmmb  and  forefinger  and  the  scissors  dissection  be 
carried  up  higher  and  higher  between  the  rectum  and 
vapna,  a  plane  is  finally  reached  where  there  is  only 
Che  flimsiest  union  between  the  vagina  and  rectum,  and 
the  finger  can  bluntly  separate  the  two  right  up  to  the 
cervix  if  necessary.  Now.  if  this  be  done,  the  separa- 
tion being  not  only  carried  high  enough  but  extended 
(by  dissection)  freely  on  both  sides,  and  the  long, 
triangular  flap  of  vaginal  membrane  thus  produced 
be  fttUy  excised,  you  find  a  condition  exactly  similar 
to  that  produced  by  Mr.  Martin  in  its  free  exposure  of 
the  pelvic  or  recto-vesical  fascia.  Some  of  this  has 
been  ahready  removed  by  the  removal  of  the  vaginal 


floor  above  it,  and  you  can  see  the  edge  of  the  fascia  as 
a  distinct  structure  on  each  side,  a  divided  membrane, 
which  can  be  still  further  excised  or  united  at  once,  at 
the  discretion  of  the  operator.     It  is  the  repair  and 
firm  suture  of  this,  confining  the  rectum  bgickwards. 
that  is  the  essential  in  the  cure  of  every  reCtocele.  bat 
I  question  whether  it  is  of  much  use  in  the  preventioii 
of  a  cystocele.     Tne  accompanying  cystocele  in  cases 
of   bad   protrusion   needs   separate    treatment.    The 
usual  operation  I  have  done  for  some  years  in  cases  <rf 
severe  prolapse  is,  first,  a  repair  of  the  cystocele  by 
anterior  colporrhaphy,  with  a  buried  tier-snture  of  tlie 
base  of  the  bladder,  so  as  permanently  to  contract  its 
capacity  and  cure  all  anterior  bulging.     The  suture  is 
a  continuous  one  of  the  finest  silk,  carried  from  nrethiat 
orifice  to  cervix,  back  again  from  cervix  to  urethra, 
and  still  back  again  from  urethral  orifice  to  cervix,  en- 
folding more  and  more  of  the  dilated  and  redundant 
bladder,  until  the  base  of  the  bladder  and  anterior 
wall  of  the  vagina  are  perfectly  taut  and  firm.  Here  the 
fascia  is  sometimes  recognisable,  more  often  it  is  not; 
but  the  remains  of  it  are  taken  up  with  the  floir  oi 
the  bladder  in  the  silk  suture.     Tlus  suture  is  IxuiecL 
A  separate  running  silk  suture  unites  the  vaginal  woond 
over  this.     The  uterus  is  then  fully  replaced,  another 
posterior  dissection  between  the  rectum  and  bladder 
carried  out  as  I  have  described.     As  much  of  the  pos- 
terior and  lateral  vaginal  wall  as  is  considered  advisable 
is  then  removed  througn  nearlv  the  whole  length  of 
the  vagina.     Deep  sutures  of  silkworm-got  are  passed 
to  bring  the  raw  surfaces  into  close  apposition,  and  a 
separate  fine  silk  buried  suture  is  oftmi  nsed  for  the 
'  fascia  oiily.     It  may  help  to  explain  my  description  H 
I  show  the  parts  removed  in  a  recent  case,  occurring 
about  two  weeks  ago,  after  the  meeting  is  concluded. 
The  operation  is,  of  course,  a  minor  one.  and  the 
wounds  heal  readily  without  any  suppuration  or  ten- 
perature.     By  this  means  the  vagina  is   contracted 
through  its  whole  length ;    the  recto-vesical  fascia  is 
repaired,  the  bladder  is  kept  up,  but  the  vagina  is  re- 
tamed,  and  no  definite  function  or  organ  is  necessarily 
lost.     I  cannot  say  whether  all  of  the  cases  operated 
on  in  this  way  will  stand  the  test  of  time,  but  so  far  1 
have  not  met  with  any  real  failure.     In  one  respect 
even  as  regards  the  protrusion,  I  am  inclined  to  think 
that  the  method  I  have  described  may  compare  very 
favourably  with  that  of  total  extirpation  of  the  vagina. 
Some  cystocele-bulging  or  impulse  was  present  in  the 
cicatrix  cf  one  of  the  cases  Mr.  Martin  kindly  showed 
me,  and  this,  I  think,  may  be  avoided  by  the  cure  of 
the  cystocele  before  repairing  the  fascia  posteriorly. 
I  should  like  to  suggest  that  even  in  extirpation  of  the 
vagina  it  might  be  advisable  (if  time  permitted)  to 
enfold  and  narrow  the  base  of  the  bladder  by  a  buried 
suture  before  bringing  the  rest  of  the  wound  together. 
I   think  that  the  S<Kiety  is  to  be  congratulated  in 
having  such    an    original    and    bold    innovation   in 
surgery  and  such  a  valuable   and  interesting  paper 
brought  before  it   by  one  of  our  Fellows.     As  your 
President  as  well  as  his  colleague,  in  thanking  him  for 
his  communication,  I  would  Mke  especially  to  notice 
the  fine  and  virile  restraint  which  has  markfd  tm 
practice.    The  treatment  is,  as  he  has  acknowledged, 
a  severe  and  even  dangerous  one.     He  has  used  it  witli 
rare  judgment  and  discretion. 

Mr.  Christopher  Martin,  in  reply,  said:  Firtt 
let  me  thank  the  President  and  members  of  the  Society 
for  the  most  kind  manner  in  which  they  faav^  received 
and  discussed  my  paper.  In  reply  to  Dr.  MasKil 
MouUin,  I  bave  never  found  any  difficulty  in  recog- 
nising the  fascia  and  in  sewing  the  edges  -tijgether.  It 
is  a  very  distinct  arid  definite  layer.  In  re^l/  to  Dr. 
Hodgson,  who  asked  why  the  bloody  effusion  broke 
down  into  i>us.  I  would  point  out  it  was  open  to  two 
sources  of  infection — bacteria  from  the  rectum  and 
bacteria  from  the  ulcerated  cervix  and  vagina.  Di- 
Fenwick  asks  "  Why  not  leave  the  anterior  wall  of  the 
vagma  and  be  content  with  removing  the  posterior 
vaginal  wall  and  sewing  up  the  fascia  ?  "  I  would  point 
out  that  this  would  not  cure  the  cystocele.  Ergot  and 
strychnine  given  with  the  idea  of  reducing  the  siie  of 


Nov.  a3»  1904- 


TRANSACTIONS   OF   SOCIETIES.       Thi  Medical  Pmm$9,    545 


^he  uterus  would,  I  am  sure,  be  perfectly  useless  in 
bad  cases  of  total  prolapse.  Moreover,  most  of  these 
>vomen  are  past  the  menopause.  I  am  interested  to 
learn  from  Dr.  Macnaughton- Jones  that  Professor 
Martin,  of  Berlin,  has  devised  and  carried  out  a  some- 
vrhat  similar  proceeding.  I  appreciate  the  value  of 
the  suggestion  of  Dr.  Micnaughton- Tones  that  the 
uterine  arteries  should  be  ligatured  before  the  vaginal 
mucous  membrane  is  dissected  off.  It  would  no  doubt, 
tend  to  diminish  the  arterial  bleeding.  Hie  most 
troublesome  bleeding  comes  from  the  veins  of  the 
vaginal  plexus,  and  I  do  not  think  that  it  would 
prevent  this.  I  am  very  grateful  to  the  President  for 
his  generous  remarks.  I  am  pleased  to  know  that  he 
agrrees  with  me  in  insisting  on  the  importance  of 
suturing  the  pelvic  fascia  in  operating  for  uterine  pro- 
lapse. In  all  these  cases  of  plastic  operations  it  will 
be  found  tnat  the  more  thoroughly  the  vaginal  mucous 
membrane  is  removed,  and  the  more  completely  the 
pelvic  fascia  is  brought  together,  the  better  will  be 
the  ultimate  result. 

Dr.  Macnaughton- JONBs  read  notes  of  the  condition 
Xuberose  Subchorial  Decidual  Hematoma,  and  touched 
-on  the  etiology  of  the  condition  as  advanced  by  Breus, 
Oo'dspobn.  Newman,  Davidsohn,  and  H.  ^chroeder. 
Fie  showed  with  the  epidiascope  a  specimen  of  Pro- 
fessor H.  Schroeder's  of  this  condition,  whicn  he  (Dr. 
NIacnaughton-Jones)  had  recently  brought  from  Pro- 
fessor Fritsch's  klinik  at  Bonn. 


ROYAL  ACADEMY  OF  MEDICINE  IN   IRELAND. 
Section  of  Mbdicinb. 


Meeting  held  in  the  Royal  College  of  Physicians, 
ON  Friday.  November  iith,  1904. 

The  President,  Dr.  W.  J.  Smyly,  in  the  Chair. 

sporadic  cretinism. 

Dr.  Kirkpatrick  showed  a  child,  aet.  4,  which  at 
the  present  time  weighs  15  lbs.  Two  years  ago  the 
•child  was  under  observation,  and  then  weighed  13  lbs. 
The  child  is  greatly  emaciated  and  shows  little  or  no 
signs  of  intelhgence,  and  has  never  made  any  attempt 
to  speak.  The  skin  is  clear  and  soft,  and  the  hair 
well  grown,  the  characteristic  cretinoid  aspect  being 
completely  absent.  There  is  no  history  of  congenital 
syphilis,  nor  are  there  any  well-marked  signs  of  this 
condition,  and  though  there  are  some  sigiis  of  previously 
existing  rickets,  there  was  no  evidence  of  the  acute 
stage  of  this  disease  while  the  child  was  under  obser- 
vation. No  trace  of  the  thyroid  ^land  can  be  detected 
by  palpation  in  the  neck,  and  dunng  the  last  fortnight, 
while  the  child  has  been  under  thyroid  treatment,  he 
has  shown  some  signs  of  improvement.  Dr.  Kirk- 
patrick was  inclined  to  look  on  the  case  as  a  rathn* 
anomalous  one  of  sporadic  cretinism. 

Dr.  Walter  Smith  asked,  was  the  possibility  of 
rickets  with  hydrocephalus  considered  as  a  diagnosis, 
as  the  symptoms  would  fit  in  with  that  ? 

Dr.  Langford  Symes  said  that  one  or  two  possibili- 
ties occurred  to  him.  First,  rickets.  The  head  was 
typically  rhachitic,  with  large  fontanelles  and  extreme 
bossing.  There  was  also  some  beading  of  the  ribs, 
though  there  was  a  lack  of  the  enormous  beading  one 
would  expect.  Second,  there  was  a  possibihty  of 
some  congenital  syphilis.  The  child's  teeth  were 
strongly  notched.  The  atxlomen  was  peculiar,  being 
a  very  large,  protuberant  one,  and  the  mtestines  were 
apparently  a  good  deal  matted.  The  child  was  also 
suffering  from  great  marasmus.  There  was  serious 
mental  defect,  and  probably  some  hydrocephalus. 

Colonel  McNbece  asked,  was  there  any  history  of 
-consanguinit]^  ?  He  related  a  case  of  two  first  cousins 
having  married,  the  parents  of  one  being  also  first 
•cousins.  The  first  child  presented  exactly  the  same 
appearance  as  Dr.  Kirkpatric  c's  patient.  Twins  were 
afterwards  bom,  one  like  the  first  child,  the  other 
iiealthy.    There  was  no  history  of  syphilis. 

Dr.  Kirkpatrick  said  he  had  thouj^t  of  rickets  and 
hydrocephalus,  but   since  seeing  the  child  first  it  had 


never  shown  signs  of  acute  rickets,  nor  was  there  a 
history  of  any  acute  illness.  The  condition  had  deve- 
l^d  gradually.  Possibly  rickets  might  explain  some 
of  the  symptoms,  but  not  all.  The  child  was  in  fairly 
good  health,  had  no  pain,  lay  quietly  in  bed.  had  no 
fever.  He  could  find  no  symptoms  which  would  de- 
finitely point  to  congenital  syphilis.  There  was  no 
history  of  a  rash,  nor  were  there  any  s  ars  on  the 
body.  The  notching  of  the  teeth  went  for  nothing,  as 
the  typical  syphilitic  teeth  occurred  in  the  secondary 
dentition.  Also  the  child  would  probably  not  have 
remained  in  its  present  condition  for  two  years  without 
improving  or  unim proving.  Ten  days  ago  it  was  put 
oa  thyroid  extract,  and  during  that  period  the  child 
had  shown  signs  of  improvement.  It  had  shown  more 
intelligence,  took  more  interest  in  its  surroundings, 
and  was  more  anxious  for  food. 

Dr.  Travers  Smith  exhibited  the  four  following 
patients  :-^a)  A  girl,  act.  10,  looking  perfectly  healthy, 
with  no  history  or  signs  of  rheumatic  taint.  She  had 
never  complained  of  any  cardiac  symptoms.  A  strik- 
ingly distinct  systolic  thrill  was  felt  all  over  the  prae- 
cordialarea,  most  marked  in  the  region  of  the  pul- 
monary artery.  The  thrill  corresponded  to  an  ex- 
ceedingly loud,  rough  murmur,  most  audible  in  the  pul- 
monary area.  T.ie  right  ventricle  was  slightly  enlarged. 
A  diagnosis  of  some  congenital  defect  of  the  pulmonary 
artery  leading  to  slight  stenosis  was  made  by  Dr. 
Smith,  who  aSso  pointed  out  that,  though  the  cardiac 
lesion  was  unquestionabltr  organic  in  nature,  the 
murmur  was  diminished  by  a  full- inspiration  almost  to 
the  same  degree  as  one  expects  in  the  case  of  the  so- 
called  pulmonary  haemic  murmur,  (b)  A  middle-aged 
woman  with  complete  loss  of  perception  of  tactile, 
thermal,  and  painlul  sensation  in  her  entire  skin.  The 
mucous  membranes  were  not  affected.  The  conditions 
had  existed  for  a  week  or  more.  The  diagnosis  of 
hysteria  was  made.  She  has  since  ^eatly  improved. 
{c)  A  man,  »t.  35.  who  had  been  adxmtted  to  the  Whit- 
worth  Hospital  a  year  previously  suffering  from  left- 
sided  hemiplegia  and  hemianaesthesia.  Thrombosis  of 
the  branch  of  the  middle  cefebral  artery  supplying  the 
right  internal  capsule  was  dia^gnosed,  and  though  a 
history  of  syphilis  was  dented,  this  was  considered  the 
most  likely  cause.  He  left  hospital  after  a  few  weeks 
very  greatly  improved.  He  returned  a  few  weeks  ago 
complaining  of  typical  lightning  pains :  Argyll-Robert- 
son pupils  had  developed,  and  slightly  impaired  sen- 
sation m  the  feet.  The  knee-jerk  on  the  left  side  was 
still  greatly  exaggerated,  and  Babinski's  sign  was  pre- 
sent, whilst  the  right  knee-jerk  was  almost  completely 
lost.  Ataxia  was  doubtful,  even  with  severe  tests. 
Tabes  dorsalis  was  now  diagnosed,  thereby  confirming 
the  suspicion  c^  syphilis.  The  persistence  of  the 
exaggerated  left  knee-jerk  Dr.  Smith  considered  an 
interesting  point  in  the  case,  {d)  An  elderly  woman, 
who  some  months  ago  developed  hemi-athetosis  affect- 
mf^  the  leg,  arm,  lower  part  of  face,  and  tongue  on 
right  side.  There  was  no  history  of  apoplexy.  Dr. 
Travers  Smith  had  observed  her  for  a  fortnight,  and 
came  to  the  conclusion  that  she  was  upidly  becoming 
demented.  He  considered  some  variety  of  cerebral 
softening  to  be  present. 

CAISSON  DISEASE. 

Dr.  J.  B.  Coleman  ^made  a  communication  on  the 
subject  of  caisson  c:isease,  as  experienced  by  workers 
engaged  in  boring  a  tunnel  for  five  miles  beneath  the 
bed  of  Lake  Erie  from  and  after  the  year  1897^  He 
mentioned  the  theories  of  this  disease:  (i)  Emboli  of 
nitrogen  Uberated  from  the  blood  in  consequence  of 
reduced  pressure  and  so  obstructing  the  small  vessels 
and  injuring  the  nerve  elements ;  (2)  the  toxic  effect 
of  oxygen  under  high  pressure ;  (3)  congestion  with 
either  acute  revulsive  anaemia  or  comparative  stasis. 
The  symptoms  came  on  after  rapid  decompr^on  of 
one  to  three  minutes.  From  ten  minutes  to  six  hours 
after  reaching  normal  pressure  the  patient  suffered 
excruciating  pains,  usually  in  his  knees,  sometimes  in 
shoulders  ana  elbows,  rarely  in  his  hips;  maniacal 
attacks  supervened  occasionally;    retention  of  urine 


546    Tm  Medical  Press.         TRANSACTIONS    OF   SOCIETIES. 


Nov:  23=  1904. 


was  common,. and  in  the  severe  attacks  paralysis  oi  the 
sphincter  anii  Paraplegia  occurred  and  lasted  for  a 
few  hours  to  months,  and  in  severe  cases  persisted  with 
the  S3rmptoms  of  spastic  paraplegia ;  transient  facial 
paralysis  was  seen ;  an  rsthesia  extending  up  to  the 
ribs  was  common  ;  an  intense  feeling  of  pruritus  ("  the 
itch  ")  might  occur  without  pains  ;  bleeding  from  nose 
and  ears ;  vertigo,  dimness  of  vision,  hesuiache,  vomit- 
ing, and  muscular  cramps  were  other  symptoms  noted. 
Urgent  attacks  of  dyspnoea  ("  the  chokes  *')  Were  fre- 
quent,, during  which  the  patient  felt  his  lungs  over- 
distended  ;  then  a  cough  was  set  up,  and  large  quan- 
tities of  gas,  seemingly  from  the  stomach,  issued  from 
the  mouth.  Kelief  from  the  joint  pains  and  from  re- 
tention of  urine  was  obtained  by  a  very  hot  bai^; 
After  work  the  men  felt  "  wearied  and  bruised/*  and  on 
returning  to  the  compressed  air  they  be  ame  exhilarated 
and  relieved.  Except  in  the  most  severe  attacks  the 
symptoms  always  abated  on  undergoing  recompression. 
The  highest  pressure  was  46  lbs.  to  the  square  inch. 

Dr.  Walter  Smith  said  the  interest  of  the  disease 
centred  in  its  pathology.  The  first  point  was  the  com- 
paratively moderate  pressure  which  produced  the 
disesLse.  It  was  sometimes  laid  down  that  it  requires  a 
pressure  of  three  atmospheres,  but  this  patient  had 
worked  under .  considerably  less.  The  second  point 
was  the  persistence  of  the  effects ;  this  man  was  re- 
garded as  incurable.  Thus  a  difficulty  was  raised  as 
to  the  mechanical  theory  of  causation.  It  had  been 
proved  by  experiments  on  animals  that  gas  embolism 
could  occur,  but  it  puzzled  him  to  understand  how  a 
mechanical  explanation,  especially  with  a  gas  like 
nitrogen,  could  produce  such  terrible  and  long-abiding 
effects;  There  was,  therefore,  some  other  factor.  A 
direct  myelitis  was  set  up,  and  it  was  possible  that  a 
sudden  mechanical  disturbance  of  the  pressures  might 
cause  not  only  gas  embolism,  but  also  an  ebb  and  flow 
in  the  vascular  condition.  It  must  cause  a  shock  to 
the  nervous  elements,  and  he  did  not  know  what  might 
happen  to  the  protoplasm  of  the  nerve  elements. 
Therefore  he  thought  it  {Mremature  to  suppose  that  the 
symptoms  were  caused  by  gas  embolism  only  It  was 
well  to  examine  the  converse  case,  and  compare  the 
results  of  over-pressure  with  under-pressure,  as  '  in 
balloon  ascents  or  mountain  sickness.  It  was  known 
that  below  a  certain  pressure  a  person  would  die,  owing 
to  diminution  of  the  oxygen  tension  in  the  arterial 
blood.  It  is  not  the  absolute  pressure  of  the  gases,  but 
the  increased  oxygen  tension  that  is  important.  There 
might  also  be  the  direct  irritant  or  toxic  effect  of 
oxygen  gas.  As  to  preventive  measures,  he  thought 
the  method  of  purifymg  air  and  absorbing  COj  by 
sodium  peroxide  should  be  employed,  and  the  patients 
provided  with  it 

Dr.  NiNiAN  Falkiner  asked  if  the  presence  of 
marsh  gas  could  account  for  the  symptoms  ? 

Dr.  Travers  Smith  asked  how  the  purely  mechanical 
theory,  namely,  that  of  gas  embolism,  could  be  reconciled 
with  the  frequent  delay  of  the  onset  of  the  symptoms 
after  the  return  of  the  workers  to  normal  atmospheric 
pressure. 

Dr.  Coleman  said  that  his  patient  got  his  sjnnptoms 
worst  when  going  through  strata  of  marsh  gas,  but  got 
the  "  chokes  "  when  there  was  no  obvious  presence  of 
that  ga  .  In  reference  to  the  comparatively  small  air 
pressure  which  brought  on  the  symptoms,  the  highest 
pressure. the  nntient  worked  under  was  46I  s.,  about 
three  atmospheres.  No  theory  would  satisfactorily 
explain  all-  the  S3rmptoins  of  the  disease,  and  it  was 
not  unlikely  that  two  or  three  conditions  were  neces- 
sary to  bring  it  about.  It  was"  'ikely  that  the 
disease  was  caused  by  gaseous  emboli  of  .  nitroaen 
acting  mechanically,  or  by  oxygen  from  a  direct 
irritant  effect  In  reference  to  therapeutics  he  was 
not  aware  that  peroxide  of  sodi  im  hsul  been  used, 
but  the  method  of  ventilation  was  to  pump  in  large 
quantities  of  fresh  air,  the  air  escaping  from  the  lower 
end  of  the  caisson.  His  patient  found  that  when  the 
symptoms  were  coming  on,  they  were  arrested  if  he 
went  back  into  the  compressed  air.  Medical  locks  were 
in  use  in  well-regulated  works ;  the  men  were  treated 


there,  and  decompression  was  gradually  piodiiccd. 
As  to  the  delay  in  the  onset  of  S3nxiptoins.  in  some  cases 
they  did  not  come  on  for  hours,  though  it  was  Takdy 
that  any  gas  which  was  going  to  escape  from  the  bkrad 
did  SO  almost  inmiediately.  but  the  nuschief  had  already 
been  done  to  the  nerve  elements. 

Dr.  G.  Peacocks  described  two  cases  of 
hodgkin's  disease 
that  occurred  in  twin  boys,  set  4.  One  of  them  had 
died  eighteen  months  after  the  glandular  eolazgeme&t 
first  appeared.  At  the  time  of  his  death  the  glands 
on  the  right  side  of  the  neck  and  a  few  in  the  right 
axilla  were  enlarged.  The  spleen  reached  as  low  as 
the  umbilicus.  The  red  cells  numbmd  1,500.000  per 
cm. ;  hapmiR:lobin.  15  per  cent. ;  wh'te  cells,  8,  00  pa 
cm.;  differential  coimt — lyxnphocytes.  21  percent; 
poljrmorphs,  86  per  cent.  The  other  hoy,  whtm 
illness  dated  from  last  February,  was  still  alive,  aaj 
his  general  condition  satisfactory.  Some  greatly  en- 
larged glands  in  the  left  side  of  his  neck  had  oeen  re- 
moved a  few  weeks  previously.  Microscopic  exami- 
nation showed  the  enlargement  of  the  glands  was  dne 
to  a  general  increase  of  the  cellular  portion  of  the 
glands.  His  spleen  was  not  enlarged  and  a  bk>od 
count  showed  red  cells  4.000.000  per  cm. ;  haemo- 
globin. 85  per  cent. ;  white  ceUs,  8,500  per  cm. 

WEST  LONDON  MEDICO^HIRURGICAL 
SOCIETY. 
Meeting  held  Friday.  Novebcber  4TH,   1904, 

C.  M.  TuKE,  Esq.,  President,  in  the  Chair. 

Clinical  Mebtii>ig. 
'  Dr.  p.  S.  Abraham  showed  (i)  a  case  of  "sclero- 
derma with  bulle  and  ulceration."  occarring  in  a 
woman  aged  55  years.  The  progress  of  this  case 
was  remarkable  and  probably  unique,  as  bnllae.  which 
usually  do  not  occur  in  sclerodeiltiic  integuments, 
formed  about  the  knees  in  this  patient  six  months 
after  the  onset.  (2)  A  remarkable  case  of  "  keloid." 
the  result  of  a  bum  from  a  gun-cotton  explosion  at 
Woolwich  two  years  ago. 

Dr.  A.  E.  Russell  showed  a  case  of  "  tabes  dor- 
salis"  with  gastric  crises  in  a  patient  42  years  old. 
He  evinced  very  typical  symptoms  which  are  of  tiro 
years*  duration,  and  accompanied  by  severe  gastric 
crises,  being  associated  with  troublesome  vomiting, 
which  resist  ordinary  treatment. 

Dr.  A.  E.  Russell  also  exhibited  for  Dr.  A.  P- 
Beddard  (i)  a  case  of  "tremors,"  the  patient  being 
a  man,  27  years  of  age.  who  went  througn  the  siege 
of  Ladyfemith,  where  he  contracted  typhoid  and 
dysentery,  after  which  the  tremors  appeared  at 
irregular  intervals,  involving  chiefly  the  hands,  and 
to  a  less  extent  the  head  and  lower  limbs.  Dr.  Russell 
considered  this  case  to  be  fimctional  in  origin,  there 
being  no  s)nnptoms  of  organic  lesion. 

He  also  exhibited  a  case  of  (2)  "  myositis  ossificans" 
in  a  man  aged  37  years,  which  had  developed  slowly 
since  the  age  of  seven  years.  Bony  growths  are  felt 
m  the  muscular  system  in  innumerable  positions  is 
the  form  of  bony  masses  in  the  tendons  and  insertions 
of  the  muscles,  causing  great  impairment  of  movement 
of  joints,  several  of  which  are  ankylosed.  rendering 
him  quite  nelpiess. 

Mr.  A.  Baldwin  considered  there  was  some  rela- 
tionship between  this  disease  and  pseudo-hypertrophic 
paralysis,  also  naemopbilia.  and  transmitted  throogh 
the  females  to  the  males  of  the  family. 

Dr.  A.  Gaster  related  that  he  had  a  family  under 
his  observation  in  which  the  grandfatner,  fother,  and 
three  sons  had  the  disease,  whereas  the  mother  and 
two  daughters  had  escaped. 

M'-.  ^LETT  Baldwin  showed  a  case  of  "  tabes 
dorsalis  "  with  Charcot's  disease  of  tarsus,  in  a  man. 
set.  34  years.  The  disease  apparently  commenced 
in  1900,  after  a  slight  injury  to  the  feet,  and  since 
which  time  the  enlargement  of.  the  feet  has  slowly 
progressed.  He  could  walk  very  well  until  August, 
1904.  when  the  right  foot  suddenly  commenced  to 


Nov. 


23.  1904. 


FRANCE. 


turn  inwards,  necessitating  the  wearing  of  irons  to 
keep  the  foot  straignt.  He  exhibits  well-marked 
symptoms  of  locomotor  ataxy. 
^  Mr.  G.  A.  Garry  Simpson  showed  (i)  a  case  of 
"  clonic  spasm  of  soft  palate  "  in  an  unmarried  woman, 
aet.  40.  This  affection  arose  about  a  year  ago,  when 
she  received  a  severe  shock  owing  to  the  sudden  death 
of  a  brotner.  The  contractions  of  tne  velum  palati 
are  at  the  rate  of  60  per  minute,  and  are  accompanied 
by  a  clicking  sound  audible  to  the  patient  and  to 
those  arouj&d  ner.  There  is  no  irritation  of  nose  or 
pnarynx  to  be  discovered,  and  the  muscle  principally 
mvolved  is  tne  levator  palati  supplied  by  the  facial 
nerve  ;  (2)  **  pharyncomycosis  leptothricis,"  thd  sub- 
ject being  a  married  woman,  a;t.  27  years,  whose 
attention  was  first  drawn  to  the  disease  by  havine  a 
constant  disagreeable  taste,  and  having  hard,  white, 
chalky  substances  on  tne  tonsils.  Tne  disease  is  associ- 
ated with  the  leptothrix  fungus,  a  specimen  of  which 
Mr.  Garry  Simpson  exhibited  under  the  microscope. 
He  considered  tnat  the  leptothrix  forms  a  nucleus  in 
the  tonsillar  crjrpts  and  accumulates  altered  cells  and 
debris. 

Dr.  Baix  was  of  opinion  that  local  treatment  was 
of  very  little  use,  he  having  tried  all  kinds  of  germicides, 
which  only  led  to  disappointment.  He  considered  the 
leptothrix  as  accidental,  and  not  the  cause  of  the 
disease. 

Dr.  Neville  Wood  asked  whether  the  disease  has 
become  more  common  of  late,  as  recently  he  has  had 
a  number  of  such  cases  under  his  observation. 

Mr.  Cous  Marshall  showed  for  Dr.  K.  P.  Paton 
a  case  of  "misplaced  testicle"  situated  in  the  left 
side  of  tlie  perinxum.  Tne  testis  is  surrounded  by 
a  hydrocele,  with  a  hernia,  probably  sciatic. 

Mr.  Donald  Armour  showed  (i)  a  case  of  "  anky- 
losis of  jaw  "  in  a  girl,  aet.  24  years,  wno  is  one  of  six 
children,  who  are  all  living  and  well.  Her  jaw  has 
been  ankylosed  since,  infancy,  and  the  jaws  cannot  be 
separated.  The  teeth  (two  central  incisors)  have  been 
broken  to  enable  her  to  get  food  into  tne  mouth,  and 
she  masticates  with  the  tongue.  There  is  no  paralysis 
of  the  masseter  or  temporal  muscles.  No  cause  can 
be  attributed  fo-  this  condition,  unless  possibly  a  fall 
downstairs  in  infancy,  which  has  left  a  scar  on  the 
chin.  (2)  "  Parotic  swelling,"  commencing  in  a  man 
ten  weeks  ago.  associated  with  pain  at  base  of  zygoma, 
whicD  was  periodical.  Two  weeks  ago  he  began  to 
have  difficulty  in  opening  the  mouth.  The  swelling 
is  Limited  by  the  paroti  1  fascia,  and  is  slowly  increasing, 
and  the  paroxysm^  of  pain  are  increased  with  a  point 
of  tenderness  over  the  base  of  the  zygoma. 

Dr.  Pardoe  did  not  think  the  swelling  to  be  con- 
nected with  the  temporo-maxiUary  joint,  although 
this  joint  is  specially  liable  to  attacks  of  gonorrhoeal 
synovitis.  He  considered  it  to  be  a  case  of  suppurative 
parotitis. 

Mr.  Baldwin  also  considered  it  to  be  a  case  of 
supp'irative  parotitis,  and  suggested  excision  of  the 
gland  and  examination  of  tne  pus. 

D-.  Armour  a  so  shoved  (3)  "hypertrophic  pul- 
monary osteo-arthropathy "in  a  man  suffering  from 
syphilitic  S3m6vitis  of  knee-joint. 

Dr.  A.  M.  Ross  Sinclair  showed  an  interesting 
and  rare  case  of  "paralysis  of  tne  cranial  nerves," 
in  a  woman  29  years  of  age,  who  first  complained  in 
the  beginning  of  September  of  pain  in  swallowing 
solid  food,  irritable  cough,  and  hoarse  voice,  with 
loss. of  weight.  T.ie  rignt  side  of  tongue,  soft  palate 
and  vocal  cord  on  same  side  were  completely  parsdysed, 
together  with  the  stemo-mastoid  and  trapezius  muscles. 
The  patient's  sensory,  motor,  and  reflex  functions  are 
otherwise  normal.  The  lesion,  he  considered,  was 
probably  due  to  syphilis  contracted  seven  years  ago, 
and  there  is  probably  a  gummatous  thickening  of  the 
membrane  at  the  base  of  the  meduUia.  The  patient 
is  improving  under  specific  treatment. 


The  MedicalPmm.    547 


1904,  Sir  William  Thiselton  Dyer  in  the  Chair.  Sir 
Lauder  Brunton  was  elected  President  of  the  Society, 
and  Dr.  H.  French  Assistant  Secretary.  The  thanks 
of  the  Society  were  given  to  Sir  W.  Thiselton  Dyer 
for  his  services  as  President  of  the  Society  from  its  com-' 
mencement. 

In  response,  he  said  that  under  the  Presidency  of 
Sir  Lauder  Brunton  the  Society  was  certain  to  prosper. 
It  was  then  agreed  that  in  future  candidates  should  be 
elected  by  the  general  meeting  of  the  Society. 

Dr.  Arthur  Harries  then  read  a  paper  on  "  Some 
Applications  of  the  Continuous  Current,"  which  he  said 
might  act  either  mechanico-physically  by  cataphoresis ; 
electro-chemically,  termed  electrolysis;  or  electro- 
pfaftically,  called  catalysis,  and  he  gave  illustrations  of 
Denefits  from  each  of  these  actions  in  cases  of  rachialgia, 
arthritic  and  other  affections,  also  in  cases  of  stricture, 
disease  ot  prostate  and  lupus. 

Dr.  George  Crichton  read  a  paper  on  the  "  Metric 
System  in  Dispensing."  showing  the  great  incon- 
venience of  the  present  system,  which  consists  of 
three  entirely  different  measures — the  pound,  the 
drachm,  and  the  fluid  drachm  and  mimm,  causing 
much  difficulty  in  correlating  these.  In  prescribing, 
the  gramme  is  nearly  one-quarter  of  a  drachm,  and 
one-fifth  of  a  centimetre  is  nearly  three  minims-  Mis- 
takes owing  to  the  wrong  position  of  a  decimal  point 
ought  not  to  occur  if  proper  care  is  use^d  ia  writing 
prescriptions. 

France* 


[from  our  own  corrbspondbnt.] 


TllERAPEUTICAL  SOCIETY. 
At  the  third  annual  meeting  of  this  Society,  held  at 
the  Apothecaries'  Hall.  Blackfriaxs,  on  October  25th, 


Faeis,  Novtmber  SOfeh,  1904. 
A  Sign  of  Phlegmonous  Tonssllftis. 

Professor  Vincent,  of  the  military  hospital  of  Val 
de  Grace,  has  described  a  new  sign  of  quinsy—contrac  ^ 
tion  of  the  pupil  on  the  same  side  as  the  phlegmon. 
The  patient  standing  in  an  average  light,  it  is  easy  to 
observe  the  inequality  of  the  pupils.  It  is  true  that  this 
unilateral  ihyosis  also  accompanies  other  forms  of  sore 
throat,  but  it  is  very  inconstant  and  but  slightly  p^- 
ceptible.  It  is,  on  the  contrary,,  very  frequent  in 
pUegmon  of  the  tonsil,  and  persists  with  the  malady 
even  several  days  after  the  abscess  has  been 
evacuated.  The  explanation  of  this  phenomenon  is 
embarrassing.  The  contraction  is  probaoly  the  result 
of  a  special  reflex,  and  this  reflex  originates  in  the 
velum  of  the  palate,  for  it  appears  only  when  that  region 
is  affected.  According  to  one  authority.  Meckel's 
ganglion  and  the  ophthalmic  ganglion  are,  in  some 
individuals,  in  direct  communication  one  with  another, 
and  that  fact  could  explain  that  a  painful  unilateral 
inflammation  taken  by  the  palatine  nerves  might,  in  a 
reflex  medium  of  which  the  spasmodic  centre  is  Meckel's 
gangUon,  produce  the  contraction  of  the  iris  on  the 
same  side. 

Treatment  of  Burns. 

The  fundamental  division  of  bums  is  .ais  f<^ows  : — 
(I)  The  burn  is  recent ;  (2)  the  burn  has  existed  for 
several  days  and  has  been  modified  by  more  or  less 
prolonged  suppuration.  As  regards  the  former^  the 
accident  has  just  occurred,  and  no  smpUcation  has  yet 
been  made.  What  is  to  be  don^i  ?  The  treatm.ent  will 
differ  according  to  the  gravity  of  the  lesion  and  the 
degree  bf  the  bum. 

If  it  is  a  case  of  the  first  degree  (erythema),  an  ampli- 
cation of  vaseline  and  cociaone  (i-iop),  covered  with  a 
sterilised  compress,  will  De  sufficient  to  relieve  the  pain. 
If  the  burn  be  of  the  second  degree,  if  it  be  accom-. 
panied  by  phlyctena,  these  should  be  scrupulously  rer 
spected.  The  common  practice  of  piercing  the  skin  to 
let  out  the  serosity  should  not  be  followed.  It. is  suffi- 
cient to  cover  the  region  with  a  compress  wet  with  a 
solution  of  picric  acid  (1-106),  and  finally  a  thick  layec 
of  carded  wool  maintained  with  a  bandage. .  This 
dressing  should  not  be  disturbed  for  three  or  lour  days. 
If  the  bullae  are  already  opened  the  treatment  will  be 


54*    The  Medical  Pm«&>. 


GERMANY. 


Nov.  23.  19Q4. 


that  of  the  third  degree,  or  that  of  ulceration,  which 
consists  in  antiseptic  washing  of  the  parts  and  appli- 
cations tendiiig  to  provoke  the  renovation  of  the 
epiderm  s. 

The  antisepsis  of  the  region  consists  in  carefully 
cleansing  the  immediate  healthy  skin  and  the  lesion 
itself.  If  the  patient  is  courageous  enough,  this  opera- 
tion can  be  done  without  anxsthesia.  But  if  the. 
lesions  are  extensive  and  the  patient  cannot  support ' 
the  suffering,  it  is  preferable  to  have  recourse  to  local 
anaesthesia  with  stovaine,  or,  better  still,  to  general 
anxsthesia.  The  bullae  will  be  completely  opened  with 
scissors,  sterilised  in  the  flame,  so  as  to  lay  bare  the 
wound.  The  ulcerations  will  be  carefully  washed  with 
soap  and  warm  water  so  as  not  to  lacerate  the  tissues, 
and  the  soap  removed  by  compresses  of  boiled  water, 
and,  finally,  the  region  will  be  washed  with  ether  and 
alcohol,  ihe  wound  will  then  be  covered  with  a  dress; 
in^  of  picric  acid  solution,  as  in  the  first  case,  and' a 
thick  layer  of  cotton  wool.  The  dressing  will  not  be 
removed  for  four  or  five  days,  when  the  ulcerations  will 
be  generally  cicatrised  or  partly  headed.  Care  must 
be  taken  not  to  take  off  the  dressing  roughly  for  fear 
of  destroying  the  new  skin. 

In  caise  of  extensive  bums,  therapeutics  are  generally 
of  little  avail.  It  is  the  general  condition  of  the  patient 
that  should  be  attended  to.  Warm  baths,  according 
to  the  Hebra  method,  may  be  of  some  use.  Bums  of 
old  standing  are  those  badly  treated  at  the  beginning 
and  arrived  at  the  stage  of  suppuration.  They  aire  no 
longer  bums,  but  ulcers  without  tendency  to  cicatrise. 
The  region  should  be  cairefuUy  cleansed  as  above  a^id 
for  three  or  four  days  oxygen  water  (12  volume^) 
should  be  applied.  In  certain  cases  oxygen  water  is 
ill  tolerated;  it  cam  be  replaced  by  compresses  of 
boiled  water.  After  this  penod  of  wet  dressing,  when 
the  wound  will  have  been  properly  cleaned  and  gramu- 
lations  will  have  begun,  peroxide  of  zinc  (ectogam)  will 
be  applied. 

.  The  wound  generally  heads  very  rapidly  under  this 
treatment. 

Treatment  of  Hydrocele. 

Withdraw  one  or  two  drachms  of  the  liquid  atnd  inject 
hadf  a  Pravaiz  syringe  of  a  solution  of  adrenadin 
(1-1,000).  Repeat  the  operation  eight  days  after.  By 
this  method  a  rapid  cure  is  effected. 

Another  Tuberculosis  Cure  1 

The  explorer,  Dathan  de  Saint-Cyr,  whose  researches 
on  the  cure  of  consumption  by  a  West  Indiain  plant 
have  been  frequently  referred  to,  has  just  plau^  his 
thesis  <m  the  subject  before  the  Paris  Acadjmie  de 
M^decine,  which  will  investigate  the  daiims  makle  for 
the  remedy  by  its  author. 

(Bermani? 

[prom  our  own  correspondent.] 


BUtLm,  No««mlMr  l»»li.  1904. 

At  the  Medical  Society,  Hr.  P.  Maxcuse  showed  a 
boy  suffering  from 

MicuLicz's  Disease. 
so  nauned  from  having  been  first  described  by  that 
surgeon.  The  lachrymad  glands,  as  also  the  whole  of 
the  aadivary  glands  and  those  of  the  heaLft — ^the 
pairotid,  the  submaixiUaurv,  the  sublinguad  and 
Muhn's  glands  —  were  adl  enlarged  amd  formed 
well-defined  rather  soft  tumours,  not  painful,  amd 
easily  movable  under  the  skin.  The  disease  be- 
gBMk  three  months  ago  with  padn  in  the  head  and 
neck,  and  the  day  after  the  lumps  were  felt.  The 
lachrymal  secretions  haul  ceased  entirely,  amd  the 
sadivairy  secretion  almost ;  the  small  quantity  of 
salivaury  secretion  contained  no  cyanide  of  potassium. 
The  urine  was  free  from  sugar,  and  the  blood  wais 
normal.  There  was  not  much  distress.  The  speaiker 
thought  the  cause  was  some  infection.  Therapeuticallv 
potaissium iodide  arsenic, amd massaige had  been  advised. 

Hr.  Westenhoeffer  spoke  on 
Meat  Inspection  with  Regard  to  Tuberculosis. 


He  said  that  in  a  previous  address  he  had  sUted  tia: 
the  flesh  of  tuberculous  aiiimais  cpntauned  no  tabcfde 
bacilli  «xcept  in  the  cases  of  acute  mihauy  tubercakaB. 
and  he  was  now  in  a  position,  ais  a  result  of  his  continiied 
investigations,  to  support  this  view.  He  impfamted 
pieces  of  muscle  from  tuberculous  amimals  into  guinea- 
pigs,  which  were  known  to  be  extremely  susceptibie 
to  tuberculosis,  but  always  with  negative  results.  CM 
seven  cmimads  inoculated  from  awimaU  suffering  h<m 
aumte  miliary  tuoerculbsis  four  only  t>ecame  diseased. 
When  the  direct  implantation  o!  the  flesh  of  tuber- 
culous mimals  into  guinea- pigs  gave  only  a  negative 
restAt,  it  wais  not  to  be  wondered  at  if  feeding  them  with 
suon  flesh  set  up  no  diseaise. 

^®  suggested,  therefore,  that  only  the  flesh  froa 
tuberculous  organs  (bones  and  joints),  as  well  as  the 
flesh  of  animals  suffering  from  acute  miliairy  tuber- 
culosis, or  animals  much  emaciated  from  tuboculob 
need  be  destroyed,  amd  that  the  flesh  of  amimals  sufio- 
ing  from  internal  tuberculosis  wais  fit  for  food.  U 
axillary  glands  or  those  of  the  legs  were  diseased,  the 
whole  of  the  quarter  need  not  be  destroyed. 

According  to  recent  regulations,  meat  from  tk 
country  that  had  undergone  veterinary  inspection  at 
the  plau:e  of  slaughter  did  not  require  further  inspectkt 
before  being  sold  in  the  city.  Independently  of  the 
country  veterinairy  not  being  so  well  skilled  in  meat 
inspection  as  their  speciadist  confrere  in  the  city,  h^ 
wsts  also  to  a  certain  extent  dependent  on  the  persoa 
employing  him,  aiid  he  might,  therefore,  be  not  quite 
so  strict  as  he  should.be.  As  a  matter  of  fact,  i  per 
cent,  of  the  meat  inspected  in  the  city  control  statioos 
that  had  been  killed  in  the  country  had  to  be  rejected. 
Country  slaughterhouses  should  be  in  centrad  localities, 
and  only  fully  paid  inspectors  independent  of  private 
practice  should  be  appointed.  Until  thai  was  dooe 
meat  from  the  country  could  not  be  Deyond  suspickn. 
In  the  Dermatological  Section  of  the  Naturfdrscher- 
versammlung,  Hr.  Strebel  spoke  on  the  use  of 
Cathodal  Rays  as  a  Substitute  for  R6ntgen  am> 
Radium  Rays. 
In  their  auction  the  speaker  said  they  resembled 
radium  rather  tham  X-rays.  In  two  caLses  of  cancer, 
and  vaurious  patches  of  lupns,  ray-emamation  of  eignt  to 
ten  minutes  sufficed  to  cause  moderate  reaiction.  and, 
on  this,  absorption  of  infiltration.  The  advantage  of 
this  process  lay  in  its  oeing  able  to  replace  the  very 
expensive  and'  hardly  procured  radium.  He  then 
described  the  advantages  of  his  photocauistic,  which 
wais  a  useful  complement  to  Finsen  light  treatment, 
one  advantage  being  that  after  cauterising  to  the  third 
degree  the  cutaneous  nerves  were  destroyed,  so  that 
when  the  patient  woke  up  after  the  operation  she  did 
so  free  from  pain.  Photocaustic  could  also  be  em- 
ployed in  the  consulting  room  oy-  making  use  of  a 
cooling  appairatus  that  he  had  devised.  In  three  cases 
of  severe  and  intractable  X-ray  ulcer,  that  had  resisted 
all  treatment  for  a  yeau*  and  longer,  healing  was  Droaght 
about  in  four  or  five  weeks  by  the  use  of  the  photo- 
cautery.  The  glow-light  treatment  in  diseases  of  the 
urethra  was  perfectly  idead  ;  any  staige  of  inflammation 
could  be  set  up  at  will,  from  simple  erythema 
blistering,  and  with  the  certainty  that  after  the  arti- 
ficial inflammatory*  process  haul  subsided  there  would 
be  no  danger  of  subsequent  stricture.  The  pure  light 
reaction  wais  the  3trongest ;  with  later  reaction  the 
rays  must  be  used  longer. 

Mrs.'D.  Lydia  Rabinowitsch,  who.  in  consort  with 
Dr.  Mauc  Kdbh,  had  examined  a  laurge  number  of  birds 
from  the  Zoological  Gau^ens,  spoke  on  _  \ 

Bird  and  Mammalian  Tuberculosis. 
Of  200  birds  of  the  most  varied  kinds,  about  2$  per 
cent,  were  tuberculous.  The  disease  appeared  to  com- 
mence in  the  digestive  organs.  Pulmonakry  tubercoloss 
was  more  frequent  than  it  had  been  understood  to  be. 
The  damger  of  infection  from  bird  to  bird  was  not  great ; 
it  lay  mostly  in  eating  the  excreta  of  diseased  animals. 
or  feeding  on  infected  rats  or  mice.  The  bacilli  of  bird 
tuberculosis  might  invade  inammalia.  MammaKaa 
tuberculosis  was  found  in  two  eagles  :    this  lonn  had 


Nov. 


23.  1904. 


THE    OPERATING    THEATRES. 


Trb  Medical  Pixsi    549 


tiitherto  only  been  met  with  in  parrots.  The  culture 
of  pathogenic  properties  of  bird  and  mammaUan 
tuberculosis  were  different.  Transitions  and  certain 
variations  in  toxic  property  were  observed  in  some 
^strains.  Attempts  to  change  one  kind  into  another  by 
^experiments  on  animals  were  but  rarely  successful. 

BuBtrta* 


[prom  cor  own   CORRBSPONSBlfTj 


Vdbsnva,  November  19th,  1904. 

Orthostatic  Tachycardia. 

At  the  last  Breslau  meeting,  Thomayer  recorded 

"three  cases  of  tachycardia  in  which  the  pulsations  were 

-normal  when  the  patients  lay  down,  bat  immediately 

tlie  body  ¥ras  raised  into  the  normal  attitude  the  tachy- 

•oardia  was  aggravated.     Thb  being  a  rather  unusual 

iform  of  the  morbid  condition,  he  has  desi^ated  it 

orthostatic  tachycardia,  which  depends  for  its  origin 

upon  some  weakness  at  the  bulbar  centre,  producing 

lowering  of  the  arterial  blood-pressure  on  the  vessels 

^when  the  body  is  erect.    He  is  of  opinion  that  t^is 

orthostatic  tachycardia  is  particularly  confined  to  the 

origin  of  the  vagus  in  the  bulbar  centre,  which  is  proved 

"by  intoxicants  acting  on  this  centre. 

In  the  horixootal  position  the  liquor  cerebro-spinalis, 
"Which  seems  to  be  the  exciting  cause,  i»  allowed  to  be 
^nore  distributed,  but  when  the  head  is  raised  the 
-pressure  is  increased  and  produces  the  morbid  symptom. 
In  support  of  this  hypothesis  he  quoted  from  a  number 
of  experiments  p^ormed  on  healthy  persons  where  the 
-palsation  is  greatly  reduced  immediatriy  the  head  is 
-depressed  below  the  pelvis.  In  this  position  the  pul- 
-sation  is  slower  than  in  the  horizontal  and  still  less 
than  in  the  vertical  position. 

Otogenic  Meningitis  with  Recovery. 
At  a  meet^nt^  of  the  Naturiors :her  Fiich^r  re- 
lated the  history  of  a  case  of  meningitis  in  a  young 
man.  set.  19.  The  lUness  commenced  with  great 
pain  in  the  head,  vertigo,  and  loss  of  conscious- 
-ness,  but  no  convulsions  or  vomiting.  On  the  second 
<iay  of  the  disease  the  temperature  rose  to  38*9° 
C.  (102°  F.),  the  pulse  100  with  a  difference  in  ih^ 
size  of  the  pupils,  left  facial  paralysis,  stiffness 
iin  the  neck.  Komig's  symptom,  and  a  very  high  state 
of  hyperaesthesia  in  the  sensory  nerves.  There  was 
also  otitis  with  rupture  of  the  tympanum. 

Puncture  of  the  membranes  of  the  spine  in  the  lumbar 
region  emitted  a  cloudy  cerebro-spinal  fluid  under 
great  tension.  The  fluid  was  rich  in  leucocytes,  but 
no  organisms  could  be  found  either  by  culture  or 
inoculation.  After  this  the  patient  gradually  im- 
proved for  five  da3rs,  when  the  puncture  of  the  lumbar 
region  was  repeated,  by  which  a  clear  fluid  was 
obtained  this  time.  On  the  sixth  day  a  new  com- 
plication appeared  in  the  form  of  typical  croupous 
pneumonia,  which  reached  a  crisis  on  the  tenth  day 
cff  the  disease.  After  this  period  he  gradually  re- 
covered, and  is  now  quite  well. 

Such  prominent  symptoms  could  not  be  explained 
on  any  other  ground  than  a  secondary  meningitis 
from  the  otitis,  and  forcibly  proves  that  all  pustular 
centres  should  be  cleared  out  as  soon  as  possible. 

BLOOD-PiftESSURB. 

Hurtle  gave  a  historical  account  of  tne  experiments 
on.  and  writers  who  have  attempted  to  elucidate,  this 
subject.  Pressure  and  velocity  have'  engaged  the 
attention  of  Volkmann.  Ludwig.  &c.,  who  conducted 
their  exp^iments  with  chronnic  colours,  which  are 
rather  fallacious  as  the  resistance  is  an  uncertain 
factor.  If  velocity,  index  pressure,  and  resistance 
be  represented  by  V.  I  P,  and  R,  the  equation  for 
velocity  would  be  V  =  J  (P  R).  but  as  we  know  so 
little  about  the  resistance  the  blood  meets  with  on  its 
course,  both  internal  and  external,  the  former  depend- 
ing on  the  viscosity  of  the  blood,  the  latter  on  the  dimen- 
sions of  the  vessels.  The  greater  the  viscosity  the 
^eater  the  internal  resistance ;  and  as  the  normal 
blood  of  the  dog  is  four  to  five  times  that  of  distilled 
water  at  the  same   temperature,    by   means  of  this 


value  we  can  arrive  at  the  external  pressure  in  the 
equation  which  may  be  confirmed  by  the  bromtndex. 
Hurtle  gave  a  lew  formulae  from  authors  on  the  subject, 
which  were  quite  erroneous,  and  demonstrated  one 
case  where  he  proves  that  the  velocity  of  the  blood 
in  the  artery  falls  quicker  than  the  pressure. 
Deafness  in  School. 

Konig,  as  medical  officer  of  health  in  Westphalia, 
has  selected  a  particular  small  town  in  his  area  for 
exact  observation,  and  gives  us  the  following: — From 
787  children,  289.  or  367  per  cent., had  normalhearing; 
498.  or  6328  per  cent.,  had  defective  hearing ;  432,  or 
54*8  per  cent.,  being  bilateral.  In  analysing  the  defec- 
tives 9  per  cent  h4d  discharging  ears,  17  per  cent, 
enlargement  of  the  pharyngeal  glands,  14  per  cent. 
enlarged  tonsils,  while  60  per  cent,  suffered  from 
catarrh  of  the  Eustachian  tube  and  middle  ear.  In 
the  whole  school  15  per  cent.'  of  the  boys  would  be 
exempted  from  military  service  owing  to  deafness. 
Only  2^  per  cent,  were  actually  conscious  of  deafness 
or  any  defect  aboat  the  ears.  He  thinks  the  Slate 
should  see  to  the  treatment  of  these  children  as  part 
of  its  duty. 

Eosm  Light  Treatment. 

With  the  advances  of  light  treatment  every  device 
seems  to  be  resorted  to  with  satisfactory  results. 
Pick,  of  Prague,  has  obtained  all  the  beneficial  results 
if  not  better  than  those  accomplished  by  the  R5ntgen 
rays.  The  morbid  part  is  painted  over  with  a  i  per 
cent,  solution  of  eosin  and  then  exposed  to  the  sun's 
rays. 

The  long  series  of  cases  treated  in  this  way  includes 
tivelve  of  lupus,  five  of  trichophitis,  three  of  scrofula 
dermis,  and  one  case  of  tuberculosis  cutis  verrucosa, 
with  ulcus  rodens.  In  the  lupus  cases  the  inflammatory 
appearance  receded  in  a  very  ^ort  time  after  commenc- 
ing the  treatment  and  consequently  the  hypertrophic 
tissue  soon  disappeared.  In  no  cs«e  had  he  yet  met 
with  any  bad  after  effects.  The  trichophyte  cases 
healed  in  a  few  days,  while  the  ulcus  rodens  lingered 
about  a  week  after,  before  perfect  healing  was  accom- 
plished. 


XTbe  ^etattno  XTbeatres. 

LONDON  HOSPITAL. 
Operation  for  Sinus  following  Appendicular 
Abscess. — Mr.  F.  Eve's  patient  was  a  boy,  at.  15. 
who  had  been  operated  on  for  appendicular  abscess  in 
the  country  more  than  a  year  aga  The  sinus  having 
persisted,  he  had  been  operated  on  two  or  three 
times  subsequently.  Mr.  Eve  remarked  that  a  sinus 
following  an  appendicular  abscess  may  be  due,  first, 
to  the  sinus  communicating  with  an  appendix 
which  had  been  perforated,  the  appendix  not  having 
been  destroyed  by  the  abscess ;  secondly,  to  a  faecal 
concretion  which  had  aot  been  removed  when  the 
abscess  was  evacuated  ;  thirdly,  to  a  silk  suture  when 
the  appendix  had  been  removed,  therefore  catgut 
sutures  should  always  be  employed  ;  fourthly,  the. 
abscess  may  have  burst  into  the  caecum  or  other 
part  of  the  bowel;  fifthly,  the  original  disease 
in  the  appendix  may  have  been  tuberculous — a  tuber- 
culous sinus  persisting  after  the  operation  ;  sixthly^  as 
a  rarity  the  original  disease  may  have  been  actino- 
mycosis. It  was  often  stated,  Mr.  Eve  pointed  out, 
that  the  appendix  was  usually  destroyed  or  rendered 
obsolete  in  those  cases  in  which  abscess  farmed*  but 
this  was  by  no  means  always  the  case.  Therefore, 
patients  should  be  warned  that  a  fistula  may  follow 
in  those  instances  in  which  it  has  been  found  impossible 
or  inadvisable  to  remove  the  appendix.  As  regards 
the  operation  itself,  he  said  the  most  important  point 
was  to  open  the  abdomen  sufficiently  freely  by  an 
incision  at  a  distance  from  the  fistula.     If  the  fistula 


550    Th»  Mbpical  Prbss 


THE    OPERATING    THEATRES. 


Nov.  2^.  1904. 


were  laid  open  di-ectly,  the  peritoneal  cavity  might  also 
be  opened  at  the  same  time  and  thus  infected  from  the 
fistula ;  and,  further,  the  bowel  would  'probably  be 
found  adherent  to  the  parietes  and  might  be  injured. 
The  method  of  making  the  incision  at  a  distance  from 
the  fistula  allowed  the  surgeon  also  to  make  a  thorough 
inspection  of  the  interior  of  the  abdomen  and  to  sepa- 
rate adhesions  when  necessary  before  the  sinus  itself 
was  interfered  with.  In  the  case  under  observation  the 
fistula  was  situated  a  little  above  and  internal  to  the 
anterior  superior  spine.  An  incision  was  made  to  the 
inner  side  of  the  fistula  and  an  inch  and  a  half  from  it. 
The  peritoneal  cavity  was  freely  opened,  and  the  krea 
ot  operation  packed  off  with  gauze  from  the  general 
peritoneal  cavity.  The  £stula  was  then  laid  open,  and 
it  was  found  to  terminate  in  the  distal  end  of  an^  tip-. 
peodix  about  an  inch  long,  which  apparently  iiad 
been  separated  from  the  main  body  by  sloughmg. 
The  proximal  part  of  the  appendix  had  apparently 
been  removed  at  a  former  operation,  as  the  stump  was 
found  attached  to  the  caecum.  The  sinus  and  portion 
of  appendix  were  removed.  The  wound  was  then 
thoroughly  cleansed,  the  packing  removed,  a  gauze 
drain  mserted,  and  the  wound  closed. 

ST.  PETER'S  HOSPITAL  FOR  STONE. 
A  Case  of  Complete  Prostatectomy  for  Enlarged 
Prostate. — Mr.  Thomson  Walker  demonstrated,  a 
case  on  which  he  had  performed  complete  prostatec- 
tomy six  weeks  previously.  Before  operation  the  patient, 
act.  66,  had  suffered  from  complete  retention  of  urine 
for  five  years,  and  previous  to  this  from  increasing 
frequency  of  micturition  for  four  yeprs.  During  the 
five  years  previous  to  operation  he  had  passed  his 
catheter  four  times  daily,  but  not  ?t  night.  During 
the  last  month  he  had  frequent  desire  to  micturate  and 
had  passed  his  catheter  about  every  hour  and  had 
caused  bleeding  on  each  occasion.  There  was  recurrent 
left  epididymitis.  His  prostate  per  rectum  was  moder- 
ptely  enlarged,  rather  soft  and  movable.  With  the 
cystoscope  a  well-marked  projection  into  the  bladder 
was  seen.  There  was  slight  cystitis,  but  no  vesical 
stone.  Th?  bladder  was  first  washed  out  until  the 
fluid  became  quite  clear,  it  was  then  distended  with 
twelve  ounces  of  boracic  solution  and  the  coud^e 
catheter  plugged  and  left  in  position.  On  open- 
ing the  bladder  above  the  pubis  at  the  operation, 
a  well  -  marked  collar-like  intra-vesical  projection 
of  the  prostate  was  felt  with  the  left-  forefinger  in 
the  rectum  pushing  the  enlarged  prostate  up- 
wards. The  prostatectomy  was- commenced  by  scraping 
through  the  mucous  membrane  covering  the  most 
prominent  part  of  the  collar ;  the  mucous  membrane 
stripped  off  readily  before  the  finger,  which  was  then 
passed  onwards  between  the  prostate  and  the  vesical 
sphincter ;  the  finger  then  slipped  between  the  fibrous 
sheath  and  the  capsule  of  the  prostate  and 
was  swept  round  the  extra-vesical  part  of  the 
right  lobe;  without  removing  the  finger  from  its 
position  between  prostate  and  sheath  it'  was  swept 
across  the  middle  line,  passing  behind  the  prostatic 
urethra  and  left  lobe  of  the  prostate.  The  enucleation 
was  continued  by  raising  both  lobes  with  the  finger  so 
that  they  were  separated  from  the  sheath  as  far  as  the 
membranous  urethra.  The  prostate  still  remained 
attached  at  the  junction  of  the  prostate  and  membran- 
ous urethra  and  along  the  middle  line  anteriorly.  By 
forcing  the  enlarged  gland  upwards  these  connections 


were  torn  through  and  the  prostate  was  projected  into 
the  bladder  by  the  forefinger.  A  pair  of  sharp  toothed 
forceps  were  introduced  into  the  bladder,  and  grasping 
the  prostate  removed  it  from  the  suprapubic  itoqimL 
The  nozzle  of  an  irrigator  was  then  connected  with  the 
catheter,  which  still  remained  in  position,  and  very  hot 
boracic  lotion  was  introduced  into  the  prostatic  cavity 
and  bladder  and  welled  up  through  the  saprapabic 
wound.  The  lotion  at  first  was  blood-stained,  but  vm 
rapidly  became  quite  clear,  and  there  was  no  fnrtbcr 
bleeding.  A  large  drainage-tube  three-quartersof  an  inch 
in  diameter  with  a  side  opening  near  its  lower  end.  vi» 
then  introduced  into  the  bUdder.  The  Irfadder  im 
again  irrigated  and  the  catheter  removed.  The  rect- 
muscles  were  brought  together  by  a  single  stitch  aid 
two  other  skin  stitches  were  introduced.  There  vas 
no  collapse  after  the  operation,  and  no  further  bleedis|. 
Irrigation  of  tne  bladder  was  conunenced  twenty-lov 
hours  after  the  operation,  the  drainage-tube  bcB| 
washed  out  with  fluid  from  the  irrigator,  but  not 
removed.  In  forty-eight  hours  irrigation  throned  the 
urethra  was  commenced  without  the  aid  of  a  catheter, 
and  was  repeated  daily.  A  little  urine  was  paaed 
along  the  urethra  on  the  twelfth  day  after  the  open- 
tion.  From  the  fourteenth  day  urine  came  regularly 
by  the  urethra  in  increasing  amount..  The  supvapabic 
bladder  wound  closed  on  the  twentieth  day.  and  the 
patient  left  the  hospital  four  weeks  after  the  operatkn. 
He  is  now,  six  weeks  after  the  operation,  in  perfect 
health.  His  stream,  as  was  seen  at  the  demonstration, 
was  powerful,  commenced  at  once,  and  did  not  dribUe 
at  the  end.  He  makes  his  water  three  times  during  the 
day,  and  does  not  rise  at  night  unless  he  drinks  beer* 
after  which  he  gets  up  once.  His  urine  is  still  sUgiitiy 
cloudy.  Examination  of  the  rectum  shews  a  loose 
empty  sac  in  place  of  the  prostate ;  below  this  the 
median  ridge  of  the  membranous  urethra  is  readify 
felt,  at  the  upper  end  of  which  a  small  nodule  the  size 
of  a  split  pea  can  be  detected. 

Mr.  Thomson  Walker's  remarks  on  this  case  win 
appear  in  "  Operating  Theatres  "  of  next  week. 

I 
Trinity  College.  Dublin. 

The  following  have  passed  the  Final  Examination  io 
Medicine — Section  A,  Michaelmas  Term,  1904:— 
Ralph  S.  Oldham,  John  du  P.  Langrishe,  John  C.  P. 
Beatty  ;  Francis  R.  Coppinger,  John  W.  Tomb,  eqnal ; 
Robert  B.  Jackson,  Thomas  O.  Graham,  Thomas  H. 
Peyton,  Francis  O'B.  Ellison,  Thomas  J.  Coboe,  Henry 
D.  Drennan,  Edward  Gibbon,  Michael  P.  Leahy. 
Thomas  L.  de  Courcey ;  Joseph  H.  Elliott,  Dudley  F. 
Torrens,  equal ;  Basil  G.  Brooke,  Daniel  M.  Corbett. 
Reginald  Holmes,  equal ;  John  Murdoch.  James  £. 
M'Farlane,  Ernest  D.  Caddell,  Francis  Casement. 
Joseph  P.  R.  Poch,  George  E.  G.  Vickery,  Joseph  C.  A. 
Kidgway. 

Conjoint  ETanilnatiors  in  Ireland. 
Diploma  in  Public  Health  Exam^ation.  Autumx. 

'  1904. 
C\ndidat£s  have  passed  this  examination  as  under- 
notei  : — Honours. — John  Amallt  Jones,  M.D.Durh. ; 
M.R.C.S.Eng.,  L.R.C.P.Lond.,  L.S.A.Lond.  Passed.— 
Samuel  John  James  Kirby,  L.R.C.P.Ed..  M.R.CS.Eng.. 
L.SA.Lond.  ;  Frederick  Charles  Wilbnot.  L.R.C.P. 
and  S.Ed.;  James  Wood,  M.B.,  Ch.B.  Victoria ; 
Thomas  James  Wright,  L.R.C.P.  and  S.I.,  R.A.Bf.C. 

Boyal  C  lleire  of  Surgeons  «n  Irelaod. 
Dental  Examination. — ^The  following  candidates 
having  passed  the  necessary  examination  have  been 
admitted  Licentiates  in  Dental  Surgery  of  the  College : 
L.  Ellenbogeri,  B.  Jackson,  W.  Matthews,  and  J.  J. 
Murphy.  The  following  candidate  passed  the  primary 
part  of  the  examination  :-^T.  J.  Bradley. 


Nov.  23.  X904« 


GERMANY. 


Th»  Medical  Ps^ss..  ,551 


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XTbe  Aedtcal  ptcss  anb  Circular* 


'  SALUS  POPULI  SUPHEMA  LEX." 


WEDNESDAY.  NOVEMBER  23,  1904, 


SWEDISH    PHYSICAL    CULTURE    AND 
UNQUALIFIED  MEDICAL  PRACTICE. 

The  medical  profession  is  called  upon  yearly  to 
lace  new  forms  of  competition  by  unquali&ed 
persons.  The  evil  has  recently  assumed  a  number 
of  more  or  less  subtle  and  semi-scientific  disguises. 
The  beauty  doctors,  for  instance,  study  medical 
books  on  skin,  hair,  and  minor  surgery  ;  and  they 
proceed  to  deal  forth  the  flimsy  knowledge  thus 
gained  at  exorbitant  rates  to  credulous  clients. 
The  results  are  no  less  disastrous  than  pathetic. 
Highly  skilled  and  honourable  members  of  the 
medical  profession,  who  have  fulfilled  all  the 
terms  demanded  by  the  State,  as  a  condition  of 
legal  qualification,  are  condemned  to  lives  of 
prolonged  struggle,  and  often  of  actual  penury. 
On  the  other  hand,  owing  to  the  defectiveness 
of  the  laws  and  to  the  listless  apathy  of  the  medical 
profession,  the  quack  flourishes  apace,  and  piles 
up  wealth  at  the  expense  of  the  health,  and  .some- 
times of  the  lives,  of  his  victims.  A  Bond  Street 
beauty  doctor,  to  take  a  concrete  instance,  has 
lately  formed  her  business  into  a  large  limited 
company,  with  branches  in  many  parts  of  the 
Kingdom.  In  the  same  street  a  well-known  hair- 
dresser makes  appointments  and  receives  guineas 
for  consultations  upon  the  hair.  One  grave 
aspect  of  the  matter  is  that  these  abuses  show 
no  sign  of  decrease.  The  public  has  not  yet  learned 
to  assess  medical  science  by  its  successes  rather 
than  by  its  failures,  the  latter  of  which  clearly 
open  the  door  to  the  quack.  In  the  matter  of 
electrical  treatment  medicine  has  achieved  great 
strides  within  the  last  few  years.  These  advances, 
among  which  may  be  mentioned  X-ray  therapy, 
electric  batteries  and  the  high-frequency  current, 
have  at  once  been  seized  upon  by  a  horde  of 
unqualified  persons,. who  advertise  widely  as  being 
willing  and  able  to  cure  a  number  of  diseases  at 
various  homes,  institutes    err    private    establish- 


ments. The  General  Medical  CounciT  nsbf esses 
itself  powerless  to  do  anything  towards  stemming 
this  current  of  illegitimate  practice.  That' ^august 
body  does  not  venture  even  to  draw  up  any 
recommendations  or  suggestions  to  the)  Privy 
Council  or  the  Government,  with  a  view  of  defend- 
ing the  interests  of  the  pubUc  no  less  than  of  the 
medical  profession  in  a  matter  vital  to  the  interests 
of  both.  The  British  Medical  Association  has 
made  various  hitherto  futile  efforts  to  promote 
discussion.  The  Colleges  and  other  qualifying 
bodies  make  no  attempt  to  defend  the  professional 
rights  and  interests  of  their  former  pupils.'  Often 
where  a  little  plain  speaking  on  the  part  of  promi- 
nent men  in  the  profession  would  nip  a  threatened 
evil  in  the  bud,  the  words  of  warning  remain  un- 
spoken. In  the  case  of  the  recent  midwives 
legislation,  for  example,  the  united  protest  of  a 
score  of  leading  men  in  the  medical  world  might 
readily  have  saved  the  profession  from  the  in- 
dignity of  being  faced  with  another  set  of  un- 
qualified practitioners,  recognised  and  legalised 
as  they  now  are  by  the  State.  So  far  from  opposing 
the  step,  it  has  been  publicly  upheld  and  sup- 
ported by  various  prominent  consultants  who 
are  obviously  out  of  touch  with  the  thoughts, 
wishes,  and  aspirations  of  the  general  practitioner. 
One  of  the  most  recent  attempts  to  foist  upon  the 
British  public  ia  new  set  of  unt^ualified  competitors 
is  the  proposal  to  found  a  college  for  the  teaching 
of  physical  education  after  the  model  of  the 
Royal  Swedish  Institute  of  Sweden.  The  Bishop 
of  Bristol  presided,  and  the  chief  apostle  and 
advocate  of  the  project  was'  a  Miss  Theodora 
Johnson,  who  presides  over  the  destinies  of  a 
Swedish  Institute  in  Bristol.  The  lady  urged 
that  a  national  college  should  be  estabhsh^d,  with 
a  charter  to  receive  both  men  and  women.  The 
objects  would  be,  as  in  Sweden,  to  license  massage, 
and  to  teach  hygiene  and  physiology.  Sir  William 
Church,  who  was  present,  pointed  out  that,  in  his 
opinion,  the  physical  deterioration  was  due  to 
poverty  rather  than  to  lack  of  knowledge  of  hygiene 
and  systematic  exercise.  Sir  Lauder  Brunton 
received  the  proposal  with  faint  praise.  It  would 
have  been  more  reassuring  to  the  medical  pro- 
fession, and  more  helpful  to  the  public,  had  both 
these  gentlemen  condemned  the  proposal  in  the 
unsparing  fashion  it  deserves.  If  they  care  to 
inquire  into  what  is  going  on  at  their  doors, 
they  will  find  that  Swedish  massage  practitioners 
are  quartered  in  some  of  the  best  streets  of  the 
West  End  of  London,  where  they  are  carrying  on 
a  flourishing  practice.  Now  or  never  is  the  time 
to  settle  whether  this  new  race  of  unqualified  com- 
petitors is  to  invade  our  towns.  To  a  great 
extent  this  question  could  be  disposed  of  by  the 
medical  profession,  were  it  able  to  speak  out 
with  clear  and  united  voice.  Meanwhile  we 
devoutly  hope  and  trust  that  medicsil  men  of  all 
ranks  will  henceforth  decline  to.  have  anything 
to  do  with  this  unclean  thing,  now  that  its  real 
nature  has  been  .clearly  and  emphatically  stated 
in  the  columns  of  a  medical  journal.- 


552      TbX  MSDlCiM,  PRX8t. 


LEADING  ARTICLES. 


^ov.  23.  1904 


SUTURE  OF  THE  HEART. 

It  i3  less  than  nine  years  since  the  first  recorded 
attempt  was  made  to  treat  a  wound  of  the  heart 
by   suture.    Though    unsuccessful,    its    example 
was  soon  followed,  and  the  general  result  has  been 
so  good  that  it  is  now  regarded  as  the  duty  of  a 
surgeon,  when  called  to  attend  a  patient  with  a 
wounded  heart,  at  once  to  cut  down  and  attempt 
to  su':i:re.  There  are,  in  fact,  at  present  sixty  cases 
of  this  sort  on  record,  with  no  less  than  twenty- 
three   recoveries.  "  This  gives  a  recovery-rate  of 
38  per  cent.,  instead  of  a  rate,  in  cases  where 
suture  was  not  performed,  certainly  not  exceeding 
10  per  cent.    The  great  majority  of  the  wounds 
treated  were   caused   by   stabbing,   but   of   five 
gunshot  wounds  of  the  heart  two  have  recovei'ed. 
The  usual  method  of  exposing  the  heart  is  to  cut 
through  two  or  three  ribs  some  inches  from  the 
sternum,  and  bend  the  fiap  thus  formed  to  the 
right,  fracturing  the  cartilages  dose  to  the  sternum. 
The  pericardium  is  then  opened,  and  the  heart 
steadied  with  the  left  hand  while  the  stitches  are 
inserted.  If  necessary  to  check  bleeding,  the  httle 
finger  may  be  thrust  into  the  heart  wound  during 
the   passage   of    the   needle.      It  was    formerly 
held  that  the  stitches  should  only  be  inserted 
during  diastole,  but  recent  operators  think  this  an 
unnecessary  precaution,   and,  indeed,   often  the 
pulsations  of  the  heart  are  so  irregular  as  to  render 
the  distinction  of  diastole  and  systole  impossible. 
It  is  advised,  too,  that  cessation  of  the  heart's 
movements  should  not  interrupt  the  insertion  of 
the  sutures.     With  a  quiescent  heart,  the  work 
can  be  concluded  in'  a  short  time,  and  a  little 
rhythmical   manipulation  will   then   probably  be 
sufficient  to  restore  the  cardiac  movements.     An 
interesting  question  arises  as  to  the  advisability 
or  otherwise  of  taking  elaborate  antiseptic  pre- 
cautions.    It  is  obvious,  on  the  one  hand,  that 
time  may  be  a  matter  of  urgency,  and  that  no 
unnecessary  delay  is  to  be  made  before  reaching 
the  injured  organ.    On  the  other,  it  is  of  the  ut- 
most importance  that  the  parts  should  not  be  ex- 
posed to  septic  infection.     In  one  unsuccessful 
case  recorded  by  Dr.  J .  H.  Gibbon,  of  Philadelphia, 
he  believed  his  failure  was  due  to  the  delay  entaHed 
in  cleansing  the  seat  of  operation.     He  ooncRides 
that  with  patients  who  are  in  imminent  danger  it 
is  wise  to  expose  and  repair  the  heart  with  the 
least  possible  delay,  while  with  others  who  have 
lived  some  hours  after  the  injury,  or  in  whom 
symptoms  are  not  so  urgent,  time  should  be  taken 
to  practise  precise  antiseptic  precautions.     In  the 
great  majority  of  cases  recorded  the  ventricle — 
left  or  right — ^was  the  part  wounded.     Curiously, 
considering  its  relation  to  the  chest-wall,  the  left 
ventricle  suffered  more  frequently  than  the  right. 
Only  two  cases  of  wound  of  the  aurides  are  men- 
tioned, and  in  each  case  a  fatal  result  followed. 
Considering  the  previous  mortality  of  wounds  of 
the  heart,  the  results  of  surgical  interference  are 
very  encouraging,  and  the  improvement  in  surgical 
technique  which  is  sure  to  follow  increased  prac- 
tice  should  give   still    better  prognosis    in   this 

serious  condition  in  the  future. 


SANITATION  AND  ART. 
When  the  history  of  the  nineteenth  century 
comes  to  be  written,  not  the  least  striking  amoog 
the  many  notaUe  features  to  be  recorded  will  be 
the  development  of  the  science  of  .hygiene  that 
characterised  the  latter  half  of  its  coarse.    Beioce 
the  PubUc  Health  Act  of  1848  hygie&e  as  a  recog- 
nised communal  obligation  could  hardly  be  said 
to  exist,  the  previous  enactments  having  beea 
generally  conceived  in  haste  to  meet  exigencies, 
and  more  honoured  in  the  breach  than  in  the  ob- 
servance   when    those    exigencies    had    passed. 
Certain  glaring  nuisances  were  provided  for  br 
legislation  of  one  kind  and  another,  but  no  cqe- 
sistent,  enlightened,  or  far-seeing  body  of  r^nla- 
tions,  or  provisions  against  the  evils  of  human 
^aggregation,  were  in  force.     Even  to-day  sanHazr 
science  is  only  in  an  embryonic  condition,  caosisX' 
ing,  as  it  does,  chiefly  of  a  patch-work  of  tit-bm 
from  other  sciences  and  a  number  of  still  empirical 
deductions  made  from  them.     Still,  it  has  already 
definite  results,  and  unquestionably  hygiene  has 
come,  not  only  to  stay,  but  to  make  itself  of  tar 
more  weight  in  the  community.     Till   now  the 
sanitarian  has  been  looked  upon  l»y  the  majority 
of  people  as  rather  a  bore,  and  as  his  teachings 
and  advice  run  counter  to  many  cherished  tradi- 
tions and  privileged  prejudices,  it  can  hardly  be  a 
matter  for  wonder  that   public    appreciation  of 
sanitary  science  has  not  been  of  a  very  enthusias- 
tic character.     The  knighthood  just  conferred  ob 
the  London  County  Council's  Medical  O&ca  of 
Health  may  perhaps  be  taken  as  a  presage  that  is 
future  the  man  who  lives  to  save  lives  and  preserve 
health  will  be  considered  as  worthy  a  candidate 
for  public  reward  as  is  the  man  who  kills  the  most 
of  the  country's  enemies,  or  he  who  brews  the  most 
beer.     In  spite  of  its  many  benefits  to  society, 
however,  hygiene  is  still  unpopular,  and  till  that 
unpopularity  has  worn  off  it  will  be  difficult  or 
impossible   to   establish   those    conditions    under 
which  people  may  live  together  comfortably  and 
happily  without  "being  a  source  of  danger  to  their 
neighbours,  or  themselves  subject  to  many  kinds 
of  preventable  dangers.     It  has   been  said  that 
care  for  sanitation  is  the  last  teaching  that  reaches 
the  civilised,  and  if  this  be  so,  the  sanitary  arrange- 
ments and  institutions  of  a  nation  may  be  taken 
as  a  gauge  of  its  general   advancement  in  the 
comity  of  nations.     But  there  is  another  teachini;  ' 
that  comes  late  in  a  nation's  life,  and  that  can  be 
of  inestimable  service  to  sanitation  if  sympathe- 
tically allied  with  it — we  mean  art.     Art  can  only 
be  developed  when  the  more  immediate  necessities 
of  existence  have  been  supplied  and  a  margin  of 
the  nation's  resources  can  be  diverted  from  the 
more  pressing  business  of  fighting  enemies  and 
obtaining  food,  and  though  the  British  people  are 
not  in  themselves   an  especially  artistically  dis- 
posed people,  they  have  already  evolved  a  more 
than  creditable  school  of  native  art,  and  are  more 
or  less  capable  of  being  influenced  by  it.    The 
failure   of   sanitation   to   take    hold    of   people's 
imaginations  and  enlist  their  sympathies  has  been 


Nov,  23,  i^. 


NOTE?   ON   CURI^NT   TOPICS. 


THg  Mbpical  PMtss.   553 


<iue   to  the  facts  that  its  teachings  have  been 
formal,  and  its  influence  has  been  for  ugliness. 
X3oubtless  it  is  difficult  to  a  new  science  which  is 
ossentially   utilitarian    in   its    object    to    appear 
x-eady-garbed  in  attractive  guise,  but  we  feel  sure 
t:hat  while  yielding  nothing  in  principle,  hygiene 
^would  be  made  far  more  acceptable  if  it  came  linked 
^with  art.    The  civilising  influence  of  sanitation, 
"too,  would  be  greater,  and  art  loses  nothing  in 
dignity  by  being  useful.     In  matters  of  dress  the 
olothing  best  adapted  to  the  phjrsiological  require- 
ments of  the  body  is  generally  objected  to  by  people 
"to  whom  it  is  recommended,  because  it  is  not 
Isecoming,  and  not  unnaturally  the  owner  of  a 
p>retty  house  resents  having  its  lines  broken  and  its 
skppearance   spoiled    by    outside   soil-pipes — even 
t)y  the  most  irreproachable  plumber.     Waterworks 
spK>il  many  a  rural  scene  ;    vfentilating-shafts  der 
face  the  finest  streets,  and  rooms  without  carpets, 
curtains  and  pictures  are  cold  and  unattractive. 
^What  is  first  needed  is  a  standard  of  taste  and 
artistic  perception  in  sanitarians,  so  that   their 
creditable  enthusiasm  for  the  cause  they  have  at 
heart  may  have  increased  enthusiasm  with  their 
fellows,  and  what  is  secondly  needed  is  some  artist 
who  can  do  for  sanitation  what  Morris  did  for 
house    decoration.     That    sanitation    should    be 
synonjrmous  with  ugliness  to  the  pubUc  mind  is 
a  vast  pity,  and  we  venture  to  think  that  the  an- 
tagonism is  more  plausible  than  real.     The  truth 
would  seem  to  be  that  sanitarians  have  been  bent 
on  producing  a  standard  of  scientific  and  practical 
excellence  in  the  articles   and  institutions  with 
which  hygiene  concerns  itself,  and  that  they  have 
not  yet  had  time  to  introduce  the  element  of  ele- 
gance   and    refinement    into    their    construction. 
The  public,  on  the  other  hand,  have  already  had 
their  eye  trained  to  look  for  beauty  in  the  objects 
that  surround  them,  and  objects  like  drain-pipes, 
that  have  no  pretence  to  beauty,  repel  and  dis- 
appoint them.    Now,  it  is  well  recognised  that  art 
that  is  developed  merely  in  response  to  the  de- 
mands of  commerce  and  manufacture  never  can 
secure  the  same  height  of  greatness  and  originality 
as  if  left  untrammelled  by  such  consideration^, 
but,  on  the  other  hand,  it  can  be  very  usefully  em- 
ployed as  an  auxiliary  in  the  sterner  aspects  of  life 
when  it  has,  independently  and  for  its  own  sake, 
already  reached  the  standard  it  has  attained  in 
England  to-day.    There  are  plenty  of  artists  and 
plenty  of  sanitarians  ;    the  two  only  n^d  take 
counsel   together,    and    sanitation    may    become 
as  popular  as  Bridge,  and  eventually  even  find 
itself  in  a  position  to."  snatch  a  grace  beyond 
the  reach  ol  art."     For  the  present  \^e  should  be 
satisfied   if   it  were  able  to  snatch  some   of  the 
graces  within  its  reach. 

flotes  on  Cnrtent  TEopfcs* 

Insects  as  Plaffue-Carriers. 
The  discoveries  of  Manson  and  Ross  with  regard 
to  the  rSle  of  mosquitoes  in  disseminating  malaria 
and  filaria  opened  up  a  line  of  research  in  the  pro- 
pagation of  disease  that  had  up  to  that  time  been 


almost  unthought  of.  Their  brilliant  results  have 
encouraged  a  host  of  workers  all  over  the  world 
and  it  is  possible  that  top  much  may  be  now  attri- 
buted to  insects  and  too  little  to  other  agencies 
unless  absolute  and  demonstrative  proof  is  de- 
manded in  every  case  of  putative  transmission- 
For  instance,  it  has  been  somew;hat  hastily  as- 
sumed that  as  the  rat  is  known  to  suffer  from 
plague,  and  is  also  known  to  be  infested  with  fleas, 
these  fleas  are  very  likely  the  mediate  agents  of 
plague- transference  from  rat  to  man.  A  paper 
vfas  ^T<^a.d  at  the  September  meeting  of  the  Manilla 
Medical  Society  by  Maximillian  Herzdg,  of  the 
Government  Laboratory  in  the  Philippines  relating 
the  .results  of  his  attempts  to  fix  the  responsibility 
of  these  insects  in  the  matter.  His  first  experi- 
ments were  directed  to  ascertaining  whether 
fleas  from  rats  would  bite  man,  and  after  a  hun- 
dred attempts  to  induce  them  to  feed  on  his  own 
hand  he  came  to  the  conclusion  that  the  fleas  that 
live  on  rats  in  Manilla  will  not  bite  man.  Then 
he  tried  to  see  if  fleas  fed  on  plague-infected  rats 
would  infect  guinea-pigs  with  the  disease.  The 
guinea-pig  had  part  of  their  backs  shaved  and 
infected  fleas  applied,  but  in  no  case  could  he  ob- 
tain transmission  of  plague  by  this  means .  Herzog 
next  endeavoured  to  discover  if  head-lice  could 
act  as  carriers  of  contagion,  and  finding  some 
alive  on  a  plague  patient  who  had  died,  he  was 
able,  by  grinding  them  up  and  inoculating  broth 
tubes  with  the  resulting  mass,  to  isolate  plague 
bacilli  in  pure  culture  from  the  culture  that  ensued. 
His  final  opinion  was  that  fleas  were  only  re- 
motely responsible  for  transmitting  plague,  if 
they  were  responsible  at  all.  There  appears, 
however,  to  be  more  than  one  variety  of  rat-flea> 
and  some  of  the  rarer  kinds  do  bite  man,  but,  on. 
the  whole,  it  must  be  conceded  that  work  such  as. 
that  of  Herzog  suggests  a  possible  doubt  as  to 
whether  some  tropical  enthusiasts  may  not  have 
been  somewhat  inclined  to  jump  at  conclusions, 
instead  of  laboriously  verifying  every  step 
on  the  way.  At  the  same  time  it  is  only  right 
to  add  that  the^  earlier  experiments  on  the  infection 
of  healthy  rats  from  their  plague-infected  fellows 
in  adjoining  cages  appeared  convincing  as  to  the 
agency  of  fleas  as  carriers,  to  say  nothing  of  the 
cases  in  which  jcoolies  contracted  the  plague  from 
handling  dead  rats.  Fortunately,  in  any  case,, 
prevention  consists  in  killing  the  rats  which  act 
as  hosts  alike  to  fleas  and  to  lice. 


Vitality  of  Gtorms  in  Water, 
While  it  has  long  been  known  that  water^ 
even  apparently  pure,  may  act  as  the  carrier  of 
disease  germs,  it  has  generally  been  thought  that 
their  vitality  gradually  decreased  with  time^ 
and  consequently  that  the  danger  from  an  infected 
water  was  merely  temporary  in  character.  It 
was  stated  that  though  pathogenic  germs  con- 
tinned  to  live  for  a  short  time  in  pure  water,  yet 
they  tended  to  multiply  but  little,  if  at  all.  Many 
observations  had  been  made  which  seemed  to  give 
a  solid  basis  to  this  belief.     For  instance,  Bolton 


554    The  Medical  Puss. 


NOTES  ON  CURRENT  TOPICS. 


-Nov.  23.  1904- 


was  led  to  conclude  that  the  typhoid  bacillus 
requires  a  considerable  quantity  of  nitrogenous 
material  to  render  water  habitable,  and  that  in 
ordinary  tap  water  its  limit  of  life  is  about  seven 
da3rs.  In  investigations  by  Karlinsky  on  the 
anthrax  bacillus  and  the  cholera  vibrio  very  similar 
conclusions  were  reached.  While  some  observers 
maintained  that  the  lack  of  nutriment  was  the 
principal  cause  of  the  disappearance  of  pathogenic 
bacteria,  others  thought  that  they  succumbed  in 
the  struggle  with  the  more  hardy  non -pathogenic 
organisms.  Recent  experiments  by  Kbnfadi 
seem  to  show,  however,  that  in  regard  to  these 
points  current  opinion  is  in  the  wrong.  He  has 
found  that  instead  of  djring  out  in  tap  water, 
certain  pathogenic  bacteria — ^typhoid  bacillus, 
anthrax,  bacillus,  and  staphylococcus  aureus — 
live  for  a  long  time,  finally  killing  out  all  the 
ordinary  water  organisms.  Thus,  in  the  case  of 
typhoid  bacillus,  a  pure  culture  resulted  in  about 
two  months,  of  anthrax  in  half  that  time.  The 
t3rphoid  bacillus  lived  in  tap  water  at  room  tem- 
perature for  499  days.  The  practical  lesson  to  be 
learnt  from  Konradi's  experiments  is  that  when 
water  is  once  infected  it  retains  its  dangerous 
properties  for  much  longer  than  has  hitherto 
been  supposed. 


Chemists  and  Prescribinff. 

The  attitude  of  the  best  class  of  chemists 
towards  the  question  of  "  counter-prescribing " 
is  always  more  or  less  apologetic.  It  is  admitted 
that  prescribing  does  not  fall  within  the. legitimate 
sphere  of  work  of  the'dAemist,  but  there  generally 
goes  with  this  admission  an  attempt  to  show  that 
there  is  a  certain  amount  of  unavoidable  prescrib- 
ing which  falls  into  a  chemist's  business,  and  is 
said  to  be  beneficial  to  the  public.  Some  of  the 
arguments  brought  forward  by  Mr.  F.  Trumaii, 
in  a  paper  read  recently  to  his  fellow-chemists  at 
Richmond  in  support  of  this  thesis,  strike  us  as 
worthy  of  comment.  In  minor  ailments  he  thinks 
it  is  not  only  necessary  for  the  business  of  the 
chemist,  but  for  the  good  of  the  public,  that  the 
chemist  should  be  able  to  prescnbe  suitable  re- 
medies. Curiously  enough,  he  instances  warts 
as  one  of  these  minor  ailments  which  nattirally 
fall  to  the  chemist  for  treatment.  This  is  rather  an 
unfortunate  example,  for  in  the  very  same  number 
of  our  contemporary  (a)  in  which  we  read  Mr. 
Truman's  remarks,  we  find  a  report  of  an  action 
against  a  chemist  for  injuries  to  a  boy's  hand  by 
treating  it  with  nitric  acid  for  warts.  Mr.  Tru- 
man holds,  too,  that  were  it  not  for  the  treatment 
by  chemists  many  cases  would  remain  untreated 
at  all  until  too  late.  This  is  possible,  but  there 
are  probably  far  more  cases  where  the  treatment 
given  by  a  chemist — ^in  no  true  sense  medical 
treatment  at  all — encourages  a  patient  or  his  friend 
to  do  without  medical  assistance  till  it  is  too  late 
for  it  to  be  of  service.  The  same  number  of  our 
conte-nporary  draws  attention  to  a  coroner's 
remarks  on  this  very  point.     We  are,  however. 

(a)  tkarm,  Joum,,  October  22nd,  1904, 


quite  ready  to  believe  Mr.  Truman  when  ht  sayi 

that  the  chemist,  more  frequently  than  is  credited, 
prescribes  a  doctor. 


Sterile  Water  Ansesthteia. 
Great  as  has  been  the  boon  confcrx^d  on  surgical 

patients  by  the  discovery  of  genend  anaesthetics, 
it  would  be  folly  to  assert  that  any  anaesthetic 
yet  known  is  free  from  drawbacks.  They  all  havt 
their  disadvantages  and  dangers,  and  tiU  tbe  ideal 
anaesthetic  is  found,  several  of  the  methods  in  use 
at  present  will  each  have  its  appropriate  spbcrf. 
Gant,  the  professor  of  rectal  surger\'  in  the  Xe» 
York  Post-Graduate  School,  has  just  published  > 
a  third  contribution  in  eighteen  months  2uivo- 
cating  the  use  of  sterile  water  as  a  local  jinaesthctic 
He  claims  that  it  is  safe  and  trustworthy,  and  Is* 
states  that  he  has  adopted  it  only  after  tryin| 
codaine  and  various  other  agents,  which  were 
liable  either  to  produce  toxic  effects  or  to  be  foS- 
lowed  by  post-operative  pain  or  haemorrhage.  The 
great  point  to  be  observed  in  using  sterile  water  is 
to  produce  distension  of  the  tissues  until  ther 
become  anaemic.  To  do  this  no  large  quantity  of 
water  is  needed,  ten  minims  to  half  a  drachm 
being  all  that  is  required  for  small,  and  a  half  to 
four  drachms  for  more  extensive  operations.  An 
ordinary  hypodermic  needle  is  sufficient  in  the 
way  of  apparatus,  and  though  the  first  injectioo 
may  cause  a  little  stinging  this  soon  passes  off,  and 
the  injections  can  be  continued.  Effective  local 
anaesthesia  is  rapidly  produced,  and  no  unpleasant 
complications  or  sequelae  have ,  follow^ed  in  his 
320  cases  in  which  water  injections  have  been  used. 
G^nt  claims  that  he  is  now  able  to  do  in  his  office 
scores  of  operations  on  patients  who  would  other- 
wise have  had  to  leave  their  work  for  some  time  and 
go  into  hospital.  As  most  of  his  operations  hav« 
been  in  connection  with  rectal  diseases,  we  think 
his  evidence  is  particularly  significant,  as  there 
are  no  more  tender  spots  than  the  rectum  and  the 
margin  of  the  anus  when  diseased.  Piles,  internal 
and  external,  fistula,  fissure,  and  prolapsus  recti 
have  all  been  dealt  with  under  simple  water 
distension.  Besides  these,  Gant  has  done  a  good 
variety  of  other  operations,  including  an  explora- 
tory laparotomy,  by  the  same  plan.  He  does  not 
consider  that  his  method  is  likely  to  supersede  the 
use  of  general  anaesthetics  for  all  ordinary  surgical 
work,  but  for  small  operations  he  is  convinced  that 
no  meth6d  can  touch  it,  and  he  warmly  recommends 
surgeons  to  try  it. 


Burgeon-General  Evatt  on  Irish  Medical 
8fchoo]8. 

We  have  had  occasion  in  the  past  to  differ  with 
Surgeon-General  Evktt,  the  special  commissioner 
of  the  Irish  Medical  Association,  when  he  informed 
the  public  at  large  that  there  was  no  mechanism 
in  Ireland  by  which  medical  practitioners  could 
obtain  information  on  practical  points  connected 
with  their  profession,  and  we  must  now  again 
differ  with  him  in  respect  of  his  most  uncalled-for 
attack  on  the  Irish  Medical  schools.  After  a 
{a\  Med,  Record,  October  S9th.  1004, 


Nov.  23.  iy>4> 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    SSS 


public  dinner  given  in  his  honour  last  week  in 
Roscommon,  Surgeon-General  Evatt  spoke  as 
follows  : — 

"  They  had  no  idea  of  the  energy  and  force 
of  English  medical  education.  There  they  had 
plenty  of  money  and  a  string  of  universities. 
The  position  of  the  Irish  schools  on  the  other 
hand  called  for  the  most  earnest  inquiry.  In 
England  and  Scotland  it  was  recognised  that  the 
training  of  a  doctor  demanded  money  and  energy.. 
Oxford  had  wjaJcened  up,  and  all  England  was 
waking  up,  re-acting  against  the  Irish  doctors, 
whose  chances  of  getting  employment  in  the  public 
service  were  greatly  injured  by  the  want  of  fuller 
training  and  teaching  in  the  Irish  schools.  In 
Ireland  they  wanted  efficiency  in  every  branch 
of  the  medical  service.  The  doctor  ought  to  be 
the  teacher  of  humanity  in  the  ways  that  lead  to 
the  betterment  of  humanity.  But  for  this  they 
required  men  of  energetic  and  carefully  trained 
character.  At  the  present  time  the  Irish  medical 
schools  are  hardly  mentioned,  because  they  do 
not  take  part  in  research  work." 

May  we  ask  Surgeon-General  Evatt  his  authority 
for  these  statements,  which  appear  to  us  to  consti- 
tute a  libel  on  the  Irish  medical  schools  7  His 
indictment  is  all  the  more  dangerous  in  that  it  is 
indefinite  and  vague.  Does  he  mean  to  suggest 
that  the  Oxford  medical  school  is  superior  to 
the  Irish  schools  ?  Where  is  it  that  the  Irish 
schools  are  never  mentioned  ?  It  can  hardly  be 
where  tkeir  graduates  have  gained  distinctions, 
and  if  it  is  in  places  where  they  have  not  done  so 
that  *'  we  never  mention  her,  her  name  is  never 
heard,"  it  is  not  a  matter  of  particular  importance, 
for  there  are  few  such  places.  We  notice  that  Sur- 
geon-General Evatt  has  been  addressing  the  stu- 
dents of  these  same  Irish  medical  schools  during 
the  past  week.  Did  he  when  doing  so  tell  them  his 
opinion  of  their  teachers  ?  If  he  did  not  do  so, 
why  did  he  not  ?  If  the  creation  of  dissatisfaction 
is  the  surest  way  of  effecting  reform,  surely  it 
would  be  better  to  create  such  dissatisfaction 
at  the  centre  rather  than  in  a  country  town,  where 
there  are  none  to  answer. 


Twin  Spirits. 

There  is  not  much  to  be  said  in  favour  of  the 
public  exhibition  of  human  freaks  and  monstrosi- 
ties, but  while  human  nature  likes  to  be  surprised 
and  horrified  at  the  same  time  there  will  always 
be  showmen  ready  to  cater  for  this  morbid 
taste.  Since  the  Siamese  twins  shocked  and 
delighted  the  British  public  a  good  many  years 
ago,  there  have  been  many  rivals  for  their  fame, 
but  none  who  have  quite  attained  it.  Two— or 
perhaps  we  should  rather  say  one — ^bold  candidates 
have  entered  the  lists  in  the  shape  of  the  Bohemian 
twins,  young  ladies  of  prepossessing  appearance 
joined  to  each  other  at  the  hips.  They  are  twenty 
years  old  and  not  in  the  least  alike,  whilst  in  order 
to  walk  they  have  to  pass  their  arms  round  each 
others'  waists.  An  interesting  and  curious  medico- 
legal question  has  arisen  in  connection  with  their 
journey  to  England  ;  and  as  there  appears  to  be  no 
possible  final  solution  to  the  problem,  it  will  pro- 


bably commend  itself  warmly  to  anthrop<dogists, 
ante-natal  pathologists,  and  counsel  learned  in  law. 
The  point  is  this  :  are  the  twins  entitled  to  travel 
with  one  railway  ticket  ?  As  a  practical  aid  to  the 
discussion,  it  may  be  stated  that  the  German 
railway  ofiicials  insisted  on  two  tickets  being 
taken,  the  Belgian  authorities  were  content 
with  one,  whilst  our  own  South-Eastern  was  un- 
gallant  enough  to  follow  the  Teutonic  lead.  To 
psychologists  the  question  of  duality  or  identity  of 
the  units  that  compose  the  twins  should  appeal  with 
specicd  attractiveness,  and  Mr.  Rider  Haggard's 
dog  wiU  now,  have  to  take  a  back  seat,  as  the  ques- 
tion of  the  hour,  with  those  who  are  wrapped  up 
in  .matters  concerning  thought-transference  and 
telepathy.  For  ourselves,  we  only  venture  to 
express  the  hope  that  the  young  ladies  are  good 
friends ;  a  quarrel  leading  to  mutual  estrangement 
opens  up  awkward  possibilities. 

The  Soience  Sohools  in  Trinity  Ck>lleflre, 
Dublin. 

It  will  be  remembered  that  some  eighteen  months 
ago  Lord  Iveagh  made  the  munificent  offer  to 
supply  funds  for  the  erection  of  buildings  as  schools 
of  science  in  Trinity  College,  provided  funds  for 
their  up-keep  were  forthcoming  from  other  sources 
within  three  years.  It  was  calculated  that  a  sum 
of  ;£34,ooo  was  necessary  for  building  purposes, 
and  that  £7^,000,  invested  at  3^  per  cent.,  would 
be  required  for  up-keep.  For  this  ;£78,ooo  appea 
was  made  to  the  public,  and  particularly  to 
graduates  of  the  University.  It  can  hardly  be 
said  that  the  response  has  been  gratifying.  Those 
immediately  interested  in  the  College — ^Fellows 
and  Professors — ^have  contributed  generously  to 
the  fund,  but  the  sum  received  from  the  body  of 
graduates  in  general  is  not  what  might  have  been 
expected.  Up  to  the.  present  about  sixteen  thou- 
sand pounds  has  been  received,  and  this  being 
sufficient  for  the  maintenance  of  a  physical  labora- 
tory, the  building  of  the  latter  is  about  to  be  under- 
taken. We  understand  that  the  administration  of 
the  fund  is  to  be  in  the  hands  of  trustees  quite  inde- 
pendent of  the  Board  of  Trinity  College,  so  that 
those  who  disapprove  of  the  present  oligarchical 
method  of  governing  the  College  have  no  excuse 
on  that  ground  for  refusing  to  contribute.  We  are 
sure  that  there  are  many  medical  graduates  of 
Dublin  who  will  be  glad  to  take  the  present  oppor- 
tunity of  showing  their  love  for  *'  Old  Trinity," 
and  we  have  pleasure  in  bringing  the  appeal  to 
their   notice. 


Militant  Antivaccinists. 
Among  the  minor  troubles  of  the  central  govern- 
ment in  this  country  the  chronic  difficulty  with  the 
antivaccinists  is  not  the  least.  But  bold  and 
recalcitrant  as  they  are,  the  antivaccinists  confine 
their  methods  of  warfare  with  the  constituted 
authorities  to  the  legitimate  ones  of  public  meet- 
ings and  pamphleteering — ^with  an  occasional  ap- 
pearance in  the  law-courts.  Not  so,  however,  their 
confreres  in  Brazil.  The  Congress  of  that  country 
recently    passed    a   law    to    enforce    compulsory 


556    Tbx  Mbdical  Pkbss. 


NOTES   ON   CURRENT   TOPICS. 


Nov.  23.  1904. 


vacdaation,  and  a  commission  was  appointed 
to  draft  the  regulations  required  to  administer  the 
enactment.  There  was  considerable  public  excite- 
ment in  Rio  de  Janeiro  at  the  time  over  the  law* 
which  was  opposed  to  popular  prejudice,  and  the 
premature  publication  of  the  regulations  set  the 
tinder  aflame.  In  South  American  States  the 
popidace  have  a  very  practical  way  of  showing 
their  opinions  on  matters  of  public  interest, 
and  a  riot  which  almost  attained  the  dignity  of  a 
revolution  was  promptly  organised.  The  Miqi^try 
of  Industry,  when  the  commission  was  sitting; 
was  surrounded  by  the  mob,  and  so  threatening 
was  its  attitude  that  the  troops  were  called  out 
and  a  free  fight  began.  The  water-mains  were  cut 
the  street-liEimps  destroyed,  the  trams  set  on  fire, 
and  the  telephone  wires  cut.  The  rioting  con- 
tinued in  spite  of  repeated  charges  by  the  troops, 
and  when  night  fell  it  was  found  that  seven  persons 
had  been  killed  and  thirty  wounded.  The  next 
day  the  disturbances  were  renewed,  but  fortu- 
nately the  authorities  were  able  to  get  wind  of  the 
movements  of  the  ringleaders,,  and  have  them 
arrested.  The  riot  was  then  suppressed,  but  not 
until  quite  an  alarming  list  of  casualties  had  oc- 
curred. After  reading  of  these  disturbances  we 
are  glad  to  think  that  our  own  antivaccinists,  at 
any  rate,  employ  only  hard  words  in  their  con- 
troversies.    And  hard  words  break  no  bones. 


Public  Libraries  and  Infectious  Diseases. 
The  statement  so  often  circulated  in  the  lay 
press  that  free  libraries  spread  infectious  disease 
far  and  wide  has  created  a  perennial  flutter  among 
those  literary  dovecotes.  Regarded  simply  as  a 
place  where  all  sorts  and  conditions  of  men, 
women,  and  children  congregate  for  the  purpose  of 
satisfying  the  wants  of  the  mind,  a  process  which 
necessitates  touching  the  same  object  suc- 
cessively by  scores  of  ungloved  and,  in  many 
cases,  unwashed  hands,  there  is  every  reason  why  a 
public  library  should  be  an  unfailing  source  of  in- 
fectious disease.  We  have  not  seen  any  recently  re- 
corded instance  of  a  contagious  malady  contracted 
by  a  visit  to  a  reading-room,  but  in  the  event  of  a 
person  in  the  desquamating  stage  of  scarlet  fever 
handling  a  magazine  and  scattering  epitfffi-mic 
scales  around  him  while  so  occupied  it  is  con- 
ceivable that  the  periodical  in  question  might 
become  a  source  of  infection  to  others.  This  is 
not,  however,  the  fault  of  the  library.  Other 
public  buildings  are  daily  exposed  to  the  same 
risk.  The  majority  of  the  municipal  authorities 
are  now  so  fully  alive  to  the  dangers  incurred  by 
spitting,  wetting  the  fingers  before  turning  over 
the  pages  of  a  book  or  newspaper,  in  view  of  the 
omnipresence  of  the  tubercle  bacillus,  that  in  many 
localities  notices  prohibitory  of  such  practices  are 
posted  up  in  conspicuous  places  in  the  interior  of 
the  buildings.  The  only  improvement  that  might, 
perhaps,  be  suggested  with  a  view  of  further 
diminishing  the  risk  of  infection  is  the  substitution 
of  washable  covers  for  magazines,  &c.,  instead  of 
the  leather  ones  now  in  use.  With  regard  to  the 
question  of  infection  from  books  taken  home  it  is 


gratifying  to  note  that  an  inquiry  instituted  into 
the  subject  a  few  years  ago  as  a  result  of  dicn- 
larising  the  medical  officers  of  health  in  the  priodpal 
towns  possessing  public  libraries  showed  that  not  a 
single  case  of  infectious  disease  could  b:^  definite^ 
traced  to  this  source. 


Teaohixiff  of  Hygiene  in  Primary  Bchook 
In  connection  with  the  movement  for  the  teach- 
ing of  hygiene  in  primary  schools,  an  influeotiai 
deputation  waited  the  other  day  on  Dr.  Staikie. 
the  Resident  Commissioner  of  National  Edocatkn 
in  Ireland.  Sir  William  Thomson  was  tiie  priadpal 
spokesman,  and  he  was  accompanied  by  the  respec- 
tive Presidents  of  the  Royal  Colleges  of  Physidaib 
and  Surgeons,  the  Academy  of  Medicine,  and  the 
I^inster  Division  of  the  British  Medical  Associa- 
tion, and  other  gentlem^i.  It  was  strong 
pressed  on  Dr.  Starkie  tiiat  the  teaching  of  hypat 
and  temperance  should  be  made  compnhorr 
in  the  primary  schools  l^iroughout  the  country, 
and  that  greater  care  should  be  taken  to  keep  school 
buildings  in  proper  sanitary  coadition.  It  ms 
freely  admitted  by  the  Resident  CommiasioDcr 
that  the  rules  of  the  Board  as  to  the  saaitai) 
care  of  school  buildings  had  been  quite  neglected 
in  the  past,  and  he  quoted  instances  ol  scandaloc 
mismanagement  in  this  respect.  Steps  are  being 
taken,  however,,  to  stop  the  grant  to  any  school 
which  shall  in  future  be  reported  by  the  Boanl's 
inspectors  as  improperly  kept  as  regards  sanitary 
arrangements.  With  respect  to  the  teaching  of 
hygiene,  Dr;  Starkie  bound  hioaself  to  urge  qb  his 
colleagues  the  advisability  of  including  it  in  the 
new  programme  of  studies  as  a  compulsory  subject. 
The  result  of  the  deputation  is,  on  the  whole, 
satisfactory,  and  it  is  hoped  that  before  long  even 
child  in  elementary  schools  in  Ireland  will  lean 
something  of  the  value  of  fresh  air  and  cleanliness, 
and  of  the  proper  care  of  the  human  body. 


Health  and  Statistics  of  Ireland. 

It  is  difficult  to  pick  any   crumbs  of  comfort 
out  of  the  latest  Quarterly  Return  from  Charie- 
mont  House.     Although  the  state  of  the  country 
is  good  as  regards  prevalence  of  disease,  yet  the 
birth-rate  is  low  in  proportion  to  the  death-rate, 
and  the  marriage-rate  remains  almost  stationai)-. 
The  emigration  figures  still  show  an  alarming  in- 
crease,  not  merely  relatively   to   the  estimated 
population,  but  in  absolute  numbers.    Thus,  the 
number  of  emigrants  who  left  Irish  shores  duria|i 
the  months  of    July,  Angust  and  September  was 
11,784,  of  whom  nearly  two-thirds  were  females. 
This  total  is  590  more  than  in  the  corresponding 
quarter  of  last  year,  and  1,075  abovq  the  average 
for  the  third  quarter  of  the  past  ten^yeais.    Com- 
pared to  the  vital  rates  of  England  during  the  last 
quarter,  the  Irish  birth-rate  is  23*3  per  1,000  to 
28- 1  in  England,  while  the  death-rate  approaches 
as  dose  at  14*8  per  1,000  to  1 5*8  per  1,000.    These 
figures  depend  in  Ireland  on  the  fact  that  it  is  th^ 
young  adults  who  emigrate  at  the  very  time  when 
they  should   be  adding  to  the   birth-rate.   The 
mortality  from    infectious    diseases  is  somewhat 


Nov.   23i  I904« 


NOtES   ON   CURRENT   TOPtOS.  Thk  Mbptcal  Piess.   ^SJ 


below  the  average.  Small*pox  has  appeared  in 
sixteen  or  more  centres  during  the  quarter,  and 
four  deaths  resulted.  Measles  had  caused  less 
trouble  than  in  previous  3rears,  but  whooping- 
cough  of  a  severe  type  has  been  more  prevalent 
than   usual.      Enteric  fever  has  been  less  preva- 


though    in  Belfast  it  is  responsible    for    thirty- 
one   deaths. 


lent     than   is    usual   in    the  September  quarter,  [  asked  by  the  Coroner  whether  he  thcmght  the  rays 

used  on  that  occasion  caused  an  irritation  and 
affected  the  child's  heart.  Instead  of  fieferring 
so  highly  crucial  and  technical  a  question  to  a 
medical  man,  th^  witness,  according  to  a  report 
in  the  Daily  Chronicle,  expressed  a  view  that  the 
heart  would  not  be  so  affected,  but  that  beyond  a 
doubt  the  X-rays  would  produce  a  painful  disease 
if 'the  use  extended  over  several  years.  Mr.  Vezey 
is  well  known  as  the  treasurer  of  the  R6ntgen 
Society,  and  also  as  an  amiable  and  unassuming 
student  of  scientific  matters.  We  venture  to 
think,  however,  that  he  is  entirely  out  of  place  as 
a  witness  to  medical  questions  of  an  extremely 
complicated  nature.  The  attitude  of  the  Coroner 
towards  his  evidence  absolutely  endorses  our  view 
as  to  the  danger  likely  to  arise  from  the  inter- 
ference of  unqualified  persons  in  things  that  are 
obviously  purely  medical. 


Hats  or  No  Hats? 
Some  of  the  lay  papers  in  New  York  have  re- 
cently been  discussing  the  question  of  the  effect  of 
hats  upon  the  health.  It  appears  that  it  was  more 
or  less  fashionable  this  year  in  America  to  go  with 
the  head  uncovered,  and,  as  is  natural,  the  hy- 
gienic advantages  of  the  custom  are  being  pointed 
out.  It  is  stated,  fairly  enough,  that  the  presence 
of  a  hat  deprives  the  head  of  the  healthy  in- 
fluences of  the  light  and  air,  both  of  which  are  pro- 
bably efficacious  in  maintaining  a  {M-oper  growth 
of  hair.  Further,  there  can  be  no  doubt  that  a 
hard  hat,  such  as  the  ordinary  silk  or  felt  hat, 
encourages  the  growth  of  bacteria  about  the  hair 
by  keeping  it  bathed  in  a  warm,  moist  atmo- 
sphere. Objectors  urge  that  to  uncover  the  head 
may  bring  on  neuralgia,  rheumatism,  and  other 
diseases,  but  this  is  only  liable  to  occur  when  one  is 
suddenly  exposed  to  unaccustomed  chill.  Patients 
in  open-air  sanatoria  rarely  wear  head  covering, 
and  they  rapidly  become  hardened  against  the  Hi- 
effects  supposed  to  be  due  to  sudden  changes  of 
temperature.  There  is  no  doubt,  of  course,  that 
hats  may  be  necessary  for  protection  against  the 
sun,  but  this,  again,  is  only  true  where  one  is 
exposed  to  a  degree  of  heat  to  which,  individually 
or  racially,  he  is  unaccustomed.  A  native  of  the 
tropics  goes  bareheaded  with  safety  where  a  Euro- 
pean would  infallibly  suffer  from  heat-stroke. 
WTiile  **  hatlessness  "  in  fashionable  society  is  at 
present  Httle  more  than  a  fad,  yet  it  is,  on  the 
whole,  a  healthy  one,  and  we  welcome  it  as  part 
of  the  same  rational  view  of  costume  which  has 
rendered  light  and  comfortable  head-gear  so  much 
in  vog^e  in  England  during  the  past  few  summers. 


X-Bay  Operator  as  Medical  Witness. 

The  new  science  of  radiography  has  given  birth 
to  a  fresh  order  of  unqualified  practice.  Persons, 
who  hold  no  medical  qualification  pose  as  authori- 
ties on  dislocation,  fractures,  and  other  injuries, 
not  to  mention  boner  diseases,  lupus,  cancer, 
rodent  ulcer,  and  conditions  open  to  treatment  by 
the  focufihtube.  To '-a  great  extent  the  medical 
profession  has  itself  to  thank  for  having  opened 
the  door  to  this  particular  kind  of  competition. 
From  the  outset  of  this  new  branch  of  diagnosis 
we  have  insisted  that  medical  men  shoirid  send 
their  cases  to  properly  qualified  medicsd  radio- 
graphers and  not  to  instrument  makers  and  photo- 
graphers and  other  unqualified  persons  who  buy 
an  apparatus  and  pose  as  medtical  advisers.  The 
greatest  blame  we  attach  unhesitatingly  to  hos- 
pitals that  employ  non-medical  radiographers. 
The  evil  likely  to  result  in  the  creation  of  a  kind  of 


hybrid  medical  practitioner  was  a  week  or  two 
since  illustrated  at  a  Deptford  inquest  held  upon 
the  body  of  a  child  that  died  imder  chlordform 
administered  for  the  purpose  of  taking  a  radiogram. 
Mr.  Vezey,  the  non-medical  superintendent  of 
the  X-Ray  department  of  the  MiHar  Hospital,  was 


The  Wellcome  Historioal  BbehlbiftioB. 

The  proposed  Historical  Medical  Exhibition 
has  been  postponed  to  a  later  date  than  that  ori- 
ginally intended.  The  following  announcement 
to  that  effect  has  been  received  from  Mr.  Henry  S. 
Wellcome  : — 

"  The  response  to  the  announcement  of  the 
proposed  Historical  Medical  Exhibition  has  been 
beyond  my  expectations,  and  this,  together 
with  the  many  valuable  suggestions  received  from 
leading  members  of  the  profession  and  the  tYade, 
at  home  and  abroad,  has  j^ompted  me  to  consider- 
ably widen  its  scope.  The  extent  of  the  work 
involved  renders  it  impossible  to  fix  a  definite  date 
for  the  exhibition  until  a  later  period,  announce- 
ment of  which  will  be  duly  made.  Although  in  one 
sense  I  regret  this  delay,  it  will,  on  the  other  hand, 
enable  me  to  make  the  exhibit  more  comprehensive 
and  complete,  and  to  include  many  objects  of  ex- 
ceptional interest  that  have  been  promised  from 
different  quarters  of  the  globe." 

The  original  discovery  of  the  virtues  of  many 
therapeutic  substances  is  svurronnded  with  great  in- 
terest, and  we  understand  that  Mr.  Wellcome  has 
given  a  good  deal  of  attention  to  that  branch  of 
investigation.  The  collection  of  a  large  number 
of  objects  of  special  medical  virtue  cannpt  fail 
to  be  of  value,especially  as  the  bulk  of  the  exhibits 
will  be  lent  by  medical  men.  The  exhibition  is 
meant  not  for  the  public  but  for  the  profes- 
sion, and  is  intended  to  commemorate  the  c(ym- 
I^etion  of  the  first  quarter  of  a  century's  existence 
of  the  firm  of  Burroughs,  Wellcome  and  Co. 


.^otioa  AsBvatit  Qbr  Patrick  Heron  Watson. 
The  decision  oi  the  second  division  in  Sir 
Heron  Watson's  appeal  against  Lord  Kincairney's 
interlocutor  approving  of  the  issues  for  the  trial  was 
given  on  the  i8th  inst.,  and  was  partially  favourable 
to  the  appellant.  The  Court,  by  a  majority  of  three. 


55^    The  Medical  Fkess. 


SPECIAL   CORRESPONDENCE. 


Nov.  23,  10Q4. 


to  one,  disallowed  the  first  issue — ^that  as  to  breach 
of  confidentiality  in  disdosure,  during  precognition, 
to  a  law  agent  of  facts  concerning  the  pursuer. 
The  second  issue  was  allowed — whether  the  de- 
fender stated  to  the  l&w  agent  and  counsel  that  the 
pursuer  was  bent  on  inducing  premature  labour 
so  as  to  free  her  from  any  permanent  reminder  of 
her  marriage.  The  case,  it  may  be  remembered, 
arose  out  of  evidence  given  by  Sir  Patrick  Watson  in 
an  action  for  separation  and'  aliment,  the  pursuer 
in  this  action  failing  in  her  case,  and  subsequently 
suing  Sir  Heron  Watson  on  account  of  evidence 
given  by  him  in  behalf  of  her  husband.  Lord 
Young,  who  dissented  from  the  remaining  judges, 
thought  that  there  was  no  relevant  case  whatever 
for  sending  to  a  jury  against  Sir  Patrick  Heron 
Watson,  and  that  it  was  only  just  and  fair  to  state 
that,  so  far  as  his  opinion  w^it,  nothing  which 
he  was  alleged  to  have  done  or  said  was  at  all  in»- 
proper  or  discreditable  to  him  or  any  member  of 
his  profession.  The  case  involved  a  principle  of 
great  importance,  namely,  the  inviolabihty  of 
knowledge  gained  of  a  patient's  affairs.  In  this 
instance  Sir  Patrick  Watson  was  consulted  by  a 
wife  who  was  bringing  an  action  for  separation 
against  her  husband.  Sir  Patrick  gave  evidence 
for  the  husband,  and  stated  that  the  wife  on  the 
occasion  of  her  visit  requested  him  to  perform  a 
certain  operation.  For  this  alleged  breach  of 
professional  secrecy  both  the  wife  and  her  father 
brought  actions  against  Sir  Patrick,  claiming 
£2,500  each  damages.  The  part  of  the  action 
remaining  to  be  settled  i^  that  his  statements  as  to 
the  operation  were  falsely  and  calumniously  made. 


PERSONAL. 
T&B  King  has  sent  the  following  reply  to  a  letter 
announcing  the  death  of  Dr.  Vintras,  the  late  physician 
to  the  French  Hospital  in  London  : — "  Sandringhani, 
November  nth.  1904.  Sir, — I  have  had  the  honour  of 
submitting  your  letter  to  the  King, and  I  am  commanded 
to  inform  you,  in  reply,  that  his  Majesty  regrets  to 
hear  of  the  loss  which  the  hospital  has  suffered  by  the 
death  of  Doctor  Achille  Vintras.  I  am,  Sir,  your 
obedient  servant,  Knollys.  The  Secretary,  French 
Hospital  in  London." 


Mr.  Anthony  Bowlby.  C.M.G.,  F.R.CS.,  has  been 
appointed  to  the  post  of  Surgeon  to  the  Household 
by  his  Majesty  the  King,  a  y  ost  rendered  vacant  by 
the  recent  lamented  death  of  Mr.  Herbert  AlUngham. 

Dr.  Mitchell  Bruce,  who  has  been  connected  with 
Charing  Cross  Hospital  and  Medical  School  for  the  last 
thirty  years,  has  i  een  elected  consulting  physician  to 
the  hospital  on  his  retirement  from  the  active  staff. 

Dr.  J.  S.  Collier,  Assistant  Physician  to  the 
National  Hospital,  Queen  Square,  and  Dr.  E.  I.  Sprigge, 
Assistant  Physician  to  the  Chest  Hospital,  Victoria 
Park,  and  the  Victoria  Hospital  for  Children,  have  been 
recently  appointed  Assistant  Physicians  to  St.  George's 
Hospital. 


It  is  probable  that  the  proposed  American  memorial 
to  Professor  Osier  will  take  the  form  of  a  great  medical 
and  Ubrary  building  to  be  erected  in  Baltimore. 


The  inaugural  address  of  the  Medical  Women's 
Society,  Edinburgh,  was  given  on  Friday,  November 
I  ith,  in  the  hall  of  the  University  Union,  by  Dr.  George 
A.  Gibson,  on  *•  The  Uses  o*  a  Debating  Society." 


The  King  has  been  pleased,  on  the  reoommendatioo 
of  the  Secretary  for  Scotland,  to  appoint  Dr.  W.  Le& 
Mackenzie  to  be  medical  member  of  the  Local  Govon- 
ment  Board  for  Scotland,  in  room  of  Dr.  RqskH, 
deceased. 


The  second  biexinial  dinner  of  the  past  and  present 
resident  assistants  of  the  Vi  to  ia  Infirmary  was  held  in 
Glasgow,  on  November  nth.  under  the  presideocy  of 
Dr.  William  Dove  Macfarlane,  Jun.,  of  Busby. 


Mr.  John  Tweedy,  President  of  the  Royal  CoUe^ 
of  Surgeons  of  England,  will  unveil  the  memonal 
window  to  the  late  Mr.  W.  Cadge  in  Norwidi 
Cathedral  on  Tuesday  next,  when  a  short  service  irin 
be  conducted  by  the  Dean. 

It  is  interesting  to  learn  that  the  widow  of  the  late 
Professor  Finsen  has  been  accorded  a  pension  of  3.600 
kroner  yearly  by  the  unanimous  vote  of  the  Danisk 
ParUament  on  the  proposition  of  the  Cultus  Minister. 

Dr.  W.  F.  Dsarden,  a  prominent  citixen  of  Mancho- 
ter,  has  been  placed  on  the  Commission  of  the  Peace  of 
that  city.  Another  medical  man  has  been  accorded  1 
similar  distinction  in  the  East  Riding  of  Vorkahire  ia 
the  person  of  Dr.  J.  J.  Jefferson,  of  Market  lATeightoo. 

Dr.  Whitelegge,  C.B.,  delivered  a  most  interesting 
inaugural  address  to  the  Epidemiological  Society  on 
November  i8th.  upon  the  subject  of  the  epidemioiogi- 
cal  aspects  of  industrial  diseases. 

Dr.  E.  H.  Tweedy,  Senior  Medical  Ofl&cer  of  the 
Gold  Coast  Colony,  acts  as  Cantonment  Magistrate  o( 
Kumasi  in  place  of  Captain  T.  A.  Pamplin  Green,  who 
is  acting  as  Commissioner  for  the  North- Western  Dis- 
trict of  A^anti. 


Mr.  John  Ironside,  of  the  Medical  Department  of 
the  Orange  River  Colony,  has  been  promoted  to  the 
position  of  Secretary  and  Registrar  of  the  Medical  and 
Pharmacy  Council  of  that  Colony. 

Dr.  J.  H.  Bain  has  been  appointed  District  Surgeon 
of  Richmond,  Cape  Colony,  in  place  of  Dr.  David  TraiO. 
who  has  xesigned,  and  Dr.  Ludwig  Schloss  becomes 
District  Surgeon  of  Bredasdorp. 


Special  dotvcB^onbcncc 

[from  our  own  correspondents.] 


SCOTLAND. 

Age  Limit  for  the  Staff  of  the  Royal  Infirmary. 
Edinburgh. — Contrary  to  the  general  anticipation, 
the  Court  of  Contributors  of  the  Royal  In&rmary  last 
Monday  refused  to  endorse  the  report  of  the  special 
committee  on  this  subject,  and  passed  a  resolution  that 
an  age  limit  of  sixty-five  be  adopted  for  all  physicians 
and  surgeons,  including  University  Professors.  The 
resolution  was  moved  by  Mr.  Charles  Ritchie,'  and 
seconded  by  Dr.  P.  H.  Maclaren,  the  members  of  the 
committee  who  dissented  from  the  findings  of  the 
majority,  as  mentioned  in  this  column  last  week. 
The  Ix)rd  Provost,  who  presided  over  the  meeting  of 
contributors,  said  he  earnestly  hoped  that  the  decisioo 
of  the  meeting  would  make  for  the  benefit  of  the 
institution.  The  managers  would  loyally  carry  it  out. 
It  is  not  yet  known  whether  the  rule  will  be  applied  to 
those  presently  holding  office  as  full  physicians  9nd 
surgeons,  several  of  whom  have  passed  the  age  of  sixty- 
five. 

Quatercentenary  of  the  Royal  College  of 
Surgeons,  Edinburgh. — ^This  ancient  CorporatioD 
completes  the  four-hundredth  year  of  its  existence  in 
1905,  and  for  some  time  back  the  officials  have 
been  preparing  for  its  celebration.  The  lunction 
has  been  arranged  for  the  20th  and  21st  July,  when, 
among  other  events,   a  large  number  of  distinguished 


Nov.  23,  1904- 


SPECIAL    ARTICLES. 


The  Medical  Press.    559 


members  of  the  profession,  both  at  home  and  abroad, 
will  be  admitted  as  honorary  Fellows.  On  Thursday 
the  20th.  there  is  to  be  divine  service  in  St.  Giles 
Cathedral,  followed  by  a  luncheon  and  an  address  from 
the  president ;  thereafter  the  honorary  Fellowships 
will  be  granted,  and  there  will  be  a  reception.  On  the 
2 1  St  ttiere  will  be  visits  to  museums  pnd  other  institu- 
tions of  medical  interest,  a  garden  party,  a  dinner,  and 
a  reception.  The  sister  college  and  the  Co -^oration  of 
Edinburgh,  will  also  take  part  in  entertaining  the 
College  of  Surgeons  and  its  guests. 
BELFAST. 

The  Small-pox  O  jtbreak. — ^During  the  past  week 
there  have  been  five  more  cases  of  small-pox  in  Belfast, 
all  removed  as  soon  as  discovered  to  the  hospital  at 
Purd)rsburn.  Of  these  five,  one  is  a  severe  case  in  an 
unvaccinated  child  of  eight  years,  while  the  other  four 
are  all  modified  by  vaccination. 

Ulster  Medical  Society. — ^The  first  of  a  series  of 
social  evenings  for  the  members  of  the  Ulster  Medical 
Society  was  held  in  the  Medical  Institute,  BeUast,  on 
Thursday  evening,  the  17  th  inst.  The  President  of  the 
Society,  Dr.  WilUiam  Calwell,  entertained  the  members 
and  some  other  medical  men  to  Ught  refreshments, 
and  the  social  amenities  offered  by  the  Institute  were 
enjoyed  till  a  late  hour.  The  Council  of  the  Society 
intend  to'  issue  invitations  to  a  similar  evening  next 
month,  the  idea  being  to  bring  the  members  of  the 
profession,  not  only  in  Belfast,  but  in  the  surrounding 
districts,  into  more  intimate  social  relationship  in  tl^eir 
leisure  time.  The  Institute  forms  a  common  meeting 
ground  for  men  from  all  parts  and  in  all  classes  of  work, 
practice  or  teaching,  and  such  evenings  cannot  fail  to 
promote  friendship  among  them. 


GorresponDence. 


'We  do  not  hold  oanelvw  reiponiibto  for  the  optniooe  of  oar 
Correependente.  J 


THE  DIMINISHING  BIRrH-R\TE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
.    Sir, — In  the  letters  which  you  did  ms  the  honour  of 
inserting  in  your  pages  during  the  discussion  of  the 
a'x>ve-named  subject  soms  weeks  ago,  I  insisted  on 
two  maia  facts — first,  that  the  diminishing  birth-rate 
is  due  mainly  to  the  practice  of  preventing  conception 
by  artificial  means,  which  already  prevails  among  large 
sections   of  every  class  of  the  people :  and.  secondly, 
that  the  restriction  of  the  number  of  children  was.  in 
the  majority  of  cases,  not  prompted  by   motives  of 
prudence,  but  was  rather  the  outcome  of  a  narrow  form 
of  anti-social  egoism  which  is  willing  to  give  up  every* 
thing  in  the  pursuit  of  ease,  pleasure,  and  amusement, 
and  looks  upon  duty,  toil,  and  self-sacrifice  as  evils  at 
all  costs  to  be  avoided.     I  pointed  to  France  as  a  living 
object-lesson  in  these  matters,  and  ventured  to  declare 
that  the  nations  which  should  follow  her  example  to 
its  logical  conclusion  were  doomed,  as  she   is  unless 
she  speedily  mend  her  ways,  to  destruction.    As  a 
lover  of  my  country  and  a  believer  in  the  mighty  possi- 
bilities  for  good   of  a  vast  dominant  Anglo-Saxon 
empire,  I  should  have  been  gratified  if  my  views  could 
have  been  proved  false ;   and  I  am  not  at  all  pleased 
now  to  find  them  receiving  the  strongest  corroboration 
from  what  is  evidently  the  highest  authority.     I  refer 
to  the  author  of  a  series  oi  special  articles  on  "Infantile 
.Mortality."  the  last  of  which  appeared  in  the  Times 
of  to-day  (Wednesday.  November  9th).    The  intrinsic 
quality  of  these  articles,  not  excepting  their  literary 
style,  stamps  them  as  the  work  of  a  first-rate  man-^ 
not  an  uncommon  phenomenon  among  Times*  con- 
tributors— and  I  feel  a  little  flattered  to  find  he  ex-^ 
.  presses,  although  much  more,  forcibly  than  I  could 
have  done,. virtually  the  same  conclusions  that  I  had 
in  my  letters  put  forth.    The  articles  deserve  your 
attention ,  Sir.  and  that  of  all  students  of  this  truly 
importaat  question — a  question  upon  which  the  pros- 
perity aiLd  the  stabiUty  of  the  Empire  tests  beyond  aU 
others.    1  will  quote  only  two  passages  from  the  last 


article ;  for  the  facts  and  arguments  upon  which  they 
are  based  the  originals  must  be  consulted.  Probably 
they  may  be  published  in  a  permanent  form  later : — 
*'  Although  fewer  children  are  t>om  in  proportion  to 
population,  a  larger  number  of  them  die  soon  after 
birth.  What  is  the  explanation  of  this  grave  state  of 
things  ?  It  might  possibly  be  explained  by  a  general 
decline  in  physique,  which  renders  women  leas  capable 
of  child-be«tring.  so  that  they  have  fewer  children,  and 
those  whom  they  have  are  weaker.  But  the  change 
has  been  much  too  rapid  and  general  to  permit  of  that 
hypothesis,  which  has  no  other  evidence  to  support  it. 
Moreover,  physical  incapacity  is  not  the  cause  of  the 
declining  birth-rate.  That  is  well  known  to  be  due  to 
deliberate  prevention,  which  is  practised  more  exten- 
sively among  the  industrial  classes  than  among  those 
above  them  in  the  social  scale." 

"  To  sum  up,  the  unnatural  concurrence  of  a  sta- 
tionary or  increasing  infantile  mortality  with  a  falling 
birth-rate,  which  so  seriously  threatens  the  national 
vitality,  finds  its  true  explanation  neither  in  external 
circumstances  nor  in  the  employment  of  women,  but  in 
the  habits  of  the  people.  Throughou :  the  scale,  from 
mere  thoughtlessness  to  actual  murder,  the  same  ele- 
ment»  are  seen  to  be  at 'work  and  to  tend,  in  varying 
degrees,  towards  repudiation  of  the  duties  of  life  and 
their  subordination  to  eaise,  comfort,  pleasure,  and 
self-indulgence." 

I  am.  Sir,  yours  truly, 

A  Student  of  Sociology. 

November  9th,  1904. 

-^THE  SPA  TREATMENT  OF    ARTHRITIS 

/-      ■    '%    ^4      DEFORMANS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— I  have  read  with  great  interest  the  article 
contained  in  this  week  s  issue  of  The  Medical  Press 
and  Circular  by  Dr.  Bowen-Davis  on  "The  Spa 
Treatment  of  Arthntis  Deformans."  While  agreeing 
with  him  in  a  great  deal  of  what  he  says.  I  am  never- 
theless inclined  to  think  that  lie  attaches  too  Uttle 
importance  to  the  r5U  played  'by  rheumatism  in  its 
production.  Seeing  that  rheumatism  is  now  almost 
(if  not.  indeed,  conclusively)  proved  to  be  of  microbial 
origin,  I  would  suggest  that  the  various  lesions  of 
arthritis  deformans,  resembling  as  they  do  the  joint 
changes  observed  in  Charcot's  disease,  may  be  the 
result  of  inadequate  nerve  supply,  due  to  the  poisoning 
of  nerve  endings  by  the  toxins  elaborated  in  the  system 
by  Poynton's  micrococcus. 

It  is  noteworthy,  as  Dr.  Bowen-Davis  says,  that  these 
lesions  should  be  so  inrone  to  manifest  themselves  at 
the  climacteric  period,  and  it  may  be  as  well  to  bear  in 
mind  in  this  connection  that  the  nervous  system  is  at 
that  period  of  Ufe  undergoing  profound  changes,  none 
the  less  important  that  they  may  not  be  accompanied 
by  visible  changes.  From  my  experience  of  balneo- 
therapeutic measures  in  this  class  of  case  I  am  con- 
vinced that  they  hold  out  distinct  chances  of  improve- 
ment if  not  of  actual  recovery. 

A  point  in  the  history  of  these  cases  is  worth  noting, 
viz.,  that  if  careful  inquiry  be  made  a  history  of  weak- 
ness long  preceding  the  joint  changes  may  be  obtained. 
In  fact,  I  feel  that  it  b  hardly  going  too  far  to  utilise 
this  symptom  when  complained  of  as  a  means  of  differ- 
entiating between  arthritis  deformans  and  chronic 
rheumatic  arthritis.  Perhaps  Dr.  Bowen-Davis  may 
be  able  to  corroborate  this  observation. 

I  am.  Sir,  yours  truly, 

Arthur  G.  Bennett. 

St.  Ann's  Hill,  Cork,  Nov.  i8th.  1904. 


Special  articled. 


REPORT    ON    SLEEPING    SICKNESS    IN    THE 

CONGO. 

The    members   of    the   expedition   despatched    by 

the  Liverpool  School  of  Tropical  Medicine  have  sent 

to  the  Committee  a  long  report  on  their  experiences 


560    Tag  Mbdical  PB«<g. 


SPEGIM.  ARTICLES. 


Not.  23.  1904. 


intheOmgQ-    Dated  from  Stanley  Falls,  S^tesxbeF  30, 
tlie  report  iftyfi:— 

''H^e  aunnlHHrs  c^  ovar  expedi^icm  left  Leopold viUe 
on  jHne  93.  and  reached  Stanley  Falls  on  September  15. 
Qb!$  of.  the  Stage's  steamers,  the  Roi  d^s  Beiges,  was 
very  kindly  placed  at  our  disposal  by  the  Gcrvernment, 
and  we.  were  thus  enaUed  to  make  fairly  coio^te 
observe tiiws.  on  the  spread  and  distributien  of  sleepmg 
sickness  along  the  Congo  River  from  the  '  Pool ' 
to  the  '  Falls,'  a  dist^ice  ot  nearly  1,000  nules.  A 
disease  whose  natare  had  been  previously  ujarecognised 
occurred  among  the  State's  cattle  at  Coqailhatville, 
Nouvelle  Anvcis,  and  Romee.  It  was  investigated, 
and  its  pathogenic  agent  shown  to  be  a  trypanosomie, 
whose  qpecies  is  as  yet  undetermined.  It  wasi  con- 
sidered advisable  to  communicate  the  results  of  tnis 
work  directly  to  the  Governor-General  at  Boma,  in 
order  that  immediate  measures  might  be  taken  against 
the  disease.  It  is  no  exaggeration  to  say  that  sleep- 
ing sickness  is  a  terrible  scourge  among,  especia%, 
the  riverine  tribes^-wno,  bv  the  way,  are  generally 
totally  distinct  from  the  tribes  living  frequently  only 
ten  to  thirty  minutes'  walk  from  the  river  banks. 
From  LeopoldvUle  to  Bumba  cases  of  sleeping  sick- 
ness were,  present  in  practically  every  town  visited, 
and  the  percentage  of  tyrpanosome-iufected  individuals 
among  the  general  population  was  high.  After  Basoko 
and  up  the  Falls  only  imported  cases  (with  two  excep- 
tions) of  sleeping  sickness  were  seen  in  a  few  of  the 
towns,  and  no  trypanosomes  were  found  in  the  general 
population.  The  inland  towns  which  were  exammed, 
at  M'Swata,  Tschumbiri.  Lisala,  and  Bumba,  showed 
a  much  smaller  percentage  of  trypanosome  infections 
than  did  the  corresponding  riverine  towns,  and  it 
was  exceedingly  rare  to  see  a  case  of  sleeping  sick- 
ness. 

"  From  our  observations  and  from  information  which 
we  have  collected,  it  is  very  ^parent  that  sleeping 
sickness  has  spread  in  the  Congo  m  recent  years  along 
the  lines  of  communication — i.e.,  along  the  rivers. 
The  spread  of  the  disease  has  been  much  assisted  by , 
the  practice  of  taking.iaxge  bodies  of  natives,  soldiers,  \ 
and  labourers,  from  one  part  of  the  Free  State  to  an-  • 
other.  For  instance,  four  natives  were  chosen  for 
gland  puncture,  because  of  large  lymphatics,  from 
yj  persons  examined  at  Yalemba.  Two  of  these  were 
found  to  c  e  infected  with  trypanosomes.  Both  seemed 
in  robust  health.  Three  years  previously  one  had 
returned  from  a  year's  work  as  a  labourer  at  Bolobo, 
where  there  is  much  sleeping  sickness.  The  ottier 
had  spent  three  years  as  a  labourer  on  board  a  steamer 
plying  to  infected  districts.  A  third  man.  suspected 
of  sleeping  sickness,  was  examined  and  trypanosomes 
found.  He  had  been  ill  for  two  months,  and  had 
returned  one  and  a  quarter  years  before  from  a  year's 
work  at  Bolobo.  We  are  told  that  there  was  a  well- 
marked  case  of  sleeping  sickness  in  the  village  (absent 
at  the  time  of  our  visit)  who  had  also  been  a  Bolobo 
workman.  Yalem  e,  situated  on  the  river  bank,  I 
some  little  distance  above  Basokp,  is  in  an  uninfected 
area,  and  the  latter  two  cases  are  the  only  instances  of 
sleeping  sickness  known  there.  It  is  only  a  few  months 
since  the  transportation  of  cases  of  sleeping  sickness 
on  State  steamers  has  been  forbidden.  Individuals 
previously  afitected  had  been  allowed  to  return  to ' 
die  in  tneir,  perhaps,  uninfected  villages.  Declared 
cases  of  sleeping  sickness  are  easily  recognised ;  but, 
as  we  showed  in  the  Gambia,  trypanosoma  gambiense 
may  be  present  in  the  blood  for  months,  even  years, 
and  the  patient  remain  in  apparently  perfect  health. 
The  importance  of  the  early  recognition  of  such  cases 
is  obvious,  and  it  has  long  been  one  of  our  chief  aims 
to  devise  some  easy  and  £urly  accurate  method  of 
detecting  the  presence  of  trypanosomes.  We  believe 
that  in  '  cervical  gland  palpation  '  we  have  now  an 
excellent  clinical  method  of  detecting  an  infected  person. 
When  many  of  the  cervical  glands  have  been  enlarged 
to  above  1*5  by  i  cm.,  other  causes  being  absent, 
trypanosomes  have  generally  been  found  in  the  drop 
of  fluid  obtained  by  aspirating  a  gland  witn  a  hjrpo- 
dermic  syringe.     As  a  rule  simultaneous  examination 


of  the  blood  had  given  a  negative  result  Ctrncsl 
glands  have  been  chosen  because  the  native's  fenonl 
and  inguinal,  and,  to  a  les^  extent,  his  anUvy 
glands,  are  usually  enlarged.  In  uninfected  areu  Ui^ 
cervical  glands  very  rarely  reach  the  size  indicated 
above,  and  in  none  of  the  glands  punctured  in  bca. 
infected  areas  have  trypanosomes  oeen  found.  Ov 
work  in  this  direction  is  far  from  complete,  but  ve 
believe  that  it  tends  to  indicate  that  no  inteDding 
labourer  or  recruit,  coming  from  an  area  in  vhick 
sleeping  sickness  exists,  should  be  accepted  if  he  is 
found  on  examination,  other  causes  being  absent,  to 
have  fairly  numerous,   moderately   enlarged  cervical 

f lands.  The  tsetse  fty  was  incessantly  present  inn 
tanley  Pool  to  Basoko.  These  flies  were  very  numerous 
among  the  myriads  of  islands  with  which  the  middle 
Congo  is  strewn,  and  frequently  came  on  boaxd  or 
steamer  while  we  were  in  mid-stream  and  distji: 
300  or  500  yards  from  land.  After  Basoko  was  passei 
there  were  very  few  flies,  and  just  after  we  left  tic 
mouth  of  the  Lomami  river  the  last  one  was  seen  ob 
the  steamer.  Although  the  natives  of  the  to«s 
at  which  we  stopped  above  Basoko  recognised  tk 
fly,  none  were  found  in  tne  neighbouring  bnsh.  The* 
is  certainly  a  marked  reduction  in  the  number  of 
tsetse  flies  above  Basoko,  and  it  is  possible  that  theit 
may  be  stretches  of  river  where  none  occur.  It  is  a 
interesting  coincidence  that  where  there  were  maoy 
tsetses  there  was  much  sleeping  sickness.  What 
these  flies  were  Scanty,  cases  were  rarely  seen.  Tht 
common  species  of  tsetse  on  the  middle  Congo  k 
Glossina  palpalis.  At  Mensemt)e  and  Nouvelle  Anven 
this  fly  frequented  the  houses  of  Europeans." 

METROPOLITAN  ASYLUMS   BOARD. 
An  ordinary  meeting  of  the  managers  of  the  Bietio- 
poUtan  Asylum  District  was  held  at  the  offices  on  the 
Embankment,  Mr.  A.  C.  Scovell  presiding.     A  letter 
was  read  from  the  London  County  Council  stating  that 
the  Public  Health  Committee  were  desirous  of  discus- 
sing with  representatives  of  the  Board  "  the  subject  d 
facilities   to  medical  practitioners   and    students  for 
acquiring  experience  of  small-pox,"  and  asking  tin 
Board  to  appoint  representatives  to  the  conference. 
The   communication   was  referred    to    the   Hospitals 
Committee,   with  power   to  appoint   refMresentativei 
The  Works  Committee  reported  that  the  total  cost  of  the 
erection  and  fitting  up  of  the  Millfield  Homes  (wheie 
accommodation  is  provided  for  xoo  patients),  including 
the  cost  of  the  site,  but  exclusive  of  that  of  fninitiire. 
was  ;£25,o84,  which  works  out  at  nearly  ^£251  per  bed. 
The  original  contract  amount  was  £17,228.  but  certain 
unfoiyseen    works    were    found    necessary,  when  the 
buildings  were  in  progress,  which  involved  additional 
expenditure.    The  same  committee  reported  that  the 
total  cost  on  completion  of  the  White  Oak  School  was 
£11^,707,  or  £5.986  less  than  the  anticipated   expendi- 
ture of  ;£i25.694,  for  which   the  Local   Government 
Board  issued  their  order  on  March  23rd.  1901.    On  tiie 
recommendation  of  the  Hospitals  Committee,  it  was 
reserved  to  affix  the  seal  of  the  Board  to  certain  agne- 
ments   with    the   Royal   Colleges   of    Physicians  and 
Surgeons  consequent  on  the  decision  of  the  Boaid  t» 
take  oyer  from  those  colleges  the  work  of  prepaiatioo 
of  anti-toxin  serum,  which   the  managets,  with  Uic 
s^proval  of  the  Local  Government  Board,  have  decided 
to  undertake  for  one  year  from  January   ist  next. 
Dr.  G.  E.  Cartwright  Wood  wa»  appointed  for  one  year 
Irom  January  ist  next  to  have  charge  of  the  work  at  his 
present  salary  of  £400  for  the  year,  with  duties,  in 
addition  to  the  preparation  of  anti^toadn.  of  general 
bacteriological  work  for  the  Board  as  might  be  directed ; 
and  Professor  G.  Sims  Woodhead  was  appointed  for  the 
same  period  as  adviser  in  connection  with  the  Boaid's 
work  of  the  preparation  of  an  ti- toxin  serum  at  a  iee  oi 
100   guineas.     Mr.   T.    Duncomtje   Mann,    the  derk, 
presented    returns  showing  that  there  was  only  one 
small-pox  patient  under  treatment,  and  that  there  bad 
been  no  admissioas  to,  or  dis^iarges  from,  the  Boai^'s 
small-pox    institutions    during    the   fortotght  ended 
Thursday  last. 


Nov.  23.  1^4 


MEDICAL  N5WS. 


Thk  Mkpical  Pmms.    561 


9bituarv« 

W.  C.  NEVILLP.  M.D.DUB..  F.R.C.P.I. 
It  is  with  more  than  ordinary  regret  we  record  the 
death  of  Dr.  William  C.  Neville,  of  Dublin,  who  died 
on  the  15th  inst.  After  a  di^tineuished  course  in 
Trinity  CoUege  he  took  his  medicia  degrees  in  1878. 
and  90on  devoted  himself  to  the  obstetric  branch  of 
the  profession.  In  this  line  he  had  already  reached  a 
high  place  both  as  a  teacher  in  the  old  Carmichael 
School  and  in  practi  e,  when,  unfortunately,  his  health 
and  he  had  for  some  years  to  retire  from 


gave  way, 

practice.     During  his  retirement  he  gave  much  tmie 

to  the  study  of  pathology  and  b  cteriology,  with  the  i.,     j-     •    .*  *•         r     •  . 

r«Mlt  that  when  he  resumed  more  active  work  a  few  »»  a  Wand,  ummtatm^.  oleaginous  base. 


It  is  an  excellent  application  in  inflammatory  affections 
of  the  nose  and  throat,  and  is  recommended  as  a 
soothing  and  antiseptic  astringent  in  acute  rhinitis 
or  coryxa.  The  best  results  are  <^btaiQed  by  n>raying 
it  mto  the  nasal  passages  from  a  nebuliser.  Of  great 
service  in  the  treatment  of  hay  fever  and  chronic  nasal 
catarrh,  and  superior  to  many  other  astmgeiit  agents 
because  of  its  bland  nature  in  the  treatment  ol  pharyn- 
gitis. tonsilUtis.  and  laryngitis  with  aphonia*  Also 
used  as  a  luMcant  for  urethral  instruments,  tending 
to  reduce  the  turgescence  of  the  mucus  by  its  astrin- 
gent action. 

3. — Adrenaiin    OtfUmeni    is    compounded    of    one 
thousand  parts  to   one    pttrt    of   adreaalin    cnk>ride 

It  is  adapted 


the 


years  ago  his  opinion  as  a  pathologist,  particularly  m  i  to  the  treatment  of  inflammatory  conditums  of 
gynaecological  c^s.  was  recognised  as  one  of  the  best  mucous  membrane  of  the  nose  m  ccayza,  or  rhmitis, 
hi  Dublin.  Under  the  mastS-ship  of  Dr.  Purefoy  he  ^^Y  ^ever  ^d  asthma.  It  is  a  useful  appUcation  to 
was  installed  as  Pathologist  to  the  Rotunda  Hospital,  ir^med surfaces  such  as exUrnala^ 
and  the  work  he  did  there  has  been  of  the  greatest  1  '^^^"^%  ^^^  «P  ^?  coUaps»We  tubes  provided  with  an 
value.  In  fact,  at  the  time  of  his  death  his  authority  elongated  tip.  to  facilitate  mtroduction  mto  the  nose, 
in  the  special  branch  of  gynaecological  pathology  was  urethra,  and  external  ear^  ajid  by  means  of 


second  to  none  in  the  kingdom.  His  work,  however, 
was  done  so  modestly  that  few  outside  his  own  circle  of 
acquaintances  knew  anything  of  it.  Though  ailing  for 
some  weeks,  he  was  unaware  that  there  was  anything 
seriouslv  wrong  with  h  m  and  he  kept  at  work  until 
eight  days  before  his  death.  An  acute  attack  of 
nephritis  proved  quickly  fatal.  A  man  of  wide  culture 
outside  his  specialty,  an  athlete  of  note  in  his  younger 
days,  he  once  captained  the  Irish  Fifteen.  Dr.  Neville 
retained  to  middle  life  the  freshness  and  honesty  of 
youth.  Of  marked  hterary  tastes,  and  with  a  literary 
gift  of  a.  very  high  order,  it  is  unfortunate  that  circum- 
stances forbade  more  generous  contributions  to  the 
literature  of  science.  His  name  is  associated,  however, 
with  wtiat  is  probaDly  the  most  useful  axis- traction 
midwifery  forceps  that  has  been  devised.  At  the  time 
that  his  health  first  broke  down  he  had  in  preparation 
a  work  on  obstetrics,  which,  alas  I  has  never  been 
carried  to  a  conclusion  ;  and  again  at  the  time  of  his 
death  lie  was  engaged  in  writing  a  contribution  on 
puerperal  septic  infection  to  a  similar  work.  He  also 
had  in  contemplation  the  preparation  of  a  manual  on 
gynaecological  pathology.     Had  Neville  not  succumbed 


[  an  oint- 


ment syringe  within  the  rectum. 

Allsopps  Lagsr  B&BR. 
Sir  a.  Cameron  reports  that  his  analysis  of  the  lager 
beer  manufactured  by  Messrs.  Allsopp  and  Sons  gave 
the  following  results : — 100  parts  by  weight  contain 
the  following  percentages:  Water.  89.49;  absolute 
alcohol.  4-34;  malt  sugar.  2.04;  Dextrine,  3.34; 
albumen  and  albumenoids,  0.40 ;  acids,  calctdated  as 
acetic,  0.12;  and  mineral  matter  {ash),  0.27.  It  is 
free  from  excess  of  acid,  from  "  preservatives."  and 
from  arsenic  and  other  impurities  which  have  some- 
times been  detected  in  ales.  It  is  an  excellent  beverage.^ 
and  one  which  persons  who  cannot  drink  heavier  malt 
liquors  will  be  likely  to  find  digestible  and  wholesome. 
It  is  brewed  on  the  continental  low-fermentation  system 
the  fermentation  rooms  being  kept  at  a  uniform  tem- 
perature all  the  year  round  by  ammonia  ice  machines, 
whilst  the  method  of  manufacture  in  their  new  lager 
brewery  at  Burton-on-Trent  is  thoroughly  up  to  date. 


Addresses  on  the  Poor-La w  Medical  Servles  in  Ireland. 

During  the  past  week  Surgeon-General  Evatt,  who 

^^   «        *            ^.  is  on  tour  in  Ireland  under  the  auspices  of  the  Irish 

in  the  first  instance  to  the  consequence  of  hard  work  Medical  Association,  addressed  a  series  of  meetings  at 
and  mental  strain  he  would  long  ere  this  have  reached  the  different  medical  schools  in  Dublin.  The  first 
the  very  topmost  rank  in  his  profession.  There  are  meeting  took  place  at  the  Royal  College  of  Surgeons, 
many  men  who  can  claim  pre-eminence  in  the  practical  and  at  it  Sir  Lambert  Ormsby  took  the  chair  ;  the 
side  of  the  profession  of  medicine,  there  are  many  who  second  meeting  in  Trinity  College.  Sir  Charles  Ball  in 
have  acquired  a  wide  knowledge  of  theory  and  who  at  the  chair  ;  and  the  third  at  the  Catholic  University 
the  same  time  have  the  power  of  placing  their  know-  Medical  School,  Dr.  Anthony  Roche  in  the  chair.  At 
ledge  before  their  feUowfi  ;  but  there  is  no  main  with  all  three  meetings  Surgeon-ueneral  Evatt's  address  was 
whose  work  we  3it  familiar  who  unites  the  three  received  with  great  enthusiasm.  The  question  is^  how- 
qualities  as  did  he.  A  man  of  absolute  honesty  and  ever.  t>eing  asked.  What  is  it  all  for,  if  the  Irish  MedicaJ 
fearlessness  of  principle^  withal  of  singular  gentleness  Association  ax^  about  to  abandon  the  Enniskillen 
and  tractabiUty,  with  am  indescribable  charm  of  programme,  and  to  withdraw  their  demand  for  a 
manner.  Neville's  memory  will  remadn  green  aimong  minimum  saJary  of  ;^200  per  annum  ?  It  is  not  the 
his  friends  when  many  who  have  figured  more  largely  metre  abandonment  of  the  au:tual  sum  demanded  as 


in  the  world  of  medicine  have  been  forgotten. 


Xaboraton?  "RoteB. 

1PE;W    REMEDIES. 

MvtSB^  Fasks.  Davis  and  Company  have  sent 
us  satmples  oi  the  foflpwinf  three  new  specialities: — 

i,—^Ac^(qzQmt  Inha/^ni  Is  a  powerful  germicide, 
deodorant  aoid  local  anaestbotic.  It  is  stated  to  con- 
tain   1    per  cent,    of    acetozone  dissolved  in  liquid 


Enniskillen  that  we  feakr  will  work  harm,  so  much  ais 
the  sending  abroad  of  an  impression  that  the  members 
have  been  beaten  on  one  point  and  can  therefore  be 
also  beaten  on  others. 

The  Medlevl  Graduates'  CoUege  and  Polyelfnle. 
The  sixth  annual  dinner  of  the  Medical  Graduates' 
College  and  Polyclinic  will  be  held  at  the  Ifracadera 
Restaurant,  PiccadiUy  Circus,  on  Wednesday.  Decem- 
ber 7th,  at  7.15  for  7.50  p.m..  Dr.  C.  Theodore  WiUiatms 
in  the  chair.    Ladies  are  admissible  as  guests.     Dinner 


petroleum,  a  colourless,  odourless,  liquid  paraflSn.   The ,  tickets,  7s.  6d.  (exclusive  of  wine),  can  be  obtained 
Inhalant  is  used  as  a  spray  from  a  nebuliser,  after  the   from  Mr.  Hayward  Pinch,  F.R.C.S..  22.  Chenies  Street, 
nasal  chamber  has  been  thprougnly  cleansed  with  an   W.C, 
alkaline  solution.     The  germicidad  action  takes  place 
only  s^ter  the  acetozone  has  been  hydrolysed  by  the 
moisture  of  tne  mucous  mepxbrane.  amd  thus  ensures 
the  therapeutic  application  of  the  per-acids  whilst  these 
are  in  the  naiscent  condition. 

2.'-'Adr4naUn>  Inha^jftni  U  a  preparation  consisting 
of  a  solution  1  1,000  of  adrenalin  chloride  in  an  aroma- 
tized neutral  oil  base  with  3  per  cent,  of  chloretone. 


to  whom  adl  communications  shovld  be  addressed. 
St.  Louts  Exhibition  Awards. 
^  Besides  those  already  announced  in  connection  With 
medicine  and  medicad  appliances,  a  gold  medal  has  been 
awarded  to  the  Jeyes'  Sanitary  Compounds  Company 
for  Cyllin  and  its  preparations.  Also  to  the  Hutchison 
Acoustic  Company,  a  Gold  Medal  lor  the  Massacoa  and 
Acousticon.  ais  the  best  appliances  known  for  ^e  reltet 
of  deaifness  amd  instruction  for  the  dumb. 


562    The  Medical  Press.         NOTICES  TO  CORRESPONDENTS. 


Nov.  23.  1904 


JUrttCtB  t0 


jH^  OoiunomiMn  req«irioir*  Nplj  <n  thJi  oolmnn  are  pMtfcm- 
lirly  reqofliUd  to  main  um  of  a  difMiieMw  Mpmtfvrt  or /ntttel,  and 
avoid  th« pnMStioa of  aigiiiDsr  themselves  "Header,"  "Sabeoriber/* 
»*  Old  Sobsoriber/'  ko.  Much  oonfusion  will  be  spared  bj  attontloii 
to  tbisrule. 

*  Obwmal  AsnoLM  or  Lrtbrs  intended  for  publioatioB  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  aothentieated 
with  the  name  and  address  of  the  writer,  not  neoessarily  for  publlaa- 
tlon,  but  as  cvidenoe  of  identitr. 

CoimiBSTOBS  are  kindly  requested  to  send  their  communtoations 
if  raeident  In  Bntrland  or  the  Colonies,  to  the  Editor  at  the  London 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  In  order  to  save  time 
in  re-forwardingr  from'  office  to  office.  When  sendlnar  snbeorlptiqDS 
the  same  rule  applies  as  to  office;  these  should  be  addressed  to  ttMe 
Publisher. 

BwaiKTB.— Beprints  of  avtioles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

IRISH  POOR-LAW  MEDICAL  SERVICE. 
WRiTno  a  letter  of  regret  for  inability  to  attend  a  lecture  by 
Surgetiii-Oeneral  Evatt,  the  Most  Bev.  Dr.aoare,  Bishop  of  Ardagh, 
expresses  sympathy  with  the  object  of  the  meeting  and  with  the 
intention  of  the  Irish  Medical  Association,  and  says  :— '  It  is  quite" 
wiong  to  expeo(>  piofessional  men  to  discharKe  their  onerous  and 
responsible  duties  with  credit  to  themselves  and  satisfaction  to  the 
Bttblic,  unless  a  doe  sense  of  proportion  in  the  remuneration  «*f  their 
vzofefsional  services  i»  qbserved  by  the  people's  repreaentatives. 
MO  d«ubt  the  people  are  |>oor.  and  the  demands  uiK>n  them  conse* 
quent  ui  on  the  Local  Government  Act  are  well  mga  oppressive,  but 
there  should  bean  amelioration  of  the  status  of  the  hardest  wpilced 
mun  in  eaistence  -  the  I«ish  Dispensary  and  Workhouse  Doct*  r.' 

BuxTOV  (F  O.B.).— If  you  will  give  a  little  more  detail  as  to  the 
4xact  current  available  from  the  main  we  should  be  pleased  io  advise 
you  as  to  apparatus. 

THE  VAGARIES  OF  MODERN  LOCOMOTION. 

LoED  Baring's  motor-car,  which  wee  sent  to  WinoheKter  in  haste 
last  week  to  fstoh  Doctor  Apvlebe  and  a  nurse  to  Stratton  Fark,  to 
attend  on  Lord  Nor  hbrook,  raannte  m  milk-cart  on  the  return  Journey 
Dr  Applebe  and  the  ohaulfetit  Were  thrown  out,  the  docto  susta  ntng 
a  fracture  of  the  left  arm,  and  the  chauffeur  a  aisloc*tion  of  the 
ahoulder. 

O  A.  O.  BaowN  (Liverpool).— If  you  are  anxious  to  secure  a  resi- 
dent natient  the  beet  course  is  to  write  for  particnlarK  to  the  Hon. 
g^,  XjHOCiation Revklent  Patients,  18a  Hanover  ht,,  London,  W. 

▲  THERAPEUTICAL  NOMENCLATURE. 

Wb  understand  that  the  two  new  ships  on  order  for  the  White 
Star  Line  are  to  be  named  in  aocordiinoe  with  the  t'aditional 
tarminatioaia'*io"  -one  the  ''Cathartic  " specially  reoomm«>nded  for 
laaD  edjpassage,  and  the  other  the  '*  Emetio,"  more  particularly 
ikd^.ted  f  or  travellers  who  desire  a  quick  tetutn. 

MoHOPkseiA  (Orkney).- Whether  the  conditions  be  one  of  neuras- 
Chenia  or  of  hyste*  la.  it  would  be  wise  to  try  the  effect  of  a  ooorre  of 
hffh-f reouency electrical  current.  The  good  effect  is  not  usually 
experienced  until  the  eighth  or  tenth  application.  Oo  to  a  medical 
flpeoialist. 

^jeetittgB  of  the  §cdriieB,  %tttv(xt»,  *jc 

Thubsdat,  Novxmnt  a4th. 
MniCAL  Gbaduates'  Collxgi  and  Poltolinic  (2S  Ohenies  Street, 
W.C.).-- 4  p.m.  Mr.  Hutobinson  :    CUniqoe.    (Surgical.)     6  16  p.m. 
Dr.  G.  Hersch  Ul :  Modem  Intra-Gastric  Methods  in  the  Treatmen  t 


^J^^^^SJ^  Geaddams*   (>>llb«b  An>    Voi,^cixMtc   (tt  r^— ^ 
8ti2et,W.O.).-4p.m.Mr.M.  YeataleyrCUnique.    (Ear.)    ^^ 
n  ^^^^^^VAtm  COLLMB  (Weat  L.«4idon  noep  tal,  Hamw 
■0^1  W.).~5  p.m.    Mr.  Anhuur :  Injuries  to  the  bpine  aad 

Natiohal  HosprrAi.  F'>e  thb  PAftALTSSD  AVD  EriLvnc  (Qntta'i 
Square,  Bloomsbury,  W.C  ).-8.ao  pum.  Dr.  J.  Taylor :  OylSSSm^ 
plegiam  Diseases  of  the  Nervous  bystem 
;t  r ®*?5;^*"  Lokdou  Post-Gkadoatb  Oo  LMi<TotteDliaa  BoentiL 


W.)  -  8  p  m.  Papers  bv  :-Mr.  T.  H.  KeU.Ksk,  M.D..  Jl 

S°^  Antinomyoosis,"  Mr.  R.  Denison  Pedley  F.F 

L^8.Gng,    Oil    "The  Relationship    between 
J/tseases. 


MovDAT,  NovxMBn  SSth. 

Odovtolooical  Socibtt  op  Gbbat  Bbitaiv  cm  Baaovcr  Som. 

rv_«...-    °- "        -i.D..ll.A.F.SaJl!; 

.R.a8.Sd.,  M.Ejci^ 
It    Uental   and  dkw 


NoaxMiJlASTLoHDOH  Pubt-Gkaduam  OohLmaM  (TottanhasBHsvi. 
tal).-4.a05.m.    Leature:  Dr.  Comer:  Mmda  and  Melancftola.^ 

Bermondsey  Parish.—FlrBt  Assistant  Medical  Oflloer.    8ola»y  £a 

per  annum,  together  with  rationa,  wtaabing.-  f .  ndshed  asaiv 

ments,  and  attendance.    Applications  to  K.  Pitts  f^ntqs^  UoL 

Ouaidians'  office*,  188,  Toolry  Htreet,  b.  E. 
Royal  Murrey  county  Hosp  tal,  Goiloioitl.-  lUaident  House  flamioe. 

fiala  y  iBlOO  per  annum,  with  bgard,  reaidenoe.  and  teiMkT. 

Applicatious  to  the  Hon.  becietary. 
^^^^  Genersl    Dispensary    and    Inflrmaiy— BeakleDt   Medfcsi 

Oflloer.    Salary  4S1«0  a  year,  with  rooms.  gM  mud  ^■^^-Onrr. 

Applications  to  Hon.  decrecary,  Inflnnary,  Jeiaejr. 
Bracebndge    Asylum,  near    Lincoln.— JuiJor  As  istaia 

OfDcer.    B^Iaiy  £126  per  annum,  with   fu  nishad   a, 

&c.^AppIteationstoW.T  rage  Jun.,BodeitorAiMl  Olcfktolhi' 

Visiting  C«.mmittee,  .^  Ba«ik  street,  Linoolu. 
AddMbrooke;s     H  spital,    Cambridge.    8eor«tary49iiperfateBdMi 

Salary  £260  1  er  annum.  Appikationa  to  iha  cccMtary.  S3  dL 

Andrew's  Strset,  Cambridge.  ^ 

'^^3^^  *;^^^^  Chi.dren,  Great  Orsoad  Street.  Londsa, 

WC— Resident    Medical  buperintendeuc.    Salaty    £lim 

annum,  with  board  nud  residence  in  the  hoapital  arid  £6 


sUowance.  Applicatioos  to  James  flieK«y.  aoUng  8eei«ttr7 
County  Mayo  Infirmary.—  ssistant  Surgeon,  al-o  to  act  as  Gen- 
pounder,  tialary  £iC9  per  annum,  with  a|4trtincnta,  aUcndsaee. 
iko  Applloauonsto  Dt,  M.  O'MaUey  Knott,  Ass  dent  dofgcsT 
( Hee  advt> ) 
Beyal  Hospital  for  Incurables,  Dublin.— Reaideat  Madieal  OiBeer 
tMLla  y  gl20D«r  annum,  with  board  Ao.  AppJioattena  to  J.  J. 
Thompson,  Registrar.    (6eeAdvt.J 


JlppomtmeniB. 

BuxBLBT,  W.  B.,  M.R.C.8.,  L.RC.P,    House    Saittaosi  to  dM 

Women's  and  ChlMreu's  Hospital,  Leeds  ^^ 

liAuan  Jamxs.  H.B.,  O.M.Glasg.,  MedficAl  Oflloer  to  tbe  SmlttastoBe 

Asylum  and  Poor  House  Greenock. 
Ls^,R,  H.,  MD,  Resident  Ph>sioUn  Blohmond,  Whltworth  sad 

B<udwicke  Hospitals,  Dublm. 
RuTHKHFORD,  J.  W.,  M.D.,  Resident  Surgeon,    WMtwottbt  sad 

Harwickc  Hospitals.  Dublin.  ^ 

St.  Jobv.  Wihstan  ^t.  a..  M.R.C.8 ,  L.R.  ''.F.Lond.,  Honocarv  8nr- 

geon  to  the  D  rbyshire  Hospital  for  Siuk  Children. 
TUiiVBft,  H.  fiiTAKLXT.  M.tt.O.S.Kng.,  LR.C.P.LoDd.,'BMirtn»  io 

the  Central  London  Rnr  and  Thioat  Hoapital. 


ofDseasesof  the  Stomach.  *.„..,„ 

Pq8i-G&aduatcColl»oi  (West  London  Hospftal,  Hsmmersmibh 
Soi^  W.).— 6 j>  m.  Mr,  8.  E  warris :  Cancer  of  the  Rectum. 

.  Samautax  Fa  %  Hospital  vor  Wombv  (Marylebone  Road,  N.W.). 
—8  p.m.  Dr.  Roberts  :  Cases  from  tbeWaids. 

'Momrr  Yx&von  Hospital  foe  CoBsuicrrxoH  abd  Disbasm  of 
THB  •  HBST  (7  Fitxroy  Square,  W.).— 6  p  m  Lecture  :  Dr.  F. 
N.  Kelyuack  :  Practical  Points  in  the  Hygienic  Treatment  of  the 
Respiratory  Affections  (illustrated  by  prep^ratioos).    (Post-Graduate 

CHAauiQ  Caoea  Hospital.— 8  p.m.  Mr.  Gibba  :  DemonstratioBs  of 
Surgical  Cases.    (Poai-Graduate  Course ) 

Tbb  Hospital  fob  Sick  Childbbm  (Great  Ormond  Street,  W.C.).— 
4  p.m.    Lecture :— Mr.  S.  Collier :  Peritonea^  Infection  in  Childhood. 

Fbisat,  Novbmbbr  25th. 

Cldooal  Sooixrr  of  Lobdom  (20  Hanover  Square  WJ.— 8.80  p.m. 
Papers  :  Dr.  C  R  Box  :  The  Crises  «f  Poster  or  B^sic  MenlngiUs  — 
Dr;  H.  D.  R  Ifestoo  :  A  Case  of  Uoilateral  Tuberculous  Meningitis 
in  «h  ch  aBultoos  Rruption  followed  Lumbar  Puncture.— Mr.  £.  M. 
Comer  and  Mr.  L.  8.  Dadgeoo  :  Post-operative  Acute  Local  Tuber- 
culous Infection.— Mr.  C.  WaUaoe :  A  Series  of  Intussusceptions  in 
Children. 


gtirths. 


Watsob.-Ou  Nov.  14th  at  47  Mount  Pleasant  Road,  Tkmbridff 
Wells.'  the  Wife  of  G.  Triutram  Wataun,  M.A.rM4B..  BLC, 
F.R.C.S.,  of  a  daughter. 


Bbtdbv- Kbtchbb.— On  Nov.  17th,  at  All  Sainta'  SBBlsoMre  Gsr* 
deos,  London,  8.W.,  Charlea  lAiaisdaine.  8«tn  •  f  the  late  snigeoa- 
Mal.r  J.  L.  Bryden,MD.  Sengal  Medical  ^e>vloe.  t-»  Beiyl 
EHme,  younger  daughter  of  Major^ienend  1.  Ketcben.  late  Bojd 
Artillery,  of  6  Nevern  Rausious.  LQnd»«n. 

LoMBa  -  Mkssum.  Qn  Nov.  i6tii  at  elt.  atephen«  a  Chnrch.  London, 
S.W.,  Ca  U  C.  A  Mclliree  L>nMfr  9Ut  Hoaaara.  aeoond  sob  of 
Cecil  W  ilson  Lomer.  Esq.,  late  uf  Rosamttfo,  Hhirley,  Hants,  to 
Maude  Antuinette,  eideat  daughter  o<  Gordon  Measum,  M.D.,  of 
the  Gables,  Ftetoria. 

CHlLD.-On  Nov.  18th,  at  Wei-hai-Wei,  Cecil  Rdwin  Criswfck  sged 
29, su  geon  R.N  ,  H.M.8.  Ocean,  second  ton  of  thw.a^e  Rdvm 
i  h  Id,  M.aC.8.  of  New  Maiden.       ,  „  ,.«.,. 

HopwooD.-On  November  »th.  at  Oovlton,  Boumem-vth,  Ssisk, 
Elisabeth  (Sela).  the  dearly  loved  wife  of  Dep.  burgeoo^GeDoal 
H-pwood  (Ret),A.MD.  aged  60.  .  ^  ... 

Nevillb.— On  November  I6th,  at  70  Lower  Mount  Strset.  DoUis. 
Wm.  Cox  Neville,  M,D.,  aged  4»  yeara.  800014  ■«•  •«  «*«  >i* 
John  Neville,  C.B..  County  surveyor,  00.  l.outh. 


Wkt  ^dim\  ^xm  mA  fettt»t 


*'BALVB   POPULI   BUPBEMA   LEX.* 


Vol.  CXXIX. 


WEDNESDAY,    NOVEMBER    30,    1904.        No.    22. 


(Pridfnal  Communfcatfons. 

COCAINISATION   OF   THE 
SPINAL    CORD,    (a) 

By  ROBERT    TONES,   F.R.C.g., 
Surgeon  to  the  Boyal  Southern  Hospital  and  the  Liverpool  Country 
Hospitnl  for  Children. 

Mr.  President  and  Gentlemen, — Spinal  co- 
cainisation  has  been  known  among  foreign 
surgeons  as  having  distinct  claims,  yet  very  little 
is  heard  of  it  from  our  own  people.  It  is  because 
I  believe  that  its  employment  is  more  often 
indicated  than  English  surgeons  seem  to  recognise 
"that  I  venture  to  draw  attention  to  two  typical 
cases  where  its  use  proved  of  value. 

A  working  man,  aet.  30,  was  sent  to  me  by  Dr. 
Marsh,  of  Atherton.  He  had  been  af  wilful, 
obstinate  patient,  who,  in  spite  of  every  care  on 
the  part  of  his  doctor,  presented  a  malunited 
fracture  of  the  lower  third  of  the  tibia  and  fibula. 
His  foot  was  everted,  and  the  lower  fragments 
in  addition  were  displaced  backwards.  I  ex- 
plained to  him  it  was  necessary  to  exsect  bone 
and  wire  fragments,  and  to  this  he  at  once  con- 
sented. He  was  a  big  person,  and  as  soon  as  he 
had  taken  two  or  three  whiffs  of  chloroform  he 
jumped  off  the  table  and  scampered  down  the 
corridor  and  back  to  bed.  Persuasive  methods 
ivere  unavailing,  and  Nature  had  so  endowed 
him  that  we  felt  forcible  methods  had  best  be 
kept  in  abeyance.  There  was  nothing  left  us 
but  to  dismiss  him  and  to  forget  him.  A  fort- 
night later,  his  promises  had  been  so  alluring, 
we  re-admitted  him,  and  we  underwent  precisely 
the  same  experiences  as  before,  and  a  second 
time  he  left  the  hospital.  I  explained  to  Dr. 
Marsh  how  impossible  he  was,  but  I  promised 
to  take  him  in  a  third  time,  and  on  this  occasion 
determined  to  cocainise  his  cerebro-spinal  fluid. 
He  submitted  to  this  without  protest.  A  fifth 
of  a  grain  was  injected  between  the  third  and 
fourth  lumbar  vertebrae,  and  in  ten  minutes  all 
sensation  left  him  to  well  above  the  umbilicus. 
He  was  an  old  poacher,  and  while  I  was  operating 
he  poured  into  the  ears  of  Mr.  Littler  Jones 
anecdotes  relating  to  his  art.  He  exhibited  no 
signs  of  pallor  and  nausea,  and  the  only  interest 
he  took  in  the  operation  happened  when  I  was 
chiselling  through  very  hard  callus — he  then 
asked  "  what  is  that  knocking  ?  "  He  took  a 
good  meal  when  he  went  back  to  the  ward,  had 
no  untoward  symptom,  and  made  an  uneventful 
recovery. 

The  second  case  I  present  to  you  is  that  of  a 
man  of  nearly  sixty,  who  had  always  led  an  active 

(a)  R^adat  the  Liverpool  Medical  Institution,  Thnrsdar.  Hovem- 
l)eT  17th,  1904. 


I  life,  but  had  for  some  years  been  crippled  by  a 
I  disorganised  tuberculous  hip.  I  saw  him  with 
I  Dr.  Warburton,  and  found  his  condition  truly 
deplorable.  He  had  fallen  on  his  already  diseased 
and  painful  joint.  It  was  flexed  to  a  right  angle, 
tense,  glazed,  adducted,  exquisitely  sore.  A  foot- 
step on  the  floor,  the  closing  of  a  door,  a  cough 
were  followed  by  intense  suffering.  A  splint  he 
had  always  refused  to  wear.  We  removed  him 
in  a  few  days  to  a  little  ward  in  the  hospital, 
where  he  arrived  much  exhausted  and  distressed. 
One  then  found  that  in  addition  to  an  abscess 
deep-seated,  he  had  cavities  in  his  lungs.  The 
problem  we  put  to  ourselves  was  this — Are  we 
justified  in  exsecting  a  hip,  in  an  exhausted 
patient  with  a  pulse  of  130  and  cavities  in  his 
lungs,  so  that  should  he  survive  the  shock  he 
might  wear  a  splint  with  comfort  and  end  his 
days  comparatively  free  from  pain  ?  Our  decision 
was  made  easy  by  the  patient,  who  pleaded  that 
death  would  be  a  grateful  release  from  so  much 
suffering.  We  decided  to  operate,  and  Mr. 
Alexander  proceeded  to  administer  chloroform. 
Only  a  few  whiffs  had  been  taken  when  the  patient's 
face  became  blue,  his  pulse  disappeared,  and  his. 
extremities  became  cold.  We  thought  he  would 
die  on  the  table,  and  he  was  hurriedly  removed 
to  the  ward.  The  anaesthetic  produced  consider- 
able shock,  and  for  some  days  serious  reaction 
occurred  in  the  lungs.  We  decided  on  the  next 
occasion  to  cocainise  the  spine.  His  pulse  was 
140,  and  we  sterilised  very  carefully  the  spine, 
using  specially  prepared  hermetically  sealed 
aseptic  cocaine  solution  for  injection.  In  from 
five  to  ten  minutes  his  hip  could  be  moved  without 
pain,  and  he  was  carried  into  the  theatre.  A 
screen  was  placed  in  front  of  him,  and  the  opera- 
tion was  proceeded  with.  Very  rapidly  a  long 
incision  was  made,  a  large  abscess  of  foetid  pus 
evacuated,  the  head  of  the  femur  removed,  and 
the  acetabulum  scraped.  When  the  femur  was 
being  sawn  the  patient  said,  "  I  know  he  is  doing 
something  to  me  now,  for  I  feel  my  body  shaking." 
Dr.  Stenhouse  Williams  told  me  at  the  end  of 
the  operation  that  the  pulse  was  steadier  and 
better  than  when  we  started.  The  patient  did 
not  suffer  appreciably  from  shock,  his  only  dis- 
comfort being  nausea,  which  lasted  some  hours. 
Several  weeks  have  elapsed  since  the  operation 
and  the  patient  has  lived  a  life  he  can  bear  with 
comfort,  and  he  complains  but  little  of  his  hip. 
I  have  chosen  these  two  case  as  types  in  support , 
of  the  undoubted  value  of  this  form  of  anaesthesia. 
In  one  case  the  patient  would  not  take  chloroform  ; 
in  the  other  he  could  not.  Cocaine  in  each  instance 
answered  admirably.  Cases  of  this  kind  are 
common,  and  we  all  have  met  with  many  people 
who    forego    very   necessary   surgical    procedures 


564    The  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


Nov.  3a  1904. 


because  they  refuse  a  general  anaesthetic.  A  few 
words  regarding  the  history  and  status  of  spinal 
cocainisation  may  not,  therefore,  be  out  of  place. 
It  was  first  suggested  and  tried  by  Corning,  of 
Chicago,  but  Bier  and  I-eldswitsch  were  pioneers 
on  the  Continent,  and  Tuffier  of  Paris,  one  of 
the  most  trustworthy  and  best  of  surgeons,  used  it 
as  a  routine  anaesthetic.  It  is  perhaps  this  use 
of  it  as  a  routine  anaesthetic  which  has  prevented 
English  surgeons  from  doing  justice  to  its  useful- 
ness. The  concensus  of  opinions  abroad  is 
adverse  to  any  attempt  at  substituting  cocaine 
for  ether  and  chloroform.  About  eleven  deaths 
have  occurred  in  about  three  thousand  cases,  all 
of  which  seem  to  be  due  to  toxic  poisoning.  If 
for  no  other  reason  this  should  negative  its  routine 
employment.  Some  surgeons  like  Tuffier  have 
been  remarkably  free  from  catastrophe.  When  I 
heard  last  he  had  operated  upon  over  three 
hundred  under  cocaine,  with  only  one  death 
which  might  reasonably  be  ascribed  to  the  drug. 
Morton,  who,  like  Tuffier,  is  remarkably  good  in 
his  technique,  out  of  253  cases  had  only  seen 
alarming  symptoms  in  one  case,  and  in  that  case 
a  quantity  of  cerebro-spinal  fluid  had  been  rer 
moved  for  investigation.  Stone,  out  of  441  cases, 
met  with  only  one  death,  and  I  merely  mention 
these  statistics  in  support  of  the  argument  that 
even  if  cocaine  cannot  compete  with  ether  or 
chloroform  as  a  routine  anaesthetic,  it  is  sufficiently 
safe  to  be  used  as  an  occasional  substitute  in 
suitable  cases.  Obviously,  for  its  safe  practise 
an  irreproachable  technique  is  demanded.  The 
patient's  skin  should  be  scrupulously  clean.  The 
cocaine  solution  must  be  sterile.  The  glass 
S3rringe  should  be  boiled  and  placed  in  sterile 
water.  The  needle  should  be  introduced  between 
the  third  and  fourth  or  fourth  and  fifth  lumbar 
vertebrae.  It  should  be  sufficiently  long,  fine, 
and  not  too  acutely  pointed.  The  patient  should 
be  made  to  stoop,  and  the  needle  should  be  intro- 
duced very  slowly  and  in  stages,  in  order  to  give 
the  cerebro-spinal  fluid  time  to  escape.  This  is 
a  most  important  point,  otherwise  it  is  easy  to 
traverse  the  canal.  No  injection  must  under 
any  condition  take  place  until  the  fluid  escapes 
through  the  needle.  The  causes  of  failure  in 
reaching  the  canal  are  easily  avoidable.  They 
may  arise  from  the  needle  impinging  on  the 
laminae,  from  failure  of  the  eye  to  enter  the 
canal,  from  a  clot  of  blood  or  tissue,  or  from 
traversing  the  canal.  If  the  needle  does  not 
reach  the  subarachnoid  space,  it  should  be  with- 
drawn and  re-applied.  It  is  a  mistake  only 
partially  to  withdraw  it.  Thirty  minims  of  a 
2  per  cent,  solution  should  be  a  maximum 
dose.  The  cocaine  should  be  introduced  very 
slowly.  Some  surgeons  advocate  receiving  the 
abstracted  cerebro-spinal  fluid  in  a  sterile  glass 
containing  one  grain  of  the  drug,  and  re-intro- 
ducing it  into  the  subarachnoid  space.  The  needle 
is  withdrawn  and  the  puncture  sealed.  When 
the  injection  has  been  completed,  the  patient  soon 
feels  a  sense  of  warmth  through  his  body,  thirst 
which  comes  on  in  about  five  minutes,  and  a 
certain  amount  of  nausea  which  laists  about  ten  or 
twenty  minutes.  If  the  patient  attempt  to  walk, 
some  inco-ordination  is  present,  his  sense  of  contact 
is  not  affected,  but  the  reflexes  are  slightly  dimin- 
ished. Intestinal  peristalsis  and  uterine  contrac- 
tions are  stimulated.  When  first  administered 
there  is  an  increaise  of  pulse  and  sometimes  pallor, 


perspiration,  and  vomiting,  while  sometimes  the 
sphincter  action  of  the  vagina,  rectrnn  and  IiIhiMl. 
are  abolished. 

Analgesia  usually  begins  in  the  feet  and  ascends 
slowly  in  from  three  to  ten  minutes,  until  it 
generally  ends  well  above  the  xiphoid.  There  is 
often  noted  an  abnormal  loquacity.  The  analgesb 
usually  lasts  for  over  one  hour,  sometiincs  for 
two  of  three.  The  fatal  cases  have  been  generaD\ 
due  to  direct  toxic  effects. 

In  order  to  convey  a  general  idea  of  the  fre- 
quency of  annoying  symptoms,  I  will  quofe 
Morton's  analysis  of  253  cases.  The  ages  of  ti* 
cases  operated  upon  ranged  from  eight  to  eighth- 
six  ;  many  of  the  patients  suffered  from  orgas: 
diseases  of  heart,  kidneys  and  lungs. 

Of  253  cases,  nausea  was  present  in  65 

„      „       „         vomiting        „  ,,       53 

headache       „  „       37 

„      „    •   ,,         invol.  evacuation     „        9 

„      ,,       „         post-operative  chill  „       6 

One  other  not  unusual  symptom  I  will  reier 
to,  and  this  is  a  post-operative  rise  of  temperature. 
ranging  from  99°  to  103''. 

For  tropa-cocaine,  of  which  I  have  no  expen- 
ence,  it  is  claimed  that  the  effects  are  not  neaxiy 
as  toxic,  and  are  recovered  from  more  quicUy. 
and  that  thirst,  heat,  vomiting,  and  perspiratioD 
seldom  follow  ;  against  this  some  observers  com- 
plain that  its  effects  are  not  sufliciently  constant 
to  warrant  its  substitution  for  cocaine.  Goinanl. 
however,  by  employing  cerebro-spinal  fluid  as  a 
ntiedium,  has  given  seventy  administrations  d 
tropa-cocaine  without  an  unpleasant  symptom. 
It  is  very  necessary,  however,  to  place  cottoo 
wool  in  the  ears,  and  place  a  screen  before  the 
patient  to  deaden  him  to  his  environment.  Many 
symptoms  may  be  due  to  fear  ;  as  Rodman  says, 
discussing  pallor,  "  no  one  can  look  at  his  own 
blood  without  misgiving  and  apprehension." 

What  are  the  contra-indications  ?  On  this  point 
opinions  differ  very  much.  From  the  point  of 
view  of  danger  Tuffier  warns  us  against  giving 
it  to  the  hysterical  and  to  children.  Others  with 
less  experience  proscribe  senile  degenerations  and 
renal  affections.  Morton,  with  his  250  cases,  says 
there  are  no  contra-indications,  although  be 
does  not  advocate  its  routine  use,  I  suspect  thai 
until  the  dose  is  administered,  nobody  can  tdl 
the  nervous  system  to  which  cocaine  is  a  poison. 
In  doubtful  cases  I  would  suggest  that  a  ven* 
small  subcutaneous  dose  might  solve  the  problem 
as  to  immunity. 

Tuffier,  although  he  has  performed  200  intra- 
abdomin£d  operations,  six  of  them  being  gastro- 
enterostomies, under  cocainisation,  thinks  the 
operator  may  be  somewhat  handicapped  by 
rigidity  of  muscle  and  occasional  vomiting,  and 
it  seems  generally  conceded  that  the  drug  is  best 
suited  to  those  instances  where  operations  are 
performed  for  herniae,  for  bladder  affections,  and 
for  serious  operations  on  the  limbs. 

My  feeling  is  that  spinal  cocainisation  has  come 
to  us  to  stay,  that  with  careful  aseptic  precautions 
the  risks  are  but  small  ;  its  indications  point 
towards  : — 

1.  Patients  not  suited  for  general  anaesthetics, 
such  as  in  those  suffering  from  advanced  phthisis 
and  from  respiratory  affections  like  bronchiti? 
and  asthma. 

2.  Towards  people  who  have  a  fixed  aversioa 


Nov.  30,  X904. 


ORIGINAL    COMMUNICATIONS.  Thb  Medical  P»em.    565 


to  taking  an  anaesthetic,  and  on  whom  an  opera- 
tion is  urgently  needed. 

3.  Towards  those  suffering  from  great  shock 
due  to  severe  injuries  of  the  lower  limbs. 

With  caution  in  its  employment,  and  the  careful 
selection  of  cases,  surgery  has  much  to  gain  from 
cocainisation. 


SOME   ASPECTS  OF 

METABOLISM-CHIEFLY 

CLINICAL,  (a) 

By  WILLIAM  CALWELL,  M.A..  M.D.. 

PrMidMt  of  the  Ulstmr  Medical  Society :  PhyBician  to  the  BelfMl 

Roy»l  Vietorift  HoepiteL 

Part    II. 

The  mysterious  influences  of  the  internal  secretion  of 
various  organs  now  come  into  play.  They  add  a  new 
wonder  to  life,  and  are  potent  for  good  and  evil. 

This  play  of  action  and  interaction  form  the  sym- 
ptom-complex of  nutrition  and  malnutrition.  There 
may  be  error  in  food  or  error  in  the  preparation,  or 
some  defect,  initial  or  acquired,  in  living  matter,  or 
perversion  of  internal  secretion,  or  some  mal-excre- 
tion. 

The  living  protoplasm  of  the  cells  can  apparently 
most  easily  assimilate  the  proteid  in  the  serum,  next 
tbe  carbohydrate,  and  the  fat  with  the  greatest  difh- 
ctslty.  The  proteid  molecule  is  the  most  compticated, 
but  also  most  accommodating,  too  accommodating  at 
times :  not  only  does  it  give  rise  to  the  simpler  mole- 
cules of  ammonium  carbonate  and  carbamate,  but 
glycogen  and  a  mono-saccharide  can  be  split  off,  and 
f&t  finds  a  ready  origin.  This  great  huge  lumbering 
mass  of  a  molecule  has.  like  the  Empire  of  China, 
enough  to  give  and  to  spare.  Of  all  proteid  molecules, 
the  nucleo-albumens  and  cerebrals  probably  furnish 
the  most  complicated  of  all. 

All  the  chemical  processes  of  cells  may  be  in  time 
reduced  to  fermentation,  the  function  of  the  living 
protoplasm  being  confined  to  the  determination  of  the 
direction  of  the  process  at  any  moment.  These 
ferments  are  innumerable ;  there  are  eight  known 
unorganised  ferments  in  the  alimentary  canal  and  a 
whole  array  in  the  body  fluids.  They  bring  about 
composition  with  an  evolution  of  kinetic  energy  without 
themselves  being  used  up  in  the  process.  If  products 
of  action  are  removed,  the  process  can  go  on  like  the 
reversible  action  in  chemistry.  Those  of  you  who 
practise  the  quantitative  estimation  of  sugar  by 
boiling  an  ammoniacal  solution  of  citric  hydrate  are 
often  puzzled  how  to  decide  when  all  the  copper  is 
exhausted.  You  boil  and  the  blue  colour  disappears ; 
but  then,  as  you  watch  the  solution  on  exposure  to 
air,  it  regains  some  of  its  blueness.  You  repeat  the 
process,  and  yet  again  repeat  it.  Apparently  an 
indefinitely  large  quantity  of  the  dextrose  can  be 
oxidised  by  the  same  solution  of  copper  ;  this  is  one 
of  the  fadlsicies  of  this  test ;  it  is  called  the  "  reversible 
action,"  and  in  the  inorganic  world  is  analogous  to 
the  fermentation  so  richly  found  in  physiological 
chemistry ;  the  fadlacy  in  practical  work  is  of  course 
avoided  by  noting  the  results  at  the  instant  that  the 
blue  colour  first  disappears.  Another  instance  is  the 
fact  that  spongy  platinum  will  effect  a  rapid  reunion 
between  oxygen  and  hydrogen  to  form  water.  Ferment, 
then,  is  a  factor  which  adds  nothing  to  the  total  energy 
of  the  reaction,  yet  materially  alters  its  velocity. 

Of  the  vital  action  of  the  protoplasm  itself  we  know 
little  ;  it  is  the  deepest  physical  secret  of  life,  next 
to  the  material  origin  of  consciousness ;  it  is  an  ultimate 
fact. 

This,  then,  is  about  as  compressed  a  synopsis  of 
the  metabolism  in  our  bodies  as  it  is  possible  to  make. 
From  the  evolutionary  point  of  view,  it  is  the  result 
of  millions  of  milUons  of  experiments  in  plant  and 

(a)  Openiofr  Address  delivered  befbre  the  Ulster  Medical  Society, 
Sesnon  1904-05. 


I  animal  life,  during  the  last  50,000,000  yeaxs.  Each 
I  living  bein^  has  been  a  test  tube  wherein  Nature  has 

been  experunenting ;    we  but  touch  the  fringe  in  the 

most  advanced  vital  chemistry. 

Can  we  propose  now  to  examine  into  the  question 
I  of  disease  arising — 

,  I.  From  some  perversion  of  the  ferment  action, 
I  by  which  albumen  is  converted  into  peptone  and 
I  starch  into  dextrose; 

2.  From  some  perversion  of  the  protoplasmic  or 
,  synthetic  action,   by  which  peptone  is  re-converted 

'  into  serum  albumen  and  dextrose  into  glycogen ; 

3.  From  some  perversion  of  the  anabolic  process 
of  the  most  highly  complicated  molecules  of  Uving 
protoplasm  throughout  the  whole  body; 

4.  From  some  perversion  of  the  kataboUc  or  dis- 
:  integrative  processes? 

This  would  be  the  theoretical  course,  but  for  practical 
I  purposes  a  different  and  more  clinical  course  will  be 

adopted, 
r  I . — ^The  natural  variations  in  metabolism  are  infinite — 
.  age.  sex,  temperament,  occupation,  hereditary  influ- 
ence, and  a  hundred  other  minor  causes  all  combine 
to  form  permutations  and  combinations  of  the  force 
of  which  we  can  only  make  a  sort  of  intuitive  guess, 
but  the  exact  value  of  which  in  an  individual  case 
under  special  circumstances  baffles  us  completely 
when  we  endeavour  to  establish  a  careful  estimate. 
You  know  of  Professor  Kraepelin's  (of  Heidelberg) 
experiments  on  certain  fundamental  properties  of 
mind,  as  capacity  for  work,  susceptibility  to  mental 
fatigue,  the  power  of  recovery  from  much  fatigue, 
the  power  of  concentration,  the  relation  of  bodily  and 
mental  fatigue,  depth  of  sleep  and  so  on.  Many  of 
these  experiments  and  results  might  be  applied  by 
analogy  to  metabolism  if  we  chsmged  some  of  the 
terms.  The  forces  of  metabolism  vary  in  individuals 
as  much  as  the  manifestations  of  nervous  energy. 
They  deserve  to  be  more  closely  studied  at  the  bedside. 
It  is  impossible  to  go  into  all  the  variations ;  two 
types  will  illustrate  my  meaning.  We  all  know  the 
big-boned  child  with  a  huge  appetite,  that  is  never 
fat ;  this  type  in  adult  life  performs  a  vast  amount 
of  work  at  a  spurt,  but  is  rather  deficient  in  staying 
power,  and  takes  alcohol  badly.  The  opposite  typs. 
the  phlegmatic,  rather  cold  child,  with  poor  appetite, 
eats  little,  but  still  is  fat ;  and  in  adult  life  often  endures 
prolonged  work,  and  even  privation,  and  shows  the 
strain  but  little  ;  he  can  also  take  for  years  an  unusual 
amount  of  alcohol,  with  at  first,  at  any  rate,  apparently 
no  further  result  than  being  a  little  too  stout. 

It  is  a  pity  that  our  old  friends,  choleric,  melan- 
chohc,  sanguine,  and  phlegmatic,  have  completely 
disappeared  from  our  note  taking ;  they  point  at  the 
power  and  changeability  of  emotions  and  metabolism, 
which  students  now  completely  ignore,  but  which 
they  subsequently  learn  from  pure  experience  with 
no  science  to  guide  them.  We  should,  however,  re- 
member the  natural  variations,  and  just  as  there  is  a 
slow  burning  coal  and  a  quick  burning  coal,  even  to 
an  explosive  petroleum  ;  and  just  as  there  is  a  coal 
with  little  ash,  and  a  coal  that  soon  puts  itself  out  by 
its  own  accumulation,  so  we  find  endless  variations 
in  the  firing  of  the  human  body. 

It  has  occurred  to  me  that  we  should  have  some 
clinical  method  of  examining  a  patient's  metabolism, 
as  we  examine  his  lungs,  and  heart,  and  brain.  The 
methods  that  we  find  exemplified  in  experimental 
investigation  in  the  Jovrnal  of  Phvsi  I'fry  are  out  of 
place  by  the  bedside ;  in  exceptional  instances  in 
hospital  the  chemical  examination  of  food,  urine, 
and  faeces  might  be  undertaken,  but  the  possibility 
and  advantage  of  any  general  practice  would  be  more 
than  dubious ;  as  far  as  we  can  see,  it  would  not  be 
compensatory  for  the  trouble.  I  am  inclined  to  think 
that  some  such  descriptions  of  the  metabolism  should 
be  added  to  notes  of  our  students  in  hospital. 

II. — Next,  of  the  changes  that  take  place  in  acute 
starvation  one  does  learn  but  little.  I  have  seen  one 
case  of  gastric  uher  where  a  return  to  feeding  by  the 


566    The  Medical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Nov.  30,  1904. 


mouth  was  delayed  so  long  on  account  of  previous 
haemorrhage  that  the  patient  died  from  actual  star- 
vation supervening  on  excessive  haemorrhage  at  an 
earlier  date.  But  although  such  an  occurrence  is 
rare,  the  gradual  starvation  that  ensues  in  malignant 
disease  of  the  cardiac  end  of  the  stomach,  and  the 
yet  more  complicated  starvation  that  follows  extensive 
and  chronic  gastric  ulceration,  is  not  uncommon. 
There  was  nothing  in  any  of  the  cases  that  I  have 
seen  that  struck  me  as  very  exceptional ;  the  natural 
conservation  of  energy,  the  want  of  mental  initiative, 
the  small  amount  of  urine  and  constipation  form  a 
familiar  picture.  No  special  examination  of  the 
excreta  was  made.  But  such  cases  form  opportunities 
ready  to  hand  for  examination  into  metabolism. 

As  an  instance  of  changed  metabolism  due  to  insuffi- 
ciency of  one  kind  of  food  and  an  excess  of  another, 
rickets  suggests  itself,  and  then  scurvy ;  their  study 
is  valuable  not  only  for  the  sake  of  the  disease  itself, 
but  as  types  of  disease  that  arise  from  some  small 
deficiency  in  food,  of  little  importance  for  one  day, 
but  when  repeated  daily,  week  in  week  out.  giving 
rise  to  an  affection  which  may  be  fatal  in  its  severity. 

III. — ^Excessive  feeding  has  been  well  studied  of 
late  in  our  consumptive  sanatoria,  and  an  interesting 
problem  faces  us.  In  Vol.  xxviii  of  the  Journal 
of  Physiology,  details  are  given  by  Goodbody,  Bard- 
well,  and  Clapman  of  an  investigation  into  the  meta*- 
holism  of  three  ordinary  healthy  men,  first  on  ordi- 
nary diet,  secondly  on  excessive  diet ;  the  results  are 
important,  and  are  summed  up  as  follows : — 

The  latter  in  all  cases  had  to  be  stopped  within  a 
few  weeks  ;  loss  of  appetite,  haemorrhoids,  dyspnoea  on 
walking,  mucous  colitis ;  at  first  a  rapid  increase  of 
weight,  a  subsequent  rapid  loss,  and  marked  deteriora- 
tion of  health  occurred  in  one  or  all.  This  result  is 
interesting  with  regard  to  feeding  of  consumptives. 
Dr.  Howard  Sinclair  and  Dr.  Burton  Fanning  have 
both  written  to  me  to  the  effect  that  the  limit  of  diet 
is  probably  the  same  as  in  health ;  my  own  view  is 
that  it  is  more  a  question  of  deficiency  before  than 
excess  after  entrance  to  a  sanatorium. 

The  question  of  an  excess  of  carbohydrates  in  food 
is  interesting.  No  excess  of  such  simple  articles  of 
diet  as  rice  appears  to  disagree  in  the  ordinary  indivi- 
dual. Excess  of  any  forms  of  sugar,  di-saccharides, 
or  mono-saccharides  soon  disagrees,  and  the  symptoms 
are  too  well  known  to  need  mention.  If,  however, 
we  inject  subcutaneously  large  quantities  of  dex- 
trose, 5  to  7  grammes  per  kilo  of  body  weight,  so 
that  it  is  acted  on  by  the  general  tissues  of  the  body, 
not  by  the  liver,  it  is  at  once  secreted  by  the 
kidney,  and  at  the  same  time  causes  a  marked  increase 
of  proteid  metabolism.  In  fact,  dextrose,  or  more 
probably  an  acid  derivative  of  dextrose,  under  such 
circumstances  acts  like  such  toxic  agents  as  phos- 
phorus, poisoning  the  protoplasm. 

These  results  (which  I  have  taken  from  V.  art.  by 
James  Scott,  M.D.,  in  Journal  of  Physiology,  vol. 
xxiii)  have  a  bearing  on  the  boils  and  phthisis 
of  diabetes,  and  also  on  the  acne  spots,  the  carious 
teeth  of  ordinary  sweet  eating ;  and  this  again  leads 
to  the  variations  in  susceptibility  to  the  evil  effect 
of  sweet-eating.  To  take  our  lesson  from  e very-day 
life,  one  young  lady  can  scarcely  touch  sugar  without 
disfiguring  her  face  ;  her  companion  in  the  parterre 
seems  to  think  nothing  of  a  box  of  chocolates,  and 
retains  the  peach-like  bloom  unspotted.  The  "  pro- 
tective substance"  in  the  latter  must  be  well  developed 
and  aUe  to  overcome  all  the  stray  staphylococci 
lodging  in  her  sebaceous  glands ;  or  the  sieve-like 
action  of  her  liver  must  be  peculiarly  delicate  and 
efficient.  People  vary  enormously  in  the  power  of 
dealing  with  not  only  alcohol,  but  carbohydrates  and 
proteids,  and  we  do  not  understand  the  secret. 

IV. — Dr.  Calwell  then  referred  at  some  length  to  cases 
ol  diseases  resulting  from  gastro-intestinal  toxins  and 
the  consequent  changes  in  metabolism.  He  con- 
tinued : — 

*  V. — Coming  to  the  next  class  of  cases — that  by 
changes  in  metabolism  due  {<o  affection  of  other  organs 


— I  must  be  content  merely  to  mention  the  diabetes 
mellitus  that  accompanies  atrophy  or  removal  of  the 
pancreas ;  the  causal  relation  is  not  tcnown ;  ikt 
wasting  vrithont  diabetes  that  follows  cixrhOBis  ol  tl^ 
pancreas,  and  has  so  often  misled  op«rators  into  the 
opinion  of  malignancy,  is  also  recognised  since  Mayo 
Robson's  publication. 

Of  the  kidneys  as  influencing  metabolism  we  meet 
not  infrequently  with  the  following  type  of  case:  A 
man  over  60  complains  of  some  I09S  of  weight,  bit 
most  of  loss  of  strength  and  energy:  there  is  a  s«b- 
normal  temperature,  large  quantities  of  urine  are  passed 
with  low  specific  gravity,  this  condition  deepens,  asc 
after  a  lapse  of  a  few  months  he  finally  dies,  being  tm- 
scious  up  to  his  death,  perhaps  a  little  delirious ;  b 
pupils  are  small,  and  there  is  muscular  trembling  ai^ 
restlessness.  Most  probably  an  enlarged  prostates 
discovered  during  life,  but  on  examination  after  6an 
there  is  found  hydronephrosis  of  both  kidne3rs.  wiik 
but  little  kidney  substance  left.  This  is  Robens 
"  latent  urasmia,"  and  its  symptoms  coincide  vor 
closely  with  Rose  Bradford's  results  in  removing  fn- 
tions  of  the  healthy  kidney.  He  found  that  when  a  frac- 
tion, say  one-fourth,  of  the  total  kidne^r  substance  was 
removed,  the  urine  increased  in  quantity,  its  spedic 
gravity  fell,  but  there  was  an  increased  excretion  of  ar*a 
greater  than  in  health,  and  as  high  as  when  the  ammal 
was  on  a  full  diet,  although  now  starving.  VThoi 
three-fourths  of  the  total  kidney  substance  was  removei 
the  wasting,  the  subnormal  temperature,  and  grelt  ac- 
cumulation of  urea  were  observed.  There  was  no  cooa 
convulsion,  dyspnoea,  vomiting,  nor  appreciable  rise  a 
arterial  pressure.  The  symptoms  are  not  those  a 
Bright' s.  they  point  to  a  peculiar  effect  of  the  Iddaey- 
perhaps  an  internal  secretion— on  proteid  metabdiB 
generally.  As  the  pancreas  has  some  peculiar  relatioB 
to  carbohydrate  metabolism,  so  the  kidney  has  sob? 
relation  with  proteid  metabolism. 

With  regard  to  the  effects  of  the  suprarenal  bodiK 
on  metabolism,  it  must  suffice  simply  to  menliBi 
Addison's  disease ;  similarly,  with  the  pttnitait 
body,  acromegaly;  with  the  thjrroid,  exophthalmic 
gottre,  myxoedema,  and  cretinism  ;  with  the  testa, 
the  great  change  that  ensues  concomitantly  vitk 
their  growth  during  adolescence,  their  inlubitonr 
influence  on  fat  formation,  their  general  stimulation  «' 
metabolism,  and  the  quite  as  remarkable  a  change  after 
their  removal ;  the  alteration  in  the  female  at  cuberty 
at  the  menopause,  and  on  artificial  removal  of  the 
ovaries.  The  very  strong  effect  of  the  cerebntm  oc 
metabolism  is  well  known  ;  an  angry  altercation,  deep 
woe,  any  strong  passion  for  a  few  hours,  make  oat 
haggard,  and  bring  down  the  weight  by  a  few  poiuds. 
Literature  is  full  of  illustrations.  Alienists  tell  us  of 
the  changes  that  come  over  the  insane  in  this  respect 
wasting  to  excess  in  acute  cases,  overgrowth  oitatia 
the  dement,  the  necessity  for  terrific  doses  of  purgatives, 
all  help  the  picture. 

VI.  and  VI I. — ^Time  is  left  only  to  mention  the  eiEect 
of  such  toxins  as  the  fevers  on  metabolism  ;  and  abo 
the  effect  of  such  articles  of  diet  or  of  luxury  as  akohd 
tea,  tobacco,  and  of  such  drugs  as  phosphorus,  arsenic 
iron,  mercury,  and  salicylate  of  soda,  and  last,  but  most 
interesting,  of  phloridzin.  Pavy  mentions  38  artifidai 
conditions  which  have  been  reported  as  leading  to  the 
production  of  sugar  in  the  blood,  which  is  tantamoant 
to  saying  glycosuria,  as  the  amount  of  sugar  in  tht 
urine  is  always  an  index  of  the  sugar  in  the  blood. 

VIII. — In  treating  of  the  primary  or  idiopathic  foni» 
of  diseases  of  metabolism,  one  enters  upon  the  most 
difficult  problems  of  pathology ;  as  our  knoviedgr 
becomes  more  exact  and  extensive,  the  group  becomes 
smaller.  For  instance,  many  forms  of  gl3rco8aiia  air 
secondary :  secondary  to  the  food,  to  functioaal  dis- 
turbance of  intestine  and  liver,  to  disease  of  the  pan- 
creas or  of  the  brain.  It  is  curious  that  diabetes  or 
glycosuria  is  not  associated  with  any  organic  dsease  at 
the  liver.  There  still  remains  however,  an  appaiestlr 
primary  diabetes  mellitus.  where  sugar  appears  ia  the 
urine,  although  carbohydrates  are  disa&owed  aad 
liver,  pancreas  and  brain  show  no  e\'idencc  of  disease : 


Nov. 


30,  1904- 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Psess.    567 


where  apparently  a  dextrose  escapes  into  the  blood 
stream  from  the  huge  molecule  of  living  protoplasm, 
from  its  own  intrinsic  weakness  of  combination.  This 
is  the  '•  composite  "  diabetes  of  Pavy ;  whether  the 
excess  of  urea  that  accompanies  the  sugar  is  also  due  to 
the  primary  disintegration  of  proteid,  or  is  secondary  to 
the  sugar,  as  in  the  case  of  the  subcutaneous  injection  of 
dextrose,  is  unknown.  The  questions  of  pentosuria,  of 
levulosuria.  of  glycolytic  action  of  the  blood  are  yet  too 
sttb  j'udice  to  allow  any  practical  deductions  to  be  made. 
The  opposite  type  of  a  primary  disease  of  metabolism 
is  ob^ity  ;  the  tendency  is  often  hereditary :  it  seems  to 
be  a  faulty  tissue,  not  a  simple  failure  to  effect  oxida- 
tion. Whethei'  at  all,  or  how  far,  it  is  connected  with  the 
th3rroid  gland  is  uncertain,  but  cases  have  been 
reported  of  the  gland  having  been  found  changed.  As 
an  instance  of  the  want  of  proper  testing  of  methods  of 
treatment,  Von  Noorden  relates  the  case  of  a  stout  lady, 
who  submitted  to  massage  of  one  arm  ;  massage  was  a 
vaunted  remedy  for  obesity,  and  warranted  to  remove 
an  overphis  of  adipose  tissue  ;  however,  at  the  end  of  a 
suitable  time,  the  circumferences  were  again  measured : 
the  arm  which  had  not  undergone  treatment  remained 
as  before ;  the  other  had  increased  one  and  a  half 
centimetre. 

I  now  come  to  some  other,  rather  rarer  forms  of 
apparently  primary  disorders  of  metabolism.     One  has 
received   the  name  azoturia ;    it  is  a  rare  condition, 
we  commonly  enough  see  milder  forms  of  it,  or  perhaps 
more  truly,  we  see  mild  acute  attacks  of  it ;  there  is  an 
excess  ol  urea  and  urates ;  this  causes  a  certain  amount 
of  polyuria,  a  feeUng  of  languor,  weariness  in  loins  and 
thighs,  a  disordered  stomach,  dirty  tongue,  and  dis- 
turbed  appetite,  with  loss  of  weight.     I   have   seen 
several  mild  instances  of  it.  and   the  patients  were  all 
more  or  less  under  the  influence  of  some  pretty  powerful 
emotion.     As  a  pure  proteid  diet  does  not  stop  a  prim- 
ary diabetes,  so  a  pure  carbohydrate  does  not  stop  this 
azoturia.     Some  cases  are  reported  as  running  into 
diabetes.      An    analogous    condition   called  baruria, 
where  there  is  a  general  pathological  increase  of  the 
solid  constituents  of  the  urine,  is  also  reported  ;  the 
symptoms  are  much  the  same  as  in  azoturia.  Whether 
under  this  head  we  should  include  diabetes   insipidus 
or    not    is    debatable.     However,    we    must    include 
"  phosphaturia  "  or  "  phosphatic  diabetes,"  of  which 
most  of  us  have  come  across  at  any  rate  mild  types  of, 
although  a  rare  affection.     By  this  tenn  is  not  meant 
phosphates  deposited  in  alkaline  urine,  or  the  triple 
phosp  ates  due  to  decomposition,  but  a  pathological 
constant    increase    of    earthy    phosphates.     We    find 
phosphates  somewhat  excessive  in  gout,  where  it  may 
alternate  with  uric  acid,  and  also  in  the  opposite  kind  of 
disease,  namely,  phthisis  ;  phosphates  are  said  to  be 
increased   by   administration   of   ovarian   substance ; 
and  although  excess  of  these  salts  is  not  found  in  moUi- 
ties  ossenm.  yet  removal  of  the  ovaries  is  said  to  arrest 
this  disease.     Like  uric  acid,  phosphates  are  derived 
chiefly  from  the  food,  but  some  come  from  tissue  dis- 
integration ;  the  urine  removes  the  alkaline  phosphates, 
but  the  mucous  membrane  of  the  intestine  removes  the 
phosphates  of  calcium ;  and.  lastly,  phosphates    are 
diminished  in  Bright' s  disease  and  are  in  excess  where 
uric  acid  is  in  excess — ^namely,  where  there  is  a  breaking 
up  of  nuclein  into  its  proteid  and  purin  radicle.     It  is 
said  there  maybe  a  renal  inadequacy  for  phos  hates,  as 
there  is  for  urea,  and  as  we  shall  see  for  chlorides.   Von 
Noorden  lays  considerable  stress  upon  these  phosphates, 
and  advises  in  Bright's  disease  the  administration  of 
carbonate  of  calcium  several  times  daily  in  milk,  as  he 
says  by  this  means  half  of  the  phosphoric  acid  remains 
in  the  intestine,  or  after  circulatmg  in  the  body  is  poured 
into  the  intestinal  secretion  and  appears  in  the  faeces, 
and  so  the  kidneys  are  spared.     We    thus  see  that 
there  is  more  than  empirical  reason  for  adding  lime 
water  to  milk. 

The  symptoms  of  phosphaturia  are  much  the  same 
as  in  azoturia — namely,  emaciation,  nervous  irritability, 
dyspepsia  with  pain  in  back  and  loins ;  and  the  iU- 
health  may  deepen  into  phthisis  or  diabetes. 


Under  the  same  heading  and  with  much  the  same 
symptoms  comes  oxaluria,  which  need  not  delay  us. 
•  While  on  this  subject  of  what  has  been  called  the 
'*  deminenJisation  **  of  the  tissues,  one  must  not  omit 
the  theory  lately  advanced  by  some  French  clinicians, 
that  if  sodium  chloride  is  not  eliminated  by  the  kidneys 
at  a  rate  proportional  to  its  absorption,  the  salt  accu- 
mulates in  the  tissues,  causing  a  hydration  which  leads 
to  oedema.  The  excretory  power  of  the  kidneys  for 
common  salt  in  some  cases  of  Bright's  disease 
is  less  than  in  health ;  the  opinion  was  advanced 
that  chloride  retention  was  a  sign  of  renal  inadequacy. 
The  figures  given  are  as  follows.  A  man  eats  about 
15  grammes  of  salt  every  day;  healthy  kidneys  can 
excrete  more  than  30  grammes,  but  diseased  kidneys 
perhaps  not  more  than  2  or  3  grammes;  urea,  phosphates, 
and  other  urinary  constituents  may  remain  normal.  In 
some  cases  of  tubular  nephritis  with  oedema  there  is  a 
renal  inadequacy  for  sodium  chloride ;  the  opposite 
condition  is  said  to  exist  in  some  cases  of  chronic 
interstitial  nephritis,  in  which  a  state  of  hyperchlorid- 
uriais  present,  by  which  the  tissues  are  dechlorinated. 
We  thus  seem  to  have  a  disassimilation  for  nitrogen,  for 
phosphates,  and  now  for  chlorides.  On  the  other  hand, 
in  one  case,  more  chloride  was  excreted  than  had  been 
absorbed  ;  the  tissue,  instead  of  fixing  some  of  the  salt, 
had  lost  part  of  what  it  had  already  held ;  the  sym- 
ptoms were  poljruria,  thirst,  absence  of  oedema,  and 
hyperchloruna.  On  post-mortem  examination  both 
kidneys  were  very  small.  {PracHHotier,  November, 
1904.) 

The  result  of  these  statements  is  that  in  future  we 
must  pay  more  attention  to  the  quantitative  analysis  of 
urine  for  such  salt,  and  endeavour  to  find  out  in  how 
far  they  are  primary  diseases  or  merely  signs  of  a 
disease.  The  treatment  of  all  these  conditions  of  which 
pathology  is  obscure,  but  in  which  the  nervous  element 
in  my  experience  is  the  most  important,  is  much 
the  same — ^rest,  quietness,  removal  from  all  sources  of 
emotion,  cold  salt  bathing  or  sponging,  and  acids,  cool 
rooms,  and  light  clothing  and  purified  food.  Of  drugs, 
I  think  opium  should  be  tried  in  cases  that  do  not  yield 
to  hygienic  measures. 

A  FATAL  CASE  OF  CEDEMA 

ASSOCIATED    WITH 

ALBUMINURIA  IN  AN  INFANT 
AGED  EIGHT  MONTHS,  (a) 

By  GEORGE  CARPENTER,  M.D., 
Senior   Assistai't  Physiciao  to   the   North   B  stem   Hospitsl    for 
Child 'en  i  late  Phjtloia  1  to  the  Evelina  Hospital  for  Sick  Children. 

Maud  S.,  aet.  8  months,  was  brought  to  the 
North  Eastern  Hospital  for  Children  on  Decem- 
ber 7th,  1903,  with  a  history  of  having  wasted  since 
measles,  ten  weeks  previous.  Her  abdomen  was 
prominent,  and  her  liver  extended  three  fingers' 
breadth  below  the  costal  margin  in  the  nipple  line. 
She  was  neither  rickety  nor  anaemic,  and  there 
were  no  physical  signs.  Her  mother  had  borne 
six  children  ;  she  had  one  bom  dead  and  one  still- 
birth, and  had  produced  three  children,  living, 
since  then.  On  Dec.  4th  the  child  was  considered 
to  be  progressing  well,  but  a  week  later  her  face 
began  to  sweU,  and  then  her  hands  and  feet.  The 
illness  commenced  with  sickness  every  time  she 
took  the  breast.  She  did  not  pass  much  water, 
and  it  was  said  to  be  a  "  kind,  of  brown  colour.'* 
On  January  4th  her  face  was  waxy-looking  ;  both 
eyes  were  cedematous,  the  right  eye  especially. 
The  feet  and  legs  were  very  dropsical,  deeply 
pitting  on  pressure,  also  the  trunk  ;  and  the  feet 
were  cold  and  blue-looking.  The  buttocks  and 
groins  were  raw-looking  and  weeping.  On  the 
right  cheek  there  was  a  tiny  cutaneous  gumma 

(a)  Head  before  the  Society  for  the  Study  of  Disease  in  Children, 
February  mh,  1904. 

D 


568  *  The  Medical  Press.  TRANSACTIONS    OF    SOCIETIES. 


Nov. 


with  a  reddened  surface,  the  size  of  buck-shot. 
The  mucous  membranes  were  rather  pale.     There 
was  also  a  number  of  superficial  lesions  on  the 
cheeks,  the  size  of  hemp-seed,  with  a  certain  amount 
of  surface  exudation,  which  the  mother  said  came 
out  like  yellow  blisters.     She  was  admitted  into 
the  hospital.     On  January  7th  the  oedema  of  the 
trunk  had  increased  slightly,  and  that  of  the  eyes 
had  decreased.     The  spots  on  the  face  were  more 
numerous.     The  smallest  quantity  of  urine  which 
had  been  passed  was  4  ounces  in  the  twenty-four 
hours,  the  largest  5  ounces.     The  highest  pulse- 
rate  per  minute  was  1 16,  the  lowest  92  ;  the  highest 
respiration-rate    ^6,    the    lowest    24.     The    tem- 
perature was  about  97°  F.,  the  highest  97*8''  F. 
There  was  a  decided  cloud  of  albumin  in  the  urine, 
and    a   sediment   on   boiling.     On    January    8th 
the  oedema  was  less  on  the  dorsa  of  the  hands, 
and  on  the  right  side  of  the  trunk.     CEdema  was 
well  marked   on  the  inner  side  of    each    thigh, 
the  fronts  of  the  legs,  and  the  backs  of  the  feet. 
There  was   shght   oedema   round  the   umbilicus. 
The  most  marked  swelling  was  on  the  buttocks. 
where  several  drops  of  serum  could  be  seen  exuding 
from  the  surface,  which  was  red  and  shiny.     There 
was  no  lumbar  oedema.     On  January  9th  the  urine 
was  thick  and  cloudy,  and  contained  i  gramme  of 
dried  albumin  per  1,000  c.c.      The  urea  amounted 
to  '4375    grain   per  ounce.     The  oedema  was  less 
in  the  morning  than  at  night.     On  January  loth 
there  was  a  slight  trace  of  albumin,  and  the  urea 
was  '4375  grain  per  ounce.     On    January    nth 
there  was  a  slight  trace  of  albumin.     The  swelling 
was  slightly  less  than  before.     On  January  12th 
there  was  a  shght  trace  of  albumin  ;  there  were  no 
tube  casts.     The  largest  quantity  of  urine  that  had 
been  passed  since  the  previous  record  was  5 jounces, 
the  smallest  quantity  3  ounces.     The  child  was  in 
a    very    precarious    condition  ;     no   radial    pulse 
could  be  felt,  and  the  breathing  was  shallow  and 
irregular,  and  she  died  on   January   13th.     The 
post-mortem   examination  was  made  on  the  same 
day.     The  brain,  which  weighed  23  ounces,  was 
normal.     The  heart  was  healthy.     The  right  lung 
weighed    2J    ounces  ;    it    was    in     part    oedema- 
tous.     The  left  weighed  2^  ounces,  and  was  in  a 
similar  condition.     The  Uver  was  pale  ;  it  weighed 
iij  ounces.       The  right  kidney  weighed  i  ounce, 
the  left  I J  ;  neither  appeared  abnormal.  The  spleen 
weighed  }  ounce.      The  stomach   and   intestines 
were  normal.     Microscopically,  nothing  abnormal 
was   detected   in   the   kidneys.      The    liver   was 
fatty  ;  the  heart  was  normal.     Some  small  patches 
of  broncho-pneumonia  were  found  in  the  lungs. 

Remarks. — In  the  absence  of  definite  pathological 
changes  in  the  organs  one  is  forced  to  fall  back  upon 
the  explanation  of  toxaemia  to  account  for  the 
symptoms  during  life,  though  how  and  where  the 
toxin  was  manufactured  which  produced  the  fatal 
result  the  autopsy  does  not  show. 


30.  1904. 


XCransactionB  ot  Societies. 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  November  25TH,  1904. 


Dr.  Frederick  Taylor  in   the  Chair. 


CRISES   IN    COURSE    OF    POSTERIOR    BASIC    MENINGITIS. 

Dr.  C.  R.  Box  read  a  paper  on  certain  paroxysmal 
exacerbations  of  symptoms  which  occur  during  the 


progress  of  posterior  basic  lepto-meningitis  in  patknts 
whose  cranial  fontanelles  have  closed.  These  exacer- 
bations he  proposed  to  call  "  the  crises  of  postcno- 
basic  meningitis."  In  the  most  complete  form  this 
complex  of  symptoms  is  as  follows  :  The  tempefatore 
suddenly  rises  from  subnormal  or  near  nonnal  to  a 
considerable  height— it  may  be  as  much  as  7="  F.  The 
patient  experiences  a  feeling  of  chilliness  or  even  has 
a  rigor.  Headache,  frontal  or  vertical,  sets  in  and 
often  is  accompanied  by  vomiting.  The  neck  becomes 
stiff  or  retracted  and  the  mental  condition  is  dnlL  At 
the  same  time  the  pulse-rate  does  not  fall.  but.  on  tW 
contrary,  is  usually  increased.  The  temperature  n^ 
mains  high  for  a  short  tune  and  then  may  fall  a» 
abruptly  as  it  rose,  the  urgent  symptoms  at  the  same 
time  subsiding.  The  whole  crisis  may  be  over  in  a  ies 
hours,  or  it  may  be  twelve  hours  or  even  more  beforr 
the  normal  condition  is  regained.  In  one  ca^e  tk( 
lateral  column  symptoms,  exaggerated  knee-jerb 
clonus,  &c.,  were  decidedly  exaggerated  during  tk 
paroxysms.  Five  cases  were  reported,  three  of  wfakh 
showed  the  crises  in  a  typical  form  and  two  in  vhidi 
the  crises,  although  present*  were  not  so  prominem. 
Lantern  sUdes  of  the  temperature  charts  were  denux- 
strated.  Dr.  Box  remarked  that  this  form  of  paros}v 
mal  pyrexia  was  not  included  in  the  list  formulated  br 
Murchison,  but  apparently  was  recognised  by  Bristo«t. 
Attention  was  drawn  to  the  fact  that  the  co-existeace 
of  secondary  deafness  or  of  secondary  otitis  media  k 
posterior  basic  meningitis  might  give  rise  to  consider- 
able difficulty  in  distinguishing  cases  in  which  the  oises 
occurred  from  cases  of  ear  disease  with  secondary  intra- 
cranial complications.  Temporary  increase  in  the 
intra- ventricular  pressure  was  suggested  as  the  caoft 
of  the  exacerbations,  and  the  advisaDility  of  lambr 
puncture  or  of  some  other  operation  for  the  relief  0: 
the  pressure  was  suggested. 

Dr.  F.  £.  Batten  was  not  familiar  with  the  cla&sa 
case  described,  as  they  were  in  patients  over  the  ac: 
of  nine.  In  young  children,  however,  he  had  frequently 
observed  this  sequence  of  symptoms.  He  asked  what 
evidence  there  was  that  the  cases  were  true  posterior 
basic  meningitis,  i.e.,  due  to  Weichselbaum's  diplo- 
coccus.  He  hardly  thought  the  term  "crisis'*  an  appny 
priate  one.  as  that  indicated  either  a  turning-point  or  a 
critical  period.  The  rise  and  fall  in  temperature  might 
occur  as  described,  with  no  other  symptom  except  a 
little  cyanosis  of  the  extremities.  The  fall  was  jost 
as  characteristic  as  the  rise,  and  he  had  seen  greater 
falls,  e.g.,  to  the  extent  of  10^  F.  in  twelve  hours.  As. 
however,  the  same  series  of  symptoms  might  occur  is 
such  conditions  as  hydrocephalus,  middle  ear  disease, 
suppurative  pericarditis,  he  could  not  agree  that  they 
were  characteristic  in  any  way  of  posterior  basic 
meningitis. 

Dr.  Pasteur  thought  that  the  term  "crisis"  was 
a  bad  one.  A  point  that  struck  him  was  that  the 
drowsiness  was  present  in  between  the  attacks,  and 
not  at  them,  this  being  much  against  their  being  doe 
to  increased  intra-ventricular  pressure. 

Dr.  Taylor  similarly  wanted  to  see  justification  fcr 
the  use  of  the  term  crisis,  though  it  had  a  wider 
meaning  than  that  given  by  Dr.  Batten,  as  evidenced 
by  its  use  in  locomotor  ataxy.  He  had  never  seen  ihe 
phenomena  described  in  the  course  of  posterior  basic 
meningitis,  but  had  seen  it  on  one  occasion  apart  from 
that  condition. 

Dr.  Box  said  that  he  applied  the  term  to  the  irbok 
syndrome  and  not  to  the  temperature  alone,  and 
thought  that  he  was  justified  by  its  use  in  reference  to 
floating  kidney.  Bacteriological  tests  were  applied  in 
only  two  cases ;  in  one  a  streptococcus  was  obtained 
and  in  another  an  organism  of  indeterminate  natme 
Clinically,  however,  the  cases  were  clearly  posterior 
basic  meningitis. 

A  CASE  OF  unilateral  TUBERCULOUS  MEKIXGITIS  W 
WHICH  A  BULLOUS  ERUPTION  FOLLOWED  LUMWK 
PUNCTURE. 

Drs.  H.  D.  RoLLESTON  and  Tebbs  described  the  ase 


Nov.  30,  1904. 


TRANSACTIONS    OF   SOCIETIES.       Thb  Medical  Piigs.    569 


of  a  boy,  aet.  5,  who  was  perfectly  well  until,  after  a 
day's  malaise,  he  was  seized  with  general  convulsions, 
more  marked  on  the  right  side,  with  conjugate  devia- 
tion of  the  head  and  eyes  to  the  right.  Lumbar  punc- 
ture  was  performed  between  the  spines  of  the  third  and 
fourth  lumbar  vertebrae,  and  subsequently  a  cannula 
was  introduced  in  this  position  and  cerebro-spinal 
iiuid,  which  at  first  was  blood-stained,  allowed  to  run 
away.  On  the  following  day,  on  the  afternoon  of 
which  death  occurred,  two  bullae  appeared  on  the  outer 
aspect  of  the  right  little  toe.  The  whole  illness  occupied 
five  days.  At  the  necropsy  there  was  tuberculous 
meningitis,  limited  to  the  left  Sylvian  fissure,  which  was 
thought  to  be  due  to  an  embolus  derived  from  a  caseous 
gland  invading  the  apex  of  the  left  lung.  There  was 
an  elongated  blood  clot  three  inches  long  under  the 
arachnoid  and  in  contact  with  the  posterior  nerve 
roots  of  the  cauda  equina  on  the  right  side.  This  clot, 
which  was  probably  due  to  lumbar  puncture,  was  re- 
garded as  having  irritated  the  posterior  nerve  roots 
and.  ganglia  and  produced  a  bullous  eruption  resembling 
herpes. 

Dr.  Box  said  that  the  case  was  of  interest  in  that 
it  showed  that  lumbar  puncture,  though  of  great  service, 
was  not  always  harmless.  He  had  twice  seen  exten- 
sive intra-meningeal  haemorrhages  follow  the  operation. 

Dr.  Battbn  asked  whether  the  first  sacral  ganglion 
had  been  examined.  He  pointed  out  that  the  posterior 
root  ganglion  was  some  distance  away  from  the  site  of 
puncture.  The  evidence  that  a  subdural  haemorrhage, 
or  any  other  injury  of  the  posterior  nerve  roots  apart 
from  the  ganglion,  could  produce  a  herpetic  eruption 
was  very  slight. 

Dr.  A.  E.  Russell  said  that  the  case  was  of  consider- 
able interest  from  a  physiological  side.  Bayliss  had 
shown  that  stimulation  of  the  peripheral  end  of  a  cut 
posterior  nerve  root  caused  great  vaso-motor  changes 
in  the  limb  supplied. 

Dr.  H.  D.  RoLLESTON  said  that  the  sacral  ganglion 
had  not  been  examined. 

POST-OPERATIVE  ACUTE  LOCAL  TUBERCULOSIS. 

Mr.  Edred  M.  Corner  and  Dr.  Leonard  S. 
Dudgeon  described  a  case  in  which,  after  an  operation  for 
tuberculous  glands  of  neck,  a  local  tuberculous  infection 
of  all  the  surrounding  tissues  occurred.  The  chief  sign 
of  this  infection  was  local  swelling  after  the  wound  had 
healed.  The  case  therefore  sheds  light  on  the  nature 
of  "  swellings  "  seen  after  operations  for  tuberculous 
lesions.  Several  cases  were  narrated  to  illustrate  this 
in  connection  with  glands  of  neck,  tuberculous  disease 
of  the  knee-joint  and  kidney.  In  these  instances,  and 
in  many  more,  not  specifically  quoted,  the  healing  of 
the  wound  had  been  by  first  intention.  Local  infection 
does  not  seem  to  occur,  or  perhaps  it  occurs  only  in 
lesser  intensity  and  degree  if  the  wound  is  left  open  or 
drained.  The  question  of  the  advisability  of  the  em- 
ployment of  drainage  after  such  operations  is  raised  ; 
and  where  there  has  been  obvious  chance  of  infection 
occurring,  as  if  glands  burst  whilst  being  excised,  and 
the  situation  allows  of  it,  the  sounder  surgery  is  to 
close  the  wound  incompletely  and  employ  drainage. 

Mr.  F.  C.  Wallis  urged  that  better  results  than  those 
described  were  obtained  by  draining  the  wound  for 
twenty-four  hours  so  as  to  allow  of  the  escape  of  the 
inevitable  collection  of  serum,  that  took  place. 

Mr.  W.  G.  Spencer  had  never  seen  such  a  case  after 
antiseptic  operations.  He  thought  that  its  occurrence 
was  due  to  incomplete  removal  of  diseased  tissue,  and 
urged  more  extensive  operations  in  tuberculous  cases. 
He  had  been  impressed  by  the  latency  of  tubercle 
bacilli.  This  was  well  shown  in  the  lighting  up  of  old 
foci  after  injection  of  Koch's  tuberculin.  The  activity 
of  the  micro-organisms  was  far  larger  than  appeared 
clinically. 

Mr.  R,  P.  Rowlands  asked  whether  in  the  kidney 
case  described  infection  through  the  ligature  could  be 
excluded.  Another  fallacy  was  disease  of  the  ureter. 
He  had  seen  recuiirence  after  this  had  been  incom- 
pletely removed. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Section  of  Obstetrics. 
Meeting  held  November  i8th,  1904. 


Dr.  a.  J.  Smith,  President,  in  the  Chair. 

Dr.  A.  J.  HoRNE  showed  a  case  of  Elephantiasis  of 
Leg  and  Vulva. 

Dr.  W.  J.  Smyly  showed  a  specimen  of  Cancer  of 
Both  Ovaries.  Patient,  aet.  66.  ceased  to  menstruate 
at  ^4.  In  April  last  there  was  a  slight  red  discharge 
which  ceased,  but  came  on  again  in  three  months. 
Scrapings  from  curetting  were  benign.  A  small  tumour 
could  be  felt  on  each  side  of  uterus.  In  November  a 
lazige  ovarian  cystoma  had  formed.  Uterus  and  both 
ovaries  were  removed  by  Doyen's  method.  The  second 
case  was  Tuberculous  Pyosalpinx,  and  in  it  the  uterus 
and  appendages  were  removed  by  the  same  method. 

Dr.  E.  H.  Tweedy  asked  if  there  were  adhesions 
behind  the  uterus  in  these  cases,  as  Doyen  only  em- 
ployed his  operation  for  myoma  of  the  uterus.  Also, 
would  he  remove  pyosalpinx  by  that  method  in  every 
case  ? 

Dr.  R.  D.  PuREFOY  thought  the  question  of  diagnosis 
was  interesting.  A  malignant  tumour  sometimes  simu- 
lated pedunculated  fibroid  very  closely.  He  did  not 
see  why  the  uterus  should  be  removed  in  every  case  of 
removing  the  tubes.  He  had  found  great  advantage 
in  operating  on  these  cases  from  trying  the  ovarian 
artery  in  the  infundibular  pelvic  ligament. 

Dr.  Kidd  thought  it  too  sweeping  to  say  that  the 
uterus  should  be  removed  in  every  case  of  removal  of 
the  tubes.  He  related  a  case  of  pyosalpinx  of  both 
tubes,  which  drained  into  the  uterus  from  time  to  time. 
The  patient  was  too  weak  to  be  operated  on.  She 
afterwards  got  perfectly  well,  and  bore  a  living  child. 

Dr.  A.  J.  Smith  said  he  used  to  be  content  with  re- 
moving the  tubes  in  tuberculous idisease,  but  then  found 
that  patients  often  came  back  complaining  of  pains, 
which  he  thought  were  due  to  adhesions.  In  one  case 
he  operated  again  and  found  a  large  tuberculous  mass, 
and  now  he  always  removed  the  entire  uterus.  In 
ordinary  cases  of  pyosalpinx  he  had  not  yet  adopted  it. 

Dr.  PuREFOY  wished  to  know  how  one  would  recog- 
nise these  cases  of  tuberculous  tubes,  if  he  advocated 
the  removal  of  the  entire  uterus  in  these  cases  only. 

Dr.  Smyly,  in  replying,  said  that  in  these  cases  of 
pyosalpinx,  tuberculous  or  gonorrhoeal,  the  tubes 
were  twisted  and  surrounded  by  dense  adhe- 
sions, rendering  it  very  difficult  to  get  them  out. 
The  chances  were  very  much  against  cases  being 
like  Dr.  Kidd's,  in  which  there  was  drainage.  His  own 
experience  was  like  Dr.  Smith's — that  is,  having 
patients  coming  back  after  removal  of  the  tubes  only, 
and  he  thought  now  that  the  uterus  should  be  removed 
in  most  cases.  In  the  case  he  had  shown  there  were 
a  lot  of  adhesions  behind  the  uterus. 

Dr.  A.  J.  HoRNE  opened  a  discussion  on 

THE     INFLUENCE    OF    FIBRO-MYOMATA    ON     PREGNANCY 
AND    PARTURITION. 

Dr.  W.  J.  Smyly  said  that  the  general  impression 
was,  that  women  with  fibroids  were  less  likely  to  con- 
ceive than  others,  but  these  women  were  generally 
sterile  long  before.  The  cause  of  steriUty  appeared  to 
be  the  condition  of  the  mucous  membrane.  Another 
point  was  that  these  women  went  on  bearing  children 
to  a  later  period  in  Ufe  than  others,  and  it  was  attri- 
buted to  ovulation  and  menstruation  going  on  to  a  later 
period.  His  own  experience  did  not  either  support  or 
contradict  these  opinions.  He  thought  that  these 
tumours  did  not  often  cause  obstruction  during  labour, 
even  when  growing  low  down  in  the  pelvis,  as  they  were 
usually  drawn  up  out  of  the  way.  He  related  a  case  in 
which  there  was  a  subperitoneal  myoma,  pushing  the 
peritoneum  up,  and  the  vaginal  mucous  mem- 
brane down.  He  had  to  do  Csesarean  section 
and  remove  the  uterus  and  tumour.  In  another 
case  there  was  an  interstitial  myoma  in  the  lower 
uterine  segment.  The  patient  went  into  labour  for  a 
few  hours,  and  then  labour  pains  apparently  ceased  ; 
came  on  again  in  a  few  hours,  and  memoranes  ruptured* 


57^    1'h£  Mbdical  Pkess. 


TRANSACTIONS   OF   SOCIETIES. 


Nov.  30.  1904. 


She  was  in  labour  on  and  oQ  for  a  week.  The  os  then 
allowed  two  fingers  in,  and  a  foot  was  pulled  down,  and 
after  a  long  time  the  foetus  came  away.  He 
thought  the  chief  danger  of  myomata  was  during 
the  puerperium.  In  one  case  a  hospital  patient 
died  fi'om  post^parlum  haemorrhage,  and,  post-morUm^ 
a  submucous  myoma  was  found,  the  size  of  an  orange. 
He  had  also  found  that  portions  of  the  membranes  were 
retained  sometimes  in  these  cases,  which  decomposed 
and  caused  sepsis.  Retained  placenta  was  also  com- 
mon. He  did  not  agree  with  Bland-Sutton  that  all 
myomata  should  be  removed,  though  the  risk  of  opera- 
tion was  not  great. 

Dr.  PuREFOY  thought  the  influence  of  fibroids  in 
causing  sterility  was  over-rated.  An  interesting  aspect 
of  the  question  was  the  greatly  increased  difficulty  in 
diagnosmg  pregnancy  in  the  first  three  months.  If  a  my- 
oma invaded  the  cervical  region  it  was  most  difficult,  as 
he  thought  the  cervix  did  not  undergo  the  characteristic 
amount  ot  softening  of  pregnancy.  He  related  a  case 
in  which  a  fibrcnd  occupied  the'  pelvis,  and  he  did 
Caesarean  section.  A  fibroid  in  the  uterine  wall  also 
enfeebled  the  uterine  contractions,  and  they  often 
caused  marked  interference  with  the  course  of  labour. 
He  related  another  case  of  a  primipara,  aet.  30.  with  a 
fibroid  in  the  lower  uterine  segment.  She  went  five 
weeks  beyond  full  term.  1  he  presenting  part  could  not 
be  reached,  and  there  was  a  complete  absence  of 
labour.  The  uterus  was  removed  along  with  the  child, 
and  the  patient  made  a  good  recovery.  Displacement 
should  be  done  in  these  cases  if  possible,  and  he  thought 
myomectomy  was  only  advisable  in  the  early  n^onths 
of  pregnancy.  He  tabulated  these  cases  in  the 
Rotunda,  and  noticed  an  absence  of  post-parium 
haemorrhage.  Most  of  the  patients  were  young  women, 
aet.  between  30  and  40.  He  suggested  that  the  occur- 
rence of  pregnancy  rather  hastened  the  development, 
and  increased  the  size,  of  these  tumours. 

Dr.  E.  H.  Tweedy  related  a  case  in  which  he  had 
removed  the  uterus  at  the  fifth  month,  as  the  patient 
could  not  have  gone  on  to  full  term.  As  to  fibroids 
causing  sterility,  he  said  it  was  not  the  fibroids,  but 
the  endometritis  that  caused  it  in  a  certain  number  of 
cases.  If  there  was  a  subperitoneal  myoma  it  would 
not  cause  endometritis,  and  there  would  be  no  sterility. 
Another  point  was  that  they  might  directly  cause 
twisting,  or  pressing,  or  stretching  of  the  tubes,  which 
might  cause  sterility. 

Dr.  KiDD  agreed  as  to  the  difficulty  of  diagnosing 
pregnancy  in  the  early  months,  when  associated  with 
myomata.  As  to  sterility,  he  thought  the  question 
was  one  of  comparative  and  not  absolute  sterility. 
He  related  a  case  of  a  primipara,  aet.  44,  with  two  large 
tumours  at  the  fundus.  They  caused  transverse  pre- 
sentation ;  version  was  done.  The  placenta  had  to  be 
removed  manually.  Patient  made  a  good  recovery. 
He  had  examined  the  patient  since,  and  found  that  the 
tumours  had  entirely  disappeared.  When  pregnancy 
was  complicated  by  cancer,  the  cancer  usually  increased 
rapidly,  owing  to  the  hyperaemia.  He  thought  the 
same  increase  usually  occurred  in  the  case  of  other 
tumours  under  similar  circumstances.  He  related 
another  case  in  which  a  tumour  sprang  from  the 
posterior  wall  of  the  supravaginal  portion  of  cervix. 
Panhysterectomy  was  performed,  and  the  patient  made 
a  good  recovery.  In  another  case  in  which  a  tumour 
was  present  which  could  not  be  lifted  out  of  the  pelvis, 
Caesarean  section  was  performed.  Two  years  later 
the  patient  again  came  into  hospital,  after  she  had 
been  in  labour  for  73  hours.  On  this  occasion  it 
was  possible  to  deliver  her  with  forceps.  In  another 
case  labour  was  induced,  but  soon  ceased.  A  tumour, 
the  size  of  a  hen's  egg,  was  then  enucleated  from  the 
cervix ;  after  ten  days  labour  came  on  again,  and 
the  patient  delivered  herself. 

Dr.  Jellett  said  that  another  aspect  of  the  question 
was  the  efiect  of  myomata  on  the  life  of  the  ovum 
during  the  last  months  of  pregnancy.  Quite  recently, 
he  had  had  a  case  in  which  death  of  theloetus  in  u  eyo 
apparently  resulted  from  a  myoma  of  the  fundus. 
He  saw  a  patient  in  February'  last  who  was  expecting 


to  be  delivered  about  May  ist.  She  went  aQ  thron^i 
May,  and  then  a  myoma,  the  size  of  a  coooannt 
was  found  on  the  anterior  wall  of  the  fundus.  A 
dead  and  macerated  child  was  born  on  June  3rd,  aad 
the  placenta  was  little  more  than  the  normal  size. 
He  was  interested  to  know  if  such  a  caise  could  be 
attributed  to  the  myoma,  or  whether  it  was  a  mere 
accident  of  pregnancy.  If  the  former,  there  were 
two  views  of  the  case.  First,  was  the  patient's  lustory 
correct,  and  should  she  have  been  delivered  00  May  isf. 
and  did  the  myoma  afifect  the  innervation  of  the  ntens. 
and  prevent  labour  coming  on  at  the  proper  timer 
Secondly,  did  the  myoma  interfere  with  the  develop 
ment  of  the  placenta  ?  This  was  probably  the  correct 
view.  Four  months  after  the  labour  he  found  another 
myoma  on  the  posterior  of  the  fundus,  so  that  then 
was  very  little  healthy  area  at  the  fundus  for  the 
placenta.  It  then  became  a  question  of  how  dose 
the  myomata  lay  to  the  mucous  membrane,  as  n 
they  lay  very  close  there  might  not  be  sufficient  rooE 
for  the  uterine  sinuses  to  develop  and  hence  an  is- 
sufficient  circulation.  After  a  certain  period,  tin 
the  foetus  would  die  from  interference  with  the  frface&ti. 
One  cause  of  sterility  in  cases  of  uterine  myoma  wza 
probably  to  be  found  in  cystic  degeneratioa  of  tk 
ovaries. 

Dr.  A.  J.  Smith  related  two  cases.  The  first  had  2 
large  fibroid  tumour,  the  size  of  an  eighth  months pn^ 
nant  uterus.  There  were  no  urgent  symptoms,  b«i 
there  was  no  room  for  a  pregnant  uteros  along  iFith 
the  tumour.  He  removed  the  tumour  and  the  foDoir- 
ing  year  the  patient  was  delivered  of  a  full  term  daU. 
and  had  had  four  since.  The  seccmd  case  was  one  d 
six  months'  pregnancy,  complicated  by  a  large  fibroid 
tumour.  There  was  great  distress  and  dyspnoea,  and 
the  tumour  was  removed  along  with  the  pregnaat 
uterus.  This  was  another  example  of  the  danger  of  a 
large  fibroid  tumour  in  pregnancy. 

Dr.  A.  J.  HoRNE,  in  replying,  said  he  never  knewol 
a  primipara,  aet.  more  than  47.  He  said  there  woe 
two  questions  he  had  avoided  in  his  paper,  first,  the 
diagnosis  of  fibroids  with  pregnancy,  and.  second,  their 
after-effects  on  the  puerperal  state.  In  the  case  he  had 
with  Dr.  McArdle,  the  patient  was  six  months  pregnaoL 
There  was  a  tumour  in  the  right  hypochondriani. 
which  overshadowed  the  uterus,  but  there  was  a 
distinct  line  of  demarcation.  It  <mly  gave  rise  to 
sUght  pressure  symptoms,  and  the  pregnancy  went  ob 
to  full  time.  There  was  a  breech  presentation.  As  to 
post'partum  haemorrhage,  he  had  always  referred  to 
the  danger  of  it  in  these  caises.  but  had  seen  many 
without  it.  He  did  not  see  how  sterility  was  caused 
by  pressure  on  the  oviducts,  as  in  these  cases  there 
was  excessive  menstruation. 


THE  BRITISH  LARYNGOLOGICAL.     RHINOLO- 

GICAL    AND    OTOLOGICAL     ASSCX:iATION. 
Annual  General  Meeting  held  November  iith. 


Mr.  Bark,  and  subsequently  Mr.  Chxchelb  Nol^rse 
presiding. 

A  VOTE  of  thanks  to  the  retiring  president,  Bfr.  Bark 
was  proposed  in  terms  of  cordial  appreciation  by  Dr. 
D  sNNis  VfNRACE,  who  referred  particularly  to  the  Icm^ 
distance  travelled  by  Mr.  Bark  in  order  to  carry  out  he 
presidential  duties.  This  was  seconded  by  Dr.  Wyatt 
WiNGRAVE,  and  carried  unanimously. 

Dr.  Kelson  described  a  case  in  which  the 
patient  came  complaining  of  hoarseness  of  several 
years'  duration,  but  recently  increasing.  There  was 
no  history  of  syphilis,  tubercle,  or  malignant  disease.  Od 
examination,  a  pinkish  growth  was  to  he  seen  occupy- 
ing the  anterior  commissure  and  anterior  part  of  thr 
left  cord.  A  portion  of  this  has  been  removed,  and 
proved  to  be  a  papilloma.  The  movement  of  both 
cords  was  good. 

Dr.WvATT  WiNGRAVE  showed  a  case  of  "  Salivary  Cal- 
culus Simulating  Angina  Ludovici  in  a  Male,  aet.  30." 
A  male  patient  came  to  hospital  with  considerabk 
swelling  immediately  beneath  the  jaw  between  tlie 
tongue   and   the   hyoid   bone.     It   was   very  painful. 


Nov.  30.  1904. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Press.    57^ 


and.  he  could  not  open  his  mouth  more  than  half  an  inch* 
and  there  was  considerable  difficulty,  not  only  in 
breathing  but  in  swallowing  and  masticating.  The  voice 
MTSLS  characteristic  of  that  of  a  patient  suffering  from 
acutely  inflamed  tonsils.  The  swelling  all  round  led 
him  to  the  belief  that  it  was  a  case  of  angina  Ludovici, 
|>erhaps  associated  with  inflammation  and  suppuration 
of  the  lingual  tonsils.  As  far  as  he  could  see  the  latter 
w'ere  distinctly  enlarged  and  they  completely  hid  the 
epiglottis.  But  on  running  the  fingers  along  the  floor 
of  the  mouth  and  around  the  tongue  he  came  upon  a 
hard  resisting  surface  at  the  side  of  the  fraenum,  and 
that  he  pressed  upon,  perhaps  more  than  usual,  and 
discovereid  a  very  hard  point  projecting.  It  was  a 
salivary  calculus,  and  when  the  calculus  was  removed 
there  was  a  discharge  of  pus  from  the  surface.  The 
svrelling  went  down  and  the  patient  was  all  right  in  a 
few  da3rs.  The  case  was  interesting  from  the  point  of 
vie-w  of  differential  diagnosis.  The  stone  was  in 
Wharton's  duct. 

Mr.  W.  Stuart-Low  explained  that  Dr.  Abercrombie 
had  hoped  to  be  present,  but  found  it  impossible,  and 
he  had  therefore  asked  him  to  read  the  following  de- 
scription of  a  somewhat  similar  case : — In  connection 
with  Dr.Wingrave's  case,  the  following  notes  of  a  similar 
one  occurring  in  my  (Dr.  P.  H.  Abercrombie's)  practice 
may  prove  interesting.     I  was  consulted  on  April  25  th 
last  by  a  man,  st.  54,  a  commercial  traveller,  who  com- 
plained of  a  painful  swelling  under  the  chin  and  left 
side  of  the  tongue  of  between  two  and  three  weeks' 
duration.     The  swelling,  which  was  very  evident  on 
inspection,  was  situated    under  the  chin  and  the  left 
side  of  the  lower  jaw,  and  was  hard  to  the  touch  and 
very  tender.     It  had  pushed  up  the  tongue  and  inter- 
fereid  with  speech,  and  swallowing  was  difficult  and 
painful.     There  was  considerable  constitutional  dis* 
turbance,  and  the  patient's  facial  aspect  was  one  of 
great  suffering  and  anxiety.     Carious  teeth  were  pre- 
sent in  the  left  lower  jaw,  and  there  was  enlargement  of 
the    left   submaxillary   lymphatic   glands.     I    incised 
the  sublingual  swelling  in  the  mouth  and  some  fcetid 
pus  escap^.  but  I  failed  to  detect  any  stone  with  the 
probe.     A  few  days  later,  however,  the  two  specimens 
of  salivary  calculus  which  I  show  to-day  were  found 
loose  in   the  mouth,   and   removed   by  the  patient. 
After  this  he  recovered  rapidly,  and  was  soon  quite  well. 
I>r.  WvATT  Win  GRAVE  on  a  case  of  "  Epithelioma 
of  the  Laryngo-Pharynx,  wearing  Jacques'  CEsophageal 
Tube."     The  patient  was  a  man,  act.  about  60,  who 
came  eight  or  nine  months  ago  to  the  hospital  com- 
plaining of  difficulty  in  swallowing.     It  was  evidently 
a  case  of  epithelioma  involving  the  lower  part  of  the 
laryngo-phamyx.     The     infiltration     was     extensive, 
so  that  it  was  inoperable,  and  in  order  to  feed  him  a 
Jacques'  tube  was  passed  through  the  oesophagus  into 
the  stomach,  and  then  it  was  caught  by  passing  a  loop 
through  the  nose,  and  brought  up  through  the  nostril 
and  carried  over  to  the  ear,  where  it  was  fixed.     The 
man  was  then  taught  to  introduce  the  food  by  that 
means.     It  was  interesting  from  the  point  of  view  of 
how  long  such  a  state  of  matters  could  exist.     The 
man  had  never  had  the  tube  out  for  seven  months,  and 
beyond   a   certain    amount   of   discomfort   from    the 
foe  tor  he  was  none  the  worse  for  it.     It  certainly  was 
not  very  nice,  from  an  aesthetic  point  of  view,  to  have  a 
tube  over  the  ear,  but  the  patient  could  swallow  with 
it,  and  feed  himself  remarkably  well.     He  was  now 
able  to  correct  the  unpleasant  fa* tor  which  existed  at 
first  by  having  a  mouthful  of  sanitas  and  water  and 
swallowing  it  until  it  reached  the  constriction,  and  then 
eructating.    The  pain  was  so  great  that  he  ordered  him 
a  grain  of  powdered  opium  to  mix  with  his  tobacco, 
and  that  gave  him  more  comfort  than  anything  else, 
l^he  last  he  heard  of  the  patient  was  that  he  was  doing 
well,  and  that  he  had  not  lost  in  weight. 

Dr.  Kelson  agreed  with  Dr,  Wingrave  with  regard 
to  the  utility  of  those  tubes  in  such  cases,  and  described 
a  particular  case. 

Mr.  Bark  thanked  Dr.  Wingrave  for  bringing  the 
case  forward.  One  knew  the  difficulty  there  was  in 
conducting  comfortably  and  peaceably  those  inoperable 


cases  to  their  final  destination.  His  own  experience  in 
the  use  of  tubes  for  feeding  and  the  dysphagia  pro- 
duced by  laryngo-pharytfgeal  carcinoma  had  been  in 
the  use  of  Symonds'  tubes.  He  had  found  those  tubes 
very  unsatisfoctory  in  most  cases.  The  patient  very 
soon  rejected  the  tube.  He  was  very  pleased  to  hear 
of  the  Jacques'  tubes  and  that  they  could  be  retained 
in  order  to  feed  the  patient,  who  would  otherwise  in-* 
evitably  die  of  starvation. 

Dr.  Andrew  Wylie  :  Case  of  '*  Epithelioma  of  the 
Auricle." 

Mr.  Stuart-Low  apologised  for  the  absence  of  Dr. 
Wylie,  and  said  that  gentleman  desired  him  to  ask 
the  opinion  of  Fellows  as  to  whether  he  should  0{>erate 
in  that  case,  which  had  been  proved  microscopically 
to  be  epithelioma.  Could  the  whole  of  it  be  got  away 
by  operation  ? 

Dr.  Haslam  (Croydon)  asked  whether  there  was  any 
enlargement  of  the  lymphatic  glands  in  the  case. 

Mr.  Stuart-Low  replied  that  the  deep  lymphatics 
were  enlarged,  and  also  those  well  behind  the  jaw.  Of 
course,  the  operation  would  have  to  be  a  very  radical 
one,  and  that  was  why  Dr.  Wylie  was  doubtful  as  to 
the  expediency  of  operation. 

Dr.  Wyatt  Wingrave  thought  an  entire  removal 
of  the  disease  was  fairly  probable,  although  it  was  diffi- 
cult to  say  to  what  extent  the  meatus  was  implicated, 
and  how  far  the  growth  was  connected  with  bony  wall. 

Dr.  DuNDAS  Grant  :  "  Exostosis  of  the  Auditory 
Meatus." 

Dr.  Atkinson,  in  Dr.  Grant's  absence,  explained 
what  had  been  done  in  the  case.  The  exostosis  pre- 
sented close  to  the  external  auditory  meatus,  and  he 
first  of  all  used  a  dental  burr,  and  mto  the  aperture 
made  by  it  introduced  an  instrument  like  a  large  wool- 
holder,  working  in  a  corkscrew  fashion.  He  simply 
twisted  that  in,  and  the  exostosis  came  out  quite 
easily.  There  seemed  to  be  none  of  the  growth  left 
behind. 

Dr.  Haslam  (Croydon)  asked  why  Dr.  Dundas  Grant 
operated  in  the  case,  because  he  believed  it  was  an 
understood  thing  that  the  best  plan  was  to  leave  an 
exostosis  alone  unless  it  was  complicated  by  disease. 
Was  it  a  pure  exostosis,  the  result  of  which  was  some 
obstruction  and  deafness  ? 

Mr.  Bark  said  that  evidently  an  exostosis  of  that 
size  in  the  external  auditory  meatus  would  cause  a 
large  amount  of  deafness,  and  if  it  were  easily  remov- 
able, as  in  the  present  case,  that  operation  would  be 
perfectly  justifiable.  The  exostosis  appeared  to  have 
had  a  pedicle,  and  therefore  it  was  an  excellent  case 
for  removal. 

Dr.  Wyatt  Wingrave  showed  a  case  of  "  Primary 
Chancre  of  the  Nose." 

Dr.  ViNRACE  said  he  did  not  feel  satisfied  as  to  it 
being  a  primary  ulcer  of  the  nose.  He  asked  whether 
the  inoculation  was  not  due  to  conception.  One  often 
saw  such  cases  where  the  subjects  were  healthy  until 
pregnancy,  and  then  they  showed  manifestations  in 
different  parts  of  the  body.  Possibly  the  nose  was  an 
uncommon  site,  but  he  thought  it  would  be  found  to 
be  secondary  to  needle  inoculation. 

Dr.  Wingrave  said  that,  first  of  all,  the  patient  had 
a  slight  discharge  from  her  nose.  There  was  swelling 
and  stiffness  referred  to  the  root  of  the  nose,  That 
disappeared,  and  in  a  short  time  a  small  pimple  showed 
itself  at  the  edge  of  the  nostril,  which  gradually  spread 
but  did  not  discharge.  The  discharge  came  m>m  the 
interior  of  the  nose.  The  swelling  got  much  harder, 
but  about  three  weeks  ago  it  began  to  soften.  She 
had  complained  for  the  last  week  or  so  of  an  amount  of 
soreness  in  the  throat.  But  in  addition  there  was  a 
well-defined  rash,  which  had  been  partly  on  her  trunk, 
but  chiefly  on  the  extensor  aspects  of  the  forearms, 
and  to  some  extent  on  her  legs. 

Dr.  ViNRACE  said  he  feared  he  had  been  misunder- 
stood. He  did  not  doubt  the  nature  of  the  complaint — 
it  was  syphilitic,  but  he  doubted  the  actual  causation  of 
the  lesion.  He  regarded  it  as  a  case  of  inoculation 
through  the  foetus  and  not  an  inoculation  by  direct 


Syz    The  Medical  Press. 


TRANSACTIONS    OF   SOCIETIES. 


Nov. 


30,  1904- 


contact,  forming  a  primary  sore.     Was    the  patient 
pregnant  or  not  ? 

iSr.  WiNGRAVE,  in  further  reply,  said  he  could  not 
give  any  history  with  regard  to  the  inoculation.  She 
had  been  married  fourteen  months,  and  the  woman 
did  not  think  she  was  pregnant. 

Dr.  Wyatt  Wingrave  showed  a  case  of  "  Cystic 
Disease  of  the  Antrum." 

The  President  showed  a  case  of  "  Disease  of 
Sinuses."  He  said  it  was  a  case  of  disease  of  sinuses 
in  which  a  permanent  opening  had  been  made  into 
the  inferior  meatus  of  the  nose. 

Mr.  Bark  said  he  was  never  in  favour  of  treating 
antral  suppuration  by  an  opening  such  as  that  de- 
scribed. He  preferred,  if  he  were  going  to  make  an 
extensive  opening  into  the  outer  wall  of  the  nose  or 
the  inner  wall  of  the  antrum,  to  do  the  complete  opera- 
tion, to  remove  the  external  wall  and  the  superior 
maxilla.  If  for  any  reason,  such  as  the  objection  of 
the  patient,  he  could  only  do  a  tentative  operation,  he 
preferred  to  make  an  opening  into  the  canine  fossa 
and  insert  an  indiarubber  tube,  by  means  of  which  the 
patient  could  cleanse  out  the  antrum  through  the  nose. 

The  President  replied  that  he  had  a  particular 
reason  for  not  doing  the  radical  operation  in  the  pre- 
sent case.  One  point  was  that  it  was  not  clear  to  his 
mind  whether  it  was  a  case  of  simple  myoma  or  actual 
sinusitis  of  the  antrum.  And  in  cases  where  one 
desired  to  open  the  sinus  without  doing  the  radical 
operation  he  certainly  did  not  care  to  make  an  opening 
into  the  mouth,  because  the  mouth,  being  a  septic 
cavity,  it  very  often  happened  that  re-inoculation 
took  place  and  the  suppurative  abscess  continued  indefi- 
nitely. That  patient  had  had  no  trouble  whatever  in 
the  manipulation  of  her  tube  ;  she  passed  it  quite 
easily,  and  it  kept  the  sinus  washed  out.  Otherwise 
he  endorsed  Mr.  Bark's  remarks  about  the  desirabiUty 
of  doing  the  complete  operation. 

The  President  showed  a  case  of  "  Maxillary  Sinus- 
itis." It  was  shown  on  account  of  the  ease  with 
which  the  sinus  could  be  catheterised  through'  the 
infundibulum. 

Dr.  Vim  RACE  asked  how  long  it  was  suggested 
catheterisation  should  take  place.  Was  it  to  be  done 
to  the  end  of  the  patient's  life,  or  gradually  relaxed  and 
finally  left  of!  ? 

Mr.  Bark  said  he  supposed  that  the  frontal  sinus 
was  cured,  and  that  the  case  was  simply  brought  to 
see  how  easily  the  sinus  could  be  catheterised. 

Dr.  Haslam  (Croydon)  said  he  presumed  that  in- 
fundibulum was  not  as  it  would  be  in  an  old  case  in 
which  there  were  secondary  changes.  It  would,  no 
doubt,  be  necessary  to  do  the  radical  operation  if  it 
were  an  old  case  in  which  there  were  secondary  changes. 
He  would  be  glad  to  hear  how  long  the  catheterisation 
had  been  continued. 

The  President,  in  reply,  said  that  when  he  first  saw 
the  case  the  frontal  sinus  on  that  side  was  patent 
through  the  infundibulum,  but  empty.  There  was  no 
sinusitis.  He  mentioned  the  fact  of  the  antral  sinusitis, 
for  which  he  had  done  the  operation,  as  being  part  of 
the  case,  but  that  was  not  the  reason  he  showed  it. 

The  President  showed  "  An  Aural  Case  for  Dia- 
gnosis." 

Dr.  Clayton  Fox  suggested  that  possibly  the  case 
might  be  one  of  keloidal  formation  secondary,  probably, 
to  some  small  cicatrix,  which  was  first  started  by  the 
rubbing  of  the  hairpin  which  the  patient  had  been 
using.  It  also  had  somewhat  the  aspect  of  a  sebaceous 
cyst,  but  against  that  was  the  fact  that  it  was  lobu- 
lated. 

Mr.  McDouGALL  (Liverpool)  said  he  thought  the  case 
was  one  of  chronic  furuncular  inflammation,  and  that 
dealing  with  it  radically,  by  thorough  scraping,  would 
probably  cure  it.  He  did  not  think  it  presented  the 
appearance  of  keloid  at  all. 

The  President  said  his  own  idea  on  the  matter  was 
that  it  was  possibly  a  form  of  external  otitis  due  to 
some  bacterial  infection,  but  there  had  been  no  chance 
yet  of  making  any  microscopical  investigations. 


MICROSCOPICAL    SPECIMENS. 

Dr.  Wingrave  said  he  wished  to  remark  only  on  one 
of  the  specimens  he  showed,  that  of  toberculons  cer- 
vical lymphatic  glands.  Of  late  he  had  examined  a 
large  number  of  such  cases,  although  he  was  doobt&l 
as  to  why  they  should  be  called  tuberculous.  It  was 
true  that  one  found  in  them  giant-cells  and  practically 
all  the  evidence  of  tuberculosis  except  the  bacillus. 
The  remark  would  apply  equally  well  to  lupus,  in  whkh 
no  tubercle  bacilli  were  found.  The  granulation  cells 
were  found  in  granulomata  associated  with  syphilis, 
more  particularly  the  tertiary  stage,  but  there  were  no 
micro-organisms  to  be  found  which  were  obvionslT 
connected  with  the  disease.  That  specimen  exhibited 
and  a  number  of  others  he  had  stained  most  carefully 
for  evidence  of  tubercle  bacilli,  but  without  succea. 
And  on  examining  those  glands,  particularly  those 
which  were  removed  before  there  was  any  sign  ot 
suppuration,  there  was  no  sign  of  any  definite  character 
of  tubercle ;  there  were  simply  hard  dense  masses  oi 
epithelioid  cells,  and  a  certain  amount  of  interstitxal 
fibrotic  change.  Many  of  those  suppurating  glands 
were  found  terminating  in  pus,  and  pouring  out  larg.- 
quantities  of  streptothrix  and  other  organisms,  so 
that  there  were  a  large  number  of  so-called  tubercukm^ 
glands  which  were  not  due  to  tubercle  at  all,  but  which 
presented  all  the  histological  features  minus  the  sped£c 
organism.  So  it  was  likely  there  might  be  infectior. 
from  streptothrix  from  the  tonsils  and  adenoids  froic 
the  ear  and  other  channels,  which  gave  rise  to  the 
characters  of  so-called  tuberculous  glands,  but  withont 
presenting  the  respective  micro-organisms. 

Dr.   Jobson  Horne  said    that    Dr.    Wingrave  had 
touched  up)On  a  very  important  subject.      Although  the 
difficulty    of    staining    sections    to    demonstrate    the 
tubercle  bacillus  was  a  common  experience,  he  did  not 
think  it  should  lead  one  to  junip  to  the  other  extreme 
and  say  that  the  glands  so  examined  were  not  tuber- 
culous.    A  similar  condition  of  things  was  met  witli 
in  adenoid  tissue  and  post-nasal  growths,  and  in  fonsih. 
and,  indeed,  in  lymphoid  tissue  generally,  i.«.,  there 
were  sections  such  as  that  excellent    one   under  the 
microscope  demonstrating  giant-cells  and  all  the  histo- 
logical structures  of  tubercle,  but  not  the  all-importazit 
bacillus.     But  it  was  questionable  whether  one  should 
say  that  the  bacilli  were  absent  from  that  section.     He 
thought  one  should  not  go  further  than  to  state  that 
they  were  not  stained.     And  the  reason  they  were  not 
stained,  although  the  section  had  been  treated  with  the 
most  perfect  technique,  was,  for  son\e  occult  cause,  to 
be  found  in  the  action  of  the  lymphoid   tissue  itself 
upon  the  organism.     By  way  of  demonstrating  whether 
such  a  gland  was  or  was  not  tuberculous,  the  following 
little   animal   experiment    would    be    of    interest.    A 
patient  had  tuberculosis  of  the  temporal  bone,  and  he 
injected  a  portion  of  the  tissue  into  a  ^^uinea-pig.     In 
due  course  a  gland  adjacent  to  the  site  of  inoculation 
enlarged  and  also  more  distant  glands.      He  inoculated 
two  pigs  with  it.     One  he  killed  before  it  had  run  its 
full  term,  and  examined    the    glands.     In  the  largest 
gland,  that  next  to  the  site  of  the  inoculation,  he  was 
able    to   demonstrate    sections    very    similar    to   that 
shown  by  Dr.  Wingrave,  that  is  to  say,  having  all  the 
histological    structure   of    tubercle    but    none    of  the 
bacilli.     The  same  was  true  of  the  other  smaller  glands. 
But  upon  inoculating  a  third  guinea-pig  from  the  first 
and   largest  gland  which   demonstrated    no   tubercle 
bacilli  under  the  microscope,  he  was  able  to  kill  that 
guinea-pig  with  tubercle  and   to  demonstrate  in  the 
aninaal    tubercle    bacilli.     Therefore    he     thought    it 
would  be  more  correct  to  say  that  one  failed  to  demon- 
strate tubercle  bacilli  in  a  gland  rather  than  to  say 
that  they  were  not  present. 

Dr.  Wyatt  Wingrave  demonstrated  a  syringe  for 
intra-laryngeal  injections. 

LIVERPOOL  MEDICAL  INSTITUTION. 

Meeting  held  November  i/th,  1904. 

Dr.  James  Barr,  the  President,  in  the  Chair. 

EXTRACTION    OF   DOUBLE    CATARACT. 

Mr,  Thos.  H.  Bickerton  exhibited  a  fexxiale  patient 


Kov.  30,  1904- 


FRANCE. 


The  Medical  Press.    573 


sbU  76,  upon  whom  he  had  operated  for  double  cataract. 
Cocaine  was  first  tried,  but  the  patient  was  so  restless 
tliat  the  operation  could  not  be  undertaken.  A  few 
days  later,  chloroform  was  administered  and  double 
cataract  extraction  performed.  An  uneventful  re- 
covery followed,  and  an  excellent  result  as  regards 
vision  had  been  obtained.  Mr.  Bickerton  said  this 
\vas  the  first  occasion  on  which  he  had  performed  double 
cataract  extraction  at  one  sitting,  and  remarked  upon 
the  rarity  with  which  it  was  necessary  to  administer 
a  general  anaesthetic  for  operations  of  this  nature. 

I>r.  K.  A.  Grossmann  congratulated  Mr.  Bickerton 
upon  his  pluck,  and  upon  the  admirable  result  obtained, 
but  he  considered  double  extraction  at  one  sitting  a 
very  risky  procedure,  and  mentioned  a  case  in  which 
he  had  seen  most  disastrous  results  follow. 

Mr.  W.  Thelwall  Thomas  read  a  note  on  the 

TREATMENT  OF  SO-CALLED  CONCUSSION    OF    THE    BRAIN. 

He  referred  to  recent  physiological  research,  which  had 
demonstrated  the  absence  of  vaso-motor  nerves  in 
the  cerebral  arteries,  the  impossibility  of  producing 
any  effect  on  the  circulation  of  the  brain  by  applica- 
tions to  the  exterior  of  the  cranium,  the  importance 
of  the  cerebral  venous  pressure,  and  the  control  the 
splanchnic  vaso-motor  mechanism  exercised  by  acting 
indirectly  through  the  general  circulation.  He  divided 
concussion  into  three  varieties:  (i)  simple  concussion, 
merely  a  temporary  disturbance  of  pressure  equilibrium 
within  the  cranium,  which  is  quickly  recovered  from  ; 
<2)  severe  concussion,  which  he  considered  to  be  simply 
shock  ;  he  deprecated  the  use  of  ice-bags  in  this  con- 
dition, and  mentioned  cases  in  wtiich  the  continued 
application  of  ice  had  perpetuated  the  symptoms,  and 
recovery  had  quickly  followed  on  changing  the  treat- 
ment; (3)  Continued  concussion,  in  which  he  con- 
sidered contusion  of  the  brain  and  meninges  existed. 
In  this  condition  unconsciousness  quickly  gave  place 
to  irritability,  restlessness,  mild  delirium,  &c.  A 
sedative  line  of  treatment  was  strongly  insisted  upon, 
and  for  this  purpose  morphia  and  chloral  were  greatly 
preferable  to  bromides.  The  importance  of  absolute 
quietness,  tactful  nursing,  and  the  administration  of 
free  nourishment  was  emphasised.  Free  purgation 
was  not  recommended,  as  it  interfered  with  rest.  On 
returning  consciousness,  the  administration  of  iodides 
was  of  marked  value,  many  of  the  so-called  after-effects 
of  concussion — clouded  intellect,  loss  of  memory,  and 
headache — being  thus  cleared  up.  So  long  as  the  tem- 
perature, pulse,  and  respiration  remained  normal,  if 
the  patient  could  be  made  to  take  adequate  nourish- 
ment, the  prognosis  was  good.  Long-continued  un- 
consciousness, with  paresis,  paralysis  or  coma,  indicate 
cerebral  laceration,  and  a  rise  of  temperature  without 
a  corresponding  quickening  of  the  pulse  and  respiration, 
together  with  a  loss  of  control  of  the  bladder  and 
rectum,  generally  indicate  severe  laceration,  and  the 
prognosis  is  consequently  much  more  unfavourable. 

Mr.  Damer  Harrisson,  Dr.  W.  Alexander,  Dr.  W.  B. 
Warrington,  Mr.  Rushton  Parker,  Mr.  G.  P.  Newbolt, 
Mr.  E.  M.  Stockdale,  Professor  Sherrington,  and  the 
President  took  part  in  the  discussion. 

Mr.  Robert  Jones  read  a  note  upon 

SPINAL   COCAINISATION, 

which  will  be   found  in  another  column   under   the 
heading  of  "  Original  Communications,"  page  563. 
Dr.  William  Carter  read  a  paper  on 

SOME    OLD    AND    NEW   REMEDIES. 

The  main  proposition  was  that  medicinal  and  other 
agents  can  often,  in  an  unknown  way,  so  modify  cells 
and  tissues  as  to  make  a  diseased  person  sound,  and 
not  that  they  merely  relieve  symptoms,  while  Nature 
effects  a  cure.  He  illustrated  this  by  mentioning  cases 
in  which  prolonged  and  most  serious  illnesses  were 
arrested  and  the  patient  cured  by  using  such  old 
remedies  as  the  liquor  sarsae  co.  concentratus,  mercurial 
inunction,  and  vinum  antimoniale.  He  drew  atten- 
tion to  the  fact  that  the  result  of  examining  25.500 
recent  prescriptions  adopted  in  the  "Extra  Pharma- 
copceia  "  showed  that  not  one  of  these  substances  was 
so  much  as  mentioned.  He  contrasted  the  opinion 
expressed  on  the  one  hand  by  Boecker,  and  on  the 


other  by  the  late  Mr.  Allanson.  of  Leeds,  concerning 
the  first  of  these  drugs.  Boecker  simply  dismissing  it  as 
useless,  while  Allanson  thought  highly  of  it  though 
unable  to  explain  its  mode  of  action.  Among  other 
remedies,  succinate  of  iron  in  biliary  eolic.  and  large 
draughts  of  pure  water  in  renal  colic,  were  mentioned, 
and  their  utility  illustrated  by  cases.  Reference  was 
made  to  the  useful  effects  on  leucocytosis  and  chronic 
splenic  enlargements  by  X-rays,  and  a  photograph  was 
shown  of  a  very  large  and  remarkable  tumour  of  the 
face  which  was  considered  to  be  malignant  by  all  the 
medical  men  who  saw  the  patient.  An  operation  for 
its  removal  had  been  recommended,  but  under  X-ray 
treatment  the  tumour  had,  in  a  comparatively  short 
time,  entirely  disappeared.  Lastly,  allusion  was  made 
to  the  contradictory  opinions  of  Schmiedeberg  and 
Ringer  on  the  utility  of  aconite,  the  first  asserting  that 
"  saving  its  value  in  neuralgias  it  can  be  relegated  to 
the  obsolete  means  of  treatment,"  while  the  second 
states  that  "  perhaps  no  drug  is  more  valuable  than 
aconite."  and  cases  were  mentioned  showing  the  extra- 
ordinary benefit  which  the  drug  is  capable  of  affording 
in  certain  conditions  of  the  heart. 

Dr.  R.  E.  Kelly.  Dr.  A.  G.  GUlan,  Dr.  F.  H.  Barendt, 
Dr.  E.  T.  Davies,  Mr.  F.  Larkin.  Mr.  T.  H.  Bickerton. 
Dr.  R.  J.  M.  Buchanan,  Dr.  C.  J.  Macalister.  Dr.  N. 
Roberts.  Dr.  O.  T.  Williams,  and  Dr.  K.  A.  Grossmann 
took  part  in  the  discussion. 


jfrance. 


[from  our  own  correspondent.] 


PABI3.  November  Seth,  1001. 
Treatment  of  Vaginal  Gcnorrh(ea  . 

The  reatment  of  blennorrhagia  in  woman,  says 
Dr.  Daniel,  is  a  problem  which  has  much  occupied 
the  practitioner.  The  difficulties  of  the  treatment  are 
derived,  on  the  one  hand,,  from  the  special  anatomical 
disposition  of  the  female  genital  organs,  and  on  the 
other  from  the  multiplication  of  the  microbe  of  Neisser 
in  the  different  segments  of  the  uro-genital  apparatus. 
By  its  canicular  form,  by  its  very  oblique  direction 
downwards  and  forwards,  the  vagina  forms  an  organ 
difficult  to  disinfect.  Between  the  folds  of  the  mucous 
lining  the  microbes  are  concealed  in  chronic  blen- 
norrhagia ;  they  seem  to  take  refuge  in  these  localities, 
from  whence  they  are  ready  to  reinfect  the  whole 
region. 

It  is  true  that  Brumm  denied  the  primitive  infection 
of  the  vagina  ;  the  microbe  would  be  found  particularly 
in  the  glandular  regions:  the  vulva,  the  urinary  meatus, 
and  also  in  large  numbers  in  the  os.  If  that  be  so 
it  is  none  the  less  true  that  the  vagina  in  gonorrhoea 
infection  is  the  seat  of  intense  inflammation,  consti- 
tuting the  most  comnion  form  of  vaginitis. 

In  [any  case,  the  only  way  to  treat  ani  cure 
vaginal  blennorrhagia  scientifically  is  to  attack  the 
microbe  where  it  is  found.  The  treatment  should 
consequently  be  both  vulvar,  cervico-uterine,  urethral 
and,  above  all,  vaginal. 

In  ver>'  acute  cases  at  the  outset,  irrigations  (6 
quarts  of  boiled  water  or  a  solution  of  permanganate  of 
potash,  1-10,000),  associated  with  prolonged  baths, 
will  be  sufficient  until  the  acute  stage  has  passed.  At 
this  period  the  following  rapid  treatment  will  be 
attended  with  remarkable  results  : — 

(a)  The  whole  region  inside  and  out  will  be  washed 
with  soap  and  warm  water  by  means  of  a  vaginal 
brush  or  a  piece  of  sterilised  wooL 

(b)  Rinsing  of  the  vagina  with  simple  boiled  water, 

(c)  Injection  of  six  quarts  of  a  warm  solution  of 
permanganate  of  potash,  1-4,000. 

{d)  Plugging  of  the  vagina  with  five  or  six  plugs 
of  sterilised  gauze  impregnated  with  the  same  solution. 

(e)  At  the  end  of  twenty-four  hours  the  plugs  are 
withdrawn  and  the  injection  repeated  as  before,  and 
followed  hy  fresh  plugging.  At  the  end  of  another 
twelve  or  twenty-four  hours  the  plugs  are  definitely 
removed. 


574     'I'HK  Medical  Press. 


AUSTRIA. 


Nov.  50.  1904. 


Such  is  the  treatment  in  its  essential  points.  It  is 
executed  in  two  sittings  at  an  interval  of  twenty-four 
hours.  As  to  the  results,  in  the  numerous  cases 
in  which  he  had  employed  it.  the  absence  of  all 
gonococci  was  verified  by  the  microscope. 

During   the   following   days   the   irrigation   of   the 
vagina  by  the  permanganate  solution  wiU  be  continued 
two  or  three  times  a  day  (two  quarts  at  a  time)  to 
prevent  any  possible  return.     At  the  end  of  ten  or  ' 
fifteen  days,  when   the  vaginitis  will  be  cured,   the 
disinfection  of  the  vagina  may  be  completed  by  that 
of  the  uterine  os,  the  vaginal  cuU-dz-sac,  the  vulva,  and 
the  urethra.     For  this  it  will  be  sufficient  to  paint 
the  parts  every  two  da3rs  with  a  solution  of  nitrate  | 
of  silver,  i-ioo.     As  to  the  urethra,  a  pencil  of  the 
nitrate  will  be  introduced  and  immediately  withdrawn 
every  eight  days  for  about  a  month,  when  all  infection  ^ 
will  be  removed.  1 

Treatment    of   Obesity. 

Breakfast,  7  o'clock, — Cold  lean  meat,  two  to 
four  ounces ;  two  drachms  of  bread,  a  cup  of 
weak  tea  without  sugar  or  milk.  10  o'clock. 
— one  egg  without  bread.  12  o'clock. — Roast  or 
grilled  meat,  two  to  four  ounces  without 
gravy  or  sauce,  green  vegetables  ad  libitum,  without 
butter  or  grease,  weak  tea  without  sugar.  4  o'clock. — 
A  cup  of  tea  without  sugar.  7  o'dock. — ^Two  eggs* 
green  vegetables,  one  ounce  of  bread,  weak  tea. 

A  walk  of  half  an  hour  after  the  principal  meals. 

In  this  way  the  patient  will  have  lost  twenty-four 
pounds  in  twenty-five  days.  At  the  end  of  that  time 
the  rigour  of  the  regime  may  be  lessened ;  the 
quantity  of  bread  may  be  increased,  and  the  tea 
may  be  replaced  by  a  little  wine  and  water,  and^,;^ 
little  butter  may  be  allowed  in  the  vegetables. 

For  some  months  the  patients  will  continue  to 
observe  the  regime,  and  finally  they  will  have  lost 
from  forty  to  eighty  pounds  weight,  by  which  the 
dyspeptic  troubles,  oppression,  and  bronchial  catarrh 
from  which  they  generally  suffer  will  have  been  greatly 
relieved. 

Such  is  the  treatment  recommended  by  Professor 
A.  Robin. 


Octmant- 


[FROM   OUR  OWN   CORRESPONDENT.] 


BsaiiDi.  KoTember  26th,  1004. 
At  the  Medical  Society,  Hr.  Baginsky  showed  an 
Extreme  Dilatation  of  the  Colon, 
especially  of  the  sigmoid  flexure;  along  with  the 
dilatation  there  was  atrophy  of  the  wall  of  this  section 
of  intestine.  The  disease  was  first  described  by 
Hirschsprung.  The  preparation  was  taken  from  a 
child,  aet.  10  months,  who  was  admitted  with  extreme 
meteorism,  and  died  shortly  afterwards.     There  was 

Ffro^ably  a  congenital  disposition  to  the  abnormality, 
t  was   only  when    faecal  stasis   developed    that    the 
condition  came  about. 

The  speaker  then  proceeded  to  discuss 

Acute  Rheumatism  in  Childhood. 
He  had  observed  a  total  of  139  cases  of  articular 
rheumatism  in  children.  One  of  his  assistants  had 
already  published  an  account  of  73  of  the  cases  ; 
there  remained,  therefore,  66  to  report  on.  Those 
cases  of  pure  primary  articular  rheumatism  only 
would  be  considered,  not  those  in  which  the  joint 
inflammation  was  secondary  to  other  infantile  disease. 
Amongst  infants  at  the  breast  there  was  no  case ;  between 
the  ages  of  one  and  five  there  were  5  ;  between  5 
and  10,  32  cases ;  and  29  between  the  years  10  and  14. 
It  appeared,  therefore,  that  the  greatest  number  of 
cases  occurred  at  the  age  when  the  greatest  increase 
in  height  was  taking  place,  i.e.,  between  5  and  7 
and  II  and  14.  His  statistics  did  not  show  that  the 
disease  was  more  frequent  during  the  colder  parts 
of  the  year,  as  24  cases  were  admitted  in  the  wmter 
months  and  42  in  the  summer.  It  could  not  be 
determined  that  heredity  played  any  part,  as  after 
inquiries  showed  that  only  seven  of  the  patients  had 


suffered  from  the  disease.  In  spite  of  this,  ho*' 
ever,  observation  in  private  practice  gave  liim  the 
impression  that  hereditary  disposition  was  of  im- 
portance. 

An  initial  angina,  the  importance  of  which  had  ben 
over-rated,  was  present  only  in  nine  cases. 

He  distinguished  two  principal  groups  of  the  disease 
of  which  one  passed  off  quickly  and  was  readily  ameo- 
able  to  treatment,  while  the  other  was  a  malignant 
form,  and  ran  its  course  either  rapidly  or  led  to  cardiac 
complications,  which  then  became  the  procnineot 
feature.  Both  forms  might  have  a  strong  commence- 
ment. 

Examination  of  the  blood  was  mostly  negatived 
nephritis  appeared  rarely,  but  chorea  on  the  other 
hand  frequently.  At  one  time  various  serious  com- 
plications on  the  part  of  the  central  nervous  systcD 
were  described,  but  he  believed  that  such  cases  verr 
really  cases  of  cerebro-spinal  meningitis*  Chorea 
developed  in  a  third  of  the  cases.  In  spite  of  this, 
however,  chorea  minor  could  not  be  considered  as  1 
rheumatic  affection  as  it  came  on  when  there  was  do 
rheumatism,  and  then  no  explanation  could  be  gives 
for  its  occurrence. 

The  occurrence  of  endocarditis  in  the  course  of  2 
rheumatic  attack  was  of  special  importance.  Hie 
heart  remained  intact  only  eight  times.  17  were  kfi 
after  subsidence  of  the  cardiac  mischief  with  as 
apparently  healthy  heart.  35  were  discharged  vitb 
unsound  heart,  and  6  died. 

Pericarditis  had  been  of  special  interest  to  him. 
He  exhibited  a  series  of  curves  and  diagrams  whid) 
showed  the  importance  of  this  disease  in  relatioo  to 
the  course  of  the  cases  ;  most  of  the  cases  ended 
fatally. 

He  then  showed  a  number  of  preparations — ^widdy 
dilated  hearts,  the  enormous  dilatation  of  which, 
flat-sided  or  band-like,  could  not  be  explained  by 
the  endocarditis,  but  by  pericarditis.  If  children  got 
over  the  pericarditis  for  the  time,  they  almost,  without 
exception,  died  from  it  during  puberty. 

In  rare  cases  the  articular  rheumatism  of  childhood 
might  become  chronic,  leading  to  ankylosis  of  most 
or  even  all  of  the  joints. 

Therapeutically,  since  the  introduction  of  salidn. 
only  one  thing  had  changed,  the  articular  diseases  could 
be  treated  with  success.  As  regarded  cardiac  disease, 
we  were  as  powerless  as  before.  The  only  things  that 
had  proved  of  any  value  out  of  the  great  array  of 
remedies  were  ice  and  potassium  iodide. 

Bttstria^ 


[from  our  own  corrbspondent.] 


■  Vienna,  November  teth,  MM. 
Gale  Norvegienne. 

Amicis  relates  a  peculiar  case  of  itch,  or  **  gale 
Norvdgienne,"  ss  he  is  pleased  to  designate  it.  in 
the  case  of  a  child  that  had  come  under  his  care,  ^lir 
he  calls  it  Norwegian  itch  is  not  so  easily  explained,  as 
the  patient  was  an  Italian  from  Naples,  aet.  ij 
rachitic  and  greatly  emaciated. 

The  whole  suriace  of  the  body  was  red  between  the 
large  rupia  crusts  universally  spread  over  the  skin,  re- 
sembling in  every  detail  psoriasis  imiversalis.  The 
diagnosis  might  have  been  more  difficult  had  Amias 
not  had  the  father  previously  under  his  care  for  scabies. 
On  examining  the  crusts  on  the  child  the  sarcoptes 
scabei,  or  Bergh's  acari,  was  discovered  by  the  micro- 
scope, which  confirmed  his  opinion  of  its  being  the 
Norwegian  disease. 

Hydrophobia  and" Inoculation. 

Heydenreich  tells  a  fine  story  of  how  two  persGO^ 
were  bitten  by  a  dog  which  was  supposed  to  be  mad. 
To  confirm  the  opinion  the  dog  was  taken  to  a  veterinary 
surgeon  and  duly  killed,  but,  strange  to  say.  no  post- 
moriem  examination  was  made  of  the  dog.  nor  the 
membranes  of  the  brain.  Pasteur's  prevcntivf 
lymph  was  inoculated  in  one  of  the  cases,  while  the 
second  refused  the  "  saving  grace." 


Nov.  30.  1904- 


THE    OPERATING    THEATRES. 


The  Medical  Press.    575 


After  the  inoculation,  the  patient,  who  had  every 
confidence  in  the  wisdom  of  his  medical  man,  was  taken 
ill  mrith  a  high  fever,  great  pain  in  the  bowels  w^ith 
intractable  constipation.  Shortly  after  this,  paralysis, 
with  a  severe  form  of  psychosis,  made  its  appear- 
ance. 

At  this  stage  of  the  disease  Heydenreich  saw  the 
patient  and  declared  that  some  mistake  had  arisen,  as 
the  whole  train  of  symptoms  were  not  in  accord  with 
the  recognised  descriptions.  The  mad  dog  was 
exhumed  and  examined,  but  no  condition  of  the  mem- 
branes could  be  found  resembling  "  wirt."  It  was 
therefore  concluded  that  the  symptoms  were  due  to  the 
lymph  and  not  to  any  poison  from  the  dog.  as  the  second 
party  bitten  by  the  dog,  who  refused  the  treatment, 
remained  perfectly  well,  and  smiled  at  his  fellow's 
credulity ! 

HiCMATic  Concentration  and  Nephritis. 
Loeb  a^d  Adrian  have  recently  been  experimenting 
with  the  molecular  concentration  of  blood  and  its  effect 
on  the  kidneys.  They  find  that  it  is  only  in  bilateral 
nephritis  that  this  concentration  of  the  blood  takes 
place.  Blood  freezing  at  the  normal  point,  therefore, 
may  cause  functional  disturbances,  or  morbid  conditions 
of  the  renal  tract  anywhere  in  the  kidney  affected, 
but  never  when  both  kidneys  are  involved.  He  con- 
siders this  test  pathognomonic  of  bilateral  nephritis. 
and  easier  apptied  than  testing  the  urine  from  the 
individual  ureters. 

Thermopalpation. 
Sommer  in  his  investigations  reveals  a  state  of  tem- 
perature which  may  have  some  bearing  on  the  thera- 
peutics of  the  ear.  In  using  Herz's  thermopalpation 
mstroment  he  has  come  to  the  conclusion  that  both 
of  our  ears  have  not  the  same  temperature;  that  the 
left  ear  cavity  has  a  higher  temperature  than  the  right. 
The  difference  is  not  great,  but  sufficient  to  be  distinctly 
observed  by  the  instrument.  He  concludes  that  this 
high  temperature  is  due  to  a  more  active  condition  of 
the  left  side  of  the  brain,  where  the  circulation  is  greater 
in  the  left  hemisphere  than  the  right. 

Syphilis  and  Mercurial  Vapour. 
Welander,  of  Stockholm,  writes  to  the  Wochen^chfift 
his  experience  oi  the  vapour  treatment  of  syphilis  in 
females,  which  he  prescribes  in  measured  quantities  for 
inhalation.  He  finds  this  form  of  administering 
mercury  admirable  for  children  suffering  from  here- 
ditary syphilis.  The  urine  must  be  carefully  watched 
for  adbumin  and  cylinders,  which  frequently  super- 
vene. This  treatment  requires  special  wards,  wnich  have 
now  been  in  existence  in  that  city  for  the  last  four  years, 
and  have  been  instrumental  in  saving  many  children 
that  would  have  inevitably  died  if  left  in  their  own 
Homes.  In  Sweden  syphilis  is  not  so  widespread  as 
in  many  other  countries,  as  all  persons  so  affected  are 
taken  into  hospital  and  carefully  treated  till  aU 
trace  of  the  disease  has  disappeared.  This  is  one  of  the 
causes  assigned  for  the  low  number  of  cases  to  be  found 
in  that  country. 

Acne  Vulgaris. 
Sollner    finds  a  large  number  of  micro-organisms 
in  acne  vulgaris,  but  there  is    not   one    among  the 
number  that  could  be  cited  as  the  etiology  of    the 
disease. 

Is  Tubercle  Inherited? 
Schmorl  and  Zeipel  have  devoted  a  great  deal  of  time 
to  the  examination  of  the  placenta  in  order  to  determine 
the  absence  or  presence  of  tubercle  in  membranes  of  the 
offspring.  They  give  a  long  history  of  twenty  cases. 
One  of  miliary  tuberculosis,  one  of  tuberculous  meningi- 
tis, eleven  of  advanced  tuberculosis,  four  of  fully  deve- 
loped and  three  of  incipient  pulmonary  tuberculosis.  In 
nine  of  these  cases  tuberculous changeswere  present  in  the 
placenta.  It  requires  careful  manipulation  to  discover 
the  morbid  product,  as  may  be  inferred  from  2,000 
sections  being  necessary  in  one  case.  The  tuberculous 
centres  are  usually  located  to  the  outer  shaggy  surface 
or  the  inner  ;  more  rarely  on  the  decidua  basciUs,  and 
least  of  all  on  the  broad  chorial  surface  of  the  placenta. 
By  this  it  is  argued  that  tuberculosis  can  be  directly 
transmitted  without  infection  at  all. 


XTbe  Operating  XTbeatree. 

ST.  PETER'S  HOSPITAL  FOR  STONE. 
Remarks  on  last  week's  Case  of  Prostatectomy, 
— Dr.  Thompson  Walker  pointed  out  that  the  ques- 
tions of  practical  importance  in  regard  to  prostat- 
ectomy are :  What  is  the  risk  of  the  operation  ? 
How  long  will  it  be  before  the  patient  is  well  ?  And 
what  are  the  after  results  ?  He  said  that  recently 
{Practitioner,  August,  1904)  he  had  collected  83  case* 
of  suprapubic  prostatectomy  by  various  surgeons  and 
found  that  the  total  death-rate  of  the  operation,  both  . 
immediate  and  during  convalescence,  was  10*8  pe^^ 
cent.  This  included  some  cases  in  which  the  fatal 
result  was  not  directly  due  to  the  operation,  but  as 
it  occurred  before  the  patient  was  completely  recovered 
from  the  operation  these  deaths  had  to  be  counted  as 
part  of  the  mortality  of  the  operation  itself.  Taking 
this  death-rate  as  it  stands  it  is  an  astonishingly  low 
figure ;  for  it  must  be  remembered  that  the  average 
age  of  these  patients  was  65  years  and  8  months* 
while  22  of  them  were  over  70  years  of  age,  and  79 
per  cent,  of  this  total  number  of  cases  were  over  60 
years.  On  tabulating  the  ages  with  the  deaths  he 
found,  however,  that  the  risk  did  not  increase  with 
the  age.  The  hsk  is,  of  course,  greater  where  advanced 
kidney  disease,  bronchitis,  or  such  complications  are 
present,  but  even  in  such  cases  the  patient  need  not 
be  refused  operation,  for  many  of  the  successful  cases 
had  been  suffering  from  these  and  other  serious  com- 
plications. When  this  mortality  is  compared  with 
that  of  other  operations  of  equal  gravity,  it  will 
be  seen  to  be  very  smaU.  The  duration  of  convales- 
cence varies*  a  good  deal.  A  few  cases  may  be  healed 
and  out  of  the  surgeon's  hands  in  three  weeks,  but 
some  take  double  that  time.  The  average  is,  he  thought* 
about^four  or  five  weeks.  By  this  time  the  suprapubic 
wound  is  healed,  and  the  patient  is  well  enough  to 
leave  the  surgeon's  care.  The  recovery  of  vitality 
and  general  health  in  these  patients  is  remarkable, 
and  it  is  the  more  striking  the  more  depressed  the 
general  condition  was  before  the  operation.  The 
risks  of  the  operation  extend,  however,  through  the 
whole  course  of  the  convalescence,  and  there  are  few 
operations  he  knew  of  in  which  the  anxiety  of  the  surgeon 
is  more  prolonged.  In  the  series  of  cases  he  collected, 
death  occurred  as  late  as  the  twentieth  and  twenty 
second  days  after  operation.  In  a  case  of  his  own  the 
patient  progressed  without  any  unfavourable  sym- 
ptoms, except  delayed  healing  of  a  very^thick  abdomi- 
nal wall,  until  the  end  of  the  fifth  week,  when  he  began 
to  lose  ground,  and  died  six  weeks  after  the  operation, 
apparently  from  septic  absorption.  The  complication 
of  sepsis  he  considered  to  be  one  of  the  most  important 
the  surgeon  has  to  fear,  and  it  is  difficult  to  guard 
against,  for  many  of  the  bladders  operated  upon  are 
in  a  state  of  chronic  cystitis  and  the  urine  is  foul. 
Prolonged  preparation  by  bladder  washing  previous  to 
the  operation  is  not  always  possible,  although  it  is 
very  important  in  these  septic  cases.  Nor  is  it  always 
effectual,  for  the  bladder  often  contains  pouches  and 
calculi  may  be  present.  Urethral  drainage  through  a 
catheter  is  imperfect,  and  perineal  drainage  is  little 
better.  Suprapubic  cystotomy  in  such  cases  is 
attended  by  too  high  a  mortality  to  be  lightly  con- 
sidered as  a  preliminary  measure.  He  thought  the  best 
preparation    was  prolonged    careful   bladder  washing 


57^    The  Medical  Press. 


LEADING  ARTICLES. 


Nov.  y,  1904. 


by  the  urethra.  The  after -results  of  prostatectomy 
as  it  is  now  practised  in-  this  country  are  very  sur- 
prising and  completely  controvert  the  statements  of 
the  great  surgeons  of  the  last  generation,  that  the 
bladder  function  was  destroyed  and  would  not  be 
regained  even  if  the  obstruction  were  removed.  These 
patients  retain  their  urine  as  long,  and  pass  it  in  as 
powerful  and  free  a  stream,  as  they  did  before  the 
prostate  began  to  obstruct  the  outlet  of  the  bladder. 
The  result  of  the  operation  is  therefore  perfect.  There 
is  no  incontinence,  no  fistula,  and  there  is  no  stricture. 
The  two  former  sequela;  may  be  noticed  in  the  records 
of  cases  done  by  the  perineal  method.  He  referred 
especially  to  the  cases  reported  by  Continental  surgeons, 
who  have  told  him  personally  that  such  results  are 
far  from  uncommon.  The  possibility  of  stricture  has 
been  more  than  once  raised  as  an  objection  to  this 
operation.  Experience  has  shown  that  such  fears  are 
groundless. 


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'•  SALUS  POPULI   SUPSEMA  LEX." 

WEDNESDAY.  NOVEMBER  30.  1904, 


THE  ANNUAL  MEETING  OF  THE  ROYAL 
COLLEGE  OF  SURGEONS,  ENGLAND. 
The  times  have  changed  at  the  annual  meeting 
of  the  Fellows  and  members  of  the  Royal  College 
of  Surgeons,  England,  as  may  be  gathered  by  the 
fact  that  on  the  17th  inst.,  when  the  meeting  was 
held,  the  proceedings  had  to  be  suspended  in  con- 
sequence of  the  necessary  quorum  not  being 
present.  As  far  as  we  are  aware  no  such  incident 
has  ever  occurred  before;  on  the  contrary,  the  occa- 
sion has  always  been  one  on  which  many  members 
have  availed  themselves  of  the  pretext  to  visit 
their  College,  and  by  their  presence  support  those 
who  had  made  themselves  the  leaders  of  what  used 
to  be  knbv/n  as  '*  college  politics  '*  ;  there  is, 
however,  no  gainsaying  the  fact  that  at  the  present 
moment  so-called  "  college  politics  "  are  at  their 
lowest  ebb.  The  Association  of  Fellows,  which 
represented  the  Reforming  body  of  fellows,  has 
ceased  to  exist ;  and  the  Association  of  members, 
if  it  has  now  any  political  existence,  is  not  taken 


seriously ;  and  thus  it  has  come  to  pass  that  despite 
the  fierce  engagements  which  in  former  years  took 
place  between theCounciland  the  "  body  corpOTatc  *' 
the  lapse  of  time  has  converted  the  sword  into 
the  ploughshare,  and  the  Council  reigns  serenely 
as  of  yore,  secure  in  its  traditions   and  just  as 
unassailable.     Still,  it  is  interesting  to  recall  that 
the  present  President  owed  to  the  suffrages  of  thf 
Reforming  body  of  Fellows   his  first  election  into 
the  Council.     At  the  time  in  question  he  was  an 
active  member  of  the  former  and  lost  no  opportunity 
of  impressing  upon  the  Council  the  necessity  of 
granting  concessions  in  favour  both  of  the  Fellows 
and  members.     It  was  soon  after  his  election  that 
the    career   of    real   political    importance   of  the 
Association  of  Fellows  began.     Its  candidates  at 
the  annual  election  of  members  of  the  Council  weit 
then  nearly  always  successful  ;  the  Association,  in 
fact,  had  attained  a  degree  of  organisation  which 
constituted  it  a  real  menace  to  the  old  time  coo- 
servatism  of  the  Council.     The  Council  were  thus 
compelled  to  recognise  its   political    importana, 
earnestness,  and  influence,  and  then  it  was  that 
certain    reforms    were    granted    from    which  the 
Fellows  have  since  benefited.     So  far,  howcvo",  as 
the  meeting  on  the  17th  instant  is  concerned,  we 
are  glad  to  note  that  the  business  transacted  thereat 
consisted  &f  ieveral  important  matters  apart  from 
College    politics.     Nothing,    for    example,    could 
have  been  more  in  keeping  with  the  character  of  the 
meeting  than  the  resolution  moved  by  Dr.  Danford 
Thomas,  having  reference  to  the  relations  of  the 
medical  profession  to  the  Coroners'  Courts.     It  is 
unnecessary  to  point  out  why  this  has  become  such 
a  burning  question  of  the  day,  inasmuch  as  the 
facts    are     notorious     in     connection     therewith. 
Nevertheless,  when  the  matter  was  referred  by  the 
London   County   Council   to   the    Council   of  the 
College  no  steps  were  taken  to  prepare  an  exhaus- 
tive  report  thereon,  nor  was    any   authoritative 
attempt  made  by  the  latter  to  indicate  the  strong 
feeling  which  existed  in  the  profession  against  the 
irregularities  which  had  occurred  in  one  particular 
Coroner's   Court.     We     entirely     agree   with  Dr. 
Danford  Thomas  that  the  Council  of  the  College. 
instead    of    acting    in    an  invertebrate    manner, 
would  have  done  well  to  have  arranged  an  inde- 
pendent inquiry  into  the  matter  with  the  assistance 
of  some   FeUows  and  members   ha\'ing  intimate 
knowledge  of  the  subject.     We  hope  that  even  now 
some  means  may  be  found  by  which  the  Coll(^, 
may  exert  its  influence  by  the  expression  of  an 
authoritative  opinion  upon  the  irregularities  which 
have  occurred.  As  a  member   truly   pointed  cot 
according   to    Bye-law  XV.    of    the   College   the 
College  promises  at  all  times  to  protect  and  defend 
the  Fellows  and  members  in  the  exercise  of  their 
rights,  and  in  our  opinion  this  is  precisely  the  occa- 
sion  on   which  the    Bye-law   in   question   might 
usefuUv  be  carried  out. 


THE  HOSPITAL  FUNDS  AND   THE  SMALL 
HOSPITALS. 
Nor  unnaturally  the  publication  of  our  recent 


Nov. 


30^1904. 


NOTES    ON    CURRENT    TOPICS. 


leading   article   dealing   with   the   policj^   of   the 
Hospital  Saturday,  the  Hospital  Sunday,  and  the 
King  Edward's  Funds  towards  the  small  metro- 
politan    hospitals    has     attracted     considerable 
attention.     Our  main  contention  was  to  the  effect 
that    whereas   the   institutions  in   question  were 
supjxjrtcdbythe  Saturday  Fund  that  many  of  them, 
on    the  other  hand,  sustained  serious  damage  in 
loss  of  prestige  and  of  income,  owing  to  their  non- 
recognitionby  the  other  two  of  the  above-mentioned 
funds.    The  Editor  of  the  Hospital,  an  acknow- 
ledged authority  in  the  world  of  medical  charity, 
has  entered  a  temperately  worded  tentative  pro- 
test against  our  position  and  has  asked  for  a  list 
of   excluded  small  hospitals.      He  points  to   the 
fact    that   the  grants   to   the   thirty-three   small 
hospitals  have  materially  increased  during  the  past 
few  years.     That  argument  by  no  means  disposes 
of  the  claims  of  the  small  hospitals  that  happen 
to  be  outside  the  charmed  circle  of   favoured  insti- 
tutions. Itisrauchthe  same  as  saying  that  because 
the  Registrar-General  has  devoted  more  care  to  the 
statistical  returns  of  the  thirty-three  great  towns 
of  England  and  Wales,  therefore  other  insignificant 
towns  left  out  in  the  cold  should  rest  and  be  thank- 
ful.     We  venture  to  suggest  to  Sir  Henry  Burdett, 
however,    that  the    alleged  injur>'  to  the  small 
hospitals   not  included   among  the   recipients  of 
grants  from  the  King  Edward's  and  the  Hospital 
Sunday   Funds   is   in   no  way   mitigated   by   his 
pointing  to  the  thirty-three  small  hospitals  that 
have  been  so  favoured  and  recognised.      Indeed 
his    statement    merely   serves    to    emphasise    the 
inequality  of  distribution  and  to  invite  an  inquiry 
into  the  principles  that  prompt  the  Committees 
in   making  their  awards.     In  an  early  issue  we 
hojje  to  furnish  Sir  Henry  vkith  the  desired  list  of 
small  hospitals  that  have  been  excluded  from  the 
benefits  of  the  two  Funds  in  question.  Meanwhile 
it  is  only  fair  and  right  that  the  pubUc  who  contri- 
bute the  money  should  be  fully  and  exactly  informed 
as  to  the  precise  principles  upon  which  the  grants 
are  allocated.     So  far  as  it  is  possible  to  form  a 
judgment  from  results  the  wisdom  of  the  control- 
ling Funds  is  not  altogether  self-evident.  Take  the 
case  of  the  Royal  Orthopaedic  Hospital,  which  until 
recently  stood  upon  an  enviously  valuable  site  in 
Oxford  Street.    Some  years  ago  the  then  executive, 
under  the  chairmanship  of   Sir   Walter   Gilbey, 
wished  to  sell  the  site  ;  but  their  scheme  was  not 
approved  by  the  Governors,  and  Sir  Walter  was 
succeeded   in   the   chairmanship   by   Mr.    H.    H. 
Marks,  the  well-known  financial  magnate  and  now 
M.P.      The  newly-elected  executive   again  deter- 
mined to  sell,  and  that  course  was  urged  by  the 
Sunday  Fund  in  the  most  forcible  way  at  their 
command — namely,  by  withholding  a  grant  until 
amalgamation  or  sale    of  the  Royal  Orthopaidic 
Hospital     had     been     effected.     Meanwhile    the 
opponents  of  the  scheme  for  sale  did  not  relax  their 
efforts,   and   although   they  did   not  succeed  in 
preventing  the  sale,  they  nevertheless  raised  the 
selling  price  by  no  less. a  sum  than  ;f  12,000.     Now 
the  Sunday  Fund  had  urged  the  Hospital  to  sell  at 
the  lower  price,  so  that  if  the  advice  of  the  Fund 


The  Medical  Press.    577 


had  been  followed  twelve  thousand  pounds  would 
have  been  lost  to  the  charity.  Now  we  think  the 
public  is  entitled  to  know  on  what  grounds  the 
Hospital  Sunday  Fund  urged  the  sale  of  the 
enormously  valuable  site  in  Oxford  Street,  not 
only  at  the  lower  price,  which  was  clearly  far  under 
the  actual  value,  but  at  any  price  at  all.  What 
ordinary  citizen  of  any  business  capacity  would 
have  dreamed  of  parting  with  a  valuable  freehold 
in  order  to  spend  the  purchase  money  in  building 
another  hospital  on  leasehold  property  elsewhere  ? 
We  are  entitled  to  ask  if  the  Hospital  Sunday  Fund, 
before  assuming  this  great  responsibility  with" 
regard  to  urging  theeale  of  the  Or  thopaxlic  Hospital 
premises,  made  itself  fully  acquainted  with  the 
arguments  of  the  minority  opposing  the  sale. 
There  is  no  need  to  remind  Sir  Henry  Burdett  of 
the  history  of  the  dispute  in  question,  with  the 
details  of  which  he  is  already  acquainted.  We 
should  be  glad  to  hear  his  explanation  of  the  part 
played  by  the  Hospital  Funds  in  the  sale  of  the 
Royal  Orthopaedic  Hospital  site.  We  shall  be 
also  glad  to  learn  what  evidence  was  taken  for  and 
against  the  proposal.  In  short,  this  case  may  be 
taken  as  a  prehminary  opening  up  of  our  inquiry 
into  the  methods  that  control  the  Hospital  Funds. 
His  Majesty  King  Edward,  as  we  said  on  a  previous 
occasion,  will  be  the  first  to  insist  upon  the  correc- 
tion of  any  inequality  of  administration  that  may 
be  revealed.  We  may  commend  to  his  gracious 
consideration  as  a  first  step  towards  security  of 
justice  the  proposition  that  every  hospital,  regard- 
less of  its  size,  should  be  represented  upon  his 
own  and  upon  the  Hospital  Sunday  Funds,  as  in 
the  case  of  the  Saturday  Fund. 

Vlotee  on  Current  UopicSt 

Spinal  Ansesthesia  in  Labour. 

Since  the  fall  of  our  first  parents  it  has  been  the 
lot  of  womankind  to  bring  forth  children  only  at 
the  cost  of  much  suffering  to  herself,  and  the  in- 
ventor of  a  method  by  which  that  process  could 
be  accomplished  without  pain  would  deserve, 
and  probably  receive,  the  benediction  of  a  host  of 
mothers.  Martin  has  been  trying  whether  the 
production  of  local  anaesthesia  by  spinal  cocainisa- 
tion  would  not  be  as  serviceable  in  labour  as  it  is 
reported  to  have  been  in  a  large  number  of  sur- 
gical operations.  In  all  he  has  employed  the  me- 
thod in  thirty  cases,  his  usual  plan  being  to  inject 
a  centigramme  of  a  i  in  2,000  solution  of  adrenalin 
into  the  subdorsal  space,  and  to  follow  this  five 
minutes  later  by  a  solution  of  cocaine.  The  effects 
were  not  all  consistent,  but  although  marked 
variations  occurred  in  the  duration  of  the  action 
of  the  drug,  in  twenty-nine  cases  good  anaesthesia 
was  obtained.  In  nine  of  these  cases  it  lasted 
only  half  an  hour,  but  in  most  of  the  others  it 
persisted  from  one  to  three  or  even  four  hours- 
WTien  labour  came  on  within  aui  hour  or  an  hour 
and  a  half  after  the  injection,  the  pains  were  but 
little  felt  by  the  mother,  but  in  all  cases  the  uterine 
contractions  were  retarded,  and  the  patients  used 
their  abdominal  muscles  only  when  urged  to  do 


^78    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


Nov.  30.  1904. 


so.  The  majority  of  the  patients  had  marked 
vomiting  and  nansea  after  the  injections,  an  effect 
that  was  not  counteracted  by  the  subsequent 
injections  of  caffeine  salicylate,  as  Martin  had  ex- 
pected. This,  however,  seems  to  have  been  the 
worst  that  happened,  for  the  puerperium  was  not 
disturbed  and  inilk  secretion  was  natural.  Martin, 
at  any  rate,  is  so  far  pleased  with  his  plan  that  he 
proposes  to  continue  it  in  further  cases  where 
chloroform  is  inadvisable.  We  should  be  glad  if 
he  could  so  far  perfect  the  operation  as  to  make  the 
birth  of  a  child  no  more  of  a  burden  to  a  healthy, 
civilised  woman  than  it  is  at  present  to  a  negro 
woman  in  Central  Africa  ;  but  we  fear  that  such  a 
consummation  is  more  to  be  wished  for  than  ex- 
pected. 


FifiTB  as  Physio. 

The  generous  amplitude  with  which  the  British 
Pharmacopoeia  is  recruited  from  the  vegetable 
world  is  recognised  mainly  by  students  of  therapeu- 
tics. From  every  quarter  of  the  globe,  from  every 
herb  that  bears  fruit  and  those  which  do  not,  some 
active  principle  may  be  obtained,  if  only  man's 
ingenuity  can  find  it  out.  Many  of  these'products, 
from  the  stately  tree  of  the  forest  to  the  humble 
weed  that  flourishes  in  the  ditch,  are  of  distinct 
use  "  for  the  healing  of  the  nations."  The 
therapeutic  value  of  the  fig  has  been  recognised 
from  remote  ages.  As  an  article  of  food  it  was  largely 
used  by  both  the  Greeks  and  the  Spartans,  while 
an  alcoholic  beverage  prepared  from  the  fermented 
fruit  was  known  to  Pliny  under  the  name  of 
syciies.  The  so-called  seeds,  which  are  in  reality 
the  fruit  proper  contained  within  a  fleshy  recep- 
tacle, have  long  enjoyed  a  reputation  as  a  mild 
laxative,  and  to  this  day  the  fig  itself,  green  or  dry, 
or  syrupy  preparations  thereof,  are  consumed 
with  this  object.  It  is  somewhat  strange,  however, 
that  this  popular  remedy  only  receives  the  sanction 
of  the  Pharmacopoeia  as  one  of  the  ingredients  of 
that  most  comfortable  electuary,  Confectio  Sennas. 
The  receptacles  when  cut  open  act  admirably  as 
a  cataplasm,  the  knowledge  of  their  heat-retaining 
properties  as  adapted  to  the  treatment  of  boils 
being  at  least  as  old  as  the  daj-s  of  Hezekiah.  In 
virtue  of  the  sugar  which  they  contain,  such  an 
application  would  be  quite  as  antiseptic,  if  not 
more  so,  as  the  more  familiar  hnseed -poultice.  A 
syrupy  extract  of  figs  has  also  been  recommended 
as  a  demulcent  in  certain  irritable  affections  of  the 
throat.  The  j  uice  from  the  stems  and  leaves  of  the 
Fictis  carica  is  acrid  and  it  has  been  employed  to 
raise  blisters.  The  fruit  enters  largely  into  the 
dietary  of  the  nations  of  Southern  Europe,  and  an 
attempt  is  being  made  in  certain  quarters  to  insti- 
tute a  "  cult  "  for  the  more  general  consumption  of 
the  fig  in  this  country. 


Weiffht-oanTinff  and  Growth. 

The  adaptation  of  the  skeleton  to  the  strain 
imposed  upon  it  while  lifting  or  carrying  heavy 
burdens  is  no  less  surprising  than  the  amount  of 
muscular  strength  exhibited  by  those  who  are 
daily  accustomed  to  such  tasks.     Physical  endur- 


ance is  by  no  means  invariably  commensurate  mith 
great  muscular  development,  but  there  is  no  dis- 
puting the  fact  that  feats  involving  Hermkar 
strength  can  only  be  performed  by  persons  wfao» 
muscular  tissue  is  powerfully  knit  together.  Jfcrc 
bulk  alone  is,  of  course,  no  criterion  whatever  of 
muscular  strength,  as  may  be  readily  pro\-ed  in  tbf 
case  of  that  curious  affection,  pseudo-h>-pertrophic 
paralysis.  It  is  the  fitness  of  each  individual  fiht 
and  its  ability  to  contract  co-ordinately  with  it^ 
fellows  in  response  to  its  owner's  commands  wbict 
constitutes  real  muscular  efficiency.  x\s  far  a« 
lifting  heavy  weights  is  concerned,  everyone  ksoi^ 
who  is  accustomed  to  such  work  that  there  is  a  good 
deal  in  getting  hold  of  the  load  in  the  right  mansr 
and  also  in  the  method  by  which  it  is  supported  \k 
the  body.  In  other  words,  knack  is  almost  ii 
important  as  muscular  strength,  a  fact  to  which  aur 
railway-porter  can  testify.  The  head  and  shooldfr 
are  the  best  anatomical  sites  for  weigh t-carryinf 
and  it  has  been  shown  that  characteristic  bom 
change  may  ensue  after  an  individual  has 
been  engaged  in  this  work  for  a  number  of 
years.  The  worst  position  is  that  in  which  the 
weight  is  held  in  front  of  the  trunk  and  the  body 
consequently  bent  backwards,  the  head  being 
flexed.  A  good  deal  of  strain  is  thus  imposnl 
upon  the  abdominal  muscles,  and  if  the  abdominal 
rings  are  abnormally  patent  there  is  a  risk  of  a 
hernia  coming  down.  The  dwarfing  effect  « 
weight-lifting  upon  young  girls  was  dwelt  upon  ty 
Miss  Anderson,  Chief  Lady  Inspector  of  Factories 
in  her  evidence  before  the  Physical  Deterioriatioi 
Committee.  Heavy  lumps  of  clay  are  sometiines 
carried  by  girls  in  their  teens,  and  loads  of  froit 
are  similarly  borne  in  certain  jam  factories  b> 
young  women.  It  is  most  desirable  that  a  general 
maximum  of  weight  that  may  be  handled  by  yoaoi! 
persons  should  be  legally  established  for  all  indus- 
tries alike. 


Idirht  as  an  AnsBBthetic. 

One  might  have  been  pardoned   for  believing: 
that  most  of  the  uses  of  light  had  already  beer 
explained  within  recent  years.      Red  light,  white 
light,  the  ultra-violet  rays,  and  so  on,  each  wi« 
stated  to  have  its  own  sphere   of   usefulness  in 
therapeutics  or   in  diagnosis.     If  we  are  to  put 
faith  in  some  recent  reports,  however,  blue  li|»b: 
has  a  peculiar  power  of  its  own,  in  that  it  is  said 
to    produce    anaesthesia.     Professor    Kedard,  « 
Genoa,    has    published    several    cases    in    whicb 
he  states  that  he  produced  brief  periods  of  excellent 
surgical  anaesthesia  by  the  simple  device  of  mak- 
ing the  patient  fix  his  gaze  on   an  intense  Woe 
light.     The  apparatus  used  is  simply  an  electric 
arc    lamp  enclosed    in   a  blue   globe,   and  hxtd. 
in  a  blue  polished  reflector.     The  patient's  head 
is  covered  by  a  blue  cloth  in  such  a  way  as  to 
shut  out  all  Tdiys  of  Ught  but  those  coming  from 
the  lamp.     He  is  instructed  to  keep  his  eyies  open 
and   fixed   on   the  Ught,  and    Professor  Redard 
states  that  in  two  or  three  minutes  the  papik 
become   widely   dilated,    and    anaesthesia  exists 
It   persists  long  enough   to   permit   of  such  an 


Nov.  30.  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    579 


operation  as  extraction  of  five  or  six  teeth,  and 
the  patient  is  quite  unconscious  of  what  is  being 
done.  Redard  does  not  regard  the  phenomenon 
as  hypnotic,  for  he  has  failed  to  produce  it  by 
suggestion,  or  b}'  the  use  of  any  other  light  than 


The  Cause  of  Babies. 

It  is  curious  that  some  of  the  diseases  in  regard 
to  w'hich  we  have  been  most  successful  in  the 
production  of  artificial  immunity  depend  on 
ca.uses  of  which  we  are  still  ignorant.  This  is 
true  both  of  small-pox  and  of  rabies,  for  although 
in  the  investigation  of  these  diseases  many  bodies 
have  been  given  by  their  discoverers  a  causal 
importance,  yet  up  to  the  present  there  is  no 
general  agreement  in  either  case.  In  regard 
to  rabies,  most  interest  at  present  centres  round 
the  researches  of  Dr.  I-egri,  of  Pavia,  who  last 
year  described  certain  bodies  found  in  the  nervous 
sy^^tem  of  animals  dead  of  rabies.  The  bodies 
are  round  in  shape,  and  vary  in  size  from  what 
can  be  just  seen  with  the  highest  po^ver  of  a 
microscope  up  to  a  diameter  of  twenty-five  mi- 
crons^ the  average  size  being  four  to  ten  microns. 
They  were  found  in  all  parts  of  the  nervous 
system^  and  can  be  demonstrated  by  the  ordinary 
stains.  Legri  himself  found  them  present  in 
fifty  out  of  fifty-two  cases  examined,  while  he 
has  never  seen  them  in  any  other  condition  than 
rabies.  His  observations  have  been  confirmed  by 
several  Italian  investigators  of  repute,  and  though 
the  case  is  far  from  proven,  yet  there  is  on  the 
face  of  it  nothing  against  Legri's  belief  that  he 
has  discovered  the  organism  of  rabies. 


A  Hospital  for  the  Insane. 
Very  slowly,  but  it  may  be  hoped  surely,  the 
idea  is  beginning  to  filter  into  the  minds  of  ad- 
ministrators of  the  Lunacy  Acts  that  a  mentally- 
affected  man  is  not  merely  a  useless  unit  in  society 
for  whom  a  pigeon-hole  has  to  be  found  to  keep 
him  out  of  harm's  way,  but  a  sick  person  who  needs 
treatment.  The  accurate  diagnosis  of  mental  cases 
is  as  important  as  that  of  physical  ones,  and  the 
consequent  classification  with  a  view  to  remedial 
treatment  should  be  the  foremost  consideration  in 
all  lunacy  adminLstration.  The  chief  function  of 
diagnosis  should  be  to  separate  the  curable  from 
the  incurable,  and  the  former  should  be  considered 
so  distinct  a  class  from  the  latter  that  they  should 
have  no  communication  with  them  in  the  asylum. 
The  ideal  arrangement  would  be  to  have  the 
patients  susceptible  of  cure  housed  and  looked  after 
in  separate  establishments,  but  though  it  will  be 
necessary  to  wait  long  to  see  such  a  desirable  con- 
summation, we  are  glad  to  note  in  the  report  of  the 
Asylums  Committee  of  the  I-ondon  County  Council 
that  a  step  in  the  right  direction  is  to  be  taken. 
At  the  Bexley  Asylum  it  is  proposed  to  build  a 
*  villa,"  containing  accommodation  for  fifty  male 
patients,  where  cases  capable  of  amelioration 
or  cure  will  be  placed,  and  from  which  any  patient 
deemed  incurable  will  be  drafted  to  the  main 
asylum.     Already   a  similar   villa   is   in   working 


order  on  the  female  side,  and  the  arrangement  has 
proved  most  beneficial,  for  it  has  proved  that  the 
bulk  of  the  new  cases  need  never  enter  the  asylum 
proper  at  all.  After  discharge  from  the  hospital 
villa  cases  will  be  transferred  to  a  convalescent 
viUa,  and  kept  there  till  able  to  re-mingle  with 
their  sane  fellows  in  the  world  once  more.  Hospital 
as  opposed  to  asylum  treatment  of  mental 
diseases,  especially  for  mild  and  curable  cases, 
will  be  a  great  advance,  and  hand  in  hand  with  it 
should  go  increased  facilities  for  the  study  of  mental 
diseases.  The  Asylums  Conunittee  of  the  London 
County  Council  are  certainly  waking  up  ;  it  may  be 
hoped  that  they  will  not  be  tempted  to  turn  over 
and  go  to  sleep  again. 


Bepetition  of  Prescriptions. 

We  have  at  various  times  commented  on  the 
danger  to  the  public  which  is  the  result  of  the 
undue  repetition  of  prescriptions.  To  cite  no 
other  example,  it  is  obvious  that  the  presenting 
time  after  time  of  an  old  prescription  may  make 
the  path  easy  for  the  victim  of  a  drug  habit, 
in  order  to  attempt  the  solution  of  a  problem 
which  not  only  by  medical  men  but  by  pharmacists 
is  recognised  to  be  urgent,  a  conference  has 
recently  been  held  between  representatives  of  the 
British  Medical  Association  and  of  the  Pharma- 
ceutical Society.  It  is  to  be  hoped  that  a  friendly 
discussion  of  this  sort  will  lead  to  some  settle- 
ment agreeable  both  to  the  physician  and  the 
dispenser.  In  the  meantime,  certain  suggestions 
are  to  be  sent  for  consideration  to  the  divisions 
of  the  British  Medical  Association,  which,  if 
adopted  by  a  large  body  of  the  profession,  and 
supported  by  dispensing  chemists,  will  go  far 
to  check  the  evil.  They  are  that  every  prescriber 
should  signify  in  his  prescription  the  maximum 
number  of  times  it  may  be  prescribed,  and  that 
he  should  also  sign  it  with  his  full  name  and 
address.  Any  real  solution  must  depend,  how- 
ever, on  the  hearty  co-operation  of  the  pharma- 
cists throughout  the  country  with  the  medical 
profession. 


Detention  of  Medical  Witnesses. 

There  are  few  medical  men  who  have  not,  time 
and  again,  been  dragged  into  court  to  give  evidence 
in  a  case  for  a  fee  of  a  few  shillings,  and  been  kept 
waiting  for  many  hours  during  which  their  ordinary 
work  was  urgently  demanding  their  presence.  It 
is,  of  course,  inevitable  that  medical  men,  as  part 
of  their  duty  to  the  State,  should  give  evidence  in 
criminal  cases,  but  they  have  a  right  to  expect  that 
the  State  in  return  will  consider  them  and  their 
patients  in  every  possible  way.  Such,  unfortu- 
nately, is  far  from  being  the  case.  The  object  of 
solicitors  is  to  have  their  case  ready  and  their 
witnesses  present  in  good  time,  and  the  language 
in  which  subpoenas  are  couched  makes  the  absence 
of  any  witness  so  serious  an  offence  that  it  is 
generally  unwise  to  risk  not  being  available  when 
a  case  is  called  unexpectedly.  But  the  want  of 
thought  in  this  matter  on  the  part  of  many  solicitors 
often  amounts  to  an  abuse  of ^their  powers,  andlve 


580    The  Medical  Pebss. 


NOTES  ON  CURRENT  TOPICS. 


Nov.  30,  1904. 


are  glad  to  see  that  Mr.  Justice  Grantham  warmly 
espoused  the  cause  of  professional  witnesses  at 
the  recent  sessions  at  the  Old  Bailey.  The  Judge 
said  that  he  had  received  many  complaints  from 
medical  men  about  the  way  they  were  summoned 
day  after  day  when  their  services  were  not  in  the 
least  likely  to  be  required,  and  he  was  bound  to 
admit  that  in  his  opinion  the  complaints  were  well 
justified.  Cases,  he  said,  were  put  into  the  lists 
when  there  was  no  chance  of  their  being  called, 
and  the  medical  men  engaged  were  kept  kicking 
their  heels  about  the  court  at  great  detriment  to 
themselves  and  their  profession.  He  impressed  on 
counsel  the  duty  of  keej!>ing  the  clerk  informed  of 
the  length  of  time  cases  were  likely  to  last,  and  on 
solicitors  of  finding  out  when  their  cases  would  be 
reached,  and  on  both  the  importance  of  obviating 
inconvenience  to  medical  men.  It  is  refreshing 
to  hear  of  a  judge  standing  up  for  the  much-tried 
doctors,  and  we  hope  his  words  will  be  taken  to 
heart  by  the  officials  of  other  courts  besides  that 
in  which  they  were  spoken. 

Bepeated  Bnpture  of  the  Utems. 

There  is  no  accident  occurring  in  child-birth 
which  is  regarded  as  more  serious  than  rupture 
of  the  uterus,  especially  when  it  is  complicated 
by  passage  of  the  child  into  the  peritoneal  cavity^ 
It  is  luckily  a  rare  occurrence,  and  does  not  happen 
if  the  patient  is  under  proper  observation.  When 
it  does  occur,  however,  prognosis  is  bad  for  both 
mother  and  child.  The  child  usually  dies  imme- 
diately, and  the  mother  is  likely  to  succumb 
to  the  effects  of  haemorrhage  and  shock,  or,  if 
she  rally  from  them,  to  general  peritoneal  infection, 
A  case  recently  reported,  therefore,  by  Patz, 
of  Vienna,  is  all  the  more  remarkable  in  that 
rupture  occurred  twice  in  the  same  woman, 
with  an  interval  of  five  years,  and  the  patient 
still  survives.  On  each  occasion  a  laparotomy 
was  performed  and  a  dead  child  extracted,  and 
the  uterine  woimd  repaired.  The  first  rupture 
took  place  in  the  anterior  wall  of  the  cervix  and 
vagina,  and  the  second  through  the  posterior 
wall,  the  old  scar  remaining  firm.  The  woman 
had  a  contracted  rickety  pelvis,  and  in  order 
to  prevent  her  increasing  her  already  remarkable 
record,  Patz  accompanied  his  second  operation 
by  a  hysterectomy. 


confess  their  sins,  and  weep  on  each  other's  neci* 
like  women.  Some  of  these  meetings  last  half  the 
night,  and  others  begin  at  three  in  the  mcxTmog. 
Everywhere  the  same  excitement  prevails,  and 
there  can  be  no  doubt  about  the  depth  of  the 
impression  produced  at  the  time.  The  interestin; 
point  is  that  Mr.  Roberts  himself  is  by  no  mcaxb 
a  good  speaker  ;  many  of  his  hearers  arc  knoft-Q 
locally  to  be  far  better  orators.  Moreover,  osuafly 
the  key-Rote  of  his  meetings  is  said  to  be  merrimcx, 
Mr.  Roberts  smiling  as  he  prays,  and  laughing  as  bf 
preaches.  But  he  has  a  vivid  idea  of  his  missiGa. 
and  believes  himself  inspired  by  a  Supceor 
Being  *'  which  put  its  hands  on  his  shoulders  and 
bent  him  double  till  the  blood  rushed  to  his  head  " 
The  imitative  influence  of  many  hjrsterical  aficc- 
tions  is  illustrated  in  this  particular  instance  by  tbr 
fact  that  at  one  meeting  he  fell  on  the  floor  whikt 
praying  and  continued  his  supplication  in  the 
prone  position.  One  after  another  his  audieoc? 
proceeded  likewise  to  fall  on  the  ground  and  begir. 
praying  aloud.  The  psychological  disposition  of  a 
crowd  is  an  interesting  study,  for  the  effect  of  sug- 
gestion is  much  more  easily  seen  in  a  mass  of  people 
together  than  in  a  single  individual,  and  the 
power  of  affecting  crowds  of  people  till  the\'  lose 
self-control  is  given  to  but  few  individuals.  Oae 
thing  certain  is  that  Mr.  Roberts'  campaign  canno: 
go  on  for  ever,  and  his  health  is  sure  to  be  under- 
mined by  these  long  drawn-out  periods  of  excite- 
ment and  abstinence  from  food,  whilst  there  arr 
worse  dangers  than  mere  bodily  fatigue  likely  to 
be  incurred  by  those  who  attend  revival  meetings 


BevivaJism, 

The  curious  wave  of  revivalism  that  is  now  pas- 
sing over  some  parts  of  South  "N^  ales  illustrates  the 
power  of  personality  in  a  remarkable  fashion, 
especially  when  that  personality  is  animated  by 
an  intense  and  conscious  prepossession.  A  Mr. 
Evans  Roberts,  a  young  working  collier,  is  con- 
ducting a  series  of  services  in  various  villages 
at  which  extraordinary  manifestations  of  en- 
thusiasm and  loss  of  self-control  are  witnessed. 
The  audiences  assemble  long  before  the  appointed 
time  of  meeting,  and  immediately  the  doors  open 
the  chapels  are  crammed  to  suffocation.  Hymns, 
prayers,  and  addresses  from  Mr.  Roberts  go  on  for 
hour  after  hour,  till  strong  men  fall  on  the  floor, 


History  of  Syphilis. 

Some  interesting  information  is  brought  together 
by   Dr.    Knott,   in   the    current    number  of  the 
Dublin  Journal  of  Medical  Science,  with  regard 
to  the  early  history  of  the  disease  and  the  word 
"  syphilis."     He  tells  us  that  the  word  was  fint 
used  in  1530  as  the  title  of  a  poem  by  Hieronimn 
Fracastorio,  a  native  of  Verona.    This  astonishing 
poem,  which  describes  what  was  then  thought  to 
be  a  new  disease,  fills  a  quarto  book  of  thirt}-si-\ 
leaves,  and  is  highly  praised  by  many  critics  from 
Scaliger  to  Dr.  Knott  himself.     The  latter  is  mfi 
a  believer  in  the  doctrine  that  syphilis  was  first 
introduced  to  Europe  by  the  sailors  of  Columbia, 
and  he  brings   much  evidence    to   show  that  it 
existed  long  before,  though  there   is  no  doubt, 
of  course,   that  its  great  prevalence  in  raodem 
society  dates  from  the  Siege  of  Naples  in  14.94 
From  its  devastation  of  the  French  army  at  that 
time  it  obtained  the  well-known  name  "  morbus 
gallicuSy"   though  the   French   themselves  called 
it   **  morbus  neapolitafius"       Indeed,  there  were 
many   national   names   given    to    it    in  diferent 
countries,     as,    for    instance,     "  Spanish    itch." 
"  German,"  '*  Polish,"  "  Turkish,"  disease,  whife 
the  Turks  responded  with  the  name  "  Christian 
disease."     Frorn    its    similarity    to    the   physical 
affliction  of  Job,  it  has  been  known  as  "  morbus 
sancH  J  obi,'*  and  certain  saints — ^St.  Mevius,  St. 
Roch,    and    St.    Lementius — ^have    also  had  the 
discredit  of  giving  it  a  name. 


Nov.  30,  1904. 


NOTES    ON    CURRENT    TOPICS. 


Occupation  Pains. 

It  is  noteworthy  that  many  symptoms  of 
disease  and  even  some  physical  signs  arc  causally 
associated  with  certain  occupations.  The  more 
or  less  continuous  assumption  of  a  particular 
attitude,  as  writing,  sewing,  or  digging,  or  the 
habitual  exercise  of  the  same  group  of  muscles, 
as  in  handling  certain  tools,  cannot  fail,  after  a 
time,  to  leave  its  mark  upon  the  body  and  some 
times  even  upon  the  bony  skeleton.  This  latter 
point  has  been  elaborated  by  Mr.  Arbuthnot  Lane^ 
who  has  found  that  considerable  changes  may 
and  do  occur  in  the  osseous  framework  of  the  body 
as  a  result  of  an  alteration  in  the  manner  in  which 
lines  of  force  are  transmitted  through  one  of  its 
segments.  These  changes  are  chiefly  of  anatomi- 
cal and  pathological  interest.  From  the  sub- 
jective point  of  view  pain  of  some  kind  or  other 
is  nearly  alwa^'S  a  prominent  feature  wherever 
there  is  unnatural  or  persistent  strain  to  be  borne. 
The  stooping  posture  at  work  is  one. of  the  com- 
monest deviations  from  the  normal,  and  whether 
the  patient  be  a  seamstress  or  a  coal-heaver,  a 
city  clerk  or  a  market-gardener,  each  and  all 
are  liable  to  suffer  from  a  twisted  chest  and  a 
crooked  back.  Among  resulting  ills  are  dyspepsia, 
a  tendency  to  bronchial  troubles  and  phthisis, 
backache,  scintica,  and  lumbago.  Different  occu- 
pations must  necessarily  give  rise  to  varied  sym- 
ptoms which  are  due  to  the  particular  kind  of 
work  undertaken.  The  expressions  "occupa- 
tion-neurosis "  and  "  occupation-dermatitis  "  aie 
in  common  use,  but  we  do  not  hear  so  much  about 
'* occupation-pain."  Dr.  James  J.  Walsh,  of  New 
York,  read  a  paper  upon  this  important  subject 
before  the  recent  meeting  of  the  State  Medical 
A.ssociation,  in  which  he  stated  that  many  of  the 
aches  and  pains  in  reality  caused  entirely  by  the 
individual's  work  were  erroneously  supposed  to 
be  due  to  chronic  rheumatism.  The  fact  remains, 
however,  that  the  majority  of  such  pains  are  de- 
cidedly aggravated  by  cold  and  damp. 


The  Medical  Press.    18  i 


^»'i> 


Hygiene  as  She  is  Wrote. 

Thk  desirability  of  including  teaching  in  the 
elements  of  hygiene  to  youngsters  in  elementary 
schools  has  been  considerably  to  the  fore  of  late, 
and  it  is  encouraging  to  know  that  in  some  schools 
instruction  is  already  being  given.  But  it  is  one 
thing  to  give  instruction  and  another  to  receive  it, 
and  the  examiner  is  likely  to  be  relieved  of  a  good 
deal  of  the  tedium  that  usually  attaches  to  his 
office  if  pupils  in  general  are  as  naif  as  those  whom 
Dr.  Newsholme  recently  had  the  pleasure  of  testing 
in  hygiene  and  first  aid.  One  boy  had  so  firmly 
grasped  the  principles  of  sanitation  that  he  was 
able  to  reply  to  a  question  that  "  the  best  way  to 
avoid  danger  from  impure  water  in  the  cistern — is 
to  have  water  from  the  main  sewer  in  the  road  in 
front."  Such  a  youth  ought  to  run  but  little  risk 
of  typhoid  fever  in  after  life.  The  treatment  of 
dog-bites  seems  to  have  taken  a  firm  hold  on  the 
pupils,  and  amusing  as  the  answers  are,  they  point 
to  instruction  of  a  somewhat  archaic  type  ha\'ing 
been  instilled  into  the  you;ng  brains.     "It  should 


be  burnt  out  with  a  cosmetic,"  wrote  one  hopeful 

a  procedure  a  good  deal  more  humane,  and  not 
much  less  appropriate  than  the  one  he  intended  to 
describe.  A  laconic  fellow  -  student  answered 
the  same  question  with  "  Red-hot  poker,"  without 
mention  of  extenuating  circumstances.  His 
teacher  must,  we  fear,  have  been  of  what  the 
homoeopaths  call  **  the  old  school  "  ;  at  any  rate 
one  would  be  inclined  to  give  both  tbacher  and 
pnpU  a  wide  berth  if  one  happened  to  have  been 
bitten  by  anything  but  a  very  rabid  dog.  But  the 
answer  at  once  most  humorous  and  least  open 
to  cavil  was  that  of  a  young  gallant,  mote  circum- 
spect than  altruistic,  who  suggested.  "  If  any  p^-^ 
son  is  found  handy  and  foolish  enough  to  stick  the 
bite,  let  it  be  done."  There  is  a  fine  air  of  detach- 
ment about  this,  which  makes  us  fear  that  the 
spiiit  of  the  Good  Samaritan  had  not  imbued  the 
little  author  with  the  nobility  of  his  calling. 

A  Parisian  on  American  Sur^r^ry. 
Dr.  Faure,  the  well-known  Paris  surgeon, 
has  recently  paid  a  visit  to  America,  and  0:1  his 
return  to  France  has  published  the  result  of  his 
observations.  He  was  particularly  astonished 
at  the  magnificence  of  some  of  the  operating- 
rooms  in  the  New  World,  and  he  mentions  the 
Mount  Sinai  Hospital,  New  York,  as  the  handr 
somest  he  has  seen.  Both  walls  and  ceiling  are 
formed  of  single  sheets  of  white  marble,  and  M. 
Faure  naturally  regards  such  opulence  rather  as  a 
mark  of  prodigality  than  as  justifiable  expenditure. 
The  number  of  assistants  and  nurses  present  at 
an  operation — ^three  or  four  of  each — is  in  contrast 
to  what  obtains  in  France,  where  the  surgeon  aims 
at  performing  his  work  with  the  aid  of  only  one 
assistant.  What  seized  M.  Faure's  admiration 
more  than  anything  else  was  the  excellent  and  in- 
telligent nursing  across  the  Atlantic.  The  Ameri- 
can nurse  is  usually  a  young  woman  of  good  educa- 
tion and  social  standing,  quite  different  from  the 
French  infirmiere,  and  tasks  are  entrusted  to  her 
which  in  Paris  are  the  duty  of  the  internes.  Ameri- 
can surgical  instruments  appeared  clumsy  and 
coarse  to  one  used  to  the  neatness  of  the  hand-made 
articles  in  use  in  France.  While  M.  Faure,  like 
another  observer,  thinks  that  there  are  som^ 
matters  they  order  better  in  France,  yet  he  is, 
on  the  whole,  an  appreciative  critic  of  American 
surgery. 


Carbonio  Oxide  Poisoningr* 

The  risks  run  by  factory  workers  in  lime  kilns, 
cement  works,  and  other  places  where  braziers' 
and  coke  fires  are  employed  in  confined  spaees 
from  the  inhalation  of  carbon  monoxide  are 
notorious.  Milder  degrees  of  poisoning  by  that 
gas,  however,  are  often  overlooked.  Insufficient 
ventilation  of  workrooms  and  defective .  gas- 
fittings,  for  instance,  whereby  small  quantities  of 
the  gas  are  continuously  and  imperceptibly 
inhaled  for  many  hours  daily,  induce  a '  condi- 
tion of  chronic  ansemia  which  in  its  turn  leads  on 
to  something  worse.  A  memorandum  upon  the 
use  of   water-gas  and  the  consequent  dangefr*  of 


582    Thk  Medical  Press. 


SPECIAL    CORRESPONDENCE. 


Nov.  30.  1904. 


poisoning  by  carbonic  oxide  has  been  issued  by  the 
Chief  Inspector  of  Factories.  In  the  annual  report 
of  the  Factory  Department  during  the  five  years 
r899  to  1903  fifty-one  cases  of  poisoning  by  water- 
gas  are  detailed.  Seventeen  of  these  were  directly 
due  to  carbonic  oxide,  while  thirty-four  were  due 
to  gases  of  a  similar  nature,  such  as  those  of 
Dowson  and  Mond,  employed  for  heating  furnaces, 
boilers,  aftd  for  other  industrial  processes.  Many 
different  causes  contributed  towards  the  casualties, 
such  as  ignorance  of  the  nature  of  the  gas,  cleaning 
of  flues  before  a  sufficient  time  had  been  allowed 
for  the  gas  to  escape,  lack  of  rescue  apphances,  and 
soon.  It  is  recommended  that  notices  of  warning 
he  posted  up  in  factories  and  workshops  where  any 
danger  of  this  nature  exists,  and  it  is  to  be  hoped 
that  the  instructions  contained  therein  will  be 
carefully  followed.  The  value  of  a  knowledge  by 
the  master  and  foremen  of  a  factory  of  the  princi- 
ples of  first  aid,  especially  of  the  methods  of  per- 
forming artificial  respiration,  should  certainly  be 
more  fully  recognised,  as  it  is  only  by  the  prompt 
application  of  remedial  measures  that  life  can  be 
saved.  The  stabiUty  of  the  combination  of 
carbonic  oxide  with  haemoglobin  is  weU  known  to 
chemical  physiologists,  and  this  being  the  case 
there  is  all  the  more  urgent  need  for  immediate 
and  energetic  treatment. 

PERSONAL. 


.  ThompsoD 
E.    Gcffdoi 


Dr.  C.  Theodore  Williams  will  preside  at  the  Sixth 
Annual  Dinner  of  the  Medical  Graduates*  College  and 
Polyclinic,  to  be  held  at  the  Trocadero  Restaurant, 
London,  on  December  7th.  Further  particulars  can 
be  obtained  of  the  Hon.  Sec.,  Mr.  A.  E.  Hayward 
Pinch,  F.R.C.S.,  22,  Chenies  Street,  W.C. 


Symington,  M.D.,  F.R.S..  Professor  '^'-  H. 
M.D.,  Dr.   A.  R.    Parsons,    and   Mr.    T. 

F.R.C.S. ^     ^ 

Dr.  Robert  Pugh,  assistant  medical  officer  at  tl» 
London  County  Asylum.  Claybury^^  has  been  appomttd 
medical  superintendent    to    the    "" 
Lunatic  Asvlum. 


Brecon   and   Radmi 


Professor  Arthur  Thomson,  M.B.,  who* holds  the 
chair  of  Human  Anatomy  in  the  University  of  Oxford, 
last  week  formally  took  his  seat  on  the  General  Medical 
Council  as  representative  of  this  University. 

At  the  same  meeting  of  the  General  Medical  Council 
Dr.  A.  G.  Barrs  was  introduced  as  the  member  repre- 
senting the  University  of  Leeds  for  three  years  from 
October  19th,  1904. 

Dr.  Arthur  G.  Boycott,  Fellow  of  Brasenose 
College,  Oxford,  Gordon  Lecturer  in  Experimental 
Pathology  at  Guy's  Hospital,  has  been  appointed 
Assistant  Bacteriologist  at  the  Lister  Institute  of 
Preventive  Medicine. 


Sir  James  Reckett  has  made  a  handsome  dona- 
tion of  £6,000  to  the  Hull  Royal  Infirmary  for  the  pur- 
pose of  ccMUpleting  the  extension  of  the  buildings  of 
that  Institution. 


The  Lady  Cheylesmore,  Mayoress  of  Westminster, 
has  kindly  consented  to  open  the  new  building  of  the 
Roysd  Ear  Hospital,  recently  erected  in  Dean  Street, 
Soho,  on  Monday,  December  12th,  at  3  p.m. 

Dr,  L.  V.  Dubois,  Government  and  Poor  law 
Medical  Officer  of  Pamplemousses,  Mauritius,  has  been 
appointed  Government  Medical  Officer,  Savanne.  Dr. 
L.  de  Boucherville  takes  the  place  of  Dr.  Dubois  at 
Pamplemousses.  

Professor  Francis  Dixon,  M.D..  delivered  an  ad- 
dress on  the  "  Distribution  of  the  Peripheral  Nerves '' 
at  the  opening  meeting  of  the  Dublin  University 
Bicdogical  Association  on  Thursday  last.  Amongst 
the   speakers   who   followed    him   were   Professor    J. 


Special  dotrespoii&cnce* 

[from  our  own  correspond bnt. J 

SCOTLAND. 
Report  on  Edinburgh  District  Asylcmat  Bax- 
GOUR.— Dr.  Frazer's  report  on  the  Asylum,  wtiidi  has 
but  recently  been  opened,  is  of  an  entirely  <&vooaUe 
character.  Since  June  ist,  182  patients  have  been  ad- 
mitted ;  their  condition  is  highly  satisfacto^^ 
there  has  been  no  employment  of  seclusion  or  re^jMt 
in  the  treatment  of  any  case.  The  employment  of  tk 
patients  is  exceptionally  well  attended  to,  66  per  ceiL 
being  engaged  in  useful  work,  mostly  on  the  fann^- 
den,  or  grounds,  showing  that  full  advantage  is  beaj 
taken  of  the  benefits  afforded  by  the  abundance  of  out- 
door labour  possiWe  on  the  Asylum  estate.  The  day  sbf 
is  in  the  proportion  of  one  to  nine,  and  the  nights^ 
of  one  to  thirty-six  patients.  The  permanent  tofld 
ings — administrative,  laundry,  and  supermtendeais 
house— are  well  advanced  in  progress.  The  capa^ 
of  the  reservoir,  which  is  nearly  completed.wiU  he  im«^ 
I3i  miUion  gaUons,  which  will  be  adequate  lor  ^ 
future  needs.  The  following  statement  shows  thr 
number  of  pauper  lunatics  in  the  Edinburgh  parish  n 
1894  and  1904  : —  _  ^ , 

Year.     Royal        Poor-      Other       Private  Totai 

Asylum,     house.     Asylums.    Houses. 
1894        346  79  ^  310  741 

1904        389  234  169  ^  294  i.oft 

The  percentage  in  private  dweUings  is  27-1.  wlucft  b 
much  higher  than  that  in  any  other  urban  parish  n 
Scotland.  _,, , 

Chalmer's  Hospital,  Edinburgh. — ^This  mstito 
tion  will  be  reopened  on  December  ist.  after  ha\TBg 
been  closed  for  several  months  whUe  undeigoa« 
structural  alterations  to  bring  it  up  to  the  requuemoife 
of  modem  surgery.  As  stated  in  this  column  sotm 
months  ago,  it  is  an  endowed  non-teachmg  hospitji. 
partiallv  free,  partially  for  paying  patients.  The 
charges' for  the  latter  are  very  moderate,  and  this  ptft 
of  the  hospital  has  alwavs  been  fully  occupied.  Th* 
chief  alterations  made  during  the  summer  COTSist  m 
the  removal  of  the  out-patient  department  from  the 
main  building  to  a  structure  formerly  used  as  a  laundrj 
which  has  now  been  reconstructed  so  as  to  include  a 
waiting-room,  consulting-room,  small  theatre,  ophthal- 
mic room,  and  surgical  storeroom.  The  south  wia^ 
of  the  main  building,  set  free  by  the  removal  of  the  oai 
patient  department,  has  been  transformed  mto  an 
operating  theatre  with  adjoining  sterilismg  and  aii»- 
thetic  rooms.  The  theatre  is  floored  with  marttf 
terazzo,  and  a  special  feature  has  been  made  of  smi- 
pUcity  of  fittings.  The  autoclave  for  sterUismg  di«. 
ings  is  of  the  latest  type,  suppUed  by  the  Kny  Schaw 
Surgical  Company,  New  York.  The  old  operate 
theatre  at  the  top  of  the  building  has  been  cOTverted 
into  general  accommodation  for  the  staff.  The  directors 
have  appointed  Mr.  C.  Balfour  Paul  assistant-suig«» 
to  the  Institution.  ^  ,      *     , 

Ether-drinking  in  Glasgow.— In  reply  to  a 
petition  of  the  Glasgow  Corporation  that  ether^ouW 
be  included,  by  an  Order  of  Council.among  the  schedakd 
poisons,  the  Lord  President  of  the  Council  ha^replied 
that,  after  consulting  with  experts  and  the  Phanaa- 
ceutical  Society,  he  is  of  opinion  that  there  »  no  ««; 
quate  pubUc  reason  for  restrictmg  the  s^  of  ethff  m 
Great  Britain.  He  points  out  that  e^her  is  nola 
poison  in  the  ordinary  sense  of  the  word.  Mid  if  it  ww 
to  be  scheduled  because  it  is  an  intoxicant  there^DO 
logical  reason  why  alcohol  should  escape  sunilar  mat- 
ment.    The  law  at  present  prohibits  the  sale,  nndera 


IJov.  30,  1904. 


SPECIAL  REPORTS. 


Tm  Medical  Ph»S8.    5^3 


penalty  of  ;(ioo,  of  any  derivative  of  methylated  spirit 
sts  a  beverage,  and  if  any  person  were  caught  retailing 
etlier'for  purpo^s  of  consumption  as  a  beverage  there 
^►vould  be  no  difficulty  in  proving  that  the  ether  was 
ixxafle  from  methylated  spirit. 

Glasgow  Western  Infirmary. — The  thirteenth 
stnnnal  meeting  of  contributors  was  held  on  the  24th 
inst..  when  the  report  was  read.  22,000  outdoor  and 
€►,  132  indoor  patients  were  treated  during  the  year,  and 
Q.4,CKX>  visits  made.  The  maximum  number  of  occu- 
I>ied  beds  was  475,  the  minimum  376.  The  average 
cluration  of  treatment  was  26  days,  and  the  inclusive 
death-rate  just  under  8  per  cent. 

Spectal  l^eportd. 

THE  GENERAl'mEDICAL  COUNCIL. 

The  80th  Session  of  the  General  Medical  Council  was 
opened  on  the  22nd  inst.,  Sir  William  Turner. 
K.C.B.,  F.R.S.,  the  President,  in  the  Chair. 

After  the  introduction  by  Dr.  MacAUster  of  Mr. 
A^rthur  Thomson,  M.A.,  Professor  of  Anatomy  in  the 
I'niversity  of  Oxford,  and  by  Mr.  Young  of  Professor 
Alfred  George  Barrs,  M.D.,  as  new  members  of  the 
Council, 

Presidential  Address  :    the  President's 
rssk^nation. 

The  President,  in  his  opening  address,  after  referring 
to  some  recent  changes  in  the  personnel  of  the  Council, 
passed  on  to  the  business  immediately  before  them. 
He  said  that  he  had  communicated  to  the  Clerk  of  the 
Privy  Council  the  resolution  passed  in  May  last  re- 
questing the  Lord  President  to  introduce  into  Parlia- 
ment a  Bill  to  confer  upon  the  General  Medical  Council 
statutory  powers  to  establish  and  maintain  registers 
of  medicaf  and  dental  students,  and  to  impose  a  fee 
not  exceeding  £1  for  registration.  Mr.  Almeric  FitzRoy. 
in  a  letter  dated  November  ist,  informed  him  that 
communications  on  the  subject  had  been  received  from 
the  Presidents  of  the  Royal  Colleges  of  Physicians  and 
Surgeons  in  London,  and  he  suggested  that  in  the  cir- 
cumstances it  might  be  expedient  for  the  Medical 
Council  to  confer  with  the  Colleges  with  a  view  to  the 
preparation  of  a  scheme  providing  for  their  co-opera- 
tion towards  the  desired  end,  on  a  basis  that  would, 
in  some  form  or  other,  recognise  existing  rights.  This 
matter  should  be  considered  during  the  present  session. 
Copies  of  the  judgments  in  the  cases  of  "  O'DufFy  v. 
Jafte  "  and  "  The  King  (Rowell)  v.  Registrar  of  Joint 
Stock  Companies,"  together  with  the  resolutions  of 
the  General  Medical  Q>uncil  in  the  cases,  had  been 
forwarded  to  the  Lord  President,  who  had  informed  the 
Council,  in  reply,  that  his  (the  President's)  letter  was 
referred  by  him  to  the  Board  of  Trade  for  considera- 
tion, and  he  communicated  the  opinions  on  the  points 
raised  which  the  Board  had  received  from  its  legal 
advisers.  After  stating  that  the  Council's  corporate 
seal  possessed  on  one  side  of  its  central  figure  the 
device  of  a  mace,  and  that  that  emblem  of  ceremonial 
dignity  and  authority  had  up  to  this  time  been  no  more 
than  a  device  on  paper,  he  asked  the  Council's  accept- 
ance of  a  mace  which  in  its  design  expressed  their 
identification  with  the  great  profession  of  medicine 
and  their  place  as  the  administrative  body  represen- 
tative of  the  three  divisions  of  the  United  Kingdom. 
In  conclusion,  he  announced  that,  although  re-elected 
President  of  the  Council  for  a  further  period  of  five 
years  from  December  3rd,  1901,  provided  he  remained 
a  member  of  the  Council,  and  although  his  appointment 
as  representative  of  the  University  of  Edinburgh  did 
not  expire  until  December,  1906,  he  had  formed  the 
opinion,  after  giving  the  subject  mature  consideration, 
that  the  time  had  come  when  it  was  advisable  that  he 
should  retire  from  the  Presidentship  of  the  Council. 
His  duties  in  Edinburgh  as  Principal  of  the  University 
were  of  an  onerous  and  absorbing  nature,  and  had  the 
first  call  on  his  time  and  energy.  Through  their  favour 
and  confidence,  for  which  he  could  not  too  strongly 
express  his  grateful  acknowledgment,  he  had  occupied 
the  chair  during  six  years.     But  the  business  of  the 


Council  was  ever  on  the  increase,  and  with  advancing 
age  he  felt  he  should  not  be  able  to  continue  to  dis- 
charge efficiently  the  duties  of  the  responsible  office  to 
the  satisfaction  either  of  himself  or  his  colleagues.  He 
had  to  request  the  Council,  therefore,  to  arrange  for 
the  appointment  of  his  successor  before  the  end  of  the 
present  session. 

The  thanks  of  the  Council  were  voted  to  the  President 
for  his  address  on  the  motion  of  Dr.  M\cAlister,  and 
for  the  magnificent  present  of  the  mace  by  Dr.  Pve- 

SvflTH. 

Army  and  Navy  Examination  Returns. 

Sir  Patrick  Heron  Watson  moved  that  the  follow- 
ing yearly  tables  for  1904  be  received  :  Table  showing 
results  of  competition  held  on  May  i6th,  1904,  for 
commissions  in  the  medical  staff  of  the  Royal  Navy  ; 
and  table  showing  results  of  competition  held  in  July, 
1904,  for  commissions  in  the  Army  Medical  Service. 

Dr.  McVail  seconded  the  motion,  which  was  agreed 
to ;  and  the  thanks  of  the  Council  were  voted  to  the 
Director-General  of  the  Medical  Department  of  the 
Royal  Navy  and  the  Director-General  of  the  Army 
Medical  Service,  respectively,  for  the  returns  which 
they  had  again  furnished. 

Medical  and  Dental  Companies. 

The  Council  received  and  entered  on  the  minutes  a 
report  from  the  Executive  Committee  on  the  dental 
business  transacted  since  last  session.  It  was  stated 
in  the  report  that  an  application  from  the  Dental 
Board  of  Victoria  for  the  recognition  of  its  diploma  had 
been  received  and  referred  to  the  Dental  Education 
and  Examination  Committee  for  consideration  and 
report  during  the  present  session.  The  answer  of  the 
Privy  Council  to  the  President's  letter,  transmitting 
the  Council's  resolution  respecting  companies  for  the 
practice  of  dentistry,  and  also  a  Parliamentary  return, 
which  had  been  obtained  by  Sir  John  Tuke,  in  regard 
to  similar  medical  and  dental  companies,  had  been 
remitted  to  the  Medical  Companies  Bill  Committee 
for  consideration  and  report  to  the  Council  during  the 
present  session. 

Medical  "  Pupils  "  as  Assistants. 

Mr.  Jackson  asked  the  President  whether  the 
Council  had  indicated  what  meaning  was  to  be  attached 
to  the  phrase  *'  the  proper  training  and  instruction  of 
hond'fide  medical  students  as  pupils,"  occurring  in  the 
notice  regarding  the  employment  of  unqualified  per- 
sons as  assistants  or  otherwise,  issued  on  November 
24th.  1 897.  He  said  it  had  come  to  his  knowledge  that, 
in  certain  districts — in  the  North  of  England  more 
especially — there  were  cases  of  men  who  acted  as 
qualified  assistants  posing  as  pupils ;  that  was  to  say, 
that  if  any  objection  were  taken  to  them  the  reply 
was  that  they  were  pupils.  That  had  been  going  on 
for  a  considerable  time.  In  one  instance  it  appeared 
that  a  man  employed  in  a  colliery  district  had  been  an 
unqualified  assistant  under  the  guise  of  a  pupil  for  the 
last  thirty-five  years. 

The  President,  in  reply,  read  the  resolution  of  the 
Council  embodying  the  phrase  in  question,  and  said 
that  in  a  case  of  alleged  covering  it  would  rest  with  the 
person  accused  to  prove  that  the  assistant  employed 
was,  in  fact,  a  bond-fide  medical  student  undergoing 
training  and  instruction  in  connection  with  his  fifth 
year  of  medical  study. 

The  Council  afterwards  considered  matters  in  camerd, 
and  at  its  rising  adjourned  for  the  day. 


WEDNESDAY.  November  23RD. 

Much  of  this  day's  sitting  was  devoted  to  the  con- 
sideration of  penal  and  disciplinary  cases. 

The  Case  of  Mr.  C.  J.  Nally. 

The  first  case  taken  was  that  of  Christopher  Joseph 
Nally.  registered  as  of  9  Hardy  Terrace,  Crook,  county 
Durham.  L.R.C.P.  &  S.I.,  who  had  been  summoned  to 
appear  before  the  Council  in  consequence  of  his  con- 
viction at  Durham  Assizes  on  July  13th  last  on  an 
indictment  for  unlawfully  wounding  his  son.  aged 
17  months.  The  accused  practitioner,  who  was  sen- 
tenced  to  six   months'   imprisonment  in   the  second 


584      "^BE  MbDICAL  PlBSS. 


SPECIAL   REPORTS. 


Nov.  3a  I9H. 


division,  attended  in  the  charge  of  warders.  A  petition 
largely  signed  by  residents  in  the  district  in  Dr.  Nally's 
favour  was  also  put  in.  The  Council  deliberated  in 
private,  and  when  the  press  were  readmitted,  the 
accused  practitioner  was  informed  that  the  Council  had 
decided  not  to  erase  his  name  from  the  Medical  Register. 
The  Case  of  Mr.  H.  S.  Revell. 

In  the  second  case,  Hugh  Stanley  Revell,  registered 
as  of  the  Briars,  West  Hill  Road,  Southfields,  London, 
S.W..  M.R.C.S.Eng.  and  L.R.C.P.Lond.,  had  been 
summoned  to  appear  before  the  Council  in  consequence 
of  his  conviction  at  the  Central  Criminal  Court  on 
June  20th  last  on  an  indictment  for  obtaining  money  by 
false  pretences  from  the  guardians  of  the  Wandsworth 
and  Clapham  Union.  Mr.  Revell,  upon  whom  the 
Recorder  passed  a  sentence  which  resulted  in  his 
release  the  same  day,  appeared  in  person  and  made  a 
statement,  in  which  he  said  his  defence  to  the  charges 
would  have  been  that  whatever  had  happened  was 
through  inadvertence  and  stress  of  work  at  a  time 
when  he  was  in  a  most  anxious  state  of  mind  owing  to 
the  illness  of  his  wife.  The  Council  deliberated  in 
private,  and  when  the  public  were  readmitted,  the 
president  informed  the  accused  practitioner  that  the 
Registrar  had  been  directed  to  erase  his  name  from  the 
Medical  Register, 

Proposed  Registration  Scheme. 

The  remainder  of  the  sitting  was  mainly  occupied 
with  the  discussion  of  a  letter  from  the  Privy  Council 
in  reply  to  the  proposal  of  the  General  Medical  Council 
for  the  establishment  of  a  register  of  medical  students 
and  the  imposition  of  a  registration  fee  not  exceeding 
£1.  Communications  on  the  subject  had  been  received 
from  the  Presidents  of  the  Royal  Colleges  of  Physicians 
and  Surgeons,  and  it  was  suggested  that,  in  the  drcum^ 
stances,  it  might  be  expedient  for  the  Medical  Council 
to  confer  with  the  Colleges  with  a  view  to  the  prepara- 
tion of  a  scheme  providing  for  their  co-operation  to- 
wards the  desired  end  on  a  basis  that  would,  in  some 
form  or  other,  recognise  existing  rights.  Sir  William 
Church  stated  in  his  letter  that,  from  its  incorporation  to 
the  present  time,  under  the  authority  of  its  charter  and 
statutes  the  Royal  College  of  Physicians  of  London 
had  determined  the  conditions  of  admission  to  its  pro- 
fessional qualifications,  and  it  claimed  to  have  faith- 
fully exercised  the  powers  entrusted  to  it  for  the  public 
good.  It  appeared  to  the  College  that  the  effect  of  the 
proposed  measure,  so  far  as  it  had  been  made  known, 
would  be  to  transfer  to  the  Medical  Council  an  im- 
portant part  of  this  power  which  had  hitherto  been 
safeguarded  in  the  Medical  Acts,  and  that  it  would 
similarly  infringe  the  authority  of  the  Royal  College 
of  Surgeons  of  England  and  of  the  Universities  m 
granting  degrees  in  medicine.  It  w^ould,  moreover, 
impose  an  additional  pecuniary  charge  on  persons  enter- 
ing the  profession,  which  was  believed  to  be  undesir- 
able and  unnecessary.  The  President  of  the  Royal 
College  of  Surgeons  stated  that  the  passing  of  such  a 
Bill,  without  the  introduction  of  restrictions,  would 
probably  enable  the  General  Medical  Council  to  lay 
down  conditions  of  registration,  and  thus  might 
transfer  to  that  body  the  right,  which  that  College  had 
exercised  for  more  than  a  century,  of  selecting  the 
institutions  at  which  the  curriculum  of  professional 
study  might  be  commenced  by  candidates  for  its  di- 
plomas. The  council  of  the  College  were  by  no  means 
disposed  to  relinquish  that  right.  Both  Colleges  asked 
to  be  allowed  an  opportunity  of  expressing  their  views 
on  the  subject,  as  did  also  the  council  of  the  University 
of  Oxford. 

Sir  Christopher  Nixon  said  it  would  be  of  no  use 
having  a  conference  with  the  two  Royal  Colleges  unless 
they  could  elicit  at  the  same  time  the  feelings  of  the 
other  Royal  Colleges  as  to  the  Bill. 

The  same  opinion  was  expressed  by  several  other 
members.  Sir  Robert  Ball  and  Sir  John  Moore  stat- 
ing that,  in  their  opinion,  the  Bill  would  be  opposed 
by  the  Royal  Colleges  in  Ireland. 

Sir  John  Moore  moved,  and  Dr.  Norman  Moore 
seconded,  a  resoluticm  to  the  effect  that  a  copy  of  the 
Council's  resolution  on  the  subject  be  sent  to  every 


icensing  body  in  the  United  Kingdom  with  a  reqiest 
that  they  would  favour  the  Council  with  their  apiBiu 
thereon. 

Dr.  Mack  AY  moved,  and  Sir  John  Tuke.  MJ>.. 
seconded,  an  amendment  to  the  effect  that,  insteadof 
going  into  conference  with  the  licensing  bodies,  a  dE> 
tailed  statement  be  prepared  of  the  proposals  of  the 
Council  with  regard  to  the  establishmeiit  of  a  students' 
register  and  the  institution  of  a  registration  iee. 

Sir  Victor  Horsley  said  that  if  anything  weie  to  be 
gained  by  a  conference  at  all  it  must  be  l^  a  farths 
statement  on  the  part  of  the  Council  as  to  what  ib 
position  was  in  regard  to  medical  education,  becai» 
that,  apparently,  was  wholly  misunderstood  by  maov 
of  the  licensing  bodies.  The  Privy  Council's  proposi: 
was  made  in  similar  ignorance.  The  Medical  Coood! 
itself  was  the  Conference,  and  that  fact  did  not  seea 
to  appeal  to  the  Privy  Council  in  the  least,  because  it 
had  all  along  proceeded  on  the  lines  that  the  liceosni 
bodies  were  entitled  to  as  much  consideration  as  the 
Council.  He  held  that  that  was  fatal  to  the  prospecu 
of  medical  education.  It  was  time  that  they  made 
their  position  clear  to  the  Privy  Council. 

The  debate  had  not  concluded  when  the  ConncI 
adjourned. 


THURSDAY,  November  24TH.    IQ04. 
Sir  William  Turner,  president,  in  the  Chair. 

Absent.  Mr.  Morris,  Sir  Charles  Ball,  Mr.  Tichbonie 

The'minutes  of  the  last  meeting  were  read,  amended, 
and  confirmed. 

Moved  by  Dr.  MacAlister,  seconded  by  Dr.  Lindsay 
Steven,  and  agreed  to  :  That  pursuant  to  a  cdoqb- 
mendation  of  the  Executive  Committee.  Sir  Cfaaiies 
Ban  be  added  to  the  Medical  Companies  Bill  Commitfeee. 

The  Council  then  proceeded  to  the  cpnsuiefaliaD  of 
the  case  of  Herbert  Du  Cane,  registered  as  of  56  BdttoB 
Road,  Darwen,  Lanes.,  Lie.  Soc.  Apotn.  London.  1890 
who  had  been  summoned  to  appear  before  the  Cooadl 
to  answer  the  followinf(  charge,  as  formulated  by  the 
Council's  solicitor  :  "  That  you  abused  your  position  as 
a  medical  man  by  committing  adultery  with  a  patient 
namely,  Mrs.  Taylor,  a  married  woman  whom  you  had 
been  and  were  attending  professionally."  f  I 

Mr.  J.  Rothwell  Haslam,  solicitor,  attended  on 
behalf  of  the  Darwen  Medical  Society,  the  compSatn- 
ants  ;   and  also  represented  the  husband.  Mr.  Taylor. 

Mr.  Ellis  J.  Griffith,  instructed  by  Messrs.  Edwards 
and  Cohen,  solicitors,  attended  to  represent  Mr.  Dn 
Cane. 

After  Mr.  Winterbotham,  the  Council's  solicitor,  bad 
read  the  notice  to  attend,  Mr.  Griffith  applied  for  the 
adjournment  of  the  hearini^  on  the  grounds  that  the 
notice  was  not  served  on  Mr.  Du  Cane  tUl  November  7th. 
he  being  in  Australia,  therefore  he  had  not  had  time 
to  prepare  his  defence.  Mr.  Haslam  did  not  oppose 
the  application  and  left  the  matter  in  the  Council's 
hands.  The  Council  deliberated  in  catnerd.  and  00 
strangers  being  readmitted,  the  president  announced 
that  the  application  for  postponement  was  acceded 
to,  the  case  being  adjourned  to  the  May  meeting,  bnt 
that  the  documents  of  Mr.  Du  Cane's  defence  must  be 
given  to  the  Council's  solicitor  as  soon  as  possible. 
Mr.  Griffith  undertook  that  this  decision  should  be 
communicated  to  Mr.  Du  Cane. 

The  Council  next  resumed  the  case  adjourned  from 
May  26th.  1904,  of  Richard  Henry  Darwent,  registered 
as  of  Rokeby  Newington,  Hull,  Yorks.  with  the  triple 
qualification  of  Scotland,  1 8Q3,  who  had  been  summooied 
to  appear  before  the  Council  in  answer  to  the  following 
charge,  as  formulated  by  the  Council's  solicitor :  "  TTut 
you  abused  your  position  as  a  medical  man  by  com- 
mitting adultery  with  a  patient,  namely,  Mrs.  Spink,  a 
married  woman  whom  you  had  been  and  wereatteodiofT 
professionally,  of  which  adultery  you  were  found  guilty 
by  the  Decree  of  the  Probate.  Divorce,  and  Admiralty 
Division  (Divorce)  of  the  High  Court  of  Justice,  made 
on  October  2Qth,  1902,  in  the  case  of  Spink  v,  Spialf. 
Benson  and  Darwent,  in  which  you  were  one  of  the 
co-respondents." 

Mr.  Darwent  attended,  accompanied  by  his  solicit©". 


Nov.  30,  1904. 


SPECIAL  REPORTS. 


Tax  Medical  Pkxss.   5^5 


Mr.  F.  W.  Hill.  Mr.  M.  P.  Oldfield.  solicitor,  appeared 
on  behalf  of  Mrs.  Spink,  the  complainant,  who  was  not 
present. 

After  the  president  had  announced  that  the  members 
of  the  Council  who  were  not  present  at  the  previous 
hearing  of  the  case  should  take  no  part  in  the  delibera- 
tions, the  proceedings  at  the  previous  consideration  of 
the  case  were  read. 

Mr.  Hill  made  a  statement  in  regard  to  the  reason 
why  no  steps  had  been  taken  to  procure  the  prohibition 
of  the  case,  for  which  purpose  Mr.  Muir  (who  had 
appeared  for  Mr.  Darwent  in  May)  had  obtained  the 
postponement.  This  was  due  to  the  expense  of  the 
proceedings.  He  then  read  a  letter  from  Mr.  Muir 
stating  that  he  (Mr.  Muir),  being  detained  at  the 
Central  Criminal  Court,  would  be  unable  at  this  time 
to  resume  the  defence  of  his  client,  and  asking  for  a 
postponement  to  a  time  when  he  would  be  able  to 
attend.  After  Mr.  Hill  had  asked  formally  for  such 
a  postponement,  the  Council,  after  having  deliberated 
in  canterd,  did  not  accede  to  this  application.  Mr. 
M.  P.  Oldfield.  at  a  request  from  the  Chair,  read  the 
confession  of  Mr.  Darwent,  which  had  been  put  in  at 
the  trial.  Mr.  Hill  then  addressed  the  Council  on  behalf 
of  Mr.  Darwent.  ending  with  an  appeal  for  justice  to 
be  tempered  with  mercy.  After  the  Council  had 
deliberated  in  earner d,  the  President,  on  strangers 
being  readmitted,  announced  the  finding  of  the 
Council  as  follows :  .*'  Mr.  Darwent,  the  Council  has 
adjudged  you  guilty  of  infamous  conduct  in  a  pro- 
fessional respect,  and  has  directed  the  Registrar  to 
erase  your  name  from  the  Medical  Register.** 

At  the  request  of  Sir  Victor  Horsley,  and  with 
the  consent  of  the  Council,  communications  (remitted 
to  the  General  Council  by  the  Executive  Committee) 
from  the  Medico- Political  Committee  of  the  British 
Medical  Association  respecting  a  letter  from  the  Educa- 
tion Committee  of  the  Borough  of  Bootle  in  regard  to 
the  giving  of  a  medical  certificate  by  a  local  chemist 
and  drug;$ist  named  Procter  Williams,  in  the  case  of  a 
girl  unable  to  attend  school,  were  considered  while  the 
legal  advisers  of  the  Council  were  present. 

The  Executive  Committee  on  May  24th,  1904,  re- 
solved :  That  the  attention  of  the  Medico-Political 
Committee  of  the  British  Medical  Association  be  called 
to  Section  37  of  the  Medical  Act,  1858  ;  that  they  be 
informed  that  on  the  face  of  it  the  certificate  forwarded 
to  the  Council  appears  to  be  invalid  under  that  Section. 
and  that  the  Council  has  no  jurisdiction  over  chemists 
who  give  invalid  certificates.  A  further  letter,  how- 
ever, had  been  received  by  the  Council  from  the 
Medico-Political  Committee  of  the  British  Medical 
Association  to  the  effect  that  it  was  well  aware  that  the 
certificate  was  invalid  under  Section  37  of  the  Medical 
Act,  185!^,  but  that  the  mere  statement  of  this  fact  does 
not  appear  to  the  M.-P.  Committee  to  constitute  a 
sufi^cient  recognition  of  the  duties  to  the  public  as 
well  as  to  the  medical  profession  entrusted  to  the 
Medical  Council ;  also  that  the  issue  of  such  a  certificate 
by  a  person  not  registered  as  a  medical  practitioner  is 
an  infringement  of  those  privileges  of  registered  medical 
practitioners  which  Parliament  by  the  Medical  Acts 
created  for  the  protection  of  the  public,  and  that  it  is 
a  fraud  upon  the  public  of  a  kind  which  the  Council 
may  reasonably  be  expected  to  use  every  effort  to  have 
punished  and  thereby  prevent  its  repetition,  and  that 
the  reply  of  the  Executive  Committee  appears  to  the 
M.-P.  Committee  of  the  B.M.A.  to  indicate  a  failure 
to  appreciate  the  true  position  of  the  question  submitted 
for  the  consideration  of  the  B.M.C. 

Sir  Victor  Horslev  said  that  his  object  was  to 
obtain  the  opinion  of  the  legal  advisers  of  the  Council 
as  to  what  could  be  done  in  this  matter.  After  some 
remarks  by  Drs.  Bruce,  MacAlister,  Windle,  Finlay, 
Lindsay  Steven.  Caton,  and  Pye-Smith,  Sir  John 
Moore,  and  Mr.  Jackson,  chiefly  in  defence  of  the  answer 
sent  by  the  Executive  Committee,  Mr.  Muir  Mackenzie 
expressed  a  desire  that  he  might  be  permitted  to 
submit  his  opinion  in  writing  on  .the  following  day. 

The  Council  resumed  the  consideration,  adjourned 
from  November  23rd,  on  the  motion  of   Sir  Willlam 


Thomson,  of  the  following  motion  by  Sir  John  Moore* 
seconded  by  Dr.  Norman  Moore  :  "  That  a  copy  of 
the  resolution  of  May  30th,  1904,  be  sent  formally  to 
every  licensing  body  in  the  United  Kingdom  with  a 
request  that  every  such  body  should  favour  this  Council 
with  their  views  on  the  subject,  and  that  the  Lord 
President  of  the  Privy  Council  should  be  informed  that 
this  Council  has  placed  itself  in  communication  with 
all  the  licensing  bodies  on  the  subject  of  a  proposed 
Medical  Bill,  and  will  in  due  course  inform  the  Lord 
President  of  the  result."  together  with  the  following 
amendment,  moved  by  Dr.  Mackay,  seconded  by  Sir 
John  Batty  Tuke,  which,  subject  to  the  permission 
of  the  Council,  has  been  alter^  to  read  as  follows : 
"  (i)  That  the  Lord  President  of  the  Privy  Council  be 
informed  that,  in  the  opinion  of  the  Medical  Council,  it 
would  not  be  expedient  at  the  present  stage  to  confer 
with  the  Royal  Colleges  on  the  subject  of  the  resolu- 
tion of  May  30th,  1904 ;  (2)  that  before  proceeding 
further  in  the  matter,  a  memorandum  be  prepared, 
setting  forth  the  grounds  on  which  the  Council  is  acting 
in  reference  to  the  resolution,  and  giving  the  specific 
proposals  which  the  Council  thinks  should  be  embodied 
in  the  contemplated  Bill."  After  a  discussion,  in 
which  Sir  Wm.  Thomson,  Mr.  Brown.  Mr.  Jackson. 
Dr.  Little,  Mr.  Thomson,  Dr.  McVail,  Dr.  MacAlister. 
Dr.  Mackay,  and  Mr.  Tomes  took  part,  the  amendment 
was  put  and  carried  by  17  to  5  ;  8  did  not  vote,  3 
absent. 

On  the  amendment  being  put  as  a  substantive 
motion,  the  following  further  amendment  was  moved 
by  Sir  Christopher  Nixon,  and  seconded  by  Dr. 
Bruce  : 

*'  That  a  reply  be  sent  to  the  Privy  Council  stating 
that  this  Council  now  see  great  difficulties  from  oppo- 
sition by  certain  licensing  bodies  in  asking  the  Lord 
President  to  introduce  a  Bill  giving  the  General  Medical 
Council  statutory  power  to  establish  and  maintain 
registers  of  medical  and  dental  students,  a^d  to 
impose  a  fee  of  £1  for  registration  therein.  The 
General  Medical  Council  will  be  prepared  at  the  proper 
time  to  offer  an  alternative  proposition,  which  it  hopes 
may  be  approved  by  the  Lord  President." 

A  discussion  followed,  in  which  Sir  Victor  Horsley 
protested  against  the  idea  Contained  in  Sir  C.  Nixon's 
speech  of  taxing  medical  practitioners.  Dr.  Norman 
Moore  went  against  the  Council  trying  to  extend  its 
power.  Mr.  Brown  said  a  few  words  on  registration 
of  students.  Sir  Batty  Tuke  deplored  Dr.  Norman 
Moore's  remarks  in  decrying  the  influence  of  the 
Council,  as  it  possesses  the  confidence  of  the  public 
and  of  the  profession.  Drs.  Mackay  and  McVail  and 
Sir  J.  Moore  made  some  remarks,  and  on  the  amend- 
ment being  put  it  was  carried  15  to  lO;  4  did  not  vote, 
4  absent.  The  amendment  was  then  put  as  a  sub- 
stantive motion  and  carried  14  to  10;  5  did  not  vote, 
4  absent. 

Dr.  Lindsay  Steven  then  moved,  seconded  by  Dr. 
McCall  Anderson  :  "  That  it  be  remitted  to  the 
Education  Committee  to  consider  and  report  to  the 
next  session  of  the  Council  whether  the  adoption  by 
the  Council  of  one  or  other  or  both  of  the  following 
resolutions  would  not  help  to  secure  the  attainment  of 
the  object  the  Council  had  in  view  in  instituting  the 
five  years'  curriculum,  viz.  :  (i)  That  the  preliminary 
scientific  examination  in  physics,  biology,  and  chemis- 
try should  be  passed  before  the  student  begins  the 
qualifying  study  of  anatomy  and  physiology.  (2)  That 
before  being  admitted  to  the  final  examination  the 
student  should  produce  evidence  that  he  has  devote<l 
the  last  year  of  his  curriculum  exclusively  to  practical 
and  clinical  work  and  study." 

Moved  by  Dr.  Norman  Moore,  seconded  by  Dr. 
McCall  Anderson,  and  agreed  to  :  "  That  Clause  i 
of  Chapter  IV.  of  the  Standing  Orders  be  suspended 
until  Dr.  Lindsay  Steven  has  finished  his  speech  in 
support  of  the  motion. 

The  Council  then  adjourned. 

-    FRIDAY.  November  25TH,  1904. 

Absent,  Mr.  Morris,  Mr.  Power,  Mr.  Tichbome. 

After  the  minutes  of  the  last  meeting  had  been  read, 


586    The  Medicajl  Press; 


SPECIAL  REPORTS. 


Nov.  30.  1904. 


the  President  informed  the  Council  that  the  Registrar 
had  that  morning  received  a  letter  from  the  Pharma- 
ceutical Society  of  Great  Britain  in  regard  to  an  item 
in  the  minutes  of  the  day  before,  The  letter  was  read. 
It  was  to  the  effect  that  the  person,  Mr.  Procter 
Williams,  who  had  given  a  medical  certificate  at 
Bootle  was  not  on  the  official  Register  of  chemists  and 
druggists.  The  Registrar  was  directed  to  append  the 
letter  to  the  Minutes,  which  were  then  confirmed. 

The  Council  proceeded  to  the  consideration  of  the 
following  memorandum  prepared  by  Mr.  Muir  Mac- 
kenzie at  the  request  of  the  Executive  Committee  in 
regard  to  the  question  of  embodying  in  the  Standing 
Orders  a  certain  rule  of  procedure  laid  down  by  the 
Penal  Cases  Committee  for  its  guidance. 
Memorandum. 

As  regards  the  form  and  contents  of  statutory 
declarations,  the  following  proposed  new  Standing 
Order  is  framed  on  the  basis  of  the  rules  which  prevail 
in  the  Supreme  Court,  and  is  adapted  from  those  rules 
so  as  to  apply  to  the  procedure  of  the  Council  in  penal 


Proposed  New  Standing  Order  as  to  Statutory 
Declarations. 

After  Clause  9  of  Standing  Order  XIV.  insert  as 
a  new  Clause  : — 

"  Every  statutory  declaration  must  state  the  de- 
scription and  true  place  of  abode  of  the  declarant, 
and  where  a  fact  stated  in  a  declaration  is  not  within 
the  personal  knowledge  of  the  declarant  the  source  of 
the  information  and  grounds  for  the  belief  of  the 
declarant  in  its  truth  must  be  accurately  and  fully 
stated. 

"  Declarations  and  parts  of  declarations  which  are 
made  in  contravention  of  this  rule  will  not  be  accepte4 
as  evidence." 

It  was  then  moved  by  Mr.  MacAlister,  seconded 
by  Sir  Victor  Horsley,  and  agreed  to :  "  That  the 
new  Standing  Order  be  adopted.  " 

The  Council  next  proceeded  to  the  consideration  of 
the  subjoined  memorandum  prepared  by  Mr.  Muir 
Mackenzie  at  the  request  of  the  Executive  Committee 
in  consequence  of  the  following  resolution  adopted  by 
the  General  Medical  Council  on  May  31st,  1904. 

'*  That  it  be  remitted  if  the  Executive  Committee 
to  consider  and  draft  an  iifetruction  to  the  Penal  Cases 
Committee  requiring  them  to  ascertain  in  each  case 
from  the  person  or  persons  who  have  lodged  a  com- 
plaint against  a  practitioner  whether  the  complainant 
or  complainants  have  brought  under  the  notice  of  the 
practitioner  charged  their  disapproval  of  his  conduct." 
—(Minutes,  Vol.  XLI.,  p.' 91.) 

Memorandum. 

The  cases  which  come  before  the  Penal  Cases  Com- 
mittee for  consideration  may  be  shortly  divided  into 
two  classes — namely,  (i)  those  which  are  brought 
before  the  Committee  by  private  individuals  or  societies 
as  complainants  or  informants  ;  and  (2)  those  which  are 
brought  before  the  Committee  by  public  officers  or 
bodies,  such  as  the  medical  authorities  or  coroners. 

In  the  latter  class  of  cases  there  is  no  person  who  can 
be  properly  called  a  complainant,  and  it  would  be  most 
inexpedient,  and  indeed  impracticable,  to  require  a 
public  body  or  official,  before  reporting  a  case  of  grave 
professional  misconduct  by  a  practitioner  to  the 
Council,  to  give  notice  to  or  communicate  with  the 
practitioner. 

As  regards  the  former  class  of  cases,  namely,  those 
in  which  professional  misconduct  by  a  practitioner  is 
reported  to  the  Council  or  complained  of  by  a  private 
individual,  it  would,  I  fear,  cause  inconvenience  and 
mischief,  and  even  lead  to  injustice  in  some  cases,  if  a 
general  rule  applicable  to  all  cases  were  passed  requiring 
the  complainant,  before  lodging  his  information  and 
complaint,  to  give  to  the  practitioner  notice  of  his 
disapproval  of,  or  his  complaint  against,  the  practi- 
tioner's conduct.  Such  a  general  rule  would  be  in- 
consistent with  the  judicial  position  which  the  Council 
occupies  in  relation  to  professional  misconduct,  and  is 
not  required  for  the  protection  of  the  party  complained 
of. 


If  the  rule  were  passed  so  that  the  practitioner  com" 
plained  of  knew  beforehand  the  subject-matter  oi 
complaint,  and  who  the  complainant  was,  he  migtn 
attempt  to  arrange  and  coniproniise  the  matter  with 
the  complainant  before  the  tacts  were  placed  before 
the  Council,  or  might  endeavour  to  get  inconvenient 
evidence  out  of  the  way. 

The  Council's  position  is  not  that  of  having  to  decide 
a  dispute  between  a  complainant  and  respondent,  but. 
when  facts  are  brought  to  its  notice,  of  haying  to  decide 
in  the  interests  of  the  public  and  the  medical  profession 
whether  the  misconduct  alleged  and  prtn'ed  against  a 
practitioner  requires  the  erasure  of  his  name  from  tbe 
Register.  Tne  question  whether  the  complainant  dis- 
approves or  not  of  the  practitioner's  conduct  is  im- 
material. 

Under  the  present  practice  the  complaint  or  infor- 
mation is  considered  by  the  Penal  Cases  Committee 
and  that  Committee,  in  its  discretion,  decides  wbai 
steps  shall  be  taken,  both  as  regards  entertaining  tbe 
complaint  at  all  and  giving  notice  to  the  practitioner. 

I  would  suggest,  therefore,  that  no  definite  instruc- 
tions to  the  Penal  Cases  Conmiittee,  applicable  to  case 
generally,  should  be  prepared.  I  would  submit  thai 
it  may  be  left  to  the  discretion  of  the  Penal  Cases 
Committee  in  any  case  in  which  in  their  judgment  the 
complainant  should  have  communicated  witn  the 
practitioner  before  lodging  the  complaint,  to  require 
this  course  to  be  adopted  before  proceeding  further  vith 
the  case. 

Moved  by  Sir  William  Thomson,  seconded  by  Dr. 
MacAlister,  and  agreed  to :  '*  That  the  Council 
accept  the  advice  given  in  the  memorandum  of  Mr. 
Muir  Mackenzie  and  direct  the  Executive  Committee 
to  proceed  no  further  in  the  matter." 

The  Council  next  proceeded  to  the  consideration  ol 
the  case  of  Robert  Evans,  registered  as  of  74  Brooksby's 
Walk,  Homerton.  London,  N.E.,  L.R.C.P.Edin.,  i8«5 
M.R.C.S.Eng.,  1885,  who  had  been  summoned  to 
appear  before  the  Council  to  answer  the  foUoving 
charge,  as  formulated  by  the  Council's  solicitor  :  "  Tnat 
you  have  employed  as  assistant  in  connection  vith 
your  professional  practice  a  person  not  duly  qualified 
or  registered  under  the  Medical  Acts,  namely.  Griffith 
Ellis  W^illiams,  and  have  knowingly  allowed  such  un- 
qualified person  to  attend  and  treat  patients  in  respect 
of  matters  requiring  professional  discretion  and  sJolL" 

Mr.  Evans  attended,  accompanied  by  Mr.  Marpole. 
his  solicitor,  and  by  Dr.  John  Moore  Hall,  his  partner. 
as  a  witness. 

Mr.  Wynn  Westcott,  the  coroner,  who  nad.  a.«i  the 
result  of  an  inquest  held  by  him,  brought  the  matter 
under  the  notice  of  the  Council,  was  not  present. 

Mr.  WiNTERBOTHAM  read  the  notice  to  attend,  and 
in  the  absence  of  the  complainant  read  the  letter  from 
the  coroner  to  the  Registrar  and  the  depositions  of 
various  witnesses  at  the  inquest. 

Mr.  Evans,  examined  by  Mr.  Marpole,  denied  that 
he  had  ever  given  orders  to  Williams  to  attend  patients. 
and  stated  that  he  never  had  any  suspicion  that 
Williams  was  treating  his  patients,  apd  that  he  had 
dismissed  him  at  once  on  learning  what  had  happened. 
Mr.  Evans  also  answered  questions  put  to  him  through 
the  Chair  and  by  members  of  the  CounciL 

Dr.  Hall  gave  evidence  in  favour  of  Mr.  Evans,  and 
Mr.  Marpole  then  addressed  the  Council  and  read 
several  letters  from  medical  men  (one  from  Professor 
A.  Boyce  Barrow),  all  of  which  spoke  most  favourably 
of  Mr.  Evans. 

On  strangers  being  readmitted  after  the  Council  had 
deliberated  in  camerd,  the  President  announced  the 
decision  of  the  Council  as  follows:  "Mr.  Evans,  I  am 
instructed  to  inform  you  that  the  facts  alleged  against 
you  have  not  been  proved  to  the  satisfaction  oi  the 
Council,  and  that  your  name  will  therefore  remain  on 
the  Register y 

Mr.  Muir  Mackenzie  next  read  an  opinion  which  he 
had  prepared  in  answer  to  the  question  pmt  by  Sir 
Victor  Horsley  on  the  previous  day  in  regard  to  the 
giving  of  medical  certificates  by  unqualified  persons: 
Tlie  first  sentence  of  the  opinion  lays  tlovra, :    *'  The 


Nov.  30,  1904. 


CORRESPONDENCE. 


The  Medical  Press.   5^7 


eflfect  of  Section  37  of  the  Medical  Act,  1858,  is  to 
impose  a  statutory  duty  and  obligation  on  any  public 
body,  what  by  Statute  is  required  in  specified  cases  to 
be  furnished  with  a  certificate  by  a  medical  practitioner, 
not  to  accept  a  certificate  by  an  unregistered  person, 
or  such  a  person  as  a  chemist."  However,  in  Mr.  Muir 
Mackenzie's  opinion,  the  law  gives  no  power  to  the 
General  Medical  Council  or  to  any  individual  to  take 
proceedings  against  a  public  body  which  failed  to  carry 
this  out  and  which  accepted  certificates  from  others 
than  medical  practitioners. 

It  was  moved  by  Sir  Victor  Horsley,  seconded  by 
Dr.  MacAlister,  and  agreed  to :  "  That  this  opinion 
of  .Mr.  Muir  Mackenzie  be  entered  on  the  minutes  "  ; 
and  also  :  "  That  a  copy  of  the  opinion  be  transmitted 
to  the  B.M.A.,  as  the  answer  of  the  Council  to  their 
letter." 

The  Council  then  proceeded  to  the  consideration, 
aajoumed  from  November  24th,  1904.  of  Dr.  Lindsay 
Steven's  motion,  which  was  carried. 

Moved  by  Mr.  Brown,  seconded  by  Mr.  Jackson  : 
••  That  the  resolution  of  May  29th,  1893,  be  altered  so 
that  it  reads  us  follows  :  That  the  fifth  year  be  devoted 
to  clinical  work  at  one  or  more  public  hospitals  or  dis- 
pensaries, British  or  foreign,  recognised  by  any  of  the 
medical  authorities  mentioned  in  Schedule  A  of  the 
Medical  Act,  1858,  provided  that  in  the  case  of  students 
wno  have  served  one  year's  pupilage  with  a  recognised 
practitioner  holding  a  public  appointment  or  possessing 
Buch  opportunities  of  imparting  practical  knowledge  as 
shall  be  satisfactory  to  the  medical  authorities,  only 
six  months'  clinical  work  at  a  public  hospital  shall  be 
exacted."  Comments,  mostly  unfavourable,  on  the 
motion  were  made  by  Sir  Victor  Horsley,  Dr.  McVail, 
Sir  John  Moore.  Sir  Hugh  Beevor,  Sir  W.  Thomson, 
Drs.  MacAlister  and  McCall  Anderson,  and  the  motion 
vras  lost,  24 — 3  ;    i  did  not  vote.  5  absent. 

In  answer  to  a  question  by  Dr.  Finlay .  the  President 
stated  that  the  University  of  London  had  been  visited 
by  Sir  John  Batty  Tuke.  accompanied  by  the  Inspector, 
in  the  present  month,  but  that  the  Report  would  not 
be  ready  foe  consideration  till  next  Session.  The 
University  of  Oxford  would  not  hold  an  examination 
till  December,  when  it  would  be  visited  by  Dr.  McCall 
Anderson,  accompanied  by  the  Inspector.  He  ex- 
plained that  as  the  two  Universities  had  been  revising 
their  regulations  it  was  not  possible  to  inspect  the 
new  examinations  at  an  earlier  date. 

Moved  by  Dr.  Bruce,  seconded  by  Mr.  Jackson, 
and  agreed  to  :  "  That  the  Report  by  the  Public  Health 
Committee  be  received  and  entered  on  the  minutes." 

Moved  by  Dr.  Bruce,  seconded  by  Mr.  Jackson. 
and  agreed  to  :  "  That  the  recommendation  in  the 
second  paragraph  of  tne  Report  of  the  Public  Health 
Committee  be  adopted,  viz.,  that  the  regulations  for 
the  Diplomas  in  Public  Health  of  the  University  of 
Liverpool  and  of  the  University  of  Leeds  be 
approved." 

Moved  by  Dr.  Bruce  and  seconded  by  Mr.  Jackson  : 
•'  That  the  recommendation  contained  in  the  last 
paragraph  of  the  Report  of  the  Public  Health  Cor»- 
mittee  be  adopted,  viz.,  that  the  Council  should  refuse 
a  certain  application  for  exemption."  After  a  dis- 
cussion, in  which  Drs.  MacAlister,  Lindsay  Steven, 
Norman  Moore,  Sir  Chas.  Ball,  Dr.  McVail,  and  Sir 
J.  Batty  Tuke  took  part  (most  of  these  members  of  the 
Council  being  against  the  exemption  in  question  being 
granted),  it  was  moved  by  Sir  John  Batty  Tuke, 
seconded  by  Dr.  McVail,  and  agreed  to  :  "  That  this 
debate  be  now  adjourned  till  Monday,  November  28th, 
1904." 

The  Council  then  adjourned. 

CENTRAL  MIDWIVES  BOARD. 

Meeting  of  the  Central  Midwives  Board  held 

November  24TH,  1904. 

Dr.  F.  H.  Champnevs  in  the  Chair. 

A  LETTER  was  read  from  the  hon.  secretary  of  the 

Metropolitan  Counties  Branch  of  the  British  Medical 

Association,  asking  for  the  co-operation  of  the  Board 

with  the  London  County  Council  in  obtaining  powers 


from  Parliament  to  pay  registered  medical  practi- 
tioners, when  called  in  by  midwives,  in  emergencies. 
After  consideration  it  was  decided  "  that  the  Board 
would  give  assista)ice  in  the  matter,  but  that  the  sugges- 
tion must  come  from  the  British  Medical  Association." 
A  letter  was  also  read  from  the  Clerk  of  the  Monmouth- 
shire County  Council,  asking  the  Board's  construction 
of  the  words  **  otherwise  than  under  the  direction  of  a 
qualified  medical  practitioner."  (Midwives  Act,  Section 
I ,  sub-section  2. )  A  medical  man  may  leave  an  uncerti- 
fied midwife  in  sole  charge  of  a  case  ;  is  she  then  acting 
under  his  directions  ?  After  discussion  Dr.  Culling- 
woRTH  proposed  that  "  The  Central  Midwives  Board 
cannot  give  a  general  answer,  the  point  being  a  legal 
one  on  which  no  authority  has  yet  been  given  us." 

Miss  Wilson  then  moved  :  "  That  trained  women 
inspectors  be  appointed  by  the  Board  to  inspect 
institutions  applying  for  recognition  to  the  Board." 
Sir  William  Sinclair  objected  to  the  word  "  women," 
and  it  was  finally  decided  to  omit  the  word,  and  the 
resolution  was  passed. 

Dr.  CuLLiNGWORTH  moved  :  *'  That  the  representa- 
tives of  the  press  be  required  to  withdraw  during  con- 
sideration of  matters  having  reference  to  the  judicial 
or  penal  powers  of  the -Board,  or  of  applications  for 
recognition  or,  approval."  It  was  resolved  "That 
the  motion  be  postponed  till  the  procedure  of  the 
General  Medical  Council  be  inquired  into." 

The  meeting  shortly  afterwards  adjourned. 


Correspondence. 

rWe  do  not  hold  oanelvM  retponsible  for  the  opinions  of  our 
Oorrwpondents.] 


TAORMl    .X  MINERAL  SPRINGS  AND  SYRACUSE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  read  your  notes  on  various  health 
resorts  of  Great  Britain  and  the  Continent  with  much 
interest,  and  having  recently  visited  Syracuse,  I  shall 
be  glad  if  you  will  allow  me  to  state  for  the  information 
of  those  of  your  readers  who  contemplate  journeying 
in  that  direction  that  I  found  the  town  not  only 
traditional  as  to  antiquities,  but  amazing  in  its  grand 
works  of  architecture,  carried  out  by  our  ancestors, 
who  were  supposed  to  be  at  that  epoch  the  conquerors 
of  the  world.  We  may  have  modified  or  embellished 
art.  but  we  must  admit,  when  visiting  spots  like  this, 
that  we  are  only  copying  on  different  Imes  what  our 
forefathers  have  accomplished.  Speaking  from  the 
point  of  view  of  a  physician,  I  believe  that  the  climate 
of  Syracuse  would  suit  persons  suffering  from  hepatic 
disorders  or  chest  diseases.  The  atmosphere  is  dry 
and  bracing,  rain  is  not  infrequent,  and  the  barometer 
temperate.  To  those  who  desire  to  visit  the  Taormina 
mineral  springs  in  search  of  health  and  fresh  sur- 
roundings, the  best  route  is  undoubtedly  vid  Syracuse, 
and  at  the  Grand  Hotel  of  that  city  invalids  and  con- 
valescents receive  all  care  and  attention ;  whilst 
visitors  who  are  not  invalids  will  do  well  to  go  there, 
not  only  for  the  accommodation  afforded,  but  for  the 
panoramic  view  obtainable  therefrom,  for  its  cleanliness 
and  for  its  hygienic  conditions  generally,  which  are  so 
unusual  in  these  parts. 

I  am.  Sir,  yours  truly, 
Charles  Helfield,  M.A.,  M.B.,  L.M. 

Malta,  Nov.  23rd,  1904. 

CONSTIPATION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sin, — Dr.  Tom  Robinson  has  hardly  done  himself 
full  justice  in  his  too  brief  paper  he  contributes  to 
your  issue  of  this  week  ;  but  he  has  at  least  furnished 
a  text  for  a  discussion  which  might  with  advantage  be 
taken  up  by  your  readers.  The  enormous  sale  of  quack 
remedies  for  constipation,  not  to  speak  of  aperioat 
mineral  waters,  aflfords  unmistakable  evidence  of  the 
widespread  prevalence  of  the  complaint  in  question. 
It  is  no  doubt  in  the  vast  majority  of  cases  a  merely 
functional     derangement     due      to    faulty     personal 


588  .  The  Medicai.  Press. 


MEDICAL  NEWS. 


Nov.  30,  1004. 


management  and  is  in  most  cases  to  be  cured  by  proper 
dietary,  and  wise  personal  hygiene.  The  sufiering 
which  accompanies  the  condition  of  sluggish  bowels  is 
very  real ;  and  in  most  cases  patients  have  sufficient 
intelligence  to  trace  to  it  the  mental  depression  which 
is  often  its  most  painful  symptom.  No  doubt  it  is 
possible  to  classify  cases  broadly,  but  no  malady  needs 
more  careful  discrimination  in  every  instance  ;  in  none 
is  routine  treatment  more  certain  to  end  as  a  rule  in 
failure.  On  the  other  hand,  the  cases  are  very  rare 
which  cannot  be  made  amenable  to  treatment  after 
thorough  investigation  and  patient  experiment  in 
dietary,  habits,  and  administration  of  drugs.  The 
habitual  taking  of  purgatives  everyone  may  agree 
with  Dr.  Robinson  in  condemning ;  but  we  must  dis- 
tinguish between  drastic  purgatives  and  true  laxatives. 
Of  these  latter  we  have  now  a  good  choice  ;  and  many 
of  them  may  be  used  habitually  without  ill-effect. 
Constipation  is  one  of  those  minor  ailments  which  the 
general  practitioner  too  often  neglects.  In  many  cases 
he  prescribes  aperients  without  sufficient  investigation, 
and  drives  the  patient  to  seek  reUef  from  quack  nos- 
trums. With  inteUigent  patients  it  will  always,  in  the 
best  sense  of  the  word,  pay  to  explain  matters  at  full 
length,  to  assure  them  that  permanent  relief  can  be 
had  if  proper  time  and  patience  be  bestowed  on  obser- 
vation and  experiment  with  both  diet  and  drugs. 
This  is  the  course  which  is  so  often  overlooked  by  the 
general  practitioner  in  deaUng  with  other  or  all  so- 
called  minor  ailments,  and  it  is  a  course  which  as  often 
loses  for  him  the  confidence  of  at  least  that  class  of 
patient — perhaps  not  the  largest  class  nowadays — who 
have  confidence  in  medical  science  and  due  respect  for 
its  votaries. 

I  am,  Sir,  yours  trulv, 

G.  P. 
November  24th,   1904. 

^bituars* 

DR.  G.  VIVIAN  POORE. 
Dr.  Poore,  whose  death,  at  the  age  of  sixty-one, 
is  announced,  was  bom  at  Andover,  and  was  educated 
at  the  Royal  Naval  School,  New  Cross,  and  at  the 
Medical  School  of  University  College  Hospital,  London, 
taking  his  M.R.C.S.  in  1866,  and  the  M.D.  Lond. 
degree  in  1871,  and  in  1877  he  was  elected  a  Fellow  of 
the  Royal  College  of  Physicians,  London.  His  first 
professional  appointment  was  that  of  surgeon  on  the 
Great  Eastern  steamship,  while  engaged  in  laying  the 
Atlantic  cable,  and  he  was  afterwards  medical  attendant 
to  the  late  Duke  of  Albany,  and  in  1872  to  the  King 
(as  Prince  of  Wales.)  He  also  filled  at  various  times 
the  office  of  Professor  of  Medicine  and  Clinical  Medicine 
at  University  College,  physician  to  University  College 
Hospital,  consulting  physician  to  the  Royal  Hospital 
for  Children  and  Women,  and  to  the  Cheyne  Hospital 
for  Children  at  Chelsea.  Dr.  Poore  received  the 
decoration  of  Knight  Commander  of  the  Dannebrog 
for  professional  services  to  Princess  Thyra,  Duchess 
of  Cumberland,  in  1872.  In  1891  he  was  secretary- 
general  of  the  Sanitary  Congress.  Dr.  Poore  had 
written  largely  on  sanitation  and  cognate  questions, 
and  had  published  a  number  of  medical  works. 


AcDtcal  Vlew6« 


MAJOR  THOMSON,  OF  PENRITH,  M.D..  ^Edin. 
Dr.  D.  G.  p.  Thomson,  of  Bishopsyards,  Penrith, 
died  at  Algiers  after  a  very  brief  illness.  He  was 
ordered  to  winter  abroad  owing  to  lung  trouble,  and 
only  left  home  with  Mrs.  Thomson  three  weeks  ago. 
Meningitis  following  influenza  is  understood  to  have 
been  the  cause  of  death.  In  his  younger  days  he 
was  an  enthusiastic  football  player,  and  several  times 
captained  the  Cumberland  team.  He  was  an  ardent 
volunteer,  and  three  years  ago  was  promoted  to  the 
rank  of  Major,  after  commanding  the  two  Penrith 
companies  for  several  years.  Dr.  Thomson  was  also 
medical  officer  of  health  for  Penrith,  besides  holding 
other  public  offices. 


Irish  Medical  Sehools  aad  GradiimUs'  Dinacr. 

The  annual  dinner  of  this  .popular  Associaticm  was 
held  last  week  in  London  at  the  Hotel  Cecil,  the  pre- 
sident, Surgeon-General  C.  SibthOTpe.  C.B..  piresidmg 
supported  by  a  large  and  distinguished  company. 
amongst  whom  were  many  ladies.  The  dinner  was 
served  in  the  Grand  Hall,  and  was  in  every  way  worthy 
the  reputation  of  the  establishment,  but  climatic  con- 
ditions were  at  their  worst  on  that  particular  evening. 
and  many  empty  chairs  were  seen  in  consequence. 
Albeit  everything  went  off  with  considerable  <clat. 
and  a  thoroughly  enjoyable  reunion  resulted.  After 
the  usual  loyal  and  patriotic  toasts  had  been  duly 
honoured.  Professor  £.  Halloran  Beimett  proposed 
(on  behalf  of  Sir  John  W.  Moore)  the  toast  of  -  Our 
Defenders,"  which  was  responded  to  by  Surgeon- 
General  A.  M.  Branfoot  and  Surgeon-Lieutenant 
F.  Swinford  Edwards,  the  former  representing  the 
Navy  and  the  latter  the  Volunteers.  The  toast  of 
"  Our  Guests  "  was  proposed  by  Surgeon-General  C.  B. 
Mosse,  C.  B.,  C.M.G.,  and  responded  to  by  Professor 
Bury  and  Dr.  William  Hill.  In  proposing  the  toast 
of  "  Ourselves,"  Dr.  Pye-Smith.  Vice-Chancellor  of 
the  University  of  London,  said  that  he  had  the  honour 
of  proposing  the  toast  of  the  medical  profession  of 
Ire^nd,  which  he  regarded  as  the  most  distingnisfaed  in 
the  world,  and  he  regarded  it  as  a  high  honour  that  he 
had  been  brought  into  contact  with  some  of  the 
biggest  and  brightest  names  on  the  Irish  Medical  Regis- 
ter. He  regretted  he  was  not  an  Irishman,  and  he 
could  only  say  it  was  no  fault  of  his.  However,  he 
took  comfort  in  the  fact  that  he  had  taken  measnrea> 
that  some  of  his  descendants  would  be  able  to  compete 
with  the  native  wit  of  the  sister  isle.  The  president 
replied  in  very  felicitous  terms,  and  proposed,  as  the 
final  toast  o£  the  even  ng,  the  **  Health  of  the  Hon.  Sec.. 
Mr.  Swanton,"  who,  he  said,  as  secretary  to  the  com- 
mittee, had  worked  wcmders  in  promoting  the  success 
of  the  Association. 

THe  Hsematoffen  Case. 
Considerable  medical  interest  was  aroused  in  this 
case,  which  was  tried  in  June  last  before  Mr.  Justice 
Warrington  and  a  jury.  The  action  was  then  brought 
by  Dr.  Hommel,  a  Swiss  physician,  trading  in  this 
country  as  Nicolay  and  Co.,  to  restrain  the  defendants, 
a  Messrs.  Gebruder,  Bauer  and  Co.,  of  Mincing  Lane. 
London,  from  infringing  the  plaintifi's  registered 
trade-mark,  "  Haematogen,"  and  from  passing  off  goods 
net  of  the  plaintiff's  make  as  and  for  the  plaintiffs 
goods.  The  plaintiff  made  a  preparation  of  haemo- 
globin, which  he  put  upon  the  market  under  the  name 
of  "  Haematogen,"  and  registered  it  as  his  trade-mark. 
The  plaintiff's  case  was  that  no  other  preparation  had 
been  sold  under  the  name  of  "  Haematogen  "  in  the 
United  Kingdom  up  to  1902,  and  that  anyone  who 
asked  for,  or  ordered,  or  prescribed  Haematogen 
intended  to  refer  to  the  plaintiff's  preparation  and  no 
other.  The  plaintiff  alleged  that  the  defendants, 
who  acted  as  the  London  representatives  of  a  Ham- 
burg firm,  had  recently  been  soliciting  orders  for,  and 
selling  in  London,  a  preparation  not  manufactured  by 
the  plaintiff  under  the  plaintiff's  trade  mark  "  Haema- 
togen," and  had  been  supplying  his  preparation  in 
response  to  orders  for  Haematogen  to  the  damage 
and  injury  of  the  plaintiff.  The  defendants,  on  their 
part,  contended  that  Haematogen  was  not  in- 
vented by  the  plaintiff  or  first  used  by  him,  but  that 
the  word  was  in  common  use  in  Germany  and  else- 
where, and  that  preparations  so  called  were  previously 
well  known  to  medical  men,  chemists  and  scientists. 
The  plaintiff  and  the  defendant  and  a  great  many 
medical  men,  chemists  and  scientists  were  examined, 
and  many  dictionaries  and  medical  text-books,  both 
English  and  foreign,  were  put  in  evidence  as  to  the 
origin  and  meaning  of  the  word  "  Haematogen,"  and  to 
show  that  it  had  not  been  invented  by  the  plaintifi, 
but  was  the  recognised  description  of  an  organic  form 
of  iron,  or  of  a  preparation    tending    to  form  blood. 


Nov.  30.  1904 


MEDICAL  N£WS. 


The  Medical  Pkess.    589 


The^earned  Judge  held  that  the  word  "  Haematogen  " 
must  be  stnick  off  the  Register  of  Trade  Marks  on  the 
ground  that  it  was  not  an  "  invented  word."  He 
also  held  that  the  plaintiff  had  failed  to  show  that  the 
word  had  come  to  mean  his  preparation  exclusively, 
and  that  the  defendants  had  not  been  guilty  of  pass- 
ing off  their  goods  as  those  of  the  plaintiff.  The 
action  was  accordingly  dismissed  with  costs. 

Lord  Justice  Vaughan  Williams  delivered  judgment 
on  Friday  last,  November  23rd,  in  the  Supreme  Court 
of  Judicature  ;  he  said  that  he  agreed  with  the  con- 
clusion of  Mr.  Justice  Warrington  that  it  had  not  been 
proved  that  the  word  "  Haematogen  "  had  acquired  a 
secondary  meaning  as  denoting  only  the  plaintiff's 
preparation.  His  lordship  did  not  doubt  that  among 
doctors  and  chemists  the  word  had  a  meaning  inde- 
pendent of  its  primary  meaning.  The  Court  had  to 
consider  whether  among  the  p^rsons  who  had  to  deal 
with  this  kind  of  preparation  the  word  would  mean 
the  plaintiff's  preparation  exclusively,  but  his  lordship 
agreed  with  Mr.  Justice  Warrington  that  on  the  evidence 
it  was  not  proved  that  the  word  had  acquired  a  secon- 
dary meaning  which  attached  it  to  the  plaintiff's 
preparation  only.  The  appeal  must  therefore  be  dis- 
missed with  costs.  Lord  Justice  Romer  also  agreed 
in  the  conclusion  of  Mr.  Justice  Warrington,  and 
adopted  his  reasoning.  Loid  Justice  Cozens-Hardy 
agreed,  and  adopted  every  word  of  Mr.  Justice  War- 
rington's judgment. 

Charlnff  Cross  Hospital. 

At  the  annual  distribution  of  prizes  on  Wednesday 
last  to  the  students  attached  to  this  hospital,  the 
following  were  the  chief  awards  for  the  winter  session, 
1903-4,  and  the  summer  session,  1904 : — Epsom 
Scholar,  Mr,  N.  G.  Salmon  ;  Livingstone  Scholar, 
Mr.  R.  H.  H.  JoUy ;  University  Scholar,  Mr.  W.  D. 
Ke3rworth ;  Llewellyn  Prize,  certificate,  and  £2$,  Mr. 
J.  W.  Evans  and  Mr.  R.  K.  Shepherd  (equal) ;  Golding 
Prize,  certificate,  and  ;£io,  Mr.  R.  H.  H.  Jolly  ;  Pereira 
Prize,  certificate,  and  £$,  Mr.  H.  H.  R.  Bayley  ;  Gover- 
nors' Clinical  Gold  Medal,  Mr.  J.  W.  Evans ;  Huxley 
Medal,  with  prize  oi  £10,  Mr.  W.  S.  Fenwick  ;  anatomy 
(senior)  prize,  Mr.  W.  S.  Fenwick ;  anatomy  (junior) 
prize  (Steadman),  Mr.  R.  H.  H.  Jolly ;  prize  (school), 
Mr.  W.  E.  Wilks  ;  biology,  Mr.  P.  E.  Stibbe  ;  chemistry, 
Mr.  P.  E.  Stibbe  ;  physiology  (senior),  Mr.  W.  S. 
Fenwick ;  physiology  (junior),  }Ar,  R.  H.  H.  Jolly  ; 
medicine  (senior),  Mr.  J.  W.  Evans  ;  medicine  (junior). 
Mr.  W.  W.  D.  Chilcott ;  surgery  (senior).  Mr.  R.  K. 
Shepherd  ;  surgery  ( junior ),  Mr.  W.  W.  D. 
Chilcott ;  practical  medicine,  Mr.  L.  E.  M.  Smith  ; 
psychological  medicine;  Mr.  J.  W.  Evans  ;  ophthal- 
mology. Mr.  R.  K.  Shepherd  ;  practical  midwifery,  Mr. 
E.  C.  Sprawson  ;  practical  chemistry,  Mr.  C.  J.  Butler  : 
midwifery.  Mr.  W.  K.  Beaman  :  pathology,  Mr.  W.  K. 
Beaman  ;  public  health,  Mr.  R.  K.  Shepherd  ;  thera- 
peutics. Mr.  J.  W.  Heekes ;  forensic  medicine  and 
toxicology,  Mr.  W.  K.  Beaman  ;  materia  medica,  Mr. 
T.  W.  R.  Strode. 

The  Medico  Legal  Sedety. 

A  MEETING  held  on  November  8th,  Sir  Wm.  Collins, 
the  President,  being  in  the  chair.  He  paid  a  memorial 
tribute  to  Mr.  C.  H.  Hopwood,  K.C.  (a  late  vice-presi- 
dent) and  hoped  that  the  Society  would  see  its  way  to 
appoint  a  standing  committee  to  watch  medico-legal 
progress.  Dr.  Claye  Shaw  read  a  paper  on  "An 
ObscureForm  of  Alcoholism  Involving-Irresponsibility," 
which  we  hope  to  publish  in  our  next.  Miss  Louise 
Appel,  M.B.,  narrated  the  Hindu  (subjective)  method 
of  viewing  responsibility.  Mr.  J.  Troutbeck  thought  a 
physical  examination  of  many  prisoners  was  desirable 
prior  to  their  conviction.  Dr.  Lewis  Lewis  agreed-,  he 
had  known  epileptics  commit  criminal  acts  after  being 
"  cured."  Dr.  F.  S.  Toogood,  from  his  experience  at 
I.^\visham  Infirmary,  stated  that  two- thirds  of  the 
lunatics  received  there  became  sane  after  a  few  days' 
residence.  The  President  thought  lawyers  held  a 
statical,  medical  men  a  dynamical,  view  of  responsi- 
bility.    Delirium    tremens  was    not.    in    his    clinical 


experience,  precipitated  by  sudden  abstention  from 
alcohol.  Dr.  Stanley  B.  Atkinson  then  considered 
"  Definitions  of  Accident  and  Accidental."  as  used  in 
the  coroners'  court,  insurance  policies  and  Workmen's 
Compensation  Acts.  Dr.  A.  D.  Cowburn  cited  cases 
of  nervous  shock  and  held  such  often  led  to  organic 
derangements.  Several  others  joined  m  the  discussion 
which  was  concluded  by  the  President  who  suggested 
the  possible  wide  extensions  of  recent  legal  decisions 
which  had  confused  insurance  companies  as  to  the  exact 
nature  of  an  accident. 

Rosnal  CoUeffe  of  Supgeoni  of  England. 
The  Bradshaw  Lecture  will  be  delivered  in  the  Theatre 
of  the  College  by  Professor  A.  W.  Mayo  Robson. 
F.R.C.S.,  Vice-President,  on  Thursday  next,  December 
1st.  at  5  o'clock  p.m.  precisely.  The  subject  of  the 
Lecture  will  be  "  Cancer  and  its  Treatment."  Fellows 
and  Members  of  the  College  are  invited  to  attend. 
Students  and  others  who  are  not  Fellows  or  Members 
of  the  college  will  be  admitted  on  presentation  of  their 
private  visiting  card. 

National  Dentol  Hospital. 

The  Students'  Annual  Dinner  of  the  National  Dental 
Hospital  was  held  at  the  Trocadero  Restaurant.  London 
on  November  19th.  The-  chair  was  taken  by  Mr. 
Andrew  Clark,  who  remarked  that  the  President  of  the 
hospital  was  the  Prince  of  Wales.  In  proposing  the 
toast  of  "  The  National  Dental  Hospital  and  College." 
the  Chairman  explained  how  the  hospital  could  lay 
claim  to  the  title  of  "  National,"  and  proceeded  to  show 
that  the  dentist  of  the  present  time  cannot  be  a  mere 
mechanic,  but  must  receive  instruction  in  general 
medicine  and  surger>'  before  receiving  a  necessary 
qualification  to  'practice. — Professor  A.  S.  Undewocd. 
of  King's  College,  proposed  the  toast  of  "  The  Past  and 
Present  Students,"  which  was  responded  to  by  Mr. 
Rose  and  Mr.  Cooke.  Mr.  Harry  Rose  submitted  the 
toast  of  "  The  Visitors,"  which  was  acknowledged  by 
Professor  Spencer.  Mr.  Goadby  proposed  "  The 
Health  of  the  Chairman,"  and  the  proceedings  ter- 
minated. 

Trinity  Colloffo,  Dublin. 

The  following  have  passed,  during  Michaelmas  term , 
the  Final  Examination  in  Medicine — Sec; ion  B.  : 
Robert  A.  Askins.  Henry  H.  A.  Emerson,  equal ;  George 
E.  Nesbitt.  John  W.  Burns,  Francis  J.  Usher,  Charles 
E.  C.  Williams.  William  G.  Harnett,  Henry  H.  White. 
James  M.  Harold,  John  Murdoch,  and  Hercules  J. 
Knox. 

Navy  Medleal  Service* 

The  following  appointments  have  been  officially 
gazetted  : — 

Fleet  Surgeons.--^H.  J.  Hadden,  M.B..  B.A.,  to  the 
"  President,"  additional  for  three  months'  hospital 
course,  to  date  November  i6th ;  H.  Elliott.  M.B.,  to 
the  "  Empress  of  India "  ;  J.  M.  Rogers,  to  the 
"  Lion,"  to  date  November  14th. 

Siaff  Surgeon.— E.  A.  Penfold.  M.B..  to  the  "  Brit- 
tannia,"  additional,  for  the  "  Highflyer."  on  com- 
missioning, to  date  November  i8th. 

Surgeons. — R.  Thompson,  to  the  "  Britannia,"  addi- 
tional, for  the  "  Highflyer."  to  date  November  i8th  ; 
M.  Cameron,  H.  C.  Whiteside,  to  the  '*  President," 
additional,  for  three  months'  hospital  course ;  and 
J.  H.  Lightfoot,  to  the  **  Albacore,"  to  date  November 
14th. 


It  is  announced  in  connection  with  the  visit  of  the 
King  and  Queen  of  Portugal  to  this  country,  Don 
Antonio  Maria  de  Lancastre.  physician  to  their 
Majesties,  has  been  appointed  an  Honorary  Knight 
Commander  of  the  Royal  Victorian  Order. 

Dr.  E.  Boys  Russell,  of  Lismore.  has  been  appointed 
to  the  Commission  of  the  Peace  for  the  county  of 
Waterford. 

The  first  annual  dinner  of  the  United  Hospitals 
Clinical  School,  I  University  of  Liverpool,  will  take  place 
at  the  Adelphi  Hotel,  Liverpool,  on  Saturday.  December 
3rd,  at  7.15  p.m. 


590    The  Mepicai.  Pems. 


NOTICES  TO  CORRESPONDENTS. 


Nov-  y.  1904. 


JUrttceB  to 
(^otxtepovibmtB,  ^\mt  ^letters,  &c. 


|g^  CtouuBFOinnuin  requiring  a  reply  in  this  oolumn  are.  partiou- 
larly  requested  to  make  use  of  a  dMinetitw  Sigitahm  or  /nttioi,  and 
-voW  the  praotloe  of  signing  themselves  "Reader,"  "Subscriber/' 
**  <Hd  Subsoriber/'  Jto.  Much  oontusion  wiU  be  spared  by  attention 
to  this  rule. 

OmiaiHAL  Aeiigus  or  Lrtbbs  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  f6r  publica- 
tion, but  as  evidence  of  identity. 

CoHTKiBinoRS  are  kindly  requested  to  send  their  oommunioalions, 
if  i«sident  In  England  or  the  Colonies,  to  the  Editor  at  the  London 
oAoe ;  if  resident  in  Ireland,  to  the  Dublin  oflBoe,  in  order  to  save  time 
la  re-forwanUng  from  offlce  to  ofltos.  When  sendhig  subscriptions 
the  same  misapplies  as  to  office,  these  should  be  addressed  to  th^ 
Publisher. 

ftSTRiXTS.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notiee  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  ptooti. 

OVABSVB.—The  article  on  the  "  8ea  Air  Oure  "  contained  in  M.P. 
k  C,  tor  August  8,  was  virtually  a  synopsis  of  the  Transactions  of  the 
NinA  Conmss  and  was  derived  in  great  measure  from  the  excel- 
lei^renunethereof  published  in  the  "  Bulletin  Kedical  d*  Algeria  " 
for  190i,  f ol.  917  by  Dr.  Bordet,  of  Algiers,  to  which  we  must  refer  ^ou 

DE-McWALiBa'B  letter  is  unavoidably  crowded  out  of  our  present 
issue. 

CELLULOID  COMBS. 

West  Tows  (Somerset).— A  correspondent  calls  attention  to  the 
danffer  of  celluloid  combs  for  the  hatr  sold  as  tortoiseshell  and 
encloses  account  of  a  case  in  which  combs  of  the  kind  caught  fire 
ud  inflicted  serious  injury  to  a  lady's  head.  We  thank  ojr  oorre- 
SDondeut  for  calling  attention  to  the  matter,  which  will  be  found 
alluded  to  more  fully  in  our  editorial  columns. 

BxBi-BSRi.-This  sfleciion  is  primarily  a  degeneration  of  motor 
nerve-endings.  The  disturbing  fsctor  is  apparently  connected  with 
bad  food,  although  its  precise  nature  has  not  been  hitherto  deter- 
mined. 

A  8AXOP  PEACTiTXOxnB — ^Thc    first  obvious  step  is  to  make  an 
examination  of  the  blood.     Bhould  you  not  have  the  necessary  time 
and  skill  at  command  send  to  one  of  the  research  lab3ratories. 
THET  LIKE  THEIB  MEDICINE  STRONG. 

Overheard  in  a  hospital  waiting  room.  "  What  was  I  a-sMf in' ? 
Oh  !  The  med'cine,  its  only  'art  water.  I  looked  through  the  pidgin'- 
ole  where  they  serves  it  out,  one  day,  and  I  see  the  dispenser, 
meself  a-flllin'  up  the  bottle  onto'  the  water  tap,  and  I  went  strite 
to  the  doctor,  I  did,  and  I  ses.  •  Was  that  the  way  pore  people  orier 
beuUted?  .  .  .Whatdid's  say?.  ,  .  Only  larfed.  and  said, 
•*  Better  romplain  to  the  Inland  Bevenoo '  :  I  dunno  wot  e  meant." 
—  *  Our  Hospitals  and  Charities  Illustrated." 

WnrsTAHLBYfBeds.).- You  will  find  the  answer  to  your  question  in 
the  following  qnoUtion  from  ChurehUrs  "  Met'losl  Directory."  **  In 
all  cases  where  a  servant  falls  ill  or  meets  with  an  accident,  and  is 
unable  to  pay  for  necesHary  medical  assistance,  the  parish  is  boand 
to  supply  avsisUnoe,  alUiough  the  servant  may  not  have  previously 
stood  in  need  of  parish  relief.  If  a  deputy  overseer  or  even  a  mere 
stranser  direct  a  surgeon  to  sttend  a  poor  man,  such  person  is 
liable  for  the  surgeon's  bill.  A  medical  man  called  on  by  the  police 
to  visit  a  sick  person  in  a  stotioD-house  within  the  metropolitan  dis- 
trict may  cUdm  the  sum  of  8s.  6d.  for  every  such  visit  in  the  dsytimo. 
and  the  sum  of  Ts.Od.  for  every  siich  visit  paid  between  the  hours  of 
11p.m.  andSa-m.  

Jfltetings  of  the  |l0dtli»,  ICeclures,  &t. 

WkdkxsDat  NovKMinBR  80th. 

XiDiOAL  ORADUATks'  CoLLXOS  AKD  PoLYCLivic  (2S  Chenies  street, 
W.C.).-4  p.m.  Mr.  J.  Smith:  Clinique.  (Surgical.)  6.15p.m. 
Mr.  O.  B.  M.  White :  Whitlow  and  Suppurations  in  the  Hand. 

Cbvtbal  Londov  Thboat  astd  Ear  Hospital  (Oray's  Inn  Road 
W.C.).— 5  p.m.    Demonstration  :— Dr.  Dundas  Grant  :  Larynx. 

TbUBSDAT,  DiCEMBUt  Ist. 

BoETOBK  80CIBTT  (20  Hanover  Square).- 8.16  p.m  Paper:  Dr. 
'W.  Cotton,  of  Bristol,  on  "  The  Perspective  Nature  of  X-Bay  Pro- 
jection." Short  note  by  J.  H.  Gardiner,  Esq.,  F.C  8.  Thi«  New  Ultra- 
violet Glass  recently  produced  by  Messrs.  Schott  and  Gerrosen,  of 
Jena.    Both  will  be  illustrated  by  the  Epidiascope. 

ROTAL  COLLBOB    OP   SVROXOMS    OP    ENGLAND  —6  p.m.  Mr.  A.    W. 

Hayo-Robson :  Cancer  and  its  Treatment.   (Bradf^haw  Lecture.) 
Mbdioal  GEAnuATBs'  College  and  Poltclinic  (22  Chenies  Street, 

W.C.).— 4  p.m.  Mr.  Hutchinsou :    Clinique.    (Surgical.)    6.15  p.m. 

Dr.  H.  Tiliey  :  Earache,  its  Causes,  Diagnosis,  and  Treatment. 
Mount  Yeenom  Hospital  poe  Consuxftion  and  Diseases  of 

THE     Cbest    (7   Fitsroy  Square,  W.).— 5  p.m.    Lecture  :    Dr.  T. 

Lister:  Congestion  of  the  Lungs.   (Post-Graduate  Course.) 
Friday,  Decreber  2nd. 
West  Kent  Medico-CHiruroical  Sooiett  (Royal  Kent  Dispensary 

Greenwich  Road.  S  E.).>8.45  p.ni.  Mr.  J.  Bland-Sutton  :  Abdominal 


Piegnaooj  in  Women,  Cats,  Dogs,  aixl  B»hbiis.    ■■hm. 

Exhibit!  :-The  President:  Slides  in  th«  OiurhidrDseBlMta.. 
Dr.  8.  Bamett :  Btereosooplc  Sfciagrapha— Mr.  J.  J.  Tost  :  a 
Apparatus  for  Wireless  Telegraphy  tin  action) ;  (2)6oneFhNnKCK 
Materials  shown  in  Ultrfr-violet  Ligtit  by  means  of  the  Optaol  La. 
tern:  (3)  Radium  and  Polonium.— Medical  l^npply  ftmnrliiliii 
Surgical  Instruments.— Messrs.  Duncan.  Flocfchsit,  sad  Oo. 
Therapeutic  Preparations.— The  Galen  Mannlactnring  Ge. :  8v- 
gical  Dressings. 

West  London  Medxco-Cbieuboical  Sooxbtt  (West  Loate  B» 
pital,  Hamroersmiih,  W.).~8.80  p.m.  Capers  :— Dr.  A.  E.  BmkB: 
The  Diagnosis  of  Acute  Abdominal  DfEeaae.^Dr.  C.  B.  Fiondl: 
Juvenile  Genersl  Paralysis. 

SocuTT  OP  ANiESTUBTisTs  (90  Hanover dqoaie,  W.).-8jt|a, 
Resumed  Discussion  on  the  Yemon-H^roonrt  Inhaler.    Dr.  D. 


Buxton,  Sir  Victor  Borsley.  Mr.  Silk,  Mr.  Irf>w.  Mr.  MscHiidk,XL 
**.  Billiard,  Mr.  BakewcU.  and  Mr  Crouoh  will  take  part. 
Laetnoolooical  Society  op  Lonbon  (:2»  Hanover  Sqaare.  W.).- 


6  p.m.  Cases,  Specimens.  Ac,  will  be  abowa  by  Dr.  Lav,  Bir  P. 
Semon,  Dr.  Bronner,  and  others. 

Medical  Obaduatbs'  Colleos  and  Poltclinic  (fS  OmiB 
Street,  W.C.).— 4  p.m.  Mr.S.  Stephenson  :  GBoique.    (Eye.) 

Noetm-Bast  London  Post-Graduate.Colliws  (Tottsnhasi  Hoa. 
tal).~4.80p.m.  Lecture:  Dr.  Whiting:  Modem  MeUiodib& 
Diagnosis  of  Stomach  Disorders. 


The  Hospital  for  Sick  Children,  Great  Onnood  Street,  Losdn, 

W.C— Resident    Medical  Superintendent.    Salaiy   £111  m 

atonum,  with  board  and  residence  in  the  heqiital  and  iK  VMn^ 

allowance.   AppllcaUoBS  to   the  Seoretary. 
Addenbrooke's     Hispital,    Cambridge.— .Seoretaiy-SiipsrialMdbL 

Salary  £200  per  annum.  Applioations  tothe  feeGNftatr,Sat. 

Andrew's  Street,  Cambridge. 
Jersey    General    Dispensary    and    Inflrmaxy.— Bessdent  Mhl 

Oiiloer.  Salary  £120  per  annum,  with  rooMS.  gasand     ' 

Applications  to  Hon.  Becretazy,  Inllnnary,  jersey. 
Royal  Hospital  for  Incurables,  DubUn.- Resident  Met 

Salaiy  £120  per  annum,  with  board  Ac.    AppHcatioos  to  1 1 

Thompson,  Registrar. 
Stirling  District  Asylum,  Larbert,  N.B.— Asaietant  Mediod  0C«. 

Salary  £160,  per.  annum,  with  board,  dfcc,    AppUestioaitste 

Medical  Superintendent. 
Liverpool  Dispensaries.— Assistant  Burgeon.  Salary  £100perBBam^ 

with  board  and  apartments.     Applications  to  tiam  B.  LekeitE, 

Secretary,  56  VauEhall  Read,  Liverpool. 
London  Hospital,  Whitechapel.  B.— Medical  BegiEfcranUp.    Sdur 

£i00  per  annum.  Applications  to  E.  W.  Morris,  Secrclsiy. 
Holloway    Sanatorium  Hospital  for  the  Insane,  \1rgiBis  Wite, 

Surrey.— JuniorAssistant  Medioal  Officer  (Lady).8a!a>y  fUOprr 

annum,  with   board,  lodging,  washinir»  end  attendsnee.  tt 

Applications  to  Dr.  W.  D.  Moore,  Medical  Superlntendnt. 
Dr.  btevens'  Hospital.— House  Sut geon.    Salary  £100  per  nsna, 

with  apartments,  fire  and  light.    Also  a  Patliologistk  Aniiri- 

tions  to  the  Secretary.    (BceAdvt.) 


^VfOitdmtniB. 

JOTNBS,  Feancis  James,  M.R.C.B.j^LJBiA.,  Medical  Officer  of  Httlth 

for  the  Dnrslw  (Gloucester)  Rural  District  0>unciL 
OODKN,  OoDEN  .Watson,  M.D.,  B.S.Durh-,  M^CS-Eog.,  LB.CP. 

Ix>nd.,  Honorary  Physician  to  the  Hospital  for  Sick  ChiUi«, 

Newcastle-upon-Tyne. 
Saukdees,  G.  J.,  M.B.,  B.S.Aberd.,  Certifying' Surgeon  onhrthe 

Factory  Act  for  the  Burghead  Distriot  off  the  oooaty  of  Ebia 
StmesThompson,  H.   E.,  M.A.,  M.B.Oantob,  M.R.aP.LoBl,  ha 

been  appointed  an  Assistant  Phyaioian  to  the  Royal  Hotiitil 

for  Diseases  of  the  Chest.  <?ity  Rosd.  R.C. 
Savill,  niss.  AONES  F.,  M.A.,  M!.D.,  M.B.C.P.I..  has  been  amaisM 

an  Hon.  Assistant  Physician  to  St.  John's  Hospital  for  Ditum 

of  the  Skin,  Leicester  Square,  London. 
Tovbt,  Arthur,  M.R.C.S.,  L.R.(;.P  ,  has  been  appofnted  sCBiial 

Assistant  at  St.  John's  Hospital  for  Diseasea  of  the  Skin,  Leio» 

ter  S<fuare,  London. 


girths. 


MvRPHT.— On  Nov.  23rd,  at  Portobello  House,  Dublin,  the  wife  of  W. 
W.  Murphy,  L.R.C.8.  and  P.I.,  Coolgreany,  co.  Wexford, of  i 
daughter. 


Codd— Cooper.- On  Nov.  23rd,  at  the  Parish  Church,  BTonlnr.  Keii 
Arthur  Frederick  Gamble  Codd,'  M.B.,  P.R.OlS.,  of  BolTood 
Lodge,  Bromley,  Kent,  son  of  the  late  Arthur  OsmUe  Oodd,  of 
the  Inner  Temple,  to  Ada  Margaret,  second  daiyhter  cf  Ir. 
and  Mrs.  (George  Quilton  Owper,  of  WlDow  Biak,  Bnnk}. 


^t$ihB. 


FooRF.— On  Nov.  28rd,  at  Portland  House,  Audover.  0««P^"*" 
Poore,  M.D.,  F.R.C.P.,  youngest  son  of  the  late  ConmiMder  Wm 
Poore,  R.N.,  aged  61  years. 


Mh  ^dial  §tm  m&  €muht 


"SALUS   POPULI    SUPREMA    LEX' 


Vol.  CXXIX. 


WEDNESDAY,    DECEMBER    7.     1904- 


No.    23. 


pte8i&entfal  H&&te99 

ON 

THE  DOSAGE  OF  REMEDIES,  (a) 

By   J.   THEODORE   CASH,   M.D.,   F.R.S., 
Be^ius  ProfeMor  of  Materia  Medica  in  the  University  of  Aberdeen 

We  find  chronicled  an  astonishing  liberality  in 
the  prescription  of  remedies  by  the  ancient 
physicians.  An  instructive  paper  published  in 
Edinburgh  by  Dr.  Milligan  some  eighty  years  ago 
gives  much  interesting  information  on  this  pomt. 
The  wise  and  cautious  Dioscorides  ordered  62 
grains  of  aloes  as  a  medium  purging  dose,  or  in  its 
place  elaterium  lo^  grains  or  scammony  30  grams. 
The  antidote  of  Mithridatus  had  its  35  constitu- 
ents of  which  opium  formed  the  forty-third  part 
by  weight,  so  that  calculating  from  the  amount  given, 
no  less  than  6  grains  of  opium  would  go  to  an 
anod\Tie  dose.  Marcellus  ordered  3 1  grains  of  aloes 
as  a  laxative,  Rufus  Ephesius  drachm  doses  of 
pulp  of  colocynth.  Hippocrates  ordered  an  obolus 
containing  105  grains  of  elaterium.  No  doubt  is 
admissible  as  to  the  amount  prescribed,  asthe  value 
of  the  denarius,  the  weight  quoted,  is  known. 

Are  these  large  doses  satisfactorily  accounted 
for  on  the  hypothesis  of  Arbuthnot  that  the  pre- 
-scriptions  were  written  in  multiples  (probably  of  4 
as  suggested  by  Duncan)  of  the  amounts  actually 
intended  to  be  administered,  with  the  object  of  con- 
cealing the  method  of  treatment,  or  may  it  have 
been  that  drugs  were  frequently  so  inert  owing  to 
imperfect  methods  of  preparation  and  the  pre- 
sence of  adulterations  that  such  large  doses  were 
actually  required  to  produce  a  desired  effect  ?  It 
appears  to  be  unlikely  that  the  ancients  had  any 
peculiar  tolerance  towards  remedies,  their  physique 
was  inferior  to  that  of  the  Gauls,  and  though  rickets, 
struma,  and  chronic  rheumatism  seem  to  have  been 
rare  among  them,  their  excesses  both  in  eating 
and  drinking  would  predispose  to  disorders  which 
would  in  various  ways  lessen  their  resistance. 

Our  knowledge  of  the  existence,  development, 
and  separation  of  the  active  principles  of  plants  is 
of  comparatively  recent  growth,  the  necessity  for  a 
standardisation  of  many  preparations  has  been 
recognised,  and  a  further  extension  in  this  direction 
is  desirable  in  the  interests  of  exact  medication. 

As  concerning  our  present  system  of  dosage  an 
advance  has  been  made  in  the  latest  edition  of  the 
British  Pharmacopoeia  by  the  specification  for 
many  preparations  of  a  dosage  applicable  to 
repeated  administration  as  well  as  for  a  single  dose. 
The  question,  What  is  meant  by  repeated  adminis- 

(a)   Delivered  before  the  Aberdeen  Medio 3-Chlrurg1c»l  Society, 
November,  1901. 


I  tration  ?  may  not  admit  of  an  easy  answer  in  every 
I  case.  Some  remedies  may  be  repeated  With 
I  advantage  every  two  or  three  hours,  others  not 
oftener  than  every  five  or  six  hours.  The  speed  of 
absorption  and  elimination  or  de-energisation 
must  be  considered  carefully  in  this  connection. 
On  the  whole  the  quotations  of  a  summated  dosage 
for  a  period  of  time  such  as  twelve  or  twenty-four 
hours  is  likely  to  be  of  more  use  to  the  prescriber 
who  desires  to  know  what  amount  of  his  remedy 
may  be  safely  but  effectively  given.  To  him 
should  be  left  the  distribution  of  the  fractional 
doses  he  may  elect  to  use,  and  the  time  of  their 
administration. 

The  German  Artznerbuch  acknowledges  this 
principle  by  quoting  a  *'  day's  dose  "  for  some  of 
the  more  important  drugs  and  preparations 
contained  in  its  pages.  If  we  examine  the  rela- 
tionship of  the  day's  dose  to  the  single  dose,  we 
find  that  whilst  in  the  majority  of  cases  the  sum- 
mated  dose  is  thrice  the  amount  of  the  single  dose, 
there  are  many  exceptions  to  this  relationship — 
thus,  for  example,  whilst  extract  of  opium  has 
for  the  day's  dose  three  times  the  amount  of  the 
single  dose,  the  nitrate  of  strychine  has  only  twice 
as  much,  whilst  the  sodium  salicylate  of  theo- 
bromine has  six  times  the  amount. 

The  dynamical  properties  of  individual  reme- 
dies, and  the  probable  duration  of  their  operation 
within  the  tissues,  are  to  be  considered  in  connec- 
tion with  the  therapeutical  purpose  for  which 
they  are  given.  It  is  quite  clear  that  a  uniform 
system  cannot  be  applicable  to  all  the  remedies  we 
employ,  and  that  the  stereotyped  formula  "  take 
three  times  a  day  "  may  often  be  amended  with 
much  advantage  to  treatment. 

In  order  to  illustrate  the  variation  in  effect 
producible  by  repeated  dosage,  two  series  of  ex- 
periments were  illustrated  diagrammatically.  The 
standard  chosen  was  the  fall  of  temperature  pro- 
duced by  two  alkaloids  (A  and  B)  nearly  related 
to  one  another  botanically  and  chemically.  The 
plan  adopted  was  the  following  : — After  ascertain- 
ing the  exact  lethal  proportion  of  each  per  kilo 
body  weight  for  rabbits,  a  calculated  fractional 
dose  was  given  hypodermically  at  regular  time 
intervals.  The  fraction  of  the  lethal  varied  from 
tV  to  i,  and  the  time  of  re-administration 
from  45  minutes  to  4  hours.  It  was  found  that  in 
the  case  of  the  slightly  less  toxic  body,  the  elimina- 
tion or  de-energisation  occurred  more  rapidly  than 
in  the  case  of  the  slightly  more  toxic  all^oid. 

With  the  former,  doses  of  t*«  to  T>f  of  the 
lethal  may  be  followed  by  a  slight  summation 
in  effect  when  re-administration  is  made  every 
45'  or  60',  but  if  re-administration  is  at  intervals 
of,  or  greater  than,  90'  the  initial  effect  is  neither 
maintained  nor  reproduced  in  extent.     Even  after 


59^    The  Medical  Psess. 


ORIGINAL    COMMUNICATIONS. 


Dec-  7   5904. 


a  proportion  of  -J  lethal,  there  is  only  slight 
indication  of  summation  when  an  inter vad  of  90' 
is  allowed  to  elapse  before  re-administration. 
Should  the  proportion  of  the  dose  be  so  large  as 
i  of  the  lethal,  a  progressive  fall  of  temperature 'is 
observed  when  re-administrations  occur  every 
45',  and  a  fourth  dose  proves  fatal  ;  but  if  the 
interval  is  extended  to  60',  the  same  proportionate 
amount  may  be  given  a  fourth  or  even  a  fifth  time, 
and  although  a  distinct  summation  of  effect  is 
registered,  the  total  fall  of  temperature  is  less  than 
that  following  three  administrations  at  intervals 
of  45'. 

These  and  other  observations  made  with  the 
body  A  were  contrasted  with  those  in  which  B 
was  employed.  As  this  body  is  eliminated  or 
otherwise  de-energised  more  slowly  than  A,  greater 
evidence  of  summation  is  observable  after  doses 
bearing  a  small  proportion  to  the  lethal,  re- 
administered  at  short  time  intervals  as  well  as  of 
larger  proportions  re-administered  at  longer  time 
intervals. 

It  is  probable  that  the  greatest  therapeutical 
advantage  would  not  be  derived  from  an  identical 
method  of  employing  these  two  bodies  A  and  B  in 
practice,  given  a  permissible  dose  for  a  certain  time 
period :  the  size  of  the  fraction,  as  well  as  its  allo- 
cation in  point  of  time,  would  differ. 

Such  a  conception  which  recognises  an  individu- 
ality in  a  remedy  is  no  mere  fancy ;  it  is  worthy  of 
study  as  bearing  directly  upon  the  most  efficient 
handling  of  that  remedy  as  a  therapeutical  weapon. 

In  connection  with  the  prescribing  and  prepara- 
tion of  remedies,  an  early  and  general  adoption  of 
the  decimal  S3rstem  of  weights  and  measures  is 
highly  desirable.  In  medicine,  as  in  commerce, 
our  present  chaotic  system  is  a  bar  to  a  mutual 
understanding  with  other  countries,  whilst  it  is  a 
constant  difficulty  to  ourselves.  Our  Continental 
neighbours,  with  the  exception  of  Russia,  have 
adopted  the  more  workable  and  intelUgible  system, 
and  there  is  no  probability  that  they  will  ever 
relinquish  it. 

Our  present  system  as  applied  to  medicine  is  not 
merely  antiquated,  but  intrinsically  bad ;  as  applied 
to  commerce,  its  operation  is  well  summed  up  by 
Lord  Lansdowne  when  he  describes  it  as  "  dis- 
tractihg  to  learners,  obstructive  to  trade,  and 
probably  advantageous  to  no  one." 

There  must  necessarily  be  a  period  of  calcula- 
tion and  study  for  those  of  us  who  are  accustomed 
to  the  older  system,  before  the  gramme  and  the 
cubic  centimetre  become  usable  actualities,  but 
the  period  need  be  but  a  brief  one.  Sir  Wm. 
Ramsay  assures  us  that  the  change  to  the  employ- 
ment of  the  decimal  system  was  effected  in  Ger- 
many without  any  trouble  in  a  week's  time,  and 
the  Scandinavian  countries  adopted  it  with  equal 
ease  and  celerity.  I  trust  that  our  next  Pharma- 
copoeia will  give  doses  in  terms  of  the  decimal 
system  and  thus  render  the  transition  more  easy, 
both  to  practitioners  and  students  of  medicine. 
One  other  question  affecting  dosage  is  of  serious 
importance. 

When  the  decimal  system  is  adopted  and  pre- 
scribers  make  daily  use  of  it,  by  what  method 
shall  the  patient  have  his  dose  measured  ?  To 
direct  that  he  shall  take  so  many  cubic  centi- 
metres of  the  contents  of  his  bottle  would  probably 
give  rise  to  much  trouble  and  dangerous  mis- 
understanding, for  the  system  in  nine  cases  out  of 
ten  would  be  foreign  to  him.     To  regulate  the 


dosage  by  the  so-called  "  domestic  measures "~ 
spoons  and  wineglasses — ^would  be  a  serious  enor, 
for  the  capacity  of  these  individually  ^•aries 
enormously,  so  that  their  use  is  in  most  cases 
utterly  fallacious.  (Parenthetically,  it  may  be 
stated  that  the  capacity  of  the  tea-spoon  may  be 
anjrthing  from  40  to  90  n\^,  so  that  the  patient  may 
receive  only  two-thirds  of  his  dose,  or,  ontheothcr 
hand,  half  as  much  again  according  to  the  resources 
of  his  table  equipment.) 

The  larger  measures  are  even  less  trustwortliy 
Now  the  use  of  these  should  be  altogether  aban- 
doned, and  a  glass  measure — accurate,  but  of  smaL 
cost — should  be  universally  employed. 

Such  a  measure  might  suitably  have  an  eproi. 
vette  from  the  cylinder  having  a  height  of  abo« 
20  cm.,  with  a  diameter  of  2  cm.  On  this  foar 
graduation  marks  might  be  placed,  indicatis: 
(from  the  lowermost  upwards)  capacities  of  r> 
5,  10  and  20  c.c.  respectively. 

The  first  might  be  indicated  by  the  numeral  I , 
the  second  II.,  the  third  IV.,  as  it  represents 
(25  c.c.  x  4) ;  the  uppermost  8  (2*5  x  8;.  Tht 
patient  might  recognise  these  as  so  many  parts, 
so  that  when  the  physician  directed  4  parts  a: 
certain  time  intervals  he  would  measure  or  haw 
measured  for  him  his  10  c.c,  without  risk  of  confa- 
sion. 

It  seems  likely  that  some  such  method  wook] 
materially  assist  the  prescriber  reforming  his 
system,  and  if  some  recollection  of  the  old  nomeG- 
clature  serves  in  any  way  to  steady  him  in  finding 
certain  parallels  with  the  newer  standard,  he  conld 
associate  the  figure  i  (2*5  c.c.)  "with  a  small  tea- 
spoonful  ;  4(10  c.c.)  with  a  large  dessert -spoonful ; 
and  so  on. 

By  the  patient,  who  would  receive  an  exact  mea- 
sure for  3d.  or  4d.,  the  outlay  could  only  be  re- 
garded as  a  good  and  safe  investment,  whilst  the 
progress  of  therapeutic  observation  would  be 
cleared  of  many  fallacies,  which  are  apt  to  arise 
when  an  aesthetical  silver  teaspoon  takes  the  place 
of  its  ample  brittanic  metal  predecessor  as  the 
trusted  domestic  measure  of  the  familv. 


PAROTITIS  AS   A 

COMPLICATION     OF     GASTRIC 

ULCER. 

By   W.   SOLTAU   FENWICK,    M.D.,    M.R.C.P.. 

Physician  to  the  Evelina  Hospital  for  Sick   Children   and  to  tk 

Ix>ndon  Temperance  Hrapital ; 

AND 

HERBERT  RHODES.  M.B.Lond., 
Senior  Besident  Medical  OlHoer  at  the  London  Tempenace  Hospitil 
Inflammation  of  the  parotid  gland  is  occasioiiallr 
observed  after  injuries  to  or  operations  upon  the 
abdominal  viscera,  as  well  as  during  the  course  of 
certain  specific  fevers,  dysentery,  carcinoma,  and 
phthisis.  As  a  complication,  however,  of  simple  ulcer 
of  the  stomach  the  condition  is  comparatively  rare,  asd 
scant  allusion  is  made  to  it  even  in  works  which  deal 
exclusively  with  diseases  of  the  digestive  organs  We 
find  that  during  the  five  years  1898  to  1902  there  were 
admitted  into  the  medical  wards  of  the  London  Tem- 
perance Hospital  153  cases  of  gastric  ulcer,  and  that 
m  three  of  these  {2  per  cent.)  parotitis  supervened  whilf 
the  patient  remained  under  treatment.  The  actual 
frequency  of  the  complication  is,  however,  infinitely 
less  common  than  these  figures  would  suggest,  sinoe. 
owing  to  the  great  demands  made  upon  the  ho^ital 
accommodation  by  persons  suffering  from  diseases  of 
the  stomach,  cases  of  gastric  ulcer  are  only  admitted 
when  suffering  from  haematemesis,  perforation,  or  some 


Dec.  7,   1904. 


ORIGINAL    COMMUNICATIONS. 


Tn  Medical  Press.    593 


other  important  complication  or  sequela  of  the  disease. 
■  The  parotitis  may  arise  either  from  a  local  infection 
of  the  gland  through  its  duct  or  from  general  pysmia. 
The  former  condition  is  by  far  the  more  common,  and 
was  responsible  for  the  mischief  in  each  of  our  three 
cases ;  but  in  another  instance  which  came  under  our 
notice  the  formation  of  a  small  perigastric  abscess  due 
to  leakage  through  the  base  of  an  ulcer  was  followed  by 
fatal  pya?mia,  with  secondary  abscesses  in  the  liver, 
lungs,  and  in  the  right  parotid  ^land. 

In  each  of  our  cases  the  gastric  disease  was  chronic 
in  character  and  the  immediate  cause  of  the  patient's 
admission  to  the  nospital  was  a  severe  attack  of 
hsematemesis.  It  is  interesting  to  note  that  the  parotid 
■complication  invariably  ensued  upon  the  fourth  day 
after  the  hzpmorrhage.  In  one  instance  the  right 
^land  alone  was  affected  and  the  inflammation  subsided 
-under  treatment,  but  in  the  other  two  the  mischief 
•became  bilateral  after  an  interval  of  three  or  four  days 
and   termirDated  in  suppuration. 

The  first  indication  of  the  disease  was  a  complaint 
of  pain  in  the  face  or  the  ear.  witn  Umitation  of  the 
movements  of  the  jaw  and  the  development  of  a  smooth, 
tender  swelling  in  the  region  of  the  parotid.  As  the 
Ttumour  increasied  in  size  the  pain  became  more  severe, 
and  often  radiated  over  the  temple  and  the  back  of  the 
head  or  down  the  neck,  while  in  one  case  it  was  chiefly 
•experienced  in  the  ear  and  was  accompanied  by  partial 
•deafness.  When  suppuration  occurred  the  skin  over 
the  tumour  became  tense  and  shining,  and  deep  flue- 
nt uat  ion  could  be  detected  on  palpation.  Occasionally 
the  whole  of  the  affected  side  of  the  face  and  scalp  was 
•oedematous.  Unless  promptly  relieved  by  an  incision, 
the  pus  showed  a  tendency  to  point  behind  the  ramus 
of  the  jaw,  to  burrow  into  the  neck,  or  burst  into  the 
external  auditory  meatus. 


l\%  I  t  %  I  I  I  I 


The  febrile  disturbance  that  accompanied  the  paro- 
titis was  almost  identical  in  its  gf^neral  features  in  the 
three  cases,  its  course  in  the  two  instances  where 
suppuration  took  place  being  represented  in  the 
.annexed  chart.  It  is  interesting  to  note  that  the  tem- 
.perature  began  to  rise  on  the  fourth  evening  after  the 


haemorrhage  and  attained  its  maximum  in  fyHRfty-four 
hours,  after  which  it  gradually  declined  until  it  reached 
its  former  level  at  the  end  of  four  days.  Contrary, 
however,  to  most  cases  of  abscess-formation,  signs  of  sup- 
puration did  not  manifest  themselves  until  two  or  three 
days  after  the  crisis  of  the  fever.  It  is  necessary,  therefore, 
to  watch  the  parotid  swelling  each  day  and  Xo  operate 
as  soon  as  the  existence  of  pus  becomes  evident,  whether 
there  be  fever  or  no.  The  insidious  manner  in  which 
pus  may  form  was  well  illustrated  in  one  of  our  cases, 
where,  although  the  gland  was  incised  and  drained  on 
the  seventh  day,  a  few  days  later,  and  without  any 
access  of  fever,  another  abscess  burst  into  the  external 
auditory  meatus  and  caused  some  trouble.  When 
the  other  parotid  is  attacked  a  similar  though  less 
severe  febrile  reaction  is  observed. 

As  a  rule,  the  state  of  the  pulse  affords  a  better 
criterion  of  the  progress  of  the  inflammation  than  the 
presence  of  fever.  In  each  of  our  cases  the  onset  of 
the  pain  and  swelling  was  accompanied  by  a  sudden 
acceleration  in  the  pulse-rate,  from  about  80  to  116 
beats  per  minute,  with  a  further  increase  of  rapidity 
when  the  fever  subsided  and  suppuration  occurred  ; 
indeed,  it  was  not  until  the  discharge  had  practically 
ceased  that  the  pulse  regained  its  normal  rate. 

During  the  progress  of  the  disease,  the  patient  com- 
plained of  great  prostration.  The  mouth  and  tongue 
were  extremely  foul,  and  the  inability  to  open  the 
mouth  rendered  it  difficult  to  cleanse  the  buccal  cavity. 
When  the  tension  in  the  inflamed  gland  became  severe 
partial  deafness  was  present  on  the  affected  side,  and 
in  one  case  facial  paralysis  developed,  apparently  from 
stretching  of  the  nerve,  and  did  not  subside  until  con- 
valescence was  established. 

Causation. — Many  theories  have  been  put  forward  to 
explain  the  occurrence  of  parotitis  after  abdominal 
operations,  and  some  authorities  still  seem  to  incline 
to  a  belief  in  a  reflex  nervous  influence  ;  but  in  the 
variety  which  occasionally  ensues  after  haemorrhage 
from  the  stomach  we  are  convinced  that  the  exciting 
cause  is  invariably  to  be  found  in  an  ascending  infection 
of  Stenson's  duct.  Our  reasons  for  this  are  shortly  as 
follows :  ( I )  The  parotid  inflammation  is  invariably 
preceded  by  foulness  of  the  mouth  and  never  occurs  if 
the  buccal  cavity  is  maintained  in  a  clean  and  moist 
condition  ;  (2)  it  is  rarely  seen  in  cases  which  are  per- 
mitted throughout  the  whole  course  of  the  treatment 
to  drink  milk  or  partake  of  other  forms  of  food,  while 
it  is  unduly  frequent  in  those  that  are  nourished  en- 
tirely by  the  rectum,  all  the  cases  that  have  come  under 
our  own  observation  having  belonged  to  the  latter 
category ;  (3)  the  side  which  is  first  affected  seems  to 
be  determined  to  a  great  extent  by  the  position  assumed 
by  tne  patient  when  in  bed,  the  gland  usually  in  con- 
tact with  the  pillow  being  that  commonly  attacked. 
Subsequently,  when  it  becomes  necessary  to  recline 
upon  the  opposite  side  owing  to  the  painful  swelling  of 
the  face,  the  other  parotid  is  usually  implicated. 
(4)  A  bacteriological  examination  of  the  pus  obtained 
from  the  abscess  always  shows  a  mixed  culture,  the 
principal  elements  of  which  (staphylococcus  pyogenes 
aureus  and  micrococcus  lanceolatus)  are  also  abundantly 
present  in  the  thick  secretions  of  the  mouth. 

Treatment. — The  fact  that  parotitis  occasionally 
ensues  after  severe  haematemesis  renders  it  important 
that  special  measures  should  be  adopted  to  prevent  its 
occurrence  in  such  cases.  In  every  instance,  therefore, 
the  state  of  the  mouth  requires  immediate  attention, 
and  an  effort  must  be  made  to  stimulate  the  secretion  of 
saliva.  As  a  rule,  constant  cleansing  of  the  mouth 
and  tongue  with  a  moderately  strong  solution  of  Condy's 
Fluid  is  most  efficacious,  but  one  of  listerine  (2  per 
cent.),  resorcin  (10  per  cent.),  or  sulphurous  acid  may 
be  employed  if  preferred,  especial  care  being  taken  to 
thoroughly  cleanse  the  spaces  between  the  upper  teeth 
and  the  cheek.  In  order  to  induce  a  secretion  of 
saliva  the  patient  should  be  directed  to  chew  a  piece  of 
horseradish  or  pellitory  root  at  intervals,  to  keep  a 
pebble  in  the  mouth  or  to  suck  an  indiarubb^  ring  or 
teat.  Sometimes  the  mastication  of  a  piece  of  raw 
meat  or  gargling  the  mouth  with  a  dilute  solution  of 


594    Xhs  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec.  7,  1904. 


a  mineral  acid  is  also  of  value  as  a  sialagogue.  If  the 
inflammation  has  already  set  in  the  parts  must  be  well 
fomented,  and  the  pus  should  be  evacuated  as  soon  as 
its  existence  can  be  detected. 


A  CASE  OF   ACUTE  YELLOW 
ATROPHY  OF   THE  LIVER. 

By    WILLIAM    J.    THOMPSON.    M.D.,    F.R.C.P.I.. 
Phydci&D,  Jenis  Street  Hospital,  Dublin. 

That  acute  yellow  atrophy  of  the  liver  is  a  com- 
paratively rare  disease  in  this  country  is  sufficiently 
demonstrated  by  the  fact  that  no  case  has  been  reported 
at  .any  of  the  sections  of  the  Royal  Academy  of  Medi- 
cine in  Ireland  since  its  inception  twenty-one  years 
ago.  Murchinson,  in  his  writings  about  this  disease, 
stated  that  during  a  period  of  nine  years,  and  out  of  a 
total  number  of  27,000  patients  admitted  into  the 
London  hospitals,  he  had  only  seen  one  case,  and  Dr. 
Wickham  Legg  could  only  trace  one  case  in  the  records 
of  St.  Bartholomew's  Hospital  for  a  similar  period. 

It  is  an  interesting  as  well  as  an  historical  fact, 
according  to  Dr.  William  Hunter,  of  Charing  Cross 
Hospital,  that  it  was  Dublin  physicians  who,  in  the 
beginning  of  the  last  century,  first  in  this  country  made 
observations  about  the  disease — Cheyne  and  O'Brien 
in  the  year  181 8  and  Marsh,  four  years  later  ;  Morgagni 
had  previous  to  this  described  cases  presenting  features 
of  the  disease.  The  first  accurate  clinical  account 
recorded  was  that  by  Bright  in  the  year  1836.  He 
described  the  changes  which  took  place  in  the  liver  as 
"  a  diffuse  inflammation  affecting  more  tne  glandular 
portion  than  the  connective  tissue,  leading  to  great 
diminution  in  the  size  of  the  organ  and  accompanied 
by  intense  jaundice,  severe  nervous  s\'mptoms  and 
often^  a  hapmorrhagic  tendency."  Two  English 
observers — Busk,  in  the  year  1845,  ^^^  Handfield 
Jones  two  years  later — accurately  described  the  char- 
acteristic microscopic  appearance  of  the  degenerated 
liver  cells,  and  about  the  same  time  Continental  investi- 
gators confirmed  these  observations  and  added  more 
to  what  had  already  been  made  known. 

The  patient,  E.  B.,  was  admitted  into  Jervis  Street 
Hospital  on  August  24th  last.  She  was  a  wejl- 
nourished  woman  of  medium  height  and  build,  "Nyith 
dark  hair  and  dark  complexion,  aet.  2y.  She  was  born  in 
Dublin  and  had  a  good  personal  and  family  history. 
She  had  been  married  five  years,  had  three  children, 
the  youngest  of  which  was  four  weeks  old ;  the  other 
two,  aged  respectively  4  and  2  years,  were  strong  and 
healthy.  She  had  not  had  any  miscarriage,  nor  was 
there  a  history  of  a  rash  or  sore  throat,  so  that  syphilis 
as  a  cause  must  be  excluded.  Her  husband,  a  labourer 
by  occupation,  was  not  always  steady  or  at  regular 
work,  which  necessitated  her  doing  washing,  and  in  this 
way  she  contributed  to  the  support  of  her  family. 
She  had  not  been  in  the  habit  of  taking  either  porter 
or  any  other  stimulant.  She  resided  in  a  tenement 
house  situated  in  one  of  the  most  congested  parts  of  the 
city,  where  the  surroundings  could  not  be  anything 
other  than  detrimental  to  a  robust  state  of  health.  Wliile 
carrying  her  last  baby  she  enjoyed  average  health,  as 
she  did  on  the  two  former  pregnancies.  Parturition 
seemed  to  have  been  normal  and  she  was  able 
to  be  up  and  about  at  the  end  of  one  week, 
and,  as  with  the  other  two  children,  she  nursed  this 
child.  In  the  beginning  of  the  third  week  after 
her  confinement,  she  felt  sickness  of  stomach,  loss  of 
appetite,  languor  and  the  jaundice  first  appeared 
three  weeks  after  child-birth.  A  week  later,  she  first 
came  under  my  care.  At  that  time  there  was  nothing 
in  her  condition  to  suspect  anything  other  than'  an 
ordinary  case  of  catarrhal  jaundice.  The  liver  dulness 
was  not  affected,  no  hardness  or  resistance  of  the  organ 
could  be  detected  and  the  gall-bladder  was  not  dis- 
tended ;  there  was  no  pain  on  pressure.  The  tongue 
was  thickly  coated,  enlarged,  flabby,  and  indented  A^ith 
teeth  marks — the  teeth  were  exceptionaUy  good  ;  the 
tonsils  were  normal  and  no  enlarged  glands  could  be 
found.  The  abdomen  was  soft  and  flaccid,  no  rigidity 


at  or  about  the  liver  region,  all  the  abdominal  organs 
seemed  normal,  as  also  the  heart  and  lungs.  There 
was  marked  constipation  and  more  sickness  of  stontadi 
perhaps,  than  one  usually  gets  in  a  simple  case.  The 
skin  and  mucous  membrane  presented  all  the  appear- 
ance of  a  well-marked  case  of  jaundice,  as  also  did  thf 
urine.  The  quantity  of  urine  passed  per  day  wis 
below  the  average,  35  oz.  Urates  were  abundant 
there  was  a  slight  trace  of  albumin,  no  sugar,  sp.  gr. 
1022,  and  the  quantity  of  urea  was  less  than  normal 
At  this  time  leucin  and  tjrrosin  were  not  looked  for. 
There  was  one  other  symptom  patient  complained  of  oo 
admission — viz.,  a  shooting,  acute,  spasmodic  paa 
lasting  only  a  short  time,  apparently  in  the  liver.  Sis? 
stated  that  the  pain  was  deep-seated  and  scarcely  ott 
occurred  in  the  exact  place  a  second  time,  and  ha 
description  of  the  pain  was  as  it  were  the  stab  of  a  shar, 
instrument.  External  pressure  had  no  effect  in  eitbtr 
relieving  or  increasing  it,  nor  did  a  deep  breath  affect  ir. 
All  through  her  illness  this  symptom  was  promisem 
and  towards  the  end  became  sometimes  so  severe  that 
she  had  to  cry  out.  Her  temperature  was  normal  and 
pulse  62  per  minute.   Stools  tjrpically  those  of  jaundict 

For  the  first  week  in  hospital  this  patient  seerott!  to 
improve,  took  light  nourishment  well ;  the  tonpaf 
became  cleaner  and  the  jaundice  was  apparently  not  «© 
intense.  The  bowels,  however,  required  strong  porgz- 
tives.  There  was  no  trouble  with  the  breasts,  as  tbe 
milk  ceased  coming  at  once,  although  she  had  been 
suckling  her  child  until  her  admission.  During  hsr 
second  week  in  hospital  the  patient  did  not  fed 
so  well,  the  nausea  and  epigastric  discoinfort  became 
very  marked,  the  bowels  more  stubborn  and  the 
jaundice  more  intense.  From  this  until  her  death  thr 
patient  got  gradually  worse,  vomiting  became  afanos: 
incessant,  the  liver  dulness  diminished  in  area,  and  :: 
was  now  found-  the  amount  of  urea  was  diminished  to 
about  half  what  it  was  on  admission  and  leucin  a»: 
tyrosin  were  present.  The  temperature  now  becace 
irregular,  varying  from  96*5  to  102"^.  and  tbe 
pulse  intermittent  and  fluctuated  between  80  ajot! 
1 20.  There  was  no  direct  relationship  between  the 
temperature  and  pulse ;  when  the  temperature  ^a* 
high,  the  pulse  might  be  low  and  vice  vetsti. 

At  the  end  of  the  third  week  in  hospital  cerebral 
symptoms  developed  ;  "  she  gradually  bei:ame  drowsr 
and  semi-conscious,  was  restless  and  had  slight  delirima 
— the  jaundice  became  very  intense  and  appeared  as  a 
greenish  hue  ;  the  tongue  becaxn^  dry  and  brown,  and 
the  amount  of  urine  passed  diminished  to  13  oz.  per 
day.  The  liver  dulness  practically  disappeared  in  front 
and  only  posteriorly  CQuld  it  be  slightly  detected.  She 
remained  in  this  condition  for  three  days,  but  graduaflr 
becoming  more  unconscious  and  weaker,  and  died 
about  four  and  a  half  weeks  after  the  jaundice  first 
appeared.  The  vomiting  was  always  gastric  :  at  b(> 
time  had  she  any  haematemesis,  meUena.  or  any  otko' 
haemorrhagic  manifestations. 

In  the  post-mortem  room  the  body  was  not  mucn 
wasted  considering  the  severity  of  her  illness  and  tbe 
small  quantity  of  nourishment  she  was  able  to  make 
use  of.  On  opening  the  abdomen  there  was  found  a 
small  quantity  of  greenish-coloured  fluid.  The  Uvtr. 
instead  of  presenting  as  usual,  was  small.  bagg>--like 
and  crflapsed,  and  could  only  be  seen  by  its  being  kept 
in  position  by  the  ^  suspensory  ligament.  When 
removed  it  felt  soft  and  spongy-like,  with  a  H-rinkled 
capsule  and  weigned  29  oz.  The  stomach  was  smaD, 
and  on  opening  It  the  mucous  membrane  was  found  to 
be  pale  and  apparently  healthy.  Tiie  other  abdominal 
organs  seemed  to  the  naked  eye  ncrmal.  The  spleow 
pancreas,  and  the  kidneys  seemed  healthy  in  size  and 
on  section.  The  uterus  was  normal  and'  there  was  a 
small  ovarian  cyst  about  the  size  of  a  marble.  Xooe 
of  the  abdominal  glands  were  enlarged.  The  heart 
and  lungs  were  healthy  and  there  was  not  any  fluid  id 
the  pleural  cavity  or  pericardium.  I  did  not  get  ao 
opportunity  of  examining  the  brain. 

The  clinical  points  of  interest  about  this  case  are  :— 

I .  The  rather  protracted  course — about  four  and  a 

half    weeks,     although    Hunter    in    his J^ twenty-nine 


_    X>EC.  7.  1904. 


ORIGINAL    COIMiUNIGi^IONiS. 


Tbb  Msbical  Pbbss.    595 


*^ollected  cases  gives  nine,  or  31  per  cent.,  as  running 
^'     course  of  from  three  to  eight  weeks. 

2.  The  acute,  short,  spasmodic  liver  pain  which  was 
I>«rsistent  throughout. 

3.  The  total  absence  of  any  ha^morrhagic  symptoms. 


ABSTRACT  OF  THE 

XtaOdbaw    Xectttre 

ON  THE 

TREATMENT    OF    CANCER,  (a) 

By  A.  W.  MAYO  ROBSON,  F.R.C.S.,  Hon.D.Sc, 
Vlc«-P]nMMeiifc  of  the  College. 

Preventive  Operations. 

Precancerous  Conditions.  —  The  so-called  precan- 
cerous stage  of  malignant  disease  may  be  due  to  dis- 
turbances of  nutrition,  to  previous  injury,  to  congenital 
clefect,  or  to  other  departures  from  the  normal  con- 
<litions. 

Senility  and  decadence  of  tissues  which  have  passed 
ttie  period  of  their  usefulness  and  are  about  to  undergo 
physiological  rest  are  predisposing  factors.  Predis- 
posing conditions  also  exist  in  certain  parts  of  the  body 
>vhere  embryological  vestiges  or  rests  are  found,  and 
in  certain  regions,  as  the  pylorus  and  the  caecum,  and 
at  the  lines  of  junction  of  skin  and  mucous  membrane. 

In  certain  situations  precancerous  conditions  can 
lie  readily  recognised,  especially  in  the  tongue,  lips, 
larynx,  uterus,  and  the  skin,  suggesting  strongly  that 
cancer  is  a  new  implantation  on  a  prepared  ground. 
Probably,  if  we  could  only  find  it,  every  cancer,  whether 
external  or  internal,  follows  on  a  precancerous  cbn- 
dition.  The  liability  of  benign  tumours,  especially  on 
epithelial  surfaces,  to  undergo  malignant  changes  is 
well  recognised,  hence  the  removal  of  such  is  generally 
advisable. 

A  general  acceptance  of  the  view  that  cancer  has 
usually  a  precancerous  stage,  and  that  this  stage  is 
one  in  which  operation  ought  to  be  performed,  would 
be  the  means  of  saving  many  useful  lives,  for  it  would 
lead  to  the  removal  of  all  suspicious  epithelial  condi- 
tions before  the  onset  of  cancer.  I  hold  that  the  arrest 
or  removal  of  known  causes  as  well  as  the  abolition  of 
discoverable  precancerous  conditions,  whenever  or 
however  occurring,  constitute  true  preventive  treat- 
ment. 

The  Gall-Bladder  and  Liver.— The  lecturer  said  that 
facts  recorded  by  himself  and  by  Zenker,  Courvoisier, 
Schroeder,  Beadles,  and  Rolleston  established  an  un- 
doubted relationship  between  cholelithiasis  and  cancer 
of  the  gall-bladder  and  ducts. 

As  gall-stones  produce  characteristic  symptoms,  and 
are  therefore  as  a  rule  diagnosed  early,  and  as  they  can 
be  removed  before  serious  complications  have  super- 
vened with  extremely  little  risk  (in  my  experience, 
extending  over  some  hundreds  of  operations,  less  than 
I  per  cent.),  the  preventive  treatment  for  cancer  of  the 
^all-bladder  is  obviously  removal  of  the  source  of  irri- 
tation. 

So  impressed  am  I  with  the  importance  of  this  view, 
that  although  I  know  the  symptoms  of  gall-stones, 
which  frequently  depend  on  the  associated  catarrh,  can 
often  be  relieved  for  a  time  by  general  treatment 
(though  the  gall-stones  producing  the  catarrh  cannot 
be  removed  by  medicine),  yet  I  consider  it  wise  to  re- 
commend their  early  removal,  not  only  because  it  can 
safely  be  done,  but  also  because  the  symptoms  are 
likely  to  recur  and  lead  to  other  complications,  and 
not  least  important  because  in  a  considerable  per- 
centage of  such  cases  malignant  disease  will  supervene 
if  the  irritation  be  not  removed. 

The  Mammary  Glands. — In  the  breast  there  are 
certain  well-known  precancerous  conditions,  such  as 
eczema  of  the  nipple  (first  described  by  Sir  James  Paget 
as  a  precursor  of  duct  cancer),  chronic  inflammatory 
enlargements  (the  chronic  cirrhosing  mastitis  of  Bill- 
roth, the  interstitial  mastitis  of  English  pathologists), 
cysts  and  adenomata,  and  last,  but  not  least,  induration 
following  on  injury.     Many  of  these  conditions  will,  if 

'a*  Delivered  before  tbe  Boyal  Collei^  of  Surifeout  of  England  on 
December  1st,  1004. 


properly  and  seriously  attended  to,  yield  to  treatment. 
Patients  have  usually  themselves  to  blame  for  ignoring 
what  they  seem  to  think  are  trifling  ailments,  though 
sometimes  the  medical  attendant  may,  to  avoid  frigh- 
tening his  client,  make  light  of  the  condition.  I  would 
say  far  better  to  alarm  and  cure  than  to  lull  into  a 
false  sense  of  security,  and  have  to  counsel  operation 
later  when  the  conditions  are  less  favourable  for  radical 
treatment. 

If  eczema  of  the  nipple  does  not  speedily  yield  to 
treatment,  the  nipple  should  be  freely  excised,  and 
with  it  the  first  portion  of  the  primary'  ducts.  If  a 
chronic  inflammatory  swelling  does  not  disappear  under 
adequate  treatment,  the  lobule  or  lobules  involved 
ought  to  be  removed,  or,  if  general,  the  breast  should 
be  ablated.  Cysts  or  tumours,  even  if  simple,  should 
be  taken  away,  and  if,  on  examination  after  removal, 
there  is  any  suspicion  that  the  simple  stage  is  passed, 
the  whole  breast  should  be  removed,  and  with  it  the 
nearest  lymph  glands.  I^M 

It  ought  to  be  recognised  that  the  watching  of  a 
doubtful  tumour  of  the  mammary  gland  until  it  be- 
comes definitely  malignant  is  an  unjustifiable  and  a 
blameworthy  procedure.  Removal  in  this  stage  can 
be  done  without  risk,  and  while  the  anxiety  of  the 
patient  is  relieved  the  fear  of  the  development  of 
malignancy  is  removed. 

The  Stomach,  —  Precancerous  conaitions  of  the 
stomach  are.  in  certain  cases,  distinctly  recognisable, 
and,  if  diagnosed  and  treated,  might  save  many 
patients  from  carcinoma.  As  the  stomach  is  one  of 
the  commonest  sites  of  cancer,  if  even  a  percentage  of 
cases  can  be  saved  from  malignant  disease  by  timely 
treatment  a  great  advantage  will  have  been  gained. 

Carcinoma  occurs  most  n-equently  in  those  areas  in 
which  the  ulcers  chiefly  lie.  Whatever  the  frequency 
of  the  malignant  change  in  chronic  ulcer  may  prove  to 
be,  the  fact  of  its  occurrence  should  be  an  additional 
incentive  to  the  earlier  surgical  treatment  of  ulcers 
which  prove  rebellious. 

I'firmly  believe  that  greater  regard  for  oral  asepsis 
and  more  careful  attention  to  the  teeth  would  save 
much  stomach  disease,  and  I  think  one  of  the  chief 
causes  of  the  frequency  of  gastric  ulcers  among  the 
mill  operatives  of  Yorkshire  and  Lancashire  is  carious 
taeth  with  its  accompaniment,  oral  sepsis.  I  am  also 
firmly  convinced  that  the  early  and  thorough  medical 
ti^dtment  of  gastric  ulcers  and  the  surgical  treatment, 
either  by  gastro-enterostomy  or  excision  of  those  that 
prove  rebellious,  would  do  much  to  lessen  the  amount  of 
cancer  of  the  stomach. 

The  Pelvic  Organs  of  Women. — Cancer  is  perhaps 
more  commonly  noticed  to  supervene  on  a  recognisable 
precancerous  condition  in  the  uterus  than  is  observable 
in  any  other  organ,  and  the  frequency  with  which  cancer 
develops  in  multiparae,  and  especially  in  those  who  have 
had  lacerated  cervix,  points  distinctly  to  cause  and 
effect. 

The  frequent  advent  of  cancer  on  old  scars  is  well 
known  in  various  parts  of  the  body,  especially  in  those 
placed  where  their  nutrition  is  liable  to  disturbance, 
as  in  the  scars  of  bums.  Now  in  the  cervix  uteri  we 
see  the  scars  of  old  ulcers,  the  result  of  laceration  in 
childbed,  often  remaining  untreated  for  years  and 
leading  to  constant  distress,  with  backache,  leucorrhoea, 
and  other  well-known  symptoms.  Only  a  few  months 
ago,  I  saw  a  case  of  this  kind  pass  from  the  simple  to 
the  malignant  stage,  an  operation  having  been  de- 
clined on  both  occasions  when  I  saw  the  patient,  and 
only  consented  to  six  months  later,  after  epithelioma 
had  developed.  Cancer  of  the  cervix  uteri  is  infre- 
quent in  sterile  women  whose  cervical  canal  has  not 
been  subjected  to  the  lacerations  which  often  occur  in 
parturition,  whereas  cancer  of  the  body  of  the  uterus 
is  of  equal  frequency  in  those  who  have  and  have  not 
borne  children.  Most  careful  attention  to  post- 
puerperal  conditions  and  the  performance  of  the  simple 
operation  described  by  Emmett  would  remove  this 
source  of  danger  in  a  great  number  of  cases. 

Uterine  adenomata  doubtless  predispose  to  cancer 


596    Th»  Mbdical  Pekw.  original    COMMUNICATIONS. 


Dec.  7,  1904. 


of  the  uterus,  and  the  co-existence  of  mucous  pol)rpi 
and  epithelioma  is  not  ii-ithout  its  significance,  as  early 
operation  in  such  cases  would  probably  prevent  the 
onset  of  malignant  disease.  The  malignant  degenera- 
tion of  uterine  myomata  is  probably  commoner  than  is 
generally  supposed,  and  on  several  occasions  I  have 
removed  what  was  supposed  to  be  a  simple  myoma  of 
the  uterus,  and  found  a  sarcomatous  change  going  on. 
As  myoma  of  the  uterus  can  be  removed  by  hysterec- 
tomy with  very  small  risk,  I  make  it  a  rule,  whenever 
a  myoma  begins  to  enlarge  at  or  near  or  after  the 
menopause,  to  advise  its  removal ;  while  I  hold  with 
those  writers  who  recommend  the  removal  of  "  fibroids  " 
whenever  the  symptoms  of  haemorrhage,  pres- 
sure, or  pain  seriously  interfere  with  health  or  comfort. 
Surely,  it  is  better  to  accept  a  risk  of  2  to  3  per  cent., 
with  a  view  to  the  removal  of  a  disease  that  in  itself 
promises  to  endanger  life,  and  which  in  a  certain  per- 
centage of  cases  undergoes  a  malignant  change,  than 
to  have  to  operate  when  cancer  or  sarcoma  have 
already  developed,  and  when  the  risk  of  operation  will 
be  seriously  increased  and  the  chances  of  permanient 
cure  very  much  lessened. 

The  fact  that  malignant  disease  of  the  ovary  begins 
in  the  first  place  as  a  small  tumour  (often  cystic),  and 
that  cystic  disease  is  apt  to  undergo  malignant  degene- 
ration, affords  good  ground  for  recommending  opera- 
tion at  an  early  stage  in  the  case  of  any  ovarian  tumour, 
when  perchance  the  disease  may  be  caught  in  a  pre- 
cancerous condition  ;  or  should  malignant  disease  have 
already  commenced  it  will  be  limited  and  removable. 

The  Intestines. — ^Though,  on  account  of  its  inaccessi- 
bility to  direct  examination,  a  precancerous  condition 
is  difficult  to  diagnose  in  the  upper  intestines  generally, 
it  will  be  found  in  many  cases  that  there  have  been 
premonitory  symptoms  pointing  to  ulcer  or  colitis. 
Irregular  pains,  the  passage  of  mucus  or  blood,  and 
constipation,  possibly  alternating  with  diarrhoea,  should 
rouse  a  suspicion  of  organic  disease,  and  lead  to  a  careful 
physical  investigation  that  may  reveal  irregular  peri- 
stalsis or  possibly  a  tumour,  which,  even  if  not  caught 
in  the  precancerous  stage,  will  be  recognised,  and 
treated  in  the  incipient  and  curable  stage  of  cancer. 

Any  disease  high  up  in  the  rectum  or  in  the  lower  loop 
of  the  sigmoid  flexure  is  quite  out  of  reach  of  the  finger, 
and  cannot  be  palpated  through  the  abdominal  wall 
unless  of  considerable  size  ;  here,  as  a  rule,  disease  has 
had  to  be  diagnosed  by  symptoms  alone,  and  symptoms 
sufficiently  definite  to  warrant  exploration  only  come 
on  when  the  disease  has  passed  the  most  favourable  time 
for  radical  treatment.  Fortunately,  by  means  of  the 
electric  sigmoidscope  invented  by  Professor  Strauss, 
of  Berlin,  to  which  attention  was  drawn  by  Mr.  P.  L. 
Mummery,  a  clear  view  of  every  portion  of  the  inside 
of  the  bowel  may  be  obtained,  even  as  high  as  the  top 
of  the  sigmoid  flexure,  without  inconvenience  or  danger 
to  the  patient.  It  will  do  away  with  the  need  for 
exploratory  operations  in  this  region  for  mere  diagnostic 
purposes,  and  will  enable  disease  to  be  more  frequently 
removed  in  the  precancerous  condition. 

In  the  rectum  the  earlier  treatment  of  haemorrhoids 

and  ulcers  and  of  all  chronic  sources  of  irritation  ,^s 

obviously  rational  and  advisable,  and  may  sometimes  be 

the  means  of  preventing  the  onset  of  malignant  disease. 

Radical  Treatment  of  Cancer. 

By  the  radical  treatment  of  cancer  I  mean  the  entire 
removal  of  the  disease  at  an  early  period,  together  .with 
a  wide  margin  of  healthy  tissue,  and,  if  practicable,  the 
nearest  lymphatic  glands. 

In  estimating  what  may  be  done  for  cancer  by  radical 
treatment,  I  do  not  think  it  sufficient  simply  to  con- 
sider the  mortality  of  any  special  operation,  as  has  so 
often  been  done,  when  operative  success  was  used  as  a 
cloak  to  mask  therapeutic  failure,  but  I  want  to  know 
the  ultimate  results,  after  the  lapse  of  years,  of  opera- 
tions undertaken  at  an  early  stage  of  the  disease,  where 
the  cancer  had  been  freely  and  widely  excised.  Nor 
do  I  think  it  fair  to  surgery  to  average  the  statistics 
of  all  surgeons,  or  even  of  all  hospitals,  but  rather  to 
r.elect  the  statistics  of  operators  interested  in  special 
lines  of  work  who  can  show  w:hat  can  be  done  in  their 


own  particular  region.  The  levelling  process  shoaki. 
from  my  point  of  view,  he  a  levclling-up  to  the  best 
and  not  an  averaging  down  to  the  worst. 

Cancer  of  the  Breast. — In  my  experience  in  hosptul 
and  in  private  practice  I  can  point  to  a  very  large 
number  of  radical  mammary  operations,  and  I  ha\t 
been  astonished  to  find  how  many,  especially  of  tbc; 
private  cases  where,  through  the  Idndness  of  the  family 
physicians.  I  have  been  able  to  trace  the  after-historis. 
have  survived  beyond  the  three  years'  limit,  and  hor 
many  are  still  living  and  well  many  years  after  apoa- 
tion. 

Of  the  62  operations  I  have  done  in  private  pracnce 
for  cancer  of  the  breast,  there  was  no  operative  mrc- 
tality,  23  survived  the  three  years'  limit,  and  20  art 
now  alive  and  well  at  periods  up  to  twelve  years  after 
operation ;  5  died  from  other  diseases  without  re- 
currence of  cancer,  i  twenty  years  after  the  major 
operation,  28  had  recurrence,  though  in  8  it  was  ovg 
three  years  subsequent  to  operation  ;  8  could  not  br 
traced. 

My  early  operations  were  not  so  thorough  as  those 
done  in  later  years,  otherwise  I  feel  sure  that  the  re- 
currences  would  have  been  even  fewer. 

To  Dr.  Halstead,  of  Baltimore,  belongs  the  distiDc- 
tion  of  carrying  operations  for  cancer  of  the  breast  to 
their  widest  limits  at  the  Johns  Hopkins  Clinic,  of  whid 
the  following  is  a  brief  account  of  the  ultimate  result 
of  161  patients  admitted  with  operable  primary 
tumours  of  the  breast,  on  whom  complete  operations 
were  performed  between  June,  1889,  and  August.  1890 

In  August,  1902,  60  patients  were  living  and  cured 
7  had  lived  over  three  years  and  died  from  other  causes, 
and  2  had  died  from  other  causes  with  the  three  year 
limit,  autopsy  showing  no  signs  of  recurrence.  This 
gives  60  cases,  or  42*8  per  cent.,  positively  cured.  An 
analysis  of  the  161  patients  shows  that  83.  or  51'; 
per  cent.,  survived  the  three  year  limit. 

The  operations  performed  consisted  of  complete 
excision  of  the  breast,  both  pectoral  muscles  and 
axillary  contents  in  one  piece,  and  complete  excisios 
of  the  contents  of  the  supraclavicular  fossa.  During 
thirteen  years  305  patients  with  primary  and  38  with 
secondary  tumours  were  admitted  to  the  clinic,  and  of 
these  it  is  worth  noting  that  83,  or  27 '2  per  cent.,  were 
inoperable,  owing  to  delay  in  seeking  surgical  assistance. 
It  is  also  of  interest  to  note  that  in  no  case  was  local 
recurrence  or  internal  metastasis  observed  after  three 
years. 

Mr.  Bryant  has  recorded  from  his  own  experience  4^ 
cases  of  amputation  of  the  breast  for  cancer,  in  which 
the  patients  survived  the  primary  operation  from  fivr 
to  thirty- two  years. 

My  colleague,  Mr.  Watson  Cheyne.  adopting  a  mos: 
thorough  and  radical  operation  on  lines  similar  to  those 
of  Professor  Halsted,  shows  very  satisfactory  result*. 
He  says  that,  taking  the  average  of  all  cases  operated 
on,  favourable  or  otherwise,  something  like  50  per  cent, 
will  remain  well  for  a  number  of  years,  and  in  these 
leases,  in  which  the  tumour  is  small  and  well  limited. 
!  and  the  glandular  infection  is  slight,  the  proportion  ol 
i  successes  will  be  considerably  greater.  In  these  view> 
I  most  thoroughly  agree. 

Cancer  of  the  breast,  if  operated  on  early  and  with 
thoroughness,  is  by  no  means  the  incurable  disease  that 
many  still  think ;  in  a  very  large  percentage,  50  or 
more,  the  patients  may  look  for  over  three  years' 
respite ;  and  in  40  per  cent,  to  a  much  longer  period 
of  freedom,  and  many  to  a  genuine  cure 

Radical  Treatbient  of  Cancer  of  the  Stomach. 

It  was  only  in  1879  that  Pean  performed  his  first 
pylorectomy  for  cancer  of  the  stomach,  and  in  1881 
that  Billroth  did  the  first  successful  operation ;  before 
that  time,  and  long  after  by  many,  the  disease  was  held 
to  be  incurable.  At  first  sight  it  would  appear  to  be 
hopeless  to  expect  that  eradication  of  the  disease  could 
be  possible  in  an  organ  situated  as  the  stomach  is  and 
so  treely  supplied  with  blood  vessels  and  lymphatics; 
yet  a  careful  study  of  its  anatomy  shows  it  to  be  fixed 
only  at  the  cardiac  extremity,  and  with  the  exceptioo 
of  that  part  the  remainder  is  as  freely  accessible  for 


Dec,  7,  1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Piess.    597 


operative  purposes  as  the  intestines ;  moreover,  the 
disease  if  caught  early  can  be  completely  removed.  I 
can  point  to  a  number  of  patients  in  good  health  on 
whom  I  performed  partial  removal  of  the  stomach  years 
ago,  and  to  one  especially. 

A  man,  aet.  42.  from  whom  I  removed  the  whole 
stomach,  except  a  small  portion  of  the  dome  and  the 
cardiac  onfice,  four  years  ago.  He  was  reported  last 
month  to  be  robust  and  well,  to  be  able  to  take  quite 
ordinary  diet,  and  to  have  followed  his  business  without 
any  disability  from  within  two  months  of  his  operation 
up  to  the  present  time. 

In  another  case,  a  woman,  aet.  54,  a  partiargastrec- 
tomy  was  performed  at  the  same  time  as  removal  of 
the  gall-bladder,  both  organs  being  involved  in  cancer. 
She  remains  well  now  in  the  fifth  year  after  operation. 
In  another  case,  a  woman  of  50  remains  well  nearly 
four  years  after  the  removal  of  the  centre  of  a  cancerous 
hour-glass  stomach,  the  proximal  and  distal  healthy 
portions  having  been  joined  over  a  decalcified  bone 
bobbin. 

Whenever  a  patient  at  or  after  middle  age  complains 
somewhat  suddenly  of  indefinite  gastric  uneasiness, 
pain,  and  vomiting,  followed  by  progressive  loss  of 
weight  and  energy,  and  associated  with  anaemia,  the 
possibility  of  cancer  of  the  stomach  should  be  recog- 
nised, and  if  no  improvement  takes  place  in  a  few  weeks 
at  most,  an  exploratory  operation  is  more  than  justi- 
fied. Our  diagnosis  can  only  be  rendered  certain  by  a 
digital  examination,  which  may  be  effected  through  a 
small  incision  that  can.  if  needful,  be  made  under 
cocaine  anaesthesia  with  little,  if  any,  risk. 

Removal  at  any  early  stage  offers  good  prospects  of 
immediate  recovery  and  a  f^  probability  of  cure,  and 
excision  of  even  a  considerable  portion  of  the  stomach 
may  be  something  more  than  a  palliative  operation. 
Although  it  is  better  to  have  cancer  diagnosed  and 
operated  on  early,  yet  we  need  not  take  the  pessimistic 
view  that  if  a  tumour  be  manifest  it  is  too  late  to  per- 
form a  radical  operation. 

Cancer  of  the  Tongue. 
I  remember  as  a  student  seeing  a  number  of  removals 
of  the  tongue  by  the  6craseur,  there  being  no  question 
of  removal  of  the  glands  or  of  the  floor  of  the  mouth. 
In  nearly  every  case  recurrence  took  place  within  a  few 
months,  and  the  operation  was  falling  into  disfavour, 
when  Whiteheaid  invented  his  operation  of  removing 
the  tongue  widely  with  scissors,  and  Kocher's  opera- 
tion of  clearing  out  the  tongue,  floor  of  the  mouth, 
and  the  submaxillary  and  lymphatic  glands  also  came 
to  be  practised. 

These  operations  brought  a  marked  change,  and  it 
was  soon  found  that  a  good  percentage  of  patients 
operated  on  remained  free  from  disease  for  some  time, 
and  others  were  really  cured.  I  can  point  to  a  case, 
well,  seven  years  after  operation,  to  another  five  years, 
and  to  others  over  three  years,  and  it  is  of  interest  to 
note  that  in  these  cases  very  good  power  of  speech  is 
retained  by  the  patients. 

If  only  diseases  of  the  tongue  were  attacked  in  the 
precancerous  stage :  if  only  this  were  done  more  fre- 
quently, and  if,  even  when  cancer  had  develop«d,  time 
were  not  lost  in  dosing  patients  with  iodides  week  after 
-week  until  the  disease  has  extended  too  widely,  there 
would  be  a  much  brighter  tale  to  tell. 
Cancer  of  the  Larynx. 
What  could  at  first  sight  appear  more  hopeless  for 
radical  treatment  than  cancer  of  the  larynx,  which 
formerly  used  only  to  be  treated  palliatively  by  tracheo- 
tomy, later  was  removed  by  the  formidable  operation 
of  complete  laryngectomy  with  a  very  high  mortality, 
and,  lastly,  has  been  most  successfully  dealt  with, 
when  seen  early,  by  the  much  more  simple  operation 
of  th3nrotomy  and  removal  of  the  diseased  part,  as 
advocated  by  Mr.  H.  T.  Butlin  in  1889?  My  friend, 
Sir  Felix  Semon,  has  been  kind  enough  to  give  me  the 
statistics  of  his  thyrotomy  operations,  the  results  of 
which  are  remarkable,  and  which  prove  up  to  the  hilt 
the  special  point  which  I  want  to  insist  on  in  this 
lecture,  that  if  we  get  cancer  cases  sent  to  us  sufliciently 
early,  operation  is  not  merely  palliative,  but  curative. 


Radical  Operations  for  Cancer  of  the  Intestine. 
Intestinal  cancer  is  nearly  always  columnar-celled 
carcinoma,  and  even  when  it  has  advanced  to  a  fatal 
issue,  tne  disease  is  limited  to  the  gut  in  ov^  40  per 
cent,  of  cases.  I  believe  that  all  the  cases  in  which 
the-disease  is  limited  ought  to  be  capable  of  cure  by 
enterectomy  if  operated  on  early.  It  should  also  be 
borne  in  mmd  that  even  if  enlarged  glands  be  present 
it  does  not  necessarily  mean  that  they  are  cancerous, 
for  clinical  and  pathological  experience  has  shown  the 
contrary.  In  some  of  my  own  cases,  enterectomy, 
despite  the  presence  of  exUarged  glands,  has  resulted 
in  cure. 

In  all  chronic  ailments  associated  with  dyspepsia 
or  constipation  or  abdominad  pain,  a  careful  examina- 
tion of  the  abdomen  should  be  made  in  order  to  dis- 
cover disease  at  the  earliest  possible  moment,  for  to 
wait  until  obstruction  occurs  is  to  lose  the  favourable 
moment,  and  to  add  very  seriously  to  the  danger  of 
any  operation. 

In  operating  I  make  a  very  wide  sweep  of  the  disease, 
going  several  inches  beyond  the  growth  above  and 
below,  and  removing  the  lymphatics  and  glands  be- 
longing to  the  affected  parts  of  the  bowel  as  far  as 
possible.  Personally.  I  prefer  to  use  my  decalcified 
bone  bobbin,  but  I  have  employed  with  success  the 
simple  suture  and  the  Murphy  button,  though  I  still 
feel  that  by  means  of  the  bobbin  used  as  a  temporary 
splint  around  which  to  apply  sutures,  I  can  perform  a 
safer  operation  than  by  any  other  method. 
Cancer  of  the  Rectum. 
This  is  an  affection  that  of  all  others  lends  itself  to 
a  radical  cure,  for  it  can  be  recognised  early.  It  is  safe 
to  say  now  that  there  is  no  part  of  the  alimentary  canal 
that  cannot  be  reached  for  a  radical  operation,  for  even 
in  the  rectum  that  part  which  cannot  be  reached  from 
the  perinaeum  can  be  got  at  from  above  by  opening  the 
abdomen  with  the  patient  in  the  Trendelenberg  posi- 
tion, as  was  so  ably  demonstrated  by  my  friend.  Sir 
Charles  Ball,  from  this  chair  last  yeau* ;  and,  fortun- 
ately, there  need  be  no  doubt  about  the  nature  and 
extent  of  the  disease  in  this  region,  for  the  electric 
proctoscope  enables  the  lower  bowel  to  be  examined  by 
the  eye  without  difficulty  to  a  height  of  30  centimetres. 
Among  other  notable  examples  of  radical  cure,  I 
can  point  to  one  patient  living  in  perfect  health  and 
with  good  control  of  the  bowel,  from  whom  I  removed 
a  cancer  of  the  rectum  by  proctectomy  twelve  years 
ago-^  to  another,  eight  years ;  and  to  others  who  are 
well  and  enjoying  life  several  years  after  operation. 
Cancer  of  the  Gaix-Bladder  and  Liver. 
If  the  fe,vourable  precancerous  period  has  passed, 
and  malignant  diseaise  has  actually  supervened,  can 
anything  be  done  for  the  sufferers  ? 

At  first  sight  it  would  appear  that  cancer  of  the  gall- 
bladder is  an  utterly  hopeless  disease,  especially  when 
it  has  extendea  to  the  liver.  I  have,  however,  operated 
on  12  cases  of  cancer  of  the  gall-bladder,  and  in  11  the 
disease  extended  to  the  liver,  forming  the  tumour  of 
some  sixe  Of  these  12  cases  10  recovered  from  the 
operation  and  lived  for  varying  periods.  Five  of  these 
patients  are  at  the  present  time  alive  amd  in  good 
health  at  periods  of  si,  5,  4^,  4,  and  ij  years  respec- 
tively subsequent  to  operation.  These  were  cases  of 
primary  cancer  of  the  ^all-bladder  due  to  the  irritation 
of  gall-stones,  aoid  the  fiver  growth  was  due  to  extension 
by  continuity,  not  to  secondary  deposits  in  that  organ. 
In  one  caise  I  was  able  to  remove  as  much  as  hsdf  a 
pound  of  the  liver  with  success. 

Cancer  of  the  Lip. — Even  if  the  precancerous  stage 
has  passed,  a  free  removal  of  the  disease  at  an  early 
stage  and  while  it  is  still  local  enables  a  very  good 
prognosis  to  be  given. 

Cancer  of  the  Penis. — In  epithelioma  of  the  penis 
amputation  yields  a  cure  in  one-third  of  the  cases 
operated  on. 

Cancer  of  the  Uterus. — Much  may  be  done  to  prevent 
this  dread  disease  by  careful  surgical  treatment,  and 
that  without  risk.  Even  when  the  precancerous  stage 
is  passed,  if  women  could  be  educated  to  the  fact  that 
were  they  to  seek  advice  earher,  and,  in  fact,  whenever  . 


59^    Tbx  Medical  Psbss. 


CLINICAL    RECORDS. 


Dec.  7.  1904. 


an  abnormal  sanguineous  discharge  appears,  apart  from 
a  menstrual  period,  in  a  very  large  percentage  of  cases 
the  cancer  would  be  recognised  in  its  incipient  con- 
dition when  the  disease  is  local,  and  removal  could  be 
carried  out  and  cure  effected. 

It  seems  to  be  most  desirable  that  some  crus€ide 
against  the  neglect  of  the  well-known  early  symptoms 
of  uterine  cancer  should  be  undertaken,  and  that 
women  should  be  warned  how  important  it  is  for  them 
to  consult  their  medical  attendants  at  an  early  stage, 
when,  in  case  of  doubt,  a  small  piece  of  tissue  can  easily 
be  removed  and  examined  microscopically. 

In  conclusion,  Mr.  Robson  remarked  that  his  purpose 
would  have  been  served  if  he  had  been  able,  in  however 
small  a  degree,  to  convince  those  who  had.  the  chance 
of  seeing  patients  in  the  early  stages  of  their  illness, 
that  in  many  cases  cancer  could  be  prevented  by  treat- 
ment in  the  precancerous  stage ;  that  even  when 
cancer  had  developed,  if  it  were  seen  early  and  tho- 
roughly removed,  it  was  frequently  a  curable  disease  ; 
and,  lastly,  that  even  in  the  later  stages  much  might 
be  done  by  surgical  treatment  to  give  real  relief. 

Was  it  too  much  to  hope,  he  asked,  that  some  of  the 
views  he  had  enunciated  might  filter  through  the  pro- 
fession to  the  public,  and  serve  to  convince  them  that 
until  a  true  prophylactic  for  cancer  was  discovered, 
they  would  be  consulting  their  own  interests  best  by 
seeking  medical  advice  earlier,  since  to  trifle  with  their 
ailments  in  the  early  stages  was  to  lose  the  favourable 
moment  and  ultimately  to  hear  the  verdict — ^alas,  too 
often  pronounced — too  late  ! 


Royal  Free  Hospital. 

The  following  scholarships  have  been  awarded  at 
the  London  (Royal  Free  Hospital)  School  of  Medicine 
for  Women :  St.  Duns  tan's  Medical  Exhibition  of  £60 
for  five  years  to  M.  Muncey,  the  School  Schoarship  of 
£^0  to  E.  M.  Morris,  two  Mackey  prizes  of  jf  20  each 
to  E.  Griffiths  and  E.  H.  Lepper,  the  Fanny  Butler 
Scholarship  of  lij^  los.  to  G.  M.  Stagg. 

Mater  Mlserlcordls  Hospital,  Dublin. 

At  a  meeting  last  week  of  the  Medical  Board  of  the 
Mater  Misericordiae  Hospital,  the  following  appoint- 
ments were  made  :  — Temporary  Assistant  Surgeon. 
Mr.  Denis  Keane,  M.B.,  B.Ch..  B.A.O.R.U.I.  ; 
House  Physicians,  Drs.  Thomas  Barry,  M.B.,  B.Ch., 
B.A.O.R.U.I.,  and  William  L.  Murphy.  B.A.Cantab., 
L.R.C.P.I.,  L.R.C.S.I.  ;  House  Surgeons,  Messrs. 
Thomas  Cronin,  M.B..  B.Ch.,  B.A.O.R.U.I.,  Richard 
Flood,  M.B.,  B.Ch.,  B.A.O.R.U.I..  and  Michael 
Keane,  L.R.C.P.I.,  L.R.C.S.I. 

St.  Thomas's  Hospital. 

The  following  have  been  selected  as  House  Officers 
from  yesterday  (Tuesday) : — Resident  House  Phy- 
sicians :—B.  Higham.  M.R.C.S.,  L.R.C.P.  (Extension); 
W.  Haward,  M.B.,  B.S.Durh.,  M.R.C.S.,  L.R.C.P. 
(Extension)  ;  A.  G.  Gibson,  B.A.,  M.B.,  B.Ch.Oxon., 
B.Sc.Lond.  ;  K.  Takaki,  M.R.C.S..  L.R.C.P.  House 
Physicians  to  Out-patients  :— R.  E.  Whitting.  M.A., 
M.B.,  B.C.Cantab.  ;  F.  A.  Brodribb,  M.R.C.S.. 
L.R.C.P.  Resident  House  Surgeons  :—H.  S.  Bennett, 
M.R.C.S..  L.R.C.P.  ;  N.  C.  Carver,  B.A.,  B.C.Cantab., 
M.R.C.S..  L.R.C.P.  ;  A.  C.  Birt,  M.R.C.S.,  L.R.CP.  ; 
G.  T.  Birks,  M.A.,  M.B.,  B.C.Cantab.  House  Surgeons 
to  Out-patients  :— H.  A.  Kisch,  M.R-.C.S.,  L.R.C.P.  ; 
G.  R.  Footner,  B.A.Cantab.,  M.R.C.S.,  L.R.C.P.  ; 
R.  E.  G.  Gray,  M.A.Cantab.,  M.R.C.S.,  L.R.C.P.  ; 
J.  C.  F.  De  Vaughan.  M.R.C.S..  L.R.C.P.  (Extension), 
Obst.  House  Phys.  :— (Senior)  H.  I.  Pinches.  M.A. 
M.B.,  B.C.Cantab.,  M.R.C.S..  L.R.C.P.;  (Junior) 
E.  W.  Parry,  M.R.C.S..  L.R.C.P.  Ophthalmic  House 
Surgeons ;  —  (Senior)  H.  S.  Stannus.  M.B.Lond.. 
M.R.C.S..  L.R.C.P.  ;  (Junior)  A.  B.  Bradford,  M.B., 
B.S.Durh.,  M.R.C.S.,  L.R.C.P.  Throat  Department  • 
— C.  N.  Sears.  M.B..  B.S.Lond..  M.R.C.S.,  L.R.C.P. : 
D.  K.  Coutts.  M.R.C.S.,  L.R.C.P.  Skin  Department  — 
W.  L.  Harnett,  M.A.,  M.B.,  B.C.Cantab.,  M.R.C.S., 
L.R.C.P.  (Extension) ;  F.  M.  Bulley,  B.A.Cantab., 
M.R.C.S.,  L.R.C.P.  (Extension) ;  Ear  Department  :— 
T.  Guthrie,  M.A..  M.B.,  B.C.Cantab.,  M.R.C.S.. 
L.R.C.P.  (Extension);  L.  E.  C.  Norbury.  M.R.C.S 
LRCP 


Clinical  IRecords* 


ROTUNDA  HOSPITAL.  DUBLIN. 

A  Case  of  Ctesarean  Section. 

Performed  by  E.  Hastings  Tweedy,  M.D.,  &c.. 

MMter  of  the  BotaikLa  HiMpiUL 

[Recorded  by  A.  N.  Holmes.  M.B..,  B.Ch..  B.A.O.Uni%-. 
Dub.,  and  L.M..  Assistant  Master.  Rotunda  Hospital/ 

In  view  of  the  fact  that  Caesarean  section  is  so  great 
a  rarity  in  this  country,  it  may  prove  of  interest  to  chf 
the  following  case,  which  occurred  recently  in  th« 
Rotunda  Hospital. 

A.  O'R.,  primipara,  xt.  29,  was  admitted  to  tbr 
hospital  on  Sunday  evening.  November  6th.  at  8  p.&: 
She  was  a  very  small  woman,  her  height  being  4  ft.  3  in. 
and  her  limbs  and  pelvis  presented  wi^-markBd 
rachitic  deformity. 

On  inquiry  she  stated  that,  as  far  as  she  knew.  ^ 
was  up  to  full  term,  and,  further,  that  the  membrace 
had  ruptured  several  hours > before  she  came  into  hoc- 
pi  tal.     She  was  not  having  any  pains. 

On  inspection,  there  was  seen  a  prominent  tumoo: 
over  the  symphysis  pubis,  which  palpation  proved  to  be 
the  head,  freely  movable.  Foetal  movements  'were  also  j 
felt  and  the  heart  heard.  A  vaginal  examination  «a$ 
made  and  the  promontory  felt  with  the  greatest  ease 
low  down,  and  the  os,  which  was  high  up,  admitted  o» 
finger.  Pelvimetry  was  at  once  done,  and  the  foOov- 
ing  measurements  obtained  : — Conjugata  vera,  6  cms. ; 
transverse,  11  cms.;  interspinous.  25  cms.;  intcr- 
cristal,  24'8  cms.;  extern,  conjugata.  1/  cms. 

On  finding  these,  Cesarean  section  presented  itself 
as  the  only  means  of  delivery.  As  the  patient  shoired 
no  signs  of  labour,  the  following  morning  at  10.30  a.m. 
was  hxed  on  for  operation  should  no  indications  for 
earlier  interference  arise. 

In  the  morning  the  patient  had  one    or  two  slight 
pains      about     9.30      a.m.        At      10.30      a.m.,     the 
master.      Dr.     Hastings     Tweedy,      assisted     by    Sir 
Arthur     Macan     and     the     two      assistant     masters, 
opened  the  abdomen  by   a    six-inch    incision,  having 
the  umbilicus  as  centre.     An  assistant  kept  the  incisea 
wound  in  close  apposition  to     the    uterus    to    guard 
against  the  possibility  of  fluid  entering  the  abdominal 
cavity.     The  uterus  was  now  rapidly  laid  0|>en  b\-  a 
five-inch  incision  along  the  interior  aspect  of  the  upi>er 
uterine  segment.     In  doing  this  the  placenta  was  en- 
countered and  occasioned  smart  hsemorrhage.     ^^'itll- 
out  making  any  effort  to  control  this,  a  limb  was  seized 
by  the  hand  and  the  foetus  having  been  rapidly  re- 
moved, was  handed  over  to  the  care  of  an  assistant. 
The  uterus  with  its  contained   after-birth,   was  now 
delivered   from    the   abdominal    cavity,    and   all   the 
haemorrhage  from    it   controlled   by   the  hand  of  an 
assistant    tightly    compressing     the     cervical    region- 
Another  assistant  temporarily  closed  the  upper  part  of 
the  abdominal  incision  by  means  of  a  bnllet  forceps, 
whilst  a  moist  sterihsed  towel   protected    the  uterus 
from   the   skin.     During   the   progress    of    these  pro- 
cedures, the  master  was  engaged  in  detaching  the  after- 
birth, and  it  was  curious  to  note  the  rapid  and  marked 
thickening  of  the  muscle,  which  took  place  despite  the 
absence  ot  uterine  contraction,  a  proof  of  the  independ- 
ence of  the  processes  "  contraction  "  and  "  retraction." 
The  uterine  wound  was  now  stitched  in  a  careful 
and   deliberate   manner   with    No.    3    antiseptic  silk 
interrupted  sutures.     These  were  placed  at  close  in- 
tervals and  were  not  drawn  too  tightly.     A  tear  had 
taken  place  during  the  extraction  of  the  child,  which 
extended  some  distance  from  the  original  incision  and 
required  more  than  ordinary  care  in  its  closure.    The 
uterus  contracted  well,  stimulated  by  hot  towels,  and 
the  abdomen  was  closed  in  three  layers — ^peritoneal 
fascial  of  continuous  silk,  and  a  subcuticular  cutaneous 
of  silkworm-gut.     Throughout    the  operation  rubber 
gloves  were  worn  by  all. 

The  puerperium  has  been  quite  uneventful.  The 
suture  was  removed  on  the  fourteenth  day.  lea\'ing  a 
perfectly  healthy  scar,  and  the  patient  has  been  able 
to  nurse  her  baby  from  the  third  day. 


r>Ec. 


1Q04. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Pee3s.    599 


ZTtansacttons  Of  Societies. 


ROYAL  !\CADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  Pathology. 
^l££ting  held  november  25th,   i9o4. 

The   President,   H.   C.    Earl,   in   the   Chair. 


The  President  exhibited  a  small  "  Villous  Tjmour 

OF  .THE  B-ADDER." 

■A     CASE    OF    ACUTE    YELLOW    ATROPHY    OF    THE    LIVER. 

Dr.  W.  J.  Thompson  stated  that  E.  B.  was  admitted 
to  Jervis  Street  Hospital  on  August  24th.  1904,  a  few 
weeks  alter  her  confinement,  and  suffering  from  jaun- 
-dice  one  week.  She  was  jet,  2y,  married  six  years,  had 
three  children  ;  her  family  and  personal  history  were 
^ood  :  had  a  hard  life  and  lived  in  a  tenement  house  in 
a  congested  part  of  the  city.  On  admission,  case 
seemed  an  ordinary  catarrhal  one  ;  no  enlargements 
of  liver,  all  the  organs  normal,  urine  contained  a  slight 
■trace  of  albumin.  She  seemed  to  improve  the  first 
Aveek,  but  got  worse  during  the  second  week.  Nausea 
became  almost  constant  and  acute  ;  sharp,  spasmodic 
pains  in  liver  became  severe.  During  third  week  liver 
-dulness  greatly  diminished.  Leucin  and  tyrosin  were 
■detected  in  the  urine,  and  at  same  time  urea  was 
diminished.  At  end  of  third  week  severe  nervous  and 
-cerebral  symptoms  developed  and  she  died  three  days 
afterwards,  four  and  a  half  weeks  after  first  sign  of 
jaundice.  At  the  post-mortem  examination  the  liver 
was  found  to  be  small  and  soft,  and  only  weighed 
29  oz.  All  the  abdominal  organs  were  in  a  healthy 
condition,  save  for  a  small  ovarian  cyst.  The  clinical 
points  of  interest  are  :  ( i )  The  protracted  length  of 
the  attack,  four  and  a  half  weeks;  (2)  the  acute, 
spasmodic,  and  agonising  liver  pains  ;  (3)  no  haemor- 
rhagic  manifestations. 

Prof.  E,  J.  McWehney  then  described  the  character 
of  the  specimen  as  follows :  Liver  weighing  29  oz., 
small,  very  soft  and  pulpy ;  capsule  wrinlded.  pale 
red  with  yellowish  mottlings.  On  section,  mostly 
reddish  with  bright  yellow  patches,  lobular  marking 
obliterated.  Dimensions  of  right  lobe,  6  in.  from  side 
to  side,  5i  in.  from  before  backwards,  ij-in.  thick. 
The  left  lobe  was  at  most  only  half  an  inch  thick. 
Oall-bladder  normal.  The  microscopic  examination 
was  ma.de  by  means  of  teased  preparations,  frozen  and 
paraffin  sections.  It  showed  complete  necrosis  of  the 
liver  cells ;  patches  of  round-cell  infiltration,  which 
still  preserved  their  nuclear  staining  ;  patchy  pigmen- 
tation of  the  liver  cells  with  yellow  granular  matter 
which  did  not  give  an  iron reiction  (bile) ;  moderate  fatty 
degeneration ;  and  the  presence  of  minute,  yellowish- 
brown  globular  concretions  in  groups  and  rows.  These 
were  very  abundant  in  the  tissue,  and  varied  from 
1 2tt  to  30.M  in  diameter.  Some  of  them  seemed  radially 
•cleft,  others  were  coated  with  a  prickly  layer  of  minute 
needle-shaped  crystals,  whilst  others  presented  obscure 
concentric  striation.  There  were  also  minute  colourless 
acicular  crystals  lying  singly  and  in  sheaves.  These 
•objects  were  doubtless  crystals  of  leucin  and  tyrosin. 
The  globules  were  soluble  in  alkalies  and  weak  H2SO4  ; 
msoluDle  in  ether,  alcohol,  and  chloroform  ;  partly 
soluble  in  water.  A  few  bacilli  were  demonstrable  on  the  I 
•sections,  and  of  the  numerous  culture-tubes  inoculated,  j 
a  few  showed  colonies.  Study  of  the  organisms,  how-  1 
ever,  convinced  him  that  they  were  merely  ordinary  ! 
putrefactive  germs.  I 

Prof.  O'SuLLiVAN  said  he  remembered  one  case  of 
the  kind,  which  belonged  to  Dr.  Wallace  Beatty.  He  1 
had  some  sections  of  it  which  resembled  those  shown  ! 
-considerably,  but  his  were  more  advanced.  He  was 
not  sure  that  he  would  have  taken  Prof.  McWeeney's 
view  of  the  condition  of  the  liver  cells,  as  he  did  not 
think  the  process  was  very  far  advanced.  There  was 
certainly  not  so  much  disintegration  shown  in  the 
sections  as  in  those  of  the  case  in  his  possession.  The 
process  seemed  to  be  starting  from  the  heptic  veins, 
the  portal  areas  being  less  affected.  I 

The  President  had  seen  portions  of  a  liver  from  an  | 
undoubted  case  of  this  disease.     There  was  a  large 


portion  of  the  right  lobe  involved,  and  on  section  of 
this,  more  than  half  the  affected  portion  was  a  brilliant 
red  colour,  and  the  rest  an  equally  brilliant  yellow.  In 
the  red  area  the  liver  cells  had  disappeared,  and  in  the 
portal  canals  there  was  small  round  cell  infiltration. 
In  the  yellow  areas  were  cells  which  looked  absolutely 
normal.  He  was  surprised  at  the  small  amount  of  fat 
he  found  in  the  cells.  He  noticed  in  some  parts  of  the 
yellow  areas,  where  they  bordered  on  the  red,  that  the 
centres  of  the  lobules  were  certainly  more  affected  than 
the  margins.  The  process  seemed  to  be  progressing 
from  the  centre  of  the  lobule  to  the  periphery. 

Prof.  McWeeney,  in  replying,  said  he  considered 
that  the  cells  were  completely  necrotic,  though  their 
outlines  were  preserved.  They  did  not  give  the  ordi- 
nary nuclear  stain.  The  protoplasm  had  stained  dif- 
fusely with  haematoxylin  stain.  .  The  preparations 
showed  no  well-pr.eserved  liver  cells.  The  yellow  pig- 
mentation was  well  marked  in  one  of  the  sections.  The 
bacteriology  of  these  cases  was  very  interesting,  because 
it  was  verj"  important  to  eliminate  the  theory  of  living 
bacteria.  The  generally  accepted  theory  was  that  it 
was  due  to  toxins.  He  had  set  going  a  number  of 
aerobic  and  anaerobic  cultures,  but  the  material  was 
not  perfectly  fresh.  The  anaerobic  tubes  remained 
I  sterile,  and  the  aerobic  showed  some  small  white  colo- 
I  nies  which  he  considered  unimportant.  He  cut  some 
sections  in  paraffin,  and  found  an  occasional,  bacillus, 
which  he  thought  were  ordinary  putrefactive  organisms. 
He  thought  the  toxaemia  theory  still  held  the  field. 
glanders. 
The  Secretary  (for  Dr.  E.  F.  Stephenson)  read 
notes  of  a  fatal  case  of  "  Glanders  in  a  Man." 

Mr.  Story  and  the  President  exhibited  a  "  Glioma 
of  the  Retina,"  with  microscopic  sections. 

GLIOMA    OF    retina. 

Dr.  MooNEY  exhibited  a  specimen  which  was  a  right 
eye  removed  from  a  female  child,  aet.  3,  for  glioma  retinae. 
Four  months  l?efore  admission  to  the  Children's  Hospi- 
tal, Temple  Street,  the  eye  squinted,  and  for  four  weeks 
the  pupil  had  been  white  and  eye  blind.  The  eye  showed 
no  irritation,  nor  was  there  pain,  although  the  tension 
equalled  +  2.  No  proptosis.  Microscopically,  the 
tumour  showed  usual  appearances,  much  of  it  being 
necrotic  and  fluid,  with  spots  of  hyaline  degeneration. 
The  optic  nerve  was  wholly  invaded  by  gliomatous 
cells  up  to  point  of  section,  only  the  fibrous  trabecular 
remaining. 

prof.  McWsENEV  said  he  never  saw  a  prettier 
example  of  infiltration  of  the  optic  nerve.  The  resem- 
blance between  the  cells  of  the  tumour  and  the  nuclear 
cells  of  the  retina  was  very  striking.  He  agreed  as  to 
the  rarity  of  finding  tubes  lined  with  epithelium. 
These  tumours,  when  not  necrotic,  were  formed  of  small, 
round  nuclei,  broken  up  here  and  there  by  patches  of 
necrosis.  In  Dr.<Mooney  s  case  patches  of  hyaline  de- 
generation could  be  seen.  It  was  not  so  well  marked 
in  Dr.  Earl's  case. 

Prof.  O'SuLLiVAN  thoight  the  resemblance  to  angio- 
sarcoma was  due  to  the  fact  that  the  cells  in  theneig  - 
bourhood  of  the  vessels  were  well  nourished,  while 
those  away  from  them  were  not  and  therefore  became 
necrotic.  This  should  be  borne  in  mind  in  examining 
all  cases  of  angio-sarcoma.  The  cells  thus  seemed  to 
exist  as  tubes  round  the  vessels. 

Dr.  MooNEY,  in  replying,  said  he  had  omitted  to 
mention- that  there  were  some  calcareous  spots  in  his 
specimen. 

-  The  President,  in  replying,  said  he  agreed  with  Prof. 
O'Sulli/an  as  to  necrosis  occurring  in  those  cells  which 
were  far  away  from  the  vessels. 

H-'EMATOLOGICAL   OBSERVATIONS    ON    A   CASE   OF 
MYEL^MIA. 

Prof.  E.  J.  McWeeney  described  this  case,  and 
exhibited  the  spleen  and  bone-marrow,  as  well  as 
numerous  blood-slides  and  sections  of  the  various 
organs.  The  patient  was  a  man,  aet.  41.  an  inmate  of 
MuUingar  District  Asylum  for  the  past  six  years, 
suffering  from  paranoia  with  hallucinations  and  delu- 
sions. After  four  years  of  good  bodily  health  he  began 
to  lose  weight  and  became  unable  to  work.     A  larg- 


600    Tbx  Medical  Pkess. 


TRANSACTIONS   OP  SOCIETIES. 


Dec.  7.  1904. 


abdominal  tumour  was  then  discovered  and  recodified 
to  be  the  hvgely  enlarged  spleen.  Blood  counts  3nelded 
reds,  3,680,000,  and  whites,  450,000.  Despite  rest  in 
bed,  good  food,  and  open  air,  he  became  steadily  weaker. 
There  was  slight  fever.  Anxmic  symptoms  never  pro- 
minent, and  haemorrhages  did  not  supervene  till  a  few 
days  before  death,  when  he  suffered  from  epistaxis  and 
hsmorrhagic  effusion  into  subcutaneous  tissue  of  right 
thorax.  The  duration  of  the  case  from  the  discovery 
of  the  splenic  tumour  was  fourteen  months.  The 
autopsy  revealed  the  following  chief  points  :  Enormous 
enlargement  of  the  spleen,  which  weighed  145  oz.,  was 
firm,  dark  red  and  homogeneous  on  section,  and  pre- 
sented neither  hemorrhages,  infarcts,  nor  whitish  in- 
filtrations. Marrow  of  long  bones  pink,  fleshy,  vascu- 
lar, completely  altered  from  its  normal  fatty  state. 
Superficial  lymph-glands  not  enlarged.  Of  the  internal 
ones,  the  bronchial,  omental,  mesenteric,  and  cceliac 
were  sightly  enlarged.  There  was  slight  obsolete 
tubercle  in  both  apices.  The  liver  weighed  13802., 
but  showed  no  macroscopic  change  beyond  slight  nut- 
meg discoloration  and  marked  hyperemia.  No  leu- 
kemic infiltration  in  any  of  the  organs.  The  results 
of  the  histological  examination  were  then  given.  Blood - 
films  taken  shortly  before  death  showed  :  Polymorphs. 
35  percent.  ;  myelocytes,  45  per  cent. ;  transitionals, 
3*5  per  cent. ;  small  lymphocytes,  2  per  cent ;  eosino- 
philes,  poly  and  mononuclear,  14*5  percent.  A  certain 
number  of  mast-cells  were  seen,  and  polymorphs  with 
mitotic  nuclei  were  readily  found  in  the  peripheral  blood. 
Marrow  films  revealed  giant-cells,  myelocytes,  eosino- 
philes  of  both  kinds,  large  and  small  hyaline  mono- 
nuclear and  normoblasts  in  varying  proportions. 
Megaloblasts  were  very  few,  and  that  class  ot  cell  was 
represented  by  forms  with  nucleus  and  discoplasm  of 
megaloblastic  type,  but  smalier  than  an  ordinary  red 
corpuscle.  The  speaker  expressed  his  deep  sense  of 
obligation  to  Dr.  A.  Finegan,  Resident  Medical  Superin- 
tendent of  Mullingar  Asylum,  for  permission  to  bring 
the  case  forward,  and  to  Dr.  W.  S.  Gordon,  Assistant 
Medical  Officer,  for  the  very  full  clinical  notes  of  the 
case. 

Prof.  White  said  that  the  point  which  interested 
him  most  was  the  section  which  showed  what  was 
probably  mitosis.  He  was  convinced  of  the  fact  that 
mitoses  did  occur  in  the  circulating  blood  under  certain 
conditions* 

Prof.  O'SuLLiVAN  suggested  the  possibility  that  the 
giant-cells  in  the  liver  capillaries  might  have  been 
marrow  cells  carried  there. 

Prof.  McWeenev,  in  replying,  said  that  the  giant - 
cells  were  products  of  the  endothelium. 


NORTH     OF    ENGLAND     OBSTETRIC  AT-     AND 

GYNiECOLOGICAL  SOCIETY. 
Meeting  held  at  Sheffield,  November  iSth,  1904. 


Dr.  R.  Favell,  Vice-President,  in  the  Chair. 


The  Society  passed  a  unanimous  vote  of  hearty  con- 
gratulation to  the  President,  Sir  William  Japp  Sinclair, 
on  the  honour  recently  conferred  upon  him  by  H.  M. 
the  King. 

Dr.  J.  B.  Hellier,  whilst  showing  a  myomatous 
uterus  removed  by  abdominal  hysterectomy,  men- 
tioned that  although  the  operation  presented  no  diffi- 
culty and  the  patient  made  a  good  recovery,  without 
any  suppuration,  an  interesting  complication  occurred 
on  the  second  morning  after  operation.  The  tempera- 
ture rose  to  ioo'6*,  and  the  pulse  to  140 ;  there  was 
acute  abdominal  pain  with  distention  and  hiccough, 
and  a  turpentine  enema  brought  no  relief.  The  dis- 
tension was  chiefly  at  the  upper  part  of  the  abdomen, 
and  it  was  therefore  decided  to  wash  out  the  stomach. 
On  passing  the  stomach  tube  there  was  an  immediate 
escape  of  gas,  a  large  quantity  of  mucus  was  removed, 
and  imm^iate  relief  was  obtained.  The  lavage  was 
repeated  in  the  evening,  and  the  symptoms  abated 
from  this  time. 


Dr.  J.  E.  Gbmmell  (Liverpool}  read  a  short  paper  on 
a  case  of 

CESAREAN  SECTION  FOR  MYASTHENIA  GRAVIS. 

The  case  had  been  referred  to  him  by  Dr.  W.  B, 
Warrington.  Physician  to  the  Northern  Hospital,  vho 
had  described  it  from  the  physician's  point  ci  vicv  m 
the  Medical  Chronicle  for  April,  i$K>4.  Dr.  GenuDeQ 
remarked  that  the  dinical  feature  of  the  disease  is 
muscular  weakness  of  some  or  all  of  the  voluntary 
muscles,  sometimes  amounting  to  paralysis.  After  a 
prolonged  rest  these  same  muscles  may  respond,  to  the 
will,  but  they  again  become  rapidly  exbaasted.  Sooi 
after  the  patient's  admission  to  the  Northern  Hosptul. 
it  was  found  that  she  was  pregnant,  and  that  as  tbe 
pregnancy  advanced  the  disease  became  worse,  imtfl 
physical  exertion  of  the  slightest  kind  produced  the 
greatest  exhaustion  and  led  to  the  onset  of  aiarmisf 
dyspnoea.  Labour  was  expected  about  October  20th,' 
and  the  patient  was  admitted  to  the  Lying-in  Ho^ma! 
on  October  15  th.  During  the  first  twenty-four  honn 
she  had  four  attacks  of  d3r8pnoea.  each  lasting  frvr 
minutes,  whilst  for  the  first  forty-eight  boors  she 
scarcely  slept  at  all.  Dr.  Warrington  had  pointed 
out  that  if  the  patient  did  not  saccumb  dannf 
the  first  stage  of  labour,  attempt  at  the  use  of  the 
secondary  powers  in  the  following  stage  wcmU 
almost  certainly  bring  on  a  fatal  attack  of  dyspnoea. 
Dr.  Gemmell  decided  to  await  the  advent  of  laoonr  and 
act  as  occasion  might  require.  However,  the  dyspfupa 
increased  in  gravity,  and  on  October  i^th,  it  wais  fooad 
that  the  only  respiratory  movements  were  those  asso- 
ciated with  hiccough.  Cesarean  section,  as  the 
speediest  means  of  deUvering  the  patient,  was  decided 
upon.  The  operation  was  rapidly  carried  out  witbos: 
any  difficulty,  and  was  followed  by  nnintemipted 
recovery  and  gradual  improvement  of  the'  respiratorr 
symptoms.  Dr.  Gemmell  remarked  that  he  had  bees 
unable  to  find  any  reference  to  the  effect  of  partuntioo 
in  advanced  cases  similar  to  this  one.  One  patienr 
with  ocular  paralysis  became  pregnant  and  became 
practically  well  of  the  paralyses.  Another  developed 
the  disease  when  six  months  pregnant,  improved,  aod 
then  is  recorded  as  a  typical  case  three  years  later. 

Prof.  Arthur  J.  Hall  (Sheffield)  thought  that  the 
right  and  proper  treatment  had  been  carried  out.  and 
remarked  that  such  an  event  as  Caesarean  section  was 
probably  unique  in  the  annals  of  myasthenia  gram 
He  referred  to  the  rarity  of  cases  of  this  disease,  and 
to  the  constancy  with  which  they  were  usoally  dia- 
gnosed as  hysteria  in  their  earUer  stages,  chiefly 
because  of  the  extreme  variability  of  the  symptoms 
from  day  to  day,  or  even  from  hour  to  hour.  In  a  fatal 
case  of  the  disease  which  he  had  recorded  a  few  ytui 
ago  in  Brain,  this  variability  was  a  striking  featore: 
at  one  time  the  patient  would  walk  fairly  well,  at 
another  she  would  hardly  be  able  to  stand.  After  a 
sleep  she  would  be  able  to  speak  clearly  and  to  opei 
the  eyes  .widely,  whilst  as  the  day  went  on,  her  voice 
would  become  nasal  and  there  would  be  marked  ptosb. 
Even  the  sudden  death  of  the  patient  from  respiratory 
failure  followed  a  day  after  she  had  seemed  bettff 
than  she  had  been  for  weeks. 

After  further  discussion.  Dr.  Gemmbll  said  that  tJie 
anaesthetic  employed  had  been  chloroform,  verv  little 
being  required.  If  such  a  case  had  been  met  with  la 
the  earlier  stages  of  pregnancy,  it  would  have  bees 
proper  treatment  to  cut  short  the  gestation. 

Dr.  John  W.  Martin  (Sheffield)  read  notes  of  a  case 
of 

DOUBLE   OVARIAN   PAPILLOMATOUS    CYSTIC   TUMOrRS. 

with  a  large  fibroid  springing  from  the  fundus  uteri 
The  points  of  interest  were  :  ( i )  There  was  not  much 
ascitic  fluid  found  on  opening  the  abdomen :  {2)  the 
ovarian  tumours  followed  the  ordinary  rule  in  being 
bilateral ;  (3)  the  right  ovary  was  as  large  as  any 
ordinary  cystic  adenoma  of  the  ovary,  papillomatoos 
tumours  as  usually  described  being  smaller.  {4) 
there  was  no  peritoneal  infection,  although  the  papiBo- 
matous  growth  had  penetrated  the  wall  of  the  nght- 
sided'tumour. 


Dec. 


1904. 


TRANSACTIONS   OF   SOCIETIES.       Tbb  Uuvkal  Pmist.    60Z 


Dr.  Lloyd  Roberts  commented  on  the  absence  of 
ascites  and  on  the  question  of  malignancy. 

Dr.  Gemmell  remarked  on  the  frequency  with  which 
ovarian  new  growths  and  inflammatory  conditions 
oomplicated  fibroids  of  the  nterus. 

Dr.  Percival  Barber  (Sheffield)  read  notes  of  the 
following  cases  :— (i)  Fibroma  of  the  Abdominal  Wall, 
-which  was  removed  from  a  woman,  st.  37.  In  the 
9pace  of  three  months  it  had  increased  from  the  sise  of 
a.  small  nut  to  a  lump  measuring  2|  by  ij-  inches.  It 
inras  situated  about  two  fingers'  breadth  internal  to  the 
right  anterior  superior  iliac  spine.  Removal  was  easy. 
(2)  Ectopic  Gestation.  (3)  Rupture  of  Uterus,  which 
occurred  in  a  very  obese  woman,  act.  32,  who  was  sent 
into  the  Jessop  Hospital  after  labour  on  account  of  a 
supposed  rupture  of  the  vaginal  wall.  Forceps  having 
failed,  the  delivery  had  been  effected  by  version.  When 
rhr.  Barber  saw  the  patient  she  was  comfortable,  the 
temperature  102*^,  pulse-rate  126.  Abdominal  exami- 
nation disclosed  nothing  unusual,  the  uterus  being 
-  firmly  contracted.  Vaginal  examination  was  difficult 
by  reason  of  the  patient's  size,  but  no  vaginal  tear  could 
be  discovered.  The  cervix  was  ragged  and  a  tag  hung 
4lown  from  it.  The  urine  contained  a  little  blood  at 
first,  but  none  later.  AH  day  the  condition  remained 
good,  but  pneumonia  developed  at  night.  Next  morn- 
ing, after  an  action  of  the  bowels,  the  patient  became 
very  ill  and  died  in  a  few  minutes,  without  exhibiting 
the  classical  signs  of  internal  haemorrhage.  Autopsy 
on  the  same  evening  :  Stomach  and  intestines  greatly 
distended  by  ^as ;  no  evidence  of  peritonitis ;  the 
abdomen  contamed  much  free  recent  blood  :  blood  was 
found  also  in  both  broad  ligaments,  chiefly  in  the  right ; 
a  complete  rupture  of  the  uterus  ran  obliquely  upwards 
from  right  to  left,  involving  the  lower  uterine  segment 
principally  ;    Bandl's  ring  was  very  conspicuous. 

THE  SOCIETY  FOR  THE  STUDY  OF  DISEASE 
IN  CHILDREN. 

At  a  meeting  held  on  November  i8th.  Mr.  Robert 
Jones  in  the  Chair,  twenty-one  new  members  were 
elected.  The  Glas-Sedlbanck  lamp  for  the  cure  of 
lupus  was  demonstrated. 

A  specimen  of  "  Congenital  Atresia  of  the  Tricuspid 
Valve  "  was  shown  by  Dr.  Bertram  Rogers  (Bristol) 
and  Dr.  J.  M.  Fortescue-Brickdalk  (Bristol).  The 
child,  set.  2,  was  admitted  into  the  Children's  Hospital, 
Bristol,  suffering  from  bronchitis  with  extreme  dyspnoea 
and  cyanosis.  The  fingers  and  toes  were  clubbed, 
and  the  Ups  and  extremities  deep  purple.  There  were 
no  cardiac  bruits  and  no  apparent  increase  of  cardiac 
<lulness.  She  had  suffered  from  repeated  attacks  of 
cyanosis.  She  died  in  a  few  hours.  Post-mortent, 
the  heart  weighed  3 J  o«.  When  opened  it  showed 
hjrpertrophy  and  dilatation,  mostly  of  the  right  auricle 
and  left  ventricle,  patent  foramen  ovale,  atresia  of  the 
tricuspid  orifice,  and  a  small  opening  between  the 
ventricles.  There  was  no  sign  of  endocarditis ;  the 
ductus  arteriosus  was  closed. 

A  specimen  of  "  Congenital  Pulmonary  Stenosis  " 
was  shown  by  Dr.  George  Carpenter.  The  condition 
was  associated  with  a  perforated  septum  ventricu- 
lorum  and  a  patent  foramen  ovale.  The  aorta  in 
great  part  arose  from  the  right  ventricle.  The  heart 
was  removed  from  a  child,  aet.  2,  free  from  other 
congenital  abnormaUties.  The  right  ventricle  was 
hyper  trophied  and  during  Ufe  this  was  an  obvious 
feature.  There  was  a  loud  systolic  murmur  audible 
all  over  the  pericardial  area  and  of  maximum  intensity 
at  the  xiphoid  ;  it  was  inaudible  in  the  great  vessels 
of  the  neck  and  only  occasionally  heard  in  the  back. 
The  lips  were  cyanosed,  and  the  fingers  and  toes  blue 
and  clubbed.  The  child  was  bom  blue,  and  the 
cyanosis  had  latterly  increased — she  had  twice  been 
convulsed.  The  red  corpuscles  were  7,800,000  per  cm., 
and  the  haemoglobin  122  per  cent.  She  died  of  measles. 
Dr.  Carpenter  drew  attention  to  the  large  increase 
in  the  number  of  red  corpuscles  and  of  the  haemoglobin 
percentage,  which  in  his  experience  was  not  an  un- 
common feature  in  cases  of  congenital  morbus  cordis 
%vith  cyanosis.     He  also  commented  on  the  value  of 


the  skiagram  in  such  cases,  and  on  the  early  advent  of 
cyanosis.  The  absence  of  a  systolic  bruit  in  the  great 
vessels  of  the  neck  was  touched  upon,  and  its  value 
when  audible  there  as  a  diagnostic  sign  of  the  condition 
of  perforate  septum  ventriculorum  was,  he  thought, 
oi  considerable  importance. 

A  specimen  of  "  Atresia  of  the  Pulmonary  Artery  " 
was  also  shown  by  Dr.  Sydney  Curl. 

A  case  of  'Muvenile  General  Paralysis  "  was  shown  ^ 
by  Dr.  James  Taylor.  The  patient  was  a  boy,  aet.  x  xf , 
the  fifth  in  a  family  of  nine,  all  said  to  be  hesdthy.  He 
was  bom  at  full  term,  suffered  from  abscesses  "  in  the 
head  and  groin  "  at  i,  but  did  not  walk  till  he  was  4. 
At  6  he  developed  a  faculty  for  romancing,  telling 
wonderful  stories  apparently  merely  to  excite  ad- 
miration. He  was  also  frequently  violent  and  vicious. 
The  physical  signs  and  the  mental  symj^toms,  slight 
as  they  may  be,  appear  to  indicate  defimtely  that  the 
case  is  one  of  juvenile  general  paralysis,  and  the  physical 
and  mental  degeneration  are  likely  to  become  much 
intensified. 

A  case  of  "  Bell's  Paralysis  with  a  Hemiplegic  On- 
set "  Iwas  shown  by  Dr.  J.  Porter  Parkinson.  The 
boy,6et.  4,  had  been  perfectly  healthy  till  July  last, 
when  paralysis  in  the  riffht  arm  and  leg  and  left  side 
of  the  face  occurred  suddenly.  The  weakness  of  the 
arm  and  leg  passed  away  in  a  week,  and,  when  ex- 
amined, there  remained  only  weakness  of  all  the  left 
side  of  the  face.  Dr.  Parkinson  thought  the  case  due 
to  a  lesion  of  the  nucleus  of  the  facial  nerve  involving 
the  pyramidal  tract  in  some  temporary  manner, 
possibly  passing  oedema,  and,  from  the  sudden  onset 
during  the  summer,  with  hyperaesthesia,  in  a  pre- 
viously healthy  child,  it  resembled  the  lesion  known 
as  encephalitis  inferior,  pathologically  similar  to  acute 
anterior  polio-myelitis. 

A  case  of  "  Ataxy  of  the  Cerebellar  Type  "  in  a  girl 
aet.  4,  was  shown  by  Dr.  Porter  Parkinson.  The 
condition  of  the  fundi  of  the  eyes  suggested  it  was  a 
degeneration  occurring  in  hereditary  syphilis,  though 
there  was  no  other  evidence,  personal  or  family,  to 
corroborate  this. 

A  case  of  "Progressive  Palsy"  in  a  boy,  aet.  13, 
was  shown  by  Dr.  Harry  Campbell  (introduced). 
The  paralysis  began  in  the  legs  at  the  age  of  five  years, 
and  was  noticed  in  the  hands  at  the  age  of  nine,  and  in 
the  face  at  the  age  of  ten.  It  was  symmetrical,  and 
in  the  extremities  mainly  confined  to  the  long  exten- 
sors. Electrical  reactions  were  normal.  Dr.  Camp- 
bell was  uncertain  as  to  the  nature  of  the  affection. 

Three  cases  of  "  Unilateral  Congenital  Dislocation  of 
the  Hip  "  of  varying  degrees  of  severity  were  shown 
by  Mr.  Douglas  Drew. 

'  A  case  of  "  Old-standing  Dislocation  forwards  of 
the  Head  of  the  Radius."  of  two  years*  duration,  was 
shown  by  Mr.  Douglas  Drew.  The  dislocation  was 
reduced  by  operation,  but  in  spite  of  the  greatest 
care  the  condition  recurred.  Inasmuch  as  the  function 
of  the  arm  was  little  impaired  and  the  deformity  was 
trifling,   Mr.   Drew  advocated  no  further  interference. 

Two  cases  of  "  Cephalhaematoma  Neonatomm  over 
the  Occipital  Bone  "  were  shown  by  Mr.  T-  Howell 
Evans,  who  subsequently  gave  a  lantern  demonstra- 
tion on  the  subject.  Mr.  Evans  considered  these 
blood  effusions  w^ere  due  to  a  reactionary  haemorrhage 
from  a  small  artery  which  had  been  injured  in  the 
moulding  of  the  infant's  head  during  its  passage 
through  the  birth-canal.  Foetal  skulls  and  many  lan- 
tern slides  of  the  skulls  of  various  animals  were  shown 
to  illustrate  Mr.  Evans'  views.  The  author  advocated 
the  immediate  surgical  treatment  of  cephalhaematoma 
neonatomm. 

A  case  of  "  Graves'  Disease  "  in  a  boy,  aet.  12,  was 
shown  by  Mr.  Sydney  Stephenson.  The  thyroid  was 
enlarged,  there  was  slight  tachycardia,  slight  exoph- 
thalmos, and  a  curious  pallid  puffiness  of  each  upper 
lid.    There  were  no  nervous  symptoms. 

Two  cases  of  "  Traumatic  Keratitis  following  Diffi- 
cult Instrumental  Labour  "  were  shown  by  Mr.  Sydney 
Stephenson.  _ 

Aspecimen'of  a  "  Tuberculous  Fallopian  Tube  "  and 


6o2    Vbbi^M  soiOAi;*  Pkbss. 


TRANSACTIONS   OF   SOCIETIES. 


Dec  ;.  ig04. 


"  Tuberculous  Ulcers  of  the  Intestine/'  removed  from 
a  case  of  general  tuberculosis,  aet.  2^,  was  also  shown 
by  J)r.  Sydney  Curl.  It  was  not  suspected  during 
life.  -^The  uterus  and  ovaries  were  healthy. 

The  cases  Avere  discussed  by  Mr.  Robert  Jones,  Dr. 
Edmund  Cantley,  F.  Parkes  Weber,  C.  W.  Chapman, 
G.  A.  Sutherland.  C.  O.  Hawthorne  and  Mr.  L.  McGavin. 


NORTH-EAST    LONDON    CLINICAL     SOCIETY. 


Clinical  Evening  held  Thursday,  December*  ist, 
1904. 


Dr.  R.  Murray  Leslie,  President,  in  the  Chair. 


Dr.  J.  W.  Hunt  showed  a  middle-aged  woman  with 
an  Innominate  Aneurysm  which  had  existed  for  two 
years  without  causing  any  deterioration  of  health. 

The  President  exhibited  (i)  a  case  of  Haemo- 
Pneumothorax  in  a  man,  aet.  30,  the  origin  of  which 
was  doubtful.  The  pneumothorax  was  limited  to 
the  upper  part  of  the  left  chest.  On  aspiration  of  the 
base  about  half  a  pint  of  dark  blood  was  withdrawn. 
The  heart  was  considerably  displaced  towards  the 
right,  and  there  was  a  small  band  of  hyper-resonance 
above  the  stomach  due  to  a  layer  of  compressed 
lung.  The  early  symptoms  presented  by  the  patient 
were  more  abdominal  than  thoracic  in  character, 
resembling  those  of  diaphragmatic  pleurisy.  All  the 
ordinary  causes  of  this  affection  could  be  excluded. 

Dr.  Herbert  P.  Miller  referred  to  a  case  which 
had  been .  under  his  care  in  which  the  diagnosis  of 
haeino-pneumothorax  was  proved  by  the  fact  that 
paracentesis  had  been  performed  twice,  and  on  each 
occasion  blood  was  withdrawn.  The  patient  made  a 
complete  recovery. 

(2)  A  case  of  Actinomycosis  in  a  man  aet.  36  (through 
the  courtesy  of  Dr.  H.  Cuff,  Medical  Superintendent  of 
the  North-Eastem  Fever  Hospital).  The  condition 
affected  the  feft  side  of  the  face,  inferior  maxilla,  and 
buccal  mucous  membrane.  The  typical  ray-fungus 
was  obtained  microscopically. 

Mr.  Herbert  Carson  emphasised  the  importance 
of  giving  very  large  doses  of  potassium  iodide  in  such 
cases,  and  referred  to  the  difficulty  sometimes  experi- 
enced in  distinguishing  actinomycosis  from  early 
cases  of  malignant  disease. 

Mr.  R.  F.  Tomlin  showed  a  case  of  Raynaud's 
disease  in  a  middle-aged  woman. 

Dr.  J.  A.  Whiting  showed  an  in-patient  at  the 
Tottenham  Hospital,  the  subject  of  an  Aneurysm 
of  the  Ascending  Aorta.  The  patient  was  a  man,  act. 
48,  and  the  aneurysm  was  visible  externally  as  a 
tumour  the  size  of  a  goose's  egg,  situated  to  the  right 
of  the  upper  end  of  the  sternum. 

The  President  remarked  that  the  sac  was  probably 
well-filled  with  clot,  as  a  murmur  could  only  be  faintly 
heard  over  it.  He  considered  that  the  case  was  a 
suitable  one  for  attempting  a  cure  by  the  introduction 
of  silver  wire. 

Mr.  Walter  Edmunds  thought  that  surgical  inter- 
ference was  for  the  most  part  impracticable  in  aneu- 
rysms of  the  aorta,  but  in  the  case  of  innominate 
aneurysm  exhibited  the  effect  of  the  distal  ligature 
might  be  well  worth  considering.  The  treatment  of 
gelatine  injection  was  sometimes  open  to  fallacy,  as 
the  improvements  reported  after  its  use  might  con- 
ceivably be  due  to  the  enforced  rest  in  bed  to  which 
the  patients  had  to  submit.  Mr.  Edmunds  also 
exhibited  ( i )  a  boy,  set.  1 3,  upon  whom  he  had  operated 
for  Ruptured  Liver.  A  collection  of  bile  had  re-formed 
shortly  after  the.  operation.  There  was  very  little 
liaemorrhage. 

Dr.  Whiting  asked  whether  this  case  might  not 
have  been  an  example  of  .the  condition  known  as 
*'  bile-cysts,"  and  referred  to  a  case  reported  by  Mr. 
Alban  Doran,  in  which  operation  was  performed  three 
years  after  an  injury  to  the  right  hypochondrium. 

(2)  A  boy,  aet.  12,  from  whom  he  had  excised  a  growth 
of  the  inner  end  of  the  left  clavicle.     The  appearances 


at  the  time  of  the  operation  suggested  an  endosteal 
sarcoma. 

Dr.  David  McAskis  showed  a  case  of  Splenomeplic 
Leukaemia  in  a  man,  aet.  38.  He  had  been  tnated 
with  arsenic  for  seven  weeks,  but  subsequently  be 
had  had  the  X-rays  applied  twice  a  week.  Before 
the  latter  treatment  was  commenced  the  blood-coani 
was  as  follows  : — red  cells,  3,000,000 ;  white  cdls. 
392,000.  Three  weeks  afterwards  the  leucocytes  had 
diminished  to  40,000,  and  the  spleen  was  lessened  ia 
size  to  the  extent  of  two  inches.  Of  late  a  bttk 
perisplenitis  had  developed.  The  large  mono-nucleated 
leucocyte  predominated. 

Mr.  Carson  showed  a  Cyst  of  the  Tongue  which  W 
had  removed  from  the  case  exhibited  at  the  Ua 
meeting  of  the  Society  by  Dr.  F.  Tresilian.  and  mhid 
proved  to  be  a  sequestration-dermoid.  there  being  ao 
connection  with  the  thyroglossal  duct. 

Dr.  Arthur  £.  Giles  exhibited  a  specimen  oi  a> 
Ossified  Fibro-myoma  U  teri.  The  patient  was  a  woman 
set,  65,  in  whom  a  hard  tumour  could  be  felt  prescntiniL 
at  the  external  os.  The  capsule  around  it  was  sloagV 
ing,  giving  rise  to  a  most  offensive  vaginal  discharge. 
In  spite  of  the  narrowness  of  the  vagina,  it  was  deddec 
to  attempt  the  removal  of  the  mass  by  that  route. 
The  operation  was  attended  by  no  small  difficulofe 
on  account  of  the  hardness  of  the  tumour  and  the  cob^ 
striction  of  the  natural  passages.  The  fibroid  V2» 
ultimately  extracted  after  splitting  the  cen*u  ani! 
parts  of  the  posterior  vaginal  wall,  and  rotating  tb 
tumour  upon  its  long  axis.  The  mass  weighed  it  oz. 
The  patient  made  a  good  recovery. 


THERAPEUTICAL  SOCIETY. 
Meeting  held  Novbmber  22Nd,   1904. 


Sir  Lauder  Brunton.  President,   in   the  Chair. 


The  Secretary  read  a  paper  by  Dr.  Gordon  Shas?. 
of  Leeds,  who  was  unable  to  attend,  on 

STRYCHNOS  TOXIFERA  A.ND  OTHSR  PARALYSERS  OF  MOIor 
NERVE   ENDINGS. 

He  said  many  had  endeavoured  in  vain  to  di>C(n-cr 
the  plant  that  proauced  curarine.  until  Mr.  J.  Qudd 
brought  him,  in  1902,  some  poisoned  arrows  and  spec- 
mens  of  the  plant  given  him  by  ■  an  Indian  chief  0 
Guiana.  The  plant  was  found  by  Mr.  £.  Holman  to 
be  the  Strycnnos  toxifera  (Benth).  and  curarine  was 
found  in  the  bark,  but  not  in  the  leaves.  This  alkaloid 
is  very  deliquescent  and  easily  decomposed — its  salt> 
are  more  stable;  commercial  curarine  contains  9  to  1 1  per 
cent,  of  the  alkaloid.  Curare  has  been  used  in  chom 
convulsions,  and  to  prevent  painful  spasms  in  movmi 
wounded  persons.  He  compared  its  action  with  that 
of  strychnine,  delpho-curarine,  alstonine,  aconite.  sIlaJ[^ 
poison,  and  diphtheria  toxin. 

The  President  said  that  the  paper  reminded  him 01 
one  by  Majendi,  on  the  upas  p>oison,  wnich  wa» 
strychnos  nux  vomica.  He  thought  alstoniue  migbt 
be  useful  in  cases  of  excessive  itching  in  diabetes  an>) 
albuminuria. 

Dr.  C  rich  TON  remarked  that  death  from  curare  a 
frogs  occurred  only  after  forty  hours,  while  strychniaf 
killed  them  in  two  hours. 

Mr.  G.  C.  Moor.  F.I.CF.C.S.,  read  a  paper,  entitled 

NOTES   ON    brandy, 

showing  that  the  different  constituents  in  brandy  couU 
be  accurately  estimated  by  chemical  analysis,  but  .t 
was  quite  possible  to  prepare  a  brandy  which  woali'' 
answer  every  analytical  standara  and  yet  not  ]x 
brandy  as  understood  and  prescribed  by  the  medical 
profession.  Therefore  brandy  factories  should  be 
properly  inspected  by  Government,  as  is  done  m 
Australia  with  the  Orion  brandy  exported  to  th:> 
country. 

Sir  Lauder  Brunton  remarked  that  theefiectsof 
wines  were  very  diversified.  Some  promoted  meni- 
ment,  others  quarrelsomeness,  but  it  was  impossible  to 
say  on  what  this  depended,  and  the  same  results  pro- 
bably followed  on  the  imbibition  of  various  brandits 
whether  pure  or  adulterated. 


Dec.  7,  1904. 


AUSTRIA. 


Tbx  Msdical  Pkbss.    603 


^Ir.  McEwEN  said  that  nine-tenths  of  the  brandies 
met  with  -were  not  really  brandy  at  all,  but  a  mixture. 
£thef  could  easily  be  added  to  silent  spirit  and  form 
a  good  imitation. 


jf  ranee* 

[from  our  own  correspondent.] 

Paris,  Deccionber  4th,  IMM. 
Treatment  of  Dvsmenorrho:a. 
Every  practitioner  knows  how  painful  and  trouble- 
some dysmenorrhoea  is,  and  the  following  counsel  given 
by  M.  Dalch6  on  the  affection   may  be  useful. 

The  first  thing  to  be  done  is  to  discover  the  cause  of 
the  malady.    Constipation  should  be  avoided  as  well  as 
intellectual  and  physical  fatigue.     To  ease  the  pain, 
simple  means  may  be  at  first  enjoined — rest,  warm 
applications,     belladonna    suppositories.     An    enema 
may  be  given  in  the  morning  with  : — 
Antipyrine,  1 5  grs. ; 
Laudanum.  20  drops; 
or  the  following  ointment : — 

Extract  of  hyoscyamus,  ^  dr.; 
Extract  of  belladonna,  i  dr. ; 
Vaseline,  i  02. 
As  to  applications  of  ice,  recommended  by  some, 
they  are  dangerous,  for  if  they  ease  the  pain  they  may 
arrest  the  flow  of  blood.     A  German  author,  Fliess, 
having  found  that  there  existed  regions  of  the  mucous 
membrane  of  the   nasal   fossie  constituted  of  erectile 
tissue,  remarked  that  when  the  ovary  became  turgescent 
the  mucous  membrane  of  the  nose  was  similarly  afiected. 
Hence  he  wanted  to  endeavour  to  calm  the  pain  of 
dysmenorrhcea  by  touching  the  nasal  cartilage  with  a 
solution  of  cocaine  and  with  some  success. 

M.  Dalch6  tried  the  method  of  Fliess  with  satisfac- 
tory results  in  some  cases. 

When  the  blood  is  normal  in  quantity  at  each  period, 
antipyrine  should  be  prescribed  in  1 5  gr.  doses,  associ- 
ated with  10  grs,  of  bicarbonate  of  soda,  or  6  grs. 
of   pyramidon.     Dr.  Huchard  recommends  : — 

Tincture  of  piscidia  erythrina,   10  grs. ; 
Tincture  of  viburnum  prunifolium,  10  grs. 
Twenty  drops  four  or  five  times  daily. 
For   lumbar   neiuralgia,  ichthyol  externally  is  very 
efficient. 

Ichthyol,  2  dr.; 
Chloroform,  3  dr. ; 
Camphorated  spirits,  2  oz. 
Between  the  periods  cannabis  indica  should  be  pre- 
scribed. 

If  the  flow  was  excessive  (menorrhagia),  the  fluid 
extract  of  hydrastis  canadensis  is  indicated  (20  drops 
three  times  a  day).  If,  on  the  contrary-,  the  flow  is 
insufficient  or  slow  to  appear,  general  tonic  treatment 
should  be  ordered  with  ovarian  opotherapy. 

Where  the  menses  are  entirely  irregular,  cold  bathing, 
corporal  exercise,  gymnastics,  and  ovarian  opotherapy 
will  render  good  service.  Marriage  might  also  b^ 
recommended. 


according  to  his  observations  a  portion  of  these  milder 
cases  died  during  the  first  ten  years  of  the  disease. 
The  cases  of  the  mild  group  were  not  all  alike ;  the 
amount  of  sugar  was  of  great  importance ;  the  urine 
should  be  examined  for  months,  in  order  to  ascertain 
how  much  carbohydrates  could  be  digested.  Accord- 
ing to  this  the  speaker  divided  this  group  again  into 
two  groups :  First,  the  cases  that  from  106  grammes 
of  carbohydrates  excreted  20  to  25  grammes  of  sugar, 
and  second,  those  that  from  the  same  quantity 
excreted  10.  In  the  first  group  nephritis  came  on 
between  the  4th  and  7th  years,  and  between  the 
40th  and  55th  year  of  life.  Polyuria,  adiposity, 
nephrolithiasis  and  cystitis  all  appeared  to  favour  the 
development  of  nephritis.  The  nature  of  the  nephritis 
was  not  yet  clear.  The  speaker  thought  it  was  a 
chronic  parenchymatous  nephritis  and  not  one  from 
arterio-sclerosis.  As  regarded  diet,  he  rejected  milk, 
but  recommended  cream,  and  a  diminution  of  the 
quantity  of  flesh.  Chitside  of  nephritis  the  causes  of 
death  in  the  middle  group  were  coma,  apoplexy, 
cardiac  weakness,  and,  rarely,  gangrene  and  tuber- 
culosis. Few  of  these  cases  died  ^of  intercurrent 
diseases. 

At    the    Gesellschaft    der   Charites-Aerzte,    Herren 
Mossen  and  Milchner  spoke  on  the 
Treatment  of  Blood  Diseases  by  the  Rontgen 
Rays. 

The  X-rays  destroyed  the  follicles  in  the  spleen 
and  the  lymphatic  glands  just  as  in  the  medulla 
of  bones,  as  experiments  on  animals  had  proved. 
The  white  cells  were  influenced  whilst  the  cells  contain- 
ing haemoglobin  were  resistent.  In  so  far  the  X-rays 
exercised  an  electric  action.  This  discovery  was 
opposed  to  the  assumption  that  both  sets  of  cells  were 
from  a  common  stock.  Eczema  or  injury  to  the  roots 
of  the  hair  was  never  observed  in  the  animal  experi- 
ments. Preparations  of  blood  and  bone  marrow  were 
shown. 

Hr.  Krause  had  seen  failure  in  a  case  of  mixed -celled 
leukaemia.  Hr.  Gorawitz  observed  that  all  erythro- 
blasts  did  not  originate  out  of  a  white  preliminary 
stage ;  most  were  found  by  homoplastic  increase . 
In  a  case  of  leucaemia  he  saw  a  surprising  result  from 
the  X-rays. 

Hr.  Kaiserling  observed  that  after  the  destruction  of 
the  follicles  mentioned  there  was  a  remarkable  re- 
generation. 

Hr.  Senator  had  seen  marked  diminution  of  the 
spleen  in  three  cases  after  application  of  the  rays. 


Oetmani?. 


[from  our  own  correspondent.] 


Berlin.  December  ith,  1904. 
At  the  Society  for  innere  Medizin,  Hr.  Hirschfeld 
discussed  ' 

The  Prognosis  of  Diabetes. 
He  said  that  in  general  diabetes  was  divided  pro- 
gnostically  into  two  groups — into  the  grave,  which  was 
distinguished  by  the  appearance  of  sugar  in  the 
urine  even  where  no  carbohydrates  were  given  in  the 
food,  and  into  the  mild,  in  which  this  was  not  the  case. 
The  grave  form  ended  fatally  within  five  years  ;  the 
mild,  on  the  other  hand,  with  favourable  conditions 
of  life,  and  with  suitable  feeding,  &c..  led  to  no  great 
shortening  of  life.  This  view  had  been  given  expression 
to  by  Naunyn,  and  it  had  been  generally  agreed  to. 
According    to    the    speaker,    this    was    not   correct ; 


Hustrta* 


[from  our  own  correspondent.] 


ViENKAt  December  8rd,  1904. 
Gas  Cysts  in  the  Brain. 
At  the  Prague  meeting,  Chiari  raised  a  discussion 
on  multiple  spaces  in  the  substance  of  the  human  brain, 
without  any  lining  or  covering  to  indicate  a  cavity 
produced  by  f^uid.  Clarke  gave  it  the  name  of  the 
Swiss  cheese  brain,  from  its  appearance  to  that  article 
of  diet.  Reuling  and  Herring,  in  1899,  came  to  the 
conclusion,  after  many  experiments,  that  the  cavities 
were  formed  by  the  accumulation  of  gas  produced  by 
the  bacillus  aerogenes.  Since  that  time,  many  inte- 
resting cases  have  been  published,  while  the  brain  sub- 
stance has  been  preserved  by  hardening  with  formol, 
and  sections  thereafter  made  to  demonstrate  the 
lamellae  of  the  cyst.  Chiari  reported  five  cases  that 
he  had  seen  himself  since  1893.  two  from  typhoid,  one 
from  Bright's  disease,  and  two  from  sephthxmia  cr 
septicemia.  These  cysts  were  demonstrated  .on  post- 
mortem and  after  hardening.  In  oiaeJQf  the  ^ephtbzmia 
cases  large  emphysematous  cavities  were  found  in  the 
subcutaneous,  inte^'muscular,  mediastinal,  and  sub- 
peritoneal cellular  tissue,  as  well  as  the  presence  of 
tympanites  uteri.  The  streptococci  pyogenes  of  puer- 
peral females  produce  the  same  results  as  those  of  the 
aerogenes  capsulatusrcni,  which  have  been  cultivated 


6o4    Trb  Mxdical  Pkbss. 


THE    OPERATING   THEATRES. 


Dec.  7.  1904. 


la  a  brain  saffering  from  the  latter,  one-half  was  cut 
into  sections,  but  no  cysts  could  be  observed ;  the 
other  half  was  hardened  in  formol,  with  the  result  that 
after  two  months  beautifully  laminated  c\^ts  could  be 
found  with  the  corresponding  bacteria.  This  was  also 
the  case  in  one  of  the  sephthaemia  cases. 

Ehrlich's  Colour  Reaction. 
The  red  colour  of  urine  with  a  salt  of  dinnethyl-amin- 
benzoUaldehyde  (Ehrlich)  depends  upon  the  presence  of 
urobilin  or  its  d^vatives.     Although  this  may  not  be 
pathognomonic,  it  indicates  the  presence  of  pyrrol, 
which,  according  to  Nencki  and  Zaleski, .  forms  the 
colouring  matter  of  the  tissues.     Its  pathology  in  the 
urine  is  to  be  found  in  cases  of  pneumonia,  blood 
diseases,  and  hepatic  disorders  in  which  the  reaction  is 
very  much  accentuated  from  the  normal  conditions. 
The  absence  of  this  reaction  in  the  urine  is  to  be  found 
in  cases  of  icterus,  where  the  choledochus  and  hepaticus 
is  closed.     The  gall  secretion  gives  a  red  colouring  with 
the  aldehyde,   because  it  contains  the  urobilinogen. 
This  aldehyde  reaction  is  also  found  in  the  faeces, 
where    indol,  skatol    and    urobilinogen    are    present. 
Haemopyrrol,  which  is  found  in  all  blood  colouring, 
matter,  and  is  therefore  present  in  most  of  the  albuminous 
secretions  of  the  body,  with  the  exception  of  gelatine 
or  gluten  is  too  comprehensive  to  be  of  any  re£  value 
in  the  diagnosis  of  any  individual  disease,  although 
Ehrlich  himself  contends  that  there  are  various  shades 
of  colours  produced  with  concentrated  sulphuric  acid 
that  give  a  violet  colour  when  the  indol  group  is  pre- 
sent with  a  molecule  of  albumin.  The  aldehyde  may  be 
considered  a  reagent  for  all  the  pyrrol  derivatives.    The 
red  c<Houring  is  not  confined  to  the  acid  form,  as  acetyl- 
glycos-amin,  when   treated  with  an  alkali,   and   the 
aldehyde  produces  the  red  colour  also. 
Alkaptonuria. 
Falta  treated  the  audience  to  a  long  history  of  a  case 
of  alkaptonuria,  which  is  the  morbid  elimination  in  the 
urine  of  a  uroleucin  salt,  sometimes  designated  haemo- 
gentisin.     This  substance  is  often  present  in  healthy 
children  as  well  as  in  cases  of  diabetes  and  phthisis, 
and  can  be  detected  by  Fehling's  solution.     It  would 
seem  from  Falta 's  observation  that  haemogentisin  is 
obtained  in  small  quantities  from  albuminous  bodies, 
and  may  be  reconused  as  an  animo-complex  salt  and 
eliminated  in  a  form  of  alkaptonuria.     The  adminis- 
tration of  bromine  and  iodine  checks  the  eliminatioA 
in  the  urine  by  their  action  on  the  albuminoid  molecule. 
It  is  therefore  a  specific  change  when  this  haemogdnti^in 
is  produced,  as  the  whole  disturbance  is  located  in  the 
structure  of  the  albuminoid  molecule.     Langstein  said 
that  he  always  considered  ha^mogentisin  to  be  closely 
allied  to  tyrosin,  which  he  had  obtained  from  plants 
as  an  experiment  with  phenylalanin  with  sections  of 
turnips,    whose   ferment   will   produce    the   so-called 
haemogentisin  salt.     Klemperer  asked  if  the^e  had  been 
any  hereditary  conditions   to  cause  alkaptonuria  in 
Falta's  cases,  as  consanguinity  was  often  found  to  be 
present  in  these  cases.     Falta  said  that  neither  con- 
sanguinity or  hereditary  could  be  proved. 
His  and  Weigbrt. 
The  journals  this  week  contain  long  records  of  the 
scientific  work  of  these  two  investigators.     His  was 
known  in  anatomy  and  embryology,  and  his  works  have 
now  become  classic.  Bom  in  E^sle,  1 83 1 ,  hestudied  under 
MuUer,  and  Remak,  and  became  professor  of  anatomy 
in  his  own  university  in  1857.     Weigert  died  rather 
suddenly  in  his  fifty-sixth  year.     His  investigations 
lay  in  the  examination  of  the  secretions  and  blood 
circulation  according   to  Cohnheim's  views,   and  he 
finally  devoted  the  whole  of  his  time  to  bacteriology 
and  histology  in  conjunction  with  Koch  and  others. 
His  methods  of  colouring  sections  wUl  long  be  remem- 
bered by  students  of  medicine. 

JLtK  9pctaxino  JLbeatttB. 

ROYAL  FREE  HOSPITAL. 
Operation  for  Traumatic  Extra-dural  HiEMOR- 
RHAGE. — Mr.  T.  P.  Legg  operated  on  a  man,  act.  35, 


who  had  fallen  on  to  his  head  whilst  riding  a  bkyde. 
He  was  unconscious  for   a   moment,   but  recovcved 
quickly  and  rode  on  home,  a  dtstance  of  about  haU  » 
mile.     He  went  to  bed  at  once  and  complained  of  a 
good  deal  of  headache,  especially  in  the  frontal  ragioa. 
There  was  considerable  epistaxis,  and  the  left  eye  was 
proptosed.     He  was  sick  once  or  twice,  and  remained 
conscious  for  some  hours ;    then  he  became  quite  on* 
conscious  about  twelve  hours  after  the  accident.   On 
admission,  he  could  not  be  roused,  his  breathing  vas 
not  stertorous,  his  pulse  was  54,  full  and  regular.    The 
pupils  reacted  very  slightly  to  the  strong  light,  the  kit 
pupil  being  somewhat  larger  than  the  right.     Thecevas 
a  superficial  excoriation  over  the  left  eyebrow,  and  a 
large  haematoma  around  it  extending  into  the  eyelids  oi 
the  same  side.     On  separating  the  left  eyelids  an  exta> 
sive  sub-conjunctival  haemorrhage  was  found  on  tbe 
outer  side  of  the  globe  of  the  eye.     The  right  arm  attl 
leg  were  paralysed,  and  dropped  when  raised  mm 
quickly  than  the  left  arm  and  leg  ;  both  knee-jerks  wen 
present.     There  were  no  other  injuries.     A  diagnosis 
of  fissured  fracture  extending  into  the  base  of  the  skoll 
through    the    anterior    fossa,  l^a^ing    to    extra-dmal 
haemorrhage,  was  made  and  immediate  operation  under- 
taken.    A  large  flap  consisting  of  the  whole  of  the 
structures  of  the  scalp  was  turned    down  from  the 
temporal  and  frontal  regions  of  the   left  side ;    the 
fissured   fracture   was    then    seen    running    vertically 
downwards  in  the  frontal  bone  a  short  distance  behind 
the  external  angular  process,  and  one  or  two  snu]I 
fissures  radiating  from  the  main  one.     A  i  -inch  trephine 
was  then  used  to  remove  the  bone  close  to  the  main 
fissure  ;  a  large  clot  was  at  once  exposed.     The  opening 
in  the  skull  was  rapidly  enlarged  by  Hoffmam's  forceps 
and  the  clot  removed  by  means  of  a  Volkman's  spoon. 
On  the  dura  mater  a  small  branch  of  the  middle  menin- 
geal artery  was  found  to  be  bleeding,  and  this  was  tied 
by  running  a  suture  underneath  it.     The  clot  extended 
downwards  into  the  anterior  fossa  of  the  skull,  and 
about   four  ounces  of  it   were   removed.     The  dnia 
mater  was  seen  to  be  pressed  inwards  so  as  to  fonn  a 
saucer-shaped  depression  ;  the  brain  could  be  felt  pul- 
sating as  soon  as  the  clot  was  removed ;  it  at  oncebqpn 
to  expand  as  soon  as  the  pressure  of  the  clot  on  it  was 
relieved,  and  the  depression  in  the  dura  mater  for  the 
most  part  then  became  obliterated.     Running  across 
the  anterior  fossa,  a  fissured  fracture  was  found  passing 
from  left  to  right,  and  somewhat   baickwards.    The 
bone  was  not  replaced,  and  two  or  three  small  {Meoes 
of  gauze  were  placed  in  the  space  between  the  dura 
mater  and  the  bone.     The  flap  was  sutured  in  position, 
a  drainage-tube    being    inserted   through   a  counter- 
opening  in  the  middle  of  its  base,  the  pieces  of  ganze 
being  brought  out  at  each  end  of  the  incision.    Mr. 
Legg  said  that  this  was  a  typical  case  of  extra-doral 
haemorrhage,    showing    all    the    classical    symptoms, 
namely,  an  injury  and  temporary  loss  of  consciousness, 
recovery  of  consciousness,  and  then  steadily  increasing 
coma.     The  signs  present   were  very  characteristic,  a 
slow  pulse,  which  was  of  good  volume  and  regular;  the 
condition  of  the  pupils  and  a  haematoma  of  the  scalp 
suggested  the  seat  of  the  fracture  and  the  place  where 
any  operation  should  be  performed.     The  projectioo 
of  the  left  eye  was  due  to  haemorrhage   t>ehind  it,  and 
this,  coupled  with  the  epistaxis,  suggested  what  was 
found  to  be  a  fact,  that  there  was  also  a  fracture  of  the 
base  in  the  anterior  fossa.     As  regards  theepentioo. 


Dec. 


7*  1904. 


LEADING,  ARTICLES. 


TrK  M SDICAL  PlXiS.     60S 


&  small  amount  of  chloroform  was  required  while  the 
skin  incision  was  being  made ;  afterwards  the  opera- 
tion was  completed  without  any  more  anaesthetic. 
V^en  the  clot  was  exposed  no  pulsation  was  observed, 
ivhich  suggested  that  the  haemorrhage  had  naturally 
ceased,  and  when  the  dot  was  removed  no  recurrence 
of  the  bleeding  took  place,  so  that  the  actusd  source 
of  the  blood  was  not  defined.  The  small  vessel  which 
vras  ligatured  on  the  surface  of  the  dura  mater  was  un- 
likely to  have  been  the  source  of  so  large  a  haemorrhage, 
^which.  it  was  probable,  came  from  a  sinus  at  the 
base  of  the  skull,  and  in  CMrder  to  prevent  its  re-accumu- 
lation, if  any  subsequent  haemorrhage  took  place,  the 
Sauze  drains  were  placed  inside  the  cavity.  The  bone 
'was  not  replaced  oecause  the  brain  had  not  completely 
expanded,  and/  therefore,  the  pieces  of  bone  might 
have  become  displaced  and  acted  subsequently  as  a 
source  of  irritation.  As  regards  the  prognosis  in  these 
cases,  it  must  be  always  grave.  A  certain  number  of 
patients  do  recover,  but  the  majority,  even  when  the 
haemorrhage  is  capable  of  being  dealt  with  and  dia- 
gnosed as  in  this  case,  will  die  for  these  reasons :  First* 
extensive  injury  to  the  brain  itself  leading  to  subdural 
haemorrhage ;  second,  the  pressure  to  which  the  brain 
is  subjected,  and  which  prevents  the  brain  expanding 
when  the  clot  is  removed :  if  this  expansion  fails  to  take 
place  the  patient  invariably  dies ;  and,  thirdly,  other 
injuries,  as  extensive  fracture  of  the  base  of  the  skull 
The  patient  recovered  consciousness  five  hours  after 
the  operation,  and  recognised  that  he  was  in  the 
hospital.  His  pulse  was  72  per  minute,  and  otherwise 
normal ;  the  right  pupil  reacted  readily  to  light,  and 
was  normsd  in  site.  He  subsequently  made  an  abso- 
lutely uninterrupted  recovery,  and  left  the  hospital  in 
the  fourth  week  after  operation. 


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OomkktAbto  RcdaoUona  tram  the  fongoiov  eoiae  era  mede  when 

en  order  iegiren  tor  e  eeriee  ol  liMerttone.     l^nne  00  efpUon- 

tion  to  the  Pnbiieher . 
amel]  ennounoenMnti  of  PreoUoee,  Aeeietenoiee.  Veoenclee,  Booke. 

Ac-Seven  Unee  or  onder  (70  words).  4e.  Od.  per  ineertkm  ; 

6d.  per  Une  beyood. 

fUBtOftlYTIOSB. 
SubecriptkMie  may  oonunenoe  ec  eny  period  of  the  yeer.    If  peid  in 

edvance  the  ooet  ie  only  21e.  per  ennom,  poet  free.    An  edition 

is  printed  on  thin  plate  peper  fbr  foreign  end  Odoniel  eab- 

ocrilMn  St  He.  per  ennuni,  poet  free,  if  paid  in  adTanoe,  or 

SSs.  «d.  oradit  rate. 


XCbe  AcMcal  pre00  ati^  Circular* 


SALUS  POPULI  SUPRBMA  LEX. 


WEDNESDAY.  DECEBfBER  7,  1904. 


INFANTS'  HEALTH  SOCIETY. 
Infantile  mortality  is  one  of  the  chief  socio- 
hygienic  problems  of  the  day.  .No  single  question 
is  more  worthy  of  study,  ior  in  the  infantile  death- 
rate  are  reflected  all,  or  nearly  all,  the  diseases  of 
corporate  national  life.  The  extent  to  which 
infant  mortalityjprevails  expresses  the  sum  of  the 


factors  of  intemperance^  over-crowding,  insanitary 
conditions,  improper  and  insufficient  food,  parental 
neglect,  and  want  of  education.  All  these  the 
infantile  death-rate  denotes,  but  it  connotes  more — 
namely,  the  measure  in  which  the  brothers  and 
sisters  of  the  dead  children  are  being  affected  in 
mind,  body,  and  estate  by  the  same  conditions. 
To  meilical  men  the  influence  on  the  rising  genera- 
tion of  these  conditions  is,  and  has  been  for  many 
years,  painfully  apparent,  but  for  the  most  part 
their  warnings,  born  of  experience,  have  fallen  on 
deaf  ears.  We  are  glad  to  note  that  now,  before  it 
is  too  late,  these  warnings  are  beginning  to  be 
heeded,  and  that  in  the  '*  physical  degeneration  " 
scare  which  followed  the  South  African  War  the 
facts  brought  to  light  have  stirred  a  desire  and  a 
determination  on  the  part  of  many  influential  and 
philanthropic  people  to  tackle  the  problem  in 
earnest.  In  the  columns  of  the  Timss  a  series  of 
bold,  strongly-worded  articles  has  been  appearing 
dealing  with  the  matter  in  various  aspects,  and  the 
recent  foundation  of  the  Childhood  Society  and  the 
Infants'  Health  Society,  both  of  which  include 
laymen  as  well  as  medical  men  among  their 
members,  also  points  to  an  amount  of  interest  in  the 
welfare  of  the  young  of  poor  parents  that  is  very 
gratifying.  It  seems  likely,  then,  that  in  the  near 
future  definite  and  concerted  action  will  be  taken 
to  reduce  by  every  practicable  means  a  mortality 
and  sickness  amongst  the  infants  of  this  countr>^ 
which  may  be  characterised  as  a  blot  upon  our 
civilisation.  The  matter,  however,  is  not  a  simple 
one  ;  it  involves  in  reality  the  rectification  of 
practically  every  social  disadvantage  and  sanitary 
disability  existing — a  task  that  might  well  cause 
the  stoutest  heart  to  quail.  The  first  and  fore- 
most necessity  is  for  all  engaged  in  the  task  to  be 
wen  cognisant  of  the  nature  and  extent  and  causes  of 
the  evil,  and  be  thoroughly  clear  and  unanimous  as  to 
the  right  line  of  procedure.  Enthusiasm  is  good, 
but  enthusiasm  must  be  tempered  with  discretion. 
The  Infants'  Health  Society,  which  was  formed  in 
February  of  this  year,  has  placed  before  itself  an 
ambitious  task,  and  actuated  as  it  is  by  an  ardent 
desire  to  save  the  lives  and  improve  the  physique 
of  the  children  of  the  poor  we  need  hardly  say  that 
we  are  in  entire  sympathy  with  its  main  aims. 
This  sympathy,  however,  must  not  deter  us  from 
offering  a  iev,'  friendly  criticisms  of  the  methods 
by  which  it  proposes  to  work  and  the  means  which 
it  proposes  to  adopt  to  attain  its  ends.  'The 
society  has  published  a  pamphlet  setting  these 
forth,  and  this  pamphlet  is  now  available  for  dis- 
tribution to  those  likely  to  be  influenced  by  it. 
It  is  to  be  regretted  that  the  writer  of  this  pamph- 
let in  urging  a  good  cause  has  allowed  himself  to  be 
betrayed  into  hyperbole,  and  that  instead  of  setting 
forth  the  sober  facts — which  are  convincing  enough 
in  all  conscience — he  has  allowed  his  pen  to  run 
into  a  certain  extravagance.  For  instance,  such  a 
statement  as  that  "  among  substitute-fed  infants, 
it  is  becoming  a  comparatively  rare  thing  to  find 
a  single  case  of  healthy  growth  and  development," 
is  not  likely  to  find  endorsement  in  the  experience 


6o6    Ths  Mkdical  Pxsbs. 


LEADING  ARTICLES. 


Dec.  /,  1004. 


of  those  into  wh6seMiSii9J^  the  pamphlet  falls- 
The  bulk  of  town-bred  children  are  wholly  or 
partially  substitute-fed,  and  fortunately  there 
are  stiU  a  good  many  healthy  among  them. 
Sweeping  generalisations  of  this  kind,  and  there  are 
several  similar  ones,  tend  to  endanger  an  excellent 
cause  ;  good  wine  needs  no  bush.  The  society 
rightly  insists  on  proper  feeding  in  infancy 
plajring  a  leading  part  in  the  avoidance  of  death 
and  disease,  and  insists  also  on  the  undesirability 
of  undermining  parental  responsibility  in  the 
up-bringing  of  children.  It  is  true  that  great 
difficulty  is  experienced  by  employed  women  in 
nursing  their  children  at  the  breast  ;  but  the 
importance  of  doing  so  whenever  possible  should 
be  recognised  fully  by  all  enlightened  endeavour. 
The  question  is  largely  one  of  education — the 
tradition  of  breast  -  feeding  is  dying  out  in  many 
classes  owing  to  a  great  extent  to  the  cheapness  of 
tinned  milks  and  the  fashion  of  babies*  foods. 
These  two  points,  the  education  of  the  mother  and 
the  encouragement  of  breast-feeding,  are  the 
greatest  desiderata.  Too  much  stress,  we  think,  is 
laid  by  the  society  on  the  pro\'ision  of  milk  dep6ts 
for  the  distribution  of  milk — free  or  for  small  pay- 
ments. In  the  first  place  the  cost  of  an  organised 
system  of  depots  all  over  the  great  towns,  such  as 
they  wish  to  institute,  would  be  enormous,  and  in 
the  second,  it  would  militate  against  the  principle 
of  parental  responsibility.  The  society  would 
do  well  to  direct  their  most  strenuous  efforts  to- 
wards the  reformation  of  the  milk  trade,  so  that 
the  poorest  could  be  assured  of  obtaining  a  per- 
fectly trustworthy  article  of  diet  for  their  young. 
The  modification  of  cow's  milk  to  suit  the  human 
infant  is  not  such  a  difficult  matter  as  the  society 
seems  to  think  ;  it  can  be  done  easily  by  anyone  if 
properly  instructed,  and  the  best  way  to  aid  in  this 
particular  is  to  urge  local  authorities  to  appoint 
female  health  visitors  to  educate  and  help  ignorant 
mothers.  The  potentiality  for  good  of  such  visitors 
is  enormous,  both  in  bringing  to  light  parental 
neglect  and  in  teaching  those  willing  to  learn, 
provided  suitable  women  are  chosen  for  the  posts. 
We  think  that  the  society  would  be  more  likely 
to  be  successful  if  they  worked  on  these  lines  than 
by  embarking  on  a  policy  so  expensive  and  difiicult 
to  maintain  as  that  of  the  wholesale  provision  of 
milk  depots. 


MICRO-ORGANISMS    IN  THE  STOMACH. 

It  has  long  been  recognised  that  an  important 
function  of  the  hydrochloric  acid  in  the  gastric 
juice  is  the  destruction  of  bacteria  ingested  with 
the  food.  With  every  mouthful  of  food,  particularly 
raw  foods  and  cold  meats,  we  swallow  myriads  of 
living  organisms,  yet  it  is  probable  that  as  long  as 
a  stomach  is  healthy  but  few  of  them  pass  the 
pylorus  alive.  On  the  other  hand,  any  departure 
from  health,  such  as  ulceration,  diminishes 
considerably  the  bactericidal  power  of  the  gastric 
juice  or  gives  organisms  such  a  firm  foothold  that 
its  action  is  neutralised.  Some  observations  and* 
experiments  recently  made  by  Dr.  Hewfetsbn,  of 


Birmingham,  (a)  illustrate  this  in  a  conclusive 
manner.  In  a  number  of  patients  suffering  from 
gastric  dilatation,  the  opportunity  of  a  gastro- 
jejunostomy was  taken  to  obtain  specimens  of  the 
gastric  contents  for  bacterioscopic  examinatioa 
direct  from  the  stomach.  In  Ss  per  cent,  of 
the  cases  where  there  was  no  ulceration  tbe 
stomach  was  sterile,  while  in  only  28  per 
cent,  of  those  with  ulceration  was  it  so.  Dr. 
Hewetson  has  also,  by  experiments  on  Imnself  and 
a  number -of  gastrostomy  patients,  disoo\'eied  the 
approximate  time  required  by  a  healthy  stomack 
to  destroy  certain  classes  of  bacteria.  He  foond 
that  rich  growths  of  staph3^ococcus  p\'Ogenes 
aureus  were  completely  destroyed  in  from  thirty 
to  forty-five  minutes  after  being  swaUowtd. 
while  bacillus  pyocyaneus  required  about  twice 
that  time.  Further,  it  is  noted  that  no  ill 
result  ever  followed  the  ingestion  of  A-irulcnt 
cultures  of  these  organisms.  The  practical  bear- 
ings of  these  observations  are  wide,  both  in 
the  domains  of  medicine  and  surgery.  On  the  one 
hand  they  show  us  of  what  importance  it  is  in 
the  prevention  of  intestinal  infection  that  the 
gastric  wall  and  its  secretion  should  be  in  a  healthy 
condition.  Though,  of. course,  it  is  impossible  to 
perform  experiments  with  the  typhoid  bacillus 
similar  to  those  reported  by  Dr.  Hewetson,  there 
is  no  reason  to  believe  that  its  resistance  to  gastnc 
juice  is  greater  than  that  of  the  organisms  with 
which  he  has  experimented.  If  we  are  right  in 
this,  it  will  tally  with  the  current  belief  of  clinical 
observers  that  a  low  state  of  vitality  generally,  and 
particularly  a  disorder  of  the  gastric  secreting 
function,  is  an  important  element  in  the  causation  of 
that  disease.  "From  the  surgical  point  of  \4ew,  the 
comparative  sterility  of  the  stomach  and  jejunam 
is  of  interest  as  showing  how  slight  is  the  dan^r 
of  sepsis  in  most  cases  of  operation  on  these 
viscera,  and  as  explaining  the  ease  with  which 
smaH  wounds,  such  as  bullet  wounds,  of  the  upper 
part  of  the  alimentary  canal  heal.  From  bac- 
terioscopic examination  of  the  extravasated  fluid 
in  cases  of  perforation  of  the  stomach,  important 
practical  results  follow  as  regards  prognosis. 
If  the  fluid  should  be,  as  often  happens,  sterile,  an 
excellent  prognosis  may  be  given.  On  the  other 
hand,  though  the  presence  of  bacteria  does  not 
netessarily  mean  a  bad  outiook,  yet  the  prospects 
are  worse  in  proportion  to  the  number  and  rina- 
lence  of  organisms  present. 


MEDICAL   MEN    AND    POISONOUS    DRUGS. 

Last  week  the  City  Coroner,  Dr.  F.  J.  Waldo, 
held  an  inquest  which  opens  up  many  considera- 
tions of  importance  ±0  the  medical  profession. 
The  inquiry  was  held. by  him  upon  the  body  of  a 
man  whose  death  was  alleged  to  have  taken  place 
from  an  overdose  of  opium  prior  to  his  rcmo\-al 
for  an  operation  at  St.  Bartholomew's  Hospital. 
The  facts  of  the  case,  briefly  narrated,  were  as 
follow.  For  several  weeks  deceased  had  been 
ailing,  when  he  became  so  much  worse  that  his 

(c)  Hrit.  Mid,  Joum.,  Norember  26th,  19C»4. 


Dec.  7,  1904- 


NOTES    6k    Cfj^RENT    TOPICS.  The  Medical  PiBts.    607 


medical  man  called  in  a  consultant.     The  latter, 
iiiagnosed  appendicitis  and  ordered  opitim'  iexter'* 
nally  and  internally.    A  box  of  pills  was  sent,  with 
-the  directions  that  one  pill  was  to  be  takett  ^e'very 
four  hours,  instructions  which  were  followed  by 
the    nurse  subsequently  engaged,  although    she 
stated  that  she  had  no  knowledge  of  the  nature  of 
the  medicine.     She  had  then  seen  neither  of  the 
medical  men  in  attendance,  and  when  she  left  the- 
case  for  purposes  of   rest  she  gave  the  patient's 
mother  instructions  in  writing  to  continue  the  pills. 
The  mother  and  three  other  witnesses  swore  that 
both  boxes  had  written  instructions  upon  them  to 
the  effect  that  two  pills  were  to  be  given  every 
half  hour  until  sleep  was  induced.     The  medical 
attendant,  on  the  other  hand,  swore  that  there  were 
no  written  directions  at  all  on  the  second  box  but 
that  he  had  ordered  two  piUs  to  be  given  at  once, 
and   one  pill  every  two   hours   afterwards  until 
sleep  followed.     The  nurse's  version  of  this  was 
that  he  directed  her  verbally  to  give  two  pills  at 
once  and  two  more  every  half  hour  subsequently. 
The  attention  of  the  medical  attendant  was  at 
length  arrested  by  the  state  of  the  patient's  eyes, 
and    he   himself   admitted   in  evidence  that     he 
remarked  that  the  sick  man  "  had  had  too  many 
pills."     A  surgeon  was  summoned  ."\y^^  advised 
immediate  operation,  which  wa.^  performed  at  St. 
Bartholomew's  Hospital  on  the  Saturday  evening, 
but  the  patient  died  on  the  following  evening. 
Under  these  circumstances  it  is  hardly  to  be  won- 
dered that  the  relatives  of  deceased  communicated 
with   the    Coroner.     There    can    be   little    doubt 
that  owing  to  some  misunderstanding  an  unusual 
amount  of  opium  was  administered  to  the  patient. 
According  to  the  wife's  statement,  she  gave  her 
husband      twenty      or     thirty      pills      between 
11.30  a.m.   and   4   p.m.   on   the   Saturday.     The 
surgeon   stated   that   death  resulted   from   shock 
and  not  from  the  effects  of  opium.     A  post-mortem 
examination   revealed   extensive   organic   disease, 
so   much  so   that   it   was   extremely  improbable 
deceased  could  have  survived  any  severe  operation. 
That  fact,  however,  does  not  shift  the  responsi- 
bility for   the   laxity  shown  in   deahng  with   so 
dangerous  a  drug  as  opium.     Clearly  it  would  be 
inadvisable  for  medical  men  to  label  distinctively 
all  medicines  for  internal  use  which  happen  to 
contain  poison.     At  the  same  time  ordinary  pru- 
dence would  suggest  that  in  giving  opium  pills  no 
more  than  a  maximum  d^y's  do^e  should  be  en- 
trusted   to   the    patient's   friends,  and  that  clear 
and  full  wntten  instructions  should  be  appended. 
Had  a  chemist  dispensed  boxes  of  opium  pills  in 
the  wholesale  fashion  that  appears  to  have  been 
done  in  this  case,  especially  without  proper  direc- 
tions, or  with  none  at  all,  as  the  medical  man 
asserted  was    the  case  with  the  secoQd  box,  he 
would  have  laid  himself  open  to  a.  charge  of  man- 
slaughter.    Speaking  generally  of  another  aspect 
of  the  case  the  use  of  opium  in  latter  days  has 
considerably  diminished,  in  fact,   many  modern 
practitioners  would  regard  opium-  as  a  last  resort 
in  hopeless  cases  and  would  then  order  it  only 


with  the  merciful  view  of  securing  a  state  of 
euthanasia.  The  tise  of  narcotics  in  appendicitis 
has  been  practically  abandoned  and  there  appears 
to  be  little  question  that  its  administration  merely 
serves  to  mask  S3anptoms  and  greatly  to  reduce  the 
chances  of  success  in  any  operative  measures  that 
may  be  afterwards  undertaken.  However,  opium 
no  doubt  still  has  it  value  in  skilful  hanas,  and 
under  special  circumstances  which  were  no  doubt 
present  in  the  case  under  notice.  On  the  whole 
the  medical  attendant  may  consider  himself  some- 
what fortunate  that  he  has  escaped  more  serious 
consequences  than  a  rider  from  the  j  ury,  represent- 
ing that  in  all  cases  where  medical  men  pre- 
scribed poisons  it  was  desirable  that  the  package 
Should  bear  instructions  as  to  their  administration 
but  not  necessarily  the  name  of  the  drugs.  Had 
this  particular  inquest  been  in  the  hands  of  a 
pathologist  and  a  coroner  whose  relations  with 
the  medical  profession  were  not  of  the  most  cordial 
nature,  the  results  might  have  been  of  a  less 
reserved  iand  conciliatory  character. 


I^otes  on  Current  Ii;opiC0« 


Mr.  Beck's  Double. 

An  interesting  example  of  the  ethics  of  irregular 
priictice  is  supplied  by  the  history  of  John  Smith, 
the  criminal  who,  in  addition  to  his  original  mis- 
demeanours, allowed  another  man  to  suffer  the 
l5unishment  that  •  should  justly  have  been  his. 
John  Smith  who,  after  all,  is  not  particularly  like 
the  unfortunate  Mr.  Beck  in  appearance,  has  passed 
a  wandering,  adventurous  life,  living  apparently 
for  the  most  part  '*  on  his  wits,"  and  in  certain 
stages  of  it  not  doing  so  badly.  He  is  said  to  be  a 
man  of  extraordinary  ability  and  intelligence,  who 
can  speak  and  write  no  fewer  than  thirteen  lan- 
guages and  was  at  one  time  the  moving  spirit  of  all 
gatherings  and  social  functions  in  Adelaide.  He 
has  been  in  many  countries  and  is  possessed  of  a 
large  amount  of  general  information  about  people 
and  things,  not  the  least  interesting  of  his  experi- 
ences being  those  gained  in  the  Hawaiian  Islands 
as  assistant  to  Father  Damien  in  ministering  to  the 
lepers.  But  the  part  of  his  career  which  will  have 
most  interest  to  medical  men  is  that  spent  in 
Australia,  where  he  set  himself  forth  as  a  specialist 
in  the  treatment  of  tuberculosis  and  skin  diseases. 
Where  he  gained  his  knowledge  is  somewhat  of  a 
mystery,  but  when  he  was  challenged  as  to  his 
right  to  practice,  diplomas  of  high  merit  were  forth- 
coming to  substantiate  his  claims.  To  whom  these 
diplomas  were  originally  granted  is  not  known, 
but  Smith  made  a  great  reputation  on  the  strength 
of  reputed  medical  knowledge  and  skill,  and  gained 
a  large  and  lucrative  practice  ;  so  much  so  that 
the  general  practitioners  of  Adelaide  found  his 
opposition  cut  seriously  into  their  incomes.  His 
practice  is  saiid  to  have  been  the  largest  in  the  town, 
and  even  legally-qualified  practitioners  seem  to 
have  availed  themselves  of  his  help  from  time  to 


6o8    Ths  MiDicAL  Pbbss.      notes   on   CURRENT   TOPICS. 


Dec  7.  1904. 


time.  Why  he  gave  up  a  comfortable  livelihood 
is  not  mentioned,  but  probably  the  routine  of 
medical  work  preyed  on  his  versatile  nerves,  and 
he  set  off  on  some  more  exciting  pursuit.  The 
moral  of  the  tale  is  so  obvious  that  one  need  not 
dwell  on  it ;  the  spirit  of  the  irregular  practitioner 
is  essentially  that  of  the  adventurer,  and  from 
quackery  to  crime  is  but  a  short  step. 

Alooholio  Aatomatiwm. 

It  is  not  an  uncommon  occurrence  that  certain 
acts  are  committed  by  a  drunken  person  of  which, 
when  sober,  he  is  quite  oblivious.  Indeed,  after  a 
violent  fit  of  intoxication,  more  often  than  not  the 
subject  forgets  a  great  part  of  what  happened  while 
he  was  in  that  state.  Of  entirely  different  order, 
however,  and  deserving  of  close  study,  are  those 
cases  of  temporary  loss  of  consciousness  which  some- 
times occur  in  habitual  alcohoUcs.  It  happens  that 
a  patient  in  this  condition  may  commit  some  offence 
against  the  law,  for  which  he  is  afterwards  brought 
to  book,  although  he  protests,  quite  truly,  entire 
ignorance  both  of  the  alleged  crime  and  of  his  own 
movements  at  the  time.  Dr.  Crothers,  the  dis- 
tinguished American  aUenist,  deserves  credit  for 
drawing  the  attention  of  medical  men  to  this  con- 
dition, which  indeed  is  often  unrecognised.  It 
usually  occurs  in  persons  who  are  in  the  habit  of 
consuming  fair  quantities  of  spirits,  without  at 
any  time  actually  becoming  drunk.  Suddenly, 
and  for  a  period  varying  from  some  hours  to  several 
days  or  even  weeks,  the  patient  passes  into  a 
condition  of  unconscious  automatism,  exactly 
resembhng  that  which  may  occur  in  epileptics 
following  a  fit.  On  recovery  from  the  condition 
his  mind  is  an  entire  blank  as  to  what  has  taken 
place  during  the  interval.  His  actions  may  have 
been  perfectly  regular  and  usual,  attracting  tio 
attention  from  those  he  has  met.  On  the  other 
hand,  he  may,  apparently  in  a  sober  and  rational 
manner,  have  performed  some  strange  act,  such  as 
murder,  wrecking  a  train,  or  disposing  of  his 
property  without  cause.  Without  going  into  the 
vexed  question  of  the  degree  of  criminal  responsi- 
biUty  in  alcoholics,  it  is  obvious  that  it  is  the  duty 
of  physicians,  as  well  from  a  scientific  as  from 
a  medico-legal  point  of  view,  to  study  carefully  any 
cases  of  alleged  amnesia  which  occur  in  alcoholic 
subjects. 


OsteojMbthy  in  Bnffland. 

The  **  science  "  of  osteopathy  is  largely  culti- 
vated in  America ;  it  has  its  colleges,  its  professors, 
its  diplomas,  and  its  clientele  of  laymen,  who 
prefer  the  ministrations  of  the  osteopathic  doctor 
in  times  of  sickness  to  those  of  the  legitimate 
practitioner.  Not  the  least  use  to  which  the 
Americans  put  their  boasted  freedom  is  that  of 
choosing  what  "  system  '*  their  ailments  shall  be 
treated  by,  and  as  their  proverbial  "  cuteness  "  is 
aUied  with  a  generous  share  of  creduUty  the  quack 
of  all  species  has  an  excellent  field  for  his  enterprises. 
The  osteopathist  is  quite  a  recognised  institution 
in  many  States,  and  Bills  have  been  introduced 
into  their  legislatures  to  legahse  his  position  as  a 


practitioner.  Fortunately  these  Bills  have  all 
been  defeated,  and,  more  fortunately  still,  the 
osteopathist  has  not  hitherto  ventured  to  crois 
the  Atlantic.  But  whether  it  be  from  the  local 
over-production  of  osteopathists  or  from  the  scienoe 
developing  cosmopohtan  tendencies,  this  country 
is  at  present  to  have  at  least  one  professor  dumped 
into  its  midst.  His  arrival  has  been  heralded  in 
the  columns  of  one  of  the  small  fry  of  **  society  " 
journals  who  keep  up  their  circulation  by  pro- 
viding mild  sensations  for  their  readers.  This 
particular  publication  is  somewhat  partial  to 
novelties  in  the  medical  line,  so  that  the  osteopa- 
thist is  quite  a  httle  god-send  to  it.  Some  time 
back  its  columns  were  descanting  on  the  skill  of  an 
appendicitis-curer  who  was  able  to  accomplish  by 
electricity  all  that  surgeons  could  or  could  not  do 
for  that  disease  by  the  knife.  This  professor  seems 
to  have  disappeared,  for  we  have  not  heard  of  him 
lately,  but  his  place  is  more  than  supplied  by  the 
osteopathist  who  can  remove  stoppages  in  the 
blood,  *'  merely  in  a  moment,"  and  by  replacing 
bones  and  untwisting  muscles  is  able  to  perform 
**  some  instantaneous  cures."  We  only  regret 
that  there  is  no  instantaneous  cure  for  those  who 
are  beguiled  by  such  nonsense. 

Abolition  of  Sea  Burial. 

A  PROPOSITION  of  a  curious  sort  is  being  mooted 
at  present  in  New  York.  It  is  that  a  law  should  be 
passed  forbidding  the  burial  of  any  dead  body  at 
sea.  We  confess,  on  first  reading  the  suggestion, 
we  were  in  some  doubt  as  to  how  it  could  haw 
originated,  but  the  matter  afterwards  became 
clearer.  The  custom  itself  is  an  eminently  sanitar}- 
one,  and  it  seemed  hard  to  find  any  arguments 
against  it.  On  the  other  hand,  the  retention  of  a 
body  till  land  could  be  reached  is  open  to  gra\"e 
objection.  In  but  few  vessels  would  there  be  any 
sufficient  method  of  preservation  available,  and 
the  keeping  a  dead  and  decomposing  body  for 
weeks  on  a  tropical  voyage  would  be  no  less  offen- 
sive than  dangerous.  Indeed,  in  many  cases  it 
would  be  an  impossibility,  and  in  all  an  incon- 
venience. The  explanation  of  the  suggestion, 
however,  is  simple.  It  originated  in  an  address 
given  by  the  President  of  the  New  York  State 
Embalmers*  Association !  We  shall  hear  next 
probably  of  gravediggers  demanding  a  law  to  pot 
a  stop  to  cremation. 


The  Antiseptic  Barber. 
Dr.  Collingridge's  recommendations  for 
safeguarding  the  City  populace  from  infection 
conveyed  at  hairdressing  estaUishments  have  been 
approved  by  the  Court  of  Common  Council,  and 
have  now  been  published.  They  are  certainly 
thorough,  and  if  carried  out  by  the  barbers  with  the 
same  zeal  as  that  with  which  they  were  concd^-ed 
by  Dr.  Collingridge,  a  "  shave  and  hair-cut  "  in  the 
heart  of  the  Empire  should  have  no  terrors,  even 
to  the  most  timorous.  The  regtdations  demand 
that  all  shelves  and  fittings  in  hairdressers'  shops 
small  be  made  of  glass,  marble,  or  other  impervious 
material ;    that  clean  towels  be   used  and  fresh 


Dec.  7,  1904. 


NOTES   ON   CURRENT   TOPICS. 


The  Medical  Pitgss.    609 


paper  or  linen  placed  on  the  head  rest  of  the  chair 
for  each  customer  ;  no  sponges  or  powder  pu£Fs 
be  used  ;  all  shaving-brushes,  combs,  scissors, 
razors,  &c.,  be  placed  in  disinfectant  solution  after 
use  ;  no  general  alum-blocks  be  used  as  a  styptic  ; 
and  various  other  drastic  measures  for  ensuring 
cleanliness  be  instituted.  Hairdressers  complying 
with  these  demands  will  be  registered  and  cer- 
tificated as  fit  and  proper  persons  to  undertake 
the  removal  of  superfluous  hair  from  their  clients. 
We  should  be  inclined  to  regard  the  scheme  as 
Utopian  were  it  not  for  the  fact  that  the  regula- 
tions were  drawn  up  and  approved  by  a  joint 
committee  of  the  Public  Health  Committee  of  the 
Council  and  of  the  Incorporated  Guild  of  Hair- 
dressers, and  it  may  be  taken  as  certain  that  the 
latter  would  not  have  sanctioned  any  measures 
that  could  not  be  carried  out  in  consonance  with 
business  principles.  There  are,  however,  many 
small  barbers*  shops  at  which  the  penny  and  three- 
halfpenny  shave  is  a  great  attraction,  and  we 
confess  ourselves  unable  to  see  how  such  establish- 
ments are  to  carry  on  their  trade  at  a  profit  unless 
their  prices  are  raised  materially.  At  any  rate, 
the  ideal  of  what  a  barber's  establishment  should 
be  and  how  it  should  be  managed  will  be  lifted  to  a 
higher  plane  by  the  action  of  the  Common  Council, 
and  we  trust  their  excellent  example  will  have  an 
influence  extending  far  beyond  the  square  mile 
over  which  they  rule. 


Sursrery  in  the  Newspapers. 

Our  readers  are  aware  that  some  of  the  less 
reputable  of  the  London  daily  papers  have  been 
in  the  habit  during  the  past  year  or  two  of  publish- 
ing paragraphs  dealing  in  a  sensational  manner 
with  surgicai  affairs.  The  articles  are  usually  ill- 
informed,  and  almost  invariably  give  the  public  a 
false  impression  of  the  matters  dealt  with.  In 
addition  they  not  infrequently  give  an  unseemly 
prominence  to  the  name  either  of  some  hospital, 
or  still  worse,  of  some  surgeon.  We  regret  that 
this  custom,  which  we  had  hoped  was  confined  to 
the  London  press,  is  spreading  to  other  places, 
and  within  the  past  week  two  respectable  Dublin 
newspapers  published  paragraphs  of  this  kind. 
In  one  case  a  highly-coloured  and  absurdly 
inaccurate  account  was  printed  of  the  operation  for 
excision  of  the  Gasserian  ganglion  which  had  been 
done  a  day  or  two  before  in  one  of  the  Dublin 
hospitals,  the  name  of  the  latter  being  given. 
Among  other  things  it  was  stated  that  this  was  only 
the  fourth  time  the  operation  had  been  performed. 
In  the  other  case  a  long  account  was  published  of 
an  operation  on  the  stomach  for  the  removal  of 
foreign  bodies.  It  is  greatly  to-be  regretted  that 
respectalJle  journals  lend  themselves  to  the  pur- 
veyance of  sensational  news  of  this  sort. 

A  Consumption  Cure. 
An  amusing  action  was  tried  before  Mr.  Justice 
Lawrence  last  week  in  which  a  Mrs.  Long  sued  Dr. 
Boyd  for  breach,  of  contract  in  connection  with  the 
discovery  of  a  treatment  for  consumption  which 
Mrs.  Long  was  trying  to  introduce  to  the  notice 


of  the  world.  The  remedy  in  question  is  a  blending 
of  herbs  which  is  described  as  an  ''  absolute  cure/' 
and  a  good  deal  of  fun  was  created  in  the  course  of 
the  trial  by  one  of  the  witnesses  relating  that  her 
husband  had  died  of  consumption  after  taking  this 
absolute  cure.  The  plaintiff  conducted  her  own 
case,  and  the  evidence  produced  in  support  of  it 
was  so  slight  that  the  jury  returned  a  verdict  for 
Dr.  Bo3^  without  leaving  the  box.  Indeed,  no 
other  result  was  possible,  and  so  ridiculous  were 
the  proceedings  that  Dr.  Boyd  is  more  to  be 
condoled  with  on  the  annoyance  and  expense 
to  which  he  was  subjected  than  congratulated  on  a 
result  which  was  inevitable  ^  from  the  beginning. 
One  of  Mrs.  Long's  witnesses  was  Sir  William 
Broadbent,  who  confessed  that  he  had  no  idea  why 
he  had  been  subpoenaed,  and  whose  evidence 
consisted  principally  in  shaking  his  head  when 
asked  several  times  if  he  woqld  not  try  her  remedy 
on  hospital  patients.  The  Judge  excused  him  from 
attendance  as  soon  as  possible,  and  the  farcical 
action  continued.  A  man  named  Smith  who  had 
been  given  up  as  an  incurable  consumptive  gave 
evidence  that  he  had  been  cured  by  Mrs.  Long,  and 
that  his  case  was  a  most  complicated  one.  Dr. 
Watson,  who  was  called  by  Dr.  Boyd,  was  able  to 
prove  that  the  complications  from  which  Smith 
suffered  did  not  include  consumption,  and  alto- 
gether Mrs.  Long's  patients  did  not  provide  very 
good  advertisement  for  the  absolute  cure.  The 
ground  for  the  action  was  professedly  that  Dr. 
Boyd  had  availed  himself  in  confidence  of  the 
precious  secret  and  exploited  it  for  his  own  profit — 
— an  insinuation  one  would  have  thought  that 
hardly  needed  rebutting.  It  is  a  curious  thing 
that  the  time  of  the  courts  can  be  wasted,  and 
professional  men  put  to  inconvenience  and  ex- 
pense, for  silly  actions  of  this  kind  ;  the  only 
function  they  serve  is  to  entertain  the  readers  of 
evening  papers.  The  doctor  as  a  rule  has  to  make 
sufficient  appearances  in  court  as  a  witness  without 
being  summoned  in  frivolous  action,  which  are  of 
no  use  to  anybody  except  the  lawj^rs. 


The  Treatment  of  Bad  Temper. 

We  do  not  remember  in  any  work  on  therapeutics 
to  have  seen  a  chapter  devoted  to  the  treatment  of 
irritable  temper.  Nor,  indeed,  is  irritable  temper 
as  such  commonly  brought  under  the  notice  of  the 
physician  for  medical  treatment.  Many  physi- 
cians must,  nevertheless,  number  among  their 
patients  certain  irascible  individuals  the  reduction 
of  whose  temper  to  an  equable  frame  would  be  a 
blessing  not  only  to  themselves  but  to  their 
associates  in  business  or  family  life.  For  the  treat- 
ment of  such  people  a  hint  may  be  gathered  from 
the  communication  which  Sir  Lauder  Brunton  has 
been  persuaded  to  make  to  a  lay  journal.  Our 
contemporary  sought  advice  from  several  clerical 
gentlemen  as  to  the  best  method  of  preserving 
perpetual  amiability,  and,  reflecting  that  the  body 
as  well  as  the  soul  might  be  concerned,  invited 
also  Sir  Lauder  Brunton  *s  opinion.  He,  by  his  own 
confession,  is  in  the  habit  of  prescribing  what  he 


6x0    Tsn  Medical  Press. 


NOTES   ON   CURRENT  .TOPICS. 


Dec.  7.  1904. 


calls  a  **  temper-powder,"  with  excellent  efiect  in 
cases  of  irritability  in  gout.  It  consists  of  20 
grains  of  bicarbonate  of  potash,  with  10  to  20 
grains  of  bromide  of  potash.  In  cases  where  the 
irritability  springs  from  cardiac  disease  or  **  is  the 
precursor  of  headache,"  "  a  few  doses  of  bromide 
of  potassium  and  salicylate  of  soda  give  rehef  and 
improve  the  temper."  We  have  no  doubt  that 
Sir  Lauder  Brunton's  prescriptions  are  admirably 
adapted  to  their  purpose,  but  we  hardly  think  the 
columns  of  The  House  Beautiful  a  suitable  channel 
for  their  publication. 

Dangers  of  Celluloid  Combs. 

The  risks  attending  the  use  of  celluloid  combs 
and  collars  have  been  abundantly  illustrated  by 
many    a    tragedy.     Again    and    again    have    the 
luckless  wearers  of  such  articles  been  severely  or 
fatally  burnt  by  chance   contact  with   a   flame. 
There   is   another   celluloid   danger,    however,   to 
which  the  public  is  not  generally  ahve,  namely,  the 
use  of  that  material  so  cleverly  masked  as  to  be 
unrecognisable  as  celluloid  save  to  the  expert  in 
such  matters.     The  facts  of  a  recent  case  brought 
under  our  editorial  notice  were   as   follows  : — A 
young  lady  in  the  country  was  wearing  two  hand- 
some and  costly  combs,  apparently  made  of  tor- 
toiseshell,   mounted  with  silver   and   ornamental 
stones,  while  tending  a  sick  domestic  pet — country- 
wise — in  the  kitchen.     She  stooped  with  her  head 
some  two  or  three  feet  away  from  a  hot  fire  for  a 
space  of  about  ten  minutes  or  a  quarter  of  an  hour. 
Suddenly  her  head  was  seen  to  be  enveloped  in 
smoke.     The  smouldering  material,  which  proved 
to  be  the  so-called  tortoiseshell,  burnt  through 
aprons  and  other  extinguishers,  and  was  at  last 
subdued  only  by  a  prolonged  douche  beneath  the 
kitchen    water-tap.     The    resulting    burns    were 
severe  and,  had  not  prompt  assistance  been  at 
hand,    might    readily    have    proved    fatal.     The 
moral  of  all  this  is  that  the  world  of  women  should 
learn  that  combs  may  be  sold  to  them  at  high 
prices  as  tortoiseshell,  whereas  they  are  in  reality 
made  of  inflammable  celluloid.     The  aristocratic 
tortoiseshell   does   not  blaze   and   smoulder,   and 
when  placed  in  an  actual  flame  departs  from  the 
world  in  the  odour  of  calm  and  stoical  incineration. 
Vulgar  celluloid,  on    the  other    hand,    swells    up 
into  an  inflated  mass  of  hot   and  vixenish  com- 
bustion when    brought  close   to  a  stove,  lamp, 
or  other  source  of  heat.     Therefore,  ladies,   be 
sure  what    you  buy  as  tortoiseshell  is  the  real 
thing  and  not  that  modified  form  of   gun-cotton 

known  as  celluloid.        

A  Judi3re*8  "  Surprise  "  at  a  Medical  Witness. 


without  a  clear  undertaking  as  to  payment  of  feto 
Even  where  his.  evidence  is  material  to  a  decision 
he  runs  a  considerable  chance  of  receiving  nt\xi  a 
penny  in  return  for  his  services.     That  land  of 
experience  comes  sooner  or  later   to  the  young 
medical  man  and  bums  into  his  soul  the  con\nctioa 
of  the  folly  of  trusting  either  lawyers  or  litigants 
when  it  comes  to  a  question  of  payment  of  wit- 
ness' fees.      The  proper  course  is  for  the  medical 
man,  when  he  steps  into  the  witness-box,  to  refuse 
to  be  sworn  unless  his  fees  are  first  paid.    It  i? 
astonishing   how  often  judges   are    apt  to  bring 
pressure  to  bear  upon  medical  men  under  such  dr- 
cumstances,    although    their    zeal    for    gratuitona 
justice    rarely,  if    ever,   extends   to    members  0: 
the    legal    profession.     Some    weeks     ago    Judge 
Gwilym  Wilhams,  in  a  compensation  case  brought 
against  the  Great  Western  Railway,   adopted  as 
extreme,  and,  so  far  as  can  be  gathered  from  a 
report  in  the    Western   Mail,   an    unfair   attitudt 
towards  a  medical  man  in  Court  who  had  been  sub- 
poenaed by  both  sides,  and  who  naturally  wanted 
to  know  who  was  going  to  pay  for  his  evidence. 
The  judge  is  reported  to  have  said   severely:  **  I 
am  surprised  at  a  medical  gentleman   making  sd 
much  fuss  about  his  fees  in  a  case   of  this  kind 
when  so  much  is   at  stake."    Surely,  if  the  mag- 
nitude of  the  case  is  to  be  an  argument  against 
ensuring  the  payment  of  fees,  the  rule  would  apply 
equally  to  the  judge,  counsel,  solicitors  and  un- 
skilled   witnesses.     Subsequently    the    judge   ex- 
pressed regret  for  those  remarks  on  the  ground 
that  Dr.  Evans'  evidence  was  of  the  utmost  im- 
portance, but  we  fail  absolutely  to  recognise  the 
proposition  that  the.rights  of  a  witness  are  to  be 
upheld  or  treated  with  contempt  in  proportion  to 
their  direct*  value  in  relation  to  the  merits  of  a 
given  case. 


The  easy-going  wajrs  of  the  medical  profession 
are,  beyond  a  doubt,  answerable  for  the  loss  of  a 
good  deal  of  legitimate  income.  Take,  for  in- 
stance, the  lax  methods  of  medical  men  compared 
with  those  of  lawyers  engaged  in  a  legal  case. 
Before  coming  into  Court  the  lawyer  either  pockets 
his  fee,  or  assures  himself  with  a  reasonable  amount 
of  certainty  that  his  costs  will  be  forthcoming 
should  his  client  win  or  lose.  Woe  to  the  medical 
witness   who   is   weak   enough   to   give   evidence 


Sanatoria  as  Public  Educators. 

The   anti-tuberculosis   crusade,  however   much 
its  achievements  may  fall   short   ot    its   aims,  is 
exercising  an  influence  of   untold   weight  in  the 
education  of  our  countrymen   in    the   matter  of 
phthisis   and   its   prevention.     Every    local   com- 
mittee in  this  way  becomes  a  radiant  centre  for 
the  diffusion  of  knowledge  of  the  highest  preven- 
tive  value  in  its   immediate    neighbourhood.     A 
good  instance  of  the  awakening  effect  of  the  crusade 
was  shown    last  week  in  the   important  inquirv 
opened     at    Exeter     by    the     General    Purposes 
Committee  of  the  Devon  County  Council  as  to  the 
proposed  establishment  of  a  hospital  for  the  treat- 
ment of  phthisis.  The  widespread  public  interest  in 
the  question  was  evidenced  by  petitions  from  five 
towns  and  a  large  number  of  public  authorities 
concerned.     Of  the  latter  no  less  than  thirty-two 
bodies  expressed  themselves  in  favour  of  the  pro- 
posed   hospital.     In    addition,    many    prominent 
men,  medical  and .  non-medical^   expressed  views 
which  will  gain  the  widest  publicity  by  means  of 
newspapers  and  reports.     In  this  case  the  Exeter 
organisation  has  spread  the  leaven  of  useful  in- 
formation   not    only   through    Devon,    but    also 
through  adjoining  counties. 


Dec.  7,   1904- 


PERSONAL. 


Tbk  Mkdical  Pebss.   61 1 


The  Late  Sir  Williani  Mitchell  Banks. 

On  Tuesday,  November  29th,  a  meeting  was 
convened  at  the  Liverpool  Town  Hall,  under  the 
presidency  of  the  Lord  Mayor,  to  take  into  con- 
sideration a  proposal  to  perpetuate  in  some 
fitting  and  material  way  the  memory  of  the  late 
Sir  William  Banks,  M.D.,  F.R.C.S.  The  meeting 
was  in  every  way  a  representative  and  influential 
one,  and  a  spirit  of  unanimity  pervaded  the  whole 
proceedings.  It  was  everywhere  felt  that  the 
late  distinguished  surgeon  had  deserved  well  of 
the  community  amongst  which  he  bad  spent  a 
laborious  and  eminently  useful  hfe.  It  was,  and  is, 
felt  by  many  that  the  Liverpool  University  itself 
owes  its  very  existence  to  him  ;  more  so,  perhaps, 
than  to  any  one  individual  besides.  The  Lord 
Mayor  proposed:  "  That  a  memorial  of  a  permanent 
character  be  established  to  commemorate  the 
name  and  the  services  of  the  late  Sir  William 
Mitchell  Banks."  The  proposition  was  seconded 
in  an  eloquent  speech  by  Vice-ChanceUor  Dale, 
who  observed  that  a  "  better  idea  had  occurred  to 
some  influential  friends  of  the  movement  that  there 
should  be  a  lectureship  established,  permanently 
identified  with  Sir  William  Banks'  name  and  asso- 
ciated with  the  objects  of  medical  education  which 
he  had  in  view."  The  idea  seemed  to  '*  catch  on  " 
at  the  meeting,  and  at  the  close  a  subscription -list 
was  opened,  when  a  considerable  number  of  the 
gentlemen  present  liberally  responded.  There  can 
be  no  doubt  that  the  movement  will  be  carried  to 
a  deservedly  successful  issue. 


The  Pastime  of  Oyoling. 

From  the  point  of  view  of  the  medical  man, 
cycling  as  a  form  of  physical  exercise  cannot  be  too 
highly  recommended,  but  naturally  everything 
depends  upon  the  way  in  which  it  is  followed. 
The  method,  of  course,  of  the  "  Clan  McScorcher  " 
— the  members  of  which  pace  the  roads  at  the  top- 
most of  their  powers,  with  their  noses  on  the  handle 
bar,  and  their  backs  and  arms  curved  like  "  mon- 
keys on  the  stick  " — need  only  be  mentioned  to 
be  condemned  ;  often  the  youths  who  thus  attempt 
to  acquire  the  name  of  "  speed  merchants,"  as  the 
term  goes,  may  be  met  with  whose  faces,  from  their 
cyanosed  condition,  betoken  only  too  plainly  the 
dangerous  physical  effort  to  which  they  are  sub- 
jecting themselves.  Again,  cycle  racing  is  a  prosti- 
tution of  this  pleasure-affording,  attractive  pastime 
which  calls  for  no  further  comment,  even  apart 
from  the  direct  risk  to  life  to  which  its  followers 
are  exposed.  In  view,  then,  of  the  health,  enjoy- 
ment, and  exercise  which  pleasure  cycling  affords, 
it  is  regrettable  to  note  that  evidence  exists  of  its 
waning  popularity.  We  presume  that  the  Cyclists* 
Touring  Club  may  be  taken  as  representing  the 
measure  of  popular  interest  devoted  to  cycling  in 
this  country,  and  yet  while  a  few  years  ago  the 
membership  of  this  club  amounted  to  nearly 
60,000,  in  the  present  day  it  has  diminished  to 
half  that  number.  What  does  this  mean  ?  Does 
it  imply  that  cycling  is  less  attractive  as  a  pastime 
than  it  used  to  be  ?  We  sincerely  trust  that  this  is 
not  the  case  ;  on  the  other  hand,  it  seems  difl&cult 


to  account  for  the  serious  falling  off  in  the  mem- 
bership of  this  erstwhile  flourishing  club.  The 
latter,  however,  recently  announced  that  they 
were  about  to  embark  upon  a  new  scheme  in  which 
they  had  great  hopes  of  bringing  back  the  popu- 
larity which  they  had. lost.  This  great  scheme 
consists  in  offering  to  Spend  some  of  the  club's 
hard-earned  savings  to  the  extent  of  ;f400  in 
prizes  for  the  discovery  of  a  device  for  preventing 
side-slip.  We  may  now  expect  the  railway 
companies  to  offer  prizes  for  the  prevention  of 
railway  accidents.  The  idea  of  such  a  scheme  is 
splendid  from  the  point  of  view  of  its  impractica- 
bility, and  it  is  scarcely  needful  to.  state  that  if  the 
Council  of  the  C.T.C.  can  suggest  nothing  better 
than  this  to  restore  the  former  popularity  of  the 
club,  the  members  should  take  an  early  occasion 
to  elect  other  representatives  to  protect  their 
interests. 


The  "  Hospital  "  and  the  Funds. 

The  Editor  of  the  Hospital  is  exceedingly 
wroth  with  The  Medical  Press  and  Circular  for 
not  having  replied  forthwith  to.  his  challenge  to 
us  to  substantiate  certain  statements  with  regard 
to  the  Hospital  Sunday  and  King  Edward's 
Hospital  Funds.  He  may  rest  assured  that  there 
will  be  plenty  of  material  for  him  to  work  upon 
before  the  Ides  of  March  are  upon  us.  Pressure 
upon  space  and  the  verification  of  facts  and 
figures,  so  far  as  possible  upon  the  basis  of  scanty 
reports,  may  or  may  not  be  accepted  as  satis- 
factory reasons  for  the  delay,  but  in  any  case  we 
have  not  the  least  intention  of  being  hustled  by 
the  editor  of  any  contemporary,  lay  or  medi- 
cal. The  relations  of  the  Royal  Orthop.-rdic 
Hospital  to  the  Hospital  Sunday  Fund  will  require 
restating,  as  the  Editor  of  the  Hospital  has  failed 
to  grasp  our  points.  We  fear  our  contemporary 
will  have  to  wait  another  week,  but  we  note 
that  delay  does  not  prevent  him  anticipating 
some  of  our  arguments.  1 


PERSONAL. 


Dr.  Priestley  Smith,  who  has  filled  the  post  of 
Ophthalmic  Surgeon  to  the  Queen's  Hospital,  Bir- 
mingham, for  more  than  thirty  years,  has  resigned  his' 
appointment.  The  Committee  have  accepted  the  same 
"  with  deep  regret,"  and,  as  a  mark  of  their  apprecia- 
tion of  his  services^  have  recommended  the  Governors 
that  he  should  be  elected  honorary  consulting  surgeon 
to  the  hospital. 

The  lifework  of  the  late  Sir  Wm.  Mitchell  Banks, 
Emeritus  Professor  of  Anatomy  at  the  Liverpool 
University  and  Consulting  Surgeon  to  the  Royal 
Infirmary,  is  about  to  be  perpetuated  by  a  memorial, 
tne  form  of  whicn  is  undecided.  We  refer  more  fully 
to  the  subject  in  the  previous  column. 


By  a  recent  decree  of  the  Provost  and  Senior  Fellows 
of  Trinity  College,  Dublin,  a  Chair  of  Applied  Chemistry 
has  been  established  in  the  University.  The  first 
occupant  is  Mr.  E.  A.  Werner,  for  many  years  Assistant 
to  the  Professor  of  Chemistry.  His  work  is  well  known 
in  the  scientific  world. 


Prof.  Sir  \V.  Japp  SiNCL.\rR,  M.A.,  M.D.,  has  been 


6l2     The  Mkdical  Pkbss. 


SPECIAL    CORRESPONDENCE. 


Dec.  7.  1904- 


^ected  Chairman  of  the  Universities  of  Glasgow  and 
Aberdeen  Conservative  and  Liberal  Unionist  Associa- 
tion for  promoting  the  candidature  of  Prof.  William  R. 
Smith,  M.D.,  to  represent  these  Universities  in  Parlia- 
ment. 


The  Nobel  prijse  in  the  Physical  and  Chemical 
Sciences  Section  is,  according  to  the  Paris  Journal  des 
Sciences,  likely  to  be  award^  this  year  to  Sir  William 
Ramsay,  Professor  of  Practical  Chemistry  in  University 
College,  London. 

An  appeal,  signed  by  the  Hon.  Sydney  Holland, 
Sir  Francis  Laking,  Sir  Frederick  Treves,  and  Mr. 
Malcolm  Morris,  has  been  issued  for  subscriptions  to 
the  fund  for  the  erection  of  a  monument  to  the  late 
Professor  Finsen.  The  British  Committee  formed  to 
co-operate  with  the  Danish  Committee  has  received  a 
donation  of  £so  from  the  King  and  of  ;£ioo  from  the 
Queen.  Subscriptions  may  1^  paid  to  the  Finsen 
memorial  fund  at  the  National  I^ovincial  Bank,  112, 
Bishopsgate  Street,  London,  £.C. 

The  Earl  of  Rosebery,  Chancellor  of  the.University, 
has  given  ;£  1,000  to  the  Institute  of  Medical  Sciences 
Fund.  University  of  London. 


The  Astley  Cooper  Prize  of  ;£300,  which  is  offered 
triennially  for  medical  research,  has  been  awarded  to 
Mr.'  W.  Sampson  Handley,  Hunterian  Professor  in  the 
Royal  College  of  Surgeons,  for  an  essay  entitled 
"  Epigastric  Invasion  of  the  Abdomen  in  Breast 
Cancer.'* 


Mr.  Lynn  Thomas,  C.B.,  F.R.C.S.,  has  accepted  the 

S»sition    of    honorary   consulting    surgeon    to    Barry 
ospital. 

Dr.  Donald  MacAlister,  of  St.  Jonn's  College, 
Cambridge,  has  been  elected  President  of  the  General 
Medical  Council,  on  tne  retirement  of  Sir  William 
Turner. 


Lady  Cheylesmore,  wife  of  the  Mayor  of  West- 
minster, opened  the  new  building  of  the  Royal  Ear 
Hospital,  recently  erected  at  42  and  43,  Dean  Street, 
Soho,  on  Monday  last,  at  3  p.m. 

We  are  officially  informed  that  the  Local  Govern- 
ment Board  of  Scotland  have  appointed  Dr.  Fred. 
Dittmar.  M.A.,  M.D.,  D.P.H.,  to  the  office  of  Medical 
Inspector,  vacant  by  the  promotion  of  Dr.  W.  Leslie 
Mackenzie  to  be  Medical  Member  of  the  Board.  He 
is  the  Medical  Officer  of  Health  for  Scarborough,  and 
previous  to  his  present  appointment  he  was  for  some 
years  resident  Medical  Officer  to  the  City  of  Glasgow 
Fever  Hospitals,  and  afterwards  assistant  to  the  Medical 
Officer  of  Health  for  that  city. 


Mr.  John  Utting,  J. P.,  a  medical  member  of  the 
city  council,  has  been  elected  to  the  important  post  of 
Chairman  of  the  Port  Sanitary  and  Hospitals  Com- 
mittee of  the  Liverpool  Corporation. 

On  November  22nd,  the  Right  Hon.  George  W^ynd- 
ham,  M.P.,  Chief  Secretary  for  Ireland,  was  formally 
installed  as  Rector  of  the  University  of  Glasgow.  The 
Corporation  of  the  city  was  represented  by  the  Lord 
Provost,  Sir  John  Ure  Primrose,  and  several  members 
of  the  town  council. 


Dr.  Reclus,  Professor  of  Operative  Surgery  in  the 
Paris  Faculty  of  Medicine,  has  been  appointed  at  his 
own  request  Professor  of  Clinical  Surgery  in  succession 
to  the  late  lamented  Professor  Tillaux. 


The  following  telegram  from  Sir  C.  Boyle,  Governor 
of  Mauritius,  has  been  received  at  the  Colonial  Office  : — 
■ '  For  the  week  ending  December  ist,  32  cases  of  plague, 
25  fatal,  2  white." 


Special  correspondence* 

[from  our  own  correspondents.] 

SCOTLAND. 

Glasgow  Maternity  Hospital. — H.R.H.  the  Prin- 
cess Louise,  whose  philanthropic  interest  in  medical 
charities  has  been  conspicuous  on   many  occasions, 
attended  a  meeting  in  the  Grand  Hotel,  Glasgow,  cd 
November  29th,  for  support  of  the  movement  for  the 
extension  of  the  Glasgow   Maternity   HospitaL    For 
a  number  of  years  the  work  of  the  hospital  has  been 
hindered  by  lack  of  accommodation,  both  for  patienu 
and  students,  and  to  remedy  this  the  directors  have 
acquired  a  considerable  amount  of  property  adjaccai 
to  the  present  building,  on  which,  in  addition  to  in- 
creased accommodation  for  patients,    they  intend  to 
provide  a  school  for  the  practical   teaching  of  mki- 
wifery   and   gynaecology.     The   sum    required    to  be 
collected  is  ;t54.5«).  including  ;£i4.5«>  as  thecost  ol 
the  site  and  £40,000  for   new  buildings.       Profesaor 
Murdoch  Cameron,   after  dwelling   for   a   moment  or 
two  on  the  poverty  of  many  of  the  inhabitants  of  a 
great  city  like  Glasgow,  in  which  30  per  cent,  of  the 
houses  were  of  one  apartment  only,  said  that  donas 
the  past  ten  years  the  hospital  had  attended  29^)13 
cases,  90  per  cent,  of  which  had  been  the  wives  of  poor 
working  men.     During  the  same  time  they  had  trained 
1,244  students  and  800  nurses.     These  men  were  now 
practising  throughout  the  country,  and  those  who  had 
comfortable  homes  were  at  the  mercy  of  these  men  ami 
women  therein    trained  and  educated  for  their  work. 
His  Grace  the  Duke  of  Argyll  moved   the  foUowis^ 
resolution  :— *'  That  in  view  of  the  urgent  need  that 
exists  for  the  increased  accommodation   of  patients, 
and  for  the  training  of  students  and  nurses,  this  nwet- 
ing  resolves  to  support  the  Directors  of  the  Maternity 
Hospital  in  their  efforts  to  effect  both  these  objects." 
This  was  seconded  by  Prof.  A.  R.  Simpson,  Edinburgh, 
and  carried.     Lady  Ure  Primrose  moved   the  second 
resolution  : — "  That  the  meeting  do  all  in  its  power  to 
raise  the  necessary  funds,"  which  was   supported  bj 
Rev.  Dr.  Macleod,  and  carried. 

School  Board  Certificates. — The  Dundee  Branch 
of  the  British  Medical  Association  has  passed  a  re- 
solution maintaining  that  the  responsibihty  for  the 
supply  of  medical  certificates  for  absent  children  rests 
on  the  School  Board,  and  recommending  medical  officers 
of  charities  and  other  public  bodies  to  decline  to  fill 
them  up.  This  entirely  reasonable  action  appears  to 
have  incensed  the  School  Board  authorities,  for  00c  of 
the  members  in  consequence  asserted  that  the  medical 
profession  were  desirous  of  foisting  two  or  three  of 
their  own  number  on  the  Board.  He  pointed  oat, 
what  is,  we  think,  sufficiently  well  known,  that  until  a 
new  Act  was  in  force  the  School  Board  had  no  power  to 
appoint  medical  men,  but  this  in  no  way  makes  the 
present  system  of  expecting  every  medical  officer  to  a 
charity  to  fill  up  certificates  for  non-attendance  at 
school  less  anomalous. 

BELFAST. 

Annual  Dinner  of  the  Ulster  Medical  Society. 
-—The  annual  dinner  of  the  Ulster  Medical  Society  was 
held  on  Saturday  evenmg  last  in  the  Medical  Institute, 
Belfast,  when  a  marble  bust  of  Sir. William  Whitk 
the  donor  of  the  Institute,  was  unveiled  by  Sir  Lauda 
Brunton,  who  had  kindly  come  from  London  for  the 
purpose.  The  chair  was  occupied  by  tne  President 
of  the  Society,  Dr.  William  Calwell,  and  among  the 
guests  present  were  the  Lord  Mayor  of  Belfast,  the 
President  of  Queen's  College.  Belfast.  Mr.  Chance,  the 
President  of  the  Ro^l  College  of  Surgeons.  Ireland ; 
Professor  W.  Smith,  T.C.D. ;  Sir  John  Moore.  Sir  Wm. 
Thompson,  Sir  T.  Myles,  and  Professor  Lorrain  Smith. 
After  the  toasts  of  the  "  King"  and  the  **  Lord  Lieo- 
tenant"  and  "Prosperity"  to  Ireland.  Dr.  CalweU called 
on  Sir  Lauder  Brunton,  explaining  in  a  few  words  the 
history  of  the  Institute  and  of  the  movement  to  provide 
a  permanent  memorial  of  the  donor  in  it.  Sir  Lauder 
Brunton,  who  received  a  very  enthusiastic  wdcome. 
spoke  of  his  many  years'  friendship  with  Sir  WilMam 


Dec.  7,  1904. 


SPECIAL  REPORTS. 


The  Medical  Pee$s.    613 


\pVhitla  and  of  the  personal  qualities  of  kindness  and 
sympathy  which  endeared  him  to  all  with  whom  he 
came  in  contact,  of  his  success  as  a  practitioner  and 
teacher,  and,  lastly,  as  a  writer  who  had  enriched  the 
^whole  world  by  his  works.  The  Ulster  Medical  Society 
were  under  a  special  debt  of  gratitude  for  the  Institute  ; 
he  attached  the  greatest  importance  to  the  opportu- 
nities for  social  intercourse  which  it  afforded  and  en- 
couraged, for  differences  of  opinion  and  divided  in- 
terests were  sure  to  arise  in  the  course  of  practice 
-which  could  be  smoothed  down  by  the  men  meeting 
together  in  friendly  social  intercourse.  He  had  the 
^eatest  pleasure  in  unveiling  the  bust  and  proposing 
the  health  of  the  donor  of  the  Institute.  Sir  William 
Whitla  was  also  received  very  warmly  on  rising  to 
reply  to  his  health.  He  thanked  Sir  Lauder  Brunton 
from  the  bottom  of  his  heart  for  all  his  kind  and  flatter- 
ing words,  and  said  that  for  all  he  had  done  he  was 
amply  repaid  when  he  looked  into  the  Institute  occa- 
sionally in  the  evening  and  saw  the  members  of  the 
Society  enjoving  its  use.  He  gave  an  amusing  account 
of  the  modelling  of  the  bust  in  clay  by  Miss  Kathleen 
Shaw,  the  sculptor,  and  his  hope,  when  he  found  that 
the  clay  had  been  previously  used  for  a  bust  of  the 
Primate  of  All  Ireland,  that  some  of  his  great  gifts  of 
oratory  might  descend  on  him,  but  when  he  tried  to 
express  his  feelings  he  found  he  was  common  clay 
after  all.  The  other  toasts  were  "  The  Dublin  Schools 
of  Medicine,"  proposed  by  Professor  Lindsay,  and 
responded  to  by  Mr.  Chance,  President  R.C.S.I. ; 
Professor  Walter  Smith,  T.C.D.,  and  Sir  John  Moore, 
Ex-President  R.C.P.I. ;  "  Our  Guests,"  proposed  by 
I>r.  Walton  Browne  and  responded  to  by  Sir  Lauder 
Brunton  and  the  President  of  Queen's  College ;  and 
"*  The  President,"  proposed  by  Dr.  Kevin,  responded 
to  by  Dr.  Calwell. 

The  Health  of  the  City. — During  the  four  weeks 
ending  November  19th,  276  cases  of  zymotic  disease 
were  notified  in  Belfast,  including  63  typhoid,  70  simple 
continued  fever,  56  scarlet  fever,  41  erysipelas,  18  small- 
pox, 21  diphtheria.  5  membranous  croup,  and  2  puer- 
peral fever.  The  deaths  from  zymotic  diseases  were  72. 
and  those  from  phthisis  and  other  diseases  of  the  re- 
spiratory system  189.  The  annual  death-rate  from 
all  causes  was  18*4,  an  increase  of  o'5  over  the  same 
period  last  year. 

The  Small-pox  Outbreak. — During  the  past  fort- 
night there  have  been  10  new  cases  of  small-pox  dis- 
covered and  removed  to  hospital.  Four  of  these  were 
from  one  family  ;  two  children  had  suffered  from  mild 
attacks  and  were  only  found  out  when  another  child, 
unvaccinated.  took  a  severe  attack,  and  the  father  also 
became  ill.  Two  other  cases  of  the  ten  were  unvacci- 
nated, an  adult  and  a  child  of  fifteen  months.  Except 
for  these  unvaccinated  cases,  the  general  type  of  the 
disease  is  mild.  There  was  one  death  during  the  fort- 
night, an  unvaccinated  adult  of  37,  who  had  come  in 
the  previous  week.  The  outbreak  hajs  now  lasted 
nearly  fourteen  months,  and  there  have  been  137  un- 
doubted cases  of  small-pox  under  treatment. 


Special  IReports. 

THE  GENERAL  MEDICAL  COUNCIL. 

SATURDAY,  November  26th. 

The  President,  Sir  W.  Turner,  in  the  Chair. 

Aosent,  Mr.  Morris,  Mr.  Power,  Mr.  Tichbome. 

The  Minutes  of  the  last  meeting  were  read  and 
confirmed. 

Dr.  Caton  was  elected  on  the  Examination  Com- 
mittee as  a  member  representing  the  English  Branch 
Coancil,  in  the  place  of  Dr.  Payne,  no  longer  a  member 
of  the  Council. 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  McVail,  that  the  Report  of  the  Examination 
Committee  on  the  Inspection  of  the  Final  Examination 
of  the  University  of  Edinburgh  be  received  and  entered 
on  the  Minutes. 

The  Committee  in  their  Report  (signed  by  the  Chair- 
man, Sir  Patrick  Heron  Watson)    recommended    that 


As  the  difference  of  opinion  between  the  Visitor  and 
Inspector  on  one  hand,  and  the  University  on  the 
other,  is  fundamental  as  to  the  nature  of  the  Surgical 
Examination,  and  as  the  Visitor  and  Inspector  have 
not  given  any  detailed  evidence  in  support  of  their 
adverse  criticisms,  and  as  some  of  the  Statements  of 
Opinion  by  the  Visitor  and  Inspector  are  irreconcilable 
with  each  other,  the  Medical  Council  should  direct 
that  a  further  inspection  be  made  of  the  surgical  part 
of  the  Final  Examination  in  the  University  of  Edin- 
burgh. 

Sir  John  Tuke  proposed,  and  Dr.  Mack  ay  seconded, 
an  amendment  to  omit  certain  phrases  in  the  Section 
of  Remarks  by  the  Visitor  and  Inspector  before  the 
Report  was  entered  on  the  Minutes. 

A  long  discussion  followed,  nearly  all  the  speakers 
being  of  opinion  that  all  Reports  of  Visitors  and  In- 
spectors should  be  treated  with  great  respect,  and 
should  be  sent  on  entire  to  the  Privy  Council. 

Sir  John  Batty  Tuke  and  his  seconder  sought  the 
permission  of  the  Council  to  withdraw  his  amendment 
m  favour  of  another  by  Dr.  Norman  Moore. 

Dr.  Pye-Smith  moved  the  closure,  and  that  the 
Council  should  proceed  to  vote  on  the  amendment. 
Dr.  Lindsay  Steven  seconded,  and  the  motion  was 
carried. 

The  Council  then  proceeded  to  vote  on  the  amend- 
ment, which  was  lost  22 — 4 ;  4  did  not  vote,  3  absent. 

It  was  then  put  that  the  Report  be  received  and 
entered  on  the  Minutes.     This  was  carried. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Su: 
Victor  Horsley.  and  carried  :  "  That  the  discussion 
on  this  Report  be  adjourned  to  Monday,  November  28th, 
1904." 

Dr.  WiNDLE  moved  that  the  Report  of  the  Educa- 
tion Committee  be  received  and  entered  on  the  Minutes. 
He  clearly  explained  the  scheme  it  contained.  Sir 
Christopher  Nixon  seconded. 

Moved  by  Dr.  Windle,  seconded  by  Sir  Christopher 
Nixon  :  "  That  any  well-considered  plan  which  would 
tend  to  a  diminution  in  the  number  of  examinations 
in  preliminary  subjects  of  education,  and  to  a  unifica- 
tion of  standard  of  those  which  remain,  would  meet 
with  the  hearty  approval  of  the  Council." 

Sir  Victor  Horsley  proposed,  and  Mr.  Jackson 
seconded,  an  amendment :  "  That  while  recognising  the 
practical  difficulties  of  unifying  methods  of  testing 
secondary  education,  the  General  Medical  Council 
expresses  the  hope  that  the  Board  of  Education  may. 
in  considering  any  system  of  School  Certificates,  find 
it  possible  to  establish  a  Central  Board  for  the  purpose 
of  creating  and  supervising  a  single  examination  of 
such  a  standard  that  it  might,  in  the  opinion  of  the 
General  Medical  Council,  be  recognised  as  qualifying 
for  entrance  to  a  course  of  professional  study." 

This  was  lost,  18 — ^4 ;    8  did  not  vote,  3  absent. 

Dr.  Windle's  original  motion  was  carried. 

Moved  by  Dr.  Windle,  seconded  by  Dr.  Pye-Smith. 
and  agreed' to  :  "  That  if  the  Standard  of  Examination 
contemplated  in  the  scheme  were  such  as  to  be  gener- 
ally accepted  for  entrance  or  matriculation  by  the 
Universities  of  England,  the  Medical  Council  would 
be  prepared  to  recognise  it  as  qualifying  for  entrance 
on  a  course  of  professional  study." 

Moved  by  Dr. Windle,  seconded  Dy  Dr.  Mac  Alister. 
and  agreed  to  :  "  That  pending  the  general  adoption  of 
a  uniform  system  of  educational  tests,  the  Council 
would  welcome  the  establishment  under  the  Board  of 
Education  of  a  Central  Board,  for  the  purpose  of 
classifying  examinations  according  to  standard  and 
arranging  for  the  mutual  recognition  of  certificates ; 
and,  further,  that  they  regard  the  establishment  of 
such  a  Board  as  highly  desirable  from  an  educational 
point  of  view." 

Moved  by  Dr.  Windle,  seconded  by  Sir  John 
Moore  :  ''  That  the  Report  of  the  Education  Com- 
mittee as  modified  be  approved." 

The  Reports  of  the  Pharmacopoeia  Committed  and 
of  the  Finance  Committee  were  received  and  entered  on 
the  Minutes  without  discussion. 

The  Council  then  adjourned. 


6X4    Tbk  Mbdical  Press 


SPECIAL   REPORTS, 


DbC.   '.    1^4^ 


.    MONDAYj  November  28th,  1904. 

The  Presidents  Sir  Wm.  Turner,  in  the  Chair. 

Absent,  Mr.  Morris,  Mr.  Power,  Mr.  Tichbome. 

The  Minutes  pf  the  last  meeting  were  read,  amended, 
and  confirmed. 

The  Council  proceeded  to  the  consideration,  ad- 
journed from  November  2j6th,  1904,  on  the  motion  of 
Dr.  Norman  Moore,  seconded  by  Sir  Victor  Horsley, 
of  the  Report  by  the  Examination  Committee  on  the 
Inspection  of  the  Final  Examination  of  the  University 
of  Edinburgh.  The  inspection  contained  an  un- 
favourable criticism  on  some  of  the  arrangements  and 
methods  of  the  Examination  in  Clinical  Surgery.  The 
Visitor  and  Inspector  also  deemed  it  their  dutv  to 
point  out  the  desirability,  if  not  the  necessity,  of  the 
Edinburgh  University,  with  all  other  teaching  bodies, 
so  adjusting  its  curriculum  as  to  give  Medical  Students 
greater  facilities  than  they  now  seem  to  possess  of 
gaining  a  better  knowledge  of  disease  and  its  treatment 
by  clinical  work. 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  McVail  :  That  the  Recommendation  of  the 
Examination  Committee  contained  in  the  Report  be 
adopted. 

The  President,  as  representing  the  University  of 
Edinburgh  on  the  Council,  made  a  few  remarks  in 
defence  of  the  system  of  Examination  in  Clinical 
Surgery  therein.  He  thought  some  parts  of  the  Report 
by  the  Visitor  and  Inspector  might  be  regarded  as 
strongly  adverse  criticism,  and  some  of  the  statements 
as  of  a  very  sweeping  character.  He  pointed  out  that 
the  difference  among  schools  in  the  Examination  in 
Surgery  on  the  cadaver  was  mainly  due  to  some 
schools  getting  more  bodies  than  others,  but  that  every 
candidate  going  through  the  University  of  E^inburjgh 
must  study  Operative  Surgery. 

Sir  Victor  Horsley  supported  the  Report  aiid'the 
Recommendations,  as  the  rejections  in  Surgery  at 
the  University  of  Edinburgh  were  higher  by  a  half  than 
those  in  medicine. 

An  amendment  was  then  proposed  by  Dr.  Pye- 
Smith  and  seconded  by  Sir  John  Moore  :  That  the 
Recommendation  be  adopted  in  the  following  form  : 
"  That  the  Council  direct  that  a  further  inspection  be 
made  of  the  Surgical  part  of  the  Final  Examination  in 
the  University  of  Edinburgh  during  the  year  1905." 

Sir  Christopher  Nixon  considered  that  the  Council 
should  deal  very  tenderly  with  a  Report  *  of  the 
Council* s  own  Visitor  and  Inspector. 

Professor  Thomson,  Dr.  McVail,  Mr.  Brown,  and 
Dr.  Lindsay  Steven  made  a  few  remarks,  and  Sir  G.  H. 
PhiUpson.  as  the  Visitor  in  question,  said  a  few  well- 
chosen  words  in  defence  of  thej  Recommendations  ; 
after  which  Sir  Patrick  Heron  Watson  and  his 
Seconder  accepted  the  amendment  on  the  part  of  the 
Committee,  and  the  Amendment,  which  had  thus 
become  the  sole  Motion,  was  put  and  carried. 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  McVail,  and  agreed  to  :  "  That  the  Report  by 
the  Examination  Committee  on  the  Inspection  of  the 
Final  Examination  of  the  Apothecaries'  Hall,  Dublin 
(July,  1904),  be  received  and  entered  on  the  Minutes." 
The  Report  was  then  adopted.  (Same  Proposer  and 
Seconder.) 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  McVail,  and  carried  :  "  That  the  Report  of 
the  Examination  Committee  on  the  Inspection  of  the 
Final  Examination  of  the  University  of  Glasgow  be 
received  and  entered  on  the  Minutes."  The  Report 
was  then  adopted.     (Same  Proposer  and  Seconder.) 

Moved  by  Sir  P.  Heron  Watson,  seconded  by  Dr. 
McVail,  and  agreed  to :  "  That  the  Report  of  the 
Examination  Committee  on  the  Inspection  of  the  Final 
Examination  of  the  University  of  Aberdeen  be  received 
and  entered  on  the  Minutes." 

Moved  by  Sir  P.  Heron  Watson,  seconded  by  Dr. 
McVail.  and  agreed  to:  "That  the  Report  of  the 
Examination  Committee  on  the  Inspection  of  the  Final 
Examination  of  the  University  of  St.  Andrews  be 
received  and  entered  on  the  Minutes."  The  Report  by 
the  Visitor  and  Inspector  was  not  always  favourable,  it 


being  mentioned,  inl(^r  alia,  that  it  was  by  no  means 
certain  that  the  method  of  excluding  all  the  candidate* 
from  the  wards  of  the  Royal  Infirmary  for  ten  dayr 
previous  to  the  examination  was  effective  ;  also  that 
in  the  oral  examination  in  some  cases  only  one  ficamrncs 
was  present ;  also  that  the  teaching  examiner  was  too 
prone  to  show  his  teaching  capacity  rather  than  his 
examining  power.  On  the  other  hand,  great  praise 
was  given  to  the  Examinations  in  Ophthalmology,  in 
diseases  of  the  ear,  throat  and  nose,  and  in  skin  diseasesu 
On  the  motion  for  the  adopticm  of  the  Report  being 
made  by  the  same  Proposer  and  Seconder,  Dr.  Mackat. 
made  a  few  observations  in  defence  of  St.  Andrews. 
which  were,  however,  rather,  traversed  by  Sir  Johx 
Moore,  the  Visitor,  who  asked  leave,  which  was  ac- 
corded, to  alter  an  error  in  a  sentence  of  the  Report. 
which  now  reads :  "Both  Examiners  gave  fifteen 
minutes  each  to  the  Examination  of  each  of  the  six 
candidates.''  Subject  to  this  correction  the  Report  was 
adopted. 

The  Council  then  .adjourned. 

.  Tuesday,  November  29TH.    1904- 

Sir  William  Turner,  President,   in  the  Chair. 

The  Minutes  of  tne  last  meeting  were  read  and^con- 
firmed  after  an  explanation  by  Sir  Hugh  Beevor  with 
reference  to  bis  signature  appearing  at  the  end  o: 
the  report  of  the  Visitation  of  the  University  of 
Glasgow ;  he  had  found  out  that  his  signature  bad 
been  put  in  the  final  proof  as  a  matter  of  form  in  the 
office,  and  the  final  proof  had  not  been  sent  to  him. 
He  hoped  that  in  future  no  signatures  would  be 
appended  without  a  final  proof  being  submitted. 

Sir  Patrick  Heron  Watson  moved,  Pr.  McVail 
seconded,  and  it  was  agreed  to  : — '*  That  the  Exam- 
ination Committee  be  requested  to  consider  their 
Report  on  the  Final  Examination  of  the  I  niversin- 
of  Edinburgh  in  conjunction  with  tne  results  of  the 
additional  inspection  of  the  surgical  parts  thereol 
directed  by  the  Council  to  be  made  in  1905.  and  to 
present  a  Final  Report  of  the  second  inspection  at  the 
November  session  of  the  Council  in    1905." 

Moved  by  Sir  P.  Heron  Watson,  seconded  by  Dr. 
McVail,  and  carried  :  "  That  the  Report  by  the  Exam- 
ination Committee  on  the  further  reply  by  the  Royal 
College  of  Surgeons  of  England  to  the  Inspector's 
report  on  tiie  final  examinations  of  the  £nglish  Con- 
joint Board  be  received  and  entered  on  the  minutes." 
The  Examination  Committee  in  their  Report  wm 
satisfied  with  the  alteration  in  the  system  of  marking 
recommended  by  the  Court  of  Examiners,  but  regretted 
that  the  Court  of  Examiners  consider  as  unnecessary 
an  examination  in  ophthalmic  surgery,  which  thi 
Committee  regarded  as  being  essential,  and  tl^ 
Examination  Committee  did  not  see  any  reasons  to 
alter  their  opinion  that  a  written  report  on  a  medical 
or  surgical  case  was  neither   useful    nor   practicaUe. 

The  adoption  of  the  Report  (same  Proposer  and 
seconder)  was  agreed  to,  after  Sir  Charles  Ball  had 
made  a  few  remarks  on  the  importance  nowadays  of  a 
training  in  operative  surger^r,  which  he  maintained 
could  not  be  properly  taught  excepting  on  the  dead 
body.  Sir  Victor  Horslev  received  an  afifirmative 
answer  from  the  President  as  to  whether  this  qnestio: 
could  not  be  taken  up  next  session  as  a  resolatkxi 
based  on  this  Report. 

The  Council  next  proceeded  to  the  consideraijoo 
(adjourned  from  Nov.  25th,  1904.  on  the  motion  d 
Sir  Batty  Tuke)  of  the  recommendations  contained 
in  the  last  paragraph  of  the  report  of  the  PnUic 
Health  Committee  :  "  That  the  Council  shonld  refuse 
a  certain  application  for  exemption." 

Sir  Batty  Tuke,  in  support  of  the  refusal,  thougbi 
that  the  introduction  of  individual  cases  was  very 
dangerous,  but  he  wished  to  withdraw  nis  motim 
and  refer  the  matter  to  the  Public  Health  Committee 
n^xt  session. 

Dr.  Lindsay  Steven-  then  moved;  and  Sir  Chaius 
Ball  seconded,  a  modified  amendmcfnt  (of  which 
notice  had  been  given) :  '*  That  should  the  applicaai 
be  admitted  to  the  examination  by  any  of  the  -qoafih*- 


Dec.  7,  1904. 


SPECIAL  REPORTS. 


The  Medical  Pmss.    615 


ing  bodies  without  having  persooaUy  compUec)  with 
-Kule  3,  the  Council  will  have  no  objection  to  the 
registration  of  his. diploma  when  obtained." 

Dr.  Bkuc£»  as  chairman  o{  the  Committee,  accepted 
the  amendment »  and  in  answer  to  Sir  VicTbR  Horsl£Y. 
Avho  wished  to  know  why  the  Committee  had  changed 
their  opinion  in  this  matter,  said,  that  it  was  owing  to 
a.  communciation  from  Mr.  Power,  who  did  not  see 
his  way  .to  oppose  the  amendment.         « 

Pr.  MacAlistbr,  although  he  believed  it  was 
dangerous  to  grant  exemptions,  was  of  opinion  that 
if  the  Council  thought  that  it  was  a  hard  case  they  could, 
deal  with  it  by  accepting  the  amendment ;  but  he 
considered  that  the  whole  matter  should  be  referred 
to  the  Public  Health  Committee. 

The  amendment  was  then  first  carried,  and  then 
carried  as  a  substantive  motion.  Dr.  MacAlister 
then  moved,  and  Dr.  Brucb  seconded,  that  the 
m^ttar  be  referred  to  the  Public  Health  Committee 
to  be  reported  on  next  session. 

The  resolution  proposed  by  Dr.  ]V1\cAixist£R, 
seconded  by  Dr.  Norman  MpOR£»  to  receive  place  on 
the  Minutes  and  adopt  the  Report  of  the  Pharma- 
copceia  Committee,  was  then  carried. 

£)r.  NokMAN  Moore  then  moved,  Dr.  Little 
seconded,  and  it  was  agreed  to  unanimously,  that  two 
votes  of  thanks  of  the  Council  should  be  presented  : 
one  to  ,Dr.  MacAlister  for  his  services  in  regard  to 
international  uniformity  in  the  pharmacopceial  remedies 
a.nd  the  second  to  Dr.  Payne,  who,  on  retirement,  had 
piesented  the  Council  with  a  copy  of  the  earliest 
P  harmacopoeia. 

Dr.  PyetSmith  proposed,  and  Mr.  Tomes  seconded  : 
"That  the  Report  of  the  Finance  Committee  be 
received  and  entered  qn  the  Minutes.  This  was 
agreed  to,  and  the  report  was  adopted,  after  the 
three  propositions  it  contained  had  been  moved  and 
seconded  separately.  These  propositions  had  refer- 
ence (i)  to  ;i 1, 000' received  from  the  builders;  (2) 
to  the  dental  funds  ;  and  (3)  to  a  loan  from  the 
Pharmacopoeia  Account. 

Sir  V.  HoRSLEV  moved,  and  Dr.  MacAlister 
seconded  that  the  report  of  the  Preliminary  Scientific 
Education  and  Examination  Committee  be  received, 
entered  on  the  minutes,  and  adopted.  This  was 
carried. 

Moved  by  Sir  Victor  Horsley,  seconded  by  Dr. 
Windle,  and  carried,  :  "  Tnat  the  elements  of  embry- 
ology should  be  definitely  associated  with  morpho- 
logical zoology  and  included  in  the  syllabus  of  Ele- 
mentary Biology."  (Extract  from  Para.  6  of  the 
report.) 

Moved  by  Mr.  Tomes,  seconded  by  Sir  V.  Horsley, 
and  carried  :  "  That  the  Report  of  the  Medical  Com- 
panies Bill  Committee  be  received,  entered  on  the 
Minutes,  and  adopted  with  an  addition  to  the  Appen- 
dix." 

Moved  by  Mr.  Tomes,  seconded  by  Sir  Charles 
Ball,  and  carried  :  "  That  the  Report  by  the  Dental 
Education  and  Examination  Committee  be  received, 
and  entered  on  the  Minutes." 

In  moving  the  adoption,  which  was  carried,  Mr. 
Tomes,  who  was  seconded  by  Dr.  Lindsay  Steven, 
remarked  that  the  Dental  Board  of  Victoria,  which  had 
come  into  close  contact  with  the  University  of  Mel- 
bourne, had  made  every  eflfort  to  make  its  Ucence  up 
to  date. 

Mpved  by  Sir  Hugh  Beevor,  seconded  by  Dr. 
Norman  Moore,  and  carried  :  "  That  the  Report  by 
the  Students'  Registration  Committee  be  received, 
entered  on  the  Minutes,  and  adopted." 

The  Council  then  considered  tor  a  long  time  in 
canterd  the  mode  of  procedure  in  the  election  of  a 
President.  When  strangers  were  re-admitted.  Sir  W. 
Turner  made  a  few  graceful  remarks  before  relin- 
quishing' the  Chair,  expressing  his  deep  acknowledg- 
ments for  all  the  kindness,  sympathy,  and  support 
he  had  received  from  the  members  of  the  Council 
during  the  discharge  of  his  presidential  duties,  which 
last  were  occasionally,  he  admitted,  of  a  rather  trying 
character,  and  asking  pardon  if,  during  discussions. 


he  had,  either  in  word  or  manner,  hurt  the  feelings 
of  any  member  of  the  Council.  The  President's 
words  were  very  cordially  received. 

Sir  Patrick  Heron  Watson  proposed,  and  Dr.  Pye- 
Smfth  seconded,  that  Dr.  MacAlister  be  elected 
President.  This  being  agreed  to,  the  proposer  and 
seconder  brought  Dr.  MacAlister  into  the  Council 
room,  where  he  was  installed  in  the  Chair  by  the 
retiring  President.  Dr.  MacAlister  said  a  few 
words,  thanking  the  CouncU  for  the  honour  conferred 
upon  him,  wnich  he  considered  the  greatest  of  his 
life,  after  which  the  members  fiocked  round  the  new 
President  to  shake  hands  with  him. 

On  resumption  of  business.  Dr.  MacAlister  in  the 
Chair,  it  was  moved  by  Dr.  Norman  Moore,  seconded 
by  Dr.  McVail,  and  carried  as  an  instruction  :  "  That 
in  the  opinion  of  the  Council,  it  is  desirable  that 
when  new  or  amended  Regulations  are  adopted  by  the 
Council,  a  formal  statement  should  be  placed  on  the 
Minutes  as  to  the  effect  of  the  new  or  amended  Regu- 
lations upon  previous  Regulations  on  the  same  subject." 
Leave  was  then  given,  on  the  motion  of  Sir  Chris- 
topher Nixon,  for  Dr.  Mackay  to  postpone  to  the 
next  session  his  motion,  seconded  by  Sir  William 
Thomson,  with  reference  to  Resolution  3  upon  the 
Minutes  of  May  30th,  1904,  in  regard  to  Registers  of 
Dental  Students.  A  communication  was  then  read 
from  the  University  of  Liverpool,  asking  for  recog- 
nition by  registration  in  the  Medical  Register  of  the 
Diploma  in  Tropical  Medicine  of  that  University. 
The  President  suggested  as  an  answer  that  the 
Council,  in  the  absence  of  special  legislation  on  the 
subject,  had  no  authority  to  direct  the  registration 
as  an  additional  qualificatipp  or  a  diploma  on  tropical 
medicine.     This  was  agreed  to. 

The  President  answered  in  the  negative  Mr. 
Brown's  question :  "  Whether  the  University  of 
Cambridge  had  communicated  to  the  Council  its 
decision  to  establish  an  examination  and  to  grant 
diplomas  in  Tropical  Medicine  and  Hygiene." 

Moved  by  Sir  John  Batty  Tuke,  and  seconded 
by  Dr.  Mackay  :  "  That  the  legal  advisers  of  the 
Council  be  requested  to  state  an  opinion  on  sub- 
section 3  of  Section  3  of  the  Medical  Act,  1886,  bearing 
on  Uie  obligation  of  the  Council  toiotward  the  Reports 
of  Visitors  and  Inspectors  to  the  Privy  Council  in 
their  entirety,  irrespective  of  what  they  may  contain." 
At  the  suggestion  of  the  President,  the  words  :  '*  as 
to  ^whether  an  obUgation  rests  on  the  Council,"  were 
inserted,  and  the  motion,  as  amended,  was  carried. 

A  motion  by  Sir  Christopher  Nixon,  seconded  by 
Sir  William  Thomson:  "That  in  forwarding  the> 
reply  of  the  General  Medical  Council  to  the  letter  of 
the  Privy  Council  of  November  ist,  this  Council 
desires  to  bring  formally  before  the  Lord  President 
the  suggestion  made  in  the  memorandum  of  the 
President  of  the  Council,  dated  May  ist,  1903.  that 
the  Treasury  should  be  urged  to  grant  a  sum  sufficient 
to  defray  the  expenses  of  the  disciplinary  functions 
of  the  Council "  was  withdrawn  after  a  brief  discus- 
sion. 

The  Council  then  went  into  camerd  to  confirm  the 
Minutes,  and  the  session  terminated. 


CENTRAL    MIDWIVES    BOARD. 


A  MEETING  of  the  Central  >Iidwives  Board  was  held 
on  November  24th,  Dr.  F.  H.  Ch'ampneyS  in  the  chair. 

A  letter  from  Miss  Oldham,  resigning  her  position 
as  a  member  of  the  Board  representmg  the  Royal 
British -Nurses'  Association,  was  received  and  accepted 
with  regret. 

A  letter  was  received  from  the  Honorary  Secretary 
of  the  Metropolitan  Counties  Branch  of  the  British 
Medical  Association,  enclosing  a  copy  of  letter  ad- 
dressed by  the  Branch  to  the  London  County  Council 
and  asking  for  the  co-operation  of  the  Board  with 
the  London  County  Council  in  obtaining  powers  from 
Parliament  to  pay  registered  medical  practitioners 
when  called  in  by  midwives  in  emergencies.     Upon 


6l6     The  Medical  Press. 


LUNACY  DEPARTMENT. 


Pec.  7.  1904. 


the  motion  of  Mr.  E.  Parker  Young,  seconded  by 
Dr.  J.  Ward  Cousins,  it  was  resolved:  "That  the 
Honorary  Secretary  of  the  Metropolitan  Counties 
Branch  of  the  British  Medical  Association  be  informed 

(1)  that  this  Board  agrees  that  statutory  provision 
should  be  made  for  the  payment  of  the  services  of  a 
registered  medical  practitioner  when  called  in  by  a 
midwife  in  accordance  with  the  rules  of  the  Board  : 

(2)  that  the  Board  has  already  forwarded  a  resolution 
to  this  effect  to  the  Privy  Council." 

After  consideration  of  applications  for  certificates, 
the  names  of  1,068  women  were  passed  under  Section 
II.  of  the  Act,  and  ordered  for  entry  on  the  Roll. 

In  Section  i  Sub-Section  (2)  the  Midwives  Act 
states  that  no  woman  shall»  after  April  ist,  1910, 
habitually  and  for  gain  attend  women  in  childbirth 
otherwise  tnan  under  the  direction  of  a  qualified 
medical  practitioner  unless  she  be  certified  under  the 
Midwives  Act.  In  regard  to  this,  the  Clerk  of  the 
Monmouthshire  County  Council  wrote  asking  the 
Board's  construction  of  the  words  '  *  otherwise  than 
tmder  the  direction  of  a  qualified  medical  practi- 
tioner." 

It  was  decided  that  the  Secretary  should  reply  to 
the  letter  stating  that  the  Central  Midwives  Board 
was  unable  to  give  a  general  answer  to  tne  inquiry 
because  it  was  largely  a  legal  question  on  which  no 
authoritative  decision  had  been  given. 

Dr.  Ward  Cousins  said  that  at  Portsmouth  the  County 
Council  had  received  applications  from  several  women 
to  be  put  on  the  list  of  midwives  who  had  received 
certificates  from  the  Central  Midwives  Board,  but 
were  unable  to  read  or  write.  It  wis  decided  that 
though  the  Board  was  bound  to  put  on  the  roll  any 
woman  who  at  the  time  of  the  passing  of  the  Midwives 
Act,  had  been  for  at  lea'st  one  year  in  bona-fide 
practice  as  a  midwife,  and  bore  a  good  character, 
nevertheless  the  local  supervising  authorities  were 
not  bound  to  have  them  on  their  lists. 

Reports   of   the   Proceedings.         • 

Dr.  CullingwortA  moved  :  "  That  during  tne  con- 
sideration of  matters  having  reference  to  the  judicial 
or  penal  powers  of  the  Board,  or  of  applications  for 
recognition  or  approval  on  tne  part  of  institutions  as 
training  schools,  or  of  medical  practitioners  as  teachers 
the  representatives  of  the  Press  shall  Ve  requested 
to  withdraw." 

Sir  William  Sinclair  said  he  was  sorry  to  hear  Dr. 
Cullingworth  move  such  a  resolution.  He  might 
have  waited  till  the  representatives  of  the  Press  had 
given  evidence  of  any  want  of  judgment.  The  reso- 
lution proposed  by  Dr.  Cullingworth  required  two  or 
three  words  to  make  it  complete,  and  those  were  to 
exclude  the  Press  on  all  other  occasions  ;  and  further, 
Dr.  CuUinjgworth  made  so  many  exceptions  that  Sir 
William  Sinclair  said  he  really  could  not  see  on  what 
occasions  Dr.  Cullingworth  would  trust  the  Press  at 
all. 

Mr.  Parker  Young  said  it  was  a  protection  to  the 
public  to  have  the  proceedings  of  the  Boaird  in  carrying 
out  the  duties  of  an  Act  of  Parliament  reported.  He 
considered  that  the  greater  the  publicity  the  better 
for  all  concerned. 

The  consideration  of  this  subject  was  postponed  for 
reference  to  be  made  to  the.  procedure  of  the  General 
Medical   Council. 


Xnnacs  I^artment 


LUNACY  IN  IRELAND. 
The  Fifty-Third  Annual  Report  of  the  Irish  Lunacy 
Inspectors,  which  has  recently  appeared,  affords  con- 
siderable food  for  thought.  From  it  we  learn  that  a 
marked  increase  has  again  taken  place  in  the  numbers 
of  the  insane,  there  being  656  more  in  the  Irish  asylums 
at  the  end  of  1903  than  in  the  previous  year,  showing 
an  advance  of  104  over  the  yearly  average  increase  for 
the  past  ten  years — ^in  fact,  the  increase  is  the  largest 


since  1898.  All  classes  of  asylams  are  affected  br  it 
except  the  criminal  asylum  at  Dundrum  (which  sfaovs 
a  slight  decrease),  but  the  yearly  aagmentatkm  m  tkt 
numbers  has  chiefly  taken  place  in  the  district  as3FlBais. 
the  population  of  which  is  9,4^7  lug'^w'  ^h»n  it  was  23 
years  ago.  One  satisfactory  point  in  so  much  that  is 
gloomy  is  that  the  proportion  of  lunatics  in  workhouses. 
the  unsuitable  conditions  of  which  for  this  class  ot 
inmates  are  notorious,  continues  to  sho^  a  steady 
decrease,  numbering  16  per  cent,  in  1903  as  against 
18  per  cent,  in  the  previous  year,  and  27  per  cent,  id 
1880.  This  is  notwithstanding  the  fact  that  an  actaal 
increase  of  121  took  place  in  the  htoatic  workhoose 
population  in  1903,  the  suggested  explanation  bnag 
that  a  number  of  aged  and  doting  persons  have  tnes 
transferred  to  the  lunatic  wards  from  other  parts  oJ 
the  workhouses. 

It  is  reassuring  to  find,  however,  that  the  nnmbecs 
admitted  to  the  mstitutions  of  the  county  show  prac- 
tically no  advance  (three  only)  over  those  of  the 
previous  year ;  in  fact,  the  number  of  "  first  admis^ 
sions  "  is  less  by  48.  That  is  to  say,  there  has  been  110 
increase  in  the  number  of  fresh  cases  of  mental  disease, 
and  the  increment  of  the  asylum  population  must  be 
due  merely  to  accumulation.  Nevertheless,  this  acpi- 
mulation  has  to  be  dealt  with,  and  we  learn  from  this 
report  that  some  of  the  asylums  are  already  over- 
crowded, while,  on  the  other  hand,  the  necessity  for 
making  different  arrangements  for  the  Inna tic  inmates 
of  workhouses  is  a  pressing  one.  The  principle  of 
auxiliary  asylums  on  tne  lines  of  that  at  Yougbal  is  one 
which  those  who  have  had  practical  experience  of  the 
treatment  of  the  insane  almost  universally  distntst. 
and  it  would  seem  that  the  best  way  out  of  the  diffi- 
culty would  be  some  form  of  the  colony  or  "  l>oarding- 
out  "  system,  which  has  been  successful  without  ex- 
ception wherever  tried,  including  Scotland.  It  is 
sincerely  to  be  hoped  that  this  experiment  will  sooa 
be  legalised  for  Ireland.  In  the  meantime  blocki 
managed  somewhat  on  auxiliary  asylum  lines,  but  in 
much  closer  association  with  the  p&rent  asjrlums. 
would  probably  aflord  the  best  means  of  reconciling 
the  dictates  of  humanity  with  the  shallow  pocket  of 
the  Irish  ratepayer. 

The  recoveries  show  an  advance  on  the  previoiis 
year,  the  percentage  calculated  on  the  admissions  being 
367,  as  against  35*8  in  1902.  ITie  death-rate  is  slighthr 
higher  than  in  the  previous  year.  In  view  of  the  over- 
crowding alluded  to  above  it  is  important  to  note  that 
over  one-fourth  of  the  deaths  was  due  to  consnmptioD. 
— a  proportion,  however,  not  greatly  differing  from  that 
in  other  recent  years.  A  regrettable  falling  off  in  thf 
number  of  autopsies  is  reported,  and  we  fail  to  find 
that  any  advance  has  been  made  with  the  project  of 
a  central  laboratory. 

Lastly,  the  return  of  the  Census  Commissioners  is 
referred  to,  the  most  important  point  bein^  the  decrease 
in  the  proportion  of  idiots  as  compared  to  lunatics  in 
1 90 1,  probablv  owing  to  more  accurate  diagnosis. 
ALCOHOLIC  INSANITY. 

Dr.  G.  M.  Robertson,  medical  superintendent  of 
StirUng  {District  Asylum,  in  his  report  for  the  year 
ending  May.  1904,  takes  up  the  question  of  alcoholic 
insanity.  He  alludes  to  the  satisfaction  with  which 
those  interested  in  the  care  of  the  insane  have  observed 
the  growing  interest  of  the  public  in  the  action  of 
alcoholism  in  producing  mental  disease.  No  single 
factor  sends  more  men  insane  in  this  country'  than 
over-indulgence  in  alcohol.  As  it  is  a  cause  over  the 
action  of  which  absolute  control  can  be  exercised,  it 
appears  little  short  of  criminal  to  allow  this  evil  to 
exist  unchecked  by  the  State  to  the  moral  and  material 
damage  of  its  citizens.  From  May,  1894,  to  May,  1899, 
the  proportion  of  alcoholic  insanity  was  20*  i  per  cent, 
for  men  and  6*6  per  cent,  for  women — 13*2  per  cent,  of 
the  total  admissions.  The  difference  between  the  tim 
sexes,  whether  it  be  owing  to  the  different  customs  of 
men  and  women  or  the  greater  self-control  and  better 
morals  of  the  latter,  is  so  great  that  when  the  admissions 
of  the  two  sexes  are  unequal  the  total  percentage  may 


Dec.  7>  1904. 


CORRESPONDENCE. 


The  Mbdical  Press.    617 


give  rise  to  eiror  of  deductions  from  it  if  it  is  applied 
to  the  general  population.  The  percentage  of  alco- 
holic insanity,  allowing  for  this  source  of  fallacy,  rose 
from  1 3" 3  per  cent,  in  the  quinquennium  under  con- 
sideration to  i8'4  per  cent,  in  1900,  and  to  25*8  per 
cent,  in  1901.  It  then  fell  to  20* i  per  cent,  in  1902, 
1 8* I  per  cent,  in  1903,  and  back  to  i3'2  per  cent,  in 
1 904.  The  association  of  periods  of  good  wages  for  the 
working  classes  with  an  increase  of  drunkenness  and 
insanity  has  already  been  noticed,  while  cycles  of  bad 
trade  and  low  wages  tend  to  be  accompanied  by  a 
decrease.  An  additional  explanation  of  the  apparent 
paroxysm  of  intemperance  now  happily  passing  off  has 
been  suggested  by  Lord  Balfour  of  Burleigh.  During 
the  acme  of  this  period  the  South  African  War  was  in 
progress,  and,  owing  to  large  numbers  of  able-bodied 
young  men  having  enlisted  and  left  the  country,  the 
lowest  class  of  labourer,  for  the  first  time  for  many 
years,  got  constant  work  and  steady  wages.  His 
sudden  good  fortune  w^as  too  much  for  his  power  of 
self-control,  and  the  extreme  excesses  of  his  class  made 
a  substantial  increase  in  the  amount  of  alcoholic  in- 
sanity admitted  to  this  asylum. 

LUNACY  IN  GLASGOW. 
The  annual  report  on  the  certification  of  lunatics  for 
the  year  ending  May  15th,  1904,  by  Dr.  Carswell, 
certifying  physician  in  Lunacy  to  the  Glasgow  Parish 
Council,  has  just  been  published.  It  states  that  during 
the  year,  886  appUcations  were  made  to  the  Inspector 
of  Poor  on  behalf  of  persons  supposed  to  be  insane, 
and  as  a  result  of  the  examination  of  these  cases,  544 
were  certified  and  342  uncertified.  Of  the  544  cases 
certified,  164  had  suffered  from  previous  attacks  of 
insanity,  the  remaining  380  represent  the  actual 
number  of  persons  who  became  insane  for  the  first  time 
during  the  year.  The  actual  number  of  first  attacks 
certified  this  year  is  seven  less  than  last  year,  and  the 
proportion  per  100,000  of  the  population  is  63*5,  com- 
pared with  65 "5  last  year.  This  is  the  lowest  produc- 
tion rate  for  four  years.  The  figures  show  that  at  all 
ages  under  45  insanity  affects  males  and  females 
almost  equally  ;  that  at  ages  over  45  more  men  become 
insane  than  women,  and  both  sexes  become  insane  in 
larger  proportion  to  the  numbers  living  at  those  ages 
as  they  advance  in  years  ;  and  that  there  is  a  relatively 
larger  number  of  persons  sent  to  asylums  at  ages  over  45 
than  under.  The  ages  15  to  45  are  the  most  important 
in  relation  to  the  question  whether  lunacy  statistics 
indicate  a  process  of  mental  deterioration  going  on  in 
the  community  ;  those  are  the  ages  of  greatest  stress 
and  temptation  and  it  cannot  be  said  that  a  production 
rate  of  8  per  10,000,  relating  to  a  section  of  the  popu- 
lation numbering  300,000,  is  alarming.  If  the  ex- 
perience of  the  last  four  years  is  normal,  as  Dr.  Carswell 
thinks  there  is  reason  to  believe  it  is,  then  we  are 
justified  in  interpreting  the  steady  production  rate  as 
meaning  that  so  far  as  the  masses  of  the  people  were 
concerned  there  was  no  evidence  of  an  increasing 
mental  deterioration.  Turning  to  the  figures  relating 
to  the  number  of  population  to  each  public-house.  Dr. 
Carswell  shows  that  the  general  case  is,  that  with  a  few 
striking  exceptions  a  high  lunacy  rate  is  associated 
with  a  large  number  of  public-houses  in  the  district. 
The  figures  before  us  confirm  that  general  view,  but 
they  give  no  support  to  the  exaggerated  views  that  have 
been  expressed  in  various  qiuarters  that  lunacy  caused 
by  alcohol  is  seriously  increasing  in  Scotland. 

Corte0pon&ence« 

rWe  do  not  hold  ovuvelv««  retpontible  for  the  ophiions  of  our 
CorrespoDdent*.] 


an  irritant  poison.  This,  of  course,  is  absurd.  There 
is,  I  believe,  a  case  on  record  in  which  the  ingestion  of  an 
enormous  quantity  of  the  acid — some  600  grains,  was 
followed  by  death,  and  indications  of  irritation  naturally 
existed ;  but  in  ordinary  cases,  where  a  dose  of  about 
twenty  grains  is  taken  and  when  the  acid  is  almost 
always  neutralised  to  a  harmless  salt,  tartaric  acid 
is  not  only  not  poisonous,  but  of  much  utility. 

The  analyst  who  delivered  the  obiter  dicta  is,  of  course, 
not  a  medical  man,  and  I  think  the  time  has  come  for 
the  profession  to  resent  very  keenly  the  utterances  of 
mere  analytical  chemists  on  questions  which  pre- 
eminently require  a  training  in  physiology. 

Some  short  time  since  practically  all  public  analysts 
were  medical  men,  and  all  recent  reforms  in  toxicology 
and  in  the  Food  and  Drugs  Acts  were  due  to  their  la- 
bours. Of  late,  not  only  have  chemists  ousted  them  from 
the  merely  technical  part  of  analysis,  for  which  they  are 
possibly  trained,  but  they  now  presume  to  pose  as 
authorities  on  the  most  vexed  questions  of  the  effects  of 
small  doses  of  drugs  on  the  human  organism,  and  on 
other  matters  on  which  a  man  with  a  medical  training 
only  has  a  right  to  be  heard.  It  is  obviously  not  be- 
cause a  man  is  competent  to  detect  a  fraction  of  a  grain 
of  formalin  in  milk  that  he  should  be  considered  an 
authority  on  the  question  whether  this  amount  was 
calculated  to  do  harm. 

I  am.  Sir,,  yours  truly, 
J.  C.  McWalter,  M.A.,  D.P.H.,  M.D.Brux. 

Dublin,  November  21st,  1904. 


THE  MERE  ANALYST  AS  AN  EXPERT  IN 
TOXICOLOGY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Considerable  uneasiness  has  been  caused  to  con- 
fex^tioners  and  others  throughout  the  country  because 
of  a  statement  published  in  the  daily  papers,  and  attri- 
buted to  a  Belfast  analyst,  that  tartaric  acid,  so  largely 
used  in  effervescing  drinks  and  in  cake-making,  is  really 


HOSPITAL  FUNDS  AND  THE  SMALL  HOSPITALS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — If  the  Hospital  Sunday  and  Hospital  Satur- 
day and  King  Edward's  Funds  could  be  merged  into  a 
central  hospital  board,  having  some  real  power  of 
control,  it  is  certain  that  a  great  number  of  the  small 
hospitals  would  soon  cease  to  exist ;  reason  for  their 
existence  being  evidently  lacking  entirely.  This 
applies  particularly  to  special  hospitals.  These  institu- 
tions may,  with  few  exceptions,  be  divided  into  three 
classes — the  unnecessary,  the  useless,  and  the  sham. 
Many  of  them  have  grown  out  of  the  sham  into  the 
useful  form,  although  most  of  these  are  unnecessary, 
seeing  that  the  maladies  they  deal  with  are  all  provided 
for  in  general  hospitals.  Can  any  member  of  the  pro- 
fession affirm  that  there  exists  any  real  need  whatever 
for  separate  hospitals  for  throats,  or  teeth,  or  skin 
diseases,  or  for  deformities,  or  diseases  of  the  eye  or  of 
the  rectum,  or  for  stone  ?  Many  such  hospitals,  if  not 
most,  have  owed  their  origin  to  medical  adventurers — 
men  eager  for  wealth  or  finding  themselves  failures  in 
practice  under  legitimate  conditions — ^who  have  recog- 
nised a  sham  special  hospital  as  a  most  effective  cloak 
for  personal  advertisement — advertisement,  moreover, 
paid  for  by  the  public  out  of  the  subscriptions  to  the 
hospital  funds.  Everyone  with  any  view  behind  the 
scenes  of  medical  life  in  London  is  aware  how  success- 
fully this  game  was  played  years  ago ;  and  how  the 
demoralising  spectacle  of  worldly  prosi>erity  gained  by 
such  means  brought  forth  numerous  imitators.  The 
profession,  the  public,  and  the  poor  would  be  aU  bene- 
fited by  the  closure  of  the  majority  of  special  hospitals, 
and  if  the  incomes  of  these  establishments,  with  the 
wasted  funds  the  separate  administrations  give  rise  to, 
were  transferred  to  the  general  hospitals  the  pressing 
needs  of  these  would  probably  be  at  once  almost  fully 
satisfied. 

I  am,  Sir.  yours  truly, 
Henry  Sewilt., 

Cavendish  Square,  November  30th,   1904. 

[We  print  the  above  letter  with  pleasure  as  it  repre- 
sents a  strong  view  of  one  side  of  the  question.  At  the 
same  time  we  think  it  right  to  point  out  that  personal 
advertisement  and  professional  experience  are  derived 
by  holders  of  medical  appointments  in  large  hospitals 
just  as  much  as  in  small  — Ed.,  M.P.&.C] 

To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  small  special  hospitals  have  a  claim  on  the 


6l8     The  Medical  Press. 


MEDICAL  NEWS. 


Dec.  ?, 


1V»4. 


gratitude  both  of  the  medical  profession  and  of  the 
pubhc.  Fifty  years  ago  they  were  the  pioneers  of 
specialism  when  special  departments  were  unknown 
in  the  general  hospitals.  The  Golden  Square  Throat 
Hospital  is  ah  instance  in  point,  for  there  the  founda- 
tions of  modern  laryngology  were  laid  by  the  late  Sir 
Morell  Mackenzie,  and  there  the  laryngoscope  found 
its  first  introduction  in  this  country.  Other  classic 
instances  are  the  Blackfriars  Skin,  the  Moor- 
fields  Eye  and  the  Soho  Women's  Hospital — not  to 
mention  the  National  Dental,  the  Cancer  and  tne 
Brompton  Consumption  Hospitals.  Many  of  these 
institutions  started  in  the  smallest  and  most  unassum- 
ing fashion  and  have  developed  into  great  centres  of 
scientific  work  and  teaching.  Who  is  to  say  tnat  the 
small  special  hospital  of  to-day  is  not  to  bear  fruit  one 
•clay  of  equal  value  to  the  community.  Lastly,  under 
the  conditions  that  rule  the  hospital  medical  world  of 
London  the  only  chance  of  any  man  not  born  into  the 
purple  lies  in  obtaining  an  appointment  at  a  small 
special  hospital.  Is  the  medical  alone  of  all  professions 
to  deny  the  chance  of  promotion  to  its  rank  and  file. 
No.  sir,  the  small  special  hospitals  of  London  have 
done  and  are  doing  a  noble  work  both  socially  and  pro- 
fessionally. 

I  am,  sir,  yours  truly. 
A  Sm.\ll  Hospital  Physician. 


<Pbituari?« 


GEORGE  VIVIAN  POORE.  M.D. 


assistance  in  some  form  or  other  from  one  who  w^ 
always  ready  with  advice,  help,  and  encouragemeat. 

**  His  eminence  as  a  physician  is,  of  course,  knmm 
to  all.  and  there  are  many  to  testify  to  his  exceptitma] 
teaching  powers  and  his  popularity  -with  students ;  \»i\ 
it  was  mainly  in  connection  with  public  health  matter^ 
that  I  saw  most  of  Dr.  Poore.  His  interest  in  pnWa 
health  subjects  generally  was  of  the  keenest,  bnt  i: 
was  mainly  during  the  latter  years  of  his  active  lit*' 
that  he  gained  notoriety  by  his  able  and  stnenooG* 
advocacy  of  the  principle  of  paying  back  to  Naturt 
the  organic  matter  originally  derived  from  it,  by  gi\inf 
directly  to  the  soil  our  solid  and  liquid  dejecta.  As  as 
advocate  of  the  dry  system  of  sewage  collection  and 
the  subsequent  application  of  human  dejecta  to  tk 
soil  in  immediate  proximity  to  dwellings,  he  occup»: 
a  position  which  met  with  curiously  little  sympath: 
from  the  rank  and  file  of  public  health  workers.  T^ 
clever  and  logical  advocacy  of  his  views,  supported  b 
it  was  in  public  debate  by  exceptional  rhetorical  as: 
oratorical  gifts,  rarely  carried  the  entire  convictx: 
to  the  minds  of  those  exj>erienced  in  public  heahi 
administration,  who  recognised  (perhaps  more  than  b- 
the  difficulties  and  dangers  involved  in  the  practKi. 
application  of  his  views,  save  in  exceptional  circom 
stances. 

"  Whatever  ne  wrote  or  said  upon  this  subject 
however,  was  always  interesting  and  well  informei 
and  his  experimental  work  upon  the  subject  in  iriiici 
he  took  so  much  interest  will  for  long  be  studied  acd 
quoted  as  valuable  contributions  upon  a  matter  re- 
garding which  it  cannot  by  any  means  be  said  that  ih? 
last  word  has  been  spoken.  He  was  precisely  oat  c: 
those  individuals  in  whom,  despite  the  claims  for 
respect  and  admiration  which  much  good  work  ol  k 
high  order  demands  the  personality  of  the  man  prr 
dominantly  asserts  itself  and  constitutes  him  first  c: 
all  an  object  of  warm  friendship.  ^Vith  Dr.  Poor- 
there  passes  away  a  kindly  and  courtly  gentleman  a 
pleasant  colleague,  and  a  true  friend." 


In  addition  to  our  obituary  notice  of  last  week  we 
have  pleasure  in  publishing  the  following  appreciative 
memoir  of  the  late  Professor  Vivian  Poore  from  Pro- 
fessor H.  Kenwood,  a  friend  and  colleague  : — 

*'  As  one  who  was  for  many  years  privileged  to  enjoy 
the  friendship  of  Dr.  G.  V.  Poore,  the  sad  news  of  his 
death  comes  as  a  great  shock  and  creates  as  s  of 
real  and  enduring  personal  loss.  His  unfailing  charm 
of  manner  endeared  him  to  all  and  not  a  few  of  us  who 
have  been  associated  with  the  work  at  University 
College   and   Hospital   retain   grateful   recollections  of 


AeMcal  Dews* 


Medical  Sickness  and  Accident  Society. 

The  usual  monthly  meeting  of  the  Medical  Sicknes? 
Annuity  and  Life  Assurance  Society  was  held  at  4JC 
Strand,  London.  W.C,  on  November  25th.  Th«-t 
were  present  :  Dr.  de  Havilland  Hall  (in  the  chair: 
Dr.  J.  Brindley  James,  Dr.  Frederick  S.  Palmer 
Dr.  J.  W.  Hunt,  Dr.  St.  Clair  B.  Shadwell,  Dr.  F.  J 
Allan,  Dr.  W.  Knowsley  Sibley,  and  Dr.  J.  B.  Ball 
The  accounts  presented  showed  that  the  sickness 
experience  of  the  Society  was  about  the  same  as  l> 
usual  at  this  time  of  the  year.  The  recent  co^l 
weather  produced  a  rather  large  number  of  claims 
but  they  were  not  for  the  most  part  of  a  sehoos 
nature,  and  the  business  for  the  whole  year  will  prolv- 
ably'show  a  fair  margin  in  favour  of  the  Society.  A 
considerable  number  of  the  members  have  been  laid 
up  through  septic  wounds,  but  as  all  accidents  as  veS 
as  illnesses  are  covered  by  the  certificates  of  the 
Society,  full  pay  has  been  allowed  in  ever\'  case. 
Prospectus  and  all  particulars  on  application  to  Mr 
F.  Addiscott,  Secretary  Medical  Sickness  and  .\ccident 
Society.  Chancery  Lane.  London.  W.C. 
8uff vested  Visit  to  Paris. 

A  MEETING  of  medical  men  was  held  in  Paris  ac 
November  25th,  when  it  was  resolved  to  invite  British 
physicans  and  surgeons  to  pay  a  return  visit  to  Paris. 
Professor  Bouchard,  member  of  the  Institut.  wa^ 
I  elected  President  of  the  Paris  Committee,  and  the 
opinion  was  expressed  that  some  date  early  in  Ma> 
— probably  between  May  7th  and  14th — ^would  be  mast 
convenient. 

Badly  Ventilated  Schools  at  Burnley. 

Dr.  De.\n.  the  Burnley  medical  officer  of  health, 
reporting  on  the  measles  epidemic,  severely  condemn* 
the  lack  of  ventilation  and  overcrowding  of  class-rooms. 
In  one  case  he  found  the  air  almost  unbreathable 
the  class-room  overcrowded,  and  the  infants  sleep> 
and  half-poisoned. 


Dec. 


i9<-»4. 


PASS  LISTS. 


Tbe  Medical  Press.    619 


CyUln  and  CreoUn  In  thjB  Law  CourU. 

A  CASE  has  just  been  decided  in  Germany  relative 
to  the  bactericide  and  disinfectant  called  "  Cyllin," 
^vhlch  IS  of  interest  to  the  medical  profession.  The 
right  to  the  word  belongs  exclusively  to  the  Jeyes' 
Sanitary  Compounds  Company,  Ltd.,  of  London,  who 
coined  it  as  a  substitute  for  the  trade-mark  "  Creolin." 
formerly  used  by  them,  and  which  they  claim  to  be 
very  much  more  powerful  in  bacteria-killing  efficacy 
than  that  represented  by  the  orginal  title.  Finding 
that  Creolin  was  still  being  sold  in  Germany  by  the 
Pearson  Company  of  Hamburg  as  Jeyes'  preparation, 
the  latter  company  published  a  statement  to  the  effect 
that  the  fluid  which  they  now  make  (Cyllin)  is  four  times 
the  strength  of  that  which  they  formerly  sent  to 
Oermany  as  "  CreOlin."  Consequent  on  this  state- 
ment Mr.  Pearson  took  action  against  the  company  in 
the  District  Court  of  Hamburg,  and  the  Court,  having 
referred  the  matter  to  the  Hygienic  Institute  of  the 
city.  Dr.  Kister.  of  the  Institute,  was  deputed  to 
examine  a  long  series  of  specimens.  That  autnority 
reported,  as  the  result  of  bacteriological  experiments, 
that  the  defendants  (Jeyes)  had  succeeded  in  quad- 
rupling the  bacteria-destroying  properties  of  the  fluid 
formerly  supplied  to  Germany  by  them  under  the  name 
of  "  Creolin."  and  that  *'  Cyllin  "  is  eleven  times 
stronger  than  pure  carbolic  acid.  With  this  ex- 
pert testimony,  judgment  has  just  been  pronounced 
by  the  Hamburg  District  Court  in  favour  of  the  English 
company,  and  the  plaintiff's  claim  dismissed  with 
costs. 

Liverpool  Hoipltal  Saturday  Fund. 

The  annual  report  of  the  Liverpool  Hospital  Satur- 
day Fund  showed  the  largest  advance  in  any  one  year 
since  1873,  the  total  collection  from  all  sources  (in- 
cluding ^646  4s.  5d.  from  the  ladies'  street  collection) 
being  ig.ooy  i6s.  4d..  as  against  ^£8,062  i8s.  id.  in 
1903,  an  increase  of  £944  i8s.  3d.  The  workshop  or 
general  fund  was  still  moving  upwards,  £8,006  14s.  3d. 
being  subscribed-,  which  was  £603  i6s.  5d.  more  than  j 
last  year.  The  ladies'  street  collection  also  showed  a 
very  creditable  improvement.  The  total  expenses 
only  amounted  to  £532  los.  4d.,  or  about  5I  per  cent., 
against  6^^  per  cent,  in  1903.  The  amount  distributed 
to  the  hospitals  in  connection  with  the  Hospital  Sunday 
Fund  was  £14,850.  or  £250  more  than  last  year.  Of 
this  the  Hospital  Saturday  Fund's  share  was  £8,363  2s. 
The  total  number  of  collections  was  3,610  ;  boxes, 
2,385  ;  cards  and  lists,  1,973  I  21'^^  firms  using  own 
methods.  152.  The  total  in  1903  was  3,423- 
*    Royal  College  of  PhyftlclanB  of  England. 

The  Council  of  the  College  invite  applications  for  the 
office  of  Milroy  Lecturer  for  1906.  The  course  must 
comprise  not  less  than  "  three  "  nor  more  than  "  six  " 
lectures,  and  are  to  be  given  on  Tuesdays  and  Thursdays 
in  February  or  March,  1906.  Applications  must  be, 
addressed  to  the  Registrar,  on  or  before  January  7th, 
and  should  contain  a  statement  of  the  division  of  the 
subject  selected  by  the  candidate.  A  copy  of  Dr. 
Milroy's  *'  Suggestions  "  on  the  subject  of  his  bequest, 
and  information  as  to  the  emolument,  may  be  obtained 
from  the  registrar. 

Royal  Wateploe  Hoepltal  for  Children. 

The  lady  who  had  so  generously  offered  to  endow  a 
cot  in  the  Royal  Waterloo  Hospital  for  Children  and 
Women,  on  the  condition  that  five  others  will  come 
forward  and  do  the  same,  has  found  a  worthy  supporter 
in  the  Executors  of  the  late  Mr.  Arthur  O.  Crooke's 
will,  who  bequeathed  £20,000  to  the  Hospitals  of 
London  and  Surrey.  These  Executors  have  given 
the  sum  of  2,000  guineas  to  the  above  hospital, 
which  enables  the  Board  to  endow  two  more  beds, 
so  providing   three  of  the  number  stipulated. 


PASS  LISTS. 


Royal  College  of  Surgeons.  England. 

The  following  having  passed  the  necessary  examin- 


I  ations  and   having  conformed   to  the  by-laws    have 
been  admitted  members  of  the  college,  viz.  : — 

L.  A.  Amould,  T.  Bates,  arid  J.  A.  Bell,  St.  Bar- 
tholomew's ;  J.  Avery,  London  Hosp.  ;  W.  G.  Aviss, 
Birm.  Univ.  ;  J.  H.  Banlces,  St.  George's ;  H.  E. 
Barrett,  St.  Mary's;  J.  F.  Beale,  B.A.Camb.  and 
London  Hosp. ;  A.  R.  Beaumont  and  A.  M.  Benett. 
Guy's ;  C.  H.  Berry  and  J.  H.  D.  Bolton,  Univ.  Coll. 
Hosp. ;  A.  Blanc  and  J.  H.  Burridge,  King's  Coll. 
Hosp. ;  G.  H.  Boyden.  EUin.  Univ..  Owens  Coll. 
Manchester,  and  St.  Thomas's;  A.  C.  Brown,  St. 
Bartholomew's ;  A.  H,  Burnett,  Edinburgh.  Univ.  and 
London  Hosp.  ;  G.  Carlisle,  Guys ;  H.  Chitty,  Univ. 
Coll.  Hosp. ;  S.  H.  Clarke,  B.A.Camb.  and  London 
Hosp.  ;  A.  P.  Coker,  L.S.A.Lond.  and  Middlesex 
Hosp.  ;     J.   Cook,    Univ.   Coll.,   Cardiff,   and   Guy's  ; 

D.  K.  Coutts,  St.  Thomas's  ;  A.  W.  D.  Coventon. 
M.A..  B.C.Camb..  and  St.  Bartholomew's ;  G.  F. 
Dalton,  M.D.,  CM.,  Kingston,  Ontario,  and  Middlesex 
Hosp.;  T.  S.  Davies.  Univ.  Coll.,  Bristol;  H.  R. 
Dean,  Oxford  and  St.  Thomas's ;  G.  De  la  Cour, 
Univ.  Coll.  Hosp.  ;  C.  H.  Denyer.  Guy's  ;  F.  L.  De 
Verteuil,  Edin.  Univ..  St.  Thomas's,  and  King's  Coll. 
Hosp.  ;  C.  M.  Dickinson,  London  Hosp.  ;  G.  R.  Ernst, 
M.D.,  Rush  Medical  Coll.,  Zurich  and  Berlin  L^nivs.  ; 
G.  J.  Evans,  St.  Mary's  ;  C.  R.  B.  Eyre,  St.  Thomas's  ; 
R.  Felton,  Guy's  ;  L.  C.  Ferguson,  St.  Bartholomew's  : 
A.  R.  Finn.  St.  Mary's;  W.  J.  Fordham,  Univ.  Coll.. 
Sheffield  ;  F.  Forrest,  Edin.  Univ.  and  Victoria  Univ., 
Manchester ;  C.  J.  Galbraith,  King's  Coll.  Hosp.  ; 
H.  Hardwick  Smith.  M.A.  Camb.  and  St.  Bartholo- 
mew's;  A.  E.  U.  Hawkes,  L.S.A.Lond.,  St.  Mary's 
and  I'niv.  Coll.,  Liverpool ;  E.  C.  Hayes,  New  Zealand 
Univ.  and  St.  Bartholomew's ;  S.  C.  Hayman,  Univ. 
Coll..  Bristol;  T.  B.  Henderson,  M.B.,  B.Ch..  Oxon, 
and  St.  Thomas's  :  W.  R.  Higgins,  Camb.  and  London 
Hosp.  ;  L.  Hill,  St.  Mungo's  Coll.,  Glasgow,  and 
Middlesex  Hosp.  ;  J.  C.  L.  Hingston,  Middlesex 
Hosp.  ;  R.  F.  V.  Hodge,  B.A.Camb.  and  St.  George's  ; 
A.  H.  Hudson,  St.  Thomas's ;  C.  L.  Isaac,  Camb. 
Univ.  and  St.  Mary's;  B.  J.  F.  Jackson -Taylor. 
Univ.  Coll.,  Bristol,  and  King's  Coll.  Hosp.  ;  F.  A. 
G.    Jeans.    ^LA.Camb.    and    Univ.    Coll.,    Liverpool : 

E.  C.  Johnston,  Westminster  Hosp.  ;  G.  F.  Jones, 
Univ.  Coll.  Hosp.  ;  O.  W.  Jones.  Univ.  Coll.,  Liverpool ; 
A.  E.  Kerr,  Camb.  and  St.  Thomas's;  F.  C.  R.  M. 
Knight,  A.  E.  F.  Kynaston  and  A.  Leeming,  Guy'^  ; 
E.  B.  Lathbury  and  E.  Leverton-Spry,  St.  Bartholo- 
mew's ;  G.  Laurence,  Univ.  Coll.,  Liverpool,  and  St. 
George's ;  W.  Lister,  Univ.  Coll.,  Leeds,  and  St. 
George's  ;  A.  S.  Littlejohns,  Camb.  Univ.  and  Guy's  ; 
J.  MacArthur  and  R.  H.  Miller,  St.  Mary's  ;  J.  McCrae, 
B.A.,  M.B.,  Univs.  of  Toronto  and  Montreal ;  J.  A. 
Mcllroy,  Birm.  Univ. ;  W.  T.  P.  Meade- King,  Guy's  ; 
W.  M.  Mollison,  M.A.,  B.C.Camb.,  and  Guy's;  W. 
P.  Morgan.  M.A.Camb.,  B.Sc.Lond.,  Univ.  Coll.. 
Cardiff,  and  St.  Mary's ;  J.  F.  Murphy  and  J.  Papa 
Nicolas,  London  Hosp. ;  A.  Nell»  Ceylon  Medical 
Coll.,  L'niv.  Coll.,  and  Charing  Cross  Hosp.  ;  L.  E.  C. 
Norbury  and  E.  W.  Parry,  St.  Thomas's;  C.  W. 
O'Brien,  St.  Bartholomew's;  C.  E.  Palmer.  B.A. 
Camb.  and  St.  Thomas's ;  C.  Parker,  L.R.C.S.  and 
P.  Edin.,  L.F.P.S.Glasg.,  and  Westminster  Hosp.  ; 
R.  N.  Poignand,  B.A.Camb.  and  St.  Thomas's  ;  L. 
E.  Price,  Birm.  Univ.  ;  G.  H.  Rees  and  F.  Rogerson. 
Guy's ;  A.  Reute,  Univ.  Coll.,  Liverpool ;  H.  G. 
Sievewright,  Univ.  Coll.,  Cardiff,  and  St.  Mary's;  J. 
D.  Sinclair,  Edin.  Univ.  ;  W.  H.  Smailes,  Leeds 
Univ.  ;  G.  R.  Southwick,  M.D.,  Harvard  and  Boston 
Univs. ;  M.  Spotswood.  Liverpool  Univ. ;  C.  M. 
Stevenson,  Guv's  ;  H.  V.  Swindale.  Middlesex  Hosp.  ; 
A.  G.  Sworn,'  Univ.  Coll.  Hosp. ;  W.  A.  Tatchell 
and  J.  Turtle,  London  Hosp.  ;  R.  J.  C.  Thompson, 
St.  Thomas's ;  A.  W.  Wakefield,  Camb.  Univ.  and 
London  Hosp. ;  T.  R,  Waltenburg,  M.A. Oxon.,  B.A. 
Durh.,  L.S.A.Lond.,  and  Owens  Coll..  Manchester ; 
A.  C.  Warren  and  J.  K.  Willis,  B.A.Camb.  and  St. 
Bartholomew's;  R.  G.  Williams,  B.A.Camb.  and 
St.  Bartholomew's ;  R.  A.  Worthington,  Camb. 
Univ.  and  London  Hosp. 


620  Tm  Medical  Pkbss. 


NOTICES  TO  CORRESPONDENTS. 


Dec. 


1904. 


^Mxtte  to 
Corrt)ei)>onbent0,  ^kort  'jjUtUxe,  itt. 


H/S^  OoBEMroHDBcn  reqpirlng  a  reply  in  this  column  are  partioa- 
larly  requeeted  to  make  use  of  a  ^MiiMliv  Signatwrt  wr  fnUUO,  and 
ayoid  the  practioe  of  signing  themselves  "Reader,"  "Subscriber," 
**  Old  Subscriber/'  aeo.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Oeioinal  AxtiCLis  or  Lrtsbs  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  publfsa- 
tion,  but  as  evidence  of  identity. 

CORTUBViORS  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
In  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office,  these  should  be  addressed  to  the 
Publisher. 

BvBncTS.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

F»SAT0E.~We  have  carefully  considered  our  correspondent's 
offer,  but,  regretfully,  we  are  compelled  to  decline  it. 

MJt.C.S.~Our  con ebpondent  will  see  that  the  matter  to  which  he 
refers  is  commented  upon  in  our  editorial  columns. 

M.D.  (Brux.).— Application  should  be  made  to  the  Home  Office. 

Pbactitiovsr.— The  dispute  which,  it  «[>pear8  to  us,  is  a  trivial  one, 
should  be  nubmitted  to  the  arbitratioh  of  a  mutual  fricLd. 

Stabilitas  (Devon.).— It  the  patient  refused  to  follow  your  instruc- 
tions and  to  wear  the  splint,  your  responsibility  as  to  results  is  clearly 
waived.  Any  action  he  might  bring  woiUd  be  predoomed  to  failure, 
although  it  might  involve  you  in  a  good  deal  of  trouble  and  annoyance. 
Thebest  way  in  dealing  with  such  a  patient  would  have  been  to  point 
out  the  possibility  and  the  likelihood  of  bad  results  if  your  di'  ections 
were  not  obeyed,  and  to  have  washed  your  hands  of  the  whole  case 
when  he  remained  obstinate.  Many  an  ununited  fracture  ha»  been 
brought  about  by  mulish  obstinacy  of  that  kind. 

W.  O.  liAMsntT  (Lntoa^.— The  case  of  the  medical  man  who  wants  a 
suture  only  upon  rare  ocossions  is  exactly  met  by  the  asceptic 
threaded  needles  now  to  be  bought  in  sealed  glass  tubes  which  are 
broken  at  one  end  when  wanted,  and  the  ligature  and  needle  taken 

**"'■  ORIENTAL   GRATITUDE. 

The  Daily  TeUgrarth  reports  that  according  to  a  despatch  from 
Kittanning,  Pennsylvania,  Dr.  C.  A  Flower,  who  was  mysteriously 
<;slled  to  Ht.  Louis  a  week  ago,  returned  loaded  with  Oriental 
pi«sents  and  documents  to  show  that  he  had  been  appointed  house 
physician  for  life  to  the  Rajah  Tipoo  Sahib,  a  potentate  oflndia,  who 
after  seven  years'  search  found  the  physician  wh  >  dragged  him  from 
under  a  cimel  and  saved  his  foot  from  amputation.  Dr.  Flower, 
who  is  a  wealthy  man,  says  he  will  go  to  India  in  April  and  spend 
the  remainder  of  his  life  there. 

Db.  Fielpsn.— Your  paper  has  been  marked  for  early  insertion. 

Db.  C.  H.  8.  (Brighton).  We  regret  our  inability  to  insert  our 
correspondent's  letter  as  it  would  open  up  a  religious  controversy, 
which  would  be  out  of  place  in  a  medical  Journal. 

RvTHnGLBK.— The  National  Association  for  the  Prevention  o^ 
Ckmsumption  was  inaugurated  at  Marlborough  House,  under  the 
Presidency  of  iiis  Malesty  the  King,  when  Prince  of  Wsles,  on 
December  20tli,  1896. 


^etings  of  the  ^oneliee,  ^ettures,  &r* 

WSDKSSDAT  DECBMBSR  7th. 

OssTtTBiCAL  Socnrr  or  Lovdov  (SO  Hanover  Square,  W.).-8p.m. 
Specimens  will  be  shown  by  Sir  W.  J.  Sinclair,  Dr.  Lewers«  Dr. 
Williamson,  Mr.  J.  D.  Malcolm.  Short  Communication  :  —Lieut- 
Col.  Sturmer:  On  a  Case  of  Abdominal  Gestations.  Paper  :-Dr. 
W.  Tate  :  Three  Cases  of  Intestinal  Obstruction  foUowingOperations 
for  Fibroid  Tumour  of  the  Uterus,  with  Special  Reference  to  the 
Ohoice  of  Operation. 

Mkdioax.  GRADUATfeS*  CoLLBOB  AKD  PoLTCUVXC  (2i  Chenies  street, 
W.C.).-4  p.m.  Mr.  A.  H.  Tubby  :  Clinique.  iSurgical.)  5.15  p.m. 
Mr.  J.  Bland  Sutton  :  The  Surgery  of  the  Uterus.  7.15  for 
7.90  p*Bft*  Annual  dinner  at  the  Trooadero  Restaurant,  Ficcadllly 
Circus,  W. 

Obhtbal  Londoh  Thboat  A2n>  Bab  Hospital  (Gray's  Inn  Road, 
W.C.).— 5  p.m.    Demonstration  :— Dr.  W,  Wmgrave :  Ear. 

THUBSDAT,  DtCBMBBB  8th. 

BBrriSH  GTM.fiOOLoeiCAL  Socibtt  (20  Hsnovsr  Square,  W.)  •Sp.m. 
Specimens  will  be  shown  l^  Dr.  Maonaughton-Jones,  Prof.  J 
Tkylor,  Dr.  Elder,  Dr.  R.  T.  Smith,  and  Dr.  B.  Fenwick.  Paper  :^ 
Mr.  W,  Alexander  :  Adenoma  of  the  Endometrium  (illustrated  by 
microscopic  sections,  photographs  and  lantern  slides). 

Bbxtxsh  Balbbolooical  abd  Climatozxmical  Booibtt  (80  Hanover 
Square,  W.).— 6  p.m.  Paper  :— Dr.  N.  H.  Forbes  (Tun bridge  Wells) : 
Observations  on  the  Climate  and  Health  Resorts  of  Scotland. 

Opiithalmouwical  Socibtt  opthb  Ubitbb  Kibodom  (11  Chsndos 
Street.  Cavendish  Square,  W.).-^pm.  Clinioal Evening.  Oases  and 
Specimens  will  be  shown  by  Mr.  £^  H.  Jones,  Mr.  G.  W.  Roll,  M. 
A.  Lawson,  Mr.  ▲.  H.  Thompson,  Mr.  D.  Marshall.  Mr.  J.  H. 


Parsons,  Mr.  G.  W.  Thoropsoo  and  Ifr. 
Coates,  and  Mr.  J.  W.  Tomlinson. 


E.  ChsttflrtOB,  Xt  <s. 


Dbvinb,  Ubbrt,M.B.C.S.,  L.R.O.P.Lond.  Assistant  Medical  Officer 

at  the  Wakefield  Asylum. 
Gbovbs.  Bbxbst  W.  Hbt.  M.D.,  B.S.,  BScXond.,  Demonstrator  of 

Anatomy  at  Unlversit?  College.  BristoL 
Savill.  AexBs  F.,  M.D.Glasg..  M.B.C.P.Irel..  Honoran-  Assistut 

Physician    to  fit.  John's  HospiUl  for    DIseaaes  of   the  Skis, 

Leicester  Square. 
TnoMSOB.  WiLLUM  Tbaill,  M.R.C.S.,  L.B.G.P.,  House  Snigcon  to 

the  Wameford  Ho«pital,  Leamington. 
TovBT.  Abthub.  M.R.C:S.,  L.R.CP.Lond.,  ClinSeal  Assistant  at  Sc 

John's  Hospital  for  Biseases  of  the  Skin,  Leicester  Square. 


$irtk0. 


Daboak.— On  Nov.  22nd,  at  45  Stephen's  Green,  East,  DuUin,  the 
wife  of  Wniiam  Dargan,  M.D.,  of  a  son. 


P0PB-0wLB8.~On  December  1st.  at  the  Parish  Church  of  St.  Man *•, 
Barnes.  Edwyn  Lonsdale,  third  son  of  Alfred  Crosby  Pope.M.D., 
of  Clittonville,  to  Florence  Ada,  seoond  daushterof  Cliarlei 
Henry  Owles,  oC  Scarth  House.  BameB. 

Woods -Hampdbb.— On  Dec.  1st.  at  the  Parish  Church,  Ewdne, 
Oxon,  Major  Albert  Bdward  Woods.  Indian  Arrav,  Assam  Cost- 
mission,  of  Bushey,  Herts.,  youngest  son  of  the  bte  W.  B. 
Woods,  M.D.,  M.A.,  T.C.D.  et  Ozon..  Burgeon  RX..  to  Audrey 
Katherine  Mary,  elder  daughter  of  the  late  Prebendary  B.  &, 
Hampden,  rector  of  Crsdley,  Herefordshire,  and  of  Mrs.  Hsap- 
den,  Ewelme. 


fBtxlhB. 


MOTT.-On  December  2nd.  at '» Wfldetbope,"  Scdlesoombe  Bosd,  8t 
LeonaidsonSea,  Dr.  Charles  G.  Mott.  fl^wt  son rf  the  We 
Charles  Mott.  of  Church Stretton.  Salop,  to  hi»22f  J*^'  g-^ 

8cBiVB».-On  December  2nd.  at  Abberly.  StoiMiwrt.  John  9na 
Scriven,  M.D.,  R,N.,  aged  68.  bite  of  DofHeld.  Derby. 


HaevbiabBociitt  op  LoBDOB  (Stafford  Booms,  TftcfaboncStiMt 
Edgware  Road,  W.X-8  80  p.m.  Discussion  on  the  Treatmest  ofP^ 
monary  Tuberculosis  (opened  by  Dr.  Mackenzie).  Sir  W.  BtaidhsBL 
Bart,  Dr.  J.  K.  Fowler,  K*.  8.  fhopiMon.  Dr.  W.  Bwart.  Dr.CBMc; 
Dr.  Mag^  Dr.  J.  J.  Perkins,  Dr.  jTe.  Squixe,  andotheissililS 

MbdIOAL  OBADUATBS'  CoLLBOB  AJTD  POLYCI.IBIC  (22  QMhsStML 

W.C.).— 4p.ni.  Mr.  Hutchinson :    Clinique.    (SnifiosL)   fij&n.ia. 
Dr.  P.  Stewart .  Ptoslyrit  of  the  (Terriail  Sympathetic 

Nobth-EastLobdob  Post-Gbai>uatb  Coixbob  (Tottenhua  Htsn. 
tal,  N  ).^4.30  p.m.    Dr.  O.  N.  Meachen :  Skin  DiseaK  b  O^Sk 

MoxTBT  Ybbbob  Hospital  rom  CoBSUMPnon  abd  Disbasr  or 
TBB  CHB8T  (7  Fltztoj  SquBrs,  W.).— 6  p.m.  Lecture :  Dr.  P 
W.  Price  I  Mitral  Stenosis  (Ulustrated  bj  oases).  Poct-Ondaaie' 
Course.) 

_  FaiDAT,  DBCRMBsaOih. 

Cubical  Socibtt  op  Lobdob  (85  Hanover  Square,  W.).->8aiiu£. 
Papers  :  -  Mr.  C.  Wallace  :  A  Series  of  IntoasuaceptioQ^  in  ChikfaeT 
—Mr.  H.  White :  A  Case  of  Acute  Rheamatoid  Arthritt8.-0r.  B. 
Abrahams :  On  Arthritis  Deformans  and  its  Allies. 

Epidbbiologioal  Socibtt  op  Lobdov  (llChandosStre^  Ckvcs. 
dwh  Squar*,  W.).-8.S0  p.m.  Lecture  :~ Dr.  NuttoU  :  Ticks  »iH 
Tick-transmitted  Diseases. 

Mbdical   Gbaduatbs'   (}oixbob  abd    Polvgubic    (t2  Ghtsa 
Street,  W.C.).-4  p.m.  Mr.H.  W.  Dodd  :  CUnfame.    (Bye.) 
^TuBSDAT,  Dbcbmbbb  13th. 

Tub  Ml  dioo-Lboal  Socibtt  (in  the  Booms  of  TheBoyal  Aaste 
Society).— 8  p.m.  JSxhibitionof  fourMedioo-LegalspecnnensbTDr 
Harvey  Littlejohn.  Discussion:  Degeneration  i  Its  OaoseB  and  Frw 
vention— with  reference  to  the_propoeed  Sterilization  of  eerba 
Degenerates.    To  be  opened  by  Dr.  Robert  BentouL 

Stirling  District  Asylum.  Larbert.  N.B.— Assistant  Medical  Q%x. 
Salary  £150  per  annum,  with  board.  Ac,  Applioatkmitotte 
Medical  Superintendent. 

White  Moss  Sick  and  Accident  Society.  Skelmeradale  -M^iilal 
Officer.  Salary  HiOO  per  annum.     Applications  to  theSecrettn 

London  Hospital,  Whitechapel,  E.— Medical  B^strarship.  Sdm. 
£100  per  annum.  Applications  to  £.  W.  Morris,  Becretaiy. 

Whitehaven  and  West  Cumberland  Infirmary.— Besidcnt  Hove 
Surgeon.  Salary  £120  per  annum,  with  board  and  lodgief. 
Applications  to  Wm.  H.  Sands,-  Secretary . 

Nottingham  General  Hospital.— Assistant  House  Physician.   SSlu?       | 
£100  per. annum,  with  board,  lodging,  and  washing  in  the  Hos- 
pital.   Applications  to  the  Secretary. 

Nottingham  General  Hospital.— Assistant  House  Burgeon.  Sshiy 
£100  per  annum,  with  board,  lodging,  and  washing  in  the  Hos- 
pital.   ApplicaUorns  to  the  Secretary. 

The  victoria  Hospital  for  Burnley  and  District.— BesideBt  Medial 
Officer.  Salary  £100  per  annum,  with  residence,  board,  asd 
WMhing.    Applications  lo  7,  Grimshaw  Strset,  Bumlev. 

Ck>unty  of  London.— Assistant  Medical  Officer.  Salar>- '£300  fcr 
annum.  Applications  to  The  Clerk  of  the  Council,  County  Htfl, 
8p  ing  Gardens.  S. W. 


^lt(  ^dial  §tm  mA  (iiittvAm. 


^SALUS  POPULI  SUPREMA  LEX" 


Vol,  CXXIX. 


WEDNESDAY,    DECEMBER    14,     1904.       No.    24. 


(S^rfdlnal  Communications. 
AN  OBSCURE  FORM 

OF 

ALCOHOLISM     INVOLVING 
IRRESPONSIBILITY,  (a) 

By  T.  CIAYE  SHAW,  M.D.,  F.R.C.P. 
Of  all  the  causes  or  mental  conditions  which  even- 
tuate in  murder  or  self-destruction,  none  is  so  frequent 
OT  powerful  as  drink,  whether  acting  directly  or  in- 
directly. The  imbecile  or  degenerate  is  easily  led 
into  crime  by  impulse  when  he  has  had  drink,  but  under 
ordinary  circumstances  his  very  stupidity  makes  him 
tolerant — or  indifferent — to  anger-stirring  causes, 
yhich  would  strain  the  balance  of  a  higher  equipoised 
intellect.  Jealousy  and  revenge  will  hesitate  for 
years  on  the  brink  of  action,  but  they  plunge  boldly 
into  accomplishment  under  the  compelling  force  of 
■drink.  The  scientific,  calculating  murderer  is  rare, 
and  he  is,  as  a  rule,  careful  in  his  methods,  and  patient 
and  deliberate  in  his  tactics ;  he  knows  that  alcohol 
would  lead  him  to  carelessness  and  risk  of  failure, 
and  be  keeps  away  from  excess  of  it.  In  all  ways 
drink  is  the  beginning  of  the  end.  It  has  had  its 
good  results  when  leading  to  babbling  by  the  accom- 
plices in  unlawful  enterprise,  but  it  is  the  ban  ot  secret 
societies,  and  its  powers  of  denudation  are  so  well 
recognised  that  no  one  wh©  is  a  slave  to  it  can  be 
trusted,  for  henceforth  the  veil  is  torn  away  from  the 
inner  mind,  and  he  has  lost  the  proprietorship  of 
himself. 

•-  So  immediate  is  the  connection  between  drunkenness 
and  crime  that  all  the  details  of  it  should  be  well 
analysed  with  the  view  to  explaining  the  question  of 
responsibility,  and  I  propose  to  draw  the  attention  of 
Ihe  Society  to  one  phase  where  the  signs  of  inebriety 
are  so  masked  (though  the  real  loss  of  inhibition  is 
intense)  that  only  by  a  special  consideration  can  we 
come  to  a  right  conclusion  as  to  whether  the  individual 
is  to  be  held  responsible  or  not.  One  reason  why 
secret  societies  flourish  best  abroad  is  that  drunken- 
ness is  more  rare.  I  am  not  a  Freemason,  but  it  has 
often  struck  me  as  strange  that  out  of  the  thousands 
of  male  patients  with  whom  I  have  been  brought  in 
contact,  not  one  has  ever  divulged  by  sign  or  word 
any  one  of  the  mysteries  of  that  very  close  corporation. 
To  the  uninitiated  the  fact  suggests  that  either  the 
obligation  to  secrecy  is  so  overpowering  as  to  be  an 
unassailable  inhibition,  or  else  that  there  is  no  secret 
or  mystery  to  disclose. 

The  question  of  responsibility  in  criminal  cases — 
which  it  is,  understand,  the  proprium  of  the  jury  to 
•decide — has  perhaps  a  different  meaning  as  applied 
medically  and  legally.  The  law  takes  no  notice  of  a 
nian  getting  drunk  as  long  as  he  is  not  incapable  or 
-disorderly,  and  it  holds  him  responsible  for  his  actions, 
which  seems  to  be  logical ;  but  the  physician  knows  that 
when  a  man  is  drunk  he  is  not  medically  responsible, 
liis  voluntary  actions  become  reduced  to  impulsive 
ones,  he  acts  upon  motives  which  in  his  true  character 


^(a)A   Pftper  md.  b«fo.^  the   MecUco-LegAl    Soc:«ly.   Lopdon< 
3f  ovember  8th,  1904. 


would  have  been  restraining  ones.  Law  and  medicine 
are  not  likely  to  agree,  therefore,  upon  this  question 
of  responsibility  until  the  former  recognises  that 
character  is  the  ultimate  cause  of  will,  and  that 
whatever  changes  the  character  modifies  the  will,  and 
therefore  changes  the  conditions  of  responsibility. 

In  the  earlier  stages  of  intoxication  we  notice  how 
the  upper  centres  of  the  brain  become  involved,  at 
first  showing  instability  (which  many  mistake  for 
brilliancy),  tl>en  going  on  to  incoherence,,  and  finally 
to  exhaustion  or  to  coma  due  to  toxaemia.  After  a 
time,  varying  with  capacity  for  elimination  of  the 
poison,  resistive  power  of -the  nerve-elements  and  other 
causes,  the  intellectual  paralysis  ceases,  and  the  parts 
resume  function  in  the  inverse  order  from  that,  in 
which  they  disappeared,  in  the  majority  of  cases ;  but 
there  is  a  class  where  this  complete  recovery  does  not 
really  occur,  though  the  individuals  regain  the  power 
of  the  ordinary  reflex  brain  functions  to  so  complete 
a  degree  as  to  deceive  those  with  whom  they  axe  usually 
in  contact,  whilst  they  are  at  the  time  in  a  state  of 
minus  inhibition,  and  are  really  very  dangerous  persons 
both  to  themselves  and  others.  To  the  ordinary 
observer  they  would  pass  for  sane  persons,  but  they 
lEire  really  unfit  for  responsibility,  and  their  acts  are 
more  like  those  of  somnambulists,  or  of  p^sons  in 
the  stage  of  recovery  from  an  epilepsy. 

Some  time  ago  the  head  of  a  large  Government 
institution  asked  me  the  explanation  of  a  'condition 
which  he  occasionally  found  in  some  of  the  workmen, 
and  which  was  attended  with  dangerous  ■  results, 
though  the  condition,  which  he  attributed  to  drink, 
was  of  a  character  very  special  in  its  nature,  and 
characterised  by  absence  of  many  of  the  usual  indica- 
tions of  intemperance.  The  rules  at  this  institution 
in  question  are  very  drastic  on  the  subject  of  intem- 
perance on  the  part  of  the  officials,  and  it  transpired  that 
though  the  workmen  did  not  (perhaps  could  not) 
indulge  in  drink  by  day.  they  did  so  exceed  at  night, 
in  the  hope  that  probably  the  effects  would  not  be 
visible  the  next  morning,  and  that  they  would  be 
able  to  carry  on  their  duties  undetected  in  their  bad 
habits.  On  more  than  one  occasion  it  was  reported 
to  the  chief  that  men  who  had  come  in  to  work,  to 
all  appearances  in  a  proper  condition,  had  in  the 
course  of  the  day  committed  acts  foreign  to  their 
previously  understood  nature,  and  in  more  than  one 
instance  of  a  suicidal  character.  In  particular, .  one 
man,  who  was  an  old-established  servant,  came  in  to 
work  as  usual,  but  after  a  few  hours  made  an  attempt 
to  poison  himself  by  oxaUc  acid.  It  was  found  on 
inquiry  that  the  man  had  done  his  work  as  usual, 
and  been  able  to  converse ;  though  how  far  his  inter- 
course with  other  people  had  gone  was  not  stated : 
probably  it  was  not  much  beyond  slight  references  to 
the  usual  work  or  the  commonplaces  of  the  institu- 
tion. It  appeared  afterwards  that  the  man  had  been 
a  heavy  night  drinker,  but  had  always  been  punctual 
on  duty  in  the  mornings. 

It  has  occasionally  been  remarked  that  people  who 
have  left  off  drinking  for  a  short  time  have  become 
suicidal  or  even  insane  when  it-  might  have  been 
supposed  that  the  ill^efiects  of  the  drink  should  have 
disappeared,  though  as  a  fact  the  higher  centres  would 
appear  not  to  have  regained  their  k>st  power,  and  in 


622     The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec.  14.  19C34. 


reality  an  impulsive  state  was  present.  I  have  often 
remarked  in  lunacy  practice  that  the  insane  symptoms 
have  come  on  after  the  drinking  habits  had  been  dis* 
continued  for  a  few  days  or  even  Jonger,  and  though 
it  would  have  been  difficult  to  %a.ve  demonstrated 
that  these  people  were  still  und^^the  influence  of 
drink,  and  therefore  impulsive  and  uncertain,  there 
could  be  really  no  doubt  of  it  in  the  light  of  subsequent 
events.  These  conditions  are  always  very  puzzling 
to  those  who  meet  with  the  victims  m  the  £^pparently 
sane  intervals,  and  without  doubt  they  have  been 
the  cause  of  miscarriage  of  justice  before  now,  because 
the  persons  so  suffering  have  been  judged  to  be  in  the 
possession  of  faculties  to  which  they  were  really  not 
entitled. 

It  would  not  be  difficult  to  propose  theories  for 
the  interpretation  of  these  cases.  It  might  be  sup- 
posed that  between  the  intervals  of  drinking  and  the 
appearance  of  the  insane  or  dangerous  symptoms  and 
acts  the  patient  had  been  unable  to  take  food  and  rest 
and  therefore  had  become  weak,  though  possessing 
his  faculties  because  he  showed  no  prominent  signs 
of  perturbation  ;  or  that  possibly  during  the  interval 
some  ptomaines  had  been  developed  which  caused 
the  subsequent  explosion  ;  and  this  is  a  by  no  means 
improbable  explanation,  though  pathology  is  as  yet 
scarcely  ripe  for  this  interpretation. 

I  remember  being  called  in  to  see  a  gentleman 
whose  delusions  (of  an  exalted  nature)  were  very 
prominent.  I  suspected  that  the  condition  was  of 
alcoholic  origin,  and  so  it  turned  out,  but  I  had  con- 
siderable difficulty  in  eliciting  the  fact  from  the 
friends,  because  they  said  that  though  he  used  to  take 
a  good  deal,  he  had  recently  not  taken  any,  and  there- 
fore alcohol  could  have  had  nothing  to  do  with  it. 
Over  and  over  again  I  have  seen  cases  where  alcohol 
has  produced  suicidal  or  homicidal  conditions,  an 
interval  elapsing  between  the  cessation  of  drink  and 
the  outbreak  of  the  attack,  nothing  wrong  being  in 
the  meantime  noticed  by  casual  observers.  Please 
note  that  I  do  not  mean  to  say  that  a  proper  examina- 
tion would  not  detect  some  abnormality  or  impair- 
ment of  function,  but  that  to  those  in  his  casual 
surroundings,  judging  only  by  the  way  in  which 
methodical  or  ordinary  routiue  duties  were  performed, 
there  seemed  to  be  no  change.  Minute  investigSition 
would  probably  have  disclosed  incapacity  for  attention 
to  new  subjects,  irritability  of  temper,  instability, 
and  change  in  emotional  tone,  all  pointing  to  an  im- 
pulsive condition  and  loss  of  inhibition. 

Clinically  we  note  that  the  effects  of  alcohol  are 
either  immediate  in  producing  the  delirium  and 
excitement  familiarly  known  as  drunkenness,  or  in 
chronic  changes  which  gradually  set  up  organic  faults 
in  the  nervous  and  general  system,  leading  to  slow 
loss  of  normal  function,  or  else  in  the  condition  which 
I  am  describing,  and  which  has  not  hitherto  received 
the  attenticm  it  deserves.  I  can  best  describe  the 
^tate  as  one  akin  to  shock  of  a  partial  kind,  as  if, 
whilst  leaving  the  lower  centres  free  to  act,  the  upper 
centres  were  for  the  time  in  a  greater  or  less  degree 
of  paralysis,  the  general  condition  of  inanition  of  the 
system  with  its  impairment  of  appetite  and  want  of 
p.oper  sleep  causing  a  depressed  emotional  tone,  and 
p  rhaps  a  distorted  functioning  of  such  parts  of  the 
higher  centres  as  may  be  capable  of  action  of  some 
sort. 

'  A  parallel  course  is  not  unconmionly  seen  in  mental 
shock  on  the  receipt  of  bad  news,  where  some  time 
after  the  stunning  effect  of  the  primary  blow,  the 
usual  organic  functions  being  in  the  meantime  per- 
fcMmed  as  is  customary,  other  signs  of  irregular  mental 
processes  appear,  due  to  the  gradual  re-integration 
of  centres  that  have  been  profoundly,  but  not  irre- 
trievably, damaged. 

That  illegal  acts  are  not  infrequent  (indeed  are  only 
to  be  expected)  in  other  conditions  where,  the  lower 
centres  Deing  left  in  action,  the  upper  ones  are  partially 
or  wholly  incapacitated,  is  well  shown  in  a  case  which 
came  under  my  notice,  of  a  gentleman  who  was 
indicted  for  indecent  exposure  before  some  children 


in  the  street.  Evidence  was  to  the  effect  that  the 
gentleman,  who  was  said  to  t>e  rather  addicted  fe» 
stimulants,  had  an  attack  of  the  nature  of  a  fit,  aoKl 
that  a  short  time  after  when  in  the  street,  be  mcfid 
the  buttons  of  his  trousers  in  the  presence  of  some 
children  and  passed  urine  publicly.  I  had  little 
difficulty  in  showing  that  the  act  was  merdy  a  reflex 
one,  done  without  premeditation,  and  indeed  in  all 
probability  unconsciously.  Owing  to  fluid  dxinking. 
the  bladder  had  become  surcharged,  then  came  the 
fit  and  its  after  effects,  which  set  up  a  sabconsdous 
condition,  whilst  the  sensation  of  stress  of  urine  pat 
in  action  the  usual  reflex  act  of  unfastening  the  dress. 
&c.,  regardless  of  the  public  circumstances  under 
which  it  was  done.  The  man  was  acquitted  of  criminal 
intent,  owing  to  temporary  disablement  from  disease. 

In  order  to  understand  this  dass  of  cases,  we  have 
only  to  consider  the  doctrine  of  evolution  propounded 
by  Dr.  Hughlings  Jackson.  The  higbest  brain  stnicr 
tures  are  the  last  to  be  evolved  ;  they  represent  the 
most  complete  development  of  inhibition  and  triB. 
In  the  acquisition  of  habits  and  of  business  they  aie 
regulative  and  determining,  but  this  co-operative 
function  once  brought  about,  the  carrying  on  of  the 
process  is  relegated  to  lower  centres  which  are  able  to 
perform  unaided  the  work  which  has  been  put  upon 
them ;  they  are  more  automatic,  less  voluntary, 
more  organised,  than  are  the  structures  above  them; 
they  are  also  less  liable  to  impairment  by  poison  (such 
as  alcohol)  and  disease,  and  a  little  consideration  viS 
show  how  many  of  the  ordinary  exchanges  of  conyena- 
tion  and  action  in  social  life  are  but  the  exercise  of 
these  subordinate  agents. 

'•  Man  thinks  Uttle  and  thinks  seldom,"  say«  Wundt 
Were  it  not  so  the  fatigue  of  life  would  be  too  great. 
Much  repetition  reduces  the  emotional  tone  so  that 
we  react  without  strain,  almost  without  consciousness. 
processes  which  may  have  cost  much  thought  and 
much  attendant  feeling  to  acquire. 

When  will-power  and  the  higher  mental  faculties 
such  as  attention  are  masked,  the  lower  or  subcon- 
scious faculties  still  react  in  obedience  to  external  or 
internal  stimulus,  and  this  form  is  either  of  a  simply 
reflex  character,  or  it  issues  in  impulsive  display. 
Action  on  impulse  is  often  of  a  dangerous  character, 
sometimes  it  is  conservative.  It  is  the  mode  of 
action  of  the  untutored  mind  of  the  child  and  of  the 
mind  which  has  fallen  from  its  high  estate.  It  is 
the  mode  of  the  hasty  and  impetuous,  and  it  is  the 
method  adopted  by  Nature  for  the  safety  or  destruc- 
tion of  the  individual  at  a  crisis,  issuing  sometimes  in 
the  one,  sometimes  in  the  other.  Certainly  it  is  the 
action  of  the  incomplete  mind,  and  therefore  it  con- 
notes irresponsibility. 

The  foutine  of  life  is  attended  with  so  little  vivid 
consciousness  that  it  is  often  difficult  to  say  what  has 
transpired,  so  little  attention  do  the  customary  pro- 
cesses call  forth,  and  even  in  the  best  educated  classes. 
where  there  is  wider  orientation  of  thought  owing  to 
greater  range  of  associations,  the  same  reduced  process 
is  at  work  during  the  greater  part  of  the  social  life. 
In  fact  the  higher  centres  are  out  of  function  for  long 
periods  at  a  time,  and  the  coruscations  that  surprise 
the  ordinary  person  are  but  the  flashes  of  light  rendered 
visible  when  the  chief  part  of  the  greater  centre  is 
obscured. 

To  define  accurately  the  line  of  margin  between 
responsibility  and  non-responsibiUty  is  impossible. 
Men  may  write  coherent  letters,  may  dictate  the  dis- 
posal of  their  property  and  of  their  remains,  may  go 
about  their  ordinary  work  and  social  observances,  and 
yet  be  meditating  suicidal  or  homicidal  acts  all  the 
time ;  there  is  no  key  to  the  inner  Ufe  and  motives 
of  a  man  beyond  his  acts,  and  even  these  can  only  be 
relatively  estimated.  When  they  (the  acts)  d^Lsh 
with  the  ordered  social  codes  we  must  conclude  that 
the  actor  is  either  criminal  or  insane,  or  of  some  innate 
mental  peculiarity  ;  in  the  former  and  latter  conditions 
he  may  or  may  not  be  responsible ;  in  the  middle 
term  he  is  certainly  not. 

Post-morlem  examination  of  any_braui  would  sho« 


I>BC.    14,    1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Pkss.   ^23 


imperfection.  It  is  a  fact  that  microscopic  explora- 
tion shows  defects  and  deteriorations  in  what  have 
been  considered  to  be  thoroughly  healthy  minds,  and 
if  3o,  who  shall  determine  the  effect  of  these  intimate, 
if  minute,  lesions  upon  processes  of  mind  ?  To  me 
they  account  for  many  of  the  shortcomings  of  which 
^we  are  ourselves  conscious,  but  of  which  the  outside 
vrorld  is  ignorant  and  refuses  to  condone. 

A  well-known  present-time  actor  said  to  me  the 
other  day  that  the  greatest  difficulty  connected  with 
the  stage  was  having  to  perform  a  part  when  under 
the  stress  of  worry  or  anxiety,  and  yet  the  audience 
vrould  know  nothing  of  this  inner  mental  state  obscured 
to  public  gaze  by  the  function  of  subordinate  centres 
AKrhich  they  are  all  the  time  mistaking  for  the  higher 
processes,  which  are  in  reality  very  diSereatiy  occupied. 
If  men  would  only  recognise  how  uncertain  their 
responsibility  is,  how  incapable  they  often  are  to 
form  correct  judgments  where  their  own  interests 
are  concerned,  and  how  vital  it  is  for  the  community 
that  they  should  seek  the  advice  of  others  whose 
higher  centres  are  unimpeded  by  personal  considera- 
tions, there  would  be  less  crime  and  fewer  mistakes.  He 
iwho  goes  to  his  lawyer,  his  doctor,  his  priest,  or  his 
friend  obtains  relief  because  he  is  substituting  for 
&  Kmited  and  untrustworthy  hierarchy  the  judgment 
of  an  unbiassed  mind,  free  to  act  because  recognisant 
of  the  conditions  involving  responsibility. 

It  is  the  knowledge  of  the  imperfect  integrity  of 
brain  structure  in  the  highest  regions  which  often 
causes  conflict  between  the  lawyer  and  the  physician  ; 
the  former  sees  the  codes  transgressed  or  evaded, 
and  would  make  the  individual  responsible  because 
there  is  apparently  nothing  wrong  in  the  ordinary 
reflexes  of  social  Hfe ;  the  latter  knows  that  the  highest 
and  most  delicate  centres  are  rarely  complete  and 
.  able  to  function  regulativel)r,  and  he  therefore  hesitates 
before  allowing,  responsibility. 

Incomplete  function  in  any  other  viscus  than  the 
brain  is  every  minute  before  our  eyes,  but  as  it  rarely 
leads  to  anything  beyond  inconvenience  to  the  indi- 
vidual it  is  not  of  so  much  importance  to  the  com- 
munity ;  but  when  the  brain  is  impaired  no  one  can 
forecast  what  will  happen  to  the  individual,  or  to 
society. 

I  look  upon  the  law-lists  as  evidence  more  of  disease 
than  of  wickedness,  and  the  lawyer  and  the  physician 
as  allies  in  the  corporeal  and  spiritual  treatment  of 
the  infirmities  of  crime  and  insanity.  It  may  be 
objected  to  the  above  interpretation  that  punish- 
ment often  prevents  the  repetition  of  crime.  This  1 
quite  admit,  but  it  has  nothing  to  do  with  the  question 
of  responsibility.  The  conditions  of  punishment  often 
act  medically  and  enable  a  disordered  or  impaired 
organ  to  recover  its  equilibrium ;  in  some  cases  punish- 
ment comes  as  a  relief,  the  individual  feels  that  his 
debtor  and  creditor  account  is  balanced,  stress  is 
relieved,  and  the  overburdening  of  a  paralysed  centre 
is  cant  off ;  but  to  proceed  to  the  ultimate  resort  of 
doing  away  with  the  individual  for  all  time  is  a  process 
which  should  only  be  carried  out  under  the  most 
particular  circumstances  ;  in  my  opinion,  the  extreme 
penalty  of  the  law  should  rarely  be  visited  on  women  ; 
they  are  too  delicately  organised,  their  mental  integrity 
is  too  easily  destroyed,  their  impulses  and  emotions 
are  beyond  our  ken,  and  therefore  we  can  only  judge 
them  by  an  inadequate  standard. 

Is  it  not  for  medicine  to  determine  the  conditions 
of  responsibility  at  the  time,  and  for  the  moral  physician, 
the  lawyer,  the  toll  to  be  paid  ? 

SOME 

CLINICAL     EXPERIENCES. 

By    WILLIAM    H.    PEARSE,    M.D.Ed., 
Contalting  Physician,  Plymouth  Public  Dispeoiwy. 

Verge  of  Poisoning, — ^A  little  personal  experi- 
ence of  one's  own  case  may  be  worth  recording,  as 
it  suggests  truths  accurately  observed. 

I  was  perfectly  well  and  in  the  best  of  spirits  on  a 


certain  day  ;  after  a  light  lunch,  I  took  a  pleasant 
journey  of  eight  miles  by  rail  into  the  country, 
where  with  friends  I  had  a  light  tea,  but  including 
Devonshire  cream  and  stewed  bottled  prunes.  I 
am  inclined  to  think  that  the  cause  of  my  illness 
was  more  in  the  bottled  prunes  than  in  the  cream. 
On  returning  home,  I  felt  uncomfortable,  took 
a  cup  of  cafe  noir,  going  to  bed  at  1 1.30  ;  a  feeling 
of  nausea  came  on  ;  about  every  four  minutes  a 
severe  pain  extended  round  the  lower  ribs,  and 
which  lasted,  on  each  occasion,  about  one  minute  ; 
the  pain  was  most  severe,  seemingly,  in  the  liver. 
The  pain  came  like  an  even  band  around  the 
ribs.  I  now  and  then  drew  a  deep  breath  to  find 
out  if  any  inflammation  existed  in  the  pleura  or 
surface  of  the  liver.  After  three  hours  of  such 
feeling  of  nausea  and  pain,  associated  with  much 
depression,  I  poured  up,  three  or  four  times,  great 
streams  of  vomit,  and  in  ten  minutes  felt  well. 

AVhat  is  interesting,  pathologically,  is  the  wide 
region  of  the  pain,  and  especially  the  very  marked 
pain  in  the  liver.  The  hypothesis  arises,  that  the 
cream  or  prunes  passed  slowly  into  a  mode  of 
"  poison  '* ;  that  the  *'  unconscious  memory  and 
wiU  "  of  the  cells  of  theUver,  resisting  the  entrance 
of  inharmonic  modes  and  motions — **  poisons  " — 
into  the  system,  passed  into  a  heightened  action, 
with  the  evolution  of  what  one  may  call  a  "  mode 
of  motion,'*  a  '*  will  "  resistance — pain.  1  ate 
the  cream  between  5  and  6  p.m.,  but  did  not 
vomit  until  3  a.m.  ;  thus  we  have  a  record  of 
the  time  involved  in  such  processes  of  poisoning. 
The  case  is  interesting  in  another  aspect,  viz.,  as 
illustrating  the  phenomena  of  epigastric  neuroses 
and  indigestion  of  neurotic  type,  the  aspects  of 
which  are  so  very  varied,  and  which,  without 
much  care,  and  without  a  wide  general  view  of 
many  functions  and  their  correlations,  are  apt  to 
lead  us  astray,  both  in  diagnosis  and  treatment. 

Arterial  Embolism, — Thirty  years  ago  a  gentle- 
man, ast.  50,  of  fine  ph3rsique  and  of  active  habits, 
carried  a  heavy  Portland  vase  down  one  and 
up  another  flight  of  garden  steps.  I  was  called 
the  day  after  ;  he  was  in  bed.  The  heart's  action 
was  rapid  and  most  irregular.  I  gave  him  entire 
rest  for  a  week.  From  that  day  to  now  the  heart's 
action  has  been  irregular ;  but  in  my  very  numerous 
examinations  during  thirty  years,  I  have  never 
heard  a  bruit.  In  1890,  the  heart's  action 
became,  for  a  few  weeks,  slow,  the  pulse  some- 
times from  50  to  60. 

The  general  health  during  thirty  years  has  been 
good.  He  has  had,  however,  in  two  or  three 
winters,  some  bronchial  attacks,  and,  rarely,  a 
little  diarrhoea. 

In  January,  1902,  he  fainted,  or  semi-fainted. 
I  found  the  heart  most  irregular  and  feeble  in 
impulse  ;  the  left  thigh  and  leg  were  cold.  I 
could  find  no  pulse  in  the  left  femoral  artery,  nor 
in  the  iliac  as  far  as  I  could  reach  over  and  above 
the  groin.  The  left  iliac  and  femoral  arteries 
seemed  blocked.  The  leg  and  thigh  swelled 
greatly  for  two  or  three  weeks,  the  skin  being 
very  tense  ;  during  the  same  period,  the  patient 
suffered  much  pain  over  the  gluteal  region  and 
back  of  thigh,  seemingly  due  to  the  compensating 
expansion  of  the  arteries  there. 

There  was  never  any  sign  of  gangrene  of  the 
toes.  The  tension  of  the  limb  remained  for  a 
year,  and  some  swelling  of  the  limb  remains.  He 
wears  an  Ai  Martin  rubber  bandage,  and  leada 


624    The  Mbdical  PaK8». 


ORIGINAL    COMMUNICATIONS. 


Dhc.  14.  1904. 


an  active  life,  making  no  complaint  about  his 
limb. 

At  the  time  of  the  embolism  he  was  kept  in 
bed  for  three  weeks,  the  Umb  being  swathed  in 
cotton  wool.  I  sought  to  keep  up  the  body 
temperature,  of  984°  only,  around  the  limb, 
to  allow  no  extreme  of  heat  by  hot  jars,  and 
the  avoidance  of  winter  cold. 

The  patient  has  pretty  continuously  taken 
cafiEeine  and  Oppenheimer's  Glycero-phosphate 
Pal^tanoids,  each  holding  ^  of  a  grain  strychnine. 

The  patient's  pulse  now  is  about  75  ;  heart's 
impulse  of  fair  power;  the  irregular  rhythm  remains. 
He  walks  about  with  great  comfort,  and  enjoys  an 
hour  or  two  light  gardening  daily. 

I  have  interdicted  all  standing  on  steps  to 
trim  his  over-head  vines  ;  he  cluncks — Eastern 
fashion — ^when  gardening. 

I  remember  a  child,  a  year  old,  who  having  had, 
without  known  cause,  one  profuse  stinking  motion, 
collapsed  to  such  a  degree  that  embolism  having 
happened  during  the  collapse,  several  of  its 
toes  gangrened  and  came  off.  The  diarrhcEa, 
which  continued  after  the  primary  onset,  could 
not  be  arrested  ;  the  motions  were  stinking.  I 
advised  an  egg-spoonful  of  lemon  juice  four  times 
a  day.  In  two  days  the  child  was  well  of  the 
diarrhoea,  and  the  foetor  was  natural.  This  free 
use  of  lemon  juice  or  lime  juice  I  very  largelj'- 
practised  in  the  chronic  diarrhoea  and  dysenteric 
diarrhoea  of  the  natives  of  India,  and  with  the 
happiest  results. 

On  Reducing  Fat. — E.  S.,  aet.  19,  came  in  June, 
1903  ;  she  weighed  197  lbs.  She  had  taken  for 
nearly  a  year,  thyroid  extract  and  Blaud's  pills, 
but  without  benefit.  The  menses  had  been 
absent  a  year. 

It  was  obvious  that  the  thyroid  had  not  balanced 
the  correlations  of  her  functions  and  system.  I 
could  make  but  a  guess,  in  this  orderly,  obscure, 
and  prof oundly  deficient  correlation.  I  thus  con- 
tinued the  Blaud's  pills,  also  I  kept  the  bowels 
fairly  regular  by  Pil.  Aloes  et  Fer.,  and  for  the 
s)rstem's  general  healthy  metabolism  I  ordered 
the  juice  of  two  lemons  a  week. 

But  I  had  read  somewhere  of  benefit  following 
the  use  of  thymus  gland  ;  so  in  place  of  thyroid 
I  gave  thymus  extract.  At  somewhat  regular 
intervals  since  June,  1903,  her  weight  has  been 
197, 190,  189,  182,  174,  171,  i67i,  170,  168,  i62lt)S., 
a  gradually  ^i^ummmg  decrease  of  35  lbs.  in  ten 
months. 

Her  menses  were  absent  for  two  years,  up  to 
January,  1904  ;  they  appeared  once,  and  have 
again  ceased. 

The  gradual  decrease  of  weight  seems  to  indicate 
that  the  thymus  may  have  had  some  influence  for 
good.  The  girl's  whole  mental  condition  has 
improved,  and  she  is  equal  to  the  duties  of  active 
domestic  service. 

One  need  not  enlarge  on  the  profound  and 
complex,  yet  orderly,  correlations  of  the  structures 
and  functions  of  the  system  ;  but  we  can  always 
go  a  long  way  toward  balancing  these  active 
energies  and  functions  by  attention  to  the  prima! 
via,  the  great  organic  tract ;  the  daily  action  of 
the  bowels,  estabUshed  slowly  and  the  habit 
formed,  influences  for  good  the  whole  system  ; 
every  function  is  promoted  toward  harmonious 
correlation  by  the  just  activity  and  action  of  the 
great  organic  tract. 

Disease^    one_may    say,    is    grandly    general; 


secondarily,  local.  This  truth  is  recalled  u> 
memory  on  a  view  of  the  prospectus,  latdy  cir- 
culated, of  the  vast  list  and  nomendatare  d 
**  different "  diseases  of  the  skin  ! 

But  the  principle  was  vividly  forced  on  me 
forty-five  years  ago  and  after,  when  I  saw  tfae 
night  blindness,  the  anaemic  cardiac  bruits,  tbe 
ulcerations  of  the  legs,  the  ulcerative  dyaeatenc 
diarrhoea,  and  other  malconditions  of  the  natives 
of  India  disappear,  after  the  free  use  of  "add 
fruits  " — ^lime  juice,   tamarind,    &c. 

The  general  nature  of  disease  is  most  strongly 
and  continuously  forced  on  my  attentioa 
here,  in  the  great  stream  of  pracphtliiss 
and  phthisis  which  passes  before  me.  For 
years  even,  before  phthisis  exists  in  tk 
lungs,  the  young  people  will,  in  diflterent  caso. 
suffer  from  a  sense  of  "  weakness,"  or  sense  oj 
coldness,  or  indigestion,  or  disturbed  menstro^ 
function,  or  failure  of  appetite;  and  these  prz^ 
phthisical  symptoms,  variously  min^^  is 
different  cases,  will  be  correlated  to  certain  wdl- 
defined  physical  types  of  the  bone  system— sack 
as  large  hands,  large  clavicles,  unduly  hr^ 
terminal  cartilages  of  the  nose,  which  are  often 
markedly  unsymmetrical  on  the  two  sides;  or 
the  physical  type  of  the  praephthisical  is  often 
seen  in  abundant  coarse  hair,  heavy  eyebroiR 
which  meet  in  the  mesial  line,  transverse  ridges 
of  the  nails  ;  so  that,  in  my  experience  and  re- 
corded observations,  the  final  lung  disease  is 
quit^  a  minor  part  of  phthisis,  phthisis  being  a 
most  general  condition. 

I  could  hardly  avoid  drawing  these  iUustratioos 
from  East  Indian  diseases,  and  from  European 
phthisis,  of  the  general  character  of  some  of  oar 
seemingly  most  demarked  diseases,  as  suggestive 
of  caution  in  affirming  the  *'  cause  "  of  E.  S.'s 
fatness,  and  no  less  as  suggestive  of  caution  in 
affirming  the  **  cause  "  of  her  recovery. 

One  would  not  dare  to  affirm  that  the  thymus 
led  to  this  girl's  improvement ;  she  was  treated 
on  wide  general  principles,  but  the  thymus  may 
have  justly  co-ordinated  her  inharmonious  cor- 
relations. 

Slow  Progress  of  Phthisis. — It  is  within  the 
knowledge  of  all  practitioners  that  cases  of  phthisis 
have  a  most  varying  duration.  One  sees  the 
bright  young  girl  or  youth  carried  off  in  a  few 
months,  and  one  no  less  sees  cases  running  on 
for  years,  even  to  past  middle  age.  It  is  im- 
possible to  state  absolutely,  the  dififerences  of  the 
associated  or  correlating  deviations  of  structnre 
or  function,  which  belong  to,  and  precede,  such 
different  types  of  cases.  Try  as  one  will,  it  is 
impossible  to  state  any  single  or  group  of  differ- 
ences, either  in  structure  or  function,  which  beloni; 
exclusively  to  either  group  ;  and  yet  the  ex- 
perienced and  observant  practitioner  may  often 
predicate  aright,  which  cases  will  be  rapid  and 
which  will  be  slow  in  progress. 

Of  the  roses  which  bloom  over  the  portico, 
some  will  fade  and  die  earlier  than  others;  and 
in  young  people,  the  same  facts  are  seen.  All 
may  have  the  bacillus — ^yet  some  will  rapidly 
succumb,  others  will  survive  for  years. 

The  basis,  or  greater  nature  of  phthisis,  is  deep 
down  in  the  potential  and  kinetic  '*  energies," 
and  ultimate  modes  and  motions  of  bioplasm- 
modes,  motions,  and  ultimate  attractions  which 
are  of  cosmic  range  and  infinite  delicacy  jret 
power,  and  which  correlate  both   with  structure 


Dec.  14,  1904. 


ORIGINAL    COMMUNICATIONS. 


Th£  Mbdical  Pkess.    625 


and  function,  atavicly  and  alternately,  often 
through  many  generations.  Hardly  a  week 
passes  but  that  I  see  the  far-back  and  wide 
correlations  of  phthisis,  both  of  structure  and 
function,  and  I  see  also  their  atavism  and  alter- 
nation. 

The  phenomena  are  thrust  on  my  observation  ; 
I  am  compelled  to  state  them.  I  am  compelled 
to  see  pathology  as  an  orderly  series  of  deviations 
of  the  infinite,  eternal,  and  cosmic  biological 
evolution,  and  as  having  no  less  wide  correlations 
in  the  S3rstem. 

And  as  Herschel  says,  "...  a  principle  may 
be  as  completely  and  as  plainly  elucidated  by  the 
most  famUiar  and  simple  fact  as  by  the  most 
imposing  and  uncommon  phenomenon,"  I  will 
cite  but  three  cases  in  which  bacilli  were  present, 
and  in  which  the  cases  were  of  long  duration. 
This  long  duration  d  fortiori  illustrates  how  very 
near  to  absolute  immunity  were  the  patients. 
One  of  the  cases  further  illustrates  how  the 
patient,  ill  in  phthisis  for  twenty  years,  with 
bacilU  known  for  the  past  four  years,  still  survives 
as  a  bright  active  woman,  whilst  in  the  meantime 
she  has  lost  two  daughters — one  at  12  years  of 
age,  the  other  at  20,  of  phthisis.  Where  is  the 
potential  condition  which  saves  the  mother  ? 
We  must  lift  our  mental  view  above  and  beyond 
the  bacillus  ;  we  must  give  up  the  false  but  capti- 
vating rest  in  '*  single  causes,"  in  pathology ;  we 
must  "  stoop  to  conquer,"  have  **  humihtj' 
of  pretension,"  and  see  biology  and  pathology  in 
their  cosmic  relations.  Empiricism  and  the 
simple  observation  of  Nature  may  lead  us  on  a 
right  path,  long  before  Science  has  revealed  the 
exact  details. 

E.  H.,  female,  aet.  50,  a  bright  little  woman, 
slight  and  active  ;  hair  wavy  and  coarse  ;  nose 
rather  pointed  ;  for  fifteen  years  past  has  had 
rdles,  and  impaired  resonance  on  percussion  in 
the  left  infra-clavicular  region  ;  has  had  occasional 
rdles  in  right  infra-clavicular  region.  Tubercle 
bacilli  are  found.  She  is  thin,  but  full  of  Ufe 
and  spirit.  One  daughter,  act.  12,  and  one,  aet. 
20,  have,  in  the  same  period,  died  of  phthisis. 

The  physical  signs  in  her  lungs  have  not  pro- 
gressed during  fifteen  years.  How  does  her  lung- 
apex  bioplasm  resist  the  molecular  attractions 
of  the  unicelled  bacillus  ?  And  how  did  that  of 
her  two  daughters  succumb  ?  I  am  forced  into  view 
of  a  region  of  biology  and  pathology  more  general 
and  deeper  than  that  mainly  confined  to  the  baciUus. 
We  are  carried  into  the  presence  of  **  energies," 
modes  of  motion,  and  attractions,  absolutely 
infinite  in  their  correlations,  delicacy,  and  power ; 
the  highest  physics  and  vito-physics  are  involved. 

I  encouraged,  in  this  case,  fresh  air  ;  I  encouraged 
her  individual  psychological  tendencies  and  tastes, 
also  allowed  her  what  food  she  desired,  what  her 
bioplasmic-cell  **  unconscious  memory "  longed 
for,  e.g.y  the  allyl  modes  and  motions  of  the 
onion. 

But  the  same  efforts  did  not  save  her  two 
daughters — How  not  ?  With  her  age,  the  cell- 
activities  and  inter-cellular  bioplasmic  attractions 
and  bonds  had,  in  the  processes  of  the  orderly 
evolution,  become  stable. 

Viewing  the  phenomena  of  this  mother  and  her 
two  daughters,  one  can  only  say,  with  Goethe, 
"  Thus,  the  whole  of  the  throng  points  to  deep- 
hidden  law,  points  at  a  sacred  riddle  !  "  But 
bacillus  is  not  the  key  to  that  riddle  I 


A.  H.,  female,  aet.  34,  single,  had  severe  pleurisy 
of  the  right  side  seven  years  ago.  The  physicsd 
signs  of  the  pleurisy  slowly,  during  two  years, 
cleared  off,  but  bronchial-like  moist  rdles 
were  ever  present  in  the  right  lung.  She  gradually 
developed,  during  three  years,  well-marked 
phthisis  of  the  right  lung ;  and  during  the  past 
year,  in  a  less  degree,  of  the  left  apex.  She  has, 
during  the  past  year,  begun  to  waste,  the  appetite 
has  failed,  and  amenorrhoea  has  existed  during 
the  same  period. 

A.  H.  has  worked  up  to  six  months  ago  in  the 
active  duties  of  a  country  inn,  and  has  always 
done  her  duties  well ;  has  lived  well.  She  is  a 
woman  of  beautiful  physical  proportions^  fine 
features,  beautiful  and  sound  teeth ;  her  bone 
system  is  exquisitely  fine,  such  as  small,  delicately- 
formed  wrists.  Tubercle  bacilli  are  found  m 
her  sputum.  Her  system  has  held  on  long — six 
to  seven  years,  but  not  so  successfully  as  that  of 
E.  H.,  aet.  50. 

J.  M.,  male,  aet.  50,  came  to  me  for  shortness  of 
breath  and  cough  at  night.  I  fouhd  slight  im- 
pairment of  resonance  on  percussion  over  the 
left  apex,  with  a  few  moist  rdles.  Tuberde 
baciUi  existed  in  his  sputum.  He  had  lived  very 
much  an  out-of-door  active  life,  in  a  most  healthy 
region  of  West  Dartmoor ;  had  drank  malt 
liquors  and  spirits  freely  and  habitually.  His 
nsuls  were  rather  clubbed.  Fourteen  years  ago 
he  "  took  a  chill,"  and  has  had  cough  ever  since. 
Six  months  ago  he  took  "  another  chill  "  ;  since 
then,  his  cough  has  been  worse. 

Here,  again,  as  in  the  two  former  cases,  is 
slow  evolution  of  the  disease,  or,  as  better  ex- 
pressed, there  exist  "strong  molecular  bonds" 
m  his  lung-apex  bioplasm,  coincident  with,  and 
in  correlation  with,  hiis  age  and  his  entire  general 
system. 

For  it  cannot  be  too  strongly  stated  that  in  the 
widest  use  of  that  word  phthisis  is  a  general 
condition,  and  that  its  major  form  is  not  in  the 
bacillus. 


MEDICAL  ACTS  AMENDMENT. 

By  GEORGE  C.  CRICHTON,  M.D. 

It  has  for  some  time  been  proposed  to  reform 
the  General  Council — ^to  amend  the  Medical  Acts. 

The  amendment  on  which  at  present  most  stress 
is  laid  is — Increase  in  the  numbers  of  the  direct 
representatives.  Not  much  is  to  be  hoped  for 
from  this,  which  is  to  be  regarded  not  as  a  reform 
in  itself  so  much  as  a  means  to  bring  about  reforms. 
But  which  of  these  is  possible  in  a  Council  whose 
only  function  is  examinations,  and  every  ten  years 
a  Pharmacopoeia  ?  The  choice  of  the  constituen- 
cies will  fall  upon  the  respectable  middle-aged  or 
elderly  successful  doctors  ;  wise  and  experienced, 
no  doubt,  but  not  greatly  daring.  How  many 
club  doctors,  East  End  doctors — ^two  shillings,  or 
shilling,  or  so  much  a  week  ?  If  one  looks  through 
the  journals  for  the  last  twenty  or  thirty  years, 
as  I  have  done,  one  finds  repeatedly  the  accusation 
that  the  Council  do  very  Uttle  but  talk  very  much. 
If  twenty  general  practitioners,  besides,  get  on  the 
Council,  the  effect  must  be  disastrous  to  business 
being  completed,  for  what  is  the  use  of  their  being 
elected  if  they  do  not  express  their  views  ?  So  that 
one  hesitates  as  to  the  value  of  this  reform.  When 
I  looked  in  upon  the  representative  meeting  at 
Oxford,  I  could  not  but  be  struck  with  the  seniority 

D 


626     Th£  Mxdical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec.  14.  1904. 


of  the  members.  Capable  and  alert,  no  doubt,  * 
otherwise  they  would  not  have  attained  their 
position  there.  One  stood  up,  said  two  sentences, 
and  sat  down  ;  then  another  said  a  sentence  or 
two,  and  every  second  or  third  speaker  proposed 
an  amendment  to  another  amendment  to  a  motion. 
I  soon  got  lost,  and  hopelessly.  The  chairman, 
however,  arranged  it  all  in  his  mind,  and  kept  all 
the  threads  of  the  debate  so  completely  in  hand 
that  he  gave  his  decision  when  called  for  clearly 
and  promptly.  He  looked  the  youngest  of  them 
all,  and  he  is  hardly  a  chicken.  As  I  stood  and 
looke  1  on  I  saw  the  machine  working — smoothly, 
stead''y  ;  but  the  absence  of  the  note  of  boyhood 
touched  me  as  something  just  a  little  pathetic. 
A  large  infusion  of  the  general  practitioner  into  the 
Council  will,  I  think,  hardly  do. 

With  regard  to  other  reforms,  such  as  registra- 
tion and  finance,  the  question  should  at  once 
arise  whether  every  detail  should  be  fixed  by  Act 
of  Parliament  or  whether  general  instructions 
should  be  laid  down  and  large  powers  given  to 
the  General  Council  to  make  whatsoever  arrange- 
ments might  prove  to  be  the  best  from  time  to 
time  ?  Other  reforms,  death  certificates,  foreign 
and  Colonial  diplomas,  &c.,  have  long  waited  for 
settlement.  What  more  reasonable  than  to  em- 
power a  duly  constituted  Medical  Council  to  settle 
these  ?  Of  course,  under  supervision  by  a  Secre- 
tary of  State.  An  annual  grant  towards  the 
Council's  expenses  would  afford  to  Parliament  an 
opportunity  of  discussion,  so  keeping  the  Council 
in  touch*  with  the  community  and  Parliament 
acquainted  with  the  fresh  currents  of  medical 
knowledge.  But  this  aspect  of  the  case  is  too 
large  for  a  short  paper. 

A  New  Council. 
Let  us  imagine  a  convulsion  of  Nature  to  occur 
and  Parliament  to  pass  an  Act  reforming    the 
General  Council.     We  should  expect  that  its  func- 
tions and  duties  would  be  everything  concerning 
public  health,  and  that  it  would  be  in  constant 
communication  with  the  Government  of  the  day 
as    a   consultative    or    advisory    committee.      It 
would  have  the  power  to  issue  decrees  having  the 
force   of   law,    after   obtaining   the    sanction   of 
Parliament,  in  the  same  way  as,  I  beheve,  the 
Board  of  Agriculture  and  the  Board  of  Education. 
Practically  it  would  constitute  a  standing  Com- 
mittee of  Public  Safety  in  Time  of  Peace. 
It  would  necessarily  be  representative. 
First.  In  the  first  place,  instead  of  being  a  Com- 
mittee of  Examiners,  appointed  by  every  examin- 
ing board  in  the  Kingdom,  there  would  be  repre- 
sentation given  to  educational  authorities,  which 
are,  however,  also  examining  boards.     It  would  be 
the   chief  business  of   the   Council   to  supervise 
education,  upon  which  depends  admission  to  the 
Register,  examination  being  only  a  test  of  efl&cient 
education.     The    Universities,    then,    wiU    each 
select  one  representative.     (For  the  present,  the 
new  universities  in  the  Midlands,  with  Durham, 
would  be  grouped.)    This  would  give  ten  or  eleven 
members.     It    should    be    decided    by    the    Bill 
whether  the  Senatus,  as  at  present,  or  the  General 
Council  (Convocation)  of  the  Universities  (as  for 
the   representative  in   Parliament)   should  elect. 
The  great  London  medical  schools  would  have  a 
member,  elected  probably  by  the  staffs  of  the 
twelve   hospitals.      Perhaps   the   managing   com- 
mittees of  these  hospitals  should  elect  one  of  them- 
selves in  addition. 


Secondly,  Direct  Representatives.  —  Evm 
man  or  woman  on  the  Register  should  have  ow 
vote,  and  the  votes  should  be  as  nearly  as  possible 
of  equal  value.  This  is  only  possible  by  divtsioii 
into  electoral  areas  or  provinces.  In  England. 
North,  Middle,  South,  County  of  I^ndon,  Wal& 
and  Monmouth  (5)  ;  in  Scotland,  North-west  and 
South-east  (2) ;  in  Ireland,  North  and  South  (2  : 
in  all,  9  members.  It  is  a  debatable  qnestimi 
whether  the  corporations  should  be  represented. 
In  a  very  special  and  real  sense  they  do  represeat 
the  profession.  They  might  send  three  repi- 
sentatives.  In  England,  e.g.,  the  Presidents  ci 
the  Colleges  and  the  Master  of  the  Apothecaries 
would  in  turn  elect  one  member  to  sit  for  three 
years. 

The  medical  element  of  the  Council  is  now  coc- 
plete.  If,  however,  it  is  to  have  large  admiois. 
trative  and  consultative  powers,  the  gencnl 
public  will  be  represented.  The  only  practicable 
way  in  which  this  can  be  accomplished  is,  I  fear, 
by  giving  another  third  of  the  representation  to 
the  President  of  Council,  or  other  Cabinet  Minister. 
It  would  be  for  him  annually  to  appoint  two  meiit- 
bers  to  serve  for  five  years,  ten  in  all.  The  Ctovb 
members  would  thus  (i)  be  attached  to  no  politica] 
party,  and  (2)  on  the  occasion  of  any  new  questioa 
cropping  up  there  would  automatically  be  tm^ 
vacant  places  for  experts  to  be  appointed  to.  These 
appointments  should  be  not  as  heretofore  filled  up 
by  fashionable  Court  physicians  and  surgeons,  \m 
a  country  doctor,  an  Army  doctor,  if  you  win,  bai 
non-medicals  chiefly,  a  barrister  or  t'wo,  some  Gtr 
merchants,  perhaps  a  bishop.  A  too  narrow  pre- 
fessional  tone  should  be  shunned.  Finally,  2$ 
already  said,  a  grant  from  the  Exchequer  would 
give  to  Parhament  a  yearly  opportunity  of  review- 
ing the  proceedings  of  what  would  be  then,  and 
for  the  first  time,  a  Getter al  Medical  Counal, 

Its  representatives  would  consist  of  : — 

1.  Universities,  &c.       11  to   13   members. 

2.  Professional        ..       9  to   12  „ 

3.  Government       . .      10  to   10  „ 

i.e.,  from     . .      30  to  35   members. 
The    exact    constitution    of     the    Council  ivil 
obviously  depend  entirely  on  its  duties,  and  tbe 
purpose    for   which    it    is    called    into    existcna. 
Representation  implies  Devolution. 


PULMONARY  EMBOLISM, 

PROBABLY  FOLLOWING  THROMBOSIS  OF  THE 

H/EMORRHOIDAL  VEINS. 

By  ALFRED  S.  GUBB,  M.D.Paris.  M.R.C.S.,  Ac 

Of  Aix-le^-Bains  and  Algiers. 

Instances  of  pulmonary  embolisoi  are  sufficientlT 
rare  in  general  practice  to  render  diagnosis  a  matter  ii 
considerable  difficulty,  especially  in  the  absence  of 
phlebitis  or  other  morbid  ccmdition  to  put  the  prac- 
titioner on  his  guard.  Moreover,  in  many  cases  tbe 
symptoms  at  the  onset  are  so  vague  and  ill-defined  and 
withal,  so  violent  that  relief  of  suffering  is  apt  to  occoik^ 
one's  whole  attention  to  the  exclusion  of  pathologica] 
problems.  Even  if  one  reads  up  the  literature  of  the 
subject  in  the  Ught  of  a  recent  case  one  obtains  but  little 
assistance.  The  various  kinds  of  emboli  are  dnh''  classi- 
fied, and  fhey  are  traced — in  the  post-mortem  room— 
into  the  ultimate  ramifications  of  the  pulmonary  artery 
if  indeed  their  dimensions  do  not  happen  to  be  soch  as 
to  have  caused  them  to  become  impacted  in  one  or 
other  of  the  larger  branches.  When  we  tnm  to  the  sym- 
ptomatology one  finds  nothing  absolutely  distinctive : 


Dec.  14,  i9Ck4. 


TRANSACTIONS   OF  SOCIETIES.       Tn  Meohui.  Pmw.    627 


^n  fact,  I  am.  fain  to  thinkXthat  in  the  majority  of 
instances  the  diagnosis  can  only  be  a  matter  of  surmise 
Tin  til  the  case  has  run  on  to  its  logical  conclusion.  This 
l>eing  so,  a  few  brief  notes  of  a  case  that  recently  came 
Tinder  my  notice  at  Aix-les-Bains  may  not  be  devoid  of 
interest. 

The  patient  was  an  elderly  gentleman,  a  patient  of 
T>r.  Cazalis.  He  had  been  operated  upon  a  month  pre- 
"viously  for  the  removal  of  troublesome  rectal  prolapse. 
"Matters  had  progressed  favourably,  and  at  the  end  of  a 
month  the  wound  had  soundly' healed  and  he  was 
authorised  to  travel  to  Aix,  but  he  was  directed  to 
make  daily  use  of  a  bougie  to  overcome  any  tendency 
to  cicatricial  contraction.  He  had  no  varicose  veins, 
and  was  in  every  respect  in  perfect  health.  He  took 
a  few  baths  and  felt  so  well  tluit  he  was  on  the  point  of 
leaving  for  his  distant  home  when  suddenly,  one  after- 
noon, he  was  seized  with  intense  pain,  with  a  feelins;  of 
"Constriction  in  the  left  side  of  the  chest,  more  marked 
in  front,  the  pain  radiating  down  the  left  arm  as  far  as 
the  fingers.  The  pulse  was  rapid  and  the  breathing 
shallow  and  somewhat  gasping.  At  first  siglit  it  looked 
like  a  typical  case  of  angina  pectoris,  and  a  dose  of  ether, 
followed  by  the  hypodermic  injection  of  morphine, 
afforded  a  great  measure  of  relief.  The  dyspnoea, 
liowever,  persisted  on  the  following  day  and  on  ausculta- 
tion a  patch  of  fine  rMes  was  made  out  just  to  the  left 
of  the  sternum,  behind  the  fourth  and  fifth  costal 
cartilages.  The  pulse  was  still  rapid  and  small,  the 
heart  sounds  were  distant  and  muffled,  and  they  were 
masked  by  the  rdles,  which  were  attributed  to  peri- 
cardial friction.  The  temperature  was  normal.  The 
tongue  was  very  thickly  furred  and  there  was  com- 
plete anorexia  with  occasional  attacks  of  nausea,  and 
even  actual  vomiting  after  taking  food. 

In  view  of  tke  intensity  and  obscurity  of  the  sym- 
ptoms the  patient  was  kept  under  close  observation, 
and  it  was  at  this  juncture  that  Dr.  Cazalis  asked  me  to 
assist  him  in  the  management  of  the  case.  A  blister 
was  applied  over  the  base  of  the  heart,  followed  by 
poultices,  with  occasional  injections  of  morphia,  but 
although  we  were  successful  in  relieving  the  pain  and 
•dyspnoea  to  some  extent,  the  patient's  condition  in  no 
Tvise  improved.  On  the  morning  of  the  second  day 
after  the  onset  of  the  attack  dulness  and  crepitation 
-appeared  in  the  front  of  the  right  lung,  and  on  the 
lollowing  day.  April  26th,  the  patient,  who  so  far  liad 
not  been  troubled  by  cough,  began  to  expectorate 
-sputum  containing  bright  red  olood,  frothy  and  mixed 
^with  viscid  mucus.  There  was  nowhere  any  bronchial 
breathing  and  the  temperature  remained  normal.  On 
reviewing  the  symptoms  we  came  to  the  conclusion 
•that  it  was  probably  a  case  of  pulmonary  embolism, 
although  we  were  at  a  loss  to  account  for  its  occur- 
xence,  the  pos^bility  of  its  having  any  etiological  con- 
nection with  the  operation  on  the  rectum  six  weeks 
previously  appearing  rather  remote. 

Advantage  was  taken  of  the  presence  in  Aix  of  Pro-  1 
fessor  Chantemesse,  of  Paris,  to  obtain  the  benefit  of 
his  experience.  He  confirmed  the  view  that  the  case 
was  probably  one  of  pulmonary  eihbolism,  presenting 
the  unusuaJ  feature  that  the  left  lung  was  the  first  to  be 
involved.  In  the  absence  of  any  other  plausible 
explanation  of  the  origin  of  the  emboUsm  he  was  inclined 
to  incriminate  a  thrombosis  of  the  hemorrhoidal  veins, 
consecutive  to  the  operation.  Possibly  the  introduction 
of  the  bougie  had  displaced  part  of  the  clot,  whidh  had 
thus  found  its  way  into  the  circulation.  Inasmuch  as 
clots  in  that  situation  would  in  all  probability  be  in- 
fected, he  took  a  grave  view  of  the  case. 

The  congestion,  with  the  accompanying  rdles  in  the 
left'lung  in  front,  interfered  greatly  with  auscultation  of 
the  heart,  but  the  small,  rapid  and  sometimes  unequal 
pulse  testified  to  the  existence  of  profound  cardiac 
disturbance.  Digitalin  (Nativelle)  was  prescribed  for 
the  purpose  of  reinforcing  cardiac  action,  out  the  result 
did  not  fulfil  our  expectations. 

During  the  next  few  days  the  patient's  condition 
varied,  there  were  temporary  improvements  followed 
by  fresh  outbursts  of  congestion,  both  in  front  and  at  the 
bases,  and  increased  dyspnoea,  and  on  each  occasion  the 


sputum  which,  from  bright  red  had  become  rusty,  again 
contamed  fresh  blood.  The  temperature  oscillated 
aoout  normal,  and  the  pulse,  rapid  and  small,  varied 
between  no  and  130  per  minute. 

On  the  tenth  day  of  the  illness  the  urine  became 
scanty  and  contained  a  trace  of  albumin.  The  patient 
became  subject  to  violent  attacks  of  spasmodic  dys- 
pnoea, which  distressed  him  greatly,  especially  at  night. 
These  attacks  presented  a  close  resemblance  to  asthma, 
and  were  assuaged  by  morphine,  dry  and  wet  cupping 
and  stramonium  inhalations.  In  the  course  of  the 
next  few  days  the  urinary  secretion  fell  to  about  a  pint 
in  the  twenty-four  hours,  in  fact,  it  was  obvious  that  the 
pulmonary  condition  was  complicated  by  uraemia.  T he 
pulse  became  very  weak  and  at  times  almost  imper- 
ceptible, and  at  intervals  copious  cold  sweats  broke  out. 
He  rallied  for  a  time  under  injections  of  spartein  and 
caffeine,  but  his  speech  soon  became  incoherent  and  he 
lapsed  into  a  state  of  coma,  in  which  he  died  in  spite  of 
inhalations  of  oxygen  and  stimulants. 

No  post-mortem  examination  was  obtainable,  but  the 
history  of  the  case,  the  repeated  formation  of  rounded 
areas  of  pulmonary  congestion,  the  expectoration  of 
bright  red  and  then  brown  sputum,  followed  by  further 
expectoration  of  bright  blood  consequent  upon  fresh 
areas  of  congestion,  the  absence  of  marked  febrile 
reaction,  and  finally  the  toxic  uraemia  that  closed  the 
scene  all  point  to  pulmonary  embolism  as  the  result  of  a 
disintegrating  clot  somewhere  in  the  venous  system, 
the  source  of  the  mischief  being  in  all  probability  in  the 
haemorrhoidal  veins. 


TTransactiohs  of  Societies* 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  December  9th,  1904. 
The  President,  Db.  Frederick  Taylor,  in  the  Chair. 


the  treatment  of  intussusception  in  children. 
Mr.  Cuthbert  S.  Wallace  read  a  paper  on  a  series 
of  cases  of  intussusceptions  in  children  treated  at  St. 
Thomas's  Hospital  and  the  East  London  Hospital  for 
Children  between  the  years  1898  and  1904.  There 
were  20  cases  in  all,  the  ages  varying  between  three 
months  and  tnirty- three  months.  There  were  12 
males  and  8  females.  Of  the  twenty  cases  19  in- 
volved both  the  small  and  the  large  gut ;  the  re- 
maining case  was  one  of  tne  colic  variety.  Eleven  were 
single  tumours  and  9  were  double.  The  author 
agreed  with  Mr.  Edred  M.  Comer  that  the  double 
tumours  were  more  common  than  supposed,  and  he 
referred  to  the  difficulty  that  was  encounte-ed  if  a 
complete  nomenclatural  classification  were  attempted. 
The  diagnosis  was  clinched  by  the  finding  of  a  tumour, 
and  if  there  were  any  doubt  of  the  presence  of  a  tumour 
an  anaesthetic  should  be  given  and  the  matter  settled  at 
once.  The  treatment  was  primary  coeliotomy,  the 
most  convenient  incision  being  through  tne  right  rectus 
beside  the  umbilicus.  The  author  did  not  lay  any 
great  stress  on  the  reduction  of  the  tumour  within  the 
abdomen,  but  thought  that  time  was  the  most  im- 
portant element  in  the  treatment.  The  after  history 
of  the  cases  seemed  to  show  that  as  far  as  the  ultimate 
result  was  concerned  the  method  of  suture  of  the  beUy 
wall  was  immaterial.  The  method  favoured  was  by 
deep  sutures  through  the  whole  thickness,  and  buried 
sutiires  through  the  sheath  of  the  anterior  rectus.  By 
this  method  the  danger  of  the  incision  coming  open  from 
failure  of  union  was  reduced  as  far  as  possible.  Of  the 
twenty  cases  four  died,  giving  a  case  mortality  of  20 
per  cent.  If  the  two  cases  of  resection  were  excluded 
the  case  mortality  fell  to  11 'ii  per  cent.  The  author 
finally  referred  to  the  great  fall  in  the  case  mortality 
that  had  taken  place  of  late  years.  Statistics  drawn 
from  the  records  of  St.  Thomas's  Hospital  showed  that 
there  was  a  marked  increase  in  the  number  of  cases  of 
intussusception  admitted  to  hospital.  ■ 
ON  the  treatment  of  intussusception  in  children 

BY   LAPAROTOMY. 

Mr.  C.  H.  Fagge  read  a  paper  based  on  the  results  of 


628    Th»  Medical  Pmss.         TRANSACTIONS   OP  SOCIETIES. 


Pbc.  14.  1904. 


18  laparotomies,  of  which  17  were  primary  and  one  was 
undertaken  after  two  attempts  at  reduction  by  inflation 
had  failed.  In  16  a  tumour  was  discovered  either  in 
the  abdomen  or  per  rectum  ;  both  the  other  two  easels 
ended  fatally ;  in  the  first  no  surgeon  was  called  in  for 
twenty-four  hours  and  though  reduction  was  easy, 
the  patient,  aet.  9,  died  on  the  fourth  day;  in  the  second, 
a  boy,  aet.  15,  the  intussusception  of  the  enteric  type, 
was  irreducible,  and  was  resected.  He  drew  attention 
to  the  variable  position  occupied  by  the  tumour  and 
insisted  on  the  importance  of  routine  rectal  and  bi- 
manual examination,  if  necessary  under  an  anaesthetic, 
as  aids  in  coming  to  a  prompt  diagnosis.  Duration 
before  operation  varied  from  five  hours  to  three  weeks, 
and  though  there  was  no  direct  relation  between  this 
and  ease  of  reducibility,  he  pointed  out  that  no  case  in 
which  the  duration  was  less  than  forty-eight  hours  had 
been  irreducible.  Eleven  were  single  and  seven  double 
intussusceptions,  of  which  at  least  10  were  ileo-caecal, 
and  3  colic  ileo-caecal ;  he  did  not  regard  a  minute  divi- 
sion of  intussusceptions  as  of  much  clinical  value ;  prob- 
ably 8  of  his  cases  would  not  have  been,  owing  to  their 
origin  above  the  ileo-caecal  valve,  in  any  way  affected  by 
inflation  or  irrigation.  Keduction  was  by  laparotomy, 
carried  out  with  all  possible  speed  through  an  incision 
usually  in  the  right  semilunar  line,  and  this  was  aided  if 
necessary  by  an  assistant's  finger  in  the  rectum,  which 
reduced  the  intussusception  well  into  the  descending 
colon.  Five  cases  were  irreducible  and  all  were  fatal ; 
in  one  an  artifical  anus  was  formed,  and  in  all  the 
others  resection  was  performed  and  the  ends  of  the 
bowel  united,  in  one  by  MaunselVs  method,  and  in  the 
other  three  by  simple  end-to-end  anastomosis  with  two 
rows  of  sutures,  the  inner  passing  through  all  the  coats 
and  the  outer  through  the  muscular  and  peritoneal 
coats.  Of  the  18  cases  7  died,  giving  a  mortality  of 
39  per  cent.;  of  the  reducible  cases  (13  in  all)  2  died,  a 
mortality  of  15*4  per  cent. ;  in  the  14  cases  under  one 
year  the  mortality  was  21  '4  per  cent.,  or,  excluding  the 
two  which  were  irreducible,  there  was  only  one  death, 
giving  a  mortality  of  8*3  per  cent. 

Mr.  Arthur  Barker  remarked  on  the  large  number 
of  double  intussusceptions  recorded  by  the  authors. 
He  had  never  seen  a  case  of  this  nature,  although 
he  had  operated  on  over  thirty  cases.  He  agreed 
with  Mr.  Fagge  that  escape  of  the  bowel  from  the 
abdomen  was  a  most  undesirable  complication  of  the 
operation,  as  it  lengthened  the  time  occupied,  and 
added  to  the  shock.  He  differed  from  both  authors  as 
to  the  length  of  incision  necessary,  and  thought  it  was 
rarely  advisable  to  make  one  over  two  inches  long. 
He  attributed  the  cases  just  described  of  bursting 
open  of  the  wound  to  this  factor,  as  he  has  never  seen 
such  an  occurrence  in  his  cases.  In  this  connection 
he  believed  it  was  important  to  conduct  the  first 
dressing  under  opium  and  chloroform.  He  was  very 
interested  in  the  question  of  toxaemia,  and  had  several 
times  noted  a  rise  of  temperature  on  the  foUo^^^ng 
day  to  105°  F.,  and  even  to  107°,  there  being  no 
diarrhoea,  distension,  or  other  symptom.  He  was 
very  pessimistic  about  the  gangrenous  cases,  as  he 
had  never  had  recovery  after  resection  in  such  cases, 
and  never  expected  to  see  one.  The  only  hope  lay 
in  earlier  operation. 

Dr.  Chas.  Box  referred  to  the  medical  aspect  of 
the  subject  and  upheld  the  custom  of  admitting  all  acute 
abdominal  cases  first  under  a  physician.  He  believed 
that  the  danger  of  a  double  administration  of  chloro- 
form, first  for  diagnostic  purposes  and  then  for  treat- 
ment, was  counterbalanced  by  the  gain  in  knowledge 
attained  when  dealing  with  cases  of  doubtful  enteritis 
with  melaena.  He  discussed  the  diagnosis  and  men- 
tioned a  case  of  Riedel's  lobe  of  the  liver,  thought 
to  be  of  congenital  origin,  which  gave  rise  to  difliculty. 
He  did  not  think  that  any  additional  shock  arose  from 
the  escape  of  intestines  from  the  wound,  while  this 
was  often  an  indispensable  aid  to  the  operator.  He 
considered  that  the  occasional  bursting  open  of  the 
wound  resulted  from  non-union,  due  to  toxaemia, 
and  instanced  the  analogous  cases  of  non-union  after 
operation  on  perforated  typhoid  ulcers. 


Mr.  Douglas  Drew  had  o|>erated  on  thirteei 
cases.  Two  gangrenous  cases  died,  and  one  other. 
This  latter  had  a  temperature  of  106^  on  the  ioflow. 
ing  day,  and  died  of  toxaemia.  This  case  was  oat 
of  double  intussusception,  the  only  one  he  bad  ever 
seen.  He,  like  Mr.  Barker,  reduced  within  the  abdo- 
men, but  always  withdrew  the  caecum  'so  as  to  '■"Tn^nf 
it.  In  several  of  his  cases  the  caput  coli  was  the  man 
difficult  position  to  reduce.  He  had  never  seen  a 
wound  burst  open. 

Dr.  Brook  asked  whether  inflation  was  ever  justi- 
fiable. He  had  performed  it  with  success.  He  also 
would  like  to  know  what  treatment  Mr.  WaSaa 
recommended  for  the  irreducible  cases,  whetlMi 
splitting  of  the  outer  layer  or   resection. 

Mr.  Walter  Spencer  speculated  as  to  the  cacse 
of  the  toxaemia.  It  might  arise  from  the  intestiaal 
lumen  from  the  strangulated  vessels,  or  from  & 
peritoneal  cavity.  Could  anything  be  done  for  the 
condition,  say  by  stimulating  peritoneal  phagocytoos^ 

Mr.  James  Berry  had  seen  forty  or  fifty  caao 
operated  on.  He  had  never  heard  of  a  successfsl 
resection  under  the  age  of  two,  and  doubted  its  justi- 
fiability. That  being  so,  it  was  correct  to  use  foro 
in  persisting  in  the  attempt  to  reduce  difficult  cases. 

Mr.  McGavin  asked  how  often  relapses  occomd 
after  laparotomy,  as  compared  with  relapses  after 
inflation. 

Dr.  Taylor  pleaded  guilty  to  having  assisted  at 
inflation,  and  had  even  recorded  successful  cases 
before  this  Society. 

Mr.  Wallace,  in  reply,  said  that  his  unusual  numbo- 
of  double  intussusceptions  was  probably  due  to  chance, 
though  it  had  been  suggested  that  many  such  cases 
dealt  with  intra-abdominally  were  overlooked-  Tbe 
length  of  incision  was  a  personal  preference,  it  beiag 
impossible  for  some  operators  to  work  through  a 
small  orifice.  He  was  convinced  that  the  burstifi? 
open  of  wounds  was  not  due  to  long  incisions,  as  it 
occurred  when  these  were  only  one  inch  long,  bat 
was  probably  due  to  toxaemia.  He  thought  that 
inflation  should  never  be  done,  as  no  one  could  ever 
tell  whether  complete  reduction  had  taken  i^ace. 
the  disappearance  of  the  tumour  might  only  mean  that 
the  intussusception  was  tucked  away  behind  a  flexure 
or  under  the  liver.  He,  like  Mr,  Berry,  had  nevo- 
heard  of  a  case  of  successful  resection  under  the  age 
of  two,  so  that  forcible  manipulation  was  the  ooIt 
thing  to  do.  In  certain  cases,  such  as  those  with  a 
prolapse  of  the  ileum  through  the  ileo-caecal  vahc. 
actual  pulling  was  indicated  as  well  as  the  usual 
pushing  and  squeezing.  He  had  never  seen  a  recnr- 
rence  after  operation. 

Mr.  Fagge,  in  reply,  also  thought  that  doufak 
intussusceptions  were  often  missed,  but.  as  lapar- 
otomy was  always  indicated,  their  importance  need 
not  be  insisted  on.  He  never  made  an  incision  under 
three  inches  long,  even  in  a  small  child.  He  regarded 
the  onset  of  toxemic  symptoms,  such  as  a  temperatnn 
of  103°  or  104**,  as  of  favourable  import.  He  had 
only  seen  one  case  of  recurrence  after  operatioo,  li^l 
many  after  inflation. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAXD. 
Section  of  Surgery. 


Meeting  held  in  the  Royal  College  of  Strgeoss 
ON  Friday.  December  2nd. 


The  President,  Mr.  Arthur  Chance,  in  the  Chait 


Exhibits. 

Mr.  R.  C.  B.  Maunsell  exhibited  a  child  after 
operation  for  spina  bifida,  also  the  meningocele  which 
he  had  removed. 

Mr.  Kennedy  exhibited  (a)  Infant  operated  00  fa- 
int ussusception  ;  and  (6)  child  treated  for  hydro- 
cephalus by  repeated  lumbar  puncture. 

Mr.  Blaynev  exhibited  a  Gasserian  ganglion  rv> 
moved  for  epileptiform  neuralgia. 

Mr.  W.  Taylor  exhibited  {a)  Gall-bl?dder  snnoved 


Dbc.  14,  IQ04. 


TRANSACTIONS  OF  SOCIETIES.  The  Medical  Press.   62g 


for  gangrenous  cholecystitis  ;    and  (6)  hydronephrotic 
iddney. 

Mr.  Edward  H.  Taylor  read  a  paper  entitled 

A  NEW  METHOD  OF  PROCEDURE  FOR  THE  RADICAL  CURE 
OF  INGUINAL  AND  FEMORAL  HERNIA, 

and  illustrated  its  various  stages  by  means  of  lantern 
slides.  Having  introduced  the  subject  by  some  general 
remarks  concerning  the  anatomy  of  the  inguinal  canal 
and  the  aims  of  herniotomy,  he  proceeded  to  explain 
his  method  of  operation.  With  the  patient  in  the 
Trendelenberg  position,  a  vertical  incision  about  four 
inches  in  length-  is  made  midway  between  the  middle 
line  and  the  outer  border  of  the  rectus  muscle  in  its 
lower  part.  The  superficial  tissues  and  the  rectus 
«heath  having  been  divided,  the  outer  lip  of  the  divided 
sheath  is  raised  and  the  corresponding  border  of  the 
TKuscle  defined  and  drawn  inwards.  The  transversalis 
fascia  is  then  divided  and  the  extraperitoneal  fat  ex- 
posed. The  next  step  consists  in  fully  retracting  the 
outer  margin  of  the  wound  towards  Poupart's  ligament, 
and  identifying  the  neck  of  the  hernia.  By  seizing 
the  parietal  peritoneum  close  up  to  the  internal  abdo- 
minal ring  with  the  finger  and  thumb,  the  sac  is  drawn 
up  to  some  extent  out  of  the  inguinal  canal  and  opened, 
aiter  which  a  finger  is  introduced  into  its  interior  to 
act  as  a  guide  while  it  is  being  separated  from  the 
structures  of  the  cord.  A  ligature  or  purse-string 
suture  is  then  applied  to  the  neck  of  the  sac,  and  the 
iundus  cut  away.  The  inguinal  canal  and  the  two 
Tings  are  now  explored  by  the  finger,  the  structures  of 
the  cord  are  identified,  and  the  deep  epigastric  vessels 
held  aside.  By  means  of  special  needles  in  handles — 
modifications  of  the  ordinary  aneurysm  needle  with  a 
slot  at  one  side  opening  into  the  eye — a  series  of  silk 
sutures  (No.  6  size)  are  passed  so  as  to  connect  the 
conjoined  tendon  and  the  transversalis  muscle  with 
Poupart's  ligament,  just  enough  space  being  left  to 
allow  the  structures  of  the  cord  to  pass  without  being 
unduly  compressed.  The  rectus  muscle  now  resumes 
its  normal  position,  but  for  greater  security  its  outer 
border  is  connected  to  the  deep  aspect  of  the  trans- 
versalis muscle  by  a  few  interrupted  sutures.  Finally, 
the  rectus  sheath  is  closed  in  front  by  interrupted 
sutures  also,  and  the  skin  margins  approximated  by  a 
continuous  subcuticular  suture  of  silkworm-gut. 
Should  the  external  abdominal  ring  be  unduly  patulous 
it  may  be  readily  exposed  before  closing  the  wound 
by  drawing  aside  or  reflecting  the  overlying  tissues, 
and  its  dimensions  reduced  by  one  or  two  sutures. 
In  the  case  of  femoral  hernia  the  steps  of  the  operation 
corresponded  to  the  above  up  to  th6  point  at  which  the 
femoral  ring  is  exposed.  The  sac  is  isolated  as  already 
described,  ligatured  at  its  neck,  and  its  fundus  cut  away. 
The  closure  of  the  femoral  ring  is  then  effected.  Two 
sutures  generally  suffice  for  this  purpose.  Each  passes 
through  the  conjoined  tendon  and  Poupart's  ligament 
in  front,  beneath  Cooper's  ligament  behind.  In  some 
cases  it  is  advisable  to  pass  them  through  two  holes 
previously  drilled  in  the  pubic  bone.  Mr.  Taylor 
pointed  out  that  a  somewhat  similar  method  for 
occluding  the  femoral  ring  had  been  described  by  Mr. 
Mayo  Robson  in  the  "  Year-Book  of  Treatment "  (1904), 
but,  nevertheless,  it  differed  from  his  in  certain  im- 
portant particulars. 

Mr.  Jameson  Johnston  expressed  himself  in  favour 
of  Bassini's  operation,  as  he  considered  it  the  simplest, 
most  scientific,  and  the  easiest.  He  regarded  the 
objection  to  dividing  the  aponeurosis  of.  the  external 
oblique  in  this  operation  as  more  or  less  theoretical. 
Mr.  Taylor's  operation  would  probably  be  a  good  one  in 
old  hemiae,  in  which  the  internal  abdominal  ring  ap- 
'  proached  the  middle  line. 

Mr.  T.  £.  Gordon  considered  there  was  no  one 
method  of  operation  for  hernia.  Mr.  Taylor's  method 
-was  not  suitable  in  the  case  of  a  congenital  hernia  in 
a  young  child.  He  believed  there  were  many  of  the 
operations  practised  which  were  hopeful  as  regarded 
ultimate  success.  The  essential  thing  in  these  opera- 
tions was  asepsis. 

Sir  Thomas  Myles  referred  to  the  valve-like  nature 
of   the  inguinal  canal.     So  long  as  its  anterior  and 


posterior  walls  remained  in  contact  and  the  muscles 
sufficiently  tense  a  hernia  was  unable  to  push  these  walls 
apart.  He  thought  there  was  a  hereditary  predis- 
position to  hernia.  The  valve-like  closure  of  the  canal, 
due  to  muscular  action,  was  essential,  and  that  being 
so.  no  amount  of  suturing  of  the  conjoined  tendon  to 
Poupart's  ligament  would  provide  an  obstacle  to  re- 
currence, because  sufficient  space  had  to  be  left  to 
permit  the  cord  to  pass. 

Mr.  Blayney  was  of  opinion  that  the  weakness  of 
the  abdominal  wall  in  the  inguinal  region  was  for  a 
special  purpose,  viz.,  to  allow  the  thin  fascia  transver- 
salis being  pushed  against  the  external  oblique  when  the 
intra-abdominal  pressure  was  increased. 

Mr.  Taylor,  in  reply,  stated  that  he  believed  his 
method  of  operation  was  best  suited  for  large,  well- 
developed  inguinal  hemiae,  in  which  the  inguinal  canal 
had  undergone  marked  changes  in  size  and  direction. 
As  bearing  upon  the  success  of  the  procedure  he  thought 
it  of  importance  to  mention  that  the  sutures  in  the 
conjoined  tendon  should  not  be  tied  too  tightly,  and 
that  the  parts  should  be  kept  at  rest  for  a  sufficient 
time  afterwards  to  permit  of  healing  taking  place. 
Patients  were  frequently  allowed  to  get  about  too  soon 
after  herniotomy  ;  absolute  rest  for  at  least  a  fortnight 
was  desirable.  As  to  the  mode  of  development  of  an 
inguinal  hernia,  he  thought  it  probable  that  there  was 
in  many  instances  a  degree  of  congenital  weakness  at 
the  internal  abdominal  ring,  in  consequence  of  which 
the  latter  went  on  increasing  in  size.  There  was  such 
a  thing  as  a  hernial  type  of  abdomen,  and  it  was  in 
such  cases  that  weakness  or  dilatation  at  the  internal 
abdominal  ring  was  most  likely  to  be  found.  Upon  the 
hernia  commencing  to  develop,  the  conjoined  tendon 
and  the  fascia  transversalis  yielded  more  and  more, 
and  the  inguinal  passage  became  progressively  larger 
and  less  oblique  in  its  direction. 

Mr.  T.  E.  Gordon  read  an  account  of  a  case  of 

ACUTE    INTESTINAL   OBSTRUCTION    FROM    A    GALL-STONE. 

The  patient,  aet.  73,  had  had  an  attack  of  biliary 
colic  in  February,  and  she  did  not  recover  fully  from 
this  for  two  months.  On  August  6th,  she  was  seized 
with  intense  pain  in  the  liver  region,  and  this  was  fol- 
lowed by  complete  obstruction  of  the  bowels.  Three 
stages  in  the  course  of  the  illness  were  clearly  defined  : 
(i)  A  stage  of  onset  lasting  from  August  6th  to 
August  7  th,  marked  by  intense  epigastric  pain  and 
vomiting,  but  without  fever  ;  (2)  a  stage  of  quiescence 
lasting  until  August  9th  ;  (3)  a  stage  with  unequivocal 
signs  of  intestinal  obstruction.  The  operation  was  per- 
formed by  Mr.  Gordon  on  August  nth.  A  gall-stone 
was  found  firmly  impacted  in  the  upper  part  of  the 
jejunum.  After  the  operation  all  vomiting  ceased,  and 
the  patient  was  able  to  leave  her  bed  in  about  a  fort- 
night. Mr.  Gordon,  in  attempting  to  interpret  the 
clinical  signs,  said  he  thought  it  probable  that  impaction 
did  not  occur  prior  to  the  third  stage.  It  was  difficult 
to  understand  why  a  stone  of  such  small  size  should 
cause  intestinal  obstruction.  Spasm  was  obviously  an 
important  factor. 

Mr.  W.  Taylor  stated  that  he  had  seen  the  patient 
a  few  days  before  Mr.  Gordon  performed  the  opera- 
tion and  on  the  day  before  he  left  town  for  his  holi- 
day. She  was  then  under  the  influence  of  opium.  He 
thought  that  at  that  time,  the  gall-stone  made  its  exit 
from  the  bile  passages.  At  the  same  time,  however, 
he  had  not  overlooked  the  possibility  of  intestinal 
obstruction.  He  would  like  to  know  if  any  reasonable 
explanation  could  be  offered  why  a  calculus  of  this  size 
should  become  impacted. 

Sir  Thomas  Myles  alluded  to  a  case  in  which  he  had 
removed  a  large  impacted  gall-stone,  fifteen  years  ago. 
He  thought  it  likely  that  the  impaction  in  the  present 
case  was  due  to  the  opium  administered,  the  muscular 
tissue  of  the  bowel  being  paralysed.  He  would  advise 
in  such  cases  that  the  incision  into  the  intestine  be  made 
not  directly  over  the  gall-stone,  but  on  the  proximal 
side,  as  otherwise  one  cut  through  infiltrated  ai^d 
devitaUsed  tissues. 

Mr.  Jameson  Johnston  inquired  as  to  the  amount 
of  distension  present  and  the  condition  of  the  bowel 


630    Thb  Mkdical  Pmss.         transactions   OF   SOCIETIES. 


Dbc.  14,  i^ 


at  the  site  of  impaction.  Mr.  Gordon  alluded  to  spasm* 
but  he^did  not  think  spasm  could  exist  under  the  con- 
ditions present,  viz.,  inflammatory  infiltration  and 
oedema  of  the  bowel  wall. 

Mr.  Blayney  thought  the  impaction  of  the  gall- 
stone in  the  present  case  might  be  due  to  its  rough 
exterior,  by  which  the  mucous  membrane  of  the  intes- 
tine was  irritated  and  abraded,  thus  permitting  micro- 
organisms to  act.  This  resulted  in  oedema  of  the  sub- 
mucous tissue  which  extended  inwards  rather  than 
outwards.  He  believed  the  impaction  was  due  more 
to  inflammatory  oedema  than  to  spasm. 

Mr.  Gordon,  in  reply,  said  he  thought  some  of  the 
suggestions  which  had  been  made  as  to  the  cause  of  the 
impaction  were  correct,  but  that  he  himself  had  none 
to  oflFer.  The  abdominal  distension  was  not  very  great. 
He  made  the  parietal  incision  above  the  umbilicus, 
because  the  early  pain  complained  of  was  referred  to 
the  upper  part  of  the  abdomen. 

LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  December  ist,   1904. 


Dr.  James  Barr,  the  President,  in  the  Chair. 


Dr.  Grossm  ANN  showed  a  patient  with  Conical  Cornea, 
and  demonstrated  the  skia.scopic  appearances,  which 
were  particularly  striking  in  this  case  owing  to  the  high 
degree  of  the  deformity,  its  centrally  situated  apex,  its 
complete  transparency,  and  the  easy  comparison  with 
the  other  unaffected  eye. 

Dr.  W.  B.  Warrington  read  a  note  on  the  Plantar 
Reflexes.  He  described  the  plantar  reflex  of  the  normal 
flexor  type  and  the  pathological  extensor  response. 
He  emphasised  the  importance  in  the  method  adopted 
for  obtaining  it,  and  considered  that  only  to  the  slow, 
deliberate  extension  could  a  certain  pathological  sig- 
nificance be  attached,  though  other  types  of  extension 
might  be  very  significant.  The  reflex  obtained  in 
various  diseases  of  the  nervous  system  was  described, 
and  it  was  maintained  that  the  character  of  the  reflex 
was  a  valuable  aid  in  distinguishing  between  functional 
and  organic  disease,  and  equally  so  in  diflerentiating 
between  the  different  kinds  of  organic  nervous  disease. 

Dr.  T.  R.  Glynn,  Dr.  R.  J.  M.  Buchanan  and  Dr.  J. 
Hill  Abram  took  part  in  the  discussion. 

Dr.  W.  Alexander  exhibited  a  Dumb-bell  Calculus 
he  had  removed  from  a  man,  aet.  43.  The  calculus  had 
existed  for  some  years,  and  a  rigorous  administration  of 
solvents  had  no  influence  upon  it.  Suprapubic  litho- 
tomy was  performed,  a  stone  removed,  and  the  wound 
closed.  It  was  then  found  that  another  stone  remained 
behind  the  prostate ;  this  was  removed  by  median 
lithotomy.  The  two  stones  thus  removed  formed  a 
dumb-bell  calculus.  The  bladder  was  divided  into 
two  cavities  with  a  constriction  between.  It  was  found 
impossible  to  distend  the  bladder  with  lotion  prepara- 
tory to  the  suprapubic  lithotomy,  as  when  the  small 
sac  was  filled  contractions  occurred  and  the  urine  was 
expelled  with  force  alongside  the  catheter.  Dr. 
Alexander  said  the  case  was  unique  in  his  experience, 
but  Mr.  Poland,  in  '*  Guy's  Hospital  Reports  "  for  1857, 
described  a  nearly  similar  case  and  discussed  the  mode 
of  formation  of  such  calculi. 

Mr.  RusHTON  Parker  said  that  the  first  perineal 
section  performed  by  him,  now  many  years  ago,  on  a 
boy,  act.  about  11,  gave  a  dumb-bell  calculus,  one 
portion  of  which  lay  in  a  sac  by  the  prostate,  and  the 
other  in  the  bladder. 

Dr.  C.  J.  Macalister  read  a  paper  on  "  Some 
Thoughts  and  Suggestions  Concerning  Gastric  Ulcer." 
He  pointed  out  the  fact  that  the  characters  of  the  ulcers 
are  peculiar,  both  as  to  their  shape,  the  course  which 
they  run.  and  their  surroundings,  and  commented  upon 
the  unsatisfactory  explanations  which  have  been  given 
heretofore  concerning  the  cause  of  the  disease.  By  a 
series  of  lantern  slides  he  demonstrated  the  characters 
of  the  simple  gastric  ulcer  in  its  uncomplicated  con- 
dition, as  distinguished  from  the  same  ulcer  when 
secondary  inflammations  had  taken  place,  and  he  also 
gave  illustrations  of  other  types  of  ulceration,  and 


pointed  out  that  these  did  not  tend  to  be  connned 
mto  the  so-called  simple  perforating  ulcer.  In  seekn^ 
for  a  cause  of  the  condition,  it  -was  obvious  that  ti» 
disease  mainly  attacked  women ;  and  from  a  study  of  tht 
sequence  of  events  connected  with  the  development  of 
the  th>To*d,  the  association  of  amenonhoea  and  of 
concomitant  indications  of  vaso-motor  spasm,  foUaiicd 
by  the  chlorosis  and  stomach  disorder,  he  suggested 
that  the  disease  was  another  instance  of  vaao-motor 
spasm  followed  by  necrosis  dependent  upon  a  toxatmiL 
He  thought  this  the  more  probable  since  the  admins- 
tration  bf  thyroid  extracts  frequently  relieved  the 
amenorrhoea,  and  that  following  this  there  was  toat- 
times  great  general  improvement  in  the  health  of  tte 
patients.  Dr.  Macalister  was  emphatic  concquag 
the  necessity  for  taking  the  cases  in  hand  during  tk 
early  stages,  and  that  whatever  might  be  done  in  the 
way  of  thyroid  treatment  later  in  the  disease,  it  vas 
necesssiry  to  use  all  the  usual  precautions  as  reganb 
rest,  diet,  and  palliative  treatment  in  addition. 

The  President,  Dr.  E.  T.  Davies,  Mr.  E.  M.  Stockdak. 
Dr.  W.  Carter,  Dr.  T.  R.  Glynn.  Dr.  T.  R.  Bradahaw, 
Dr.  J.  Hill  Abram,  Dr.  E.  E.  Gl3mn.  and  Dr.  R.  ]. 
Logan  took  part  in  the  discussion. 

A  resolution  congratulating  Mr.  £.  R.  Bickersteth 
on  having  attained  his  jubilee  of  membership  w» 
proposed  by  the  President,  seconded  by  Mr.  RuslitOD 
Parker,  and  carried  with  acclamation. 


LARYNGOLOGICAL    SOCIETY     OF     LONDON. 
Meeting  held^  Dbcbmber  3RI>,   1904* 


Dr.  Law  showed  a  case  of  incrustations  in  tht 
trachea,  which  had  been  shown  at  the  former  meeting. 
The  patient  suffered  from  considerable  dyspnoea,  aad 
the  question  was  raised  as  to  whether  tracheotonj 
might  not  be  necessary.  Dr.  Bronner  showed  some  crusts 
from  a  case  of  dry  catarrh  of  the  nose  and  nasc-pharyin 
which  had  been  treated  by  formalin  spray.  Ai 
interesting  case  of  epithelioma  of  the  larynx  was  shovi 
by  Sir  Felix  Semon.  Thyrotomy  had  been  perfonned 
but  was  followed  by  fairly  rapid  recurrence.  Sntw- 
quently  a  great  part  of  the  affected  half  of  the  larynx 
was  removed,  and  the  man  made  an  excellent  recovoy. 
The  striking  part  of  the  case  was  the  extraoidinariy 
good  voice  left.  An  apparently  almost  unique  case 
of  a  bony  growth  in  the  ethmoidal  region  of  the  nose 
in  a  girl  was  shown  by  Dr.  Lambert  Lack.  There  was 
obstruction  of  the  maxillary  osteum  from  the  growth, 
and  mucocele  of  the  antrum.  The  diagnosis  micixK 
scopically  suggested  was  ossifying  sarcoma.  Tw& 
cases  were  shown  of  tumours  in  the  neighbourhood  d 
the  tonsil ;  one  by  Dr.  Wyatt  Wingrave,  in  a  femafe. 
aet.  64,  and  the  second  by  Dr.  Tilley,  in  a  young  man.  la 
Dr.  Tilley 's  case  there  were  a  large  number  of  enlaig^l 
cervical  glands,  and  in  both  cases  the  diagnosis  was 
that  of  a  lympho-sarcoma.  In  Dr.  Tilley's  case  the 
glands  and  the  enlargement  of  the  tonsil  had  alvost 
entirely  disappeared  under  the  influence  of  large  doses 
of  arsenic.  An  interesting  case  of  chronic  laryngitis 
in  a  man,  aet.  32,  was  shown  by  Eh*.  Cathcart.  The 
general  opinion  of  members  was  that  the  condition  was 
one  of  extreme  pachydermia.  Mr.  F.  J.  Steward 
showed  a  case  of  complete  paralysis  of  the  left  vocal 
cord,  due  to  a  tumour  of  the  thyroid.  The  clinical 
aspects  of  the  tumour  were  those  of  non-malignancy, 
but  the  case  was  shown  with  the  view  to  eliciting  opin- 
ions as  to  the  question  of  malignancy. 


ULSTER     MEDICAL     SOCIETY. 
Meeting  held  in  the  Medical  Institute,  Belfast. 
December  8th,   1904. 


Dr.  JohnXampbell,  in  the  al>sence  of^the  PresideBt. 
in  the  Chair. 


The  following  gentlemen  were  elected  Fellaws  of 
the  Society : — Drs.  D.  C.  Kirkhope,  S,  Macauley.  and 
J.  H.  Lowry,  all  of  Belfast ;  and  the  following  as 
Members:     Drs.    S.   T.    Irwin    and     S.    Blakelev.  of 


Dec.  14,  1904. 


FRANCE. 


The  Medical  Presi,   631 


Belfast  ;  T.  M'Clatchey,  of  Dumurry  ;  and  J.  McArthur,  | 
of  Grey  Abbey. 

Mr.  Robert  Campbell,  F.R.C.S.,  read  a  paper  on 

SOME    INJURIES    TO    JOINTS. 

Dealing  with  those  of  the  lower  end  of  the  humerus, 
he  said   that  all  fractures  should  be  put  up  in  the 
acutely  flexed  position,  except  those  in  which  there 
was  displacement  of  fnigments  of  the  bone.     Fractures 
of  the  head  of  the  radius  he  found  most  often  as  the 
result  of  bicycle  accidents,   the  rider  getting  a  side- 
slip  and    lighting  on   the  palm  of  the  hand.     The 
fracture  generally  ran  in  an  antero-posterior  direction 
down  the  head  of  the  bone,  tailing  off  to  the  inner 
side.     The  fragment  of  bone  was  often  broken  into 
two  }»eces.     The  signs  of  this  fracture  might  be  slight : 
simply  swelling  and  tenderness  over  the  head,  but  on 
pronating  and   supinating   the  hand   to  an   extreme 
degree  one  could  get  crepitus  over  the  head.     If  such 
a  &acture  were  left  alone  the  callus  would  eventually 
interfere  with  movement,  and  the  best  treatment  was 
to  cut  down  on  the  head  of  the  bone  and  remove  it, 
the    results    being    good.     Fractures    of    the    carpal 
bones  were  frequently  seen  in  hospital  as  cases  of 
"  sprained  wrist "   that  had  never  been  treated,  or 
which    had    not    recovered    under    treatment.     They 
showed   thickening  and   tenderness  over  the  carpus. 
These  fractures  were  due  to  a  fall,  not  a  crush.     The 
diagnosis  could  only  be  made  by  a  careful  palpation'  of 
each  TOW  of  carpal  bones ;    tenderness  will  be  found 
at  both  back  and  front  of  one  bone.     Radiography  is 
most   useful   in   confirming   one's   diagnosis  in   these 
cases.     Fracture  of  the  base  of  the  first  metacarpal 
bone  is  due  to  force  applied  to  the  end  of  the  thumb, 
and  is  discovered  by  the  tenderness  on  pressure  in 
that  direction.     The  diagnosis  is  difficult  unless  one 
gets  a  history  of  violence  applied  in  this  direction, 
and  may  only  be  possible  by  radiography.     Disloca- 
tions of  the  semilunar  cartilages  of  the  knee-joint  are 
often  described  as  being    outwards,  but  in  the  large 
number  of  cases  which  Mr.  Campbell  had  seen  in  the 
Royal  Victoria  Hospital  extern  he  had  never  seen 
one  outwards.     He  had  operated  on  seven,   and  in 
all  but  one  the  displaced  cartilage  was  living  between 
the  condyles  of  the  femur.     He  considered  the  only 
really   satisfactory   treatment   was  removal.      If  his 
observation  as  to  the  direction  of  displacement  was 
correct,  it  showed  the  absolute  futility  of  all  special 
pads  and  such  things. 

The  paper  was  discussed  by  Drs.  O'Neill,  Fuller- 
ton,  Mitchell,  Moore,  St.  George,  and  O'Connell, 
several  of  whom  expressed  strong  dissent  from  the 
views  set  forth  in  the  paper. 

Mr.  Andrew  Fullerton,  F.R.C.S.I..  showed  skia- 
grams of  (a)  fracture  and  dislocation  of  the  astragalus, 
and  (6)  dislocation  of  the  scaphoid  and  fracture  of 
the  carpal  bones. 

Mr.  A.  B.  Mitchell,  F.R.C.S.I.,  read  a  paper  on  some 

inefficient    GASTRIC    OPERATIONS, 

giving  an  account  of  six  operations  in  which  the 
hoped-for  relief  had  not  been  obtained,  or  had  been 
only  temporary.  The  paper  was  virtually  a  continu- 
ation of  one  read  last  session,  giving  an  account  of 
'  a  large  number  of  operations  for  the  relief  of  gastric 
ulcer  and  the  conditions  arising  therefrom.  The  paper 
was  discussed-  by  Messrs.  Kirk,  Fullerton,  and  Robert 
Campbell. 

france* 

[from  our  own  correspondent.] 

Pabis.  December  12th,  1904. 
Epigastric  Pain  in  Neurasthenia. 

This  symptom,  common  enough  in  general  practice, 
is  frequently  misunderstood  by  the  practitioner.  It 
may  be  classed  with  the  painful  form  of  dyspepsia 
where  there  exists  hyperaesthesia  of  the  mucous  mem- 
brane. 

The  patient  is  generally  a  w^oman.  She  complains 
of  pain  in  the  stomach  coming  on  after  eating.  Some- 
times a  sensation  of  burning  exists,  with  acid  regur- 


gitation. The  case  is  supposed  to  be  one  of  hyper- 
acidity of  the  stomach,  which,  in  fact,  often  co-exists, 
but  not  constantly,  or  that  of  ulcer.  The  patient  is 
ordered  milk  diet,  absorbent  powders,  and  warm 
drinks,  but  with  no  result ;  the  suffering  continues. 
After  a  time  the  patient  throws  aside  the  r/gime  and 
eats  as  usual,  and  is  surprised  to  find  that  the  food, 
passes  without  any  inconvenience,  except  spiced  food 
and  wine.  M.  Page  published  lately  several  cases 
where  the  above  symptom  was  the  most  prominent, 
and  came  to  the  conclusion  that  such  patients  are  of 
the  neurasthenic  class,  in  whom  the  epigastric  pain 
is  provoked  by  difierent  causes — emotion,  food, 
monthly  periods,  &c.  The  pain  is  very  violent,  and 
has  two  points  of  election  :  three  fingers'^  breadth  from 
the  xiphoid  cartilage  in  front  and  the  eighth  dorsal 
vertebra  behind,  and  is  due  to  neuralgia  of  the  solar 
plexus.  Certain  organs,  as  the  uterus  and  kidneys,  being 
in  the  territory  of  this  nerve  system,  should  be  examined 
with  care,  and  by  treating  the  affections  of  these 
organs  (metritis,  floating  kidney,  anteversion,  &c.), 
the  epigastric  pain  would  be  cured.  But  frequently 
no  cause  can  be  discovered. 

M.  Page  recommends  faradisation  of  the  stomach. 

Treatment  of  Exophthalmic  Goitre. 
Among  the  agents  employed  in  the  treatment  of 
exophthalmic  goftre,  there  is  one  which  was 
recommended  some  years  ago  by  a  provincial  physician, 
and  although  others  tried  it  with  considerable  success, 
that  treatment  has  fallen  more  or  less  into  oblivion. 
However,  quite  recently  Dr.  Joussemet  took  this 
subject  for  his  thesis  and  published  eighteen  cases 
of  exophthalmic  goitre  treated  by  this  method, 
with  unvaried  success.  M.  Joussemet  does  not 
believe  that  every  case  is  amenable  to  salicylate 
of  soda.  For  him,  it  is  the  pure  form,  with  or  without 
gottre,  with  neuro-arthritis  as  predisposing  cause, 
emotion  for  determining  cause,  and  phenomena  due 
to  the  functional  hyper-activity  of  the  cells  of  the 
sympathetic  system  for  symptoms,  that  this  agent 
acts  almost  as  a  specific. 

The  dose  is  generally  fifteen  grains  three  times  a 
day,  but  larger  doses  may  be  given  if  well  borne  by 
the  patient.  To  avoid  irritating  the  stomach,  how- 
ever, it  is  good  treatment  to  give  it  in  milk  or  in 
Vichy  water. 

The  treatment  must  be  continued  for  weeks,  months, 
and  even  a  year,  with  a  few  days' interruption  every 
month. 

Treatment  of  Senile  Gangrene. 
The  treatment  varies  according  to  the  period  of 
the  disease.  At  the  beginning,  when  the  condition  of 
the  threatened  region  can  be  improved,  recourse  will 
be  had  to  vaso-dilators  or  cardiac  tonics,  rest  in 
bed  with  the  limb  bound  in  dry  cotton  wool  to  en- 
courage the  circulation  in  the  affected  parts,  and 
as  a  therapeutic  agent : 

Iodide  of  potassium,    i  dr. ; 
Water,   lo  02. 

A  tablespoonful  twice  a  day. 
At  the  same  time  theobromine,  an  admirable  diuretic 
eliminating  the  toxins    of    the  blood,  and  a  cardiac 
tonic,  will  be  given  in  the  daily  dose  of  ten  grains. 

After    twenty    days    of     this    treatment,    trinitrin 
will  be  ordered  for  the  last  ten  days  of  the  month  : 
Solution  of  trinitrin  i-ioo,  40  min. ; 
Sulphate  of  spartein,   15  grs. ; 
Water,   12  oz. ; 
Three  dessert-spoonfuls  daily; 

or 
Nitrite  of  soda,   30  grs.  ; 
Bicarb,  of  soda,  2  J  drs.  ; 
Nitrate  of  potash,  2J  drs. ; 
Water,  10  oz.  ; 
Three  dessert-spoonfuls  daily. 
Once   the  gangrene  has  set  in,  the  above  treatment 
can    be    continued,    and    local    antiseptic    treatment 
instituted.     According  to  Dr.   Huchard,  lotions  with 
permanganate  of  potash  solutions  (1-1,000)  followed 
by  the  permanent  application  of  compresses  wet  with 
oxygen  water,  recently  prepared,  is  the  best.     Some 


632    The  Medical  Press. 


AUSTRIA. 


Dec.  14,  1904. 


patients,  however,  prefer  the  dry  treatment.  In  such 
cases,  after  cleaning  the  parts  with  oxygen  water, 
peroxide  of  zinc  gauze  is  applied. 

Germans* 

[from  our  own  correspondent.] 


Bbklih.  December  lotb,  1904. 

At  the  last  meeting  of  the  Gesellschaft  der  Aertze 
Hr.  Bumm  spoke  on 

Ligature  of  the  Efferent  Uterine  Vessels  for 
Pyaemia. 

Four  years  ago,  Freund  proposed  ligature  of  the 
vessels  going  from  the  uterus  in  cases  of  pyajmia  pro- 
ceeding from  that  organ,  as  they  frequently  contamed 
suppurating  thrombi.  Freund  had  had  a  recovery, 
but  he  had  not.  Trendelenberg  ligatures  the 
hypogastric  veins  without  touching  the  spermatic 
in  one  case,  and  with  a  good  result.  The  latter  opera- 
tion also  led  to  a  good  result  in  the  hands  of  Michaelis. 
The  speaker  now  brought  forward  the  two  first  cases  of 
recovery  from  chronic  pyaemia  after  ligature  of  the 
hypogastric  veins.  In  the  first  case  peritonitis  set  in 
soon  after  delivery  ;  the  patient  recovered  from  this  by 
drainage.  Then  rigors  took  place.  He  ligatured  the 
spermatic  before  the  hypogastric.  The  ligatures 
sufficed  to  completely  arrest  the  circulation  in  the  veins 
of  the  pelvis  ;  double  ligature  and  excision  would  only 
have  given  a  fresh  occasion  to  renewed  infection.  As 
the  veins  were  still  there  after  the  operation  there 
might  still  be  a  few  rigors  of  no  importance.  In  the 
second  case,  the  pya?mia  followed  delivery  by  forceps. 
Whilst  Trendelenberg  operated  extra-peritoneally,  he 
proposed  to  operate  from  the  peritoneum,  as  the  desired 
result  was  obtained  more  quickly.  One  must  bear  in 
mind  not  to  ligature  the  ureter,  which  ran  near  to  the 
vein. 

Hr.  Stoeckel  related  a  case  of 

Gangrenous  Cystitis 
in  a  woman  (with  cystoscopic  demonstration).  In  a 
case  of  sepsis  following  forceps  delivery,  recovery  was 
delayed  by  an  attack  of  gangrenous  cystitis.  Such  a 
cystitis  might  cause  a  patchy  or  a  more  extensive 
superficial  destruction  of  the  bladder  wall.  The  pain 
accompanying  the  affection  resembled  that  of  labour. 
The  destruction  was  not  total,  as  was  formerly  believed, 
so  that  attachments  to  bowels  helped  to  form  a  con- 
tainer for  the  urine,  but  the  bladder  was  retained  in 
toto,  the  shelled-off  part  only  reaching  to  the  middle 
muscular  layer,  the  part  where  the  circular  muscles 
lay  around  the  orifices  of  the  ureters.  The  result  was 
insufficiency  of  all  the  openings,  through  loss  of  the 
controlling  muscles.  Thus  in  the  case  before  them 
(demonstration)  the  openings  of  the  ureters  were  not 
small  fiat  slits,  but  crater-like,  gaping  depressions. 
This  loss  of  closing  power  was  the  cause  of  the  increased 
danger  of  ascending  suppuration. 

At  the  Society  fur  innere  Medizin,  Hr.  Senator  spoke 
on 

Physiological  and  Pathological  Albuminuria. 

Up  to  modern  times,  albumin  in  the  urine  was  always 
looked  upon  as  pathological.  He  himself,  in  1882,  had 
shown  that  traces  of  albumin  were  sometimes  met  with 
in  healthy  urine.  Later  on  it  was  shown  that  the 
albumin  was  a  sero-albumin.  and  that  it  could  only  be 
discovered  by  delicate  methods.  In  other  more  recent 
times,  a  real  albuminuria  had  been  observed  in  persons 
who  showed  no  symptoms  of  disease,  at  any  rate  they 
had  no  kidney  disease.  This  had  been  called  functional 
or  idiopathic  albuminuria,  and  it  was  a  question 
whether  the  symptom  was  a  pathological  or  a  physio- 
logical one.  Leube  had  shown  in  1878  that  after  heavy 
marches  soldiers  not  infrequently  had  albumin  in 
their  urine.  The  idea,  however,  could  not  be  rooted 
out  that  normal  urine  was  free  from  albumin,  and  this 
arose  from  a  misunderstanding  or  mixing  up  of  the 
terms  abnormal  and  pathological,  and  there  were  many 
abnormalities  that  were  not  pathological.  There  w^as 
a  so-called  physiological  glycosuria,  and  a  physiological 


acetonuria,  &c.  It  was,  therefore,  not  strange  that  after 
violent  exercises  such  as  football,  &c.,  or  after  a  ham 
meal,  there  should  be  some  albumin  in  the  nrioe. 
Rapp  foun4  albumin  in  cadets  in  i  '7  per  cent,  of  tht 
cases.  Menstruation  caused  albuminuria  in  many 
women,  and  cold  baths  also,  and  albuminoria  was 
pathological  when  it  appeared  under  normal  conditions, 
and  not  when  it  occurred  under  certain  conditioas  and 
disappeared  when  the  special  condition  ceased. 

Another  kind  was  the  cyclic  or  orthotic,  whid 
occurred  in  children  when  they  vrere  moved  from  a 
horizontal  to  an  upright  position,  but  this  was  certainiy 
pathological.  In  all  these  forms  the  albumin  hardh 
ever  exceeded  \  per  cent.  As  regarded  cold  baths, 
the  blood  film  was  altered  by  cold  baths  ;  a  leucocytoaa 
developed  in  the  blood  stream,  and  these  nub- 
nuclear  leucocytes  could  exert  an  influence  on  the 
kidney.  Rosenbach  had  made  the  interesting  obse- 
vation  that  in  periodic  ha^moglobinuria  albumin  vaa 
present  in  the  urine  even  at  the  commencement  of  ac 
attack  ;  even  in  incomplete  attacks  from  cold  then 
was  always  albumin  in  the  urine.  Under  such  drcnm- 
stances  the  albumin  was  pathological.  Of  the  canses 
of  albuminuria  in  menstruation  he  knew  nothing. 

After  copious  meals  the  circulatory  condition  played 
a  part.  Possibly  the  flow  of  blood  from  the  kidney* 
was  hindered  by  distension  of  the  abdomen,  or  ihat 
might  be  open  communication  betvireen  the  portal  veia 
and  the  general  venous  system.  In  the  normal  con- 
dition such  communication  mi^h't  remain  open,  so  that 
albumin  might  get  into  the  circulation  indthout  going 
through  the  liver  at  all. 


Bustrfa* 


[from  our  own  corrbspondbnt.] 


VZBNNA,  December  lOtb,  itti 
Hepatic  Rupturb. 

At  the  Gesellschaft  der  Aerzte,  Schnitzler  presented 
a  drayman  on  whom  he  had  operated  for  mptnre  of 
the  liver.  Nine  hours  after  being  crushed  by  a  caA 
of  beer,  the  patient  w^as  brought  to  hospital  in  a  very 
ansemic  condition,  the  abdomen  greatly  distended, 
both  flanks  dull  on  percussion,  while  the  hepatic 
dulness  was  normal.  A  tear  of  the  mesentery  was 
diagnosed,  and  laparotomy  decided  upon  as  an  imme- 
diate operation. 

On  opening  the  abdomen  a  large  rent  in  the  liver 
presented  itself,  the  mesentery  between  the  stomadi 
and  liver  being  torn.  Two  htres  of  t>Iood  were  re- 
moved. The  rupture  was  located  in  the  lower  and 
posterior  margin  of  the  left  lobe,  in  which  a  man's 
fist  might  be  placed.  As  stitches  in  this  position  were 
almost  impossible,  the  haemorrhage  was  checked  by 
temporising  with  a  w^eak  solution  of  adrenalin,  con- 
ducted through  the  upper  angle  of  the  abdominal 
wound. 

The  case  is  interesting  from  the  sequelae,  as  embolism 
of  the  left  lung  speedily  followed  the  recovery  from 
the  accident.  At  the  present  time  infiltration  and 
shrinkage  of  the  lung  still  exist.  The  morbid  changes 
are  likely  to  have  arisen  from  primary  embolism  of 
the  hepatic  cells,  from  which  fragments  were  carried 
along  the  pulmonary  artery  to  the  lung,  where  the 
destruction  took  place.  Schnitzler  thought  as  far  as 
the  wound  of  the  liver  was  concerned  it  would  heal 
itself  without  much  trouble,  but  the  danger  lay  in 
the  styptic. 

Here  he  read  a  published  case  of  hepatic  rupture 
where  no  operation  was  performed,  which  nine  months 
after  the  accident  discharged  in  the  form  of  a  sob- 
phrenic  abscess,  large  sequestra  of  liver  being  found  in 
the  purulent  matter. 

Lotheissen  had  another  case  to  show  the  members 
where  the  tear  in  the  liver  was  more  superficial  than 
either  of  the  two  cases  previously  described.  The 
patient  had  been  engaged  in  removing  benzine  when 
one  of  the  casks  exploded,  throwing  him  violently  to 
the  ground  on  the  abdomen,  rupturing  the  liver.  When 


Dbc.   14,  1904. 


THE    OPERATING   THEATRES. 


The  Medical  Press.    633 


received  into  hospital  be  was  ansemic,  abdomen  tense 
and  painful,  especially  over  the  umbilical  region.  Both 
flanks  were  slightly  dull,  and  no  blood  in  the  urine. 
Five  hours  after  the  accident  he  was  operated  upon, 
and  about  two  litres  of  blood  taken  out  of  the  abdomen. 
It  was  then  discovered  that  the  left  lobe  of  the  liver 
was  torn,  leaving  a  rent  that  would  hide  a  good-sized 
apple.  A  portion  was  hanging  by  a  pedicle,  as  thick 
as  the  finger.  Four  stitches  were  applied,  over  which 
was  placed  a  pad  of  iodoform  gauze,  while  the  pedicle 
was  removed  by  the  Paquelin  to  prevent  haemorrhage, 
and  finally  a  tampon  of  gauze  placed  between  the 
stomach  and  liver,  which  was  ultimately  removed 
by  the  upper  angle  of  the  abdominal  section.  The 
bleeding  in  this  case  was  checked  by  the  Matratzen 
stitches,  which  were  first  so  successfully  applied  by 
Hochenegg.  The  prognosis  of  subcutaneous  rupture 
of  the  Uver  is  never  very  favourable  according  to 
literary  statistics,  but  probably  depends  largely 
on  the  extent  of  the  rupture  and  the  time  that  elapses 
after  the  accident  before  operating. 

Invagination  caused  by  Adenoma. 
Haim  showed  a  case  on  which  he  had  operated 
for  invagination  of  the  bowel,  said  to  be  due 
to  the  presence  of  an  adenoma.  The  patient  was  a 
male,  act.  65,  who  had  suffered  for  some  time  from 
colicky  pains  in  the  abdomen,  but  no  vomiting  or 
meteorism  was  present  at  any  time.  After  one  of  these 
attacks  he  was  brought  to  hospital  with  stoppage  of  the 
bowel,  with  meteorism  and  vomiting  on  this  occasion. 
There  was  tenderness  on  pressure  over  the  ileo-caecal 
region,  no  convulsive  contractions  of  the  bowel  to 
be  observed,  nor  uncontrollable  vomiting,  and  neither 
2tool  nor  gas  passing  from  the  bowel,  although  the 
patient  confessed  that  he  was  fairly  well  otherwise. 
After  considering  all  the  symptoms,  the  case  was 
diagnosed  as  strangulation  of  the  ileus,  with  probably 
a  tumour  in  the  ileo-cscal  region  as  the  cause. 

On  operating  it  was  found  that  a  portion  of  the 
small  intestine  had  become  invaginated  immediately 
above  the  tumour,  which  was  resected  along  with  15 
•centimetres  of  the  bowel.  The  wound  was  closed  in 
the  usual  manner,  and  the  patient  speedily  recovered. 
The  microscopic  examination  of  the  tumour  proved 
it  to  be  a  malignant  adenoma,  which,  according  to 
clinical  history,  is  a  rare  morbid  process  of  the  bowel. 
Nephritic  Calculi. 
Konigstein  gave  the  history  of  a  case  of  a  female 
from  whom  he  removed  a  large  stone  from  the  pelvis 
of  the  kidney,  which  had  its  origin  from  an  attack  of 
gonorrhoea.  The  stone  was  of  a  dark  red  colour, 
about  the  size  of  a  hazel  nut,  and  embedded  in  a 
quantity  of  pus,  mucus,  and  chalky  matter. 

She  had  been  seven  months  married,  aet.  22, 
and  had  had  urethritis,  cystitis,  endometritis, 
and  swelling  of  the  left  adnexa,  due  to  gonorrhoea! 
infection  from  the  husband.  On  examination  over 
the  left  kidney,  which  was  tender,  fluctuating  and 
swollen  to  the  size  of  two  good  fists,  the  diagnosis 
was  conclusive  that  operation  was  desirable.  She  was 
generally  ill  with  high  fever  and  nephritic  colic,  and 
£L  large  quantity  of  pus  in  the  urine  prompted 
immediate  interference.  The  pelvis  of  the  kidney 
was  greatly  distended,  the  stone  and  debris  evacuated, 
after  which  the  temperature  fell  to  normal,  and  the 
patient  speedily  recovered. 

Colour  Impressions  on  the  Senses. 
Urbantschitch  again  treated  the  audience  to  a 
discourse  on  the  various  impressions  •  produced  by 
different  colours.  This  condition  is  variable  in  different 
individuals.  It  sometimes  happens  that  this  mental 
condition  is  produced  by  one  eye  affecting  the  hearing 
on  the  same  side  of  the  body.  The  acuity  of  hearing 
has  much  to  do  with  the  production  of  colour.  He  finds 
that  many  persons  have  their  taste  perverted  by  colour, 
so  much  so  that  sugar  may  taste  bitter  or  salt,  and 
bitter  sweet.  No  particular  colour  can  be  said  to 
raise  or  lower  this  sensation  as  a  general  rule,  but 
many  individuals  are  subject  tp  their  influence.  Any- 
one with  a  favourite  colour  may  have  the  sense  excited 
by  simply  applying  the  rajrs  to  the  skin.     AH  these 


experiments  must  be  conducted  when  the  .body  is  at 
perfect  rest,  or  fallacies  will  obtrude  themselves. 

Dungars* 

[from  our  own  correspondent.] 


BUBAPBST,  December  7th,  1904.    . 
The  Value  of  Koplik's  Spots  in  Early  Diagnosis 
OF  Measles. 

In  the  last  number  of  the  Orvosi  Hetilaps,  Dr. 
Navratil  says  that  he  had  looked  for  the  spots  on 
the  buccal  mucous  membrane,  first  described  oy  Koplik 
as  preceding  by  some  days  the  general  eruption  of 
measles,  and  had  found  them  in  24  cases.  In  one 
case  they  preceded  the  eruption  by  6  hours,  in  11 
cases  by  24  hours,  in  3  by  32  hours,  in  4  by  48  hours,  in 
2  by  3  days,  and  in  2  by  6  days.  The  spots  were 
generally  situated  on  the  mucous  membrane  of  the 
cheeks  opposite  the  molar  teeth,  but  occasionally  also 
on  the  lips,  beginning  as  slightly  raised,  bluish-white, 
circular,  sharply-defined  points,  in  size  less  than  a 
pin's  head,  and  surrounded  by  a  narrow  red  areola. 
In  a  few  days  they  generally  increase  slightly  and 
become  more  prominent,  and  the  areola  enlarges  and 
becomes  irregular  in  outline.  Their  number  varied 
between  six  and  twenty,  and  the  time  during  which 
they  persisted  from  two  to  six  days.  They  were 
most  marked  just  before  or  at  the  time  of  the  general 
eruption.  They  were  not  present  in  fourteen  cases. 
Since  they  are  never  seen  in  other  conditions  accom- 
panied by  fever,  they  become  of  the  greatest  import- 
ance for  the  early  diagnosis  of  measles.  Navratil 
claims  that  the  buccal  eruption  in  measles, was  first 
mentioned  by  Gerhard  t,  and  that  their  injportance 
was  recognised  by  Filaton  in  1895,  a  year  before  their 
independent  discovery  by  Koplik. 

Radical  Treatment  of  Varicose  Ulcers. 

Dr.  Polydk  writes  that,  though  some  varicose 
ulcers  on  the  leg  heal  with  almost  any  dressing  such 
as  iodoform,  zinc  ointment,  airol  or  xeroform,  the 
greater  number  resist  such  treatment,  or  if  they  heal 
quickly  relapse.  For  such,  skin-grafting,  after  thorough 
disinfection  of  the  ulcer,  is  by  far  the  best  local  treat- 
ment, but  whenever  extensive  varicosities  are  present, 
this  is  also  unsatisfactory.  The  only  radical  treat- 
ment in  such  cases  is  to  ligature  the  saphenous  vein 
according  to  Trendelenberg's  method  oefore  proceed- 
ing to  the  transplantation  of  the  skin. 

Dr.  Huber  has  contributed  a  valuable  paper  on  the 
Prevention  of  Recurrences  in  Syphilitic 
Diseases  of  the  Eve. 
He  believes  that  he  prevents  recurrence  in  syphilitic 
ocular  disease  by  the  following  treatment : — In  syphili- 
tic disease  of  the  choroid,  mercurial  inunctions 
should  be  undertaken  for  two  years,  the  place  of 
inunction  being  varied  daily.  The  dose  should  not 
exceed  30  gr.,  and  according  to  the  age  and  consti- 
tution of  the  patient,  doses  of  8  gr.,  or  i  s  gr.  are  better. 
After  every  ten  inunctions  a  pause  of  four  days  may 
be  made.  The  best  base  for  the  mercurial  ointment 
is  lanolin.  Longer  pauses  than  three  weeks  should  not 
occur  in  the  whole  two  years.  A  pause  of  three 
months  completely  nullifies  the  treatment. 

Potassium  iodide  has  no  curative  influence  on  ocular 
syphilis,  but  is  directly  injurious  on  account  of  the 
conjunctivitis  to  which  it  predisposes,  and  should 
not  be  given  in  the  majority  of  cases.  Potassium 
iodide  has  only  one  use  in  the  treatment  of  ocular 
syphilis,  namely,  to  counteract  the  injurious  influ- 
ences of  large  doses  of  mercury. 


Ube  Operating  Ubeatree. 

GUY'S  HOSPITAL. 

Novel  and  Very  Effective  Mode  of  Treatment 

OF  General  Suppurative  Peritonitis. — Mr.  Arbuth- 

not  Lane  operated  on  a  man,  the  subject  of  an  acute 

suppurative  peritonitis,   clearly  the  result  of  appen* 


634    The  Medical  Press. 


THE    OPERATING   THEATRES. 


Pec-  14.  1984. 


dicitis,  of  three  days'  duration.    The  muscles  of  the 
abdomen  were  very  rigid,  and  the  abdominal  wall  did 
not  move  during  respiration.     An  incision  was  made 
along  almost  the  entire  length  of  the  outer  margin  of 
the  right  rectus.     The  distal  portion  of  the  appendix, 
which  was  abruptly  kinked  about  its  centre,  was  gan- 
grenous, and  the  foul-smelling  pus  which  had  formed 
about  it  was  retained  by  fairly  firm  adhesions.     The 
abdomen  contained  a  large  quantity  of  turbid  fluid, 
which  was  not  exactly  offensive  in  smell,  but  was 
certainly  not  sweet.     The  peritoneum  covering   the 
intestines  was  inflamed   throughout.     The  appendix 
was  removed  and  its  stump  inverted  by  a  purse-string 
suture.     The    wall    of    the    abscess  was  thoroughly 
cleaned  with  pads  wet  with  normal  saline  solution. 
The  intestines  were  then  turned  out  through  the  incision 
and  every  portion  of  the  abdominal  cavity  and  of  the 
protruding  viscera  were  thoroughly  irrigated  with  a 
very  large  quantity  of  warm  normal  saline  solution 
Owing  to  the  retraction  of  the  muscle  wall  it  was 
obvious  that   the  apposition  of  the  margins  of  the 
incision  would  entail  a  great  loss  of  time,  a  very  serious 
matter  in  the  patient's  critical  condition,  and  when 
effected  would  exert  a  very  great  pressure  upon  the 
dilated    and    inflamed    intestines,    and    prevent    the 
passage  of  their  contents.     In  such  cases,  Mr.  Lane 
said,  he  used  to  cover  in  the  intestines  with  cyanide 
gauze  soaked  in  saline  solution,  and  retain  them  with 
a  towel  used  as  a  binder  ;  but  recently  he  had  adopted 
a  more  efficient  method.     He  had  brought  the  margins 
of   the   skin   together  with   a  continuous  horse-hair 
Suture,  leaving  a  gauze  plug  or  drainage-tube,  or  both, 
in  the  situation  of  the  appendical  abscess.     The  dis- 
tension has  then  been  relieved  with  turpentine  enemata, 
supplemented  by  calomel  or  other  drugs  if  necessary. 
When  the  peritonitis  suosides   he  reopens  the  wound 
and  brings  the  cut  edges  of  muscle  together.     As  the 
muscle     wall     is    lax,    and    the     intestines    are    no 
longer  distended,  this  is  done  easily.     By  this  means, 
he  pointed  out,  the  operation  is  performed  rapidly  and 
with  the  greatest  possible  efficiency,  while  the  obstruc- 
tion resulting  from  the  distension  of  the  intestines  com- 
pressed by  the  rigid  abdominal  wall  is  removed.     The 
intestines  occupy  the  considerable  interval  between  the 
edges  of  the  muscles  and  beneath  the  thin,  loose  skin. 
By  this  simple  means  he  had  been  able  to  save  many 
lives,  which  would  not  have  been  the  case  with  the 
methods  usually  employed. 

Excision  of  the  Rectum  and  Lower  Portion  of 
THE  Sigmoid  for  Cancer. — ^The  same  surgeon  operated 
on  a  woman,  aet.  36,  who  had  a  carcinomatous  ulcer  in 
the  lower  third  of  the  rectum,  about  three-quarters  of  an 
inch  in  depth.  It  did  not  involve  the  vaginal  wall,  but 
it  appeared  to  be  adherent  to  the  anterior  surface  of 
the  sacrum.  Mr.  Lane  remarked  that  he  had  for  a 
long  time  advocated  a  more  effective  method  of  dealing 
with  cancer  of  the  rectum  than  that  usually  adopted, 
namely,  of  attempting  the  removal  of  the  growth  and 
the  affected  glands  from  below,  such  removal  being 
rendered  possible  in  extensive  cases  by  the  cutting  away 
of  a  variable  portion  of  the  sacrum.  This  operation  he 
considered  barbarous  and  useless.  It  leaves  the 
patient  in  discomfort,  and  often  in  misery,  for  the 
reason  that  it  is  often  necessary  to  pass  bougies  in 
order  to  keep  the  aperture  open,  and  the  process  of 
dilatation  is  painful  in  the  extreme  :  the  patient  looks 
forward  with  dread   to  its  performance.     Again,   he 


insisted  that  it  is  impossible  in  a  very  large  proportioQ 
of  cases  to  deal  effectually  with  the  glandular  infecttts 
by  this  method  of  operating.     He  considered  all  mth 
operations  a  reproach  to  the  surgery  of  the  present  dsv. 
The  method  he  employs,  he  said,  is  equally  appUcaUr 
to  the  male  or  female,  and  is  accompanied  with  ver^' 
little  risk.     The  patient  was  pUtced  in  the  semi-praae. 
or  lithotomy,   position  ;     the   anus  was  dosed  by  a 
suture  ;   the  parts  were  cleansed,  and  the  lower  part  of 
the  aperture  of  the  bowel  was  encircled  by  an  indsioo. 
through  which  it  was  freed  as  far  as  the  peritoneal 
reflection.     The  patient  was  then  put  on  the  back,  aal 
a  long  incision  was  made  in  the  left  iUac  regum.   The 
sigmoid  was  exposed  and  the  adhesions  which  UBa% 
shorten  up  its  mesentery  and  possibly  attach  the  intes- 
tine itself  were  carefully  divided.     These  result  fron 
the  obstruction  offered  by  the  growth.     Mr.  Lane  said 
he  had  already  fully  described  them.     The  freeing  of 
these  adhesions,  he  pointed  out,  enables  the  snigeon  to 
bring  the  sigmoid  out  through  fhe  edges  of  the  womd. 
The  primary  growth  was  then  examined  and  the  extent 
of  glandular  infection  accurately   determined.    This. 
Mr.   Lane  demonstrated,   can    be   done  with  peito 
accuracy  and  great  facility,   and  he  had  often  been 
surprised  with  the  extent  of  the  glandular  infection. 
In  this  particular  case,  although  the  primary  gnnrth 
was  small  and  low  down,  glands  of  considerable  size 
were  present  in  the  meso-sigmoid,   eight  inches  fraa 
the  primary  growth.     The  sigmoid  was  ligatured  veB 
above  any  large  glands.     It  was  cut  through  above  the 
ligature  and  the  lower  ligatured  end  was  inverted  into 
the  distal  bowel  by  means  of  a  purse- string  suture,  and 
a  tube  connected  with  a  removable  rubber  bag  was  tied 
into  the  upper  part  of  the  sigmoid.     The  lower  part  of 
the  sigmoid,  with  an  area  of  meso-sigmoid  extending 
well  beyond  any  glandular  infection,  with  the  rectum 
and  meso-rectum,  were  all  freed  from  their  attachments 
the  greatest  care  being  taken  to  remove  any  secondair 
focus  of  infection.     The  abdominal  wound  was  dosed 
except  where  the  proximal  portion  of  sigmoid  escaped 
through  it.     The  patient  was  then  placed  in  the  semi- 
prone  or  lithotomy  position,   and  the  bowel  was  re- 
moved from  belo^'.     Most  of  the  anal  aperture  ms 
closed,  a  plug  of  gauze  being  left  in  for  a  few  days  to 
drain  the  pelvis.     When  removed,  Mr.  Lane  said,  the 
remaining  aperture  either  closes  spontaneously  or  vith 
the  help  of  a  suture. 

The  advantages  of  this  method  are.  in  Mr.  Lane's 
opinion,  (i)  the  complete  removal  of  any  fear  of  infec- 
tion ;  (2)  its  freedom  from  any  discomfort  whatever 
after  the  operation ;  (3)  the  fact  that  tfic  greatest 
possible  benefit  is  obtained  at  a  risk  which  is  probaWy 
less  than  that  incurred  in  the  usually  utterly  inefficient 
method. 


City  Hospital  for  IMsoasM  of  the  Sktai,  DnMin. 

The  annual  meeting  of  this  hospital  was  held  on 
November  30th,  the  Lord  Mayor  of  Dublin  in  the 
chair.  The  report,  which  was  read  by  Dr.  C  IL 
O'Brien,  stated  that  during  the  year  ending  December 
1st,  1904,  the  attendance  of  patients  numbered  65S. 
Fifty-nine  patients  had  undergone  the  light  treat- 
ment. Of  forty-nine  cases  of  lupus,  twenty-nine  had 
been  cured  by  this  treatment.  Of  ten  cases  of  cancer 
treated  by  rays,  three  had  been  quite  cured.  Amoo^ 
those  who  proposed  resolutions  at  the  meetin{[  vere 
Rev.'J.  Burke,  Rev.  P.  Hayden,  and  Dr.  Tobin. 


Dec.  14*  1904^ 


LEADING  ARTICLES. 


Thz  Medical  Press.   635 


HDc  flJcMcal  press  anD  Ctrculan 

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TTbe  AeDfcal  press  atiD  Circular* 


SALUS'POPULI  SUPSBMA  LEX. 


WEDNESDAY.  DECEMBER  14.  1904. 


THE   LONDON  HOSPITAL  ''FUNDS"  AND 
THE  SMALL  HOSPITALS. 
We  axe  glad  to  find  that  at  length  the  Hospital 
Sunday   and   the    King   Edward   VII.    Hospital 
Funds   have  found  a  voice.     As  the  trustees  of 
large  sums  of  money  confided  to  their  care  by  the 
public  they  are  clearly  open  to  criticism  and  should 
be  prepared  at  all  times  to  justify  their  action  in 
particular  instances.     For  our  own  part,  we  have 
always    credited   those  bodies  with  the   highest 
possible  standards  of  aim  and  purpose,  but,  at  the 
same  time,  we  have  never  hesitated  to  point  out 
what  appeared  to  us  to  be  defects  in  pohcy  or  in 
administration.     Our  views  have  been  expressed 
with  nmoderation,  and  we  beg  to  refer  all  who  are  in- 
terested in  this  discussion  to  the  tone  of  our  remarks 
in  a  leading  article  of  November  30th.     It  would 
be  impossible  for  anyone  having  read  that  article 
to  imagine  that  our  position  was  prompted  by 
any  desire  other  than  to  secure  by  means  of  friendly 
criticism  and  suggestion  a  possibly  more  perfect 
justice  in  the  administration  of  the  grants  issued  by 
the  Funds,  and  that  our  opinion  of  the  inherent 
soundness  and  absolute  good  faith  of  those  im- 
portant public  bodies  was  of  the  highest.     Our 
aim,  we  repeat,  is  to  secure  an  administration  of 
the  Funds  that  shall  be  free  from  the  slightest 
suspicion  of  unfairness.    The  Hospital,  an  excel- 
lent journal,  if  not  exactly  a  purely  medical  con 
temporary,  has  assailed  us  in  the  severest  terms 
for     a     chance    expression   in     a   recent   issue. 
The  passage  in  question  spoke  of  the  host  of  small 
but  deserving  medical  charities  that  had   been 
injured  in  reputation  and  in  income  by  not  re- 
ceiving grants  from  the  Sunday  and  the  King 
Edward  Hospital  Funds.    The  word  "  host "  is 
obviously  an  over-statement  that  has  escaped  the 
editorial  vigilance.     The  use  of  the  word  *'  host  *' 
would  hardly  be  warrantable  if  applied  to  the 


whole  of  the  London  hospitals  taken  together. 
Indeed,  so  clearly  has  the  word  been  used  in  error 
that  we  wonder  that  any  experienced  editor  could 
possibly  take  exception  to  a  slip  which  he  is  bound 
to   fall  into  sooner  or  later  in  his  own  columns, 
possibly  and  probably  in  a  far  more  serious  form. 
Indeed,  forbearance    towards    obvious    editoriat 
lapses  is  a  sort  of  unwritten  but  cardinal  law  of 
the  better  kind  of  journalism.     However,  we  have 
no  intention  of  declining  responsibility  for  the 
statement  in  question.   The  Editor  of  the  Hospital 
calls  upon  us  in  the  name  of  responsible  journalism 
to  justify  a  certain  phrase.     In  the  name  of  re- 
sponsible journalism  and  in  support  of  the  honour- 
able traditions  that  have  always  governed  The 
Medical  Press  and  Circular  we  withdraw  that 
phrase  and  regret  that  it  should  have  inadvertently 
crept  into  our  columns.     Sir  Henry  Burdett,  how- 
ever, must  pardon  us  if  we  point  out  that,  having 
disposed  of  this  minor  preUminary,  we  shall  expect 
him  to  answer  the  rest  of  our  criticisms.     If  he 
can  furnish  a  f uU  and  satisfactory  answer  we  shall 
be  pleased  to  reconsider  our  criticisms  and  to  give 
that  fact  the  widest  possible  publicity.     He  must 
not  think,  however,  that  by  pointing  out  a  mere 
inadvertence    he   is   relieved  from  answering  the 
rest  of  the  issues  we  have  raised.    That  method  of 
avoiding  full  discussion  is  not  uncommon  with 
controversialists  of  a  certain  type  who  imagine  that 
to  detect  a  flaw  in  an  opponent's  statements  is  to 
answer  his  whole  question.      Sir  Henry  Burdett 
has  now  come  forward  on  behalf  of  the  King 
Edward  Hospital  Fund.     He  may  be  reminded 
that  similar  criticisms  to  those  under  consideration 
have  appeared  in  this  journal  for  years]  past  but 
have  hitherto  remained  unanswered.     Why,  then, 
should  he  complain  bitterly  because  of  a  delay  of 
a  week  or  two  in  answering  his  triumphant  ex- 
posure of  a  clerical  error  ?     On  the  one  hand,  the 
principles  of  distribution  adopted  by  a  great  public 
trust  have  been  criticised  year  after  year  by  an  old- 
standing  medical  journal,  but  the  editorial  energy 
of  Sir  Henry  Burdett  lay  dormant  until  a  word 
was  used  which  chanced  to  express  in  hyperbole 
more  than  was  warranted  by  facts.     If  the  public 
and  the  medical  world  can  wait  five  or  six  years 
for  an  explanation  of  such  serious  matters  from 
Sir  Henry  Burdett,  surely  he  can  wait  a  week  or 
two  for  the  explanation  of  a  verbal  slip  in  a  jour- 
nalistic article.     It  is  to  be  hoped  that  now  the 
subject  has  been  fairly  launched  before  the  public 
it  will  not  be  allowed  to  drop  before  the  constitu- 
tion and  the  policy  of  the  Hospital  Funds  are  clearly 
stated  and  discussed.  This  result  we  anticipate  with 
some  amount  of  confidence,  as  it  was  only  after 
our  direct  appeal  to  His  Majesty  the  King  that  the 
matters  to  which  we  drew  attention  have  been 
brought  into  the  arena  of  public  discussion.     We 
doubt  not  that  the  well-known  fairness  of  mind  and 
love  of  absolute  justice  of  His  Majesty  will  ulti- 
mately   secure    full    recognition   of  all   medical 
charities,  great  and  small,  by  his  own  Fund.  Other 
matters  raised   in  regard   to   the  Funds  will  be 
dealt  with  in  successive  issues. 


636    The  Medical  Pkess. 


LEADING  ARTICXES. 


Dbc,  14,  1904. 


CENTRAL  BRITISH  RED  CROSS  COUNCIL. 
An  appeal  is  being  made  by  Lord  Knutsford, 
as   chairman  of  the  Central   British  Red   Cross 
Council,  for  personal  and  financial  support  to  be 
given  to  the  excellent  cause  of  which  he  is  the 
official  head.     This  cause,  it  will  be  recollected,  is 
the  preparation  and  organisation,  in  time  ot  peace, 
of   voluntary  agencies    for    supplying    help    and 
reinforcement  to  the  medical  services  of  the  Army 
and  Navy  in  time  of  war.     It  may  be  argued  that 
the  energies  of  those  interested    in  the    welfare 
of  the  sick  and  wounded  in  war  might  be  more 
usefully  employed  in  securing  an  efficient  medical 
department   to    the   two   arms   of   our   national 
defence  than  in  merely  trying  to  supplement  what 
is  defective  in  their  preparations.     And  so  indeed 
it  would  be,  if  every  campaign  that  has  taken  place 
had  not  shown  the  same  waste  of  life  and  intensifi- 
cation of  suffering,  due  to  the  same  causes,  repro- 
duced with  unerring  regularity.     We  need  hardly 
point  out  what  those  causes  are — official  neglect, 
official  short-sightedness,  and  official  incompetency. 
The  price  is  alwa}^  the  same — in  flesh  and  blood — 
and  the  price  is  always  paid.     Reform  schemes  are 
drawn  up  and  improvements  are  set  on  foot  with  a 
flourish  of  trumpets  ;   only  to  dwindle  away  and 
-die  of  inanition  as  soon  as  the  popular  fervoiu"  is 
directed  to  some  other  object.     It  is  of  the  essence 
of  any  scheme  for  properly  serving  the  Army  and 
Navy  with  doctors,  nurses,  hospitals,  and  stores 
that  it  should  be  possessed  of  an  almost  inex- 
haustible amount  of  elasticity,  so  that  as  wastage 
occurs  and  more  troops  are  needed  the  department 
should  be  in  a  position  to  supply  the  medical 
reinforcements  automatically.     A  fixed  department 
with  cut  and  dried  resources  soon  reaches  the  limits 
of  its  capabilities,  and  then  come  haste,  bustle, 
and    blundering,  with   their   accompaniments    of 
extravagance    and  inefficiency.     The  lesson    has 
been  taught  over  and  over  again,  and  as  many  times 
neglected,  so  that  the  only  man  who  could  oppose 
the  necessity  for  such  work  as  the  Central  British 
Red  Cross  Council  are  engaged  upon  would  be  one 
who  is  thoroughly  satisfied  with  the  preparedness 
and  aptitude  of  liie  medical  arms  of  the  Services. 
Such  a  man,  if  he  exist,  must  be  an  incurable 
optimist,  and  may  well  be  excluded  from  the  scope 
of  Lord  Knutsford 's  appeal.     But  to  those  who 
■admire  our  soldiers  and  sailors  and  are  concerned 
for  their  welfare — ^to  those,  that  is,  who  constitute 
the  bulk  of  the  nation — ^the  work  of  the  Red  Cross 
Council  must  be  a  matter  of  deep  concern,  and  one 
worthy    of    substantial    assistance.    The    Council 
was  formed  in  1899  with  the  object  of  co-ordinating 
and  bringing  into  line  the  admirable  Associations 
which  have  sprung  up  sporadically  to  meet  one  or 
another  deficiency  in  the  humanitarian  armament 
of  the  country, butwhich,if  left  to  themselves, must 
unconsciously  overlap  and  duplicate  each  other's 
work.     Fortunately  these .  associations  have  suc- 
ceeded in  obtaining  recognition  from  the  heads 
of  the  Army  and  Navy  through  the  medium  of  the 
<ientral  British  Red  Cross  Council,  and  they  may 
now  be  regarded  as  integral  portions  of  the  country's 


defence.     Everyone,  therefore,  should  fed  caDed 
upon  to  contribute  to  the   maintenance  of  their 
resources  in  finance  and  personnel.    But  though 
the   Red  Cross  Council   is    the   channel  of  com- 
munication between  the  War  Oflice  and  Admiralty 
on  the  one  hand  and  the  voluntary  associations  of 
the  other,  its  position  remains   that  of  a  mm 
channel,  and  it  has  in  itself  no  other  duty  than 
that  of  helping  unofficial  bodies  to  do  their  work 
to  the  best  advantage.     For  this  reason  there  is  no 
little  danger  that  it  may  fail  to  excite  the  intcret 
and  support  that  it  deserves,   and  we  hope  that 
Lord  Knutsford 's  appeal  may  have  the  effect  d 
drawing  subscriptions  to  its  funds  and  of  bringii^ 
forward  the  heading  people  of  counties  and  laripc 
towns  to  aid  in  forming  committees  to  promote  its 
objects.     The    haste    with     which     the    varions 
voluntary   hospitals   were   organised   during  the 
South  African  War  and  the  regrettable  waste  ot 
money  that  that  haste  entailed   in  many  cases  are 
still  fresh  in  the  public  mind,  nor  should  the  want 
of  harmony  and  direction  that  prevailed  as  the 
result  of  these  spasmodic  and  irresponsible  efiorts 
be  forgotten.      No  great  naval  war  in  which  this 
country    has    been    an    active    participator  has 
occurred   within  living  memory,    but   can  it  be 
reasonably  doubted  that  similar  confusion  and  ill- 
directed  energy  would  characterise  efforts  to  aid 
in  mitigating  the  horrors  of  a  long-drawn  out  sea- 
fight  with  a  first-class  power  ?   The  appeal  comes 
at  an  appropriate  moment  when  people  are  just 
recovering  from  the  shock  of  the  Dogger  Bank 
incident  and  the  startUng  suddenness  with  which 
it  brought  home  to  everyone  that  there  is  sometimes 
but  one  step  between  us  and  a  European  conflagra- 
tion.    A  war  with  such  a  country  as  Russia  would 
soon  have  exhausted  the  resources  of  even  the 
reorganised  Army  Medical  Service,  and  the  vdun- 
tary  agencies  would  have  come  forward  to  siip(dy 
the  want  with  their  old  vigour  and,  we  fear,  with 
their   old   want  of  co-ordination.     Si  vis  paam 
para  helium  is  as  true  of  the  humanitarian  as  it  is 
of  the  beUicose  preparations  for  war,  and  the  way 
to  aid  the  sick  and  wounded  when  the  hour  comes 
to  succour  them  is  })y  carefully  organising  in  peace 
time  the  efforts  of  those  who  would  help  to  that 
end.     The  Red  Cross  Council  aims  at  establishiuf 
committees  in  each  county,  which  will  be  left  free 
to  decide  in  what  way  they  wiU  render  assistance— 
whether  by  preparing  auxiliary  hospitals,  hospital 
ships,  convalescent  homes,  or  hospital  trains.    By 
this  plan  full  play  will  be  given  to  local  aptitude 
and  predilection.     We  hope  that  the  response  to 
the  appeal  will  be  commensurate  with  the  natural 
importance  of  the  issues  involved. " 

SOME  ASPECTS  OF  OVERCROWD LVG. 
The  general  report  of  the  Census  Commissioners 
provides  many  interesting  problems  for  the 
sanitarian,  but  we  have  still  to  deal  with  the  moot 
question  of  overcrowding.  The  Census  confirms 
the  growing  inclination  of  the  population  to  leave 
the  country  districts  and  to  flock  to  town.  We 
find  that  persons  occupied  in  agricultural  pursuits 


Dec.  14,  1904. 


NOTES   ON   CURRENT   TOPICS. 


declined  in  numbers  by  6*2  per  cent,  since  1891. 
Even  this  does  not  convey  the  most  serious  aspect 
of  the  phenomenon,  for  we  find  the  decrease  in  the 
number  of  agricultural  labourers  actually  189 
per  cent.  On  the  other  hand  there  was  an  increase 
of  20*4  per  cent,  of  persons  employed  as  gardeners 
and  in  market  gardening.  This  would  show  that 
it  is  high  time  we  should  recognise  the  new  con- 
ditions under  which  agriculture  must  be  pursued 
in  Great  Britain.  The  serious  falling  off  in  agri- 
cultural labourers  mitigated  by  the  increase  of 
other  classes  employed  on  the  land  would  seem  to 
point  unmistakably  to  the  necessity  for  intense 
cultivation.  This  practically  amounts  to  the  need 
for  a  revolution  in  our  system  of  land  tenure.  We 
require  smaller  holdings  and  a  multiplication  of 
allotments.  It  is  clear  that  there  is* a  movement 
to'wards  decentrahsation,  but  this  does  not  really 
mean  that  the  people  are  going  back  to  the  land ; 
the  real  fact  is,  that  large  towns  are  spreading  out- 
wards, the  suburban  population  is  increasing  by 
leaps  and  bounds,  and  we  have  here  one  explana- 
tion of  the  rise  in  cost  of  local  government.  It 
appears  that  the  general  increase  in  town  popula- 
tion was  40  per  cent,  between  1891  and  1901,  as 
against  12-2  per  cent,  between  1881  and  1891. 
The  average  increase  for  all  London  between  the 
two  last  Censuses  was/*  3  per  cent.  There  was ,  how- 
ever, a  decrease  in  the  dwellers  of  Central  London, 
and  also  in  Westminster  and  Chelsea.  On  the  other 
hand  we  are  confronted  with  the  astounding  in- 
crease of  193- 5  per  cent,  in  East  Ham,  105-3  i^ 
Walthamstow,  87- 4  in  Willesden,  61-4  in  Homsey, 
567  in  Leyton,  43- 7  in  Tottenham,  13*5  in  West 
Ham,  and  30*4  in  Croydon.  This  state  of  affairs 
is  not  confined  to  the  Metropolis :  the  same  con- 
ditions are  found  to  exist  in  the  large  industrial 
centres  of  the  provinces.  Birmingham  itself 
shows  an  increase  of  92  per  cent,  only,  but  the 
accumulation  of  the  population  in  the  immediate 
neighbourhood  has  been  far  more  rapid,  and  in 
Kingsfield  and  Northfield  we,  find  an  increase  of 
lOi'S,  at  Handsworth  61 -6,  and  at  Smethwick 
51*1.  At  Liverpool  the  increase  was  8-8  per  cent., 
but  at  Wallasey,  on  the  opposite  side  of  the  Mersey, 
the  increase  was  61 '2,  and  there  is  an  equally 
marked  increase  in  other  suburbs  of  the  great  sea- 
port. In  spite  of  this  agglomeration  of  the  popu- 
lation, there  is  a  distinct  decrease  in  actual  over- 
crowding, that  is  to  say  if  we  take  overcrowding 
to  mean  that  more  than  two  people  inhabit  one 
room.  This  decrease  is  to  be  observed  in  all  parts 
of  the  country,  both  urban  and  rural.  We  will 
deal  with  this  in  greater  detail.  At  the  last  Census 
there  were  6,260,852  houses  inhabited,  which  shows 
an  increase  of  14' 87  per  cent,  since  1891.  The 
houses  "  in  a  state  of  building  "  showed  an  increase 
of  60  per  cent.,  which  is  heavier  than  any  previous 
record.  The  average  number  of  persons  per  house 
in  towns  was  54  and  in  rural  districts  46.  The 
lowest  urban  average  was  4-34  at  Great  Yarmouth, 
and  the  highest  was  8*  8  5  at  Devonport.  The 
average  for  London  was  7*93,  which  compares  with 
7*73  in  1 89 1.     But  the  density  varied  considerably 


The  Medical  Press.    637 


in  different  districts.  For  instance,  in  Stepney 
33  per  cent,  of  the  entire  population  was  living  in  an 
overcrowded  state ;  even  this  was  not  the  worst, 
for  in  one  of  the  parishes,  St.  George 's-in-the-East^ 
the  overcrowded  percentage  was  45.  The  total 
number  of  persons  living  in  an  overcrowded 
condition  was  481,653  in  1891,  dropping  to 
392,414  in  1 90 1,  showing  respectively  an  average  of 
11*2  and  8-2  per  cent,  of  the  total  population. 
This  is  a  result  which,  though  satisfactory,  should 
spur  on  local  authorities  to  do  still  better  in  the 
future.  We  have  heard  a  great  deal  about  the 
alien  invasion,  though  this  is  bad  in  the  results  it 
impels  on  certain  restricted  districts,  the  general 
outcry  has  been  somewhat  exaggerated.  It  is 
true  that  foreign  population  in  our  midst  has- 
trebled  since  1861.  At  the  last  Census  there  were 
106,000  more  than  in  1891.  More  than  half  of  the 
total  were  to  be  found  in  London,  and  20,000  in  the 
adjoining  counties.  The  remainder  of  the  foreigners 
were  almost  entirely  to  be  found  in  the  large  sea- 
port industrial  centres .  While  in  London  generally 
there  were  30  foreigners  for  every  1,000  inhabitants^ 
in  Stepney  there  were  182  foreigners  for  every 
1,000  inhabitants,  which  compared  with  113  in 
1891,  and  57  in  1881.  In  Holbom,  the  proportion 
was  92  foreigners  to  i  ,000  of  the  population.  There 
is,  therefore,  some  justification  for  the  statement 
that  the  presence  of  the  poorer  foreigners  connotes 
overcrowding,  and  although  the  evil  may  not  be 
very  general  or  very  great,  yet  we  know  what 
deteriorating  effects  on  the  whole  population  danger- 
spots  have.  It  is  clear  that  much  still  remains  to- 
be  done  not  only  in  inducing  the  people  to  go  back 
to  the  land,  but  also  in  improving  the  poorer 
quarters  of  our  great  cities.  That  we  have  reduced 
considerably  the  number  of  single  room  tenements, 
and,  in  fact,  all  tenements  with  rooms  below  the 
number  of  five,  should  be  an  incentive  to  greater 
efforts  in  the  future. 


noted  on  Current  Uopic0« 

The  Metropolitan  Hoepital  Sunday  Fund 
and  the  Small  HospitiJs. 

We  have  received  a  letter  from  the  Honorary 
Solicitor  of  the  Metropolitan  Hospital  Sunday 
Fund  calling  in  question  several  statements  that 
have  appeared  in  The  Medical  Press  and  Cir- 
cular. This  action  of  the  Fund  we  welcome  as  a 
preliminary  step. to  full  discussion  of  the  adminis- 
trative policy  of  an  important  public  body.  We 
hope  to  enter  fully  into  the  points  raised  in  an 
early  issue.  Similar  criticisms  have  been  pub- 
lished for  years  past,  but  as  the  Hospital  Sunday 
Fund  has  hitherto  allowed  them  to  be  taken  by 
default  as  granted  in  the  absence  of  any  question 
or  contrary  assertion,  there  can  be  no  over- 
powering need  for  hurry  in  our  reply.  We  note  a 
tendency,  moreover,  on  the  part  of  our  corre- 
spondents to  confuse  issues.  Meanwhile, we  can 
assure  the  Hospital  Sunday  Fund  of  our  complete 
sympathy  and  respect,  which  is  in  no  way  alienated 
by  what  we  conceive,  perhaps  mistakenly,  to  be 


638      Thb  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


Dgc.  14.  1904, 


our  duty  in  inviting  public  attention  to  certain 
points  in  the  policy  of  the  Fund  that  appear  more 
or  less  open  to  improvement.  If  the  Fund  can 
justify  their  system  of  grants  and  of  withholding 
grants  we  shall  be  the  first  to  withdraw  our 
criticisms  and  to  accord  our  hearty  approval. 

Suburban  Sanitation. 

In  no  surroundings  is  there  need  for  more  care- 
ful sanitary  supervision  than  in  the  suburbs  of  our 
large  towns.  They  usually  appear  as  typical 
abodes  of  health,  with  their  roomy  houses,  green 
lawns,  and  clear  skies.  But  just  on  account  of 
this  appearance  of  rude  health,  so  to  speak, 
is  there  the  greater  risk  of  overlooking  the  want 
of  proper  sanitation  and  hygienic  precautions.  It 
is  not  uncommon  to  find,  especially  in  rapidly- 
growing  districts,  that  a  water  supply  or  a  drainage 
•system  is  being  strained  beyond  what  it  can  bear. 
The  sewer  that  was  large  enough  for  a  population 
of  five  thosand  is  inadequate  for  one  of  seven.  It 
is  unusual  to  find  in  suburban  districts  any  rigorous 
attention'  given  to  the  supervision  of  the  food 
supply.  Milk  which  could  not  run  the  gauntlet  of 
the  sanitary  inspectors  in  a  town  may  often  be 
purveyed  without  question  outside  the  town  limits. 
There  is,  again,  but  little  care  taken  as  to  the  site 
of  new  buildings.  Many  are  put  up  with  haste 
on  ill-drained  fields,  or  even  on  rubbish-heaps, 
used  for  filling  quarries  or  sandpits.  Scattered 
here  and  there  between  the  houses  of  the  well-to-do 
are  little  congested  areas  of  dwellings  for  the  poor. 
In  them  the  conditions  are  often  worse  than  in  the 
crowded  tenements  of  the  city,  for  supervision  by 
the  health  authorities  is  more  often  absent.  There 
may  be  no  water  supply,  and  for  sanitary  con- 
venience only  a  privy  which  is  rarely  cleaned.  A 
well  or  pump  in  close  proximity  supplies  the 
•  drinking  water,  and  near  at  hand  is  an  ash-heap 
containing  garbage  of  all  sorts.  This  statement 
of  conditions  is  true  of  many  a  suburban  district, 
though,  of  course,  on  the  other  hand,  many  are 
veritable  health-resorts. 


Human  and  Bovine  Tuberculosis. 

The  last  word  in  the  controversy  as  to  whether 
human  and  bovine  tuberculosis  are  the  work  of  the 
same  or  different  organisms  remains  yet  to  be  pro- 
nounced. Professor  Koch  still  sticks  to  his  guns, 
but  none  of  his  arguments  or  their  own  experi- 
ments have  yet  convinced  the  Royal  Commission 
on  Tuberculosis  that  there  is  any  recognisable 
difference  between  the  organisms.  Indeed,  their 
conviction  as  to  the  identity  of  the  bacilli  is  fairly 
well  established.  It  is  interesting,  therefore,  to 
note  that  the  recent  report  of  the  Imperial  Com- 
mission on  Consumption  appointed  by  the  German 
Government  some  time  ago  asserts  strongly  that 
the  bacilli  are  absolutely  distinct  from  one  another 
biologically,  and  that  one  bacillus  can  never  be 
made  to  develop  or  change  into  the  other.  On 
the  other  hand,  though  they  find  tuberculosis  in 
man  to  be  generally  due  to  the  bacillus  of  human 
tuberculosis,  it  may  in  some  cases  be  caused  by 
the  bovine  bacillus.     In  fifty-six  cases  of  persons 


dead  of  tuberculosis,  they  found  the  homat 
bacillus  in  fifty  and  the  bovine  in  six.  Three  of 
the  latter  were  young  children,  whom  it  is  reason- 
able to  assume  may  have  contracted  the  disease 
from  infected  milk,  and  the  practical  lesson  that 
stringent  precautions  should  be  taken  to  elimiiute 
tubetculous  cows  from  dairy  herds  receives  addi- 
tional confirmation  by  this  finding.  After  Koch's 
startUng  pronouncement  at  the  Intematioiul 
Tuberculosis  Congress  in  London,  there  was  con- 
siderable danger  that  those  who  defied  the  regu- 
lations would  quote  his  authority  to  support  their 
attitude  ;  fortunately,  now  they  will  not  havt 
that  excuse. 


Pneumonia  in  Cliioaso. 

We  drew  attention  not  long  ago  to  the  extra- 
ordinary death-rates  due  to  pneumonia  in  sook 
of  the  American  cities,  and  to  the  attempt  which  is 
being  made  by  a  committee  of  experts  to  disco^Ti 
some  method  of  meeting  this  veritable  scourge. 
In  Chicago  the  deaths  from  pneumonia  make  op 
no  less  than  16  per  cent,  of  the  total,  and  have 
shown  during  the  past  few  years  an  alarming  ten- 
dency to  increase  in  number.  In  fact,  in  1900, 
the  percentage  was  13^,  and  each  year  since 
shows  a  regular  increase.  It  is  but  litde  satisfac- 
tion that  at  the  same  time  as  this  change  has  been 
going  on  there  has  been  a  slight  dinxinution  in  the 
number  of  deaths  from  phthisis,  for  it  is  not  neariy 
enough  to  make  up  for  the  increase  of  the  other 
disease.  It  is,  indeed,  a  discouraging  thing  to 
sanitary  practice  that  at  the  moment  when  we 
seem  to  be  gaining  some  control  over  most  of  the 
infectious  diseases,  pneumonia  denies  all  restraint 
Last  year  in  Chicago  it  caused  50  per  cent,  more 
deaths  than  all  the  other  infectious  diseases  com- 
bined, including  cerebro-spinal  meningitis,  ery- 
sipelas, diphtheria,  influenza,  malaria,  measles, 
mumps,  scarlatina,  small-pox,  typhoid  fever, 
whooping-cough,  and  puerperal    fever. 


The  Action  of  Sufirar  on  the  UteroB. 
Some  of  the  simplest  remedies  he  ready  to  one's 
hand ;  so  close,  in  fact,  that  they  are  persistently 
overlooked.  Many  have  been  the  drugs  used  and 
various  have  been  the  devices  employed  by  the 
harassed  accoucheur  to  expedite  labour,  and  yet 
had  he  known  it  a  lump  or  two  of  sugar  woold 
have  done  all  he  wanted.  At  least,  so  one  would 
gather  from  the  researches  of  Keim,  (a)  who  had 
been  acquainted  with  the  fact  for  six  years,  but 
hesitated  to  make  it  fully  known  tiU  stimulated 
by  Marquis,  another  worker  in  the  same  field. 
Lactose  he  beUeves  to  be  the  most  efficacious  sugar 
to  administer,  and  this  is  readily  absorbed  in  late 
pregnancy  owing  to  the  usual  hepatic  insufficienc}-. 
In  labour,  if  the  os  is  a  long  time  in  dilating,  the 
glycogen  in  the  blood  is  used  up  and  the  uterine 
muscle  needs  more  carbohydrate  to  help  it  in  its 
work.  If  this  deficiency  be  supplied  by  the 
administration  of  sugar,  the  muscle  gains  fresh 
vigour    and    begins    to    contract    with    renewed 

(a)  Archiv,  gm.  de  Mtdi,  September  27feh,  1904. 


Dbc.  14.  1904- 


NOTES    ON    CURRENT    TOPIC&  The  Medical  Peess.    639 


-energy.  The  best  time  to  give  sugar  is  two  and  a 
half  hours  after  dilatation  has  begun  in  multiparae. 
and  three  and  a  half  hours  in  primiparae.  When, 
however,  the  os  has  dilated  considerably,  giving 
more  sugar  hurries  on  the  process  of  labour  mark- 
edly, especially  if  inertia  is  threatening.  A  case 
is  quoted  of  a  multipara,  whose  labours  usually 
lasted  one  or  two  days,  being  given  sugar  fifteen 
hours  after  her  pains  began.  Within  one  hour  the 
child  was  bom.  Stress  is  laid  by  Keim  on  the 
fact  that,  unUke  drugs  such  as  ergot  and  quinine, 
rsugar  is  not  toxic,  is  alwa3rs  available,  and  acts  not 
only  on  the  muscles  of  the  uterus  but  also  on  those 
■of  the  abdominal  wall.  The  prescription  has  the 
added  advantage  of  being  a  palatable  one.  Doubt- 
less the  accoucheur  of  the  future  will  improve  on 
crude  lactose  as  the  vehicle  of  administration  of 
carbohydrate,  as  it  may  happen  that  shortly  a 
box  of  Fuller's  sweets  will  be  deemed  as  essential 
an  item  in  the  equipment  of  the  midwifery  bag 
as  forceps,  chloroform,  and  perchloride  tabloids. 
We  trust  that  the  present  rise  in  the  price  of  sugar 
may  not  interfere  with  the  proper  trial  of  the 
remedy. 

The  Burgioal  Bzamination  at  Bdinbargh. 

It  is  with  considerable  interest  that  the  pro- 
fession will  await  the  further  inspection  of  the  final 
surgical  examination  of  Edinburgh  University 
as  ordered  by  the  General  Medical  Council.  With 
this  pending  it  would  be  unfair  to  make  any  com- 
ments on  the  questions  at  issue,  as  there  are  serious 
differences  of  opinion,  if  not  of  fact,  between  the 
visitor  and  inspector  on  the  one  hand,  and  the 
medical  faculty  of  the  University  on  the  other. 
We  axe  not  precluded,  however,  from  criticising 
the  method  and  manner  of  the  report  of  the  visitor 
and  inspector.  These  gentlemen,  who,  no  doubt, 
have  performed  a  difficult  duty  with  perfect 
honesty  and  bond  fides,  seem  to  have  given  an  un- 
usually wide  meaning  to  the  terms  of  their  com- 
mission. They  took  no  steps  to  discover  the  lines 
laid  down  for  their  guidance  in  the  Standing 
Orders  of  the  Council,  and,  in  consequence,  they 
erred  both  by  omission  and  commission.  On 
the  one  hand,  they  have  not  kept,  at  any  rate  as 
official  documents,  diaries  of  their  inspection,  and 
have  therefore  been  unable  to  point  to  specific 
instances  of  the  general  faults  of  which  they  speak. 
On  the  other,  they  include  in  their  report  a  quan- 
tity of  extraneous  matter  in  the  way  of  general 
discussion  of  the  ideals  of  medical  education  and 
examination.  Under  the  circumstances,  the 
General  Medical  Council  has  had  practically  no 
alternative  but  to  order  a  re-inspection  of  the 
surgical  examination  at  Edinburgh.  We  may  add 
that  it  is  fortunate  for  Sir  George  PhiUpson  and 
Mr.  Bryant  that  they  had.  not  to  submit  their 
report  for  the  criticism  of  the  Regius  Professor 
at  Cambridge  or  any  other  medical  stylist.  Many 
of  their  sentences  are  so  long  and  complicated 
as  to  recall  vividly  the  famous  letters  a  certain 
peer  addressed  to  the  Times  a  few  years  back  on 
ecclesiastical   subjects. 


Bed  Gross  Work  in  Japan. 

Miss  McCaul,  in  her  recently  published  book 
on  her  experiences  in  Japan  and  Manchuria,  gives 
an  account  of  the  organisation  of  the  Japanese 
medical  department  which  should  make  the 
mouths  of  our  reformers  water.  Miss  McCaul  was 
sent  to  Japan  to  inspect  their  Red  Cross  work  in 
actual  operation,  and  thanks  to  the  courtesy  she 
received  she  was  able  to  make  a  pretty  complete 
study  of  it.  The  chief  reason  of  her  success  lay 
apparently  in  her  assuring  the  authorities  that  she 
*'  had  come  to  learn  and  not  to  teach,"  and  as  our 
little  allies  take  a  considerable  pride  in  their  work, 
and  resent  being  patronised,  this  declaration  acted 
as  the  "  open  sesame "  of  the  hospital  doors. 
What  struck  Miss  McCaul  particularly  was  that 
the  Red  Cross  Society  is  a  great  national  organisa- 
tion permeating  every  class  in  the  country  ;  none 
are  too  noble  and  none  too  poor  to  be  influenced 
by  it.  One  plain  **  nurse  "  that  Miss  McCaul  met 
afterwards  proved  to  be  the  Marchioness  Nab6- 
shimd — a  lady  of  high  rank  and  distinction.  But 
although  nursing  sick  soldiers  is  regarded  as  a 
pleasure  and  a  duty  by  ladies,  Manchuria  does  not 
seem  to  suffer  from  Sir  Frederick  Treves'  "  plague 
of  women."  for  all  the  women  know  how  to  do 
their  work  and  make  it  their  business  to  carry  it 
out  without  regarding  their  toilettes  and  prospects 
of  getting  husbands.  Great  care  is  bestowed  on 
the  preparation  and  transport  of  food,  whilst  all 
along  the  route  arrangements  are  made  for  the 
soldiers  to  fill  their  water-bottles  with  sterilised 
water.  When  one  compares  their  enlightened, 
scientific,  and  orderly  procedures  in  all  these 
essential  points  with  the  scurry  and  muddle  of  the 
South  African  War,  one  is  forced  to  admit  that 
new  civiHsations  have  advantages  which  are 
denied  to  older  ones.  It  would  be  rather  humi- 
liating to  ask  Generals  Oyhama  or  Kuroki  to  take 
charge  of  our  War  Office  for  five  years ;  but  we 
are  inclined  to  think  that  worse  suggestions  might 
be,  and  have  been,  made  in  connection  with  Army 
reform. 


The  Public  Health  Laboratory  at  Boston. 

No  right-minded  person  thinks  of  questioning 
the  dogma  that  "  Boston  is  the  hub  of  the  uni- 
verse." It  is  a  necessary  consequence  that  its 
new  bacteriological  laboratory  **  licks  creation." 
Seriously,  the  organisation  of  public  health  work 
in  Boston  is  as  admirable  a  sjrstem  as  has  yet 
been  devised,  and  the  description  of  the  laboratory, 
as  given  in  one  of  our  American  contemporaries,  (a) 
is  enough  to  rouse  the  envy  of  our  sanitary  officials 
at  home.  The  laboratory  supplies  medical  men 
with  outfits  to  procure  specimens  of  suspected 
sputum,  membranes,  blood,  and  so  on,  and  these 
are  distributed  from,  and  collected  at,  various 
stations  throughout  the  city.  An  ingenious 
device  is  made  use  of  to  obviate  delay  in  the  exa- 
mination of  diphtheria  specimens  which  arrive 
after  closing  time.     The  laboratory  closes  at  six, 

(a)  Bo8ton  Med.  and  Surj.  Journ.,  November  10th,  1904. 


640    Th«  Medical  Press,  NOTES    ON    CURRENT    TOPICS. 


but,  side  by  side  with  a  big  box  for  receiving  other 
specimens  is  a  chnte  for  diphtheria  specimens 
which  leads  directly  into  a  small  incubator.  By 
this  means  an  examination  can  be  made,  and  a 
report  given  as  soon  as  the  laboratory  opens 
in  the  morning. 


The  Study  of  Ghreek. 

The  question  of  demanding  Greek  as  a  compul- 
sory subject  from  students  entering  the  ancient 
Universities  has  come  up  again  in  practical  form. 
Oxford   has   already  voted   on  the  matter,   and 
Greek  is  to  remain  obligatory  on  the  banks  of  the 
Isis.     Cambridge,  however,  has  not  yet  registered 
its  opinion;  but  along  and  interesting  debate  has 
taken  place  on  the  report  of  the  Studies  and  Exami- 
nations Syndicate  containing  the  proposal.     To 
medical  men  the  question  is  interesting  principally 
as  affecting  candidates  for  scientific  and  medical 
degrees,  and  there  will  be  few,  we  think,  who 
would  be  in  favour  of  requiring  a  man  who  has 
shown  a  marked  aptitude  for  the  natural  sciences 
to  be  forced  to  present  a  smattering  of  Greek  as 
a  preliminary  to  the  serious  study  of  his  life.     The 
difficulty   of   the   Greek  language   is   admittedly 
great,  and  the  amount  of  ground  that  has  to  be 
broken  in  the  way  of  grammar  and  accidence  before 
any  possible  acquaintance  can  be  made  with  the 
authors  in  the  language    demands  years  of  close 
and  attentive  study.     It  is  beyond  dispute  that 
the  disciplinary  value  of  such  study  can  be  ob- 
tained in  many  other  ways,  all  of  which  would  place 
the  student  in  a  position  of  more  practical  advan- 
tage than  that  of  being  able  to  hammer  out  a 
mediocre  translation  of  Thucydides  or  Homer  with 
the  aid  of  a  dictionary  and  a  grammar.     It  is  a 
compUment  to  Greek  and  Greek  scholars  to  admit 
that  proficiency  in  the  language  is  reserved  for  the 
few,  and  we  are  glad  to  see  that  the  Master  of 
Trinity  and  the  Provost  of    King's  recognise  the 
superior  advantages  of  other  studies  for  men  whose 
minds  are  cast  in  a  different  mould  from  their  own. 
It  is  much  to  be  hoped  that  if  the  whole  of  the 
Syndicate's  recommendations  are  not  carried,  the 
plan  advocated  by  the  President  of  Queen's  may 
be  adopted,  and  that  while  Greek  remains  com- 
pulsory for  men  seeking  an  Arts  degree,  an  alter- 
native degree,  namely,  a  B.Sc,  may  be  created  for 
science  students. who  would  not  have  to  pass  in 
Greek  as  a  compulsory  preliminary  to  working 
for  it. 


B€K)teria  in  the  Stomach. 
No  cUnical  investigation  of  a  case  of  gastric 
disease  is  now  complete  unless  a  chemical  exami- 
nation of  the  contents  of  the  stomach  be  made. 
The  value  of  this  is  rightly  insisted  upon  by  those 
who  endeavour  to  place  the  affections  of  this  organ 
upon  a  scientific  basis.  Microscopical  examination 
of  the  material  thus  provided  is  of  equal  import- 
ance, for  the  recognition  of  undoubted  cancer  cells 
may  be  the  only  way  of  confirming  a  hitherto  doubt- 
ful diagnosis  of  malignant  disease.  Now  it  seems  as 
if  a  bacteriological  investigation  is  also  necessary  if 
the  physician  is  to  have  a  right  comprehension  of  the 


Pec.  f4«  1904 


case  under  his  charge.  The  appearance  of  saidna? 
and  tonilae  has  been  held  to  be  valuable  evidence 
of  the  existence  of  fermentative  conditions  within 
the  stomach,  whether  in  certain  varieties  of  dys- 
pepsia or  in  simple  dilatation  of  the  organ.  Dr.  EL 
Palier,  of  New  York,  working  in  Berlin,  has  cxanu- 
mined  thirteen  samples  of  gastric  juice  from  diffe- 
rent classes  of  stomach  disease.  The  results  of 
the  bacteriological  tests  which  he  has  conducted 
with  a  view  to  further  elucidating  the  pathokigy 
of  dyspepsia  and  carcinoma  are  most  instructive. 
Thus,  in  all  cases  of  malignant  disease  staphyio- 
cocci  were  found  in  great  abundance.  The  so- 
called  lactic  acid  bacillus,  the  same  organism  as  is 
concerned  in  the  souring  of  milk,  is  fonnd  to  possess 
a  ffagellated  extremity,  and,  because  it  is  not  a 
straight  rod  but  bent  in  the  middle,  the  author 
would  apply  to  it  the  name  of  Vibrio  geniculatus 
ventriculi.  This  germ  wiU  develop  well  in  any 
medium  which  is  deficient  in  hydrochloric  add,  so 
that  it  is  found .  plentifully  in  carcinoma.  In 
cases  of  hyperchlorhydria,  on  the  contrary,  this 
organism  is  absent,  but  different  varieties  of  yeast 
fungi  and  sarcinae  flourish  instead.  These  lattcr 
are,  of  course,  absent  in  cancer.  A  knowledge, 
therefore,  of  the  flora  of  the  stomach  will  probably 
be  of  some  assistance  to  the  physician  as  well  as 
to  the  surgeon. 

Alcohol  and  Tremor. 
A  FINE  muscular  tremor  of  a  static  character  is 
generally  considered  to  be  one   of   the   signs  ot 
chronic  alcohoUsm.     When  nervous  control  is  im- 
paired to  such  a  degree  that  the  condition  becomes 
practically  chronic,  the  tremor  can  be  reUeved  np 
to  a  certain  point  by  greater  indulgence  in  the 
drug.     The  popular  idea  that  alcohol   "  steadies 
the  nerves,"  which  is  stiU  only  too  prevalent,  has 
probably  arisen  from  a  knowledge  of  its  action  id 
this  respect.     The  tremor  produced  in  this  manner 
is  toxic  in  nature,  acting  through  the  nervous  sys- 
tem, though  when  once  well  established  it  is  diflS- 
Cult  to  distinguish  from  other  varieties  of  nervous 
tremor.     It  would  appear  that  alcohol  may  occa- 
sionally be  of  some  therapeutic  value  in  controlling 
tremors  of  a  totally  different  origin.     The  case  re- 
corded by  M.  Mayet  (a)  is  worthy**  of  note  in  this 
respect.     The  patient  was  a  man,  aet.  52,  who  pre- 
sented  the   symptoms   of   disseminated  sclerosis, 
from  which  he  had  suffered  for  many  years.     The 
vohtional  tremors  were  very  severe,  so  that  eating 
and  drinking  were  difficult.     The  man  had  found, 
however,  that  these  movements  were  almost  en- 
tirely controlled  by  drinking  a  large  quantity  of 
wine  ;   at  any  rate,  he  was  by  its  means  enabled 
to  earn  his  Uving  as  a  labourer.     He  had  other 
signs  of  alcoholism,  such  as  impaired   digestion, 
disturbed  dreams,  and  occasional  excitement.    An 
attempt  was  made  as  soon  as  he  came  under  medi- 
cal observation    to    substitute  some  other   drug 
for  alcohol  in  order  to  lessen  the  amplitude  and 
intensity  of  the  intentional  tremors  associated  with 
his  nervous  disease,  but  each  one  was  a  failure- 

(a)  Lyon  ire4(ca2r,  Nov  ember  trth,  190i. 


Dgc.   14,  I904» 


PERSONAL. 


The  Medical  Pbess.    64  c 


Alcohol  was  the  only  thing  that  appeared  to  con- 
'trol  them  to  anything  hke  a  reasonable  extent. 
The  raison  d'etre  of  its  action  in  this  case  is  not 
obvious,  and  it  can  hardly  be  supposed  that  the 
l>eneiicial  results  will  be  permanent. 

Alterations  in  Examination  of  the  Boyal 
University,  Ireland. 
The  Senate  of  the  Royal  University  of  Ireland 
has  decided  upon  an  important  alteration  in  the 
examination  for  medical  degrees  held  by  the  Uni- 
versity.    Up  to  the  present  the  system  of  examina" 
tion  has  been  that  first  a  general  examination  for  all 
candidates  is  held,  and  that  all  candidates  who  ob- 
t:ain  over  a  certain  p)ercentage  of  marks  are  allowed 
to  present  themselves    for  a  further  honours  ex 
amination.     The  actual  awards  of  honours  and 
exhibitions  are  then  made  on  the  results  of  this 
honorary  examination.     This  system  has  met  with 
adverse  criticism  from  both  examiners  and  stu- 
dents for  a  considerable  time,  and  various  efforts 
have  been  made  to  have  it  altered.     In  future 
two   separate   examinations   will   be   held   simul- 
taneously, one  for  pass  candidates  only,  the  other 
^or  honours  candidates  only.   When  entering  for  the 
examination,  each  candidate  must  state  at  which 
of  these  examinations  he  elects  to  present  himself. 
.A  candidate  who  has  entered  for  the  honours  exa- 
xnination  may  be  allowed  to  change  to  the  pass 
examination  on  giving  a  satisfactory  reason  fcr 
doing  so,  at  least  one  week  before  the  date  of  exa- 
mination, but  under  no  circumstance  will  a  candi- 
date who  has  entered  for  the  pass  examination  be 
allowed  to  change  to  the  honours  examination. 
Honours  and  exhibitions  will  be  awarded  on  the 
results  of  the  honours  examinations  alone.     It   is 
impossible  to  offer  a  de^nite  opinion  on  the  merits 
of  this  system  until  it  has  been  tested,  but  we  are 
of  opinion  that  it  is  preferable  to  the  previous 
examination.     We  are,  however,  further  of  opinion 
a  rule  ought  to  have  been  added  to  the  effect  that 
candidates  who  had  failed  on  a  previous  occasion 
to  satisfy  their  examiners  at  either  the  pass  or  the 

honours  examination  should  not  be  allowed  to 
subsequently  present  themselves  for  the  honours 
■examination.  Honours  and  exhibitions  should 
"be  reserved  for  the  most  deserving  candidates, 
and  the  most  deserving  candidate  is  not  the  man 
who  has  been  rejected  at  a  previous  examination. 


The  Earl  of  Derby,  K.G.,  presided  at  the  first  dinner 
of  the  Manchester  Medical  School  af  er  its  amalgama- 
tion with  the  newly  founded  University  of  Manchester. 

Professor  Arthur  Robinson,  of  King's  College, 
London,  has  been  appointed  to  the  Chair  of  Anatomy 
at  the  University  of  Birmingham,  in  succession  to 
Professor  B.  C.  A.  Windle,  now  President  of  Queen's 
College,  Cork. 

The  Wilhelm  Order,  which  is  awarded  in  recognition 
of  services  rendered  in  the  cause  of  the  public  welfare, 
has  been  conferred  on  Professor  Robert  Koch. 


It  is  reported  that  Dr.  William  H.  Welch,  Professor 
of  Pathology  at  Johns  Hopkins  University,  Baltimore, 
will  succeed  Professor  Osier  in  the  Chair  of  Medicine. 


Dr.  J.  M.  English,  New  Westminster,  British 
Columbia,  has  been  appointed  Resident  Physician  at 
Quesnel,  in  place  of  Dr.  A.  P.  Morgan,  who  has  re- 
signed. 


Dr.  Hindle,  who  has  ceased  practice,  and  is  leaving 
Askem,  in  Yorkshire,  was,  on  Thursday  last,  with  his 
wife,  the  recipient  of  several  handsome  presentation 
gifts  from  friends  and  patients. 

Mr.  John  Tweedy,  the  President  of  the  Royal 
College  of  Surgeons,  on  the  6th  instant  unveiled  a 
window  which  has  been  erected  in  memory  of  Mr. 
William  Cadge,  Fellow  of  the  Royal  College  of  Surgeons, 
in  Norwich  Cathedral. 


The  United  Hospitals  Clinical  School  of  Liverpool 
held  its  first  annual  dinner  at  the  Adelphi  Hotel  on 
December  3rd,  Dr.  William  Carter,  J. P.,  Senior  Phy- 
sician to  the  Royal  Southern  Hospital,  being  in  tne 
chair. 


At  a  recent  meeting  of  the  Liverpool  Medical  Institu- 
tion, Mr.  E.  R.  Bickersteth,  F.R.C.S.,  formerly  presi- 
dent of  the  institute,  and  this  year  president  of  the 
Royal  Infirmary,  was  cordially  congratulated  on  the 
completion  of  his  fiftieth  year  of  membership  of  the 
institution. 


Mr.  Priestley  Smith  has  resigned  the  appointment 
of  Honorary  Ophthalmic  Surgeon  to  the  .  Queen's 
Hospital,  Birmingham,  to  the  great  regret  of  every- 
body connected  with  the  institution. 

Professor  Debove  has  been  unanimously  re-elected 
Dean  of  the  Medical  Faculty  of  the  University  of 
Paris. 


PERSONAL. 


It  is  stated  that  his  Majesty  the  King  on  his  visit 
to  Manchester  next  spring  will  take  part  in  the 
inaugural  ceremonies  of  the  Sanatorium  for  Consump- 
tion in  Delamere  Forest,  an  institution  which  owes 
its  existence  to  the  generosity  of  the  late  Mr,  W.  J. 
■Crossley. 


Mr.  George  C.  Franklin,  Surgeon  to  the  Leicester 
Royal  Infirmary,  will  deliver  his  Presidential  Address 
to  the  British  Medical  Association  meeting  at  Leicester 
on  Friday,  July  25th.  1905. 

The  address  in  Medicme  at  the  Leicester  Meeting 
will  be  delivered  by  Dr.  Henry  Maudsley,  and  the 
address  in  Surgery  by  Mr.  C.  J.  Bond,  of  Leicester. 


Professor  Arnold  Heller,  Director  of  the 
Institute  of  Morbid  Anatomy  at  Kiel,  has  been  elected 
Rector  Magnificus  of  that  University. 


As  previously  announced  in  this  journal  the  Nobel 
Prize  award  for  Chemistry  has  this  year  been  made  to 
Sir  William  Ramsay,  Professor  of  Chemistry  at  Uni- 
versity College.  The  sum  of  money  attached  to  each 
prize  is  about  ;{7,825. 

King  Oscar  of  Sweden  made  the  Nobel  Award 
in  Physics  to  Lord  Rayleigh,  Professor  of  Philosophy 
at  the  Royal  Institute. 


On  the  same  occasion  at  Stockholm  the  prize  in 
Medicine  and  Physiology  was  bestowed  upon  M. 
Pavloff,  Professor  at  the  Military  Academy  of  Medicine 
in  St.  Petersburg. 


Professor  Windle,  M.D.,  F.R.S.,  of  the  University 
of  Birmingham,  who  was  recently  appointed  President 
of  Queen's  College,  Cork,  was  honoured  on  Thursday 
last  with  a  public  dinner  under  the  auspices  of  the 
University  at    the    Grand    Hotel,    Birmingham.     Sir 


642     The  Medical  Pkess. 


CORRESPONDENCE. 


Dec.  14,  iQOii. 


Oliver  Lodge,  Principal  of  the  University,  presided 
over  an  en&usiastic  gathering  of  Dr.  Windle's  late 
colleagues  and  friends,  anxious  to  show  their  apprecia- 
tion of  his  work  in  the  past. 

Dr.  Gramshaw,  of  York,  has  been  presented  by  the 
Sheriff  Hutton  Free  Gift  Society  with  a  handsome 
testimonial  bearing  the  inscription — "  Presented  to 
F.  Sidney  Gramshaw,  M.D.,  F.R.C.S.Edin.,  as  a  token 
of  respect  and  esteem  for  nearly  thirty  years  of  faithful 
service. 


Special  Correepondence. 

(from  our  special  correspondent.) 


SCOTLAND. 

Leukemia  and  Allied  Diseases. — On  Thursday 
last  Professor  Muir,  of  the  University  of  Glasgow, 
delivered  an  instructive  address  before  the  Glasgow 
Medico-Chirurgical  Society  on  this  subject.  By  means 
of  the  lantern  he  showed  numerous  slides  of  the  various 
forms  of  cells  and  the  changes  they  undergo  in  the 
medullary  form  of  leucocythxmia  or  what  has  often 
been  called  spleno-medullary  leukaemia,  as  well  as  in 
the  lymphoid  form  of  the  disease.  In  the  course  of  his 
address  Professor  Muir  stated  that  while  in  the  chronic 
forms  of  the  disease  the  rule  was  to  find  the  spleen 
much,  and  oftentimes  enormously  enlarged,  in  other 
cases  where  the  disease  ran  its  course  rapidly  there 
might  be  very  slight  enlargement  of  the  spleen.  Further 
the  enlargement  of  that  organ  was  due  to  the  multipli- 
cation of  the  cells  or  corpuscles  and  not  to  any  marked 
fibroid  change  in  the  enlarged  spleen.  Coming  to  the 
diseases  allied  to  leukaemia  he  referred  to  Hodgkin's 
disease,  and  to  the  confusion  which  has  long  existed 
with  regard  to  the  numerous  terms  applied  to  the 
general  enlargement  of  the  lymphatic  glands  through- 
out the  body,  such  as  lymphadenoma,  lymphoma, 
lympho-sarcoma,  etc.  In  this  form  of  disease  the  cell 
proliferation  was  not  so  pronounced  as  in  leukaemia, 
and  there  was  certainly  a  distinct  tendency  to  connec- 
tive tissue  growth — to  a  fibroid  condition — existing 
in  a  marked  degree.  1 1  was  his  opinion  that  there  was 
an  infective  process  at  work  in  Hodgkir/s  disease,  and 
that  it  was  not  of  a  tuberculous  character.  He  made 
reference  to  the  Transactions  of  the  Pathological 
Society  of  London  in  1878,  on  this  subject,  and  to  the 
writings  of  several  American  authors  with  whose  views 
he  was  disposed  to  agree.  •  Drs.  Workman,  Lindsay 
Steven,  and  Hunter  took  part  in  the  discussion  which 
followed,  and  generally  expressed  themselves  as  in 
complete  agreement  with  the  conclusions  arrived  at  by 
Professor  Muir,  that  while  no  organism  had  yet  oeen 
found  as  the  cause  of  the  disease,  that  it  was  at  least 
not  a  tuberculous  process.  On  the  motion  of  the 
chairman.  Dr.  R.  M.  Buchanan,  a  hearty  vote  of  thanks 
was  accorded  Professor  Muir  for  his  instructive  address 
which  was  listened  to  by  an  unusually  large  number  of 
members  of  the  Society. 

The  Glasgow  Medical  Club. — For  some  years 
there  existed  in  the  city  on  the  south  side  of  the  River 
Clyde,  what  was  called  the  Southern  Medical  Club,  the 
membership  of  which  was  composed  largely  but  not 
exclusively  of  medical  men  belonging  to  the  southern 
district  of  the  city.  A  short  time  ago  it  removed  its 
habitation  to  much  more  commodious  premises  situated 
at  22;  Carlton  Place.  The  name  of  the  club  has  been 
changed  to  "  The  Medical  Club,"  with  the  intention  of 
embracing  within  its  membership  as  many  members 
of  the  profession  throughout  the  city  and  the  suburban 
districts  as  can  be  prevailed  upon  to  join.  The 
subscription  is  £1  is.  per  annum,  without  any  entrance 
money.  There  is  a  large  room,  forming  the  library, 
which  is  admirably  adapted  for  holding  medical  society 
meetings.  It  is  there  the  Southern  Medical  Society 
holds  its  meetings  every  alternate  Thursday  evening. 
It  is  also  equipped  with  a  billiard  room,  as  well  as  a 
card  room,  and  ample  accommodation  for  caretaker. 
Since  removing  to  the  new  premises  a  considerable 


accession  to  the  membership  has  t>een  made,  the  nev 
members  being  drawn  from  the  different  districts  of  tbf 
city.  It  is  hoped  that  many  others  may  see  their  vav 
to  join,  and  when  the  existing  lease  expires,  as  it  does  b 
four  years,  still  larger  and  more  central  premises  in  tk 
centre  of  the  city  may  be  procured.  There  is  no  reason 
why  Glasgow,  with  over  six  hundred  medical  ma 
practising  in  the  city  and  suburbs,  should  not  have  a 
large  and  flourishing  club  where.  x>erhaps,  the  varioos 
medical  societies  could  hold  their  meetings,  and  whor 
country  members  might  find  comfortable  accommodi. 
tion  if  required  when  visiting  the  city,  with  the  advaa- 
tageof  friendly  intercoursewith  their  fellow  practitiooeti 
The  club  is  managed  by  general,  house,  library,  aal 
amusement  committees.  It  is  proposed  to  set  apat 
one  evening  of  the  week  as  a  "  house  "  night,  and  to 
have  occasional  social  evenings.  One  snch,  heU 
recently,  was  a  great  success,  the  musical  talent  beio; 
quite  up  to  the  average  if  not  beyond  it  of  snch  gather- 
ings. With  a  further  increase  in  the  membei^hipaf 
the  club  its  sphere  of  usefulness  would  be  lar^ 
extended,  and  the  interests  of  the  profession  might, 
perhaps,  be  more  strictly  conserved  than  at  preseo! 
obtains.  This  would  at  least  be  one  way.  and  a 
pleasant  one,  of  arriving  at  the  accomplishment  of  sdcIi 
a  very  desirable  end. 

Corredpotidettce. 

r W«  do  not  hold  ounelvot  naponsibie  for  the  o|>iniQai  ^m 
Ck>rrespondeiit8.  ] 


HOSPITAL    FUNDS    AND    SMALL    HOSPITALS. 
To  the  Editor  0/  The  Mkdicai,  Press  and  Cncuui. 

Sir, — ^This  question  is  well  worth  full  discnssioD 
It  would  be  interesting  if  "  A  Sn?all  Hospital  Physkas* 
would  clearly  explain  what  he  means  when  he  write 
that  "  under  the  conditions  that  rule  the  ho^tal 
medical  world  of  London,  the  only  chance  for  anr 
man  not  born  into  the  purple  Ues  in  obtaining  aa 
appointment  at  a  small  special  ho|8pital."  S]wcial 
departments  exist  at  all  general  hospitals ;  and  if  thr 
unnecessary  special  hospitals  were  closed  these  depait- 
ments  would  be  enlarged,  and  their  staffs  increased 
to  meet  the  demand  upon  them.  Does  your  corre- 
spondent mean  to  imply  that  appointments  to  the 
staff  of  general  hospitals  are  made  with  regard  to 
anything  save  the  professional  attainments  and 
personal  qualities  of  the  candidates.  The  appoint- 
ments are  controlled  by  professional  opiniOB.  and 
governed  by  the  merit  displayed  throughout  a  career 
under  the  eyes  of  future  colleagues  when  the  candidate 
is  an  old  student  of  the  hospital,  or  well-known  bi* 
careful  inquiry  when  an  outsider.  The  personal 
character,  the  professional  ideals,  the  scientific  and 
practical  work  and  attainments  of  applicants  for 
special  appointments  at  general  hospitals  are  thonragfahr 
understcxxi  by  those  having  the  gift  of  the  posts; 
and  the  danger  of  the  offices  being  filled  at  the  wont 
by  ignorant  adventurers,  or  at  the  best  by  men  haviii 
no  valid  claim  to  the  title  of  specialist  is  in  tbe^e 
institutions  reduced  to  the  lowest  possible  point.  It 
is  not  less  to  the  interest  of  the  poor,  the  public,  aad 
the  profession,  as  weU  as  of  progress  in  medical  sdeoce 
that  professors  of  specialism  should  present  ample 
guarantees  of  their  claims  to  recognition  and  distinc- 
tion ;  and  these  guarantees  are  not  provided  noder 
the  conditions  which  exist  at  the  great  majority  d 
special  hospitals. 

I   am.   Sir,    yours   truly, 

Cavendish  Square,  Henry  Sewill 

December  7th,   1904. 


CELLULOID    COMBS. 

To  the  Editor  of  The  Medical  Press  and  Circuiii. 
Sir,—- On  page  610  of  Thb  Mbdical  Pkess  ixi> 
Circular  you  kindly  sent  me,  you  say,  in  ooooectioi 
with  celluloid  combs,  "  unrecognisable  ascellaloidasw 
to   the  expert  in  such  matters."     May  I  call  ywr 


I^nc  14,  1904. 


LITERATURE. 


Tbs  Mkdical  Puss.    643 


attention  to  a  method  of  detection  which  occurred  to 
ntie,  and  which  is  as  simple  as  I  believe  it  to  be  infallible : 
Heat  a  metal  skewer  in  a  candle  flame,  touch  the  comb 
>^th  it.  and  smell  the  fumes.  If  the  article  is  tortoise- 
ihell,  the  smell  is  of  burnt  bone»  familiar  in  the  horse- 
shoeing forge.  If  it  is  celluloid,  the  smell  is  sweet  and 
camphoraceous. 

If  you  try  this  method  you  will  at  once  perceive  the 
ii£Eerence.  If  it  is  done  on  the  inside  surface  of  the 
comb,  no  disfigurement  results. 

I  am,  sir,  yours  truly, 
Harold  Nuttall,  M.A.,  M.D. 
Bryn-y-Craig,   Conway  Road,  Colwyn  Bay, 
December  7th.  1904. 

JOHN  KENNEDY,  M.D.R.U.I.,  M.Ch. 

The  death  is  announced,  in  his  66th  year,  of  Dr. 
John  Kennedy,  of  Famham  Place,  Old  Trafford.  Dr. 
Kennedy  took  his  degree  of  Doctor  of  Medicine  in  the 
Queen's  University  of  Ireland  exactly  forty  years  ago, 
and  two  years  later  he  qualified  as  M.Ch.  He  was  one 
of  the  <ddest  and  most  respected  members  of  the  medical 
profession  in  Manchester. 

EDWARD  BATEMAN  HECTOR,  M.D.Edin. 

We  regret  to  announce  the  death  of  Dr.  Edward  B. 
Hector,  of  Castle-Douglas,  who  died  suddenly  on  the 
2nd  inst.  He  returned  from  a  visit  about  four  o'clock, 
and  a  few  hours  later  was  found  in  a  state  of  collapse, 
and  expired  soon  afterwards.  The  deceased,  a  native 
of  Montrose,  took  his  M.B.C.M.£din.  degree  in  1883, 
and  M.D.  in  1902.  Dr.  Hector  had  an  extensive  local 
practice,  and  was  medical  officer  for  the  parishes  of 
Balmaghie  and  Parton.  His  wife,  a  daughter  of  Dr. 
Munro,  Moffat,  died  last  year. 

WILLIAM    G.     VAUDREY      LUSH,       M.D.Lond., 
F.R.C.P.LOND.N 

I>R.  W.  G.  Vaudrey  I-ush,  physician  at  the  Dorset 
County  Hospital,  died  at  Weymouth,  on  December 
7  th.  He  had  just  addressed  a  meeting  of  the  committee 
at  the  hospital  when  he  fell  from  his  chair  and  expired. 
Dr.  Lush,  who  took  an  M.B.  degree  with  a  treble  first 
class  in  1865,  and  that  of  doctor  of  medicine  at  London 
University  in  the  following  year,  was  one  of  the  bes  t- 
known  practitioners  in  Dorset.  He  was  an  active 
Churchman  and  county  secretary  of  the  Queen  Victoria 
Clergy  Fund,  and  leaves  behind  him  a  Targe  circle  of 
friends  and  acquaintances.  He  made  numerous 
contributions  to  medical  literature. 
CHARLES  WILLIAM  CHALDECOTT,  M.R.C.S.Eng., 
L.S.A. 

With  much  regret  we  announce  the  death  of  Mr. 
Charles  William  Chaldecott,  of  Dorking,  Surrey,  on 
November  5,  at  the  age  of  seventy-six.  He  received  his 
professional  training  at  St.  Thomas's  Hospital,  where 
lie  studied  from  1848  to  185 1,  and  distinguished  himself 
much  as  a  student.  In  185 1  he  became  qualified  as 
M.R.C.S.Eng.,  and  L.S.A.,  and  took  over  his  father's 
practice  at  Dorking.  Until  his  retirement  in  1 901,  no 
less  a  period  than  fifty  years,  Mr.  Chaldecott  was  in 
the  active  pursuit  of  a  large  practice.  He  was  twice 
maxried,  his  first  wife,  who  died  in  1866,  being  a  sister 
of  the  late  Sir  John  Simon,  and  he  leaves  a  family  of 
nine  sons  and  daughters.  In  him  the  profession  has 
lost  one  of  the  typical  representatives  of  the  old  school 
of  honourable  medical  men  of  high  social  standing. 
DR.  D.  ASTLEY  GRESSWELL. 

By  telegram  we  have  been  informed  of  the  death 
of  Dr.  D.  Astley  Gresswell  on  December  loth,  at  Mel- 
bourne. The  deceased  was  Chief  Health  Officer  for  the 
Colony  of  Victoria,  an  appointment  he  has  held  some 
fifteen  years,  during  which  he  has  inaugurated  far-reach- 
ing sanitary  improvements  in  the  city  of  Melbourne  and 
throughout  the  colony.  He  was  an  indefatigable 
worker,  and  his  patience  and  persevering  industry  were 
well  known.  He  is  the  au thor  of  a  work  on  ' '  Scarlatina'  * 
and  joint  author  with  his  brother,  Mr.  G.  Gresswell,  of  a 
treatise  on  "  Comparative  Pathology."  He  took  the 
degree  of  M.B.Oxon.,  in  1881,  and  M.D.  of  the  same 


university  in  1889.  He  was  also  a  member  of  the 
Royal  College  of  Surgeons  of  England,  J. P.  for  Victoria^ 
and  was  much  appreciated  as  a  genial,  cultured  man. 

DEATHS  OF  EMINENT  FOREIGN  MEDICAL 
MEN. 
The  deaths  of  the  following  eminent  foreign  medical 
men  are  announced  : — Dr.  W.  Massen,  professor  of  mid- 
wifery and  gynaecology  in  the  University  of  Odessa. 
Dr.  A.  Sanchez  Herrero,  professor  of  clinical  medicine 
in  the  University  of  Madrid.  Dr.  K.  von  Stellwag. 
formerly  professor  of  ophthalmology  in  the  University 
of  Vienna.  Dr.  Albert  Reder  v.  Schellmann,  formerly 
professor  of  dermatology  in  Vienna,  at  the  age  of 
seventy-eight  years.  Dr.  Alfred  Zimmermann,  a 
Vienna  staff  surgeon,  who  was  a  very  experienced 
operator,  especially  in  abdominal  cases.  His  death 
was  due  to  septic  poisoning.  He  was  only  thirty-nine 
years  of  age.  Dr.  Redtenbacher,  one  of  the  medical 
officers  of  the  Vienna  General  Hospital.  Dr.  Hugo 
Mittenszweig,  one  of  the  editors  of  the  Berlin  Zeitschrift 
fiir  Medicinalbeamte.  Dr.  Robert  Langerhans.  privat- 
doceni  of  pathological  anatomy  in  the  University  of 
Berlin.  Dr.  Joaquim  Pereira  da  Cunha,  professor  of 
ophthalmology  in  the  University  of  Rio  de  Janeiro. 


Xiteratttte* 


TRANSACTIONS    OF    THE    MEDICO-LEGAL 
SOCIETY,  (a) 

The  constantly  growing  importance  of  the  relations, 
between  the  two  great  professions  of  law  and  medicine 
has  recently  been  marked  by  the  foundation  of  the 
Medico-Legal  Society.  The  first  volume  of  the  pro- 
ceedings 1ms  just  been  published,  and  contains  some 
papers  of  great  interest .  One  burning  question  appears 
continually  throughout  its  pages,  namely,  the  subject 
of  coroners*  inqnests.  Mr.  Troutbeck  gives  a  very 
interesting  paper  on  "  Inquest  Juries,"  in  which  he 
goes  very  fully  into  their  advantages  and  defects  ;  and 
there  is  no  doubt  that  if  there  were  no  other  advantage- 
except  that  *'  the  jury  constitutes  the  only  practical 
check  on  the  coroner,"  it  would  be  a  mistake  to  try  to- 
abolish  them. 

Dr.  Littlejohn  gives  a  valuable  paper  on  "  Medico- 
Legal  Post-mortem  Examinations,"  which  necessarily 
deals  with  the  same  subject.  Undoubtedly  the  medical! 
profession  feels  that  there  is  too  much  uncertainty,  and 
perhaps  laxity,  in  the  matter  of  having  autopsies  in 
cases  of  sudden  death  ;  but  this  is  owing  to  the  present 
state  of  the  law,  and  it  is  one  of  the  functions  of  such 
societies  as  this,  to  help  to  educate  public  opinion  in 
the  matter,  as  it  is  only  in  this  way  that  reform  can 
be  expected.  But  Dr.  Littlejohn  emphasises  one  point 
that  is  too  often  forgotten  by  teachers  and  students, 
alike — that  no  subject  in  the  curriculum  is  more  neg- 
lected than  medical  jurisprudence.  This  ought  not 
to  be  the  case,  as  no  practitioner  is  able  to  be  certain 
that  he  will  not  at  some  moment  find  himself  involved' 
in  a  case  of  the  first  importance. 

Mr.  Wellesley  Orr  gives  a  short  paper  on  "  Crema- 
tion," showing  its  steady  if  somewhat  slow  increase  in 
popularity.  One  of  the  great  arguments  against 
cremation  has,  of  course,  been  that  destruction  of  the 
body  may  facilitate  crime,  but  Mr.  Orr  enumerates  the 
precautions  taken  by  the  Cremation  Society  to  guard 
against  this  ;  but  even  so  it  will  take  time  to  educate 
the  public  up  to  realising  this,  and  till  then  there  is- 
always  a  risk  that  a  man  might  be  emboldened  to 
commit  a  crime  if  he  knew  that  the  body  was  to  be 
cremated. 

The  price  of  the  volume  is  rather  excessive,  and  the 
Society  would  be  wise  if  they  could  see  their  way  to 
lowering  it,  'so  as  to  increase  the  circulation. 

ASTHMA  IN  RELATION  TO  THE  NOSE.  (*) 
The  greater  part  of  this  little  volume  consists  of  an 


(0)  «'  TTRaBMUont  of  the  Hedioo-Legal  Society  lor  tho  jeftrs 
lOOa.  1903, 1004.    LondontBaimei«,-niMfaill,andCox.    7t.6d.    lOiM. 

(h) .'*  Asthma  In  Bdatlon  to  the  Xoae."  By  Alextiider  Tn^^B . 
M.B.,  B.C.CMiteb.  Pp.  186.  Price  Ot.  net.  London  1  Adlwd  and  Son. 
1908, 


644    Tbb  Mbdical  Press. 


LITERATURE. 


Dec  14,  1904. 


appendix  containing  brief  notes  of  over  400  cases  of 
asthma  treated  by  the  author's  method,  and  we  can 
at  least  say  that  they  supply  ample  primd  facie  evidence 
ol  the  value  of  the  procedure  which  he  has  discovered. 
The  opening  chapters  of  the  book  deal  with  the  etiology 
•pf  the  disease,  Dr.  Francis'  view  being  that  it  is  due  to 
^asm  of  the  bronchial  muscles  induced  by  reflex  action. 
The  question  of  the  relation  of  nasal  lesions  to  asthma 
is  fuUy  dealt  with,  the  conclusion  being  that  asthma 
is  not  directly  due  to  any  mechanical  obstruction  of  the 
nasal  passages,  and  only  rarely  to  reflex  nasal  irritation. 
The  novel  conception  led  up  to  is,  that  in  asthma  a 
morbid  connection  subsists  between  some  part  of  the 
nose  and  the  respiratory  centre,  whereby  that  centre  is 
thrown  into  a  state  of  unstable  equilibrium.  This 
theory  has  been  arrived  at  empirically,  by  the  observa- 
tion of  the  efiect  of  cauterising  the  nasal  septum,  which 
is  the  plan  o^  treatment  advised.  Contrary  to  the 
usual  opinion,  the  author  holds  that  the  prognosis  is  in 
inverse  ratio  to  the  extent  ol  the  nasal  lesion — polypus 
•cases  being  the  least,  and  those  in  which  the  nose  ap- 
pears healthy  the  most,  hopeful.  It  is  impossible  to 
•express  an  opinion  on  the  value  of  the  treatment  until 
further  trial  has  been  made,  but  we  feel  strongly  that 
Dr.  Francis  offers  cogent  reasons  for  the  faith  that  is  in 
him,  and  if  his  treatment  yields  even  half  as  good 
results  in  the  hands  of  others  as  it  has  done  in  his,  he 
need  not  feel  that  his  book  has  been  written  in  vain. 


THOMSON  AKD  MILES'   MANUAL  OF 
SURGERY,  (a) 

The  second  volume  of  this  work,  dealing  with 
*'  Regional  Surgery."  maintains  the  excellent  characters 
-of  the  first  volume  which  we  recently  had  the  pleasure 
-of  reviewing.  One  of  the  best  chapters  is  that  on  the 
"  Kidney  and  Ureter  "  (Chap,  xxxii) ;  in  it  the  more 
recent  metho  Is  of  ascertaining  the  condition  of  the 
kidneys,  such  as  catheterisation  of  the  ureters  and 
cryoscopy,  are  fully  gone  into.  Taking  the  book  as  a 
whole,  there  are  but  few  statements  with  which  we 
have  to  find  fault.  One  such,  however,  occurs  in 
Chapter  xkx\  on  "  The  Rectum  and  Anus,"  where, 
in  dealing  with  carcinoma  of  the  rectum,  the  authors 
say,  "  Pain  is  a  variable  symptom,  but  is  usually 
present,  and  in  some  cases  is  agonising."  This  is  a 
statement  which,  especially  in  a  book  intended  for 
students,  we  cannot  help  thinking  to  be  rather  un- 
fortunate. We  too  frequently  see  carcinomata  of  the 
rectum  that  have  reached  the  inoperable  stage,  and  in 
which  the  patient  has  never  suffered  pain.  If  the 
student  has  been  led  to  regard  pain  as  a  usual  symptom, 
its  absence  may  cause  him,  as  a  practitioner,  to  neglect 
to  make  a  digital  examination  of  the  rectum  until  the 
disease  has  progressed  too  far  for  complete  removal. 

The  book  concludes  with  an  appendix  on  anaesthetics. 
The  authors  prefer  a  chloroform  and  ether  mxture, 
containing  one  part  of  the  former  to  two  of  the  latter 
for  children  under  five  and  adults  over  sixty  ;  but  in 
vigorous  adults  of  from  eighteen  to  forty-five  they  say 
it  is  advisable  to  induce  anaesthesia  with  some  other 
anaesthetic,  owing  to  the  risk  during  the  struggling 
stage. 

The  illustrations  are  not  so  numerous  as  in  the  first 
volume,  but  the  majority  are  exceedingly  good.  One 
•could  not  wish  for  better  illustrations  than  those  show- 
ing the  various  forms  of  hare  lip.  We  can  congratu- 
late the  authors  on  the  way  they  have  completed 
their  work.  1 1  is  one  which  we  can  strongly  recommend 
to  the  practitioner  and  senior  student. 


DEVELOPMENT      AND      ANATOMY  \  OF     THE 
PROSTATE  GLAND,    {b) 
The  author,  in  his  preface,  states  that  this'is'not  a 

(a)  ••  Manual  of  Surgery."  By  Alexis  Thomson,  M.D.,  F.R.C.S. 
Ed.,  and  Alexa&der  llilea,  M.D.,  F.R.C.8.Ed.  Vol.  II.— Regional 
Surgery.  Illustrated  with  156  wood  engravings.  Pp.  728.  Edln- 
baigh :  Toung  J.  Pentlaad.    19  M . 

iby  "  The  Development  and  Anatomy  of  the  Prottate  Gland,  together 
'Wich  an  Aoooant  of  Ita  Injariea  and  Diseams,  and  theiy  Buxgcal 
Treatment '  By  W.  O.  Biohardson.  H.B..  B.H.,  F.B.O.S.  Pp.  ISI. 
46.  (Uiistrations.  Lepdm:  J.  and  A.  Chuichilt.  1901.  Price, 
10s.  6d. 


treatise  upon  the  prostate  and  its  diseases,  bat  is  aa 
essay  which  was  submitted  by  him  for  the  Health 
Scholarship  in  the  University  of  Durham.  The  6at 
frfty  pages  are  devoted  to  a  very  ezceUent  account  ot 
the  anatomy  and  comparative  anatomy  of  the  prostate 
gland.  The  remainder  of  the  volume  coosisu  oC  a 
description  of  chronic  enlargement  of  the  prostate,  iti 
surgical  treatment  and  the  complications  foQo«ia| 
operation,  together  with  a  table  of  thirty-six  cases  ei 
prostatectomy. 

There  is  no  doubt  that  this  essay  deserved  the  prift 
which  was  awarded,  and  we  can  heartily  recommesd  it 
to  surgeons  who  are  interested  in  prostatic  surgerr. 
The  manner  of  treating  the  subject  is  both  interestiEi 
and  instructive.  The  illustrations  are  a  remarkafe 
feature  and  very  valuable,  whilst  the  publishers  desen* 
great  credit  for  the  way  in  which  the  book  has  ba 
turned   out. 


THE  PURIN  BODIES  OF  FOODSTUFFS.    {a\ 

This  work  is  a  re-issue  of  that  given  to  the  medial 
world  in  1903  by  Dr.  Hall.  The  previous  issne  hai 
been  revised,  partially  re-written,  .the  results  of  nom 
investigations  included,  together  with  new  estimatiooi. 
and  the  literature  on  the  subject  has  been  brou^t  i^ 
to  date.  A  chapter  on  the  action  of  drugs  upon  paiia 
excretion  is  also  added. 

This  work  is  the  result  of  the  desire  of  Dr.  Waiko 
Hall  to  further  investigate  "  the  action  of  purin  bodks 
and  their  metabolism,  and  to  discover  some  meaas 
whereby  the  early  pathological  changes  in  certah 
metabolic  disorders  may  be  detected."  To  effect  this 
the  author  first  estimated  the  purin  bodies  present  a 
some  of  the  commoner  articles  of  food,  and  then  ob- 
served their  specific  effects  upon  human  and  aniaa! 
metabolic  processes,  when  injected  subcutaneously,  cr 
when  introduced  per  os, 

Purin  bodies,  or  alloxuric  bodies,  are  substances  cqb^ 
structed  on  the  base  C^  N4,  the  nucleus  C,  N4  havi^ 
been  termed  "  purin "  by  Emil  Fischer.  The  most 
common  purin  bodies  are  hypoxanthin.  xanthia.  one 
acid,  guanin,  adenin,  caffein,  and  theobromine  Alto- 
gether, about  twelve  of  these  bodies  are  known  to  exa 
in  nature,  but  146  have  been  synthetically  prepared  a 
the  laboratory.  After  briefly  explaining  the  compo- 
sition and  properties  of  the  food  purins.  the  author 
explains  the  various  methods  that  have  been  soggested 
for  the  extraction  and  estimation  of  purins.  one  of  the 
main  difficulties  being  to  find  an  efficient  process  for 
removing  the  proteids.  The  author  gives  a  detaikd 
description  of  the  method  he  employed,  and  relates  the 
experiments  he  made  to  show  the  accuracy  of  tkf 
process.  The  quantities  of  purins  in  meat  lootk 
vegetable  foods,  and  beverages  having  been  enumerated. 
he  devotes  a  chapter  to  the  action  of  food  purins  oi 
the  alimentary  and  circulatory  systems,  and  also  at 
the  respiratory,  genito-urinary,  nervous,  and  mascahr 
systems.  Dr.  Hall  then  gives  us  records  of  experi- 
ments, made  upon  himself  and  others,  to  ascertain  the 
comparative  effect  of  purin  bodies  upon  the  prodoctki 
of  carbon  dioxide,  and  of  experiments  showing  tk 
effect  of  daily  injections  of  purin  bodies  in  rabbits. 

A  chapter  is  devoted  to  "  The  Fate  of  Food  Pufinsa 
the  Body,"  and  one  on  "  The  ^Sle  of  Purin  Bodie  ii 
Morbid  Conditions,'*  where  the  author  allows  the 
necessity  for  experiments  affording  information  r^ 
garding  the  nietabolism  of  the  chfldrea  of  gooty 
parents  and  its  alterations  dturing  their  growth.  Mar 
we  hope  that  many  medical  men  who  desire  to  be^ 
forward  medical  research  wUl  assist  those  workers.  Uu 
Dr.  Hall,  who  are  striving  so  hard  to  ^ucidate  tke 
abstruse  subject  of  ROut  ? 

The  author  tersely  remarks.-  when  di^m«»«g  the 
action  of  drugs  upon  th^  elimination  of  purin  bodies, 
that  in  gout  and  allied  disorders  "  Fashion  has  decreed 
the  use  of  numerous  drugs  in  the  active  and  prophf- 

(a)  '*TbePttrlii  BodiM  of  Foottatiiffa,  ami  the  MtU  ol  Vm  kM 
in  BoAlthand  Disea^.*' .  B/  J.  Walker  Hall.  ILD.  Seeood  Sfidoi. 
Reviled.  Pp.  fiOl  .and  xiti,  with  29  TabiM  and  lUtistratioat.  Lai- 
don  :  Shen-AU  and  Huehea    190S.. 


I>EC.  '4/  19^4. 


LITERATURE. 


Thb  Mkdical  PmESs.    643 


1  actic  treatment  of  these  conditions,  and  the  value  of 
each  medicament  has  been  measured  in  terms  of  its 
solvent  powers  for  nric  acid  in  the  test  tube,  quite 
regardless  of  the  fact  that  it  could  not  be  safely  intro- 
duced into  the  blood  in  sufficient  quantities  to  exercise 
its  soluting  properties.'*  The  author  says  that  Luff's 
belief  that  sodium  salicylate  is  contra-indicated  in 
gout  deserves  wider  appreciation,  and,  again,  "  In 
our  present  state  of  knowledge,  one  fact  stands  out 
prominently,  viz.,  that  we  have  not  a  drug  that  can  be 
administered  in  sufficient  quantities  to  affect  the  circu- 
lation of  urates  in  the  tissues." 

Altogether  this  book  is  a  straightforward  account  of 
the  present  state  of  knowledge  on  the  subject  of  purin 
bodies,  and  the  author  must  be  congratulated  on  the 
comparatively  successful  issues  of  his  experiments  and 
upon  the  valuable  asbistance  his  work  has  afforded  to 
medicine ;  but  there  are  one  or  two  minor  details  we 
should-like  to  point  out — for  example,  on  page  34,  the 
author  is  a  bit  ambiguous.  Does  he  mean  that  the 
residue  was  boiled  several  times  with  acidulated  water  ? 
Again,  in  describing  the  estimation  of  sulphates  on 
page  197,  the  author  omits  to  say  that  the  barium 
chloride  solution  should  be  added  boiling,  and  also  that 
after  that  addition  the  urine  containing  the  precipitate 
ought  to  be  boiled  for  fifteen  minutes.  The  above 
omissions  are  obviously  due  to  the  proof  sheets  being 
perhaps  hurriedly  revised,  evidence  of  which  appears 
several  times  through  the  book.  Superfluous  '*  ands  " 
occur  in  two  places,  an  *'  of  "  would  not  be  out  of  place 
betvireen  "  excess  "  and  "  phosphotungstic  "  on  page 
32,  Kjeldahe  is  given  for  Kjeldahl,  stop  for  stop-cock, 
nervour  for  nervous,  and,  finally,  the  table  of  atomic 
weights,  which  is  so  up  to  date  that  it  includes  radium 
(while  excluding  sulphur,  calcium,  and  several  others), 
contains  four  elements  spelt  in  ways  that  are  new  to 
us — i;t>.,borium  for  boron,  molybdium  for  molybdenum, 
silica  for  silicon,  and  tungstium  for  tungsten.  Lead  is 
also  placed  among  elements  commencing  with  B.  The 
author  uses  the  words  "solute"  and  "soluting"  for 
"  dissolve"  and  "dissolving."  There  is,  however,  one 
serious  blunder,  and  that  is  on  page  197,  where  we  gather 
that  the  author  incinerates  the  preparation  formed  by 
adding  sulphuric  acid  to  the  wash  water  from  his 
barium  sulphate-precipitate,  together  with  the  latter 
precipitate.  Surely  this  cannot  be  what  Dr.  Hall 
intends,  and  multiplying  the  weight  of  BasO  by 
0-3433  will  give  SO,,  and  not  sulphuric  acid.  Except 
for  the  few  typographical  errors,  this  little  book  is 
admirable  in  every  respect,  and  we  wish  the  author 
many  further  successes  in  the  continuance  of  his  re- 
searches on  the  subject  under  consideration,  and  we 
hope  members  of  the  profession  will  seriously  consider 
the  results  of  Dr.  Hall's  experiments,  they  being  so 
vitally  important  in  reference  to  this  all  too  common 
disorder. 


TOLDT  ON  ANATOMY.(a) 
We  have  received  from  Messrs.  Rebman,  Parts  IV 
and  V  of  this  most  excellent  atlas.  Part  IV  deals 
with  the  subject  of  "Splanchnology."  and  contains 
nearly  three-hundred  illustrations  to  illustrate  the 
anatomy  and  histology  of  the  various  organs  of  the 
body.  The  system  of  illustrating  adopted  in  former 
volumes  is  continued,  as  a  rule  with  good  results. 
There  are  special  sections  devoted  to  the  male  and  female 
reproductive  organs,  and  though  these  are  both  good 
so  far  as  they  go,  we  should  like  the  latter  to  have  been 
more  fuUy  dealt  with.  especiaUy  in  view  of  the  manner 
in  which  it  is  neglected  in  most  anatomical  works. 
Part  V  deals  with  "  Angeiology,"  and  is,  perhaps,  the 
finest  part  as  yet  pubUshed.  It  contains  something 
like  200  illustrations,  the  majority  of  which  are  full-page, 
and,  in  almost  all.  the  vessels  are  shown  m  colours. 

lay  *' An  AtlM  of  Hunutn  Anatomy,  for  Students  and  Phyaidant" 
Bv  Cfcrl  Toldt,  M.D.,  Professor  of  Anatomv  In  the  University  of 
vinna,  aiSSj  by  Prirfessor  A.  D.  Bosa.  M  6.  Tranriated  from  the 
Third  German  Mition  by  M.  Bden  Paul.  MJ)^rux.  PourUi  Section. 
Splanchnclogy.    London  and  New  York:  Hebman,  Limited,    1904. 


The  illustrations  of' the  pelvic  vessels  are  good  but 
again  might  be  more  numerous.  The  Part  concludes, 
with  a  description  of  the  lymphatic  system.  The 
Atlas  has  well  fulfilled  the  expectations  that  were 
formed  of  it  on  the  appearance  of  its  first  part,  and 
we  can  thoroughly  recommend  it.  One  part  remains 
for  publication,  and  will  deal  with  the  subject  of 
Neurology  and  with  the  Organs  of  the  Senses. 

BACTERIOLOGY  OF  MILK,  (a) 

It  was  once  remarked  by  a  well-known  bacteriologist 
that  searching  for  specific  bacteria  in  milk  was  like 
looking  for  nails  in  a  ten-acre  grass  field,  with  the  aid 
of  a  pair  of  badly-suited  spectacles.  Considering  that 
a  cubic  centimetre  of  milk  may  contain  over  1 50.000,000 
micro-organisms,  this  analogy  is  not  exaggerated,  and 
even  with  the  many  methods  at  present  at  our  dis- 
posal, the  bacteriology  of  milk  is  a  very  difficult 
matter  indeed.  The  authors  of  this  valuable  booki 
therefore,  deserve  the  hearty  thanks  of  the  medical 
profession,  of  bacteriologists,  of  sanitary  inspectors,  and 
the  public  generally.  The  subject  bristles  with  diffi- 
culties, for  when  we  have  overcome  the  difficulty  of 
examining  a  milk  bacteriologically,  we  are  astounded 
at  the  great  possibilities  of  danger  that  may' lurk  in 
this  iniportant  and  universal  article  of  diet,  and  to 
lessen,  if  not  to  prevent,  these  dangers  appears  to  heed 
stringent  legislation.  These  and  many  other  con- 
siderations are  ably  discussed  in  this  work,  which  the 
authors  believe  to  be  "  the  first  occasion  on  which  an 
attempt  has  been  made  to  deal  in  a  systeinatic  manner 
with  the  bacteriology  of  milk." 

As  an  example  of  the  progress  of  the  subject,  take 
the  question  of  acid-fast  bacilli.  Not  so  many  years 
ago  we  fondly  hoped  that  the  Ziehl-Neelsen  method  of 
staining  excluded  all  organisms  except  the  B.  tuber- 
culosis, B.  leprae,  and  the  Smegma  bacillus,  but  now. 
thanks  to  the  researches  of  Koch,  Petri,  Korn,  and 
others,  we  find  that  other  organisms  have  been  found 
in  milk  and  milk  products,  having  originally  occurred 
in  the  grass,  dust,  &c..  which  also  retain  their  colour 
when  stained  by  this  method,  and  the  authors  are 
constrained  to  insist  on  "  the  importance  of  the  inocu- 
lation test  being  applied  to  all  acid-fast  and  tubercle- 
like organisms  detected  in  milk  or  butter.'*'  We  may 
remark  in  passing  that  the  book  contains  some  beautiful 
coloured  plates,  illustrating  the  appearances  of  growths 
of  these  acid-fast  bacilli.  As  at  the  time  this  book 
was  published  the  Royal  Commission  on  Tuberculosis 
had  not  issued  their  interim  report,  the  atithors  take 
up  the  provisional  attitude  "  that  tuberculosis  in  all 
animals  is  generically  one  and  the  same  disease,  but 
that  it  differs  in  various  ways  in  different  animals,  and 
according  to  the  strain  ^d  virulence  of  the  infecting 
bacillus." 

The  authors  in  considering  the  question  of  a  practical 
standard  of  the  number  of  organisms  which  might  be 
permitted  in  milk,  divide  the  conditions  affecting  the 
number  of  bacteria  into  three  divisions :  The  influence 
of  time,  the  influence  of  temperature,  and  the  inter- 
relationship of  different  species  of  bacteria  and  the 
germicidal  effect  of  the  milk:  Anyone  reading  the 
matter  included  under  the  fir&t  two  headings  must  be 
forced  to  the  conclusion  that  milk  ought  to  be  re- 
frigerated as  soon  as  it  is  drawn.  After  showing  how 
milk  is  theoretically  an  air  ost  ideal  medium  for  both 
saprophytic  and  parasitic  bacteria,  the  writers  give,  on 
page  20.  a  table  compiled  from  the  experiments  of 
Backhaus.  of  Konigsberg.  which  shows  the  possible 
extent  of  contaniination  of  milk  from  various  sources 
in  the  interval  between  the  milking  of  the  cow  and  its 
ingestion  by  the  public. 

In  the  chapter  relating  to  the  "  Examination  of  Air 
and  Water  in  Relation  to  the  Milk  Supply."  we  find 


(a)  ••  Bacteriology  of  HUk. "  By  Harold  Swithiabank  and  Geonre 
Newman,  M.P.,F.B.&B.,  D.P.H.  With  special  cbapters,  a'so  b/  Dr. 
Kewman,  on  the  Bpresd  of  Disease  by  Milk  and  the  Control  of  the 
Milk  Supply.  With  8S  plates,  36  text  illtiBtraftioBat  and  4  maps  and 
chavtB.  Pp.  606  and  xx.  Prica  2.7b.  net.  London :  John  Murray. 
1908, 


646    The  Mbdical  Psess. 


MEDICAL  NEWS. 


Dec  14,  1904. 


one  or  two  little  details  in  which  we  must  differ  from 
the  authors.  Many  people  will  disagree  with  the  state 
ment  that  "  B.  coli  is  a  most  accurate  measure  of  in- 
testinal pollution/'  and  an  enumeration  of  this  bacillus 
is  certainly  a  wearisome  and  unsatisfactory  way  of 
judging  the  extent  of  pollution.  A  note  to  the  effect 
that  a  partial  chemical  examination  of  the  water  would 
be  most  valuable,  probably  more  so  than  the  tedious 
bacteriological  examination,  would  not  perhaps  be  out 
of  place.  We  might  venture  to  point  out  that  the 
percentage  of  salts  in  milk  given  on  page  4.  vix,,  07. 
is  lower  than  it  should  be,  viz.,  not  lower  than  075. 
Twenty  appendices  dealing  with  Acts  affecting  mUk, 
regulations  in  force  in  private  companies  and  in  various 
districts  and  on  kindred  subjects,  close  a  volume  which 
is  well  illustrated,  well  written,  singularly  free  from 
errors,  and  which  must  be  considered,  in  the  present 
state  of  our  knowledge,  the  standard  book  on  the 
subject. 

REPORT  OF  THE  REGISTRAR-GENERAL. 
IRELAND,  (a) 

The  conceiitrated  information  contained  in  the 
summaries  compiled  for  the  pages  of  this  "  Supple- 
ment "  makes  it,  of  course,  a  most  interesting  and 
instructive  volume  of  reference.  The  causes  of  death 
which  have  been  most  profusely  discussed  of  recent 
years  in  this  country  are,  we  believe,  alcoholism,  cancer, 
and  phthisis.  On  this  account  the  following  extracts 
will  be  of  the  greatest  interest  to  all  readers: — (i) 
''*  During  the  decade,  i  ,601  deaths  were  attributed  to  the 
effects  of  alcohol ;  of  these  i,6ox  persons.  1,306  were 
males  aiid  295  were  females.  Of  the  total  deaths,  421 
were  registered  as  having  been  caused  by  delirium 
tremens  (388  males  and  33  females) ;  and  1,180  persons 
fell  victims  to  chronic  alcoholism  (318  males  and  262 
females)."  (2)  "  According  to  the  system  which  ob- 
tained during  the  ten  years  now  the  subject  of  review, 
the  deaths  classified  under  the  head  of  cancer,  malig- 
nant disease,  include  those  deaths  which  were  certified 
as  carcinoma,  scirrhus,  epithelioma,  rodent  ulcer.  &c.. 
and  sarcoma.  The  total  number  of  these  deaths  re- 
corded in  the  decade  is  24,435,  ^^  which  1 1,062  were  of 
males  and  13,373  were  of  females.  In  the  preceding 
decade  the  number  of  deaths  from  cancer  in  Ireland  was 
20,036,  viz.,  8,964  males  and  11,072  females,  and  in 
the  decade  which  ended  with  the  year  1880,  the  total 
number  of  deaths  recorded  was  17,790  (7,789  males, 
and  10,00  X  females)..  The  average  annual  rate  per 
10,000  of  the  population  represented  by  the  deaths 
from  cancer,  malignant  disease,  which  for  the  decade 
1871-8C,  was  3*4  per  10,000  of  the  mean  population, 
rose  to  4*1  for  the  following  ten  years,  and  to  5*3  for 
the  decennium  ending  with  the  year  1900.  .  .  .  The 
deaths  of  1 1 ,062  males  and  1 3,373  females  were  recorded, 
these  numbers  are  equal  respectively  to  the  average 
annual  rate  of  4*90  and  576  per  10,000  of  the  mean 
population  of  males  and  females  in  Ireland."  Omitting 
the  cases  under  25  years  of  age  registered  as  deaths 
from  cancer,  "only  294  (156  males  and  138  females) 
during  the  decennium,"  ..."  and  basing  the  calcu- 
lations on  the  estimated  mean  number  of  persons  aged 
25  years  and  upwards  in  the  population,  it  is  found  that 
the  deaths  from  cancer  and  malignant  disease  during 
the  decade  were  equal  to  an  average  rate  of  in  per 
10,000  persons,  against  an  average  rate  of  8*8  per  10,000. 
for  the  preceding  ten  years,  and  a  rate  of  73  per 
10,000  for  the  ten  years  1871-80,  so  that  in  the  ten 
years  1891-1900,  allowing  for  the  decrease  in  the 
population,  the  registered  mortality  under  the  head  of 
persons  aged  20  years  and  upwards  was  52  per  cent,  in 
excess  of  that  for  the  ten  years  1871-80,  and  26  per 
<:ent.  in  excess  of  that  for  the  decade  1881-90.  The 
average  rates  for  the  sexes  taken  separately  were  : 
In  ten  years  ending  with  1880,  males  67  per  10,000 

(a)  **  Sopplement  to  the  Thirty-«eventh  Report-  of  the  Regiatnu*- 
Oeneral  of  MairUffea,  B<rth«,  and  Deaths  in  Ireland,  containingr 
Deoennial  Summariee  of  th«  Saturns  of  Marria«re8,  B'lths,  Deaths 
and  Oauaet  o(  Death  in  Ireland  ior  the  years  1H»1-1900."  hablin: 
B.  Ponsonby ;  London :  Eyre  and  Spotiiswoode ;  Edinburgh  *. 
Oliver  and  Boyd.  1V04. 


males  aged  25  years  and  upwards  in  the  popolatkm: 
females    78    per    10.000  ;     in    the  ten  years  iS8i-^ 
males  82,  females  9-3  ;   and  in   the  decade  1891-1900 
males   10*4,  females   11  7   per    10.000."     (3)  "In  i\^ 
classification  followed  during    the    decade   1891-1900 
deaths  from  tuberculosis  were  distributed  under  ioor 
heads,    namely,    '  Phthisis,'  '  Tuberculous  Meningits 
(acute    hydrocephalus),     '  Tabes      Mesentcrica,'    amj 
*  Other    Forms   of   Tuberculosis,    Scrofula.*  .  .  .  Tbr 
tuberculous  death-rate  has  risen  in  Ireland  since  tbc 
first  of  the  decades  [1871-80]    covered   by  the  abovt 
statement — a  fact  which  goes  to  show  that  the  sanitarr 
and  other  measures  which  have  been  undertaken  fc- 
the  improvement  of  the  public  health  have  not  as\v 
arrested  the  ravages  of  this  formidable  disease.'*  Tli» 
extracts  form  ample  proof  that  there  is  full  scope  !b^ 
the  future  labours  of  the  moralist,    the  sanitarian « 
the  therapeutist  in  the  opening  era  of  the  denKxm 
section  of  Irish  history. 


PARLIAMENTARY  REPRESENTATION  OF  THl 
UNIVERSITIES  OF  GLASGOW  AND  ABERDEB 
At  a  meeting  of  the  Graduates  of  the  al>ove  Vmv 
si  ties  held  at  the  Holbom  Restaurant.  London,  ce 
Thursday,  the  8  th  inst.,  the  Rev.  Canon  D.  Rcith.  3L\ 
in  the  chair,  to  hear  an  address  from  Professor  l^lBSaa 
R.  Smith.  M.D.,  it  was  subsequently  moved  by!4r.T.  K 
Browning,  M.A.,  seconded  by  Dr.  J.  Nelson  Bfatttmv 
and  carried,  "  That  this  meeting  of  graduates  of  Glasgot 
and  Aberdeen  Universities  cordially  endorse  the  candi- 
dature of  Prof.  William  R.  Smith,  M.D..  and  pledfn 
itself  to  use  its  best  endeavours  to  secure  his  reton. ' 
In  supporting  the  resolution.  Prof.  A^'.  J.  Simpso: 
M.D.,  F.R.C.P.,  and  Dr.  J.  Ford  Anderson  pointed  w 
the  totally  inadequate  representation  of  the  Medical  ^ 
fession  in  Parliament,  that  this  seat  offered  oneof  br 
very  few  of  the  opportunities  for  returning  a  medicalisa 
to  Parliament,  and  the  difificulty  always  experieocc 
in  finding  a  medical  candidate ;  they  insisted  npoo  tk 
reflection  which  would  be  cast  upon  the  graduates  r 
they  had  to  seek  a  representative  from  another  Uii- 
versity  as  was  suggested,  and  urged  that  in  Profeoor 
Smith,  who  had  attained  a  prominent  positioD  n 
Preventive  Medicine  and  had  great  public  expenenct 
they  had  a  candidate  whom  it  was  most  desirable  shovki 
be  elected.  Meetings  of  the  medical  graduates  bm 
also  been  held  in  Sheffield,  Blackburn,  and  Lincob,  ai 
which  a  similar  resolution  was  passed. 

Aedical  Dews* 


The  London  P  »lycllnlo  Dinner. 

The  sixth  annual  dinner  of  the  London  Poljxte 
was  held  on  the  7  th  instant  at  the  Trocadero  RestaniaBi 
under  the  genial  presidency  of  Dr.C.  Theodore  WilliaiQ& 
It  was  announced  that  Mr.  Jonathan  Hutchinson,  ok 
of  the  founders  of  this  flourishing  and  valuable  institi- 
tion,  was  unfortunately  unable  to  be  present  on  accons! 
of  indisposition.  Another  founder  -was  present,  ]»*- 
ever,  in  the  person  of  Dr.  Fletcher  Little.  A  hip 
company,  including  many  ladies,  appeared  to  off 
thoroughly  into  the  swing  of  a  capital  eveiiii|» 
entertainment.  Dr.  Theodore  Williams  made  a  capca. 
speech.  Among  other  things  he  spoke  of  the  post- 
graduate courses  that  formerly  sent  the  student  all  are 
London  in  search  of  hospitals  for  this,  that,  and  tbe 
other  speciality,  until  he  arrived  finally  at  Bedlam  c 
an  exhausted  condition  and  more  fitted  to  be  an  inmaie 
than  a  mere  visitor.  Captain  Haward  Punch,  the 
energetic  secretary,  delivered  an  amusing  and  apponte 
speech.  Mr.  Mayo  Robson  responded  for  the  Poly- 
clinic and  Mrs.  Scharlieb  for  "  The  Ladies."  Seveni 
speakers  dwelt  on  the  present  state  of  affairs  in  this 
undertaking  as  most  promising  of  future  prosperity. 
Liverpool  School  of  Tpoploal  lledi<*lne. 

Last  week  a  deputation  from  the  Liverpool  Sdioal 
of  Tropical  Medicine  waited  on  the  Colonial  Secretary, 
Mr.  Lyttelton,  for  the  purpose  of  bringing  before  his 
notice  the  despatch  of  a  large  medical  and  scientific 
expedition  to  West  Africa  for  the  purpose  of  hdpiiig 


Dec. 


14.  1904. 


MEDICAL  NEWS. 


The  Medical  Pkess.    647 


to  promote  the  work  of  stamping  out  tropical  diseases. 
Sir  Alfred  L.  Jones  introduced  the  deputation,  which 
consisted  of  the  following  gentlemen : — Professor 
Boyce.  F.R.S..  Sir  Ralph  Moor,  K  C.M.G.,  Colonel 
Giles  (India  Medical  Service),  Dr.  Evans,  Dr.  M'Connell 
^Canada),  Dr.  Jollerton  Thomas  (Canada),  Dr.  Anton 
Bainel  (Austria),  Dr.  Clarke,  and  Mr.  A.  H.  Milne 
(hon.  secretary,  Liverpool  Tropical  School),  Mr.  John 
Holt,  Mr.  J.  Irvine,  Mr.  J.  Strafiord,  Mr.  Haggart, 
and  Mr.  B.  Caarten. 

Heavy  Damages  for  Assault  on  a  Kodical  Man. 
Dr.  A.  D.  Griffiths  was  last  week  awarded  ;£500 
damages  at  Swansea  yesterday  for  an  assault  com- 
mitted Dy  George  Faithfull,  an  electrician,  while  Dr. 
Griffiths  was  attending  the  defendant's  wife.  The 
assault  was  aggravated  by  a  charge  reflecting  on  the 
doctor's  character. 

Sympathy  with  Dp.  Arthup  Griffltht,  Bridgend. 
At  a  largely-attended  meeting  of  the  South  Wales 
and  Monmouthshire  Branch  of  the  British  Medical 
Association,  held  at  Carmarthen,  the  following  reso- 
lution was  unanimously  passed  : — "  That  the  members 
of  the  South  Wales  and  Monmouthshire  Branch  of 
the  British  Medical  Association  desire  to  convey  to 
Dr.  Arthur  Griffiths  their  sincere  sympathy  with  him 
in  the  painful  position  in  which  he  was  recently  placed 
by  the  unfounded  charge  laid  against  him,  and  their 
congratulations  on  his  having  so  completely  justified 
their  trust  in  his  unblemished  character."  This 
motion  was  proposed  in  the  name  of  the  President  of 
the  Branch  by  Mr.  Tatham  Thompson  (Cardiff), 
seconded  by  Dr.  Evan  Jones  ( Aberdare),  and  supported 
by  Dr.  Cresswell  (Dowlais)  and  Dr.  Lynn  Thomas 
(Cardiff). 

Nottingham  Medtoo-Chlrurgloal  Society. 
The  Nottingham  Medico-Chirurgical  Society  held 
itsT  annual  dinner  at  the  George  Hotel,  last  week, 
under  the  presidency  of  Dr.  H.  J.  Neilson.  The  Mayor 
of  the  City  (Alderman  Joseph  Bright)  was  the  guest  of 
the  evening,  and  Councillor  Dr.  T.  J.  Day  bell  attended 
in  a  dual  capacity  as  Sheriff,  and  as  a  member  of  the 
organisation,  the  company  numbering  about  70.  The 
toast  of  "  The  Society  "  was  submitted  by  the  President 
of  the  Leicester  Medical  Society  (Dr.  R.  C.  Stewart), 
and  acknowledged  by  the  President.  The  Vice-Pre- 
sident (Dr.  J.  F.  Blurton)  proposed  "  The  Visitors  and 
the  Mayor  of  Nottingham,"  and  "  The  President  of  the 
Derby  Medical  Society"  (Dr.  F.  R.  Cassidy), 
Trinity  College,  Dublin. 
Th£  following  candidates  passed  the  Final 
Examination  in  Midwifery:  —  Benjamin  Johnson, 
Arthur  A.  M'Neight,  John  Cunningham,  Lily  A. 
Baker,  William  J.  Powell,  William  R.  Galwey  and 
William  Nunan  (equal).  Thomas  J.  T.  Wilmot,  Eva  J. 
Jellett,  James  H.  C.  Thompson,  Henry  E.  M'Cready, 
Thomas  Creaser,  George  McG.  Millar,  William  Hassard, 
CarlUe  KeUy,  and  Alfred  G.  Alexander. 
Chemists*  Exhibition. 
CovENT  Garden  Theatre  has  been  selected  as  the  site 
for  the  next  annual  Chemists'  Exhibition,  organised 
by  the  British  and  Colonial  Druggist.  The  same 
building,  it  may  be  remembered,  was  used  for  the 
exhibition  some  seven  years  ago.  The  Exhibition  will 
be  open  from  March  13th.  1905,  to  March  17th. 
inclusive. 

Hospital  Sunday  Fund. 
The  annual  general  meeting  of  the  Metropolitan 
Hospital   Sunday  Fund  will  be  held  at  the  Mansion 
House  on  Friday  next  at  2.30. 

Royal  College  of  8ur«eons  of  England. 
At  the  ordinary  meeting  of  the  Council  of  the  College 
held  on  Thursday  last,  Mr.  John  Tweedy,  F.R.C.S., 
President,  in  the  Chair,  the  death  of  Professor  Tillaux 
of  Paris,  an  honorary  Fellow  of  the  College  was  reported. 
Diplomas  of  Fellowship  were  issued  to  29  candidates, 
and  diplomas  in  Dental  Surgery  to  40  candid  t  s. 
In  accordance  with  the  recommendation  of  the  Board 
of  Examiners  in  Dental  Surgery,  it  was  decided  to 
publish  a  syllabus  defining  the  scope  of  the  examination 
in  anatomy,  physiology,  and  surgery  which  candidates 


for  the  licence  in  Dental  surgery  are  required  to  pass. 
It  was  also  decided  that  this  examination  should  be  held 
three  times  instead  of  twice  during  the  year.  In  refer- 
ence to  a  communication  from  the  Board  of  Education 
asking  the  opinion  of  the  College  upon  proposals  framed 
by  the  consultative  committee  of  the  Board  for  a  .system 
of  school  certificates,  a  resolution  was  adopted  expres- 
sing general  approval  of  the  scheme.  Mr.  Bernard 
Pitts,  F.R.C.S.,  surgeon  to  St.  Thomas's  Hospital, 
was  re-elected  a  member  of  the  Court  of  Examiners. 
The  resolutions  carried  at  the  annual  meeting  of 
Fellows  and  Members  on  the  17th  ultimo  were  reported 
to  the  Council.  The  Liverpool  Stanley  Hospital  was 
added  to  the  list  of  General  Hospitals  recognised  for 
the  purposes  of  study  by  candidates  for  the  Diploma 
of  the  college.  It  was  also  determined  to  add  the 
Municipal  College,  Grimsby,  to  the  list  of  institutions 
recognised  for  instruction  in  chemistry,  physics,  and 
practical  chemistry.  A  report  was  received  from  the 
laboratories  committee  stating  that,  during  the  three 
months  ending  December  ist,  7,548  doses  of  diphtheria 
antitoxin,  each  containing  3.0Q0  units,  have  been 
supplied  to  the  hospitals  of  the  Metropolitan  Asylums 
Board. 

The  following  members  of  the  Royal  College  of 
Surgeons  of  England  were  admitted  to  the  Fellowship 
of  the  College  at  the  meeting  of  the  Council  on  the 
8th  instant,  Mr.  John  Tweedy,  the  president,  in  the 
chair : — John  Arthur  Hayward,  M.D.  London,  St. 
Bartholomew's  and  Oxford  ;  Cecil  Edward  Marriott, 
M.B.  Cambridge,  Cambridge  and  University  College, 
London ;  Francis  Joseph  Maria  Hasslacher,  M.B. 
London,  King's  College,  London  ;  John  Clay.  M.B. 
Durham,  Durham ;  Herbert  Dean  Pollard,  M.B. 
London,  London ;  Donald  Johnstone  McGavin,  M.D. 
London,  Birmingham  and  London ;  Charles  Ferrier 
Walters,  L.R.C.P.  London,  Bristol;  Reginald  Cheyne 
Elmslie,  M.B.  London,  St.  Bartholomew's ;  George 
Ernest  Waugh,  M.B.  London,  Cambridge  and  Uni- 
versity College.  London ;  William  Francis  Harriott 
Coke,  L.R.C.P.  London,  St.  George's ;  Ernest  Rock 
Carling,  M.B.  London,  Westminster ;  Somerville 
Hastings,  M.B.  London  ,  Middlesex  ;  Hugh  Davies- 
CoUey,  M.B.  Cambridge,  Cambridge  and  Guy's ; 
Harold  Upcott,  L.R.C.P.  London,  St.  Thomas's; 
Joseph  Ebenezer  Adams,  L.R.C.P.  London,  St. 
Thomas's ;  Harold  Ash  ton  Lyth.  M.B.  London,  Uni- 
versity College  ;  London  ;  William  Arthur  Rees,  M.B. 
London,  Middlesex ;  Arthur  Robertson  Brailey. 
L.R.C.P.  London,  Cambridge  and  Guy's ;  Norman 
Carpmael,  L.R.C.P.  London,  St.  Thomas's ;  Charles 
Bernard  Goulden,  M.B.  Cambridge,  Cambridge  and 
Middlesex;  Walter  Lidwel  Harnett,  M.B.  Cam- 
bridge, Cambridge  and  St.  Thomas's ;  Archibald 
Trevor  Moon,  L.R.C.P.  London,  London ;  Kenneth 
Black,  L.R.C.P.  London,  Guy's^;  Thomas  Jefferson 
Faulder,  L.R.C.P.  London,  Cambridge  and  St.  Bar- 
tholomew's ;  Neville  Ivens  Spriggs,  M.B.  London, 
Guy's ;  Frederick  Henry  Parker,  M.B.  Cambridge, 
Cambridge  and  Guy's.  The  following,  not  being 
members  of  t  he  College,  were  also  admitted  Fellows  : 
Robert  James  Ferguson,  M.D.R.U.I.,  Belfast ;  Angus 
McNab,  M.B.  Edinburgh,  New  Zealand  and  Edin- 
burgh ;  Herbert  Bell*  Tawse,  M.B.  Aberdeen,  Aber- 
deen  and  King's  College,  London. 


On  Saturday,  the  loth  instant,  the  employes  of  the 
united  firms  of  Messrs.  Odhams  Limited,  and  South- 
wood,  Smith  and  Co..  Limited,  gave  their  annual  dinner 
at  the  King's  Hall,  Holbom  Restaurant,  London. 
Some  capital  speeches  were  made  by  the  Chairman, 
W.  J.  B.  Odhams.  Esq.,  and  Messrs.  Elias.  Moir. 
Lathbury.  and  Filson  Young.  The  proceedings  were 
varied  with  an  excellent  programme  of  glees  and  songs. 
Our  readers  will  be  familiar  with  the  name  of  Odhams 
Limited,  as  printers  of  the  Medical  Press  and 
Circular  for  many  years  past. 

The  annual  meeting  of  the  Dublin  branch  of 
the  National  Association  for  the  Prevention  of 
Tuberculosis  will  be  held  in  the  Royal  College  of 
Physicians  this  afternoon  (Wednesday J  at  4.30  p.m. 


648    The  Medical  Press. 


NOTICES  TO  CORRESPONDENTS. 


PgC-  14.  I9Q4. 


gisAmsi  t0 

_J»  ooEEMFOiTOMn  requiring  *  wply  fa  this  ooinum  an  pwiiou. 
i!i«  MMmMtad  to  make  use  of  a  dUtimeHve  S^pnuOurt  or /nttioK,  and 
'•'y _ '^'^j!^. •^».t»»  t^^hmnMivea  ••  R^dAr.**    •*Sabiorlber/' 


TunDAT.  DacsMBUt  lOth. 
Nortr-East  LoNSOir  Pobt-Oraduatk  Collxos  (Totteahia  Bm- 
pital,  N.).~-4.90  p.m.  Lectore-DemooatratioD  :  Kr.  dc  PRadetTb 

Thsbapsutical  Socistt  (Apotheoariea  Hall,  B.G.).>4am.  Ik 
Nesror  TInrd  :  On  Some  CI  nicftl  Oboerrationa  with  mm  kinete' 
The  Secretary  will  read  a  paper  by  Joba  B.  Ofaalettc  oaOcd  "Sih, 
on  tome  Metboda  employed  by  Kalantan  Malaya  fa  the  Tmtia  j 
Puru  or  Yaws. 


of  aseptic 
rional  anrg 
win  serve  to 


IToil'tSepfaBtioaofalpitog  thomaalTes  "Reader; 
'oSsSbJciibsr/'to.    Mnohoonfoslonwm  be  spar«lhy  attention 
to  tUsrole. 

Oemiital  A»TiCLa8  or  Lhtrm  fatended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  addreaa  of  the  writer,  not  necessarily  for  pubKoa- 
tion,  but  as  evidence  of  identity. 

GoimxBinOB8  are  Wndly  requested  to  send  their  communications 
if  resident  fa  England  or  the  Colonies,  to  the  Editor  at  the  London 
oflloe ;  if  realdeni  fa  Ireland,  to  the  Dublin  ofBce,  fa  order  to  save  time 
la  re  forwaiding  fwm  oflloe  to  oflloe.  When  sending  subscriptions 
the  same  rule  appliea  as  to  oflloe,  these  should  be  addressed  to  th 
Publisher. 

Bwwiffli.-»«P'*n*»  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providtog  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.    This  should  be  done 

when  returning  proofs.      

,  Dr.  ScH.aB(Algiers).-ira^W^a  private  note. 

Tfi^^^.    And  what  is  your  husband's  ^complaint,  Mrs.  Green? 

?7oouldonlysleep<J^ni^t|'e^d^5^^^^^ 

!iSSo2l i^w^heW aJlover  the  Batlsh  dominions.  The  services  were 
«S^SS^it  a  cwSJn  chuf  ch  by  the  singing  of  a  weU-known  hymn, 
2Snh  taiSeii^be  fa  the  biok  portion  of  the  book.  "  Let  us 
^,***®*f?KIS"  the  rector  said/'^  singinE  the  hymn/  Peace 
?L^J?pSS^inSlwSdfa,'^-34xa*A6rf^  ,    ^ 

^K™iS!?8T»?L-l  proper  apparatus  is  needed  to  prepare  instru- 

2S?t  SScStton«r?however:  who  is  weU-grounded  fa  the  pi^lples 
^*    *«?teTuiSry.cando  ^1  the  sterilfstog  wanted  for  an  occa- 
fuMoMritlon  by  extempore  methods.    A  smaU  sauoepan 
IJItoatoStoe  a  scipei,  a  pair  of    cissors,  dr^saing  forceps. 
JW  MHiwr™  'J^^n'd  t&ad.  With  this  aimplemeans  and 

^nSsir^.n^^' V^^^  Of 

i»^t^S5  taTrauS^ic  Intra-mSsSular  Osteom  s"  is  in  hand. 
Sd^  i^  P-^W'SSTaa  soon  aa  the  necessary  illuatrations  are 

"h15Lb.  (Uverpool).  ia  thanked,  but  the  paper  is  scarcely  suitable 
'^i^^fSSSSo  (Berlfa).-Your  paper  on  the  "  Development  oj 
I)£Siori??»TTrKi  of  Urlniry'^Disease.  "  ha.  been  received 

^.r^^^--TS^''^^^^  of  Health  of  the  District  I. 
^/^^if^Enr^hrSTn  to  whom  your  patient  should  apply.     If. 
'^MSiSSSLtJfy  ^pens  fa  <^n*'y  disteicts.  he  is  a  rfval  prac- 
M  unfortuMW^  napp«^  ,iiowed  to  hinder  or  affect  the  dis- 

titionerjtbatfMtsm»uia^nOTDejp^^^       A  more  desfaable  sUteof 

^hS  ^iSd  bJ"  d^J^eJThi  Unctions  of  Medical  Officer  of  He^th 
SiTof^riVatV  ^wtitioner.  as  thetwoare  facongmous.  and.  as  a 
rule,  incompatible 

iRtetittg«  of  the  §od«lie«,  %ttivpcte,  *£. 

"  WedkmDat  Decbmbke  14th.     ^    ^    _      .^  , 

qoDTH.WBST  LownoB    M»wcAL  SociBTT    (Bolfagbroke  Howpital, 

mXroSfco^on).-8.45p.m.  Paper:    br.  8.  Taylor:  Errors 

^'SSS^'JiiiCAL  SocwTT  or  Lo»DO»  (11  Chando.  Street.  Cavendish 
Rn^J?  W  K-M6  p.m*    Demonstration  of  Casea  of  Intereat. 
ISSaaOi^^nfrr  (Loudon  Inatltution,  Finsbury  Circus,  B.C.) 
•  «ft ««     Paner  •  Dr.  G.  B.  Herman  :  LeucorrhoBa. 
^\!St^^(S1^\tJ^Oou^b^  akd  Polvclwic(M  Chcnlea  Street, 
W^TIT  p^?     ™^Wlnock:   Cliniaue.  .Surgical.)    5.15  p.m. 
TkL  T  nnfti^P  •  Mental  Overstrain  in  Childhood. 
^'i^^^i^V^T^A?S^^  HOSPITAL  (Or^jy-s  Inn  Eoad 
wSl3!^p.m:   Demonstration  ;-Dr.Abcrcrombie:  iTose. 

THUBSDAT,  DSCSMBBB  15th. 

uimrxtnti  aRAonAns'  CoLLKGB  AH©  PoLTCLiKic  (22  Ohenics  street, 
wlSrfirWu^in^^^^  5.15  p.m. 


Nottingham  General  Hospital.—Aasistant  House  Physiciaa.  hbn 
£100  per  annum,  with  board,  lodginE.  and  waahiag  In  tki  k 
pitaL    Applications  to  E.  M.  Keeiy,  Secretary. 

Nottingham  General  HospltaL— Aaaistant  House  Suigeoa.  fl^ 
£100  per  annum,  with  board,  lodging,  and  waaUag  fai  tbt  ]fe 
pitaL    Applicationa  to  E.  M.  Kady.  Sleerelaiy. 

Whitehaven  and  Weat  Cumberland  iTrfirmarr  BrsViiat  Ba« 
Surgeon.  Salary  £120  per  annum,  with  boaid  and  kdeiM 
Applit  ati'>ns  to  wm.  H.  Sands,  Secretary.  '^ 

Cumberland  and  Weatmorlaad  Aaylom.  Oariaada,  Oai]iris.-Jte 
Assistant  Medical  OfBoer.— Salaiy  £130  per  aaaaai,vjthkiMi 
lodging,  and  washing.  Applications  to  the  Hedky  8^ 
fatendent. 

West  Sussex  County  A^fam,  Oraylingw«U,  ChiQhcsfev.-jiH 
Assistant  Medical  Oflloer.  Salary  £  50  per  aaaoai.  wjth^. 
nished  apartments,  board,  attaodanoe,  Ac  Applieakioaato  iir 
Medical  Superintendent. 

Nottingham  City  Workhouae  Infh-mary.-^anior  Bcaideal  Mt^ 
Officer.  Salary  £U0  per  amrain,  with  apartmeati.  hoMd,  mm- 
ing  and  attendance.  Applicationa  to  Q.  Xoncaater  SLon,'d,  Cbfc 
to  the  Board,  Poor-law  Offices.  Nottiogliam. 

JAffray  Branch  of  the  General  Hospital  Oravd'y  BO,  mi 
Birmfagfaam.— Besideot  Medical  and  Surgical  Ofltow.  Msj 
£150  per  annum,  witn  board,  residence  and  waahii^.  Aptfja- 
tions  to  the  House-Governor,  General  Hospital,  BinifaKbiB. 


JlptrointmtniB. 

Bashxbmas,  William,  M.B.,  O.M.Bdin.,  Medical  Oflkscr  sad  PdEe 

Vaccinator  for  the  North  District  of  the  Cirencester  Ubm. 
Cablb  FaxDxaiCK  C  M.B.Lond.,  M.B.O.S.,  Senior  GUnieal  Aaaba 

to  the  Throat  Hospital,  Ooldaa  Square.  W. 
Davixb,  D.  L.,  M.B ,  B.S.Lond.,  Certifying  Surgeoa  sader  tk 

Factory  Act  for  the  Wisbech  and  Walsoken  Distriet  of  iht 

conntiea  of  Cambridge  and  Norfolk. 
Day,  Lbigh,  M.B..  B.Ch.Oxon., 'Honorary Assistant Saijreos tab 

Essex  and  Cokshester  HospiUl. 
Dhjivt,  K.,  L.B.C.P.I.,  L  B.G.8.L.  Certlfyfag  Sorgeen  nader  fk 

Factory    Act    for    the    Carrick-on -Shannon    Diacrict  «f  tk 

County  of  Leitrim. 
DiTTM Aft.  F.,  M.D.Gla8g..  D.P.H.Oantab.,  Medical  InspecUr  d  tkt 

Local  Government  Board  of  Scotland. 
EwAET.  B.  W.  T.J|1.B..  aM.Edfa.,  Clfaical  Asaistant  to  the  Cbdn 

Hospital  for  women. 
Fabquharsoit,  J.  Malcolm.  M.B..  F.B.C.P.Edfa.,  Second  Amis 

Surgeon  to  the  Ear,  Nose,  and  Tbroat  Deparunent  of  Oa  iej^ 

Infirmary,  Edinburgh. 
Hall.  Donald  G.,  M.A.,  M.D.Oantab..  M.B.C.P.Loiid.,  AahtsK 

Physician  to  the  Sussex  County  Hospital,  Brighton. 
Jobbs.  Edward  T.,  M.E.C.S.Bng.,  Medical  Officer  of  Heahh  of  tk 

Borough  of. Hel8ton,0oniWaJl :  Medical  Officer  to  tfae  Wat 

house  and  to  the  No.  1  District,  and  Public  VaeeliiatM'. 
Maclabbk.  Nobxab,  B  C.Cantab.,  FJft.C.8.£ng.,  Asrislaat  SoigMD 

to  the  Cumberland  Inflmary. 
Booxbs,  J..  L.B.Q.C.P.I .  Certi^fag  Surgeon  under  the  IMaixIa 

for  the  Ballyfamon  District  of  toe  county  of  Sligo. 
Skaw,  W.  F.  M.a,  Ch.B.vict..  House  Surgeon  and  EesideBtObilebi 

assistant  Suiveon  toBt.  Mary's  Hoapital,  MaacheBtcr. 
Tevcii,  M.,  M.B.C.S.,  LJLCP.Lond.,  Certlfyfag  Sargeon  noderlk 

Factory  Act  for  the  Dunraow  District  of  tlie  oooatj  of  Sao. 


rh^  -L  'am  iirie  :  Mental  Overstrain  fa  OhUdhood. 
MoSmfvSL^OB  Hospital  ro«  Cobwmptiob  jjid  Disbasbs  or 

SoCIBtT    POETUB    STUDY    OF    DiSBASB   IB  CHILDBBN    (IJ    ChandOS 

qSS?  W^—6  30  pjn.  Discusaion  on  Sudden  and  Unexpect^ 
D^^Mn  Childfin  (<»ened  by  Dr.  C.  J.  Macalister,  Liverpool).  Dr. 
jP^lS.MrTw.TSomfonWa'ker  Mr.A.  H.  fubby,  and 
nV  J  Blumfeld  wiU  t*ke  part  in  the  Discussion.      ^  ^^    ^        __ 

NoothXst  Lobdoh  Eir-GEADUATBOoLLBOi  (Tottenham  Hos- 
piSSrN ).-^«)P^-  Lcoture-Demonstratlon  :-Mr.  de  IrenderviUe  : 
Anaesthetics. 


§itikB. 


Addibob.-  On  December  8th,  at  Wican  Croft.  Northwood,MlddIatt 

the  wife  of  Christopher  Addison,  M.D. .  of  a  son. 
pBBViivoTox.—On  December  8th,  at  Carlton  Boose.  Aigrk  Boi 

West  Ealing,  W..  the  wife  of    S.  B.    Pennington.  ILBXi. 

L.B.C.P.,  of  a  daughter. 
Bbtvolds.— On  December  9th,  at  Highcroft,  Shepherd^  ffi8.Hfk^ 

gate.  N.,  the  wife  of  AnsUn  Edward  Beynokls,  lLB.a&Em,ri 

a  son. 


f^tCtXX&QtB. 


IPUiril  Qdiik 


FHiLLiPB-Oox0H.-On  Decembsr7th.  i^S^pstaai 

Llewellyn  PoweU  PhUllps.M.  A,.  M.D.Camb.,  M.».v,^  -*w. 
of  Easroel  Alny  Hospital,  and  the  School  of  HedMse,  CIdol 
Eaypt,  only  son  of  the  late  Dr.  Jam*  s  MathiasFliUttpi,  ofOMk 
gon,  to  Edith  Helen,  daughter  of  the  fate  Alfred  CSaoaiadtf 
Mrs.  Coxon,  Grindon  House,  Surbiton. 


Lusa-On  December  7th  at  Dorcheatar,  fuddenly.  ^^^f^^H^ 
a  meeting  at  the  Dorset  County  Hospital,  Wifliam  6«om  n«^ 
dref  ^ih.  M.D^  F.B.C.P.Coiid..  Fja.C.8.B»g.,  d  ^  ^ 
Fiederick  Place,  Wej-mouth. 


^h  ^dm\  ^tm  Md  ^itmht 


^8ALUB   FOPUU   BTTPBEKA   LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    DECEMBER    21,    1904.       No.    25. 


Original  Communications. 
VDENOMA    IISmORRHAGICA 

OF  THE 

ENDOMETRIUM,  (a) 

By  WILLIA^l  ALEXANDER,  M.D.,  F.R.C.S., 
Honorary  Surgeon,  Royal  Soathem  Hospital,  Liverpool,  ftc. 
It  is  very  strange  how  frequently  students  of 
ledicine  have  to  search  in  vain  for  assistance  from 
ooks  in  regard  to  conditions  that  they  meet  with 
1  their  practice,  conditions  that  they  have  seen 
rith  comparative  frequency,  and  that  have  appa- 
ently  been  overlooked  by  other  observers,  or  if 
een  have  not  been  considered  of  sufficient  in- 
erest  to  secure  a  record.  Some  conditions  seem 
0  be  recorded  too  frequently,  others  are  perhaps 
lentioned  by  some  old  writer,  but  not  a  modem 
en  is  raised  to  rescue  them  from  obscurity, 
uch  are  the  cases  I  bring  before  you  to-night  in 
he  hope  that  I  may  obtain  more  information 
ban  I  have  been  able  to  derive  from  books  : — 

Case  I. — In  1899,  a  lady,  aet.  34,  consulted  me  for 
letrorrhagia  of  eighteen  years'  duration.  During 
ne  of  these  years  she  had  no  bleeding,  not  even  at  men- 
fcruation.  This  year  of  freedom  was  early  in  the 
isease.  Like  the  lady  in  Scripture,  she  had  consulted 
lany  physicians  without  lasting  benefit.  She  had  been 
uretted  by  an  eminent  gynaecologist,  now  dead,  but  the 
elief  was  only  for  two  months,  when  the  metrorrhagia 
ppeared  as  before.  She  was  frequently  bed-ridden, 
nd  at  all  times  a  useless  invalid,  although  she  had 
trong  aspirations  after  a  useful  and  busy  life.  Oophor- 
ctomy  had  been  recommended  quite  recently.  This 
tie  felt  inclined  to  have  performed,  but  her  medical 
ttendant  on  hearing  of  the  proposal  warned  her  against 
:.  telling  her  that  removal  of  the  ovaries  was  frequently 
>llowed  by  insanity.  Such  a  possible,  or  rather 
robable,  result  naturally  frightened  her,  and  she 
^nctantly  refused  that  operation,  resumed  her  couch, 
er  bed,  and  her  ergot,  without  much  hope  of  ever  being 
ored,  and  with  the  prospect  of  spending  her  life,  up  to 
tie  menopause  at  any  rate,  as  an  invalid  under  medical 
apervision.  She  knew  all  about  it,  having  had  a  large 
iqperience  of  medical  men  and  medical  subjects, 
inding  that  after  a  more  prolonged  trial  such  a  life  was 
itolerable,  she,  without  consulting  either  her  doctor 
r  her  relatives,  came  to  the  out-patient  gynaecological 
Unique  at  the  Royal  Southern  Hospital.  The  patient 
as  fairly  nourished,  but  pallid  and  flabby,  the  result 
t  repeated  haemorrhages  and  of  her  sedentary  life. 
.  -walk  or  even  slight  movements  about  her  room  would, 
le  said,  bring  on  the  bleeding,  and  sometimes  she  had 
>  remain  in  bed  altogether  for  day^.  The  uterus  was 
lightly  enlarged  and  congested,  but  there  was  no  sign 
f  msdignant  disease,  and  the  patient's  age  did  not 
ivour  such  a  serious  diagnosis.  There  were  no  palpable 
broids,  although  the  existence  of  small  fibroids  was  the 
iagnosis  arrived  at.  The  previous  history  of  the 
isease  and  its  treatment  did  not  permit  the  hope  that 

(a)  Read  at  a  meeting  of  the  British  Gynscological  Society 
•Member  8th,  1904. 


further  curetting  would  be  more  permanently^  successful 
than  before,  and  her  wish  was  to  have  the  bleeding 
stopped,  at  any  cost  but  that  of  tier  sanity  and  her  life. 
She  had  no  intention  of  marrying,  but  wished  to  live  an 
active,  useful  life,  and  did  not  mind  the  loss  of  any  of 
the  child-bearing  organs.  She  was  advised  to  have 
a  vaginal  hysterectomy  performed.  This  operation* 
she  was  tpld.  was  certaun  to  stop  the  metrorrhagia, 
and,  the  ovaries  being  left  behind,  was  not  likely  to 
produce  such  serious  symptoms  ais  were  alleged  to  foUow 
odphorectomy.  After  consulting  with  her  friends,  she 
came  into  the  private  ward  of  the  Royal  Southern 
Hospitad  ;  hysterectomy  was  successfully  performed 
on  July  6th,  1899,  and  the  patient  left  the  hospital 
well  on  August  8th.  1899.  On  opening  up  the 
uterus  after  its  removal,  we  found  the  mucous  mem- 
brane replaced  by  a  soft,  white,  gelatinous-looking  sub- 
stance about  one-sixth  of  an  inch  thick,  spreading  up 
into  the  Fallopian  tubes  on  each  side,  where  it  was 
specially  luxuriant  and  almost  polypoid,  becoming 
scanty  below  and  not  so  even  on  the  surface.  It  looked 
as  if  the  growth  was  reforming  below  after  having  been 
torn  away  there  by  the  curette.  The  uterine  walls 
seemed  normal,  and  there  was  no  induration.  | 


Photograph  of  interior  of  Uterus  in  Caise  I. 

Case  II. — In  1900,  a  Miss  G.,  aet.  39,  was  seen  by  me 
with  Dr.  George  Johnston,  of  Liverpool,  on  account  of 
persistent  and  profuse  metrorrhagia  extending  over 
eight  yeairs.  She  was  very  amaemic.  but  did  not  seem 
to  have  lost  much  flesh.  She  haid  been  curetted  about 
five  years  ago,  not  only  without  lasting  benefit,  but  she 
said  the  haemorrhage  had  been  worse  since  the  curetting. 
I  performed  the  curetting  m^lf  most  carefully  and 
thoroughly.  Her  family  history  was  distinctly 
phthisical,  and  the  dread  of  the  onset  of  phthisis  that 
possessed  the  minds  of  her  relatives  and  of  her  mpdical 


650     The  Medical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Dec.  21,  1504, 


attendant  was  naturally  intensified  by  the  haemorrhage, 
especially  as  she  had  been  losing  weight.  I  described 
my  experience  with  the  former  case,  and  the  same 
treatment  was  readily  agreed  to  both  by  the  patient 
and  her.  friends,  and  by  Dr.  Johnston.  On  April  5  th, 
1900,  vaginal  hysterectomy  was  performed.  The 
uterus  presented  exactly  the  same  appearance  as  in 
the  previous  case.  The  results  of  the  operation  were 
all  that  could  be  desired,  the  anaemia  was  gradually 
recovered  from,  and  no  signs  of  phthisis  have  so_far 
appeared. 


Photograph  of  interior  of  uterus  in  Case  II. 
Case  III. — ^Miss  C,  aet.  38,  single,  had  been  quite 
regular  and  normal  as  regards  menstruation  up  to  five 
years  ago,  when  she  became  the  subject  of  frequent 
uterine  haemorrhages  at  all  times,  and  sometimes  to  a 
great  ^extent.  The  haemorrhage  was  checked  at  first  by 
ergot.'  When  ttis  failed,  curetting  was  performed, 
and  the  haemorrfiage  abated  for  a  few  months.  It  then 
came  on  again  more  vigorously  than  ever,  and  in  the 
meantime  one  sister  had  died  from  recurrent  cancer  of 
the  breast,  and  the  second  had  been  recently  operated 
upon  for  the  same  disease.  The  patient  was  also  the 
subject  of  a  nervous  twitching  of  the  muscles  of  the  head 
and  neck,  which  was  made  much  worse  by  the  haemor- 
rhage. Marriage  and  child-bearing  were  not  likely 
events.  She  was^n  the  meantime  much  reduced  by  the 
repeated  losses  of  blood.  From  every  point  of  view  it 
seemed  to  be  desirable  to  have  the  uterus  removed. 
This  was  done  on  September  i8th,  1900.  The  ovaries 
were  left  behind.  The  patient  is  now  (1904)  in  ex- 
cellent health.  The  uterus  presented  the  same 
appearance  as  the  other  cases. 


Photograph  of  interior  of  uterus  in  Case  III. 


Case  IV. — Mrs.  H.,  set.  36,  married,  one  child 
years  ago,  from  the  birth  of  which  she  recovered  aa:». 
factorily.    Ten  years  ago  she  had  an  ovarian  tnait 
removed,  and  soon  afterwards  began  to  sufier  fnt 
leucorrhoea  and  occasionad  metroriiiagia.    Neither  1 
these  symptoms  ever  became  severe,  but  they  pens^ 
in  spite  of  treatment  of  different  kinds.     Twelve  mos^ 
ago   she    began    to    suffer   pain  in    the  right  sde« 
the  pelvis,  which  continued  ever  since  nninfiuenoed  '> 
any  drugs,  except  sedatives.    Six  months  ago  dyspo^ 
nia  set  in,  and  was  accompamied  by  blood-stained,  fee- 
smelling    discharge.     Patient      is      cachectic4ot^ 
On  examination,  the  os  uteri  was  found  doogii^i 
eroded,  and  very  hard,  but  not  appatf-ently  the  saf 
malignant  disease.     The  canal  of  the  uterus  was  no^ 
in  depth. '    ^Ticroscopical  examinations  of  coreiati 
did  not  give  a  decided  diagnosis  of  any  kind.    Clioiat 
the  disease  looked  so  malignant   in   its  nature  tst 
removal  of  the  uterus  was  advised,  and  was  i^slL" 
agreed  to  both  by  the  patient  and  her  husband.  T^ 
operation  was  performed  on  November  3rd.  I9i>4.  Qi 
cutting    the   uterus   open,    the  pathologist  remaiiBd, 
"  The  whole  endometrium  was  infiltrated  with  a  wfet 
fibrous-looking  formation  that  merely    thickened  ^ 
walls  of  the  uterus  without  altering   their  coatocr; 
It  was  an  exact  counterpart  of  the  conditions  foood  1 
the  other  cases.     On  November  29th  the  patient  m 
discharged,  quite  well. 

Case  V. — Emily  E.,  aet.  41,  admitted  to  hospii 
November  13th,  1903.  She  was  confined  ei|;hlea 
months  ago.  Soon  after  convadescence  from  the  c» 
finement  she  began  to  suffer  from  pain  in  the  lovff 
part  of  the  abdomen  and  bax:k.  and  from  intenrntts 
attacks  of  bleeding,  which  were  not  amenable  to  tnsh 
ment.  Two  days  before  admission  she  had  scvc; 
haemorrhage,  and  was  bleeding  profusely  when  admittx 
to  hospital.  Ergot  was  given,  and  the  haemonrbe 
stopped.  Examination  showed  an  enlarged.  en>k' 
anterior  os,  uterine  cavity  normal  in  size.  A  cnmt? 
passed  in  did  not  show  any  growth  or  irregularity  of  taf 
uterine  wall.  As  the  state  of  the  os  was  consado^ 
suspicious,  a  small  piece  of  the  anterior  lip  was  remo^ 
for  examination,  and  a  section  showed  dense  fibne 
tissue  with  cystic  dilatation  of  the  cervical  ghsa 
No  evidence  of  malignancy.  She  was  douched  «i 
creolin.  Ergot  and  hydrastis  were  prescribed.  Tk 
haemorrhage  continued,  and  was  frequently  acc» 
panied  by  so  much  pain  that  nepenthe  had  to  > 
resorted  to.  On  December  i6th,  1903.  the  os  wasdiktif 
up  to  22,  and  the  cavity  thoroughly  curetted.  Tb 
pathologist  did  not  make  anything  definite  oat  d  tip 
cure t tings,  except  that  the  glandular  tissue  was  increasei 
For  a  few  days  she  was  reUeved.  i^hen  the  haemorriafr 
began  again,  and  continued  at  frequent  intervals.  0» 
January  21st,  she  had  a  severe  attack  of  metronfaag*^ 
accompanied  by  severe  pain  in  the  pelvis.  She  it» 
evidently  losing  ground  so  rapidly  that,  being  conviKd 
that  the  disease  was  probably  malignant.  I  adtisri 
vaginal  hysterectomy,  which  was  performed  m 
January  25th,  1904.  The  patient  made  a  goo) 
recovery,  but  some  troublesome  pains  in  her  ba± 
continued  more  or  less  till  May,  when  she  reportai 
herself  as  quite  well.  She  hats  not  been  seen  sna. 
The  uterine  cavity  presented  an  exactly  similar  appeai- 
ance  to  the  previous  two  cases,  ixrhere  a  fine,  soft  gdati* 
nous  substance  was  spread  over  the  surface  of  the 
uterine  cavity. 

It  will  be  seen  that  the  chief  symptom  in  aE 
these  cases  was  persistent  haemorrhage  recnrrinf 
after  curetting  and  after  all  treatment ;  not  » 
great  as  to  destroy  life,  but  sufficient  to  keep  e? 
a  condition  of  anaemia  and  invalidism.  The  sis 
or  shape  of  the  uterus  did  not  differ  materia&r 
from  that  of  a  normal  uterus,  and  the  curettinp 
did  not  present  to  the  pathologist  anything  ab- 
normal. The  glands  were,  perhaps,  more  nim^ 
rous,  but  nothing  more.  One  had  a  child  sixtees 
years  ago,  and  another  had  a  child  one  year  aod  2 
hall  ago  ;    the  rest  were   all  nuUiparous  women. 


DbC.    2Ip    1904. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Pkess.    651 


Aiter  removal,  the  uterine  cavity  presented  very 
distinct  and  uniform  features  in  a  thick,  semi- 
g^elatinous,  semi-fibrous  membrane,  running  into 
lolds  or  polypoid  masses  affecting  the  whole  mucous 
membrane  of  the  uterus  and  the  beginnings  of 
"the  Fallopian  tubes.  Little  points  of  blood  ap- 
I>eared  here  and  there  in  some  of  the  specimens. 
I  am  sorry  not  to  be  able  to  show  a  recent  speci- 
men, as  hardened  specimens  become  quite  different 
in  appearance.  I  can,  however,  show  slides  which 
"^11  give  some  idea  ofthe  appearance  of  recent  cases. 
I  have  only  recently  had  Case  IV.  thoroughly 
examined  by  Dr.  F.  Griffith,  one  of  the  patho- 
logical Fellows  at  the  Thompson  Yates  Labora- 
tories, Liverpool.  He  reports  the  disease  to  be 
an  adenoma  of  the  endometrium,  and  the  two 
photo-microscopic  lantern  sUdes  he  has  prepared 
for  me  will  show  you  at  a  glance  the  nature  of 
the  change.     You  will  then  see  how  the  glandular 


Microphotographs  showing  downgrowths  of 
epithelium. 

tissue  has  dipped  down  between  the  bundles  of 
muscular  fibres  of  the  wall  of  the  uterus,  and  it 
is  probably  the  presence  of  these  downgrowths  of 
adenomatous  tissue  that  produces  the  haemor- 
rhage, and  hence  the  disease.        


H3rsterectomy  was  successful  in  all  these  cases' 
and  a  cure  resulted  in  them  all.  That  resource  is 
only  to  be  had  recourse  to  when  all  well- 
known  methods  have  failed,  and  when  sufficient 
time  has  elapsed.  Eighteen  years  is,  however, 
too  large  a  shce  out  of  a  human  life  to  let  pass 
before  using  curative  means. 


A   NOTE    UPON     SOME     SUBSTITUTES      FOR 

SILVER   NITRATE    IN    EYE 

WORK,    WITH     PARTICULAR 

REFERENCE      TO      ARGYROL. 

By  SYDNEY  STEPHENSON.  M.B.,  CM.. 
Editor  of  the  OpKthalmoteope,  4o.,  Ac. 

Nitrate  of  silver  (or  lunar  caustic,  as  it  used  to  be 
called)  has  enioyed  for  nearly  two  hundred  years  a 
reputation  in  the  treatment  of  superficial  affections  of 
the  eye.  Its  value  was  recognised  by  the  older  writers. 
For  example,  Saint- Yves  certainly  used  and  recom- 
mended silver  in  the  earlier  years  of  the  eighteenth 
century.  V.  Graefe,  in  1826,  was  using  a  solution  of 
the  nitrate,  ten  grains  to  the  ounce.  In  1830,  Velpeau 
adopted  silver  in  inflammations  of  the  eye.  Gouz6e, 
a  Belgian  surgeon,  in  1839  warmly  advocated  a  con- 
centrated solution  of  the  caustic  for  the  treatment  of 
a  disease  then  known  as  the  -'  Egyptian  ophthalmia,"* 
commonly  but  erroneously  supposed  to  have  been  intro- 
duced  into  Europe  by  the  return  of  the  French  troops- 
from  Napoleon's  Egyptian  and  other  campaignBi. 
Guthrie,  of  the  Royal  Westminster  Ophthalmic  Hos- 
pital, London,  treated  trachoma  by  an  ointment  which 
contained  about  eighty  grains  of  the  finely  pulverised 
silver  salt  to  an  ounce  of  hog's  fat.  This  preparation, 
commonly  known  as  Guthrie's  "  Black  Ointment,"  or 
more  pedantically  as  the  "  Unguentum  ophthalmicum 
magicum,"  was  applied  directly  to  the  conjunctiva  by 
means  of  a  brush,  and  the  application  was  repeated! 
daily.  Graphic  accounts  are  upon  record  of  the- 
sufferings  caused  to  patients  by  this  somewhat  heroic,, 
although  doubtless  efficacious,  agent.  In  1842,  Des- 
marrcs  (*'  M6moire  sur  une  nouvelle  m^thode  d'em- 
ployor  le  nitrate  d'acgent  dans  quelques  ophtalmies," 
Paris,  1 85 2)  described  a  new  application  of  silver  nitrate. 
He  clearly  distinguished  between  the  astringent  and 
the  caustic  effects  of  the  remedy,  which  he  employed 
as  a  solution  containing  40  to  90  centigrammes  in  ten 
grammes  of  water,  dropped  into  the  eye  every  half- 
hour  for  forty-eight  hours.  William  Mackenzie  in  his 
classical  -"  Practical  Treatise "  (1854)  describes  the 
action  of  the  silver  in  catarrhal  ophthalmia  in  the 
following  graphic  words  : — '•  I  have  sometimes  alarmed 
other  practitioners,"  wrote  Mackenzie,  •  *  by  proposing 
to  drop  upon  the  surface  of  an  eye  highly  vascular, 
affected  with  a  feeling  as  if  broken  pieces  of  glass  were 
rolling  under  the  eyelids,  and  evidently  secreting  puri- 
form  matter,  a  solution  of  lunar  caustic  ;  and  I  have 
been,"  he  continues,  "  not  a  little  pleased  and  amused 
at  their  surprise  when,  next  day,  they  have  found  all 
the  symptoms  much  abated  by  the  use  of  this  appli- 
cation." A  treatment  for  so-called  ■-  strumous  "  in- 
flammation of  the  conjunctiva  and  cornea  that  had  a 
large  vogue  at  about  this  time  consisted  in  applying 
solid  silver  stick  to  the  palpebral  conjunctiva.  It  is  a 
somewhat  curious  coincidence  that  an  identical  treat- 
ment has  been  recommended  this  year  by  Schiele^ 
{Woch.  f.  Therapie  u.  Hygiene  des  Auges,  September  8th 
and  15  th,  1904). 

The  employment  of  silver  nitrate  was  extended  by 
the  encomiums  of  that  great  master  of  ophthalmology^ 
Von  Graefe,  and  popularised  by  the  recommendations- 
of  Scarpa,  Arlt,  and  others. 

Nitrate  of  silver,  then,  reigned  supreme  in  the  treat- 
ment of  superficial  eye  diseases  until  comparatively 
recently.  That  it  possessed  disadvantages  was  re- 
cognised even  by  its  most  strenuous  advocates,  but  it 
was  generally  felt  that  these  were  more  tham 
outweighed  by  its  potent   escharotic,  astringent,  and 


652     The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec  21.  T904. 


antiseptic  properties.  It  was  admitted  on  all  sides  that 
the  remedy  called  for  no  little  experience  in  its  appli- 
cation ;  that  much  pain  was  often  caased  ;  that  it 
might  destroy  tissue  if  used  carelessly  ;  that  it  did  not 
penetrate  deeply  owing  to  insoluble  compounds  formed 
with  albuminoids  ;  and,  finally,  that  its  long-continued 
use  was  liable  to  produce  an  indelible  staining  of  the 
tissues,  as  the  conjunctiva  and  the  cornea,  with  which 
it  was  brought  into  contact.  William  White  Cooper 
perhaps  summed  up  the  position  when  he  wrote  v — 
--  But  the  nitrate  of  silver  is  the  most  frequent  agent 
of  mischief  ^  powerful  for  good  if  used  with  judgment, 
it  is  all-powerful  for  evil  if  misused  "  ("  On  Wounds 
and  Injuries  of  the  Eye,"  London,  1859,  p.  290). 

Of  the  caustic  effects  of  silver  nitrate  I  nave  person- 
ally witnessed  several  deplorable  examples.  In  one 
case  a  nurse  applied  to  the  palpebral  conjunctiva  a  con- 
centrated solution  of  the  salt,  with  the  result  that  the 
conjunctiva  became  sloughy  and  ulceration  of  the 
cornea  was  set  up.  The  patient  made  a  slow  recovery, 
but  with  scarred  conjunctiva  and  defective  sight,  due 
to  the  corneal  cicatrices.  In  another  case  a  woman 
had  had  a  rectus  muscle  advanced  for  the  correction  of 
a  divergent  squint.  A  fortnight  or  so  after  the  opera- 
tion, a  small  button  of  granulation  tissue  was  found  to 
be  growing  from  the  site  of  operation.  It  was  deter- 
mined to  cauterise  the  little  growth.  Accordingly,  a 
stick  of  silver  nitrate,  fixed  in  a  goose-quill  holder,  was 
held  under  a  stream  of  water  for  a  moment  for  the 
purpose  of  freeing  it  from  some  impurity.  It  was  then 
used  to  touch  the  excrescence.  The  front  of  the  eye, 
including  the  cornea,  at  once  became  covered  and 
hidden  by  a  whitish  film,  which,  under  the  influ- 
ence of  the  bright  sun  shining  into  the  room,  turned 
black  in  a  few  moments,  so  that  the  eye  presented  a 
horrifying  appearance.  The  explanation  of  the  un- 
toward circumstances  was  simple.  Water  had  re- 
mained in  the  quill  above  the  silver  point,  and  when 
the  eye  was  touched  with  the  stick,  the  parts  were 
immediately  flooded  with  a  highly  concentrated  solu- 
tion of  silver.  The  cauterisation  was  fortunately  super- 
ficial, and  the  patient  eventually  made  a  good  recovery. 
In  a  third  case,  the  facts  of  which  I  communicated  to 
the  Ophthalmological  Society  in  1900,  a  lad,  a^t.  9, 
had  been  operated  on  for  trachoma  elsewhere  by  re- 
moval of  the  granulations  by  silver  nitrate  followed  by 
irrigation  of  the  eye  with  a  solution  of  sodium  chloride. 
When  I  saw  the  patient  about  a  month  later,  I  found 
extensive  cicatrices  of  the  conjunctiva  and  slight 
flymblepharon,  while  in  addition  about  two-thirds  of 
one  cornea  was  occupied  by  a  greyish-yellow  deposit, 
apparently  of  silver  chloride.  Vision  was  reduced  to 
one-thirtieth  of  the  normal.  Lastly,  I  have  notes  of  a 
case  where  a  nurse  rubbed  the  palpebral  conjunctiva  of 
a  boy,  a't.  xi,  with  solid  silver  nitrate  in  mistake  for 
some  other  application  which  had  been  prescribed. 
The  results  were  serious,  since  one  cornea  became 
sloughy  and  eventually  leucomatous,  with  sight  equal 
only  to  the  counting  of  fingers  at  half  a  metre  from  the 
face.  Moreover,  an  adhesion  formed  between  the  inner 
part  of  the  lower  lid  and  the  eyeball. 

During  recent  years,  a  host  of  remedies,  nearly  all 
the  output  of  the  unceasing  labours  of  the  busy  syn- 
thetic chemist,  have  been  introduced  as  substitutes 
for  silver  nitrate.  The  list,  already  a  long  one,  in- 
cludes argyrol,  protargol,  largin,  collargol,  itrol,  argo- 
nine,  argentamine,  and  silver  lactate.  For  most  of 
these  products  it  is  claimed  that,  whilst  as  efficacious 
as  the  nitrate,  they  penetrate  more  deeply,  possess 
higher  bactericidal  powers,  do  not  stain  the  conjunc- 
tiva or  the  cornea,  can  be  employed  by  inexperienced 
hands  without  risk,  and.  last  but  not  least,  that  they 
cause  little,  if  any,  pain.  Clinical  investigation  has 
confirmed  some  of  these  claims,  and  has  at  the  same 
time  negatived  others.  '  Certain  of  the  agents  named 
have  already  sunk  into  a  deserved  oblivion,  but  others 
appear  calculated  to  replace  silver  nitrate  in  some,  if 
not  in  all,  of  its  applications  at  no  very  distant  date. 

For  my  own  part,  since  I  became  thoroughly  familiar 
with  the  action  and  uses  of  protargol,  and  more  espe- 
cially of  argyrol,  I  have  not  employed  silver  nitrate  in 


the  treatment  of  a- single  disease  of  the  eye.  Omb 
that  once  would  have  seemed  to  me  to  cry  akmd  for 
lunar  caustic  have  yielded  to  the  action  of  the  new 
remedies,  so  that  what  was  once  more  or  leas  of  m 
experiment  in  my  practice  has  been  converted  into  a 
firmly  established  and  very  substantial  fact. 

In  my  subsequent  remarks  I  shall  consider  brkSy 

the  advantages  and  disadvantages  of  the  three  sihv 

substitutes  of  which  I  have  had  the  most  expencKs. 

namely,  (I)  Largin,  (II)  Protargol,  and  (III)  ArgynL 

I. — ^Largin. 

Largin,  a  synthetic  compound,  has  not  attracted  id 
much  attention  from  ophthalmic  surgeons  as,  in  B7 
opinion,  its  intrinsic  merits  deserve.  It  cootaas 
XI  to  10  per  cent,  of  silver  combined  with  protalbin,  aod 
occurs  in  the  form  of  a  stone-coloured,  granular  povda 
soluble  in  water.  It  is  a  non-irritating  bactericide 
possessing  some  astringent  properties.  I  have  em- 
ployed largin  as  a  3  per  cent,  to  10  per  cent.  sohitioK 
extensively  in  the  treatment  oi  superficial  eye  disordos 
more  especially  in  the  various  forms  of  ophthafanb. 
Its  application  causes  neither  pain  nor  irritation  k 
these  strengths,  neither  is  it  followed  by  appreditie 
reaction.  It  has  been  claimed  by  Falta  {CentraRd.  f. 
prak,  Augen.,  February,  1899)  that  largin  docs  not 
stain  the  conjunctiva  after  long-continued  applicatioD. 
but  my  experience  has  furnished  me  -with  more  thu 
one  instance  where  this  complication  was  observ«l 
Indeed,  elsewhere  (Brit.  Med.  Journ.,  March  i;th. 
1900)  I  have  published  ten  cases  where  argyrosis  vu 
produced  by  largin,  and  since  then  I  have  met  urith 
many  more.  Rightly  or  wrongly,  I  have  formed  the 
opinion  that  largin  is  more  apt  to  stain  the  tissues  thm 
even  silver  nitrate  itself. 

In  the  gonococcal  ophthalmia  of  newly-born  childrBi 
I  have  found  that  a  10  per  cent,  solution  of  largin  is 
inferior  to  both  silver  nitrate  and  to  protargoL  Tht 
case  is,  however,  altogether  different  as  regards  acute 
contagious  ophthalmia,  an  afifection  common  at  certais 
seasons  in  England,  and  nearly  always  due  to  the  tiny 
Koch-Weeks'  bacillus.  In  twenty  such  cases,  some  of 
a  severe  character,  a  rapid  cure  followed  the  daily 
application  to  the  conjunctiva  of  a  10  per  cent,  solutia 
of  largin.  In  acute  trachoma,  also,  the  same  remedv 
yielded  good  results  in  subduing  the  obvious  signs  d 
inflammation,  and  in  paving  the  way,  as  it  were,  for  the 
use  of  more  powerful  means,  escharotic  or  surgical,  h 
blepharo-conjunctivitis,  common  in  poorly-nourished 
and  ill-cared-for  children,  and  generally  associated  iriti 
pyococci  (s.p.  aureus  and  albus),  a  3  per  cent,  solatiaa 
gave  good  and  speedy  results  when  applied  to  the  eyts 
three  or  four  times  a  day.  In  suppurative  affections  of 
the  lachrymal  sac  a  similar  solution,  applied  either  as 
-"  drops  "  or  by  injection,  succeeds  admirably. 

In  brief,  the  application  of  largin  is  painless,  but 
when  prolonged  beyond  a  few  weeks,  is  apt  to  stain 
the  conjunctiva  of  an  indelible  light-brownish  hoe. 
The  more  resistent  cornea  withstands  the  action  d 
largin  for  longer  than  the  conjunctiva,  but  eventnaUy 
it  also  takes  on  the  stain.  Largin  is  an  efficient  sub- 
stitute for  silver  nitrate  in  any  of  the  conjunctiral 
inflammations  associated  with  the  Koch-Wceis' 
bacillus,  such  as  acute  contagious  ophthalmia  and 
acute  or  subacute  trachoma.  Largin,  in  fact,  is 
specific  as  regards  that  particular  micro-organisni, 
just  as  protargol  is  specific  as  regards  the  gonococcos. 
Largin  also  acts  well  in  blepharojunctivitis  and  in 
dacryocj'stitis.  As  is  the  case  with  all  silver  prepara- 
tions, it  is  a  matter  of  practical  importance  that  largio 
should  be  brought  thoroughly  into  contact  with  all 
parts  of  the  diseased  membrane. 

II. — Protargol. 

Protargol  can  scarcely  be  mentioned  without  asso- 
ciating the  product  with  the  name  of  Dr.  A.  Darier.  of 
Paris,  to  whom  we  owe  the  introduction  into  ophthal- 
mology of  this  valuable  synthetic  product  {La  Gin. 
Ofhtal.,  January  loth,  1898).  It  is  a  combination  of 
silver  (8'35  per  cent.)  and  protein,  and  is  met  with  in 
the  form  of  a  yellowish  powder,  readily  soluble  in  cold 
water. 

My  experiences  with  protargol  have,  upon  the  whole 


Dec.  21,  1904- 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    ^53 


t>een  favourable  as  regards  eczematous  blepharitis 
(blepharitis  ulcerosa),  gonococcal  ophthalmia,  acute 
contagious  ophthalmia,  and  suppurative  affections  of 
the  lachrymal  passages.  Attention  to  the  strength  of 
the  preparation  I  have  found  to  be  important.  Thus, 
in  cases  of  ophthalmia  neonatorum,  due  to  the  g[ono- 
coccus,  5  per  cent,  to  10  per  cent,  solutions,  which 
I  used  at  first,  did  not  yield  me  any  striking  successes. 
They  were,  indeed,  inferior  to  the  2  per  cent,  silver 
nitrate  in  common  use.  A  50  per  cent,  solution,  to 
'which  I  then  resorted,  gave  results  that  it  would  be 
difficult  or  impossible  to  surpass.  In  acute  contagious 
ophthalmia  I  employed  a  10  per  cent,  to  20  per  cent, 
solution  with  happy  results,  and  in  lachrymal  affections 
a  3  per  cent,  to  5  per  cent,  solution.  In  many  cases  of 
l>lepharitis,  cure  was  brought  about  by  the  thorough 
rubbing  into  the  diseased  part  of  an  ointment  contain- 
ing 10  per  cent,  of  protargol.  But  since  I  acquainted 
myself  with  Dr.  Darier's  soaping  {savonnage)  I  seldom 
find  it  necessary  to  resort  to  the  ointment.  A  50 
per  cent,  solution  is  used,  and  this  is  rubbed  into  the 
edges  of  the  eyelids  by  means  of  a  brush  steeped  in 
the  liquid.  A  kind,  of  savonnage  of  the  parts  is  thus 
obtained,  which  is  often  capable  of  curing  even  rebel- 
lious cases  of  that  unsightly  disease. 

To  my  mind,  the  disadvantages  of  protargol  are  two 
in  number,  and  the  recognition  of  these  has  prevented 
me  from  using  the  remedy  as  much  as  I  formerly  did. 
They  are  :  (a)  staining  of  the  conjunctiva  ;  and  (6)  pain 
and  discomfort.  The  discoloration  after  prolonged 
use  of  protargol  even  exceeds  that  observed  after  the 
use  of  largin.  After  three  months'  employment  once 
a  day  of  a  10  per  cent,  solution  I  have  seen  the  parts 
assume  a  dirty  brownish  hue  as  unpleasant  to  the 
patient  as  it  was  unsightly  to  the  bystanders.  Dis- 
comfort short  of  actual  pain  is  a  not  uncommon  com- 
plaint in  my  experience,  but  real  pain,  on  the  other 
hand,  is  distinctly  rare.  In  some  instances  these 
drawbacks  appear  to  be  due  to  incorrect  dispensing  of 
the  solution,  to  the  keeping  of  stock  solutions,  or  to 
the  reducing  effect  of  light.  The  water  must  be  cold, 
and  the  powder  must  be  dusted  on  the  surface  of  the 
liquid,  which  is  then  allowed  to  stand  until  solution 
has  taken  place.  On  no  account  must  hot  water  be 
employed.  Small  quantities  should  be  made  at  a  time, 
and  the  solution  should  be  kept  in  non-actinic  bottles. 
III. — ^Argyrol. 
We  now  come  to  a  product,  the  latest  and,  in  my 
opinion,  the  best  of  them  all,  which  has  popularised 
itself  in  a  wonderful  way  since  its  introduction  into 
practical  ophthalmology  less  than  three  years  ago 
(Med.  Record,  May  24th,  1902).  It  is  known  as  argyrol, 
or  silver  vitellin.  It  contains  no  less  than  30  per  cent, 
of  metallic  silver  combined  with  a  proteid  substance. 
Notwithstanding  its  high  ratio  of  silver-content,  I 
have  never  known  it  cause  the  least  pain,  irritation, 
or  reaction.     It  is  extremely  soluble  in  water. 

During  the  last  eighteen  months  I  have  employed 
argyrol  upon  an  extensive  scale,  chiefly  in  all  kinds  of 
conjunctivitis,  in  blepharitis,  in  phlyctenular  affec- 
tions of  the  cornea  aind  conjunctiva,  and  in  affections 
of  the  lachrymal  passages.  Sly  experiments  have  been 
made  with  a  15  per  cent,  solution,  and  only  in  cases  of 
gonococcal  ophthalmia  have  I  resorted  to  a  20  per  cent, 
strength.  The  weaker  liquid  has  been  dropped  into 
the  eye  three  to  eight  times  a  day  according  to  the  kind 
and  severity  of  the  inflammation.  The  stronger  liquid 
has  been  painted  over  the  exposed  conjunctiva  once 
or  twice  in  the  twenty-four  hours.  An  argyrol  oint- 
ment, as  will  be  explained  later,  has  been  used,  chiefly 
in  phlyctenular  affections  of  the  eye. 

Almost  the  first  thing  that  struck  me  about  argyrol 
was  the  fact  that  many  patients  volunteered  the  state- 
ment that  even  after  the  initial  application  relief  to 
symptoms  was  obtained.  It  thus  appeared  to  act  as  a 
direct  sedative  to  the  inflamed  mucous  membrane. 
No  single  patient  has  ever  complained  of  any  pain 
attending  its  use.  No  caustic  or  escharotic  action  ever 
follows  its  use.  To  judge  from  its  effect  on  cases  of 
acute  contagious  ophthalmia,  its  powers  of  penetration 
must  be  of  a  very  searching  description.     The  sym- 


ptoms of  a  sharp  attack  of  acute  conjunctivitis,  due 
to  the  Koch- Weeks'  bacillus,  may  be  subdued  in  the 
course  of  two  or  three  days,  and  that,  be  it  remem^ 
bered,  without  the  least  discomfort  to  the  patient,  t 
have  further  found  argyrol  capable  of  quickly  healing 
those  small  peripheral  ulcers  of  the  cornea  which  are" 
now  and  then  associated  with  acute  catarrhal  ophthal- 
mia in  middle-aged  and  elderly  people.  As  is  well 
known,  these  small  ulcers  may  become  extremely  pain- 
ful, a  symptom  that  speedily  yields  to  argyrol.  A 
15  per  cent,  solution  used  as  an  injection  in  suppurative 
lachrymal  affections  has,  in  my  hands,  often  dried  up* 
the  muco-purulent  secretion  and  materially  assisted  in 
restoring  the  tear  passages  to  a  healthy  condition.  In 
ophthalmia  neonatorum,  due  to  gonococcal  infection, 
the  25  per  cent,  solution  painted  once  or  twice  a  day' 
over  the  conjunctiva,  exposed  for  that  purpose  by 
eversion  of  the  lids  and  carefully  dried  from  adherent 
discharge,  with  the  frequent  use  by  instillation  of  the 
1 5  per  cent,  or  of  a  weaker  solution,  will  cure  the  case  a^ 
quickly  and  certainly  as  any  remedy  with  which  I  am 
acquainted.  If  ulcers  of  the  cornea  are  present  when 
the  case  falls  under  notice,  argyrol  is  more  than  ever 
indicated,  and  should  then  be  used  twice  a  day.  In 
such  cases  I  beheve  I  have  seen  benefit  from  letting  the 
argyrol  run  freely  over  the  ulcerated  surface  of  the 
cornea,  a  thing  that  may  be  done  with  perfect  safety. 

Many  cases  of  obstinate  ulcerative  blepharitis  may 
be  cured  by  rubbing  the  inflamed  lids  vigorously  with 
a  pledget  of  wool  soaked  in  the  15  per  cent,  solution,  and 
repeating  the  process,  at  first  daily,  and  later  at  longer 
intervals.  This,  combined  in  the  more  severe  cases 
with  occasional  cauterisation  of  the  little  ulcers  lying 
at  the  roots  of  lashes  with  the  acidum  carbohcum 
liquifactum  of  the  "  British  Pharmacopoeia,"  is  the  best 
treatment  that  I  have  ever  adopted  in  long-standing 
and  rebellious  cases.  It  need  scarcely  be  added  that 
before  the  argyrol  is  used  every  trace  of  scab  should  be 
removed  from  the  inflamed  edges  of  the  eyelids.  An 
ointment  containing  10  grains  of  argyrol  to  the  ounce 
of  vasehne  acts  well  in  many  cases  of  eczematous 
(phlyctenular)  conjunctivitis  and  keratitis,  and  if 
marked  photophobia  and  blepharospasm  be  present, 
two  to  four  grains  of  alkaloidal  atropine  may  with 
advantage  be  added  to  the  prescription.  The  oint- 
ment, simple  or  combined,  should  be  applied  two  or 
three  times  a  day.  There  are  few  cases  even  of  the  most 
intense  blepharospasm  that  will  not  yield  to  this  treat- 
ment, especially  if  at  the  same  time  the  patient's 
forehead  be  painted  daily  with  liniment  of  iodine  until 
the  skin  becomes  sore  and  slightly  cracked.  I  need 
say  nothing  of  constitutional  remedies,  which  are  called 
for  in  practically  every  case. 

The  only  form  of  conjunctivitis  in  the  treatment  of 
which  argyrol  has  disappointed  me  is  in  the  chronic  or 
subacute  form  due  to  the  Morax-Axenfeld  diplo*- 
bacillus,  the  so-called  "  angular  blepharitis,"  where  the 
zinc  salts,  in  rather  strong  solution,  have  seemed  to  me 
much  superior. 

It  has  been  claimed  that  argyrol  never  stains  the 
conjunctiva,  no  matter  in  what  concentration  or  for 
how  long  it  may  be  applied.  If  this  be  true,  it  at  once 
gives  argyrol  a  superiority  over  the  other  salts  of  silver, 
organic  or  inorganic.  The  claim,  however,  needs  some 
slight  modification,  inasmuch  as  in  one  case  I  have  seen 
argyrol  produce  slight  argyrosis.  The  facts  are  as 
foUows  : — Miss  E.,  aet.  54,  suffering  from  a  chronic  and 
rather  severe  palpebral  conjunctivitis,  was  ordered  a 
15  per  cent,  solution  of  argyrol  for  use  four  times  a 
day  on  August  22nd,  1903.  On  October  2nd,  the 
number  of  applications  was  increased  to  five  a  day^ 
On  January  13th,  1904 — that  is  to  say,  after  she  had 
used  the  remedy  for  144  days — a  very  faint  staining  of 
the  palpebral  conjunctiva  was  noted.  This  is  the  sole 
instance  I  have  met  with. 

Conclusion. 

Silver  nitrate,  although  invaluable  in  the  hands  of 
those  who  know  how  to  use  the  remedy,  is  apt  to  be- 
come a  somewhat  dangerous  weapon  if  employed  with- 
out due  experience,  skill,  and  discrimination.  The 
knowledge  of  this  fact  has  led  chemists  to  endeavour 


654    '^HE  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec.  21.  1904. 


to  find  an  agent  that  shall  possess  the  antiseptic  powers 
of  silver  nitrate  without  its  undesirable  qualities.  It 
has  been  recognised  that  the  clinical  value  of  a  silver 
compound  depends  upon  the  amount  of  the  contained 
silver,  and  that  is  modified,  often  in  an  undesirable 
direction,  by  the  other  chemical  constituents  of  the 
salt  (see  Ophthalmoscope,  March,  1904).  Hence,  the 
last  few  years  have  witnessed  the  production  of  many 
new  silver  compounds  belonging  to  the  organic  class. 
The  ideal  agent,  according  to  Fraenkel,  must  fulfil  the 
several  requirements  of  not  coagulating  albumen  or  of 
precipitating  sodium  chloride,  of  ready  solubility  in 
water,  of  not  producing  pain  or  of  setting  up  irritation 
when  applied  to  the  eye.  Largin,  protargol,  and 
argjrrol  fall  more  or  less  in  line  with  these  requirements. 
The  staining  propensities  of  largin  and  especially  of 
protargol  make  me  give  the  preference  to  argyrol  as  an 
agent  for  general  employment.  So  far  as  my  personal 
experience  goes,  it  never  does  the  least  harm,  while  it  is, 
without  doubt,  an  efficient,  speedy,  and  painless  remedy 
in  most  superficial  affections  of  the  eye. 

THE  PERSoTjaT^LEMENT 

IN  THE 

ADMINISTRATION  OF 
AN/ESTHETICS.  (a) 

By   V.    G.    L.    FIELDEN,  M.B.,  B.Ch.    R.U.I., 

Senior  Anasthetist,  Royal  Victoria  Hospitol ;  Anesthetist.  Belfast 

Ophthalnilo   Hospital,  and   Ulster  Hospital  for  Women  and 

Children,  Ac. 

The  title  of  this  paper  may  be  a  little  ambiguous, 
so,  at  the  outset,  I  must  mention  that  I  do  not  mean 
by  **  personal  element  "  that  of  the  anaesthetist, 
but  entirely  that  of  the  patient. 

No  two  persons  are  exactly  alike,  and  so  the 
anaesthetist  finds  that  his  patients  do  not  corre- 
spond in  every  detail.  It  is  in  consideration  of 
some  of  these  personal  points  which  I  have  met 
with  in  my  work  that  I  desire  to  occupy  your  atten- 
tion for  a  brief  space. 

I  am  frequently  asked  by  students  :  "  How  do 
you  know  when  a  patient  has  had  enough  ?  " 
I  briefly  recapitulate  the  different  stages  of 
anaesthesia  with  their  signs,  and  these  embryo 
practitioners  probably  go  off  quite  satisfied  in 
their  own  minds  that  they  will  be  able  to  give 
anaesthetics  as  soon  as  they  have  gained  the  coveted 
degree  or  diploma.  These  students  are  not  asked 
by  their  examining  bodies  to  produce  a  certificate 
of  having  devoted  a  certain  amount  of  time  to 
this  branch  of  their  profession,  so  they  do  not 
consider  it  worth  while  to  voluntarily  attend  a 
short  course  of  lectures  and  demonstrations  on 
such  an  important  subject.  A  small  percentage 
of  students  in  a  medical  school  will  be  found  to  be 
interested  in  the  subject  for  its  own  sake,  but  the 
majority,  knowing  that  there  will  be  not  even  a 
single  question  on  the  subject,  will  become  qualified 
to  practise  without  having  considered  the  rudi- 
ments of  anaesthetics  and  their  administration. 
Their  qualifications  to  practise,  however,  entitle 
them  to  administer  such  potent  drugs  as  anaes- 
thetics, and  the  general  public  consider  their  freshly 
acquired  degree  or  diploma  a  guarantee  of  their 
ability  *'  to  give  chloroform." 

Many  practitioners  remain  content  with  a  know- 
ledge of  the  general  signs  of  amaesthesia  without  a 
thought  of  any  peculiarity,  from  disease  or  other- 
wise (the  personal  element),  on  the  part  of  the 
patient.  **  He  took  the  anaesthetic  very  well  " 
auid  "  he  took  it  very  badly  "  are  common  expres- 

(a)  Paper  read  at  a  meeting:  of  the  Belfast  Division  of  the 
Ulster  Branch  of  the  British  Medical  Association. 


sions.  The  latter  may  be  due  to  faulty  admiois- 
tration  or  to  the  personal  element  on  the  part  oi 
the  patient,  in  whom  some  condition,  known  or 
unknown,  renders  a  perfectly  smooth  condition 
of  anaesthesia  more  or  less  impossible,  and  it  is  only 
experience  or  alert  thoughtf ulness  which  can  fore- 
stall or  control  difiiculties  as  they  arise. 

Numbers  of  such  cases  are  to  be  met  with,  and 
Hewitt  has  given  us  the  benefit  of  some  of  his 
valuable  observations  in  two  lectures  entrded 
"  The  Anaesthetisation  of  So-called  Bad  Subjects  " 
{Lancet,  January  loth,  1903).  In  these  be 
points  out  the  part  played  by  such  familiar  condi- 
tions as  nasal  or  other  obstructions  liable  to  caise 
respiratory  embarrassment  ;  a  full  set  of  powerful 
teeth  set  in  a  strong  jaw  ;  a  very  muscular  man  . 
and  a  man  of  the  "  John  Bull  "  tjrpe,  &c.  A  fnD 
and  careful  perusal  of  these  lectures  by  such  an 
authority  wiU  amply  repay  the  reader. 

Alcoholism. — ^This  is  perhaps-the  most  familiar  of 
examples  of  the  patients'  personal  element  so  far 
as  it  affects  the  production  and  maintenance  of 
anaesthesia.  Alcoholics  are  admittedly  bad  sub- 
jects, and  we  approach  them  with  a  certain  amomxt 
of  dread  when  the  administration  of  an  anaesthetic 
is  desired.  It  is  not  an  absolute  necessity  that 
alcoholism  is  S3monymous  with  difficulty.  Occa- 
sionally it  will  be  found  an  easy  task  to  anaesthetise 
an  alcoholic.  I  have  given  an  anaesthetic  the  day 
after  a  "spree"  without  the  slightest  trouble.  Oi 
the  other  hand,  a  dytist  and  I  had  quite  a  little 
scrimmage  with  a  ydung  fellow  before  anaesthesia 
resulted.  He  admitted  having  had  five  glasses  of 
brandy  during  the  day,  and  it  mras  then  only  3 
o'clock. 

I  have  come  to  consider  that  the  ethyl  chloride- 
ether  sequence  is  the  best  for  inducing  anaesth^a 
in  an  alcoholic. 

Fear. — ^This  is  a  great  source  of  worry  and  trouble 
to  an  anaesthetist,  and  it  has  been  the  cause  oi 
many  so-called  accidents.  I  have  had  many  very 
nervous  patients  to  deal  with,  whom  it  was  difficult 
or  impossible  to  reassure.  I  have  heard  them  give 
directions  regarding  the  care  of  their  children  and 
their  affairs,  fearing  approaching  death,  even  after 
being  seated  in  a  dentist's  chair  or  placed  upon  the 
operating  table.  Such  cases  w^ould  be  enough  to 
scare  a  timid  administrator,  and  cannot  fail  to 
increase  the  anxiety  of  an  experienced  ainaesthetist 
Should  a  fatality  occur  the  anaesthetic  or  the 
anaesthetist  would  no  doubt  be  accredited  with  the 
death,  whereas  fright  has  no  doubt  had  more  to  do 
with  it.  That  death  from  fright  can  occur  has  been 
proved.  One  case  occurred  in  Bdinburgh.  The  1 
patient  was  placed  on  the  table,  and  before  the 
administration  was  commenced  was  found  to  be 
dead.  Hewitt  quotes  a  case  of  Kappeler's,  and  two 
cases  of  death  from  fear  prior  to  the  administratioo 
of  an  anaesthetic  are  the  subject  of  a  leading  artide 
in  the  British  Medical  Journal,  February  21st, 
1903.  Had  even  the  smallest  quantity  of  anaes- 
thetic been  inhaled  in  these  caises  they  would  have 
been  branded  deaths  due  to  the  drug.  There  is 
no  doubt  that  the  element  of  fear  is  one  to  be 
dreaded  by  any  administrator.  May  I  mention 
that  it  is  decidedly  wrong  for  an  operator,  in 
attempting  to  reassure  the  patient  and  friends,  to 
make  the  dogmatic  statement  that  there  is  abso- 
lutely no  danger,  for  it  would  put  the  anaesthetist 
in  a  most  unfortunate  position  should  a  fatality 
result? 


I>SC.    21,    IQO4. 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Press.    655 


S/iockf  either  due  to  the  condition  requiring  ope- 
a-tlon  or  occurring  during  operation,  is  a  source 
f  increased  danger  and  requires  the  exercise  of 
inch  care.  I  have  met  with  it  prior  to  operation 
1  cases  of  severe  accident  with  or  without  the  loss 
f  blood,  in  cases  of  rupture  of  the  bowel  or  stomach, 
:c.,  and  during  operations  in  abdominal  surgery, 
riiere  a  profound  impression  has  been  made  on  the 
olax  plexus  and  acting  reflexly  through  the 
a.g^s.  Once  did  I  meet  it  in  enucleation  of  the 
yeball  following  pan-ophthalmitis.  Stretching  of 
be  sphincter  and  cutting  the  cord  in  excision  of  the 
estis  are  liable  to  cause  shock.  In  his  Address 
a  Surgery  at  the  recent  Oxford  meeting,  Sir  Wm. 
lacEwen  dealt  at  length  with  the  cardiac  and 
espiratory  reflexes  which  may  be  obtained  through 
tie  pudic  nerves,  and  I  am  glad  to  see  that  he  does 
LOi:  now  blame  the  anaesthetist  as  he  once  did. 
n  such  conditions,  where  shock  is  either  present  or 
ts  occurrence  feared,  a  preliminary  injection  of 
trychnine  (t^  gr.  for  an  adult)  and  either  ether 
>r  a  mixture  containing  it  is,  in  my  experience,  the 
>es"t  method  of  procedure. 

Glycosuria  is  a  condition  in  which  one  fears  ill 
ifter-effects.  I  have  had  a  few  such  cases,  and  I 
il-wajrs  give  ether  if  at  all  possible,  and  my  reason 
s,  that  chloroform  has  been  known  to  be  followed 
i>y  sugar  in  urine  which  had  hitherto  been  free. 
I  have  had  invariable  success  with  ether  and  no  ill 
after-efiects.  Coma  has  followed  the  administra- 
tion of  an  anaesthetic  in  diabetes.  I  have  not 
seen  it.  One  case  that  I  have  notes  of  had  slight 
glycosuria  when  admitted  to  hospital.  This  had 
disappeared  by  dieting  before  operation  for  a 
radical  cure  of  hernia.  I  gave  ether  for  an  hour, 
and  no  sugar  appeared  as  a  result. 

Albuminuria  is  another  condition  which  induces 
me  to  give  ether  unless  otherwise  contra-indicated. 
Thompson,  Buxton,  and  Levy  have  demonstrated 
that  there  is  '*  no  specific  ether  effect  "  upon  the 
kidney.  Chloroform,  on  the  other  hand,  has  occa- 
sionally caused  albuminuria. 

Pregnancy. — Apart  from  anaesthetics  given  in 
obstetric  practice  I  have  been  called  on  frequently 
for  surgical  or  dental  cases  during  pregnancy,  and 
my  experience  goes  to  prove  that  it  is  not  a  contra- 
indication to  the  use  of  an  anaesthetic.  Perhaps 
my  best  example  was  a  case  of  nephrectomy  taking 
over  an  hour  during  the  fourth  month.  The  patient 
returned  to  hospital  and  was  delivered  at  full 
term. 

Empyema  cases  are  particularly  anxious  ones, 
especially  as  the  majority  are  operated  upon  by 
turning  the  patient  upon  his  sound  side  for  the 
benefit  of  the  surgeon. 

Coma. — Only  once  have  I  had  to  give  a  comatose 
patient  (a  girl,  aet.  17)  an  anaesthetic  (trephining 
for  cerebral  abscess).  There  was  no  conjunctival 
and  sUght  corneal  reflex  when  the  patient  was 
placed  upon  the  table.  I  gave  A.C.E.,  and  very 
little  of  that  was  necessary. 

Valvular  Disease  is  not  a  contra-indication  to 
the  use  of  an  anaesthetic  if  compensation  is  perfect. 
Care  is  very  necessary  that  no  undue  strain  is  put 
upon  the  heart  in  any  way.  I  have  had  two  cases 
with  double  aortic  murmur  and  used  ether.  Mitral 
disease  is  much  more  common.  Irregularity  is  a 
greater  cause  for  anxiety.  In  one  case  in  which 
I  gave  ether  for  the  amputation  of  a  foot  in  a  young 
man,  the  heart  became  irregular  during  the  adminis- 
tration and  remained  so  the  following  day.  It  was, 
no  doubt,  functional. 


Certain  conditions  arise  during  the  administra- 
tion which  must  influence  more  or  less  the  adminis- 
trator. 

Vomiting  is  a  very  familiar  cause  of  trouble  on 
the  part  of  the  patient,  especially  to  the  inexperi- 
enced, the  reason  being  that  he  is  not  able  to  keep 
up  such  an  even  degree  of  anaesthesia  as  one  with 
more  practice.  Some  patients  do  not  suffer  from 
nausea  or  vomiting  to  even  the  sUghtest  degree, 
whilst  others  are  greatly  upset  by  it.  When  a 
patient  vomits  during  an  operation  it  is  a  sign  that 
he  is  not  getting  enough — ^in  other  words  he  has 
returned  to  the  second  stage  of  anaesthesia  in  which 
the  vomiting  centre  is  no  longer  paralysed.  It  is 
the  more  frequent  inability  of  the  inexperienced 
to  maintain  evenly  the  third  stage  that  accounts 
for  his  greater  trouble  with  this  troublesome 
complication.  The  older  teaching  that  alteration 
in  the  size  of  the  pupil  is  an  index  of  the  onset  of 
vomiting  is  fallacious.  I  have  several  times  seen 
the  pupil  remain  contracted  during  vomiting. 
Swallowing  movements  and  pallor  are  frequent 
precursors.  Vomiting  is  mostly  due  to  the  irrita- 
tion of  the  vomiting  centre  by  the  anaesthetic,  and 
its  irritability  varies  greatly  in  different  individuals. 
The  swallowing  of  saliva  in  which  some  of  the 
anaesthetic  is  dissolved  no  doubt  is  a  cause  of 
vomiting  by  its  action  upon  the  mucous  lining  of 
the  stomach.  I  have  had  frequent  opportunity  of 
proving  the  fact  that  a  patient  who  suffers  from 
prolonged  and  severe  vomiting  after  chloroform 
may  suffer  little,  if  at  all,  after  ether  given  for  a 
further  operation. 

Vomiting  after  ether,  though  more  frequent  than 
after  chloroform,  is  usually  not  so  severe,  but  I  have 
notes  of  one  remarkable  case  in  which  it  persisted 
from  Wednesday  morning  till  Saturday  evening 
after  ether  given  for  an  appendicectomy. 

Fcscal  vomiting,  or,  as  I  think  it  should  be  more 
properly  called,  faecal  regurgitation,  as  a  symptom 
of  the  condition  requiring  operation  should  be 
accepted  as  a  warning  for  great  care.  The  fluid 
regurgitates  from  a  stomach  more  or  less  distended, 
the  only  means  of  exit  (for  example  in  intestinal 
obstruction)  being  by  the  mouth,  and  the  epiglottis 
is  not  closed  as  in  the  act  of  true  vomiting.  Re- 
spiration proceeds  normally  and  the  inspiratory  act 
draws  the  faecal  fluid  into  the  trachea.  I  have 
once  seen  death  result  in  this  way,  and  I  deter- 
mined that  in  all  such  cases  I  would  wash  out  the 
stomach  prior  to  giving  an  anaesthetic.  I  have 
more  fully  reported  this  and  a  successful  case  else- 
where (Medical  Press  and  Circular,  January 
27th,  1904),  and  since  I  have  added  half  a  dozen 
more  cases  to  my  list  in  which  I  have  drawn  off 
the  faecal  fluid  by  a  syphon  tube,  and  then  washed 
out  the  stomach.  In  this  way  I  considerably 
reduced  the  danger  and  difliculty  in  what  are 
acknowledged  to  be  bad  subjects  for  anaesthetics. 

Spasm. — ^This  may  be  general,  as  is  more  palr- 
ticularly  seen  in  very  muscular  individuals,  or  it 
may  be  local — e.g.y  of  the  jaw  or  of  the  glottis. 
Heavy  smokers  are  liable  to  spasm  of  the  jaw,  and 
Hewitt  suggests  that  it  may  be  due  to  hypertrophy 
of  the  muscles  caused  by  constant  pufl&ng  or  pulling 
of  the  pipe,  &c.  Spasm  of  the  glottis  may  be  the 
effect  of  an  unusual  delicacy  of  the  mucous  lining, 
or  it  may  be  that  too  concentrated  a  vapour  is  being 
inhaled.  In  either  case  a  more  dilute  vapour 
must  be  used.  Impure  drugs  which  may  be  the 
source  of  trouble  must  of  necessity  be  avoided. 
Spasm  of  the  jaw  is  much  more  common  than  that 


656    The  Medical  Press. 


ORIGINAL    COMMUNICATIONS. 


Dec.  21,  1904. 


of  the  glottis  and  may  be  very  severe.  The  worst 
case  I  have  had  was  in  a  tetanus  case  with  some 
trismus,  to  whom  I  administered  ethyl  chloride  for 
the  amputation  of  a  toe.  Forcible  use  of  the  gag 
sufficed  to  remedy  the  condition. 

Cyanosis  may  be  the  result  of  spasm  of  the  jaw  or 
larynx,  or  it  may  occur  independently  of  either. 
Its  presence  must  always  make  an  anaesthetist  very 
watchful,  for  whatever  the  cause  there  is  great  risk 
of  unhappy  cardiac  effects.  Forcible  opening  of 
the  mouth  and  traction  upon  the  tongue  may 
relieve  the  cyanosis,  and  sometimes  the  gag,  with  or 
without  pushing  forward  the  angle  of  the  jaw,  may 
suffice.  In  desperate  cases  tracheotomy  may  be 
the  only  remedy.  I  have  not  had  to  resort  to  the 
use  of  the  tubes  which  I  always  carry  in  my  bag. 
I  recently  had  a  casein  which  deep  cyanosis  resulted 
when  the  patient  was  placed  in  the  Trendelenberg 
position.  Both  gag  and  tongue  forceps  failed  to 
relieve  it  in  the  slightest  degree,  and  it  was  only 
when  the  flat  posture  was  resorted  to  that  it  passed 
off.  Another  bad  case  that  I  have  notes  of  was 
that  of  a  gentleman  who  was  to  have  haemorrhoids 
removed.  Chloroform  caused  deep  cyanosis, 
whilst  ether  added  to  the  trouble  by  causing  such  a 
great  amount  of  coughing  as  to  interfere  with  the 
operator  who,  learning  the  state  of  affairs,  worked 
against  time  whilst  I  proceeded  cautiously  for 
a  very  uncomfortable  twenty  minutes.  This  patient 
smoked  cigarettes  to  such  an  extent  that  he  had 
furnished  himself  with  a  pound  box  of  them  for 
consumption  during  his  stay  in  the  private  hospital. 
I  have  notes  of  two  cases  (twin  girls,  aet.  12)  who 
both  coughed  severely  and  became  cyanotic  whilst 
getting  chloroform  prior  to  the  removal  of  adenoids. 
Was  its  occurrence  in  both  merely  a  coincidence  or 
was  it  a  natural  tendency  or  due  to  the  adenoids  ? 
I  am  not  able  to  say  which. 

Several  of  my  cases  have  demonstrated  the  fact 
that  cyanosis  may  result  from  the  presence  of  food 
in  the  stomach.  In  such  cases  it  passed  off  when 
the  stomach  emptied  itself  by  vomiting. 

I  have  several  times  noticed  the  great  tendency 
to  cyanosis  that  there  is  in  patients  in  the  Tren- 
delenberg position,  who  retch  unless  very  deeply 
anaesthetised.  The  profound  anaesthesia  necessary 
to  avoid  annoyance  to  the  surgeon,  together  with 
the  effect  of  gravity,  may  be  a  source  of  great 
anxiety  to  the  anaesthetist. 

Milder  respiratory  effects  than  the  foregoing 
are  more  frequent,  e.g.  : — 

Cough  and  Holding  the  Breath,  both  of  which  are 
more  common  with  ether  or  a  mixture  containing 
ether.  Cough  is  generally  tiie  result  of  the  direct 
effect  of  the  anaesthetic  on  the  respiratory  mucous 
membrane,  and  in  patients  who  are  very  irritable 
it  may  occur  during  deep  anaesthesia.  Should 
ether  be  the  anaesthetic  used  it  may  be  necessary  to 
change  to  chloroform,  and  if  it  occurs  with  the 
latter  the  administrator  will  require  to  exercise 
his  best  endeavours  to  keep  the  patient  anaesthe- 
tised with  as  dUute  a  vapour  as  possible.  I  have 
notes  of  one  case  in  which  there  was  frequent  cough 
under  chloroform,  which  was  greatly  diminished  by 
painting  the  nasal  cavities  with  a  solution  of 
cocaine.  Cough  may  be  due  to  excessive  bronchial 
secretion.  Even  under  chloroform  I  have  seen  such 
profuse  secretion  that  cyanosis  and  cough  both 
occurred,  and  it  was  necessary  to  encourage  the 
coughing  at  intervals.  Such  cases  fortunately  are 
Tare. 

Holding  the  Breath  may  be  due  to  too  condentrated 


a  vapour,  but,  apart  from  this,  iscomm(miiL\^y 
nervous  patients.  When  it  occurs  it  is  wefl 
especially  if  chloroform  is  being  given,  to  aOovi 
free  breath  of  air,  as  great  risk  is  incurred  by  ^ 
inhalation  of  chloroform-laden  vapour  with  tljt 
very  deep  breath  which  naturally  follows. 

Excessive  Buccal  Secretion  requires  removal 
either  by  occasional  sponging  or  by  a  simple  dcvict 
suggested  by  Blumfeld  (a)  in  his  little  book— i^ 
by  the  comer  of  a  towel  tucked  into  the  dependes 
cheek,  which  has  a  syphonage  action.  I  ha\t 
found  this  hint  very  useful. 

Hiccough  is  occasional.  I  have  seen  it  a  fer 
times,  but  never  very  severe. 

Sneezing. — ^This  occurred  several  times  in  j 
young  fellow  during  the  inhalation  erf  chlorofora 
for  enucleation  of  the  eyeball  for  syj^iilitic  iiitii 

Epilepsy. — A  history  of  this  tends  to  increaae 
our  anxiety  lest  a  fit  should  be  induced. 

I  have  had  four  or  five  cases,  but  in  none  did  anr 
trouble  occur — one  of  the  cases  had  had  a  fit  in  tilt 
extern  whilst  being  examined  afewdaysiH'e\ioiishr. 
I  have,  however,  notes  of  one  case,  without  as 
epileptic  history,  which  resembled  what  is  described 
as  an  epileptiform  seizure. 

Dilated  Pupils  persisting  after  abolition  oi  tit 
corneal  reflex  puts  an  anaesthetist  upon  his  mettle. 
This  symptom  may  (but  not  invariably)  be  foood 
under  the  following  conditions  : — 

1.  Digestive  disturbance. 

2.  Shock,  either  before  or  during  operation. 

3.  With  profuse  haemorrhage. 

4.  After  struggling. 

5.  In  presence  of  the  following  three  conditiGSB 
— anaemia,  emaciation  and  pyrexia. 

6.  After  the  general  or  local  use  of  atropine  or 
belladonna. 

7.  In  those  who  have  been  very  frightened. 

8.  With  cyanosis. 

I  could  quote  many  cases  I  have  come  across,  btt 
time  does  not  permit.  The  greatest  care  is  necesarr 
in  such  cases  lest,  in  trying  to  obtain  contractioD 
of  the  pupils,  the  anaesthetic  is  pushed  too  far. 

Unequal  Pupils. — I  have  frequently  been  able  to 
demonstrate  to  students  and  others  the  prcscnct 
of  this  condition.  One  pupil  may  be  well  contracted 
whilst  the  other  may  be  more  or  less  dilated.  TTds 
always  increases  my  anxiety,  for  when  present 
after  abolition  of-  the  corneal  reflex  one  cannot 
help  feeUng  that  the  dilatation  of  one  pupil  may 
be  a  sign  of  danger.  I  should  be  glad  to  learn  tbe 
significance  of  this  phenomenon.  I  have  thought 
that  it  may  be  due  to  some  difference  of  refraction, 
but  can  offer  no  proof  of  this  theory.  Whilst 
writing  this  paper  I  had  an  exceedingly  good 
example  of  it  in  the  Royal  Victoria  Hospital. 
Dr.  Macllwaine  and  Dr.  Nelson  very  kindly  exam- 
ined the  eyes  for  me,  but  found  such  a  very  minute 
difference  in  the  refraction  of  the  t^vo  eyes  that  it 
hardly  supports  my  theory. 

I  do  not  profess  to  have  dealt  with  every  condition 
on  the  part  of  the  patient  which  must  weigh  with 
us  in  the  administration  of  an  anaesthetic,  nor  to 
have  gone  into  detail  in  those  on  which  I  ha\t 
touched  ;  much  more  time  would  be  necessary  thaa 
is  available  at  this  meeting.  I  trust,  however, 
that  what  I  have  said  is  sufficient  to  show  that  the 
proper  performance  of  this  branch  of  our  professioc 
is  not  such  a  sinecure  as  too  many  seem  to  suppose. 

(a)  "  Isesthetics."  By  Dr.  Blumfeld.  Medical  Monompb  S«i»> 
BaiUiere,  TiodaU  and  Cox,  1004. 


Dec.  21,  1904. 


TRANSACTIONS  OF  SOCIETIES.  Tbe  Medical  Peess.   657 


dUnlcal  IRecor^B. 


FAIXOPIAN  TUBES,  LIGATURED  TWICE  AT 
PREVIOUS  OPERATIONS.  AND  REMOVED 
IN  THE  CASE  OF  A  THIRD  CiESAREAN 
SECTION,  (a) 

By  J.  W.  Taylor.  M.D.,  F.R.C.S.. 

President  ot   the     British    O^nn^otoqfioal  Socltty ;    Professor   of 

Qynsecologry  in  the  University  of  Birminghjim. 

The  history  of  these  specimens  is  as  follows : — 
M.S..  a  strumous  dwarf,  set.  25.  with  both  curvature 
of  spine  and  contracted  pelvis,  was  married  in  July, 
1900.  She  immediately  became  pregnant,  and  was 
sent  to  me  for  operation  by  Dr.  DarroU.  of  Leint- 
wardine.  in  February,  1901. 

Labour  commenced  on  the  morning  of  March  20th, 
-when  I  operated  by  Caesarean  section,  removing  a 
healthy  female  child  which  is  still  Uving.  After 
suturing  the  uterine  wound.  I  tied  each  Fallopian 
tube  by  a  single  ligature  of  silk  as  some  bar  to  further 
pregnancy.  The  mother  and  child  both  did  well, 
and  left  the  hospital  on  April  17th,  but  remained  at 
our  Convalescent  Home  for  some  time  longer.  The 
following  year  (1902)  the  patient  developed  tuber- 
culous disease  of  the  right  knee-joint,  and  her  leg 
was  amputated  above  the  knee  at  Shrewsbury  In- 
firmary on  September  22nd.  1902.  In  1903  she  again 
became  pregnant,  and  was  sent  up  to  me  once  more 
by  Dr.  Darroll  towards  the  end  of  August.  I  did  a 
second  Caesarean  section  on  September  14th.  1903, 
removing  again  a  living  female  child,  which,  however, 
was  very  feeble,  and  only  lived  about  half  an  hour. 
After  the  suturing  of  the  uterine  incision  was  com- 
pleted. I  carefully  examined  the  Fallopian  tubes,  and 
found  considerable  atrophy  at  each  site  of  ligature. 
The  atrophy  was  most  marked  on  the  right  side, 
where  the  tube  seemed  narrowed  to  a  point.  The 
silk  had  been  absorbed.  I  placed  two  fresh  ligatures 
of  silk  on  each  Fallopian  tube  (four  ligatures  in  all, 
but  without  any  cutting  or  removal),  and  closed  the 
abdominal  wound.  The  patient  did  well  after  the 
operation  so  far  as  the  section  was  concerned,  but 
during  the  whole  of  the  time  of  her  stay  in  hospital 
she  was  troubled  with  chronic  strumous  conjunctivitis 
and  ulceration  of  the  cornea,  an  affection  from  which 
she  had  been  suffering  for  nearly  two  years,  in  spite 
of  the  free  administration  of  cod-liver  oil.  She  went 
to  the  Convalescent  Home  on  October  8th,   1903. 

Early  in  this  year  I  heard  from  Dr.  Darroll  that 
from  the  date  of  her  return  home  she  had  never 
menstruated,  and  was  evidently  again  pregnant.  She 
came  up  in  July  last,  and  I  found  that  this  was  indeed 
the  case.  On  this  occasion  I  determined  to  remove  the 
uterine  appendages,  but  was  anxious  not  to  hurry 
the  performance  of  the  operation  so  as  to  obtain  a 
living  child,  if  possible. 

On  August  4th  I  went  for  a  holiday,  and  two  days 
later,  the  patient  beginning  to  be  in  labour,  my  col- 
league. Mr.  Christopher  Martin,  kindly  operated  for 
me,  removing  a  living  child,  which,  like  the  preceding 
one,  only  lived  about  three-quarters  of  an  hour. 

Mr.  Martin,  before  closing  the  abdomen,  removed 
the  whole  of  each  tube,  and  a  small  portion  of  each 
•corresponding  cornu  of  the  uterus.  He  also  removed 
one  ovary.  The  patient  made  a  good  recovery,  and 
left  the  hospital  soon  after  my  return  on  Sep- 
tember 7  th. 

On  looking  at  the  tubes  removed,  it  may  be  seen 
that  one  tube  is  as  completely  divided  by  the  double 
.ligature  as  if  a  piece  had  been  cut  out  of  it,  while 
in  the  other  the  whole  of  the  muscular  coat  appears 
to  be  gone,  but  (in  all  probability)  the  mucous  channel 
is  still  pervious. 

In  addition  to  the  direct  interest  of  these  specimens 
as  contributing  to  the  general  sum  of  knowledge 
regsLrding  Caesarean  section,  and  the  utility  or  non- 
utility  of  ligature  of  the  tubes  as  a  bar  to  future 
pregnancy.   I   must  confess   that   they  have   a  very 

(a)  Read  and  sneoimen  shown  at  the  British  Gynscological  Society, 
December  8th,  idOI. 


considerable  interest  to  me  as  bearing  on  the  question 
of  the  causation  of  tubal  pregnancy. 

It  would.  I  suppose,  be  difficult  to  find  two  Fal- 
lopian tubes  in  which  an  ovum  would  be  theoretically 
more  likely  to  be  stopped  on  its  journey  to  the  uterus, 
yet  the  pregnancy  on  each  occasion  after  ligature 
was  uterine  and  not  tubal. 

It  seems  to  suggest  that  the  cilia  of  the  epithelial 
coat,  even  within  the  lumen  of  the  tube,  have  more 
to  do  with  the  progress  of  the  ovum  than  any  peri- 
staltic muscular  contraction. 

A    LARGE    ABSCESS    OF    THE    OVARY. 

This  specimen  is,  I  believe,  a  rather  rare  one,  it 
being  unusual  to  find  so  large  an  abdominal  tumour 
due  to  ovarian  abscess.  The  history  is  interesting  : — 
The  patient,  Mrs.  C.  C,  had  been  married  five  years, 
but  had  never  been  pregnant,  when  in  August  of 
this  year  she  developed  a  rising  temperature  with 
obscure  abdominal  pains,  and,  rather  naturally,  w^as 
supposed  to  be  suffering  from  typhoid  fever. 

She  was  seen  on  August  21st  by  another  consultant, 
who  diagnosed  suppuration,  and  opened  an  abscess 
by  the  vagina  on  the  23rd.  over  a  pint  of  pus  and 
blood  being  evacuated. 

This  undoubtedly  gave  her  very  great  relief,  and 
she  was  able  to  get  up  and  go  out  of  doors  a  little 
later  ;  but  since  this  date  an  increasing  enlargement 
was  noticed  in  the  lower  part  of  the  abdomen,  the 
catamenia  having  ceased  from  the  date  of  her  illness. 

When  she  was  sent  to  me  by  Dr.  Kingsland.  about 
the  middle  of  November,  I  found  a  remarkably  promi- 
nent cystic  swelling  reaching  to  the  umbilicus,  and 
looking  like  a  five  months'  pregnancy  or  a  very  dis- 
tended bladder. 

On  examination,  however,  I  found  it  was  due  to 
neither  of  these  conditions,  but  to  a  tumour  of  the 
left  ovary  or  left  broad  ligament  pushing  the  uterus 
to  the  right.  The  lower  pole  of  the  cyst  came  down 
to  the  level  of  the  vaginal  cervix  on  the  left  side, 
the  side  of  the  uterus  being  apparently  fixed  to  the 
wall  of  the  cyst,  and  a  diagnosis  was  made  of  adherent 
ovarian  tumour  or  broad  ligament  cyst.  The  patient's 
temperature  was  never  quite  normal,  but  usually 
slightly  raised  ;  on  the  evening  of  admission  into 
hospital  it  was  101°  F.  Under  anaesthesia,  on  Nov- 
ember 19th,  I  came  to  the  conclusion  that  the  tumour 
must  be  intra-peritoneal,  and  operated  by  abdominal 
section,  removing  a  large  single  abscess  of  the  left 
ovary,  with  dense  adhesions  to  the  pouch  of  Douglas 
at  the  site  of  the  first  tapping,  or  incision.  As  there 
was  necessarily  some  fouling  of  the  pelvis  in  the 
separation  of  these  adhesions,  I  finished  the  operation 
by  posterior  vaginal  coeliotomy  and  gauze  drain^^e. 
The  pus  removed  was  examined  by  my  assistant, 
Dr.  Smallwood  Savage,  and  showed  a  pure  growth 
of  bacillus  coU,  but  at  no  time  during  the  operation 
was  there  any  visible  adhesion  or  channel  of  com- 
munication found  between  the  ovary  and  the  rectum. 
The  patient  made  a  good  recovery,  and  went  to  the 
Convalescent  Home  two  days  ago. 


Trraneactions  of  Societiee. 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  December  8th.  1904. 


Professor   John   W.   Taylor.   M.D.,   F.R.C.S., 
President,  in  the  Chair. 


Specimens, 
carcinoma  of  the  fallopian  tube. 
Dr.  Macnaughton-Jones  said  that  he  exhibited 
this  specimen  solely  for  its  pathological  interest. 
For  some  years  he  had  lost  sight  of  the  case  from 
which  the  tumour  was  removed,  and  it  was  only 
recently  that  he  had  discovered  the  latter  among 
others  in  his  collection.  When  he  had  sent  it  for 
examination  and  report  to  Dr.  Cuthbert  Lockyer,  it 
proved  to  be  one  of  exceptional  interest.  The  report 
was  as  follows : — "  The   tumour  is  oval  in     shape. 


658    Tm  Medical  Pebss.         TRANSACTIONS   OF   SOCIETIES. 


Dec.  21, 1904. 


and  measures  10  inches  in  its  greatest  and  8  inches 
in  its  shortest  circumference.  It  has  a  lobulated 
surface  ;  some  of  the  lobes  are  smooth,  the  growth 
being  enclosed  in  a  highly-stretched  fibrous-looking 
shiny  capsule.  Other  lobes  are  rough  and  papilli- 
form,  consisting  of  growth  which  has  burst  through 
the  containing  capsule.  The  smooth  thin  capsule 
has  been  peeled  off  the  greater  part  of  one  portion 
of  the  growth,  revealing  a  rough  surface  studded 
with  nodules  the  size  of  a  pin's  head  A  further 
portion  of  the  tumour  has  been  cut  through  its  greatest 
diameter,  the  cut  surface  has  a  pale  yellow  colour,  and 
consists  of  soft  friable  granular-looking  material.  At 
one  point  there  was  a  small  projection  which  admitted 
a  fine  bristle.  This  on  transverse  section  proved  to 
be  the  cut  end  of  the  Fallopian  tube.  On  following 
this  up  it  was  found  to  lead  through  the  capsule 
into  the  cavity  containing  the  new  growth.  Sections 
have  been  prepared  at  various  levels  to  show  that  the 
capsule  of  the  growth  is  continuous  with  the  wall 
of  the  undilated  tube.  These  sections  prove  that 
the  smooth  capsule  enclosing  the  tumour  consists 
of  fibro-muscular  tissue  continuous  with  that  forming 
the  wall  of  the  unexpanded  tube.  The  tumour  is, 
in  fact,  of  tubal  origin." 

Dr.  Macnaughton- Jones  remarked  that  unfortu- 
nately the  clinical  history  of  the  case  had  been  lost 
sight  of,  and  he  could  not  say  what  the  ultimate  issue 
was.  In  Mr.  Alban  Doran's  recent  paper  in  the 
Journal  of  Obstetrics  and  Gyncrcology,  October,  1904, 
there  was  a  table  of  over  fifty  complete  cases  of 
primary  cancer  of  the  Fallopian  tubes.  Gracfe,  of 
Halle,  had  in  1902  found  fifty- two  recorded  cases. 

Mr.  BowREMAN  Jessett  said  that  he  had  never  met 
with  a  case  of  primary  columnarrcelled  carcinoma 
of  the  Fallopian  tube,  and  suggested  that  the  specimen 
might  possibly  be  a  secondary  growth  of  carcinoma 
of  the  bowel. 

Dr.  F.  A.  PuRCELL  also  spoke  of  the  extreme  rarity 
of  primary  carcinoma  of  the  tube,  and  suggested 
that  there  might  have  been  primary  growth  in  the 
uterus. 

Dr.  C.  F.  H.  RouTH  asked  what  was  the  age  of  the 
patient. 

Dr.  Macnaughton- Jones,  in  reply,  said  that  the 
capsule  of  the  tumour  was  a  direct  extension  of  the 
FaJlopian  tube ;  the  analysis  of  Mr.  Doran's  cases 
showed  that  the  uterus  was  involved  in  only  six  out 
of  53  instances. 

The  President  showed  "  Fallopian  Tubes  Ligatured 
Twice  at  Previous  Operations,  and  removed  in  the 
course  of  a  Third  Cesarean  Section  "  ;  also  a  specimen 
of  a  "  Large  Abscess  of  the  Ovary."  Notes  of  these 
cases  will  be  found  under  the  heading  of  "  Clinical 
Records,"  page  657. 

The  President  also  exhibited  three  cases  of 
cancer  of  the  body  of  the  uterus, 
reading  notes  as  follows : — ^The  first,  a  simple  case  of 
cancer  of  the  body,  occurring  in  a  married  woman 
of  56  years  of  age,  four  years  after  the  menopause, 
attended  by  the  classical  symptoms  of  watery. 
foul-smeUing  and  bloody  discharges  for  three  months 
before  operation.  The  uterus  was  removed  by  vaginal 
hysterectomy  on  October  31st.  and  on  being  laid 
open  disclosed  a  fairly  typical  and  very  pretty  speci- 
men of  the  disease.     The  patient  made  a  good  recovery. 

The  second  case  appeared,  clinically,  to  be  one  of 
ovarian  tumour,  complicated  by  a  small  uterine 
polypus  or  fibroid.  The  patient  was  single,  set.  43, 
never  regular,  the  last  normal  period  having  taken 
place  some  three  years  previously ;  since  then  she 
stated  that  she  had  suffered  from  a  daily  coloured  dis- 
charge, never  profuse,  and  never  amounting  to  more  than 
a  "  £ow."  On  examination,  she  was  found  to  have  a 
Isu^e  abdominal  tumour  reaching  well  above  the  um- 
bilicus. The  uterus  was  pushed  backwards  by  the 
tumour ;  the  cervix  was  open,  and  a  small  growth,  like  a 
polypus,  which  did  not  break  down  or  bleed  on  exam- 
ination, was  just  to  be  felt  by  the  tip  of  the  examining 
finger.  I  operated  on  November  17  th,  and  on  first 
attending  to  the  condition  of  the  uterus  under  anaesthesia 


found  that  the  growth  presenting  at  the  cenrix^as 
soft,  brain-like,  and  almost  certainly  malignaji. 
I  therefore  proceeded  to  remove  the  whole  of  tt» 
uterus  as  well  as  the  ovarian  tumour  and  the  utetue 
appendages  of  the  opposite  side,  hoping  in  this  irayta 
oDtain  freedom — or  a  longer  freedom — from  recvreiot 
The  patient  has  done  well,  and  is  now  convalesKr. 
The  uterine  growth  has  been  examined  by  Prafesor 
Leith,  who  reports  ux>on  it  as  malignant  Hie 
ovarian  tumour  is  still  under  examination,  but  preser* 
the  rough  general  characters  of  malignancy. 

The  third  case  was  originally  one  of  myoma  of  fte 
uterus,  attended  for  several  years  by  menonia^ 
The  patient,  a  midwifery  nurse,  single,  aet.  52,  ^)peaRi! 
to  have  passed  through  the  menopause  18  months  af: 
and  the  haemorrhage  ceased.  For  six  months  an  irregi 
foul-smelling  discharge  returned,  and,  in  Scptcmbff 
and  October  last,  she  suffered  from  severe  hsmonltt^ 
with  "  floodings."  The  patient  was  virginal  aaf 
the  vaginal  cervix  was  free  from  any  taogibit 
ulceration.  The  tumour  filled  the  pelvis,  ad 
therefore  no  estimate  could  be  made  of  the  fixatioc. 
The  abdominal  characters  of  the  tumour  net 
those  of  a  fibroid.  The  diagnosis  was  madt 
of  cancer  of  the  uterus  or  a  "sloughing"  fibroid 
and  I  operated  on  December  ist,  doing  a  pai- 
hysterectomy  by  the  combined  method.  TTiHt 
was  pyometra  and  right  pyosalpinx,  and  the  extrac- 
tion of  the  tumour  was  by  no  means  an  easy  <ne. 
During  its  removal  the  uterus  tore  at  the  jnoctioi 
of  the  body  with  the  cervix,  and  the  latter,  irtiid 
was  removed  separately,  was  unfortunately  not  pre- 
served. The  pathological  examination  a])pearstosbov 
that  a  malignant  adenoma  is  invading  a  myomatoss 
uterus,  but  the  case  is  too  recent  to  obtain  a  foD 
report.     The  patient  (to-day)  is   doing  well. 

Dr.  Heywood  Smith  said  that  ligature  aUovred  i 
certain  amount  of  patency  in  the  lumen  of  the  tube; 
more  radical  measures  were  required  to  ensure  sterility. 
Dr.  J.  A.  Mansell  Moullin  concurred  as  to  tkt 
inadequacy  of  ligature ;  the  easiest  and  best  coara 
to  adopt  IS  to  remove  the  whole  of  the  tube  at  \\t 
primary  operation. 

Dr.  J.  H.  Dauber  remarked  that  cases  had  ben 
recorded  in  which  both  ovaries  had  been  removed 
and  yet  the  patient  had  become  pregnant. 

Dr.  J.  FuRNEAUx-JORDAN  Said  that  Ca&sareas 
section  was  now  attended  witli  such  good  resdts 
that  he  did  not  see  the  necessity  of  sterilising  a  yoonr 
woman  merely  because  she  could  not  have  a  child 
bom  through  the  pelvis. 

Dr.  Macnaughton- J  ONES  remarked  that  in  somet^ 
these  cases  the  method  introduced  by  Pincus  had 
been  successfully  employed  to  seal  up  the  ntenne 
canal  by  atmocausis.  In  regard  to  the  specimnof 
carcinoma  of  the  fundus,  it  was  precisely  similar  to 
a  case  brought  forward  by  him  before  the  Society, 
and  from  the  appearance  of  the  uterus  it  did  not 
seem  that  the  cervix  uteri  was  involved.  In  his  case 
it  was  proved  microscopically  not  to  be  so.  It  would 
be  well  that  the  specimen  were  examined  to  settle^ 
this  point. 

The  President,  in  reply,  said  that  though  thcr 
now  knew  that  ligaturing  the  Fallopian  tube  was  a 
very  poor  bar  to  future  conception,  his  critics  must 
remember  that  in  1900,  which  was  the  date  of  his 
case,  their  knowledge  was  by  no  means  so  complete. 
However  tightly  a  ligature  was  tied,  the  serons  mem- 
brane and  muscular  tissue  might  offer  such  resistance 
that,  in  spite  of  the  ligature,  a  minute  aperture  might 
be  left  through  which  the  ovum  could  pass.  The 
surest  method  of  ensuring  sterility  was,  he  tbonght 
that  adopted  by  his  colleague,  Mr.  Martin:  toremo^T 
not  merely  the  tube,  but  also  the  corrcspondinjr 
cornu  of  tike  uterus  by  a  wedge-shaped  or  triaogoiar 
incision,  and  to  bring  the  edges  of  the  wound  together, 
so  as  to  close  the  channel  effectually  by  some  depth  of 
muscular  tissue.  For  closing  the  wound  in  the  ntenis. 
he  always  used  sterilised  silk,  and  had  not  employed 
gut  for  that  purpose  for  many  years.  The  laqp 
ovarian  tumour  removed  with  the  uterus,  dia^osed 


Dec.  21,  1904. 


TRANSACTIONS   OF    SOCIETIES.       Th«  Medical  Pm8>.    659 


to  be  cancerous  after  curettage,  had  all  the  micro- 
scopic characters  of  a  carcinomatous  tumour,  and  if 
proved  to  be  one,  must  have  existed  for  several  months 
before  anything  was  known  to  be  wrong  with  the 
uterus. 

Dr.  William  Alexander  read  a  paper  on 

ADENOMA   OF   THE    ENDOMETRIUM. 

illustrated  by  microscopical  sections,  photographs,  and 
lantern  slides,  which  will  be  found  under  the  heading 
of  *'  Original  Communications."  on  page  649. 

Dr.  F.  A.  Purcell  noted  that  in  some  of  the  cases 
the  ovaries  had  not  been  removed  with  the  uterus. 
It  was  only  of  recent  years  that  due  consideration 
vras  being  given  to  a  conservation  of  the  ovaries  on 
account  of  the  value  of  their  internal  secretion.  He 
thought  that  the  ovaries,  if  apparently  normal,  should 
never  be  removed. 

Dr.  Macnaughton-Jones  said  that  he  had  brought 
cases  precisely  similar  to  those  described  by  Dr. 
Alexander  before  the  Society,  in  which  the  adeno- 
matous changes  mentioned  by  him  had  been  present. 
In  the  new  edition  of  his  book,  the  macroscopical  and 
microscopical  appearances  mentioned  by  him  were 
fully  illustrated,  and  at  the  last  meeting  he  had  shown 
a  uterus  in  which  the  cavity  was  filled  with  the  same 
gelatinous  and  mucoid  substances  as  described 
by  Dr.  Alexander.  It  was  due  to  the  breaking  down 
of  the  epithelial  debris,  and  the  haemorrhage  was 
caused  by  necrosis  of  the  vessels,  the  result  of 
pressure  due  to  the  glandular  change.  The  Subject 
vras  a  very  important  one,  as  the  recurrence  of  the 
haemorrhages  brought  about  a  most  serious  condition, 
and  at  times  a  profound  anaemia.  Curettage  was 
useless  as  a  means  of  treatment,  and  the  proper  course 
to  pursue  in  these  cases,  when  the  diagnosis  was 
made,  was  to  remove  the  uterus.  In  certain  of  these 
cases  the  ovaries  were  also  diseased,  and  if  so,  they 
should  be  removed  with  the  uterus. 

Mr.  Bowreman  Jessett,  alluding  to  the  gelatinous 
condition  of  the  uterine  mucous  membrane,  said  he 
had  not  the  slightest  doubt  that  it  was  a  pre-cancerous 
condition,  and  that  certainly  in  the  first  case,  if  left 
alone,  it  would  have  developed  into  malignant  disease 
of  the  fundus  of  the  uterus  ;  he  had  seen  several 
cases  of  the  sort,  but  the  diagnosis  of  such  pre-cancerous 
conditions  was  still  obscure.  It  was  a  question  whether 
in  a  woman  of  forty  years  of  age,  suffering  from  per- 
sistent uterine  haemorrhage,  one  would  be  justified 
in  removing  the  uterus,  if  microscopical  examination 
of  the  scrapings  by  the  curette  did  not  show  malig- 
nancy. He  thought  not  in  the  majority  of  cases. 
But  he  was  certain  that  he  had  seen  cases  pronounced 
to  be  non-malignant  on  such  examination  after- 
wards prove  to  be  so.  If  these  pre-cancerous  con- 
ditions could  be  detected  earlier,  and  the  uterus 
removed  in  time,  many  a  woman's  life  would  be 
saved. 

Dr.  J.  A.  Mansell  Moullin  said  that  though  the 
curette  in  these  cases  was  not  an  efficient  cure,  it 
was  still  of  great  value  in  diagnosis,  as,  when  it  did 
bring  away  malignant  tissue,  the  removal  of  the 
uterus  was  clearly  the  only  right  course  to  adopt. 

Mr.  FuRNEAUx- Jordan  stated  that  in  the  first 
five  cases  he  had  operated  upon  for  this  disease  he 
had  previously  tried  in  vain  to  stop  the  hemorrhage 
by  the  use  of  the  curette,  but  in  the  last  three  cases 
he  operated  on  had  not  done  so.  as  he  had  come  to 
the  conclusion  that  it  was  not  advisable.  If  profuse 
haemorrhage,  such  as  occurred  in  this  disease,  was 
allowed  to  continue,  the  patient  would  probably 
die  before  mahgnant  disease  had  time  to  show  itself. 
The  condition  was  a  most  serious  one.  and  required 
radical  treatment. 

Dr.  RouTH  confessed  that  in  the  course  of  his 
practice,  rather  a  long  one,  he  had  never  had 
occasion  to  remove  a  non-cancerous  uterus.  He  had 
not  found  scraping  of  the  uterus  of  much  use  ;  much 
better  results  would  follow  the  intra-uterine  applica- 
tion of  the  strongest  carlx)lic  acid.  In  several  cases 
of  persistent  bleeding,  even  with  a  bad  odour,  he  had 
cauterised  the  uterus  with  a  red-hot  iron  ;    this  had 


never  caused  any  bad  symptom,  and  the  patients 
had  got  perfectly  well.  There  was  no  justification 
for  removing  the  uterus  for  haemorrhage,  unless  it 
was  certain  that  the  case  was  one  of  malignant  disease. 

Dr.  Heywood  Smith  thought  that  in  casei  met 
with  sufficiently  early,  intra-uterine  measures  should 
be  tried.  Chloride  of  zinc  might  destroy  the  haemor- 
rhagic  condition,  and  give  the  uterus  a  chance  to  recover 
itself,  nor  did  he  see  why  the  actual  cautery  should 
not  be  applied.  Such  an  application  might  stop  the 
haemorrhage,  but  if  not  he  would  consider  the  advis- 
ability of  removing  the  uterus. 

The  President,  after  cordially  thanking  Dr.  Alex- 
ander for  his  paper,  said  that  the  question  of  glandular 
infiammation  was  certainly  the  one  that  at  present 
was  attracting  most  attention  from  gynaecologists, 
and  the  more  it  was  studied  the  less  possible  it  seemed 
to  draw  a  definite  line  between  that  condition  and 
cancer.  There  was  much  in  what  Dr.  Routh  had 
said  regarding  the  treatment  of  the  disease  in  its 
early  stages.  Mr.  Lawson  Tait  employed  the  actual 
cautery  extensively,  and  with  good  results,  but  it 
was  questionable  whether  the  condition  of  the  patient 
after  such  treatment  was  better  than  after  the 
removal  of  the  uterus.  He  asked  Dr.  Alexander 
whether  in  adenoma  of  the  endometrium  he  included 
all  cases  of  metrorrhagia.  He  had  himself  met  with 
cases  in  which  microscopic^  examination  disclosed 
a  growth  in  the  tubes  after  the  removal  of  the  uterus  ; 
in  others  fibroid  thickening  was  all  that  appeared. 
The  diagnosis  was  a  matter  of  great  difficulty,  especi- 
ally when  one  had  to  rely  entirely  on  the  symptoms 
of  the  patient  and  the  haemorrhage  ;  he  had  known 
instances  in  which  bleeding  had  been  profuse  and 
almost  continuous  for  two  or  three  years,  in  spite  of 
repeated  cure  t  tings,  and  without  any  assignable 
cause  had  diminished,  and  at  the  menopause  ceased, 
and  some  years  afterwards  the  patient  had  continued 
quite  well. 

Dr.  Alexander,  in  reply,  said  that  he  always  left 
the  ovaries  behind,  as  he  believed  this  made  the 
convalescence  more  satisfactory.  He  did  not  think 
that  the  disease  was  malignant  ;  at  all  events,  in  his 
experience  it  seldom  became  malignant.  His  first  patient 
after  eighteen  years  did  not  seem  to  have  any  more 
of  the  growth  than  she  had  at  the  beginning  of  that 
time.  In  another  case  the  bleeding  has  been  going 
on  for  twenty  years ;  the  patient  is  still  alive  waiting 
for  the  menopause,  and  probably  not  any  worse  now 
than  she  was  many  years  ago.  Hysterectomy  should 
only  be  performed  in  these  cases  when  all  other  means 
have  been  fairly  tried  and  have  failed.  When  this 
is  the  case,  the  treatment,  nowadays,  of  removing  a 
uterus  that  had  become  useless  and  only  a  source  of 
weakness  to  the  patient  can  hardly  be  called  heroic. 
In  these  cases  the  operation  is  a  very  simple  and  safe 
one  for  a  very  grave  disease.  He  always  removed 
the  uterus  in  these  cases  per  vaginaw,  and  did  not 
think  there  was  any  reason  why  it  should  ever  be 
removed  through  the  abdomen.  He  thanked  the 
President  and  Fellows  for  their  very  kind  remarks 
on  his  paper. 

ectopic  gestation, 

Dr.  R.  T.  Smith  showed  a  specimen  and  read  the 
following  notes  : — The  patient  was  a  Polish  Jewess, 
aet.  30,  married  two  years,  with  a  child  one  year 
old,  and  the  facts  elicited  were  simply  that  four 
weeks  ago,  after  two  months'  amenorrhcea,  she 
was  seized  with  sudden  pain  in  her  left  side, 
and  from  that  lime  had  had  a  sanguineous  dis- 
charge with  clots.  Examination  revealed  a  soft 
swelling  in  the  left  side  of  Douglas's  pouch,  an  old 
retro-uterine  haematoma.  At  the  operation,  the 
tumour  forming  the  adventitious  sac,  so  well  shown 
in  the  specimen,  was  surrounded  by  a  considerable 
amount  of  blood,  the  escape  of  which  had  probably 
caused  the  pain.  The  anterior  wall  of  the  tube  was 
extremely  thin,  and  evidently  on  the  point  of  a  second 
rupture.  The  patient  made  an  iminterrupted  re- 
covery. The  interest  of  the  specimen  lay  not  so 
much  in   any   special  pathological  feature  as  in   its 


66o    The  Medical  Peess. 


TRANSACTIONS   OF   SOCIETIES. 


Dec  21,  1904. 


structural  completeness ;  the  tumour  was  entirely 
tubal,  the  foetus  with  the  head  towards  the  uterus 
filling  the  whole  tube,  and  also  in  the  fact  that  the 
diagnosis  depended  almost  entirely  on  the  physical 
examination,  the  patient  knowing  so  little  English 
as  practically  to  be  unable  to  give  any  account  of 
her  illness. 

Dr.  Bedford  Fen  wick  showed  a  specimen  of 

t'TERINE      FIBROID      WITH      UNUSUAL      DEGENERATION. 

The  patient  was  aet.  31.  She  had  been  married 
thirteen  months,  and  was  confined  on  August  4th,  1904, 
at  full  time.  The  periods  began  at  fourteen,  had  always 
been  regular,  lasting  six  or  seven  days,  always  profuse, 
and  with  slight  pain.  Since  the  labour,  she  had  had 
increasing  losses,  and  for  some  time  past  an  increasing 
amount  of  most  offensive  discharge.  She  had  been 
rapidly  losing  flesh,  colour,  and  strength,  and,  in  fact, 
presented  the  appearance  and  ordinary  symptoms  of 
malignant  disease  of  the  uterus.  The  cervix,  however, 
was  perfectly  healthy,  the  uterus  was  enlarged,  the 
anterior  wall  being  hard  and  nodular,  and  the  right 
ovary  was  large  and  tense.  The  sound  passed  easily 
3  J  inches  forwards,  and  the  uterine  canal  was  quite 
smooth.  Dr.  Fenwick  therefore  diagnosed  the  case  as 
one  of  degenerating  fibroid  and  performed  hysterectomy 
by  abdominal  section  in  the  ordinary  manner.  The 
patient  made  an  uneventful  recovery,  and  rapidly 
gained  flesh  and  strength,  and  her  colour  became  normal. 

The  specimen  showed  that  the  anterior  wall  of  the 
uterus  contained  two  fibroids  of  about  equal  size, 
measuring  3J  inches  across,  and  2  inches  from  above 
downwards.  Each  fibroid  was  enclosed  in  a  separate 
capsule,  the  upper  one  being  uniformly  thick  all  round. 
At  the  lower  part  of  the  lower  fibroid  necrotic  degenera- 
tion has  commenced,  and  the  pus  and  dibris  ^were 
escaping  from  the  small  cavity  through  a  narrow  opening 
into  the  uterine  canal,  just  above  the  internal  os.  The 
case  was  interesting  not  only  because  the  specimen  was  so 
unusual,  but  because  the  symptoms  so  closely  simulated 
those  of  malignant  disease  of  the  uterine  body.  It  was  also 
noticeable  that  the  right  ovarian  artery  which  was  ob- 
structed by  the  fibroid  outgrowths  at  the  fundus  was 
greatly  thickened,  its  muscular  coat  being  much  hyper- 
trophied,  and  the  right  ovary  was  converted  into  a 
large  blood  cyst,  containing  eight  ounces  of  black  blood, 
the  tube  also  being  swollen  and  thickened.  The  left 
■  ovarian  artery  was  quite  normal  in  calibre,  and  the  left 
ovary  and  tube  were  perfectly  healthy,  and  Dr.  Fenwick 
emphasised  the  fact  that  where  the  ovarian  artery 
entered  the  fundus  on  the  left  side  the  area  was  free 
from  any  fibroid  outgrowth. 

After  some  remarks  from  Dr.  Macnaughton- Jones, 
the  specimen  was  referred  for  a  pathological  report, 
on  the  motion  of  Dr.  Purcell.  seconded  by  Dr.  R. 
T.  Smith. 

The  President  said  that  their  Editor  had  left  on 
the  table  a  copy  of  Dr.  Macnaughton- Jones'  *'  Diseases 
of  Women,"  and  particularly  wished  to  draw  attention 
to  the  beautiful  illustrations  in  it  of  glandular  endo- 
metritis bearing  on   Dr.  Alexander's  communication. 

JROYAL  ACADEMY   OF  MEDICINE  IN  IRELAND. 

Section  of  Medicine. 

Meeting  held  Friday,  December  9TH,  1904. 


Dr.  Hawtrey  Benson  in  the  Chair. 


Living  Exhibits. 

Dr.  Coleman  exhibited  a  case  of  {a)  Congenital 
Bulbar  Paralysis. 

Dr.  F.  C.  Purser  said  he  had  to  thank  Dr.  Coleman 
for  having  given  him  many  opportunities  of  examining 
the  case  in  hospital.  Bulbar  paralysis  was  certainly  an 
uncommon  disease,  occurring  in  young  children.  The 
first  time  he  saw  the  case  he  thought  it  could  only  be  an 
anterior  poliomyelitis,  affecting  the  nuclei  in  the 
medulla  oblongata,  and  so  causing  symptoms  of 
paraljrsis,  especially  of  the  seventh,  ninth,  and  twelfth 
nerves,  but  on  thinking  over  the  case  he  could  not 
recall  having  seen  or  heard  of  such  a  condition,  and  so 
tried   to   think  of  any  other  explanation.     He   then 


thought  it  might  be  due  to  a  thrombosis  or  other  vasco- 
lar  lesion,  but  thought  it  was  improbable  that  tbe 
symptoms  would  be  so  localised,  and  also  for  that  saosf 
reason  such  things  as  tumour,  g^mma,  Ac.  were  ex- 
cluded. Another  idea  was  that  it  was  a  peeudo-balbar 
paralysis.  There  were  cases  of  congenital  or  iniantOe 
bulbar  paralysis  recorded,  but  they  differed  in  this 
respect:  that  there  was  a  strong  family  history  of  ii 
having  occurred  in  more  than  one  member  of  the  saof 
family,  the  parents  also  having  been  blood  relatioes. 
Also  the  upper  part  of  the  face  was  as  much  afiectcdas 
the  lower.  The  observers  attributed  it  to  a  hereditair 
tendency  to  early  atrophy  of  the  nerve  nuclei,  and  a 
failure  in  the  perfection  of  their  development.  'Whether 
there  were  any  pathological  grounds  for  these  tbeoriec 
or  not.  he  did  not  know.  The  theories  which  he  would 
submit  himself  were — first,  an  affection  of  the  nerves 
themselves,  rather  than  the  nuclei  from  which  the  nerve 
fibres  arose.  In  this  connection  he  might  mention  a 
case  of  bulbar  paraljrsis  which  had  occurred  suddeoh 
in  a  young  person  after  laryngismus  stridulus.  It 
might  only  have  been  a  coincidence,  but  both  wwe 
possibly  caused  by  toxins.  Secondly,  a  primitiw 
myopathy  may  have  affected  the  involved  musdes. 
He  certainly  had  never  heard  of  such,  but  a  hereditary 
disease  had  to  begin  somewhere. 

Dr.  Coleman  in  reply,  thanked  Dr.  Purser  for  his 
very  interesting  and  instructive  communication. 

Dr.  Coleman  also  showed  a  case  of  {h)  Pitjiiasis 
Rubra. 

The  Chairman  said  the  case  reminded  him  of  a  case 
of  pityriasis  rubra  which  had  been  an  exact  f^smiU 
to  that  one,  but  there  was  no  history  of  a  preceding 
eczema.  The  chief  point  about  the  case  had  been  that 
it  got  well  under  four  or  five  weeks'  treatment  by  arsenic 

Dr.  O'Brien  said  that  the  characteristic  rashol 
pityriasis  rubra  was  very  abrupt,  but  in  this  case  it  had 
taken  a  considerable  time  to  spread,  which  woold 
contra-indicate  pityriasis  rubra. 

Dr.  Kirkpatrick  took  it  that  I>r.  Coleman  differ- 
entiated this  case  froiji  an  ordinary  case  of  pityriaas 
rubra,  as  he  looked  on  it  as  secondary,  as  it  came  on 
subsequent  to  psoriasis.  He  wished  to  know  if  Dr. 
Coleman  thought  the  treatment  of  the  psoriasis  had 
anything  to  do  with  the  causation  of  the  pityriasis 
rubra,  or  exfoliative  dermatitis.  He  thought  it  a  pity 
to  use  the  term  pityriasis  rubra,  which  had  a  definite 
connection  with  a  form  of  disease,  for  conditions  which 
were  not  similar  to  it,  and  he  considered  that  the  term 
exfoliative  dermatitis  described  it  better. 

Dr.  Coleman,  in  replying,  said  that  the  only  treat- 
ment used  was  calamine  lotions  and  olive  oil.  or  olive 
oil  and  lime  water :  simple  emollients.  He  had  not 
given  arsenic  on  account  of  the  acuteness  of  the  case. 
There  had  been  a  distinct  improvement  during  tbe 
last  week.  He  had  had  a  case  of  primary  pityriasis 
rubra  which  had  got  well  under  similar  "  treatment. 
As  to  diagnosis  he  thought  that  as  the  case  had  no  other 
symptoms  but  universal  redness  and  thin  scales,  they 
were  sufficient  to  exclude  any  other  skin  disease  bat 
pityTiasis  rubra.  It  was  not  very  essential  where  the 
disease  began,  as  it  might  begin  anywhere,  and  spread 
rapidly  over  the  whole  body.  That  being  the  case 
you  would  expect  it  to  start  from  the  psoriasis  lesions, 
which  it  had  done.  He  agreed  with  I>r.  Kirkpatrick 
that  exfoliative  dermatitis  would  be  a  better  term. 

Dr.  T.  P.  C.  Kirkpatrick  showed  a  well-marked  case 
of  Ichthyosis  Simplex.  The  patient,  a  male.  aet.  25. 
stated  that  the  condition  had  been  present  as  long  as  he 
could  remember,  but  that  none  of  his  family  ever  had 
any  similar  condition.  The  patient  has  been  recently 
infected  with  primary  syphilis,  and  is  now  developing 
an  extensive  secondary  pustular  eruption  on  the  tnmk 
and  limbs.  The  ichthyotic  condition  of  his  skin  has  not 
caused  him  any  serious  inconvenience. 

Dr.  O'Brien  said  he  had  a  patient,  a  man,  aet.  if. 
with  all  his  organs  healthy,  who  had  suffered  from  the 
condition  for  fourteen  years.  Three  brothers  had 
eczema,  and  two  sisters.  He  thought  these  cases  coold 
be  improved,  but  not  cured. 

Dr.  Kirkpatrick,  in  replying,  said  it  was  of  interest 


Dec.  21,  1904. 


TRANSACTIONS   OF   SOCIETIES. 


The  Medical  Press.    661 


to  see  whether  the  accompanying  syphilis  would  have 
^any  effect  on  the  disease,  as  in  cases  of  ichthyosis 
•associated  with  smsUl-pox. 

Dr.  F.  C.  Purser  showed  a  Peculiar  Deformity 
-of  the  Spine,  with  nervous  symptoms — a  girl»aet. 
S,  who  was  bom  with  spina  bifida.  Marked  deformity 
-of  the  spine  remained,  causing  muscular  wasting, 
anaesthesia,  lost  knee-jerk,  and  trophic  sores  on  the 
left  leg. 

Dr.  O'Carroll  reviewed  three  cases  of  Syringo- 
myelia which  he  had  formerly  had  under  his  care,  and 
gave  an  account  of  the  symptoms  of  a  fourth,  which 
had  died  recently.  In  this  case  the  appearances  were 
practically  those  of  amyotrophic  lateral  sclerosis,  with 
marked  wasting  in  the  muscles  of  the  upper  limbs, 
and  some  clawing  of  the  hands.  The  remarkable 
feature  of  the  case  was  the  absolute  absence  of  anses- 
thesia  of  any  kind,  though  frequently  searched  for, 
-coupled  with  tenderness  to  pressure  of  the  second  and 
third  dorsal  vertebrae  and  of  the  right  second  rib,  which 
had  led  to  a  diagnosis  of  disease  of  those  vertebrae 
-inducing  a  compression  myelitis.  The  cavity  in  the 
cord  extended  through  the  cervical  and  dorsal  regions, 
"was  about  5  mm.  in  average  diameter,  and  in  some  places 
-was  double. 

Dr.  Coleman  said  they  had  to  thank  Dr.  O'Carroll  for 
having  thrown  a  lot  of  light  on  this  disease,  he  having 
first  described  it  in  this  country.  He  thought  that  the 
•case  would  not  have  been  absolutely  diagnosed  as 
•syringomyelia  from  the  symptoms,  and  he  believed 
that  more  of  these  cases  would  be  discovered  if  thorough 
^ost'fnortem  examinations  were  made,  as  Dr.  O'Carroll 
w^as  in  the  habit  of  doing.  He  himself  had  had  a  case 
of  the  disease  under  observation  for  the  last  ten  years. 
It  began  when  the  patient  was  a  boy  of  ten,  and  the 
muscular  symptoms  were  then  well  marked,  with  the 
characteristic  dissociation  of  sensations.  The  anaes- 
thesia and  sensory  symptoms  were  present  in  the  arms 
now  exactly  as  they  were  ten  years  ago. 

Dr.  Thompson  said  the  history  of  the  case  showed 
•the  difficulty  of  making  a  positive  diagnosis,  and  the 
■necessity  for  making  thorough  post-moriem  examina- 
tions. 

Dr.  O'Carroll,  in  replying,  thanked  those  who  had 
-discussed  his  paper.  He  said  he  was  under  the  im- 
pression that  a  fair  number  of  those  cases  had  spastic 
3)henomena  in  the  lower  limbs,  and  the  two  other  cases  he 
liad  examined  certainly  had  them.  The  case  Dr.  Cole- 
man and  he  had  shown  was  now  in  the  Incurable  Hospi- 
tal, and  doing  well.  He  had  well-marked  spastic  phe- 
-nomena.  In  fact,  he  thought  that  syringomyelia 
might  present  a  picture  like  a  compression  myelitis, 
■except  that  it  was  uneven,  and  had  the  peculiar  sensory 
phenomena  and  trophic  disturbances,  such  as  whitlows, 
perforating  ulcers,  talipes,  &c. 


Section  of  Obstetrics. 
Meeting  held  Friday,  December  i6th,  1904. 


The  President,  Dr.  Alfred  Smith,  in  the  Chair. 


The  business  of  the  Section  was  adjourned  until  the 
:next  stated  meeting. 

EDINBURGH  MEDICO-CHIRURGICAL    SOCIETY. 

Meeting  held  December  7Th,  1904. 
iProfessor  John  Chiene,  C.B.,  President,  in  the  Chair. 

Drs.  Burn  Murdoch  and  Stuart  McDonald 
-showed  specimens  of  **  Biliary  Cirrhosis  "  in  a  young 
-child. 

Mr.  Scot  Skirving  showed  (i)  a  simple  form  of 
coin-catcher  ;  (2)  old  stereoscopic  photographs  of  cases 
•operated  on  by  Professor  Spence,  Professor  Syme,  and 
•others  ;  (3)  specimen  of  congenital  syphilitic  disease  of 
the  knee-joint. 

Mr.  Miles  showed  specimens  of  kidneys  removed 
for  calculous  pyonephrosis,  calculous  hydronephrosis, 
:and  tuberculous  disease. 

Mr.  Caud  showed  Luy's  urine  separator  with  examples 
of  urine  obtained  from  each  kidney. 


Mr.  A.  G.  MuLLER  read  a  short  paper,  entitled 
the  toilet  of  the  anus. 
in  which  the  risks  of  contamination  of  the  fingers  and 
of  adjacent  parts  from  an  insufficiently  cleansed  anus 
were  mentioned,  and  a  simple  method  of  purification 
described.  Whatever  means  were  adopted,  the  hands, 
especially  the  nails,  were  liable  to  infection,  and  re- 
quired careful  washing  and  disinfection  after  the  anal 
toilet.  Many  local  ailments  were  due  to  lack  of  clean- 
liness, particularly  of  the  hands.  Among  these  pruritus 
ani,  abscess,  piles,  and  fissure  were  mentioned.  In 
many  cases  simple  cleanliness  did  much  to  alleviate 
such  conditions ;  in  particular  small  rectal  injections 
of  cold  water  after  washing  were  most  useful  both  as 
palliatives  for,  and  prophylactic  against,  haemorrhoids. 

In  commenting  on  the  paper,  Dr.  Allan  Jamieson 
spoke  of  the  value  of  nightly  injections  of  thin  warm 
starch,  to  which  a  little  liquor,  bismuth,  had  been 
added  in  the  treatment  of  pruritus  ani. 

Dr.  Affleck  spoke  of  the  necessity  of  seeing  that 
nurses  were  properly  instructed  in  the  importance  of 
cleansing  the  parts  in  cases  of  typhoid  in  particular,  and 
Dr.  Church,  of  the  importance  of  purifying  the  nozzles 
of  syringes  used  in  giving  enemata,  &c.,  before  intro- 
ducing them  into  the  bowel. 

Professor  D.  J.  Cunningham  gave  a  lantern  demon- 
stration of  some  researches  he  had  made  on 

THE   form   of   the   STOMACH. 

His  slides  were  photographed  from  preparations  in 
which  the  stomach  and  other  viscera  had  been  hardened 
in  situ  by  formalin.  The  specimens  shown  confirmed, 
and  to  some  extent  supplemented,  the  recent  observa- 
tions of  Professor  His.  It  seems  that  the  stomach 
normally  lies  more  or  less  horizontally,  not  vertically, 
the  greater  curvature  being  somewhat  anteriorly 
placed,  close  under  the  parietes.  In  formalin-hardened 
subjects,  certain  kinks  and  indentations  are  not  in- 
frequently found  in  the  stomach.  These  are  probably 
physiological,  not  the  results  of  the  hardening  process. 
They  to  some  extent  coincide  with  Cannon's  observa- 
tions on  the  movements  of  the  stomach  of  the  cat  when 
studied  by  X-rays.  In  some  preparations  the  so-called 
hour-glass  contraction  of  the  stomach  was  shown,  and 
the  view  was  expressed  that  this  was  not  a  patho- 
logical lesion,  but  an  appearance  due  to  the  fact  that 
death  had  occurred  during  the  occurrence  of  active 
peristaltic  waves.  The  main  point  in  Dr.  Cunningham's 
communication  was  an  attempt  to  show  that  the 
stomach  was  by  no  means  an  inert,  passive  sac  or 
reservoir,  but  that  it  was  an  active,  muscular  organ 
which  might  assume  manifold  shapes,  and  that  some 
of  these,  persisting  after  death,  had  been  ascribed  to 
a  morbid  process,   whereas   they  were  physiological. 

A  long  discussion  took  place  on  Dr.  Cunningham's 
demonstration,  the  general  opinion  being  that  there 
was  not  sufficient  evidence  that  the  changes  he  de- 
scribed actually  occurred  during  life,  and  that  it  was 
possible  that  some  of  them  might  be  agonal,  or  due  to 
the  action  of  formalin. 

Mr.  Thomson  remarked  that  in  operating  on  the 
abdomen  the  stomach  was  usually  relaxed,  and  that 
peristaltic  waves  were  rarely  seen. 

Mr.  Stiles  pointed  to  the  frequency  with  which 
visible  peristalsis  occurred  in  congenital  hypertrophy 
of  the  pylorus. 

Dr.  Harvey  Littlejohn  doubted  whether  if  death 
took  place  while  the  stomach  was  acting  the  spasm 
would  not  at  once  relax.  Except  for  the  rare  case  of 
cadaveric  spasm,  death  was  followed  by  relaxation  of 
muscular  fibres.  On  the  other  hand,  as  rigor  mortis  set 
in  muscular  movements  might  take  place,  e.g.,  the 
numerous  intussusceptions  so  commonly  met  with  in 
children. 

Drs.  Ritchie,  Affleck,  and  Greenfield  discussed 
the  recognition  during  life  of  the  exact  shape  of  the 
stomach  by  percussion,  the  latter  emphasising  the 
necessity  for  percussing  down  the  mid-axillary  line. 

Dr.  Waterston  recounted  some  attempts  he  had 
made  to  secure  X-ray  photographs  of  the  human 
stomach  after  large  doses  of  bismuth  had  been  swal- 
lowed. 


'  6,62     The  Medical  Press. 


GERMANY. 


Dec.  21.  1904. 


Dr.  Rainy  spoke  of  the  radiography  of  the  organ  in 
children. 

Drs.  Black,  Caird,  George  Hunter,  and  GuUand  also 
spoke. 


France* 


[from  our  own  correspondent.] 


Pabis,  December  18th.  1904. 

Foreign  Bodies  in  the  Nose. 

Foreign  bodies  in  the  nasal  fossae  are  generally  of 
small  volume,  which  children  introduce  for  amusement ; 
they  are  also  frequent  in  hysterical  and  insane  persons. 
Buttons,  pearls,  beans,  peas  are  those  habitually  em- 
ployed. Foreign  bodies  coming  from  the  pharynx  can 
enter  the  nasal  fossae  from  behind.  This  accident  has 
happened  in  cases  of  paralysis  of  the  velum  ;  but  even 
where  this  is  intact,  the  same  may  occur  through  the 
efforts  of  vomiting.  It  is  thus  that  can  be  explained 
the  presence  of  worms  in  the  nose  as  has  been  some- 
times observed.  When  these  are  of  small  volume  they 
are  often  expelled  by  sneezing  or  of  their  own  accord. 
When  they  sojourn,  they  are  generally  to  be  found  at 
the  anterior  extremity  of  the  turbinated  bone  or  in 
the  lower  outlet.  They  can  [remain  in  situ  a  long 
while  without  producing  any  inconvenience  other  than 
an  exaggerated  secretion.  Certain  of  these  bodies,  as 
beans  or  peas,  may  swell  to  a  considerable  extent, 
blocking  up  the  whole  aperture. 

The  symptoms  provoked  by  the  presence  of  a  foreign 
body  are  at  first  an  increase  of  the  secretion  of  the 
pituitary  membrane,  but  soon  this  latter  becomes  in- 
flamed and  the  secretion  is  muco-purulent.  This 
happens  especially  when  the  body  is  hard  and  em- 
bedded in  the  fossa.  Ulceration  of  the*mucous  mem- 
brane is  the  result,  which  may  end  in  its  perforation. 
In  such  a  case  blood  is  mixed  with  the  secretion.  Sooner 
or  later  the  secretion  becomes  foetid  and  the  discharge 
is  abundant. 

The  diagnosis  of  foreign  bodies  in  the  nasal  fossae  is 
easy  when  of  recent  occurrence  and  before  awkward 
attempts  at  extraction  have  been  made.  The  stilette  is 
the  best  instrument  to  detect  the  nature  of  the  body, 
but  it  is  well  to  apply  to  the  mucous  membrane  a 
solution  of  cocaine  before  proceeding  to  expose  ;  it 
facilitates  the  operation.  If  the  instrument  reveals  a 
hard  body  the  idea  of  a  polypus  can  be  excluded  ;  it 
is  a  case  of  a  foreign  body,  rhinolith,  sequestrum,  or 
osteome.  The  necrosis  produced  by  the  existence 
of  a  sequestrum  causes  extreme  foetidity  of  the 
dischargcwhich  does  not  exist  in  cases  of  foreign  bodies. 

As  to  treatment,  in  cases  of  adults  or  intelligent  chil- 
dren, ttie  blowing  of  the  nose  vigorously  may  be  re- 
commended and  sometimes  succeeds.  The  insufflator 
of  Politzer  may  be  tried  in  young  children,  but  the 
nasal  douche  should  not  be  employed  as  the  jet  of 
water  may  penetrate  into  the  middle  ear  by  the 
Eustachian  canal. 

If  these  simple  means  fail,  what  is  to  be  done  ?  asks 
Dr.  Meiner.  A  bent  stilette  can  be  gently  passed  in 
and  passed  behind  the  obstruction,  and  extract  it,  or 
at  least  stir  it  so  as  to  render  it  possible  to  seize  it  with 
forceps,  or  it  can  be  pushed  backwards  into  the  pharynx, 
taking  the  precaution  of  passing  the  index  finger  of  the 
left  hand  behind  the  posterior  opening.  In  this  way 
M.  Menier,  by  means  of  a  catheter,  extracted  a  boot 
button  from  the  nose  of  a  child  set.  3,  and  which  had  been 
introduced  into  the  nose  two  months  previously. 

Unfortunately  all  these  operations  provoke  abundant 
haemorrhage,  which  must  be  stopped  before  continuing 
the  attempts  at  extraction.  In  my  next, letter  I  pro- 
pose summarising  the  treatment  of  "  Foreign  Bodies 
in  the  Ear." 


The  Council  of  the  London  and  Counties  Medical 
Protection  Society,  at  its  meeting  on  December  9th, 
resolved  that  on  and  after  January  ist,  1905,  an 
entrance  fee  of  ten  shillings  be  charged  to  all  new 
members  joining  the  Society. 


Ocxnumv* 


[from  our  own  correspondbkt.] 

Bnti*ur.  DmsembOT  17tk.  liM. 

At  the  Ophthalmological  Society.  Hr.  Greef  reported 
on  an  examination  he  had  made  at  the  request  of  the 
Government  on  the  sight  of  pupils  in  the  schools.  Tbe 
inquiry,  which  had  been  carried  out  by  himself  and  hb 
assistant,  had  been  an  exhaustive  one,  and  indnded 
enumeration  and  classification  of  all  diseases  met  with, 
and  measurements  of  light,  height,  and  slope  of  desksaod 
the  distance  between  the  desks  and  the  seat.  &c.  Ht 
proposed  that  before  the  erection  of  any  new  schools  the 
plans  should  be  laid  before  a  sanitary  commisstoa. 
which  should  be  empowered  to  order  any  alteration 
deemed  necessary. 

As  regarded  anomalies  of  refraction,  he  found  that 
myopia  was  increasing  in  number  and  degree  in  aB 
classes,  and  especially  in  the  middle  grades.  Betweea 
the  worst  and  the  best  lighted  gymnasia  there  was  no 
marked  difference  as  regarded  numbers,  but  as  regarded 
degree,  the  worst  lighted  showed  the  highest  degrees  ctf 
the  abnormality.  A  table  prepared  by  Cohn  showed 
that  near  eye  work  and  not  age  played  the  chief  part  in 
its  production. 

He  found  myopia  : — 

In  the  Volksschulen  i  '4  per  cent. 

In  the  Elementary  Schools  6  per  cent. 
In  the  Higher  Girl  Schools  7  per  cent. 
In  the  Middle  Schools  10  per  cent. 
In  the  Realschulen  19  per  cent. 

In  the  Gymnasium  26  per  cent. 

He  explained  short-sightedness  as  a  process  of 
stretching  at  the  fundus  oculi,  and  that  the  proce^  was 
more  common  in  early  life.  Schillnez  looks  upon  it  as  a 
racial  question.  Germany  had  the  most  myopicsv 
then  came  France,  and  then  England.  According  to 
the  speaker's  views,  however,  it  depended  more  on  the 
habits  of  the  race;  as  the  sclerotic  was  strongs 
then  the  other  body  tissues  were  also  strong.  Sports 
and  bodily  exercise  tended  to  a  diminution  of  short- 
sightedness. 

Hr.  Hirsch,  in  the  discussion  that  took  place,  said  that 
the  property  of  stretching  was  not  limited  to  early  life. 
Amongst  650  writers  he  found  245  myopics,  of  whom 
only  45  had  been  myopic  during  school  life,  so  that  they 
must  have  acquired  their  myopia  by  later  near  eye 
work. 

Hr.  V.  Michel  had  examined  the  eyes  in  the  Erlanger 
Gymnasium  for  myopia  thirty-five  years  ago,  and  io 
the  upper  classes  had  found  88  per  cent,  of  myopics. 

At  the  Medical  Society  Hr.  Grawitz  related  a  case  of 
Leuc;e.mia    Treated    by     X-rays. 

The  patient,  a  man,  a;t.  54,  came  to  him  at  the  com- 
mencement of  October  in  a  very  miserable  conditioo. 
The  proportion  of  red  to  white  blood  corpuscles  was 
almost  1:1,  the  latter  almost  exclusively  lymphoid 
cells.  The  liver  and  spleen  were  both  swollen.  After 
twenty-three  Rontgen  illuminations  the  general  con- 
dition of  the  patient  had  not  only  distinctly  improved, 
but  examination  of  the  blood  showed  only  a  slight 
deviation  from  the  normal.  Both  liver  and  spleen  wci? 
considerably  reduced  in  size.  Possibly  the  Ijinphoid 
cells  were  directly  dissolved  by  the  rays,  but  to  deter- 
mine that  a  quantitive  determination  of  the  urea  was 
necessary.  The  case  must  not  be  looked  upon  as  cured, 
but  the  influence  of  the  X-rays  was  of  therapeutic  and 
biological  interest. 

Hr.  Levy-Dorn  showed  a  man  who  had  had  pseodo- 
leucaemic  glandular  tumours,  and  who  had  been  treated 
by  the  X-rays.  A  distinct  improvement  had  taken 
place  in  the  general  condition.  Care  should  be  taken 
when  deep  action  was  required  not  to  bring  the  lamp 
too  near  the  part  to  be  acted  on. 

At  the  Free  Society  of  Surgeons  Hr.  v,  Schneider 
offered  a  contribution  to  the 

Surgery  of  the  Pancreas. 

A  woman,  aet.  4^,  had  had  repeated  attacks  of  biHary 
colic,  and  again  in  August,  1902;  in  connection  with  ths 
pneumonia  developed,  then  she  had  pains  in  her  left  side. 


Dec.  21,  1904. 


AUSTRIA. 


Tbe  Medical  Press.    663 


and  four  weeks  later  fever,  diarrhoea,  pain  and  a  tumour 
at  the  arch  of  the  left  rib  ;  exploratory  puncture  gave 
pus.  The  speaker  opened  the  abscess  and  came  into  a 
cavity  that  reached  to  the  spine  and  contained  great 
necrotic  pieces  which  proved  to  be  gangrenous  pan- 
creatic tissue. 

After  a  time  a  faecal  fistula  formed,  which,  however, 
closed  spontaneously,  and  in  the  course  of  ten  weeks 
recovery  took  place.  A  year  later  fresh  attacks  of 
colic  came  on  and  a  year  and  a  half  later  transient 
sugar  was  found  which,  however,  soon  disappeared. 
There  was  still  tenderness  on  pressure  on  the  epigas- 
trium, which  pointed  to  chronic  pancreatitis.  Probably 
there  was  a  connection  between  the  pancreatic  disease 
and  the  gall-stones. 

The  second  case  was  that  of  a  young  man  who  was 
struck  by  a  shaft  in  the  epigastrium,  and  who  then  fell 
unconscious  ;  he  vomited  afterwards.  When  seen  the 
following  day  the  man  had  pain,  but  the  general  con- 
dition was  good.  The  day  after,  however,  he  vomited, 
and  the  pulse  grew  worse.'  Laparotomy  was  performed, 
and  a  transverse  rent  found  in  the  head  of  the  pancreas. 
There  was  distinct  necrosis  of  fatty  tissue.  After 
arrest  of  the  ha-morrhage  the  cavity  was  tamponnaded. 
The  peritonitis,  however,  went  on,  and  the  patient  died. 
The  autopsy  revealed  no  injury  of  any  other  organ, 
the  case  was  one,  therefore,  of  an  isolated  rupture  of  the 
pancreas.  The  fatty  necrosis  must  have  been  secondary. 

Hr.  Riese,  who  took  over  the  first  case  soon  after  the 
operation,  was  of  opinion  that  the  greater  part,  if  not 
the  whole,  of  the  pancreas  had  necrosed  and  been  cast 
off. 

Hr.  Kote  mentioned  a  case  where  a  patient  had 
diabetes,  and  died  in  diabetic  coma  seven  years  after 
operation  for  necrosis  of  the  pancreas.  After  death,  it 
was  found  that  the  whole  of  the  head  of  the  pancreas 
had  been  retained.  Whether  the  diabetes  had  any- 
thing to  do  with  the  necrosis  of  the  pancreas  was  very 
questionable. 


HuBtrta* 


fpROM    OUR    OWN    CORRESPONDENT.] 


Vienna,  I>eociiiber  I7th,  1904. 
Angina  Ulcerosa. 

At  the  Gesellschaft,  Escherich  demonstrated  two 
cases  of  angina  ulcerosa  that  had  been  diagnosed  as 
diphtheria  before  coming  to  hospital. 

This  is  not  an  uncommon  blunder,  and  practitioners 
have  good  reason  to  justify  the  diagnosis  when  this 
occurs,  as  the  membranous  deposit  on  the  fauces  at  the 
commencement  of  the  disease  is  not  at  all  unlike 
diphtheria.  It  is  only  after  a  careful  examination  of 
the  deposit  with  a  microscope,  or  after  a  few  days  have 
elapsed  to  allow  of  the  deposit  clearing  off,  when  crater- 
like depressions  are  observed  and  loss  of  substance 
demonstrated,  that  it  can  be  proved  that  it  was  ulce- 
rative in  character  and  not  a  simple  exudation.  He 
showed  two  other  cases  with  a  deposit  that  had  con- 
tinued for  some  time  without  fever  or  swelling  of 
glands,  but  no  diphtheritic  bacilli  could  be  found 
in  the  deposit,  except  those  described  by  Vincent,  which 
were  of  a  fusiform  shape  and  innocent  in  character. 
Barlow's  Disease. 

This  is  a  commonly  recognised  disease  on  the  Conti- 
nent now.  Prior  to  Barlow's  description  in  1883  the 
disease  was  known  as  "  acute  rachitis,"  occurring 
in  the  first  year,  or  about  the  fifth  month.  The  disease 
is  closely  allied  with  scorbutus  in  the  adult,  and  is 
therefore  dependent  on  the  proper  nutrition  of  the 
infant,  occurring  in  children  fed  on  artificial  prepara- 
tions, boiled  milk,  &c.,  &c.  It  is  not  really  want  of 
food  but  rather  over-feeding  with  innutritions  food. 
As  the  want  of  fresh  vegetables  induces  scorbutus,  so  in 
the  case  ol  the  infant  a  lack  of  fresh  milk  produces  a 
deleterious  condition  in  the  child,  as  swelling  around 
the  epiphyses,  haemorrhages  into  the  subcutaneous 
tissues,  &c.,  &c. 

The  child  Escherich  showed  to  the  members  was 
eight  months  old,  and  had  been  fed  on  "  Biedert's  " 


artificial  cream.     It  had  been  sent  into  the  hospital 
with  a  diagnosis  of  spondylitis. 

The  haematoma  over  the  epiphyses  of  the  femur, 
spheno-maxillary  bones,  and  orbit  pointed  to  some 
justification  for  the  title,  but  closer  inspection,  with 
change  of  food,  soon  convinced  him  that  malnutrition 
was  the  real  factor  in  the  morbid  condition.  Fresh 
milk  was  all  that  was  necessary  to  effect  a  cure. 
Ovarian  Cyst. 

Wechsberg  gave  the  members  an  interesting  account 
of  a  cyst  which  ne  had  removed  from  a  woman,  st.  72. 
He  considered  the  cyst  to  be  a  dermoid  which  may  have 
been  there  for  some  time  past,  as  he  could  discover  no 
cause  beyond  a  sort  of  chronic  hyperplastic  perihepa- 
titis, which  had  led  to  a  reduction  of  the  liver,  though 
not  in  the  sense  of  a  hepatic  cirrhosis.  There  were  no 
sigrns  present  to  show  how  these  hepatic  changes  had 
come  about. 

Specific  Agglutination. 

Schick  reported  an  experiment  carried  out  at  the 
scarlatina  hospital  laboratory  in  which  a  child  after  one 
of  Bassini's  operations  for  hernia  had  a  large  abscess 
that  formed  over  the  new  inguinal  canal.  The  strepto- 
coccus taken  from  the  abscess  formed  a  specific  agglu- 
tination with  Roser's  serum,  which  is  reputed  to  be  an 
antidote  for  scarlatina.  It  was  presented  in  the 
proportion  of  one  to  four  thousand.  A  few  others  have 
obtained  a  similar  result  with  this  senim. 

Pregnancy  and  Puerperal  Involution. 

Halban  read  a  paper  on  the  changes  of  the  uterus  in 
pregnancy,  which  he  divided  into  physiological  and 
chemical,  some  of  which  were  benign,  others  malignant. 
Of  the  former,  decidual  formations,  hypertrophy  of  the 
uterus,  freeing  of  the  vagina,  and  mammary  changes 
were  natural  sequences,  but  renal  oedema,  pigmenta- 
tion, and  haematic  changes  were  always  fraught  with 
danger. 

According  to  the  ^periments  of  Goltz  and  Ribbert, 
the  chemical  substances  in  the  blood  are  the  real  origin 
of  the  changes,  and  are  conveyed  to  the  placenta  and 
foetal  organism  on  which  they  act.  The  speaker  aygreed 
with  the  theory,  as  he  had  frequently  had  opportunities 
to  examine  uteri  and  invariably  found  the  foetus  hyper- 
aemic  as  well  as  the  peri-uterine  vessels,  muscles,  &c., 
greatly  enlarged  and  distended  with  blood.  Decidual 
formation  was  not  observed  in  the  experiments,  but  the 
mucous  membrane  had  all  the  characteristics  of  men- 
strual changes.  In  the  mammary  gland  a  powerful 
reaction  took  place  at  birth.  In  the  foetus  these  changes 
are  also  present  in  sympathy  with  the  mother,  as  in 
both  mother  and  child  milk  will  be  found  in  the  breast 
if  a  female,  while  haemorrhage  may  be  met  with  in  both 
child  and  mother.  It  therefore  appears  that  the  toxic 
component  of  pregnancy  passes  over  the  foetus  as  well 
as  the  mother,  as  hyper-leucocytoses,  nephritic 
changes,  and  increase  of  fibrin  were  present  in  both. 
It  seems  that  this  toxin  is  derived  from  the  pla- 
centa and  from  the  epithelial  chorion  as  a  secretion 
common  to  the  two  Uves,  but  as  soon  as  the  cleavage 
takes  place  these  symptoms,  both  in  mother  and  child, 
cease,  and  involution  commences.  The  meeting  of  the 
spermatozoon  and  ovum  determine  the  placenta. 
These  foetal  changes  are  not  confined  to  the  female  sex, 
as  the  "  witch  mUk  "  of  the  placental  toxin  reacts  on 
the  prostate  of  the  boy  in  utero,  which  gradually  dim- 
inishes after  birth,  and  is  always  much  larger  at  birth 
than  in  children  many  months  older.  It  is  estimated 
that  these  active  changes  in  foetus  and  mother  take  place 
most  markedly  about  the  end  of  the  eighth  lunar  month, 
when  the  breasts  of  the  female  and  the  prostate  of  the 
male  will  then  be  found  much  larger  than  in  children 
many  months  older.  We  conclude,  therefore,  that  the 
toxin  is  equally  potent  in  both  sexes  alike.  In 
eclampsia,  which  is  connected  with  the  separation  of 
the  placenta,  the  toxin  is  present  in  the  foetus  in  as 
great  a  quantity  as  in  the  mother. 

In  the  discussion  Frankl  said  that  he  had  made  many 
examinations  of  the  round  ligament  of  the  uterus, 
which  is  the  rudiment  of  the  conus  inguinalis  of  the 
animal,  and  constantly  found  the  striated  fibres  greatly 
increased   and   the  whole  ligament   thickened.      The 


664    The  Medical  Press.  THE    OPERATING    THEATRES. 


Dec.  21,  1904. 


same  thickening  took  place  in  the  foetus  in  the  ninth  or 
tenth  lunar  months,  which  is  in  perfect  accord  with 
Halban's  theory.  He  had  also  observed  the  great  size 
of  the  prostate  in  the  male  foetus,  and  would  add  that 
the  vesiculae  seminales,  as  weU  as  the  pons  ampullaris 
•and  vas  deferens,  are  also  enlarged. 

Knopfelmacher  said  that  he  had  brought  the  enlarge- 
ment of  the  breasts  in  the  foetus  before  this  meeting  two 
years  ago.  and  suggested  then  that  the  milk  in  the 
mother  was  excited  by  a  ferment  from  the  placenta. 

Hofbauer  agreed  with  a  ferment  from  the  placenta 
excitmg  the  milk,  but  doubted  the  hypertrophy  of  the 
genitals  in  the  foetus  as  these  were  met  with,  but  were 
not  constant. 


XLbc  (Pperattttd  Ubeatree* 

ROYAL  WESTMINSTER  OPHTHALMIC 
HOSPITAL. 
Operation  for  Conical  Cornea.— Mr.  H.  B. 
<Grimsdale  operated  on  a  case  of  conical  cornea. 
The  patient,  a  woman,  ajt.  46,  had  been  in 
hospital  for  some  time  previously  owing  to  ulceration 
of  the  apex  of  the  cone.  With  the  galvano-cautery 
Mr.  Grimsdale  cauterised  an  area  surrounding  the 
apex  about  4  mm.  in  diameter,  and  thence  made  a 
superficial  bum  to  the  nearest  point  of  the  periphery 
of  the  cornea.  He  then  proceeded  to  cauterise  the 
centre  of  the  circular  bum  rather  more  deeply,  but, 
owing  to  the  thinness  of  the  comea,  this  membrane 
was  perforated  unintentionally  before  the  required 
-depth  had  been  obtained.  Mr.  Grimsdale  said  that 
there  were  two  methods  of  dealing  with  such  cases  : 
either  to  produce  a  scar  over  the  weak  area,  which 
allowed  the  protrusion  of  the  tomea,  and  thus  by 
supporting  it  to  reproduce  the  normal  curvature, 
or  tq  excise  the  weak  point  of  the  cornea,  and  to 
reform  at  once  an  almost  normal  structure.  To  deal 
with  this  latter  method  first,  it  had  great  advantages  ; 
the  resulting  scar  was  almost  invisible,  a  single  opera- 
tion  sufficed,  and  often  no  correcting  lenses  were 
necessary,  but  the  risks  of  the  operation  were  so  great 
that  it  was  rarely  justifiable  to  employ  it ;  a  very  large 
open  wound  was  left  in  the  comea  after  the  excision 
of  the  apex  of  the  cone  ;  it  was  hardly  possible,  he 
said,  to  close  this  with  sutures,  and  the  risk  of  imme- 
diate infection  and  total  loss  of  the  globe  was  very 
^reat.  Further,  many  patients  who  escaped  this 
suffered  prolapse  of  the  iris,  and  some  sympathetic 
ophthalmia ;  therefore,  he  thought,  although  the  results 
of  a  successful  operation  by  this  method  were  very 
"brilliant,  and  better  than  those  which  it  was  possible 
to  gain  by  the  cautery,  yet  the  average  results  by 
the  latter  method  were  superior.  In  such  a  case  as 
the  present,  where  the  conjunctiva  was  obviously  not 
aseptic,  it  would  be  under  all  circumstances  unjustifi- 
able to  allow  the  patient  to  run  the  risk  of  an  open 
perforated  wound  of  the  comea.  As  regards  the  method 
by  the  cautery,  he  pointed  out  that  there  were  several 
modifications ;  that  which  he  had  employed  was 
practically  the  method  of  Sir  Anderson  Critchett. 
Sir  Anderson  recommended  that  the  bum  of  the  comea 
should  be  made  in  successive  rings,  increasing  in 
^epth  towards  the  centre,  a  form  which  he  compared 
to  a  target.  In  this  patient,  Mr.  Grimsdale  said,  it 
had  not  been  possible  to  follow  this  method  in  all 
points ;  owing  to  the  thinness  of  the  comea,  the  buUs- 
«ye  of  the  target  could  not  be  burnt  to  the  depth 
which  had  been  wished.  The  accidental  perforation 
entailed  a  longer  convalescence,  but  probably  no  other 


inconvenience.     In    extending     the    bum    from    the 
target    to   the  periphery  he  was  departing  from  Sir 
Anderson  Critchett's  method  and  adopting  one  recom- 
mended by  foreign  surgeons.     The  idea  was  that  the 
promoted  the  growth  of  vessels  from  .the  sarroanding 
conjunctiva  to  the  central  scar,  which  was  therefore 
vascularised  early,  and  became  more  stout  and  resistant. 
Such  a  scar  necessarily  interfered  with  vision,  occupy- 
ing as  it  did  the  centre  of  the  comea,  and  it  would  be 
necessary   at    a  later  date  to  perform  an  optical  iri- 
dectomy to  make  an  artificiad  pupil  to  allow  useful 
vision,  and  probably  further  to  tattoo  the  central  scar 
so  as  to  prevent  the  passage  of  diffused  light;    this 
second  operation,  he  said,  would  not  be  undertakea 
for  some  months,  until  the  curvature  of  the  comea 
was  re-established. 

ST.  BARTHOLOMEWS  HOSPITAL. 
Operation  for  Strangulated   Femoral  Herxu 
IN  A  Man. — ^Mr.  McAdam  EcCles  operated  on  a  man, 
aet.  43,  a  German  baker,  for  right  strangulated  femoral 
hernia.     The  patient  had  had   a   previous  attack  of 
apparent   strangulation    three   days    before,    but  the 
contents  of  the  sac  had  then  been  reduced  by  Uxis. 
He  was  subject  to  chronic  bronchitis  and  had  a  severe 
cough,  during  a  fit  of  which  ^ix   hours   previous  to 
operation  the  hernia  became  strangulated.      In  spite  oi 
the  lung  trouble,  Mr.  Eccles  decided  to  operate  rathcf 
than  to  employ  taxis.     He  advised    that   chloroform 
should  be  selected  as  the  anaesthetic,    and    this  the 
patient  took  well.     On  the  sac  being  opened  slightly, 
blood-stained  fluid  escaped  ;  within  the  sac  were  found 
two  short  loops  of  small  intestine  lying  side  by  side 
and   tightly  gripped  by  the  femoral   ring ;   each  was 
deeply  congested,  showing  marked  evidence  of  strangn- 
lation.     The   stricture  was   divided    and  •  both   loops 
gently  drawn  down,  when  it  was  seen  that  the  constric- 
tion had  been  such  as  to  distinctly  indent  both  loops 
at  the  level  of  the  ring,  and  that  the  loops  belonged  to 
separate  parts  of  the  small  intestine,  a  portion  of  non- 
congested  bowel  lying  between  them.      After  this  in- 
spection both  were  returned  within  the  abdomen.    The 
sac  was  dissected  up,  ligatured  flush  with  the  parietal 
peritoneum,  and  the  femoral  ring  closed  by  silk  sutures 
passed  from  the  deep  aspect  of  Poupart's  ligament  into 
the  origin  of  the  pectineus  muscle.     Mr.   Eccles  re- 
marked that  there  were  several  factors  of  interest  in 
the  case.     The  patient,  he  pointed  out.  was  an  under- 
sized man  and  a  baker,  both  of  which  circumstances 
favoured  the  incidence  of  femoral  hernia,  seeing  that 
the  occupation  leads  to  severe  strain   in  a  stooping 
position.     Femoral  hemix  in  men.  he  considered,  only 
account  for  about    2    per    cent,    of    all  protrusions. 
Operation,  he  said,  was  undertaken  first  because  stran- 
gulation had  already  once  occurred,  and.  secondly,  from 
the  fact  that  strangulation  by  Gixnbemat's  ligament  is 
apt  to  be  so  severe  as  to  rapidly  damage  the  intestine 
beyond  recovery ;    thirdly,  the  operation  would  be  a 
comparatively  simple  one  on  account  of  the  thinness 
of  the  patient ;    so  that,  in  spite  of  the  lung  trouble, 
operation  seemed  to  be  the  least  risky  procedure.    The 
exposure  of  the  contents  of  the  sac  demonstrated  the 
uncertainty  that  there  always  is  in  strangulated  hernia 
as  to  the  exact  viscera  that  will  be  found  nipped.    In 
this  case  the  decidedly  rare  condition  of  two  separate 
knuckles  of  gut  strangulated  side  by  side  by  the  same 
constricting  band  was   found.      It   was    obvious,  he 
thought,  that  taxis  would  havp  been  wholly  unavailing 


Dec.  21,  1904. 


LEADING  ARTICLES. 


The  Medical  Press.    665 


both  on  account  of  the  presence  of  the  two  portions  of 
bowel  and  of  the  extreme  tightness  of  the  ring.  The 
advantage  of  a  close  examination  of  the  intestine  after 
division  of  the  stricture  was  always  great,  for  it  was 
extremely  likely  in  femoral  hernia — and  particularly  so 
in  a  male  subject— that  the  almost  knife-like  edge  of 
Gimbemat's  ligament  should  tend  to  deeply  groove 
the  bowel,  which  is  becoming  increasingly  congested  by 
the  imperfect  return  of  venous  blood  from  its  coats, 
whilst  the  arterial  influx  continues. 

The  bronchitis  was  not  aggravated  by  the  anaes- 
thetic and  the  wound  healed  very  satisfactorily.  A 
fortnight  after  operation  the  patient  had  an  attack  of 
typical  lobar  pneumonia  ending  in  crisis,  but  the 
violent  coughing  did  not  cause  any  giving  of  the  closed 
right  femoral  ring.  

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SALUS  POPULI  SUPSEMA  LEX." 


WEDNESDAY.  DECEMBER  21,  1904. 


THE  LONDON  HOSPITAL  FUNDS,  THE 
HOSPITALS,  AND  MR.  STEPHEN  COLE- 
RIDGE. 

In  a  series  of  articles  we  propose  to  criticise  the 
relations  of  the  hospital  funds  to  the  hospitals, 
the  medical  profession,  and  the  public.    The  high 
esteem    in    which    we    hold    these    distributing 
agencies  has  been  so  fully  and  so  frequently  pro- 
fessed that  there  is  no  need  to  insist  upon  the  point 
further.     Indeed,  it  is  only  the  feeling  of  sincere 
regard  for  the  future  of  the  Funds  that  leads  to  the 
inquiry  whether  they  are  not  open  to  improvement 
in  various  directions.     The  fact  that  the  most  im- 
portant, although  the  youngest  of  these  Funds,  is 
under  the  presidency  of  King  Edward  VII  renders 
it  absolutely  certain  that  every  complaint  will  be 
carefully  and  impartially  investigated,  and  that 
nothing  essentially  unfair  or  unjust  will  be  per- 
mitted to  mar  the  doings  of  the  Funds.  With  that 
conviction  well  in  sight  we  shall  have  no  hesita- 
tion in  speaking  out  our  views  clearly  and  im- 
partially.    At  the  outset  it  may  be  well  to  remark 
that  it  is  eactremely  difficult,  if  not  impossible, 
to  obtain  full  information  on  all  points,  and   if 


any  of  our  details  should  fall  short  of  accuracy 
we   shall   be   open   to   correction.     The   matter^ 
however,  is    essentially   one    of    principles,    and 
as    such   must   ultimately   be   settled   on   those 
lines.     For  years  past  we  have  asserted  in  The 
Medical  Press  and  Circular  that  the  public 
have  a  right  to  be  informed  of  the  principles  upon 
which   grants    are    made   to   medical   charities. 
Hitherto  the  Funds  have  maintained  a  silence 
upon  those   points   as  absolute   and    autocratic 
as  though  the  administration  were  in  Russia  in- 
stead of  England.     Surely  in  the  administration 
of  huge  sums  of  trust  money  the  executive  councils 
of  the  Funds  should  proceed  on  lines  of  action  de- 
finitely drawn  up  and  at  all  times  accessible  for 
public  information.     Our  first  claim,  then,  is  that 
the  policy  of  the  hospital  funds  should  be  openly 
declared,  and  that  definite  information  on  detailed 
points   of   administration    should    be   obtainable 
by  any  private  citizen.    The  necessity  of  some 
such  condition  was  illustrated  last  week  at  the 
Mansion   House   annual   general  meeting  of  the 
Hospital  Sunday  Fund,  under  the  presidency  of 
the  Lord  Mayor,  Sir  J.  Pound.     The  Hon.  Stephen 
Coleridge,  on  that  occasion,  raised  the  question  of 
the  diversion  to  medical  schools  of  funds  contri- 
buted to  the  hospitals.    The  speaker  was  perfectly 
within  his  rights  in  drawing  attention  to  the  point, 
which  obviously  has  a  most    important  bearing 
on    the    proper    conduct    of    medical  charities. 
With  Mr.  Coleridge  and  his  views  upon  vivisection 
we  have  no  sympathy  whatever,  but  that  fact  does 
not  exclude  him  either  from  courteous  treatment 
or     from    an     opportunity  for     expressing    his 
views  generally  in  the  columns  of  The  Medical 
Press  and  Circular.     Let  us  see  how  he  and  his 
friends  were    treated    by  the    Hospital    Sunday 
Fund.     His  seconder,  the  Rev.  Mr.  Lewis,  pointed 
out  an  instance  of  alleged  wrongful  diversion  of 
funds  :   £7,000  had  been  spent  by  the  authorities 
of  the  London  Hospital  for  a  sports  ground  for 
students.     The  London  Hospital  has  an  average 
annual  grant  from  the  Sunday  Fund  of  some  ;f  5,000. 
Any  subscriber  to  that  Fund,  therefore,  is  compe- 
tent to   raise  the  question  at  a  general  meeting 
as  to  how  the  money  thus  awarded  is  spent  by 
the  hospital.     Surely  the  Hospital  Fund  has  a 
policy  on  a  point  of  such  vast  importance  to  hospi- 
tal administration.     Either  it  is  right  or  it  is  not 
right  to  allot  money  subscribed  to  medical  chari- 
ties upon  medical  schools.     Instead  of  any  official 
declaration    from   the    Sunday    Fund,    however, 
the  defence  of  that  body  was  undertaken  by  the 
Hon.  Sydney  Holland,  chairman  of  the  London 
Hospitai,  a  subscriber  to,  but  not  an  official  of,  the 
Sunday  Fund,     We  have  the  greatest  respect  for 
the  conspicuous  kindness  and  genuine  disinterested 
philanthropy     that     characterises     Mr.     Sydney 
Holland.     As  counsel  for   defence,   however,   or 
as  the  expounder  of  a  calm  judicial  anal3rsis  of 
facts  and  principles,  we  should  regard  him  as 
hopelessly  out  of  place.     His  speech  at  the  Mansion 
House  was,  indeed,  a  warning  to  all  gentlemen  who 
trust  to  their  hearts  rather  than  their  heads  in 


666    The  Medical  Pkess. 


LEADING  ARTICLES. 


Dec  21.  1904. 


public  discussion.     He  described  the  remarks  of 
Mr.  Lewis  as  "  uncharitable  sneers,"  and  said  it 
would  have  been  more  generous  had  the  clergy- 
man written  him  beforehand.     '*  With  regard  to 
the    sports    ground,"  he    continued,  '*  they    had 
the  money  to  invest,  and  they  certainly  did  not 
begrudge  the  sum  paid  for  it.     It  would,  perhaps, 
surprise  Mr.  Coleridge  and  his  followers  to  know 
that  he  could  sell  the  sports  ground  any  day  for 
;^io,ooo."     All  this  leaves  the  main   question   of 
Mr.  Coleridge  unanswered.      The  point  was  the 
right  of  the  hospital  to  devote  charitable  funds  to 
the  purchase  of  a  sports  ground,  not  as  to  whether 
the  London  Hospital  was  accumulating  money  and 
making  sound  investments.     Nor  did  Mr.  Holland 
improve  his  position  or  that  of  the  Sunday  Fund 
by  admitting  that  the  London  Hospital  authori- 
ties had  refused  Mr.  Coleridge's  subscription,  be- 
cause it  was  not  sent  with  the  view  of  doing  any 
good  to  the  hospital     (Daily   News  report,   Dec- 
ember 17th,  1904).  Then  he  went  on  :  "  Mr.  Cole- 
ridge  sajrs,    *  This    money   is    given   to    medical 
colleges  which  pubHsh  no  accounts.'     Well,   we 
do  not  supply  Mr.  Coleridge  with  a  copy  of  our 
accounts,  because  we  know  the  purpose  for  which 
he  wishes  to  use  them."    We  submit  that  such  an 
attitude  is  insolent  and  unwarrantable  on  the  part 
of  any  hospital  committee.     Moreover,  Mr.  Hol- 
and  was  silent  when  asked  whether  the  accounts  of 
the  medical  school  were  sent  to  any  subscriber. 
The  end  of  this  most  unsatisfactory  discussion  was 
to  defer  the  matter,  on  the  motion  of  Sir  Henry 
Burdett,  until  the  recently-appointed  commission 
had  presented  their  report.     The  results  appear  to 
show    that  the  Hospital  Sun  day  Fund,  although 
governed  by  a  small  and  absolutely   autocratic 
executive,  has  either  no  decided  views  with  regard 
to  the  proper  disposition  of  hospital  funds,  or, 
having  such  views,  it  is  not  prepared  to  announce 
them  in  public.     Why  should  not  all  hospitals,  great 
and  small,  and  all  hospital  reformers  be  represented 
on  the  executive  of  the  Hospital  Sunday  Fund  ? 
At  present  the  council  is  a  handful  of  persons 
deeply    interested    in     particular    charities    and 
systems  of  charities.     Its  constitution  is  directly 
opposed    to    the    enlightened    and     democratic 
tendencies  of  the  age. 

ETHER  AND  THE  BLOOD. 
The  examination  of  the  blood  is  coming  more 
and  more  to  be  regarded  as  an  essential  part  of 
the  clinical  investigation  of  the  condition  of  a 
patient.  Not  alone  in  medicine  and  diseases 
affecting  the  blood,  primarily  or  secondarily,  is  it 
thought  necessary  to  have  an  accurate  idea  of  the 
condition  of  the  blood,  but  in  surgical  affections , 
and  as  an  indication  for  surgical  operation,  its 
state  is  regarded  as  of  importance,  especially  as 
there  is  no  earlier  sign  of  inflammation  than  the 
sudden  occurrence  of  leucocytosis.  In  order, 
however,  to  be  able  to  make  use,  for  diagnostic 
and  prognostic  purposes,  of  the  facts  gained  by 
examination  of  the  blood,  it  is  necessary  to  have 
accurate  knowledge  of  the  changes  brought  about 


in  the  blood  by  the  administration  of  certain  drugs. 
Of  these  by  far  the  most  important  are  the  com- 
moner anaesthetics,  for  their  action,  if  not  taken 
into  account,  is  likely  seriously   to  mislead  our 
judgment  on  the  changes  followng  surgical  pro- 
cedure.    It  is  necessary  too,   that  the  physiolo- 
gical action  of  the  usual   anaesthetics  should  be  | 
thoroughly  understood,  and  though  the  action  ot 
ether  and  chloroform  on  the  heart  and  lungs  has 
received  much  study,  their  action  on  the  blood  is 
not  known  as  it  should  be.     During  the  past  few 
years,  however,  many  investigators  have  devoted 
themselves  to  this  field  of  study,  and  already  we 
are  in  a  fair  way  to  definite   knowledge.     Drs. 
Anders  and  Boston,  of  Philadelphia,  have  published 
a  series  of  observations  (a)  on  the  effects  on  the 
blood  of  the  administration  of  ether  in  rabbits 
and  in  man.     In  the  case  of  man  they  have  only 
made  use  of  patients  who  had  not  been  prepared, 
either  by  purging  or  fasting,  for  the  anaesthetic, 
as  such  preparation  of  itself  causes  certain  changes 
in    the   blood.      The  results    obtained    are   vcr>' 
uniform,    and    allow   certain   fairly    definite   con- 
clusions.    The  first  change  noted  is  a  decrease  in 
haemoglobin,  amounting  approximately  to  10  per 
cent,    during   the    first    twenty    minutes    of   the 
anaesthetic    state.     The    haemoglobin    reaches   its 
lowest    ebb   about   twenty-four    hours    after   ad- 
ministration of    ether,  and   thereafter    tends  to 
return  to  the  normal.     This  decrease   of  haemo- 
globin explains  what  has  long  been  known  as  a 
clinical  fact,  that  severe  anaemia  is  contra-indica- 
tive to  prolonged  administration  of  an  anaesthetic. 
Various    surgeons     have     recommended    various 
minima  of  haemoglobin,  from  30  to  50  per  cent., 
under  which  they  recommend  that  major  opera- 
tions should  not  be  undertaken.      Side   by  side 
with  the  decrease  of  haemoglobin,  and  proportional 
to  the  degree  of  cyanosis   accompanying  adminis- 
tration, is  an  increase  of  the  red  blood  corpuscles. 
In  all  cases  following  on  the  use  of  ether  there  were 
definite  degenerative  changes  in  the  red  blood  cells, 
mostly  associated  with  the  abstraction  of  haemo- 
globin.    A  fairly  constant  result,    also,   of  ether 
narcosis  is  marked  leucocytosis  ;     in   some  cases 
the  leucocytes  were  doubled  in  number,  but  in  all 
the  cells  were  increased  in  their  normal  jM'opor- 
tions  to  each  other.     This  is  in  marked  contras*^ 
to  what  occurs  in  inflammatory  conditions,  where 
the  great  increase  is  in  the  lymphocyte  variety. 

THE  REGISTRATION  OF  MEDICAL 
STUDENTS. 
The  long  and  somewhat  heated  debate  on  the 
proposal  to  establish  a  compulsory  register  of 
medical  students  which  took  place  at  the  last 
session  of  the  General  Medical  Council  deserves 
careful  study.  The  point  at  issue  was  sufficiently 
important  in  itself,  but  the  mere  subject-matter 
of  the  debate  sinks  into  insignificance  when  the 
larger  questions  of  motive  and  method  are  brought 
under  review.     The  issue  really  was  two-fold— 


(a)  Therap,  Oaz.,  November  l5th,  1904. 


Dec.  21,  1904. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Press.    667 


namely,  whether  a  Students'  Register  should  be 
formed,  and  whether  the  Council  should  charge  a 
fee  for  admission  to  the  Register.   It  is  well  known 
that  the  finances  of  the  Council  have  been  for  a 
long  time  past  in  an  unsatisfactory  position.     The 
work  of  the  Council  has  grown,  its  sessions  are 
longer,  and  its  inspections  of  examinations  ar© 
more  frequent  and  thorough.     All  this  means  in- 
creased expense,  and  unless  funds  are  forthcoming 
to  meet  these  expenses  not  only  will  the  Council 
be  unable  to  extend  its  field  of  operation,  but  it 
will  be  forced  seriously  to  curtail  its  present  under- 
takings.    The  matter,  then,   resolves  itself  into 
the  following  alternatives  :  Shall  the  Council  grow 
in  power  and  influence  until  it  becomes  the  govern- 
ing body  of  the  profession  in  deed  as  well  as  in 
name,  or  shall  it  sink  into  the  position  of  an 
academic    body  whose  function  is  to   keep  the 
Register,  to    superintend  medical    education,    to 
record  pious  opinions,  and  to  furnish  the  Privy 
Council  with  information  about  the     profession 
when  asked  to  do  so  ?    These  alternatives  may 
be  put  in  another  way.     The  General  Medical 
Council  is  the  only  power-possessing  body  in  the 
Profession  on  which  the  general  practitioner  has 
any  representation,  and,   absurdly  inadequate  as 
that  representation  is,  the  fact  remains  that  it  is 
only  through  the  Council  that  the  general  prac- 
titioner has  any  chance  of  making  his  views  known 
and  his  weight  felt.     Is  the  general  practitioner, 
then,  to  be  shorn  of  the  modicum  of  power  that  is 
passing  into   his   hands  through  the   increasing 
influence  of  the  Council,  or  is  the  profession  in  the 
future,  as  in  the  past,  to  be  governed  by  a  number 
of  interested  corporations  and  big-wigs  who  care 
little  or  nothing  for  the  toiling  rank  and  file  ? 
This  question  is  contained  in  the  nutshell  of  stu- 
dents* registration.     By  extending  its  power  of  con- 
trol over  tlie  avenues  of  approach  to  the  pro- 
fession, the  advocates  of  students'   registration 
contend  that  the  Council,  by  establishing  such  a 
Register,  would  gradually  be  able  to  define  the 
standards  of  preUminary  education  which  a  stu- 
dent should  attain  before  begiiming  the  study  of 
medicine .    Moreover,  by  instituting  the  modest  fee 
of  one  pound  for  such  registration,  the  depleted 
exchequer  of  the  Council  would  be  replenished 
sufficiently  to  allow  of  extended  work  and  more 
complete    development.      The    only    alternative 
means  by  which  money  can  be  raised  is  either  by 
obtaining    an    improbable    grant    from    Parlia- 
ment,   already  refused ;    by   levying  an   annual 
tax   on   practitioners,   which   is   palpably   unfair 
without  a  far  larger  direct  representation  ;    by 
increasing  the  sum  now  paid  for  admission  to  the 
Medical  Register ,  which  is  already  sufficiently  high 
at  five  pounds  ;  or,  last  but  not  least,  by  rendering 
registration  compulsory.     The  estabHshment  of  a 
Students'Register  would  not  only  solve  the  financial 
difficulty,  but  would  also  give  the  Council  autho- 
rity in  a  direction  where  authority  is  sometimes 
needed.     At  the  last  Session  but  one,  a  resolution 
in  favour  of  asking  the  Lord  President  of  the 
Privy  Council  to  introduce  a  Bill  into  Parliament 


to  confer  this  power  on  the  Council  was  passed  by 
a  majority  of  twenty-two  to  six — a  mandate  quite 
strong  enough  for  the  purpose  if  it  had  been 
allowed  to  stand.  What  has  been  the  sequel  ? 
No  sooner  had  the  Council  stated  a  clear  and  de- 
finite opinion  than  the  Royal  College  of  Physi- 
cians and  Surgeons  of  England  approached  the 
Lord  President  by  correspondence,  protesting 
against  that  opinion  as  an  infringement  of  their 
rights,  and  the  Lord  President  in  consequence 
wrote  to  the  Council  suggesting  that  a  conference 
between  the  Council  and  the  Colleges  should  take 
place,  so  that  existing  rights  might  be  safeguarded. 
This  letter  formed  the  subject  of  the  debate  which 
resulted  in  the  Council  passing  a  motion  to  the 
effect  that  a  reply  should  be  sent  to  the  Lord 
President  saying  that  the  opposition  of  the  Colleges 
was  too  strong,  and  that  the  Council  would  prepare 
an  alternative  scheme  at  its  leisure.  In  a  word, 
the  Council  has  caved  in  completely,  and  prac- 
tically acknowledged  themselves  beaten  by  the 
Colleges,  not  in  fair  and  square  debate  in  the 
Council  Chamber,  but  by  outside  tactics.  If  this 
is  the  way  that  the  Council  is  to  be  treated,  one 
may  well  despair  of  the  future.  As  Sir  Victor 
Horsley-— the  strongest  and  clearest-headed  man 
on  the  Council — pointed  out,  the  Council  was 
appointed  by  Act  of  Parliament  to  be  supreme 
arbiter  in  matters  of  medical  education,  and  that 
position  should  be  recognised  by  the  Privy  Council. 
The  licensing  bodies  are  represented  in  over- 
powering numbers  on  the  Council,  and  have  every 
opportunity  of  making  their  views  known  in  debate. 
To  suggest  a  conference  is  manifestly  out  of  place, 
as  the  Council  itself  is  the  official  conference  for 
matters  of  this  kind  :  the  opinion  of  the  Council 
embodies  the  opinion  of  all  the  licensing  corpora- 
tions— after  full  discussion.  This  the  Privy 
Council  does  not  seem  to  understand ;  at  all 
events  they  treat  the  Colleges  which  appeal  to 
them  as  though  they  were  entitled  to  be  considered 
on  equal  terms  with  the  Council.  It  is  a  lamentable 
spectacle  for  the  general  practitioner  to  see  the 
Council,  through  which  alone  hope  of  reform  can 
come,  flouted  and  set  at  naught  by  the  close 
corporations  which  are  bent  on  preserving  their 
privileges.  The  maintenance  of  the  dignity  of 
the  Council  and  the  extension  of  its  authority, 
together  with  increased  representation  on  it  of 
the  body  of  the  profession,  are  objects  that  vitally 
concern  the  welfare  of  the  public  and  the  medical 


floted  on  Current  XToptcd* 

Preventive  Treatment  of  Cancer. 
There  are  few  surgeons  of  wider  experience 
than  the  Bradshaw  Lecturer  of  this  year,  Mr. 
Mayo  Robson.  It  is  to  be  expected,  therefore, 
that  the  views  he  has  put  forward  on  "  pre-can- 
cerous  conditions  '*  (a)  will  attract  a  good  deal 
of  attention.  He  is  of  opinion  that  the  onset  of 
malignant  disease  is  preceded  by  one  or  other  of  a 


(a)  The  Medical  Press  ajtd  CIbculab,  December  7th. 


668     The  Medical  Press. 


NOTES    ON    CURRENT   TOPICS. 


I>BC.    21,    1904. 


number  of  conditions  whose  presence  should  sug- 
gest the  adoption  of  preventive  measures.  If  this 
be  true,  and  if  these  pre-cancerous  conditions  be 
capable  of  recognition,  then  a  great  step  in  the 
prevention  of  malignant  disease  will  have  been 
taken.  Mr.  Robson  states  in  detail  several  of 
these  conditions,  which  he  regards  as  leading  to 
cancer.  For  instance,  cancer  of  the  mouth  often 
follows  on  a  chronic  ulcer,  syphilitic,  tuberculous, 
or  dental  in  origin,  or  on  the  irritation  caused  by 
tobacco  smoke.  An  old  ulcer  of  the  stomach  may 
give  rise  to  carcinoma,  eczema  of  the  nipple  to 
malignant  disease  of  the  breast,  gall-stones  to  that 
of  the  gall-bladder.  That  all  such  conditions 
should  be  treated  is  Mr.  Robson's  opinion,  and 
most  of  them  by  the  use  of  the  knife.  When  we 
ask,  however,  what  is  the  common  feature  in 
which  these  very  varied  conditions  agree,  we  are 
at  a  loss.  In  fact,  as  far  as  we  can  see,  there  is 
nothing  in  common  but  that  they  give  rise  to 
long-continued  irritation,  and  it  has  been  believed 
by  many  thinkers  that  irritation  conduces  to  the 
growth  of  malignant  disease.  But  we  can  hardly 
think  that  Mr.  Robson  suggests  that  all  the  con- 
ditions he  mentions  lead  inevitably  to  cancer,  or 
that  every  seat  of  irritation  is  to  be  removed  by 
the  knife.  But  unless  he  means  this,  we  are  still 
in  the  dark  as  to  which  of  the  **  pre-cancerous 
conditions  *'  are  to  be  so  treated,  and  which  are  not. 


A  Orilne  of  Devotion. 
A  MURDER  of  exceptional  medico-legal  interest 
took  place  recently  at  Droitwich,  but  we  were 
unable  to  comment  upon  it  at  the  time  as  the 
murderess  was  arrested  promptly,  and  our  remarks 
had  consequently  to  be  held  over  till  the  prisoner 
had  been  tried.  An  old  lady,  Mrs .  Tabitha  Lawson, 
living  at  Droitwich,  had  had  the  prisoner,  Mary 
Hardaway,  in  her  service  for  forty-seven  years, 
and  the  two  old  people — for  at  the  time  of  her 
mistress*  death  Mary  Holdaway  was  sixty  years 
of  age — ^were  exceedingly  fond  of  each  other. 
Mrs.  Lawson  fell  ill  with  some  chronic  malady 
that  caused  her  continual  suffering,  and  through 
her  long  illness  she  was  tended  with  slavish  devo- 
tion and  self-sacrifice  by  her  old  servant.  There 
can  be  no  doubt  about  the  facts,  for  in  his  evidence 
Dr.  Bryceson,  Mrs.  Lawson's  son-in-law,  said  he 
had  never  seen  such  unselfish  devotion  as  Mary 
Holdaway  showed  her  mistress.  One  day,  while 
temporarily  alone  with  her  in  the  house,  Mary 
Holdaway  cut  her  mistress'  throat.  Dr.  Bryce- 
son happened  to  arrive  shortly  after,  and  Mary 
opened  the  door,  and,  clinging  to  him  like  a  frigh- 
tened child,  kept  repeating  in  a  whimpering  voice 
"  Whatever  made  me  do  it  .>  '*  There  was  no 
doubt  that  she  was  the  culprit,  and  there  was  no 
concealment  of  the  facts.  Neither  was  there  any 
motive  in  the  ordinary  sense  of  the  word.  Counsel 
for  the  defence  put  to  the  jury  the  theory  that 
Mary's  mind  was  constantly  preyed  upon  by  Mrs. 
Lawson's  suffering,  and  that  her  intense  love  for 
her  mistress  goaded  her  to  commit  the  crime. 
This  the  jury  accepted,  and  the  poor  woman  was 


mercifully  found  to  be  insane  at  the  time  of  ti^ 
murder,  and  therefore  not  responsible  for  her 
actions.  Although  love  has  not  infrequently 
acted  indirectly  as  a  motive  for  murder,  we  do  not 
remember  an  instance  in  which  it  has  taken  the 
line  it  did  in  this  case.  The  story  reads  more 
like  the  creation  of  a  realistic  novelist  than  one  of 
sober  fact,  but  it  must  certainly  be  added  to  tie 
long  list  of  medico-legal  romances  that  are  strange 
than  fiction. 


'•  Grafts." 

A  COUPLE  of  years  ago  there  was  a  good  deal « 
discussion  in  the  American  and  honae  journals  ot 
the  question  of  the  legitimacy  of  what  was  called 
the  "  division  "  of  the  consultant's  fee.  It  iras 
the  custom,  not,  we  are  glad  to  say,  in  this  country, 
for  the  consultant  to  return  a  portion  of  the  fee 
to  the  practitioner  who  had  called  him  in.  The 
good  sense  of  the  profession,  both  here  and  ia 
America,  condemned  the  practice  as  being  higblr 
objectionable,  if  for  no  other  reason  than  that  it 
introduced  in  the  selection  of  a  consultant  con- 
siderations other  than  the  interest  of  the  patient. 
Nevertheless,  the  system  has  persisted  in  Ameria, 
and  we  learn  from  our  Transatlantic  contemporaries 
that  it  is  by  no  means  unusual  for  the  practitioiKr 
to  demand  a  "graft,"  as  it  is  called,  from  a  particu- 
lar consultant,  in  consideration  of  recommending 
him.  In  some  cases,  indeed,  the  "  graft  "  is  by  far 
the  major  portion  of  the  fee  paid  by  the  patient.  For 
instance,  A  merican  Medicine  relates  the  story  of  i 
surgeon  who  agreed  to  perforin  a  certain  opera- 
tion for  a  sum  of  five  hundred  dollars.  Some  timf 
later  he  learnt  that  the  patient  had  actually  paid 
two  thousand,  of  which  the  practitioner  had 
pocketed  the  balance.  We  learn  from  our  con- 
temporary that  customs  such  as  this  are  not 
contrary  to  business  morality  in  the  States,  boi 
we  trust  it  may  be  long  before  they  are  accepted 
by  either  professional  or  business  men  in  thi^ 
country. 


Bob  Sawyer— Ad  Kauseam. 
Admirers  of  Dickens — and  we  are  old-fashiotied 
enough  to  include  ourselves  among  them — are  fond 
of  insisting  that  with  all  his  humour  and  all  his 
pathos,  he  was  one  of  the  greatest  moral  influences 
of  the  middle  of  the  nineteenth  century.  No  other 
writer,  not  even  excepting  Charles  Reade,did  more 
to  rouse  the  public  conscience,  while  entertaining 
the  public  intellect ;  and  this  great  end  he  was  able 
to  accomplish  without  offending  susceptibihties  or 
spoiling  a  good  picture  by  using  too  warm  a  brnsh. 
The  reason,  we  take  it,  was  that  Dickens  was  a 
caricaturist  in  the  truest  sense  of  the  word — one, 
that  is,  who  points  his  characters  with  a  subtle 
grace  and  humour.  Just  as  Mr.  Chamberlain  is  said 
to  be  one  of  Mr.  F.  C.  Gould's  warmest  admirers, 
so  the  medical  profession  feel  that  they  haw  no 
grudge  against  Dickens  for  his  delineation  of  Bob 
Sawyer  and  his  pranks.  But  there  are  people, 
without  much  humour,  we  fancy,  who  out-Dickens 
Dickens,  and  find  in  that  clever  caricature  the 
eternal  t5rpe  of  the  medical  student.     On  beball 


Dec.  2I>  1904. 


NOTES    ON    CURRENT    TOPICS.  The  Medical  Press.   669 


of  the  medical  profession  we  beg  to  say  that  we 
are  rather  tired  of  them.  In  a  divorce  case  tried 
last  week  the  co-respondent  was  a  medical  student 
■of  Italian  parentage.  We  have  no  comments  to 
•offer  on  the  merits  of  the  case,  which  resulted 
in  the  jury  being  unable  to  agree  upon  a  verdict ; 
but  we  do  protest  against  the  fact  of  the  co-re- 
■spondent  being  a  medical  student  being  used  by 
the  counsel  for  the  husband  as  an  argument  in 
favour  of  guilt,  or,  at  least,  a  presumptive  element 
of  prejudice.  Counsel  is  reported  to  have  said 
that  the  co-respondent  was  not  a  child  ;  he  was 
studying  for  a  profession  in  which  wild  oats  were 
supposed  to  be  freely  sown  during  student  days, 
to  be  atoned  for  by  exceptional  severity  of  life 
afterwards.  A  speech  of  this  kind  is  as  deroga- 
tory to  the  profession  from  which  it  emanated, 
as  its  intention  was  to  that  at  which  it  was 
levelled.  The  study  of  medicine  is  at  least  as 
•ennobling  as  that  of  the  law,  and  perhaps  it  is  in 
•consequence  of  this  fact  that  we  ourselves  should 
<lecHne  to  cast  unworthy  flouts  at  future  ofl&cers 
of  the  Courts  of  Justice. 

Ethioal  Pharmacy. 

The  prescribing  chemist  and  the  patent  drug 
xiealer  in  this  country  cause  sufficient  vexation  to 
"the  medical  man  who  has  high  ideals  as  to  the 
methods  by  which  relief  should  be  conveyed  to 
suffering  humanity,  but  surely  he  would  lose  his 
vexation  in  amusement  if  they  really  manage  these 
things  in  America  in  the  manner  described  by  Dr. 
Benedict,  of  Buffalo.  From  an  entertaining  paper 
l)y  him  in  American  Medicine  (November  26th, 
1904),  we  learn  that  the  city  drug-store  represents 
a  bizarre  combination  of  businesses.  It  is  usually 
a  public  telephone  office,  a  branch  post-office, 
•express  office,  place  to  pay  gas  bills,  sometimes  a 
branch  circulating  library,  and  laundry.  One 
can  buy  candy,  hair-brushes,  tooth-brushes,  soap, 
valentines,  knives,  tobacco,  soda-water,  "  soft 
•<irinks,"  and  occasional  strong  drinks.  At  some 
stores  the  attractions  include  a  light  lunch,  pet 
animals,  and  gold-fish.  In  the  midst  of  what  Miss 
Squeers  would  call  this  '*  delightful  embarrass- 
ment," there  is  displayed  a  notice  indicating  the 
:raison  d'etre  of  the  estabhshment  in  such  terms  as 
*'  prescription  counter  in  the  rear,"  or  *'  prescrip- 
tions a  speciality."  As  Dr.  Benedict  suggests, 
such  a  proceeding  is  about  as  consistent  as  if  a 
medical  man  were  to  announce  that  he  made  a 
speciality  of  attending  patients.  But  the  com- 
peting attractions  of  the  store  pale  before  the 
-whirl  of  entertainments  provided  by  the  shop- 
vdndows.  Life-size  cards  remind  passers-by  of 
the  virtues  of  plasters  *'  which  feel  good  on  the 
back,"  and  serve  partially  to  hide  the  charms 
of  ladies  and  gentlemen  in  undress.  Gigantic 
^een  frogs  amuse  children  and  call  attention  to 
remedies  for  frog-in-the-throat  at  the  same  time, 
^whilst  a  paste-board  trained  nurse  can  be  made  to 
advertise  nearly  anything,  and  if  she  can  do  some 
automatic  feats  with  a  sprinkler  or  atomiser,  she 
is    doubly    charming.     We    rather    gather    that 


there  is  some  difficulty,  in  making  one's  way  to 
the  prescription  counter  through  this  hive  of  in- 
dustries, especially  as  to  do  so  one  has  to  pass  a 
series  of  cures  for  every  disease,  neatly  done  up 
with  directions  for  use  and  priced  at  a  cheaper 
rate  than  the  prescription  is  dispensed  at.  In  order 
that  the  directions  may  not  make  too  great  a  tax 
on  the  intelligence  of  the  sufferer,  they  are  printed 
in  pamphlets  containing  information  on  astro- 
nomy, a  collection  of  popular  songs,  or  a  complete 
joke-book.  Life  for  a  chemist  in  America  may  be 
busy  ;  it  should  certainly  not  be  dull. 

The  Dangers  of  Ice. 

A  RATHER  unseasonable  contribution  to  public 
health  literature  is  Sir  Shirley  Murphy's  just 
published  report  to  the  London  County  Council 
on  the  way  in  which  the  ice-trade  is  carried  on  in 
London.  We  need  hardly  say  that  the  report 
reaches  the  high  standard  of  interesting  thorough- 
ness that  we  are  accustomed  to  associate  with 
Sir  Shirley  Murphy's  work,  but  nevertheless  it 
sends  cold  shivers  down  the  back  in  more  ways 
than  one.  At  the  present  season  ice  as  an  addi- 
tion to  one's  food  and  drink  does  not  suggest  the 
same  comforting  ideas  that  it  does  in  July  and 
August,  and  we  are  inclined  to  think  that  unless 
some  action  is  taken  on  the  report  even  the  dog- 
days  will  seem  more  endurable  without  ice  than 
with  it.  It  is  frequently  thought  that  the  freezing 
of  water  renders  it  innocuous  as  regards  bacteria, 
but  not  only  is  this  not  the  case,  but  it  has  been 
shown  that  spores  survive  even  the  most  intense 
degrees  of  cold  that  can  be  obtained  by  means  of 
liquid  air.  Ice,  therefore,  unless  made  from  pure 
water  of  unimpeachable  antecedents,  is  just  as 
potent  and  an  even  more  insidious  foe  than 
water  in  its  ordinary  fluid  condition.  Apart 
altogether  from  the  source  of  the  water  from  which 
ice  is  derived,  and  seeing  the  facilities  that  now 
exist  for  making  artificial  ice.  Sir  Shirley  Murphy 
suggests  that  all  ice  for  mixing  with  food  and  drink 
should  be  made  from  distilled  water — ^there  is,  to 
say  the  least,  room  for  great  improvement  in  the 
way  that  ice  for  internal  consumption  is  handled 
by  dealers.  It  is  hardly  unreasonable  to  insist 
that  ice  that  is  to  be  put  in  drinks  or  placed  in 
contact  with  fish  and  butter  should  be  transported 
in  some  more  cleanly  way  than  the  usual  one  of 
being  wrapped  up  in  filthy  bits  of  sacking  in  open 
carts,  whence  it  is  often  thrown  out  on  a  pesti- 
lential city  pavement. 


Oonffenital  Word-deafaeBS. 

A  CURIOUS  symptom  in  the  course  of  certain 
cerebral  diseases  is  the  condition  described  by 
Kussmaul  as  "  word-deafness."  In  this  condition 
patients  are  unable  to  understand  the  meaning  of 
spoken  words, ^ even  though  the  hearing  itself  be 
uninjured.  The  occurrence  of  the  symptom  is 
definitely  associated  with  lesion  of  the  posterior 
part  of  the  first  temporal  convolution  on  the  left 
side,  and  is  consequently  most  often  found  along 
with  deafness  of  the  right  ear.  The  recorded 
cases  of  acquired  sensory  aphasia  of  this  sort  are. 


670    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


I>BC   21.   1904, 


of  course,  very  numerous,  but  we  do  not  remember 
previously  reading  of  any  case  where  the  condition 
was  congenital.  Dr.  Syme,  of  Glasgow,  has, 
however,  recently  met  with  a  child  who  apparently 
had  been  born  word-deaf.  He  is  quite  intelligent 
in  other  respects,  hears  sound  fairly  well,  and  is 
able  to  imitate  the  sounds  made  by  animals.  But 
he  has  no  idea  of  the  meaning  of  words, 
for  although  he  can  repeat  eaisy  words  which  are 
spoken  to  him,  they  are  never  connected  with 
objects  in  his  memory.  When  first  brought  under 
ol^ervation  hearing  was  a  little  dull,  but  both 
hearing  and  speech  have  been  improved  by  careful 
training.  Dr.  Syme  is  inchned  to  account  for  the 
condition  as  being  due  to  a  faulty  development  of 
the  centre  in  the  left  temporal  convolution. 

The  Seoret  of  Secret  Bemedies. 

It  is  an  experience  of  all  of  us  to  have  to  attend 
a  patient  who  has  been  under  a  course  of  treatment 
by  some  secret  cure.  He  may  present  a  drug  rash 
or  some  other  symptom  of  chronic  poisoning  as  a 
result  of  the  treatment,  and  it  is  important  under 
such  circumstances  to  have  some  knowledge  of  the 
nature  of  the  drug  under  whose  influence  he  is. 
The  number  of  secret  medicines,  patented  and  other- 
wise, in  common  use  is  so  large  that  it  is  impossible 
for  the  practitioner  to  cumber  his  mind  with 
details  regarding  all  of  them.  Of  the  ftiost  com- 
mon it  is  advisable,  however,  that  every  medical 
man  should  know  something,  and  such  information 
is  notoriously  hard  to  get.  In  a  lecture  delivered 
twelve  months  ago  at  the  London  Hospital,  Dr. 
Robert  Hutchison  gave  many  particulars  with 
regard  to  several  of  these  remedies,  naming,  as  far 
as  possible,  the  ingredients  present  in  each.  One 
of  our  contemporaries  is  starting  a  series  of  articles 
on  the  subject,  and  in  a  recent  number  (a)  gives 
analyses^  quantitative  as  well  as  qualitative,  on 
the  composition  of  some  of  the  best-advertised 
cures  for  epilepsy.  It  is  satisfactory,  in  a  way, 
to  note  that  none  of  those  examined  is  likely  to  be 
dangerous  in  itself,  since  they  contain  no  other  drug 
than  those  commonly  ordered  for  the  disease. 
The  basis  of  nearly  all  is  one  or  other  of  the  bro- 
mides, the  dose  in  some  cases,  however,  being  larger 
than  it  is  advisable  to  use  without  medical  super- 
vision. A  great  contrast  is  noticed,  however, 
between  the  price  of  the  preparation  and  the  esti- 
mated cost  of  the  drugs  used.  Two  cures  which 
have  a  large  sale  at  2s.  gd.  and  3s.  per  bottle 
respectively  are  calculated  to  cost  each  about  one 
penny  per  bottle.  There  is  truly  no  limit  to  the 
gullibility  of  the  public. 


Doffs  in  Warfare. 

Considering  the  almost  human  intelliefence  of 
the  dog,  it  has  often  been  a  matter  of  wonder  that 
more  use  has  not  been  made  of  him  in  warfare. 
That  he  can  be  employed  for  purposes  requiring 
extraordinary  intelligence  was  shown  long  ago 
by  the  monks  of  St.  Bernard,  who  trained  the 
dogs   of   that  monastery  to  rescue   unfortunate 

<•)  Bra.  Mgd.  Jvurn,,  Deoember  10th,  IWL. 


travellers    lost    in    the    snow.     Various   modem 
armies  have  made  use  of   dogs   for  the  special 
purpose  of  carrying  aid  to  the  wounded,  as  wdl  as 
for  fulfilling  the  ordinary  functions  of  sentinels. 
In  the  present  war  in  the  East  the  Russians  arc 
making  use  of  large  numbers  of  dogs  for  these  pnr- 
poses.     It  will  be  remembered,  too,  that  at  the 
time  of  the  expedition  of  the  allied  troops  to  Pekia, 
much  interest  was  aroused  with  regard  to  the  dogs 
attached  to  the  German   army.     The   Germans, 
indeed,  seem  to  have  devoted  more  attention  thai 
any  other  nation  to  the  subject,  and  at  the  annual 
trainings  the  Medical   Staff   Corps   are   provided 
with  dogs  for  ambulance  purposes.      In  America, 
Italy,  and  other  countries  dogs  are  similarly  cm- 
ployed.     In  our  own  country  Major  Richardsoc 
has  for  many  years  endeavoured  to  persuade  the 
War  Ofl&ce  of  the  advantages  to  be  gained  by  a 
proper  use  of  canine  help,  but  so  far  ^vithout  success. 
This  year,  indeed,  having  devoted  much  time  and 
pains  to  the  training  of  ambulance  dogs,  he  was  at 
length  invited  to  dempnstrate  his  methods  in  the 
autumn   manoeuvres.     As    a   result.    General  Sir 
Charles  Tucker  has  recommended  the  use  of  dogs 
trained   by  Major   Richardson's    method   to  the 
War  Office,  but  as  yet  no  reply  has  been  giwn. 
The  special  utility  of  the  dog  is,  we  believe,  in  aid- 
ing the  stretcher-bearers  by  discovering  wounded 
on  the  field  of  battle. 


"  Profeesor  "  Alex  and  the  London  Hospital, 

A  HYPNOTIST  has  recently  appeared  in  Londoa 
under  the  title  of  '*  Professor  "  Alex.  One  news- 
paper contained  a  grave  account  of  how^  he  para- 
lysed healthy  persons,  a  phenomenon  of  suggestioo 
well  known  to  medical  science.  It  has  also 
been  scientifically  recognised  that  certain  forms 
of  functional  paral3rsis  may  be  made  to  vanish  from 
a  patient  under  the  influence  of  a  strong  wilL 
The  curable  "  paralysis,"  however,  must  be  func- 
tional and  not  organic,  that  is,  it  must  be  due  to  a 
mere  suspension  of  healthy  nerve  action  and  not  to 
structural  changes  in  brain  and  nerves.  In  other 
words,  it  is  only  the,  so  to  speak,  mind-created 
paralysis  that  can  be  cured.  When,  therefore, 
curiosity-seekers  flock  to  see  the  palsied  made 
whole,  it  is  well  to  remind  them  that  the  wonders 
are  worked  upon  defective  minds  rather  than  upon 
the  brick  s  and  mortar  of  our  fleshly  tabernacle. 
**  Professor  "  Alex,  it  need  hardly  be  remarked, 
is  not  a  qualified  medical  man.  He  has  stepped 
over  the  fence  in  stating  that  he  has  cured  "  cases 
which  had  been  discharged  as  incurable  from  the 
London  Hospital."  His  assertion  was  promptly 
challenged,  but  the  promise  from  the  '*  Professor '' 
to  correct  his  mistake  from  the  stage  was  not 
fulfilled.  The  Chairman  of  the  London  Hospital, 
the  Hon.  Sydney  Holland,  thereupon  wrote  to  the 
newspapers  den3ring  that  any  one  of  the  "  Pro- 
fessor's "  so-called  "patients  "  had  ever  beoi  in  the 
''  London."  It  is  shameful  enough  that  a 
quack  of  his  kind  should  be  allowed  to  prey 
on  the  public,  apart  from  bolstering  up  his  false 
pretences  by  brazen  untruths  ;  but  after  all,  there  is 


Dec.  21,  1904. 


NOTES   ON    CURRENT   TOPICS. 


Thb  Medical  Pkess.    671 


little  to  choose  between  one  quack  and  another 
The  public  are  being  fleeced,  damaged  and  killed 
on  all  hands  by  kindred  roguery  of  the  worst 
possible  type.  The  inherent  cruelty  and  wicked- 
ness of  the  "  backache  "  pill  may  be  taken  as  an 
instance.  When  pain  in  the  back  is  due  to  kidney 
mischief  nothing  can  avert  dangerous  or  fatal  re- 
sults except  prompt  and  skilled  medical  care. 
Yet  the  shameless  quack  proposes  to  cure  the  kid- 
ney trouble  by  nostrums  sold  at  a  hundred  times 
their  actual  value.  The  humane  medical  man  can 
only  shake  his  head  and  murmur  a  prayer  for  the 
poor  wretches  who  are  thus  deceived.  The  re- 
sponsible party  is,  in  reality,  the  Government 
which  endorses  each  box  of  pills  for  the  sake  of  a 
paltry  stamp  fee,  and  abstains  from  passing  laws  to 
shorten  the  tether  of  the  quack  medicine  vendor 
who  sucks  the  life-blood  of  the  community. 

Plum-Pudding  from  all  Points  of  View. 

The  part  played  by  plum-pudding  in  the 
formation  of  the  national  character  can  hardly  be 
grasped,  even  in  the  land  of  its  birth,  save  by  the 
highest  and  rarest  types  of  intellect.  Its  wonder- 
working charm  begins  in  the,  nursery,  it  is  con- 
tinued in  the  schools,  and  carried  out  thence  into 
the  busy  walks  of  grown-up  life.  In  all  the  seven 
ages  of  man — not  to  mention  women  and  babies — 
it  cheers,  sustains,  comforts,  nourishes,  soothes, 
and  eke  fascinates.  Who  but  an  Englishman, 
born  and  bred  to  its  toothsome  winsomeness, 
could  tell  how  the  essence  of  plum-pudding  has 
entered  into  and  mellowed  and  ripened  and 
buttressed  the  very  marrow  of  his  bones  ?  Years 
ago  we  wrote  of  the  nutritious  virtues  condensed 
in  that  "  speckled  globe  of  savoury  delights." 
Since  then  base  rivals  in  medical  journalism  have 
analysed  the  atoms  of  this  glorious  and  hallowed 
dish  with  crucibles  and  test-tubes,  and  have  an- 
nounced to  an  indifferent  world  its  precise  amount 
of  nutrient  matter  measured  in  calorics  and  what- 
not scientific  jargon.  Away  with  that  kind  of 
cold-blooded  science  !  Let  the  Englishman  live 
for  to-day  and  for  ever,  happy  in  the  unscientific 
enjoyment  of  his  plum-pudding.  Let  us  be 
thankful  that  in  this  year  of  our  Lord,  although 
bread  and  flour  and  sugar  be  dearer,  yet  raisins 
and  currants,  on  the  other  hand,  be  cheaper, 
while  suet  and  strong  ale  and  brandy  and  the  rest 
of  the  dear  old  classic  ingredients,  have  gone 
neither  up  nor  down.  Let  us  say,  modestly  but 
firmly,  of  our  pudding,  Semper  eadem — floreat 
semper. 


Personal  Hygiene  in  Soldiers. 
The  alleged  physical  deterioration  of  recruits 
has  been  supposed  to  be  due  to  several  causes 
which,  reacting  unfavourably  upon  the  growth 
and  development  of  the  infant,  succeeds  in  lower- 
ing the  standard  of  health  in  the  adult.  Many  of 
these — such  as  overcrowding,  mal-nutrition,  and 
parental  intemperance — act  in  combination  ;  and 
in  the  preparation  of  statistics  it  is  diflScult  to  say 
with  precision  which  factor  is  the  particular  pre- 
disposing one  in  any  given  case.     Presuming  that 


the  recruit  is  of  average  physique,  it  is,  of  course, 
of  supreme  importance  that  he  should  know  how 
to  preserve  his  body  in'the  highest  state  of  efl&- 
ciency,  both  in  times  of  peace  and  when  engaged  in 
active  service.  The  knowledge  of  hygienic  matters 
possessed  by  the  average  "  Tommy  "is,  however, 
surprisingly  small,  as  Lieut-Colonel  H.  K.  Allport 
has  pointed  out  in  a  recent  issue  of  the  Journal  of 
the  Royal  Army  Medical  Corps.  The  ignorance  of 
the  men  themselves  with  regard  to  such  simple 
matters  as  the  care  of  the  teeth,  the  prevention  of 
foot-sores,  and  the  need  for  fresh  air  and  regular 
washing  is  only  too  general,  and  were  it  possible 
to  disseminate  elementary  instruction  of  this  nature 
more  widely  a  great  deal  of  unnecessary  suffering 
and  physical  inefficiency  might  be  prevented. 
The  suggestion  is  put  forward  that  the  officers  of 
the  Royal  Army  Medical  Corps  who  possess  the 
necessary  training  should  undertake  the  task  of 
teaching  the  men,  and  if  such  instruction  takes  the 
form  of  practical  demonstrations  it  is  generally 
much  appreciated.  Example  is  better  than  precept, 
but  without  the  latter  the  former  often  fails  to- 
produce  the  desired  impression.  Efforts  in  this 
direction,  as  carried  out  with  the  Royal  West  Kent 
Regiment  at  Maidstone,  were  eminently  successful 
the  instruction  taking  the  form  of  popular  lectures 
in  the  gymnasium  upon  elementary  physiology 
and  hygiene  as  applied  to  the  every-day  life  of 

the  soldier.  

Signs  of  Drunkenness. 
A  MEDICAL  practitioner  is  reported  to  have  stated 
in  Court  that  "  there  were  no  definite  signs  of 
drunkenness  to  guide  a  medical  man."  Such  an 
assertion  is,  of  course,  perfectly  true,  for  there  is 
not  a  single  symptom  of  acute  or  chronic  alco- 
holism, with  the  possible  exception  of  Quinquaud's 
sign,  that  may  not  occur  equally  in  other  morbid 
conditions.  This  is  a  little  unfortunate  from  the 
point  of  view  of  the  man  in  the  street,  who  beUeves. 
implicitly  in  the  doctrine  of  ''  one  disease,  one 
sign."  Were  such  universally  the  case  the  science 
and  art  of  medicine  would  consist  of  little  else 
beyond  a  committal  to  memory  of  a  list  of  diseases- 
with  their  corresponding  infallible  signs.  The 
minds  of  some  of  us  cannot  help  reverting  to  this- 
analogy  when  we  turn  over  the  leaves  of  some  of  the 
excellent  medical  diaries  supplied  to  each  member 
of  the  profession  by  certain  enterprising  firms. 
Good  as  these  productions  are,  we  do  not  desire 
to  see  them  degenerate  into  a  medical  rival  of  Mrs. 
Beeton.  The  diagnosis  of  alcoholism  is  some 
times  easy  and  at  others  extremely  difficult* 
involving,  as  it  does,  a  full  knowledge  of  every 
morbid  condition  leading  to  excitement,  coma  or 
muscular  inco-ordination.  The  fact  that  alcohol, 
in  some  shape  or  other,  is  frequently  administered 
by  the  friends  of  a  patient  in  fits  or  unconsciousness 
due  to  nervous  or  arterial  affections  further  helps 
to  complicate  matters.  Poisoning  by  other  drugs, 
and,  above  all,  the  possibility  of  injury  to  the  head 
with  or  without  visible  tokens,  have  also  to  be 
borne  in  mind.  There  is  no  one  cardinal  sign  of 
drunkenness  any  more  than  there  is  one  particular 


672     Thb  Medical  Press. 


PERSONAL. 


Dbc.  21.  1904. 


sign  indicative  of  heart-disease.  It  is  the  appear - 
\ance  of  a  certain  "  symptom-complex  "  or  group  of 
•clinical  manifestations  alone  upon  which  the  dia- 
.gnosis  of  alcohohsm  is  based,  and  he  who  trusts  to 
•one  sign  only  will  surely  be  deceived  in  this  as  in 
-every  other  departure  from  the  normal  state. 


Doyen's  Work  in  Oanoer. 

The  researches  of  Dr.  Doyen  have  been  consider- 
ably discounted  among  the  medical  profession 
in  Great  Britain  owing  to  the  curious  secrecy 
•  which  he  has  maintained  as  to  methods  and  details. 
After  the  recent  action,  however,  brought  against 
him  by  an  American,  whose  wife  had  died  under 
treatment  by  his  serum,  Dr.  Doyen  asked  for  a 
responsible  medical  investigation.  That  step  was 
taken  by  the  formation  of  a  committee,  including 
Professor  Metchnikoflf  of  the  Pasteur  Institute. 
Five  chief  questions  are  said  to  have  been  con- 
■sidered  :  (i)  Does  the  microbe  discovered  by  Dr. 
Doyen  (the  bacillus  neoformans)  exist  ?  (2)  If  so, 
is  it  undoubtedly  the  cancer  microbe  ?  (3)  Is  it 
unmistakably  distinguishable  from  other  known 
microbes  ?  (4)  Can  Dr.  Doyen's  microbe  form  the 
basis  for  a  serum  to  be  used  in  inoculation  ?  (5) 
Does  Dr.  Doyen*s  serum  cure  cancer  ?  So  far 
as  we  can  gather  the  Committee  find  that  the 
bacillus  mentioned  was  found  present  in  all  the 
-cancerous  tumours  examined,  and  that  the  serum 
has  always  produced  favourable  results  when 
administered  in  inoperable  cases.  It  need  hardly 
be  pointed  out  to  medical  readers  that  these  state- 
ments, assuming  their  authenticity,  are  of  poten- 
tial rather  than  of  actual  value.  It  may  be 
that  Doyen  has  succeeded  where  other  investiga- 
tors have  failed — or,  again,  it  may  not  be  the  case. 
"Some  day  the  great  discovery  will  undoubtedly 
come,  and  the  name  of  another  great  modern 
benefactor  be  added  to  the  roll  of  fame. 


A  Publio  Vacoinator  as  Magistrate. 

As  an  orthodox  medical  journal,  no  one  could 
for  a  single  moment  suspect  the  Medical  Press 
AND  Circular  of  undue  sympathy  with  the  anti- 
vaccination  cult.  At  the  same  time,  anti-vaccina- 
tors  have  their  legal  rights  just  as  much — ^no  less 
■and  no  more — ^than  their  saner  fellow-citizens. 
If  there  be  one  thing  more  desirable  than  another 
in  the  interests  of  scientific  preventive  medicine, 
it  is  that  the  vaccination  laws  should  be  adminis- 
tered in  such  a  way  as  to  avoid  the  least  breath  of 
a,  suspicion  of  unfairness.  It  seems  eminently 
undesirable,  therefore,  that  a  public  vaccinator  of 
a  district  should  be  called  upon  to  adjudicate  on 
vaccination  cases  as  a  local  magistrate.  Last 
week  it  was  reported  that  Dr.  R.  R.  Brown,  of 
Strood,  one  of  two  justices  at  the  Rochester  Police 
Court,  directed  an  order  to  be  made  out  for  the 
vaccination  of  a  child  within  fourteen  days.  The 
defendant  thereupon  pointed  out  that  Dr.  Brown 
was  favourably  interested  as  the  public  vaccinator 
for  Strood.  The  defendant  further  submitted  that 
the  information  was  bad  and  the  summons  irregu- 
iar.     Whatever  the  ultimate  outcome  of  this  case 


may  be  it  is  obvious  that  public  vaccinators  who 
happen  to  be  magistrates  would  act  wisely  in 
retiring  from  the  bench  when  vaccination  cases 
come  before  the  Court. 


PERSONAL- 


The  Secretary  of  the  North  Wales  University  College 
announces  that  the  recent  bequest  to  the  college  by 
the  late  Dr.  Isaac  Roberts  is  expected  to  realise  j£i5'O00. 

Dr.  Robert  W.m.  Boyce,  Holt  Professor  of  Patho- 
logy in  the  University  of  Liverpool,  sailed  from  the 
Mersey  on  Wednesday  last,  accompanied  by  Dr.  Evans 
and  Dr.  Clarke,  as  the  thirteenth  expedition  under  the 
auspices  of  the  Liverpool  School  of  Tropical  Medicine 
to  the  West  Coast  of  Africa.  A  considerable  number 
of  friends,  including  Professors  Ronald  Ross  and 
Williams,  and  the  popular  hon.  secretary.  Bdr.  Alan 
Milne,  assembled  on  the  landing-stage  and  gave  the 
voyagers  a  hearty  send-off. 

Dr.  Henry  Jellett  has  been  appointed  to  the  post 
of  Obstetric  Physician  to  Dr.  Steeven's  Hospital, 
Dublin,  to  fill  tne  vacancy  caused  by  the  death  of 
Dr.  J.  L.  Lane.  The  posts  of  Gynaecologist  and  of 
Obstetric  Physician  have  thus  been  amalgamated. 

Dr.  R.  J.  Rowlette  has  been  appointed  Pathologist 
to  Dr.  Steeven's  Hospital.  Dublin. 

The  London  Gazette  for  December  13th  contains 
the  names  of  four  Army  surgeons  "  mentioned  in 
despatches  "  relating  to  the  Tibet  Expedition.  Among 
these  the  highest  in  rank  is  Lieutenant-Colonel  L. 
A.  Waddell,  CLE.,  I.M.S.,  a  former  student  of  Glas- 
gow  University,  where  he  qualified  as  M.B.  and  CM. 
with  honours  in  1878,  and  was  made  LL.D.  in  1885. 


Another  surgeon  thus  distinguished  is  Major  A.  R. 
Aldridge,  R.A.M.C,  who  graduated  in  1885  as  M.B., 
CM.,  of  Edinburgh  University,  and  took  the  English 
Conjoint  D.P.H.  in  1892. 

The  third  Army  surgeon  to  be  honoured  is  Major 
C  N.  C.  Wemberley,  I.M.S.,  also  a  graduate  of  Edin- 
burgh University,  where  he  took  the  M.B.,  CM.,  in 

1889. 


The  fourth  gentleman  mentioned  is  Captain  T.  R 
Kelly,  I.M.S.,  who  is  F.R.C.S.E:din.  (1895)  and 
Licentiate  of  the  Scotch  Colleges  of  Edinburgh  and 
Glasgow.^  He  was  educated  at  Queen's  College, 
Galway,  where  he  was  at  one  time  Demonstrator 
and  Assistant  Lecturer  on  Anatomy. 

The  Inaugural  Dinner  of  the  Association  of  Medical 
Diplomates  of  Scotland  will  be  held  in  London  near 
the  end  of  January.  Particulars  may  be  obtained 
from  the  Hon.  Sec.  David  Walsh,  M.D.,  i 8a  Hanover 
Street,  London,  W. 


The  retirement  of  Dr.  TroUope  is  announced  from 
the  physiciancy  to  the  Hastings  Hospital,  a  post  which 
he  has  held  for  no  less  a  period  than  thirty-nine 
years. 

At  a  meeting  of  the  Court  of  the  University  of 
Edinburgh  on  December  12th,  Principal  Sir  William 
Turner  announced  that,  in  reply  to  an  appeal  to 
friends  of  the  University  for  funds  to  purchase  a 
site  for  other  educational  buildings,  and  for  extensioa 
of  the  teaching  stafi  Sir  Donald  Currie  had  intimated 
a  subscription  of  ;^2S,ooo. 

The  Liverpool  School  of  Veterinary  Medicine  and 
Surgery  was  opened  on  December  13th,  by  Mr,  Walter 
Long,  President  of  the  Local  Government  Board,  who 
spoke  of  the  importance  of  this  department  of  study 


Dec.  21,  1904. 


SPECIAL    CORRESPONDENCE. 


Thb  Medical  Press.    673 


from  the  point  of  view  of  the  physical  welfare  of  the 
nation,  and  said  that  Liverpool  was  the  first  university 
of  the  country  to  open  its  arms  to  veterinary  students. 

The  next  ordinary  meeting  of  the  Royal  Meteoro- 
logical Society  will  be  held  at  the  London  Institution 
of  Civil  Engineers,  on  Wednesday,  December  21st,  at 
7.30  p.m.,  when  the  discussion  will  be  taken  on  Mr. 
F.  J.  Brodie's  paper,  "  Decrease  of  Fog  in  London 
durmg  Recent  Years." 

Lord  Rayleigh,  we  understand,  intends  to  present 
to  the  University  of  Cambridge  the  amount  of  the 
Nobel  prize  for  Physics,  whicJi  has  just  been  awarded 
to  him. 


The  Right  Hon.  Joseph  Chamberlain,  M.P..  will 
preside  at  a  banquet  in  London  on  May  loth  next  on 
behalf  of  the  London  School  of  Tropical  Medicine. 

It  is  announced  that  the  University  of  London 
Unionist  Association  has  invited  Sir  Philip  Magnus 
to  contest  the  Parliamentary  representation  of  the 
University  at  the  next  Election,  and  that  Sir  Philip 
has  consented  to  stand.  The  sitting  member  is  Sir 
Michael  Foster,  M.D.,  F.R.S. 


A  MEETING  will  be  held  in  the  Town  Hall,  Manchester, 
on  Thursday,  January  19th,  1905,  at  4  p.m.,  for  the 
purpose  of  establishing  an  institution  to  promote  the 
social  and  scientific  unity  of  the  medical  profession. 
It  is  stated  that  numerous  promises  of  support  have 
been  already  received.  Members  of  the  medical 
profession  are  invited  to  be  present  at  the  meeting. 

Special  CotreBpondence* 

[from    our    own   CORRESPONDENTS.] 


BELFAST. 

The  Old  Royal  Hospital.— Since  the  opening  of 
the  new  Royal  Victoria  Hospital  last  ye^,  the  old 
hospital  in  Frederick  Street  has  been  for  sale,  and 
various  proposals  for  its  use  have  been  made.  The 
Belfast  Guardians  now  propose  to  acquire  it  for  a  tem- 
porary additional  workhouse,  and  at  their  last  meeting 
it  was  announced  that  the  Local  Government  Board 
had  given  their  consent  to  the  arrangement,  provided 
it  can  be  shown  that  the  premises  are  suitable  for  the 
purpose.  The  building  would  provide  accommodation 
for  about  400  persons,  and  it  is  to  be  feared  that  a  good 
deal  of  additional  accommodation  will  be  required 
during  the  winter,  beyond  what  the  workhouse  nor- 
mally affords.  Like  all  other  manufacturing  towns, 
Belfast  is  at  present  suffering  from  bad  times  and  lack 
of  employment  for  the  working  classes,  though  it  is 
hoped  that  the  new  electric  tramway  system  construc- 
tion, which  is  to  be  begun  at  once,  will  afford  employ- 
ment for  a  large  number  of  labourers. 

The  Pollution  of  Belfast  Lough. — ^For  as  long 
as  the  oldest  Inhabitant  can  remember  there  have  been 
complaints  every  summer  and  autumn  of  the  smell  from 
the  slob-land  at  the  head  of  the  Lough,  and  the  warmer 
the  weather  the  warmer  the  language  used  by  the  oldest 
inhabitant.  Since  the  present  drainage  system  was 
introduced  the  nuisance  has  become  much  worse,  and 
an  inquiry  into  its  cause  made  by  Professor  Letts 
showed  that  it  was  due  to  the  masses  of  decaying  sea- 
weed of  the  species  Ulva  latissima,  which  flourishes  in 
the  sewage-polluted  water.  At  the  instance  of  one  of 
the  rural  councils  of  the  neighbourhood  another  inquiry 
was  held  this  week,  this  time  by  Mr.  P.  C.  Cowan,  chief 
engineering  inspector  of  the  Local  Government  Board. 
The  inquiry  seems  to  be  an  exceedingly  futile  one,  for 
it  is  perfectly  well  known  tbiat  the  weed  grows  in 
sewage  water,  and  that  the  smaller  towns  and  villages 
on  the  shore  of  the  Lough  all  add  their  quota  to  the 
pollution,  in  proportion  to  their  population,  though,  of 
course,  Belfast  is  the  most  generous  contributor. 
The  only  result  of  the  inquiry  will  probably  be  a  pro- 
fusion of  promises  of  amendment. 


I  EDINBURGH. 

Edinburgh  University  Improvement  Fund. — At 
the  meeting  of  the  University  court  on  the  12th  inst.. 
Principal  Sir  William  Turner  was  in  the  fortunate 
position  of  being  able  to  announce  that  in  response  to 
the  appeal  made  for  funds  in  aid  of  University  improve- 
ment, a  sum  of  ;f40,ooo  had  been  promised.  Of  this, 
sum,  £25,000  has  been  given  by  Sir  Donald  Currie,  who- 
in  his  letter  intimating  the  donation,  said  that  he  wished 
the  revenue  from  the  sum  to  be  applied  to  the  re- 
muneration of  a  staff  of  lecturers  such  as  the  University- 
authorities  might  from  time  to  time  appoint,  but  that, 
if  they  found  it  necessary  to  do  so,  the  University 
Court  might  apply  £s,ooo  of  the  amount  towards  the 
purchase  of  a  site  for  new  laboratories.  Sir  Donald 
Currie's  desire  was  to  assist  in  placing  the  metropolitan 
University  of  his  native  land  on  a  sound  financial  basis^ 
and  at  the  same  time  to  aid  one  of  the  objects  of  the 
Carnegie  Trust.  He  had  communicated  with  the- 
Chairman  of  the  Trust,  asking  that,  in  view  of  his  gift, 
the  ;£ 1 0,000  voted  by  the  Trust  as  a  capital  sum  for  the 
endowment  of  teaching  should  be  paid  as  soon  as  pos- 
sible to  the  University,  or  that  its  income  should  be- 
made  available  from  the  beginning  of  session  1905-6, 
and  that  a  further  contribution  should  subsequently 
be  made  to  University  improvement.  The  chairman 
of  the  Executive  Committee  of  the  Trust,  Lord  Elgin^ 
has  expressed  his  sympathy  with  the  object  to  which 
Sir  Donald  Currie's  gift  is  to  be  applied,  and  promises- 
to  bring  the  whole  matter  before  the  Trustees.        •    , 

The  Remodelled  Leith  Hospital. — ^Within  the 
last  month  the  improvements  in  this  hospital,  which 
were  begun  in  1898  by  the  building  of  a  new  wing  to- 
the  surgical  block,  have  been  completed,  with  the- 
result  that  the  institution,  which  has  now  been  almost 
entirely  remodelled,  will  bear  favourable  comparison, 
with  any  other  hospital  of  its  size  in  the  kingdom. 
The  last  addition  has  been  the  erection  of  a  surgical 
out-patient  department  replete  with  every  convenience^ 
including  a  small  theatre.  A  very  complete  electrical 
installation  has  also  been  put  in,  including  the  most 
recent  appliances  for  high-frequency  work.  The 
hospital  is  an  old  building,  standing  in  the  most  crowded 
part  of  one  of  the  poorest  districts  in  the  city ;  up  till 
comparatively  recent  years,  all  kinds  .of  cases — fever, 
medical,  and  surgical — were  treated  within  its  walls. 
To  have  remodelled,  and  practically  rebuilt  the  in- 
stitution so  as  to  convert  it  into  a  modern  hospital 
with  accommodation  on  the  most  approved  lines  for 
medical,  surgical,  and  gjrnscological  cases,  including 
as  that  did  the  construction  of  a  nurses'  home,  the 
building  of  new  laundries,  and  a  complete  reorganiza- 
tion of  the  working  of  the  institution  without  having 
even  for  a  day  interrupted  the  routine  of  its  daUy  work, 
was  a  task  of  no  little  difficulty,  but  now  that  it  has- 
been  accomplished  it  is  only  just  to  say  that  no  small 
part  of  the  credit  is  due  to  the  indefatigable  secretary, 
Mr.  G.  V.  Mann,  whose  work  for  the  good  of  the  hospital 
during  a  long  period  of  years  makes  the  institution  his- 
debtor  to  an  extent  which  is  to  be  reckoned,  not  in 
pounds,  shillings,  and  pence,  but  in  the  position  which,, 
thanks  so  largely  to  him,  the  hospital  now  occupies  in. 
the  estimation  of  the  community. 


GLASGOW. 
The  Treatment  of  Neurasthenia. ^At  the  fort- 
nightly meeting  of  the  Glasgow  Southern  Medical  Society- 
held  on  Thursday,  last.  Dr.  Thos.  K.  Munro,  Professor 
of  Practice  of  Medicine  in  St.  Mungo's  College,  read  a 
paper  on  this  subject.  He  related  some  cases  to  illus- 
trate typical  forms  of  the  disease,  describing  in  detail 
the  various  forms  of  the  disease — ^acquired  and  trau- 
matic— including  cerebral,  spinal,  gastric,  and  cardio- 
vascular. He  considered  it  was  comparatively  easy  to- 
distinguish  between  genuine  cases  of  this  disease  and 
those  of  malingering.  The  prognosis  in  neurasthenic 
cases  was  generally  hopeful  where  the  circumstances  of 
the  patient  allowed  of  the  proper  line  of  treatment 
being  carried  out.  Dr.  Monro  advocated  the  adoption 
of  some  hobby  by  such  patients ;   an  outdoor  one  for 


674    Thk  Medical  Press.  LITERARY  NOTES  AND  GOSSIP, 


DbC.    21.    1904. 


those  who  were  previously  closely  confined,  and  suffi- 
cient exercise,  falling]  short  of  fatigue,  at  all  times. 
Drs.  Carstairs  Douglais,  Macgilvray,  Stewart,  Highet, 
Weir,  Halliday,  and  the  President,  Dr.  James  Hamilton, 
took  part  in  the  discussion  whicn  followed.  Reference 
was  made  to  the  treatment  of  neurasthenia  by  means 
of  the  high-frequency  current.  It  was  recognised  that 
in  some  cases  this  modem  and  fashionable  mode  of 
treatment  did  good.  The  Weir-Mitchell  treatment 
had,  of  course,  many  advocates,  but  its  cost  restricted 
its  use  to  those  patients  who  were  in  easy  circumstances. 
On  the  motion  of  the  President,  a  hearty  vote  of  thanks 
was  awarded  Dr.  Munro  for  his  interesting  paper. 

Prosecution  under  the  Food  and  Drugs  Act. — 
A^medical  man  in  Glasgow,  keeping  an  open  surgery 
with  shop  on  the  south  side  of  the  river,  was  last  week 
fined  £4t  including  expenses,  in  the  Summary  Sherifi's 
Court,  for  selling  three  ounces  of  spiritus  aetheris  nitrosi, 
which  was  deficient  in  ethyl  nitrite  to  the  extent  of 
38  per  cent,  or  thereby.  The  defence  was  that  the  drug 
was  highly  volatile,  and  difficult,  to  keep,  each  time 
the  stopper  was  removed  from  the  stock  bottle  a  certain 
amount  of  depreciation  took  place.  It  was  sold  as  it 
was  got  from  the  wholesale  house.  The  prosecutor 
said  tiiere  was  no  suggestion  of  fraudulent  intent  on  the 
part  of  the  respondent,  the  whole  case  being  that  the 
medicine  had  not  been  properly  kept.  This  action 
does  appear  rather  harsh  of  application,  and  shows 
that  the  Pharmaceutical  Society  is  still  active,  and  as 
this  prosecution  took  place  against  a  medical  man  with 
a  shop  open  for  the  retailing  of  drugs,  we  may  venture 
to  say  that  there  is  great  insecurity  for  others  who 
may  be  similarly  situated.  There  are  certainly  many 
dispensing  and  retailing  spiritus  aetheris  nitrosi  to 
whom  it  would  never  occur  to  test  it,  in  order  to  prove 
that  it  was  of  the  required  or  standard  strength. 

CotteeponDence* 

rWe  do  not  hold  ourwlvts  responiible  for  the  opinions  of  our 
Correspondents.  ] 


THE  LAY  PRESS   AND  THE  PROFESSION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — My  attention  has  been  called  to  the  appearance 
in  several  lay  papers  of  some  observations  of  "mine  on 
"  temper  powders,"  as  if  they  had  been  written  for 
the  lay  Press.  As  a  matter  of  fact,  these  are  quota- 
tions nrom  a  paper  "  On  the  Use  of  Salicylate  of  Sodium 
and  Bromide  of  Potassium  in  the  Irritable  Temper  of 
Cardiac  Disease  and  Gout."  This  paper  appeared  in 
The  Praciitiofier  of  July,  1896,  and  parts  of  it  having 
been  quoted  by  one  paper  without  acknowledgment 
of  its  source,  they  were  reprinted  by  other  papers. 
Hence  my  remarks,  intended  solely  for  medical  readers, 
have  been  supposed  to  be  written  for  the  general 
public.  I  regret  this  very  deeply,  for  I  think  that 
had  I  done  this,  as  many  believe  that  I  have,  I  should 
have  been  guilty  of  conduct  derogatory  to  the  pro- 
fession to  which  I  belong,  and  natursdly  am  much 
grieved  that  I  should  be  supposed  to  be  guilty  of 
this.  I  regret  also  that  the  quotations  may  do  actual 
harm  to  health,  because  the  drugs  mentioned,  though 
perfectly  safe  in  the  hands  of  the  medical  practitioner, 
for  whom  the  paper  was  written,  may  prove  mis- 
chievous in  the  hands  of  persons  ignorant  of  their 
properties. 

I  am,  Sir,  yours  truly, 

Lauder  Brunton. 

10  Stratford  Place,  Cavendish  Square. 

[We  sympathise  with  the  annoyance  SirTLauder 
Brunton  has  experienced  owing  to  the  vagaries  of 
modem  journalism.  If  we  remember  aright,  one  of 
these  journalists  had  the  unparalleled  audacity  to 
translate  the  Practitioner  into  the  form  of  a  personal 
interview  with  Sir  Lauder. — ^Ed.] 


means  us  to  believe  that  every  candidate  for  every 
appointment  at  every  hospital  does  not  make  use  <rf 
every  scrap  of  influence  he  has  at  his  command.  I 
would  not  go  the  length  of  saying  that  every  ax^int- 
ment  goes  by  influence,  but  I  have  no  hesitation  m 
saying  that  influence  helps.  It  woald  be  ridicakMis 
to  believe  otherwise. 

It  is  doubtless  true  that  some  of  the  work  done  at 
some  of  the  special  hospitals  is  bad,  but  the  same  may 
be  said  of  some  of  the  general  hospitals,  where,  to 
my  own  knowledge,  the  most  ordinary  surgical  prin- 
ciples seem  to  be  completely  ignored.  Mr.  Sewill's 
advice  to  abolish  most  of  the  special  hospitals  looks 
as  if  he  wished  to  crush  out  all  opposition.  He  seems 
to  forget  that  the  special  hospitals  have  led,  and  that 
the  general  hospitals  have  followed.  Live  and  let 
live  is  not  a  bad  motto. 

As  I  do  not  require  a  hospital  appointment,  my 
interest  is  only  that  of 

Yours  faithfully, 

Outsidek. 


HOSPITAL  FUNDS  AND  SMALL  HOSPITALS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — ^Mr.  Sewill  makes  one  think  of  the  Heathen 
Chinee,  so  child-like  and  bland.     I  wonder  if  he  really 


To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  am  sure  you  are  right  in  your  main  conten- 
tion about  the  hospital  funds.  Intelligent  interest  in 
the  administration  and  application  of  the  funds  cannot 
be  taken  by  donors  or  would-be  donors,  for  the  simple 
reason  that  the  information  supplied  by  the  Committees 
under  these  heads  is  meagre  in  the  extreme.  It  should 
be  the  aim  of  these  Committees  to  let  the  public  share 
all  the  information  that  they  acquire  in  their  ofi&dal 
capacity,  and  to  report  fully  on  their  inspections  of  the 
various  hospitals,  when,  as  in  the  case  of  the  King's 
Fund,  these  are  made  by  authorised  visitors.  The 
mischief  caused  to  the  funds  of  withholding  such  infor- 
mation I  can  illustrate  from  my  own  experience.  I 
had  recently  under  my  care  a  wcialthy  gentleman, 
widely  known  for  his  donations  to  philanthropic  in- 
stitutions. He  consulted  me  one  day  with  reg^iid  to 
subscribing  to  the  King  Edward  VTI  Fund,  the  par- 
ticulars and  official  publications  of  which  he  had  care- 
fully studied.  I  told  him  all  I  knew  of  the  work  of 
the  Funds,  but  he  was  not  satisfied.  A  keen  man  of 
business,  he  informed  me  that  he  never  gives  away  a 
penny  unless  he  is  sure  that  the  administration  of  the 
financial  arrangements  of  a  charity  is  of  the  strictest 
and  soundest,  as  he  has  often  been  scandalised  by  the 
light-hearted  way  in  which  debts  are  incurred  by 
eleemosynary  institutions.  Now  this  gentleman,  after 
a  careful  study  of  all  available  documents,  decided  that 
a  very  handsome  sum  which  he  was  prepared  to  sub- 
scribe Ought  to  be  withheld,  as  he  could  not  assure 
himself  that  it  would  be  used  to  the  best  possible 
advantage.  I  confess  that  I  felt  unable  to  disagree 
with  him. 

I  am.  Sir,  yours  truly, 

LONDINIENSIS. 

December  15  th,  1904* 

Xiteratv  flotee  and  Oosstp* 

The  German  Universities  provided  a  very  valuable 
educational  exhibition  at  this  year's  World's  Fair  at 
St.  Louis,  and  the  Conmiittee  of  the  Medical  Exhibit,  of 
which  Professor  Waldeyer  was  President,  issued  an 
excellent  handbook  (German  Educational  Exhibition, 
St.  Louis  :  Medicine.  Berlin :  W.  Buxenstein,  1904). 
which  strikingly  indicates  the  energy  and  scientific 
enterprise  of  our  German  confreres,  and  is  well  worthy 
of  study  by  English  teachers  of  medicine. 

♦♦  ^ 

The  current  number  of  Tuberculosis,  the  official 
publication  of  the  Central  International  Bureau  for  the 
Prevention  of  Consumption  (Leipzig  :  J.  A.  Barth)  very 
appropriately  is  devoted  to  the  memoxy  of  M.  FinseD. 
Among  the  illustrations  is  one  which  admirably  portnys 
our  Kuig  and  Queen  at  the  Finsen  Institute. 

Egypt  is  deservedly  a  popular  land  for  the  health  and 
pleasure  seeker,  and  Assouan  has  won  distinction  as  one 


Dec.  21.  I904' 


MEDICAL  NEWS. 


The  Mkdical  Press.    675 


of  its  most  attractive  and  advantageous  health  resorts. 
Mr.  G.  Dundas  Edwards  M.R.C.S.  in  his  "  Notes  on 
Assouan/'  (London  :  John  Bale,  Sons  andDanielsson), 
furnishes  much  practical  and  trustworthy  information 
regarding  meteorological  conditions  and  climatic  states 
iw'hich  medical  men  may  well  study  before  advising  a 
case  to  journey  to  the  Land  of  the  Pharaohs.  The 
suggestions  regarding  the  regulation  of  food,  dress,  and 
exercise  are  judicious,  and  the  section  on  sun  and  sand 
baths  contains  useful  precautions. 
*** 

The  Polyclinic  for  December  contains  a  lengthy  article 
by  Sir  Alfred  Fripp  on  the  '*  Radical  Cure  of  Internal 
Derangement  of  the  Knee-joint." 
*** 

Dr.  Dabbs  has  given  us  much  that  is  rich  in  dra- 
matic force  and  has  contributed  largely  to  poetic  prose, 
but  throughout  his  writing  there  is  ever  marked  the 
keen  clinical  instinct  of  the  physician  and  abundant 
evidence  of  the  alert  mind  of  the  analysing  psychologist, 
mingled  with  the  sympathies  of  the  natursJist  and  a 
fellowship  bom  and  bred  in  loving  contact  with 
sufiering  humanity.  In  his  latest  essay  into  the  region 
of  romance,  "  A  Sparrow,  a  Mouse,  and  a  Man :  A 
Study  in  Solitude  "  (London  ;  Partridge  and  Cooper), 
vre  have  a  study  of  primitive  methods  as  applied  in 
**  solitary  confinement/'  and  although  there  is  a  touch 
of  the  whimsical  in  the  story,  many  points  of  consider- 
able psychological  importance  are  enforced,  and  for 
those  willing  to  read  between  the  lines  important 
practical  conclusions  will  not  be  hidden. 
*** 

The  January  issue  of  * '  Longman's  Magazine  "  will  con- 
tain the  opening  chapters  of  two  new  serial  stories.  The 
first  of  which  will  especially  interest  the  medical  pro- 
fession, as  it  is  written  in  collaboration  by  Wsdter 
Herries  Pollock  and  his  son,  Guy  C.  Pollock,  and  is 
entitled  "  Hay  Fever/'  It  is  concerned  with  the 
adventures  of  a  much  and  justly  respected  stockbroker, 
and  is  founded  on  the  known  action  of  a  drug  sometimes 
prescribed  for  hay  fever ;  but,  naturally,  the  authors 
have  aimed  more  at  amusement  than  at  scientific 
accuracy. 

*** 

"  Who's  Who,"  for  1905,  has  just  been  issued  from 
the  press  by  Messrs.  A.  and  C.  Black,  and  is,  as  its  title 
impUes,  a  biographical  record  in  alphabetical  order  of  per- 
sonages more  or  less  distinguished  from  Royalty  down- 
wards to  the  plain  Mr.  Smith,  who  is  supposed  to  be 
endeavouring,  or  to  have  endeavoured,  to  make  the 
world  a  little  better  than  he  found  it,  when,  mirdbile 
dictu,  without  the  asking,  he  was  cast  on  its  shores  to 
fight  his  own  little  way  in  his  own  little  time.  Of 
course,  in  a  compilation  of  this  nature  some  arbitrary 
rule  must  necessarily  be  adopted  regarding  admission 
to  its  pages.  Here  and  there  may  be  found  the  names 
of  medical  men,  whilst  many  are  omitted  who  not  un- 
natundly  might  consider  themselves  more  eminent. 
The  book  is,  moreover,  not  without  amusement,  we 
have  just  lighted  on  a  celebrity  thus  described  :  "  twice 
married,  now  a  widower,  educated  by  his  mother,  "  etc. 
♦♦• 

The  Scientific  Press  announce  that  they  will  shortly 
publish  an  "  Elementary  Treatise  on  the  Light  Treat- 
ment for  Nurses,"  by  Dr.  James  H.  Sequeira,  Physician 
in  Charge  of  the  Skin  Department  at  the  London 
Hospital.  ♦♦♦ 

The  ninth  edition  of  Dr.  Macnaughton- Jones's 
**  Manual  of  Diseases  of  Women,"  has  just  been  issued 
by  Messrs.  Bailliere,  Tindall  and  Cox.  In  its  revised 
form  it  is  the  most  beautifully  illustrated  work  on  the 
subject  with  which  we  are  acquainted,  and  is  hound  for 
the  first  time  in  one  volume  or  in  two,  as  preferred  by 
the^ purchaser.     We  hope  to  review  it  shortly. 

<Pbftuatp« 

DR.  ROBERT  B.  MOORE. 
Dr.  Robert  B.  Moore,  of  Rockcorry,  co.  Monaghan, 
died  on  the  12th  inst.  at  the  advanced  age  of  82.     Dr. 
Moore  was  anative  of  Rockcorry,  and  practised  there 


as  dispensary  officer  for  many  years.  He  enjoyed  a 
large  and  extensive  practice,  and  was  looked  on  by  one 
and  all  as  a  very  able  practitioner.  His  remains  were 
interred  in  the  family  vault  at  Kilcrow  on  the  15th, 
many  people  attending  the  funeral  from  all  parts  of 
the  surrounding  country. 


AN  IMPROVED  STETHOSCOPE. 

Messrs.  Sumner  and  Co.,  of  Liverpool,  have  for- 
warded a  specimen  of  a  portable  stethoscope  of  an 
exceedingly  workmanlike  and  efficient  pattern.  We 
have  tested  this  instrument  carefully, 
and  find  it  one  of  the  best  all-round 
stethoscopes  that  we  have  hitherto  seen. 
The  chest-piece  has  a  celluloid  dia- 
phragm whereby  the  sounds  are  col- 
lected and  transmitted  from  the  drum 
to  both 'ears.  The  whole  packs  away 
neatly  into  a  leather  purse  of  reason- 
ably small  size,  and  it  is  carefully  con- 
structed in  every  detail.  One  would 
think  the  last  word  had  been  said  about 
stethoscopes,  and  that  the  practitioner 
had  only  to  choose  between  the  old- 
fashioned  transmitting  tube  and  the 
modern  applied  principle  of  the  microphone.  Messrs. 
Sumn&s  stethoscope,  however,  shows  that  there 
may  be  excellent  hsdf-way  houses.  The  ex- 
tremely moderate  price,  a  few  snillings  only,  brings 
it  within  the  reach  of  all.  Students  vdll  find  this 
stethoscope  excellent  for  ward  purposes. 


National  Assoelatloo  for  the  Prevention  of  Tuberculosis. 

The  fourth  annual  meeting  of  the  Dublin  Branch  of 
the  National  Association  for  the  Prevention  of  Tuber- 
culosis was  held  on  Wednesday  last  at  the  Royal  College 
of  Physicians.    The  Lord  Mayor  presided,      i^ 

Dr.  Alfred  E.  Boyd,  Hon.  Secretary,  read  the  annual 
report,  which  showed  that  the  total  number  of  deaths 
caused  by  tuberculosis  in  its  many  forms  in  Ireland 
during  1903  was  12,180.  representing  a  rate  of  2*8  per 
1,000,  whilst  in  1902  the  rate  was  27.  Of  the  12,180 
deaths,  consumption  was  responsible  for  9,5S9»  corre- 
sponding to  a  rate  of  2-2  per  1,000  of  the  population. 
Of  these  deaths,  4,667  were  of  males  and  4.892  were  of 
females.  Of  the  males  who  died  from  consumption 
during  the  year,  64  per  cent.,  and  of  the  females  58  per 
cent.,  were  between  the  ages  of  20  and  45  years. 
During  1903  tuberculosis  caused  more  than  twice  as 
many  deaths  as  were  caused  by  influenza,  epidemic 
diarrhoea,  whooping  cough,  measles,  typhoid,  and 
diphtheria  together.  In  the  face  of  these  figures,  the 
fact  was  deplored  that  the  methods  by  which  the  death- 
rate  from  this  cause  is  being  lowered  in  other  lands  are 
still  so  imperfectly  understood  and  adopted  at  home. 
The  adopt^  of  the  system  of  voluntary  notification  of 
consumption  has,  on  the  whole,  been  productive  of  but 
little  benefit.  The  Sheffield  Corporation  has  obtained 
the  sanction  of  Parliament  to  a  provision  which  makes 
notification  of  « consumption  compulsory,  and  the 
Rathmihes  Urban  Council  are  now  taking  a  similar 
step,  the  result  of  which  will  be  watched  with  interest. 
Both  Cork  and  Belfast  have  shown  much  activity  with 
respect  to  the  establishment  of  sanatoriums  for  the 
consumptive  poor,  but  in  Dublin  matters  remained  as 
they  were  a  year  ago,  and  the  difficulty  of  dealing  with 
cases  in  tenement  houses  is  as  great  as  ever.  It  was 
much  regretted  that  the  Dublin  Corporation  have  agam 
deferred  the  appomtment  of  a  City  Bacteriologist. 

Dr.  W.  J.  Smyly  proposed,  and  the  Lord  Mayor 
seconded,  the  adoption  of  the  report.  A  resolution 
urging  upon  sanitary  authorities  the  necessity  for 
making  consumption  a  notifiable  disease  was  then 
proposed  by  Mr.  Thomas  Edmundson,  and  seconded 
by  Dr.  E.  J.  McWeeney.  The  officers  for  the  ensumg 
year  were  then  elected  and  the  proceedings  termmated. 


676  TM  MMicAL  P.ESS.         NOTICES  TO  CORRESPONDENTS. 


Dec.  21,  1904. 


Rpfi-Otir  corrwpoiKieiit,  in   our  opiaion,  having  acted  in 
rtriot  mLT ^4  etii^  pro'cedure,  has  nothing   to   reproach 


^iOttOB  to 

C0trMpmtbtttt0,  ^h0rt  Itetttrs,  *c. 

19-  QoBMMSPQWDwn  requiring  a  mriy  in  tWa  oohiinn  •«  P«^- 
l!riF  requested  to  make  use  of  a  d<«Mne««  Si^^nafiiri  or /ftttioZ^ 
««M  ^BWiSioe  of  signing  themselves  "B«Kier/'    "flubscriber." 

to  l^role. 

OBieniAL  AETiCLM  or  LnraBS  Intended  for  publication  should  be 
written  on  one  side  ol  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
f ion,  but  as  evidence  of  identity. 

CoirrBiBOTOiB  are  kindly  requested  to  send  their  communications 
4f  resWent  in  ItogUnd  or  the  Colonies,  to  the  Editor  at  the  London 
offloe  •  if  resident  in  Ireland,  to  the  Dublin  offloe.  in  order  to  save  time 
In  re^orwaiding  from  offloe  to  offloe.  When  sending  subscriptions 
rue  same  rule  applies  as  to  offloe,  these  should  be  sddressed  to  the 

Publisher.  ^   ^  . 

B«niiipni.-Beprint8  of  articles  appearing  In  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

MB 

strict  

himself  with.  ^    ^         # 

Iff  D  rBalifcbury).— From  the  layman's  point  of  view,  there  was 
DertSsiome  jusSflcation  for  describing  the  late  physician  named, 

AB  an  ^  Eccentric  Doctor.* '  

OUT-PATIBNT8  AND  HOSPITAL  LETTKB8. 

0»  the  first  psge  of  each  letter  is  printed  in  laigo  type  "Keep 
♦vi-^ilJlr  ol«Sn  •»  This  o4Bc€  is  usually  entrusted  to  the  baby, 
S^Jn'^^tires  01  hokey:pok€y  other  refreshments  suppji*din  the 
wSSng.rSo^  by  sym~thette  mothers  described  as  "  kfnd  lydie." 
AnothSr^an  iftokdthe  letter  into  as  smaU  a  compMs  as  possible 
.il?i.vJ5  ?f  t?ffhtlv  in  a  Krcasy  palm,  or  else  ta  wrap  It  in  the  family 
iSirt  h«dk$S?.  Sta  mitly  lost  when  wanted,  and  ^e  search 
fiS?  it  CTitane  a  prodigious  rummage  into  pockets,  tW.  »nd 
MticulerduriDg  which  tie  doctor  fumes  and  frnmWee.  Finally  it 
^11  be  triumphantly  produced  Jrom  benea^  the  baby's  under- 
JettMWits^*'  Our  Hospitals  and  Charities  Ulustrated. 

-rb  nTiTii  FntiiiH.— Do  not  engage  in  any  further  correspondence. 
wMch  JST  i;  f^tless Jbulsutmit  the  caw  forthwith  to  the  Medical 
Defen«»Union.  of  which  we  gather  you  are  amember. 
THE  DOOTOB  WHO  SAVED  HIS  LIFE. 

"  One  dav  in  Shanghai,  when  I  was  feeling  rick,"  says  a  recent 
««^»??n«^L  the  ?^Uow  people,  - 1  caJled  a  Chinaman  to  me  and 
Sw  .  Joh^do  yoJSvr^  China?;;  Good  doctors  ! ' 

he  CTcWmed.  *  China  hVvTbefct  doctors  in  worid  1 '  '  Eudon.  oyer 
*K«!i  '  I  Sid  oointinir  to  a  house  covered  with  a  dootor*e  slgn»-'do 
?ou^l  hta'a^oSd  dSdor  ? '  *  Eudon  good  doctor  I '  he  exclaimed. 
^Si  «ltiaf  1  We  best  doctor  in  Ch  na  !  He  save  my  hfe  once  I  *  You 
dSi'tSJ  i  ?  ll2d.  ^Howvas  it  ? '  •  Me  velly  sick,' he  said  con- 
fldJntilJuy.  •  Me  oallee  Doctor  Han  Kou  ;  giveesorae  medicine  ;  get 
vellv  velly  sick !  Me  call  Doctor  Sam  Sing :  glvee  more  medicine  : 
m^liJ^Zrie  Going  to  die  !  Blmeby,,oaU  Doctor  Eudon  j  he  no 
got  time,  no  come.    He  savee  mv  life ! 

W.  W«8«wi.— The  rumour,  as  we  have  definitely  ascertained,  is 
without  foundation.  *      „,     _.   vi 

Amcws— The  next  vacancy  on  the  Surgical  staff  will  probably 
oc^r  iS  iwoyears  time-at  the  hospital  in  question. 
MEDICINE  IN  TONS. 

ar  Frederick  Treves  at  the  Mansion  House.  London,  wcently  said 
that  in  tSrEmdon  Hospital  alone  they  used  m  the  course  of  a 

^'^^  1,000,000  Hlls. 

3  tons  of  Epsom  salts- 

8  tons  of  carbolic  acid. 

l\  too  8  of  ether  and  chloroform 

10  tons  of  lint. 

whuJwS^^e^l^^^VV^^^  ligaments  for  tendons.  In  one  year, 
h?added,  thew  were  14,394  operations,  or  forty  a  day. 

jaitetingiK  of  the  §0dtlic«,  JUdmtB,  ict. 

WxnsxsDAT  Deccmbbr  21st. 
BOTAL  MiCROsconcAL  80CIITT  (fO  Hanover  Square,  W.).— 8  p.m. 
Paper :    Mr.  J.  W.  Gordon :    The  Theory  of  Highly  Magnified 

BoS^  MxTxoBOLOOiCAL  SooiXTT  (Instftutiou  of  Civil  Engineers. 
Great  George  Street,  Westminster,  S. WJ.— 7.80  pan.  Discission  on 
Mr  F.  J.  Brodie's  paper  on  Decrease  of  Fog  in  London  during  Becent 
Years.  Paper: -Mr.  W.N.  Shaw  and  Mr.  W.  H.  Dines :  The  Study 
of  the  Minor  Fluctuations  of  Atmospheric  Pressure. 


Bacanoee. 

Nottingham  General  Hospital.— Assistant  House  Phyrioian.    Salaiy 


£100  per  annum,  with  board,  lodging,  aad  wasloBg  ia  the  Bia. 

pital.    Applications  to  the  Secretar3% 
Notti  ogham  General  Hotpital.— Assistant  House  Sufgcoa.    Sibry 

£100  per  annum,  ^ith  board,  lodging,  and  washing  la  the  Bsi- 

pital.    Applications  to  the  Secretary. 
King  Edward  Vll.  Sanatorium.— Medical  Superintendent.   8s!an. 

£5U0  per  annum,  with  board,  lodging  and  attendance.    Amtia. 

tions  to  the  Becretaries.  19,  Devonshire  Street,  Portiaad  ntoe, 

London,  W. 
Cumberiand  and  Westmorland  Asylum.  Garlands,  Oarlide.-Jiaiar 

Assistant  Medical  Officer.— Salary  £180  per  an»am.witfa  Vml 

lodging,   and  waahing.     Applications    to  the  Medioa  fiapv 

intendent. 
New  Zaaland.— Professor  of  Physiology  at  the  Univeisity  of  Obc^ 

Salary  £000  per  annum,  with  half  of  the  Class  Fees.  Applicaiioa 

to  the  Agent-General  for  New  Zealand,  13  Victoria  Street.Loadn 

8.W. 
Manchester  Hospital  for  Consumption  aad  Diseaaes  of  the  Thna 

and  Chest.-Be8ident  Medical  "Officer.    Salary  £100  per  saoaa, 

with  board,  apartments,  and  washing.     AppUoatloni  to  &W. 

Hunt,  Secretary,  Hardman  Street,  Deanagate.  Manebsiter. 
Dorset  County  Hospital,  Dorchester.— Hooae  Surgeon.   Sahr;  iim 

per  annum.  Applications  to  W.  K.  Groves.  Valetta,  Icaiw*y. 

Dorchester* 
North  Staffordshire  Infirmary  and  Eye  Hospital,  Hartshai.  Stoke- 

upon-Trenu— Hoube  Surgeon.  Salary  £110  per  annum,  with  fv- 

nished  apartments,  board,  and  washing.     Applicatimto  the 

Secretary. 
Colliery  Clab.— Besident  Surgeon.   Salary  £000  per  aonnm.   Appfi. 

cations  to  A.  J.  Godfrey,  Secretary,  Vernon  Bead,  Kirk^4B- 

Ashfleld,  near  Nottingham 
GuUdford  Borough.-Medical  Officer  of  Health.     Salsry  £100  ff 

annum.     Applications  to  F.  S.  MiUer,   Town  CIsrk'i  Oiat, 

GuUdford.  _ 

Waterford  County  and  City  Inflrmary.—Besident  House  Saifcoi 

Salary  £lOqper  annum,  with  board,  Ac.   Im  mediate  applicitkB 

to  Cecil  J.  Wyatt,  Secretary.  (Bee  Advt.) 


BaAUVD,  Arthur  Mathsr.  L.B.O.P.Lond..  M.B.C.S..  Medical  Offer 

and  Public  Vaccinator  for  the  North  District  and  WorkheoK  «r 

the  Stratton  (Cornwall)  Union.  ^   «     .      „    . 

Btrkr.  J.  P.,  L.B.C.S.,L.BwC.P.I.,  appointed  Senior  BesideBtSsr* 

geon,  Provincial  Hospitol.  Port  Elizabeth,  Cape  Colony. 
Cavr,  Fravcis  Johv  HuoHTRRaa.  M.B.l4ond..  L.B.C.P..  M.ft.Cl, 

Medical  Officer  to  the  Dawlish  (Devon)  Lodge  of  OddfeUons. 
EnaLiSH,  T.  Crisp.  B.8.Load.,  F.B.C^..  Aasi^tuit  Burgeon  to  8l 

George's  Hospital;  Lecturer  on  Operative  Surgery ,  ScGeo^gfi 

Hospital  Medical  Achool,  London. 
Gaot.  d:  P..  L.H.C.P.Bdin.,  L.F.PAGlaa*.,  DP.H..  Certifying  Bur 

geon  under  the  Factory   Act .  for    the    Kilwinning    (Barih) 

District  of  the  county  of  A}*r. 
GiR,  C.  A.,  M.B.C.8.,  L.B.O.P.,  Medical  Ofltoer  f or  the  Ko.  7  Dir 

triot  by  the  Shepton  Mallett  (Somerset)  Board  of  Gnaidian.  - 
HoTsa,  W.  T.,  M.D.Canada.Qinical  AsslataBt  to  the  Chehca  Hn- 

pital  for  Women. 
Leslir,  Bobrrt.  W.D.,L.B.C.8.  ftP.L,  Besident  Medkal  Oflte 

to  the  Boyal  Hospital  for  Incurables,  I>oiuiy brook,  Dablia. 
Etas,  J.  B.,  L.B.C.P.  A  S.Irel.,  Certifying  Surgeon  under  the  Tte- 

tory  Act  for  the  Taghmon  District  of  the  oounty  of  Wexford. 
Shrpfard,  J.  F.,  L.BO.P.  AK8.1reL,  Gertdfyinor  Surgeon  UDderthe 

ntctory  Act  for  the  Newport  Pagnell  District  of  thecoui^ 

of  Buckingham. 


pittite. 


Campbell.— On  December  I'eth,  at  28  North  Street,  Elgin,  the  wife 
of  Donald  Graham  Campbell,  M.B.,  O.M.Edin..  of  a  sen. 

Eastor.— On  December  l>ih,  at  9d  Brigstook  Boad,  Thocatn 
Heath,  the  wife  of  H  at  old  Augustus  Easton,  1LR.C.&, 
L.R.aP.,  of  a  son. 


FoxoRon— CocRB&nc.-  On  December  15th,  at  Christ  Chnmb.  9dm 
Park,  Liverpool,  .  Frederick  Walter  Foxcn>r»,  M.li..  CX 
Birmingham,  youuger  son  of  the  late  Joseph  Foxcroft,  Cheetku 
Hill,  Manchester,  to  Mary  Lydia;  daughter  of  the  late  Tboeai 
Cockbain,  Uverpool  and  Valparaiso. 

GRirriTH  BuLLMORR.— On  December  ISth,  at  Penwairis  GtonA 
Falmouth,  (Cornwall.  Gordon  B.  Griffith,  of  the  Ookmlal  Gml 
Service,  West  Africa,  to  Su»an  Bthel  BuUmore.  yossKr 
daughter  of  the  late  Charles  Forrester  Bulbncre,  MJLCB., 
L.B.C.P.,  L.M.Lond.,  of  Helston,  and  of  Mrs.  BuUmofe,  of  10 
Btratton  Tsrraoe,  Faimoutfa. 


Ptatk0* 


Allard.— On  December  11th,  at  1  Bodney  Terrace.  Ch^heiihm 
Arthur  William,  eldest  son  the  late  Dr.  Wm.  allani  otiTnrhM- 

LocKR.— On  December  6th,  at  Cawdor  House,  Botherfaam.  (Tbarjci 
Alfred  Locke,  M.B.  .3.,  L.R.C.P.,  younger  son  of  John  loel«, 
late  of  Barbados,  aged  40.  ,,      .    ,  «      jj  u. 

Sedgwick.- On  December  li^b.  at  the  London  Hoepitsl,  S..siKMeBQr 
Norah  Emma,  daughter  of  W.  Sedgwick,  M.B.O.S.,  of  »  EBf 
Edwara's  Gardens,  Acton,  W. 

TuHiiRR.~On  December  19th,  after  a  long  llln.efls,  atLeinstar  LodR 
Fulham  Boad,  London,  James  Bobert  Tunmer,  MB.CA,  afw 
78. 


Mh  I^Mial  §Km  wd  ^itrnhv. 


^BALUS   POPVU   SVPREHA   LEX.' 


Vol.  CXXIX. 


WEDNESDAY,    DECEMBER    28,    1904..    No.    26. 


<9tii)inal  Communicationd. 

ON  THE  VALUE  OF 

THE  OFFICIAL  REPORTS  ON 

INSANITY. 

iBy  W.   R.   MacDERMOTT,   M.B..   T.C.D.,  F.R.C.S., 
Medical  Oflloer  of  Poynts  Pass  District. 

Thb  reader  of  the  comments  in  the  lay  press  on  the 
'Official  rejports  of  the  Commissioners  in  Lunacy  and  of 
.the  superintendents  of  the  asylums  must  note  in  the 
writers  a  feeling  of  bewilderment  often  ending  in  naive 
•expressions  of  doubt  and  distrust.  The  leeUng  is  not 
.at  all  confined  to  the  lay  mind.  When  medical  men, 
not  necessarily  in  the  light  of  their  own  technical 
knowledge,  read  a  few  of  these  reports — ^for  the  sake 
of  their  own  mental  stability  they  should  not  read  too 
imany  of  them — they  cannot  but  understand  and  share 
»n  the  perplexity  of  the  lay  reader. 

This  is  apparent  even  when  we  take  what  is  more 
peculiarly  within  the  province  of  the  medical  man,  the 
: treatment  of  the  insane  individual  in  view  of  the  in- 
•cidence  of  the  disease.  Following  Herr  Schlangen- 
.hausen.  Dr.  Godsell,  Arnold  White,  and  others,  though 
with  characteristic  moderation.  Dr.  Rentoul  proposes 
•to  meet  the  disease  by  the  sterilisation  of  certain 
degenerates,  with  respect  to  which  I  must  say  that,  as 
>a  medical  man,  I  would  kick  hard  against  the  onus 
of  ^having  to  determine  in  practice  that  "  certain  "  being 
thrown  on  me.  On  the  other  hand,  medical  men  too 
.numerous  for  citation  advocate  the  boarding  out  or 
*'  home  "  treatment  of  degenerates — "  certain  "  de- 
, generates,  of  course— oblivious  of  the  fact  that  asso- 
ciation-intercourse with  the  insane,  is  a  well-recognised 
rcause  of  insanity. 

It  would  be  unfair  to  expect  in  a  wide  field  of  obser- 
vation, and  from  a  body  of  observers  with  varying 
.personal  equations  and  limits  of  study,  a  uniform  state- 
.ment  of  fact.  In  the  field  of  observation  of  insanity, 
phenomena  or  facts,  strikingly  apparent  in  one  part, 
■are  obscure  or  absent  in  another,  and  it  is  the  duty  of 
.the  individual  observer  to  record  the  facts  within  his 
^personal  knowledge,  but  without  a  knowledge  of  the 
whole  field  he  cannot  safely  generalise  from  the  partial 
•data  at  his  command.  A  physician  in  attendance  on 
.typhoid  cases  in  a  hospital  is  able  to  accumulate 
valuable  information  as  to  the  disease,  but  he  would 
be  a  very  acute  man  indeed  if  he  could  from  such  data 
give  an  account  of  the  causation  of  it  in  palaces  and 
hovels,  cities  and  countrysides.  In  the  same  way  the 
.able  superintendents  of  our  asylums  accumulate  valu- 
.able  information  as  to  the  patients  in  their  charge,  but 
their  range  of  observation  is  not  the  actual  field  of 
incidence  of  the  disease,  and  therefore  we  need  not 
ilook  to  them  for  an  adequate  account  of  its  causation, 
or  even  of  its  general  incidence.  They  give  us  what 
we  have  a  right  to  expect  from  them.  They  are 
.hospital  physicians — I  need  not  say  rather  strictly  so. 
They  give  us  what  they  have  to  give— experience 
•formed  in  their  hospitals.     It  would  be  well  if  they 


told  us  that  they  knew  little  or  nothing  as  to  the  disease 
in  the  country,  or  as  to  the  circumstances  and  condi- 
tions under  which  it  occurred  outside  the  asylums  in 
their  charge. 

It  would  be  well  if  they  would  tell  the  Commissioners 
in  Lunacy,  Commissions  of  Inquiry  of  their  several 
kinds,  the  Medico-Psychological  Association  of  Great 
Britain,  and  all  others  appealing  to  them  for  infor- 
mation, what  the  information  they  can  give  is  really 
worth,  and  thus  enhance  the  service  they  render  the 
community,  a  service  of  all  others  the  most  arduous, 
difficult,  and  disagreeable. 

They  would,  indeed,  preserve  their  dignity  and 
efficiency  in  that  position  and  escape  much  unfavour- 
able criticism  by  realising  the  exact  tenor  of  the  re- 
quests for  information  they  receive.  They  will  find  on 
reverting  to  the  circulars  they  have  received  from  time 
to  time  from  the  Commissioners  in  Lunacy,  and  to  their 
answers  to  these  circulars,  that  a  competence  in  them 
to  decide  certain  questions  is  assumed  which,  on  re- 
flection, they  would  not  assume  themselves.  Thus  in 
the  Special  Report  of  the  Commissioners  in  Lunacy  to 
the  Lord  Chancellor  (February,  1897),  the  Commis- 
sioners state  that  they  commenced  their  inquiry  by 
addressing  a  circular  letter  to  the  superintendents  of  all 
the  county  and  borough  asylums  in  England  and 
Wales,  "  asking  their  views  on  the  subject  of  the  alleged 
increase  of  insanity  occurring  out  of  proportion  to  the 
^crease  of  population  in  the  districts  represented  by 
their  several  institutions,  and  requesting  those  of  them 
who  were  of  opinion  that  such  increase  had  taken  place 
to  specify  in  detail  the  facts  and  figures  upon  which 
that  opinion  was  based,  and  the  apparent  causes  of 
such  increase." 

Replies  were7received  from  62  superintendents  and 
others,  of  which  10  were  of  opinion  that  relative  increase 
had  occurred,  30  that  it  had  not,  and  22  declined  to 
give  any  opinion.  Now  if  the  62  men  had  a  single 
spokesman  he  would  have  said  that  the  general  answer 
was  perfectly  correct  and  perfectly  worthless,  since  if 
relative  increase  had  occurred,  it  would  be  a  mean 
quantity  the  resultant  in  sum  of  increasing,  decreasing, 
and  stationary  terms.  He  would  say  that  a  change  of 
state  affecting  a  minute  fraction  of  population  could 
not  be  supposed  to  be  uniform  over  the  country,  that 
the  answers  received  correctly  indicated  that  fact,  but 
were  worthless  as  giving  an  adequate  representation  of 
it. 

Not  even  the  Commissioners  give  the  superintendents 
credit  for  stating  collectively  the  proper  answer  to  a 
meaningless  question.  They  say  :  "In  some  instances 
it  will  be  seen  that  no  very  clear  distinction  has  been 
drawn  between  the  increase  of  insane  persons,  as  to 
which  there  can  be  no  dispute,  and  an  actual  increase 
of  insanity  disproportionate  to  that  of  population, 
respecting  which  there  is  a  wide  difference  of  opinion." 
Even  without  this  remark  the  popular  mind  after  its 
nature  would  attribute  looseness  of  thinking  and  want 
of  knowledge  to  the  62  superintendents,  collectively  and 
individually.  What  it  wants  itself  it  naturally  takes 
as  wanting  generally. 

The  want  of  knowledge  and  looseness  of  thought  are 


678    Thk  Medical  Press.  ORIGINAL    COMMUNICATIONS. 


Dec.  28.  1904 


altogether  on  the  side  of  those  making  the  inquiry.  A 
superintendent  of  an  asylum  is  able  to  say  whether  the 
number  of  insane  persons  in  his  charge  is  increased  or 
otherwise,  but  he  will  not  infer  from  increase  a  general 
relative  increase  all  over  the  country  or  even,  as  a  per- 
manent fact,  a  relative  increase  in  the  district  his  asylum 
sejves.  If  the  niinber  of  cases  of  typhoid  in  a  hospital 
doubled,  the  physician  would  not  infer  a  general  relative 
increase  of  the  disease  all  over  the  country,  and  any 
inference  he  would  make  as  to  local  incidence  would 
need  data  apart  from  the  number  of  cases -treated  m 
hospital.  The  superintendent  of  an  asylum  is  per- 
fectly justified  in  merely  stating  an  increase  of  insane 
persons  in  his  charge  and  expressing  any  opinion  he 
likes  for  what  it  is  worth  as  to  the  cause  of  the  increase. 
His  expression  of  opinion  is  no  part  of  his  statement 
of  fact,  and  should  not  be  considered  as  such. 

.  All  these  official  inquisitions  into  the  prevalence  of 
insanity  have  the  same  character.  They  all  go  to  the 
asylums  and  to  their  superintendents  "  as  scientific 
experts  whose  special  attention  had  almost  necessarily 
been  fixed  on  the  subject." 

The  superintendents,  and.  in  general,  medical  men 
engaged  in  the  treatment  of  insanity,  however,  while 
scientific  experts  as  regards  the  pathology  and  treat- 
ment of  the  disease  are  not.  and  would  not  claim  to  be. 
experts  as  regards  facts  altogether  outside  of  their 
range  of  observation,  and  which  they  have  no  occasion 
to  deal  with,  or  even  to  consider.  If,  at  the  instance  of 
the  Commissioners  in  Lunacy,  they  express  opinions 
about  what  they  have  not  considered,  these  opinions 
will  be  taken  to  mean  not  inability  to  form  a  judgment, 
but,  from  their  conflicting  and  contradictory  character, 
as  pretension  to  a  knowledge  they  do  not  possess. 

To  understand  the  false  position  in  which  they  are 
placed  and  the  use  to  which  they  have  been  put,  they 
should  remember  that  it  has  been  publicly  stated  that 
the  authorities  do  not  want  any  bond  fide  inquiry  as  to 
the  prevalence  of  insanity,  or  any  discussion  on  the 
subject.  It  has  been  stated  {Fortnightly  Review, 
January,  1893)  that  the  lunacy  reports,  i.e.,  the  in- 
formation our  superintendents  were  at  the  pains  to 
compile,  had  for  years  been  delayed  until  Parliament 
had  risen,  so  that  the  opportunity  of  calling  attention 
to  them  on  the  Estimates  could  not  arise.  Again,  the 
Commissioners  in  Lunacy  in  the  three  kingdoms  have 
been  charged  with  using  the  argument  implied  in  the* 
phrase,  "  apparent  increase  of  insanity,"  in  no  6o«<f 
fide  sense  as  an  argument,  but  to  evade  inquiry.  I 
am  not  here  speaking  for  the  superintendents  of  the 
asylums,  but,  as  far  as  I  can  judge,  they  cannot  be  held 
collectively  responsible  for  the  impUed  argument,  now 
ridden  to  death.  If,  however,  they  have  any  reason 
to  think  that  their  reports  have  been,  to  put  it  mildly, 
misunderstood  in  the  past,  they  may  take  it  as  a  reason 
to  be  on  their  guard  in  the  future.  Here,  for  instance, 
is  the  latest  proposal  coming  from  official  quarters  for 
an  inquiry  into  the  "  causes  "  of  increase  of  insanity 
in  Ireland.  The  Inter-departmental  Committee  on 
Physical  Degeneration  recommends  : — 

• '  That  an  investigation  should  be  undertaken  at  an 
early  date  into  the  extent  and  character  of  the  increase 
of  lunacy  in  Ireland,  and  a  serious  effort  made  to  trace 
it  to  causes  which  might  be  the  subject  of  some  amelio- 
rative interference." 

In  any  such  investigation  the  superintendents  of  the 
asylums  would,  of  course,  as  heretofore,  be  called  on 
to  take  a  prominent  if  not  exclusive  part,  with  the 
result  that  a  report  would  be  concocted  which  would 
be  a  facsimile  of  those  already  in  existence.  The 
report  professedly  based  on  the  evidence  of  the  super- 
intendents would  represent  the  views  of  probablv  not 
a  single  one  of  them,  and  be  as  valueless  or  valuable  as 
its  predecessors.  The  reason  is  on  the  surface  of  the 
proposal.  The  logic  of  causation  demands  that 
sequence  or  change  of  circumstance  shall  be  traced 
within  integral  limits,  i.e.,  the  entire  limits  within  which 
the  circumstances  can  be  determined.  Insanity  in 
Ireland  is  no  unitary  fact,  and  taking  it  as  such  neces- 
sarily involves  gross  fallacy.  Thus  Irish  insanity  is 
ascribed  to  emigration  under  the  crude  supposition  that 


it  drains  away  the  "  bone  and  sinew  "  of  the  conntn 
This  gross  fallacy  is,  of  course,  to  be  corrected  It 
extending  the  area  of  inquiry  to  the  United  States,  and 
the  British  colonies,  when  it  will  be  found  that  the 
Iri^  abroad  are  as  much  if  not  more  affected  tbaa  those 
at  home.  Again,  in  the  Briiish  MedicS  jGwital 
(October  22nd,  .i$04),  it  is  stated  that  "  the  chiei  c«iae 
of  the  growth  of  insanity  in  .Ireland  seems  to  be  simpty 
decadence."  The  Irish  population  is  predominantk 
rural  or  agrarian,  and  if  we  read  agrarian  instead  di 
Irish,  we  will  find  that  in  England  the  agrarian  demon 
of  population  is  as  "  decadent  *'  and  as  much  affected 
b^'~ insanity  as  in  Ireland,  the  only  difference  being  that 
the  element  is  relatively  a  small  one.  Real  inquirT 
would  need  this  observation  to  be  extended  o\'er  tla- 
agrarian  element  in  Western  Europe  and  in  general  to 
all  populations  having  the  same  form  as  the  Irish,  ai^ 
Undergoing  the  same  change  of  state.  If  the  supens- 
tendents  of  the  Irish  asylums  admit  that  such  shoald 
be  the  area  of  inquiry  they  should  not  allow  their  owi 
narrow  local  experience  to  be  made  the  basis  of  a  repon 
which  would  show  them  up  at  loggerheads  amoB| 
themselves. 

The  limitation  of  inquiry  to  "  causes  which  might  Ijc 
the  subject  of  some  ameliorative  interference  "  woaM 
put  the  superintendents  in  a  position  even  more  absurd 
than  the  limitation  of  inquiry  into  a  general  plieso- 
menon  to  a  particular  small  area.  Of  course,  the  in- 
tention is  to  exclude  conventional  morality  and  certain 
social  forms  as  causes  of  insanity  on  the  ground  that 
it  is  useless  to  touch  them.  If,  however,  the  old  notios 
that  lunacy  was  due  to  the  moon's  state  or  to  ac 
astronomical  cause  was  true,  the  knowledge  of  it  would 
enable  us  to  avoid  assigning  false  causes  and  tr>TXi| 
useless  remedies  for  the  disease.  The  diagnosis  of 
disease  or  its  etiology  aims  at  cure  and  prevention,  bn: 
is  not  governed  by  that  aim  ;  as  scientific  men  we  are 
bound  to  determine  causes  or  antecedents  free  of  pre- 
conception, and  frorii  the  mere  utilitarian  point  of  \kw 
to  exclude  false  causes  and  primd  facie  notions. 

The  reports  of  the  superintendents  of  the  asylnins 
can  have  no  value  if  they  are  conformed  to  instructioBs 
which  violate  the  canons  of  scientific  evidence,  or.  in 
other  words,  the  rules  of  common  sense.  I  venture  to 
suggest  to  the  superintendents  to  give  their  reports  in 
future  value  by  conforming  to  these  rules  and  refraining 
from  answering  inquiries  which  contradict  them. 

I  may  enforce  this  suggestion  by  stating  the  mannff 
in  which,  as  I  conceive,  an  effective  investigation  into 
the  incidence  of  insanity  must  be  conducted,  which  i$ 
the  manner  in  which  I  have  myself  conducted  investi- 
gation in,  of  course,  a  limited  field  of  observation. 

In  the  first  place,  what  is  to  be  sought  is  mere  de- 
scription of  where  and  among  "whom  it  occurs,  its 
distributional  maxima  and  minima.  The  causation, 
or  so-called  causation  of  the  disease,  w^hich  is  generafiy 
hypothesis  of  effect,  should  wait  on  this. 

The  occurrence  of  the  disease  is,  as  a  first  step,  lobe 
identified  in  place  and  time.  This  can  only  be  effec- 
tively done  by  taking  maps  of  districts  and  markise 
houses  as  representing  families  contributing  cases  cf 
the  disease  within  a  given  period,  or  by  fonning  an 
inventory  of  all  the  families  in  the  districts  and  ascer- 
taining the  number  contributing.  As  numerical  data 
only  are  needed,  this  could  be  done  without  violation  0! 
private  life,  but  under  any  circumstances  it  b  not 
merely  childish  but  criminal  in  a  matter  of  such  im- 
portance not  to  take  the  only  efficient  means  of  deter- 
mining the  actual  facts,  the  only  means  of  getting  rid 
of  the  dense  clouds  of  falsehood  in  w^hich  the  subject  is 
enveloped  by  men  who  will  not  learn,  and  can  never 
be  brought  to  learn,  the  nature  of  pritnd  facie  ideas. 

The  value  of  this  method  of  investigation  can  be  seen 
at  once  by  comparing,  say,  the  Shankill  road  district  in 
Belfast  with  a  rural  area  of  equal  population  in  Tyrone 
or  Armagh.  In  the  first-named  area  there  are  downs 
of  public  houses,  and  the  population,  a  woiking  class 
one,  is  in  a  visibly  unsatisfactory  state,  social,  moral, 
and  sanitary.  In  the  rural  district,  wherever  taken, 
there  need  be  no  public  house,  and  there  is  no  im- 
morality, illegitimacy,  or  prostitution,  no  social  miseiy 


Dec.  38,  1904. 


ORIGINAL    COMMUNICATIONS.  The  Medical  Press.    679 


and  degradation  ;  judged  by  the  death-rate,  the  sani- 
tary state  is  very  good,  and  everyone  goes  regularly 
to  chorch,  chapd,  or  meeting.  Now  the  man  who 
goes  by  his  primd  facie  notions  would  say  o£E-hand  that 
the  Belfast  district  would  give  the  maximum,  the  rural 
the  nunimum,  of  contributory  families.  But  from  per- 
sonal observation  and  statistics  I  believe  the  Belfast 
district  would  be  found  to  give  about  10  per  cent.,  and 
the  rural  50  per  cent.  It  has  to  be  noted  in  addition 
that  the  rural  group  is  a  pure  or  unmixed  one,  while 
the  urban  is  largely  composed  of  an  immigrant  rural 
element. 

The  method  of  investigation  thus  indicated  in  outline 
is  applicable  not  only  to  circumstances  of  place  and 
time,  but  to  individuals,  in  whatever  way  they  may  be 
grouped,  and  thus  gives  the  true  logical  form  for 
inquiry.  The  table  of  causes  of  insanity  of  the  Medico- 
Psychological  Association  is  a  mere  fallacy-trap  for  our 
-'  scientific  experts."  Thus  alcoholism  as  a  "  cause  " 
of  insanity  is  not  a  cause  in  any  true  sense,  but  simply 
an  observation  of  how  many  of  the  insane  are  found 
to  be  under  the  akoholic  habit.  No  number,  however 
large,  would  establish  causal  relation  or  an  effect.  The 
whole  group  of  persons  under  the  habit  gives  x  lunatics, 
but  for  all  we  know  the  numerical  value  of  x  may  be 
less  than  y,  the  figure  for  the  general  population,  or  than 
z,  the  figure  for  a  group  not  using  alcohol  at  all.  I 
believe  x  would  be  found  much  less  than  either  y  or  z, 
not  because  alcohol  prevents  insanity,  but  because  the 
alcoholic  habit  is  a  characteristic  of  a  class  socially 
distinct  from  the  group  of  families  giving  the  maximum 
of  insanity. 

In  the  same  way  syphilis  cannot  be  proved  from 
numerical  data  collected  in  the  insane  group  to  be 
either  a  cause  or  effect  in  insanity.  The  number  of 
insane  in  the  syphilitic  group  may,  for  all  we  know, 
be  less  than  the  number  in  any  equal  non-syphilitic 
group  of  the  same  age-period.  This  again  is  due  to 
class  distinction  ;  the  group  of  rural  families  giving 
the  maximum  of  insanity  are  almost  entirely  free  from 
syphilis  in  Ireland. 

Suppose  ourselves  able  to  identify  anywhere  a  group 
of  families  with  specific  character  and  found  it  increas- 
ing, would  we  be  reasonable  in  stating  influences  of  a 
destructive  nature  operating  on  it  as  the  cause  of  its 
increase  ?  Identifying  the  group  contributing  to  in- 
sanity in  proportion  as  we  would  find  it  under  the 
influence  of  aK^oholism  and  syphilis,  we  would  have  a' 
cause  for  its  decrease,  not  for  its  increase.  If  destruc- 
tive agencies  do  operate,  it  is  by  disadvantaging  in  a 
higher  degree  on  balance  the  non-contributory  group 
and  so  leaving  the  field  to  the  group  predisposed  to 
insanity.  In  the  Edinburgh  Medical  Journal  (Septem- 
ber, 1903),  and  elsewhere,  I  have  pointed  out  that  the 
last-nam^  group  is  a  clearly  marked  historical  one, 
and  is  increasing  in  Ireland  and  all  similar  agrarian 
areas  by  virtue  of  the  biological  law  of  selection.  The 
group  has  and  had  an  advantage  in  its  own  area  and 
is  accordingly  increasing.  I  need  not  repeaf  myself 
here.  What  is  to  the  point,  however,  is  that  as  long 
as  I  went  by  the  official  reports  of  Commissioners  in 
Lunacy  and  of  superintendents  of  asylums,  I  found 
nothing,  in  myself,  at  least,  but  confusion  of  mind  ;  not 
until  I  consulted  the  concrete  field  of  observation  did  I 
get  a  gleam  of  li^ht  on  the  subject.  The  reports  want 
value  because  gomg  on  worthless  primd  facie  notions  of 
causation  and  ignoring  the  whole  biological  field  and 
the  laws  operating  in  it  as  a  whole,  applicable  therefore 
to  insanity  as  a  partial  circumstance  in  it.  Until  they 
take  insanity  in  its  environment  and  under  the  law  of 
its  environment  they  can  reflect  little  credit  on  their 
compilers. 


Plymouth  Board  of  Guardians. — At  a  meeting  of 
the  Plymouth  board  of  guardians  held  on  November 
23rd,  it  was  decided  that  a  new  infirmary  should  be 
erected  on  the  site  occupied  by  the  garden  adjoining  the 
workhouse. 


NOTES  ON  THE 

GENERAL  MEDICAL  COUNCIL 
AND    ITS    PROCEEDINGS. 

By    GEORGE      JACKSON,     F.R.C.S.Eng.. 
DIrMt  Representatire  on  th«  OeMnJ  Medictl  Ooundl. 

As  one  of  the  direct  representatives  of  the  medi- 
cal profession  for  England  and  Wales,  I  wish  to 
bring  under  the  notice  of  my  constituents  some  of 
the  salient  points  of  the  matters  which  have  been 
discussed  in  the  Council  at  its  recent  meetings, 
more  especially  with  reference  to  the  meeting  held 
in  November  of  this  year.  It  may  be  within 
the  memory  of  those  who  have  taken  an  interest 
in  the  proceedings  of  the  Council,  that  there  has 
been  a  long-standing  dispute  between  the 
Royal  Colleges  of  Physicians  and  Surgeons 

OF  England  and  the  Council, 
as  to  what  should  be  recognised  as  a  sufficient 
preliminary  scientific  examination.  A  report  on 
these  examinations  was  presented  to  the  Council 
in  May,  is)03,  but  the  consideration  of  it  was  de- 
ferred on  account  of  the  gravity  of  it,  to  a  special 
meeting  held  in  July  of  the  same  year.  The  report 
was  made  by  Mr.  J.  Campbell  Brown  and  Dr. 
Windle.  With  reference  to  the  first  year's  examina- 
tion of  the  English  Conjoint  Board,  they  reported 
that  the  standard  of  the  examination  was  a  low 
one.  "  The  physics  portion  of  the  examination 
amounts  to  nothing,  while  the  chemistry  portion 
does  not  afford  any  assurance  that  knowledge  has 
been  acquired  of  such  a  kind  as  will  fit  a  student 
to  commence  the  study  of  physiology,  and  enable 
hin^  to  understand  his  reading  and  acquire  a  wider 
knowledge  in  after  life.  The  syllabus,  the  details 
of  the  paper,  the  plan  of  the  first  and  principal 
part  of  the  practical  examination,  are  at  fault, 
and  especially  the  absence  of  any  guarantee  of 
suffidentpreparation  for  the  examinations.''  The 
remarks  on  the  examinations  of  the  Apothecaries' 
HaU,  London,  and  the  Scottish  Conjoint  Board  were 
not  so  unfavourable,  but  the  standard  in  each  case 
was  considered  too  low,  as  was  also  the  case  with 
regard  to  the  Irish  Conjoint  Board  examination, 
although  this  examination  on  the  whole  was  per- 
haps the  best.  Resolutions  were  passed  at  the 
July  meeting  that  in  the  opinion  of  the  Council 
both  the  examinations  and  courses  of  study  recog- 
nised by  the  Royal  Colleges  of  England  were  in- 
sufficient, and  the  examination  of  the  Apothecaries' 
Hall  was  insufficient.  In  consequence  of  the  re- 
presentations made  to  the  examining  bodies,  the 
syllabuses  and  the  examinations  have  been  very 
much  improved.  It  is,  however,  much  to  be  re- 
gretted that  the  English  Colleges  still  recognise 
as  places  of  study,  institutions  which  are  not  suita- 
able  in  the  opinion  of  the  Council.  It  is  important 
that  the  teachers  should  be  themselves  well  quali- 
fied, that  the  laboratories  should  be  well  equipped, 
and  that  the  work  should  be  done  in  .the  daytime, 
not  at  night,  as  the  mental  faculties  of  the  students 
will  probably  be  exhausted  by  other  studies  and 
work  during  the  day. 

Registration  of  Students. 
It  is  well  known  that  owing«  to  the  multiplying 
work  of  the  Council,  the  increasing  number  of  the 
members  of  the  Council,  and  owing  to  the  greater 
number  of  Universities  entitled  to  send  repre- 
sentatives to  the  Council,  and  to  the  diminishing 
number  of  registrations,  the  financial  condition 
fo  the  Council  is  not  in  a  satisfactory  state.     In 

C 


68o    The  Medical  Pkess. 


ORIGINAL    COMMUNICATIONS. 


Dec.  28,  1904- 


order  to  remedy  this,  various  proposals  have  been 
made  from  time  to  time,  with  the  approval  of  the 
Privy  Council,  and  a  proposition  was  made  and 
carried  by  a  large  majority  at  the  May  meeting  of  the 
Council,  to  the  effect  that  a  short  Bill  should  be 
introduced  into  the  Houses  of  Parliament  to  make 
registration  by  the  Council  compulsory  by  students, 
and  that  a  fee  of  £1  should  be  paid  by  the  student. 

Unfortunately,  at  the  November  meeting  of 
this  year  exception  was  taken  to  this  course,  and 
it  was  evident  that  the  Bill  would  be  opposed  in 
Parliament  by  the  representatives  of  various 
corporations,  more  especially  by  those  of  the  Royal 
Colleges  of  England — those  bodies  objecting  to  the 
Council  having  the  power  to  register  students, 
and  by  inference  to  lay  down  the  conditions  of 
registration.  The  result  was  that  the  Council 
reversed  its  resolution  of  May  last  and  finally  re- 
solved to  send  a  reply  to  the  Privy  Council — viz., 
that  owing  to  the  opposition  by  certain  licensing 
bodies,  the  Council  does  not  desire  to  ask  the  Lord 
President  to  introduce  the  measure  formerly  pro- 
posed into  Parliament.  Personally,  I  did  not  agree 
with  this  resolution,  and  voted  against  it,  as  did 
the  other  direct  representatives  for  England.  In 
my  opinion,  it  would  tend  to  the  unification  of  the 
system  of  medical  education  if  one  body  had  the 
control  of  the  registration  of  students  and  their 
courses  of  study. 

With  regard  to  the  financial  part  of  the  question, 
I  have  always  favoured  a  small  annual  licensing 
fee.  I  moved  a  resolution  in  favour  of  this  some 
sessions  ago,  but  it  did  not  meet  with  much  support. 
It  would  have  supphed  the  Council  with  sufficient 
funds  to  carry  out  its  work  properly  ;  it  would  also 
have  brought  every  practising  medical  man  in 
touch  with  the  Council,  so  that  if  his  conduct  had 
not  been  satisfactory  in  the  past  it  might  be 
inquired  into. 

Medical  Pupilage. 

At  the  commencement  of  the  recent  meeting  of 
the  Council  I  asked  the  President  to  define  what 
was  the  exact  meaning  to  be  attached  to  the 
phrase — "  The  proper  training  and  instruction 
of  bond  fide  medical  students  as  pupils"— occurring 
in  the  notice  regarding  the  employment  of  un- 
qualified persons  as  assistants  or  otherwise,  issued 
on  November  24th,  1897.  The  President  replied 
in  effect  that  it  referred  to  the  fifth  year  of  the 
curriculum,  six  months  of  which  may  be  passed  as 
a  pupil  to  a  registered  practitioner  possessing  such 
opportunities  of  imparting  practical  knowledge 
as  shall  be  satisfactory  to  the  medical  authorities. 
The  reason  of  my  asking  the  question  was  that  it 
has  come  to  my  knowledge  that  unqualified  assist- 
ants are  employed  in  numerous  cases,  more  espe- 
cially in  the  colUery  districts  in  the  North  of 
England,  under  the  guise  of  pupilage.  I  ascer- 
tained that  the  Conjoint  Board  of  the  Royal 
Colleges  of  England  does  not  recognise  any  such 
pupilage,  and  that  the  English  Apothecaries'  Hall 
has  had  no  appUcation  for  such  recognition.  It 
cannot,  however,  be  too  widely  known  that  the 
General  Medical  'Council  cannot  institute  any 
prosecution  in  such  a  case  ;  but  that  the  case  must 
be  brought  before  them  by  some  person  or  body 
of  persons,  such  as  one  of  the  Medical  Defence 
Unions.  It,  therefore,  now  rests  with  the  persons 
who  are  acquainted  with  such  cases  to  take  action 
in  the  matter.  I  am  informed  that  medical  men 
generally  are  not  acquainted  with  the  resolution 


of  the  Council  referring  to  the  matter,  so  that  it  l> 
possible  that  many  are  acting  in  ignorance  of  it. 

With  reference  to  the  desirability  of  reviving  in 
some  form  and  to  some  extent  the  old  system  ti 
pupilage,  Mr.  Geo.  Brown,  one  of  my  colleagues 
as  a  direct  representative  on  the  Council,  moved  2 
resolution  with  reference  to  it  which.  I  seconded, 
the  purpose  of  it  being  that  students  who  had 
served  one  year's  pupilage  with  a  practitioner— 
who  could  satisfy  the  medical  autKorities  that  he 
could  give  sufficient  opportunities  of  impartinj; 
practical  knowedge — should  be  exempted  iroik 
six  months'  clinical  work  at  a  pubUc  hospital 
Both  Mr.  George  Brown  and  myself  promised  when 
we  were  candidates  for  election  as  direct  represen- 
tatives on  the  Council  that  we  -would  urge 
this  matter  on  the  Council.  Unfortunately,  it  met 
with  Uttle  support,  Dr.  Bruce,  the  direct  represen- 
tative for  Scotland,  alone  supporting  it,  in  addition 
to  ourselves.  The  remarks  I  made  on  the  matter 
have  been  partially  misunderstood.  I  did  not 
intend  to  say  that  the  medical  student  as  a  pupil 
would  be  taught  the  art  of  treating^  the  patient 
instead  of  always  treating  the  disease.  I  wished 
to  con^'ey  the  idea  that  the  student  should  be 
taught  the  art  of  treating  patient  as  well  as  the 
disease,  and  that  he  would  be  more  likely  to  lean 
that  from  an  experienced  medical  practitioner 
than  in  the  wards  or  out-patient  departments  oi 
hospitals,  I  very  well  remember  the  late  Mr. 
Arthur  Durham  sketching  out  what  he  thought 
would  be  an  ideal  student's  career,  and  including 
in  it  twelve  months  with  a  general  practitioner, 
who  had  large  opportunities  for  seeing  practice. 
Final  Examinations  of  the  Scotch 
.Universities. 

There  was  an  animated  discussion  on  this  report 
especially  on  the  part  referring  to  the  practical 
part  of  the  examination  in  surgery  at  the  Univer- 
sity of  Edinburgh,  when  it  appears  that  operations 
on  the  cadaver  are  not  required  from  every  can- 
didate, but  only  from  those  selected,  I  believe, 
by  ballot,  so  that  it  is  only  fair  to  say  that  any 
candidate  may  be  required  to  operate.  This  part 
of  the  examination  was  considered  unsatisfacton* 
by  the  inspector  and  visitor,  who  appeared  to 
think  that  this  part  of  the  examining  process  is 
usually  unsatisfactory,  except  at  Glasgow,  where 
they  expressed  great  satisfaction  with  it.  There  is 
no  doubt  of  the  necessity  for  it,  seeing  the  advances 
that  surgery  has  made  of  recent  years,  and  how 
impossible  it  is  to  acquire  the  requisite  dexterity 
without  sufficient  practice  on  the  cadaver.  It  is 
somewhat  noticeable  that  none  of  the  Scotch 
universities,  except  St.  Andrews,  lay  much  stress 
in  their  examinations  on  knowledge  of  diseases  of 
eye,  ear,  throat,  nose  and  skin,  but  at  this  Univer- 
sity there  was  an  elaborate  examination  in  these  | 
diseases — well  arranged,  and  on  all  points  satis- 
factory. In  the  end  it  was  decided  that  there 
should  be  a  re-inspection  of  the  final  surgical  ex- 
amination of  the  University  of  Edinburgh.  There 
is  no  doubt  but  that  this  University  sufiEers  from 
a  plethora  of  students,  and  in  consequence  a  lack 
of  teaching  material. 

Medical  Companies  Bill. 

This  is  a  matter  of  extreme  interest  to  the 
medical  profession  at  large.  It  arises,  as  is  well 
known,  from  the  fact  that  seven  persons  can  com- 
bine and  form  a  company  and  do  that  which  it  ]S 
unlawful  for  one  man  to  do.     This  practice  has 


Dec.  28,  1904. 


ORIGINAL    COMMUNICATIONS. 


Thb  Medical  Press.    681 


-received  a  check  by  the  judgment  of  Chief  Baron 
Palles,  in  Ireland,  by  which  the  Registrar  was  inter- 
dicted from  registering  a  company,  but,  as  Sir 
Charles  Ball  remarked,  a  company  may  go  on  for 
ever,  and  therefore  it  is  necessary  to  deal  with  the 
companies  already  registered.  An  attempt  in 
that  direction  is  being  made  in  Ireland,  but  the 
matter  is  at  present  sub  fudice.  The  Council  has 
-conununicated  with  the  Lord  President  of  the  Privy 
Council  on  the  matter,  expressing  the  hope  that 
the  Government  will  take  such  steps  as  may  be 
necessary  to  prevent  the  provisions  of  the  Medical 
and  Dental  Acts  being  evaded  by  persons  impro- 
perly taking  advantage  of  the  provisions  of  the 
Company  Acts. 

The  penal  business  of  the  Council  does  not  ap- 
pear to  call  for  any  especial  comment,  substantial 
Justice  being  done  in  each  case. 


f  cencb  Clinical  Xectut^s. 

PERIODIC    PARALYSIS     OF 
HEREDITARY    ORIGIN. 

By  Dr.  L.  CHEINISSE, 
Late  HouM  PhjsicUn  to  the  Hontpeiller  Hospital. 
fsPECIALLY  TRANSLATED    FOR    THE    MEDICAL  PRESS  AND 
CIRCULAR.] 

Some  twenty  years  ago  Professor  Westphal  pub- 
lished '*  A  Remarkable  Case  of  Periodic  Paralysis  of 
the  Four  Limbs  Associated  with  Disappearance  of 
Electrical  Excitability."  Discarding  the  possibility  of 
its  being  of  malarial  origin,  the  author  cfescribed  the 
case  as  probably  unique,  although  a  Russian  observer, 
three  years  before,  had  brought  forward  a  case  of 
"  Intermittent  Nervous  Spinal  Paraplegia "  closely 
resembling  that  of  Professor  Westphal's.  In  Dr. 
Chakhnovitch's  case,  the  motor  disturbances  appeared 
and  disappeared  during  the  night,  leaving  merely  an 
ephemeral  numbness  of  the  extremities.  It  is  worthy 
•of  note  that  the  father  of  this  patient  appears  to  have 
been  similarly  afflicted  in  childhood  and  succumbed  to 
an  attack  of  the  kind  at  the  age  of  54.  On  comparing 
the  symptoms  in  the  two  cases  it  is  obvious  that  they 
are  similar,  but  Westphal's  description  gives  greater 
prominence  to  one  of  the  most  remarkable  features  of 
periodic  paralysis,  viz.,  the  complete  loss  of  electrical 
excitability  without  any  trace  of  degeneration  in  the 
paralysed  muscles  during  the  persistence  of  the  para- 
l5rsis.  Although  periodic  paralysis  is  a  rare  affection,  it 
is  something  more  than  a  pathological  curiosity.  The 
literature  of  the  last  twenty  years  contains  a  certain 
number  of  cases  which  suffice  to  show  that  it  is  a  morbid 
'entity  with  well-defined  clinical  manifestations.  In 
its  typical  form  the  attack  is  characterised  by  the 
onset  of  paralysis  with  diminution  or  complete  loss  of 
^electrical  excitability  and  of  the  reflexes,  without  any 
concomitant  sensory  or  intellectued  disturbances.  In 
contrast  with  paralysis  of  malarial  origin  the  recurrence 
•of  the  attacks  is  governed  by  no  law  of  periodicity : 
sometimes  they  occur  daily,  in  other  instances  the 
attacks  are  separated  by  a  longer  interval.  In  a  case 
recorded  by  Dr.  Goldflam,  the^attacks  occurred  once  or 
twice  a  week  in  summer  anH  every  two  months  in 
winter.  There  may  apparently  be  a  single  attack,  as 
in  the  mother  of  Goldflam's  first  patient,  who  had  her 
first  and  only  attack  at  the  age  of  36.  As  a  general 
rule  the  attacks  are  occasional  at  the  onset,  increasing 
in  frequency  later  on,  and  after  persisting  at  a  high 
level  for  many  years  they  begin  to  diminish  in  fre- 
quency. The  duration  of  the  attacks  varies,  not  only 
in  different  individuals,  but  even  in  the  same  person. 
Usually  lasting  several  hours,  they  may  persist  for 
days  or  may  subside  in  a  quarter  of  an  hour. 

The  paralysis  often  supervenes  during  sleep,  the 
patient,  on  awakening,  discovering  that  he  is  unable 
to  move.     When  it  supervenes  in  the  waking  subject 


it  is  ushered  in  by  sundry  preliminary  phenomena  such 
as  weakness  in  the  limbs,  a  sensation  of  fatigue,  drowsi- 
ness, pricking,  formication,  intense  thirst,  &c.  Accord- 
ing to  Dr.  Cousot,  the  attack  is  not  always  complete 
from  the  onset.  The  patient  may  be  engaged  in  copy- 
ing and  the  paralysis  only  attacks  the  unoccupied  limbs, 
the  active  limbs  only  being  aflected  when  work  is  re- 
linquished. A  sharp  walk  may,  in  the  same  way,  delay 
the  extension  of  the  paralysis  to  the  legs.  Speaking 
generally,  repose  is  as  favourable  to  its  development  as 
active  exercise  is  contrary  thereto.  The  influence  of 
immobility  in  favouring  the  onset  of  the  paralysis  has 
been  clearly  described  by  Goldflam,  who  was  able  to 
induce  an  incomplete  attack  of  paralysis  of  all  four 
limbs,  with  loss  of  electrical  excitabiUty,  &c.,  merely 
by  keeping  the  patient  for  some  time  in  the  sitting 
posture.  Some  authors,  however,  have  observed 
attacks  following  great  physical  fatigue,  but  even  in 
these  cases  the  paralysis  only  supervened  after  a  period 
of  repose. 

Even  if  incomplete  at  the  onset  the  paralysis  rapidly 
extends.  As  far  as  one  can  judge  it  usually  commences 
in  the  lower  limbs,  thence  extending  to  the  trunk  and 
upper  limbs,  but  in  some  instances  it  began  in  the  arms 
or  hands.  In  one  case  the  paroxysm  was  precipitated 
by  the  prolonged  pressure  of  the  hands  on  the  handles 
of  a  bicycle. 

It  is  but  rarely  limited  to  the  lower  Umbs.  and,  as  a 
rule,  the  paralysis  involves  all  four  limbs  and  the 
muscles  of  the  trunk.  When  it  invades  the  respiratory 
muscles  the  patient  complains  of  a  difficulty  in  sneezing 
and  coughing.  Occasionally  the  muscles  of  the  neck  are 
also  involved,  interfering  with  the  head  movements. 
It  but  rarely  happens  that  the  lingual  and  pharyngeal 
muscles  are  affected,  although  Westphal  and  Cousot 
both  observed  disturbances  of  swallowing  and  speech. 
In  a  case  recorded  by  Dr.  E.  W.  Taylor,  the  motor 
branch  of  the  fifth  nerve  was  sUghtly  afEected  during 
severe  attacks,  but  usually — and  this  is  one  of  the  dis- 
tinctive characters  of  the  malady — the  cranial  nerves 
are  unaffected.  Even  when  all  the  voluntary  muscular 
system  participates  in  the  attack,  the  movements  of 
the  eyes  and  facial  muscles  remain  intact.  The  un- 
striated  muscles  also  appear  to  escape  invasion,  and 
the  constipation  observed  in  some  instances  was  pro- 
bablv  due  to  loss  of  the  action  on  the  part  of  the 
"  abdominal  compressors  "  rather  than  to  any  paresis 
of  the  intestinal  muscles.  Dr.  Taylor,  it  is  true,  notes 
complete  absence  of  micturition  in  one  case  during  the 
attack,  although,  this  lasted  thirty-six  hours,  but  he 
admits  that  it  could  not  be  described  as  retention,  but 
was  due  rather  to  the  absence  of  any  desire  to  water, 
dependent,  partly,  on  reduced  renal  activity,  and 
possibly  also  the  patient's  difficulty  in  moving  himself. 
The  severity  of  the  paraljrsis  varies  within  wide 
limits,  the  motor  disturbance  amounting  to  anything 
from  mere  paresis  to  absolute  paralysis.  Speaking 
generally  it  is  less  pronounced  in  the  upper  than  in  the 
lower  half  of  the  body. 

One  of  the  most  distinctive  and  important  features 
of  this  form  of  paralysis  consists  in  the  temporary 
abolition  of  faradic  and  galvanic  excitabihty,  in  a  degree 
corresponding  to  the  severity  of  the  attack.  This 
affects  the  nerves  as  wejl  as  the  muscles.  This  sym- 
ptom, as  Westphal  remarks,  is  *•  unique  of  its  kind," 
for  it  is  never  met  with  in  any  other  disease  of  the 
spinal  cord  or  of  the  spuaal  nerves,  and  it  had  been 
observed  in  every  case  of  periodic  paralysis  in  which 
the  electrical  test  has  been  applied.  When  the  muscles 
are  completely  paralysed,  not  the  slightest  contraction 
can  be  obtained,  no  matter  how  powerful  the  current  ; 
in  less  marked  cases  the  excitability  is  diminished  pro 
tanto.  In  the  course  of  an  attack  certain  croups  of 
muscles  mav  still  react  to  the  electrical  stimulus,  while 
others  are  absolutely  indifferent  thereto.  Dr.  Gold- 
flam notes  that  the  idio-muscular  excitability,  Hke 
the  electrical  excitability,  diminishes  in  proportion  to 
the  severity  of  the  attack,  and  may,  similarly,  be  totally 
abolished.  .    •   •  x.  j 

The  deep  reflexes  are  almost  always  dimmished  or 


682    The  Medical  Peess. 


ORIGINAL    COMMUNICATIONS. 


Dec.  2S,  1904. 


abolished  daring  the  attack,  but  the  superficial  reflexes 
are  less  constantly  affected.  These  disturbances,  in- 
deed, depend  merely  upon  the  distribution  and  the 
intensity  of  the  paralytic  phenomena.  Since  the  lower 
limbs  are  almost  invariably  more  markedly  affected 
than  the  rest  of  the  body,  it  is  easy  to  understand  that 
the  patellar  reflex  is  wanting  in  most  instances,  and 
that  the  abolition  of  the  plantar  reflex  is  more  fre- 
quently observed  than  that  of  other  cutaneous  reflexes. 
The  paralysis  is  usually  flaccid,  with  complete  re- 
solution, but  Chakhnovitch  and  Greidenberg  have 
noted  a  certain  degree  of  contraction  in  particular 
muscle  groups.  The  extent  and  the  severity  of  the 
motor  disturbances  present  a  striking  contrast  with  the 
absolute  integrity  of  the  special  senses  and  of  sensation. 
At  most,  and  then  only  at  the  onset,  have  pricking  and 
formication  been  complained  of.  In  one  case  recorded 
by  Fisciil,  however,  some  loss  of  sensibility  was  re- 
marked. 

Just  as  the  onset  of  the  paralysis  is  gradual,  so  also 
it  tends  to  disappr«ir  piecemeal.  As  a  rule,  the  mode 
of  subsidence  is  inversely  to  that  of  the  onset,  in  such 
wise  that  the  upper  limbs  are  the  last  to  lose  and  the 
first  to  regain  their  motility.  Electrical  excitability  is 
restored  pari  passu  with  the  return  of  movement  until 
it  is  at  the  normal  level.  According  to  Cousot,  gal- 
vanic excitability  is  the  first  to  return  as  the  muscles 
regain  their  contractility.  However  this  may  be,  the 
electrical  reactions  between  the  attacks  appear  to  be 
quite  normal,  although  in  one  instance  Dr.  Goldflam 
noted  some  loss  of  electrical  excitability  in  the  small 
muscles  of  the  hand  which  he  was  inclined  to  regard 
as  evidence  of  degeneration.  It  should,  indeed,  be 
borne  in  mind  that  between  the  attacks  most  patients 
suffering  from  periodic  paralysis  enjoy  perfect  health 
and  present  nothing  abnormal. 

As  will  be  seen,  the  schedule  of  symptoms  just  de- 
scribed comprises  sufliciently  distinct  and  constant 
characteristics  to  enable  us  to  differentiate  this  affec- 
tion easily  enough  from  malarial  paralysis.  Moreover, 
in  order  to  avoid  any  possible  error  of  interpre- 
tation, I  have  deliberately  left  on  one  side  all  cases 
that  could  by' any  possibility  be  ascribed  to  malarial 
influence.  For  this  reason  I  have  ignored  Cavar6*s 
cases  as  well  as  those  of  Hartwig  and  Gibney,  either  on 
account  of  the  beneficial  action  of  quinine  or  of  malarial 
antecedents,  and  this  independently  of  the  fact  that, 
with  the  exception  of  Hartwig's  case,  none  of  these  > 
cases  exhibited  the  symptoms  of  periodic  paralysis  as 
described  above.  There  were  disturbances  of  sensa- 
tion, febrile  reactions  with  attacks  of  shivering  and 
heat.  &c.  For  the  same  reason  I  have  thought  it  well 
to  discard  an  otherwise  interesting  observation  by 
Seiler  as  well  as  cases  by  Bataille  and  Rockwell,  which 
were  examples  of  intermittent  hemiplegia,  probably  of 
malarial  origin,  judging  by  the  excellent  effects  that 
followed  the  administration  of  quinine. 

The  periodic  paralysis,  of  which  numerous  examples, 
have  been  mentioned,  as  I  have  pointed  out,  has  noth- 
ing to  do  with  intermittent  fever,  and  it  is  equally  inde* 
pendent  of  malarial  cachexia,  since  the  cases  which  I 
have  instanced  were  observed  in  healthy  subjects  free 
from  any  malarial  antecedents.  It  remains  to  be  seen 
whether  any  other  infective  malady  may  or  may  not 
play  an  active  part  in  its  etiology.  Looking  closely 
at  the  facts  before  us,  this  appears  improbable.  The 
only  infective  malady  which  has  been  met  with  in  the 
antecedents  of  several  of  the  patients  suffering  from 
periodic  paralysis  is  scarlet  fever.  But,  with  the  ex- 
ception of  Fischl's  case,  the  fever  was  long  anterior  to 
the  onset  of  the  paralysis,  and  the  virus  of  scarlet  fever 
is  not  operative  at  such  long  intervals ;  moreover, 
paralyses  consecutive  to  scarlet  fever,  rare  in  themselves, 
are  almost  always  cerebral. 

M^ith  regard  to  the  predisposing  causes  of  the  disease, 
sex  does  not  appear  to  exert  any  influence,  but  it  is 
quite  otherwise  in  regard  to  age,  the  affection  super- 
vening almost  invariably  during  adolescence,  i.e., 
between  10  and  25  years  of  age.  One  of  the  most  in- 
teresting features  of  the  disease  is  its  family  or  here- 
ditary character.    This  was  noted  by  Chakhnovitch, 


but  was  particularly  emphasised  by  Cousot,  who.  cmt 
of  eight  children  belonging  to  the  same  family,  fooad 
four  suffering  from  periodic  paralysis,  as  did  also  their 
mother.  Goldflam,  moreover,  insists  on  the  family 
character  of  the  malady,  his  remarks  being  based  ozr 
observation  of  eleven  members  of  one  family.  Taylor's 
two  patients  were  brother  and  sister,  and  in  five  geoe> 
rations  on  the  maternal  side  there  had  been  no  less  than 
eleven  cases  of  periodic  paralysis.  It  is  curious  to  note- 
that  the  disease  was  almost  always  transmitted  directly, 
that  is  to  say,  the  members  of  the  family  who  were 
themselves  free  from  paralysis  begot  children  equaSy 
exempt  therefrom. 

These  facts  deserve  our  careful  attention,  if  only  for 
the  reason  that  no  history  of  disease  of  the  ner\'oiis 
system  was  discovered  in  this  family  any  more  than 
in  that  of  the  family  referred  to  by  Goldflam,  beyond 
the  occurrence  of  epilepsy  in  one  member  thereof, 
this  one,  as  it  happens,  being  free  from  paralysis.  This 
fact  does  not  diminish  the  imp>ortance  of  the  rest  of  the 
series  since  it  is  established  that  periodic  paralysis  had 
shown  itself  in  three  successive  generations  of  a  family 
apparently  exempt  from  any  other  neurotic  tendency. 
The  same  family  characteristic  was  noted  by  Hirsch. 
Mitchell,  Buzzard.  Oddo.  and  Audibert,  so  that  it  may 
fairly  be  described  as  an  hereditary  afifection. 

Under  these  circumstances,  it  appears  reasonable  to 
place  periodic  paralysis  in  the  group  of  family  diseases^ 
along  with  primary  progressive  myopathy,  congenital 
myotonia,  &c.,  the  more  so  seeing  that,  from  a  clinical 
point  of  view,  the  paralysis  in  question  presents  certaia 
points  of  resemblance  with  Thomsen's  disease.  We 
must  take  note,  on  the  other  hand,  of  the  anatomical 
observations  made  by  the  same  authoronsmaU.  freshly- 
excised  fragments  of  muscle.  By  this  means  Gold- 
flam was  enabled  to  satisfy  himself  of  the  existence  of 
certain  changes  (hypertrophy  of  the  muscle  fibres, 
wasting  of  the  primitive  fibrillae  and  vacuolisatioo}, 
which  are  also  of  a  kind  to  bring  periodic  paralysis  into 
line  with  congenital  myotonia.  These  observation* 
have,  moreover,  been  confirmed  by  MM.  Crafts,  Singer, 
and  Goodbody. 

However  this  may  be.  it  is  hardly  possible  for  us.  at 
this  stage,   to  accept   the  hypothesis   formulated  by 
Chakhnovitch,   according    to  whom    this   paralysis  i$ 
merely  a  simple  neurosis,  involving  more  particularly 
the  antero-lateral  columns  of  the  cord.     The  explana- 
tion offered  by  Cousot,  who  endeavours  to  show  that 
the  transitory  paralysis  is  due  to  a  sort  of  inhibition  of 
the   medullary   centres,   hardly    commends   itself  for 
adoption,  although  a  very  similar  hypothesis  has  quite 
recently  been  put  forward  by  Putnam.     The  view  that 
we  have  here  to  deal  with  an  affection,  strictly  speak- 
ing, of  the  muscles  is  supported  not  only  by  the  ana- 
logies of  periodic  paralysis  with  Thomsen's  disease,  and 
the  presence  of  the  above-mentioned  muscular  lesions, 
but  also  by  the  case  recorded  by  Bernhardt,  in  which 
the  attacks  were  associated  with  progressive  muscniar 
atrophy  of  the  hereditary  type.     Moreover,  even  if  we 
admit  this  explanation,  it  still  remains  for  us  to  dis- 
cover the  cause  of  the  morbid  process  thus  attackisf 
the  muscular  element. 

According  to  Goldflam,  it  is  due  to  a  variety  of  auto- 
intoxication by  substances  that  accumulate  in  the 
organism  in  the  state  of  repose,  an  hypothesis  which 
he  has  tried  to  substantiate  by  experiment.  p«..  by 
injecting  animals  with  urine  secreted  during  the  para- 
lytic attack.  He  disccTvered  that  the  co-efl[icient  of 
urinary  toxicity  was  much  higher  during,  than  between, 
the  attacks.  He  found,  on  the  other  hand,  that  the 
disappearance  of  the  patellar  reflex,  which  only  takes 
place  just  before  death  in  animals  injected  with  urine 
passed  between  the  attacks,  is,  on  the  contrary,  an  early 
symptom  when  urine  passed  during  an  attack  is  em- 
ployed ;  the  same  remark,  indeed,  applies  to  the  para- 
lysis of  the  extremities.  These  experiments,  however, 
gave  no  result  in  respect  of  the  electrical  excitability  of 
the  muscles. 

Although  the  outcome  of  these  experiments  \s  iar 
from  conclusive,  since  Goldflam  failed  to  reprodnce 
experimentally  the  characteristic  syndroma  of  pexiodir 


Dec.  28,  iqq4> 


ORIGINAL    COMMUNICATIONS. 


The  Medical  Peess.   683 


paralysis  with  loss  of  electrical  reaction,  we  are  fain  to 
admit  that  the  hypothesis  of  an  auto-intoxication  is  the 
most  plausible  and  the  best  calculated  to  explain  the 
paralytic  phenomena  and  the  injurious  influence  of 
repose  (delayed  elimination  of  toxins). 

The  etiology  and  pathogenesis  of  this  affection  being 
still  obscure,  we  must  not  be  surprised  to  find  that  the 
influence  of  the  various  therapeutical  agents  employed 
to  combat  it  (bromides,  iodides,  strychnine,  eserine, 
galvanism,  &c.)  should  be  in  great  measure  negative. 
In  view  of  the  injurious  influence  of  repose  in  the  pro- 
eduction  of  the  attacks  we  might  try  massage  and  suit- 
able gymnastic  exercises  as  soon  as  the  prodromal 
manifestations  indicate  the  proximity  of  an  attack. 
Nevertheless,  it  is  difficult  to  avert  the  attack,  and  as  a 
general  rule  the  most  we  shall  achieve  will  be  to  delay 
its  supervention.  Lastly,  if  one  bears  in  mind  that, 
according  to  Oddo  and  Darcourt,  muscl6s  faradised 
during  the  attack  resume  their  motricity  more  promptly 
than  untreated  muscles,  it  might  be  worth  while  em- 
ploying the  current  for  a  sufficiently  prolonged  period 
to  the  paralysed  muscles  during  the  attack. 


RECORD  OF  A  CASE  OF 

TUBERCULOUS     SYNOVITIS 

OF  THE 

RIGHT    KNEE-JOINT 

IN  A  BOY,  JET.  S ;  ACCOMPANIED  BY  A  NEW 
SUGGESTION  AS  TO  THE  PART  PLAYED 
BY  FOOD   IN  THEHUMAN  ECONOMY    (a) 

By  A.  RABAGLIATI.,  M.D.,  F.R.CS.Edin. 

H.  L.,  set.  9  last  March,  was  first  brought  to  me 
on  January  6th,  1904.  He  was  pale  and  thin,  and 
also  limping.  On  examination  I  found  a  swelling 
of  right  knee-joint,  the  whole  synovial  membrane 
being  thickened,  so  as  to  fill  all  the  hoUows  of 
the  joint  with  a  gelatinous,  more  or  less  elastic 
feel  all  over  it,  while  at  the  upper  and  outer  part 
of  the  sac  there  was  a  specisd  thickened  and  re- 
sistant part  raised  in  the  form,  and  about  the  size 
of  a  cricket  ball.  Whether  this  portion  of  the 
thickened  sac  was  loculated  ofi  from  the  rest  of 
the  synovial  apparatus  was  not  certain.  No  fluid, 
wave  could  be  propagated  from  one  part  of  the 
sac  to  another.  Tlus  question  was  settled  at  the 
operation.  There  was  no  demarcation,  although 
preparations  were  being  made  by  Nature  with  that 
■end  in  view  (or  at  least  adapted  to  that  end). 
Had  suppuration  been  allowed  to  occur,  no  doubt 
the  suppurating  part  would  have  been  more  or  less 
demarcated  from  the  rest.  However,  when  I  saw 
the  boy  first,  I  did  not  think  that  operation  would 
be  necessary,  and  as  I  was  very  anxious  to  avoid 
interference,  which  would  almost  certainly  have 
opened  the  joint,  I  recommended  that  the  boy 
should  go  for  treatment  into  the  Children's  Hos- 
pital. The  linib  was  laid  on  a  back  splint,  the 
knee  being  surrounded  with  strips  of  Scott's 
dressing  puUed  moderately  tight,  so  as  to  give 
support.  For  diet  I  ordered  a  pint  of  milk  daily, 
divided  into  four  portions,  to  each  of  which  an 
«qual  quantity  of  boiling  water  was  added.  I 
believe  that  tuberculosis  is  a  disease  caused  by  over- 
ieedin^  beyond  the  requirements  of  the  body  ; 
hence  my  recommendation  that  the  boy  should 
have  only  as  much  food  as  would  be  represented 
by  280  calorics  a  day,  in  place  of  the  1,200  or  1,400 
which  the  physiological  authorities  say  is  necessary 
for  him.     And  the  definition  I  venture  to  ofier 


(a)   Read   before  the 
Jfovember  15th,  IMM. 


Bradford     Medico-Chirurgical    Society, 


of  the  disease  tuberculosis  is  not  that  it  is  a  con- 
dition caused  by  the  growth  of  the  Bacillus  tuber- 
culosis in  the  tissues  and  blood  of  the  patient,  but 
that  tuberculosis  is  that  state  of  the  economy 
which  favours  the  growth  of  Bacillus  tuberculosis. 
The  boy  had  been  very  dehcate  all  his  life.  His 
parents  thought  they  would  not  be  able  to  rear  him. 
He  was  continually  taking  cold,  terrifying  his 
mother  by  waking  up  in  the  night  with  attacks  of 
spurious  croup  {laryngo-tracheo-bronchial  catarrh). 
The  least  exposure  or  exertion  seemed  to  give  him 
cold.  I  think,  in  this  connection,  that  in  treating 
deUcate  children  we  forget  that  the  definition  of 
delicacy  is  that  it  is  a  state  of  low  resistance  to  all 
sorts  of  labour,  and,  among  the  rest,  to  digestive 
labour.  In  our  desire  to  feed  such  children  suffi- 
ciently we  over-do  and  over-feed,  I  think,  and  the 
children  suffer  from  the  excess  of  our  zeal.  Delicate 
children  ought  not  to  have  their  digestive  resistance 
over-taxed  any  more  than  that  of  any  of  their 
other  powers. 

The  child  did  not  settle  well  away  from  his 
mother  and  family,  and  it  was  agreed  that  he 
should  be  taken  from  the  hospital  on  January  24th, 
1904,  and  treated  at  home.  The  diet  recom- 
mended was,  for  a  time,  the  same  as  in  the  hos- 
pital, and  by-and-bye  the  same  vrith  half  a  pint  of 
soup,  brown  or  white,  at  dinner-time,  with  some 
cooked  green  vegetables  and  half  a  slice  of  bread. 
Total  caloric  value  say  350  to  400.  He  did  very 
well  on  this  diet.  All  the  pain  disappeared  with 
rest,  and  as  there  were  no  constitutional  symptoms, 
I  hoped  for  an  improvement  in  the  knee  also. 
This  hope,  however,  was  disappointed,  for  after 
some  weeks  the  knee  was  not  better  and,  indeed, 
it  seemed  as  though  an  abscess  would  be  likely  to 
form  at  a  considerably  later  date.  As  at  last  I 
did  not  see  any  sign  of  subsidence  of  the  tumour, 
and  as  I  had  seen  an  almost  exactly  similar  case 
in  which  suppuration  had  occurred,  which  had 
penetrated  through  the  synovial  and  muscular 
tissues  even  to  the  femur,  I  recommended  that 
an  operation  should  be  performed  for  the  removal 
of  the  portion  of  the  sac  chiefly  affected.  I  was 
glad  I  did,  for  when,  with  the  kind  assistance  of 
Mr.  Miall,  I  cut  down  on  it  on  February  29th,  I 
found  that  the  general  synovial  sac  was  thickened, 
that  the  special  part  of  it  which  may  be  called  the 
tumour  was  specially  so,  and  that  it  seemed  to  be 
intimately  adherent  to  the  vastus  muscle  and  other 
parts  of  the  quadriceps  extensor,  and  also  that  the 
contents  of  the  synovial  sac,  and  especially  at  this 
place,  were  of  a  dark  grey  or  almost  black  colour. 
I  felt  convinced  that  it  was  not  hkely  to  resolve, 
and  that,  in  fact,  the  condition  was  in  process  of 
eventuating  in  the  formation  of  suppuration, 
which  from  former  experience  I  felt  sure  would 
not  have  stopped  till  it  reached  the  femur.  I 
emptied  the  contents  and  removed  the  bulging  part 
of  the  sac,  which  was  about  the  size  of  an  orange, 
bringing  the  edges  together  as  well  as  I  could  with 
catgut  sutures,  the  whole  operation  being  done 
under  aseptic  conditions  as  far  as  possible,  al- 
though, as  you  may  perceive,  I  attach  far  more  im- 
portance to  internal  asepsis — i.e.,  to  proper 
nutrition — than  to  those  multitudinous  external 
ablutions  which  pass  under  the  name  of  asepsis. 
I  examined  the  inside  of  the  joint  with  the  finger, 
but  found  no  ulceration  of  cartilage.  Then  I 
brought  the  whole  wound  together  with  silkworm- 
gut  sutures,  passed  deeply,  after  having  made 
the  parts  as  dry  as  possible  by  pressure  between 


684    The  Medical  PM8S.  ORIGINAL    COMMUNICATIONS. 


Dec  28,  1904- 


mops  wrung  out  of  Hg.I,.  solution  i  in  5,000. 
The  recovery  was  satisfactory.  Even  during  the 
first  day  and  night  the  pain  was  not  intolerable, 
and  I  used  no  morphia.  On  March  i  ith,  there  were 
no  signs  of  copstitutional  disturbance,  although 
there  was  a  considerable  amount  of  suppuration 
about  the  wound  and  the  exudation  of  some 
tuberculous  pus.  On  March  28th,  I  asked  Mr. 
Miall  to  give  me  his  opinion  again  on  the  whole 
case.  The  wound  was  then  nearly  well,  there  being 
only  one  small  granulation  excrescence  remaining 
at  the  upper  part.  The  patella  was  free  and 
movable,  as  it  has  remained  ever  since.  The 
hollows  of  the' joint  showed  very  much  as  on  the 
other  side.  Boy  looking  well ;  no  fever  ;  sleeping 
well ;  eating  well ;  bowels  acting.  Diet,  a  pint  of 
milk  daily,  with  half  a  pint  of  soup  and  a  sUce  of 
brown  bread.  I  had  removed  the  back  spUnt  on 
March  24th,  and  asked  the  mother  to  bandage 
the  limb  afresh  morning  and  evening.  Total 
calorics  from  food  as  far  as  I  could  gauge  them, 
not  more  than  500,  against  the  1,200  or  1,400 
recommended  to  an  ordinary  child  of  that  age, 
or  the  2,000  or  more  recommended  under  prevail- 
ing ideas  as  suitable  for  a  child  suffering  from  a 
wasting  disease  Uke  tuberculosis. 

Now,  in  case  any  gentleman  may  say  or  think 
that  this  was  not  a  case  of  tuberculous,  but  only, 
of  simple  inflammatory  synovitis,  I  have  to 
mention  that  I  sent  the  boy  again  to  Mr.  Miall  on 
account  of  a  strumous  irido-keratitis  w^hich  was 
very  severe,  and  accompanied  by  so  much  photo- 
phobia as  to  induce  temporary  functional  blindness. 
Mr.  Miall  thought  that  it  would  be  well  to  take  the 
opinion  of  a  speciahst,  whereupon  the  boy  was  sent 
to  Dr.  Little  in  May.  Dr.  Little  may  remember 
the  case.  At  any  rate,  he  confirmed  the  diagnosis 
of  strumous  keratitis  and  iritis,  and  gave  a  hopeful 
prognosis,  which  has  been  verified,  the  boy  being 
now  almost  well,  and  having  been  able  to  attend 
school  since  the  beginning  of  the  autumn  term. 
The  knee  has  been  quite  cured  long  since,  the  boy 
being  able  to  walk  and  even  run  a  short  distance 
without  limping.  I  do  not  know  how  it  might 
be  if  he  ran  for  a  long  distance,  but  at  any  rate  he 
does  everything  which  his  companions  do  at  school, 
(a)  He  is  in  no  sense  an  invalid,  and  his  parents  say 
he  is  stronger  and  has  fewer  colds  than  ever  before 
in  his  life,  and  has,  in  fact,  been  converted  from  a 
delicate  boy,  constantly  ailing  with  colds,  bron- 
chitis, &c.,  into  a  boy  who,  if  not  exactly  robust, 
never  ails  anything.  The  cough  which  used  to 
wake  him  up  in  the  night  never  troubles  him  at  all 
now.  His  diet  on  one  day  last  week,  taken  at 
random,  was  :  in  the  morning,  on  going  out  to 
school,  a  cup  of  cocoa.  His  mother  mentioned 
as  a  point  of  interest  that  he  never  seems  cold  on 
this.  At  dinner  he  had  an  egg  (sometimes  he 
takes  a  couple  of  ounces  of  mutton)  and  a  shce  of 
bread,  say  two  ounces,  and  about  i^  inch  square, 
or  say  2^  square  inches  of  a  fruit  pasty.  In  the 
evening  he  had  another  slice  of  bread  and  butter, 
a  glass  of  milk,  and  about  ^  oz.  to  i  oz.  of  cheese. 
The  caloric  value  of  this,  so  far  as  I  am  able  to 
gauge  it,  is  about :  Bread,  138  ;  bread  and  butter, 
208  ;  egg,  70  ;  pasty,  say  70  ;  cheese,  112  ;  milk, 
280  calorics — total,  878  calorics,  if,  indeed,  he  had 
as  much  as  this,  for  I  do  not  think  he  took  a  pint  of 
milk,  and  I  doubt  if  he  had  as  much  as  an  ounce 

(•)  His  mother  has  since  informed  me  tliat  the  boy  does  not  limp 
at  all,  even  if  h^  runs  a  lonj^  distance. 


of  cheese.  For  many  months  he  took  only  the 
morning  cup  of  cocoa,  a  slice  of  bread  with  soup 
at  dinner-time,  and  half  a  pint  of  milk  in  the 
evening,  a  diet  amounting  to  the  value  of  about 
350  calorics,  and  which  I  call  practical  monosi- 
teism.  He  is  now  dissiteous,  and  I  have  ad\'iscd  his 
mother  to  keep  him  to  this.  He  has  gained 
about  a  stone  in  weight  since  I  saw  him  in  January. 

Now,  gentlemen,  I  come  to  the  second  and  main 
part  of  my  communication.  I  will  put  what  I  hax-r 
to  say  in  the  form  of  a  suggestion.  It  has  been  sug- 
gested to  me,  (a)  and  I  in  turn  suggest  to  you,  that 
we  ask  ourselves  the  question.  Is  food  to  any 
extent,  and  if  so,  to  what  extent,  the  source  at 
the  external  energy  exerted  by  the  body  ? 

Do  not  please  put   this    question  aside  as  un- 
worthy of  consideration.     It  will  be  put  to  jrou,, 
I  venture  to  say,  on  other  occasions  than  to-nighu 
I  want  to  ask  whether  the  analogue  of  the  human 
body  considered  as  a  niachine  is  not  rather  the 
electric  motor  of  the  electric  engineer    than  the 
steam  engine  of  Watts;  suggested  as  an  analogy 
by  Liebig  and  Playfair,  Moleschott,  Ranke,  and 
the  rest  of  the  modern  authorities.     The  difEerence 
is  enormous.     If  the  analogy  is  the  jsteam  engine^ 
then  the  body  gets  the  energy  which  it  exerts 
externally  (and  which,  for  the  sake  of  brevity,  I 
shall  call  its  external  energy),  from  the  potential 
energy  of  its  fuel ;    and  food  is  the  fuel.     But  if 
the  analogy  is,  properly  speaking,  not  the  steam 
engiile  but  the  motor,  then  the  body  gets  its  ex- 
ternal   energy  not  from    its    food    or    fuel,  but 
through    the    analogue    of    its    wires,     or    even 
wirelessly — viz,,    from   the   illimitable     stores  of 
energy  with  which  in   Nature   it   is  surrounded. 
Let  us  think  of  this.      It   seemed   incredible   at 
first,  but  the  more  I  think  of   it   the  more  does 
the  idea  fascinate  and  hold  me.      "What  seems  to 
me  to  be  the  truth  is  this  :  Qua  internal  energy 
— i.e.,   so  far  as  nutrition  and  the  maintenance 
of  the  animal  heat  are  concerned — the  body  does 
seem  to  be  analogous  to  a  steam  engine,  and  gets 
its  energy  for  these  two  purposes  from  the  food. 
The  maintenance  of  the  animal  heat  is  a  serious 
task.     The  body  of  a  man  weighing,  say,  1 20  Ihs.,. 
has  to  be  maintained  at  40°  or    50**   or  60°  F.^ 
above  that  of  the  surrounding  atmosphere.     Even 
if  the  specific  heat  of  animal  tissue  is  the  same  a& 
that  of  water,  this  imphes  an  important  amount  ci 
work.     Some  years  ago,  I  made  out  from  some- 
what rough  experiments  that  the  specific  heat  of 
animal  tissue  was  about  780  foot  pounds.     If  this 
is  nearly  correct,  the  internal  energy  of  the  body 
will  amount  (besides  the  energy  of  simple  nutri- 

.     .  ^     120x60x780 
tion)  to —  or  about  2,500  foot  tons 

of  energy,  a  very  considerable  amount  ;  and  it  is 
for  this  purpose  that  I  believe  food  to'  be  neces- 
sary for  the  body.  But  the  exUmal  energy  of  the 
body,  I  suggest  to  you,  does  not  come  from  the  food,, 
nor  even  from  the  body.  It  comes  from  those 
stores  of  energy  with  which  the^body  is  surrounded,, 
and  in  which  it  lives  and  *moves.  This  idea 
does  not  contravene  the  law  of  the  conservation  of 
energy.  The  body  no  more  creates  its  external 
energy  than  the  motor  does.  Like  it,  however,  it 
transmits  and  transforms  the  energy  which  it 
receives.  I  have  said  what  is  the  fimction  of 
food  ;  and  the  function  of  the  engineer  or  owner  of 

(a)  Bylfr.  HerewaidCarriDpion,of  New  York. 


Dec.  28,  1904. 


TRANSACTIONS    OF   SOCIETIES.  The  Medical  Peess.   685 


the  body — i,e,,  of  each  person,  is  to  see  that  all 
the  points  of  contact,  so  to  say,  of  the  machine, 
all  its  electrodes  and  avenues  and  channels,  are 
bright  and  clear,  so  that  there  shall  be  as  Httle 
hindrance  as  possible  to  either  the  inflow  of  energy 
in  the  form  of  power,  or  to  its  outflow  in  the  form 
of  work  done.  If  the  internal  work  of  the  eco- 
nomy is  either  underdone  or  overdone,  its  work 
as  a  motor  must  be  interfered  with.  If  the  nutri- 
tion is  too  little,  the  receptive  power  of  the  motor 
will  be  checked  and  unduly  diminished.  If  the 
nutrition  is  overdone,  then  the  receptive  power 
will  also  be  diminished,  because  the  points  of  con- 
tact or  the  electrodes  will  be  dull  and  clogged. 
And  when  the  nutrition  is  properly  managed,  the 
motor  will  work  up  to  the  measure  of  its  capacity, 
receiving  as  much  energy  as  will  fill  it,  and  trans- 
mitting and  transforming  it  into  external  work. 
It  seems  a  very  simple  theory,  but  a  revolutionary 
one,  and  yet  very  probable.  Can  we  adduce  any 
arguments  in  its  favour  ?     I  think  we  can. 

I.  Urea,  uric  acid  and  urates  are  far  more  the 
exponent  of  the  state  of  the  nutrition  than  of  work 
done.  A  man  may  part  with  these,  and  often  does 
so,  when  he  is  doing  no  external  work  at  all,  when, 
for  instance,  he  is  lying  in  bed.  2.  In  sickness 
he  gets  rid  of  large  quantities  of  these  effete  ma- 
terials when  he  is  doing  no  external  work,  and,  in- 
deed, cannot  do  it,  mainly  because  before  he  was 
sick  he  overloaded  his  econonoiy  with  nutritive  ma- 
terial. Such  experiments  as  Weston's  walk 
showed  that  these  excreta  were  not  proportioned 
to  the  amount  of  work  done.  When  the  pedestrian 
fevered,  these  products  vastly  increased,  but,  of 
course,  then  he  could  hardly  walk  at  all.  3.  Al- 
though lifting  weights  bears  some  relation  to 
the  size  of  the  body,  intellectual,  moral,  spiri- 
tual, artistic,  organising  and  governing  work 
bears  no  predicable  relation  -at  all,  cither  to 
the  amount  of  food  consumed  or  to  the 
size  of  the  body  of  the  actor.  4.  How  does 
fasting  so  often  elevate  the  bodily  tempera- 
ture and  increase  the  strength,  if  we  receive  our 
external  energy  from  the  food  ?  5.  "Why  do  we 
go  to  bed  when  fatigued  and  not  to  the  dining- 
room  ?  How  is  it  that  we  need  sleep  at  all  ? 
Other  reasons  and  arguments  might  be  adduced, 
but  I  will  spare  your  time  and  end  with  this  one. 
Professor  Bose  has  recently  shown  that  the 
energy  of  dead  things  (so-called)  and  of  hving 
things,  or  vital  energy,  is  the  same.  And  he  has 
shown  some  other  very  remarkable  facts,  as,  for 
instance,  that  a  metal  wire  may  be  poisoned  more 
or  less,  so  far  as  the  power  to  let  an  electric  current 
pass  is  concerned,  by  treating  it  with  various 
agents  which  also  act  as  poidons  to  living  things. 
The  energy  is  prevented  from  flowing  into  inorganic 
things  by  changes  effected  by  such  substances, 
and  so  the  dead  things  cannot  trasmit,  much  less 
transform,  such  energy.  So  let  us  see  to  it  that  our 
constitutions  are  kept  so  clean,  healthy  and  bright 
that  the  vital  energy  surrounding  us  shall  have 
free  access  into  the  motors  of  our  bodies,  there 
to  be  transmitted  and  transformed  into  the  best 
work  of  each  according  to  our  several  capacities. 
I  make  no  apology  for  bringing  under  your  no- 
tice this  further  attempt  on  my  part  to  har- 
monise the  practical  cure  of  this  boy  with  high 
theory  as  to  the  meaning  of  tuberculosis,  and  the 
analogues  of  the  animal  machine  to  steam  engines 


XTransactiond  ot  Societies* 


WEST 


LONDON    MEDICO-CHIRURGICAL 
SOCIETY. 
Meeting  held  December  2nd,  1904. 


C.  M.  Tuke,  Esq.,  President,  in  the  Chair. 


■\ 


Dr.  a.  E.  Russell  read  a  paper  on 

DIAGNOSIS   OF   ACUTE   ABDOMINAL   DISEASES. 

The  first  part  of  the  paper  dealt  with  methods  of 
examination  and  their  order  of  procedure,  and  great 
stress  was  laid  upon  the  necessity  of  thorough  exam- 
ination of  the  thoracic  viscera,  the  rectum  and  vagina. 
The  general  condition  of  the  patient,  with  especial 
reference  to  the  pulse,  facial  aspect  and  vomiting, 
was  pointed  out,  as  almost  of  equal  importance  as 
local  abdominal  signs.  The  author  strongly  deprecated 
giving  opium  in  cases  of  doubtful  diagnosis.  The 
advisability  of  early  operation  in  grave  cases  was 
insisted  upon.  Consideration  of  the  relative  frequency 
of  the  diderent  varieties  of  acute  abdominal  disease, 
and  of  the  age  and  sex  of  the  patient,  as  illustrated 
by  a  large  series  of  cases,  was  very  helpful  in  forming 
an  opinion  based  upon  probabilities. 

Mr.  L.  A.  BiDWELL  considered  that  there  were  two 
distinct  questions  raised  in  Dr.  Russell's  paper,  vig,  : 
(i)  that  of  diagnosis  of  the  lesion  present,  and  (2) 
that  of  the  necessity  of  immediate  operation.  He 
affirmed  the  existence  of  a  rapid  pulse  and  low  tem- 
perature to  be  the  gravest  symptom  in  acute  cases, 
and  nearly  always  demanding  immediate  operation. 
He  drew  attention  to  the  differential  diagnosis  between 
appendicitis  and  suppurative  gall-bladder.  In  the 
former  the  rounded  &dge  of  the  tumour  is  above,  and 
there  is  an  area  of  resonance  between  it  and  the  Uver, 
whereas  in  the  latter,  the  rounded  edge  is  below,  and 
the  dulness  is  continuous  with  that  of  the  liver. 

Mr.  J.  D.  Armour  did  not  agree  with  Dr.  Russell 
with  regard  to  the  question  of  the  facies,  and  related 
three  acute  cases,  none  of  which  showed  by  their 
appearance  the  slightest  sign  of  their  condition. 

Mr.  E.  p.  Paton  pointed  out  one  feature  not  men- 
tioned by  Dr.  Russell,  which  not  infrequently  occurs 
in  acute  cases.  He  referred  to  the  quiet  period  fol- 
lowing immediately  after  the  acute  onset,  and  warned 
practitioners  not  to  be  misled  by  this,  as  often  the 
acute  symptoms  return  in  an  aggravated  form. 

Dr.  Mansell  Moullin  expressed  his  surprise  that 
so  small  a  proportion  of  gynaecological  cases  occurred 
in  abdominal  surgery,  and  alluded  to  the  frequency 
of  acute  abdominal  trouble  occurring  in  women  of 
the  child-bearing  age,  the  most  serious  cases  being 
those  of  hemorrhage  due  to  tubal  rupture. 

Mr.  McAdam  Eccles  was  struck  with  the  high 
percentage  of  cases  of  intussusception,  viz.  :  16  per 
cent.,  and  thought  it  to  be  accidental  for  the  years 
mentioned.  He  also  alluded  to  a  point  not  mentioned 
by  Dr.  Russell,  vim,,  hyperaesthesia.  With  reference 
to  the  question  of  the  administration  of  morphia, 
Mr.  Eccles  advised  one  dose  subcutaneously  when 
the  patient  had  to  be  removed,  but  if  an  operation 
is  to  be  undertaken  at  the  patient's  own  house  with- 
out any  removal,  he  strongly  advocated  that  no 
morphia  or  opium  be  given.  Mr.  Eccles  also 
mentioned  that  occasionally  there  were  two  or 
more  causes  of  acute  abdominal  symptoms  in  the 
same  patient. 

Dr.  Seymour  Taylor  pointed  out  that  in- 
dican  is  almost  invariably  present  in  the  urine 
in  acute  abdominal  cases,  and  considered  it  of  use  in 
deciding  the  diagnosis  between  injury  to  intestines 
and  peritoneum  or  muscles.  As  to  latent  symptoms 
in  cases  of  peritonitis,  he  submitted  that  the  quiet 
pulse  is  the  indication  of  the  condition  of  shock, 
which  is  the  first  and  most  prominent  condition  of 
abdominal  injuries,   soon   succeeded  by  rapid  pulse 


i_       ,1        i_   -  •  ^^^  temperature.     He  considered  pain  to  be  by  no 

and  motors,  or  its  relations  to  the  all-embraang  [  means  a  necessary  guide  to  threat  of  lesion, 
law  of  the  conservation  of  energy.  Mr.    Aslett    Baldwin    said    that    the    cutaneous 


686     Thk  Medical  Press. 


TRANSACTIONS   OF  SOCIETIES. 


Dec  28.  1904- 


hyperssthesia  mentioned  by  Mr.  Eccles  is  of  great 
interest,  at  the  same  time  the  symptom  is  very  mis- 
leading. If  present  in  a  case  of  appendicitis,  as  an 
instance,  and  it  passes  off  without  amelioration  of 
other  symptoms,  it  is  a  sign  of  grave  importance, 
and  indicates  immediate  operation.  With  reference 
to  the  prominent  symptom  of  shock  mentioned  by 
Dr.  Seymour  Taylor  as  being  invariably  present,  Mr. 
Baldwin  quoted  cases  of  severe  abdominal  injuries 
where  there  was  not  the  slightest  sign  of  shock. 

Dr.  A.  E.  Russell,  in  reply  to  Mr.  Bid  well,  com- 
mented upon  the  difficulty  in  the  diagnosis  of  appen- 
dicitis and  suppurative  gall-bladder.  In  answer  to 
Dr.  Seymour  Taylor,  he  said  that  pain  commencing 
definitely  in  a  region  such  as  the  iliac  fossa  or  gall- 
bladder was  probably  indicative  of  the  organ  at  fault, 
but  fully  agreed  with  Mr.  Taylor  that  when  the  pain 
wlis  referred  vaguely  to  the  umbilicus  or  general 
abdominal  wall,  it  was  valueless. 


LIVERPOOL    MEDICAL    INSTITUTION. 
Meeting  held  December   15TH,   1904. 


Dr.  J.  R.  Logan,  Vice-President,  in  the  Chair. 

D.^.  MiDDLEMASs  Hunt  showed  a  case  of  Primary 
Syphilitic  Infection  of  the  Nostril.  The  chancre  was 
situated  on  the  left  side  of  the  septal  cartilage.  The 
patient,  a  youth,  set.  17,.  had  suffered  from 
one-sided  nasal  obstruction  and  discharge  for  two 
months.  There  was  considerable  glandu&r  enlarge- 
ment on  the  affected  side,  and  within  the  last  fort- 
night a  characteristic  rash  had  appeared  on  the  face 
and  body.  No  history  could  be  obtained  as  to  the 
source  or  mode  of  infection. 

Mr.  Douglas-Crawford  read  a  note  on  two  oases 
of  Actinomycosis.  The  first  case  was  that  of  a  ship's 
surgeon,  the  skin  of  the  flank  being  the  affected  area. 
In  the  second  case  the  patient  was  a  butcher,  and  the 
sub-maxillary  region  the  part  affected.  Excision 
was  performed  in  both  cases  with  satisfactory  results. 

Mr.  K.  W.  MoNSARRAT  read  a  note  on  Constriction 
of  the  Ureter.  After  enumerating  the  different  types 
of  constriction,  he  related  three  cases  illustrative  of 
the  condition.  The  first  was  a  case  of  true  stricture 
of  the  pelvic  ureter  which  gave  rise  to  symptoms 
mistaken  for  those  of  appendicitis  ;  a  cure  was  effected 
by  dilatation  of  the  ureter  from  the  bladder.  The 
second  case  was  one  of  Hydronephrosis,  in  which  the 
ureter  was  flattened  against  and  bound  by  adhesions 
to  the  hydronephrotic  sac  ;  a  plastic  operation  upon 
the  ureter  was  successfully  performed.  In  the  third 
case  there  was  Pyonephrosis  with  stricture  of  the 
ureter  at  its  junction  vdth  the  renal  pelvis. 
Mr.  Monsarrat  suggested  that  in  the  etiology  of 
similar  cases  of  primary  pyelitis  of  obscure  origin, 
renal  stasis  caused  by  ureteral  obstruction  probably 
played  an  important  part. 

Mr.  George  Hamilton,  Mr.  Rushton  Parker,  Mr. 
R.  A.  Bickersteth,  Dr.  R.  J.  H.  Buchanan.  Mr,  F.  T. 
Paul.  Dr.  N.  E.  Roberts,  Dr.  W.  Alexander,  Dr.  T. 
B.  Grimsdale,  Mr.  G.  P.  Newbolt,  Mr.  Litler  Jones, 
and  Mr.  Damer  Harrisson  took  part  in  the  discussion. 

Mr.  RusHTON  Parker  read  a  note  on 

PERINEAL    PROSTATECTOMY. 

He  practised  the  operation  as  described  by  Dr.  Parker 
Syms  at  the  Manchester  meeting  of  the  British  Medical 
Association  in  1902.  He  had  thus  operated  upon 
eight  cases  between  December,  1902,  and  November, 
1904.  Tlie  ages  of  the  patients  varied  from  59  to 
76  years,  five  of  them  being  over  70  years  of  age. 
The  prostates  removed  varied  in  weight  from  }  oz. 
to  |oz.  All  the  patients  had  been  unable  to  pass 
urine  without  the  use  of  a  catheter  before  operation, 
and  all  had  subsequently  become  enabled  to  hold  and 
to  pass  water  comfortably,  except  one  case  which 
terminated  fatally.  The  after- treatment  consisted  in 
bladder  drainage  by  means  of  a  long  tube  for  two  to 
five  days,  and  pluggin  g  of  the  prostatic  gap  for  twenty- 
four  hours  with  strips  of  gutta-percha  tissue  in  prefer- 
ence to  gauze.     The  gutta-percha  strips  can  be  removed 


without  disturbing  the    patient    or    causmg 

rhage.     A  catheter  is  passed   daily  and   the  bladder 

washed  out. 

Dr.  W.  Alexander.  Mr.  Douglas-Crawford,  and  3ilr. 
G.  P.  Newbolt  took  part  in  the  discussion. 

Mr.  C.  Thurstan  Holland  reaxl  a  note  based  on  a 
case  of  Central  Round-celled  Sarcoma  of  the  Upper 
End  of  the  Femur.  The  patient  was  under  the  cait 
of  Mr.  G.  P.  Newbolt,  at  the  Royal  Southern  HosfMtaL 
A  series  of  radiographs  was  shown,  illustrating  variocs 
diseases  of  the  bone  bearing  on  the  subject.  Tht 
X-ray  appearances  of  central  round-celled  sarconu. 
myeloid  sarcoma,  periosteal  sarcoma,  abscess  of  bone, 
Ac,  were  discussed.  The  fact  that  operatioos  lor 
malignant  bone  disease  were  so  frequently  folknred 
by  return  of  the  growth  was  considered  to  be  probaUr 
due  to  the  condition  being  diagnosed  too  late.  By 
the  help  of  a  good  radiographic  examination,  sospidcm 
might  be  cleared  up  very  much  earlier  in  the  histofn- 
of  these  cases,  and  thus  enable  better  results  to  be 
obtained  by  means  of  operative  treatment. 

Mr.  G.  P.  Newbolt  described  the  clinical  historv 
of  the  case.  He  had  performed  amputation  of  the 
hip-joint,  but  the  patient  died  the  day  following  the 
operation. 

Mr.  R.  A.  Bickersteth,  Mr.  Rushton  Parker.  Dr. 
W.  Alexander,  and  Mr.  Damer  Harrisson  took  part 
in  the  discussion. 


SOCIETY    FOR   THE    STUDY    OF    DISEASE   IX 
CHILDREN. 
Meeting  held  Dbcbmbbr  i6th,    1904. 

Dr.  Frederick  Taylor  in  the  Chair. 


Dr.  C.  J.  Macalister  (Liverpool)  opened  a  discus- 
sion on 

SUDDEN    AND    UNEXPECTED    DBATH     IN     CHILDREN. 

dealing  mainly  with  a  class  of  cases  iwhich  appear  to 
be  due  to  toxic  influences.     He  referred  especially  to 
the  sudden  deaths  which  take  place   in    institutions 
devoted   to   the  care  and   keeping    of    children.    He 
quoted   several   cases  in   his   own    experience   where 
children,     sometimes    with     hardly     any     prodromal 
symptoms,  in  other  cases  with  a  few  hours*  sufierin^ 
from  headaches  and  diarrhoea    or  vomiting,  had  died 
in  a  cyanosed  condition  from  asphyxia.      At  the  po^t- 
mortem   examinations    sometimes    a     very     localised 
patch  of  pulmonary  consolidation    had    been  found, 
at  others  a  general  congestion  of  the   Inngs,  such  as 
might  be  found  in  any  case  of  sufiocation,   but  no 
lesion  of  the  nervous  system  had  ever  been  discovered 
to  account  for  these  deaths,  and  he  considered  that 
they  were  probably  due  to  a  poison   vrhich  exerted 
its   influence    upon    the    respiratory    centre.     In   the 
institutions  in  which  these  deaths   had   occurred,  it 
was  found  that  collective  bathing  was  frequently  in 
vogue,  and  Dr.  Macalister  pointed  out  how  sataiated 
the  water  became  with   organic   matter  and   micn>- 
organisms  after  a  number  of  children  had  been  washed 
in  it,  and  that  in  one  school  where   this  method  of 
bathing  was  altered,  about  five  years  ago,  these  deaths 
had  practically  been  stamped  out,    and    the  general 
health   of   the   children   had    been    vastly    improxcd. 
Dr.   Macalister  quoted  a  case   from    the'  practice  of 
Dr.  Harris,  of  Birkenhead,  of  an  appallingly  sudden 
death  in  an  infant,  which  had  previously  been  healthy, 
and  he  felt  disposed  to  ascribe  this  type  of  case  (as 
suggested  by  Buzzard  long  ago)  to  infantile  paxalysis 
attacking  the  centre  of  the  vagus,  and  suggested  that 
in  all   probability   the  curious   and    selective  poison 
which  caused  this  disease  might  be  discovered  in  some 
flaw  in  nursery  hygiene.     Other  examples  of  toxaemia 
referred  to  were  those  in  which  haemorrhage  occurred 
from  the  stomach  and  cases  of  haemorrhage  into  the 
suprarenal   bodies,    and   a   death    from    haemoriliage 
from  the  carotid  artery  was  also    recited  as  having 
complicated  scarlatina.     In  conclusion,  it  was  pointed 
out  that  in  some  cases,  which  had  been  thought  to  be 
simple     diarrhoea     or     some     unimportant     febrile 


I>EC.    28,    1904- 


TRANSACTIONS  OF  SOCIETIES.  The  Medical  Peess.    687 


•disturbance,  had  died  suddenly  and  had  proved  to  be 
examples  of  enteric  fever ;  and  he  mentioned  also 
•examples  of  sudden  death  following  diphtheria,  in 
fulminating  small-pox,  and  in  gangrenous  varicella. 

Dr.  J.  Porter  Parkinson,  in  considering  the  func- 
tional causes,  referred  to  heart  failure  and  sudden 
death  in  marasmus,  to  convulsions,  usually  causing 
death  by  asphyxia,  to  laryngismus  stridulus  as  a  rare 
•cause,  and  to  spasm  of  the  glottis  resulting  fatally 
from  pressure  of  an  enlarged  gland  on  the  recurrent 
laryngeal  nerve.  The  pathological  changes  in  these 
conditions  and  in  **  over-laid  "  babies  were  described. 
Excessive  emotion  was  a  rare  cause  of  sudden  death 
in  children. 

Mr.  J.  Thomson  Walker  discussed  the  subject  in 
relation  to  the  thymus  gland  and  the  status  lymph- 
aticus.  He  summed  up  the  clinical  pictures  of  the 
latter  constitutional  state  as  (i)  no  previous  evidence 
■of  illness  ;  (2)  previous  restlessness,  &c. ;  (3)  thymic 
■asthma.  In  many  cases  there  is  associated  rickets. 
In  others  there  is  disease  which  might  be  sufficiently 
:senous  to  end  fatally  without  the  addition  of  this 
peculiar  lymphatic  state.  Possibly  the  condition 
might  account  for  still-birth  occasionally,  and  for 
<]eaths  following  violent  emotion,  sudden  shock,  and 
•anaesthesia.  Hypoplasia  of  the  heart  and  coarctation 
of  the  aorta  have  been  found  in  some  of  these  cases, 
^nd  sometimes  an  enlarged  thyroid.  Mr.  Thomson 
Walker  laid  stress  on  the  association  of  rickets,  adenoid 
tissue  in  the  naso-pharynx  and  lar3nagismus ;  also  on 
the  state  of  lymphatism  as  an  important  factor  in 
producing  a  fatal  issue  in  an  otherwise  simple  illness. 
He  discussed  the  pathology  in  reference  to  the  pressure 
and  toxic  theories,  an  excess  of  thymic  secretion  or 
some  other  poison.  Cases  might  be  diagnosed  from 
•evidence  of  an  enlarged  thymus,  if  there  were  anything 
to  suggest  lymphatic  hyperplasia. 

Mr.  A.  H.  Tubby  considered  the  surgical  cause  in 
reference  to  circulatory  conditions  such  as  haemorrhage 
in  the  new-bom,  scurvy,  ulcer  of  the  stomach  or  duo- 
denum, haemorrhage  during  operation,  and  thrombosis  ; 
and  to  shock  and  the  means  of  diminishing  it.  The 
shock  following  irrigation  of  the  pleural  cavity  he 
ascribed  to  the  nature  of  the  fluid  rather  than  to  the 
actual  irrigation,  provided  there  were  a  free  exit  for 
the  fluid.  Among  toxic  conditions,  he  mentioned  the 
absorption  of  iodoform  and  carbolic  acid,  toxins,  and 
uraemia.  Many  other  surgical  causes  connected  with 
the  throat  and  larynx,  with  mechanical  effects  from 
tying  the  hands  of  a  restless  child,  with  foreign  bodies 
and  pressure  on  the  trachea,  were  also  considered. 

Dr.  J.  Blumfeld  referred  to  subjects  in  connection 
with  anaesthetics,  confining  his  remarks  to  those  cases 
of  sudden  death  in  children  during  or  after  anaes- 
thesia, in  which  the  ailment  had  caused  no  loss  of 
general  health.  The  importance  of  a  skilled  anaes- 
.  thetist  for  infants  could  not  be  over-estimated.  Death 
in  the  pre-anaesthetic  stage  almost  always  occurred 
with  absolute  suddenness,  and  was  due  to  too  strong 
a  vapour  of  chloroform. 

Dr.  Page  drew  attention  to  the  occurrence  of  sudden 
death  in  the  course  of  disease  not  necessarily  fatal, 
such  as  phthisis.  These  caises  were,  he  thought,  due 
to  SLU  over-dose  of  toxin,  an  auto-intoxication,  the 
patient  having  been  living,  as  it  were,  on  the  edge 
of  a  precipice.  He  thought  that  one  important  result 
of  the  discussion  would  be  to  draw  attention  to  the 
means  necessary  to  prevent  a  sudden  fatal  issue  in 
cases  requiring  surgical  treatment,  and  from  amaes- 
thesia.  In  the  toxic  cases  it  wais  difficult  to  foresee 
a  remedy. 

Dr.  Young  thought  lymphatism  more  common  than 
supposed  in  both  children  and  adults,  basing  his  con- 
clusions on  post-mortem  examinations.  Sudden  death 
was  frequent  in  exophthadmic  goitre,  especially  after 
operations,  and  in  myaisthenia  gravis,  in  which  the 
thymus  was  persistent.  Recently  he  had  found  the 
thymus  persistent  in  several  cases  of  sudden  death. 

Dr.  Edmund  Cautlev  insisted  on  the  importance 
of  the  subject  to  the  general  practitioner,  for  most 
of  these  cases  came  under  their  notice,  and  they  had 


to  make  the  autopsies  and  give  evidence  before  the 
coroner.  He  detailed  two  such  cases  in  which  death 
had  been  ascribed  to  "  mesenteric  disease  "  and  to 
typhoid  fever.  In  neither  were  the  history  of  the 
case,  the  appearance  of  the  child  shortly  before  death, 
or  the  post-mortem  results  sufficient  to  warrant  these 
diagnoses,  amd  he  was  inclined  to  aiscribe  the  deaths 
to  the  status  Ijonphaticus.  In  many  deaths  in  the 
course  of  maurasmus  in  infants,  though  the  child  was 
progressing  favourably,  it  waw  impossible  to  aissign  an 
ex£u:t  cause.  Some  died  from  syncope,  others  during 
a  slight  convulsion,  and  in  many  no  cause  could  be 
found. 

Dr,  L.  Guthrie  remarked  on  congenital  syphilis 
as  a  cause,  and  on  the  effects  of  too  rapidly  curing 
an  extensive  cutaneous  eruption. 

Mr.  G*  Pernet  spoke  in  support  of  his  views. 

Mr.  Arthur  Edmunds  thought  that  evil  effects 
from  sudden  cure  of  eruptions  were  due  to  toxic 
absorption.  He  had  seen  similau:  results  due  to 
extensive  skin  grafting. 

THE     MEDICO-LEGAL    SOCIETY. 
Meeting  held  December  13TH,  1904. 


Sir  William  Collins,  M.D.,  President,  in  the  Chair. 

Dr.  Harvey  Littlejohn  exhibited  four  specimens 
of  medico-legal  interest. 

Dr.  R.  R.  Rentoul  read  a  paper  on 
degeneration  :  its  causes  and  prevention, 
with  Reference  to  the  Proposed  Sterilisation  of  Certain 
Degenerates.  The  Census  of  1901  revealed  neaurly 
hadf  a  million  degenerates.  The  publicity  of  the 
certification  of  "  the  cause  of  death  "  prevented  many 
inebriates  being  recorded  in  our  national  statistics; 
he  would  have  the  fact  of  death  certified  to  the  personal 
representatives  of  the  deceased,  the  cause  to  the 
Registrau'-General.  From  am  exhaustive  series  of 
tables  he  exhibited,  he  concluded  that  the  ratio  of  the 
mentadly  or  physically  unfit  was  i  in  5  of  the  population, 
and  the  financial  cost  of  their  upkeep  wais  not  fair  from 
fifty  million  pounds  annually.  Immigration  of  un- 
desirable aliens  added  to  our  unfits,  emigration  of  our 
own  healthy  stock  drained  us  of  many  of  our  fit. 
He  would  exact  compulsory  sterilisation  (by  vasectomy, 
sadpingotomy,  &c,)  in  the  cases  of  idiots,  the  congenital 
deaf,  confirmed  epileptics,  certain  backward  children, 
Ac.,  amd  would  allow  voluntary  sterilisation  where 
there  wais  obstetrical  danger  in  a  womaui  being  pregnant 
and  being  delivered.  In  the  compulsory  class  there 
should  adways  be  needed  the  sanction  of  the  Com- 
missioners in  Lunacy. 

After  letters  had  been  read  from  the  Earl  of  Meath, 
M.  Max  Nordau,  Mr.  H.  G.  Wells,  and  Mr.  T.  J. 
Bamaurdo,  F.R.C.S.E.,  an  amimated  discussion  wats 
opened  by  the  President. 

Dr.  J  VMES  Scott  (Brixton  Gaw>l)  favoured  segrega- 
tion of  the  unfit,  by  an  extension  of  the  Idiots  and 
Imbeciles  Act  (1886);  Dr.  Rentoul's  proposal,  if 
carried  out,  would  add  another  burden  to  the  life 
of  the  medical  man. 

Dr.  H.  B.  DoNKiN  (Prison  Commissioner)  demanded 
a  definition  of  "  degenerate  "  ;  many  prisoners  were 
without  this  class. 

Dr.  T.  B.  Hyslop  (Bethlem  Asylum)  said  degenerates 
increased  with  the  progress  of  civilisation  ;  among 
the  unemployable  unemployed  the  inhabitants  of 
public  institutions  must  be  numbered.  London  was 
"  a  carbuncle  on  the  neck  of  England,"  its  au-eas  of 
over-crowding  were  "  acne  spots "  upon  the  body 
politic ;  treatment  must  be  dietetic  :  the  "  food " 
imported  should  be  supervised  and  unhealthy  material 
should  be  expurgated.  Dr.  Rentoul,  as  others  before 
him,  had  caught  a  "  sperm-whale."  England  and 
Englishmen  elected  to  "  stand  upon  their  heads," 
and  necessarily  experienced  intellectual  obfuscation — 
we  must  get  right  side  up. 

Sir  John  McDougall,  L.CC,  held  it  was  the 
irregular  and  not  the  strenuous  life — the  Strand,  not 
the  East  End — which  filled  the  asylum  ;    as  a  visitor 


688    Tbb  Medical  Pkess. 


GERMANY. 


Dec  28.  1904. 


he  often  felt  he  was  doing  a  social  wrong  in  discharg- 
ing the  mentally  insane  when  they  were  **  recovered." 

Dr.  F.  J.  Smith  thought  that  at  least  it  would  be 
administratively  practical  to  deal  with  those  charged 
with  homicidal  or  other  personal  violence  ;  the  public 
should  not  be  told  too  much  of  the  methods  employed. 

Mr.  Arnold  White  had  advocated  similar  measures 
nearly  two  decades  ago ;  lately,  an  hysteria  had 
afilicted  public  opinion,  its  abnormal  vibrations 
differed  greatly  from  our  pristine  steady  national 
character. 

Mr.  Bernard  Shaw  regretted  Dr.  Rentoul  had  only 
had  a  medical,  not  a  scientific,  education !  Medical 
men  should  instruct  the  public  with  authority,  but 
their  teaching  was  compromised  by  ignorance.  We 
did  not  know  what  degeneracy  nor  heredity  meant. 
If  we  got  rid  of  the  diseased  we  should  lose  many 
interesting  people ;  epilepsy  may  be  but  a  perverted 
form  of  energy.  The  terms  used  were  relative  to 
our  social  ideas  ;  he  could  imagine  an  insane  majority 
segregating  a  sane  minority.  Surgical  and  "  chalk  and 
opium "  methods  were  applied  too  frequently  by 
medical  men  to  social  problems.  The  population  was 
the  essential  factor,  and  its  quality  was  more  vital 
than  its  quantity ;  we  must  breed  from  a  good  human 
stock  even  if  the  "  sacredness  "  of  marriage  suffers. 

Dr.  C.  R.  Drysdale  believed  medical  measures 
were  not  exhausted  ;  the  families  of  medical  men  were 
smaller  than  formerly. 

Earl  Russell  feared  a  good  case  had  been  over- 
stated. Society  interferes  with  Nature's  weeding 
processes. 

His  Honour  Judge  Rentoul  faced  this  question 
practically  day  by  day  in  his  court ;  definition  and 
differentiation  were  necessary. 

Mr.  George  Pernst  affirmed  our  ignorance  of  the 
nature  of  heredity. 

Dr.  Howell  Evans,  with  a  large  experience  of 
London's  invalid  children,  held  that  these  weaklings 
were  so  either  from  accident  or  from  heredity ;  treat- 
ment differed  in  each  case;  for  the  former  ante-natal 
measures  might  do  much. 

Sir  William  Collins,  in  summing  up,  deprecated 
loose  talk  where  precise  legislation  was  desirable. 
Weissman  did  not  say  the  last  word  on  heredity,  as 
Watson's  recent  experiments  on  the  transmission  of 
acquired  maternal  immunity  showed.  The  recent 
Commission  on  Physical  Deterioration  was  more 
optimistic  than  the  present  discussion  would  indicate 
— "  the  inherited  mean  "  must  have  been  forgotten. 
Environment  was  regaining  some  of  its  temporarily 
discredited  influence.  The  ethical  aspect  of  the 
question  had  been  ignored  ;  what  would  be  the  state 
of  society  with  numbers  of  sterilised  criminal  eunuchs 
roaming  at  large  ?  He  had  little  confidence  in  the 
short  cuts  of  benevolent  despots,  and  should  hold 
up  his  hand  against  compulsory  mutilation. 

Dr.  Rentoul  having  replied  briefly,  the  meeting 
terminated.     Seven  new  members  were  enrolled. 


ftance* 


[from  our  own  correspondent.] 


Parib,  I>eoeinher  Mth,  1004. 
Treatment  of  Foreign  Bodies  in  the  Ear. 
These  are  habitually  divided  into  two  classes — live 
bodies  and  inanimate  bodies.  The  former  consist 
generally  of  fleas,  grasshoppers,  or  earwigs,  which  pene- 
trate into  the  ear  during  sleep,  while  others  are  bred 
in  the  ear,  from  eggs  deposited  by  flies,  and  these  eggs 
produce  worms  or  larvae.  Inanimate  bodies  are  as 
variable  as  those  found  in  the  nose — ^pearls,  boot  but- 
tons, pebbles,  beans,  grains  of  every  kind,  plugs  of 
cotton  wool,  paper,  &c.  These  may  remain  some 
time  without  causing  any  trouble,  but  generally  they 
provoke  buzzing,  vertigo,  nausea,  vomiting,  headache, 
and  sometimes  epileptiform  convulsions.  Symptoms 
that  resemble  cerebral  disease  (meningitis),  and  children 
have  been  treated  for  this  affection. 


If  the  foreign  bodies  are  angular,  pointed.  iniect«l 
if  they  are  capable  of  becoming  swelled  by  humiditT. 
if  they  are  insects  or  their  larvae,  they  provoke  violeat 
inflammation  with  suppuration  of  the  external  meatvs. 
The  tympanum  itself  soon  gets  inflamed  and  otitis  of 
the  middle  ear  with  all  its  complications  sets  in. 

The  treatment  of  these  foreign  bodies  should  ahrays 
begin  with  repeated  injections  which,  if  persevered  in, 
frequently  succeed.  If  the  body  can  be  reached  easily. 
a  forceps  or  a  crooked  hairpin  may  be  able  to  extract 
it.  If,  on  the  other  hand,  the  sjrmptoms  are  grave  and 
threatening  from  penetration  of  the  tympanum.  ti» 
situation  renders  more  radical  means  imperative. 
Either  extraction  should  be  made  under  chloroform  or  aa 
attempt  will  be  made  to  enter  the  middle  ear  and 
remove  the  obstruction. 

Treatbient  of  Sciatica. 

A   simple   yet    effective    method    of    reliex'ing  this 
painful  affection  will  be  found  in  the  following:— 
Nitrate  of  strychnine.  2  grs.  ; 
Water,  3^  oz. 

A  full  Pravaz  syringe  injected  daily  in  the  region. 
Excellent  results. 


[prom  our  own  correspondekt.] 


Bntux. 


UtKlML 


At  the  Medical  Society,  Hr.  Riese,  related  some 
observations  on  the 

Surgery  of  the  Gall-Blaodkr. 

He  first  spoke  on  the  origin  of  calculi.  Naunyn  aiMf 
his  school  had  shown  that  stagnation  of  bile  and  in- 
fection of  the  biliary  passages  gave  rise  to  gall-stones ; 
Courvoisier  had  recognised  this,  as  he  looked  upoD 
gall-stones  as  a  purely  local  disease.  The  view  of 
Ewald  that  there  must  be  a  disposition  to  the  disease 
was  not  of  much  importance.  The  infection  generally 
proceeded  from  the  intestines,  bnt  it  might  come  to 
pass  through  a  haematogenous  channel.  The  speaker 
himself  had  seen  cholelithiasis  develop  in  connectioa 
with  pneumonia.  He  related  two  cases  of  sevete 
cholecystitis  with  strepto-  and  staphylococcus  infection 
in  which  he  was  able  to  cultivate  the  cocci  out  of  the 
bile  obtained  at  the  operations.  In  one  case  where 
the  patients  suffered  from  severe  gonorrhcea,  he 
assumed  a  gonococcus  infection. 

The  colic  did  not  come  from  active  contraction  of  the 
bile-passages,  as  it  came  on  even  when  the  calculus 
was  imbedded  in  a  sac,  but  it  arose  from  infection  d 
the  bile-passage,  possibly,  as  Wilms  assumed,  from 
dragging  on  the  peritoneal  covering. 

Jaundice  also  was  generally  the  expression  of  ao 
infection,  as  it  often  came  on  even  when  there  was  no 
hindrance  to  the  flow  of  bile.  That  it  came  on  when 
concretions  blocked  up  the  whole  choledochus  was,  of 
course,  understood. 

As  regarded  indications  for  operation,  in  cases  where 
there  was  no  infection  of  the  bile-passages  one  might 
wait  in  calmness  if  the  gall-bladder  was  not  swolten. 
or  if  the  patient  did  not  press  for  an  operation.  li 
there  were  changes  in  the  gall-bladder  it  might  be  re- 
moved or  one  might  content  oneself  with  drainage. 
Hydrops  of  the  gaJl-bladder  called  for  operation  oohr 
when  it  caused  serious  trouble.  In  chronic  closure  ol 
the  choledochus  one  must,  of  course,  operate.  Even  in 
acute  closure  one  might  operate  with  confidence,  no 
bleeding  need  be  feared. 

In  very  acute  cholecystitis,  in  Korte's  opinion  opera- 
tion should  be  performed  at  once,  and  here  extirpation 
of  the  gall-bladder,  even  in  the  face  of  great  difficulties, 
was  to  be  preferred.  In  twenty-five  such  operations  in 
which  the  speaker  had  repeatedly  found  abscesses  in 
the  walls  of  the  gall-bladder,  he  had  only  lost  three. 
He  had  also  performed  a  successful  operation  in  a  case 
of  acute  diffuse  cholangitis  in  which  he  had  opened 
quite  a  series  of  abscesses  in  the  wall  of  the  gall-bladder, 
and  had  drained  the  bladder  for  a  lengthened  pehod. 
When  carcinoma  of  the  gall-bladder  was  suspected 


Dec.  28,  1904. 


AUSTRIA. 


Tbb  Medical  Press.    689 


at  least  a  preliminary  laparotomy  should  be  performed, 
when  some  operation  perhaps  only  palliative,  might  be 
rendered  possible. 

He  had  performed  55  cystectomies  and  30  cysto- 
tomies ;  he  had  performed  a  total  of  104  operations  on 
the  bile-passages,  with  16  deaths. 

As  to  the  question  of  recurrences,  it  must  be  borne  in 
mind  that  when  the  case  was  one  of  turning  aside 
an  imminent  danger,  the  choledochus  could  always  be 
looked  for.  That  calculi  originated  primarily  in  the 
liver  was  improbable  ;  intra-hepatic  stones  only  oc- 
curred when  extra-hepatic  processes  had  been  at  work. 
Hr.  Korte  agreed  with  the  speaker  in  all  essential 
points.  He  almost  always  performed  cystectomy,  as 
recurrences  unquestionably  took  place  after  simple 
cystotomy.  Disposition  undoubtedly  played  a  part, 
for  bile  stasis  and  infection  by  themselves  did  not  cause 
stones.  The  gall-bladder  might,  however,  be  full  of 
pus  and  the  choledochus  closed  without  any  stone  being 
present.  Whether  ectomy  of  the  gall-bladder  was  a 
certain  preventive  of  recurrence  was  at  present 
questionable. 

In  the  acutest  form  of  cholecystitis  and  in  closure  of 
the  choledochus  the  indication  for  operation  was  a 
vital  ome.  There  first  of  all  life  had  to  be  saved, 
whether  recurrence  was  likely  or  not.  In  the  simple 
form  off  cholelithiasis,  however,  we  must  not  be  too 
free  with  our  indications,  and  must  operate  only  when 
patients  wished  us  to  do  so. 

Hr.  Israel  mentioned  the  not  infrequent  occurrence 
of  gall-  stone  and  reilal  colic  in  the  same  patient,  and 
then  spoke  in  favour  of  a  stone-forming  disposition. 
The  influence  that  drainage  had  in  acute  diffuse  cholan- 
gitis wais  not  explained.  It  could  not  be  the  flow  of 
bile  that  induced  recovery  as  the  quantity  of  it  was 
much  too  small. 

Hr.  Rothn  related  two  cases  in  which  a  year  after 
cholecdochotomy,  fresh  colic  came  on  with  peritonitis. 
The  autopsy  showed  hepatic  calculi  in  both  cases.  A 
stone  liad  burst  the  cicatrix  of  the  choledochus  and 
had  C£^used  the  peritonitis. 
Hr.  Mellin  spoke  on  the 

INJECTION  OF  ThIOSINNAMIN  IN    CICATRICIAL 

Contraction. 

He  mentioned  numerous  cases,  but  could  furnish  no 
satisfactory  explanation  of  the  peculiar  action  of 
thiosinnamin  injection.  He  showed  a  woman  who  had 
had  a  series  of  injections  made  on  account  of  cicatricial 
contraction  from  bums  on  the  arms  and  face.  The 
preparation  employed  was  a  10  per  cent,  solution  with 
addition  of  glycerine.  Considerable  improvement  was 
shown  in  the  contractions. 

Hr.  Riere  confirmed  the  observation  and  said  that  an 
ectropion  of  the  eyelids  had  simply  disappeared  after 
the  injection. 

Hr.  Mankiewicz  had  observed  improvement  in 
strictures  of  the  urethra,  but  after  a  time  the  old 
condition  returned. 

Hr.  Riere  injected  around  the  cicatricial  mass  and 
not  into  it.     He  had  seen  no  development  of  ulcers. 

au0ttia« 


[from  our  own  correspondent.] 


Vienna,  I>eoexnl>er  24tb,  1004. 
Pregnancy  and  Uterine  Involution. 

The  discussion  of  this  interesting  paper  by  Halban 
gave  rise  to  an  expression  of  diverse  opinions  on  the 
function  of  pregnancy.  Halban  contended  and  gave 
evidence  from  examples  that  the  monthly  periods  of  the 
mother  acted  on  the  foetus  in  uUro  on  and  after  the 
eighth  lunar  month  of  gestation.  This,  he  concluded, 
-was  amply  proved  by  the  genitalia  of  the  foetus  being 
much  larger  at  birth  than  what  they  are  years  after. 
All  agreed  that  the  breasts  of  the  female  and  the 
prostate  of  the  male  were  greater  at  this  period. 

Hofbauer  was  opposed  to  this  theory  of  Halban,  and 
said  that  he  had  had  the  opportunity  of  examining  the 
mucous  membrane  of  the  uterus  in  twelve  cases,  and 


only  found  one  where  changes  had  taken  place,  although 
ripe  follicles  in  the  ovaries  were  discharging  ovules^ 
The  size  of  the  uterus  was  due,  according  to  his  opinion,, 
to  the  addition  of  fibrous  tissue  and  not  muscular  tissue, 
as  was  generally  supposed.  This  may  be  the  result  ol 
oedema  or  its  proximity  to  the  bladder.  It  is  too 
early  to  conclude  that  the  poison  generated  in  the 
placenta  is  the  morbid  cause  of  eclampsia. 

Fellner  was  of  opinion  that  the  ovaries  were  as  acfivc 
during  pregnancy  as  before  it,  as  we  find  follicles  in 
every  stage  of  their  life  history,  even  to  bursting  and 
leaving  the  ovaries,  while  the  menstruation  wave  can 
be  traced  along  the  mucous  membrane,  leaving  nothing 
but  the  menstrual  discharge  to  complete  the  pheno- 
menon.  It  is  quite  possible  that  the  material  from  the 
ovaries  passes  on  to  the  foetus  and  produces  in  it  the 
phenomena  described  by  Halban. 

Tandler  remarked  that  the  watery  production  of  the 
embryonal  tissues  was  generally  well  known  without 
attributing  all  this  fluid  accumulation  to  the  placenta 
alone. 

Mandl  thought  that  this  idea  of  enlarged  uterus  inr 
the  new  bom  was  not  new,  but  had  its  origin  in  Baier,. 
of  Strasburg,  who  pointed  out  long  ago  that  the 
uterus  of  the  foetus  m  uUr^  resembled  one  at  puberty 
more  than  it  did  at  any  intervening  period  when  in- 
volution really  occurred.  Under  any  circumstances 
investigations  in  this  direction  must  be  accepted  with 
great  reserve,  as  the  cases  must  be  few  where  actual 
demonstration  can  be  accurately  carried  out.  The 
menstrual  changes  in  the  mucous  men^brane  was  sup- 
ported by  an  ovarian  activity,  but  when  we  meet  with 
parturition  going  its  usual  course  after  the  ovaries 
have  been  removed,  and  the  menstrual  changes  still 
present,  we  ought  to  pause  and  await  more  accurate 
knowledge.  But  these  theorists  are  not  satisfied  with 
the  ovarian  secretions  being  the  only  cause  ;  they  tell 
us  in  the  next  breath  that  that  phenomenon  is  caused 
by  the  secretion  from  the  placenta.  The  hypotheses 
start  out  with  the  assumption  that  the  ovarian  secre- 
tion first  stimulates  the  placenta  to  secrete. 

Zappert  thought  that  oedema  during  pregnancy  was 
one  of  the  peculiarities  of  gestation,  and  particularly  in 
the  surface  of  the  foetus,  which  showed  signs  akin  to 
this  after-birth  in  parts  of  the  skin,  scrotum,  sym- 
physes, and  inner  surfaces  of  the  thighs. 

Halban,  in  replying,  said  the  menstrual  changes  in 
the  uterus  could  not  be  affected  by  ovulation,  as  careful 
section  of  the  ovaries  could  not  discover  any  follicles.- 
It  might  also  be  noted  here  that  in  elderly  children, 
though  ripe  follicles  are  present  in  the  ovaries,  no* 
change  can  be  observed  in  the  uterus.  These  facts  still 
add  to  our  difficulty  of  demonstrating  a  close  alliance 
between  ovaries  and  uterus.  If  this  be  taken  along 
with  the  fact  that  castration  of  a  female  during  preg- 
nancy in  no  way  interferes  with  the  course  of  gestation,, 
it  must  be  admitted  that  the  ovaries  have  no  influence 
over  the  foetus  during  pregnancy,  and  those  genital 
changes  so  frequently  observed  in  the  foetus  must  be- 
due  to  placental  stimuli,  as  pointed  out  by  many  in-, 
dependent  investigators. 

Urticaria  Xanthelasmoidea. 

Nobl  showed  a  child,  aet.  2^,  covered  with  an  ex- 
anthema tons  eruption  varying  in  size  from  a  millet 
seed  to  the  size  of  a  groat.  The  only  parts  escaping 
were  the  face,  palms  of  the  hands,  the  hairy  scalp,  and 
the  soles  of  the  feet.  This  rash  had  yellow  tops» 
fading  in  the  base  to  a  coffee  colour,  each  swelling  hav- 
ing a  peculiar  soft,  pliable  feeling  as  if  it  were  loose 
substance.  The  finger  nails  were  irregularly  formed! 
and  raised,  having  a  brown  pigmentary  appearance 
outlined  with  a  white  ring  mergmg  into  the  surrounding 
normal  tissue.  This  case  deviated  from  former  de- 
scriptions in  so  much  that  all  former  histories  tell  us 
that  these  tubercles  are  usually  disseminated  in 
groups  over  the  body  or  in  circinate  plaques,  while 
Nobl's  case  is  universal.  The  disease  seems  to  have 
commenced  acutely  about  the  fourth  month  of  life. 
The  first  place  of  appearance  was  the  trunk,  whence  it 
radiated  over  the  Umbs,  &c.     No  burning  or  itching,. 


690    The  Medical  Press. 


THE    OPERATING   THEATRES. 


Dbc.  28,  1901. 


nor  excoriation  appear  to  have  been  present  at  any 
time  in  its  history,  therefore  no  general  disturbance, 
Thachitis,  or  other  changes  were  noted. 

Tilbury  first  described  this  disease  in  1875  as  xan- 
thelasma, from  its  clinical  appearance,  although  he 
found  it  in  many  cases  associated  with  urticaria,  and 
presumed  that  the  efflorescence  might  be  due  to  some 
uritant  of  the  vaso  motor  centres.  It  commences  usually 
a  few  days  after  birth,  and  continues,  in  spite  of  every 
remedy  yet  tried,  for  twenty  or  thirty  years. 

Unna  examined  the  morbid  growths  histologically  in 
1887,  and  found  the  brown  coloration  to  be  a  deposit 
•of  fine  granular  melanotic  pigment  in  the  basal  rete 
mucosa,  and  subepithelium  of  the  cutis.  The  eleva- 
tions, tubercles,  and  plaques  were  caused  by  oede- 
ma tons  swelling  in  the  papillary  bodies,  but  more  par- 
ticularly owing  to  the  aggregation  of  Ehrlich's  giant- 
cells  in  the  papillae.  It  has  now  been  conclusively 
proved  that  these  giant-cells  are  pathognomonic  of 
the  morbid  process  which  is  now  presumed  to  depend 
•on  an  angio-neurotic  condition. 

Ehrmann  thought  the  presumption  of  irritation 
•clinically  failed  in  this  case,  as  no  irritation  seems  to 
have  been  present  at  any  time  of  its  history.  He  did 
not  scruple  to  accept  an  angio-neurosis,  but  to  his 
mind  the  symptoms  did  not  justify  an  irritative  origin. 
The  giant -cells  might  be  the  product  of  some  toxic  in- 
fluence and  probably  the  real  cause  of  the  disease. 
Chronic  Entero-stenosis. 

Ewald  brought  forward  a  child  on  whom  he  had 
-operated  for  cicatricial  stricture  in  the  lower  part  of 
the  jejunum.  The  central  cicatrix  was  the  result  of 
tubercle.  Above  the  stenosis  there  was  great  dila- 
tation but  very  little  hypertrophy,  while  below  the 
bowel  was  empty  and  contracted.  In  the  region  of 
the  ileo-caecal  valve  a  second  stricture  was  present, 
wnich  was  resected  also.  The  physical  conditions  were 
similar  to  the  above,  i.e.,  above  the  stricture  great 
dilatation  was  present,  but  no  hypertrophy,  which  is 
usually  present  above  obstructions.  From  these  facts 
he  attempted  to  evolve  the  principle  that  when  we 
meet  with  an  obstruction  with  dilation  above  and  no 
hypertrophy,  diligent  search  should  be  made  for  other 
obstructions  in  the  bowel  as  in  the  case  presented. 

Dunoatn?* 

[from  our  own  correspondent.] 


,  1004. 


BuoApnT,  December  24th, 
Heart  Syphilis. 

In  the  current  number  of  the  Gyoeyasxat,  two  cases 
of  heart  syphilis  are  described  by  Hartge  : 

Case  I. — A  clerk,  aet.  48,  had  suffered  for  several 
years  from  cardiac  pain  radiating  down  the  arm,  when 
he  suddenly  became  unconscious  and  was  apparently 
moribund.  He  was  revived  with  stimulants,  but 
suftered  from  attacks  of  excruciating  pain  for  weeks, 
for  which  morphine  injections  were  required.  The 
•cardiac  physical  signs  were  normal ;  the  pulse  was 
intermittent,  but  varied  in  frequency.  As  there  was 
a  history  of  a  penile  sore  for  which  he  had  taken 
•calomel  internally  thirty  years  previously,  and  of  his 
wife  having  had  several  abortions,  but  no  full-term 
•children,  he  was  treated  with  inunctions  of  blue  oint- 
ment and  iodides  internally.  Improvement  was  slow, 
but  a  year  later  he  could  resume  his  business,  the  pain 
had  ceased,  and  the  pulse  scarcely  varied  in  frequency  ; 
arterio-sclerosis  could  be  excluded  as  there  were  no 
signs  of  it  and  the  improvement  was  permanent. 

Case  II. — A  merchant,  aet.  42,  had  syphilis  at  22, 
for  which  he  was  most  carefully  treated.  Ten  years 
later  he  had  cardiac  pain  radiating  down  the  left  arm, 
which,  as  there  were  no  physical  signs,  w^as  attributed 
to  hypochondriasis.  The  patient,  how^ever,  applied 
.anti-syphilitic  remedies  and  was  cured.  On  two  sub- 
sequent occasions  this  history  was  repeated.  On  the 
last  occasion  the  symptoms,  which  consisted  of  a 
feeling  of  oppression,  insomnia,  constipation,  and 
Anginal  attacks,  for  which  morphine  was  required,  did 


not  disappear  till  some  months  after  a  course  of  ma- 
cury  and  iodides.    The  patient  is  now  quite  welL 
Urticaria  from  Odours. 

An  unusual  case  which  has  defied  treatment  may 
here  be  recorded  :  A  man,  aet.  26,  of  a  naturally  im- 
table  and  nervous  temperament,  presented  himself  at 
the  clinic.  Eleven  years  previously  he  had  had  ade- 
noids in  the  naso-pharynx,  which  were  cured  by  open- 
tion.  He  never  could  endure  the  perfume  of  can  de 
Cologne,  musk,  patchouli,  and  other  toilet  scents,  asd 
could  not  enter  a  barber's  shop,  as  these  odouis  always 
produced  severe  migraine.  He  became  a  liqnesr 
manufacturer,  and  remained  one  day  for  two  or  that 
hours  in  the  "  laboratory."  Headache,  giddiness,  and 
syncope  ensued.  On  being  removed  he  sneezed 
violently  and  was  troubled  with  abundant  nasal  dis- 
charge. His  face  then  swelled  and  the  whole  body  was 
covered  with  an  urticairial  eruption  accompanied  by- 
burning  sensations  and  great  itching.  Similar  sym- 
ptoms followed  other  attempts  to  remain  in  the  labora- 
tory and  appeared  to  be  always  provoked  by  the  per- 
fumes of  aniseed,  peppermint,  fennel,  coriander,  and 
other  aromatic  substances.  Examination  of  the  nose 
showed  nothing  abnormal,  except  slight  swelling  over 
the  right  inferior  turbinated  bone.  There  was  no 
hyperaesthesia.     All  treatment  proved  futile. 

Dr.  Hiilth  Hum6r  related  cases  of 

Syphilis  of  the  Thyroid   Gland. 

The  cases  fell  into  two  groups  : — 

Group  I. — Acute  syphiUs  with  enlargement  of  the 
thyroid  (thyroiditis  parenchymatosa  sy'philitica). 
There  is  a  diffuse  enlargement  of  the  gland,  due  to 
acute  parenchymatous  inflammation  such  as  occoxs 
in  the  liver,  spleen,  &c. 

Group  II.— This  group  is  found  in  congenital  and 
tertiary  syphilis.  There  are  two  varieties  sharply  dis- 
tinguished from  each  other. 

(a)  Thyroiditis  interstitialis  syphilitica.  Only  two 
cases  are  on  record.  In  one  the  syphilis  caused 
myxoedema,  which  rapidly  disappeared  under  anti- 
specific  treatment.  In  the  second  a  tumour,  the  sia 
of  the  fist,  was  thought  to  be  malignant.  Compfetc 
excision  was  impossible.  Microscopic  examination  re- 
vealed its  benign  character.  The  patient  had  ac- 
quired syphilis  many  years  previously.  Under  treat- 
ment with  potassium  iodide,  the  tumour  completely 
disappeared  in  three  weeks. 

(h)  Gumma  glandulae  thyroideae.  Several  cases 
have  been  observed  in  children,  the  subjects  of  here- 
ditary syphilis.  The  writer  records  a  case  of  acquired 
syphilis.  A  man,  aet.  58,  had  carcinoma  of  the  larynx 
and  benign  tumour  of  the  thyroid.  Tracheotomy  was 
performed  on  account  of  dyspnoea  and  cyanosis.  To 
reach  the  trachea,  the  enlarged  thyroid  was  divided 
with  Paquelin's  cautery.  There  was  much  haemor- 
rhage, and  the  patient  developed  acute  bronchitis. 
After  three  months'  treatment  with  potassium  iodide, 
the  enlargement  entirely  disappeared. 

XTbe  ^petatind  XCbeattes* 

NORTH-WEST  LONDON  HOSPITAL. 
Operation  for  Chronic  Nasal  Catarrh  of  Eleven 
Years'  Standing. — Mr.  Mayo  Collier  operated  on  a 
boy,  aet.  15 J,  the  subject  of  chronic  nasal  catarrh  with 
snuffling  and  mouth-breathing  for  the  last  eleven  years. 
The  mother,  who  accompanied  the  boy  to  the  hospital, 
stated  that  as  long  as  she  could  remember  her  sou  had 
perpetual  cold  in  the  head,  running  from  the  nose,  and 
cough,  more  especially  at  night  and  in  the  momixtg. 
In  fine  and  dry  weather,  for  a  few  weeks  at  a  time,  he 
was  more  or  less  free  from  cold  in  the  head,  but  on  the 
slightest  provocation  his  nose  becam.e  almost  com- 
pletely stopped  up,  necessitating  the  freqnent  use  of  a 
handkerchief.  The  boy  complained  of  headaches  and 
disinclination  to  follow  his  studies  or  to  indulge  in  the 
ordinary  games  that  most  boy«  are  pleased  with.    Mr. 


Dec.  28,  1904. 


LEADING   ARTICLES. 


The  Medical  Press.    69X 


Collier  pointed  out  that  at  his  first  examination  he  was 
surprised  to  find»  with  a  history  such  as  had  been  related, 
that  the  arch  of  the  teeth  and  the  position  of  the  palate 
were  scarcely  at  all  afiected  ;  as  a  matter  of  fact,  the 
maxillary  arch  was  particularly  well  formed  and  the 
teeth  well  shaped  and  well  grown,  and  in  perfect 
symmetry.  The  arch  of  the  palate  was  an  example 
of  what  an  arch  should  be,  and  the  whole  of  the  upper 
jaw  was  well  developed,  and  in  keeping  with  the  rest  of 
the  face.  One  would  have  expected,  he  said,  that  with 
a  history  of  nasal  obstruction  for  eleven  years  the 
maxillary  arch  would  have  been  disarranged  and  the 
palate  high  and  V-shaped.  The  more  or  less  continuous 
nasal  obstruction  could  only,  he  thought,  have  been  of 
recent  date,  otherwise  the  palate  and  the  whole  upper 
jaw  must  have  suffered  severely.  Mr.  Collier  further 
remarked  that  the  state  of  the  nose  and  of  the 
posterior  nasal  space  was  typical  of  the  condition  of 
chronic  nasal  catarrh.  The  mucous  membrane  of  the 
vrhole  nasal  cavity  was  hypertrophic  and  congested, 
and  the  lower  turbinal  bodies  on  both  side  were  com- 
pletely occluding  the  lower  meatus.  There  was  little 
doubt,  he  said,  that  the  post -nasal  space  was  full  of 
adenoid  vegetations,  which  would  be  easily  inferred 
from  the  elevations  present  on  the  oro-pharynx.  He 
proposed  not  only  to  remove  the  vegetations  on  the 
oro-pharynx,  but  also  to  take  away  the  whole  of  the 
redundant  tissue  hanging  from  the  lower  border  of 
the  lower  turbinal  bodies.  The  patient  having  been 
angesthetised  with  chloroform,  Mr.  Collier  introduced  a 
long  straight  pair  of  serrated  forceps  in  each  lower 
meatus,  and  with  the  assistance  of  his  left  index  finger 
in  the  post-nasal  space  h*e  engaged  the  whole  of  the 
redundant  tissue  in  the  grasp  of  the  forceps  ;  these, 
then,  being  securely  locked,  a  few  twists  to  the  right 
and  left  were  sufficient  to  remove  the  tissue  in  question. 
Very  little  bleeding  followed  this  manoeuvre.  The 
same  operation  was  next  repeated  on  the  other  side. 
The  oro-pharynx  was  found  to  be  full  of  adenoid  vege- 
tations, and  these  were  removed  with  a  curette.  A 
good  deal  of  haemorrhage  followed  the  removal  of  the 
adenoid  vegetations,  but  the  pressure  of  a  sponge  in 
the  posterior  space  soon  controlled  it.  The  improved 
nasal  respiration  was  very  apparent  during  the  bleed- 
ing from  the  posterior  nasal  space,  blood  and  air  passing 
through  the  nasal  chambers  with  great  ease.  Mr. 
Collier  said  that  any  other  treatment  but  the  one 
adopted  was,  in  his  mind,  quite  futile  in  dealing  with 
such  cases. 

Operation  for  Recurrent  Polypi. — The  same 
surgeon  operated  on  a  woman,  aet.  45,  who  four  years 
ago  had  presented  herself  with  severe  asthma  and  nasal 
obstruction.  He,  on  that  occation,  removed  twenty- 
nine  polypi  with  the  effect  that  the  asthma  had  com- 
pletely subsided,  and  had  not  even  returned  with  the 
recurrence  of  the  polypi.  Mr.  Collier  demonstrated 
some  particularly  large  polypi  invading  the  vestibule 
on  each  side.  With  the  assistance  of  20  per  cent, 
solution  of  cocaine  and  adrenalin,  nine  of  these  were 
removed  so  as  to  restore  respiration  on  each  side.  He 
pointed  out  that  in  these  cases  it  was  not  advisable  to 
prolong  the  sitting  indefinitely  as  the  removal  of  the 
lower  polypi  made  room  for  others  which  would  be 
visible  at  a  subsequent  examination.  It  was  remark- 
able, he  thought,  in  this  case  that,  although  the  poljrpi 
had  returned,  the  asthma  had  not.  The  most  the 
patient  complained  of  was  a  troublesome  cough  at 
night  time  and  in  the  morning. 


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SALUS  POPULt  SUPSEMA  LEX." 


WEDNESDAY.  DECEMBER  28.  1904. 


UNAVOIDABLE       MISHAPS       FOLLOWING 
OPERATION. 
The  immense  impetus  that  the  discoveries  of 
general  anaesthetics  and  antiseptic  methods  have 
given  to  surgical  operations  has  doubtless  enlarged 
the  scope  of  the  benefits  derivable  from  medical 
science  to  a  degree  undreamt  of  by  practitioners 
of  the  early  part  of  last  century,  and  without 
attempting  to  minimise  the  good  that  has  accrued 
to  humanity  at  large  by  early  and  more  extensive 
operations,  it  is  well  to  bear  in  mind  that  there  are 
still  certain  opprohria  medicinal,  or,  more  strictly,. 
opprohria  cAt>urg»cc, which  have  yet  to  be  removed. 
So  little  risk  now  attends  operations  conducted 
secundum  artem,  that  the  surgeon,  in  a  case  pre- 
senting difl&Gulty  in  diagnosis,  does  not  hesitate 
to  open  the  abdomen  or  cut  down  on  a  tumour^ 
in  order  to  solve  the  problem  by  direct  inspection. 
Compound  fractures,  once  the  most  dreaded  class, 
of  injuries,  are  now  regarded  so  light-heartedly 
that  simple  fractures,  such  as  those  of  the  patella 
and  olecranon,  are  exposed  and  wired  without 
anxiety,   and   almost  every  week  fresh  surgical 
procedures  are  planned  and  carried  out  for  the 
reUef  of  symptoms  that  are  merely  uncomfortable, 
and  detract  but  Uttle  from  the  enjoyment  of  life. 
At  the  same  time  the  light-heartedness  with  which 
the  surgeon  takes  his  scalpel  in  hand  occasionally 
receives  a  rude  shock,  not  so  much  from  any  want 
of  skill  or  prescience  on  his  part,  as  from  the 
occurrence    of    some    unlooked-for    eventuality 
which  he  is  at  a  loss  to  explain  even  when  it  has 
happened.     Some  of  these  regrettable  calamities 
were  dealt  with  by  Richardson,  of  Boston,  in  a 
recent  paper  read  before  the  American  Surgical 
Association,   and  what   is   true   of   his   country, 
where    operative    surgery  has    attained    such    a 
high  degree  of  evolution,  is  unfortunately  no  less 
true  of  the  same  art  in  the  British  Isles.     In  the 
first  place,  he  asks  very  pertinently,  can  septic 


6g2    Thb  Medical  Press. 


LEADING  ARTICLES. 


Dec.,  28  1904. 


infection  always  be  avoided  ?  Theoretically,  of 
course,  it  should  be,  but  even  in  the  modern 
temple  of  asepsis,  which  no  hospital  is  content  to 
be  without,  infection  of  deliberate  wounds  does 
occur,  and  though  the  surgeon  very  justly  regards 
such  'an  event  as  a  reproach  on  his  ischnique, 
it  may  be  taken  for  granted  that  while  man  re- 
mains fallible,  breakdowns  of  this  character  will 
continue  to  happen.  Even  though  the  conditions 
of  operation  be  approximated  as  closely  as  possible 
to  those  of  a  bacteriological  experiment,  there  are 
certain  factors  that  cannot  always  be  eliminated, 
and,  granted  that  it  is  possible,  and  it  is  always 
possible  by  aerial  contamination  for  germs  to 
reach  a  wound,  the  injury  to  parts  entailed  by  the 
operation,  and  the  impaired  vitaUtyi'of  the  tissues 
from  cachexia  or  ill-health,  will  at  times  deter- 
mine a  suppuration  which  will  cause  unpleasant 
■surprise  when  the  dressings  are  removed.  As 
with  suppuration,  so  with  haemorrhage.  Modern 
instruments  and  resources  are  theoreticallly  as 
<:apable  of  abolishing  risk  from  haemorrhage 
as  asepticism  is  that  from  infection,  but  without 
reckoning  these  instances  in  which  oversight  or 
technical  difficulties  have  allowed  a  vessel  to  pass 
unsecured,  there  is  a  proportion  of  cases  in  which 
-as  far  as  our  present  knowledge  goes,  post-opera- 
tive haemorrhage  may  be  said  to  be  inevitaUe. 
Richardson  instances  the  tendency  to  haemorrhage 
exhibited  by  jaundiced  persons  who  come  under 
operation  for  the  relief  of  obstruction  to  the  gall- 
•  ducts  ;  three  such  cases  he  has  had  in  which, 
the  patient  died  from  uncontrollable  capillary 
haemorrhage,  besides  one  similar  death  in  a 
case  where  at  the  time  the  operation  was  under- 
taken a  biliary  fistula  existed,  and  there  was  no 
jaundice.  Richardson  always  tries  for  some  time 
before  undertaking  an  operation  on  jaundiced 
patients  to  promote  the  coagulability  01  the  blood 
'by  giving  ox-gall,  fruit-acids,  and  calcium  chloride, 
but  he  has  not  found  these  means  always  effica- 
cious, and  he  consequently  writes  down  a  certain 
number  of  deaths  from  haemorrhage  after  gall- 
bladder operations  as  unavoidable.  Then,  too, 
with  regard  to  the  fortunately  rare  cases  in  which 
hysterectomy  is  followed  by  complete  suppression 
of  urine,  there  seems  to  be  a  proportion  of  instances 
in  which  no  amount  of  foresight  or  care  can  ob- 
viate this  risk.  When  the  kidneys  are  diseased, 
the  surgeon  should  take  care  to  ascertain  the  fact 
before  operating,  as  death  in  such  cases  is  to  be 
apprehended,  or,  at  least,  feared,  but  even  when 
the  kidneys  are  demonstrably  healthy  h)rsterec- 
tomy  sometimes  is  followed  by  suppression  of  urine, 
and  no  adequate  explanation  is  forthcoming  post- 
mortem. But  the  most  common  cause  of  un- 
.  avoidable  death  after  operation,  and  the  one  that 
causes  both  surgeon  and  relatives  the  greatest 
shock,  is  pulmonary  embolism,  and  this  occurs 
always  almost  without  preliminary  signs  of  phle- 
bitis. It  is  principally  after  extensive  dissections 
in  the  female  pelvis  that  phlebitis  occurs,  and  then 
generally  in  the  veins  of  the  left  lower  limb.  Un- 
pleasant  and   irksome    as   this    complication   is. 


happily  it  generally  subsides  without  giving  ii» 
to  untoward  symptoms — ^that  is,  if  the  phlebit 
is    not    septic.     Ricjiardson,     in    five    tlx>vsaae 
abdominal  operations,  has  never  seen  a    simi^ 
phlebitis  with  thrombosis  give  rise  to  a  pulmoBarv 
embolism,  but,  on  the  other  hand,  he  has  had  tb 
chagrin,  shared   by  other   surgeons,  of  seeing  a 
patient  making  a  typically  good  recovery  from  a 
severe  operation  on  the  uterus  or  the  appenda^ 
suddenly    carried   off    by    pulmonary    embohsiL 
Rare  though  these  unavoidable  cases  of  death  aftc 
operation  are,  they  have  to  be  seriously  weighed 
against  the   advantages   likely    to    accrue  before 
undertaking  or  advising  any  surgical  procedure  aa 
a  patient. 


NUMBERING  THE  PEOPLE. 
The  burden  of  the  white  man  becomes  a  vert 
real  factor  in  life  when  we  consider  our  imperial 
responsibilities.  Our  Empire  covers  some  twdve 
millions  of  square  miles,  just  one-fifth  of  the  sur- 
face of  the  earth  ;  and  the  forty-one  and  a  half 
million  people  in  the  United  Kingdom,  with  some 
few  million  white  men  in  Canada,  Australia  and 
South  Africa,  are  morally  responsible  for  the  wdl- 
being  of  over  three  hundred  and  thirty  milbons 
of  coloured  folk.  The  responsibility  rests  heavily 
upon  the  authorities,  more  especially  those  who 
are  concerned  in  the  matter  of  safeguarding 
pubhc  health  and  local  adhiinistration.  The  Censos 
of  1901  has  revealed  very  many  curious  facts, 
and  these  have  been  made  available  for  considera- 
tion and  comparison  by  the  recently  puUished 
General  Report  of  the  Commissioners.  It  woold 
appear  that  in  England  and  Whales  there  were 
36,444  men  and  10,426  women  eniplo3red  in  muni- 
cipal, parish  and  other  local  or  county  adminis- 
tration. This  shows  a  very  considerable 
progressive  increase,  for  in  i88r  there  vrttt 
rather  less  than  18,000  men,  and  only  a  littk 
over    3,000    women    so     employed.  By   1891 

these  numbers  had  risen  to  19,700  men  and 
a  little  over  5,100  women.  To  this  enumera- 
tion we  must  add  2,174  men  and  6  ivomen  engaged 
upon  the  making  and  upkeep  of  roadways,  as  weQ 
as  50,300  men  paviors  and  one  woman.  This  last 
item  shows  a  remarkable  progress,  for  in  1881 
there  were  only  15,097  men  so  engaged.  In  drain- 
age and  sanitary  service  there  were  7,189  men  and 
I  woman,  which  compares  only  with  1,363  men  in 
1 88 1.  .As  scavengers  and  crossing-sweepers  we 
find  8,478  men  and  1 10  women,  comparing  with 
2,694  men  and  174  women  in  1881.  This  is  a 
goodly  army  engaged  in  the  noble  work  of  good 
government  and  sanitary  improvement.  It  is  i 
well  to  know  that  in  spite  of  the  outcry  of  reac- 
tionaries the  number  in  these  services  are  stiH 
increasing,  and  by  comparison  this  is  notably  the 
case  as  regards  women.  There  is  a  laudable  ten- 
dency to  appoint  more  lady  sanitary  inspectors, 
and,  considering  the  overcrowded  condition  of  the 
slums,  this  is  a  very  necesssary  provision.  The 
Census  returns  confirm  the  statements  of  the 
Registrar-General  as  regards  the  prolongation  of 


Dec.  28.  1904. 


LEADING  ARTICLES. 


TH»  MlDICAL  PlBSS.      693 


^ife  and  the  fall  in  the  birth-rate  ;   but  this  latter 
<iefect  is  righting  itself,  at  all  events  so  far  as  re- 
gards England  and  Wales,  though  Scotland,  and 
especially    Ireland,    still    lag    behind.     The    dis- 
quieting fact  of  the  increase  in  the  number  of 
mentally  deficient  is  somewhat  discounted  when 
^we  reaUse  that  at  all  events  part  of  this  increase 
is  due  to  difference  of  classification,  and  more  par- 
■ticularly  to  the  text  of  the  wording  of  the  Census 
schedules.     Formerly,  heads  of  famiUes  were  re- 
quested to  give  returns  of  "  lunatics  "  and  "  idiots." 
In  1 90 1  this  was  softened  to  "  mentally  deficient," 
and  there  can  be  Uttle  room  for  doubt  that  this 
suavity  of  the  words  produced  a  nearer  approach 
to  the  truth.     Still,  the  fact  remains  that  at  the 
last  Census  4,393  persons  in   England  and  Wales, 
4,078  in  Scotland,   and  5,618  in  Ireland  for  every 
million  were   mentally  affected.     This   compares 
-with  3,552  in  England  and  Wales,  3,358  in  Scotland, 
ajid  4,504  in  Ireland  at  the  Census  of  189 1.    It  is 
also  notable  that  patients  in  asylums  have  vastly 
increased.     Turning  to  another  aspect  of  the  popu- 
lation, we  find  that  there  was  a  large  decrease  in 
the  number  of  bUnd.     The  fall  being  from  838 
persons  to  792  persons  per  miUion  inhabitants. 
We  may,  as  sanitarians,  take  credit  for  a  large 
share  in  this  decrease,  for  undoubtedly,  cleanli- 
ness is  one  of  the  great  preservatives  against  this 
calamity.     There    was    also    a    decrease    in    the 
number  of  deaf  and  dumb,  which  may,  although 
in   a  lesser   degree,   be   attributed   to   improved 
health  conditions.     There  is  a  lamentable  state  of 
-affairs  revealed  as  regards  poverty.     At  the  taking 
of  the  Census  it  was  found  that  one  in  every  131 
males,  and  one  in  every  190  females,  were  living  in 
workhouses  or  infirmaries.     This  shows  a  general 
increase. over  1891  of  55  per  cent.     The  greater 
number  of  men  is  partly  accounted  for  by  the  fact 
that  husbands  and  sons,   when  dangerously  ill, 
must,  almost  perforce,   go  into  the  infirmaries, 
but  women,  for  various  reasons,  are  more  often 
nursed  at  home.     It  was  found  that  the  greater 
number  of  men  were  classed  as  general  labourers  ; 
they  formed  rather  more  than  one-fifth  of  the  total 
male  population.     As  regards  women,  the  most 
numerous    class    were    domestic    servants,    who 
composed  nearly  one-fifth  of  the  female  workhouse 
population.     Turning  to  yet  another  aspect  ol  the 
returns,  we  find  in  some  of  the  industrial  centres  an 
increase  in  the  employment  of  very  young  boys,  and 
a  decrease  in  the  employment  of  men  above  middle 
age ;  it  would  seem  almost  as  if  we  had  here  some 
explanation  of  the  growing  pauperisation.     A  more 
pleasing  fact  is  that,  while  there  is  an  increase  in 
.  the  percentage  of  young  women  workers,  there  is  a 
slight  decrease  in  those  employed  about  marriage- 
able ages.     This  is  a  step  in  the  right  direction. 
We  must  leave  for  a  future  occasion  the  considera- 
tion of  that  most  difficult  of  problems,  the  concen- 
tration of  the  population. 

CONSUMPTIVES     IN     HOSPITALS. 
The  question  is  rapidly  coming  to  the  front 
whether  it  is  fair  to  the  inmates  of  general  hospitals 


to  expose  them  to  possible  turberculous  infection 
by  allowing  patients  suffering  from  pulmonary 
tuberculosis  to  occupy  the  same  wards  as  those 
suffering  from  other  diseases.  The  fact  that 
rooms,  clothing,  &c.,  can  be,  and  are,  rendered 
infective  by  prolonged  contact  with  consumptives 
no  longer  needs  demonstration,  and  already  many 
municipal  authorities  have  taken  steps  to  secure 
the  adequate  disinfection  of  such  premises,  the 
destruction  of  clothing,  &c.  If  it  be  admittedly 
dangerous  for  the  healthy  to  inhabit  rooms  in 
common  with  the  phthisical,  how  much  more 
dangerous  must  it  be  for  the  sick  in  hospital  ? 
Their  suffering  bodies  are  obviously  in  a  state 
of  morbid  receptivity,  or,  in  other  words,  of 
diminished  resistance,  and  it  is  impossible  to  deny 
that  the  presence  of,  it  may  be,  a  large  proportion 
of  tuberculous  patients  in  the  wards  must  create 
a  very  real  danger  for  them.  That  the  risk  should 
hitherto  have  escaped  practical  recognition  is  due, 
no  doubt,  to  the  fact  that  the  consequence  does 
not  follow  so  closely  on  the  cause  as  to  strike  the 
attention,  but  in  the  light  of  our  present  know- 
ledge the  reality  of  the  danger  cannot  much  longer 
be  ignored.  If  this  argument  should  hold  good 
for  the  inmates  of  general  hospitals,  how  much 
more  cogent  is  it  in  respect  of  hospitals  which 
receive  consumptive  patients  exclusively  ?  There 
the  infection  is  intensified,  and  they  turn,  so  to 
speak,  in  a  vicious  circle.  We  refer,  of  course,  to 
*'  closed  **  hospitals,  for  if  certain  precautions  are 
enforced,  the  open-air  sanatoria  do  not  participate 
in  this  reproach.  It  is  hardly  to  our  credit  that 
the  initiative  in  the  direction  of  the  segregation,  or 
shall  we  say  the  isolation  of  patients  afflicted  with 
pulmonary  tuberculosis  should  have  come  from 
France.  Yet  such  is  the  case,  for  we  read  that 
the  Extra-Parhamentary  Commission  appointed 
some  time  since  to  consider  how  best  to  circum- 
scribe the  ravages  of  this  disease,  has  rendered  a 
report  on  the  strength  of  which  the  Minister  has 
drawn  up  a  circular  to  be  sent  to  all  hospitals  and 
similar  institutions  throughout  the  country, 
urging  the  desirability  of  taking  immediate  steps 
for  separating  tuberculous  from  non-tuberculous 
patients.  The  wisdom  of  such  a  course  is  so 
obvious  as  to  dispense  with  the  necessity  for  argu- 
ments to  support  it.  We  are  aware  that  many 
diseases  constitute  a  *'  soil  of  predilection  "  for 
infection  by  the  tubercle  bacillus,  and  we  may  go 
a  step  further  and  assert  that  every  debiUtating 
disease — and  which  of  them  is  not  debilitating  ? — 
creates  a  passing  hability  to  tuberculous  infection. 
Chronic  malnutrition,  however  induced,  as  in 
diabetes,  rheumatism,  &c.,  materially  reduces 
the  vital  resistance  of  the  tissues,  especially  to 
tuberculosis.  Yet  we  continue  to  permit  a  morbid 
promiscuity  not  so  far  removed  from  that  of  the 
days  when  three  or  four  different  patients 
were  hnddled  into  one  hospital  bed.  We  have 
separated  the  beds,  but  we  have  only  reduced 
the  evil  in  degree  and  not  in  kind.  In  years  to 
come  our  successors  will  doubtless  look  with  as 
much  amazement  on  our  present  hospital  promis- 


694    The  Mbdical  Prb;ss.  NOTES    ON    CURRENT    TOPICS. 


cuity  as  we  do  on  that  of  our  predecessors.  The 
erection  of  sanatoria  is  one  step  in  the  specialisa- 
tion of  hospitals  from  this  point  of  view,  but  as 
the  accommodation  is  unlikely,  for  many  years 
to  come,  to  suffice  for  more  than  an  infinitesimal 
fraction  of  the  tuberculous,  it  behoves  us  to  pro- 
vide provisional  protection  to  the  tuberculous 
sick  unable  to  avail  themselves  of  the  advantages 
of  the  sanatorium.  When  we  consider  that  in 
France  45  per  cent,  of  the  in-patients  are  tubercu- 
lous, it  is  evident  that  the  problem  is  of  some  mag 
nitude.  One  solution  of  the  problem  in  town" 
where  there  are  several  hospitals  would  be  to 
allocate  one  or  more  of  the  buildings  exclusively 
for  this  purpose.  But  patients  evince  the  greatest 
objection  to  remain  in  such  special  institutions, 
preferring  the  general  wards  ;  moreover,  the  phj^i- 
cians  attached  to  the  particular  hospital  would 
probably  object,  to  the  monotony  of  ministering 
exclusively  to  the  phthisical.  On  the  whole,  the 
best  plan  for  the  present  would  seem  to  be  to  place 
apart  certain  wards  in  all  hospitals  for  the  recep- 
tion of  the  tuberculous  pending  arrangements 
for  relegating  them  to  cheap  buildings  in  the 
open  air,  far  away  from  towns — a  disposition 
which  has  the  advantage  of  being  as  beneficial 
for  the  sujSerers  as  it  is  hygienically  desirable. 

notes  on  Current  ICopfcs* 

Toilette  Bye  Drops. 
Anything  which  is  supposed  to  add  to  feminine 
charms  is  laid  under  contribution  in  these  days, 
quite  regardless  of  the  consequences  and  risks. 
Perhaps  one  of  the  most  reprehensible  and  danger- 
ous practices  in  connection  therewith  is  that  which 
makes  the  delicate  organ,  the  human  eye,  the 
medium  for  gratif3dng  vanity.  The  following 
characteristic  paragraph  appeared  in  a  recent  num- 
ber of  a  woman's  magazine  : — "  A  perfectly  safe 
and  successful  way  to  secure  the  beauty  of  eyes 

that  sparkle  is  to  put  a  drop  of  * *  eye  drops 

(price  5s.  6d.  a  bottle)  into  each  eye  before  going  to 
a  dinner,  a  dance,  or  any  other  function,  and  then 
to  take  the  bottle  with  one,  and  to  put  a  drop  with 
the  finger-«tip  into  each  corner  of  both  eyes  when 
in  the  cloak-room.  This  will  keep  them  bright 
the  whole  evening."  We  can  only  describe  the 
advice  here  given  as  in  the  highest  degree  worthy 
of  unqualified  condemnation.  To  tamper  with 
the  eyes  by  applying  to  them  drugs  which  are  sup- 
posed to  make  these  delicate  organs  spark- 
ling and  bright  is,  we  imagine,  a  practice  which 
would  hardly  appeal  to  persons  of  ordinary 
common  sense.  And  yet  it  is  grievous  to  have  to 
admit  that  there  are  persons  who,  for  the  time 
being,  cease  to  act  sanely  in  order  to  pander  to  the 
demands  of  vanity.  Vanity,  as  we  know,  stops 
at  nothing ;  among  some  women  it  becomes  a 
fetish,  which  dominates  their  whole  being,  and 
leads  them  into  paths  of  foolishness  and  wrong- 
doing, escape  from  which  is  generally  impossible 
without  the  payment  of  penalties — more  or  less 
severe.  So  far,  however,  as  the  promiscuous  appli- 
cation of  powerful  drugs  in  the  form  of  drops  to 


Dec  28,  1904. 

the  eyes  are  concerned,  every  medical  man  knovs 
that  such  a  practice  is  fraught  with  the  gravest  risk 
to  these  organs,  and  the  public  should  take  warn- 
ing that  harm  may  result  which  cannot  after- 
wards be  rectified. 


Influenza  Bampant. 
The  war  clouds  in  the  Far  Cast  are  having  a 
faint  but  distinctly  undesirable  reflex  in  the  Far 
West  in  the  shape  of  a  widespread  epidemic  d 
influenza.     It    may    be     doubted     whether    the 
malady  has  ever  been  marked  with  a  more  rampant 
aggressiveness  than  that  displayed  during  the  past 
five  or  six  weeks.     Fortunately  the  type  of  the 
disease  is   mild,  and  many  persons  may  be  sees 
following  their  daily  occupation   with  the  dole- 
fulness  of  this  most  depressing  disease  writ  large 
upon  their  features.     Needless  to  say,  any  patient 
who  goes  about  his  ordinary  business  -while  sofler- 
ing  from  influenza  is  running  a  great  and,  it  may 
be,  fatal  risk.     Rest  in  bed,  a  dose  of  quinine, 
nutritious  food  and  free  stimulation  are  the  best 
remedies,  as  all  practitioners   and   most  laymen 
have  by  this  time  learnt  to  recognise.     For  all  the 
comparative  mildness   of   the    present    type,  in- 
fluenza is,  nevertheless,  answerable   for  a  great 
number  of  deaths  in  the  United  Kingdom.     When 
the  long-continued  wave  of  infection  shall  ha,vt 
once  again  receded  from  our  shores,  it  will  be  fomid 
that  the  total  mortaUty  has  been  little  short  of 
that  experienced  in  a  great  national  war.    For 
all  that,  medical  science  may  rest  serenely  happf 
in  the  firm  persuasion   that   one    day  this  pre- 
ventable disease  will  be  prevented.      The  influenza 
bacillus  is  doomed  to  share  the  fate  of  the  mam- 
moth and  the  dodo  and  other  extinct  animals. 


A  Novel  Teet  for   Sobriety. 

Medical  men  generally,  and  police  surgeons  in 
particular,  are  frequently  called  upon  to  give  an 
opinion  on  the  sobriety  of  an  individual,  and  thev 
know  well  that  there  is  nothing  a  clever  counseT 
can  make  more  fun  of,  or  discredit  more  easily, 
than  evidence  as  to  drunkenness.      Unless  a  mas 
was  in  an  advanced  stage  of  alcoholic  poisonii^, 
it  is  always  possible  for  him  to  plead  afterwards  that 
he  was  ill,  or  mentally  distracts,  or  under  the  in- 
fluence of  some  other  drug  than  alcohol,  and— 
although  the  doctor  may  be  perfectly  certain  in 
his  own  mind  that  drink  was   the  cause  of  the 
trouble,  it  is  very  diflicult  to  make  the  evidence 
sound  convincing  to  an  unsympathetic  court.    He 
may  have  appUed  the  time-w<MTi  tests  of  "  British 
constitution  "  and  **  mixed  biscuits  "  and  satisfied 
himself  that  the  failure  of  the  prisoner  to  tackle 
these  *'  tongue-twisters  **  was  the  result  of  inco- 
ordination of  the  vocal  muscles,  but  a  lenient  bench 
do  not  alwa}^  find  these  tests  conclusive.    A  novel 
and    interesting    experiment    was  introduced  by 
Dr.  Rigby  into  the  examination  of  an  accused  man 
at  Chorley  the  other  day.     Dr.   Rigby  had  nin 
through  the  gamut  of  ordeals   for  drunkenness 
without  arriving  at  a  result  satisfactcMry  to  his  own 
mind,  although  the  prisoner  was  able  to  carry  a 
full   glass  of  water  across   the    room   and  back 


Dec.  28.  1904. 


NOTES    ON    CURRENT    TOPICS.  The  Medical  Press.    695 


without  spilling  more  than  a  few  drops  at  the  turn. 
The  poUceman  was  sure  the  man  was  druijk  from 
"  the  gleam  in  his  eye,"  so  Dr.  Rigby  evolved  a 
final  and  extempore  test  by  making  the  accused 
read  a  copy  of  the  Education  Act.  He  accom- 
plished this  task  with  such  a  command  of  phrase, 
and  such  a  degree  of  scholarship,  that  the 
magistrates'  hearts  melted  when  they  heard  of  it, 
and  they  accepted  the  prisoner's  view  of  his  own 
case.  The  Education  Act  has  been  the  cause  of 
much  vituperation  and  has  had  many  unkind 
things  said  about  it,  but  if  it  can  ward  off  con- 
victions for  drunkenness  it  is  likely  to  be  cherished 
in  a  good  many  homes. 


The  Conf  errinfir  of  Honorary  Dem^ee  on 
Sir  F.  TrevcNS  and  Major  Ronald  Boss. 

The  Senate  of  Dublin  University,  at  its  last 
meeting  conferred  the  honorary  degrees  of  Master 
of  Surgery  and  Doctor  of  Medicine  on  Sir  Frederick 
Treves,  C.B.,  Surgeon-in-Ordinary  to  the  King, 
and  of  Doctor  in  Science  on  Major  Ronald  Ross. 
The  PubUc  Orator  was  most  happy  in  the  Latin 
speeches  in  which  he  introduced  the  recipients  of 
the  degrees.  "  To  Sir  Frederick  Treves  principally, 
as  Serjeant  Surgeon-in-Ordinary  to  the  King,  is 
attendance  on  his  Majesty  entrusted,  as,  of  old, 
attendance  on  the  Emperor  Augustus  was  assigned 
to  Antonius  Musa.  You  all  remember  the  grati_ 
tude  and  uplifting  of  heart  with  which  not  only  we, 
the  subjects  of  his  Most  Gracious  Majesty,  but 
almost  the  whole  world,  rejoiced  at  the  happy 
result  of  this  eminent  surgeon's  skill,  when  the  head 
and  main  pillar  of  the  State  was  endangered,  and  it 
was  uncertain  whether  that  august  brow  was  to 
wear  the  covering  of  death  or  the  royal  crown. 
Formerly,  too,  in  the  South  African  war,  this  great 
surgeon  had  shown  with  marked  success  his  bene- 
ficent and  salutary  skill."  The  reference  to  Major 
Ross  was  no  less  happy,  and  ran  as  follows  : — "  The 
serious  mortality  caused  by  those  minute  yet  deadly 
parasites,  called  plasmodia  by  scientific  men,  is 
well  known  ;  nor  can  any  more  righteous  war  be 
waged  than  that  against  those  microscopic  Hydras 
which  germinate  in  their  myriads  throughout  our 
frame.  In  this  war  a  most  brilliant  victory  has 
been  gained  by  Ronald  Ross,  a  man  of  the  most 
varied  and  striking  gifts.  Formerly  a  distin- 
guished major  in  the  Indian  Medical  Service,  he 
has  also  won  success  as  a  profound  mathematician, 
an  admirable  noveUst,  a  dramatist  of  no  mean  order, 
and  now  is  one  of  the  most  eminent  of  Professors 
in  Tropical  Medicine.  It  has  been  supposed  that 
malaria  arose,  as  Lucretius  says  : — 

When  soaked  with  drenching  rains  the  wide 

earth  streams. 
Corruption  breeding  'neath  the  sun's  fierce 

beams. 

But,  entering  on  a  new  and  unerring  path  of  in- 
vestigation, this  great  man  has  shown  with 
brilliancy  and  certainty  that  the  seeds  of  that  dis- 
ease are  carried  broadcast  by  mosquitoes,  so 
that  in  numberless  cases  whomsoever  those  noxious 
creatures  bite,  they  not  merely  bite,  but  infect  with 


poison.  And  so.  it  has  come  to  pass  that  by  his 
aid  we  can  clearly  learn  in  what  way  to  avoid  this 
most  grievous  malady."  The  University  is  to  be 
congratulated  on  the  choice  of  the  two  eminent 
members  of  the  medical  profession  whom  it  has- 
selected  for  honour. 


"  Harvey  LewisT'  Memorial  HoepitaL 

According  to  our  lay  contemporaries,  the  sum 
of  ;f8o,cxx>  has  been  recently  left  by  a  charitable 
devisor  for  the  ultimate  purpose  of  founding 
another  hospital  in  Dublin.  While  we  quite  re- 
cognise that  such  a  munificent  bequest  for  chari. 
table  purposes  is  worthy  of  the  highest  praise,  we 
are  compelled  to  express  our  regret  that  the  devisor 
was  not  better  advised.  We  beUeve  that  our 
readers  will  agree  that  while  one  of  the  chief  needs 
of  Dubhn  in  the  direction  of  charity  is  the  provision 
of  greater  funds  for  the  existing  hospitals,  the  last 
thing  required  is  the  creation  of  a  new  hospital. 
To  put  the  present  state  of  affairs  concisely,  build- 
ings are  plentiful,  but  annual  income  is  small.  If 
in  the  present  case  this  magnificent  sum  had  been 
apportioned  between  the  large  Dublin  hospitals, 
the  benefit  would  have  been  incalculable.  As  it 
is  at  present  apportioned,  it  merely  means  that 
an  insufficient  sum  will  be  spent  in  unnecessary 
bricks  and  mortar,  and  that  another  hospita 
will  be  created  to  vie  with  those  at  present  existing 
in  appeals  to  the  charitable. 


The  Sufirarinff  of  Wine. 

All  that  glitters  is  not  gold,  and  not  all  so- 
caUed  wines  are  the  fermented  juice  of  the  crushed 
grape.  It  is  easy  and  economical  to  manufacture 
a  palatable  Uquid  from  dried  raisins  which«  in 
skilled  hands,  closely  approximates  real  wine  in 
appearance  and  taste.  During  the  last  few  years 
however,  the  production  of  wine,  particularly 
in  Algeria,  has  been  so  abundant  that  it  has  hardly 
been  worth  while  to  employ  the  comparatively 
expensive  raisins,  but  wine-growers  in  France  are 
up  in  arms  against  another  form  of  sophistication 
which  interests  us  as  consumers.  This  consists 
in  the  employment  of  sugar,  either  to  reinforce 
wines  that  are  deficient  in  alcohohc  strength,  or  for 
the  purpose  of  "  making  "  wine  by  pouring  water 
on  the  residues  after  the  expression  of  the  true 
wine  ;  this,  duly  fortified  with  sugar,  is  allowed 
to  ferment,  and  so  the  unscrupulous  grower  gets  a 
second  drop,  so  to  speak.  From  the  point  of  view  of 
health,  the  practice  is  probably  attended  by  little 
risk  in  spite  of  the  specious  arguments  advanced 
by  those  who  desire  to  see  it  put  a  stop  to.  But 
it  is  none  the  less  a  distinct  fraud  on  the  public, 
and  what  is  more  to  the  point,  the  revenue  in 
France  is  thereby  defrauded  of  its  due,  since  the 
additional  alcohol  thus  added  to  the  wine  escapes 
taxation.  Wine  is  so  plentiful  in  many  parts  that 
it  is  sold  at  three  halfpence  a  quart,  and  the  market 
is  glutted  even  at  this  price.  One  can  understand, 
therefore,  that  wine-growers  resent  unscrupulous 
dealers   being   allowed   to   enhance   the   existing 


696    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


Dec.  28.  1904. 


stagnation  by  artificial  means,  and  as  they  are  an 
influential  body  we  are  justified  in  hoping  that  all 
the  wine  imported  to  England  will,  in  the  near 
future,  be  the  unsophisticated  juice  of  the  grape. 

Medical  Report  on  the  Boer  War. 

The  quaUty  which  is  designated  in  parliamentary 
circles  "  indecent  haste  "  certainly  has  not  charac- 
terised the  publication  of  the  medical  report  on 
the  South  African  war,  for  it  only  put  in  an  appear- 
ance last  week,  and  even  now  it  is  far  from  com- 
plete. The  task  of  preparing  it  has  truly  been  a 
herculean  one,  and  it  cannot  be  said  that  Surgeon- 
General  Sir  William  Wilson  and  his  staff  have 
shirked  their  work.  Still  it  is  not  unreasonable 
to  suppose  that  with  a  Uttle  organisation  and 
equipment  the  report  might  have  been  issued 
some  considerable  time  back,  and  we  suppose  that 
the  fixed  miUtary  principle  of  cutting  the  Medical 
Department  down  to  the  severest  Umits  lies  at  the 
root  of  the  long-drawn-out  delay.  Coming  as  it 
does  years  after  popular  interest  in  the  events  of 
the  war  and  the  popular  indignation  at  the  break- 
down of  the  medical  arrangements  have  subsided, 
we  fear  that  it  will  do  little  to  clear  the  personnel 
of  the  medical  staff  from  the  blame  so  freely  at- 
tached to  them  at  the  time ;  but  if  people  will  take 
the  trouble  to  read  the  report  now  that  it  is  pub- 
lished, they  will  find  that,  whoever  was  to  blame, 
it  was  not  the  Director-General  and  his  colleagues. 
Medical  men  who  are  acquainted  with  the  scanda- 
lous shortage  of  officers  in  the  Royal  Army  Medical 
Corps  long  before  the  war  broke  out  had  over  and 
over  again  predicted  a  catastrophe  when  the  strain 
of  active  service  was  experienced,  and  it  is  only 
fair  to  say  that  the  predictions  were  nullified  solely 
by  the  unceasing  devotion  to  duty  of  the  army 
doctors  themselves.  But  although  an  a^ctual 
catastrophe  was  avoided,  a  very  serious  break- 
down occurred,  and  how  it  all  came  about  may  now 
be  read  in  the  official  report.  The  one  bright  spot 
that  shines  all  through  the  Blue  Book  is  the  fact 
that  under  conditions  of  storm  and  stress  the  offi- 
cers and  men  of  the  Royal  Army  Medical  Corps 
acted  up  to  the  highest  traditions  of  a  service 
whose  motto  is  self-sacrifice,  and  whose  reward 
principally  consists  in  the  possession  of  the  mens 
£onscia  recti. 


Neurasthenia* 
It  is  not  often  that  a  man  assumes  in  public 
the  rdle  of  iconoclast  of  the  images  made  by  his 
own  hands.  Yet  this  seems  to  be  the  position  of 
Dr.  Charles  Dana  in  regard  to  the  disease  **  neuras- 
thenia,*' which  owed  its  name  audits  recognition 
as  a  clinical  entity  to  him  in  association  with  Dr. 
Beard.  In  a  paper  recently  read  before  a  New 
York  audience  (a)  he  declares  that  the  word  has 
become  so  misapplied  that  in  the  near  future  it  is 
bound  to  disappear  from  the  terminology  of  accurate 
diagnosis.  At  the  time  of  its  introduction  the 
word  gave  greater  definiteness  to  a  group  of  clinical 
phenomena  which  had  formerly  been  referred  to 

(a)  Mediaal  Nei^-i,  Ostober  8th,  1904. 


under  the  vaguest  terms — "  the  vapours,"  "  hypo- 
chondria," "  the  spleen,"  "  liver  troubtes," 
and  so  on.  Nowadays,  however,  it  only  serves  to 
cloak  diseases  and  conditions  which  deserve  dis- 
tinctive names,  and  it  causes  confusion  by  groap- 
ing  together  neuroses  and  psychoses.  Indeed, 
according  to  Dana,  the  great  majority  of  the  cases 
passing  under  the  name  "  neurasthenia  "  are  psy- 
choses  of  one  sort  or  another,  being  most  commonly 
mild  forms  of  melancholia.  For  instance,  the 
**  queemess  "  of  young  persons  who  lose  interest 
in  their  work  and  in  the  things  in  which  their 
fellows  are  accustomed  to  be  interested  has  com- 
monly been  described  as  **  neurasthenia,"  whereas 
it  is  in  reality  a  form  of  the  insanity  of  adolescence. 
On  the  other  hand,  there  are  some  conditions  of 
purely  ph3rsical  and  non-nervous  orig^  which  have 
been  confused  with  neurasthenia.  For  instance, 
the  **  status  lymphaticus  "  of  young7people  gives 
rise  to  a  phlegmatic  condition  which  has  often  been 
mistaken  for  it,  and  in  the  old  a  lethargy,  the  result 
of  arterio-sclerosis,  has  caused  similar  error. 
The  word  "  neurasthenia,"  according  to  one  of  its 
authors,  has  fulfilled  its  function  in  the  develop- 
ment of  knowledge,  and  may  be  allowed  to  dis- 
appear. 


DrauffhtB  in  Railway  Carriaffes. 

Fashionable  and  healthy  as  is  the  desire  for 
fresh  air,  there  is  one  form  of  fresh  air  whicb 
medical  science  is  not  required  to  inform  people 
is  injurious,  for  it  is  abundantly  obvious  to  ever\' 
man  of  common  sense.  We  mean  draughts. 
The  chiUing  of  one  area  of  the  body  whilst  the  rest 
of  the  surface  retains  its  normal  heat  is  not  only 
uncomfortable,  but  dangerous.  Such  chills  usoallr 
afiect  the  head  and  neck,  because,  being  uncovered, 
they  are  most  exposed  to  the  influence  of  draughts 
and  currents  of  cold  air.  Among  minor  ills  thus 
produced,  tooth-ache,  neuralgia  and  torticollis 
are  perhaps  the  commonest,  but  facial  paralysis, 
which  may  even  remain  permanent,  is  not  in- 
frequently seen  in  those  who  have  fallen  askq) 
with  cold  air  playing  on  one  side  of  the  face. 
Of  all  places  the  one  in  which  it  is  most  difficult 
to  avoid  draughts  is  the  railway  carriage,  and 
though  con:ifort  in  travelling  has  greatly  increased 
during  the  last  few  years,  but  little  has  been  done 
to  make  the  average  railway-carriage  a  place 
where  pure  air  can  be  breathed  without  draughts 
being  created.  The  northern  railway  com- 
panies have  improved  on  the  old  hot  water-tin 
as  a  carriage  warmer,  but  the  steam-heated 
carriage  is  nearly  always  stuffy,  and  the  southera  ■ 
lines,  for  the  most  part,  have  taken  little  trouble 
with  regard  to  either  warming  or  ventilation.  A 
correspondent  of  the  Times  suggests  a  method  of 
keeping  the  rush  of  air  created  by  the  train  from 
entering  the  carriage  of  such  simplicity  that  we 
wonder  it  has  not  been  tried  long  before.  It 
consists  in  placing  a  board  four  inches  in  width 
to  project  wing-wise  outside  and  in  front  of  the 
carriage  windows.  The  correspondent  alluded  to 
claims  that  by  this  means  the  carriage-windows 


Dbc.  28,  1904. 


NOTES   ON   CURRENT   TOPICS. 


The  Medical  Press.   697 


can  be  opened  to  any  desired  degree  without  any 
draught  being  felt  by  the  passengers.  We  have 
not  tried  the  experiment  ourselves,,  but  it  sounds 
perfectly  reasonable  in  principle,  and  if  it  is  as 
effective  in  practice  as  it  seems  hkely  to  be  the  rail- 
way companies  should  surely  have  no  excuse  for  not 
adopting  it.  A  long  railway  journey  in  the  cold 
season  of  the  year,  especially  to  people  not  accus- 
tomed to  travelling,  is  a  severe  menace  to  health, 
and  it  is  little  less  than  monstrous  that  this  should 
be  so  at  the  present  day. 

Scientific  Besearch  at  EJiartoum. 

To  those  who  are  interested  in  the  study  of 
tropical  medicine,  the  report  of  the  Wellcome  Re- 
search Laboratories  at  Khartoum  will  be  of  par- 
ticular value.  It  will  be  remembered  that  at  the 
time  of  the  establishment  of  the  Gordon  Memorial 
College,  Mr.  H.  S.  Wellcome,  of  London,  fitted  these 
laboratories  and  presented  them  to  the  Soudan 
Government.  The  work  of  carrying  them  on  was 
entrusted  to  Dr.  Balfour,  as  director,  and  the  first 
report  has  recently  been  issued.  Though  Dr. 
Balfour  has  no  skilled  assistance  provided  in  the 
laboratories,  he  seems  to  have  the  gift  of  obtaining 
it  from  his  friends,  and  much  valuable  work  is 
being  done  by  medical  and  veterinary  officers  in 
the  service  of  the  Soudan  Government,  as  well  as 
by  military  medical  officers  stationed  at  Khar- 
toum. All  this  work  centres  round  the  Wellcome 
Laboratories,  and  is,  as  it  were,  inspired  by  the 
director.  Dr.  Balfour's  own  work  seems  to  be  very 
wide,  for  up  to  the  present  he  has  rather  been 
making  acquaintance  with  the  general  facts  of 
epidemiology  in  the  Soudan  than  devoting  himself 
to  any  particular  line  of  investigation.  'Malaria 
is  commoner  at  Khartoum  than  is  generally 
supposed,  and  soon  after  Dr.  Balfour's  arrival  an 
anti-malarial  brigade  was  organised  on  Major 
Ross'  lines  with  very  gratifying  results.  It  is 
noticeable  that,  in  spite  of  the  dry,  hot  climate, 
tuberculosis  is  common  among  the  natives,  but, 
as  its  incidence  is  greatest  on  women  and  children, 
it  is  almost  certainly  due  to  the  dark,  close,  crpwded 
huts  they  inhabit.  Syphilis  of  very  severe  type 
is  prevalent,  and  as  among  the  natives  it  is  con- 
sidered rather  an  honour  to  have  the  disease,  no 
steps  are  taken  to  counteract  it.  The  Director  and 
his  friends  are  engaged  in  collecting  and  examining 
blood  films  from  all  sorts  of  cases  of  tropical  disease, 
as  well  as  in  systematic  bacterioscopic  work. 
There  is  no  doubt  that  the  establishment  of  an 
institution  such  as  that  at  Khartoum  will  lead  to 
advances  in  tropical  medicine  which  would  not 
otherwise  be  made. 


Copper  as  a  Bactericide. 

The  purification  of  water  is  admittedly  one  of 
the  "problems  of  the  day,  for  whatever  care  is  ex- 
pended in  the  collection  of  water,  the  inspection 
of  sources,  and  filtration,  a  proportion  of  water- 
borne  disease  persists  in  most  large  towns.  Al- 
though there  are  more  agencies  than  one  by  which 
typhoid  may  be  disseminated,  water  is  still  the 
chief,;  and  typhoid  fever  continues  to  occur  in  the 


autumn  with  a  regularity  which  indicates  that  a 
good  deal  remains  to  be  donejn  the  treatment  of 
water  before  it  reaches  the'consumer.  What  the 
eventual  method  may  be,  it  is  impossible  to  say, 
but  that  in  the  future  sterilised  water  will  be 
considered  the  only  safe  water  for  people  to  drink 
admits  of  but  little  doubt.  A  plan  for  treating 
water  on  a  large  scale  at  a  nominal  cost  has  been 
suggested  by  Dr.  Moore,  who  has  carried  out  ex- 
periments to  attain  his  object,  and  who  is  convinced 
that  he  can  render  water  free  from  algae  and  bac- 
teria by  means  of  his  method.  This  consists  in 
adding  to  the  water  it  is  wished  to  purify,  copper 
sulphate  in  the  proportion  of  i  to  100,000,  which 
he  claims  is  sufficient  to  kill  virulent  colonies  of 
t3rphoid  and  cholera  in  four  or  five  hours  in  water 
at  ordinary  summer  temperature.  We  confess 
to  feeUng  some  surprise  that  so  weak  a  solution 
can  be  efficacious,  but  even  if  it  is  there  remains 
the  objection  that  the  consumers  of  the  water 
would  have  to  imbibe  a  certain  amount  of  copper 
with  the  fluid.  A  great  deal  of  discrepancy  is  still 
to  be  found  among  authorities  as  to  the  toxic 
powers  of  copper,  but  it  cannot  but  be  a  big  experi- 
ment to  make  people  drink  minute  quantities  of 
it  in  solution  every  day  of  their  hves.  It  is  claimed 
that  less  copper  is  contained  in  a  gallon  of  water 
so  treated  than  in  an  ordinary  loaf  of  bread  or  cake 
of  chocolate,  and  that  therefore  the  amount  of 
copper  is  harmless  to  effect  any  pathological 
changes.  However  this  may  be,  purifying  water 
by  the  addition  of  chemicals  that  must  eventually 
reach  the  tissues  of  the  consumers  is  an  experiment 
not  to  be  lightly  tried,  and  it  certainly  is  not  the 
final  solution  to  the  problem  of  water  sterilisation. 


Gentleness   in  Manipulation. 

The  importance  of  being  extremely  gentle  in 
diagnostic  manipulation  was  recently  brought 
before  the  profession  in  America  in  a  discussion  (a) 
opened  by  Dr.  Howard  Kelly,  of  Baltimore,  who 
made  special  reference  to  injuries  sustained  by  the 
bowel  in  the  course  of  gynaecological  examinations. 
Many  other  instances  were  enumerated,  however,  of 
the  damage  that  may  be  done  by  the  slightest  rough- 
ness in  performing  abdominal  palpation.  For  in- 
stance, in  the  experience  of  many  of  the  speakers, 
and  probably  of  many  of  our  readers,  such  acci- 
dents have  occurred  as  the  rupture  of  a  thin-walled 
cyst,  or,  still  worse,  of  a  localised  abscess.  Even 
the  rupture  of  a  tubal  pregnancy  is  reported  to 
have  taken  place  from  the  energetic  examination 
made  by  the  relative  of  a  patient  to  satisfy  himself 
of  the  correctness  of  the  diagnosis  of  an  attend- 
ing physician.  The  perforation  of  the  uterus 
by  a  sound  is  so  common  an  accident  as  to  need  no 
special  mention.  The  accident  of  perforation  of 
the  rectum  by  the  examining  finger  is  less  common, 
but,  nevertheless.  Dr.  Kelly  has  seen  it  happen 
four  times.  The  principal  predisposing  con- 
dition is  a  loss  of  muscular  tone,  usually  occur- 
ring in  elderly,  flabby  women.  In  such  patients 
a  rectal  examination  should  be  made  with  great 

(a)  Joum,  Amer.  Med.  ilMoc.,  November  20th,  1904. 


698    Thb  Mbdical  Press.  NOTES    ON    CURRENT    TOPICS. 


Dec.  28,  1904. 


care  and  deliberation.  The  best  treatment,  if  the 
accident  should  occur,  is  immediate  opening  of  the 
peritoneum,  preferably  by  the  vaginal  route,  and 
suture  of  the  rent  from  the  peritoneal  aspect. 

TattooinfiT  and  Disease. 

The  natural  instifict  for  personal  adornment, 
hke  many  other  primitive  impulses,  still  survives 
in  the  present  day,  even  among  the  male  sex,  who, 
if  they  cannot  render  their  clothing  attractive, 
seek  to  enhance  their  cutaneous  charms  by  im- 
printing various  devices  and  patterns  upon  their 
epidermis.  As  a  matter  of  fact,  it  is  the  true  skin 
which  has  the  greater  share  in  bearing  the  per- 
manent decoration,  for  it  is  well  known  that  the 
durabihty  of  the  marks  depends  entirely  upon 
the  depth  of  the  punctures.  The  practice  of  tat- 
tooing is  of  great  antiquity,  and  many  different 
substances,  such  as  clay  or  pine-resin,  have  been 
introduced  by  native  tribes  beneath  the  skin,  the 
use  of  indigo  or  vern>ilion  following  at  a  somewhat 
later  period.  The  desire  for  early  recognition 
and  identification  after  death  would  seem  to  be 
one  reason  for  the  great  popularity  of  tattooing 
among  soldiers  and  sailors.  On  the  other  hand, 
many  distinguished  personages  are  thus  branded 
with  mystic  emblejns  from  wholly  different  motives. 
In  the  annual  report  of  the  Director-General  of 
the  Medical  Department  of  the  Navy,  recently 
issued  to  the  Admiralty,  an  interesting  paper  may 
be  found  by  Staff-Surgeon  Finch,  of  H.M.S.  Thetis, 
which  deals  with  the  subject  of  the  communica- 
tion of  disease  by  tattooing.  In  1878,  Maury 
and  Dulles  reported  a  series  of  fifteen  cases  in 
which  syphilis  was  definitely  communicated 
through  the  practice,  the  virus  having  effected  an 
entrance  into  the  tattooed  individuals  through  the 
needles  which  were  moistened  by  the  lips  of  the 
operator,  who  was  himself  the  subject  of  the  disease. 
In  these  patients  there  had  never  been  any  pre- 
existing venereal  affections.  A  further  series  of 
twelve  cases  was  described  by  Surgeon  F.  R. 
Barker,  in  1 889,  in  which  an  outbreak  of  syphilis 
was  distinctly  traced  to  the  practice.  Unless  the 
strictest  aseptic  precautions  are  observed,  it  is 
obvious  that  many  other  contagious  or  microbic 
disorders  might  be  transmitted  by  any  operation, 
however  trivial,  involving  a  puncture  of  the  skin. 

Steedman's  Powders. 

A  CASE  of  some  interest,  both  to  medical  men 
and  chemists,  was  decided  at  the  Coroner's  Court, 
Hammersmith,  last  week.  It  appears  that  a  child, 
eight  weeks  old,  was  given  a  Steedman's  powder 
for  the  relief  of  pain,  and  twenty  and  a  half  hours 
later  died,  the  symptoms  being  contraction  of  the 
pupils  and  sleep.  Dr.  William  Robert  Hall  Hains, 
who  saw  the  patient  during  life  and  also  made  the 
autopsy,  was  of  opinion  that  death  was  not  due  to 
natural  causes,  but  was  accelerated  by  some  nar- 
cotic poison.  Suspicion  naturally  fell  on  the  powder, 
and  the  matter  was  referred  by  the  Coroner  to 
Dr.  Freyberger  for  report.  At  the  adjourned  in- 
quest, it  was  definitely  stated  by  the  proprietors 


that  although  the  composition  of  the  powder  wa& 
a  trade  secret,  it  contained  neither  opium  nor 
morphine,  and  was  free  from  any  toxic  agent. 
Dr.  Freyberger  said  that  he  had  examined  not 
only  the  viscera  and  the  contents  of  the  stomach, 
but  the  remains  of  the  powders,  and  found  that  they 
were  absolutely  free  from  any  trace  of  opium  or 
any  narcotic  substance.  Dr.  Wilson  Hake,  d 
the  Westminster  Hospital,  said  that  he  had  pur- 
chased samples  from  various  sources,  and  had  also 
examined  the  manufacturer's  stock  and  was  unable 
to  find  narcotic  acid  or  any  opium  alkaloid.  Dr. 
Murrell  stated  that  neither  the  symptoms  nor  the 
post-mortem  appearances  were  indicative  of  opium 
poisoning,  and  that  in  all  probability  the  child  bad 
died  either  from  broncho-pneumonia  or  congestion 
of^the  brain.  Dr.  Hains,  on  being  recalled,  said 
that  after  hearing  the  expert  evidence  he  was  per- 
fectly satisfied  that  death  was  due  to  natural  causes. 
He  asked  if  he  had  been  right  in  refusing  a  death 
certificate.  The  Coroner,  in  reply,  said  that  the 
Court  was  much  indebted  to  Dr.  Hains,  and  that 
he  had  acted  very  properly  in  the  matter.  A  "v-er- 
dict  in  accordance  with  the  medical  evidence  was 
returned.  As  the  sale  of  these  powders  is  said  to 
amount  to  many  millions  in  the  year,  this  result  is 
of  some  public  importance,  however  much  as  a 
scientific  profession  we  may  and  must  condemn 
the  use  of  nostrums  under  such  a  misleading 
and  unscientific  name. 


The  Corset  A^ain. 

There  is  no  more  ruthless  exposer  of  woman's 
follies  th^n  the  woman  who  has  emancipated  her- 
self   from    their    thraldom,     and     Miss     Arahriia 
Kenealy  goes  for  her  weaker  sisters  to  some  pur- 
pose   in   "  The  Nineteenth  Century    and  After  "^ 
this  month.     The  bone  of  contention  is  the  bone 
of  the  whale,  and  the  way  that  the  female  of  human 
species    surrenders    herself    to    its     embrace.    It 
hardly  needs  a  medical  expert  to  jx>int  out  that 
compressiilg  the  viscera  in  an  iron  grip,  so  that  they 
are  distorted  in  shape  and  displaced  in  position, 
is  not  calculated  to  aid  them  in  the  performing 
of  their  physiological  functions.     Such   a  truism 
the  silly  creatures  who  practise  the  art  of  tight- 
lacing     would     simpcringly      admit     themseK'cs. 
What  would  give  its  quietus  to  the  production  of 
this  artificial  deformity  would  be  the  i>encil  of  the 
caricaturist  and  the  pen  of  the  satirist,  who  laughed 
the  crinoUne  off  the  stage.     In  the  meantime,  the 
vigorous  onslaughts  of  Miss   Kenealy   are  all  to 
the  good,  and  some  of  the  facts  certainly  are  not 
generally    known.     It    may    be    news    to    many- 
readers  to  hear  that  a  series  of  exj>eriments  were 
made  some  years  agO'  on  monkey's,  to   study  the 
effects  of  tight -lacing.     The  poor  creatures  were 
encased  in  fashionable  corsets  and  then  squeezed 
till  their  figures  approximated  as  closely  to  the 
"  wasp  "  type  as  the  simian  waist  can  approach. 
It  is  not  stated  under  what  schedule  these  experi- 
ments were  performed,  and  no  mention  is  made  of 
anaesthetics.     In  spite  of  a  natural  presumption 
to  the  contrary,  the  ape  of  the  woods  did  not  show 


Dec.  28,  1904- 


PERSONAL. 


The  Medical  Press.    6r)() 


himself  possessed  of  the  constitution  of  the  grande 
-dame  of  Belgra\da,  for  some  only  lived  a  few  days 
in  their  Parisian  habiliments.  The  others  hn- 
gered  for  months  in  agony,  and  died  of  disorders 
produced  by  the  stays.  One  important — nay, 
\ntal  point  was  overlooked  by  the  experimenter. 
He  was  thinking  so  much  of  the  duration  of  the 
monkeys*  agony — which,  of  course,  was  only  an 
incidental  question — that  he  forget  to  observe  if 
the  male  monkeys  exhibited  a  more  decided 
penchant  for  the  embrace  of  the  corseted  ones 
than  they  usually  do  for  their  naked,  but  un- 
ashamed, colleagues.  It  is  to  be  hoped  that  the 
experiments  will  be  repeated  with  a  view  to  un- 
ravelling this  crucial  problem. 

Symbiosis  among  Bacteria. 

There  are  few  more  enticing  studies  in  the  field 
of  biology  than  that  afforded  by  the  subject  of 
Symbiosis,  and  few  paths  which  lead  one  into  more 
unexpected  regions.  Thus,  for  example,  the  classic 
instance  of  the  connection  between  the  life  of 
certain  wild  bees  and  the  presence  of  the  domestic 
cat  is,  at  first  sight,  quite  inexplicable,  yet  the 
causal  relation  is  simple  enough.  The  bees  are 
unable  to  cope  with  a  large  population  of  field 
mice,  and  the  great  check  on  the  latter  is  the 
domestic  cat.  In  the  realm  of  bacteriology  there 
is  good  reason  to  believe  that  certain  instances 
of  [symbiosis  occur  which  are  of  practical 
importance,  and  the  suggestions  on  this  subject 
made  by  Dr.  Klein,  in  his  recent  Dobell  Lecture, 
open  up  a  promising  field  of  research.  It  is  known, 
for  instance,  that  in  many  cases  the  lesions  due 
to  a  mixed  infection  are  greater  than  would  result 
from  a  pure  infection  by  any  one  of  the  organisms 
concerned.  Sometimes  an  infection  by  one  or- 
ganism may  be  causing  but  little  damage,  when  the 
addition  of  another  excites  a  startling  increase  of 
injurious  processes.  This  occurs,  for  instance, 
when  a  streptococcal  infection  is  superadded  to 
that  of  the  diphtheria  bacillus.  In  such  cases 
Dr.  Klein  suggests  that  not  merely  does  one  or- 
ganism serve  to  prepare  the  ground  for  another, 
but  that  one  in  some  peculiar  way  actually  in- 
creases the  virulence  of  the  other.  Similarly  it  is 
possible  and  probable  that  a  tuberculous  focus 
receives  an  impetus  to  spread  from  a  secondary 
infection  of  different  kind,  and  that  the  secondary 
infection  directly  increases  the  virulence  of  the 
tubercle  bacillus.  The  difference  between 
active  and  resting  foci  of  tuberculous  disease  may, 
on  this  theory,  be  explained  as  due  to  the  pre- 
sence or  absence  of  a  second  infection. 


duly  magnified.  It  is  in  the  dead-house,  however, 
that  the  closest  acquaintance  is  made  with  actual 
disease-processes,  and  the  practitioner  who  is  most 
familiar  with  morbid  pathology  is  in  a  far  better 
position  to  tackle  a  difficult  case  than  the  casual 
visitor  to  the  post-mortem  room.  What  medical 
man  has  not  experienced  the  peculiar  thrill, 
akin  to  awe  and  reverence,  excited  by  a  typical 
specimen  of  some  strangely  altered  organ  seen  or 
handled  for  the  first  time  ?  It  is  the  contempla- 
tion of  such  a  departure  from  the  normal  which 
fills  the  studious  onlooker  with  a  deeper  desire 
to  find  out  the  reason  why  such  things  befal  the 
human  body.  His  enthusiasm  is  stirred,  and  if 
he  possess  any  fraction  of  the  spirit  of  scientific 
research  he  will  not  rest  until  he  has  thoroughly 
grasped  the  nature  of  the  disease  in  question. 
It  is  the  most  natiural  thing  in  the  world,  there- 
fore, that  the  clinical  museum  should  be  not  the 
least  important  part  of  the  modern  hospital  equip- 
ment, more  especially  if  there  be  a  medical  school 
or  post-graduate  college  attached  to  the  institu- 
tion. Professor  Thomas  McCrae,  of  New  York, 
is  impressed  by  the  fact  that,  taken  all  round,  the 
hospital  museums  in  this  country  are  accessible 
to  students  and  are  really  utilised  as  places  of 
study.  This  is  certainly  the  case  as  far  as  the  great 
centres  of  medical  education  are  concerned,  but 
we  fear  that  even  now  in  some  of  the  smaller  hos- 
pitals the  museum  is  conspicuous  by  its  absence, 
or  is  relegated  by  the  governing  body  to  the  worst 
and  most  badly-Ughted  quarters  of  the  building. 
It  sometimes  happens  that  good  specimens  are  lost 
or  thrown  away  by  practitioners  simply  because 
the  nearest  hospital  to  them  has  no  museum. 
There  is  certainly  room  for  more  enterprise  on  the 
part  of  hospital  authorities  in  this  direction. 


Hospitcil  Museums. 

That  the  proper  study  of  disease  is  incomplete 
without  a  knowledge  of  the  pathological  changes 
and  appearances  that  occur  in  the  organs  and 
tissues  affected  few  will  be  found  to  deny.  There 
are  some  who  aver  that  too  much  time  may  be 
spent  over  test-tubes  and  microscopes,  and,  to 
some  extent,  there  is  a  danger  lest  the  office  of  the 
bacteriologist  or  the  chemical  physiologist  be  un- 


PERSONAL. 

His  Majesty  the  King  has  graciously  been  pleased 
to  grant  the  title  "  Royal  "  to  the  Victoria  Hospital  for 
Consumption,  Edinburgh. 

A  DINNER,  given  on  December  nth,  to  Professor 
Koch  to  celebrate  the  sixtieth  anniversary  of  his 
birthday  was  attended  by  a  great  many  of  his  former 
assistants,  including  Professor  Brieger,  Professor 
Lofifler,  Professor  Gartner,  and  others.  All  the 
members  of  the  Institution  for  Infectious  Diseases  were 
present. 


Lord  Strathcona  and  Mount  Royal  will  preside 
at  a  festival  dinner  to  be  held  at  the  Whitehall  Rooms, 
Hotel  Metropole,  London,  S.W.,  in  aid  of  the  National 
Hospital  for  the  Paralysed  and  Epileptic  on  April  12th 
next. 


The  foundation  stone  of  the  Llanybytheris 
Sanatorium  for  consumptives  for  the  counties  of 
Cardigan,  Carmarthen,  and  Pembroke,  is  to  be  laid  on 
April  26th,   1905,  by  Princess  Christian. 


Dr.  E.  S.  Stokes  has  been  appointed  medical  officer 
and  bacteriologist  to  the  Metropolitan  Board  of  Water- 
supply  and  Sewage,  Sydney. 

Mr.  Edward  Turner  Born,  M.B.  Dunelm,  J. P., 
has  been  promoted  from  Assistant  Colonial  Surgeon, 
Fox  Bay,  West  Falklands,  to  the  Hon.  the  Colonial 


Dec.  28.  1904- 


CORRESPONDENCE. 


The  Medical  Press.     700 


Surgeon,  Stanley,  East  Falklands,  President  Board  oi 
Health,  and  Member  Executive  and  Legislative  Councils 

Mr.  T.  Crisp  English,  B.S.  Lond.,  F.R.C.S.Eng., 
has  been  appointed  Assistant  Surgeon  to  St.  George's 
Hospital  and  Lecturer  on  Operative  Surgery,  St. 
George's  Hospital  Medical  School. 

Dr.  a.  p.  Luff  has  been  appointed  Physician  to  the 
In-patients  at  St.  Mary's  Hospital. 

On  the  15th  instant.  Miss  Amy  Sawyer,  third 
daughter  of  Sir  James  and  Lady  Sawyer,  of  Birming- 
ham, was  married  to  Mr.  H.  H.  French,  of  Guy's 
Hospital. 

Dr.  Walter  Smith,  King's  Professor  of  Materia 
Medica  and  Pharmacy  in  School  of  Physic,  Trinity 
College,  Dublin,  has  been  appointed  to  examine  at 
Examinations  of  Army  Medical  Service. 

Dr.  J.  Magee  Finny,  ex-president  R.C.P.I.,  has 
been  appointed  Honorary  Consulting  Physician  to  the 
Royal  Hospital  for  Incurables,  Donnybrook,  Dubhn, 
in  place  of  the  late  Dr.  John  J.  Cranny. 

Colonel  (temporary  Surgeon-General)  W.  F. 
Stevenson,  M.B.,  C.B.,  Royal  Army  Medical  Corps. 
Professor  of  Clinical  and  Military  Surgery,  Royal 
Army  Medical  College,  has  been  appointed  an 
Honorary  Surgeon  to  the  King,  vice  Surgeon-General  J. 
Jameson,  M.D.,  C.B.,  deceased. 

The  President  of  the  Board  of  Education  has 
appointed  Dr.  Norman  Moore,  M.D.,  F.R.C.P.,  to  be 
a  member  of  the  Consultative  Committee,  vice  Professor 
Bertram  C.  A.  Windle,  M.D.,  F.R.S.,  resigned  upon 
appointment  as  President  of  Queen's  College,  Cork. 


(Pbituati?* 


George  Andrew  Campbell,  M.D..  R.N.  (retired),  of 
2,  St.  Leonard's  Road,  Ealing,  whose  death  on  the 
19th  instant,  at  the  age  of  68,  is  annoanced,  was 
educated  at  Harvard,  U.S.A.,  and  at  Kingston. 
Canada,  where  he  took  his  M.D.  degree  in  1859. 
Entering  the  Navy  in  i860,  he  became  a  staS-surgea 
in  1872,  and  in  that  rank  served  in  the  Heda  at  Ihe 
bombardment  of  Alexandria,  on  July  nth,  18I:. 
during  the  Egyptian  campaign  which  foUoiwed,  as 
throughout  the  naval  and  military  operations  dck 
Suakin,  in  the  Eastern  Soudan,  in  1884.  For  his  war 
services  he  received  the  Egyptian  Medal,  with  the 
Alexandria  and  Suakin  clasps,  and  the  Khediveft 
bronze  star.  He  was  promoted  to  the  rank  of  fleet- 
surgeon  in  1883,  and  retired  in  1891  as  a  depaty- 
inspector-general. 

CHARLES  FREDERICK  LAING.  M.D. 
The  death  took  place  at  sea,  near  Gibraltar,  oa 
Tuesday  week,  of  Dr.  Charles  F.  Laing.  medica) 
superintendent  of  Somerset  and  Bath  County  AsyluziL 
A  few  days  ago  Dr.  Laing  started  on  a  vo>'age  for 
his  health,  and  he  was  on  his  way  to  Egypt  when  the 
sad  occurrence  took  place.  Dr.  Laing,  who  was  oolr 
in  his  36th  year,  was  bom  at  Paisley.  He  was  a  son 
of  the  late  Mr.  Charles  W.  Laing,  governor  of  the 
Town's  Hospital.  Glasgow,  and  was  educated  at  the 
High  School  and  Allan  Glen's  School,  and  afterwanh- 
at  Glasgow  University,  where  he  graduated  M-R, 
CM.  in  1890.  A  year  later  he  received  an  appoint- 
ment at  Smithston  Asylum,  Greenock,  and  from  there 
went  to  Cheshire  County  Asylum  at  Macclesfield  as 
assistant.  Three  years  ago  he  was  selected  from  a  laig^ 
number  of  applicants  as  superintendent  of  the  im- 
portant county  asylum  at  Wells.  Dr.  Laing  was  wcS 
known  in  Glasgow.  By  his  death  a  career  foil  d 
promise  has  been  prematurely  closed. 

CorreeponDence* 


I  We  do  not  hold  ourselves  responsible  for  the  opinionf  efo 
co/respendents.] 


ARTHUR  QUARRY  SILCOCK,  M.D.  LOND.,  B.Sc., 
F.R.C.S. 
We  regret  to  announce  the  death  of  Mr.  Arthur 
Quarry   Silcock,    the   eminent   surgeon   and   ophthal- , 
mologist,    which    occurred    on    the    19th     instant., 
after  a  short  illness,  at  his  residence,  52,  Harley  Street, 
at  the  premature  age  of  49.      BorA  at  Chippenham, 
Wiltshire    in      1855,     he    was     educated     privately 
at    University    College,    London,    taking    the    B.Sc. 
degree   at    London    University   in    1878,    and    being 
admitted  the  same  year  as  a  member  of  the  Royal 
College  of  Surgeons,  England.    In  1880  he  proceeded 
to  the  M.D.  degree,  and  in  1882  was  elected  a  Fellow 
of  the  Royal  College  of  Surgeons.     Dr.  Silcock,  in  the 
course  of  a  successful  professional  career,  filled  many 
important    positions.     He    held    the    post    of    senior 
demonstrator  of  anatomy  and  demonstrator  of  practical 
surgery  at  University  College  Hospital,  where  he  was 
also   surgical  registrar,    house   phvsician,   and   house 
surgeon.     He  was  pathologist  and  lecturer  on  practical 
and  operative  surgery  and  pathology  at  St.  Mary's 
Hospital,  and  had  also  been  president    of    the  Uni- 
versity College  Medical  Society.     At  the  time  of  his 
death  he  held  the  offices  of  surgeon  and  joint  lecturer 
on  surgery  at  St.   Mary's  Hospital,   surgeon  to  the 
Royal  London  Ophthalmic  Hospital,  consulting  surgeon 
to  the  Bromley    Cottage  Hospital,  and  examiner  in 
surgery    for    the    Royal    College    of    Surgeons.     Dr. 
Silcock  was  a  Fellow  of  the  Royal  Medical  and  Chir- 
urgical  Society,   and  a  member  of  the  Ophthalmic, 
Clinical,    Pathological,    and    Harveian    Societies.     He 
was  the  author  of  "  Injuries  of  the  Eye  "  in  "  Druitt's 
Surgeon's    Vade-Mecum "    and     had    contributed     a 
large  number  of  papers  to  the  transactions  of  the 
Pathological,  Clinical,   and   Ophthalmic  Societies,   as 
well  as  many  articles  to  the  professional  journals. 
GEORGE    ANDREW    CAMPBELL,    M.D.  Ed.,  R.N. 
Deputy  Inspector-General  of  Hospitals  and  Fleets 


HOSPITAL  FUNDS  AND  SMALL  HOSPITALS. 
To  the  Editor  of  The  Medical  Press  and  Cikculak. 
Sir, — Hospitals  exist  primarily  for  the  relief  of  the 
suffering  poor  ;  they  are  further  needed  to  provide 
clinical  material  for  the  education  of  students  d 
medicine,  and  they  furnish  a  field  for  the  scienftfc 
observation  and  study  of  disease  and  pathological 
phenomena.  Hospitals  do  not,  or  at  least  should  not. 
exist  for  the  purpose  of  enabling  a  few  practitiooen 
to  get  on  in  the  world  ;  but  this  seems  to  be  the  idea 
of  some  correspondents  who  so  far  have  taken  notice 
of  my  letters.  This  latter  is,  in  fact,  tire  purpose  for 
which  most  existing  special  hospitals  were  founded, 
and  for  which  some  of  them  are  being  still  employed. 
This  no  doubt  suits  some  individuals  ;  but  it  is  vcnr 
bad  for  the  bulk  of  the  profession.  The  w^hole  special 
hospital  system  is  associated  with  other  evils,  som 
of  which  I  have  previously  referred  to,  and  it  is  tb 
I  cause  of  waste  o!  public  funds  which,  if  applied  to 
I  legitimate  ends,  would  serve  almost  alone  to  satisfy 
the  needs  of  great  institutions  which  in  every  essential 
respect  are  beyond  criticism. 

I  am,  Sir,  yours' truly. 
December  2 1  st ,   1 904.  Hex r  v  Se will. 


THE  LONDON  HOSPITAL  FUNDS.  THE  LONDON 
HOSPITAL  AND  Mr.  STEPHEN  COLERIDGE. 
To  the  Editor  of  The  Medical  Press  and  Circulak. 
Sir, — Mr.  Stephen  Coleridge  has  forwarded  to  me, 
with  his  compliments  a  copy  of  your  issue  of  December 
2 1  St.  I  am  very  grateful  to  him,  and  I  congratnlate 
you  on  having  obtained  so  active  antd  zealous  a  pro- 
pagandist of  your  views. 

I  do  not  expect  from  you  any  too  charitable  a  view 
of  my  conduct  or  motives.  I  have  never  received 
anything  but  hostile  criticism  from  you  ever  since  I 
have  worked  for  hospitals.     I  may  be  wrong,  and  yon 


Dec.  28,  1904- 


MEDICAL  NEWS. 


The  Medical  Press.    701 


always  right — quite  likely.  But  you  will  allow  me, 
I  am  sure,  to  reply  to  your  criticisms  in  your  leading 
article  in  that  number. 

In  the  first  place  you  criticise  me  for  taking  upon 
myself  the  defence  of  a  grant  from  a  hospital  "  to  its 
college  " — that  is  a  better  way  of  describmg  this  than 
**  to  its  school/'  because  the  grant  is  not  made  towards 
the  education  of  students,  but  in  return  for  very  valua- 
able  services  rendered  by  the  Professors  of  the  college, 
and  by  the  students,  to  the  hospital.  But  let  this 
pass.  You  criticise  me  for  replying  because  I  am 
**  a  subscriber  to,  and  not  an  official  of,  the  Sunday 
Fund."  This  is  a  little  unfortunate,  for  I  have  been 
a  member  of  the  Council  for  many  years. 

I  might  not,  however,  have  spoken  at  all,  had  not  the 
Rev.  Lionel  Lewis  made  a  very  violent  attack  on  the 
London  Hospital  because  we,  as  he  puts  it,  spent  ;i7,ooo 
on  a  cricket  ground,  while  his  poor  people  were  dying 
for  want  of  hospital  accommodation  (his  parish  is  in 
Hoxton  not  Whitechapel).  He  held  me  up  to  scorn 
as  cruel,  extravagant  and  unmindful  of  the  crying  needs 
of  the  sick  poor. 

Surely  this  is  a  little  rough  on  a  man,  who,  however 
wrong  according  to  you  in  all  his  ways,  at  any  rate 
may  be  suppos^  to  care  something  for  the  sick  poor  ; 
or  else  to  be  an  idiot  for  devoting  the  best  part  of  his 
leisure  to  hospital  work.  You  have  never  suggested 
that  I  am  quite  an  idiot,  so  I  take  it  you  will  not  go  so 
far  as  to  agree  with  this  minister  of  the  Gospel  of  Peace 
and  Goodwill. 

What  are  the  facts — facts  which  I  was  driven  by  the 
above  sneer  to  give,  and  facts  which,  when  known  to 
the  rev.  gentleman  brought  no  apology  from  him. 
We  bought,  and  spent  on  a  cricket  ground — 
;f6,ooo,  not  iy, 000.  But  before  doing  so  we  had 
made  an  agreement  to  let  it  on  lease  at  4  per  cent, 
on  our  expenditure  to  a  very  prosperous  Club,  com- 
posed of  all  our  students  {£2  2s.  a  year  subscription). 
They  asked  us  to  lend  them  the  money  at  this  rate  on 
the  security  of  the  ground.  But  we  were  very  strongly 
advised  by  experts  to  purchase  the  freehold  ourselves. 
And  their  advice  has  been  right.  To-day  we  could  sell 
the  ground  for  far  more  than  the  £6,000, 

You  write  "  the  point  was  whether  the  hospital 
had  any  right  to  invest  charitable  funds  in  the  purchase 
of  a  cricket  ground."  Why  not  ?  if  it  pays  as  much 
as  in  a  ground  lease  or  leases,  or  land  round  the  hospital, 
or  in  Consols — an  investment,  by  the  bye,  in  which  a 
hospital  can  lose  a  good  deal,  as  I  know  to  my  cost. 

How  very  unfair  also  is  your  remark  that  "Mr. 
Holland  was  silent  when  asked  if  the  accounts  of  the 
school  were  sent  to  every  subscriber."  It  is  difficult 
to  believe  that  your  reporter  did  not  hear  my  reply. 
I  was  challenged  on  the  point,  and  gave  a  direct  answer, 
not  in  the  middle  of  my  speech,  but  a  direct  answer 
to  the  Lord  Mayor,  that  every  subscriber  to  the 
hospital  could  have  a  copy  of  the  College  accounts 
which  are  printed,  and^audited  by  a  chartered  account- 
ant. 

Attack  me  as  much  as  seemeth  good  unto  your 
circulation.     But    play   fair,    and    do   not    show   any 
personal  animosity  in  controversial  criticism. 
I  am,  Sir,  yours  truly. 

Sydney  Holland. 

December  24th,   1904. 

[Our  personal  respect  for  Mr.  Holland's  good  faith  and 
honourable  intention  has  often  been  warmly  expressed. 
At  the  same  time,  we  have  been  obliged  to  differ  from 
him  at  times.  In  the  present  instance,  a  point  of 
vital  importance  is  involved,  namely,  the  diversion 
of  funds  subscribed  for  purely  hospital  purposes. 
The  3^6,000  was  devoted  to  the  purchase  of  a  **  sports  " 
ground,  not  as  a  hospital  endowment  investment. 
Mr.  Holland  must  give  us  the  same  credit  for  fairness 
of  purpose  that  he  claims  for  himself.  We  shall  afford 
him  every  opportunity  of  a  full  statement  and  dis- 
cussion in  these  columns.  Mr.  Coleridge  is  also  entitled 
to  full  expression,  however  unhesitatingly  we  may 
condemn  his  anti- vivisection  tactics. — Ed.  M.P.  &  C] 


AeMcal  flews. 


Polsonsd  by  Gelsemium.  _^ 

At  the  assizes  at  Leeds  on  December  loth,  a  grocer 
was  charged  with  the  manslaughter  of  a  girl.  The 
story  as  it  stands  seems  highly  improbable,  for  it  runs 
that  the  girl  went  to  the  shop  to  purchase  fuller's  earth. 
The  grocer  said  he  did  not  Keep  it  but  advised  her  to 
try  witch-hazel.  In  mistake  he  sold  her  gelsemium 
and  the  girl  died  shortly  after  taking  it.  Mr.  Justice 
Darling  said  there  was  no  evidence  of  criminal  negli- 
gence and  the  jury  by  his  advice,  returned  a  verdict  of 
not  guilty. 

Prosecution  of  an  Unpogistered  Dentist. 
At  the  Cardigan  police  court  on  December  12th,  a 
man  was  fined  20s.  and  costs  for  falsely  taking  and 
using  the  name  of  a  dentist  without  being  registered  in 
accordance  with  the  provisions  of  the  Dentists  Act, 
1S78.  He  stated,  in  defence  that  he  had  a  certificate 
of  proficiency  from  an  American  college. 

New  Regulations  of  the  Royal  University  of  Ireland. 

The  Royal  University  of  Ireland  has  issued  the  fol- 
lowing new  regulations  in  reference  to  the  final  M.B. 
examinations:-— (I)  In  the  spring  and  again  in  the 
autumil  of  each  year  two  separate  examinations  will  be 
held  simultaneously,  one  for  pass  candidates  only,  the 
other  for  honour  candidates  only.  ^Hien  entering  ea£h 
candidate  must  state  at  which  of  these  examinations 
he  elects  to  be  examined.  A  candidate  who  has. 
entered  for  the  honour  examination  may  be  allowed  to- 
change  to  the  pass  examination  on  giving  to  the 
secretaries  a  satisfactory  reason  for  doing  so  at  least  one 
week  before  the  commencement  of  the  examination  ; 
but  under  no  circumstances  will  a  candidate  who  has- 
entered  for  the  pass  examination  be  allowed  to  change 
to  the  honour  examination.  (2)  Honour  exhibitions, 
will  be  awarded  on  the  results  of  the  honour  examina- 
tion only.  (3)  Candidates  at  the  honour  examination 
whose  answering  may  not  be  such  as  to  qualify  them 
for  honours  may  nevertheless  be  adjusted  to  have 
passed  the  examination  provided  they  exhibit  in  their 
answers  knowledge  equivalent  to  what  is  required  from 
candidates  who  satisfy  the  examiners  at  the  pass, 
examination. 

UDiversity  of  Oxford. 

Ih  a  congregation  held  on  December  17th,  the  last 
day  of  Michaelmas  term,  presided  over  by  the  Vice- 
Chancellor  (Dr.  Merry,  Rector  of  Lincoln  College),  the 
following  degrees  wese  conferred  : — 

M.D.~H.  P.  Chohneley  and  E.  MalUm,  Magdalen. 

M.B.  and  B.Ch.  :  E.  Burstal,  Trinity ;  R.  A. 
Chisolm,  Wadbam  ;  and  H.  R.  Dean,  Magdalen. 

D.Sc.  :  T.  C.  Porter,  Exeter ;  and  H.  B.  Baker, 
Christ  Church. 

Final  Examination. — Medicine,  Surgery,  and  Mid- 
wiferv:  A.  W.  Brodribb,  University  College;  E. 
Burstal,  Trinity;  R.  A.  Chisohn,  Wadham ;  H.  R. 
Dean,  Magdalen ;  H.  Prankish,  Worcester ;  J.  Free- 
man, University  College  ;  A.  H.  Hogarth,  and  R.  H. 
Sankey,  Christ  Church  ;  C.  J.  Singer,  Magdalen ;  E. 
Mc.L.  Smith,  Queen's ;  P.  F.  Tinne,  Magdalen ;  and. 
J.  A.  Vlasto,  New. 

Royal  College  of  Physicians  of  Edinburgh. 

At  a  recent  meeting  of  the  Royal  College  of  Physi- 
cians of  Edinburgh,  Dr.  John  Playfair  was  elected 
I  President  of  the  College  ;  Dr.  Thomas  S.  Coulston, 
Vice-President ;  and  Sir  Thomas  R.  Eraser,  Sir  John 
Batty  Tuke,  Dr.  Charles  E.  Underhill,  Dr.  James 
Ritchie,  and  Dr.  R.  W.  Philip  were  elected  to  the 
Council  with  the  President  and  Vice-President. 
Trinity  College,  Dublia. 

Michaelmas  Term,  1904  : — ^The  following  candidates 
passed  the  Final  Examination  in  Surgery  :  Eva  J. 
Jellett,  Hugh  Stewart,  William  Hassard,  Thomas 
Creaser,  Robertson  S.  Smyth,  John  Cunningham, 
Richard  Kelly  and  Arthur  A.  M'Neight  (equal),  Charles 
E.  Fawcett,  Thomas  J.  T.  Wilmot,  Thomas  Wilson. 
Gerrard  A.  Crowley,  Keith  R.  C.  Hallowes,  William  J.. 
M'lvor. 


702    Thb  Mbdical  PaBSS. 


NOTICES  TO  CORRESPONDENTS. 


Dec  28.  1904. 


giaiKtsi  to 
OtwreBpmibtntB,  ^hxrrt  Itetttw,  ict. 

^9-  OoRRMForoBKW  requiring  •  reply  in  thU  column  are  particn- 
uZ  rtauested  to  make  um  of  a  distinctive  Sigmiwre  or  IniHdl,  and 

L  ^r»nSilM  of  iigniny  themBelves  "  Reader/'  "  Subwriber," 
"SS  BuSSSbI?  iL  ^MuSh oonfusion  wiO  be  spared  by  attention 
to  thia  rule. 

OaioWAL  AETICLM  or  LBTTERS  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authentioated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  pubhca- 
Jon.  but  as  evidence  of  idfintitv. 

PAiiTiainJiOES  are  kindly  requested  to  send  their  commumcaUon. 
4f  «ddent  m  England  or  the  Colonies,  to  the  Editor  at  the  London 
^f^H  resident  in  Ireland,  to  the  Dublin  office,  In  order  to  save  time 
if^-toSngtrom  office  to  office.  When  sending  subscriptions 
.he^r^appliesastoofflce.  these  should  be  addressed  to  the 

Publisher. 

B«nuKTB  -Eeprhjts  of  articles  appearing  in  this  journal  can  be  had 
i,t  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

"  IMPURE    DRUGS.  ^      ^    ^^ 

/  r^MBSPOiTOBNT  verites  from  Tiverton  drawing  attention  to  the 
•  J^^lir  tSat  may  result  from  tbe  use  of  drugs  not  of 
K!^r«t  aualSy  In  the  case  of  salicylate  of  soda  the 
±  *S  Sn  i2feriii  quality  may  mean  loss  of  life  or  permanentheart 
use  o' *°  iV""°L2"r    "'TmD^  of   potassium  may  produce 

^n'Sl^^Um  aSdw^^^^  TSrdlii;r.fromW  drug,  are  already 
SiaiSd    Thronl?  remedi' we  can  suggestis  to  procure  allsuppUes 

''TrtiS^n)'^^o^\    ,,^  looked    in    its 

^•.  -;io2f iVfWnial  DWStioe.  The  site  of  the  disease,  the  age 
^V'^Z^iS^^^d^^l^^^  o'  ~'°«  ascertainable  chronic 
?I«a^LnhSwever  should  put  the  practitioner  on  Ris  guard.  Early 
condition,  J®  ™  JiimM  cured  by  the  X-ray  tube,  but,  candidly,  the 
cases  <»n /^^K^'S^SSit^rbe  bit  oonJulted  in  oar  opinion  by 
^"^f'^'^mJ^^LS^SlcSYxcWonr  Radium  has  not  proved  itself  of 

^"^  ""'^l  '?mS**M*?K'iellc  you  mention  was  the  property  of  a 

8TRAi)UAWU8^If  the^eiw  ^^^      readily  proved.  It  would  be  well 

iMnou8phyri^.jndth^ia^t«^  ^^rSiconie's    forthcoming 

K^fic^l  mStci?  exwSSioJ.^'You"  ^  better  communicate  with 
them  upon  the  -^J-^^^^^^^^  ^^^  g^jciDE.  . 
4  ^.»^«A»rfAnt  has  drawn  our  attention  to  various  cases  of 
f  riJf^oM  siS^riog  from  influenza.  It  would  be  wise,  for 
"V^^^'^'iS^ii^n^l^  iipon  to  treat  cases  of  influena,  especiaUj- 
;S^jSL?lt  lsi?WvS,  to  bear  in  mind- that  the  contTngenoy 
"f'^-zJ^i  2  ?sniways  potentially  present.  There  Is  no 
of  re/0  ».*f  ,«  " „  1 "  ^icb  In  typical  cases  mental  proe- 
?^l?^^i-''J^^^r£^  w  sudden  and  S  abwlute.  Prom  the  tii£e  of 
tratlon  is  so  ^"•''^f'^X  ^t  modorn  epidemic  of  influenza  that 
J*%T?  w^TrSf^hJ  wWdfnmpS«  sSmStimes  induced,  has  been 
jgBtiU.vrithus  the  wioiaai^^^  that  the  whole  facts  of  the 

recognised.      CcrsW^™f  tne  y  ^   ^  creditable  to  the 

disease  h*^«^f,)l,,"^5^^°ip,ictitiona^  time  of  day 

{^""^eSJa.?  to  wiJr'fhe^^^^      on  the  watoh  for  dangerous 

''^ctl'^The'^y^'BtT^in  on  your  elderly  patient  owing  to 
..£ortnels'^?f  bJSItT'may  be  g^itlyZrelieved  by  minuto  doses  of 
strychnine. 

Manchester  HospiUl  for  Coosumptlonand  Diseases  of  the  Thro  at 
and  ChesU-Resident  Medical  Officer.  Salattr£lOO  par  annum, 
with  board,  apaitments,  and  washing.  Applications  to  C.  W. 
Hunt.  SeoreUry,  Hardman  Street,  Deanspite,  Manchester. 

Dorset  County  Hospital,  Dorcheoter.-House  Surgeon.  Salary  £100 
ner  annum.  Applications  to  the  Chairman  of  the  Committee. 

North  Staffordshire  Infirmary  and  Eye  Hospital,  Hartshill.Stoke- 
upon-Trent.— House  Surgeon.  Salary  £110  per  annum,  with  fur- 
nished  apartments,  boatd,  and  washing.     Applications  to  the 

CoUte?yClu8^-Re8ident  Surgeon.   Salary  £S0O  per  annum.    Api)li- 
^tionsto  A.  J.  Godfrey,  Secretary,  Vernon  Road,  ftLirkby-m. 

KlngS?wMd"vn.  Baii«torimiii.-Medlcal  Superintendent.  Salary, 
£500  per  annum,  with  board,  lodginar  and  attendance.  Applica- 
tSns  to  the  Secretaries.  19,  Devonsh&e  Street,  Portland   Place. 

PriviteAsyluml-Assistant  Jtedfcal  Officer.  Salarj-  £150  per  annum, 
with  bJaid.  lodging,  and  washing.  Applications  to  H.  C.  Mac- 
Bryan,  Kingdown  Ho  ise.  Box.  Wilts.  <u.  .„j.     .rx^ 

London  CJounty  Asylum,  Banstead.-Junlor  Assistant  Medical  Officer. 
Salary  £U0  per  annum,  with    board,  furnished  japarcments, 


and  washing-  Applications  to  B.  W. ,  Partridge.  Clerk  of  tJie 
Asylums    Committee,  Asylums  Committee   Office,   6  Waterloo 

St  toufolS^w's  Hoepitah -Clerk  of  the  Hospital.  Salary  £600  per 
annum,  with  residence.  Applications  to  Wni.  Henry  Cross 
Clerk,  St.  Bartholomew's  Hospital. 


Borough  of  Scarborough.-Medical  CMBcer  of  H»lth.  Satary  £SSm 
MT  annum.  Applications  to  D.  Arthur  hichoU.  Touti  Cletk 
Town  Hall,  Scarborough.  ,  ^.  o    ,      « 

Clayton  Hospital  and  Wakefield  General  Dwocnsaix-Seiiipr  Hoote 
Surgeon.  Salary  £iao  per  annum,  with  board,  lodgioga.  atd 
washing.    Applications  to  the  Hon.  Secretaiy,  Clayusa  Hospital. 

Clayton  Hospital  and  Wakefield  Gemeral  Pispenaan.—Jamor 
House  Surgeon  Salary  £80  per  annum,  with  board,  lodjnoi, 
and  washing.  Applications  to  the  Hon.  Secretary,  Clayton  H» 
pital,  Wakefield.  „         ^  o^ 

Dewsbiiry  and  l>tat'rict  General  Irflnnary.— House  Siugeon.  sakii 
£100perannum,withfroard,  residence,  and  washing-  Apfo. 
tions  to  Charles  Abbs,  Secretary,  Infirmary.  l>ew«lniry. 

National  HosplUl  f  r  the  Paralysed  and  Epileptic,  Qn««n  ■  Smm. 
—Nervous  Diseaoes  Research  Fund.— Director  of  fiiearo;Fa»> 
logical  Betearoh.— .Salary  £i60  per  annum.-— Appl«»Uoos  la 
Edgar  Speyer,  Esq.,  1  hairman  cf  the  Fund,  ^atiwial  Hoipi:«l 
for  the  Paralysed  and  Epileptic,  Queen'a  Square,  W.C. 


for  the  Paralysed  and  Epileptic,  Qi 
Rotunda  Hospital.  Dublin,— Pathologist. 

Applications  tx)  W.  A.  Fitzgerald,  Becnstary. 


Salary  £60  per 
(See  Advt.) 


JlppoitttmeniB. 

EsoLisH,  T.  Crisp,  B.fl.Lond.,  F.R.C.S.Bng..  Assistant  Smgen  to 

St  George's  Hospital  and  Lecturer  on  Operative  Surgery,  Si. 

George's  HospiUl  Medical  School. 
Hill,  J.,  L.R.C.P.  A  S.Edin.,  Certifying  Suingeon  under  tbe  Fm 

tory  Act  for  the  MIltown-Malbay  •District  of  the  Coumy  k 

Clare. 
Hcjvtbr,  Jbssib  Sophia  Bbatbix,  M.B.,  Ch.B.01asflr.,  Junior  As& 

taut  Medical  Officer    to   the    Bracebridge    District    Asjion 

Lincoln.  ^  ^        ^    ^ 

J0HX8OH,  B.G.,  M.B.Lond..    Certifying    Surgeon  undnr  the  P»^ 

tory  Act  for  the  Poole  Distrioc  of  the  County  of  Dorset. 
Leoos,  8.  C,  M.R.C.8.,  L.K.C.P.Lond.,  Medical  Oflflccr  of  the  Walt. 

house  and  Cottage  Homes,  Worcester.  ^  ^  „     ^     , 

LVY¥,  A.  P.,  M.D.Lond.,  Physician  to  the  In-pauents  at  St.  Msir's 

Hospital. 
LuKB,  TuoMAS  D.,  M.B.,  F.B.C.S.Edin.,  Lecturer  on  the  Pzactiix  of 

Anasthetics  at  Edinburgh  University. 
MATiiBtrs,  T.  G.,  M.D.Bdin.,  Certifying  Surgeon  under  tlie  FlKtorr 

Act   for   the    Kirkby    Lonsdale    District    of    iftie    county  « 

Westmorland. 


JBz$ihB. 


IjBACBOFT.— On  December  19th  at  18  Hartfngton  Street,  Der>y  Jota 

WilUam  Leacroft,  M.B.,  late  of  Feckenham,   Woroesteiahin, 

aged  78. 
Rooks.— On  December  21st,  at  his  residence  Bournemouth,  Tbeasi 

Morlsy  Booke,  M.D.Lond.,  late  of  Cheltenham,  aged  7& 
Btav-Tkbisov.— On  December  22nd.  at  215  Uxbrldge  Road,  Skep- 

herd*s  Bush,    W.,    Edward     Tenison     Byan-Teniaon.    M.1)l, 

M.R.C.S.,  L.R.C.P.,  late  R.N.,  aged  75  years. 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WCDNESDAY.--St.  Bartholomew's  (1.90  p.m.),  Univeimy  CoO^e 
(2  p.m.),  Royal  Free  (2  p.m.),  Mkidlesex  (I.3U  pim.).  Charing 
Cross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.).  King's 
College  (2  p.m.),  St.  George's  (C^hthalmic,  1  p.m.),  St.  Mary's 
(2  p.m.).  National  Orthopiedic  (10  a.m.),  St.  Peter's  (2  pan.), 
Samaritan  (9.80  a.m.  and  2.80  p.m.),  Gt.  Orraood  Street  (19 
a.m.),  Gt  Northern  Central  (2  SO  p.m.),  Westminster  (2  plslA 
Metropolitan  (2.S0  p.m.),  London  Throat  (9.90  a.m.).  Cmeer 
(2  p.m.),  Throat.  Golden  Square  (9.90  a.nu),  Ouy's  (1.80  p.B.), 

THURSDAY.— St.  Bartholomew's  (1.30  p.n>.).  St.  Thomas's  ^ 

S.m.)t  University  College  (2  p.m),  Charinf  Cro6S  (9  p.nLX  St 
eorge's(l.p.m.),  London  (2  p.m.).  King's  College  (2  p.m.),  Hlddb- 
sex  (1.80  p.m.),  St.  Mary's  (2.30  p.m.).  Soho  Square  (2  pSL), 
North-West  London  (2  p.m.),  Chelsea  (2  p.m.).  Great  NonhoB 
(Antral  (Gynaecological,  2.30  p.m.).  Metropolitan  (SJO  pn.), 
London  Throat  (9.30  a.m.),  St.  Mark's  (2  p.m.),  Samaritaa  (9 JO 
a.m.  and  2.90  p.m.).  Throat,  Golden  Square  (9iW  a.m.),  Goj't 
(1.80  p.m.). 
FRIDAY.— London  (2  p.m.),  SL  Bartholomew's  (1.90  p.m.).  8l 
Thomas's  (8.30  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.90  pjo.). 
Charing  Cross  (8  p.m.),  St.  George's  (1  p.m.),  King  s  CoDe^  {t 

S.m.),  St.  Mary's  (2  p.m.).  Ophthalmic  (10  a.m.),  Ganoer  (2  pjsj 
helsea  (2  p.m.),  ($reat  Northern  Ontral  (2.90  p.m-).  Wot 
London  (2  80  p.m.),  London  Throat  (9.90  a.m.),  Samaritan  (9 J 
a.m.  ana  2.80  p.m.),  Throat,  (^Iden  Square  (0.80  a.m.),  CS^ 
Orthopadic  (2.80  p.m.),  Soho  Square  (2  p.m.). 
SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  IGddlesex  (LSD 
p.m.),  St.  Thomas's  (2  p.m.).  University  CtoUege  (9.15  aja.). 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  St«  Bfiary's  (10  pjn.) 
Throat,  Golden  Square  (9.80  a.m.[,  Guy  s  (1.90p.ni.). 
MONDAY.— London  (2  p.m.),  St.  Bartholomews  (1.30  p.m.),  St 
Thomas's  (8.30  p.m.),  St.  George's  (2  p.m.),  St.  Manr's  (195 
Middlesex  (1.80  p.m.).  \i^minster  (2  p.m.).  Chelsea  (2 


p.m.), 
p.m.). 


^ „  Samaritan  (GynsBoological,  bv  Physicians,  2  pjn.),  Soho 

Square  (2  p.m.),  Ro^iil  OrthopsMlic  (2  p.m.).  City  Orthopisdie  (4 
p.m.),  Great  Northern  Centre  (2.80  p.m.).  West  London  (2.9D 
p.m.j,  Ix>ndon  Thropt  (9.80  a.m.),  Ro^'ai  Free  (2  p.m.),  Guy's(lJtf 

TU&DAY.— London  (2  p.m.),  St.  Bartholomew's  (L80  pjn.),  SL 
Thomas's  (S.SOp.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.90  |mb.), 
Westminster  (2  p.m.).  West  London(2.S0p.m.),  Uniravi^' 
~ '""  '" '"  '  '   "'  Mar        " 


a.m.  and  2.30  p.m.),  Throat,  Golden  Square  <94K>  a.ni.),  Soho 
Square  (2  p.m.) 


3  ^A^  /^  ^ 


r